Iodine Deficiency Disorder (IDD)- Water Under the Bridge Article from Harvard Medicine (2004)
Water Under the Bridge
A neurologist turns to hydrology, agronomy, and veterinary medicine to tackle the worldâs most preventable cause of mental retardation.
byÂ GORDON WORLEY
As a young boy growing up in Indiana, G. Robert DeLong â61 would toss sticks into creeks to gauge the speed of the water. Little could he have known how useful his childhood game would prove decades later, when he set out to eradicate a disease that for centuries had been devastating children in a remote corner of China.
DeLong traces his fascination with iodine deficiency disorders (IDD) to nearly 25 years ago, when his mentor, John Stanbury â39, suggested that he join a medical trip to Ecuador. âI thought the reports would turn out to be exaggerated,â DeLong recalls. âBut in a single month in an Andean mountain village I saw 120 cases of a disease that, until then, Iâd only read about in textbooks. These were people in whom prenatal iodine deficiencyâand the resulting fetal hypothyroidismâhad caused cretinism, characterized by blighted physical and mental development, spastic-rigidity, and deaf-mutism. The disease just debilitated the entire community.â
DeLong remembers in particular one young woman whose limbs were so twisted that she had to use her elbows to drag her body across the floor of her family hut, with all the painful laboriousness of a beached mermaid. Her family members would often prop her up outside, then carry her in when it began to rain.
When this same young woman became pregnant, she might have given birth to a baby as impaired by iodine deficiency as she had been. But as part of the local IDD control project, she received an intramuscular injection of iodine-in-oil during the second trimester of her pregnancy. The daughter she delivered is now a college graduate who speaks three languages.
In the decades since his first encounters with IDD, DeLong, a professor of pediatric neurology at Duke University, has witnessed many other instances of the transformative power of even tiny doses of iodine in preventing the disorder. So when he encountered unusually high rates of the disease in Xinjiang, a province in northwestern China, he became determined to find a solution.
THE SALT OF THE EARTH
Symptoms of iodine deficiency have plagued humankind for millennia. A second-century frieze of Buddha and his disciples, for example, shows a figure with goiter. Drawings from the thirteenth century depict people with goiter and cretinism, and Renaissance painters from DĂŒrer to Rubens captured on canvas many subjects with goitrous necks.
Today, iodine deficiency still condemns many thousands of children to cretinism, tens of millions to varying degrees of mental retardation, and hundreds of millions to milder degrees of mental and physical impairments. An estimated 1.6 billion people are at risk for IDD, now recognized as the most common preventable cause of mental retardation worldwide.
Nearly one-third of the globeâs inhabitants live in areas of natural iodine deficiency. The regions most affected are mountainous ones, where glaciation, snow, and rainfall leach the mineral from the soil; flood plains such as that of the Ganges; and inland continental expanses far from the worldâs oceans, which are the primary sources of iodine.
Countries around the world have responded to the problem, adding iodine to tea in Tibet, bread in Australia, and fish paste in Thailand. Yet fortifying ordinary table salt with iodine, the most common method, is also considered the best. IDD was endemic in the Appalachian, Great Lakes, and mountainous western regions of the United States, for example, until the 1920s, when iodized salt consumption became widespread.
Iodized salt does not offer a solution for people living in many remote areas of the world, though. Some communities find it too expensive or difficult to obtain; others reject it as less flavorful than locally available salt. Efforts to provide oral or injected iodine-in-oil to people living in areas with endemic IDD often fail because of issues of cost, distribution, or sustainability. Cultural traditions and superstitions may create obstacles as well.
TESTING THE WATERS
The problem of iodine deficiency is hardly new to Xinjiang: while traveling through the region during the thirteenth century, Marco Polo recorded observations of people with diminished intelligence, deafness, spasticity, and enlarged throats. Throughout the intervening centuries, the tragic consequences of iodine deficiency have continued to plague Xinjiang, whose water and soil contain some of the planetâs lowest levels of naturally occurring iodine.
A constellation of factors had contributed to the failure of efforts to provide the people of Xinjiang with iodine. Some of the barriers were cultural. Forty percent of the regionâs inhabitants are Uighurs, a Turkic people who comprise the largest of Chinaâs minority groups. The Uighursâmost of whom live in villages dotting the perimeter of the Taklimakan Desertâfind iodized salt not only less affordable, but also less savory than the rock salt so abundant in the desert.
âThe Uighurs have a tradition of picking rock salt off the desert floor, dissolving it in big clay pots, and then using the brine for cooking,â DeLong says. âThe desert salt has a âbrighterâ flavorâlikely from its magnesium contentâbut unfortunately it contains little iodine.â
Exacerbating the problem was the centuries-long contentious relationship between the Uighurs and the majority Han, who dominate the countryâs central government. And so the Chinese authoritiesâ attempt to offer iodine pills failed, among other reasons, because the Uighur women suspected officials of trying to slip them contraceptives.
