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Pregnant? Researchers want you to know something about fluoride

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Pregnant? Researchers want you to know something about fluoride

Adding fluoride to drinking water is widely considered a triumph of public health. The Centers for Disease Control and Prevention says the cavity-prevention strategy ranks alongside the development of vaccines and the recognition of tobacco’s dangers as signal achievements of the 20th century.

But new evidence from Los Angeles mothers and their preschool-age children suggests community water fluoridation may have a downside.

A study published Monday in JAMA Network Open links prenatal exposure to the mineral with an increased risk of neurobehavioral problems at age 3, including symptoms that characterize autism spectrum disorder. The association was seen among women who consumed fluoride in amounts that are considered typical in Los Angeles and across the country.

The findings do not show that drinking fluoridated water causes autism or any other behavioral conditions. Nor is it clear whether the relationship between fluoride exposure and the problems seen in the L.A.-area children — a cohort that is predominantly low-income and 80% Latino — would extend to other demographic groups.

However, the results are concerning enough that USC epidemiologist Tracy Bastain said she would advise pregnant people to avoid fluoridated water straight from the tap and drink filtered water instead.

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“This exposure can impact the developing fetus,” said Bastain, the study’s senior author. “Eliminating that from drinking water is probably a good practice.”

About 63% of Americans receive fluoridated water through their taps, including 73% of those served by community water systems, according to the CDC. In Los Angeles County, 62% of residents get fluoridated water, the Department of Public Health says.

The data analyzed by Bastain and her colleagues came from participants in an ongoing USC research project called Maternal and Developmental Risks from Environmental and Social Stressors, or MADRES. Women receiving prenatal care from clinics in Central and South Los Angeles that cater to low-income patients with Medi-Cal insurance were invited to join.

Between 2017 and 2020, 229 mothers took a test to measure the concentration of fluoride in their urine during their third trimester of pregnancy. Then, between 2020 and 2023, they completed a 99-question survey to assess their child’s behavior when their sons and daughters were 3 years old.

Among other things, the survey asked mothers whether their children were restless, hyperactive, impatient, clingy or accident-prone. It also asked about specific behaviors, such as resisting bedtime or sleeping alone, chewing on things that aren’t edible, holding their breath, and being overly concerned with neatness or cleanliness.

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Some of the questions the mothers answered addressed health problems with no obvious medical cause, including headaches, cramps, nausea and skin rashes.

Among the 229 children — 116 girls and 113 boys — 35 were found to have a collection of symptoms that put them in the clinical or borderline clinical range for inward-focused problems such as sadness, depression and anxiety. In addition, 23 were in the clinical or borderline clinical range for behaviors directed at others, such as shouting in a classroom or attacking other kids, and 32 were deemed at least borderline clinical for a combination of inward and outward problems.

What interested the researchers was whether there was any correlation between a child’s risk of having clinical or borderline clinical behavioral problems and the amount of fluoride in his or her mother’s urine during pregnancy.

They found that compared to women whose fluoride levels placed them at the 25th percentile — meaning 24% of women in the study had levels lower than theirs — women at the 75th percentile were 83% more likely to have their child score in the “clinical” or “borderline clinical” range for inward and outward problems combined. When the researchers narrowed their focus to children in the clinical range only, that risk increased to 84%, according to the study.

The researchers also found that the same increase in fluoride levels was associated with an 18.5% increase in a child’s symptoms related to autism spectrum disorder, as well as an 11.3% increase in symptoms of anxiety.

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The amount of fluoride needed for mothers to go from the 25th to the 75th percentile was 0.68 milligrams per liter. As it happens, that’s nearly identical to the 0.7 mg per liter standard that federal regulators say is optimal for preventing tooth decay.

Bastain said that allowed the researchers to compare what might happen to children in two parallel universes: a typical one where their mothers consumed fluoridated water during pregnancy, and an alternate one where they didn’t.

“You can use it as a proxy for if they lived in a fluoridated community or not,” she said.

What that thought experiment shows is that children in the fluoridated community face a higher level of risk. That said, it’s not clear when that risk becomes high enough to be worrisome.

“We don’t know what the safe threshold is,” Bastain said. “It’s not like you can say that as long as you’re under the 75th percentile, there are no effects.”

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The study authors’ concerns about the effects of fluoride on developing brains didn’t come out of nowhere.

The National Toxicology Program — a joint effort of the CDC, the National Institutes of Health, and the Food and Drug Administration — has been investigating the issue since 2016. In a report last year that reviewed an array of evidence from humans and laboratory animals, a working group concluded “with moderate confidence” that overall fluoride exposure at levels at or above 1.5 mg per liter “is consistently associated with lower IQ in children.”

The working group added that “more studies are needed to fully understand the potential for lower fluoride exposure to affect children’s IQ.”

A 2019 study of hundreds of mothers in Canada — where 39% of residents have fluoridated water — found that a 1-mg increase in daily fluoride intake during pregnancy was associated with a 3.7-point reduction in IQ scores in their 3- and 4-year-old children.

