Fluoride & the Gastrointestinal Tract

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Key Findings - Fluoride & the Gastrointestinal Tract: (Click for more detail)

1) Gastrointestinal symptoms (e.g. nausea, abdominal pain, vomiting) are the most common early symptoms of acute fluoride poisoning.

2) Among people hypersensitive to fluoride, gastrointestinal ailments have been produced by 1 mg tablets of fluoride or by consumption of water fluoridated at 1 ppm. (A 1 mg fluoride tablet is more damaging than 1 ppm fluoride in water because a tablet produces a higher fluoride concentration in the stomach.)

3) A review of reports to Poison Control Centers in Utah found that vomiting was induced in children after ingestion of 5 to 9 mg of fluoride. In double-blind experiments, single doses of 6.8 mg of fluoride have induced vomiting, and other gastric symptoms, within 30 minutes.

4) A single ingestion of as little as 3 mg of fluoride, in carefully controlled clinical trials, has been found to produce damage to the gastric mucosa in healthy adult volunteers. No research has yet been conducted to determine the effect of lower doses with repeated exposure.

5) In studies where fluoride has been used (at doses of 18-34 mg/day) as an experimental drug for the treatment of osteoporosis, gastrointestinal disturbances are one of the two main side effects consistently encountered.

6) Among humans suffering from skeletal fluorosis, there is an increased occurence of gastrointestinal disorders. When fluoride intake is reduced among these patients, the gastrointestinal problems are among the first symptoms to disappear.

Articles of Interest - Fluoride & the Gastrointestinal Tract:

Irritable Bowel Syndrome (IBS) and Fluoride Toxicity? - UK IBS Network, 2004

Notable Quotes - Fluoride & the Gastrointestinal Tract:

"It is concluded: 1) Ingested fluoride damages gastroduodenal mucosa. 2) Gastrointestinal discomfort can be an early warning sign of fluorosis. 3) Fluoride toxicity should be considered a possible reason for non-ulcer dyspepsia, especially in fluorosis endemic areas. 4) Gastrointestinal discomfort during sodium fluoride therapy calls for extreme caution and close monitoring. 5) Gastrointestinal discomfort in the form of dyspeptic symptoms should be an important iagnostic feature when identifying fluorosis patients and should not be dismissed as non-specific."
SOURCE: Susheela AK, et al. (1992). Fluoride ingestion and its correlation with gastrointestinal discomfort. Fluoride 25: 5-22.

Need for More Research - Fluoride & the Gastrointestinal Tract: (back to top)

“The numerous fluoridation studies in the past failed to rigorously test for changes in GI symptoms and there are no studies on drinking water containing fluoride at 4 mg/L in which GI symptoms were carefully documented.”
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p 230.

“GI effects appear to have been rarely evaluated in the fluoride supplement studies that followed the early ones in the 1950s and 1960s.”
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p 231.

“Studies are needed to evaluate gastric responses to fluoride from natural sources at concentrations up to 4 mg/L and from artificial sources.”
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p 258.

Understanding the Dose of Ingested Fluoride vs. the Fluoride Concentration in Stomach - Fluoride & the Gastrointestinal Tract: (back to top)

"It is important to realize that GI effects depend more on the net concentration of the aqueous solution of fluoride in the stomach than on the total fluoride dose in the fluid or solid ingested. The presence of gastric fluids already in the stomach when the fluoride is ingested can affect the concentration of the fluoride to which the gut epithelium is exposed. The residual volume of stomach fluid ranges between 15 and 30 mL in people fasting overnight (Narchi et al. 1993; Naguib et al. 2001; Chang et al. 2004). Such volumes would decrease the fluoride concentration of a glass of drinking water by only about 10%. In Table 9-1, the concentrations of fluoride in the stomach were estimated from the mean reported fluoride exposures. A dilution factor was used when it was clear that the subjects already had fluid in their stomach. The results from the water fluoridation overfeed reports (concentrations of fluoride in the stomach between 20 and 250 mg/L) indicate that GI symptoms, such as nausea and vomiting, are common side effects from exposure to high concentrations of fluoride.