Efforts to introduce iodine intramuscularly had fallen short as well. Injections such as those used in Ecuador required medical expertise and supplies not widely available in Xinjiang. And local public health authorities were skittish about injections for another reason: in 1988, the area had suffered a hepatitis epidemic that had left 500 dead, and they wanted to avoid the risks of shared needles.
When DeLong first visited Xinjiang in 1989, he found one in ten children suffering from severe IDD and one in three exhibiting symptoms of iodine deficiency. âWe were examining literally hundreds of children,â he says. âSome showed extreme mental retardation and could not walk, stand, or even sit. Even the ones without severe signs were slack and dull-eyed. They simply lacked the natural vivacity of children.â
During repeated trips to Xinjiang, as DeLong pursued his initial goal of studying the impact of iodine deficiency on fetal brain development, he pondered ways to prevent the calamity from occurring in the first place. By then he had grown close to two Chinese colleagues, Ma Tai, a leading expert on IDD in China, and Cao Xue-yi, the head of Xinjiangâs Health and Anti-Epidemic Station. Together they exploredâand rejected as impracticalâpossible solutions to the seemingly intractable problem.
Then, one day after working in the clinic, the collaborators happened to drive to the countryside to see the main irrigation dam, 20 miles upstream. âWe looked out over the Hotien River with its complex system of irrigation canals, the basis of all human life there,â DeLong says. âIt was fascinating, but I didnât give it much thought. Back in the capital the next day, I chatted with a local water chemist about the concentrations of various minerals, such as iron and copper, in the water. But the penny still didnât drop.â
That evening, DeLong says, âWe were driving to a Uighur comedic performance when suddenly it hit me. I practically shouted, âWe can drip potassium iodate into the irrigation water!â Dr. Ma threw up his hands and cried, âWeâll all go to jail!â But by the next day, he was thinking about it seriously. It quickly became clear that the idea could work.â
DeLong had realized that iodinating the irrigation water could protect entire villages. The plants would absorb the iodine that had leached from the treated water into the soil. The animals, in turn, would ingest the iodine-rich plants. At the top of the food chain, people would finally consume sufficient levels of iodine.
Obtaining approval for his proposal from suspicious local communities would be tricky, DeLong knew. But an incident that had taken place the previous year had helped convince the wider Uighur community of the physicianâs good intentions.
Late one afternoon DeLong, Ma, and their team were working in a small clinic in the village of Tusala when a sandstorm swept in from the desert. DeLongâs wife, Nancy, who has shared his IDD work at every stage, recalls that day.
âAbout three oâclock the room suddenly became almost as dark as night, with an eerie yellow light,â she says. âA gale force wind was blowing the trees sideways and sending dust swirls skyward. The patients covered their mouths and noses with their headscarves and huddled along an inside corridor. The lights flickered and went out.â
Just as the medical team had begun examining patients again, a great commotion of people burst into the room; they were bringing in a young boy who had picked up a live cable blown down by the storm. For several long minutes DeLong desperately tried mouth-to-mouth resuscitation and chest compressions but could get no response. Then someone mentioned that the boyâs father had transported him to the clinic in a donkey cart for six kilometers.
âI shined a light into the boyâs eyes,â Nancy DeLong says. âHe was dead. Bob straightened up, told the father he was sorry, and stood helplessly in tears, as the father, fighting for control, gently lifted his child, wrapped a sheetânow a shroudâaround him, and carried him from the room, clasped tightly to his breast.â
âTragically, our sustained efforts couldnât revive the boy,â Ma later recounted. âYet his family bent down to express their heartfelt gratefulness. And the story about the American doctor spread, even to the capital.â
The reservoir of good will that DeLong generated that day may have helped his cause when, a year later, he and his team explained the proposal to iodinate the irrigation water to villagers in the chosen site of Long Ru township. Each phrase was painstakingly translated into Mandarin, then into Uighur. To the team membersâ relief, they found a receptive audience. The villagers discussed the dilemma, then took a vote.
âWhen we met with the village leaders in Long Ru, the temperature was hovering near zero,â remembers Nancy DeLong. âThey were all sitting around in their thin coats and wool hats. Their breaths sent tiny clouds into the air and their wonderful weathered faces looked like stone. Then suddenly everyone erupted: âYes, we approve!âââ
THE BOTTOM OF THE BARREL
One of the first tasks facing DeLongâs team was calculating the flow rate of the canal. Impatient for the arrival of outside help, DeLong drew on his youthful penchants. In the eighth grade he had taken an interest inventory test that recommended he become a county agricultural agent. So it was with a sense of familiarity that he tackled the challenge.
