In Part 1 in this series on Thyroid and Iodine, Dr. Ruscio delves into the immense body of research available today on the topic. He goes into depth on what the research tells us on thyroid, hypothyroidism and thyroid autoimmunity, why halogens might not be that important, the importance of the Sodium/Iodide Symporter and the recommended lab tests for thyroid health and iodine sufficiency.
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Iodine and thyroid health…..4:17
Research on iodine, hypothyroidism and thyroid autoimmunity…..10:34
Halogens – fluorine, chlorine and bromine…..22:03
The importance of the Sodium/Iodide Symporter…..26:12
Recommended lab tests…..33:04
- (11:21) Environmental triggers of autoimmune thyroiditis http://www.ncbi.nlm.nih.gov/pubmed/19818584
- (12:04) Chris Kresser references:
Sri Lanka http://www.eje.org/content/149/2/103.abstract
- (12:49) Well performed review paper supporting excess dietary iodine and thyroid autoimmunity http://www.ncbi.nlm.nih.gov/pubmed/1345585
- (13:23) Other population studies supporting excess dietary iodine and thyroid autoimmunity:
NW Greece http://www.ncbi.nlm.nih.gov/pubmed/10211605
- (15:04) Interventional studies have shown decreasing iodine intake can lower thyroid antibodies.
- (15:24) A fairly large study, examining 1061 subjects in coastal regions of Japan http://www.ncbi.nlm.nih.gov/pubmed/?term=8106628
- (16:54) Along these same lines some studies have even shown that hypothyroidism can be reversed simply by iodine restriction
- (17:08) In fact in one study, patients who went on a low iodine diet saw their thyroid function normalize. Then when placed back on iodine they saw their hypothyroidism return. http://www.ncbi.nlm.nih.gov/pubmed/?term=3722332
- (19:18) Study examined the effect of iodine restriction (<100mcg/day) in Hashimoto’s patients http://www.ncbi.nlm.nih.gov/pubmed/12728462
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Thyroid & Iodine, Part 1
Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.
Now, let’s head to the show!
Susan McCauley: Hey everyone welcome to Dr. Ruscio radio. This is Susan McCauley from evolvenutrition.com and evolverecovery.com, and I’m here with the Doc. Hey, Doctor Ruscio!
Dr. Michael Ruscio: Hey, how are you?
SM: I’m hanging in there. It’s been one of those crazy days, I feel like this is the first time I’ve sat all day long even though I did sit and write a newsletter But, it’s just like, I sat in my little podcasting room, and I went: “Ahhhh…”
DR: Yeah, sometimes it’s nice to sit down and just kind of relax, I get it, yeah.
SM: Yeah, I had a client this morning. I have this 81-year-old client and he is so awesome because it’s easy to get him to eat liver and sauerkraut and all those traditional foods that most of us, you know, younger people turn our nose up at, so he gets so excited.
DR: Yeah, it’s always nice when people are compliant, it makes our job a lot easier.
SM: So much. So, what about you?
DR: I’m a little sleep deprived. I was actually puppy sitting for a friend of mine last night, and this puppy woke up every hour and a half.
SM: Oh my goodness.
DR: You know, whining and crying and barking…
SM: What kind of puppy?
DR: I don’t even know.
SM: Oh, ok. I’m a cat person but I like…puppies are cute.
DR: It looks like a Chihuahua, but it has curly white hair… so I’m not sure what kind of dog that was. But, and it’s probably at the worst time because this issue that we’re going to talk about today, iodine, and how it relates to thyroid is one of the most… I don’t want to say complex, because it’s not incredibly complicated, but I guess in a way it kind of is. There’s a lot of moving parts. I mean, what we do at the end of the day is relatively straightforward… but the rational of understanding why is a little bit hairy. And, I hope we’ll be able to get this. I’m actually a little bit nervous, because I’m hoping we’ll be able to get this cross distinctly, and in a clear format for people, but, and people listening to this, please feel free to reach out through your social media, the website, or what have you. In preparing to do this episode, I’ve been pulling a lot of notes from the chapter of the book on iodine and thyroid, and I think I’m just going to release that chapter on the website as an article because I don’t want to wait until the book releases, because I think this information is so important and I don’t know if I’m going to retire or the book is going to be published first. But the way things are going, I think I may just kind of put the whole chapter out there, and that will give people all this information, but in a written format that I think will be easier to follow. But, hopefully we’ll do a good job of just doing the topic justice today.
