Note: Dr.
Alan Gaby's response to this rebuttal is online, as well as
a second rebuttal by Drs.
Abraham and Brownstein.
Editor:
We would like to submit a rebuttal to Dr.
Gaby's editorial on iodine,
published in the August/September 2005 issue of Townsend
Letter. Gaby questioned
the safety and efficacy of orthoiodosupplementation in medical practice
and also the validity of the iodine/iodide loading test we use to assess
whole body sufficiency for iodine.
Our rebuttal will cover four topics:
- The safe and effective use of iodine
by our medical predecessors
- The computation of the average daily
intake of iodide from seaweed by mainland Japanese
- The validation
of the iodine/iodide loading test
- The effectiveness and safety
of orthoiodosupplementation in current medical practice
The safe and effective use of iodine by our medical predecessors
To quote Gaby: "Recently,
a growing number of doctors have been using iodine supplements
in fairly large doses in their
practices. The
treatment typically consists
of 12 to 50 mg per day of a combination of iodine and iodide,
which is 80 to 333 times the RDA of 150 mcg (0.15 mg) per
day."
The element iodine was used in daily amounts 2 to 3 orders
of magnitude greater than the RDA by physicians for over
150 years.
Only 8 years
after the discovery of iodine from seaweed by French chemist
Bernard Courtois
in 1811, Swiss physician J.F. Coindet who previously used
successfully burnt sponge and seaweed for simple goiter,
reasoned that iodine
could be the active ingredient in seaweed. In 1819, he tested
tincture of
iodine at 250 mg/day, an excessive amount by today's standard,
in 150 goiter patients with great success. He published his
results in 1820.1 There is no question that the
amount of iodine used by Coindet was
excessive. But, Coindet was the first physician to use the
newly discovered element iodine in medical practice. Since
then, the
collective experience
of a large number of clinicians from the U.S. over the last
century has resulted in the recommended daily amount of 0.1
to 0.3 ml
of Lugol,2
containing from 12.5 to 37.5 mg elemental iodine, for iodine/iodide
supplementation.3 This range of daily intake for iodine
supplementation was based
on clinical observation of the patient's overall wellbeing.
The Lugol solution was developed by French physician, Jean
Lugol in 1829 for treatment of infectious diseases using
oral ingestion
of his
preparation.
The Lugol solution contains 5% iodine and 10% potassium iodide
in water.2 Iodine is not very soluble in water,
with aqueous saturation at
0.33 gm iodine/L. The addition of potassium iodide to an
aqueous solution of iodine stabilizes the iodine by forming
a complex
triodide I3- and
increases the aqueous solubility of iodine in the form of
a triodide complex 150 times. The recommended daily amount
of
Lugol was
0.1 ml to 0.3 ml, containing 12.5 to 37.5 mg elemental iodine.3
As late as 1995,
the 19th Edition of Remington's Science and Practice
of Pharmacy,4 continued
to recommend between 0.1 to 0.3 ml daily of Lugol 5% solution
in the treatment of iodine deficiency and
simple
goiter.
British physicians recommended a similar range of daily intake
of iodine in the form of hydrogen iodide as the ranges of
iodine recommended
by U.S. physicians in the form of Lugol solution. The recommended
daily intake of hydriodic acid syrup was 2 to 4 ml.5
The syrup is prepared
by the British apothecary from an aqueous stock solution
containing 10%
hydrogen iodide (HI), which is diluted 10 fold with syrups
of different flavors. When hydrogen iodide is dissolved in
water,
it forms hydriodic
acid. The syrup would contain 1% hydrogen iodide equivalent.
This would compute to 10 mg iodide per ml. So, the recommended
daily amount of
elemental iodine was from 20 to 40 mg.
As far back as 100 years ago, U.S. physicians used Lugol
solution extensively in their practice for many medical conditions.3
In 1932, physician
B.N. Cohn6 wrote: "…the widespread use of compound
solution of iodine, U.S.P., (For the reader's information,
that is Lugol
solution) is the result of a paper by Plummer and Boothby,
published in that year (1923). Since then compound solution
of iodine has
been used by nearly every clinician…"
Lugol solution was called then Liquor Iodi Compositus, (that
is Latin for compound solution of iodine). Marine in 19237
used a daily average
of 9 mg iodide in
the prevention of goiter in adolescent girls, an amount 60 times
the current RDA for iodine. In Marine's study, the prevalence
of
goiter decreased 100
fold compared to a control group following 2 ½ years of supplementation.
Gaby used the RDA for iodine as his gold standard: "First is
the notion that the optimal daily iodine intake for humans is around
13.8 mg per day, which is about 90 times the RDA
and more
than
13 times the
'safe upper limit' of 1 mg per day established by the World
Health Organization."
Does Gaby realize that the RDA for iodine was established very recently
in 1980, confirmed in 1989,8 and based on data supplied
by endocrinologists with thyroid
fixation ignoring the rest of the body? The goal of the RDA for iodine
is the
prevention of extreme stupidity (cretinism), iodine-deficiency induced
goiter and hypothyroidism, not whole body sufficiency for iodine.