Fluoride supplements are still routinely used today in areas where natural fluoride in the drinking water falls below 0.7 mg/L. In an early clinical trial using fluoride supplements, Feltman and Kosel (1961) administered fluoride tablets containing 1.2 mg of fluoride or placebo tablets to pregnant mothers and children up to 9 years of age. They determined that about 1% of the subjects complained of GI symptoms from the fluoride ingredient in the test tablets. If it is assumed that the stomach fluid volume after taking the fluoride supplement was approximately 250 mL, the concentration to which the stomach mucosal lining was exposed was in the neighborhood of 5 mg/L. GI effects appear to have been rarely evaluated in the fluoride supplement studies that followed the early ones in the 1950s and 1960s. Table 9-1 suggests that, as the fluoride concentration increases in drinking water, the percentage of the population with GI symptoms also increases. The table suggests that fluoride at 4 mg/L in the drinking water results in approximately 1% of the population experiencing GI symptoms."
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p 229-230.

Early Symptoms of Acute Fluoride Poisoning - Fluoride & the Gastrointestinal Tract: (back to top)

NOTE: To learn more about acute fluoride toxicity, click here

"Fluoride has several mechanisms of toxicity. Ingested fluoride initially acts locally on the intestinal mucosa. It can form hydrofluoric acid in the stomach, which leads to GI irritation or corrosive effects. Following ingestion, the GI tract is the earliest and most commonly affected organ system."
SOURCE: eMedicine.com

"Ingested fluoride is transformed in the stomach to hydrofluoric acid, which has a corrosive effect on the epithelial lining of the gastrointestinal tract. Thirst, abdominal pain, vomiting, and diarrhea are usual symptoms. Hemorrhage in the gastric mucosa, ulceration, erosions, and edema are common signs."
SOURCE: Environmental Protection Agency. (1999). Recognition and Management of Pesticide Poisonings. 5th Edition. (Available online)

"Estimating the incidence of toxic fluoride exposures nationwide also is complicated by the existence of biases. Parents or caregivers may not notice the symptoms associated with mild fluoride toxicity or may attribute them to colic or gastroenteritis, particularly if they did not see the child ingest fluoride. Similarly, because of the nonspecific nature of mild to moderate symptoms, a physician's differential diagnosis is unlikely to include fluoride toxicity without a history of fluoride ingestion."
SOURCE: Shulman JD, Wells LM. (1997). Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. Journal of Public Health Dentistry 57: 150-8.

Gastric Symptoms among Hypersensitive at 1 mg - Fluoride & the Gastrointestinal Tract: (back to top)

NOTE: To learn more about hypersensitivity to fluoride, click here

“There are a few case reports of GI upset in subjects exposed to drinking water fluoridated at 1 mg/L. Those effects were observed in only a small number of cases, which suggest hypersensitivity. However, the available data are not robust enough to determine whether that is the case.”
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p250.

"The patient was a seven-year old white child with an itchy skin rash, headache, epigastric distress, generalized weakness, and listlessness. Her discomfort was such that most of her time in school was spent in the nurse's room. When the tablets (1 mg/day) were withdrawn, symptoms disappeared but returned again when therapy was reinstituted. Again withdrawal resulted in disappearance of symptoms. The patient has been symptom free since. The parents of this child refused to allow further experimentation."
SOURCE: Feltman R. (1956). Prenatal and postnatal ingestion of fluoride salts: A progress report. Dental Digest 62: 353-357.

"The patient's face cleared up in three days on discontinuing the fluoride. Upon resuming the tablets (1 mg/day) the rash recurred in two days, this time accompanied by nausea. Tablets were again withdrawn and symptoms disappeared. Two weeks later the patient returned to the clinic and was directed to take the tablets again.The patient took the tablets for three days, the rash reappeared and she developed serious symptoms including vomiting with blood showing in the vomitus. The fluoride description was discontinued. The patient then continued an uneventful pregnancy and delivered a healthy baby."
SOURCE: Feltman R. (1956). Prenatal and postnatal ingestion of fluoride salts: A progress report. Dental Digest 62: 353-357.

