[Original article date: April 2006, most recent revision 12/5/2008]
NOTE: This article is long and somewhat technical. The issues raised and discussed are, however, extremely important. I urge you to struggle (if necessary) through the article, and to bring questions into our consultation.
UPDATE OF 12/5/2008: I continually monitor the clinical results using supplemental iodine, and they remain extremely positive. I have had a small number of patients develop new thyroid problems while on iodine, and in most of the cases there is a family history of thyroid disease, and since there are large numbers of people who develop thyroid problems without being on iodine supplementation, I have no clear sense that iodine has actually provoked any issues. In a few cases, I don't have a clear explanation yet for what has happened, and I am sharing my experience with other physicians around the country who are also using supplemental iodine, in the hope of developing a greater understanding.
In summary, I think the following points are significant:
1. If, on supplemental iodine, there are positive changes in well-being, the dose that maintains that improvement is probably in the 1/2 to 1 tablet daily range, and after several months on iodine supplementation, most people would maintain that improvement for months to years even if they stopped supplementation;
2. There is probably always bromine detoxification when taking iodine (and fluorine, and probably also lead, mercury, arsenic, cadmium, and aluminum). Approximately 1/3rd of people on supplemental iodine have at least a mildly symptomatic bromine detoxification (one that requires a salt-load procedure to relieve the symptoms). These detoxifications should be beneficial, even if they are not accompanied by any symptoms. However, after some months, at least in the case of bromine, substantial detoxification should have taken place and will continue to take place even with a lower dose of iodine. Again, there is much about this that is yet to be precisely defined;
3. Research in breast cancer raises the possibility that Iodine supplementation MAY be beneficial, and if a person is at high risk, any such benefit would require higher (4-8 tablets daily) of iodine, and we would want to know that high levels of saturation have occurred (by doing the 24-hour urine iodine loading test). Much less is known about the effect of iodine in prostate cancer, but in the best-case scenario, where high iodine intakes in Japan are the ONLY reason that prostate cancer is so much less common, because of the relatively small numbers of prostate cancer (122 men per 100,000), we would have to treat 1000 men with iodine to prevent one cancer.
4. For the 1/3rd of people (including myself) who experience no subjective response to iodine supplementation, AND who start out with no significant fatigue or other difficulty, I think that it is likely that they are genetically well-adapted to a low intake of iodine, and high levels of supplementation are not necessary;
5. These are the considerations that I am presently using to make decisions as to dosage and general management. I am less inclined to do a lot of follow-up loading tests, and less inclined in general to maintain doses of 4 tablets per day for long periods of time.
If you have not already read the original article, please do so and then come back to these points (as they will then make more sense).
ORIGINAL ARTICLE:
Over the past several years, I've been struck by how common it is to see
hypothyroidism (low thyroid function), particularly in women. One source was
quoted (in 1996) as indicating that there are 1,490,371 adults and 205,159
children in this country with Hashimoto's thyroiditis, the most common form of
hypothyroidism (Rose and Mackay, 1998, The Autoimmune Diseases, Third Edition).
The American Women's Medical Association reports that 1 in every 4,000 babies
born in the
Synthetic thyroid hormones (far more often prescribed than products derived from animal thyroid) were the 7th most frequently drug prescribed in the United States in 2005 (data from the National Prescription Audit, link no longer active). In 2006, thyroid hormones were the 5th most commonly prescribed drugs by family practitioners (Family Practice News, Vol. 37 No. 16, 8/15/07).
In a study published this year, which measured iodine concentrations in breast milk, investigators concluded that "47% of the women sampled may have been providing insufficient iodine to meet infant's requirements." (Pearce, et. al., in Breast Milk Iodine and Perchlorate Concentrations in Lactating Boston-Area Women -- Journal of Clinical Endocrinology and Metabolism Vol. 92, No. 5, pg 1673-77, February 20, 2007).
Furthermore, hypothyroidism is thought by many to be very under-diagnosed by medical professionals.
In trying to understand all this, in December of 2005 I came across an article in Holistic Primary Care regarding iodine deficiency, and in particular the work of Guy Abraham, M.D. Most of his work can be found at the website of Optimox.com, following the link to iodine research. For those of you who are interested, I'd suggest reading publications 9 and 10, which are more general, and for the technically inclined, starting the other articles with numbers 5 and 2.