âWe stripped to our undershorts, waded into the canal to measure its cross-section, then threw sticks in the water and recorded how fast they floated by,â DeLong says. âI felt like I was back on my uncleâs farm in Indiana, tossing twigs into the creek. Much later, we learned that our estimate was within 10 percent of the official measurement.â
The team next devised a primitive delivery system: a 55-gallon oil drum coated with epoxy paint to prevent oxidation and rigged with a spigot that could be turned on and off. The spigot was not precise enough in regulating the output, though, so they used intravenous tubing and two clamps to cobble together a simple valve to provide a steady flow. They tested their contraption overnight in a hotel parking lotâand found that it worked.
Next they perched the oil drum on a wooden bridge spanning the irrigation canal. For two weeks during the spring of 1992, the team dripped a 5 percent solution of potassium iodate into the canal, which supplied four villages in Long Ru township with water. They hired a local villager to protect the drum from theft, refill the tank, and monitor the flow rate. At night, the man would unfurl his rolled-up blanket and sleep right on the rough-hewn bridge.
Soon more men were needed to safeguard more barrels. Decisions about the placement of the drums and the timing of the dripping were made with the input of local officials, particularly theÂ kuai-ji, or water accountants, who oversaw all aspects of irrigation for the region. During the spring planting, as many as 20 tankfuls of potassium iodate solution were dripped into a canal from a single site.
THE TASTE OF SUCCESS
Measurements from samples sent to a laboratory in ĂrĂŒmqi, the capital, revealed that iodine concentration in treated areas had increased four-fold in the soil within weeks and three-fold in the crops and animals within months. Within one year, nearly all local women of childbearing age had iodine levels well out of the danger zone. The results were most dramatic in children conceived after the program began. Within three years of the first dripping, the infant mortality rate fell by half. Later assessments showed that the average height of five-year-olds had increased by four inches. And the intelligence quotients of children born after the dripping averaged 16 points higher than those of children born before the dripping.
âWhen we first arrived in Xinjiang, I thought the children were withdrawn because they were afraid of us,â says Nancy DeLong. âBut as time passed, and the treated water took effect, I realized that the children were growing livelier.â
Local livestock thrived too. Within a year, sheep production had increased by 40 percent. And as a result, the average annual family income rose 5 percent.
From their initial study, published in 1994, DeLong and his colleagues concluded that treating irrigation water was an effective and relatively inexpensive method of supplying iodine to people in irrigated areas where IDD is endemic. With the support of the Thrasher Foundation, the Joseph P. Kennedy, Jr. Foundation, Kiwanis International, and UNICEF, the team undertook a major expansion of its program in 1997. Iodine dripping now protects 2.6 million people from IDD in the 16 most severely deficient areas of Xinjiang. Thirteen and one-half tons of potassium iodate have already been dripped, at a cost of less than six cents per person.
Iodine concentrations in soil, crops, meat, and human urine, monitored since the one-time dripping, indicate that a single dripping can provide iodine for at least six years. Iodination of irrigation water has now been undertaken in Inner Mongolia and is planned for Kyrgyzstan.
THE SALINE SOLUTION
But what about iodine-deficient areas of the world where widespread irrigation doesnât exist? In the heart of Siberia, at the geographic center of Asia, lies Tuva, the poorest republic in Russia. Home to a Mongolian people, Tuva is renowned for its rich folklore, skilled artisans, andkhoomei, a form of throat singing whose haunting notes are said to mimic the wind sweeping across the steppes. The area is also known for its elevated rates of IDD.
There infant mortality runs high, and in some areas nearly half of the newborns have hypothyroidism caused by iodine deficiency. The lasting economic disruption that followed the collapse of the Soviet Union has made iodized salt an impractical solution. And, unlike the people of Xinjiang, the Tuvans do not rely on irrigation water. They depend instead on animal herding for their livelihood, raising sheep, cattle, horses, goats, and even camels on the elevated steppes of their ancestral homeland.
When DeLong reflected on the high rates of severe IDD in Tuva, he reasoned that the most efficient way to distribute iodine would be by adding potassium iodate to salt licks for the animals on whose productsâmutton, beef, milk, cheese, and yogurtâthe people relied. âWe knew,â he says, âthat iodinating salt licks had been successful in the Netherlands and England, where the iodine levels in cows rose dramatically.â
The plan required machinery for crushing rock salt, adding iodate, and making salt blocks. The Tuvan government approved the plan and promised to supply the potassium iodate and workers to operate the plant. Local authorities agreed to distribute free iodinated salt blocks to all herders in the region.