"On 6/10/57 the patient while being kept on a low calcium diet was given a placebo test of 300 cc. of distilled water. It caused no ill effect. On June 12th 2 mg. NaF (0.9 mg. F) in 300 cc. of distilled water was administered. The patient was not aware that the water contained fluoride. She had previously had similar tests (glucose tolerance and urea clearance). Within 20 minutes she developed a generalized urticaria associated with cough and pain in the gastric region followed by marked flatulence in the abdomen. This test was repeated on June 18th, after placing the patient on a high calcium (2 gms.) diet to which 1.3 gms. of calcium lactate had been added. The patient experienced the same symptoms as had occurred subsequent to the above-described test. Urticaria dominated the picture. Since eliminating fluoridated water for drinking and cooking foods all symptoms have subsided."
SOURCE: Waldbott GL. (1958). Allergic Reactions from Fluorides. International Archives of Allergy 12: 347-355.

"One percent of our cases reacted adversely to the fluoride (1 mg/day tablets). By the use of placebos, it was definitely established that the fluoride and not the binder was the causative agent. These reactions, occurring in gravid women and in children of all ages in the study group affected the dermatologic, gastro-intestinal and neurological systems. Eczema, atopic dermatitis, urticaria, epigastric distress, emesis, and headache have all occurred with the use of fluoride and disappeared upon the use of placebo tablets, only to recur when the fluoride tablet was, unknowingly to the patient, given again. When adverse reactions occur, the therapy can be readily discontinued and the patient or parent advised of the fact that sensitivity exists and the element is to be avoided as much as possible."
SOURCE: Feltman R, Kosel G. (1961). Prenatal and postnatal ingestion of fluorides - Fourteen years of investigation - Final report. Journal of Dental Medicine 16: 190-99.

"L.W., a 6-year-old girl, consulted one of us (GLW) on December 26, 1963, for an allergic survey because of what appeared to be gastro-intestinal allergy. She had been taking Poly-Vi-Flor, three to four drops daily, since early infancy. Her complaints were frequent nausea, vomiting, pains in the hypogastrium and episodes of abdominal cramps, diarrhea, headaches, and occasional bloody stools followed by fever, up to 104 degrees. These attacks occurred on an average of every ten days. The child failed to gain weight. At first the diagnosis of food allergy and/or chronic appendictis was considered but neither diagnosis was corroborated by x-rays and an allergic work-up. Since the gastro-intestinal episodes usually occurred within one-half hour of the ingestion of the fluoride drops, the medication was discontinued. Improvement began immediately and was followed by complete recovery."
SOURCE: Shea JJ, et al. (1967). Allergy to fluoride. Annals of Allergy 25:388-91.

"Patch tests were done for chewing gum, Lifesavers, a fluoride toothpaste which she had been using since the onset of the lesions and a non-fluoride toothpaste. The fluoride toothpaste gave a two plus reaction. During the development of the positive patch test reaction the patient experienced a flareup of the oral lesions associated with severe abdominal pain. The smear from the ulcer revealed a normal flora. After changing to a non-fluoride toothpaste the oral lesions, as well as an accompanying submaxillary lymphadenitis and the abdominal pains, subsided completely. On December 3, 1986, this child had a recurrence of the stomatitis. It began within 15 minutes after brushing her teeth and was again followed by severe abdominal pain. She had inadvertently used a fluoridated toothpaste."
SOURCE: Shea JJ, et al. (1967). Allergy to fluoride. Annals of Allergy 25:388-91.

"C.P., female age 14 months, had been taking Tri-Vi-Flor drops regularly since 3 weeks of age. Shortly thereafter she started having a persistent diarrhea. At 8 weeks of age she developed what appeared to be pylorospasm, but a pylorotomy failed to relieve the gastric symptoms. At the age of 10 months she suffered from rhinorrhea, dyspnea, intermittent swelling of the salivary glands and submaxillary lymphadenopathy. These symptoms failed to respond to antihistamines and antibiotics. On December 5, 1965, the mother discontinued the drops. Within three days there was a marked improvement. The child has remained symptom free since eliminating the drops."
SOURCE: Shea JJ, et al. (1967). Allergy to fluoride. Annals of Allergy 25:388-91.

