Tuesday, December 18, 2012

Water Fluoridation- A struggle for truth and scientific integrity, not myth and opinion based on a misrepresentation of scientific facts

The first step in scientific research is to find out what is known about it in available literature. This study is fraught with difficulties. In spite of the literally thousands of publications on the dental, biochemical and statistical phase of fluoridation, little research is available on its medical aspect. The National Research Council’s (NRC) review of fluoride in drinking water published in 2006 is perhaps the best example of this, where the scientific committee found that the quality of research available to prove the safety and effectiveness of fluoridation was seriously lacking proper scientific investigation. In total the NRC scientific committee recommended over 50 detailed scientific, medical, toxicological and epidemiological studies be undertaken to demonstrate the safety and effectiveness of fluoride, none of which have been undertaken by Health authorities to date. The U.S National Research Council were not alone in this determination.

What makes all this quite remarkable is that fifty years previously in 1954 the Canadian Medical Association adopted a report by its Ad Hoc Subcommittee where it pointed to the following gaps in fluoride research:

·       “We don’t know enough about the toxic effects of fluoride on tissues other than teeth.
·       We don’t know enough about the effect of fluoride over long periods of time.
·       We don’t know enough concerning fluorine levels in relation to fluorine bearing food combined with artificially fluoridated water.
·       We don’t know enough about the relation of nutritional factors to the action of fluorine.
·       We don’t know enough about the toxicity of fluoride as allied to climate and geography which may increase absorption or diminish excretion.”

Indeed EVERY one of these statement’s which was issued almost 60 years ago remains unanswered TODAY.

In undertaking my own independent review and risk assessment of this area, I found this fact deeply disturbing, even more so when the European Commission’s review of fluoride in 2010 (SCHER Review) clearly identified that the toxicological profile of Hexafluorosilicic acid/hydrofluorosilicic acid, the principle fluoridation chemical used in North America and Ireland, still to this day remains largely unknown.

For me, personally and professionally, I find this fact completely unacceptable. Under no circumstance should any authority no matter whom, inject a chemical into drinking water to be consumed by the public that the toxicological impact of the chemical is not known with absolute scientific certainty. To do so is in my view criminally negligent. In my professional work one of my main areas of expertise is due diligence and risk assessment. I work a lot on contaminated industrial sites including pharmaceutical sites. When I examine the environmental liabilities that may be associated with past activities the first place I start is by compiling all the toxicological data for every known chemical that was previously used on site.  I examine the human health and environmental risk associated with each and determine based on scientific assessment the degree of potential liability associated with the site and any remediation action that may be necessary for clean-up and restoration. I do not accept opinion only evidence based fact. These are the same principles that I applied to my examination of water fluoridation in my recent report which I published independently earlier this year. Simply put, because there is no toxicological data to support the use of silicofluoride chemicals and as neither the health authorities, the manufacturers or promoters of these chemicals can provide the evidence to show they are safe for human consumption, it would be remiss of any politician who ultimately is responsible for any political decision to enforce mandatory fluoridation on their population, to not demand such evidence be presented prior to any policy even being considered.  Public policy must be based on evidence based science not hypothetical theory or opinion.

This brings me to the NHS York Review undertaken for the Chief Medical Officer of the UK, which was published in the 2000. This review remains one of the most comprehensive independent scientific studies of the available scientific literature on fluoride and water fluoridation. It is remarkable that despite reviewing thousands of published papers the NHS York Review could not find one study that scientifically proved the effectiveness and safety of water fluoridation. The review concluded from available worldwide evidence that there was no credible evidence to demonstrate that water fluoridation was either safe or effective. It did however prove that in communities where artificial fluoridation occurred that a very significant percentage of the population were overexposed to fluoride, resulting in a high level of dental fluorosis amongst the population. In fact, the York Review found that in fluoridated communities up to 48% of the population may experience dental fluorosis and of these some 20% will have dental fluorosis that is more than just mere cosmetic damage. In other words the review found that one in eight people will have physically damaged teeth as a result of water fluoridation.