It is well known that iodine deficiency can cause goiter (thyroid enlargement) and hypothyroidism, and that children born to hypothyroid mothers are at risk for mental retardation and, in the extreme form, cretinism. In the developed world, deemed for the most part to be "iodine sufficient," the leading cause of hypothyroidism is said to be autoimmune disease, rather than iodine deficiency.
The data presented in the article in Holistic Primary Care made a lot
of sense to me, and certainly seemed plausibly related to the high
incidence of hypothyroidism that is experienced in this country. The
conventional view is that hypothyroidism in this country is primarily caused by
"auto-immune" thyroid inflammations, which are characterized by the
presence of antibodies against thyroid enzymes. Dr. Abraham hypothesizes
that iodine deficiency may lead to thyroid cell damage, leading to the
formation of antibodies against thyroid enzymes and thyroid tissues, thereby
beginning the auto-immune reaction. I am not aware of any proof to this
theory, but it is plausible. According to him, as of 20 years ago (the
most recent data we have) , auto-immune thyroid disorders were not nearly as
common in Japan as they are in this country. Antibodies to thyroid components
are much more common in the
The production of thyroid hormone inside the
cells of the thyroid requires, among other things, hydrogen peroxide.
Excess hydrogen peroxide (which if unused has a destructive effect) can be
broken down into diatomic oxygen (O2 ), by the enzyme glutathione
peroxidase, which in turn requires the mineral Selenium as a co-factor.
Selenium deficiency is thought to be fairly common in the
High levels of calcium relative to magnesium inside the thyroid and possibly other tissues (such as the female breast) promote excess production of H2O2 (above the level normally found) in the thyroid. Iodine above the RDA is necessary for organification of iodine into iodolipids which in turn tends to lower the production of H202 (in addition to their normal functions, which include inducing cell death in cancerous cells. Imbalances in these reactions may lead to damage of thyroid cells and the formation of antibodies to thyrogloblulin (the protein skeleton of thyroid hormone) and to thyroid peroxidase (the enzyme that “stitches” iodine into thyroglobulin to make thyroid hormone). These antibodies are markers of autoimmune thyroiditis (most notably Hashimoto’s disease, but are also found in Graves’ disease -- hyperthryoidism).
More importantly, however, were the purported links between iodine deficiency and cancers of the breast, prostate, and other sites, and the possibility that iodine deficiency was related to chronic digestive disorders (think of amount of television advertising for heartburn medicines), chronic sinusitis and other respiratory tract infections, autoimmune disease, diabetes, and many other illnesses.
The possible relationship between iodine deficiency, hypothyroidism, and breast cancer has been the subject of much research. The epidemiological and biochemical evidence to suggest these linkages is presented on the Optimox website. From that site's home page, click on the link to "iodine research" and read publication #2.
From that site, the following references are listed:
- Wiseman, R., Breast cancer hypothesis: a single cause for the majority of cases. J Epid Comm Health, 54:851-858, 2000.
- Finley, J.W., Bogardus, G.M., Breast cancer and thyroid disease. Quart. Rev. Surg. Obstet. Gynec. 17:139-147, 1960.
- Thomas, B.S., Bulbrook, R.D., Russell, M.J., et al, Thyroid function in early breast cancer. Enrop. J. Cancer clin, Oncol, 19:1213-1219, 1983.
- Thomas, B.S., Bulbrook, R.D., Goodman, M.J., Thyroid Function and the Incidence of Breast Cancer in Hawaiian, British and Japanese Women. Int. J. Cancer, 38:325-329, 1986.
- Smyth, P., Thyroid Disease and Breast Cancer, J. Endo. Int., 16:396-401, 1993.
- Eskin B., Bartuska D., Dunn M., Jacob G., Dratman M., Mammary Gland Dysplasia in Iodine Deficiency, JAMA, 200:115-119, 1967.
- Eskin, B., Iodine Metabolism
and Breast Cancer. Trans.
- Eskin B., Iodine and Mammary Cancer, Adv. Exp. Med. Biol., 91:293-304, 1977.