SM: Great. So, OK, let’s get into this. This is controversial, too.
DR: Yeah, I think it’s controversial… and what I’m really hoping to help people with is looking at what the scientific references show to get through the controversy, because when I first approached this issue, I didn’t have a dog enough fight, so to speak. I wasn’t pro-iodine. I wasn’t anti-iodine. I had heard and studied in camps of both, and so I approach this just kind of trying to find what I thought the quote/unquote truth was, or what the best approach would be. So, hopefully we can help people get to the bottom of this. And, I think there’s a couple things that I’ve uncovered that will help people come to grips with disparities, in the kind of controversy.
SM: Well, why don’t we start, too, because iodine- so , why would it be important when it comes to thyroid. I guess we could back up and start with the, you know, why we’re even talking about iodine and thyroid?
DR: Sure, and that’s a good lead in. So, it’s easy to see why the importance of Iodine regarding thyroid health would be emphasized because iodine is one of the precursors that needs to be combined with another amino acid called tyrosine to make Thyroid hormone. So, essentially, the thyroid gland uptakes both iodine and tyrosine from the bloodstream and then with the help of some familiar enzymes like tyro-peroxidase or the TPO enzyme with just a lab marker that we can use to track autoimmunity and/or thyroglobulin another marker, we eventually synthesize T-4 and T-3 and those are just tetraiodothyronine and triiodothyronine, so the ‘iodo’, meaning iodine and the thyronine for the tyrosine backbone, and certainly in mountainous areas that are iodine sufficient in terms of their soils, we see true iodine deficiency that can cause overt hypothyroidism creatinism. And that’s one of the leading causes of – preventable causes – of mental retardation and growth abnormalities. So, certainly frank iodined efficiency can be a problem. But the thinking was, ‘Well, if giving a little bit of iodine takes someone from frank hypothyroidism or I should say, giving a little bit of iodine to someone who is truly iodine deficient can take someone from hypothyroid to normal thyroid, how about a little more will make out thyroid function even better, or have what someone like in a westernized country, like the united states that is iodine sufficient, what if their hypothyroid– what if giving them iodine be helpful– and that’s where the wheels really fall off the argument and things kind of, you know, unravel.
SM: And the deficiency, so that’s why our salt in the United States is iodized– if you buy table salt, correct? Because there was a deficiency way back before they started iodizing salt, and they thought that was a great way to help the entire population?
DR: Correct…so, I wanted to try and lead in with a few of the summary points, because if you’re someone listening to this I was, you know, trying to just, reflect on, ok, I’ve spent months and months and months looking into this issue, you get so involved, I try to just zoom out and say ok let me picture I’m someone who doesn’t feel well I think I have hypothyroid, or I know I have hypothyroid, and I’m just wondering will iodine help me feel better. Right? So, let… I’m trying to bring us down to the bottom line question here. And one of the first things you want to ask is what is the risk benefit here? Risk-Benefit ratio, because iodine is cheap, right? You can buy a bottle of iodine for $10 maybe, so it’s a cheap easy kind of intervention, so does the, you know, ease of access in utilization, is that something that we need to kind of balance with the potential risks, and I absolutely think so. Here are a few of the summary points, and then we can kind of go into detail one by one with each of these. So. (Mumbling) So, the one thing that really struck me is that Iodine has been consistently… consistently shown in very well performed large population-based studies to be associated with thyroid autoimmunity. The amount of data we have showing that when we had iodine to a food supply of a giving population the incidents of hyperthyroidism and autoimmune thyroid goes up is incontrovertible.
SM: Ok, so, if you, so…. more… autoimmune problems with increased iodine in the food supply.
DR: Exactly. So that’s spent and we’ll go into detail about that in a moment… The second the…. the more ill you are and the worse your diet, the more dangerous iodine supplementation could be.
SM: That makes sense.
