Iodine: The Universal Nutrient

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Iodine: The Universal Nutrient

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By Guy E. Abraham, M.D.

 

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In textbooks of medicine, endocrinology and thyroidology, the essential

element iodine is mentioned only in connection with the most severe forms of

deficiency of this nutrient: cretinism, iodine-deficiency induced goiter and

hypothyroidism. Due to thyroid fixation, inhibitors of iodine uptake and

utilization by target cells are called goitrogens, that is, substances causing

thyroid enlargement, implying that iodine inhibitors only influence thyroid

function. Perhaps, there is a restraining order preventing iodine inhibitors

from

interfering with iodine in extrathyroidal target organs. Many physicians would

be surprised to learn that more than a hundred years ago, iodine was called “

The Universal Medicineâ€, and was used in several clinical conditions. Nobel

Laureate Albert Szent Györgyi,1 the physician who discovered Vitamin C in

1928, commented:

**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.

 

Our medical predecessors, …were keen observers and the universal application

of iodide might have been not without foundation.**

 

Recent research on the medical applications of this essential nutrient may

prove indeed that iodine is a universal medicine, or more appropriately, a

universal nutrient.2-13 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 per day, an excessive amount by today’s

standard, in 150 goiter patients with great success. He published his results

in

1820.14 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, containing from 12.5 to

37.5

mg elemental iodine, for iodine/iodide supplementation.5,15 The Lugol

solution was developed by French physician, Jean Lugol in 1829 for treatment of

infectious diseases using oral ingestion of his preparation.16 The Lugol

solution contains 5 percent iodine and 10 percent potassium iodide in water.

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 range of

daily

intake of Lugol solution for iodine supplementation based on clinical

observation of the patient’s overall well being turned out to be the exact

range of

iodine needed for whole body sufficiency, based on an iodine/iodide loading

test developed recently.5

 

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.17 The syrup is prepared by the British

apothecary

from an aqueous stock solution containing 10 percent 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

percent 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.

 

The element iodine was used for the treatment of hypo- and hyperthyroidism5

and for many other medical conditions.18 For hyperthyroidism, the daily dose

ranged from 6.25 mg to 180 mg elemental iodine in the form of Lugol solution

with the most common intake of 90 mg achieving success rate as high as 90

percent.5

 

With the availability of thyroid hormones in the 1930s, thyroidologists

started using these preparations in patients with iodine deficiency and simple

goiter instead of the previously used inorganic iodine/iodide preparations. The

situation was aggravated by the fact that during the same period, the public

was relying on iodized table salt instead of iodine/iodide preparations from

apothecaries for supplementation, due to the propaganda favoring the use of

iodized salt.19 The thyroidologists assumed that, with iodization of table

salt, iodine deficiency became a thing of the past, because of the positive

effect of iodized salt on the incidence of goiter. That was the beginning of

thyroid fixation. It only requires 0.05 mg iodide per day to control goiter.5

With an estimated daily intake of 10 gm of table salt by the U.S. population

and

at an iodide concentration of 75 PPM, the daily intake of iodide averaged

750 µg or 0.75 mg. There are 30,000 times more chloride than iodide on a molar

basis in iodized salt. Due to competition for intestinal absorption between

the halides chloride and iodide, only 10 percent of iodide in iodized salt is

bioavailable.6 This bioavailable amount of 75 µg or 0.075 mg iodide is 500

times less than 0.3 ml of Lugol solution previously recommended by U.S.

physicians. Iodization of salt decreased markedly the prevalence of goiter

because

it only takes 0.05 mg per day of iodide to achieve this goal.5

 

Most physicians by the 1950s neglected the rest of the human body, in terms

of sufficiency for iodine, and forgot that their predecessors were using

amounts of iodine/iodide 2 orders of magnitude greater than the amounts present

in the average daily consumption of table salt. This was mainly due to

iodophobic publications appearing in the late 1940s and also due to the

erroneous

assumption that absence of goiter means iodine sufficiency. Published studies

on the safe and effective use of Lugol solution in hypo- and hyperthyroidism

mysteriously disappeared during the 1940s, concurrent with the appearance of

iodophobic publications. The promotion of thyroid extracts and thyroid

hormones as an alternative to Lugol solution in the management of iodine

deficiency

induced goiter and hypothyroidism; and of goitrogens and radioiodide as an

alternative to Lugol solution in the management of hyperthyroidism with both

alternatives well synchronized with the iodophobic publications. It was a

brilliant move and it worked wonderfully. By the 1970s, following the

iodophobic

publication of Wolf20, physicians concluded that one must avoid inorganic

non-radioactive iodine “like leprosy,†unless it was incorporated into the

toxic

organic iodine-containing drugs. Then, iodine could be tolerated because

iodine could be blamed for the toxicity of these drugs.