Gastric Symptoms at 5-9 mg - Fluoride & the Gastrointestinal Tract: (back to top)

Symptom Type and Incidence Correlated with Elemental Fluoride Ingested - Poison Control Center Reports -
Total Amount	Total Cases	Symptoms (%)	Nausea	Vomiting	Diarrhea
5 - 9 mg	29	3 (10.3)	0	3	0
SOURCE: Spoerke DG, et al. (1980). Toxicity Related to Acute Low Dose Sodium Fluoride Ingestions. Journal of Family Practice 10: 139-140.

"An 8-year-old girl gave a history since infancy, of abdominal pains associated with anorexia, frequent pyelitis and pruritus vulvae. Since early 1956 she had intermittently spastic pains and paresthesias in legs and arms. She consulted me because of seasonal upper respiratory allergy... On 6/18/57 the patient was given as a placebo 300 cc. of distilled water without ill effect. The following day a test dose of 6.8 mg. of fluoride (as NaF) elicited within 20 minutes moderately severe vomiting."
SOURCE: Waldbott GL. (1958). Allergic Reactions from Fluorides. International Archives of Allergy 12: 347-355.

"After having avoided fluoride water for 2 weeks, the patient was given, 2 days before the test, 6.8 mg. of F as NaF and another 6.8 mg. on the day of the test. The first dose caused no ill effect. However, within 30 minutes after she had taken the second dose she developed a severe outbreak of urticaria, cephalgia, paresthesias in legs and hands. She became lethargic and developed pain in the epigastric region followed by spastic pain in the lower abdomen. These symptoms began to clear in about one hour... Only 3.6 percent of the total test dose of 6.8 mg. of F was recovered in the urine within 24 hours."
SOURCE: Waldbott GL. (1958). Allergic Reactions from Fluorides. International Archives of Allergy 12: 347-355.

Damage to Gastric Mucosa in Human Clinical Trials - Fluoride & the Gastrointestinal Tract: (back to top)

Values for Macroscopic and Microscopic Evaluation of the Gastric Mucosa in Control Conditions (C) and After Fluoride Application (F)
Subject	Macroscopic Evaluation*				Microscopic Evaluation **				Retained Amount of Fluoride (mg)
	Corpus		Antrum		Corpus		Antrum
	C	F	C	F	C	F	C	F
LB	0	1	0	1	0	1	0	1	6.0
KT	2	4	0	3	0	1	0	0	3.4
EF	0	4	0	3	0	1	0	0	7.8
IT	0	4	0	2	0	1	0	1	9.2
AL	0	1	0	0	0	1	0	1	3.1
MJ	0	0	0	0	0	1	0	1	3.2
MW	0	4	0	1	1	2	0	0	3.9
HD	0	0	0	0	0	1	0	0	5.3
LJ	0	0	0	0	1	0	1	1	4.1
PK	0	3	0	2	0	1	0	1	5.3
Mean									5.1
SD									2.1
* Macroscopic Evaluation: 0 = normal 1 = 1 petechia or erosion 2 = 2 - 5 petechiae or erosions 3 = 6 - 10 petechiae or erosions 4 = >10 petechiae or erosions, widespread involvement of the stomach with petechiae or erosions, ulcer of any size.					** Microscopic Evaluation 0 = normal 1 = either surface epithelium alteration with stroma edema/ hemorrhage or gastric pit damage 2 = both surface epithelium and gastric pit damage 3 = as number 2 combined with acute inflammatory cellular response
SOURCE: Spak CJ, et al. (1990). Studies of human gastric mucosa after application of 0.42% fluoride gel. Journal of Dental Research 69:426-9.

