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The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) was not asked to consider the risks of underdosage of vitamin B6 for vulnerable subpopulations as it was outside their remit. The issue of nutritional requirements of vitamins is a matter for the Committee on Medical Aspects of Food and Nutrition Policy (COMA). The COT was aware of COMA's advice that 1.4mg of vitamin B6 is sufficient or more than sufficient to meet the nutritional needs of practically all healthy people. Surveys show that average intakes of vitamin B6 in the United Kingdom from food (excluding supplements) are well above the Reference Nutrient Intake of 1.4mg. The COT recommended that the maximum daily intake of vitamin B6 from dietary supplements should be 10mg, which is more than seven times the nutritional requirement.
Baroness Hayman: The Medical Research Council, which commissions most of the Government's research into bio-medical and clinical issues, is always open to new sound scientific proposals in competition with other applications. However, the cited studies demonstrate that the absorption and effects of fluoride ions at relevant concentrations in drinking-water are identical, whether occurring entirely naturally, or partly supplemented. Assessment of the efficacy and safety of water fluoridation is based on the extensive and continuing studies of the effects of fluoride in drinking-water on human, in addition to laboratory studies in other animals and test systems.
Baroness Hayman: We agree with the World Health Organisation that "periodic assessment of total fluoride intake in a population, as well as regular monitoring of fluorosis prevalence and severity in children, enable the public health administrator to determine whether further action is called for to reduce" the prevalence of dental caries. Such periodic assessments are undertaken here. For example, analyses of fluoride are currently being conducted for the Joint Food Safety and Standards Group as part of a study of halides in the Total Diet Study samples collected in 1997. Also, concentrations of fluoride in drinking water are regularly reported by water undertakers and the Department of Health sponsors regular surveys of oral health.
Our policy on fluoridation is under review but, in the light of the existing monitoring arrangements, we are not inclined to advocate local surveys of exposure to fluoride. However, as indicated in Baroness Jay of Paddington's reply on 18 December 1997 (WA 103), we do intend to require health authorities to advise people in areas newly fluoridated that they no longer need to use topical fluorides.
Baroness Hayman: Sodium hexafluorosilicate, added to water to supplement the fluoride concentration, dissociates to produce sodium ions, silica, and fluoride ions. There is extensive information on the properties and biological effects of all of these products. Fluoridation produces no significant increase in the concentrations of sodium or silica in drinking-water.
Baroness Hayman: We consider that the public are adequately protected by the provisions in the Water Industry Act 1991 which require water undertakers to supply water that it is wholesome and ensure that, in areas which are artificially fluoridated, the concentration of fluoride supplied to the consumer is, so far as is reasonably practicable, maintained at one milligram per litre.
Baroness Hayman: Extensive studies and more than half a century of experience indicate that fluoridation is an effective and safe measure capable of producing significant improvements in public health by contributing to the prevention of dental caries. The Committee on Toxicology of the US National Research Council did not recommend the curtailment of fluoridation in the United States of America; on the contrary, it concludes that the current Maximum Contaminant Level (MCL) of 4 milligrams fluoride per litre, set by the US Environmental Protection Agency to protect human health, remains appropriate as an interim standard to be reviewed when results of new research become available. This MCL is more than twice the concentration permitted in drinking water in the United Kingdom, and four times the target concentration for water fluoridation schemes.
Baroness Hayman: The efficacy and safety of fluoridation has been under almost continuous and intensive review since it was first proposed in the late 1930s, and introduced in North America in 1945. Currently the International Programme on Chemical Safety, jointly sponsored by the United Nations Environment Programme, the International Labour Organisation, and the World Health Organisation, is revising its review of Fluorine and Fluorides in the series of Environmental Health Criteria. The Department of Health monitors these studies and would also be willing to consider proposals for a review from a United Kingdom based research organisation.
Baroness Hayman: It is generally agreed that excessive intakes of fluoride over a prolonged period of time (20-80 mg/d for 10-20 years) can lead to skeletal fluorosis, resulting in ossification of the ligaments and fusion of the spine, as stated in the cited report of the Panel on Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Quotation of this range is appropriate in a brief summary intended to provide guidance relevant to dietary intakes (rather than occupational exposure) in the United Kingdom. The relationship between daily intakes lower than 20 mg and clinical skeletal fluorosis is less certain.
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