 

Against this background, a 1993 publication by Ghent et al21 reported the

beneficial effects of 5 mg iodine ingested daily for approximately one year in

1,368 patients with Fibrocystic Disease of the Breast (FDB). I became aware

of Ghent’s publication in 1997. Ghent’s study did not confirm Wolff’s

prediction that daily iodine intake of 2000 ug (2 mg) was “excessive and

potentially

harmful.†Based on academic credentials and reputation, the opinion of

thyroidologist Wolff from the National Institute of Health would prevail over

the

findings of Ghent et al. However, being interested in facts only, not in

preconceived opinions of famous thyroidologists, I initiated an extensive search

of the literature on iodine in medicine 7 years ago, combined with some

original clinical research.7

 

The literature search revealed that 60 million mainland Japanese consume a

daily average of 13.8 mg of elemental iodine, and they are one of the

healthiest nations based on overall well being and cancer statistics.7 Japanese

women

do not stop consuming iodine-rich foods during pregnancy, and Japanese

fetuses are exposed to maternal peripheral levels of iodide at concentrations

of

10-5M to 10-6M. Either the Japanese are mutants capable of surviving on toxic

levels of iodine or we have been grossly deceived. The human body needs at

least 100 times the RDA, which was established very recently in 1980 and

confirmed in 1989!!

 

After overcoming the delusion that inorganic non-radioactive forms of iodine

are toxic, and becoming aware that the inorganic non-radioactive forms of

iodine were extremely safe (and were used extensively by U.S. physicians for

many medical conditions), I initiated the Iodine Project. It is very exciting

to learn that the team at Vitamin Research Products has decided to join the

Iodine Project. Welcome!

 

Administration of iodine in liquid solution is not very accurate, may stain

clothing, has an unpleasant taste and causes gastric irritation. We decided

to use a precisely quantified tablet form of Lugol. To prevent gastric

irritation, the iodine/iodide preparation was absorbed into a colloidal silica

excipient; and to eliminate the unpleasant taste of iodine, the tablets were

coated with a thin film of pharmaceutical glaze.2

 

To confirm the safety of the Lugol tablets, pilot studies were performed

with tablets of Lugol containing from 1 mg to 12.5 mg of elemental iodine.

Following the pilot studies, ten female subjects, 7 with breast symptomatology,

were studied for 3 months at 12.5 mg per day. Pre and post-supplementation

evaluation of blood chemistry, hematology, thyroid function tests and

ultrasonometry of the thyroid gland were performed. The results obtained in

these female

subjects using a tablet form of Lugol solution (Iodoral®) at 12.5 mg per day

for 3 months confirmed Ghent’s observations and the safety of the Lugol

tablets. The data were published in the Original Internist in 2002.2

 

The bioavailability of a Lugol tablet (Iodoral®) containing 12.5 mg

elemental iodine was evaluated by measuring 24 hr urine levels of iodide

together

with the minerals, trace elements and toxic metals before and after

administration of this preparation. The results obtained following iodine

supplementation

revealed that in some subjects, the urine levels of mercury, lead and

cadmium increased by several fold after just one day of supplementation. For

aluminum, this increased excretion was not observed usually until after one

month

or more on the iodine supplementation. Since this observation was made on a

limited number of assays, it needs to be confirmed using a well designed

protocol in a large number of patients.

 

Based on data available in the medical literature, urinary iodide levels are

considered the best index of iodine intake.3 The initial results of the

bioavailability study suggested that the Lugol tablets were not well absorbed

since only 20 to 30 percent of the administered amount was recovered in the 24

hr. urine collection of 5 subjects tested.3 Just in case medical textbooks

were wrong, and the explanation for the low recovery of iodide is body

retention

of iodine/iodide, the supplementation was continued for one month and then

urine iodide levels were measured again in the 24 hr. urine collection.

