Podcast – Thyroid & Iodine; getting to the truth – part 2

In this episode of Dr. Ruscio Radio, we bring you part 2 in a series on Thyroid and Iodine. Dr. Ruscio tackles fluoridated water, treating hypothyroidism with iodine, the importance of selenium, his preferred form of iodine, iodine in a healthy diet, what iodine levels look like in the US and why you might want to try a low iodine diet.

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Topics:
Thyroid & Iodine Part 1 recap…..2:35
Fluoridated water…..7:45
Treating hypothyroidism with iodine…..10:12
The importance of selenium…..17:46
Preferred form of iodine…..19:13
Dietary iodine…..21:41
Iodine levels in the US…..24:06
Low iodine diet…..26:52
Episode wrap-up…..34:45

 

Show Links:

  1. (7:45) Fluoride in water increases likelihood of hypothyroid http://www.ncbi.nlm.nih.gov/pubmed/25714098
  2. (10:29) Iodine alone OK, Iodine with inflammatory cytokines increases thyroid antigenicity http://www.ncbi.nlm.nih.gov/pubmed/?term=19265500
  3. (21:46) NIH iodine recommendations http://www.ncbi.nlm.nih.gov/pubmed/10731915
  4. (24:21) Average US iodine intake 2003-4 http://www.ncbi.nlm.nih.gov/pubmed/18167505?dopt=Abstract
  5. (26:46) NIH list of foods highest in iodine http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/
  6. (26:52) Low iodine diet http://www.thyca.org/download/document/229/Cookbook1pgEng.pdf

 

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Thyroid & Iodine, Part 2

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, Dr. Ruscio.

Dr. Michael Ruscio: Hey, Susan. How are you?

SM: I’m hanging in there. (I’m a) little overwhelmed right now. I’ve got a lot of irons in the fire, and I’m trying to find a way to prioritize and divide and conquer.

DR: Yep. I find going for a walk, a short walk, always kind of helps me chill out, and, you know kind of see what the next most-important task is when I’ve got too many things pulling me in to too many directions.

SM: I totally agree, and I have yet to be out for a walk outside today, and said that’s probably why I feel a little overwhelmed at the moment. I started working the moment I woke up and, not a good situation.

DR: Good luck.

SM: What’s going on with you?

DR: I want to apologize if we get a little bit of background noise on my end. My neighbors are removing their concrete patio, and they’re having to do it via sledgehammer apparently.

SM: Wow.

DR: So, even though I’ve got everything closed up, a sledgehammer that’s only about 20 or 30 yards away is hard to block out completely. So, hopefully there won’t be too much background noise here during the call.

SM: Yeah, bear with us everybody, you know. People, you know, have neighbors.

DR: Yeah, so until I can afford to live on some exclusive hill somewhere…

SM: That would be so nice.

DR: Here in California, there isn’t a whole ton of open space. I guess depending on where you go. But, where I am, it’s hard to come by.

SM: Yeah, we have some open space, but it’s expensive. And then you have to live far out from the grocery stores and all that kind of stuff. And I kind of like being near civilization.

DR: Right, right. Exactly.

SM: So, last week we had our first part in the series of thyroid and iodine, correct?

DR: Exactly. We touched on a few things. I’ll just kind of give a brief recap. And then we’ll try to finish.

SM: Get everybody up to speed.