- Ghandrakant, C., Kapdim MD, Wolfe, J.N., Breast Cancer. Relationship to Thyroid Supplements for Hypothyroidism. JAMA, 238:1124, 1976.
- Backwinkel, K., Jackson, A.S., Some Features of Breast Cancer and Thyroid Deficiency. Cancer 17:1174-1176, 1964.
- Ghent, W., Eskin, B., Low, D., Hill, L., Iodine Replacement in Fibrocystic Disease of the Breast, Can. J. Surg., 36:453-460, 1993.
- Eskin, B., Grotkowski, C.E., Connolly, C.P., et al, Different Tissue Responses for Iodine and Iodide in Rat Thyroid and Mammary Glands. Biological Trace Element Research, 49:9-19, 1995.
While it cannot be conclusively stated at this time, at least, that there is a clear causal relationship between breast cancer and iodine deficiency, the epidemiological evidence is highly suggestive:
- Finley, J.W., Bogardus, G.M., Breast cancer and thyroid disease. Quart. Rev. Surg. Obstet. Gynec. 17:139-147, 1960.
- Thomas, B.S., Bulbrook, R.D., Russell, M.J., et al, Thyroid function in early breast cancer. Enrop. J. Cancer clin, Oncol, 19:1213-1219, 1983.
- Thomas, B.S., Bulbrook, R.D., Goodman, M.J., Thyroid Function and the Incidence of Breast Cancer in Hawaiian, British and Japanese Women. Int. J. Cancer, 38:325-329, 1986.
The possible therapeutic role of iodine in the clinical treatment of breast cancer is suggested by the following:
- Kato N, Funahashi H, Ando K, Takagi H. Suppressive effects of iodine preparations on proliferation of DMBA-induced breast cancer in rat. J Jpn Soc Cancer Ther. 1994;29:582–588.
- Funahashi H, Imai T, Tanaka Y, Tobinaga J, Wada M, Morita T, Yamada F, Tsukamura K, Oiwa M, Kikumori T, Narita T, Takagi H. Suppressive effect of iodine on DMBA-induced breast tumor growth in the rat. J Surgical Oncol. 1996;61:209–213.
- Funahashi, H., et. al. in Jpn. J. Cancer Res. 92, 483–487, May 2001: Does Seaweed Prevent Breast Cancer?
- Stoddard FR, Brooks AD, Eskin BA, Johannes GJ, Breast Cancer Cell Line: Evidence for an Anti-Estrogen Effect of Iodine International Journal of Medical Sciences 2008 5(4): 189 -196
In the second study by Funahashi and his co-workers, seaweed extract
exerted a strong protective effect in breast cancer prone rats, and also
induced apoptosis (cell death) in human breast cancer cells in tissue culture,
without causing any excess cell death in normal female breast tissue in tissue culture. This was also seen in the study by Stoddard et.al., available here.
Whatever is true of breast cancer is may also likely to be true for prostate
cancer, which is also rare in societies with high dietary intakes of iodine. In Japan, for instance, the incidence of prostate cancer 90% lower than in the United States.
Prostate cancer:
- Men with a diagnosis of thyroid cancer have a 31% increased risk of subsequently developing prostate cancer;
- Men with prostate cancer have a 21% increased risk of subsequently developing thryoid cancer; (British Journal of Cancer 117: 281-288; 2006)
- Japanese prostate cancer 12.6/100,000 vs. American
124.8/100,000. Japanese men that move away from
- NHANES (The National Health and Nutrition Examination Survey) 1 (1970) and Nutrition and Cancer 58(1): 28-34, 2007 indicate that the highest tertile (1/3rd) of the population (in terms of iodine intake) have a 29% reduced risk of developing prostate cancer;
- Hoption SA, et al; in Nutr. Cancer 58(1): 28-34, 2007, examined the relationship between iodine intake, thyroid disease, and prostate cancer;
- A history of thyroid disease confers a 2.34 X overall increased risk of developing prostate cancer;
- 10 years after thyroid disease, the prostate cancer risk increases 3.38 times.