DR: And we’ll talk about some really interesting mechanisms called the sodium iodine symporter in how that all ties in with the disparity between why some people might be helped or harmed from iodine. The third point is too much or too little iodine can cause thyroid disease. The US is sufficient in iodine – the normal dietary intake will be fine for most, but, and we’ll talk about some of these studies in a moment, iodine restriction has been shown to normalize thyroid function in some hypothyroid patients. Intake… dietary intake of 150 to 1100 micrograms a day is a good dietary range and a sweet spot may emerge around 450 micrograms. However that being said those with known autoimmunity might want to try a low iodine diet will go into some of the details behind that in a moment. Some of the most popular or some popular tests like the iodine skin patch test and the iodine challenge test have not been scientifically validated at all and the final points is that something with halogens or bromide fluorine chloride…
DR: Those don’t appear to be a major issue.
SM: Really? Because we were taught that in nutrition school that… if…. that fluoride toothpaste fluoride in the water and then… the… you know… the bromide that they use on the Strawberry Fields and that could inhibit your thyroid hormone production.
DR: It could but seem to be taken out of context
DR: And so… and so that’s where we have to define the context that why they say they’re not really major issue, but will define the context, and how I mean that… when we go through. So why don’t we start off with the first point which is Iodine has been a consistently shown when added to a population’s food supply they increased the incidents of hypothyroid and thyroid autoimmunity.
DR: So, and this is going to be kind of a reference heavy podcast. Sorry, guys, if this comes over a little dry but… I mean, you need to hear the facts, so that if you’re someone who has a certain opinion and we’re hopefully trying to supply you with the information update that opinion would give you adequate evidence to update your opinion.
SM: And we’ll have all the links in the show notes, so don’t worry, we have you covered.
DR: Yeah. The links will be in the show notes. I have about fives pages of notes here. So we have a handful.
SM: Big show notes this week!
DR: Ample lengths. And it may be broken up into two episodes. Ok. So, the journal of autoimmune research 2009: the title: “An environmental trigger of autoimmune thyroiditis.” And a quote: “Autoimmune thyroiditis is multi-factorial, with contributions from genetic and environmental factors. The best-established environmental factor is excess dietary iodine. Increase iodine consumption is strongly implicated as a trigger for thyroiditis but only in genetically susceptible individuals.” So, that quote, I think, is a good prelude to this on slot of references I have that support that. Now, Chris Krasner, he’s doing some great work, he wrote an article on the issue and I’ve checked his references, which are all on point and he references a population based study in Sri Lanka, another in Turkey, another in Brazil, another in China, and another in Greece. So, we have five population-based studies, and they all showed the same thing. That when iodine was added to the food supply, usually added to salt to dairy and to bread– bread products– the incidents of hypothyroid and autoimmune thyroid all increase significantly. Now, even if these references are not compelling enough, I have found additional studies, a very well performed review paper and again a review paper is an excellent way to get to the bottom of an issue because a review paper is where a group of researchers go and try to find all the papers that are of high quality and they’re relevant to a certain issue and they summarize those papers and try to give you the arrogate findings. So a review paper found that same position. That iodine added to the food supply added to hypothyroidism and autoimmunity, in additional to another study in Greece- population study- as also another one in China, Northwest Greece, and Denmark.
SM: Wow, this is a lot of studies!
DR: Yeah, I mean, these are not like ten– this is a population-based study so this is a large sample size so, yeah. This is really– I can’t emphasize how significant this level of data is. And the Denmark study I thought…the title just tells you the whole story again. And the title of the Denmark study “A cautious iodization program brining iodine intake to a low recommended level is associated to an increase in the prevalence of thyroid auto antibodies in the population.” So, that… there’s so much evidence there showing that one of the best established, maybe the most well established risk factor of autoimmune thyroid disease which is the primary cause of hypothyroidism in westernized countries is iodine intake.
SM: OK, so, if you don’t eat iodized salt, say in the United States, cause I don’t think anything else we eat is fortified with iodine or iodide. Are you safe if you have an autoimmune thyroid condition?
DR: Well, I want to come back to that in a little more detail and outline that…but the top sources are iodized salt, dairy, and flour products. But we’ll come back to that in a moment.
