Fluoridated Salt FAQ

(White Gold)

© 2000 - 2004 PFPC

Last Update: January 2004

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1) How much fluoride is in fluoridated salt?

2) When did the use of fluoridated salt start?

3) What is universal salt fluoridation?

4) Does fluoridated salt cost more?

5) How many people are affected by salt fluoridation?

6) Who is responsible for these programs?

7) Are there any warning labels on fluoridated salt packages?

8) Are there pollutants in fluoridated salt, as they are in fluoridated water?

9) What kind of fluoride is being used for salt fluoridation?

10) How much salt are people consuming?

11) Is salt fluoridation also forced mass medication?

12) Is salt fluoridation effective against caries?

13) Who owns the salt-producing companies?

14) Is there also Dental Fluorosis?

15) Considering the fluoride-iodine antagonism, how can there be both fluoride and iodine in salt?

16) How do dentists view salt fluoridation compared to fluoridated water as far as claims for benefits are concerned?

17) What is Himalaya Salt?

18) Does Himalaya Salt contain fluoride?

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1) How much fluoride is in fluoridated salt?

Salt is most commonly fluoridated at 250 parts per million (ppm) (range 200 - 350ppm) which means 2,5 mg of fluoride for every 10 grams of salt.

It was presumed that the individual application (meaning use of the salt shaker at the table, for the sprinkling over food) would contribute 1 to 4 g of the daily salt intake, thus a person would take in 1 mg of fluoride a day at a salt intake of 4 grams a day - 1 mg/day being the optimal dose of fluoride intake to protect against caries.

This is the same concept as in water fluoridation, where the drinking water was fluoridated at 1ppm or 1 mg/liter, presuming that people would on average drink 4 glasses of water a day (one glass at 0.25 mg), thus take in said optimal level of 1 mg fluoride a day.

However, the majority of the fluoridated salt is not used for sprinkling over food but for domestic food preparation (cooking, baking, etc) - just like fluoridated water is not merely used for drinking. The use of fluoridated salt (250 ppm) for baking alone may provide much more than the optimal intake already for anyone consuming baked goods .

2) When did the use of fluoridated salt start?

In 1955 Switzerland became the first country to fluoridate salt, originally at 90 ppm. The amount was later raised to 250 ppm. France became the second country to do so in 1986, quickly followed by Jamaica and Costa Rica where there is now universal salt fluoridation.

More History

3) What is universal salt fluoridation?

Universal salt fluoridation means that all salt destined for human consumption is fluoridated - not just the salt in the shaker on the table. This situation exists in numerous cantons in Switzerland, as well as many countries in South America .

Jamaica , Costa Rica , Columbia are all countries with such universal salt fluoridation.

Universal salt fluoridation is now described as the ideal situation by dental public health experts (Marthaler, 2000).

Universal salt fluoridation is being set up through legal channels. It is being mandated on national levels. (For guidelines drafted in 2001, affecting countries in South America, please click here )

4) Does fluoridated salt cost more?

No. In many countries the price of salt is set by law, and fluoridated salt is usually no more expensive than other salt. In Switzerland it is sold under a slight subsidy, making its selling price just a bit lower than other salt (Yewe-Dyer, 2002).

Fluoridated salt is aggressively marketed in Germany , where originally salt manufacturers helped proclaim its benefits (Marthaler, 2000). It is marketed effectively as the better salt in Jamaica (Marthaler, 2000).

The fact that fluoridated salt is not associated with increased costs to governments has been a key factor in the massive and rapid implementation of salt fluoridation programs.

5) How many people are affected by salt fluoridation programs?

The exact number is hard to estimate as so many countries are currently in progress or have recently started massive salt fluoridation programs. In South America, many countries import salt from fluoridated countries.

In the year 2000 expert Marthaler (also called the Fluoride-Pope in Switzerland) projected that salt fluoridation would reach the same population as water fluoridation by 2004, a figure which was then thought to be approx. 230 million.