If hypothyroidism may be due to Iodine deficiency, treating with thyroid hormone may alleviate the symptoms, but does not correct the underlying problem that leads to the disease. If, as is proposed by Dr. Abraham and others, that Iodine serves many other functions, then only giving thyroid hormone is obviously insufficient to treat the whole person.
Testing for iodine deficiency is primarily done through the urine. There are two tests involved:
- A first morning urinary
iodine level -- this test has been done around the world, for several
decades. The World Health Organization and UNICEF, in 1994,issued a joint
statement regarding iodine deficiency. Among the criteria for a country to
supplement the food supply with iodine is a median value (a number above
which is found 1/2 the population, with the other half below that number)
of 0.2 mg/liter. The main value of this test lies in two areas: firstly,
that there is a lot of data around the world to compare with, and
secondly, it is primarily a reflection of the amount of iodine consumed in
the 24 hours prior to collecting the sample.
In evaluating approximately 300 patients with a first morning urinary iodine measurement, over 90% test below this number!
For this reason, I no longer routinely order this part of the evaluation, which also then reduces the cost of the testing. - A 24 hour loading test -- after collecting the the first morning urine (only if you are also doing the spot test, which goes into the blue bottle - otherwise discard the first morning urine), 50 mg of iodine is ingested as a single dose, and the amount of iodine excreted is measured. All other things being equal, the more deficient the body, the greater the absorption (the lower the amount excreted). Unfortunately, owing to Bromine accumulation (see below), heavy metal toxicity, and perhaps other factors, some of us need iodine but don't utilize it effectively. This discrepancy is detected by the tests, and can be helped with a proper nutritional program.
As of this this date (9/29/2008), of the 363 patients I've been able to evaluate after at least 6-8 weeks of supplementation at full doses, 66.9% are unequivocally improved, another 15.7% feel better but I can't be sure that it is solely due to iodine, 13.2% have not noticed any change (most of whom already felt well, the rest with illnesses not expected to respond directly to iodine supplementation), and 3.3% were affected negatively and dropped out of treatment (from, I believe, toxicity of bromine and/or heavy metals, as these patients had pre-existing multiple chemical sensitivities). An additional 0.8% dropped out of treatment for various reasons (moving away, philosophical issues, etc.) Since the first 6 months of beginning the iodine program, and now that I know how to predict who will have trouble, no one has had to drop out for reasons of toxicity, although a approximately 20-30 people are on reduced iodine dosages in order to slow down the bromine detoxification). Three people are included in the "dropout" group who actually responded positively to iodine but for various reasons are no longer on the program.
Those who feel improved commonly report improvements in energy, mood, and clarity of mind. Other changes are improved thyroid function, improvement in premenstrual syndromes, menopausal syndromes, fibrocystic breast disease, fibromyalgia, male sexual function, and improved (more easily managed) stress reactions.
Obviously, these results are very gratifying. There are some problematic
issues, however:
-- I have found 8 confirmed cases of thyroid cancer in this group of patients.
Two other patients are pending surgical confirmation. Thyroid cancer is known
to be more common in the presence of iodine deficiency. For this reason, and
also to detect multinodular goiter, which can (slightly) predispose to mild
(and transient) hyper- or hypothyroidism while on iodine replacement therapy,
ultrasound of the thyroid is usually recommended.
-- I have also become aware of several patients with thyroid cancer, who have already had surgery and radioactive iodine treatment but whose cancers have persisted or relapsed being treated by other physicians, with Dr. Abraham's guidance. Doses of iodine in the range of 200 mg are being used in the context of a complete nutritional program and detoxification regimen, with extremely promising results. I will continue to follow this as well.
-- A few patients known to be hypothyroid, although feeling significantly better in their energy, clarity of thinking, and even beginning to lose weight (after previous failures to do so) have had changes in their thyroid test results suggesting that their thyroid dose is too low. I continue to follow these patients, and at least in one case the test results have substantially normalized.