The respected medical physician and scientist Dr. Waldbott, one of the most distinguished medical experts in the field of allergies of the last century, best described dental fluorosis as “an external sign of internal distress”. It is a visible sign of chronic overexposure to a toxin, one that now affects almost half the population of North America as well as other fluoridated countries such as Ireland.

I am currently reading an extremely interesting book by the late Dr. Walbott titled ‘A Struggle with Titans’ on the subject of water fluoridation (which I would highly  recommend everyone to read), where he expertly documents the history of water fluoridation and his personally experiences in undertaking scientific research in this area. Dr. Waldbott highlights how dental and scientific journals including medical journals of the highest reputation, publish only what they desire, regardless of the scientific calibre of the article in question. He documents cases of intimidation and harassment of scientific professionals who opposed the policy of water fluoridation. He discusses not just the origins of fluoridation but how industry used political power to influence research, media and public policy to support fluoridation. Dr. Waldbott discusses how any research funded by industry that may be incriminating is invariably censored or withheld from publication and highlights how most if not all of the money available to scientific institutions for fluoride research flows from organisations interested in promoting fluoride. He further explains how the American Dental Association and the U.S Public Health Service have used their combined organisations, financial strength and power to promote fluoridation at all costs and discusses how through their members, who sit on the board of every major medical and dental journal in North America, they may influence not only public opinion but scientific publication of articles on water fluoridation. Dr. Waldbott described three type of promoters of fluoridation and how each has his own area of influence: Firstly the scientist who has done original work on fluoride, secondly the professional, scientific and medical news writer who is impressed by the scientists work and finally the misinformed, who adopt views of others without making an independent study of his own.

This brings me to the principle point addressed in a recent communication regarding this website, which I use to help raise awareness and educate the public on the risks associated with water fluoridation. One of the means by which I undertake this is provide a review of some of the more recent and scientific publications in a manner that may be understandable for the general reader. For scientific professionals I would expect they would always consult the primary research as I do and review the information independently.

It has been commented that the summary provided to the Russian Academy of Sciences scientific paper on the Molecular Toxicity of Fluoride is not the official summary/abstract of the original report. I believe that the summary provided in my blog accurately reflects the abstract of the original study, the principle difference being that I have attempted to write my summary in a manner that the public may better understand. The original paper was quite long and included some 154 scientific references many of which are highly acclaimed scientific journals. It has also been suggested by fluoride promoters that there is no evidence to support the fact that individuals often exceed the ‘therapeutic level’ of fluoride from dietary sources, as noted in my review and in other published papers. There is in fact comprehensive evidence of this which is evident in the prevalence of dental fluorosis in communities where fluoridation is practiced. I would highlight one important scientific publication by the European Food Safety Authority (EFSA) [1] that for me as a parent I find particularly disturbing. In this study the EFSA found that bottle fed infants who are fed formula milk made up with fluoridated tap water exceed the established maximum recommended upper tolerable safe level established for a healthy adult by almost 200%.  This is quite simply insane  and represents medical and safety negligence of the highest order, especially when recent studies by Harvard University and others have clearly found that fluoride is not only a development neurotoxin but is strongly linked to the development of childhood cancers such as osteosarcoma.

The EFSA also note that 90% of the fluoride ingested will remain within the infant where it is bound to calcified tissue, such as bone as well as deposited in other organs within the body. In addition the EFSA further note that in children up to 70% of their total fluoride burden or dietary intake may on occasion come from pharmaceutical drugs depending on their medication and note that in assessing the dietary intake of fluoride by individuals all sources of fluoride should be examined in order to determine the risk of overexposure to individuals. This fact is important as the World Health Authority itself has clearly stated that prior to any country deciding on whether to fluoridate drinking water supplies the total dietary fluoride exposure of the population must be examined for all sectors of society including the most sensitive subgroups. What is truly shocking is that this basic recommendation of the WHO has been entirely ignored by health authorities who promote fluoridation in the few countries in the world where it is still practiced. 