But the machinery still needed to be financed, manufactured in India, and transported by ship, the Trans-Siberian railway, and truck to Tuva. And all this had to be arranged from half a world away. DeLong secured financial support from friends and members of Kiwanis International. By the fall of 2002 the machinery had arrived. So DeLong returned to Tuva with his Kiwanian friends.
âOne of them was a high school mechanical shop teacher,â DeLong says, âand he had that machine up and running in two days.â By the time the Kiwanians staged a repeat visit the following spring, local workers were turning out iodinated salt blocks and distributing them to Tuvaâs mountain communities.
âTheir sheep had been producing poor quality wool because of the lack of iodine,â DeLong says. âIf weâre lucky, the salt licks should improve not only human health, but also the health of the local wool industry.â
DeLong and his team hope that, as knowledge of the health benefits, affordability, safety, and economic advantages of iodinating irrigation water and salt licks spreads to affected areas of the world, so will the adoption of their practical methods. âWith all the medical technologies we have to work with today,â DeLong says, âitâs easy to forget the incredible difference an ancient trace mineral can make to a single life, to a communityâeven to the world.â
Gordon Worley â73 is an associate clinical professor at the Duke University School of Medicine.
This article appeared in the Spring 2004 issue of theÂ Harvard Medical Alumni Bulletin.
Photo caption:Â Gordon Worleyâs idea to introduce an iodine solution into the water systems of a remote part of China helped reduce the incidence of iodine deficiency disorders among residents.
From the Book:
Disinfection, Sterilization and Preservation
edited by Seymour S. Block
Summary of Iodine Species
This is a comprehensive review (re-registration eligibility decision) by the EPA about Iodine-
Key Quote from RED Introduction-
âHazard Profile/Human Health Risk
Based on a review of the available toxicology data, the Agency has concluded that iodine and iodophor complexes are of very low toxicity by the oral, dermal, and inhalation routs of exposure.Â The toxicology database is adequate to characterize the hazard of iodine, and no data gaps have been identified.Â There are no indications of special sensitivity of infants or children resulting from exposure to iodine.Â Therefore, the FQPA Safety Factor has been removed (i.e., Reduced to 1X) for iodine.Â The Agency has not identified toxicological endpoints of concern for iodine.Â Therefore, a quantitative human health risk assessment was not conducted for this RED document.Â The Agency has no risk concerns for iodine and iodophor complexes with respect to human exposure through dietary, drinking water, residential and occupational routes. â
âSince no risks of concern were identified, no specific mitigation measures are needed for iodine and iodophor complexes.âÂ
The article below is a great primer on Iodine. Â Let’s start here!
There is growing evidence that Americans would have better health and a lower incidence of cancer and fibrocystic disease of the breast if they consumed more iodine. A decrease in iodine intake coupled with an increased consumption of competing halogens, fluoride and bromide, has created an epidemic of iodine deficiency in America.
People in the U.S. consume an average 240 micrograms (Â”g) of iodine a day. In contrast, people in Japan consume more than 12 milligrams (mg) of iodine a day (12,000 Â”g), a 50-fold greater amount. They eat seaweed, which include brown algae (kelp), red algae (nori sheets, with sushi), and green algae (chlorella). Compared to terrestrial plants, which contain only trace amounts of iodine (0.001 mg/gm), these marine plants have high concentrations of this nutrient (0.5â8.0 mg/gm). When studied in 1964, Japanese seaweed consumption was found to be 4.5 grams (gm) a day and that eaten had a measured iodine concentration of 3.1 mg/gm of seaweed (= 13.8 mg of iodine). According toÂ public health officials, mainland Japanese now consume 14.5 gm of seaweed a day (= 45 mg of iodine, if its iodine content, not measured, remains unchanged). Researchers have determined that residents on the coast of Hokkaido eat a quantity of seaweed sufficient to provide a daily iodine intake of 200 mg a day. Saltwater fish and shellfish contain iodine, but one would have to eat 15â25 pounds of fish to get 12 mg of iodine.
Health comparisons between the two countries are disturbing. The incidence of breast cancer in the U.S. is the highest in the world, and in Japan, until recently, the lowest. Japanese women who emigrate from Japan or adopt a Western style diet have a higher rate of breast cancer compared with those that consume seaweed. Life expectancy in the U.S. is 77.85 years, 48thÂ in 226Â countries surveyed. It is 81.25 years in Japan, the highest of all industrialized countries and only slightly behind the five leaders â Andorra, Macau, San Marino, Singapore, and Hong Kong. The infant mortality rate in Japan is the lowest in the world, 3.5 deaths under age one per 1,000 live births, half the infant mortality rate in the United States.
