How Do You Ingest Iodine?

• Trace element, not very common in most foods • Ocean foods • Cod, sea bass, haddock, perch • Sea Vegetables such as seaweed • Can be found in food products if iodine is added to animal feed or the food source • Salt Iodized Salt

• 1831 J.G. Boussingault proposed iodized salt to prevent goiter • 1920’s iodization of salt implemented in the U.S. to prevent goiter • The use of iodized salt has declined

Iodized Salt

• Potassium iodide • 74g iodide/gram of salt • Cost effective way to prevent goiter • Effective tool to decrease the presence of goiter • Inadequate to provide the body’s need for iodine • 53% off all salt sales in the U.S. is from iodized salt

Nutrients. 2015 Mar 10;7(3):1691-5. doi: 10.3390/nu7031691 Iodized Salt: Low Bioavailabilty

• 2 Groups • Group 1: Iodized salt • Group 2: Iodized bread • ≈750µg/day iodide in both groups

Expected result: 17.2µg/L (Serum)

Pittman NEJM 1969; 280:1431 Iodized Salt: Low Bioavailability

18 16 14 12 10 Expected 8 6 4 2 0 Serum Levels (mcg/L)

Pittman NEJM 1969; 280:1431 Abraham, G. 2004 Iodized Salt: Low Bioavailability

20 18 16 14 12 Expected 10 Bread 8 6 4 2 0 Serum Levels (mcg/L)

Pittman NEJM 1969; 280:1431 Abraham, G. 2004 Iodized Salt: Low Bioavailability

20 18 16 14 12 Expected 10 Bread 8 Salt 6 4 2 0 Serum Levels (mcg/L) Only 10% of iodine in salt is bioavailable

Is this because of competitive inhibition by chloride in salt?

So, who would still recommend iodized table salt?

Pittman NEJM 1969; 280:1431 Abraham, G. 2004

National Health and Nutrition Survey

• 1971-2012 NHANES showed iodine levels 35

declined 50% in the 30

United States µg/dl 25 20 NHANES I 1971-4 NHANES 2012 15

Urinary iodine levels levels iodine Urinary 5

0 1970 2012

http://www.cdc.gov/nutritionreport/pdf/Nutrition_Book_complete 508_final.pdf#zoom=100 Center for Holistic Medicine

• 94.7% of patients tested had significantly low iodine levels • First 250 patients FIGURE 1: IODINE EXCRETION IN 24 PATIENTS: 92% DEFICIENT

% Iodine Excreted 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Patient Number Iodine Excretion/24 Hours

45 40 35 30 25 20

15 Mg iodine/24 Mgiodine/24 hours excreted 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Patient Number Iodine Deficiency: CHM

• Over 6,000 patients tested Results: 96.4% have tested low via urine or serum testing.

Why the Soil is Deficient in Iodine

• More inland and mountainous areas • Midwestern United States • Great Lakes Basin • Michigan, Ohio, Indiana, Wisconsin • Soil Erosion • Glaciers • Deforestation • Poor farming techniques • Pollution • Pesticides and insecticides • Bromide, fluoride and chlorine • National/worldwide problem

Iodine in Food Food g iodine/serving Ready to eat Cereal 87 Dairy-based desert 70 Fish 57 Milk 56 Overall diary products 49 Eggs 12 Bread 27 Beans, peas, tuber 17 Meat 16

Poultry 15 J Food Comp Anal. 1995;8:171-217 Seaweed (1/4 ounce, dried) Variable-may be >4.5mg Why Are People Deficient in Iodine?

• Stigma of using salt • Hypertension • <50% of U.S. households use iodized salt • Radioactive iodine use in medicine • Exacerbate an iodine-deficient state • Chemical exposures: Goitrogens • Bromine, Chlorine and Fluoride (fluorine) • Drugs • Fluoride, bromide • Competitively inhibit iodine binding as well as decrease iodine uptake • Nitrate, perchlorate, thiocyanate • Competitive inhibitors of iodine at NIS • Declining mineral levels • Soil erosion, poor farming techniques, etc. • Diet.