Yet while the WHO values for recommended daily fluoride intake, for the benefit of dental health, are approximately 3mg/day for an adult female and 4mg/day for an adult male these recommendations are misleading given that the Journal of the American Dental Association (JADA)[2] clearly found that fluoride incorporated developmentally during tooth development had no significant role in caries protection or simply put, ingesting fluoride had no beneficial impact on preventing caries prevention. Why therefore recommend an optimal dietary intake, if ingested fluoride has no beneficial role in preventing dental caries? This is especially so when the European Food Safety Authority found that “Fluoride is not essential for human growth or development” a statement or position also agreed by the EU Commissions DG SANCO when they noted that “People do not need fluoride for normal growth and development”.

The problems of establishing "optimal fluoride intakes" was comprehensively examined by Warren et al.[3] in 2008 when the research  authors recommended "that due to extreme variability in individual fluoride intakes, recommending an "optimal" fluoride intake is problematic." in concluding the authors recommend that “the term optimal fluoride intake be dropped from common usage”.

Thirdly, regarding the article itself, some individuals who support fluoridation appear to attempt to discredit the research not by questioning its validity, but rather where it was published. This intellectual snobbery attempts to discredit any study that was not published in what they regard as "scientifically valid' journals, as if the pursuit of science is only valid if they say so. In this particular instance regarding the study by the Russian Academy of Sciences, I would like to see critics highlight any discrepancies that may be present in the original scientific paper or indeed any falsehoods presented in any of the 154 scientific references provided for the same published article. Of course this rarely if ever happens, instead fluoride promoters prefer to ignore any science that is critical to fluoridation in a way that if it is critical then is must be wrong. Scientists are meant to be objective but when it comes to water fluoridation this also unfortunately rarely happens, to many scientists prefer to accept opinion rather than facts. Where limitations to studies may have been found, one would imagine in the interests of public safety, that the public health authorities would repeat such studies and improve on the methodologies to improve the science thereby protecting the interests of the public. This unfortunately never happens. It appears their attitute is to be openly critical of every study that demonstrates harm and then brush it under the carpet hopefully never to see the light of day again. This is not in the interests of science, nor public health.

The authors of this particular review, the Russian Academy of Sciences, represent the National Academy of Russia which is a self-governing non-commercial organisation that is highly respected internationally. The fact that the Academy is non-commercial is extremely important, as their research is therefore more likely to be truly independent.  I would highlight for example, that it was largely through the work of this organisation that the health risks of non-ionising radiation from mobile phones was first highlighted (2009), which ultimately resulted in the World Health Organisations International Agency for Cancer Research issuing their press release in May 2011 where they classified radiofrequency electromagnetic fields as possibly carcinogenic to humans. This was followed by the Chief medical officers in many developed countries issuing public warnings on the health risks of mobile phone technology based coincidentally on the ‘precautionary principle,’ a principle that has been entirely ignored for water fluoridation chemicals in the countries that promote this policy.

Throwing stones at where the article was published does not weaken the evidence presented in the review. I had a similar discussion with a molecular biologist in Ireland regarding this very topic recently where he first suggested that the publication in which the article was printed was not academically respected and therefore was unscientific. So I asked him to identify for me any inaccuracies or misrepresentations presented in the article, I received no reply.  He subsequently suggested that any scientific paper that included as a scientific reference the journal Fluoride, (reference 92) which itself is not listed in the Medline database of journals, was not worthy of credibility, in his learned opinion. When I responded that the United States National Academy of Sciences, National Research Council included numerous references to the journal Fluoride in their publication on this subject in 2006, he finally accepted that perhaps non Medline Journals are scientifically valid in some circumstances, but still believed that such a journal was not regarded as scientifically valid. I was then provided by this individual a reference for a scientific paper which he claimed clearly demonstrated that there were no known health impacts associated with water fluoridation[4]. I immediately sought this article and purchased the Journal in question to independently examine the evidence. What was particularly astonishing in this instance was the paper in its summary/synopsis did not include the major findings of the study, which clearly found that there was clear evidence to demonstrate that a sub-group of a population may be intolerant to fluoride and that there was a remarkable 13% reduction in recorded medical ailments within a three month period in the community after fluoridation was discontinued.

