SOUTHERN INDIANA — You must drink water to stay healthy, but how healthy is the water you’re drinking?

You can’t drink bottled water because chemicals from the plastic bottle might leech into the water. The carbon footprint created by manufacturing and transporting bottled water is huge and bad for the environment and most of it is just purified tap water anyway, right?

Tap water is much better. It’s tested more frequently, it’s cheaper and it’s got fluoride, which we all need to prevent tooth decay, right? Well, it all depends on who you ask.

Ask an environmentalist and they’ll tell you bottled water creates an unnecessary amount of trash, so it’s bad. Ask someone from a water bottling company and they’ll tell you most of what we drink comes from a bottle or can and bottled water has the least environmental impact of any packaged beverage.

Ask a dentist about the benefits of fluoridated tap water and they’ll tell you it’s one of the most effective public health initiatives ever. Ask an opponent of fluoridation and they’ll tell you the link between fluoride and the prevention of tooth decay is unproven.

It seems the more people you ask about water issues the muddier the issue becomes. Southern Indiana Fitness Source talked to people on different sides of these issues to try and clear things up.

REGULATION

One of the first differences mentioned when comparing bottled and tap water is who regulates them. The U.S. Food and Drug Administration is responsible for regulating bottled water, while tap water is regulated by the United States Environmental Protection Agency. So what does that mean?

“While [the FDA is] responsible for it, the frequency with which they do those evaluations is fairly limited,” said Dr. Robert Jacobs, professor of environmental and occupational health at the University of Louisville, “whereas any municipal water supply is going to have to comply with EPA regulations regarding their maximum contaminant levels. And then require public reporting.”

If you use a municipal water supply, every so often when you get your water bill there will be a report with it, Jacobs said. In general, the standards for most municipalities comply with the EPA standards and rather aggressive action is taken if they don’t, he said.

“So the EPA has much more direct oversight of the qualities of tap water than the FDA does on the quality of bottled water,” Jacobs said.

Score one for tap water.

LECHATES

Most bottled water probably meets most of the same criteria as tap water, Jacobs said, but what happens once that water goes into a plastic bottle?

There are potential lechate products from the plastic itself that may leech into the water, Jacobs said.

The lechates are part of the organic polymers that make up plastics. Some of them have been considered to have endocrine-like or hormone-like effects. Endocrine disruptors will either accentuate your normal hormone or endocrine response or they may suppress a normal response, Jacobs said.

But Jacobs admits the data that supports this is not without it’s share of controversy. You can measure those things in some of the types of plastic bottles and it varies depending on the type of plastics used.

“There are studies that suggest it may pose a risk, but there are not definitive studies that have identified specific risks,” Jacobs said.

Jane Lazgin, director of corporate communications for Nestle Waters, doesn’t believe bottled water drinkers should be worried.

“There isn’t any evidence that it would,” Lazgin said of chemicals in plastic bottles leeching into drinking water. “We’ve looked at it.”

She said PET, or polyethylene terephthalate, is used to make plastic bottles and has been approved for food packaging by the FDA.

She does advise consumers to treat a bottle of water like they would any other food.

“Don’t leave it out in extreme temperatures, don’t put it next to a can of mothballs or something, you know,” Lazgin said. “Treat it like you would any other food product and it shouldn’t be affected.”

CONVENIENCE, COST AND THE ENVIRONMENT

While Jacobs believes most tap water is just fine, he can see why the bottled water industry has been successful.

“I think for convenience,” Jacobs said. “Obviously it’s important to people.”

Lazgin agrees.

“Bottled water gives people the ability to bring water into their lives,” she said. “They might not always have access if they’re at a gym, a sporting event, walking in Manhattan.”

In addition, Lazgin said in recent years people have been minding their liquid calories more and are looking more toward water as their beverage of choice. Evan Vickers, a senior at the University of Louisville, is one of those people.

“I was sort of on a bottled water kick,” Vickers said.

Vickers said he started carrying some sort of bottled water with him about 10 years ago.

“I do think it is a good idea to replace a lot of the liquids we drink every day, you know soda, enhanced water, whatever, with just water because it is healthier for you,” Vickers said.

Vickers eventually came to the conclusion that, while drinking water was good for his health it was bad for his wallet.