And among hundreds of pregnant women in Mexico, a 0.5-mg-per-liter increase in urinary fluoride went along with a 2.5-point drop in IQ scores for their 6- to 12-year-old children, researchers reported in 2017.

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Bastain and her colleagues write their study is the first they are aware of that examines the link between prenatal fluoride exposure and neurobehavioral outcomes in children in the United States. The results are sure to be controversial, Bastain said, but there’s a straightforward way for pregnant people to reduce the possible risk.

“It’s a pretty easy intervention to get one of those tabletop plastic pitchers” that filter out metals, she said. “Most of them do a pretty good job of filtering out fluoride.”

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49ers coach Kyle Shanahan shows performance-enhancing smelling salts aren’t just for players

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49ers coach Kyle Shanahan shows performance-enhancing smelling salts aren’t just for players

Football leans on tradition, providing convenient cover for the NFL’s lenient stance on smelling salts, ammonia crystals that players believe enhance performance when inhaled.

Does the olfactory exhilaration also enhance play-calling, amplifying one’s grasp of X’s and O’s?

Kyle Shanahan apparently believes so.

The San Francisco 49ers coach was caught by a Fox television camera moments before a playoff game Sunday against the Philadelphia Eagles taking several whiffs from a small packet before handing it to an assistant.

Earlier this season, the San Francisco Chronicle reported that 49ers players created a system to make sure everyone has immediate access to smelling salts during games. General manager John Lynch and Shanahan are users, according to the story, which stated that Shanahan “isn’t opposed to the occasional whiff.”

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Is the NFL OK with this? The answer is a qualified yes.

Ahead of the 2025 season, the league’s head, neck and spine committee recommended that teams end the longtime practice of providing smelling salts to players. The decision was prompted by a U.S. Food and Drug Administration warning about the potential side effects of inhaling ammonia, which include lung damage and masking signs of a concussion.

Players all but panicked. George Kittle, the 49ers All-Pro tight end, jumped on an NFL Network broadcast to proclaim that smelling salts were crucial to his performance.

“I’m a regular user of smelling salts, taking them for a boost of energy before every offensive drive,” he said. “We have got to figure out a middle ground here, guys. Somebody help me out.”

The NFL came to his rescue, saying smelling salts — also known as ammonia inhalants, or AIs — were not banned. Teams could no longer provide them, but players could bring their own. It’s a compromise that may or may not pass the smell test. Either way, it’s not just the 49ers using them.

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An ESPN Magazine piece in 2017 reported that “just a few minutes into the game, the Cowboys have discarded so many capsules that the area in front of their bench looks like the floor of a kid’s bedroom after trick-or-treating.”

Bottom line, legions of NFL players believe AIs enhance performance. They do so by irritating the linings of the nose and lungs, triggering a reflex that increases breathing rate and blood flow, fostering alertness.

Their effectiveness was discovered long before football was invented. Craft beer drinkers know Pliny the Elder as the inspiration for his namesake double IPA. The noted Roman naturalist and historian was indeed an early expert in fermentation, yet he also wrote about “sal ammoniac” — yes, smelling salts — in his encyclopedic work “Natural History,” published in 79 A.D.

Their popularity spread through Europe until, in Victorian tradition, they were used to rouse ladies after fainting spells. Later they were used in battle, with British medics supplying World War II soldiers with a whiff of the substance that doctors say triggers the body’s “fight-or-flight” response.

These days, the Federal Aviation Administration requires that U.S. airlines carry smelling salts onboard in case a pilot needs to be awakened after fainting. Blocking and tackling on a flight, however, remains strictly forbidden.

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The NFL’s middling position isn’t curious. Experts say it’s an attempt to reduce liability in case of concussions or other medical complications. But it is their constant use that concerns doctors.

“The use of smelling salts in sports is definitely not their intended use,” Dr. Laura Boxley, a neuropsychologist at Ohio State’s Wexner Medical Center, told NPR. “What’s happening with some athletes is they’re using them with much higher frequency than their intended use.”

Given the relative safety of the sidelines, Shanahan isn’t in danger of a brain-rattling concussion. Shortly after the NFL ceased supplying AIs, he was asked by a reporter whether he had concerns about their prevalence.

“I mean, I don’t,” Shanahan replied with a grin. “If someone gives me one, I’ll take a smell of the salt. I’m not too worried about it. I like to take one to wake myself up and lock myself in.”

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AI windfall helps California narrow projected $3-billion budget deficit

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AI windfall helps California narrow projected -billion budget deficit
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California and its state-funded programs are heading into a period of volatile fiscal uncertainty, driven largely by events in Washington and on Wall Street.

Gov. Gavin Newsom’s budget chief warned Friday that surging revenues tied to the artificial intelligence boom are being offset by rising costs and federal funding cuts. The result: a projected $3-billion state deficit for the next fiscal year despite no major new spending initiatives.