Dietary Reasons for Iodine Deficiency

• Diets without ocean fish or sea vegetables • Inadequate use of iodized salt including low sodium diets • Vegan and vegetarian diets • Bromine in food and drink • Brominated vegetable oils • Some Gatorade products, Mountain Dew and other soft drinks • Bakery products • Bread, pasta, cereal, etc. • Contain bromine What Happened to Bakery Products?

• 1960’s iodine was added to bakery products as a conditioning agent • 1 slice of bread contained the RDA for iodine: 150µg • In the 1970’s, bromine was substituted for iodine due to misinformation about iodine What did this substitution do?

Bromine for Iodine: Double Wammy!!

1. Worsened an iodine-deficiency problem already present in the United States 2. Competitively inhibited iodine in the body by adding a goitrogen (bromine) to bakery products This could be the most asinine act (amongst many) in the history of the food industry. “Stupid is as stupid does.” Bromine

• Toxic substance with no known value in the body • Family of halides • Iodine, fluorine, chlorine • All halides compete with one another • Absorption • Receptor binding • Bromine interferes with iodine utilization in the thyroid as well as other areas of the body • Goitrogen • Breast, prostate, etc.

Halogens

MW • Fluorine (Fluoride) 19 • Chlorine (Chloride) 36 • Bromine (Bromide) 80 • Iodine (Iodide) 127 • Astatine (Astatide) 210

Fluorine Chlorine Bromine Iodine Halogens

MW • Fluorine (Fluoride) 19 • Chlorine (Chloride) 36 • Bromine (Bromide) 80 • Iodine (Iodide) 127 • Astatine (Astatide) 210

Bromine

• Animal studies show that bromine intake can adversely affect the accumulation of iodine in the thyroid and the skin • High bromide intake results in iodine being eliminated from the thyroid gland and replaced by bromine • Ingestion of bromine has been shown to cause hypothyroidism in animals

When iodine deficiency is present, the toxicity of bromine is accelerated in the body. Bromine

• Antibacterial agent for pools and hot tubs • Fumigant for agriculture • Sprayed on fruit and vegetables • Crops found to contain high bromine levels • Fumigant for termites and other pests • 1981: 6.3 million pounds bromide sprayed in California • 1991: 18.7 million pounds bromide sprayed in California.

Iodine Transport

To achieve the maximum transport of iodine ≈600µg/day across the cell membrane, there must be sufficient iodine in the serum:

≈10-5-10-6 M

These numbers are impossible to reach at the RDA (150µg/day) for iodine! However, 50mg/day iodine/iodide can reach a 10-5 M! How Much Iodine Stored In The Body?

• Thyroid: ≈50mg/day • Breasts: Minimum of 5mg/day(50kg or 110# woman) for maintenance of normal breast tissue • Larger woman or woman with larger breasts will have increased requirement • Men have smaller breasts and a lower iodine requirement • Other glandular tissue: Minimum of 2mg/day • Adrenals, thymus, ovaries, hypothalamus, pituitary and others. Where is Iodine Found in the Body?

• Every cell in the body contains and utilizes iodine • WBC’s cannot effectively guard against infection without adequate amounts of iodine • Concentrated in the glandular system • Thyroid gland contains the largest amount of iodine • Breasts, ovaries, salivary glands, parotid glands, pancreas, cerebrospinal fluid, brain, stomach, skin, lacrimal glands, etc. How To Check Iodine Levels

• Blood levels • Saliva • Saliva/serum • Skin testing • Rub iodine on skin and observe for its’ disappearance • Inaccurate measure of body’s iodine status • Approx. 88% of I evaporates from skin • J. Pharm. Exp. Therap. 1932;45:85-107 • Urinary excretion • Accepted measure • Iodine loading test

Iodine Loading Test

• Hakala Lab • www.hakalalab.com • Doctor’s Data

Spot Iodine Testing

• Only check spot test if NOT supplementing with iodine • Iodine excretion: • <100µg/L moderate to severe • <50µg/L severe deficiency Transport of Iodine (1)

• Iodine present in every cell in the body • Many different glands and cells concentrate iodine against gradient • Na/I symporter • Transports iodide at a concentration gradient 20- 50 times that of plasma One iodine atom is transferred into cell with two atoms of sodium transported inside of cell.