Today 1 in 7 American women (almost 15 percent) will develop breast cancer during their lifetime. Thirty years ago, when iodine consumption was twice as high as it is now (480 Â”g a day) 1 in 20 women developed breast cancer. Iodine was used as a dough conditioner in making bread, and each slice of bread contained 0.14 mg of iodine. In 1980, bread makers started using bromide as a conditioner instead, which competes with iodine for absorption into the thyroid gland and other tissues in the body. Iodine was also more widely used in the dairy industry 30 years ago than it is now.
Now iodized table salt is the chief source of iodine in a Western diet. But 45 percent of American households buy salt without iodine, which grocery stores also sell. And over the last three decades people who do use iodized table salt have decreased their consumption of it by 65 percent. Furthermore, the much higher concentrations of chloride in salt (NaCl) inhibits absorption of its sister halogen iodine (the intestines absorb only 10 percent of the iodine present in iodized table salt). As a result, 15 percent of the U.S. adult female population suffers from moderate to severe iodine deficiency, whichÂ health authorities defineÂ as a urinary iodine concentration less than 50 Â”g /L. Women with goiters (a visible, noncancerous enlargement of the thyroid gland) owing to iodine deficiency have been found to have a three times greater incidence of breast cancer. A high intake of iodine is associated with a low incidence breast cancer, and a low intake with a high incidence of breast cancer.
Animal studies show that iodine prevents breast cancer, arguing for a causal association in these epidemiological findings. The carcinogens nitrosmethylurea and DMBA cause breast cancer in more than 70 percent of female rats. Those given iodine, especially in its molecular form as I2, have a statistically significant decrease in incidence of cancer. Other evidence adding biologic plausibility to the hypothesis that iodine prevents breast cancer includes the finding that the ductal cells in the breast, the ones most likely to become cancerous, are equipped with an iodine pump (the sodium iodine symporter, the same one that the thyroid gland has) to soak up this element.
Similar findings apply to fibrocystic disease of the breast. The incidence of fibrocystic breast disease in American women was 3 percent in the 1920s. Today, 90 percent of women have this disorder, manifested by epithelial hyperplasia, apocrine gland metaplasia, fluid-filled cysts, and fibrosis. Six million American women with fibrocystic disease have moderate to severe breast pain and tenderness that lasts more than 6 days during the menstrual cycle.
In animal studies, female rats fed an iodine-free diet develop fibrocystic changes in their breasts, and iodine in its elemental form (I2) cures it.
Russian researchers first showed, in 1966, that iodine effectively relieves signs and symptoms of fibrocystic breast disease. Vishniakova and Murav’eva treated 167 women suffering from fibrocystic disease with 50 mg KI during the intermenstrual period and obtained a beneficial healing effect in 71 percent (it is reference 49Â here).
AÂ statistical analysisÂ of the Seattle study (enlarged to include 92 women) was done, which shows that iodine has a highly statistically significant beneficial effect on fibrocystic disease (P< 0.001). Iodine reduced breast tenderness, nodularity, fibrosis, turgidity, and number of macroscysts, the five parameters in a total breast examination score that a physician blinded to what treatment the woman was taking, iodine or placebo, measured. ThisÂ 36-page report, now availableÂ online, was submitted to the Food and Drug Administration (FDA) in 1995 seeking its approval to carry out a larger randomized controlled clinical trial on iodine for treating fibrocystic breast disease. It declined to approve the study, telling its lead investigator, Dr. Donald Low, “iodine is a natural substance, not a drug.” But the FDA has now decided to approve a similar trial sponsored by Symbollon Pharmaceuticals. This company is enrolling 175 women in a phase III trial, registered onÂ clinicaltrials.gov. (Any women with fibrocystic disease reading this who might be interested in participating in this study should call its sponsor, Jack Kessler, Ph.D., at 508-620-7676, Ext. 201.)Then Ghent and coworkers, in aÂ studyÂ published in theÂ Canadian Journal of SurgeryÂ in 1993, likewise found that iodine relieves signs and symptoms of fibrocystic breast disease in 70 percent of their patients. This report is a composite of three clinical studies, two case series done in Canada in 696 women treated with various types of iodine, and one in Seattle. The Seattle study, done at the Virginia Mason Clinic, is a randomized, double-blind, placebo-controlled trial of 56 women designed to compare 3â5 mg of elemental iodine (I2) to a placebo (an aqueous mixture of brown vegetable dye with quinine). Investigators followed the women for six months and tracked subjective and objective changes in their fibrocystic disease.