What was also irionic was the fact that not only was the paper which was presented as evidence of no harm actually demonstrated harm to individuals, it was also ironinc inthis instance that the authors of this very paper included as publicished scientific references the journal Fluoride, the very same journal which the scientist whom I was in discussion with had suggested no reputable scientist would use as scientific reference. Yet, here it was being quoted as a reputable scientific reference in the very journal that the same individual presented to me which he had further informed me demonstrated that water fluoridation was safe and which in reality the study concluded the exact opposite. Of course you had the read the entire paper to find this out, which unfortunately many professionals do not do.

I will end by saying as I previously mentioned, one should always independently review any information provided and always read the source information wherever possible. Never believe everything you are told, this is especially true of water fluoridation. It is a policy based not on sound scientific evidence but rather fraud perpetrated on an unwilling public. Indeed perhaps the greatest fraud ever perpetrated on the public and certainly one of the most costly in terms of human health and financial costs.

Finally there are more historical scientific papers that I have recently sourced that demonstrate the molecular toxicity of fluoride was well known prior to water fluoridation which I would recommend individuals to read including; The Pharmacology of Fluoride By noted scientist GUSTAV W.M. RAPP, Ph.D. and Inhibition Of Cellular Oxidation By Fluoride by Hans Borei of the Wenner-Gren's Institute, University of Stockholm.

Respectfully Yours
Declan Waugh
Environmental Scientist

[1] Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission related to the Tolerable Upper Intake Level of FluorideThe EFSA Journal (2005) 192, 1-65.
[2] John D.B. Featherstone, M.Sc, Ph.D., The Science And Practice Of Caries Prevention, JADA, Vol. 131, July 2000 887-89
[3] Warren et al. Considerations on Optimal Fluoride Intake Using Dental Fluorosis and Dental Caries Outcomes – A Longitudinal Study, American Association of Public Health Dentistry, 2008
[4] Lamberg M, Hausen H, Vartiainen T, Symptoms experienced during periods of actual and supposed water fluoridation, Community Dentistry and Oral Epidemiology 1997: 25: 2915 ISSN 0301-5661

Thursday, November 29, 2012

Fluoride’s contribution to the Epidemic of Obesity and Diabetes

In the light of recent scientific evidence demonstrating that fluoride is a risk factor in both the development of obesity and diabetes, it is critically important to consider the wider medical implications of water fluoridation using silicofluoride industrial chemicals for all relevant diseases including obesity, diabetes and cancer.

According to a major new study[1] by State-funded health promotion group Safefood, the obesity epidemic in Ireland is costing the State over €1.1 billion in direct health costs and indirect costs such as absenteeism. This is the first time researchers have put a price tag on the cost of obesity in Ireland. The report highlights that the direct cost of treating people who are obese and overweight is almost €400 million annually. Indirect costs, in the form of illnesses, absenteeism and premature deaths, account for the remaining €700 million. Yet it is accepted that these costs are themselves conservative as they do not allow for mental health costs made conservative assumptions about the number of years of life lost due to weight-related problems. Given that the prevalence of obesity is dramatically increasing in both children and adults the costs society and the economy in future years will be significantly higher. 

In regard to obesity, the subject of the Safefood report, it is now accepted that high fat feeding and obesity induce endoplasmic reticulum (ER) stress in liver, which suppresses insulin production and contributes to diabetes.[2]

Recent research[3] by the Russian Academy of Sciences presented clear evidence that fluoride also 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.[4] 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-degeneration, heart disease, and diabetes.[5]

Further studies have shown that fluoride exposure may contribute to impaired glucose tolerance or increased blood glucose. [6],[7],[8] Researchers Menoyo et al.[9] and Lin et al.[10] 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 that fluoride exposure regulates insulin gene expression in murine beta pancreatic cells, resulting in reduced insulin secretion.[11]

Fluoride exposure has also been implicated (Barbier et al.)in inflammatory response of the immune system including vascular inflammation and atherosclerosis (hardening of the arteries).