DR: Now, a lot of these same lines inferential studies have show that decreasing iodine intake lowers thyroid antibodies and there’s been two trials that have looked at this and they’ve essentially put patients on a low iodine diet, and they’ve tried their antibodies and they’ve seen the antibodies decrease as a result of that. So we’ll link to those two trials there. There’s also another interesting study and I believe this is a Korean study– I’m sorry, Japan. Costal Japan. So, this study looked at 1061 subjects in Japan and they found, I’m quoting: “1. The prevalence of hypothyroidism in iodine sufficient areas may be associated with the amount of iodine ingested.”
SM: Well, you’d think so, yeah. In Japan the costal area would eat a lot of seafood and sea vegetables, which are high in iodine.
DR: Right, exactly and they’re finding that that excess, especially the excess intake, can cause hypothyroidism and so continuing their second point, hypothyroidism is more prevalent and marked in subjects consuming further excessive amounts of iodine. And then, their third point: Excessive intake of iodine should be considered an Etiology of Hypothyroidism, in addition to chronic thyroiditis in these areas.
SM: So do they define what excess iodine is? Like, the number of micrograms per day?
DR: Yes, and we’ll come to that in a little more detail. The range of RGA If You’re under 150 micrograms per day between 1100 micrograms provided that that’s according to the NIH the range but we’ll go into detail into what excessive means in a moment because it’s not incredibly well defined.
DR: And then again there are four other studies that we’ll list in the references here that have shown that you can reverse hypothyroidism by restricting iodine intake.
DR: And there’s one study that I think is really interesting to know where… in this study… it was in the journal of clinical endocrinology and metabolism… 2230 hypothyroidism patients were iodine restricted this usually means less than 100 micrograms a day.
DR: Twelve of these 22 patients saw their thyroid function return to normal… so 12 of 22 patients in the study were able to return their thyroid levels to normal just by restricting iodine intake.
SM: And that was their antibody status?
DR: This was looking at their functional status so their TSH T-4 now…I should mention that this study and in another study also sort of elucidate that the patients that seem to respond more strongly to the iodine restriction are non-autoimmune patients, probably because iodine levels that are too high, can cause functional suppression of the thyroid and cause hypothyroidism, that’s non-autoimmunity nature, however. If someone stopped ingesting high levels of iodine, they’d stop causing this functional suppression of their thyroid and things would (Snaps) kind of come back to normal. But, if you’ve been eating too much and you’ve been fueling the autoimmune process for five years or so and you’ve damage the gland then the iodine which may not help you return to normal because the glands already been damaged… does that make sense?
SM: Yes it does, I was just trying to get to the difference between autoimmune and just pure plain hypothyroidism.
DR: Yeah, in some studies look at different markers but studies have shown both thyroid function as you would measure by TSH T-4 have returned to normal as well as other studies have shown that antibodies can return to normal so it’s been effective for both.
DR: So, there’s so many studies in my notes, and which ones do I want to include another actually randomized controlled trials done Hashimoto’s patients so now looking at an autoimmune population and after three months of iodine restriction again less than hundred micrograms a day 78.3% of the iodine restricted group regained thyroid function only 45% retained thyroid function in the non-iodine restricted group so… I’m hoping this is coming across.. this is really kind of compelling data.
SM: it is it is very compelling… and I always knew you know we’re taught, like I said, in nutrition school that if that if somebody had Hashimoto’s make sure you do not supplement them with iodine. But people are always telling like – I have a good friend has Hashimoto’s and she’s always calling me – “I heard this, I heard that.” And she’s like: “I heard I need iodine!” And I’m like, “No!”
SM: You know… “No, you need to work with the practitioner to determine if maybe you do need iodine, but you probably don’t need Iodine!”
DR: Yeah, and I want to come to this question later which is, “Well I know a friend who is taking iodine and she swears by it.” Right? So, I want to come to that… how we answer the question later? But it probably has to do with sodium iodide symporter status, which is kind of the doorway that helps regulate how your body deals with either excessive or deficient intakes of iodine. But, before we get there, I do want to mention, and kind of paint the counterpoint, that we also have to be careful not to go too far in the other direction, because severe iodine restriction can lead to frank iodine deficiency, which again can cause mental retardation cretinism is so special for pregnant mothers you want to be careful so I mean… the context I kind of paint this scene is because iodine intake can cause the autoimmunity, if someone has a documented case of thyroid autoimmunity they may want to iodine restricted and track their thyroid markers, this doesn’t mean that everyone should be restricting; and it also doesn’t mean that everyone needs to go to, you know, not everyone needs to become an iodine zealot, avoiding it like the plague.