In 1930, Thompson
et al9 stated: "The normal daily requirement of the
body for iodine has never been determined." This statement is
still true today, more than 70 years later. We still don't know the
iodine/iodide
requirements
for
whole body sufficiency.
Physician Henry A. Schroeder10 who
did extensive studies on the dietary requirement for trace elements
reported
in 1975
that iodine in
dog food is 20 times higher than iodine in food consumed by humans.
The amount of iodine in the food supply of humans, of pets and laboratory
animals, expressed
as parts per million (PPM) are: for humans 0.12; for rabbits 0.59;
for
rats 1.17 and for dogs 2.25. Schroeder commented: "Because it
is doubtful that man differs much in his needs from other omnivorous
animals, we could build up a good, if very indirect, case
that man is not getting
enough."
During the period when potassium iodate was used as a dough conditioner
(1960-1980),
and prior to the introduction of the goitrogen bromate as an alternative
to iodate,3 one slice of bread contained the full RDA
for iodine.11 During this period,
Oddie et al12 reported the results of a nationwide survey of iodine
intake in the U.S. at 133 locations comprising of 30,000 euthyroid
subjects. The mean
iodine intake in these locations ranged from 240 to 740 ug/day. Correlation
between iodine intake and mortality rates from thyroid diseases revealed
a highly significant
inverse correlation between iodine intake and mortality rates. Oddie
et al comment: "Despite this high average, there is still a
significant negative correlation (r = -080)
between iodine intake and mortality rate from thyroid diseases." In
other words, the mortality rates would have continued to decrease
with higher
intake of iodine.
In Tasmania, Clement13 reported that a daily intake of
1.4 mg of potassium iodide (10 times the RDA) by infants and children
for
16
years resulted
in reduction in the prevalence of goiter, but in some regions, that
amount of
iodine did not
have a significant effect on the rates of goiter. Different amounts
of goitrogens in these different regions may explain this discrepancy.
In
Marine's study,
9 mg/day of iodide were required to decrease the prevalence of goiter
in adolescent girls by 100 fold.7 Currently, in Tasmania, potassium
iodate is added to
bread at 2 mg per loaf of bread.
"After a preliminary survey in 1949, tablets containing 10 mg potassium
iodide had been made available to infants, preschool children, and
schoolchildren through schools and child-health centres for weekly
consumption for approximately
sixteen
years. State-wide surveys at five-year intervals showed a slow steady
reduction
in the prevalence of goiter, but in some regions the rates remained
high."13
Gaby mentioned the "safe upper limit" of 1 mg/day, established
by the WHO. As previously mentioned, prior to World War II, U.S.
physicians
used routinely 12.5 to 37.5 mg elemental iodine daily for iodine
supplementation.3 Large numbers of pulmonary patients
were treated safely for years
with
daily
amounts of potassium iodide 2 to 3 orders of magnitude greater than
1 mg. Fradkin and Wolff14 commented on the safety of relatively
large
doses of potassium
iodide: "Although there are scattered case reports of IIT (iodide-induced
thyrotoxicosis) after the use of KI, these must be considered in
the light of over
108 tablets of KI prescribed annually in this country. Reports of
experience with KI (1.6-6.4
g/day) in large series of pulmonary patients revealed no hyperthyroidism
in 2404 and 502 patients."
The requirement for iodine depends on the goitrogen load. The greater
the goitrogen load, the greater the need for iodine. Bromide is a
goitrogen that interferes
with the uptake and utilization of iodide by target cells.3,18
The U.S. population is exposed to large amounts of the element bromine
in its organic
and inorganic
forms. The United States utilizes two-thirds of the annual world
production
of bromine.15 The annual world production of bromine is
280,000 tons. At 909
Kg/ton, we have then an annual world production of bromine of approximately
254,520,000 Kg. The U.S. consumes 167,983,200 Kg of bromine annually.
Out of that amount,
45,450,000 Kg are used in agriculture (food supply) and 9,090,000
Kg for water sanitation (water supply). The amount of bromine used
in
our food and water
supplies compute to 21% of the total U.S. utilization of this goitrogenic
halogen.15
It does not take a rocket scientist to figure out that we, in the
U.S., are exposed to high amounts of the goitrogen bromine via our
food and
water supplies
in all
its inorganic and organic forms, such as methylbromide in agriculture.
Bromine competes with iodine for cellular uptake and utilization;
and has goitrogenic,
carcinogenic and narcoleptic properties.3 Iodine pulls
bromine from storage sites18 and chloride increases its
excretion in urine.15
For detoxificaton
of bromide, the halides iodide and chloride are the most effective.
The annual world production of iodine in 1981 was 12,000 tons or
10,908,000 Kg.16 Some 20% of the iodine used in the U.S.
is for animal feed
supplement, and none for human food, except the minimal amount in
table salt. Between
1960 and 1980, iodate was used in bread with one slice of bread containing
the full
RDA of 0.15 mg.3 But some 20 years ago, iodophobia resulted
in the removal of iodate from bread, replacing it with…you
guessed it…bromate.
