ࡱ> \^WXYZ[a `bjbjzz .P\P\K@  P\...BBB8zfBO5R00(XX3 M Y 4444444$E8:4.a 3 3 a a 4..XX 5 a d.X.X4 a 4 04X`rr j3450O5~3; ;(4;.4,a a a a a a a 44 a a a O5a a a a ;a a a a a a a a a > : Fluoride content of UK retail tea: impact of brew time on teas of different quality. By C.H.S. Ruxton1 and T.J. Bond2, 1Freelance Dietitian, Nutrition Communications, 26 East Road, Cupar, KY15 4HQ and 2Technical expert, Tea Advisory Panel Tea is a natural source of fluoride (F-) and is a major contributor to adult F- intakes in the UK. In addition, F- has well established oral health benefits(1). We previously(2) reported the F- content of 49 retail teas, finding wide variation in results and a lower F- in speciality and single estate teas. Other work suggested that economy tea bags are higher in F-(3). As our original study used a 40s brewing time, in line with consumer preferences(4), a pilot study was undertaken to assess differences in the F- content of black tea brewed for longer time periods. Three brands of retail black tea were selected to represent economy, mid-range and premium teas. Infused F- was measured by brewing one tea bag in 240ml of freshly boiled de-ionized water for the required period, before squeezing the tea bag gently against the side of the beaker and removing it. The brews were then stirred and cooled to approximately 20oC before aliquots were taken and the F- content measured using ion selective electrode. The entire process was carried out in triplicate for each brand and each brewing time of 40, 120, 240 and 360 seconds. The results are shown below per 240ml serving. Between-subjects and repeated ANOVA were used to test for significant differences (p<0.05).  F- content was significantly different at 40s with the highest value seen in the mid-range tea. F- content significantly increased with brewing time for all three individual brands. However, the increase in F- content between 40s and 360s was greatest in the economy tea (+2.03 mg/L) compared with the premium tea (+0.53 mg/L). In conclusion, brewing time has a significant impact on the F- content of tea, particularly for economy tea. This may be because economy teas tend to contain a higher proportion of mature leaves, which have had longer to accumulate F- from the soil. This work was funded by the Tea Advisory Panel, which is supported by an unrestricted educational grant from the UK Tea & Infusions Association. 1. European Commission (2012) Official Journal of the European Union L136: 1-40. 2. Ruxton CHS & Bond TJ (2014) Proc Nutr Soc In press. 3. Chan L, Mehra A, Saikat S et al. (2013) Food Res Int 51, 564-70. 4. Ruxton CHS & Hart VA (2011) Br J Nutr 106, 588-95. TEA, HYDRATION AND FLUORIDE Executive summary Tea is the most widely consumed beverage in the world after water. 83% of UK adults drink tea with average consumption of just over two servings daily (542ml). Tea contains approximately 99% water. It is an important source of fluid and can count towards the daily intake of 8 cups of fluid. Both Public Health England and the British Dietetic Association advise that tea can help us meet our daily fluid requirements. The idea that tea contains as much caffeine as coffee is wrong. A cup of tea contains about a third of the caffeine in an average cup of filtered coffee and much less compared with an espresso. Tea is a source of natural polyphenolic compounds, which are linked, with a range of health benefits. Studies evaluating the effect of tea on markers of hydration suggest no negative impact of tea on hydration even at higher intakes. Studies suggesting that caffeine can impact negatively on hydration are based on caffeine pills. Studies on caffeinated drinks, including tea, coffee and cola, have not shown adverse effects. This is due to the high water content of these drinks. Overall the data on caffeine and hydration suggest that high doses of caffeine in people who do not normally consume caffeine may increase urine output, but this doesnt occur with acute doses of low to moderate doses of caffeine nor with chronic caffeine consumption as the body gets used to it. Fluoride is mineral that has beneficial effects on both teeth and bone. With regards to teeth the most common benefit is prevention of dental caries as confirmed by the European Food Safety Authority. In small to moderate doses, fluoride may help to strengthen bone. Tea is a source of fluoride and could in theory make a dental health claim. The UK typical intake of tea of 2-3 servings a day contributes fluoride but levels dont exceed European safe limits and are not even high enough to reach recommended levels. This suggests that a higher tea consumption of 4-5 cups daily would be better for dental health. Among higher consumers of tea (up to 5 cups daily) fluoride intakes meet recommended levels and are still below safe limits. In children aged 4-10 years an appropriate intake would be 1-2 servings and in older children up to 4 servings daily could be consumed while remaining within limits for fluoride and caffeine. Introduction Tea (Camellia sinensis) is the most widely consumed beverage in the world after water. ADDIN EN.CITE Hodgson20101(1)1117Hodgson, J. M.Croft, K. D.School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. Jonathan.Hodgson@uwa.edu.auTea flavonoids and cardiovascular healthMol Aspects MedMolecular aspects of medicineMol Aspects MedMolecular aspects of medicineMol Aspects MedMolecular aspects of medicine495-5023162010/09/15AnimalsCardiovascular Diseases/metabolism/ prevention & controlFlavonoids/administration & dosage/metabolism/ pharmacologyHealth BehaviorHumansModels, AnimalTea2010Dec1872-9452 (Electronic) 0098-2997 (Linking)20837049http://www.sciencedirect.com/science/article/pii/S009829971000073710.1016/j.mam.2010.09.004NLMeng(1) Black tea is the most popular type representing 78% of the tea consumed worldwide, 20% is green tea and 2% oolong.  ADDIN EN.CITE Siddiqui20042(2)2217Siddiqui, I. A.Afaq, F.Adhami, V. M.Ahmad, N.Mukhtar, H.Department of Dermatology, University of Wisconsin, Madison, WI 53706, USA.Antioxidants of the beverage tea in promotion of human healthAntioxid Redox SignalAntioxidants & redox signalingAntioxid Redox SignalAntioxidants & redox signalingAntioxid Redox SignalAntioxidants & redox signaling571-82632004/05/08AnimalsAnticarcinogenic Agents/pharmacologyAntioxidants/ pharmacologyFlavonoids/chemistryHealthHumansModels, ChemicalNeoplasms/prevention & controlPhenols/chemistryPolyphenolsTea/ metabolism2004Jun1523-0864 (Print) 1523-0864 (Linking)1513028310.1089/152308604773934323NLMeng(2) Up to 83% of UK adults drink tea with older adults (> 65 years) drinking more than those aged 19-64 years. ADDIN EN.CITE Ruxton20153(3)3317Ruxton, CPhillips, FBond, TIs tea a healthy source of hydration?Nutrition BulletinNutrition Bulletin166-17640320151467-3010(3) Tea consumption in the UK has decreased during the last 30 years from seven servings to just over two servings daily. ADDIN EN.CITE Ruxton20153(3)3317Ruxton, CPhillips, FBond, TIs tea a healthy source of hydration?Nutrition BulletinNutrition Bulletin166-17640320151467-3010(3) Tea contains an array of compounds including amino acids, organic acids, methylxanthines, flavonoids and related polyphenols, as well as small quantities of micronutrients, including B vitamins, manganese, zinc and fluorine, and also caffeine and L-theanine. Tea polyphenols are of great interest because of their antioxidant and anti-inflammatory properties and their links with reduced mortality, ADDIN EN.CITE  ADDIN EN.CITE.DATA (4) cardiovascular health, ADDIN EN.CITE  ADDIN EN.CITE.DATA (5) improved cognitive function,  ADDIN EN.CITE Einother20136(6)6617Einother, S. J.Martens, V. E.From Unilever Research and Development, Vlaardingen, Netherlands.Acute effects of tea consumption on attention and moodAm J Clin NutrThe American journal of clinical nutritionAm J Clin NutrThe American journal of clinical nutritionAm J Clin NutrThe American journal of clinical nutrition1700S-1708S986 Suppl2013/11/01Affect/ drug effectsAttention/ drug effectsCaffeine/ pharmacologyCamellia sinensis/ chemistryCognition/ drug effectsGlutamates/ pharmacologyHumansPlant Extracts/pharmacologyTea/ chemistry2013Dec1938-3207 (Electronic) 0002-9165 (Linking)2417230310.3945/ajcn.113.058248NLMeng(6)protection against diabetes, ADDIN EN.CITE Ruxton20127(7)7717Ruxton, CHSMason, PIs black tea consumption associated with a lower risk of cardiovascular disease and type 2 diabetes?Nutrition BulletinNutrition Bulletin4-1537120121467-3010(7) bone health ADDIN EN.CITE  ADDIN EN.CITE.DATA (8) and weight management. ADDIN EN.CITE  ADDIN EN.CITE.DATA (9) Historic concerns about caffeine and fluoride led to questions about the suitability of tea as a source of fluid and its role in hydration. However, more recent studies on caffeine commensurate with the amounts found in tea as well as studies on tea itself, suggesting that tea contributes to normal hydration in contrast to lay beliefs that caffeine is dehydrating. ADDIN EN.CITE Ruxton20153(3)3317Ruxton, CPhillips, FBond, TIs tea a healthy source of hydration?Nutrition BulletinNutrition Bulletin166-17640320151467-3010(3) Tea contains approximately 99% water. It is an important source of fluid and can count towards the daily intake of 8 cups of fluid. Both Public Health England and the British Dietetic Association advise that tea can help to meeting daily fluid requirements. Moreover, the idea that tea contains as much caffeine as coffee is erroneous. A cup of tea contains about a third of the caffeine in an average cup of filtered coffee and proportionately much less compared with an espresso. Similarly, concerns about fluoride in tea are not born out by evidence which suggests that estimated fluoride intakes from tea are well within tolerable upper limits and that tea can contribute to both dental and bone health benefits. ADDIN EN.CITE Ruxton201510(10)101017Ruxton, CHSBond, TJFluoride content of UK retail tea: comparisons between tea bags and infusionsProceedings of the Nutrition SocietyProceedings of the Nutrition SocietyE8474OCE120151475-2719(10) Tea and hydration Hydration and health The human body is up to 75% water by weight and water is essential for life. Water has a number of functions in the body, participating in almost every metabolic process, as well as lubricating the joints, helping to control body temperature through sweating and also helping to flush waste. Water is a major component of body fluids, including blood, urine and saliva. The amount of water in the body is controlled by anti-diuretic hormone such that if the volume of fluid increases and the concentration of salts in the blood falls, more urine will be excreted while if the blood concentration of salts increases and the volume of fluid in the blood falls, urinary excretion will fall. However, it is still possible to become dehydrated and severe dehydration is fatal. Even mild dehydration leads to headaches, fatigue and reduced mental and physical performance while chronic mild dehydration has been associated with constipation, urinary tract infections and cardiovascular disease. ADDIN EN.CITE  ADDIN EN.CITE.DATA (11) How much fluid do we need? Individuals vary considerably in their fluid requirements. Research has shown daily requirements ranging from 0.415litres up to 4.315 litres in a study in French adults ADDIN EN.CITE  ADDIN EN.CITE.DATA (12) while a systematic review of studies suggested a daily requirement across children and adults ranging from 0.6 litres to 3.5 litres. ADDIN EN.CITE Ozen201513(13)131317Ozen, A. E.Bibiloni Mdel, M.Pons, A.Tur, J. A.Department of Nutrition and Dietetics, Faculty of Health Sciences, Near East University, Mersin, Turkey. Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands, IdISPa, and CIBERobn (Physiopathology of Obesity and Nutrition CB12/03/30038), Palma de Mallorca, Spain.Fluid intake from beverages across age groups: a systematic reviewJ Hum Nutr DietJournal of human nutrition and dietetics : the official journal of the British Dietetic AssociationJ Hum Nutr DietJournal of human nutrition and dietetics : the official journal of the British Dietetic AssociationJ Hum Nutr DietJournal of human nutrition and dietetics : the official journal of the British Dietetic Association417-422852014/06/182015Oct1365-277X (Electronic) 0952-3871 (Linking)2493521110.1111/jhn.12250NLMeng(13) A review of 24-hour beverage requirements in British adults aged up to 64 years reported mean total daily water intakes of 2.53 litres in men and 2.03 litres in women. ADDIN EN.CITE Gibson201314(14)141417Gibson, S.Shirreffs, S. M.Sig-Nurture Ltd., Guildford, Surrey Gu1 2TF, UK. sigrid@sig-nurture.comBeverage consumption habits "24/7" among British adults: association with total water intake and energy intakeNutr JNutrition journalNutr JNutrition journalNutr JNutrition journal9122013/01/12AdultBeveragesBody WeightDiet RecordsDrinkingEnergy IntakeEuropean Continental Ancestry GroupFemaleFood HabitsGreat BritainHumansMaleMiddle AgedMultivariate AnalysisNutrition SurveysSurveys and QuestionnairesYoung Adult20131475-2891 (Electronic) 1475-2891 (Linking)23305461PMC357537610.1186/1475-2891-12-9NLMeng(14) Several official bodies provide guidelines on fluid consumption. In Europe, EFSA has set Dietary Reference Values for water, which in healthy adults are 2.5 litres daily for men and 2 litres daily for women with smaller amounts for children (see Table 1). These guidelines do not make specific recommendations on which drinks should be included but recognize that water is consumed from different drinks and food, and they state that regular and moderate consumption of caffeinated drinks does not impair hydration. ADDIN EN.CITE EFSA NDA Panel (EFSA Panel on Dietetic Products15(15)151517EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2010. Scientific Opinion on Dietary Reference Values for water. EFSA Journal 2010; 8(3):1459, 48 pp. doi:10.2903/j.efsa.2010.1459(15) Table 1: Dietary Reference Values for Water Source EFSA (2010) ADDIN EN.CITE EFSA NDA Panel (EFSA Panel on Dietetic Products15(15)151517EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2010. Scientific Opinion on Dietary Reference Values for water. EFSA Journal 2010; 8(3):1459, 48 pp. doi:10.2903/j.efsa.2010.1459(15) AgeAdequate fluid intakes (food and beverages)Infants < 6 months100-190ml/kg/dayInfants 6-12 months800-1000ml/dayChildren 1-2 years1100-1200ml/dayChildren 2-3 years1.3 litres/dayChildren 4-8 years1.6 litres/dayBoys 9-13 years2.1 litres/dayGirls 9-13 years1.9 litres/dayAdults (age 14+) (Male)2.1 litres/dayAdults (age 14+) (Female)2.0 litres/dayAdults (age 14+) (Female) pregnant2.3 litres/dayAdults (age 14+) (Female) breastfeeding2.7 litres/day What impact does tea have on hydration? Three studies have evaluated the influence of tea on hydration. One was a study in 13 members of an expedition at high altitude, which found no significant differences in urine colour, urine sodium and potassium and urine specific gravity following ad libitum tea versus water consumption. ADDIN EN.CITE  ADDIN EN.CITE.DATA (16) Although the study was non-randomised and the number of study participants was small, the study did test the impact of tea consumption in an environment where the risk of dehydration is high. Another study was a randomized crossover trial in 21 healthy men who abstained from caffeine, alcohol and exercise in the 24 hours before the study. The test group of men consumed 4 or 6 cups (240ml per cup) of black tea, providing a total of 168 and 252mg caffeine respectively, while the placebo group consumed the same volume of water. No differences were observed in any of the markers of hydration in blood or urine, nor were there any differences in mean 24-hour urine output. ADDIN EN.CITE Ruxton201117(17)171717Ruxton, C. H.Hart, V. A.Nutrition Communications, Front Lebanon, Cupar, UK. carrie@nutrition-communications.comBlack tea is not significantly different from water in the maintenance of normal hydration in human subjects: results from a randomised controlled trialBr J NutrThe British journal of nutritionBr J NutrThe British journal of nutritionBr J NutrThe British journal of