SM: Let’s not create any more zealots!
DR: Right! Just having a reasonable dietary intake like we discussed… and we’ll discuss in more detail when we get around to the dietary piece, having something that falls within the NIH recommendation between 150 and 1100 micrograms a day and you’re probably going to be okay.
DR: So, the other thing I’d like to touch on briefly before we get to like the dietary pieces and the testing pieces is the halogens: fluoride bromine bromide chlorine. Susan, you’ve heard of this, right?
SM: Yes, like I said, we were taught this in nutrition school of a lot of times people we’ll get filters for their showers that filter out the chlorine…they’ll like… I live in a city that does not have fluoridated water and I don’t use fluoride toothpaste just… that’s my personal preference, but that’s one of the things our teachers told us to look at if we had somebody with a thyroid problem – to, maybe, recommend these things to them because it can bind to the receptor, correct?
DR: Well, they’re so close together on the periodic table… that these elements seem to, you know, compete for iodine, iodine uptake. So, that’s true, right? Fluorine, bromine, chlorine: they can compete with iodine and potentially caused a decrease in thyroid function, but the context of this whole thing is important right. So, if someone is deficient in iodine, or they have a very low iodine intake, and they have a high intake of bromine, fluoride, and chlorine, that may cause a problem, right? That’s been shown in animal studies; it hasn’t really been reinforced in human studies, but I don’t think that means we need to dismiss the concept completely. But, I also don’t think this means that we have to test for this, or do any kind of crazy treatments because if you’re getting the normal dietary level of iodine intake through your diet, through regular foods and you’re not having excessive exposure to bromine, fluoride, and chlorine, then you’ll be just fine, because bromine, for example, only has a half-life of 10 days in the human body. So, if you have a good diet that will give you sufficient intake of iodine, and you are avoiding the top sources of these halogens, like bromide, for example, top sources are pesticides…
SM: And baked products right?
DR: Baked goods, soft drinks, and fire retardants; fluoride’s top sources are tap water, toothpaste that’s fluoridated, processed beverages like soda and sports drinks, pesticides, tea, Teflon, and mechanically deboned meat. So, if you’re eating a healthy diet and have a healthy lifestyle, then you’re going to be weeding out all these factors anyway. If you’re drinking filtered water, if you’re not consuming a lot of process food you, if you’re not using low fluoride, then you’re going to be just fine with these things. So, do you need to do a special test for this? And do some sort of halogen detox protocol where you take high doses of iodine to flush these things out? I really don’t think so, because, again, it’s been shown that these things will be readily cleared out of the body if you stop ingesting them or being exposed to them. Not only that but, if you’re trying to detox them out by using high doses of iodine, you risk causing hyperthyroidism or exacerbating thyroid autoimmunity.
SM: OK, yeah, that does make sense, yeah. And another: You said pesticides with bromide, and that’s why it’s really important to eat organic strawberries, because they use methyl bromide; it’s the pesticide for strawberries here in California, so it’s really super important to get that bromide, you know, just in general for your toxic load; not just your thyroid but your whole health to make sure to your berries are organic.
DR: Right, exactly. So, this one I have classified under the fancy bells and whistles, because this is interesting. But, if you’re eating a healthy diet, and have a healthy lifestyle, this is not to become an issue, so there’s no need to really get too sidetracked with this.
SM: Ok, no going down the rabbit hole, necessary?
DR: Right, exactly. So, to segue it over to the, “I know someone who has Hashimoto’s and swears iodine helped her.” You know how much we account for this, well, my position on this, is that the iodine most likely didn’t ‘help’ her but just didn’t harm her. And so, then how would we be able to know if iodine would harm some people and not harm other people. Because I don’t know about you Susan, but I’ve certainly seen patients that have gone iodine and it’s made them significantly worse.