DR: Definitely. So, last time we spoke about iodine and it’s relationship to autoimmunity, and I think we provided people with a very compelling overview of an evidence-based argument that really supports that iodine has clearly been associated with thyroid autoimmunity. And definitely too much as been shown clearly multiple, population-based observational studies to provocate autoimmunity. And then we have some clinical data showing that iodine restriction actually helps with both thyroid autoimmunity and hypothyroidism. So, we have some really good evidence there that, hopefully, will help sway people. We also talked about testing and how some of the tests, like the iodine skin patch test and the iodine loading test don’t really have much in the way of scientific validation. But there are two tests that seem to be good, reliable measures, which are, ideally, the 24-hour urinary iodine with creatinine ratio, or as a fullback, just a urine spot test for iodine. But your best bet would be the 24-hour iodine with the creatinine ratio. And we also discussed halogens – things like fluoride, bromine, chlorine – and how those things can have an impact thyroid function. However, I think they’ve been a little bit hyped, because if you look at some of the human data, as long as you have good practices in place to avoid excessive levels of things like chlorine and bromide, or fluorine or fluoride, those things shouldn’t really be an issue. And things like elaborate detox programs for halogens I don’t think are going to be necessary for most people, because, again some of the literature shows, that as long as you have the appropriate intake of iodine through just normal dietary sources, and you’re not being exposed to these other halogens or toxins in excess, then the body pretty readily rebalanced itself out. And finally, we talked about the sodium iodide symporter, which I think is probably something that a lot of people have not heard that much about up until this point. I think it really accounts for why we see some people who can go on high doses of iodine and be fine. And it can really cause significant problems with others, because the sodium iodide symporter is kind of your regulatory mechanism for iodine. If you consume too much or too little, if the sodium iodide symporter is working properly, then your body will be protected or be able to adapt to higher low-levels of intake. But, if it’s not working properly, and inflammation in certain toxins are the two main factors that can derange function there. Then your body can’t adapt to low or high-intake, and that’s when you can see problems really develop secondary to iodine; usually it’s iodine excess. So, that’s kind of the summary of what we talked about last time.

SM: OK, great. You know, I was reading up on that, because I wasn’t familiar with the sodium iodide symporter. And I read also that low selenium deficiency can make it not work as well. Have you read that?

DR: I haven’t read that specifically, but I have read that selenium helps to essentially clean out iodine to the thyroid gland, so that they have a counterbalancing function. But, it’s possibly I could’ve missed that. I think there’s maybe more about this rodium iodide symporter and then I’ve been able to ingest. So certainly, I wouldn’t be surprised…

SM: Yeah, something to do with an enzyme that selenium needed for. So, if you don’t have selenium, you don’t make the enzyme that goes into the symporter. That’s just the something – I don’t even know where I read it, but it was over the last week, because I hadn’t heard of it. So, you know me, I’m kind of geeky when I learn something new, I want to learn more.

DR: Sure, sure. I wouldn’t be surprised; there are a number of thyroid enzymes. And there’s been a number of, like, lignin peroxidase, for example, that is involved in antioxidant function, and then thyroid function, which selenium feeds. So, yeah, there’s a few major enzyme systems that selenium feeds. Some of those are anti-inflammatory enzyme systems, so I can certainly see how, if you’re deficient in selenium, knowing that selenium feeds glutathione proxies, which is one of the largest antioxidant systems is the body – and if you’re in a pro-oxidated state, that’s an inflammatory state, and know that inflammation can derange sodium iodide symporter, I certainly wouldn’t see that as being a stretch.

SM: So, tell us more.

DR: All right, well…actually, between the last episode we recorded and today, there was a study published just in February 12, 2015; so this literally was published a week-or-so ago. This was the first study I’ve seen of this nature, which showed – it was an observational population study in the medical practices in two different areas in England. It was in one community that had fluoridated water, and the other community did not.

SM: Oh.

DR: And they showed that the incidence of hypothyroidism was significantly increased in the community that was consuming for fluoridated water.

SM: Yes, what we’ve all suspected all these years, right?

DR: So, I did post that on my Facebook page. I thought that was, maybe, the best evidence I’ve seen for the connection of halogens to hypothyroid. But, I also want to bring people back to a place of practicality, which means, if you are using a water filter…

SM: Right.

DR:…and maybe a shower filter also, right? Because fluoridated water is going to work its way through multiple exposure routes – through farming, through showering, through water consumption. But, if you are doing your best effort to filter your water – we can’t say for sure, because we don’t have a study that absolutely shows this – but, I’d be very inclined to think that, if you were filtering water, filtering your shower water, and had some basic practices to avoid that fluoride, that you probably wouldn’t fall into the hypothyroid group in the study. So, great evidence showing that fluoride does have a negative impact on thyroid, and it supports, I think, a practical position of just filtering your water; not necessarily needing to do something like a quote/unquote halogen detox, where you take massive doses of iodine, because that can cause significant problems in and of itself.

SM: Yeah, I feel pretty lucky. My city does not fluoridate their water. I found that out after we moved here, and so…But we do also have, because we had a perchlorate spill about 20 years ago south of us; we do have a whole-house carbon filter just for that fact – a water softener/carbon filter. There are all kinds of things; just go online, research. There’s so many ways you can filter your water.