Angewandte Chm. Int. Ed. 2011. 50 p. 11610 Defects in Iodine Retention System

• Normal gastrointestinal absorption of iodine • Defective iodine retention system • Na/I symporter defect (or Pendrin defect) • Congenital Defect • Rare • Oxidative damage • Fluoride or perchlorate • Treat with antioxidants • Inhibition of symporter iodide uptake by competition • Goitrogen binding to receptor • Iodide can overcome competitive inhibition

Iodine loading test will come back >90% excretion! How to Spot Defects in Iodine Retention System

• Non-responders to iodine supplementation • Adverse effects to orthoiodosupplementation • Very high iodide excretion on iodine loading test (>90% excretion on first test) when not expected • Adverse effects to first iodine dose taken • Palpitations, metallic taste in mouth, etc.

Treatment of Defective Retention System

• Defective iodine retention system • Na/I symporter defect • Genetic defect: ? • Oxidative damage: Antioxidant • Goitrogen binding to receptor: Detoxification and Competitive Inhibition • Iodine • Salt

Deni

Serum inorganic iodide levels (mg/L) 30 35 0.5 1.5 2.5 0 1 2 3 Fig. 1

v Pre

the iodine retention mechanism. her basal serum inorganic iodide level was very low at 0.016 m/L. This pattern suggests defecta in subjects; and in patient a with iodide transport defect. Patient excreted 90% of the iodine load, but Serum profile of inorganic iodide levels following the iodine/iodide load (50 mg) in 6 normal female 0.5 1 2 Time ingestion IodoralPost of 3 4

5 = with Grave’sPatient Disease = of6normal female Mean subjects – –

Baseline Baseline serumiodide = 0.016 mg/L %iodide load excreted = 90% Prior intervention to 6 7  8

50 mg 50 load 9

11 12

24 hrs

250 24 hr urine bromide level = 192 mg 200

150

100

0 0 1 2 4 6 8.5 11 hrs Serum inorganic bromide levels (mg/L) levels bromide inorganic Serum Time post ingestion of Iodoral 50 mg load function of the iodine cellular transport mechanism. cellulartransport iodine the of function 2 Fig. Serum inorganic iodide levels (mg/L)

0.5 1.5 2.5 sustained release sustained Vitamin 3 C at a with intervention of 5years following defect transport iodide with patient and a in subjects; female normal 6 in mg) (50 load iodine/iodide the following levels iodide of inorganic profileSerum 0 1 2 3 v Pre

0.5 1 Time Post ingestion of Iodoral 2 3 gm /day. Her serum level was 0.42 mg/L, evidence of improved of /day. evidence 0.42 mg/L,was Herlevel serum 4

5 = Mean of 6 normal female subjects = Patient with iodide transport defect – –

Post Post 3 months Vitamin 3g/day C Baseline serum iodide = 0.42 0.42 mg/L= iodide serum Baseline 49.2% excreted= load iodide % 6 7  8

50 50 mg load 9 10

24 hrs

Denni: 5 Years Later

• Feeling better with unrefined salt and vitamin C • Euthyroid • TPO titers: WNL • Agreed to do another loading test (7.26.11) Serum inorganic iodide levels (mg/L) 30 35 0.5 1.5 2.5 0 1 2 3 Fig. 1

v Pre

5 years years later = with Grave’sPatient Disease 5 = of6normal female Mean subjects – – 6

Baseline Baseline serumiodide = 0.016 mg/L %iodide load excreted = 90% 7



50 mg 50 load 9 10

24 hrs

Denni: 5 Years Later

250

200

150 2005

100 2011 Level (mg/L)Level

50 Serum Inorganic Bromide Bromide Inorganic Serum

0 0 1 2 4 6 8 24 Time Post Ingestion of Iodoral® 50mg Load Denni: 2014

• Feeling well for six months • No Antithyroid medications • Agreed to do another loading test Serum inorganic iodide levels (mg/L) 30 35 0.5 1.5 2.5 0 1 2 3 Fig. 1

v Pre

5 years years later = with Grave’sPatient Disease 5 = of6normal female Mean subjects

– – 6

Baseline Baseline serumiodide = 0.016 mg/L %iodide load excreted = 90% 7

 8

50 mg 50 load 9 10

24 hrs

Denni: 2014

250

200

150 2005 2011

100 2014 Level (mg/L)Level

50 Serum Inorganic Bromide Bromide Inorganic Serum

0 0 1 2 4 6 8 24 Time Post Ingestion of Iodoral® 50mg Load Iodine Transport Problems

• When problems develop with iodine use, think detoxification • Vitamin C • Salt • Water • Liver and kidney support • Exercise • Clean Diet In Thyroid, What Happens to Iodine After Absorption?