Medical textbooks were wrong. The subjects excreted a mean of 50 percent of the

amount ingested, with one subject excreting 96 percent of the ingested amount.

 

The implication of such an observation was that an iodine/iodide-loading

test could be developed to assess not just thyroid sufficiency for iodine, but

requirement of the whole human body for that essential element. However,

instead of a one-month loading test, further studies were performed to shorten

this

test to a single ingestion of the preparation. Another group of 6 subjects,

(3 males and 3 females) were evaluated with 24 hr urinary iodide levels after

ingesting one, two and three tablets of the same preparation. The mean

percent excretions were: 1 Tab = 22; 2 Tab = 23 and 3 Tab = 25. In a third

group

of 6 subjects, urine iodide levels were evaluated following 4 tablets of the

same preparation. The mean percent excretion was 39. (Fig. 1) For the loading

test, a single ingestion of 4 tablets was chosen.5 This dose resulted in the

highest mean percent iodide excreted with the widest interindividual

variations. Because of the improved overall well being reported by the subjects

who

achieved 90 percent or more iodide excreted, sufficiency was arbitrarily set

as 90 percent .

 

Whole body sufficiency for iodine correlated well with overall well being,

and some subjects could tell when they achieved sufficiency even before

knowing the results of the test. Iodine sufficiency was associated with a sense

of

overall well being, lifting of “brain fog,†feeling warmer in cold

environments, increased energy, needing less sleep, achieving more in less time,

experiencing regular bowel movements and improved skin complexion. Several

clinical conditions where whole body iodine deficiency may play an important

role

are listed in Table I.

 

The iodine/iodide loading test is based on the concept that the normally

functioning human body has a mechanism to retain ingested iodine until whole

body sufficiency for iodine is achieved. During orthoiodosupplementation, a

negative feedback mechanism is triggered that progressively adjusts the

excretion

of iodine to balance the intake. As the body iodine content increases, the

percent of the iodine load retained decreases with a concomitant increase in

the amount of iodide excreted in the 24 hr urine collection. When whole body

sufficiency for iodine is achieved, the absorbed iodine/iodide is

quantitatively excreted as iodide in the urine.5-7

 

After 3 months of supplementation with 50 mg iodine/iodide per day, most

non-obese subjects not exposed to excess goitrogens achieved whole body iodine

sufficiency, arbitrarily defined as 90 percent or more of the iodine load

excreted in the 24 hr urine collections.5,6 Adult subjects retained

approximately

1.5 gm of iodine when they reach sufficiency.6

 

In patients with a normal gastrointestinal absorption of iodine but with a

very defective iodine retention system, the absorbed iodine is quantitatively

excreted in the urine with little or no retention. In these rare cases, the

loading test will suggest whole body iodine sufficiency (90 percent or more

excreted) but the serum inorganic iodide levels 24 hrs after the iodine load

will remain low (less than 0.13 mg/L).7 The inefficient iodine retention

mechanism could be due to either a defective cellular iodine transport system

or

due to blockage of this iodine cellular transport by iodine inhibitors that

compete with iodide for the halide binding site of the symporter system and for

iodine utilization. In one such case8, oral administration of Vitamin C

sustained release at 3 gm per day improved significantly the defective cellular

transport system for iodine (See Fig. 2 & 3).

 

The side effects reported with the use of inorganic non-radioactive iodine

are:

• acne-like skin lesions in certain areas of your body

• headache in the frontal sinus

• unpleasant brassy taste

• increased salivation and sneezing

Based on the experience of clinicians with several thousands of patients on

Iodoral®, with daily amounts ranging from 6.25 to 50 mg for up to 3 years,

the incidence of the above side effects has been estimated at 1 percent.12,13

Orthoiodosupplementation induces a detoxification reaction in some patients

with high bromide levels7,8, including increased body odor and cloudy urine.

The body odor lasts one to two weeks, but the cloudy urine may last several

months before clearing up. It is of interest to note that the pre- iodine

loading urine samples in these cases were clear, but following

orthoiodosupplementation, the urine samples became very cloudy with an

unpleasant odor and a

thick sedimentation upon standing. Although these cases were associated with

high

bromide excretion (greater than 200 mg per 24 hr), it is not clear if the

presence of this halogen in the urine sample was the cause of the odor and

cloudiness.