“The amount of money I was spending in a week on plastic bottles, I could just buy a reusable water bottle and fill it up at the tap.”

So he did, but this led to another problem.

“A regular water fountain, it gets your water bottle about three-fourths of the way full and then your hands are soaking wet and your water bottle is wet,” Vickers said.

He took maters into his own, albeit wet, hands. He’s been working with the administration at the University of Louisville to have water bottle refilling spigots retrofitted to water fountains around campus. He’s looking at two devices. One is a simple, more cost-effective device that attaches to the left side of water fountains and looks kind of like a long hook that allows users to fill their bottles without having to tilt them.

The other device is more expensive but it aims to point out the benefits of reusable water bottles as opposed to disposable plastic bottles. This device, from a company called Elkay, has a digital reader that counts the amount of water bottles saved by refilling at that station.

Indeed, bottled water generates a lot of trash. According to Time magazine’s June 4, 2012 issue, 222 bottles of water were consumed per person in the United States in 2011, an all-time high. But Lazgin points out that too much of the blame may be put on bottled water, when it’s not the only culprit.

“At least 70 percent of what we drink comes from a bottle or can,” Lazgin said.

She explains that for most of civilization people drank water. In the 1970s and 80s, soft drinks overtook tap water consumption. In the 1990s, bottled water became available in smaller bottles and in the 2000s, soft drink consumption started to drop while bottled water consumption increased. As our consumption habits changed, so did the focus of environmentally conscious individuals. Lazgin argues the shift from soft drinks to water is actually better for the environment.

“Compared to any other packaged beverage, bottled water has the least environmental impact,” Lazgin said.

Environmental impact aside, cost and quality alone were enough for Vickers to change his habits.

“Companies like Coca-Cola are bottling it up and selling it to you at 10 to 20 times the cost that just your tap water comes to you at,” he said. “And the tap water has got fluoride and it’s tested more rigorously.”

Bottled water is expensive when compared to tap water, and Jacobs said tap water is tested more frequently, but Lazgin said different brands get their water from different sources. She said most of Nestles Waters’ brands come from natural spring waters. One brand, Nestle Pure Life, originates either from private wells on company property or from a public water supply. She said if it comes from a public water supply it is labeled as such and the water goes through a rigorous treatment filtration process called reverse osmosis. Only when water is put through a very rigorous and sensitive filtration process can you call it purified, Lazgin said.

“So the water is basically highly filtered,” she said. “It’s kind of stripped of its properties and then we add some minerals back in just to add some taste to it.”

And as for the fluoride, Lazgin said there are a lot of differences of opinion so they have brands that cater to both preferences.

“Some of our natural spring waters have it naturally occurring, so it very much depends on the brand, but if it contains fluoride it very obviously says ‘with fluoride,’” Lazgin said. “So then consumers can make that choice.”

That’s good, because water fluoridation is one of the most divisive issues surrounding water consumption.

FLUORIDE

“Fluoridation of water has probably been one of the most effective public health initiatives ever,” said Dr. Lee Mayer, DMD, associate professor and director of community dental health at the University of Louisville School of Dentistry. “It’s cheap in preventing decalcification and tooth decay; that’s wonderful.”

Not everyone thinks water fluoridation is as wonderful as Mayer.

“Drinking fluoride free water is not unhealthy in any way shape or form,” said Carol Kopf, Fluoride Action Network media director. “In fact, it’s healthier because the body doesn’t need fluoride and just like all other chemicals that are added to the water supply or bottled water, some people could be allergic to it or intolerant of it.”

Mayer and Kopf couldn’t disagree more on water fluoridation, but they do agree on how it started.

In the early 1900s people who lived in some towns in the southwestern United States were known to have a distinctive type of staining on their teeth now referred to as mottling of the enamel, but they didn’t have tooth decay, Mayer said.

“At that time, tooth decay was just running wild every place else,” he said.

Through analysis it was determined that fluoride was the chemical that brought this about, Mayer said. Kopf agrees.

“He’s correct about how it started,” she said. “There were towns in the southwest that had very high natural fluoride in the water.”

But Kopf points to other variables that may have influenced the dental health of people in those areas.