-- One patient, known to be hypothyroid (and who also has chemical sensitivities) became hyperthyroid while on iodine supplementation. I am not sure at this time if this was related to iodine, or perhaps to bromine or fluorine toxicity. After stopping thyroid hormone and iodine supplementation she improved, but relapsed briefly but notably after taking a liquid multi-mineral supplement with a very small amount of iodine, fluorine, and bromine in it. This patient appears to be very sensitive to iodine intake, and after consulting with an endocrinologist, it is felt that she has both hypothyroidism and hyperthyroidism. This might have represented a "Jod-Basedow" effect, which can be related to toxic nodular goiter. However, an ultrasound done prior to instituting iodine treatment failed to demonstrate any nodules. She has antibodies typical of Graves' disease (and so apparently has two forms of auto-immune thyroiditis. This is rare, but is reported in the medical literature. As of this writing (10/21/2007) this is the only one of my patients using iodine supplementation to have shown this effect. Her hyperthyroidism quickly began to subside when iodine supplementation was stopped although it has not yet reached normal levels, and she is still being assessed.
-- (update of 11/20/2007): Another patient, with multinodular goiter,
but normal thyroid function, just came in with symptoms of
hyperthyroidism. I'd treated her with iodine at 50 mg doses for about a
year, with a 40% increase in her iodine saturation, but no subjective
changes. Two weeks after increasing the iodine dose to 75 milligrams
daily, she began to feel jittery and a rapid heart beat. Lab studies
confirm that she is hyperthyroid. Medical texts state that this is a rare
occurrence, that may occur in the setting of iodine deficiency and subsequent
replacement, and primarily in the elderly. I'll report further on this
case as I know more.
update as of 12/3/2007 -- she has also been found (by antibody
testing) to have Graves' disease (autoimmune hyperthyroidism). The other
possibility would have been that one of the pre-existing nodules had become
"autonomous" and overactive, which is a normal progression of
multinodular goiter.
-- In the early days of iodine supplementation of the nation's food supply (salt and bread), it was noted that a few people became hyperthyroid, consuming supplemental iodine. For this reason, it was considered safe to supplement at low doses, and not at higher doses. Before iodine was removed from commercial breads, one slice would contain 150 micrograms of iodine. Textbooks on thyroid disorders now note this to be a "rare" effect, mostly noted in the elderly with multiple thyroid nodules. It is still the consensus among medical experts that the benefits of iodine supplementation of the food supply for virtually everyone outweighs the small risk that a few individuals may become hyperthryoid.
Iodine-induced hyperthyroidism was reviewed by Stanbury (in Thyroid 1998 Jan;8(1):83-100) who noted that this seemed to occur in people with pre-existent multinodular goiter (which might be too small to be detected) or in people with Graves' disease who were too idoine deficient to over-produce thyroid hormone. Hyperthyroidism is treatable, but is a more dangerous condition in the elderly (owing to the strain on the heart).
-- bromine is an element close to iodine (in a chemical sense), and which is ubiquitous in our environment. Dietary sources include soft drinks like Dr. Pepper, Mountain Dew, and other citrus-flavored soft drinks (some Gatorade products), vegetables contaminated by the use of methyl bromide used as a fumigant in agriculture, and seaweeds (which, however, also containing iodine and large amounts of salt, and so are not problematic, assuming enough iodine in the system). Environmental sources include methyl bromides from the burning of unleaded gasoline (reduced now, but still very problematic) but mostly from the use of bromine in flame retardants, which are used in clothing, mattresses, building materials, airplane (and presumably automobile) construction, furniture construction, etc.
Bromine interferes with iodine biochemistry, and is toxic in its own right (psychological symptoms include disinhibition, self-neglect, fatigue, difficulty with memory and concentration, irritability, emotional instability, depression).
Iodine supplementation causes bromine to be released from within the tissues of the body, into the bloodstream, and if this happens rapidly and in sufficient quantities, produces toxic symptoms. This is treated with salt (the chloride ion flushes the bromine into the urine) and may necessitate the reduction of the iodine dosage. Potassium chloride can be used in place of ordinary salt (table salt, for example) in people who are salt-sensitive. Coping with bromine issues has necessitated intervention with salt in approximately 33% of patients. 96 out of 115 people (83% !) who have tried the "salt load" have felt better from doing so.
I am recognizing bromine toxicity symptoms much more commonly than I had, even several months ago, and now consider that this may be an extremely common toxicity.