SM: Yes, definitely, I’ve seen the…the hypothyroid symptoms exacerbated immensely.
DR: Right, or the antibodies jump or what have you. I’ve also seen patients who’ve been on iodine and not really notice much difference. So how do we account for that? Well, there’s something known as sodium iodine symporter, like I’ve been alluding to, and the sodium iodide symporter is essentially the doorway for letting or absorbing thyroid – I’m sorry – iodine into the thyroid. Now, its supposed to help us adapt to variations in iodine availability, meaning, if you’re not getting a lot of iodine through your diet, then this will – this mechanism will – increase absorption. Now conversely, if you’re eating maybe too much iodine, this will help excrete more iodine so the sodium iodine symporter is a very important mechanism in helping us adapt to deficient or excessive intake, and especially (for) protecting us from some of the deleterious effects that can be seen by excessive intake. But, here is the very, very interesting and important point: The two most common factors that will disarrange the ability of this sodium iodine symporter, and therefore, make you very susceptible to damage from iodine, is inflammation and toxins.
SM: It all becomes clear!
DR: The sicker you are, so to speak, the more dangerous iodine may be because, the sicker you are, the higher chances are you’re inflamed, and you’re being exposed to some kind of toxins.
SM: And so the symporter isn’t working, really.
DR: So, before anyone considers using iodine, they should really make sure that they’ve gotten rid of any inflammation in their body and toxins. And the main talks in, I’ve been trying to do this, is perchlorate… which is… perchlorate is in a lot of… like fireworks and other explosives, and so it’s worked its way pretty thoroughly it appears into the water supply. And that’s why filtered water would be important. And then inflammation is something that… it’s not very specific in this presentation, but we come back to some fundamentals: How is your gut health? Are you bloated? Do you have gas? Do you have heart burn? Do you constipation or diarrhea? If you – do probably got gut inflammation? Are you eating a diet that’s high in inflammatory foods? If you are, you probably have gotten potential systemic inflammation. Is your blood sugar too high? If it is you, probably have inflammation? Are you very stressed, not sleeping enough? If you are, then you probably have high levels of inflammation. Are you smoking? Are you drinking unfiltered water? Then you’re probably exposed to some of these perchlorates. So we kind of want to go through some of the basic fundamentals that anyone should be going through after trying to increase their thyroid health before using iodine, because those things will help to allow your sodium iodide symporter to work more properly, and why that’s important is – if you take iodine and you don’t have this mechanism work properly, you don’t have good function of the mechanism that protects you from excessive iodine intake. And that, I think, is why some people respond so negatively to iodine and others don’t. It’s the people that respond negatively where their sodium iodine symporter is broken, and it’s the people that respond with no change that the sodium iodine symporter’s working and that just simply excretes the excess iodine.
SM: Hm, interesting. OK, yeah, we have a person…
DR: Are you with me on that? Or did I totally put you to sleep?
SM: No, you didn’t! And the perchlorate; they had a spill, an airplane spill, south of me like 20 years ago, and so we have a notification. That’s why we have a whole house water filter, because of the perchlorate in our… and that could be in our water supply.
DR: Right, right. OK.
SM: And that it’s very evolutionary that the symporter…because… because food… in our past, it wasn’t always readily available, so and we need iodine so that symporter is very evolutionary. It just shows you that you know your body is a very smart organism when we treat it properly.
DR: Exactly, exactly. And it also comes back to just some of the fundamentals where it so easy to get caught up into these exotic things – like, let me test my bromine levels, then try doing the iodine bromide detox with high doses of iodine – but really some of the simple foundational things that we kind of harp on – which is diet, lifestyle, gut health, inflammation – by addressing those another factor. The sodium iodine symporter that is going to be favorably impacted by that. So, yeah, definitely. You know, first things first. And so, hopefully that’s…that will help people who are, despite all my warnings, still want to try iodine. Hopefully this will help them see the appropriate timing of iodine, which would be after you’ve addressed the foundational dietary pieces, lifestyle pieces. Then, I’d also make sure you have very good gut function, because the gut is one of most common sources of inflammation in the body. So once all those things are addressed, if you are still gung ho about giving iodine a try, then maybe you could do up a – but we’ll outline in a little more detail some of the testing and some of the dietary pieces. But, I don’t know if we’ll have enough time to get through all… but…let’s… try to go little more than maybe we’ll… cut this one. We’re kind of right on the cusp of over 30 minutes. But, let’s go quickly into the testing, and then we’ll see where we’re at at the end of that. And, if not, if we’re not too far along, we’ll wrap this up in the second episode.
