This incredibly detailed paper was written by Declan Waugh who listed it with 163 peer reviewed papers and sent it by post and email to 4 cardiologists in Ireland as well as the Irish Heart foundation.  Not only did he get no response but not one acknowledgement…………..do him and the world a favor and if you feel so compelled, drop the appropriate agencies an e-mail asking for an acknowledgement.-A.M.

Fluoride and Cardiovascular Disease:
Implications for Public Health in Ireland and other Fluoridated Communities
2013
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By: Declan Waugh BSc. CEnv. MCIWEM. MIEMA. MCIWM.
Introduction
Fluoride_Water_Main_600cartoonCardiovascular disease remains the most common cause of death in Ireland, currently accounting for one-third of all deaths and one in five premature deaths.
Vascular diseases, of which cardiovascular disease is the most common, account for over 40% of all deaths and 37% of deaths under 65 years in Ireland. Approximately 10,000 people die each year in Ireland from cardiovascular disease (CVD) – including coronary heart disease (CHD), stroke and other circulatory disease. The largest number of these deaths relate to CHD – mainly heart attack – at 5,000, with approximately 22% of premature deaths (under age 65) due to CVD. According to figures from the cardiac rehabilitation unit at Wexford General Hospital, the number of deaths from Coronary Artery Disease in Ireland is 60,7 per 100,000, almost twice the EU average of 32.6.1
Abstract
Cardiovascular disease (CVD) is Ireland’s greatest killer with almost 10,000 people dying every year from conditions such as coronary heart disease and congestive cardiac failure (heart failure); cerebral (brain) conditions such as stroke; and peripheral (limb) conditions such as peripheral vascular disease. The main base cause of heart disease is atherosclerosis whereby blood vessels narrow or become completely blocked. Mortality rates from CVD increased sharply after commencement of water fluoridation in Ireland and peaked when all major urban areas and the majority of the population were fluoridated in the mid 1970’s. Today Ireland continues to have the highest rate of premature deaths from ischaemic heart disease (<65yrs) in the European Union and life expectancy for both men and women ranks below the EU 15 average life expectancy. Research has demonstrated that fluoride is a risk factor in cardiovascular disease, as well as other major diseases including hypothyroidism, diabetes and obesity. Fluoride interferes with heart function, incorporates into the aorta and atherosclerotic plaque in coronary arteries as well as impairs homocysteine, insulin and glycogen synthesis in addition to mitochondria respiration all of which are known contributors to heart disease. Research has demonstrated that oxidative stress and inflammation are important pathophysiological mechanisms involved during ischaemic stroke. Fluoride is recognized to contribute to oxidative stress and inflammation as well as respiratory disease. Coronary heart disease has been found to be strongly associated with dental fluorosis (a biomarker for chronic overexposure to fluoride). Ireland has the highest prevalence of dental fluorosis in the EU and is also the only EU Member State to support mass intoxication of its population with fluoride and silicofluorides through public water supplies. The recent epidemic of respiratory disease diabetes and obesity in Ireland and their future contribution to cardiovascular illhealth will place further enormous social and economic burdens on the Irish state. In light of these findings it is critical that risk factors such as fluoride exposure are urgently reassessed and mass medication without informed consent of populations through artificial fluoridation of water is ended to protect public health.
Keywords: Cardiovascular disease, ischaemic heart disease, diabetes, obesity, respiratory disease, water fluoridation, risk factors.
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Implications for Public Health in Ireland and other Fluoridated Communities
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Ireland has the highest rate of premature deaths from ischaemic heart disease (<65yrs) in the European Union2 and life expectancy still ranks below the EU15 average for both men and women.3
This article reviews the available information examining how fluoride interferes with heart function, incorporates to the aorta and atherosclerotic plague in coronary arteries, and contributes to cardiovascular disease in general.
Data provided in this document will show how mortality rates from cardiovascular disease increased sharply in Ireland post commencement of water fluoridation. While mortality rates in the past decade have reduced significantly this could not have occurred without the documented four-fold increase in prescribed medication for cardiovascular disease and increased expenditure in healthcare and intervention. Without such, it can be presumed mortality rates in Ireland would be much higher than they currently are. Apart from the human cost, the cost of cardiovascular disease to the Irish economy – which includes the costs of healthcare, loss in productivity and informal care – is a significant burden.
Given the scientific information currently available demonstrating that fluoride is a risk factor in cardiovascular disease, as well as diabetes, thyroid disorders, mental depression, skin disorders, obesity and gastrointestinal disorders, in addition to its potential contribution to increased cancer prevalence in Ireland, and observing that the prevalence of many of these conditions in Ireland is significantly above the EU average; it is therefore of the upmost priority that the Government of Ireland take appropriate action and comply with the ‘precautionary principle’ in ending fluoridation of drinking water and mass fluoride intoxication of the population of Ireland immediately.
The few mainland European Member States that did previously fluoridate water supplies have all long since ceased to support such a policy. Where fluoridation was stopped, it was shown to have no negative impacts on the populations dental health and was observed to benefit public health in their communities.4,5,6,7
The current health behaviour of the Irish population demonstrates that mass fluoride intoxication of the population with untested industrial chemicals is dangerous and is contributing to the enormous health burden of disease now prevalent in Ireland today.
To add to the current crisis the Department of Health recently warned that “there is a potential epidemic of heart failure in Ireland over the next 10 years”8 It is of paramount importance therefore that every precaution must be taken to reduce the exposure of Irish citizens to any unnecessary risk factors, such as fluoridation of drinking water, that is clearly contributing to increasing disease burdens in society.