nutrition588-9510642011/04/01AdultCaffeine/administration & dosage/adverse effects/analysisCross-Over StudiesDehydration/chemically induced/prevention & controlHumansKineticsMaleMiddle AgedPotassium/blood/urineSodium/blood/urineTea/ adverse effects/chemistryWater-Electrolyte BalanceYoung Adult2011Aug1475-2662 (Electronic) 0007-1145 (Linking)2145011810.1017/s0007114511000456NLMeng(17) The amounts of tea consumed in this study (960 or 1440ml) are higher than mean daily tea intakes in UK adults aged 19-64 years (which are 542ml) and adults > 65 years (which are 648ml). The third, most recent, study (18) considered the effects of 13 different drinks on 72 normally hydrated, fasted males. After drinking 1 litre of hot tea made in a standardised way and served at 600 C or the same tea served cold at 4-6 oC, cumulative urine output was no different when compared with participants randomised to the other test beverages, including water. These studies suggest that current average tea intake of two to three cups a day is unlikely to cause diuresis or impair hydration. Indeed, tea is likely to contribute to fluid requirements. Caffeine and hydration Tea contains caffeine, and media reports have often stated that caffeinated drinks are dehydrating. Theoretically, caffeine can stimulate urine output because it increases blood flow to the kidneys and inhibits the re-absorption of sodium, potassium and magnesium thus causing water loss. However, such evidence as it exists for a diuretic effect of caffeine has largely come from trials involving caffeine pills at moderate to high doses and often in people who do not normally consume caffeine. Two studies reported moderate diuresis with caffeine pills in doses of 370-612 mg daily  ADDIN EN.CITE  ADDIN EN.CITE.DATA (19, 20) while another study showed no effect of caffeine in doses of 3-6mg/kg bodyweight on markers of hydration. ADDIN EN.CITE  ADDIN EN.CITE.DATA (21) A review of evidence from 41 studies on caffeine which included an examination of the impact on hydration of caffeinated drinks concluded there was no significant impact on hydration with a caffeine intake of 1.4-6mg per kg bodyweight. ADDIN EN.CITE Ruxton200822(21)222217Ruxton, CHSThe impact of caffeine on mood, cognitive function, performance and hydration: a review of benefits and risksNutrition BulletinNutrition Bulletin15-2533120081467-3010(22) A more recent study in 50 male moderate coffee drinkers found that compared with drinking 4 cups of water each day over 3 days the same amount of coffee had no significant impact on markers of hydration.  ADDIN EN.CITE Killer201423(22)232317Killer, S. C.Blannin, A. K.Jeukendrup, A. E.School of Sport and Exercise Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom.No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living populationPLoS OnePloS onePLoS OnePloS onePLoS OnePloS onee84154912014/01/15AdolescentAdultBiomarkers/blood/urineBody WaterBody WeightCoffeeCross-Over StudiesDehydration/ metabolismDrinking BehaviorHumansMaleMiddle AgedUrinationYoung Adult20141932-6203 (Electronic) 1932-6203 (Linking)24416202PMC388698010.1371/journal.pone.0084154NLMeng(23) Overall the data on caffeine and hydration suggest that high doses of caffeine in people who do not normally consume caffeine may increase urine output, but this does not occur with acute doses of low to moderate doses of caffeine nor with chronic caffeine consumption. ADDIN EN.CITE Killer201423(22)232317Killer, S. C.Blannin, A. K.Jeukendrup, A. E.School of Sport and Exercise Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom.No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living populationPLoS OnePloS onePLoS OnePloS onePLoS OnePloS onee84154912014/01/15AdolescentAdultBiomarkers/blood/urineBody WaterBody WeightCoffeeCross-Over StudiesDehydration/ metabolismDrinking BehaviorHumansMaleMiddle AgedUrinationYoung Adult20141932-6203 (Electronic) 1932-6203 (Linking)24416202PMC388698010.1371/journal.pone.0084154NLMeng(23) The amount of caffeine in tea is largely dependent on brewing time and varies between 1 and 90mg per 100ml, although the average is 17mg per 100ml of brewed tea. Given that the average daily intake of tea in UK adults <65 years is 542ml, mean daily intake of caffeine from tea is approximately 92 mg. ADDIN EN.CITE Ruxton201510(10)101017Ruxton, CHSBond, TJFluoride content of UK retail tea: comparisons between tea bags and infusionsProceedings of the Nutrition SocietyProceedings of the Nutrition SocietyE8474OCE120151475-2719(10) EFSA has produced draft guidelines on safe intakes of caffeine recommending that for adults aged 18-65 years 400mg of caffeine daily, including single doses of up to 200mg are safe. For pregnant women, 200mg per day is considered safe while 3 mg per kg bodyweight per day is considered appropriate for children and adolescents.  ADDIN EN.CITE EFSA NDA Panel (EFSA Panel on Dietetic Products18(15)181817EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2015. Scientific Opinion on the safety of caffeine. EFSA Journal 2015;13(5):4102, 120 pp. doi:10.2903/j.efsa.2015.4102(15) Tea and fluoride What is fluoride? Fluoride is a naturally occurring mineral that can be obtained from foods and fluids originating from soils containing fluoride, as well as by drinking water that has been fluoridated. In the UK, 10% of the population receives fluoridated water at a level of 1mg/litre. ADDIN EN.CITE Society201230(23)303017British Fluoridation SocietyOne in a million. The facts about water fluoridation. http://www.bfsweb.org/onemillion/onemillion.htm. Accessed 22 April, 20162012(24) Fluoride plays a major role in the mineralization of bones and teeth,  ADDIN EN.CITE  ADDIN EN.CITE.DATA (25) and hence has a protective effect on bone and dental health. A chronically high intake exceeding the safe upper levels for fluoride intake can lead to dental and skeletal fluorosis but this is exceedingly rare in developed countries and tends to be seen in countries, such as Kenya and China, where soil or water contains excess fluoride. Mild to moderate dental fluorosis causes white mottling of the tooth enamel and despite being considered unsightly actually has the effect of increasing resistance of the teeth to dental caries. Moderate to severe dental fluorosis affecting 3-6% of people in fluoridated areas can result in yellow marks and pits on tooth enamel but does not cause a danger to the tooth. ADDIN EN.CITE Public Health England201434(25)343417Public Health England,Water fluoridation. Health monitoring report for England. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300202/Water_fluoridation_health_monitoring_for_england__full_report_1Apr2014.pdf. Accessed 22 April, 20162014(26) A recent review that included an evaluation of the effect of fluoride on bone and dental health found from the balance of evidence that while adverse effects on bone can occur at chronically high levels of fluoride intake, bone density and strength can be improved at recommended levels of fluoride intake there are few negative implications for people living in the UK apart from mild to moderate dental fluorosis. ADDIN EN.CITE Ruxton201435(26)353517Ruxton, C.Nutrition Communications, Cupar, Fife, Scotland.Fluoride in the UK dietNurs StandNursing standard (Royal College of Nursing (Great Britain) : 1987)Nurs StandNursing standard (Royal College of Nursing (Great Britain) : 1987)Nurs StandNursing standard (Royal College of Nursing (Great Britain) : 1987)52-928492014/08/072014Aug 122047-9018 (Electronic) 0029-6570 (Linking)2509596010.7748/ns.28.49.52.e9031NLMeng(27) Tea is a major contributor to fluoride in the UK. Other sources include fish and milk as well as artificially fluoridated sources such as tablets, drops or chewing gum.  