“And by the way, those towns had healthier, wealthier people,” she said. “Generally that’s where dentists go, where they can make money.”

Kopf said the fluoride in the water was calcium fluoride and the conclusion that fluoride was preventing tooth decay was made before people knew that calcium was an essential nutrient for teeth.

“So they did study and found that it was the fluoride concentration that was making the teeth brown, so they assumed that well, if the fluoride is making the teeth brown then the fluoride must be making it decay resistant,” she said. “They totally discounted the calcium part of it.”

Mayer said he has personally seen the benefits of water fluoridation. He said before water fluoridation, teeth just generally decayed.

“As an adult, you were expected to have lost all your teeth and probably wear dentures,” he said. “Now people are keeping their teeth for a lifetime. Age and tooth loss don’t go hand in hand anymore.”

Kopf agrees that since water supplies have been fluoridated, rates of tooth decay have decreased, but she points to a multitude of contributing factors as the cause for the decline.

“Over the same period foods are fortified with vitamin D, which you also know is important for dental health,” she said. “People can afford to go to dentists and doctors . . . did the tooth decay rates go down because of water fluoridation or some other effect or combination of effects?”

The claim that water fluoridation is not an effective treatment for tooth decay isn’t as shocking as some of the other claims that have been made about fluoride, and Mayer is well aware of those.

“It’s been accused of causing everything from cardiovascular disease and stomach convulsions and abdominal pain and all types of things like that, but those are toxic levels that that would happen.” he said. “Heck, at one time it was even blamed for causing AIDS and sterility and all these other things. There’s always a lethal dose of anything, but I don’t think that’s going to happen.”

So what would be a lethal dose of fluoride? Five to 10 grams at one time, Mayer said.

“That would be like as much as 20,000 times that of what’s in a glass of water,” he said. “It’s very, very unlikely. You’d have to try.”

In the 1930s, the U.S. Public Health Service determined one part per million to be the appropriate level of fluoride in water.

To put that into perspective, one part per million is the equivalent of 1 cent out of $10,000 or one minute in two years.

Today, tap water is supposed to have even less fluoride, 0.7 parts per million, Mayer said. Kopf points to this change as evidence to support her argument against water fluoridation.

“Ironically, over the years, the safe level used to be one part per million and then they made the same claims, ‘oh nobody could be harmed at one part per million, you’d have to drink bathtubs full to be harmed,’” Kopf said. “Now, low and behold, January 2011 recommendations are that oops, too many kids are getting dental fluorosis, we have to lower that amount. So basically what they said before turned out not to be true.”

According to an article on the EPA’s website dated Jan. 7, 2011, the U.S. Department of Health and Human Services (HHS) proposed a recommendation of 0.7 milligrams of fluoride per liter of water to replace what was then the current range of 0.7 to 1.2 milligrams. They did this, according to the article, because the, “HHS and EPA reached an understanding of the latest science on fluoride and its effect on tooth decay prevention, and the development of dental fluorosis that may occur with excess fluoride consumption during the tooth forming years, age 8 and younger.”

Kopf points to fluoride consumption among young children as another reason why she is against water fluoridation.

“My daughter just had a baby that weighs 6 pounds,” she said. “You’re telling me that a 6-pound baby could drink just as much fluoride as her parents or her grandparents. That doesn’t make sense.”

Perhaps Kopf’s most convincing argument against water fluoridation is that it causes entire populations to be dosed with fluoride for their entire lives. Instead of dosing everyone who drinks tap water with fluoride, Kopf believes it should be dispensed in a doctor or dentist’s office and patients should be monitored for side effects and then, at some point, discontinued.

“There’s nothing on earth that’s safe for everyone,” Kopf said. “We’re all unique individuals and we react differently to everything.”

With so many concerns about water fluoridation, why do people like Mayer and the American Dental Association tout the benefits of water fluoridation? Is there some kind of evil conspiracy at work? Kopf doesn’t think so.

“They’re not evil corporations or evil people wanting to make money,” she said. “They truly believe what they’ve been taught.”

She believes the answer is not sinister, but rather systemic.

“It took 50 years for the link between smoking and cancer to emerge from the scientific literature into popular acceptance,” Kopf said. “I think the wheels of government just work slowly.”