He wrote:

It may seem encouraging that salt fluoridation, limited to Switzerland until 1986, was already covering more than a hundred millions at the turn of the century, and the population reached will soon approach the one reported for water fluoridation, which in 1994 was stated as 230 millions [2]..." (Marthaler, 2000)

Salt fluoridation has now far surpassed the population consuming fluoridated water. 350 million people were added in 1996 alone when the Pan American Health Organization (PAHO) launched a massive program in Bolivia, Dominican Republic, Honduras, Nicaragua, Panama and Venezuela.

The project was part of a multi-year plan launched by PAHO in 1994 to fluoridate the entire Region of the Americas (PAHO, 1996).

This project was funded, once again, by a multi-year-deal grant from Kelloggs (PAHO, 1996).

Since then many more countries in South America have been added or are currently in progress.

6) Who is responsible for these programs?

There are several responsible factors. As mentioned above, the fact that fluoridated salt is not associated with increased costs to governments has been a key factor.

Most interestingly, fluoridation programs in Latin America are initiated by people who have obtained a Masters of Public Health degree in the US.

As Marthaler writes in 2000, citing the factors which were beneficial for the implementation of salt fluoridation programs:

...many Latin American ministries have physicians in their staff who have completed their training as Master of Public Health (MPH), a degree mostly acquired in the USA. (Marthaler, 2000)

and, in 2001:

...the experts...almost all of them have went through trainimg as a Master of Public Healthin the US. They are very conscious of the simple truth that a preventative measure must reach the majority of the population.(Marthaler, 2001)

As mentioned, Kelloggs financial support was crucial for the success of the program by PAHO, as well as for the distribution of all information concerning fluoride benefits.

Salt producers are greatly involved in the implementation of these programs. For example, in Costa Rica , salt companies took upon all the additional costs in the set up of labs, in the hiring of personnel and in the improvement in the process and quality of salt production.(Teles, 1994)

In Germany it was a salt company who became actively involved in fluoridated salt promotion (Marthaler, 2000).

But, above all, its the dental profession who is responsible for salt fluoridation measures world-wide.

It was the French Union for Oral Health (UFSBD) who advised the government and who lobbied for fluoridated salt in France . In Germany dentists are currently calling for lifting of regulations so that canteens can use fluoridated salt, lobbying heavily. The kitchen at the University of Heidelberg has been the test canteen since the late 1990s.

7) Are there any warning labels on fluoridated salt packages?

Generally not. In Europe it usually only says fluoridated salt. The only European country we know of so far that has a warning label on some fluoridated salt is France. It says:

Do not consume if drinking water contains more than 0.5 milligrams of fluoride per liter"

Guidelines drafted by PAHO in 2001 concerning mandatory salt fluoridation in South America specified that the following sentence should be on the labels:

Do not consume or sell this product in areas where water for human consumption has fluorine levels higher than 0.7 ppm

In Belgium fluoridated salt has been banned, as of 2002.

8) What kind of fluoride is being used for salt fluoridation?

That depends on the process involved in salt production (dry or wet). It is either potassium fluoride or sodium fluoride.

Sodium fluoride is used for the "dry method" which is employed in small to medium sized operations.

In the "wet method" (large operations) potassium fluoride is used. Sodium fluoride is cheaper than potassium fluoride.

9) Are there pollutants in fluoridated salt, as they are in fluoridated water?

Yes, there are pollutants - including lead, arsenic, cadmium, and mercury. For a detailed list of CODEX allowable substances and their limits, please click here .

The aluminum silicates purposely added to make the salt flow easier are of great additional concern, because of the formation of new fluoride complexes which may potentiate the effects of fluoride many-fold, such as the aluminofluoride complexes ( AlFx ).

10) How much salt are people consuming?

According to most sources - too much. People all over the world are advised to curtail their TOTAL salt intake to less than 5 mg a day to help reduce risk of high blood pressure.

In Germany, daily salt intake from all sources has been estimated to be up to 15 g a day (k+s Report, 2000).