Most physicians and surgeons view iodine from a narrow perspective. It is an antiseptic that disinfects drinking water and prevents surgical wound infections, and the thyroid gland needs it to make thyroid hormones â and that’s it. (When painted on the skin prior to surgery, tincture of iodine kills 90 percent of bacteria present within 90 seconds.) The thyroid gland needs iodine to synthesize thyroxine (T4) and triiodothyronine (T3), hormones that regulate metabolism and steer growth and development. T4 contains four iodine atoms combined with 27 other atoms of carbon, hydrogen, oxygen, and nitrogen, but owing to its large size accounts for 65 percent of the molecule’s weight. (T3 has three iodine atoms.) The thyroid needs only a trace amount of iodine, 70 Â”g a day, to produce the requisite amount of T4 and T3. For that reason thyroidologists say that iodine is best taken just in microgram amounts. They consider consuming more than 1 to 2 mg of iodine a day to be excessive and potentially harmful.
Iodine has an important and little understood history. This relatively scarce element has played a pivotal role in the formation of our planet’s atmosphere and in the evolution of life. For more than two billion years there was no oxygen in the atmosphere until a new kind of bacteria, cyanobacteria (blue-green algae), began producing oxygen as a byproduct of photosynthesis. Cyanobacteria also developed an affinity for iodine. The most likely reason is that these organisms used iodine as an antioxidant to protect themselves against the free radicals that oxygen breeds (superoxide anion, hydrogen peroxide, and hydroxyl radical). Studying kelp,researchers have shownÂ how iodine does this and have found that kelp will absorb increased amounts of iodine when placed under oxidative stress. Other researchers haveÂ shownÂ that iodine increases the antioxidant status of human serum similar to that of vitamin C.Expert opinion on iodine is now the purview of thyroidologists. Mainstream physicians and surgeons accept their thyroid-only view of iodine and either ignore or discount studies that show iodine in larger amounts provides extrathyroidal benefits, particularly for women’s breasts. Thus a leading textbook on breast disease, Bland and Copeland’sÂ The Breast: Comprehensive Management of Benign and Malignant DisordersÂ (2003), fails to mention iodine anywhere in its 1,766 pages.
Iodine also inducesÂ apoptosis, programmed cell death. This process is essential to growth and development (fingers form in the fetus by apoptosis of the tissue between them) and for destroying cells that represent a threat to the integrity of the organism, like cancer cells and cells infected with viruses. Human lung cancer cells with genes spliced into them that enhance iodine uptake and utilizationÂ undergo apoptosis and shrinkÂ when given iodine, both when grownÂ in vitroÂ outside the body and implanted in mice. Its anti-cancer function may well prove to be iodine’s most important extrathyroidal benefit.
Iodine has other extrathyroidal functions that require more study. ItÂ removesÂ toxic chemicals â fluoride, bromide, lead, aluminum, mercury â and biological toxins,Â suppressesÂ auto-immunity,Â strengthensÂ the T-cell adaptive immune system, andÂ protectsÂ against abnormal growth of bacteria in the stomach.
Today’s medical establishment is wary of iodine (as they are of most naturally occurring, nonpatentable, nonpharmaceutical agents). Thyroidologists cite the Wolff-Chaikoff effect and warn that TSH (thyroid stimulating hormone) blood levels can rise with an iodine intake of a milligram or more. The Wolff-Chaikoff effect, a temporary inhibition of thyroid hormone synthesis that supposedly occurs with increased iodine intake, is ofÂ no clinical significance. And an elevated TSH, when it occurs, is “subclinical.” This means that no signs or symptoms of hypothyroidism accompany its rise. Some people taking milligram doses of iodine, usually more than 50 mg a day, develop mild swelling of the thyroid gland without symptoms. The vast majority of people, 98 to 99 percent, can take iodine in doses ranging from 10 to 200 mg a dayÂ without any clinically adverse affectsÂ on thyroid function. The prevalence of thyroid diseases in the 127 million people in Japan who consume high amounts of iodine is not much different than that in the U.S.In addition to the thyroid and mammary glands, other tissues possess an iodine pump (the sodium/iodine symporter). Stomach mucosa, the salivary glands, and lactating mammary glands can concentrate iodine almost to the same degree as the thyroid gland (40-fold greater than its concentration in blood). Other tissues that have this pump include the ovaries; thymus gland, seat of the adaptive immune system; skin; choroid plexus in the brain, which makes cerebrospinal fluid; and joints, arteries and bone.
Everyone agrees that a lack of iodine in the diet causes a spectrum of disorders that includes, in increasing order of severity, goiter and hypothyroidism, mental retardation, and cretinism (severe mental retardation accompanied by physical deformities). Health authorities in the U.S. and Europe have agreed upon a Reference Daily Intake (RDI), formerly called the Recommended Dietary Allowance (RDA), for iodine designed to prevent these disorders, which the World Health Organization (WHO) estimates afflicts 30 percent of the world’s population. The RDI for iodine, first proposed in 1980, is 100â150 Â”g/day. Organizations advocating this amount include the American Medical Association, National Institutes of Health’s National Research Council, Institute of Medicine, United Nations Food and Agricultural Organization, WHO Expert Committee, and the European Union International Programme on Chemical Safety. These health authorities consider an RDI of 100â150 Â”g/day of iodine sufficient to meet the requirements of nearly all (97â98%) healthy individuals.