"Dental prophylaxis with APF gels (1.23%) may cause gastric distress as a side-effect. This gastric irritation is probably due to a direct toxic effect of fluoride (F), swallowed in conjunction with the treatment, on the gastric mucosa. The aim of the present study was to investigate whether--and to what extent--a dental treatment with 3 g of a 0.42%-F gel could affect the gastric mucosa due to inadvertent swallowing of the gel. Ten subjects underwent a control gastroscopy, and two weeks later, a second gastroscopy was performed two h after a F gel treatment. During the gastroscopy, the mucosa was examined and the injuries graded according to an arbitrary scale. Four biopsies of the antral and corpus regions of the stomach were taken and evaluated histologically. The mean (+/- SD) amount of F retained after the application was 5.1 +/- 2.1 mg, i.e., 40% of the applied amount of F. Petechiae and erosions were found in the mucosa in seven of the ten patients. The histopathological evaluation revealed changes in nine of ten patients, with the surface epithelium as the most affected component of the mucosa. The present study clearly shows that a treatment with a F gel of rather low F concentration may result in injuries to the gastric mucosa. The importance of current recommended guidelines so that the amount of F swallowed during a gel application can be minimized is emphasized. From a toxicological standpoint, the use of a low-F gel instead of a 1.23%-F gel in small children is recommended for avoidance of adverse gastric effects."
SOURCE: Spak CJ, et al. (1990). Studies of human gastric mucosa after application of 0.42% fluoride gel. Journal of Dental Research 69:426-9.

"In a prospective case controlled study, we evaluated the adverse effects of long-term fluoride ingestion on the gastrointestinal tract. Ten patients with otosclerosis who were receiving sodium fluoride 30 mg/day for a period of 3-12 months, and 10 age- and sex-matched healthy volunteers were included... Seven subjects (70%) ingesting fluoride had abdominal pain, vomiting, and nausea. Petechiae, erosions, and erythema were seen on endoscopy in all the subjects, but not in the controls. Histological examination of the gastric antral biopsy showed chronic atrophic gastritis in all the subjects but in only one (10%) healthy volunteer. Scanning electron microscopic examination showed "cracked-clay" appearance, scanty microvilli, surface abrasions, and desquamated epithelium in the subjects ingesting fluoride, but not in the controls. We conclude that long-term fluoride ingestion is associated with a high incidence of dyspeptic symptoms as well as histological and electron microscopic abnormalities."
SOURCE: Das TK, et al. (1994). Toxic effects of chronic fluoride ingestion on the upper gastrointestinal tract. Journal of Clinical Gastroenterology 18(3):194-9.

"In a randomized double-blind study with two parallel groups of 10 male healthy volunteers each the response of gastric mucosa after a 7 days ingestion of sodium fluoride tablets (NaF) or sodium monofluorophosphate tablets (MFP) was compared. Gastroscopic evaluations were performed before treatment, day 1 and day 7... In the MFP-group no severe gastric lesions were observed, whereas in the NaF-group in 7 of the 10 subjects significant gastric mucosal lesions including acute hemorrhages and free blood in the gastric lumen were found. The differences of the lesions scores in both groups were statistically significant (p = 0.0015)... In summary, under the experimental conditions used MFP is well tolerated by the stomach while NaF produces significant gastric mucosal lesions."
SOURCE: Muller P, et al. (1992). Sodium fluoride-induced gastric mucosal lesions: comparison with sodium monofluorophosphate. Z Gastroenterol. 30(4):252-4.

"We studied the response of the gastric mucosa after a single dose of fluoride. Twelve healthy volunteers (age range 22-45, four men and eight women) underwent two endoscopies after overnight fasts. One endoscopy was a control and the other was performed two hours after subjects ingested 20 ml sodium fluoride solution containing 20 mg fluoride (53 mmol/l)... After taking fluoride all subjects had petechiae or erosions (graded 3 or 4) in the body of the stomach and six had changes (graded 1-4) in the antrum. No petechiae or erosions were recorded in the oesophagus or the duodenum. In four subjects a layer of clotted blood was found over a large part of the gastric mucosa... Three components of the gastric mucosa were affected by fluoride: the surface epithelium, the gastric pits, and the superficial stroma. The damaged epithelial cells were smaller than undamaged ones, and the vacuoles containing mucus were reduced in size or had disappeared. The most severely damaged epithelium was disrupted or totally lost. The most characteristic changes in the gastric pits were irregular dilation and flattening of the epithelial cells. There was also a noticeable loss of mucin. Our study showed that one ingestion of fluoride at a dose used to treat osteoporosis affects the gastric mucosa... Symptoms like nausea and vomiting are not unusual when fluoride is used to treat osteoporosis. They also occur occasionally when high doses are used for dental prophylaxis. In our study only four subjects developed nausea, which suggests that using nausea as the first sign of fluoride toxicity might not be valid as all our subjects showed mucosal damage."
SOURCE: Spak CJ, et al. (1989). Tissue response of gastric mucosa after ingestion of fluoride. British Medical Journal 298:1686-7.