It is known that the dietary exposure of the Irish population is high due to the consumption of fluoridated water, tea and the number of bottle fed babies fed formula milk made from fluoridated water in addition to other dietary sources of fluoride such as fluoridated toothpaste and fluoride based pharmaceutical drugs. It is particularly relevant to note therefore that the countries globally with the highest incidence of obesity are also those that practice artificial fluoridation of drinking water supplies. The prevalence of obesity in the U.S is 35% for males and 36% for females, in Canada 37% for males and 23% for females, Australia 35.6% for males and 21% for females, New Zealand 25% for males and 26% for females.[12]

When one examines statistics within fluoridated countries such as the U.S. it is equally interesting to discover that the Hawaii the state with the lowest incidence of water fluoridation also has the lowest incidence of dental fluorosis, the second lowest incidence of obesity next to Alaska and is also ranked in the lowest states for diabetes and asthma, a disease characterised by inflammation of the airways.
The statistics for diabetes are particularly interesting as native Hawaiians have more than twice the rate of diabetes as Whites. The percentage of adult Whites/Asian over the age of 18 diagnosed with diabetes in Hawaii is 1.2% compared to the National average for the general public in the U.S.A of 7%.

In Ireland, based on the findings from the 2008-10 National Adult Nutrition Survey (NANS),estimated prevalence of overweight in adults is 37%, with a further 24% meeting current body mass index (BMI) criteria for obesity with 26% for males and 21% for females documented as obese. The prevalence of obesity in 18-64 year old adults has increased significantly 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.[13]  Notwithstanding other lifestyle and dietary factors this is also the latter sub group represents individuals 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 considerable above the EU average. 

Singapore is the only other international country with a mandatory national legislative policy for water fluoridation and while the optimum level of fluoride in drinking water in Singapore is approximately half that recommended in Ireland the prevalence of obesity in Singapore is also remarkable high (16.9%) with approximately 24% of the Malaysian ethic population obese and 17% of the Indian population.[14] This is extremely high in comparison to Japan where 4% of the population are obese, the incidence for India is less 2% [15], while in Indonesian less than 10% of men are classified as obese.[16]

How does this equate to a country such as Mexico which has a obesity levels similar to the U.S.A and yet does not fluoridate drinking water. Well on closer examination it is evident that Mexico has not pursued a policy of fluoridation of water for reasons of natural elevated fluoride levels already being present in water. This is particularly evident in the fact that Mexico has one highest incidences of dental fluorosis in the world, yet mass fluoridation of salt is mandatory. Government policy provides for 250 mg of fluoride to added to each kilogram of salt destined for human consumption (table salt, cooking salt, breads and bakery products, processed foods, etc.). The current consumption of fluoridated salt per person – child or adult – is estimated at 7.14g per day[17] bringing the fluoride dietary intake from salt alone to 1.85mg similar to the dietary intake from consuming artificially fluoridated water. This may help explain the incidence of obesity in Mexico which stands at over 30% of the population, a level comparable to the USA.

Other Latin American countries with extremely high prevalence of obesity include Argentina. In Argentina extremely high fluoride levels have been recorded in groundwater with large sectors of the population exposed to very high levels of fluoride. A survey undertaken in 2003 found that less than 3% of groundwater samples had fluoride levels less than 1.5mg/l with fluoride concentrations ranging from 0.9–18.2 mg l–1, with a mean value of 3.8 mg l.[18] In addition to  naturally elevated fluoride levels artificial fluoridation is practiced in parts of the country where approximately 20% of the population consume artificially fluoridated drinking water. It is not surprising therefore to find that Argentina has the highest incidence of obesity and overweight children in Latin America.[19]

Last but not least another interesting country to examine is Saudi Arabia. Why has this desert climate such a high prevalence of obesity and diabetes? The prevalence of obesity in Saudi Arabia is recorded[20] at 36.9% which is extremely high for such a hot climate. The incidence of diabetes is recorded[21] at 16.21%. As with Mexico and Argentina extremely high fluoride levels of up to 6.2mg/L are reported in drinking water in Saudi Arabia.[22] In the Hail region of Saudi Arabia it has been documented that up to 90% of children have dental fluorosis. This is associated with the high levels of fluoride 0.5-2.8mg/l found in well water in this area.[23] The city of Mecca with fluoride levels of 2.4mg/l is also known to have endemic fluorosis.[24]

It is no surprise therefore where fluoride is a risk factor in both diabetes and obesity to see such a high incidence of both such diseases in countries where water fluoridation may  not practiced but where the resident populations are exposed to dietary fluoride levels similar if not higher than in fluoridated North America, Canada, Australia, New Zealand or the Republic of Ireland.