This consensus on iodine intake flies in the face of evidence justifying a higher amount. This evidence includes animal studies,Â in vitroÂ studies on human cancer cell lines, clinical trials of iodine for fibrocystic breast disease, and epidemiological data. An intake of 150 Â”g/day of iodine will prevent goiters and the other recognized iodine deficiency disorders, but not breast disease. Prevention of breast disease requires higher doses of iodine. Indeed, a reasonable hypothesis is that, like goiters and cretinism, fibrocystic disease of the breast and breast cancer are iodine deficiency disorders (also uterine fibroids).
These are the four most common formulations of inorganic (nonradioactive) iodine, as iodide (I-), and with or without molecular iodine (I2): Potassium iodide (KI) tablets, in doses ranging from 0.23 to 130 mg; super saturated potassium iodide (SSKI), 19â50 mg of iodide per drop; Lugol’s solution, 6.3 mg of molecular iodine/iodide per drop; and Iodoral, each tablet containing 12.5 mg iodine/iodide. Both Lugol’s solution and Ioderal are one-third molecular iodine (5%) and two-thirds potassium iodide (10%). Studies done to date indicate that the best iodine supplement is one that includes molecular iodine (I2), which breast tissue prefers.What Albert GuĂ©rard writes about new truths applies especially to iodine: “When you seek a new path to truth, you must expect to find it blocked by expert opinion.” The reigning truth on iodine is that the thyroid gland is the only organ in the body that requires this micronutrient, and a daily intake considerably more than what the thyroid gland needs is potentially harmful. The new truth is that the rest of the body also needs iodine, in milligram, not microgram amounts. Tell that to a thyroidologist and her response will call to mind this admonition on new truths.
Iodine was used for a wide variety of ailments after its discovery in 1811 up until the mid-1900s, when thyroidologists warned that “excess” amounts of iodine might adversely affect thyroid function. It is effective in gram amounts for treating various dermatologic conditions, chronic lung disease, fungal infestations, tertiary syphilis, and even arteriosclerosis. The Nobel laureate Dr. Albert Szent GyĂ¶rgi (1893â1986), the physician who discovered vitamin C, writes: “When I was a medical student, iodine in the form of KI was the universal medicine. Nobody knew what it did, but it did something and did something good. We students used to sum up the situation in this little rhyme:
If ye don’t know where, what, and why
Prescribe ye then K and I”
The standard dose of potassium iodide given was 1 gram, which contains 770 mg of iodine.
Regarding KI and other iodine salts (like sodium iodide), the venerated 11thÂ edition of theÂ Encyclopedia Britannica, published in 1911, states, “Their pharmacological action is as obscure as their effects in certain diseased conditions are consistently brilliant. Our ignorance of their mode of action is cloaked by the term deobstruent, which implies that they possess the power of driving out impurities from the blood and tissues. Most notably is this the case with the poisonous products of syphilis. In its tertiary stage â and also earlier â this disease yields in the most rapid and unmistakable fashion to iodides, so much so that the administration of these salts is at present the best means of determining whether, for instance, a cranial tumor be syphilitic or not.”
This 19thÂ and early 20thÂ century medicine continues to be used in gram amounts in the 21stcentury by dermatologists. They treat inflammatory dermatoses, like nodular vasculitis and pyoderma gangrenosum (shown here), with SSKI, beginning with an iodine dose of 900 mg a day, followed by weekly increases up to 6 grams a day as tolerated. Fungal eruptions, like sporotrichosis, are treated initially in gram amounts with great success. These lesions can disappear within two weeks after treatment with iodine.
For many years physicians used potassium iodide in doses starting at 1.5 to 3 gm and up to more than 10 grams a day, on and off, to treat bronchial asthma and chronic obstructive pulmonary disease with good results and surprisingly few side effects.
There is a case report in the medical literature of a 54-year-old man who, thinking it was iced tea, drank a “home preparation” of SSKI in water that his aunt kept in the refrigerator for her rheumatism. Over a short period of time he consumed 600 ml of this solution, which contained 15 gm of iodide, an amount 100,000 times more than the RDI. He developed swelling of the face, neck, and mouth, had transient cardiac arrhythmias and made an uneventful recovery.
Dr. Guy Abraham, a former professor of obstetrics and gynecology at UCLA, mounted what he calls “The Iodine Project” in 1997 after he read the Ghent paper on iodine for fibrocystic disease. He had his company, Optimox Corp., make Iodoral, the tablet form of Lugol’s solution, and he engaged two family practice physicians, Dr. Jorge Flechas (in 2000) in North Carolina and Dr. David Brownstein (in 2003) in Michigan to carry out clinical studies with it.