 

Increased fluid intake and a complete nutritional program emphasizing

magnesium instead of calcium minimize these side effects. Administration of

magnesium in daily amounts up to 1200 mg eliminated the body odor but not the

cloudy

urine. Scrubbing the skin with a vegetable brush while bathing is

recommended in those cases. Occasionally, the released bromide from storage

sites

induced decreased thyroid function, bromide being a potent goitrogen.5,8 If the

loading test provokes high urine bromide levels, it is best to start the

patient on a low dose of iodine (1/2 to 1 tablet Iodoral®) and progressively

increase the daily intake for optimal response to bring serum and urine bromide

levels below 10 mg/L and 10 mg per 24 hr respectively. In some patients, it may

take up to 2 years. Bromide is ubiquitous in our homes and environment.

Bromine-containing fire retardants are in our carpets, our clothes, even

children’

s clothes! The question: Is this due to collective stupidity or a well

planned conspiracy?

 

Since chloride increases renal clearance of bromide8, a trial of chloride

load (6-10 gm per day) would decrease the time required for bromide

detoxification. Use unprocessed sea salt instead of processed iodized table

salt. If

serum and urine bromide levels are not available, it is best to start with a

daily amount of one tablet of Iodoral® and increasing the amount to two

tablets

after one week, three tablets after two weeks and four tablets after three

weeks. A complete nutritional program emphasizing magnesium is recommended. Use

clinical observation of the patient’s response and overall well being to

titrate the iodine supplementation like our medical predecessors who did not

have access to serum thyroid hormone levels and procedures for assessing whole

body sufficiency for iodine.

 

Summary of findings

Based on a review of the literature, and recent clinical research

studies2-13, the concept of orthoiodosupplementation can be summarized as

follows:

1. The nutrient iodine is essential for every cell of the human body

requiring peripheral concentrations of inorganic iodide ranging from 10-6M to

10-5M.

 

2. In non-obese subjects without a defecting cellular transport system for

iodine, these concentrations can be achieved with daily intake of 12.5 mg to

50 mg elemental iodine. The adult body retains approximately 1.5 gm iodine at

sufficiency. At such time, the ingested iodine is quantitatively excreted in

the urine as iodide.

 

3. The thyroid gland is the most efficient organ of the human body, capable

of concentrating iodide by 2 orders of magnitude to reach 10-6M iodide

required for the synthesis of thyroid hormones when peripheral levels of

inorganic

iodide are in the 10-8M range.

 

4. Goiter and cretinism are evidence of extremely severe iodine deficiency,

because the smallest intake of iodine that would prevent these conditions,

that is 0.05 mg per day, is 1000 times less than the optimal intake of 50 mg

elemental iodine.

 

5. The thyroid gland has a protective mechanism, limiting the uptake of

peripheral iodide to a maximum of 0.6 mg per day when 50 mg or more elemental

iodine are ingested. This amount therefore would serve as a preventive measure

against radioactive fallout.

 

6. An intake of 50 mg elemental iodine per day would achieve peripheral

concentration of iodide at 10-5M, which is the concentration of iodide markedly

enhancing the singlet triplet radiationless transition. Singlet oxygen causes

oxidative damage to DNA and macromolecules, predisposing to the carcinogenic

effects of these reactive oxygen species.5 This effect would decrease DNA

damage, with an anticarcinogenic effect.

 

7. Preliminary data so far suggest that orthoiodosupplementation results in

detoxification of the body from the toxic metals aluminum, cadmium, lead and

mercury.

 

8. Orthoiodosupplementation increases urinary excretion of fluoride and

bromide, decreasing the iodine-inhibiting effects of these halides.

 

9. Most patients on a daily intake ranging from 12.5 mg to 50 mg elemental

iodine reported higher energy levels and greater mental clarity with 50 mg (4

tablets Iodoral), daily. The amount of iodine used in patients with

Fibrocystic Disease of the Breast by Ghent et al20 is 0.1 mg/Kg BW per day, 10

times

below the optimal daily intake of 50 mg. In our experience, patients with this

clinical condition responded faster and more completely when ingesting 50 mg

iodine/iodide per day.

 

10. For best results, orthoiodosupplementation should be part of a complete

nutritional program, emphasizing magnesium instead of calcium.