The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7 % and 439 million adults by 2030.[25]

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. Diabetes mellitus is now considered to be the leading public health problem in all developed countries. It is now estimated that there are in excess of 200 million people with diabetes mellitus worldwide and is predicted to reach 333 million by 2025.

As previously identified fluoride has been found to act as an inhibitor of insulin synthesis. In Ireland, it is estimated that there are 200,000 people with diabetes and a further 200,000 who have diabetes but are unaware that they have the condition. The majority of these people will only be diagnosed through an acute medical event of the complications of long term untreated hyperglyceamia. A further 250,000 people have impaired glucose tolerance or "pre-diabetes" of which 50% will develop diabetes in the next 5 years if lifestyle changes are not made.[26]

Type I (insulin dependent) diabetes is increasing in children, particularly in under-fives while Type 2 (non-insulin dependent) diabetes is increasing across all age groups. In Ireland, the incidence of type 1 diabetes is 16.8 per 100,000, which is above the European average.[27]

The prevalence of diabetes in Ireland is now at 8.9 per cent of the population. The prevalence of diabetes in non fluoridated Northern Ireland is 3.8 per cent of the population, while the UK average is 4.45%.[28]

The differences between Northern Ireland and the Repubic are stark, how can there be greater than a one hundred percent increase in the prevalance of this disease between two geographic regions of the same island. It is known that the only difference to exposures to environmental toxins in both populations that may contribute to this disease is that public water supplies in the ROI are artificially fluoridated with silicofluoride chemicals which drinking water in NI is non fluoridated. The evidence is staring us in the face but incredibly not one health risk study has ever been undertaken in Ireland to examine the realtionship between artificial fluoridation and disease burdens in the population. Equally disturbing is that the cost of treating diabetes in now estimated to be 10% of the overall health care burget in the ROI. Thats €1.4 billion annually.

The prevalence of diabetes internationally is similar in pattern to that for obesity with typically greater prevalence being found in either naturally high or artificially fluoridated countries. 

The prevalence for Canada is 10.8%, United States 10.98%, Israel 8.5%, Mexico 15.9%, New Zealand 10.2%, Singapore 11.1 per cent.[29] As noted earlier the prevalence for Ireland is above the EU average, including twice that recorded for non fluoridated Northern Ireland.

The economic burden of diabetes on the Irish health care system is now as with obesity a major challenge for the government and the HSE. Prof. J. Nolan’s CODEIRE study[30] published in 2006, which examined the cost of treating type 2 diabetes in Nov-Dec 1999, suggested that 10% of the national health budget is being consumed treating the condition (49% on hospitalisation for complications and wages; 42% on drug costs; 8-9% on ambulatory care and attending non-diabetes specialists for diabetes related complications).  CODEIRE remains the best available Irish source for the cost of type 2 diabetes.  In 2011 the national health budget was €14.5 billion.

Taken together both diabetes and obesity account for almost €2 billion of the Health Budget for the HSE. This figure is just the direct costs to the State. If you add the indirect costs the final figure is over € 4 billion.  Not taking the contribution of fluoride to cancer diseases or other medical ailments such as musculoskeletal pain, periodontal disease, skin disorders, thyroid disorders and neurological problems, the true cost of artificial fluoridation on public health and the economy is staggering.

This shows that water fluoridation is not just an issue of preventing dental decay; it is also an issue of reducing risk factors that are now known to be contributing to a deepening health crisis with catastrophic economic and social costs.