If
you wanted to keep a nation sick and zombified, we cannot think of
a better way to achieve this goal.3
Gaby, assuming we evolve from a Big Bang 20 billion years ago, commented: "Since
emerging from the iodine-rich oceans to become mammals, we have evolved
in an iodine-poor environment."
Actually, the oceans are very poor in iodine, based on concentration
of this element. Although the largest reservoir of iodine is in the
oceans, because
of their large volume, the concentration of iodate/iodine/iodide
in the oceans is
only 0.05 PPM, very dilute indeed, compared to bromide at 70 PPM.17
For example, to obtain the RDA for iodine from seawater, you need
3
liters. Sea
salt is very
low in iodide, much lower than iodide in iodized table salt. It is
understandable why someone who believes in the theory of evolution
has a problem with
such high requirements for iodine in an environment depleted of this
element.
Unless
sometimes
in the distant past, the topsoil of planet earth contains significant
levels of iodine and meeting these high requirements for iodine sufficiency
could
then be achieved with any diet. The theory of evolution does not
offer an intellectually satisfying answer to this paradox. However,
the Biblical
account of the origin
of the world through creation 6000 years ago followed by the fall
of man and the flood fits very well the current situation. According
to
the biblical
narrative,
the Creator declared planet earth and everything in it perfect. Therefore,
the
original planet earth contained a topsoil rich in iodine, and all
elements required for perfect health of Adam, Eve and their descendants.
A rebelled
archangel was
expelled from God's Habitation for attempting a hostile takeover
(Isaiah 14:12-15). His name was Lucifer before the attempt
(Isaiah 14:12) and Satan after his expulsion (Luke 10:18). Satan
deceived Eve into believing
that she
could become a goddess by disobeying her Creator (Genesis 3:4,5).
A sequence of events followed, culminating in the worldwide flood
4500 years ago.
Following this episode, the receding waters washed away the topsoil
with all its elements
into oceans and seas. The new topsoil became deficient in iodine
and most likely other essential elements, whose essentialities are
still unknown.
Mountainous
areas became the most iodine-deficient because the receding waters
were the most rapid over the steep slopes, eroding deeper into the
soil.
The
Biblical account
of the flood fits very well with the finding of high concentrations
of iodine in brines, which accompany oil wells and natural gas deposits.8
By 1977, the
brines associated with deposits of natural gas in Japan accounted
for 56% of the world iodine production.16 The previous existence
of iodine-rich
living
organisms from which came these iodine-rich degradation products
strongly suggests that sometime in the distant past, iodine was plentiful
on planet
earth, and
some catastrophic event resulted in washing away the iodine-rich
top soil in the oceans.
The toxicity of iodine depends on the forms of this element. Several
forms of iodine prescribed by U.S. physicians are listed
in Table I. The manmade organic
forms of iodine are extremely toxic, whereas the inorganic non-radioactive
forms are extremely safe.18 However, the
safe inorganic non-radioactive forms were
blamed for the severe side effects of the organic iodine-containing
drugs. For example, in reference #14 of Gaby's editorial, discussing
thyrotoxicosis induced by iodine,19 the form of iodine
involved is an iodophore, an organic
form of iodine. This iodophore interferes with iodine uptake and
utilization by the thyroid gland.20 From a publication
by Phillippou, et al,
published in 1992,21 it is obvious that the cytotoxicity of the
organic iodine-containing
drugs is due to the molecule itself, not the iodine released or
present in the molecule. "We can, therefore, conclude that the
effect of amiodarone,
benziodarone, Na iopanate, and other iodine-containing substances
with similar
effects is due
to the entire molecule and not to the iodine liberated. It should
be noted that the cytotoxic effect of amiodarone in all cultures
is also
due to the
entire
molecule and not to the iodine present in it."
Table 1
Various forms of iodine/iodide used
in clinical medicine and their toxicity levels (from Reference 16)
| Forms |
|
Toxicity |
| A) Inorganic |
|
|
|
1) Non-radioactive |
|
|
| |
|
a) iodides (i.e. SSKI)
b) tincture of iodine
c) Lugol Solution |
|
Extremely safe |
| |
2) Radioactive iodides for diagnostic and therapeutic purposes |
|
Carcinogenic
Cytotoxic |
| B) Organic |
|
|
| |
1) Natural occurring |
|
|
| |
|
a) thyroid hormones
b) thyroidal iodolipids |
|
Safe within physiological ranges |
| |
2) Manmade |
|
|
| |
|
a) radiographic contrast media
b) iodine-containing drugs (i.e. amiodarone) |
|
Extremely toxic |
A new syndrome, medical iodophobia, was
recently reported3 with symptoms of split personality, double
standards, amnesia, confusion
and altered state
of
consciousness. Medical iodophobia has reached pandemic proportion and it
is highly contagious (iatrogenic iodophobia). A century ago, non-radioactive
forms
of inorganic
iodine were considered a panacea for all human ills, but today, they are
avoided by physicians like leprosy.18 We have previously
discussed the factors involved
in this medical iodophobia.3,18
The computation of the average daily intake
of iodide from seaweed by mainland Japanese
Over 95% of the iodine consumed by mainland Japanese comes from
seaweed. If you want to prove that the intake of iodine by mainland
Japanese is within
the same
range as consumed by the U.S. population or maybe slightly above, just tell
your Japanese study subjects to abstain from seaweed during the study period.