ADDIN EN.CITE EFSA NDA Panel (EFSA Panel on Dietetic Products25(15)252517EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013. Scientific Opinion on Dietary Reference Values for fluoride. EFSA Journal 2013;11(8):3332, 46 pp. doi:10.2903/j.efsa.2013.3332(15) Among adults, tea has been found to provide 70% of the average daily fluoride intake,  ADDIN EN.CITE Health199126(27)262617Department of HealthDietary reference values for food energy and nutrients for the United KingdomCommittee on Medical Aspects of Food Policy. Report on Health and Social Subjects 41Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects 411991(28) although this depends on the type of tea consumed and whether fluoridated tap water was used  ADDIN EN.CITE Chan201327(28)272717Chan, LauraMehra, AradhanaSaikat, SohelLynch, PaulHuman exposure assessment of fluoride from tea (Camellia sinensis L.): A UK based issue?Food Research InternationalFood Research International564-57051220130963-9969(29) In children, a 2006 study showed that tap water, squashes and cordials were the main sources of fluoride whether tap water was fluoridated or not.  ADDIN EN.CITE  ADDIN EN.CITE.DATA (30) Fluoride guidelines Guidelines for fluoride intake have been set by official bodies including in Europe and the UK (see Table 2). In Europe, fluoride is considered to have a beneficial effect on dental health and an adequate intake of 0.05mg/kg/body weight has been set for adults, children and pregnant women. This reflects the chronic intake that would be expected to meet the bodys requirement for fluoride. ADDIN EN.CITE EFSA NDA Panel (EFSA Panel on Dietetic Products25(15)252517EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013. Scientific Opinion on Dietary Reference Values for fluoride. EFSA Journal 2013;11(8):3332, 46 pp. doi:10.2903/j.efsa.2013.3332(15) The UK set a safe and adequate intake level of 0.05mg/kg/body weight/day to reflect the no observed adverse effect level for dental fluorosis, which is a condition causing mottling of the teeth arising from excessive fluoride consumption. Safe upper levels have been set in Europe at 0.1mg/kg/body weight/day for children aged 1-8 years, 5mg daily for children aged 9-14 years and 7mg daily for adults, including pregnant and breastfeeding women. Table 2: UK and European Guidelines for Fluoride Official bodyGuidelineBritish Dental Association (1997)Fluoride is unnecessary for infants < 6 months Fluoride should not be given where the drinking water contains >700 microgram fluoride/litreDepartment of Health (199!)Safe intakes of fluoride for adults are 0.05mg/kg body weight/dayEuropean Food Safety Authority (EFSA) (2013)Adequate Intake (AI) of 0.05mg/kg/body weight/day for children, adult, pregnant and breastfeeding womenEFSA (2006)Upper levels of fluoride: Children aged 1-8 years: 0.1mg/kg/bodyweight/day (equivalent to 1.5mg/day for children 1-3 years; 2.5mg/day for children 4-8 years) 5mg/day for children aged 9-14 years 7mg/day for those > 15 years including pregnant and breastfeeding women Fluoride intakes Fluoride intakes vary quite widely. In Europe generally, fluoride intakes vary broadly from 0.13 to 8.40 mg daily. ADDIN EN.CITE Commission201431(30)313117European CommissionAre there any concerns about people's fluoride intake? If so, who is at risk? http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/4.htm#3. Accessed 22 April, 20162014(31) In the UK, a 2000 COT analysis ADDIN EN.CITE Toxicology200032(31)323217Committee on ToxicologyCOT statement on fluorine in the 1997 Total Diet Study. https://cot.food.gov.uk/sites/default/files/cot/fluoride.pdf. Accessed 22 April, 20162000(32) found fluoride exposure in children aged 18 months to 10 years to range from 0.023 to 0.031 mg/kg/body weight/day and in youngsters aged 11-18 years, the range was 0.015 to 0.017 mg/kg body weight/day, while in adults intake averaged 0.016mg/kg/body weight/day. High consumers of fluoride had intakes ranging from 0.06mg/kg in children aged 4-6 years to 0.033mg/kg/body weight/day in adults. Urinary excretion data from the NDNS for 2002-2003 have been used to estimate fluoride intakes and it was concluded that only 1% of men and 3% of women had fluoride intakes above the adequate intake (AI) of 0.05mg/kg/body weight/day. ADDIN EN.CITE Henderson200333(32)333317Henderson, LynneThe National Diet & Nutrition Survey: adults aged 19 to 64 years2003(33) Benefits of fluoride Fluoride has beneficial effects on both teeth and bone. With regards to teeth the most common benefit is prevention of dental caries. Fluoride helps to prevent caries when provided systemically in the diet or in supplements, or topically as toothpastes or mouthwashes. When given systemically, fluoride works only at the pre-eruptive stage of tooth development, before the second teeth appear, i.e. at the ages of 2-8 years. ADDIN EN.CITE Toxicology200032(31)323217Committee on ToxicologyCOT statement on fluorine in the 1997 Total Diet Study. https://cot.food.gov.uk/sites/default/files/cot/fluoride.pdf. Accessed 22 April, 20162000(30) In contrast, topical fluoride does not have an age limit, which is why toothpastes and other dental products contain it. In areas of water fluoridation, 28% fewer 5 year olds and 21% fewer 12-year olds present with decay. ADDIN EN.CITE Public Health England201434(25)343417Public Health England,Water fluoridation. Health monitoring report for England. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300202/Water_fluoridation_health_monitoring_for_england__full_report_1Apr2014.pdf. Accessed 22 April, 20162014(26) Fluoride also has benefits on bone, since at low doses, it can embed in the bone matrix protecting against erosion,  ADDIN EN.CITE Chachra200836(33)363617Chachra, D.Vieira, A. P.Grynpas, M. D.Franklin W. Olin College of Engineering, Needham, MA 02492, USA. debbie.chachra@olin.eduFluoride and mineralized tissuesCrit Rev Biomed EngCritical reviews in biomedical engineeringCrit Rev Biomed EngCritical reviews in biomedical engineeringCrit Rev Biomed EngCritical reviews in biomedical engineering183-223362-32008/01/01AnimalsBone and Bones/ drug effects/ physiopathologyCalcification, Physiologic/ drug effectsDental Caries/ physiopathology/ prevention & controlFluorides/ administration & dosage/ adverse effectsFluorosis, Dental/etiology/ physiopathologyHumansModels, Biological20080278-940X (Print) 0278-940X (Linking)19740071NLMeng(34)resulting in increased density and hardness. A meta-analysis of 25 studies found that 20mg/day fluoride equivalents was associated with a significant reduction in fracture risk. ADDIN EN.CITE  ADDIN EN.CITE.DATA (35) However, a randomised controlled trial in 180 post-menopausal women using fluoride supplements providing 2.5mg, 5mg or 10mg/day found no significant effect on bone mineral density after a year. ADDIN EN.CITE  ADDIN EN.CITE.DATA (36) Fluoride health claims Dental health claims for fluoride have been approved by the European Food Safety Authority. A source claim can be made for foods and beverages that provide at least 15% of the European Nutrient Reference Value (3.5mg) per 100g. Claims could therefore be made for products containing at least 0.5mg/100g or 100ml as sold. Approved health claims for fluoride ADDIN EN.CITE EFSA NDA Panel (EFSA Panel on Dietetic Products37(15)373717EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2009. Scientific Opinion on the substantiation of health claims related to fluoride and maintenance of tooth mineralisation (ID 275, 276) and maintenance of bone (ID 371) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2009; 7(9):1212, 13 pp. doi:10.2903/j.efsa.2009.1212(15) Proposed health claimCondition of useFluoride strengthens the teeth/enamel: Fluoride helps protect the teeth Fluoride helps the teeth to recover after mealsMust be at least a source of fluoride for example 0.5mg/100g or 100ml as soldFluoride contributes to the maintenance of healthy teeth or tooth mineralizationAs above. Applicable to both children and adults. One example of a beverage that could make fluoride-related dental health claims in future is tea since the amount of fluoride per 100g dry weight meets the criteria for a source claim for many types of black tea. Interestingly, the dental health benefits of tea have been highlighted previously since tea polyphenol compounds have antibacterial actions,  ADDIN EN.CITE  ADDIN EN.CITE.DATA (37) and can regulate acid production in dental