The Newsom administration on Friday released its proposed $348.9-billion budget for the fiscal year that begins July 1, formally launching negotiations with the Legislature over spending priorities and policy goals.

“This budget reflects both confidence and caution,” Newsom said in a statement. “California’s economy is strong, revenues are outperforming expectations, and our fiscal position is stable because of years of prudent fiscal management — but we remain disciplined and focused on sustaining progress, not overextending it.”

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Newsom’s proposed budget did not include funding to backfill the massive cuts to Medicaid and other public assistance programs by President Trump and the Republican-led Congress, changes expected to lead to millions of low-income Californians losing healthcare coverage and other benefits.

“If the state doesn’t step up, communities across California will crumble,” California State Assn. of Counties Chief Executive Graham Knaus said in a statement.

The governor is expected to revise the plan in May using updated revenue projections after the income tax filing deadline, with lawmakers required to approve a final budget by June 15.

Newsom did not attend the budget presentation Friday, which was out of the ordinary, instead opting to have California Director of Finance Joe Stephenshaw field questions about the governor’s spending plan.

“Without having significant increases of spending, there also are no significant reductions or cuts to programs in the budget,” Stephenshaw said, noting that the proposal is a work in progress.

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California has an unusually volatile revenue system — one that relies heavily on personal income taxes from high-earning residents whose capital gains rise and fall sharply with the stock market.

Entering state budget negotiations, many expected to see significant belt tightening after the nonpartisan Legislative Analyst’s Office warned in November that California faces a nearly $18-billion budget shortfall. The governor’s office and Department of Finance do not always agree, or use the LAO’s estimates.

On Friday, the Newsom administration said it is projecting a much smaller deficit — about $3 billion — after assuming higher revenues over the next three fiscal years than were forecast last year. The gap between the governor’s estimate and the LAO’s projection largely reflects differing assumptions about risk: The LAO factored in the possibility of a major stock market downturn.

“We do not do that,” Stephenshaw said.

Among the key areas in the budget:

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California confirms first measles case for 2026 in San Mateo County as vaccination debates continue

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California confirms first measles case for 2026 in San Mateo County as vaccination debates continue

Barely more than a week into the new year, the California Department of Public Health confirmed its first measles case of 2026.

The diagnosis came from San Mateo County, where an unvaccinated adult likely contracted the virus from recent international travel, according to Preston Merchant, a San Mateo County Health spokesperson.

Measles is one of the most infectious viruses in the world, and can remain in the air for two hours after an infected person leaves, according to the CDPH. Although the U.S. announced it had eliminated measles in 2000, meaning there had been no reported infections of the disease in 12 months, measles have since returned.

Last year, the U.S. reported about 2,000 cases, the highest reported count since 1992, according to CDC data.

“Right now, our best strategy to avoid spread is contact tracing, so reaching out to everybody that came in contact with this person,” Merchant said. “So far, they have no reported symptoms. We’re assuming that this is the first [California] measles case of the year.”

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San Mateo County also reported an unvaccinated child’s death from influenza this week.

Across the country, measles outbreaks are spreading. Today, the South Carolina State Department of Public Health confirmed the state’s outbreak had reached 310 cases. The number has been steadily rising since an initial infection in July spread across the state and is now reported to be connected with infections in North Carolina and Washington.

Similarly to San Mateo’s case, the first reported infection in South Carolina came from an unvaccinated person who was exposed to measles while traveling internationally.

At the border of Utah and Arizona, a separate measles outbreak has reached 390 cases, stemming from schools and pediatric centers, according to the Utah Department of Health and Human Services.

Canada, another long-standing “measles-free” nation, lost ground in its battle with measles in November. The Public Health Agency of Canada announced that the nation is battling a “large, multi-jurisdictional” measles outbreak that began in October 2024.

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If American measles cases follow last year’s pattern, the United States is facing losing its measles elimination status next.

For a country to lose measles-free status, reported outbreaks must be of the same locally spread strain, as was the case in Canada. As many cases in the United States were initially connected to international travel, the U.S. has been able to hold on to the status. However, as outbreaks with American-origin cases continue, this pattern could lead the Pan American Health Organization to change the country’s status.

In the first year of the Trump administration, officials led by Health Secretary Robert F. Kennedy Jr. have promoted lowering vaccine mandates and reducing funding for health research.

In December, Trump’s presidential memorandum led to this week’s reduced recommended childhood vaccines; in June, Kennedy fired an entire CDC vaccine advisory committee, replacing members with multiple vaccine skeptics.

Experts are concerned that recent debates over vaccine mandates in the White House will shake the public’s confidence in the effectiveness of vaccines.

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“Viruses and bacteria that were under control are being set free on our most vulnerable,” Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health, said to The Times.

According to the CDPH, the measles vaccine provides 97% protection against measles in two doses.

Common symptoms of measles include cough, runny nose, pink eye and rash. The virus is spread through breathing, coughing or talking, according to the CDPH.

Measles often leads to hospitalization and, for some, can be fatal.

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