It's
that easy and this technique has been used effectively in several publications.
As a general rule, mainland Japanese living in the coastal areas of Japan,
consume more seaweed than inland dwellers.22-24 Among
the coastal areas, the inhabitants of Hokkaido ingest the largest
amount of seaweed.25 Hokkaido
produces 90% of the seaweed consumed in Japan,25 further processed by
drying and flattening
for sales in food stores. Statistics compiled by the Japanese Ministry of
Health is based on the dry form of seaweed.26 Seaweed contains
predominantly the
inorganic form of the element iodine, mainly iodide.27 Seaweed also concentrates
other halides such as bromide, which possess goitrogenic, carcinogenic and
narcoleptic properties.3 Seawater is very poor in iodide and relatively
rich in bromide
with 0.05 PPM iodide and 70 PPM bromide. There is 1400 times more bromide
than iodide in seawater.
Mainland Japanese consume large amounts of iodine from seaweed and they are
one of the healthiest nations.11 Based on extensive surveys performed
by the International
Agency for Research on Cancer and published in 1982,28 mainland
Japanese, at least up to 1982, experienced one of the lowest incidences of
cancer in
general. Mainland Japanese have the longest lifespan in the world.29
Although seaweed
has been the main source of iodine for the Japanese population, inorganic
iodine/iodide in supplements (liquid or tablets) seems a much purer, safer
and more accurate
form for supplementation of this essential element than seaweed. It is more
difficult to titrate the amount of seaweed needed to achieve whole body sufficiency
for
iodine than the amount of a pure standardized solid dose form of this essential
element. The reported seaweed-induced goiter with normal thyroid functions
40 years ago in Hokkaido, Japan,25 was not caused by iodine. This
seaweed-induced goiter eventually disappeared.22 Suzuki et al25 questioned
whether seaweed itself was the cause of this goiter, since much larger amounts
of
iodide in
pulmonary
patients did not induce goiter. Suzuki et al commented: "Considering
the paucity of reported cases of iodine goiter with the wide spread usage
of iodine
medication, we cannot exclude factors other than excessive intake of dietary
iodine as a cause of the goiter." Also, residents in Tokyo, Japan, who
excreted similar levels of iodide in their urine (around 20 mg/24h) did not
experience goiter. Contamination of seaweed with bromide is the most likely
explanation,
since bromide is a goitrogen,3 and there is 1400 times more bromide than
iodide in seawater.17 The presence of excess goitrogens in the diet would
require
greater amounts of ingested iodine to prevent the goitrogenic effect of these
substances.11,18
In assessing the intake of iodine by mainland Japanese based on urinary excretion
of iodide, keep in mind that urinary iodide levels are not a good index of
intake unless whole body sufficiency for iodine is achieved and the form
of iodine consumed
is highly bioavailable. For example, only 10% of sodium iodide present in
table salt is bioavailable, due to competition with chloride for intestinal
absorption.8 On a molor basis, there is 30,000 times more chloride than
iodide in iodized salt. The % of ingested iodine excreted in the 24 hr. urine
collection
can
be as low as 10% of the ingested amount in iodine-deficient subjects,3
due to
body retention of iodine. With this in mind, let us review some published
data. Konno et al22 measured iodide in morning urine samples of 2,956
men and
1,182 women, all normal and healthy, residing in Sapporo, Japan. The 95%
confidence limits were from 1.14 to 8.93 mg/L. Assuming an average 24 hr.
urine volume
of
1.5 liters, the daily iodide excretion would range from 1.7 to 13.4 mg with
an average of 5 mg. As discussed previously, these amounts are an underestimate
of iodine intake. Yabu et al30 from Osaka measured iodide levels in morning
urine samples obtained from 39 male and 88 female local residents. He reported
a range of 0.6 to 17.4 mg/L. If those iodine levels are expressed as mg/24
hr.
and assuming an average 24 hr. urine volume of 1.5 liter, the range of iodine
excretion per 24 hr. would be from 1 to 25 mg in these 163 Japanese subjects.
Gaby mentioned that the calculation we used to estimate the average daily
intake of mainland Japanese was based on dry weight whereas the data in Nagataki's
publication23 on iodine in seaweed was reported per wet weight.
Quoting from that article: "For example, the dry weight of such food
as "tangle" (Laminaria)
contains 0.3% iodine1 and this may be eaten in quantities as large
as 10 g daily."23 This daily intake would compute to 30mg
of elemental iodine. However, on page 643 of the same article, Nagataki et
al23 misquoted their
Reference
#13, that is our Reference #26, when they stated: "…according
to the statistics of the Ministry of Health and Welfare,13 the average
daily
intake of seaweed was 4.6 g (wet weight)," when in fact, that Organization
confirmed by a phone interview (6/21/05) that their data on seaweed are always
expressed as dry weight.