[1] The cost of overweight and obesity on the island of Ireland, Safefood November 2012, ISBN: 978-1-905767-335
[2] Décio L. Eizirik,Alessandra K. Cardozo and Miriam Cnop, The Role for Endoplasmic Reticulum Stress in Diabetes Mellitus, Endocrine Reviews February 1, 2008 vol. 29 no. 1 42-61
[3] Natalia Ivanovna Agalakova and Gennadii Petrovich Gusev, Sechenov Institute of Evolutionary Physiology and Biochemistry Russian Academy of Sciences, Molecular Mechanisms of Cytotoxicity and Apoptosis Induced by Inorganic Fluoride, International Scholarly Research Network ISRN Cell Biology Volume 2012, Article ID 403835, 16 pages doi:10.5402/2012/403835
[4] Muthuswamy Balasubramanyam, Raji Lenin and Finny Monickaraj, Endoplasmic Reticulum Stress In Diabetes: New Insights Of Clinical Relevance, Indian Journal of Clinical Biochemistry, 2010 / 25 (2) 111-118,
[5] Xu C, Bailly-Maitre B, Reed JC. Endoplasmic reticulum stress: cell life and death decisions. J Clin Invest. 2005 Oct;115(10):2656-64.
[6] E.A. Garcia-Montalvo, H. Reyes-Perez, L.M. Del Razo, Fluoride exposure impairs glucose tolerance via decreased insulin expression and oxidative stress, Toxicology 263 (2009) 75–83.
[7] A. Rigalli, J.C. Ballina, R.C. Puche, Bone mass increase and glucose tolerance in rats chronically treated with sodium fluoride, Bone Miner. 16 (1992) 101–108.
[8] O. Barbier et al. Molecular mechanisms of fluoride toxicity, Chemico-Biological Interactions 188 (2010) 319–333
[9] I. Menoyo, A. Rigalli, R.C. Puche, Effect of fluoride on the secretion of insulin
in the rat, Arzneimittelforschung 55 (2005) 455–460.
[10] B.J. Lin, M.J. Henderson, B.B. Levine, B.R. Nagy, E.M. Nagy, Effects of iodoacetate and fluoride on islate respiration and insulin biosynthesis, Horm. Metab. Res. 8 (1976) 353–358.
[11] E.A. Garcia-Montalvo, H. Reyes-Perez, L.M. Del Razo, Fluoride exposure impairs glucose tolerance via decreased insulin expression and oxidative stress, Toxicology 263 (2009) 75–83.
[12] International Obesity Taskforce, Obesity Worldwide 2008-2010.
[13] The cost of overweight and obesity on the island of Ireland, Safefood November 2012, ISBN: 978-1-905767-335
[14] Obesity In Singapore, Prevention And Control, The Singapore Family Physician, Vol 38 No 1 Jan-Mar 2012:8
[15] Obesity Update OECD 2012
[16] Obesity Trends, Determinants and Policy Implications in Indonesia, 2012
[17] Fluoride Class Action (http://fluoride-class-action.com/districts/mexico)
[18] WHO Fluoride in Drinking Water, 2006.
[19] Centre of Studies on Child Nutrition (CESNI) Oct 2012.
[20] Al-Nozha MM et al. Obesity in Saudi Arabia. Saudi Med J. 2005 May;26(5):824-9.
[21] International Diabetes Federation 2011
[22] Aldosari AM, Akpata ES, Khan N, Wyne AH, Al-Meheithif A.Fluoride levels in drinking water in the Central Province of Saudi Arabia. Ann Saudi Med. 2003 Jan-Mar;23(1-2):20-3.
[23] Akpata et al. Dental Fluorosis in 12-15yr old rural children exposed to fluorides from well drinking water in the Hail Region of Saudi Arabia, Community Dentistry and Oral Epidemiology 1997, 25(4) 324-327.
[24] Al-Khateeb et al Caries prevalence and treatment among children in Arabian community, Community Dentistry and Oral Epidemiology 1991, 19, 277-280.
[25] Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010 Jan;87(1):4-14. Epub 2009 Nov 6.
[26] Diabetes Federation of Ireland
[27] Diabetes: The Policy Puzzle, Is Europe Making Progress? The International Diabetes Federation (2012).
[28] Diabetes UK
[29] International Diabetes Federation 2011.
[30]  Nolan JJ, O'Halloran D, McKenna TJ, Firth R, Redmond S. The cost of treating type 2 diabetes (CODEIRE). Ir Med J. 2006 Nov-Dec;99(10):307-10.