This paper presents some of the information currently available which clearly demonstrates that fluoride exposure is a contributor to cardiovascular disease. Much of this data has already been provided to the Government of Ireland by this author, however, this paper includes new evidence to support previous communications to the Government that highlighting the health risks associated with water fluoridation using silicofluoride chemicals.
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We are also approaching the 100th anniversary of the 1916 Rising, a pivotal historic period that led to the establishment of the Irish Republic. At the current time Ireland holds the presidency of the Council of the European Union.
It is lamentable therefore that in 2013 the Government of Ireland continues to enforce the mass medication of its population, mandated by national legislation, using untested industrial chemicals; a policy that every other mainland European country has independently decided, through risk assessment, is unjustifiable, unethical, uneconomical, unsafe and environmentally unsustainable.
History of Water Fluoridation and Ischaemic Heart Disease in Ireland
In 1962, prior to commencement of water fluoridation in Ireland, mortality for males from ischaemic heart disease was a rate of 190 deaths per 100,000 and 140 per 100,000 for females. In 1964, more than 25 per cent of the population of the State were receiving water from fluoridated piped water supplies. This included the greater Dublin area and the adjacent areas on the east coast. Fluoridation commenced in the second largest urban area Cork City and County in 1965 and over the following seven to eight years all the major urban communities throughout the country were fluoridated.9
In 1969, just a few years after commencement of fluoridation the rate of mortality from ischaemic heart disease had dramatically increased to 315 deaths per 100,000 for males and 235 deaths per 100,000 for females, representing an increase of 65% in mortality for this disease in both males and females respectively. By 1979, it had reached a peak of 350 deaths per 100,000 for males and 250 deaths per 100,000 for females representing an 84% increase in mortality for this disease in less than a decade after commencement of water fluoridation as illustrated below.
As is evident in the graph, a sharp increase in mortality occurred in 1967 and continued to rise significantly above European averages until 1978, when levels reached plateaued out and from where they eventually started to decline. This dramatic increase in mortality rates occurred in Ireland at a time when age adjusted mortality rates were falling internationally by 2% per annum in the 1970’s and 1980’s.10
While deaths rates have declined since for the period 2000-2004 Ireland had on average 144 deaths from CHD per 100,000 population,which was higher than EU 15 of 92 deaths per 100,000 and higher than the EU 27 of 113 deaths per 100,000. 11
In comparison, the age adjusted mortality rate in the United States, (where approximately 65% of the population consume fluoridated water, compared to 75% in Ireland) is 135.0 deaths per 100,000. The rate for males was 41.6% higher than for females (176.5 versus 103.1 per 100,000 population, respectively).12
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Similarly the age adjusted mortality rates for fluoridated Australia at 123 per 100,000 are also above the European average. As with fluoridated America and Ireland, the mortality rate in Australia for males at 169 per 100,000 is significant.13
The major decline In Ireland has occurred in the last decade, brought about largely by increased clinical intervention, medication and behavioral change. It has been estimated that half of the decrease in death rates can be attributed to treatments and interventions.14 If it were not for fluoridation, it is most likely that mortality rates would have levelled off earlier and not have risen to the record levels attained in the 1970’s, at a time in stark contrast when significant decreases in mortality were being observed in other countries.
Current Status
It is well known that life expectancy in Ireland compares poorly with that in other developed countries. Remarkably life expectancy for Irish men at age 60 in 1985-1987 (16.0 years) had changed little from that for 1925-1927 (15.8 years).15 Ireland ranks below the EU15 average for life expectancy for both men and women.16
Any gains in life expectancy through lower death rates from infectious diseases such as pneumonia and
tuberculosis were cancelled out by increased death rates from
cardiovascular disease (CVD).17
Ireland currently has the highest rate of premature deaths from ischaemic heart disease (<65yrs) in the European Union18.
In 2010 it was estimated that more than 79,000 (2.4%) adults aged 18+ years in RoI have been told by a doctor in the previous 12 months that they have CHD (clinically diagnosed CHD). This excludes undiagnosed CHD and is likely to be an underestimate of the number of people with the condition.19
In 2007 nearly 131,000 adults had ever had a Coronary Heart Disease (CHD, angina and heart attack). By 2020 this is expected to rise to over 195,000 people – an additional 65,000 people (a 50% increase in less than 15 years).
In 2007 almost 59,000 adults have ever had a stroke. By 2020 this is expected to rise to almost 87,000 people – an additional 28,000 adults (an increase of 48% in less than 15 years).20
These figures do not include individuals who have undiagnosed cardiovascular disease. International research has shown that 50% of men and 64% of women who have had a fatal heart attack or stroke never knew they had the disease.21
From 2000 to 2004 Ireland had on average 144 deaths from CHD per 100,000 population, which was higher than EU 15 of 92 deaths per 100,000 and higher than the EU 27 of 113 deaths per 100,000.22
The Department of Health, National Cardiovascular Health Policy Report23 published in 2010 compares cardiovascular health data for Ireland with other EU Member States from the years 2003 to 2007 across all ages.
During this time Ireland had a reduction on the years 2000-2004 to on average 118 (age-standardised) deaths from ischaemic heart disease per 100,000 population annually.
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Mortality was however higher than the EU151rate of 80 deaths per 100,000 and higher than the EU272 rate of 101 deaths per 100,000.
The Department of Health reported that in regard to premature deaths, ischaemic heart disease death rates annually in Ireland averaged 25 per 100,000, compared to 18 deaths in the EU 15 and 24 in the EU 27.
The Department of Health further observed that this could not have been achieved without the increasing workload in health services in the hospital, primary care including a four-fold increase in the use of prescribed cardiovascular medication.
Geographic Variation in CHD
There is a wide geographic variation in mortality rates from cardiovascular disease in Ireland. This is illustrated in Figure 3 below. The incidence rates do not include undiagnosed CHD.