Gastric Symptoms in Human Clinical Trials - Fluoride & the Gastrointestinal Tract: (back to top)

"The use of fluoride in the prophylaxis or treatment of osteoporosis seems highly questionable for the following reasons: ... (c)there are frequent gastrointestinal disturbancesand arthralgias..."
SOURCE: Inkovaara JA. (1991). Is fluoride treatment justified today? Calcified Tissue International 49 Suppl:S68-9.

"the fluoride-treated women (dose = 34 mg/day F) had about 3.0 times as many side effects as the women given placebo. The side effects fell into one of two major categories - those due to gastric irritation and those due to pain the lower extremities. The gastric symptoms consisted mainly of nausea or, less commonly, epigastric pain and vomiting, or both. The fluoride-treated women had these symptoms 2.9 times more frequently than the women given placebo."
SOURCE: Riggs BL, et al. (1990). Effect of Fluoride treatment on the Fracture Rates in Postmenopausal Women with Osteoporosis. New England Journal of Medicine 322:802-809.

"Of 48 patients who began sodium fluoride therapy (dose = 9.0 - 27 mg/day F), 25 developed significant side-effects (10 with nausea and dyspepsia, 1 with gastrointestinal hemorrhage)."
SOURCE: Hodsman AB, Drost DJ. (1989). The response of vertebral bone mineral density during the treatment of osteoporosis with sodium fluoride. Journal of Clinical Endocrinology and Metabolism 69:932-8.

"Results from several large trials indicate that significant side effects attributable to treatment occur in about one-third to one-half of patients. Symptoms have been of two types--periarticular and gastrointestinal... Gastrointestinal symptoms consist of epigastric pain, nausea, vomiting, and occasionally, blood-loss anemia; these presumably result from the irritant effect of fluoride ion on gastric mucosa. The frequency of gastric side effects can be reduced by giving the calcium supplement concomitantly in the form of calcium carbonate, an effective antacid. Diarrhea occurs occasionally."
SOURCE: Riggs BL. (1983). Treatment of osteoporosis with sodium fluoride: An appraisal. Bone and Mineral Research 2: 366-393.

"Twenty-three of the fluoride-treated patients (dose = 18-27mg/day) had adverse reactions (38 per cent), which caused five of them to discontinue therapy; 13 had rheumatic symptoms (joint pain and swelling or painful plantar fascial syndrome), nine had gastrointestinal symptoms (severe nausea and vomiting, peoptic ulcer, or blood-loss anemia), and one had both rheumatic and gastrointestinal symptoms."
SOURCE: Riggs BL, et al. (1982). Effect of the fluoride/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. Comparison with conventional therapy. New England Journal of Medicine 306:446-50.

"Major gastrointestinal side effects also occurred (dose = 18-30 mg/day). Two patients had recurrent vomiting that could be controlled only when the dosage of sodium fluoride was reduced to 15 and 7.5 mg daily, respectively."
SOURCE: Riggs BL, et al. (1980). Treatment of primary osteoporosis with fluoride and calcium: Clinical tolerance and fracture occurrence. Journal of the American Medical Association 243: 446-449.

"Treatment was ended in the fluoride group more frequently than in the controls (P < 0.001), usually because of abdominal discomfort."
SOURCE: Inkovaara J, et al. (1975). Prophylactic fluoride treatment and aged bones. British Medical Journal 3(5975):73-4.