For example, in table 8 of Nagataki's Reference #13, values for seaweed
consumption for several years from 1950 to 1963 are listed in gms of dry
weight, confirmed by the Japanese Ministry of Health and Welfare. We have
compiled some
of these data in our Table II, taken from reference 13 of Nagataki's article.
The value of 4.6 g that Nagataki quoted as wet weight was actually expressed
as dry weight and Nagataki used the value for the year 1963 only, that is,
4.6 gm. Nagataki et al mentioned correctly dry weight on page 638 at the
beginning
of their article, and for some unknown reason, they erroneously mentioned
wet weight on page 643 of the same publication, which is confusing. We have
relied,
therefore, on the original information supplied by the Japanese Ministry
of Health and Welfare, that is Nagataki's Reference #13, and our reference
#26.
The average daily intake of iodine by mainland Japanese in 1963 was 13.8
mg, based on information supplied by the Japanese Ministry of Health, which
used
only dry weight in their calculations, confirmed by a phone interview of
one of us (GEA) on June 21, 2005, with officials of this organization (See
Table
II).
Table II
Annual change of intake of food by food groups in Japan
(Except for the calories, all values below are expressed as gms / per capita
/ day)
| Yrs. |
1950 |
1952 |
1954 |
1956 |
1958 |
1960 |
1962 |
1963 |
Calories
Proteins
Total
Animal
Vegetable
Fat
Carbohydrate
Sugars
Fats & Oils
Beans
Milk
Milk products
*Sea weeds (dry weight)
|
2,098
68
17
51
18
418
7.2
2.6
53.7
6.8
3.0
|
2,109
70
23
47
20
412
14.5
3.9
68.4
10.2
0.4
4.1
|
2,074
69
22
47
21
403
15.6
4.6
68.2
12.5
0.6
4.8
|
2,092
69.1
22.6
46.5
21.8
405
15.6
5.1
72.7
19.4
2.1
5.0
|
2,118
70.1
23.8
46.4
23.7
406
12.3
5.7
71.0
22.0
2.6
5.0
|
2,096
69.7
24.7
45.0
24.7
399
12.3
6.1
71.2
29.5
3.4
4.7
|
2,080
70.4
27.3
43.2
28.3
386
13.4
7.6
70.8
35.9
5.9
4.5
|
2,083
70.6
27.7
42.9
29.2
382
14.0
8.1
69.4
38.8
6.3
4.6
|
Compiled from tables 6 and 8 of the
official publication, Nutrition in Japan, 1964, Nutrition Section,
Bureau of Public Health, Ministry
of
Health and Welfare, Tokyo, Japan, March 1965.
* In a phone interview with Guy E. Abraham, M.D., on June 21, 2005, using
Miss Hisa Izumi as an interpreter, the interviewees Miss Nichi and Mister
Arai at the Japanese Ministry of Health and Welfare confirm that, in
the nutritional surveys published in 1965, the average daily amount of
seaweed consumed is expressed as gms of dried seaweed.
One can see that iodine intake was even higher during the years 1954,
1956, 1958 and 1960. The mean value for the 8 amounts of seaweed displayed
in Table II is 4.5 gm and at 0.3% iodide, this average daily amount
would contain 13.5 mg iodide. During that phone interview (6/21/05),
Miss Nichi and Mr. Arai stated that the last survey for which statistics
are available was for the year 2001 (Heisei 14), with an average daily
intake of 14.6 gm of seaweeds (dry weight). Obviously, the consumption
of seaweed by mainland Japanese has increased significantly over the
past 40 years. The exact amount of iodine consumed in 2001 would depend
on the concentrations of iodine in the seaweeds involved. Since the
surveys performed by this organization do not report the amount of
elemental iodine and only tabulate the sum of all seaweeds consumed
per capita per day for 2001, it is not possible at this time to calculate
exactly the true daily iodine intake by mainland Japanese in 2001.
If the concentrations of iodine in seaweeds during the year 2001 remain
the same as in the 1960s, the average daily amount of iodine
consumed by mainland Japanese in 2001 would be: 3 mg iodine/gm x 14.6
gm = 43.8 mg.
We must emphasize however, that the orthoiodosupplementation
program is not based on consumption of iodine by the Japanese population,
but on whole body iodine sufficiency assessed by the iodine/iodide
loading test, which brings us to our next topic.
The validation
of the iodine/iodide loading test
Gaby questions the validity of
the iodine/iodide loading test and presents some valid arguments, "Before
the iodine-load test can be considered a reliable indicator of
tissue iodine levels,
it needs to be demonstrated that only
negligible amounts of iodine are excreted in the feces after an oral iodine load."
Inorganic iodine is an ideal element for an oral loading test.
Inorganic forms of iodine are quantitatively absorbed by the gastrointestinal
tract and highly bioavailable. Less than 5% of ingested inorganic
iodine/iodide are excreted in the feces and sweat,31 with
most of that amount
in sweat. The data in reference #9 of Gaby's paper dealing with
low bioavailability of ingested iodine in cows, which are ruminants,
should not be extrapolated to humans. Since data obtained with
the
iodine/iodide loading test revealed that 90 to 100% of the ingested
iodine/iodide is recovered in the 24 hr. urine collection when
sufficiency is achieved,3,18 it is obvious that the ingested
iodine/iodide
in the tablets used for the loading test is highly bioavailable.