The geographic spread for CHD largely mirrors that for other major diseases in
1 EU15 data refers to 9 countries in 2007 and 12 in 2006 who had reported mortality data.
2 EU27 data refers to 19 countries in 2007 and 23 in 2006 who had reported mortality data.
Ireland such as diabetes, cancer and neurological illness. The areas with the highest prevalence of disease burdens are largely those where drinking water is both soft (low in calcium) and fluoridated.24
It is interesting to note that the most Southerly part of Ireland has the highest incidence of CHD. Drinking water in large parts of South and South East Ireland including West Cork located in the southern tip of (the area identify as red on the map above) Ireland, are extremely soft with less than 20mg/L calcium. Similarly soft drinking water is found in large parts of geographic areas such as Mayo, Donegal, Kerry, Wexford, Waterford and Roscommon. All of these counties have elevated CHD significantly above the National and European average.
Comparison with England
In comparison, the highest deaths through CHD in England are in the North West of England with a death rate of 93.2 per 100,000. The figure for the South West of England is 67.4 per 100,000. CHD rates in England are lower than in the rest of the UK. Over 5% lower for men and 20% lower for women in England than in Northern Ireland. 20% lower for men and 50% lower for women in England than in Scotland. The data from England is remarkable as mortality rates for CHD are geographically located in areas where water fluoridation programmes are currently in use. It is to be noted that these areas also largely reflect those with greatest social inequality in England.
The exception being Cornwall in the South West of England, however it is known that drinking water in this region has low calcium and is defined as soft water. This would explain the high incidence of CHD in this region.25
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Nevertheless the correlation between fluoridation of public water supplies programmes, fluoride content in drinking water and CHD is significant, as illustrated below.
Comparison with Northern Ireland and Europe
According to figures from the cardiac rehabilitation unit, Wexford General Hospital, the number of deaths from Coronary Artery Disease in Ireland is 60,7 per 100,000, almost twice the EU average of 32.6.26 In comparison the age standardized death rate from CHD in Northern Ireland is 60.44 for men and women 21.01.
However it must be noted that poverty, stress and social conflict play a major role in heart disease and this is reflected for the data for NI. Significantly higher CHD prevalence is noted in the geographic areas with the highest social inequality, poverty and unemployment. These same areas not only represent those that are the most socially deprived but also where conflict and trauma were most prevalent during the ‘Troubles’ in Northern Ireland. For example significantly higher CHD rates for males are to be found in Derry (80.09), Belfast.(89.05) and Ballymena (115.45) compared to more rural areas such as Castlereagh (30.08) Antrim (24.9) and Moyle (33.48).27
What is also remarkable about the data for Northern Ireland is that the only two locations in Northern Ireland where fluoridation was introduced and continued for approximately 30 years, in Tandragee Co. Armagh and Hollywood, County Down, both had significantly higher rates of premature mortaility compared to the their adjoining local authority districts.28
In comparing CHD in Ireland with Europe the Age-standardized Disability-adjusted life years (DALYs) per 100,000 for CHD, stroke and other CVD, provides further insights to the impact of CHD and the gap between Ireland and other European Member States. The DALYS for CHD for Ireland is calculated at 671 compared to the UK (657), Iceland (470), Norway (503), for Sweden (506), Denmark (478),.Germany (574), France (259). Spain (367) and the Netherlands (460). A similar pattern is provided for CVS.29
Confounding Factors:
There are many compounding factors in CHD, some of these are discussed in the following section with comparisons where appropriate between Ireland with other EU Member States.
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Influence of Smoking
Tobacco, like tea is a significant source of fluoride and is a major source of dietary fluoride intake. In Europe, about 20% of deaths from CVD in men and about 3% of deaths from CVD in women are due to smoking. The equivalent figures for the 25 countries that made up the EU in 2006 (EU-25) are 16% and 5% respectively. For the period 1995-99 Ireland had one of the lowest prevalence of smoking for adults in EU at 32.4 percent, compared to France (35%), Germany (43%), Denmark (35.4%), Italy (33.8%), Norway (33.4%), the Netherlands (38.9%),Spain (42.8%) and Switzerland (39%).30
It is obvious that one would expect countries with higher smoking prevalence’s than Ireland to have higher CHD mortality rates. The difference between CHD mortality rates for Ireland and other European countries should be considerable less than they currently are as historically higher smoking prevalence in other European Member States should have seen a marked increase in CHD mortality rates from smoking compared to Ireland. Yet this is not the case.
What is extraordinary however is that in 2008, Ireland had the highest death rate from respiratory disease in EU, almost twice the EU average.31 In the entire league of European countries only Kyrgyzstan (formerly part of the Soviet Union) has a death rate from respiratory disease higher than Ireland.32 Remarkably approximately 69% of the population in Kyrgyzstan has dental fluorosis with up to 16% suffering from skeletal fluorosis.33 This clearly demonstrates that the population is chronically over-exposed to fluoride and that fluoride is a significant contributor to disease burdens.
It is not surprising to find that according to the latest WHO data published in April 2011 Coronary Heart Disease Deaths in Kyrgyzstan reached 12,884 or 30.19% of total deaths. The age adjusted Death Rate is 349.39 per 100,000 of population ranking Kyrgyzstan third in the world for Cardiovascular disease.34
It is significant therefore the two countries in Europe with the highest exposures to fluoride have by far the highest mortality from both cardiovascular and respiratory diseases. High mortality rates both these diseases are also recorded for the United States of America where the majority of the population are also exposed to fluoridated water.35
The ability of fluoride to impair the bodies immune system36 may explain
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help explain this anomaly, reducing the ability of the body to fight disease.