SM: Yeah that sounds good.
DR: So with testing, Susan, what are the top one or two tests that you’ve kind of heard of regarding iodine?
SM: Um, you know what, I’m not familiar with iodine testing. So, you know, the tests that I ask my clients have their doctors run. Or just, you know, a thyroid panel, and, you know, the antibodies to see if they have Hashimoto’s. But as far as testing for micronutrients, uhm, I’m not familiar.
DR: Right. OK. So, good, we have a clean slate to work from. So I don’t see that often that we have to actually do evaluation for iodine. So I want to start the testing section by saying that I have noticed the vast majority of cases by going through the foundational pieces, like addressing their diet, their lifestyle, and third, and probably most important, would be there gut health, which can be no small task. But for some people, we spend over a year working, testing, tweaking to restore their gut function so that can… that’s a significant. I don’t want to say that nonchalantly, like you can do that in two weeks. Some cases you can, but other causes you really have to work hard for it. But, by addressing those factors – diet, lifestyle, and gut health, I have seen thyroid function normalize in the majority of patients. In fact, in the newsletter that goes out, I’ve sat down with one or two patients where literally we’ve needed to cut their thyroid medication in half after clearing SIBO or small intestinal bacterial overgrowth, because their thyroid metabolism improved after just improving their gut health. So, the most important issues that I’ve seen: diet, lifestyle, gut health – and gut health, remember, will have two major impacts on thyroid, one through modulating autoimmunity, and two, modulating thyroid hormone metabolism or conversion of T4, T3. So, those are the most important things. However, if someone really wants to try to quantify, which I’ve done in the few patients, when it’s needed, the best test is probably the 24-hour urinary iodine creatinine ratio test. Now, the reason for 24 hours is, because, if you do a spot urine test levels of iodine, it can fluctuate throughout the day. So a spot tester, a single urine sample, may give you a false high or a false low. So, that’s why a 24-hour test is important. Now the other piece of this is the creatinine ratio because, anything, any test, the urine past has to do in part with kidney health. You want to have a way of assessing kidney function, and that’s where creatinine comes in, to help you rule out if there might be any kind of kidney problem that could be contributing to a false high/false low. So, the 24-hour urinary iodine with creatinine ratio available through LapCorp, available through Quest – that is probably the best measure of iodine status. Also, TSH and T4 are probably the best way to see if you have hypothyroid that could be due to iodine deficiency, because if you do have true iodine deficiency, then you could see high TSH with low T4. But, that same pattern can also be caused by Hashimoto’s or by thyroid autoimmunity. And that’s actually going to be much more common. So, the first thing to rule out if you see low TSH, I’m sorry, high TSH and low T4, would be thyroid autoimmunity. If someone has been screened multiple times for thyroid autoimmunity via blood test and maybe even once via an ultrasound, and the thyroid autoimmune has been clearly ruled out and you see low or low-normal findings on a 24-hour urine test, then a therapeutic trial of iodine might be a good idea. And we’ll come back in a moment to… kind of the treatment protocol that you can use. But, before we go into that, I also want to mention that there’s the iodine challenge test. Now, the iodine challenge test is essentially where someone will ingest a given dose of iodine, and they should see a certain amount of the excreted in the urine.
DR: So, essentially the theory is anyway, the more iodine sufficient you are, the more iodine you will excrete and the more iodine deficient you are, the more iodine you will…you will…
SM: Is that kind of like the challenge where you’re supposed to put the iodine on your skin and the more it stains the better you are? And I’ve heard that that’s not correct either.
DR: Right, and that’s the iodine skin patch test.
DR: And that doesn’t appear to be a reliable marker meeting in all of the iodine literature that I’ve examined. I have never seen that test used once.