-- fluorine, mercury, lead, and cadmium in the body are also potential sources of difficulty in managing iodine repletion programs, although evidently much less commonly than bromine.
-- another issue relates to the maintenance of iodine stores once iodine
levels have been replenished. The Japanese ingest approximately 43 mg of
Iodine, daily, on average, in their diets, primarily from kelp (see publication
#2 and 5 on the Optimox website).
Unfortunately, seaweeds concentrate heavy metals from polluted seawater, and so
the source of the seaweed is a critical issue. The inhabitants of
I currently (7/20/2008) think that for maintenance of the positive subjective responses to iodine, doses of 6 - 12.5 mg (1/2 to 1 tablet of iodoral) would probably be sufficient for most people. For the HYPOTHETICAL preventive effect of iodine on cancer (see next paragraph and below) higher doses (in the range of 50 - 100 mg/d) appear to be necessary.
-- Cancer rates, especially of the breast, are very low in
In the
That iodine is taken up by many other tissues in the body, besides the thyroid gland, is well documented in the medical literature. An interesting slide regarding this can be found in the slide show "Harmful and Healthy Halogens" on Dr. Miller's website www.donaldmiller.com. A good summary article by Dr. Miller can be found here.
I think that it is only fair to say that the issue of iodine sufficiency in the doses being recommended by Dr. Abraham and the other physicians using his recommendations is outside the conventional teaching of the medical community. These issues are all discussed on the Optimox website.
Epidemiological studies, such as the low incidence of breast cancer in
societies with high iodine intakes (eg.
It is also worth noting that no nutritional factor works in isolation. Other nutritional factors which strongly influence thyroid function and iodine biochemistry include Selenium, Magnesium, Iron, Vitamin A, Niacin (Vitamin B-3), and Riboflavin (vitamin B-2). This list should not be considered to be complete, however. A good nutritional program is important. By far the most important part of any nutritional program is adequate intake of healthy foods, grown in healthy soils.
The iodine supplementation program therefore rests on the basis of a "complete nutritional program." This, in turn, needs to be individualized in all cases, although the broad outlines pertain to most of us.
As a further consideration, it must be recognized that studying a single factor (Iodine, in this case), without taking into account the many confounding factors (bromine exposure, magnesium intake, other environmental toxins, etc.) can be expected to produce results which can at best be interpreted with caution.
I do not think, at this point (7/20/2008) that iodine supplementation will, in the short run, prevent the onset of auto-immune thyroid disease. That is to say that if the process of auto-immune thyroid disease has already begun (even if not detectable through symptoms and/or laboratory and imaging tests), iodine will probably not reverse the process. Selenium supplementation has been shown to reduce antibody levels in Hashimoto's disease, but not to return them to zero. It is theoretically possible that with early attention to adequate selenium levels, iodine levels, proper function of gluathione peroxidase systems, etc., a genetic tendency to Hashimoto's disease may be prevented.
The safety of Iodine -- in summary, there are situations in which iodine supplementation may cause problems:
-- Problems can occur in people who need to detoxify (bromine, fluorine, mercury, lead, cadmium, etc.). Some of the detoxification reactions are strong, especially in people with multiple chemical sensitivity syndromes;
-- There are also potential difficulties in people with pre-existing
thyroid disease: This includes multinodular goiter (as discussed above),
but also people with a past history of
Autoimmune hypothyroidism (Hashimoto’s
disease) was unknown in the
Iodine content of thyroid can be measured by X-ray Fluorescent scanning. A study was performed to evaluate the iodine content in individuals with and without autoimmune thyroid disease:
- Where no autoimmune disease was present, a mean value of 10 mg iodine/thyroid was found;
- In 56 individuals with autoimmune thyroiditis but normal thyroid function a mean of 4.7 mg iodine/thyroid was present;
- In 13 subjects with autoimmune thyroiditis and reduced thyroid function (hypothyroidism) only 2.3 mg iodine/thyroid was found.
This study therefore correlates low thyroid gland iodine content with the increasing severity of autoimmune hypothyroidism.