In regard to respiratory disease it is important to note that animal studies have demonstrated that lung tissues presented emphysema and lung parenchyma inflammation associated with loss of alveolar architecture in the second generation of animals exposed to fluoride in drinking water.37
The inflammatory effect of fluoride exposure has also been demonstrated in human lung epithelial cells.38
It is evident therefore that while smoking is contributing to CHD amongst the population additional factors are influencing the significantly higher burden of CHD and respiratory disease present in Ireland.
Alcohol
Alcohol use is related overwhelmingly detrimentally to many cardiovascular outcomes, including hypertensive disease (Taylor et al., 2009)39, haemorrhagic stroke (Patra et al., 2010)40 and atrial fibrillation (Samokhvalov, Irving & Rehm, 2010)41.
For ischaemic heart disease and ischaemic stroke, the relationship is more complex. Chronic heavy alcohol use has been associated uniformly with adverse cardiovascular outcomes (Rehm & Roerecke, 2011)42. But, on average, light to moderate drinking has a protective effect on ischaemic diseases (Roerecke & Rehm )43This effect is found to be equal for people who just drink beer or who just drink wine (Di Castelnuovo et al., 2002)44
The detrimental effects of heavy drinking occasions on ischaemic diseases are consistent with the physiological mechanisms of increased clotting and a reduced threshold for ventricular fibrillation which occur following heavy drinking (Rehm et al., 2010).45
People who are socially disadvantaged people or who live in socially disadvantaged areas experience more harm per gram of alcohol consumed than the better-off (Rehm et al., 2009)46.
In Finland, areas with higher levels of manual workers or of unemployment and areas with lower social cohesion had higher levels of alcohol-related mortality among men aged 25–64 years (Blomgren, Martikainen & Makela, 2004).47
The level of consumption of a country level varies throughout EU. Figure 3 below illustrates the variation across the EU.
The proportion of alcohol-attributable mortality in Ireland to all deaths in the group aged 15−64 years is <10% for men. This is significantly less than the EU average and below Germany(13%), Spain(12%),Finland(16), France(16),
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Austria(16), Poland(16), Luxemburg(14%), Denmark(14%), Switzerland(11.5%) & Belgium(11%).
For woman mortality from alcohol attributable mortality in Ireland is at <7% which is also below the European average. The highest rates of mortality are in the Baltic regions where up to 25% of deaths are attributable to alcohol.
The WHO report on alcohol in the European Union (2012) estimates that there are approximately 110,000 alcohol attributable deaths across EU each year.48 For men, the highest contribution to alcohol-attributable mortality is made by liver cirrhosis (26%) and unintentional injury (23%), followed by cancer (16%), intentional injury (15%) mental and neurological disorders (8%) and cardiovascular diseases last (7%).
For women, more than two thirds of alcohol-attributable deaths arise from liver cirrhosis (37%) and cancer (31%) (the largest proportion of which concerns breast cancer, with 21%), with cardiovascular disease other than ischaemic heart disease as a distant third cause (11%). Moderate alcohol consumption was also seen to have a beneficial effect on ischaemic heart disease.49
Based on this information it can be concluded that while alcohol consumption in Ireland is contributing to CHD, the significantly higher prevalence of alcohol related mortality in other EU countries, as noted above, should see CHD death rates higher in EU than in Ireland.
Yet this is not the case, not only does Ireland have the highest rate of premature deaths from ischaemic heart disease (<65yrs) in the European Union50 but significantly higher mortality from CHD than the EU 15 or EU 27 countries, where alcohol related deaths and their contribution to CHD deaths are much higher than Ireland.51
What is also relevant however is that draught beer sales in Ireland are much higher than in other EU countries and beer, as with any beverage product produced in Ireland, is most likely to be fluoridated as manufacturers use fluoridated public water supplies. Alcohol consumption in Ireland, compared to other EU countries is therefore a potentially significant additional dietary source of fluoride.
Vitamin D 12
Recently Vitamin D deficiency has been identified as a potential risk factor for many diseases not traditionally associated with Vitamin D, such as cancer and CVD.52
Vitamin D deficiency has been associated with CVD risk factors such as hypertension and diabetes mellitus, with markers of subclinical atherosclerosis such as intima-media thickness and coronary calcification, as well as cardiovascular events such as myocardial infarction and stroke in addition to congestive heart failure. It is plausible to suggest that vitamin D deficiency contributes to the development of CVD through its association with other known risk factors, such as diabetes and hypertension.
The differences in CHD between Northern, Southern and Western European countries and Central and Eastern European Countries would appear to support this interaction. It is evident that Southern European countries still having lower death rates from CVD than Western European countries apart from Greece and Malta
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which have significantly higher mortality rates than other southern European countries for CHD. 53
There are however significant differences between Ireland and other Northern European countries including England, Iceland, Denmark, Sweden and Norway.
This can be illustrated in the figures for Age-standardized Disability-adjusted life years (DALYs) per 100,000 for CHD, stroke and other CVD in Europe. For Ireland the figure is 671 compared to UK (657), Iceland (470), Norway (503), Sweden (506), Denmark (478), the Netherlands (460), and Germany (574), while the figures for France, Spain and Portugal are 259 and 367 and 431 respectively.54
It is likely that V D12 is playing a role in increased CHD in Ireland but these figures would suggest that it is limited and other factors dominate.
Obesity and Diabetes.
Fluoride is a risk factor in both the development of obesity and diabetes.55
It is now known that biologically relevant doses of fluoride results in impairment of glucose tolerance or increased blood glucose and decreased insulin synthesis.56 Both of these conditions are major contributors to diabetes and obesity which have also reached epidemic proportions in Ireland. In Ireland, the incidence of type 1 diabetes is 16.8 per 100,000, which is above the European average.57
Diabetes is a condition in which the amount of glucose in the blood is too high because the body is unable to use it properly. Normally, the amount of glucose is carefully controlled by the hormone insulin, which is produced in the pancreas.