NIS Oxidation (H202+ TPO) - - I I I2 Organification

100x RDA TG RDA TSH δ –Iodolactone and MIT, DIT, T3, T4 other iodinated lipids However, organification of lipids will only occur with iodine intake in excess of the RDA.

Horm. Metab. Res. 1994;26:465 Iodolactone

TPO Iodine + arachidonic acid δ-iodolactone

δ-iodolactone is a key regulator of apoptosis and cellular proliferation in the thyroid. δ-iodolactone is not detected in human tissue when iodine deficiency is present, but is present with iodine administration at 100x the RDA.

Eur. J. of Endocrin. 132. 735-43, 1995 Horm. Metab. Res. 26. 465-69. 1994 Organified Iodine

• Regulates the cell cycle in thyroid gland by inducing apoptosis

G0,1: growth and preparation of the chromosomes for replication S:synthesis of DNA G2: Preparation for Mitosis (G1 and G2)

Endocrinolgy. 1993;133:2881-2888 In Thyroid, What Happens to Iodine After Absorption?(2)

NADPH-Oxydase System

Calcium Iodinated Lipids

NIS Oxidation (H202+ TPO) - - I I I2 Organification TG TSH δ -Iodolactone MIT, DIT, T3, T4

Basolateral membrane In Thyroid, What May Happen If Iodine Levels Are Too Low?

Early

NADPH-Oxydase System

Calcium Iodinated Lipids

NIS Oxidation H202+ TPO - - I I I2 Organification Anti TPO TG TSH Anti TG δ -Iodolactone MIT, DIT, T3, T4

Apical membrane Treatment: Iodine, Magnesium, B2 and B3, Selenium, Vitamin C, as well as Antioxidants How to Dose Iodine

• Use a combination of iodine/iodide • Lugol’s Solution • 1 drop: 6.25mg (2.5mg iodine /4mg iodide) • Tableted Lugol’s • 1 tablet: 12.5mg (5mg iodine/7.5mg iodide)

Therapeutic doses of iodine/iodide combinations vary between 12.5-50mg/day.

How Much Iodine Should You Take?

• When there is iodine sufficiency, there is little (or no) radioactive iodine uptake by the thyroid gland

How much iodine is required to achieve sufficiency? How Much Iodine Should You Take?

• Thyroid • 3-5mg I/day decreased absorption of radioactive iodine by thyroid below 5%

Saxena. Science. 138:430-31. 1962 How Much Iodine Should You Take?

Amt. Iodide Ingested % Uptake Radioactive (12 days) Iodide by Thyroid 10mg 4% 15mg 1.9% 30mg 1.6% 50mg 1.2% 100mg 0.6%

Sternthal. N. .Eng. J. Med. 303:1083-1080. 1980

Iodine Dosage Guidelines

• RDA is 150g/day • RDA is inadequate to supply the body’s need • Dosage must be individualized • Use a combination of iodine and iodide • Iodozyme HP Biotics: 800.437.1298 • Appropriate testing pre and post

Medical Iodophobia

“Medical iodophobia is the unwarranted fear of using and recommending inorganic, non- radioactive iodine/iodide within the range known from the collective experience of three generations of clinicians to be the safest and most effective amounts for treating symptoms and signs of iodine/iodide deficiency (12.5- 50mg/day).”

Dr. G. Abraham, 2004 Final Thoughts

• Iodine deficiency is common • Not rectified by the use of iodized salt • Iodine deficiency may be the underlying cause of autoimmune thyroid disorders • Using a combination of iodine/iodide more effective than using iodide alone • Best results achieved with a holistic approach • Vitamins and minerals, diet, detoxification, hormone-balancing, etc. • Magnesium supplementation • Electrolyte supplementation Final Thoughts (2)

• Impossible to balance the hormonal system without iodine sufficiency • Thyroid and adrenals • Whole body iodine sufficiency generally requires higher doses of iodine/iodide combinations • 12-50mg/day

Iodine Adverse Effects

• “Acute iodine poisoning is rare and usually occurs only with doses of many grams. Symptoms of acute iodine poisoning include burning of the mouth, throat, and stomach, fever, nausea, vomiting, diarrhea, a weak pulse, cyanosis, and coma.”