plaque  ADDIN EN.CITE Goenka201339(37)393917Goenka, P.Sarawgi, A.Karun, V.Nigam, A. G.Dutta, S.Marwah, N.Department of Pedodontics and Preventive Dentistry, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India. Department of Prosthodontics, Krishnadevaraya College of Dental Sciences and Hospital, Bangalore, India. Department of Oral Maxillofacial Surgery, College of Dental Sciences, Rau, Indore, India. Department of Pedodontics and Preventive Dentistry, Government Dental College, Rohtak, Haryana, India.Camellia sinensis (Tea): Implications and role in preventing dental decayPharmacogn RevPharmacognosy reviewsPharmacogn RevPharmacognosy reviewsPharmacogn RevPharmacognosy reviews152-67142013/12/192013Jul0973-7847 (Print) 0973-6581 (Linking)24347923PMC384199310.4103/0973-7847.120515NLMeng(38)while tea consumption has been associated with reduced tooth loss. ADDIN EN.CITE  ADDIN EN.CITE.DATA (39) What level of fluoride is found in tea? Tea naturally accumulates fluoride from soil and water during its growth and estimates of fluoride content of retail tea leaves vary considerably depending on the grade of tea, country of origin and level of fermentation (i.e. whether the tea is black, green, white or oolong) ADDIN EN.CITE Malinowska200840(39)404017Malinowska, E.Inkielewicz, I.Czarnowski, W.Szefer, P.Department of Food Sciences, Medical University of Gdansk, Gdansk, Poland.Assessment of fluoride concentration and daily intake by human from tea and herbal infusionsFood Chem ToxicolFood and chemical toxicology : an international journal published for the British Industrial Biological Research AssociationFood Chem ToxicolFood and chemical toxicology : an international journal published for the British Industrial Biological Research AssociationFood Chem ToxicolFood and chemical toxicology : an international journal published for the British Industrial Biological Research Association1055-614632007/12/15Fluorides/administration & dosage/ analysisHumansTea/ chemistry2008Mar0278-6915 (Print) 0278-6915 (Linking)1807870410.1016/j.fct.2007.10.039NLMeng(40). An analysis of fluoride in retail tea bags published in 2013 suggested that consuming typical amounts of tea from economy brands could lead to excessive fluoride exposure. ADDIN EN.CITE Chan201327(28)272717Chan, LauraMehra, AradhanaSaikat, SohelLynch, PaulHuman exposure assessment of fluoride from tea (Camellia sinensis L.): A UK based issue?Food Research InternationalFood Research International564-57051220130963-9969(29) This publication led to media coverage about the potential dangers of tea consumption. ADDIN EN.CITE McArthur201441(40)414117McArthur, AlastairFluoride in tea: Could your daily cuppa really make you ill?Nutrition BulletinNutrition Bulletin95-9839120141467-3010(41) However, there were several drawbacks to the study including the creation of a standard brew using 2g of tea in 100ml whereas 3.1g of tea in 180-200ml is more common. Long brewing times of 2, 10 and 30 minutes were also used in the study. In addition, the authors determined fluoride intake from tea based on a daily intake of 1 litre whereas typical tea intakes in the UK are 500-600ml. ADDIN EN.CITE McArthur201441(40)414117McArthur, AlastairFluoride in tea: Could your daily cuppa really make you ill?Nutrition BulletinNutrition Bulletin95-9839120141467-3010(41) They also compared estimated fluoride intake with the US male adequate intake (AI) level of 4mg daily rather than the tolerable upper intake level, which in Europe is 7mg daily. Different methods were used to measure fluoride in dry tea and tea infusions. All of these issues could have served to overestimate the potential exposure of fluoride exposure from tea. A more recent study of the fluoride content of typical UK black-blended retail tea bags, specialty tea and decaffeinated tea used more robust and more realistic methodology in that a single validated analytic method was used for fluoride measurement together with a standardized brew typically consumed by the UK consumer. ADDIN EN.CITE Ruxton201510(10)101017Ruxton, CHSBond, TJFluoride content of UK retail tea: comparisons between tea bags and infusionsProceedings of the Nutrition SocietyProceedings of the Nutrition SocietyE8474OCE120151475-2719(10) Based on the analysed content of fluoride in the teas and typical intakes of tea in the UK, daily intakes of fluoride were less than the EU RDA and AI in this study except for those with very high tea consumption (>95th percentile) and were also within age appropriate tolerable upper intake levels at both mean and very high tea intakes. When non-consumers were excluded from the data, intakes of fluoride remained less than the safe upper limit for all groups except those aged 1.5-3 years and those > 65 years with very high intakes. The authors concluded that their findings suggest that tea can safely be consumed from the age of 4 years. Some of the brands they examined contained sufficient fluoride for an European health claim relating to strengthening and maintaining tooth enamel. Overall, tea can be considered to be an important source of fluoride in the UK diet and in typical amounts of tea consumed in the UK of 2-3 servings a day contributes fluoride but not at levels that meet recommended intakes, or exceed safe limits. Higher consumers of tea (up to 5 cups daily) are more likely to meet fluoride recommendations but will still generally remain below safe upper limits for fluoride. In children aged 4-10 an appropriate intake would be 1-2 servings and in older children up to 4 servings daily could be consumed. ADDIN EN.CITE Ruxton201510(10)101017Ruxton, CHSBond, TJFluoride content of UK retail tea: comparisons between tea bags and infusionsProceedings of the Nutrition SocietyProceedings of the Nutrition SocietyE8474OCE120151475-2719(10) References  ADDIN EN.REFLIST 1. Hodgson JM, Croft KD. Tea flavonoids and cardiovascular health. Molecular aspects of medicine. 2010;31(6):495-502. 2. Siddiqui IA, Afaq F, Adhami VM, Ahmad N, Mukhtar H. Antioxidants of the beverage tea in promotion of human health. Antioxidants & redox signaling. 2004;6(3):571-82. 3. Ruxton C, Phillips F, Bond T. Is tea a healthy source of hydration? Nutrition Bulletin. 2015;40(3):166-76. 4. Gardener H, Rundek T, Wright CB, Elkind MS, Sacco RL. Coffee and tea consumption are inversely associated with mortality in a multiethnic urban population. The Journal of nutrition. 2013;143(8):1299-308. 5. Zhang C, Qin YY, Wei X, Yu FF, Zhou YH, He J. 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Fluoride content of UK retail tea: comparisons between tea bags and infusions. Proceedings of the Nutrition Society. 2015;74(OCE1):E84. 11. Shirreffs SM, Merson SJ, Fraser SM, Archer DT. The effects of fluid restriction on hydration status and subjective feelings in man. The British journal of nutrition. 2004;91(6):951-8. 12. Bellisle F, Thornton SN, Hebel P, Denizeau M, Tahiri M. A study of fluid intake from beverages in a sample of healthy French children, adolescents and adults. European journal of clinical nutrition. 2010;64(4):350-5. 13. Ozen AE, Bibiloni Mdel M, Pons A, Tur JA. Fluid intake from beverages across age groups: a systematic review. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2015;28(5):417-42. 14. Gibson S, Shirreffs SM. Beverage consumption habits "24/7" among British adults: association with total water intake and energy intake. Nutrition journal. 2013;12:9. 15. EFSA NDA Panel (EFSA Panel on Dietetic Products NaA, 2015. Scientific Opinion on the safety of caffeine. EFSA Journal 2015;13(5):4102, 120 pp. doi:10.2903/j.efsa.2015.4102. 16. Scott D, Rycroft JA, Aspen J, Chapman C, Brown B. The effect of drinking tea at high altitude on hydration status and mood. European journal of applied physiology. 2004;91(4):493-8. 17. Ruxton CH, Hart VA. Black tea is not significantly different from water in the maintenance of normal hydration in human subjects: results from a randomised controlled trial. The British journal of nutrition. 2011;106(4):588-95. 