In Switzerland total salt intake is estimated to be at 10 g/day (SVE, 1999).

In the UK, the Food Standards Agency recently started a major campaign aimed at reducing salt intake, including - for the first time - target figures for children.

11) Is salt fluoridation also forced mass medication?

Salt fluoridation is as much forced medication as water fluoridation. Universal salt fluoridation - where all salt destined for human consumption is fluoridated - is worse than any water fluoridation measure, as no one can escape the measure.

Salt has a quality worse than water: an individual's preferred level of salt may be raised or lowered by progressively raising or lowering the actual level over a period of time. In other words, the amount of salt sprinkled on today might not be enough a month from now when just a little bit more will be added.

12) Is salt fluoridation effective against caries?

It is claimed that salt fluoridation has been hugely successful (PAHO, 1996) in the prevention of caries and some truly outrageous claims are made.

Regarding Jamaica - the most-commonly cited example of "success" - it has been claimed that after ten years of salt fluoridation, the number of decayed teeth per child at age 12 fell from 6 in 1984 to 1.1 in 1995 (Marthaler, 2000).

However, no properly conducted study exists which can clearly show that it was fluoridated salt which was responsible for the caries reduction, and recently renewed calls have been made to re-examine the effectiveness of salt fluoridation in Jamaica more closely (Meyer-Lueckel et al, 2002).

A a matter of fact, no study can show that ANY fluoride measure has been successful in the prevention of caries. This is also discussed extensively in PFPC Newsletter #8 .

13) Who owns the salt-producing companies?

It depends. In Switzerland almost all of the cantons have transferred their salt monopoly to the United Swiss Rhine Salt Works of which they are the exclusive shareholders. ( ICCIDD, 2003 )

ESCO is one of Europes biggest salt suppliers. It is a new company formed recently by k+s AG (Kassels) and Solvay (Brussles), the well-known global fluoride supplier. ESCO operates 15 plants, and has 6 national sales organisations in 6 European countries.

Mexico has the biggest salt works in the world. It is owned by the government - together with Mitsubishi. The plant is also one of the worst fluoride polluters, discharging many millions of gallons of fluoride-polluted wastes into the Ojo de Liebre lagoon every year (Tovar et al, 2002).

NOTE: World production of salt is 200 million tons a year. This is the fifth largest commodity produced worldwide after coal, brown coal, oil, and iron. Annual demand for salt from industry worldwide is around 160 million tons.

14) Is there also dental fluorosis?

The incidence of dental fluorosis is said to be less common in areas where salt fluoridation is used which, as Yewe-Dyer states, "might well be because too little salt is eaten at an early age to cause this problem." (Yewe-Dyer, 2002).

If this were indeed true, it would be very disturbing news as it would mean that the most-studied and acknowledged indicator of fluoride over-exposure - dental fluorosis, would no longer be appropriate for exposure investigations. The condition can occur only from fluoride exposure during the critical times of enamel formation - from in utero to approx. 2 1/2 years of age.

In the mind of the dental public health experts - who have long declared dental fluorosis to be of cosmetic concern only - this translates into believing that fluoride over-exposure is not a problem for children anymore, while benefits for caries reduction are striking. Statements to that effect are already being made (i.e. Yewe-Dyer, 2002).

There are really two issues.

Concerning salt consumption - while while babies and toddlers might not be taking in much salt, 4 to 6 vear olds consume very much salt. Just because they dont show dental fluorosis in their later years does not mean that their fluoride intake was or is within a safety limit, a fact repeatedly alerted to by UNICEF and health organizations in other countries such as India where fluoride poisoning is endemic (see UNICEF, 2001). In India the effects of fluoride poisoning - other than dental defects - are of course clearly acknowledged.