Present Knowledge in Nutrition. 10th ed: John Wiley & Sons; 2012:554-567 Iodine Adverse Effects

Allergy • Rare • Radioactive iodine allergy not a cause of allergy to inorganic, non-radioactive iodine • NAET very effective. NAET

• Clear both iodine and iodide • May need to clear in combination with endocrine glands • Clear toxic halogens with NAET • Bromine, Fluoride and Chlorine

For more information on NAET go to: naet.com Iodine Adverse Effects

Autoimmune Thyroid Disease • Iodine was treatment of choice for autoimmune thyroid disease before onset of radioactive iodine • Effective treatment dates back over 100 years • Iodine levels have fallen over 50% in last 40 years • Autoimmune thyroid illness has increased at rapid rate during same time

Iodine Adverse Effects

Detoxification Reactions • Iodine is a detoxifying agent for body • Bromine, Chlorine, Fluoride, Mercury and other metals • Can overload the body’s detoxification mechanisms • Proper nutritional support • Raise pH • Healthy diet • Water, salt, etc. • Liver support

Iodine Adverse Effects

Iodine-Induced Hypothyroidism and Goiter • Hokkaido, Japan • 1960 increased rate of goiter • 1987 found no increase rate of goiter • In patients given from 1.5-150mg daily of iodine transient decrease (24-40 hours) in thyroid hormone production noted * • Thyroid levels quickly adjust

*Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 2001 Iodine Adverse Effects

Iodine-induced hyperthyroidism • Hyperfunctioning autonomous nodules • Nodule may become hyperfunctioning with iodine replacement • Very rare possibility

Iodine Adverse Effects

Iodism • Metallic taste in mouth • Increased salivation • Sneezing • Coryza • Frontal sinus headache • Acne Rare. Personal experience shows iodism occurs in approximately 1- 3% of patients. Easily rectified by using minerals and electrolytes or lowering dose. NAET also effective. Iodine Adverse Effects

Thyroid Cancer • 1% of all cancers in U.S. • Women 3:1 • Iodine levels have fallen 50% over the last 40 years • Thyroid cancer has significantly increased during the last 40 years • From 1993-2002, thyroid cancer increased 2.4x in the U.S. • FP News. 4.1.07 • Radiation exposure increases risk • Iodine is prophylactic agent against radiation exposure when iodine is sufficient in thyroid gland • Chernobyl Iodine Adverse Effects

• Iodine may decrease the anticoagulant effect of warfarin.

Medicine (Baltimore). 2004 Mar;83(2):107-13 How to Minimize Adverse Effects

• Use adequate vitamins and minerals • Magnesium • Cytosolic free calcium which causes calcification of mitochondria • Free calcium responsible for initiating the oxydizing process of TPO in thyroid gland • Magnesium and Iodine can reverse this process • Electrolytes • Salt Medical Iodophobia

“Medical iodophobia is the unwarranted fear of using and recommending inorganic, non- radioactive iodine/iodide within the range known from the collective experience of three generationsCURED!! of clinicians to be the safest and most effective amounts for treating symptoms and signs of iodine/iodide deficiency (12.5- 50mg/day).”

Dr. G. Abraham, 2004 Final Thoughts

• Iodine levels have fallen 50% in the last 40 years • During this time, elevations in autoimmune thyroid illness, autoimmune disorders, thyroid cancer, breast cancer, prostate cancer and other cancers • If iodine were a dangerous agent for the above conditions, incidences of the above conditions would not be rising over the last 40 years. Final Thoughts (2)

• Start slow • Check pre and post levels of iodine • Follow patients closely • Get ultrasounds before starting treatment when indicated • Combine treatment with a holistic plan • Diet, vitamins, minerals, detox, etc. Albert Szent-Gyorgyi, M.D., Ph.D

“Discovery consists in seeing what everybody else has seen and thinking what nobody has thought.”

Nobel Prize 1937 for the discovery of Vitamin C