 

11. A beneficial effect of orthoiodosupplementation was observed in the

clinical conditions listed in Table I.5,7,12,13

 

12. The iodine/iodide loading test and serum inorganic iodide levels are

reliable means of assessing whole body sufficiency for elemental iodine for

quantifying the bioavailability of the forms of iodine ingested and for

assessing

cellular uptake and utilization of iodine by target cells.

 

13. Orthoiodosupplementation may be the safest, simplest, most effective and

least expensive way to solve the healthcare crisis crippling our nation.

 

References

1. Szent-Györgyi, A., Bioenergetics. Academic Press, New York, pg. 112, 1957.

2. Abraham, G.E., Flechas, J.D., Hakala, J.C., Optimum Levels of Iodine for

Greatest Mental and Physical Health. The Original Internist, 9:5-20, 2002.

3. Abraham, G.E., Flechas, J.D., Hakala, J.C., Measurement of urinary iodide

levels by ion-selective electrode: Improved sensitivity and specificity by

chromatography on anion-exchange resin. The Original Internist, 11(4):19-32,

2004.

4. Abraham, G.E., Flechas, J.D., Hakala, J.C., Orthoiodosupplementation:

Iodine sufficiency of the whole human body. The Original Internist, 9:30-41,

2002.

5. Abraham, G.E., The safe and effective implementation of

orthoiodosupplementation in medical practice. The Original Internist, 11:17-36,

2004.

6. Abraham, G.E., The concept of orthoiodosupplementation and its clinical

implications. The Original Internist, 11(2):29-38, 2004.

7. Abraham, G.E., The historical background of the iodine project. The

Original Internist, 12(2):57-66, 2005.

8. Abraham, G.E., Brownstein, D., Evidence that the administration of

Vitamin C improves a defective cellular transport mechanism for iodine: A case

report. The Original Internist, 12(3):125-130, 2005.

9. Abraham, G.E., The Wolff-Chaikoff Effect: Crying Wolf? The Original

Internist, 12(3):112-118, 2005.

10. Abraham, G.E., Iodine Supplementation Markedly Increases Urinary

Excretion of Fluoride and Bromide. Townsend Letter, 238:108-109, 2003.

11. Abraham, G.E., Serum inorganic iodide levels following ingestion of a

tablet form of Lugol solution: Evidence for an enterohepatic circulation of

iodine. The Original Internist, 11 (3):29-34, 2004.

12. Brownstein, D., Clinical experience with inorganic, non-radioactive

iodine/iodide. The Original Internist, 12(3):105-108, 2005.

13. Flechas, J.D., Orthoiodosupplementation in a primary care practice. The

Original Internist, 12(2):89-96, 2005.

14. Coindet, J.F., Decouverte d’un nouveau remède contre le goitre. Ann.

Clin. Phys., 15:49, 1820.

15. Gennaro A.R., Remington: The Science and Practice of Pharmacy, 19th

Edition, 1995, Mack Publishing Co., 1267.

16. Lugol, J.G.A., Mémoire sur l’emploi de l’iode dans les maladies

scrophuleuses. Paris, 1829.

17. Martindale, The Extra Pharmacopoeia 28th edition. J.E.F. Reynolds.

Editor: The Pharmaceutical Press, pg. 865, 1982.

18. Kelly, Francis C., Iodine in Medicine and Pharmacy Since its Discovery –

1811-1961. Proc R Soc Med 54:831-836, 1961.

19. Hartsock, C.L., Iodized Salt in the Prevention of Goiter. Jour. Amer.

Med. Assoc., 86:1334-1338, 1926.

20. Wolff, J., Iodide Goiter and the Pharmacologic Effects of Excess Iodide.

Am. J. Med., 47:101-124, 1969.

21. Ghent, W.R., Eskin, B.A., Low., D.A., et al, Iodine Replacement in

Fibrocystic Disease of the Breast. Can. J. Surg., 36:453-460, 1993.

 

 

About the author:

Guy E. Abraham, M.D., is a former Professor of Obstetrics, Gynecology and

Endocrinology at the UCLA School of Medicine. Some 36 years ago, he pioneered

the development of assays to measure minute quantities of steroid hormones in

biological fluids. He has been honored as follows: General Diagnostic Award

from the Canadian Association of Clinical Chemists, 1974; the “Medaille d’

Honneur†from the University if Liege, Belgium, 1976; the Senior Investigator

Award of Pharmacia, Sweden, 1980.