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89-92 spittle dyspepsia may 2

Dyspepsia associated with fluoridated water DYSPEPSIA ASSOCIATED WITH FLUORIDATED WATER
SUMMARY: The case is presented of 77-year-old woman with a ten-year history of
weight loss, dyspepsia, and gastric ulcer resistant to medical management. Within
two weeks after she began using a reverse osmosis (RO) unit on her municipal
fluoridated (0.85–1.0 ppm F) drinking water source and, without further medication,
the patient gained almost full recovery. In 2007, at age 87, while still continuing to use
the RO water for drinking and cooking, she remained well and described the
improvement in her health as being “just a miracle.” Fluoride in drinking water, at the
levels commonly used in water fluoridation, may produce chronic ill health with

Keywords: Dunedin, NZ; Dyspepsia; Fluoridated water; Gastric distress; Weight loss.
In 1937 Roholm noted that acute but transitory gastric symptoms often followed ingestion of fluoride-containing cryolite dust (Na3AlF6).1 Feltman and Kosel found, in 1956 and 1961, that 1% of a study population of 601 women and 495children reacted adversely with gastrointestinal symptoms, including epigastricdistress, to tablets containing fluoride in a dose of 1 mg daily. While the patientswere blind to the nature of the tablets being given, the symptoms disappearedwhen placebo tablets were substituted and recurred when the fluoride tablets werereintroduced.2,3 Czerwinski and Lankosz, in 1977, reported that “gastric ulcer”was present in 7 (12%) of 60 retired aluminium workers,4 and in 1978 Waldbott etal. described a “chronic fluoride toxicity syndrome” with gastrointestinaldisturbances.5 Moolenburgh reported that the first patient he saw in Holland withfluoride toxicity was a 14-year-old girl who developed colicky abdominal painwith fluoridated water so severe as to suggest acute appendicitis. Her condition didnot respond to medication but cleared up with stopping the use of fluoridatedwater and returned on a rechallenge.6 His research group found that certainindividuals were intolerant to fluoride and that exposure to it on a double-blindbasis could result in gastrointestinal symptoms as well as stomatitis, joint pains,polydipsia, headaches, and visual disturbances.7 Independently, Petraborg described a wide spectrum of symptoms in persons exposed to fluoridated water including extreme chronic fatigue, polydipsia,general pruritus, headaches, and gastrointestinal symptoms.8 Likewise, Susheelaet al. found that gastrointestinal discomfort, in the form of dyspepsia, was animportant diagnostic feature in identifying persons affected by fluoride and thatsuch symptoms should not be dismissed as non-specific.9-11 Some individualsbecome ill with fluoride at the levels used in fluoridated water.12,13 Here an illustrative case report is presented.
aFor correspondence: Dr B Spittle, 727 Brighton Road, Ocean View, Dunedin 9035, NewZealand. E-mail: bBased on a presentation at the XXVIIth Conference of theInternational Society for Fluoride Research, October 9–12, 2007, Beijing, PR China.
Dyspepsia associated with fluoridated water CASE REPORT
In 1997, a 77-year-old woman, a life-long resident of Dunedin, New Zealand, presented to me with a ten-year history of dyspepsia and weight loss since 1987,poorly controlled with medication. When, in 1997, after she began using a reverseosmosis (RO) unit that removes 90-95% of the fluoride in drinking water, sheexperienced lasting relief from her symptoms and gradually regained lost weight.
The public water supply she had been drinking began to be fluoridated withsodium fluorosilicate in 1967 to increase the fluoride content from the naturallevel of 0.1 ppm to 1 ppm. This level was reduced in July 1992 to 0.85 ppm F. On 19 September 1989, gastroscopy showed an 8-mm, moderately deep ulcer in the stomach at the junction of the body (or corpus, the main central section) andthe antrum (or pylorus, the lower section of the organ that facilitates emptying thecontents into the small intestine), and the histology of a stomach biopsy showed anulcer base, chronic active gastritis, and intestinal metaplasia. No diagnosticabnormality was recognized in the duodenum, and no evidence of malignancy orcampylobacter pylori could be detected. A further gastroscopy on 14 November1989, after two months treatment with sucralfate, showed a persistent but muchsmaller ulcer measuring about 3 mm across. The histology was again of severechronic active gastritis of the antrum of the stomach, and this time campylobacterwas identified. She found, however, that she obtained only temporary relief fromtreatment with sucralfate and antacids. For many years her activities wererestricted by abdominal pain, and she subsisted mainly on plain yoghurt. Atmealtime, she could eat only about 4 tablespoonfuls of food and could not toleratefoods like vegetables. She drank 4 cups of tea daily and used fluoridatedtoothpaste. Aware of my interest in the adverse effects of fluoridation from letters I had written to the local newspaper, she contacted me to ask my advice about anappropriate way to remove fluoride from the water. Because home-use ROsystems are expensive (about NZ$400), I advised her to hold off buying one andoffered to supply her with RO water from my own unit as a trial. Within about twoweeks, her symptoms remitted, and she subsequently purchased her own home ROunit that was attached to the tap on the kitchen sink. At