Serum
iodide is rapidly cleared by the kidneys with a daily clearance
rate of 43.5 liters.8 The renal clearance of iodide remains
constant
with intake from 0.001 mg to 2,000 mg iodide.32 The gastrointestinal
tract has the capacity to absorb quantitatively large amounts of
iodine/iodide.32
Studies performed with a sustained release form of iodine, amiodarone,
give further support for the validity of the iodine/iodide loading
test. Amiodarone is a benzofuranic derivative containing 75 mg
of iodine per 200 mg per tablet. It is widely used for the long-term
treatment
of cardiac arrhythmias.33-35 Broekhuysen et al36 using
balance studies of amiodarone and the non-amiodarone inorganic
iodine released from amiodarone, reported the following: In 2 subjects
treated
with 300 mg of amiodarone/day containing 112.5 mg iodine, the total
amount of iodine measured in urine and feces was very low during
the first 3 days, with a mean of 19% and 7% of the total iodine
ingested,
suggesting that as much as 93% of the iodine ingested was retained
in the body, or 105 mg iodine per day was retained by the patient.
After 25 to 27 days of therapy with 300 mg amiodarone/day, the
mean % iodine excretion of combined urine plus feces in these 2
subjects
increased 48% and 75%. Therefore, after approximately one month,
the percent of iodine retained by the body had decreased to 25%
and 50%.
No inorganic iodine/iodide was found in feces, only the organic
form, amiodarone, whereas only inorganic iodide was excreted in
urine.
In 2 other subjects treated with 300 mg amiodarone/day for 7 weeks,
balance studies revealed that at the end of the study, the total
excreted iodine in urine and feces averaged 97.4% and 96.9%. Again,
only the
organic form amiodarone was found in feces and only the inorganic
form in urine. Based on the balance studies, the amount of iodine
retained
by the body following 7 weeks on amiodarone at 300 mg/day containing
112.5 mg iodine, was estimated at 1.5 gm. The authors commented: "These
results suggest that iodine is retained in the body until a mechanism
is triggered that adjusts the excretion of iodine to balance completely
the intake." They estimated that the body retained 1.5 gm
of iodine before the ingested iodine in amiodarone is completely
excreted,
and before therapeutic efficacy.
In 3 patients who eventually died following long-term treatment
with amiodarone, the levels of inorganic iodine (not amiodarone)
present
in various organs and tissues were measured. The total body non-amiodarone
iodine content was estimated at approximately 2 gm with the greatest
amount found in fat tissues (700 mg) and striated muscle (650 mg).
Iodine was present in every tissue examined. The highest concentrations
of non-amiodarone iodine were found in descending order: thyroid
gland, liver, lung, fat tissues, adrenal glands and the heart.
We previously
reported a double peak of serum inorganic iodide levels, 8 hours
apart, following ingestion of a solid dosage form of Lugol.37
This pattern
is indicative of an enterohepatic circulation of inorganic iodine,
which could explain the high iodine content of the liver.
When a tablet form of Lugol is ingested at a daily amount of 50
mg elemental iodine, whole body sufficiency is achieved in approximately
3 months and the estimated amount of iodine retained in the body
is approximately 1.5 gm.8 This is the same amount of
iodine retained
in patients on amiodarone following 7 weeks at 300 mg/day containing
112.5 mg iodine. Clinical response to amiodarone is observed after
the same period of time on amiodarone therapy. Some comparisons
between amiodarone, an organic form of iodine, and inorganic iodine/iodide
are in order. In the patients who ingested 300 mg amiodarone for
7
weeks, the total amount of iodine ingested is: 112.5 mg × 49
days = 5.5 gm. The patients retained 1.5 gm, that is 1.5 gm / 5.5
gm × 100
= 27% of the total dose. In patients of orthoiodosupplementation
at 50 mg elemental iodine/day, sufficiency is achieved usually
in 3 months
and 1.5 gm of iodine is retained. The total amount of iodine ingested
during 3 months at 50 mg/day = 50 mg / day × 90 days = 4.5
gm. The patients retained 1.5 gm, that is 1.5 gm / 4.5 gm × 100
= 33% of the total dose. Roughly 30% of the total dose of iodine
is retained
at iodine sufficiency in both cases, but the time required to achieve
sufficiency decreases as the daily amount of iodine increases.
Whether this inverse relationship between the daily dose of iodine
and time
required for whole body iodine sufficiency will persist with daily
intake of iodine greater than 100 mg would require further investigation.
Since iodine mobilizes toxic metals and goitrogenic halides from
their storage sties,3,18 it may not be wise to achieve
whole body sufficiency
for iodine too rapidly since mobilization of these toxic substances
may increase their peripheral levels high enough to cause symptoms.