"Six (of 11) patients complained of occcasional epigastric dyspepsia."
SOURCE: Jowsey J, et al. (1972). Effect of combined therapy with sodium fluoride, vitamin D and calcium in osteoporosis. The American Journal of Medicine 53: 43-49.

"Sodium fluoride in the dose used (dose = 23-68 mg/day F) often causes anorexia or epigastric pain."
SOURCE: Rich C. (1966). Osteoporosis and fluoride therapy. Journal of the American Medical Association 196: 149.

Gastric Symptoms in Humans with Skeletal Fluorosis - Fluoride & the Gastrointestinal Tract: (back to top)

NOTE: To learn more about skeletal fluorosis, click here

"Non-ulcer dyspeptic complaints or gastrointestinal complaints were observed in all of the (fluorosis) patients before treatment. During the first impact assessment reduction in health complaints, especially in gastrointestinal discomfort, was most striking. Most of the patients ~ 70% showed relief in gastrointestinal complaints during first impact assessment. During the second impact assessment all of the patients showed relief from gastrointestinal complaints."
SOURCE: Susheela AK, Bhatnagar M. (2002). Reversal of fluoride induced cell injury through elimination of fluoride and consumption of diet rich in essential nutrients and antioxidants. Molecular and Cellular Biochemistry 234-235:335-40.

"A prospective case-controlled study was performed to evaluate the gastrointestinal symptoms and mucosal abnormalities occurring in patients with osteofluorosis. Ten patients with documented osteofluorosis and ten age- and sex-matched healthy volunteers were included in the study... All patients with osteofluorosis had gastrointestinal symptoms, the most common being abdominal pain. Endoscopic abnormalities were found in seven patients with osteofluorosis. In all 7 of these patients, chronic atrophic gastritis was seen on histology. Electron microscopic abnormalities were observed in all 10 patients with osteofluorosis. These included loss of microvilli, cracked-clay appearance, and the presence of surface abrasions on the mucosal cells. None of the control subjects had any clinical symptoms or mucosal abnormalities. It was concluded that gastrointestinal symptoms as well as mucosal abnormalities are common in patients with osteofluorosis."
SOURCE: Dasarathy S, et al. (1996). Gastroduodenal manifestations in patients with skeletal fluorosis. Journal of Gastroenterology 31:333-7.

"The present study was conducted to assess the prevalence and severity of non-skeletal manifestations, especially gastrointestinal disturbances, in an area of skeletal and dental fluorosis... The subjects, numbering 1958 inhabitants belonging to 489 families residing in four endemic villages of Faridabad District of Haryana State, were interviewed on health complaints... It is concluded that in an endemic (fluorosis) zone, where the inhabitants are consuming water of high fluoride content, the occurrence of gastrointestinal complaints - viz., loss of appetite, nausea, abdominal pain, flatulence, constipation and intermittent diarrhoea - is one of the early warning signs of fluoride toxicity and fluorosis. When water with negligible amounts of fluoride (safe water) is provided, the complaints disappear within a fortnight."
SOURCE: Susheela AK, et al. (1993). Prevalence of endemic fluorosis with gastro-intestinal manifestations in people living in some North-Indian villages. Fluoride 26: 97-104

"A prospective case controlled study was conducted to evaluate the role of fluoride as a possible aetiological factor for non-ulcer dyspepsia (NUD). Twenty patients with NUD and 10 age and sex matched healthy controls were subjected to clinical evaluation, upper gastrointestinal endoscopy and biopsies from the gastric antrum and duodenum... Fluoride levels in the drinking water, serum and urine were estimated using a ION 85 ion-analyser. These levels were significantly higher in patients with NUD than in controls (P less than 0.05).. The fluoride levels in serum and urine correlated with the symptoms, histological and electron microscopic abnormalities (P less than 0.05). It was concluded that chronic exposure to fluoride may result in NUD and should be considered in patients where other known cause of dyspepsia have been excluded."
SOURCE: Gupta IP, et al. (1992). Fluoride as a possible etiological factor in non-ulcer dyspepsia. Journal of Gastroenterology and Hepatology 7:355-9.

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