A U.S. government report says fluoride levels twice the recommended limit are linked to lower IQs in children

NEW YORK — A U.S. government report that is expected to spark debate has concluded that fluoride in drinking water at twice the recommended limit is linked to lower IQs in children.

This report, based on an analysis of previously published research, is the first time that a federal agency has determined with moderate confidence that high levels of fluoride exposure are linked to lower IQ in children. Although the report was not designed to assess the health effects of fluoride in drinking water alone, it is a striking recognition of the potential neurological risk associated with high levels of fluoride.

According to the U.S. Centers for Disease Control and Prevention, fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear. Adding low levels of fluoride to drinking water has long been considered one of the greatest public health advances of the last century.

“I think this report is critical to our understanding of this risk,” said Ashley Malin, a researcher at the University of Florida who has studied the effect of high fluoride levels in pregnant women on their children. She said it was the most rigorous report of its kind.

The long-awaited report released Wednesday comes from the National Toxicology Program, part of the Department of Health and Human Services. It summarizes an analysis of studies from Canada, China, India, Iran, Pakistan and Mexico that concludes that drinking water with more than 1.5 milligrams of fluoride per liter is consistently associated with lower IQs in children.

The report did not attempt to quantify exactly how many IQ points might be lost at different levels of fluoride exposure. But some of the studies reviewed in the report suggest that IQ was 2 to 5 points lower in children who were exposed to higher doses.

Since 2015, federal health officials have recommended a fluoridation level of 0.7 milligrams per liter of water, and for five decades before that, the recommended upper limit was 1.2. The World Health Organization has set a safe limit for fluoride in drinking water of 1.5.

The report says that about 0.6 percent of the U.S. population, or about 1.9 million people, are connected to water systems that naturally contain fluoride levels of 1.5 milligrams or more.

The findings of this report raise questions about how these people can be protected and what makes the most sense, Malin said.

The 324-page report does not reach a conclusion on the risks associated with lower levels of fluoride, saying more studies are needed. It also does not explain what effects high levels of fluoride might have on adults.

The American Dental Association, which advocates for water fluoridation, had criticized previous versions of the new analysis and Malins' research. Asked for comment, a spokeswoman responded by email late Wednesday afternoon that the organization's experts were still reviewing the report.

Fluoride is a mineral that occurs naturally in water and soil. About 80 years ago, scientists discovered that people whose water naturally contained more fluoride also had fewer cavities, which sparked a campaign to get more Americans to use fluoride for better dental health.

In 1945, Grand Rapids, Michigan, became the first U.S. city to add fluoride to its tap water. In 1950, federal officials approved water fluoridation to prevent tooth decay and continued to promote it even after fluoride toothpaste came on the market several years later. Although fluoride can come from a variety of sources, drinking water is the primary source for Americans, researchers say.

Officials lowered their recommendations for fluoride levels in drinking water in 2015 to combat a dental disease called fluorosis, which can cause staining of teeth and is becoming increasingly common among American children.

In addition, the Environmental Protection Agency (EPA) has maintained a long-standing requirement that water systems contain no more than 4 milligrams of fluoride per liter. This standard is designed to prevent skeletal fluorosis, a potentially debilitating disease that causes bone weakness, stiffness and pain.

But a growing body of research is pointing to another problem, suggesting a link between high levels of fluoride and brain development. Researchers have wondered about the impact on the development of fetuses and very young children who may ingest water with formula. Animal studies have shown that fluoride may impact the functioning of neurochemical cells in regions of the brain responsible for learning, memory, executive function and behavior.

In 2006, the National Research Council, a private nonprofit organization based in Washington, D.C., said that limited Chinese evidence indicated neurological effects in people exposed to high levels of fluoride. It called for more research on fluoride's effect on intelligence.

After other research continued to raise questions, the National Toxicology Program began work in 2016 on a review of available studies that might provide guidance on the need for new fluoride control measures.

Drafts were written, but the final document was repeatedly delayed. At one point, an expert committee said the available research did not support the conclusions of a draft.

“Because fluoride is such an important topic to the public and public health officials, it was imperative that we make every effort to ensure the science is accurate,” Rick Woychik, director of the National Toxicology Program, said in a statement.

Malin said it would be wise for pregnant women to reduce their fluoride intake, not just in water but also in some types of tea. It might also be wise to initiate policy discussions about whether to require fluoride content on beverage labels, she added.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media group. The AP is solely responsible for all content.

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