Reference: Okerlund, M., Medical Applications of Fluorescent Excitation Analysis, 1979, cited in Abraham, G., et al. The saliva/serum iodide ratio as an index of sodium/iodide symporter efficiency (see http://optimox.com/pics/Iodine/IOD-13/IOD_13.htm)
Also note that during the time that iodine
intakes (as measured by urinary iodine) in the
1935 – 1944: approximately 2/100,000
1945 –
1954: approximately 18/100,000
1955 -- 1967:
50/100,000
Iodine alone is not sufficient to "cause" autoimmune thyroid disease. The situation is, however, obviously complicated, and requires ongoing monitoring. There are goitrogens (substances that interfere with thyroid function) in the environment, and rarely, iodine supplementation may induce thyroid problems:
A study
performed in
-- I have recently (July 2008) seen two patients, who have noted good subjective benefit to iodine, go on to develop abnormalities in their thyroid tests after 18 months of supplementation. In one case there appears to be mild autoimmune hypothyroidism, and in the other the TSH level is suppressed, suggesting hyperthyroidism, although her thyroid hormone levels themselves are not elevated. This patient is currently under investigation.
Iodine conference report
I’ve presented my clinical experience with iodine supplementation twice in
2007 (
Some of the highlights of the information presented and what I learned in such discussions are:
- Guy Abraham MD, who is at the forefront of iodine research at this time, presented a several hour review of the history of use of iodine in medical practice, discussed the (apparently unfounded) aversion of medical authorities to more than very small doses of iodine, and presented information on many other issues related to the iodine project.
- He reminded us that the Japanese, who eat, on average 100 – 200 times as much iodine as we do, have much better health as a population than we do;
- He discussed and
refuted the recent
study from Denmark which purported to show an increased incidence of
hypothyroidism in
- The “increase” was of the order of 1 person in 10,000 persons supplemented;
- Toward the end of the several month study period, the incidence was actually dropping, which agrees with the experience that I and my colleagues have seen (a temporary increase in TSH [thyroid stimulating hormone] which normalizes after several months).
- We all agreed that the issue of bromine toxicity is widespread and is responsible for the great majority of the difficulties experienced by patients who are supplementing iodine in adequate dosages.
- It can take a good while to reduce the body burden of bromine. In one of the cases cited, the initial blood level was in the mid-200’s initially (normal is less than 12 mg/L).
- He felt a definite increase in energy and clarity of thinking on iodine supplementation, never needed to do a salt load for bromine detoxification reactions (presumably because he was already using a good amount of unrefined sea salt).
- His bromine level then stabilized in the range of 150 mg/L for 3-4 years, during which time he was unable to get the iodine saturation to go up significantly, despite taking 100 mg of Iodine daily.
- Recent measurement showed a level around 50 mg/L, a substantial decrease (but one that I have seen be symptomatic in my patients.)
- The persistence of bromine could be related to his high consumption of fruits and vegetables (if they are still fumigated with methyl bromide), or possibly to continued exposure to brominated flame retardants (an exposure that we all share), or some other factor or combinations of factors as yet not understood.
- It appears that there are no sources for accurate testing of bromide in body fluids other than Dr. Abraham’s laboratory, with whom I have collaborated, and FFP labs, who can, as of the last month, test urine bromides (which unfortunately are not a good indicator of total body burden.)
- There is an extensive body of research regarding bromine toxicity in the environmental literature.
- A series of studies in
- A strong relationship between bromide and thyroid disease was demonstrated by Allain (Allain, P., et al. Bromine and thyroid hormone activity. Clin Pathol 46;456-458, 1993 )
- Strong toxic effects on female rats and their offspring have been repeatedly demonstrated in research done by Stanislav Pavelka.
- Bromine readily crosses the placenta, and this must now be considered a potential issue for pregnant women (either on or off iodine).
- There is much more to the bromine story than I have time to present here. The good news is that it is not difficult to detoxify the body – it requires salt and water (see the "salt" article in Patient Education).
- The links between iodine deficiency and breast cancer was reviewed by more than one of the presenters. Bernard Eskin, M.D., a celebrated researcher in female endocrinology, who has specifically researched and elucidated iodine metabolism in the female breast, both in normal breast tissue and in breast cancer tissue, presented a review of his past and current work:
- He reviewed aspects of the link between thyroid disease and breast cancer (see Stoddard and Eskin, Iodine Alters Gene Expression Profile in the MCF-7 Breast Cancer Cell Line, Thyroid 2006;16(9):894).