The project’s hypothesis is that maintaining whole body sufficiency of iodine requires 12.5 mg a day, an amount similar to what the Japanese consume. The conventional view is that the body contains 25â50 mg of iodine, of which 70â80 percent resides in the thyroid gland. Dr. Abraham concluded that whole body sufficiency exists when a person excretes 90 percent of the iodine ingested. He devised an iodine-loading test where one takes 50 mg and measures the amount excreted in the urine over the next 24 hours. He found that the vast majority of people retain a substantial amount of the 50 mg dose. Many require 50 mg a day for several months before they will excrete 90 percent of it. HisÂ studiesÂ indicate that, given a sufficient amount, the body will retain much more iodine than originally thought, 1,500 mg, with only 3 percent of that amount held in the thyroid gland.
Thyroid function remains unchanged in 99 percent of patients.Â Untoward effectsÂ of iodine, allergies, swelling of the salivary glands and thyroid, and iodism, occur rarely, in less than 1 percent. Iodine removes the toxic halogensÂ fluorideÂ and bromide from the body. Iodism, an unpleasant brassy taste, runny nose, and acne-like skin lesions, is caused by the bromide that iodine extracts from the tissues. Symptoms subside on a lesser dose of iodine.More than 4,000 patients in this project take iodine in daily doses ranging from 12.5 to 50 mg, and in those with diabetes, up to 100 mg a day. TheseÂ investigators have foundÂ that iodine does indeed reverse fibrocystic disease; their diabetic patients require less insulin; hypothyroid patients, less thyroid medication; symptoms of fibromyalgia resolve, and patients with migraine headaches stop having them. To paraphrase Dr. Szent-GyĂ¶rgi, these investigators aren’t sure how iodine does it, but it does something good.
As these physicians point out, consuming iodine in milligram doses should, of course, be coupled with a complete nutritional program that includes adequate amounts of selenium, magnesium, and Omega-3 fatty acids. Done this way, an iodine intake 100 times the reference daily intake is “the simplest, safest, most effective and least expensive way to help solve the health care crisis crippling our nation,” as the leader of The Iodine Project, Dr. Abraham, puts it.
People who take iodine in these amounts report that they have a greater sense of well-being, increased energy, and a lifting of brain fog. They feel warmer in cold environments, need somewhat less sleep, improved skin complexion, and have more regular bowel movements. These purported health benefits need to be studied more thoroughly, as do those with regard to fibrocystic breast disease and cancer.
Meanwhile, perhaps we should emulate the Japanese and substantially increase our iodine intake, if not with seaweed, then with two drops of Lugol’s Solution (or one Iodoral tablet) a day.
- Miller DW. Iodine in Health and Civil Defense. Presented at the 24thÂ Annual Meeting of Doctors for Disaster Preparedness in Portland, Oregon, August 6, 2006. The text for this talk, with 68 references, can be foundhere, andÂ the PowerPoint slides I used for it, here.
- Abraham GE.Â The safe and effective implementation of orthoiodosupplementation in medical practice.Â The Original InternistÂ 2004;11:17â36. Available onlineÂ here. This is a good introduction to The Iodine Project. His other research studies are onlineÂ here.
- Flechas, JD.Â Orthoiodosupplementation in a primary care practice.Â The Original InternistÂ 2005;12(2):89â96. Available onlineÂ here.
- Brownstein D.Â Clinical experience with inorganic, non-radioactive iodine/iodide.Â The Original Internist2005;12(3):105â108. Available onlineÂ here.
- Derry D.Â Breast cancer and iodine: How to prevent and how to survive breast cancer. Victoria, B.C.: Trafford Publishing; 2002. The book is a bit disorganized, has references at the end of each chapter not cited in the text, and no index; but it is an eye-opener nonetheless.
- Brownstein D.Â Iodine: why you need it why you can’t live without it. West Bloomfield, Michigan: Medical Alternatives Press; 2004. Well-written and referenced, with case histories.
- Low DE, Ghent WR, Hill LD. Diatomic iodine treatment for fibrocystic disease: special report of efficacy and safety results. [Submitted to the FDA] 1995:1â38. Available onlineÂ here. This study makes a strong case for iodine as the preferred treatment for fibrocystic disease.
August 14, 2006
Donald MillerÂ (send him mail) is a cardiac surgeon and Professor of Surgery at the University of Washington in Seattle. He is a member ofÂ Doctors for Disaster PreparednessÂ and writes articles on a variety of subjects for LewRockwell.com.Â His web site isÂ www.donaldmiller.com
Copyright Â© 2006 LewRockwell.com
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