A complete nutritional program combined with increased fluid intake
will help the body eliminate these toxic elements more safely.3
To be discussed later, in cases of increased mobilization of bromide
from storage sites by orthoiodosupplementation and elevated serum
bromide levels high enough to cause bromism, the administration
of sodium chloride
(6-10 gm/day) increases the renal clearance of bromide by
10 fold and minimizes the side effects of bromism. If orthoiodosupplementation
results in elevated urine lead levels, together with increased
bromide,
ammonium chloride is preferable to sodium chloride since it is
the chloride that increases renal clearance of bromide. The ammonium
is
metabolized to urea and has an acidifying effect, which increases
renal clearance of lead also.
The above comparison of the data obtained from amiodarone administration
and orthoiodosupplementation is suggestive of an important role of
inorganic iodine released from amiodarone in the therapeutic effect
of this drug, and that whole body sufficiency for iodine is a requirement
for optimal cardiac function. Since the amount of iodine used in
the amiodarone study is twice the amount of iodine used in orthoiodosupplementation,
the time required for whole body iodine sufficiency was only 7 weeks
for amiodarone and 12 weeks for orthoiodosupplementation. In order
to achieve whole body sufficiency for iodine in 6 weeks using orthoiodosupplementation,
the daily intake required would be 100 mg.
One more argument in support of the validity of the iodine/iodide
loading test follows. Serum inorganic iodide levels measured under
steady state
conditions are a good index of bioavailability of the iodine preparation.8
We have previously calculated that the serum levels of inorganic
iodide at equilibrium would be the daily amount of iodine ingested
divided by 43.5 liters if the form of iodine ingested was completely
bioavailable.8 At 50 mg iodine/day, the expected serum
inorganic iodide level at equilibrium would be: 50 mg/43.5 L =
1.15 mg/L.
In 8 normal subjects who achieved whole body iodine sufficiency,
the
fasting serum inorganic iodide levels 24 hrs after the last intake
of iodine,
ranged from 0.85 to 1.34 mg/L.8
The effectiveness
and safety of orthoiodosupplementation in current medical practice
Physicians who use holistic therapies
are always on the search for safe and effective natural therapies
that have minimal
adverse effects.
The experience of several physicians with iodine/iodide
in daily amounts from 6.25 to 50 mg, using a solid dosage form
of Lugol
(Iodoral®)
for over three years in several thousands of patients has
shown it to be safe and effective, with minimal adverse
effect.18
Effectiveness
The Center for Holistic
Medicine in West Bloomfield, MI (office of D. Brownstein,
M.D.) has tested over 500 patients for
iodine deficiency
using the iodine/iodide loading test, developed by one
of us.3 Based on the experience of the Center, the
loading
test
provides
an accurate
and reproducible picture of the iodine status in the body.
Retesting many of these patients has shown the changes
in the test correlates
with the changes in the clinical picture. In other words,
as the loading test improves, the clinical picture improves.
Our experience at the Center for Holistic Medicine has
shown that patients with the lowest urinary iodide levels
on the
loading tests
are often
the most ill. Many of these patients with very low urine
iodide levels following the loading test have severe illnesses
such
as breast cancer,
thyroid cancer or autoimmune thyroid disorders. All of
these conditions have been shown in the literature to be
associated
with iodine
deficiency.3 Positive clinical results were seen in
most of these patients
after supplementation of orthoiodosupplementation within
the range of 6.25-50mg of iodine/iodide (1/2 to 4
tablets of Lugol in tablet form).
One of the most satisfying effects of orthoiodosupplementation
has been in the treatment of fibrocystic breasts and thyroid
nodules.
The treatment of fibrocystic breasts with iodine has been
reported for
over 100 years. Iodine/iodide supplementation has resulted
in significant improvement in fibrocystic breast illness
for nearly
every patient
treated. Thyroid nodules also respond positively to iodine/iodide
supplementation. Serial ultrasounds usually show decrease
in the size of the thyroid
cysts and nodules and eventual resolution of the lesions.
When orthoiodosupplementation is combined with a complete
nutritional
program, it is rare not to
see improvement in the palpation and radiological examination
of thyroid nodules and cysts following iodine/iodide therapy
as described
here.
The effectiveness of orthoiodosupplementation has not been
limited to the very ill. In fact, most patients treated
with orthoiodosupplementation
have quickly experienced positive results although optimal
responses are observed when whole body iodine sufficiency
is achieved based
on the iodine/iodide loading test. Our experience has shown
that a wide
range of disorders have responded to orthoiodosupplementation
including thyroid disorders, chronic fatigue, headaches,
fibromyalgia and those
with infections. Additionally, our clinical experience
has shown that iodine/iodide supplementation has resulted in
lower blood
pressure in hypertensive patients. The blood pressure-lowering
effect is seen
when sufficiency of iodine is achieved.
Occasionally, individuals on thyroid medication will develop
signs and symptoms of hyperthyroidism on orthoiodosupplementation.