- Although it is not definitively understood, he linked the anti-proliferative effect of iodine to the effect of iodine on estrogen receptors in the breast, a direct effect of iodine on cancer cells, as well as to other aspects of iodine metabolism;
- Recent advances in the study of estrogen receptors should, in the near future, improve our understanding of their role in breast cancer (approximately 80% of breast cancers are “positive” for estrogen receptors);
- As a footnote, many organic chemicals in the environment (most prominently from plastics) which migrate into the body, effect the estrogen receptors.
- Iodine will obviously not effect an estrogen receptor mechanism in those tumors which are estrogen receptor negative, although other mechanisms of iodine’s anti-cancer effect will presumably still play a role.
- Iodine does not effect the initiation of cancer, but rather inhibits its promotion (growth)
- He noted that a new study is underway to study the clinical effect of iodine in humans at risk for breast cancer. Apparently, because of disclosure rules, he was not able to share many details about the study.
- I did inquire about the dosages to be used. Unfortunately, it appears that the dose will be barely above the currently recommended minimum intake, and given the basic science that we already know, I consider it unlikely that the study will show any effect.
- The “silver lining in this cloud,” however, is that at very low doses, I don’t expect the researchers to find that the subjects intolerant to iodine (because of bromine toxicity, which I doubt has been considered in the study design).
- Dr. Abraham and Dr. Brownstein are currently engaged in a pilot study to further define iodine biochemistry, using saliva as the tested body fluid.
- The other clinicians presenting had independently arrived at the same conjecture that I’ve entertained: that if we didn’t have the apparently high levels of toxic bromine in the environment (and we should add to that list fluoride, mercury, lead, cadmium, etc.), if might not be necessary to take iodine at the levels that are being recommended in our practices.
- I picked up a number of practical tips at the conference, including the following:
- In patients with Hashimoto’s disease, it has been found to helpful to supplement Riboflavin (B-2) and Niacin (B-3) in higher doses than I have been recommending.
- People with Hashimoto’s disease (auto-immune hypothyroidism) may have very significant reductions in their antibody levels with iodine supplementation), but this is unlikely if the disease has been present for a long period of time. This is the impression of a couple of clinicians with longer experience than my own, but they were not able to quantify just what “early” or “late” actually is.
- Iodine should not be considered as a “sole” intervention. Considered solely from a nutritional standpoint, it is important to also look at the person’s general nutrition, and also to consider Selenium, Magnesium, B-vitamins (especially riboflavin and Niacin), Iron, vitamin C, possibly vitamin D, glutathione, etc.
- All the clinicians, including myself, confirm that in hypothyroid patients, the initial TSH rises, but returns to normal after several months. It is hypothesized that the TSH rises to facilitate the transport of Iodine into the cell (a known function of TSH).
- The use of unrefined sea salt, in adequate doses, appears to be important, as it includes the following health benefits:
- It tends to restore the acid-base balance (pH) of the body to a slightly alkaline state (which is normal). Most of our patients are noted to be overly acidic (which promotes osteoporosis, among other things). The pH of the body can be readily ascertained and monitored at home with commercially available pH strips or paper.
- It contains a large number of valuable trace elements which have been removed from commonly available “table salts;”
- The chloride in the salt is useful for bromine detoxification (along with adequate intake of water);
- People who eat a "healthy" diet and do not add salt may not be getting enough sodium. All this is covered in my article on salt.
- I currently estimate that in 1/3rd of the patients that I treat with iodine, special attention to bromine detoxification is necessary. But I think that we should all be using adequate amounts of good quality salt (and see Salt Your Way to Health, by David Brownstein, M.D.).
- An additional highlight was a presentation by Stephanie Buist, who described her long and and difficult saga with thyroid cancer, including 3 rounds of treatment with radioactive iodine, and how her health has changed since beginning therapy with iodine supplementation. Her story can be accessed at her blogsite.
I will make copies of the powerpoint presentations available in my waiting room for those of you that are interested.