18. Maughan RJ, Watson P, Cordery PA et al (2016) A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index. American Journal of Clinical Nutrition. 103, 3, 717-23. 19. Bird ET, Parker BD, Kim HS, Coffield KS. Caffeine ingestion and lower urinary tract symptoms in healthy volunteers. Neurourology and urodynamics. 2005;24(7):611-5. 20. Wemple RD, Lamb DR, McKeever KH. Caffeine vs caffeine-free sports drinks: effects on urine production at rest and during prolonged exercise. International journal of sports medicine. 1997;18(1):40-6. 21. Armstrong LE, Pumerantz AC, Roti MW, Judelson DA, Watson G, Dias JC, et al. Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption. International journal of sport nutrition and exercise metabolism. 2005;15(3):252-65. 22. Ruxton C. The impact of caffeine on mood, cognitive function, performance and hydration: a review of benefits and risks. Nutrition Bulletin. 2008;33(1):15-25. 23. Killer SC, Blannin AK, Jeukendrup AE. No evidence of dehydration with moderate daily coffee intake: a counterbalanced crossover study in a free-living population. PloS one. 2014;9(1):e84154. 24. British Fluoridation Society. One in a million. The facts about water fluoridation.  HYPERLINK "http://www.bfsweb.org/onemillion/onemillion.htm" http://www.bfsweb.org/onemillion/onemillion.htm. Accessed 22 April, 2016. 2012. 25. Palmer CA, Gilbert JA. Position of the Academy of Nutrition and Dietetics: the impact of fluoride on health. Journal of the Academy of Nutrition and Dietetics. 2012;112(9):1443-53. 26. Public Health England. Water fluoridation. Health monitoring report for England.  HYPERLINK "https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300202/Water_fluoridation_health_monitoring_for_england__full_report_1Apr2014.pdf" https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300202/Water_fluoridation_health_monitoring_for_england__full_report_1Apr2014.pdf. Accessed 22 April, 2016. 2014. 27. Ruxton C. Fluoride in the UK diet. Nursing standard (Royal College of Nursing (Great Britain) : 1987). 2014; 28(49): 52-9. 28. Department of Health. Dietary reference values for food energy and nutrients for the United Kingdom. Committee on Medical Aspects of Food Policy Report on Health and Social Subjects 41. 1991. 29. Chan L, Mehra A, Saikat S, Lynch P. Human exposure assessment of fluoride from tea (Camellia sinensis L.): A UK based issue? Food Research International. 2013;51(2):564-70. 30. Zohouri FV, Maguire A, Moynihan PJ. Sources of dietary fluoride intake in 6-7-year-old English children receiving optimally, sub-optimally, and non-fluoridated water. Journal of public health dentistry. 2006;66(4):227-34. 31. European Commission. Are there any concerns about people's fluoride intake? If so, who is at risk?  HYPERLINK "http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/4.htm" \l "3" http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/4.htm - 3. Accessed 22 April, 2016. 2014. 32. Committee on Toxicology. COT statement on fluorine in the 1997 Total Diet Study.  HYPERLINK "https://cot.food.gov.uk/sites/default/files/cot/fluoride.pdf" https://cot.food.gov.uk/sites/default/files/cot/fluoride.pdf. Accessed 22 April, 2016. 2000. 33. Henderson L. The National Diet & Nutrition Survey: adults aged 19 to 64 years. 2003. 34. Chachra D, Vieira AP, Grynpas MD. Fluoride and mineralized tissues. Critical reviews in biomedical engineering. 2008;36(2-3):183-223. 35. Vestergaard P, Jorgensen NR, Schwarz P, Mosekilde L. Effects of treatment with fluoride on bone mineral density and fracture risk--a meta-analysis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2008;19(3):257-68. 36. Grey A, Garg S, Dray M, Purvis L, Horne A, Callon K, et al. Low-dose fluoride in postmenopausal women: a randomized controlled trial. The Journal of clinical endocrinology and metabolism. 2013;98(6):2301-7. 37. Araghizadeh A, Kohanteb J, Fani MM. Inhibitory activity of green tea (Camellia sinensis) extract on some clinically isolated cariogenic and periodontopathic bacteria. Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2013;22(4):368-72. 38. Goenka P, Sarawgi A, Karun V, Nigam AG, Dutta S, Marwah N. Camellia sinensis (Tea): Implications and role in preventing dental decay. Pharmacognosy reviews. 2013;7(14):152-6. 39. Koyama Y, Kuriyama S, Aida J, Sone T, Nakaya N, Ohmori-Matsuda K, et al. Association between green tea consumption and tooth loss: cross-sectional results from the Ohsaki Cohort 2006 Study. Preventive medicine. 2010;50(4):173-9. 40. Malinowska E, Inkielewicz I, Czarnowski W, Szefer P. Assessment of fluoride concentration and daily intake by human from tea and herbal infusions. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association. 2008;46(3):1055-61. 41. McArthur A. Fluoride in tea: Could your daily cuppa really make you ill? Nutrition Bulletin. 2014;39(1):95-8.  TEA AND FLUORIDE: SORTING FACT FROM FICTION Background: Black tea is a significant source of fluoride in the British diet and is estimated to provide 70 per cent this important mineral. Commonly associated with toothpaste, fluoride is actually a naturally occurring mineral found in water, fish and plants that contributes to the normal mineralisation of bones and teeth. Fluoride and tea the benefits The main benefit of fluoride relates to teeth, with both systemic and topical modes of action. European health claims have been approved for fluoride-containing foods and beverages around strengthening and protecting the teeth. The mechanism is thought to involve the incorporation of fluoride into the enamel matrix of teeth, improving resistance to decay. Systemic effects are only relevant when fluoride is consumed during the pre-eruptive stage of tooth development, i.e. two to eight years of age. After that, only topical fluoride impacts on teeth. Fluoride may also have beneficial effects on bone as, at low doses, it can embed within the bone mineral complex (known as hydroxyapatite), protecting against erosion. While bone, which contains fluoride, is more stable and compact, resulting in increased density and hardness, there is no evidence that this improves mechanical strength. Fluoride content of tea - facts and stats The fluoride content of tea occurs mostly as a consequence of tea plants taking up fluoride from the soil during growth but is also due, in part, to the use of fluoridated water in the brew where available. The fluoride content of black tea, the most commonly consumed type of tea, is 4.91 mg/litre on average which equates to 1.18 mg per serving (assuming one teabag is used). (SEE POWER POINT SLIDE FOR IMAGE) Debunking a common myth Concerns have been raised about the fluoride content of tea leading to media headlines suggesting that normal tea consumption could cause excessive fluoride consumption. However, the study behind this claim estimated average daily tea consumption to be 1000 ml whereas the National Diet and Nutrition Survey suggests that only 540 ml is consumed daily by adults aged 19-64 years with older adults (50-64 years) consuming 662 ml daily. A new study found that typical tea intakes in the UK do not provide fluoride levels that exceed the UL (7mg/day for an adult). On the contrary, more tea could be consumed in order to help people meet the RDA (3.5mg/day). An intake of at least four servings daily would achieve the RDA, potentially supporting normal dental health. Drinking tea with milk (a source of calcium) can lower fluoride absorption and, indeed, most tea drinkers in the UK do this. Last word Tea drinking can have dental health benefits not only due to its fluoride content but also due to the fact that tea contains polyphenol compounds, which may have antibacterial effects and can regulate acid production. Teas polyphenols have also been associated with a range of other benefits such as contributing to heart and vascular health while, in a randomized controlled trial, tea was found to provide as much hydration as water. Overall typical tea drinking in the UK may provide benefits for dental health, as well as hydration and heart health with benefits optimised at 4 servings a day. -ENDS- FOUR CUPS OF TEA DAILY TO PROTECT YOUR SMILE: STUDY REVEALS DENTAL HEALTH BENEFITS OF THE GREAT BRITISH CUPPA A study published in Nutrition Bulletin, has revealed that tea could be the top drink for great dental health, thanks to its fluoride content. The study measured fluoride levels in standardised cups made from 49 different tea bags including regular black tea, single estate, specialty and green tea. The results showed that fluoride levels ranged from 0.72 to 1.68mg per serving which provides a quarter to half of the European Recommended Daily Allowance for fluoride for a typical mug of tea. Tea is a natural source of fluoride as the tea plant absorbs fluoride present in the soil of tea-producing countries. The level of fluoride in tea leaves will depend on where the tea is grown, with countries such as Kenya, being particularly good for fluoride-rich soils. Author of the study, Dr Carrie Ruxton from the Tea Advisory Panel, said: Just four cups of regular black tea per day would provide all of the fluoride recommended for good dental health. Studies show that moderate amounts of fluoride help protect teeth from decay by strengthening the enamel. While we can get fluoride from toothpaste, a third of men and a quarter of women dont brush their teeth twice a day, which is the recommended frequency. Dental health remains poor in the UK, with decay affecting more than eight in ten adults and a third of primary 1 children. Each adult has an average of 7 fillings. As tea is the best natural source of fluoride, switching from a sugary drink to a cup of tea would be an easy way to protect your teeth. Tea may also freshen your breath as plant compounds in tea, called flavonoids, have been found to kill bacteria in the mouth, which cause unpleasant odours,. Research shows that half the flavonoids in the British diet comes from tea. While water fluoridation continues to attract controversy, tea is more acceptable to people as the nations favourite drink drunk by nearly three quarters of adults and a fifth of teenagers. Tea also provides the right balance of fluoride, as most tea drinkers would not reach levels, which exceed the safe upper limit of intake, defined in Europe as 7mg fluoride per day over the long term. As Dr Ruxton comments: Average intakes of tea in the UK are just over two servings daily according to national surveys. Increasing this to four cups, would be well within the safe upper limit for fluoride but above recommended levels, helping people to achieve optimal levels of fluoride and protect their teeth. Tea is a healthy choice for all children and young people over 5 years of age and would be a superior alternative to sugary drinks, especially if lots of milk, which boosts calcium intakes, is added to tea. Currently, up to 40% of the sugar in childrens diets comes from beverages. Switching to unsweetened tea would help improve this situation. -ENDS- Editors notes One mug (240ml) of black blended tea provides 1.18mg fluoride on average. The figure for single estate/speciality tea, which includes green tea, is lower at 0.72mg. Decaffeinated tea is the best provider of fluoride, at 1.68mg per mug. This is probably because decaffeinated tea contains stronger flavoured leaves, which have had more opportunity to take up fluoride from the soil. Brewing tea for longer boosts the fluoride content, according to research presented at the Nutrition Society earlier this year. -ENDS- SORTING FACT FROM FICTION: Fluoride in tea is good for you Current tea consumption is unlikely to provide fluoride intakes that exceed safe limits for adults and children according to a study  presented to the Nutrition Society by Dr Carrie Ruxton, independent public health nutritionist. Commenting on the research study, author and member of the Tea Advisory Panel (TAP), Dr Carrie Ruxton notes: Current tea intakes do not provide enough fluoride to meet the Recommended Daily Amount (RDA) for this mineral, and the potential dental health benefits of fluoride cannot be accessed unless tea consumption increases to 3-4 servings/day from the current intake of 1-2 servings a day. This latest study helps to put the record straight in the context of a 2013 study that measured the fluoride content of 38 tea bags and concluded that economy versions of tea represented a risk to dental and skeletal health.  These conclusions were somewhat surprising given that official bodies view fluoride as a means to deliver dental health benefits when recommended amounts are consumed. Public Health England (PHE), for example, is clear about the benefits of water fluoridation and recommends that the practice is extended. Dr Tim Bond from TAP adds: The 2013 study was also flawed in several respects. Firstly, tea was brewed for 2 minutes longer than the typical brewing time of 30-40 seconds. Secondly, 2g of dry tea were added to 100ml of water making the infusion more concentrated that a typical tea bag in a cup or mug. Thirdly, the study compared the fluoride intake with the US Dietary Reference Intake rather than the EU Safe Upper Level. This latest study replicated the situation of a typical cup or mug of tea in that a single tea bag was added to 240ml of boiling water and brewed for 40 seconds. Tea bags from 49 retail brands were analysed. Average fluoride content of black blended tea in this study was 4.91mg/litre and similar to the findings of the 2013 study. However, according to the 2014 NDNS figures, average tea consumption in the UK is 395ml daily and intakes at the safe upper level of intake are 1155ml daily. Fluoride intakes from tea (which is estimated to provide 70% of the UKs fluoride intake) will likely be lower than the safe upper level of 7mg daily (5mg in children) even among those people with intakes of tea at the higher end of the population. Moreover, this latest study shows that current average intakes of tea do not provide the RDA for fluoride suggesting that tea intake should increase to access the benefits of fluoride for dental health. -ends-  A typical serving of tea in the UK contains 240g of water added to 3.1g of tea.  European Food Safety Authority (2009) Scientific Opinion on the substantiation of health claims related to fluoride and maintenance of tooth mineralisation (ID 275, 276) and maintenance of bone (ID 371) pursuant to Article 13(1) of Regulation (EC) No 1924/20061. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). EFSA Journal, 7: 1212 (13 pages).  Ruxton CHS, Bond T. Fluoride content of UK retail tea: comparisons between tea bags and infusions. Proceedings of the Nutrition Society, 2014. In press.  Chan L et al. (2013) Human exposure assessment of fluoride from tea (Camellia sinensis L.): A UK based issue? Food Research International 51: 564-570.  Henderson L et al. (2002) National Diet and Nutrition Survey: adults aged 19 to 64 years. Types and Quantities of Foods Consumed. The Stationery Office: London.  Ruxton CHS, Bond T. Fluoride content of UK retail tea: comparisons between tea bags and infusions. Proceedings of the Nutrition Society, 2014. In press.  Jha SK et al. (2012) Fluoride in the environment and its metabolism in humans. Reviews of Environmental Contamination & Toxicology, 211: 121-42.  Araghizadeh A et al. (2013) Inhibitory Activity of Green Tea (Camellia sinensis) Extract on some clinically isolated cariogenic and periodontopathic bacteria. Medical Principles and Practice 22: 368-72.  Goenka P et al. (2013) Camellia sinensis (Tea): Implications and role in preventing dental decay. Pharmacogna Rev 7: 152-6  Ruxton CH & Hart VA (2011) Black tea is not significantly different from water in the 30 maintenance of normal hydration in human subjects: results from a randomised controlled 31 trial. Br J Nutr 106, 588-95.  Ruxton C & Bond T (2015) Fluoride content of retail tea bags and estimates of daily fluoride consumption from typical tea drinking in UK adults and children. Nutrition Bulletin; in press.   