The prevalence of obesity in Ireland is among the highest in the EU 27.58 Obesity in18-64 year old adults increased significantly in Ireland between 1990 and 2011, from 8% to 26% in men, and from 13% to 21% in women, with the greatest increase observed in men aged 51-64 years.59
Notwithstanding other lifestyle and dietary factors this subgroup also represents those with the highest lifetime exposure to fluoride in the Republic of Ireland since commencement of artificial fluoridation in mid 1960’s. It is also worth nothing that figures for obesity in Ireland are considerably above the EU average.
It is now accepted that a high fat diet and obesity induce endoplasmic reticulum (ER) stress in liver, which suppresses insulin production and contributes to diabetes.60
The Russian Academy of Sciences recently published a review61 of scientific literature on the molecular toxicity of fluoride and noted how fluoride induces endoplasmic reticulum (ER) stress. The endoplasmic reticulum (ER) is a cellular compartment responsible for multiple important cellular functions including the biosynthesis and folding of newly synthesized proteins destined for secretion, such as insulin. Accumulating evidence suggests that ER stress plays a role in the pathogenesis of diabetes, contributing to pancreatic β-cell loss and insulin resistance. ER stress has also importantly been linked obesity and insulin resistance in type 2 diabetes.
Disturbances in the normal functions of the ER lead to cell death if ER dysfunction is severe or prolonged. Important roles for ER-initiated cell death pathways have been recognized for several other diseases, including hypoxia, ischemia/reperfusion injury, neuro-
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degeneration, diabetes and heart disease.62
Researchers Menoyo et al.63 and Lin et al.64 demonstrated the effect of fluoride on glucose metabolism using in vivo and in vitro experimental models and confirmed that biologically relevant doses of fluoride result in impairment of an oral glucose tolerance test and decreased insulin synthesis.
It has also been reported by Montalvo et al. 65 that fluoride exposure regulates insulin gene expression in murine beta pancreatic cells, resulting in reduced insulin secretion.
Further studies have shown that fluoride exposure may contribute to impaired glucose tolerance or increased blood glucose.66,67,68
The influence of fluoride in contributing to diabetes and obesity must consequently to be regarded as a significant risk factor in the high rates of CHD in Ireland. Given these facts the contribution of mass fluoridation of the population to increased CHD cannot be excluded.
An examination of the fluoride as a risk factor in both diabetes and Obesity in Ireland has previously been examined by Waugh.69
Hypothyroidism
In humans, effects on thyroid function have been documented with fluoride exposures of 0.05-0.13 mg/kg/day when iodine intake was adequate and 0.01-0.03 mg/kg/day when iodine intake was inadequate.70These ranges are well within the exposure levels experienced by the general public in Ireland. Therefore it is a scientific fact that fluoride exposure of sensitive subgroups of the population will clearly impact on the thyroid function of some consumers.
Hypothyroidism is a clinical state resulting from an insufficient amount of circulating thyroid hormone to support normal body function. It may exist in utero or develop in infancy, childhood or even in adult life. The prevalence of unsuspected overt hypothyroidism, defined as the combination of biochemical and clinical findings of hypothyroidism, ranges from 1-18 cases per thousand persons.
Ireland has the highest incidence of congenital hypothyroidism (CHT) in the EU.71,72 The incidence of CHT was 1 case per 2296 live births in the Republic of Ireland (ROI) in the past decade with increasing numbers over recent years.73 The Global mean incidence for Congenital hypothyroidism (CHT) is 1/3800 with a reported incidence of 1:3500 in Caucasian populations.
Subclinical hypothyroidism (SCH), affects about one in six people over the age of 65 in Ireland and has been linked to various health problems, such as heart attacks and strokes, in later life.
Subclinical hypothyroidism is considered a strong risk factor for later development of overt hypothyroidismassociate subclinical thyroid dysfunction with changes in cardiac function and corresponding increased risks of heart disease.74,75,76
Subclinical hypothyroidism is associated with increased cholesterol concentrations increased incidence of depression, diminished response to standard psychiatric treatment, cognitive dysfunction, and, in pregnant women, decreased IQ of their offspring.77,78
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The incidence of hypothyroidism prevalent in Ireland must consequently to be regarded as a significant risk factor in the high rates of CHD in Ireland.79 This obviously has major implications for water fluoridation, as biological relevant concentrations of fluoride are known to contribute to this disease.
Water Hardness & Calcium
The consumption of soft water is associated with increased risk of
cardiovascular mortality from cardiovascular, ischaemic heart and hypertensive heart disease.80,81,82,83,84
Calcium levels in drinking water are also of significance in fluoride absorption and fluoride retention in humans. Fluoride has been implicated in disturbing the functionality of calcium, both directly85 and indirectly in interaction with Vitamin D.86 Hammond87 found that any cause of hypocalcemia or vitamin D deficiency can lead to secondary hyperparathyroidism (elevated PTH) in an attempt by the body to maintain calcium homeostasis.
It is also now known that secondary hyperparathyroidism in response to calcium deficiency may contribute to a number of diseases, including osteoporosis, hypertension, arteriosclerosis, degenerative neurological diseases, diabetes mellitus, some forms of muscular dystrophy, and colorectal carcinoma.88
In high calcium waters most of the fluoride is excreted while in low calcium waters the majority of fluoride is absorbed; resulting in elevated blood plasma fluoride levels, and retention of fluoride in various organs of the body.89
Furthermore Dr. G. W. Rapp, Professor of Biochemistry and Physiology, noted that multiple smaller doses of fluoride (such as by drinking fluoridated water) will result in greater retention of fluoride than exposure to a single large dose.