This
situation has been easily rectified by lowering or discontinuing
the thyroid
medication. Of those individuals taking thyroid medication,
approximately 1/3 of them will need to discontinue or lower
their thyroid medication
upon taking iodine/iodide due to increased thyroid function
and improved receptor responsiveness.16 The remaining
2/3 of the
thyroid treated
patients will maintain their thyroid dosages while taking
iodine/iodide without side effects.
Safety
Dr. Gaby's editorial claims
that the relatively high doses of iodine/iodide used in
orthoiodosupplementation may lead
to hypothyroidism,
goiter or autoimmune thyroid problems. This just is not
the case. A review of the literature revealed that the
organic
forms of
iodine were involved in most of these complications.3
Iodine intake has
fallen over 50% in the U.S. over the last 30 years.38
During this same time, increases in diabetes, hypertension,
obesity,
breast and
thyroid cancer, and other thyroid disorders, have been
reported. It
appears to us that iodine deficiency, not iodine excess
may be responsible for the increase of these conditions.3,18
As of this writing (7/12/05), the clinical experience with
orthoiodosupplementation in approximately 4,000 patients
at the Center for Holistic Medicine
has clearly shown that orthoiodosupplementation at daily
dose of 6.25 to 50mg elemental iodine has not been associated
with
increases
in
hypothyroidism, goiter and autoimmune thyroid problems. On
the contrary, the use of iodine/iodide has been effective
at treating
the above
conditions with minimal adverse effects.
Dr. Gaby points out that "some people are especially sensitive
to the adverse effects of iodine." He is correct.
Just as some people are sensitive to Vitamin C, some are
sensitive
to iodine/iodide.
Few holistic physicians would deny the effectiveness of
mega doses of Vitamin C, in amounts thousands of times
greater than
the RDA
for
Vitamin C, in the treatment of wide range of illnesses.
Just as with Vitamin C therapies, individualized doses
and proper
follow-up
visits
can help minimize adverse effects of iodine/iodide therapies.
Dr. Gaby writes, "The relative absence of side effects
may be due to the use of iodine as part of a comprehensive
nutritional program." He
is correct. With orthoiodosupplementation the best results
do occur when used as part of a comprehensive nutritional
program, as do
all holistic therapies. We favor a magnesium emphasized
total nutritional approach.3
The most common adverse effects of iodine/iodide supplementation
observed at the Center for Holistic Medicine has been metallic
taste in the
mouth and acne. Based on the experience of three clinicians
at that Center, with a combined patient population of some
4,000,
the prevalence
of these side effects is about 1%. This is probably due
to a detoxification reaction. The release of bromide may
be
one cause
of this detoxification
reaction. Clinical experience has continually shown that
iodine/iodide supplementation results in a large urinary
excretion of bromide.3,18 When bromide levels
begin to decline, the above mentioned adverse
effects begin to decline as well. Chloride increases renal
clearance of bromide15 and the use of NaCl or
ammonium chloride shortens the time required for bromide
detoxification
with orthoiodosupplementation.
Oral administration
of sodium chloride (6 to 10 gm/day) increased the renal
clearance
of bromide by 10 fold with mean serum half-life of 290
hrs in
control subjects and 30-65 hrs after chloride administration.
Intravenous sodium chloride gives the same results as the
oral route.15
In the practice of medicine, we have seen very few natural
therapies as safe and effective as orthoiodosupplementation.
In the proper
forms of iodine (inorganic non-radioactive forms), in daily
amounts of iodine
for whole body sufficiency and properly monitored, orthoiodosupplementation
is not only safe, it is an effective tool for the clinician.
Prior to the availability of assays for thyroid hormones
and without
any test for assessing whole body sufficiency for iodine,
our medical predecessors recommended a range of daily iodine
intake
from Lugol
solution (12.5-37.5
mg) exactly within the range required for achieving whole
body sufficiency for iodine.3,16 Relying on
clinical observation
of the patient's
overall wellbeing, our predecessors have given us useful
information, which we have discarded in favor of preconceived
opinions of
self-appointed pseudoexperts. This has resulted in pandemic
iodine deprivation.
Iodine deficiency is misdiagnosed and treated with toxic
drugs. Orthoiodosupplementation
may be the simplest, safest, most effective and least expensive
way to help solve the health care crisis crippling our
nation.8
Correspondence
Guy E. Abraham, M.D.
Optimox Corporation, Torrance, California
1-800-223-1610 / Fax: 1-310-618-8748
optimox@earthlink.net
David Brownstein, M.D.
Center for Holistic Medicine, West Bloomfield Michigan
1.248-851-1600 / Fax: 1-248-851-0421
info@drbrownstein.com
Financial Disclosure
Guy E. Abraham, M.D. is the owner of
the company that developed and distributes Iodoral®, a tablet form
of Lugol solution, to healthcare professionals. Although he developed
the iodine/iodide loading test
at his own expense, including the procedure to measure urine iodide
levels and the positive displacement manifold, which allows semi
automation of this procedure, he has no financial interest in the
Lab that performs the loading tests. Neither did he receive remuneration
for passing this technology to others. He serves as a consultant
to this Lab without pay.
David Brownstein, M.D. has no financial interest in Iodoral® or
the Lab that performs the loading test.
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