But there is something else. When the papers which claim only neglible dental fluorosis are investigated in-depth, a different picture emerges concerning the occurrence, and once again it becomes clear that the science is being manipulated in order to mislead the public. Two examples are given here:

EXAMPLE 1: Jamaica

The World Health Organization (WHO) has a special web page on the salt fluoridation program in Jamaica , because Jamaica was considered a trial ground for salt fluoridation. It cites a study which allegedly found that ninety six percent of the children were fluorosis free, 4% had 'questionable' fluorosis and less than 1% had very mild to mild fluorosis. None of the children showed moderate or severe fluorosis. (WHO, 2002)

However, upon closer examination one finds that the majority of children investigated were already 4 or 8 years old when the program started - well past the critical stage of enamel formation when dental fluorosis occurs!

When other researchers recently studied the children in Jamaica, they found that almost half of them showed signs of fluorosis (Meyer-Lueckel et al., 2002).

The same findings can be made when other studies proclaiming no dental fluorosis are investigated closer.

EXAMPLE 2: France

In France in 1991, Fabien et al, investigated 6 to 16-year-old children, stating that:

...dental fluorosis was very uncommon; 96.1% of the 18,786 children examined in 1991 were totally free of any such lesions.

Salt fluoridation in France started in 1986/1987. As this study was done in 1991 - only four years later - it means, again, that the vast majority of the investigated children (6 to 16 year-olds) had already long surpassed the critical age of enamel formation!

The truth lies somewhere else and will become more apparent as more proper research is conducted. A recent review from Mexico revealed that the prevalence of dental fluorosis ranged from 52% to 82% in areas where fluoridated salt is used (Soto-Rojas et al, 2004).

15) Considering the fluoride-iodine antagonism, how can there be both fluoride and iodine in salt?

Dentists - seemingly entirely ignorant of the fluoride-iodine antagonism and apparently lacking all awareness that one influences the other! - have long promoted fluoridated salt programs comparing the benefits to the iodized salt programs, and promoted fluoride in salt as if it was as essential as iodine - which of course it is not - the opposite is the case. Not only is fluoride not essential at all - fluorides are iodines worst enemy.

Now salt can be a carrier of two substances of great benefit to mankind, it is said. Here is a typical statement by Dr. Hernandez, the co-ordinator of the fluoridated salt program in Mexico:

The salt fluoridation and iodization is a unique chance of combining two chemical elements (iodine and fluorine) and thus prevent two important diseases: the endemic goiter and the dental caries, respectively. (Hernandez, 1993)

How anyone could ever equal caries to iodine deficiency disorders (IDD) in importance is already incomprehensible - how one can further be entirely ignorant of the antagonistic relationship of the two chemical elements borders on the incredible.

Marthaler, in his 2000 report on salt fluoridation , actually produces tables comparing the roles of iodine and fluoride in human health as if they were of equal importance!

In the 1940s, German endocrinologists and pharmacists thought that the relationship of fluoride to iodine in the blood was somewhere around the 7 to 1 ratio, based on extensive investigations on the use of fluorides as effective anti-thyroid medication in the treatment of iodine-induced hyperthyroidism (Jod Basedow).

Keeping the above in mind it is not surprising that in Switzerland the iodine content of table salt has been increasing progressively over the last four decades, concurrent with increasing fluoride intake. The latest raise in iodine content was from 15 ppm to 20 - 30 ppm in 1998 (ICCIDD). Fluoride content in salt which originally started out at 90 ppm in 1955, is now at 250 ppm.

Considering how much evidence is available, documenting the effects of fluoride on thyroid hormones, it is simply bewildering how public health officials the world over have been blindsighted by dentists and have allowed the inclusion of fluoride in iodized salt programs.

16) How do dentists view salt fluoridation compared to fluoridated water as far as claims for benefits are concerned?

Dentists have long considered salt fluoridation as equivalent to water fluoridation (Kunzel, 1993, Yewe-Dyer, 2002).

The World Health Organization (in yet another report written almost exclusively by dentists and pro-fluoridationists!) advocates salt fluoridation for areas where there is not the political will to introduce water fluoridation (WHO, 1994).

17) What is Himalaya Salt?