Consequently dietary retention of fluoride will vary considerably by individual depending on the source and chemistry of drinking water that is fluoridated, the individuals metabolism and nutritional health.
The indirect action of fluoride decreases calcium absorption from the gastrointestinal tract increasing in the body’s calcium requirement. If dietary calcium is inadequate to support the increased requirement, the response is an increase in secondary hyperparathyroidism.90
This view is supported by Krishnamachari in his review91 when he found that In the presence of inadequate calcium, fluoride directly or indirectly stimulates the parathyroid glands, causing secondary hyperparathyroidism leading to bone loss.
It is also now accepted that altered calcium homeostasis is recognized as a key pathophysiological mechanism in heart failure, leading to altered contractile function and transcriptional activity.92
Calcium homeostasis depends on efficient energy-driven calcium and sodium pumps, while calcium concentration in turn determines energy expenditure through cellular ATPases and mitochondrial dehydrogenases. Disturbances in these finely controlled cellular processes make the myocyte enter a vicious cycle of energy mismatch and calcium dysregulation that may turn out to be highly detrimental.93
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Given the sharp increase in CHD post water fluoridation and the geographical association of CHD with low calcium areas of Ireland, the role of water fluoridation and the bioavailability of fluoride in low calcium drinking waters must therefore be considered a risk factor in the high prevalence of CHD in Ireland.
This evidence of high CHD in communities that are fluoridated in England supports this view. The widespread implementation of water fluoridation in Ireland is the only known variable and identifiable risk factor that is present in Ireland and absent in mainland European countries. Its contribution to CHD cannot be overlooked.
Homocysteine
There are a number of risk factors associated with cardiovascular disease including homecysteine.94,95,96
Homocysteine is an intermediate product of methionine metabolism. Any substance that may inhibit secondary metabolism of methionine would result in increased homocysteine levels resulting from less homocysteine being metabolized into (L)-Cystathionine.
Fluoride is known to be an inhibitor of enzymatic activity and research has identified fluoride as an inhibitor of homocysteine hydrolase.97
Inhibition of homocysteine hydrolase would result in cellular accumulation of homocysteine98 and therefore contribute to the development of cardiovascular disease.
The impact of fluoride on homocysteine must consequently to be considered a risk factor in the high rates of CHD in Ireland.
Fluoride and Heart Physiology
Research published in 2010 demonstrated that fluoride also affects the aorta (main artery) and heart in ways that lead to increased heart attacks. 99,100 This confirms earlier studies showing that high blood-fluoride levels have an effect on body calcium, leading to calcification of the aorta and other arteries.101,102
Animal studies by Ebert et al.103,104 demonstrated that fluoride exposure resulted in retarded development of heart muscle and inhibition of heart function in developing chic embyros.
Research undertake by Spratt105 concluded that primary site of fluoride action was enolase, which is distributed predominantly in the heart and skeletal muscles and is a biomarker for myocardial damage.
In addition to enolase inhibition, fluoride is recognized as a potent inhibitor of non-specific phosphatases and mitochondrial adenosine triphosphatase.106,107
Slater & Bonner108 found succinic dehydrogenase to be the site of fluoride inhibition in the succinoxidase system of heart-muscle preparations.
Subsequently it has been found that a depression of all known energy-liberating reactions in the heart may play an important role in the further development of chronic and acute heart disease.109 The implications for cardiovascular health for a population of increasing exposure of a population, through addition to drinking water, of a compound that is known to inhibit both glycolysis and mitochondria respiration are therefore significant.
Turla et al.110 observed that fluoride inhibits calmodulin, loss of calmodulin
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activity has been linked to contractile dysfunction which causes congestive heart failure as characterized by a high incidence of Sudden Adult Death Syndrome (SADS.)111
Varol et al. examined the effect of fluoride exposure on cardiovascular system in a clinical setting. and observed that elastic properties of ascending aorta were impaired in patients with endemic chronic fluorosis and that chronic fluoride toxicity can cause aortic stiffness in patients as well as ventricular diastolic and global dysfunctions.112,113
Furthermore Varol et al. found that fluoride toxicity can cause atherosclerosis at molecular level, as well as aortic stiffness and disturbed ventricular distensibility at clinical level. 114
Research has also demonstrated that fluoride accumulates in aorta vascular walls and that a significant correlation exists between fluoride uptake and coronary calcifiation.115
Further research has shown that the heart beat rate slows, and heart rate abnormalities increase, in direct proportion to increasing fluoride levels. Since fluoride is a cumulative poison, lower levels of fluoride will have a more subtle long-term effect, thus increasing heart problems and other disease burdens within society.
Due to the that fact that fluoride bioaccumulates in the human body over a lifetime even relatively low levels of used for water fluoridation, taken in additon to other dietary sources of fluoride the burden or toxic affect can easily reach the “Class 1” level (shown in the chart below that can contribute to this effect). Fluoride’s effects were evident at water levels of 0.2mg/L or more of Fluoride.116,117
This supports the findings from the earliest days of fluoridation in the USA which found that following the introduction of fluoridation, deaths from heart attacks significantly increased in fluoridated communities, compared to the non-fluoridated communities.118,119, 120
The data from the USA has appears to collerate with CHD data for the England where it can be seen that the highest prevalance of CHD is geographically located in areas where water fluoridation programmes are currently in use.
