[jandrewrogers]

> Also doesn't water fluoridation cost a few IQ points?

No, it does not. This is speculation based on a poor understanding of the actual science.

Most of our fluoride exposure comes from eating normal food, water fluoridation is a small fraction of that. There are no measurable cognitive effects in the many developed parts of the world with natural fluoride levels far higher than used in municipal fluoridation. Furthermore, there is no plausible mechanism of action for how this would cause a cognitive deficit. Fluoride toxicity is well-understood because it has an unusually simple biochemical mechanism. Therefore it isn't surprising that the handful of low-quality studies that show a weak relationship to IQ loss don't replicate.

As someone who actually worked on fluorine chemistry, it is disappointing to see how credulous even many people with a STEM background are on this topic. The absence of a plausible mechanism of action alone should raise serious questions.

[ifyoubuildit]

> The absence of a plausible mechanism of action alone should raise serious questions.

I'm just a layperson, so forgive the possibly dumb question: why would this be weighted so heavily?

I read it as "we can't think of how this could work, so we should assume it doesn't". But that just seems like hubris to me.

[jandrewrogers]

This is a fair question. It is based on the chemistry of fluorine.

Fluorine has the strongest electronegativity of any element in the periodic table. It requires extreme measures to muscle fluorine off a molecule. This is why it is used in non-stick surfaces like Teflon (nothing can “grip” the surface molecules because fluorine won’t let it) and why it is used in toothpaste (molecules that might attack the tooth surface chemically can’t compete with the fluoride that is already there). The dark side of this is that it is difficult to contain fluorine compounds, they have a tendency to attack most containers you can put them in that aren’t also fluorine based. Famously, they tend to eat glass so you can’t store it in glass vessels.

The toxicity of fluorine flows from this. It has an insatiable appetite for Type II metals, notably calcium and magnesium in the human body. If you are exposed to fluorine, it will have a seek-and-destroy mission for these metal ions. A typical human body has a lot of calcium and magnesium circulating so it can absorb exposure from diet, water, etc. The net effect is that some calcium and magnesium is removed from circulation and is no longer bio-available. Not a big deal. In extreme exposure cases, like an industrial accident, the way it kills you isn’t toxicity per se but by removing all of the calcium ions from your system. Your heart uses calcium ions for electrical signaling, so if those are all neutralized by ravenous fluorine, your heart stops.

The antidote for extreme fluorine exposure is to ingest a bunch of simple calcium and magnesium salts. The fluorine latches on to the surplus floating around and there is enough left for your heart to keep running.

This is where the mechanism of action question comes in. For fluorine to have biological effects on cognition, the body would have to be so devoid of neutralizing calcium and magnesium ions, which it strongly prefers as a matter of physics, that you’d already be dead. In extreme exposure cases (like getting concentrated fluorine compound spilled on you) with prophylactic calcium/magnesium antidote, it does really nasty damage to the bones, but there has never been a case of cognitive damage that I’ve ever seen mentioned in the safety literature.

Fluorine is a nasty element, I don’t miss working with it, but it isn’t a serious threat in trace quantities because human bodies can easily absorb the loss of calcium and magnesium. Human bodies are tolerant of almost all elemental toxins at natural levels. The few for which there is no evidence of tolerance at even trace levels are elements like mercury. Even elements like arsenic and lead are believed to be required by human biology to some extent and therefore the human body has some evolved tolerance for them. (These two are pub quiz material, most people are shocked to find out that these are necessary micronutrients.)

[ifyoubuildit]

I appreciate all that, but I think I might not have been clear with my question.

If our understanding is complete (in other words there is nothing else to know about flourine) then not having a known mechanism of action would be a good proof. But when is our understanding ever complete about anything?

It seems a lot easier to know things like "in the presence of x, fluorine does y" because you can easily observe that isolated thing under test. It's harder to know "fluorine does not do x in any circumstance" because the tests for that are infinite. How do we know we just haven't tested the right case yet?

Again, I'm a layman, so I can only try to logic my way through this. I acknowledge that it may be a dumb question.