DR: So has it hasn’t been validated? So, we really don’t know if it works well or not. But, the one that’s been consistently used in the research studies, and that’s correlated with people that have thyroid problems of various sorts, and have been successful in identifying population-based iron deficiencies, and also successful in tracking iodine deficiency when iodine has been added to the food supply of these iodine insufficient people, has been that 24-hour iodine test that we mentioned a moment ago. But, the iodine challenge test, again, this is one where you taken a large bolus of iodine before you do the urine test, and then see how much comes out of the urine.
SM: Uh huh.
DR: The values for the test were arbitrarily set by the doctor that set up the parameters for the test so it was just arbitrarily… you know… the values were arbitrarily set by one of the major iodine advocates, and you see it used nowhere in the research community or the peer-reviewed medical literature.
SM: So he just said, “I think it should be this?”
DR: Yeah, I mean it was his hypothesis, his conjecture… again I’m not saying he did that with an ill intent…
SM: He probably didn’t, no.
DR: But I think he was really into iodine and was looking for, you know, some parameters of measurement. But I don’t think that iodine panacea and so I don’t… I really don’t think we need to be that concerned about (it). And from what I’ve read, almost everyone fails this iodine test, which fits perfectly within, kind of, someone who is very, very ‘into’ iodine, because now you can prescribe high doses of iodine to everyone. So, it kind of further reinforces the…potentially, this person’s per-existing notion.
DR: So, again, in recap of the testing, the most practical pattern you want to look for – first, you’d want to rule out thyroid autoimmunity. That’s a TPO and a thyroid globulin antibody test – you want to have that run at least two, maybe three times to insure you’ve ruled that out. Also, it wouldn’t be a bad idea to do a thyroid ultrasound, because some can escape the blood test. If you have ruled out thyroid autoimmunity, and you see you have hypothyroid, which would be evidence of high THS and low T-4, then, if you see that pattern present also with low iodine n the urine test – low, low normal, or frankly low – then you may want to try a trial of iodine treatment. Which I think will go in our next episode. We’re a little over 30. And so, during the next episode, we’ll talk about treatment in terms of if you want to supplement with iodine, and how that should be balanced with selenium. We will also talk about diet and, you know, what some of the studies are showing in terms of the safe dietary intake, and what might be too much. And, (we’ll) go into a little more about potentially trying the low iodine diet, comeback to our summary, and then, if we have time, we’ll go into iodine in nodules and goiter. If not, we will do a follow-up episode on that. So, I guess welcome to Part 1 of what’s looking like our iodine series, which I had a feeling it was going to be.
SM: Well, it’s a lot of information.
DR: Yeah, so hopefully this stuff is connecting with people, and people are getting the important concepts despite the fact there is a lot of detail and science here. Sorry guys if the science is kind of boring you to death, but it’s important that you see that these recommendations that I’m making are based on really solid, grounded science, and there might be someone else whom you’ve read or followed who is really excited about the iodine. But, I would challenge them to produce references to support their claims, because as I fact checked a lot of these things, again, I was really shocked to see that the evidence for the supremely pro-iodine camp is very questionable. I think there’s a time and a place for iodine, like we’ve been going into. But, it certainly is not as common as we’ve been led to believe by some of these iodine advocates. Anyway, that’s Episode 1 of this series. Susan, do you have anything you’d like to add?
SM: Yeah, I just want to caution everybody – so, a lot of regular doctors aren’t to test the antibodies. So, if you have high TSH, and you have been given thyroid medication, and now you’re hearing us talk about iodine, you haven’t been screened for Hashimoto’s or thyroid autoimmunity yet. So, you really need to get your blood work, like you said, multiple times for the antibodies or even the ultrasound, because I know a lot of doctors refuse to test the antibodies.
DR: That’s an excellent point. Even though we are recording this episode first, maybe what we will put in our podcast feed will start off with the episode on thyroid autoimmunity, so people have a good understanding of that first. And then I can follow that up with this. Because, that’s the more important conversation to start with. They’ll probably appear in our feed that way then.
SM: Yeah. So, OK! That’s it for this week, guys.
DR: Thanks, Susan. Thanks, guys.
SM: Take care.
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