It has also been documented by Professor T. Takamori and his researchers in Japan that fluoride damages the heart muscle, especially in subjects deficient in Vitamins A and D.121 They further observed that fluoride decreases the energy building glycogen in the muscles,122 and that it adversely affects the functions of the kidneys.123
Dr. Mitsugi Hirao, another member of the research group, produced anemia and abnormal changes in the bone
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marrow by fluoride.124 He recorded an increase in blood platelets, an indication of a disturbance in the clotting mechanism of blood. These experiments correlate with clinical observations by Dr. Waldbott who measured on patients with fluorosis, significantly elevated blood platelets, at levels multiples above what would be considered normal.125
Dr. Albert Schatz, discoverer of the antibiotic Streptomycin, which was the first antibiotic remedy used to treat tuberculosis and a number of other diseases, and a distinguished recipient of the Rutgers medal in 1994 (for his contribution to medicine) investigated mortality rates in Chile pre and post commencement of water fluoridation programmes in the 1960’s and found that fluoridation of drinking water resulted in increased death rates in Chile.
He demonstrated that poor, malnourished children, especially infants, are the most sensitive barometer of fluoride toxicity. Dr. Schatz examined the data for the three “test” cities in Chile including, Curico, (F 1 ppm), San Fernando (F 0.0 ppm), and La Serena (0.67 ppm) and noted that the only possible conclusion was that fluoridation was causing significant numbers of deaths.
In examining the deaths resulting from congenital malformations as a percentage of the total number of deaths in the three test cities, he found that Curico the optimally fluoridated community had 244% more such deaths than San Fernando, and 94% more than La Serena while infant mortality rates in Curico were 69% greater than in San Fernando and La Serena.
Research undertaken by Dr. Schatz and supported by Dr. Albert W. Burgstahler of the University of Kansas Department of Chemistry, demonstrated that exposure to low levels of fluoride was a contributory cause of sudden infant death syndrome (SIDS), particularly within the lower income communities where poor nutrition was already prevalent.126,127
On the subject of infant deaths, researchers at the New York State University (Department of Epidemiology and Biostatistics,School of Public Health).documented that municipal water fluoridation causes more premature births, after controlling for age, race/ethnicity, neighbourhood poverty level, hypertension and diabetes.128
The impact of fluoride on heart function and physiology must consequently to be regarded as a significant risk factor in the high rates of CHD in Ireland.
Inflammatory Response
Fluoride exposure has been implicated in inflammation. Inflammation is the first response of the immune system to infection or tissue damage, leading to the protection of the human body against these insults.
As noted in the review by Barbier et al129 chronic inflammation is harmful and has an important role in the development of several chronic diseases such as diabetes and atherosclerosis, both of which contribute significantly to CHD.
The review further discusses how fluoride contributes to inflammatory processes that may play a significant role in cardiovascular disorders and recommends more research be undertaken on the role of low to moderate fluoride exposure in vascular disease.
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An article published by Ma et al.130 (2012) investigated the effect of exposure to fluoride alone on inflammatory response in rabbit aorta. It was found that fluoride increased the expression of VCAM-1, P-sel, MCP-1, IL-8, and IL-6 at the RNA and protein levels. All of these are now known to play a critical role in development of heart disease.131,132,133,134,135,136,137,138
The role of fluoride in inflammatory response mechanisms must consequently to be regarded as a significant risk factor in the high rates of CHD in Ireland.
Oxidative Stress
Oxidative stress is a recognized mode of fluoride action.139 Oxidative stress is also related to the pathogenesis of many chronic disorders including cancer, inflammation, and neurological diseases.140
Researchers Varol et al. reported that in addition to fluoride exposure causing oxidative stress, it may have an important role in cardiovascular disease. 141 He also observed that in addition to promoting inflammatory mechanisms, oxidative stress contributes to atherosclerosis, vascular stiffness, and myocardial cell damage.
Researchers have also found that oxidative stress and inflammation are important pathophysiological mechanisms involved during ischemic stroke.142,143
In addition endothelial dysfunction and vascular disorders have been associated with fluoride exposure in humans.144,145
According to Barbier et al. “the data suggest an important role played by factors related to oxidative stress and vascular inflammation, providing future directions for research into the cardiovascular effects of fluoride exposure.” 146
The role of fluoride in oxidative stress must consequently to be regarded as a significant risk factor in the high rates of CHD in Ireland.
Dietary Intake of Fluoride
The amount of bioavailable fluoride will also depend on the total dietary intake which will not be the same for any two individuals. For example high tea drinkers, smokers as well as fish eaters and consumers of processed food will ingest more fluoride than non tea drinkers, non smokers and vegetarians or red meat eaters.
Infants will retain more fluoride due to the developing kidneys not been able to remove fluoride from the body and through the consumption of formula milk or other beverages made from fluoridated water147.
Similarly diabetics are a high risk group to the toxicity of fluoride148, as are active sportsmen and woman who consume much larger volumes of water daily.149.
Finally once cannot control for fluoride itake from prescribed medication, which can be significant as many pharamacautical drugs are fluoride based medications. The EFSA have estimated that up to 75% of an infants total dietary intake may come from prescribed medication at any one time.150
The dietary intake of fluoride in Ireland is expected to be much higher than the European average due to a combination of water fluoridation, (nnly EU country with a national policy mandating all public water supplies are fluoridated) high consumption of tea (highest in World), high prevalence of bottle fed infants (highest in EU), high consumption of fluoridated alcoholic
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beverages such as draft beer produced in Ireland, high prevlance of smokers (tobaccco contains very high levels of fluoride) and high level of prescribed medication (highest in EU) in Ireland.