HYPERLINK "http://www.nationalsmilemonth.org/facts-figures/" www.nationalsmilemonth.org/facts-figures/   HYPERLINK "http://www.nationalsmilemonth.org/facts-figures/" www.nationalsmilemonth.org/facts-figures/  Zeng QC et al. (2010) The effect of green tea extraction the removal of sulfur-containing oral malodor volatiles in vitro and its potential application in chewing gum. Journal of Breath Research 4: 036005.  Narotzki B et al. (2012) Green tea: a promising natural product in oral health. Archives of Oral Biology 57: 42935.  From hydration review Zamora-Ros et al. 2013  Bates et al. (2014) National Diet and Nutrition Survey. London: FSA/PHE.  Ruxton CHS (2014). The suitability of caffeinated drinks for children: a systematic review of randomised controlled trials, observational studies and expert panel guidelines. Journal of Human Nutrition & Dietetics 27: 342-357.  Ruxton CHS, Bond TJ (2015) Fluoride content of UK retail tea: impact of brew time on teas of different value. Proceedings of the Nutrition Society Irish Section meeting; in press.  Ruxton, CHS and Bond T. Fluoride content of retail tea bags and estimates of daily fluoride consumption based on typical tea drinking habits in UK adults and children. Public Health Nutrition (in press)  Chan L, Mehra A & Saikat S (2013) Human exposure assessment of fluoride from tea (Camellia sinensis L.): A UK based issue? . Food Res Int 51, 564-570.     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l_PQ1 ESe/BB%VV` Ĭ.۬QP? v,l[lDDTDfNC%X'bǞ(JDhDʍBvQ2B¦Hܼ T,OB߱J'lĶ<+,ܵO퇏'W+條z m\ Ga =_Oؠ_|R̡D?c.يURf``````^8!l$l,KEi ? 99apRIf f ,mGP\ɓ+?k6AyH۳LIdtY6ʱn3b8PtDx!`k.F9v#eRe~㰿" 8WN-18 7_G+cEd4Fax>&ĸ)dr_L[7+Ea,?ɳ -+_B+972 )3000000p΄!)$lܾe\3]▢r5v }f0^EyHHٹ!B6,RAPGJ7bO^ Nƃ1:̉<{`uo]?IVbcv,6sL̏ ;(1lϘR4,޳?/۠f G(ikcb,,X/h7,1lyE.듒ւJKՈ0!hV×% nEu>lƑ FUU򎄡hp#^vgaDZJLv݆MґWq@9WBuPRqxvd`8VoWmGN JAI()? sJ>sl!~f,E*A뢰>.(z0yȮxaKD(-/Z:۴V88 mHB\k=eHLm᧐835ri E)DzR)W^ *dePrAN5EBv+tUUڜ{%/DZq.DY(+1v+U(T٦OVH.rW޹ə+I_"qz&4![HTHHZuWR5aX#!YRת%E, i*U=aJ:"';V/+}}M!bSe/Xure7>+)9`-)K978) C NP!Q6"#VbF;وKZ- Fj}+ƺ2bIW*G"?Ր-$c֛9r?[[T9e\BO[J4K[x/9Vf@!x5rj$ T9ZڔyMvx+q C Bx"#tlf8?'ppRHMVIENDB`H DGardener20134(4)4417Gardener, H.Rundek, T.Wright, C. B.Elkind, M. S.Sacco, R. L.Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA. hgardener@med.miami.eduCoffee and tea consumption are inversely associated with mortality in a multiethnic urban populationJ NutrThe Journal of nutritionJ NutrThe Journal of nutritionJ NutrThe Journal of nutrition1299-30814382013/06/21AgedAlcohol Drinking/mortalityBeveragesCitiesCoffeeDietEthnic GroupsFemaleFollow-Up StudiesHumansMaleMiddle AgedMortalityMultivariate AnalysisMyocardial Infarction/mortalityNeoplasms/mortalityProportional Hazards ModelsProspective StudiesRisk FactorsStroke/mortalitySurveys and QuestionnairesTeaUrban Population2013Aug1541-6100 (Electronic) 0022-3166 (Linking)23784068PMC370999410.3945/jn.112.173807NLMengH DGardener20134(4)4417Gardener, H.Rundek, T.Wright, C. B.Elkind, M. S.Sacco, R. L.Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA. hgardener@med.miami.eduCoffee and tea consumption are inversely associated with mortality in a multiethnic urban populationJ NutrThe Journal of nutritionJ NutrThe Journal of nutritionJ NutrThe Journal of nutrition1299-30814382013/06/21AgedAlcohol Drinking/mortalityBeveragesCitiesCoffeeDietEthnic GroupsFemaleFollow-Up StudiesHumansMaleMiddle AgedMortalityMultivariate AnalysisMyocardial Infarction/mortalityNeoplasms/mortalityProportional Hazards ModelsProspective StudiesRisk FactorsStroke/mortalitySurveys and QuestionnairesTeaUrban Population2013Aug1541-6100 (Electronic) 0022-3166 (Linking)23784068PMC370999410.3945/jn.112.173807NLMeng|DZhang20155(5)5517Zhang, C.Qin, Y. Y.Wei, X.Yu, F. F.Zhou, Y. H.He, J.Department of Neurosurgery, Shanghai Seventh People's Hospital, Shanghai, 200137, China.Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studiesEur J EpidemiolEuropean journal of epidemiologyEur J EpidemiolEuropean journal of epidemiologyEur J EpidemiolEuropean journal of epidemiology103-133022014/10/31Caffeine/adverse effectsCardiovascular Diseases/ mortalityCerebral HemorrhageCoronary Disease/mortalityFemaleHumansMortalityObservational Studies as TopicProspective StudiesRegression AnalysisRisk FactorsStroke/mortalityTea/ adverse effects2015Feb1573-7284 (Electronic) 0393-2990 (Linking)2535499010.1007/s10654-014-9960-xNLMeng|DZhang20155(5)5517Zhang, C.Qin, Y. Y.Wei, X.Yu, F. F.Zhou, Y. H.He, J.Department of Neurosurgery, Shanghai Seventh People's Hospital, Shanghai, 200137, China.Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studiesEur J EpidemiolEuropean journal of epidemiologyEur J EpidemiolEuropean journal of epidemiologyEur J EpidemiolEuropean journal of epidemiology103-133022014/10/31Caffeine/adverse effectsCardiovascular Diseases/ mortalityCerebral HemorrhageCoronary Disease/mortalityFemaleHumansMortalityObservational Studies as TopicProspective StudiesRegression AnalysisRisk FactorsStroke/mortalityTea/ adverse effects2015Feb1573-7284 (Electronic) 0393-2990 (Linking)2535499010.1007/s10654-014-9960-xNLMeng DShen20138(8)8817Shen, C. L.Chyu, M. C.Wang, J. 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M.Department of Endodontics, Faculty of Dentistry, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. abdolmehdi@gmail.comInhibitory activity of green tea (Camellia sinensis) extract on some clinically isolated cariogenic and periodontopathic bacteriaMed Princ PractMedical principles and practice : international journal of the Kuwait University, Health Science CentreMed Princ PractMedical principles and practice : international journal of the Kuwait University, Health Science CentreMed Princ PractMedical principles and practice : international journal of the Kuwait University, Health Science Centre368-722242013/03/15Aggregatibacter actinomycetemcomitans/ drug effectsCamellia sinensisDental Caries/microbiologyHumansMicrobial Sensitivity TestsPeriodontal Diseases/microbiologyPlant Extracts/ pharmacologyPorphyromonas gingivalis/ drug effectsPrevotella intermedia/ drug effectsStreptococcus mutans/ drug effects20131423-0151 (Electronic) 1011-7571 (Linking)2348565610.1159/000348299NLMengB DKoyama201045(38)454517Koyama, Y.Kuriyama, S.Aida, J.Sone, T.Nakaya, N.Ohmori-Matsuda, K.Hozawa, A.Tsuji, I.Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. a5mb1049-thk@umin.ac.jpAssociation between green tea consumption and tooth loss: cross-sectional results from the Ohsaki Cohort 2006 StudyPrev MedPreventive medicinePrev MedPreventive medicinePrev MedPreventive medicine173-95042010/01/30AdultCatechin/ pharmacologyConfidence IntervalsCross-Sectional StudiesDental Caries/ epidemiologyFemaleFood HabitsHumansJapan/epidemiologyLogistic ModelsMaleMiddle AgedMultivariate AnalysisNutrition SurveysOdds RatioRisk FactorsSelf AdministrationTeaTooth Loss/ epidemiology2010Apr1096-0260 (Electronic) 0091-7435 (Linking)2010948510.1016/j.ypmed.2010.01.010NLMengB DKoyama201045(38)454517Koyama, Y.Kuriyama, S.Aida, J.Sone, T.Nakaya, N.Ohmori-Matsuda, K.Hozawa, A.Tsuji, I.Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. a5mb1049-thk@umin.ac.jpAssociation between green tea consumption and tooth loss: cross-sectional results from the Ohsaki Cohort 2006 StudyPrev MedPreventive medicinePrev MedPreventive medicinePrev MedPreventive medicine173-95042010/01/30AdultCatechin/ pharmacologyConfidence IntervalsCross-Sectional StudiesDental Caries/ epidemiologyFemaleFood HabitsHumansJapan/epidemiologyLogistic ModelsMaleMiddle AgedMultivariate AnalysisNutrition SurveysOdds RatioRisk FactorsSelf AdministrationTeaTooth Loss/ epidemiology2010Apr1096-0260 (Electronic) 0091-7435 (Linking)2010948510.1016/j.ypmed.2010.01.010NLMengs666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666666866666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH H`HNormalCJ_HaJmHnHsH tH uDA D Default Paragraph FontVi@V 0 Table Normal :V 44 la (k ( 0No List \o\Body8B*CJOJPJQJ^J_HaJmHnHphsH tH u`o`Footnote4B*CJOJPJQJ_HaJmHnHphsH tH uH+@H Endnote TextCJOJPJQJaJ>*`!> Endnote ReferenceH*:B@2: Body Text CJOJQJ@&`A@ Footnote ReferenceH*XORXEndNote BibliographyOJQJaJsH 6U`a6  Hyperlink >*B*phT@rT Footnote Text dCJOJQJaJsH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. 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