Himalaya Salt, also called Himalayan Crystal Salt, is salt made from rocks - rock salt. Promoters claim it is superior to ordinary salt and coming from the Himalayas, with exceptional healing qualities. It is not only used for cooking, but for countless topical applications and therapies. It is a scam which emerged in Europe a few years ago and rapidly spread across the world.

It is currently being introduced in India and the United States .

To find out more about Himalaya Salt, please click here .

18) Does Himalaya Salt contain fluoride?

Yes. Although it is marketed in Europe and elsewhere as an alternative to fluoridated salt, Himalaya Salt may in fact contain even more fluoride than is present in artificially fluoridated salt. Recent analyses have shown fluoride content between 231 and 310 ppm. To view one analysis, click here .

To find out more about Himalaya Salt, please click here .

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REFERENCES:

Clarkson JJ, McLoughlin N - Role of fluoride in oral health promotion International Dental Journal 50:119-128 (2000)

http://www.fdiworldental.org/assets/pdf/commission/97_6_1.pdf

EAPD (European Academy of Paediatric Dentistry) - Guidelines on the use of fluoride in children: an EAPD policy document (2000)

http://www.eapd.gr/Parents/F%20guilines.htm

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and dental caries in Jamaica" Community Dent Oral Epidemiol 29(4):247-52 (2001)

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Hernandez LP - Prevention of dental caries through salt

fluoridation in Mexico CEDROS Newsletter Year II, N.3 (1993)

www.ibiblio.org/taft/cedros/english/newsletter/n3/prevent.html

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ICCIDD - Switzerland Data

http://www.people.virginia.edu/~jtd/iccidd/mi/idd_163.htm

k+s Report 2000 (in German)

http://www.k-plus-s.com/pdf_de/2000/info-03.pdf

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Macpherson LM, Stephen KW - "The effect on human salivary fluoride concentration of consuming fluoridated salt-containing baked food items" Arch Oral Biol 46(10):983-8 (2001) Link

Marthaler TM- "Salt fluoridation: effectiveness against dental caries and practical results in Latin America and Europe" (2001)

Marthaler TM -  Salt fluoridation in Europe, comparisons with Latin America  8th World Salt Symposium (2000); Volume 2: 1021-1026 (2000)

Marthaler (in German)

Under the heading: Zur Toxizität der Fluoride - derzeitiger Stand der Erkenntnis

Meyer-Lueckel H, Satzinger T, Kielbassa AM - Caries prevalence among 6- to 16-year-old students in Jamaica 12 years after the Introduction of salt fluoridation Caries Res 36(3):170-3 (2002)

Menghini G, Steiner M, Marthaler T, Helfenstein U, Brodowski D, Imfeld C, Weber R, Imfeld T - "Caries prevalence among students in 16 Zurich districts in the years 1992 to 2000" Schweiz Monatsschr Zahnmed 113(3):267-77 (2003)

Milner T, Estupiñán-Day D - Overview of Salt Fluoridation in the Region of the Americas: Part II. The Status of Salt Production, Quality & Marketing and the State of Technology Development for Salt Fluoridation Salt 2000, 8th World Salt Symposium , Volume 2, pg 1033-1038 (2000) LINK

PAHO - General Guidelines for Drafting a Legal Framework: Mandatory Iodization and Fluoridation of Salt for Human Consumption Division of Health Systems and Services Development Regional Program on Oral Health (November 2001)

http://newweb.www.paho.org/English/HSP/HSO/oral_20eng.doc

PAHO Press Release, Aug. 23, 1996

http://64.177.90.157/pfpc/html/paho_1996.html

http://165.158.1.110/english/DPI/rlaug27.htm

Pollick H - Questions and Answers on Water Fluoridation - Prepared by Howard Pollick, BDS, MPH (2004)

http://www.shastahealth.org/pdf/howard_pollick_qa.pdf

Reuters Health - Fluoride in Table Salt Cuts Tooth Decay in Jamaica, Aug. 21, 2001 LINK

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