Dental Fluorosis
Dental Fluorosis is a biomarker for CHD. Professor Takamori’s research team observed that children with dental fluorosis have a higher incidence of heart damage and an increase in abnormal heart rhythm than those without fluorosis.151 These observations have been supported by studies conducted by Wang et al. in China.152
This is extremely worrying as the NHS York Review, undertaken for the Chief Medical Officer of the UK, concluded that in communities where artificial fluoridation or high natural fluoride levels was present a very significant percentage of the population were overexposed to fluoride, resulting in a high level of dental fluorosis amongst the population.
The NHS York Review found that in fluoridated communities up to 48% of the population may experience dental fluorosis. 153
A recent EU study funded under the FLINT Project demonstrated that children in Ireland have the highest prevalence of dental fluorosis in the EU.
The study also compared dental fluorosis levels in both fluoridated and non-fluoridated communities in Ireland and found that for children up to age 8 in fluoridated areas up to 24% had abnormal teeth due to exposure to fluoride.
For children up to 12 years of age, 37% had abnormal teeth due to fluoride overexposure. In comparison, for children up to age 8 living in non-fluoridated communities < 10% had abnormal teeth and for children up to age 12 approximately 17% had abnormal teeth.
Astonishingly the study found that the level of dental fluorosis was 100% higher in fluoridated areas compared to non-fluoridated communities.
Not surprisingly, the EU study also found that Ireland had the highest level of dental fluorosis amongst children and teenagers.
Given the previous findings in the Japanese study and the alarmingly high prevalence of dental fluorosis in Ireland, this presents an alarming biomarker of future health burdens for society and the healthcare system in Ireland.
Concluding Remarks
The distinguished scientist Dr. Schatz believed that “fluoridation of drinking water is not safe at any level” and believed that “artificial fluoridation of drinking water may well dwarf the thalidomide tragedy, which was dramatic because it produced crippled children who are living testimonials to what that drug has done. Many victims of artificial fluoridation, on the other hand, die quietly during the first year of their lives, or at a later age under conditions where their deaths are attributed to some other cause.”154
Furthermore Dr. Schatz stated:
“(b)ecause artificial fluoridation causes deaths among individuals who are for one reason or another more sensitive to fluoride toxicity than the total population taken as a whole, the controversy over whether fluoridation
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does or does not reduce caries is purely academic. It is criminal to implement a so-called public health measure which kills certain people even if it does reduce tooth decay in some of the survivors.”
In an affidavit155 dated 1993 Dr. Schatz gave sworn evidence that “(i)t is my best judgment, reached with a high degree of scientific certainty, that fluoridation is invalid in theory and ineffective in practice as a preventive of dental caries. It is dangerous to the health of consumers.”
Given the observations of Dr. Schatz and the additional information provided in this document it is not surprising to find that Ireland (the only country in the EU with a mandatory legislative policy requirng artificial fluoridation of all public water supplies) has the highest prevalence of mortality from ischemic heart disease in all of the European member states.
The Department of Health recently stated “Current cardiovascular disease risk profiles in Ireland, must now provide a national ‘wake-up call’ to the health sector and beyond – that the cardiovascular health of the nation is in a precarious state. Cardiovascular health needs to be robustly addressed at both population and individual level.” 156
This is certainly the case and it is about time that the Irish Government and its Agencies “woke up” to the public health dangers posed by water fluoridation. These were previously comprehensively examined by Waugh in his report of March 2012 and have yet to be adequately and independently assessed by a panel of suitably qualified experts in Ireland.
According to Dr. Eoin O Brien, Professor of molecular pharmacology, University College Dublin, deaths rates in Ireland from CVD will soon begin to rise “pointing towards a dismal epidemic for future generations”.157
The risk group that he refers to represent individuals born since 1965 who are the longest exposed to the dangers of mass fluoridation. They are a generation exposed since birth to fluoride and silicofluorides compounds, providing experimental proof of the biological effects of artificial fluoridation on the health of a population.
What is particularly disturbing is that not only has Ireland the highest mortality and incidence of CHD in EU but diabetes and hypothyroidism, neurological disorders and certain cancers. Where fluoride is a known risk factor in each of these diseases and with a high prevalence of these diseases now present in the population of Ireland, increasing their exposure to fluoride through mass fluoridation is not only unwise but unsafe. Clearly, it is now evident, with a tsunami of health crisis facing the country, that the blunt, ineffective and dangerous policy of fluoridation should be discontinued. This is particularly the case with current and predicted future rises in CHD, especially knowing what is now known about fluoride, silicofluorides and their affect on the heart as well as other organs such as the thyroid, kidneys, pineal gland and brain.
Fluoride is now well acknowledged as an accumulative toxin with detrimental impacts on health that accumulates over time in calcified tissues such as bone and soft tissues.158 Fluoride has been identified by Harvard researchers as a development neurotoxin.159 This is a matter of great concern given the
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findings of Dr. G.W Rapp who documented that “the fluoride ion crosses the placental barrier” and who noted “the importance of this is that the fetus has already accumulated fluoride during its development.” 160 Therefore fluoridation of drinking water combined with other dietary sources of fluoride may contribute to a total maternal fluoride intake that could cause neurological damage to unborn babies.
Fluoride has also been identified by the U.S National Research Council as a toxin “that can cause and pro mote cancers” and negatively impact on endocrine systems.161 Masters and Copland also demonstrated that silicofluorides in drinking water can contribute to a wide range of neurological diseases contributing to learning behavioral problems, violent crime and substance addiction.162,163
Given the scientific information provided in this communication, the Government of Ireland and the Department of Health have no alternative but to comply with the ‘precautionary principle’ and end the policy of mandatory fluoridation of the population of Ireland immediately.
Failure to act presents a substantial and unjustifiable risk to the population of Ireland and in light iof the findings presented here would demonstrate criminal neligence of the authorities concerned.
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