the same time, she wasable to cease using antacid and sucralfate medication and experienced lastingimprovement in her health. The absence of current gastrointestinal symptoms wasrecorded in 2000 during a 3-day hospital admission for an episode of feeling faintwith low blood pressure on standing (postural hypotension. At follow-up after 10 years, in 2007, she remained well at age 87 and still used RO water, which she credited for her wellbeing. She said that the RO water hadbeen “like magic” to her and the improvement in her health had been “just amiracle.” She was able to eat everything she wished to and had gained 6.4 kg. Hertea consumption and use of fluoridated toothpaste were unchanged. She had notnoticed any return of symptoms with the occasional consumption of high fluoridefoods such as sardines. She also noted the remission of arthritis that she previouslyhad in her back, shoulders, and her right temporomandibular joint. Dyspepsia associated with fluoridated water DISCUSSION
No rechallenge tests were done to establish definitively that the fluoridated water played an aetiological role in the dyspepsia. However, there is a closetemporal relationship between her changing to RO water and the commencementof a lasting improvement. While it is not possible to rule out her improvementbeing due to the removal of other contaminants such as chlorination by-productsfrom the tap water, the clinical pattern is consistent with work relating fluoridetoxicity to dyspepsia.1-13 A psychosomatic explanation for the occurrence of gastrointestinal symptoms with fluoridated water is not supported by the occurrence of symptoms in adouble-blind setting in humans and their occurrence in animals such as caimansand horses.2,3,7 Krook and Justus found that an early sign of fluoride intoxicationin horses was the regular occurrence of colic and that it ceased with thetermination of fluoridation of their drinking water.14-15 Burgstahler et al. relatehow caimans and alligators developed bloated bellies and gastric distress afterreceiving fluoridated water.16 The animals became unwell without being told thattheir water supply had changed, so a psychosomatic basis was unlikely.
Scanning electron microscopy studies of the stomach after the consumption of water with 1.2-3.2 ppm fluoride have shown a loss of mucus droplets andmicrovilli, a cracked-clay appearance of the duodenal mucosa, and desquamatedepithelium in the gastric mucosa.9,11 Fluoride reacts with gastric hydrochloric acidto form hydrofluoric acid in the stomach.1 Owing to the presence of un-ionizedHF, hydrofluoric acid has tissue-penetrating and corrosive properties that cancause inflammation, petechiae, ulceration and other mucosal abnormalities in thestomach and proximal small intestine. Dyspepsia may arise with fluoridedisturbing thyroid hormone function through enzyme inhibition.2,3,17-18 In conclusion, there is little doubt that fluoride in drinking water, at the levels used in fluoridation of about 0.85–1.0 ppm, may produce chronic ill health withdyspepsia.
1 Roholm K. Fluorine intoxication: a clinical-hygienic study with a review of the literature and some experimental investigations. London: HK Lewis; 1937. p. 30-2, 85-6.
2 Feltman R. Prenatal and postnatal ingestion of fluorides: a progress report. Dent Dig 3 Feltman R, Kosel G. Prenatal and postnatal ingestion of fluorides: fourteen years of investigation; final report. J Dent Med 1961:16:190-9.
4 Fluoride-induced changes in 60 retired aluminium workers. Czerwinski E, Lankosz.
5 Waldbott GL, Burgstahler AW, McKinney HL. Fluoridation: the great dilemma. Lawrence, 6 Moolenburgh H. Fluoride: the freedom fight. Edinburgh: Mainstream Publishing; 1987. p.
7 Grimbergen GW. A double blind test for determination of intolerance to fluoridated water (Preliminary report). Fluoride 1974;7:146-52.
8 Petraborg HT. Chronic fluoride intoxication from drinking water (preliminary report). Fluoride Dyspepsia associated with fluoridated water 9 Susheela AK, Das TK, Gupta IP, Tandon RK, Kacker SK, Ghosh P, et al. Fluoride ingestion and its correlation with gastrointestinal discomfort. Fluoride 1992;25:5-22. 10 Susheela AK, Kumar A, Bhatnagar M, Bahadur R. Prevalence of endemic fluorosis with gastrointestinal manifestations in people living in some North-Indian villages. Fluoride1993;26:97-104.
11 Susheela AK. A treatise on fluoride. 3rd ed. Delhi: Fluorosis Research and Rural 12 Spittle B. Allergy and hypersensitivity to fluoride. Fluoride 1993;26:267-73. 13 Spittle B. Fluoride poisoning: is fluoride in your drinking water—and from other sources— making your sick? Revised 2nd printing. Dunedin, New Zealand: Paua Press; 2008.
14 Krook LP, Justus C. Fluoride poisoning of horses from artificially fluoridated drinking water.
15 Justus C, Krook LP. Allergy in horses from artificially fluoridated water. Fluoride 2006;39:89- 16 Burgstahler AW, Freeman RF, Jacobs PN. Toxic effects of silicofluoridated water in chinchillas, caimans, alligators, and rats in captivity. Fluoride 2008;41:xx-xx.
17 Gunsar F, Yilmaz S, Bor S, Kumanlioglu K, Cetinkalp S, Kabalak T, et al. Effect of hypo- and hyperthyroidism on gastric myoelectrical activity. Dig Dis Sci 2003; 48(4):706-12.
18 Schuld A. Is dental fluorosis caused by thyroid hormone disturbances? [guest editorial].
Copyright 2008 International Society for Fluoride Research. Editorial Office: 727 Brighton Road, Ocean View, Dunedin 9035, New Zealand.



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