DR: And, actually, it’s funny that you that. Perchlorate was one of the main chemicals shown to disrupt sodium iodide symporter function. Which is kind of a nice segue into the next point I’d like to make, working into this episode, which will be, hopefully, a little bit more concise, and just about treatment. If you wanted to try to treat yourself with iodine and diet, what are you looking at in terms of what should you do. So, a good segue there. A study was published – now this was a study that looked at looked at human thyroid cell culture. So, it’s not a clinical trial necessarily. But, what they did was they administered into the culture either iodine or iodine with inflammatory cytokine. So, essentially, inflammation, you could say to put it simply. And they found that the thyroid cells became more antigenic, or one could potentially say more prone to being attacked by the immune system when iodine was administered in conjunction with inflammatory cytokine. Whereas, the people, the cultures that were just administered iodine, they didn’t see that thyroid antigenicity. What that really means is, to put it really plainly, from this study it looks like, when people are inflamed, and they take iodine, that causes negative changes in thyroid physiology, and it makes the thyroid more prone to maybe causing an autoimmune attack. And that’s really what I think we’re seen with some of the discussion of the sodium iodine symporter. Remember, the sodium iodide symporter helps us regulate iodine intake to the thyroid gland – or the thyroid cells, I should say. So, when something is disrupting the function of that symporter – inflammation, which is known to be one of them; or cytokine, another way of saying inflammation – then that system gets faulty. And so, it’s interesting. What we are seeing here is that, when we do at this cell line study, that when iodine is administered in the presence of inflammation, it tends to have negative changes to thyroid physiology. So, it comes back to the basic principle, and it’s a good kind of preface: Before people jump into iodine, they really want to make sure that they’ve done as much as they can to insure that they are not inflamed or being exposed to toxins.

SM: Right, so all of the diet, lifestyle, checking to see if you have any gut infections; just going through the whole…whatever could be contributing to the inflammation that you have, working on that, and then maybe look at iodine.

DR: Exactly. And, again, from a practical standpoint, that’s going to be your diet, potentially trying the autoimmune paleo diet for 30 days. That’s going to be some foundational lifestyle practices like filtering your water, eating organic and free-range, and just trying to reduce the amount of toxin exposure through food supply. Getting healthy levels of sleep, exercise. And then, the second factor – which, again, we don’t want to make it sound like it’s super simple, but getting your gut as healthy as it can be. Right? For some people, if they got really chronic, deep-seated issues, it may take them well over a year to get everything in their gut sorted out. But, those are things you want to do first before jumping into iodine. And like I said in the last episode, I’ve seen clinically remarkable improvements in thyroid both autoimmunity and thyroid function when we’ve got someone’s gut straightened out. So, in my clinical experience, gut health way outweighs the importance of iodine, in terms of thyroid health.

SM: Very good point.

DR: Maybe three times in the past year have I had to put a patient on iodine.

SM: Wow, that’s not very many.

DR: And I almost felt a little bit angry because I spent so much time researching iodine. Then I turn around and I’m like, ‘What the heck. I never have to use this,’ right? Because it was just so infrequent. There were months of research that went into all this information on iodine, and I barely ever use it. So, hopefully people can benefit from that. But that’s kind of a real practical bottom piece. Anyway, so how can you use iodine if you still think you may need it? Well, again, I would strongly encourage people to first rule out any type of thyroid autoimmunity, which I think doing a blood test – if you suspect Hashimoto’s, you’d want to look at thyroid peroxidase and thyroid globulin antibodies, at least two or three times over the course of, maybe, six months or so. If those were all negative, you may also want to have a thyroid ultrasound performed, because sometimes the blood test can miss this. And for Graves’, or thyroid stimulating immunoglobulin and thyroid receptor antibodies that you can look at if you suspect you have Graves’ disease. And so, same thing there. You’d want to, you know, maybe have that tested two or three times over six months. If those are negative, follow-up with an ultrasound to see if there’s any signs of thyroid autoimmunity.

SM: So the ultrasound looks at the thyroid itself and to check for any actual physical damage, correct?

DR: Yes, it’s more of a physical window rather than antibody window, because we may not know if all of the antibodies that can potentially cause what is called lymphocytic infiltration of the thyroid gland, where you start to see white blood cells infiltrate. So, looking at the thyroid, the thyroid ultrasound specifically, can help give clues into if you’re seeing physical changes in the thyroid gland that are usually secondary to thyroid autoimmunity. And of course, there is also thyroid biopsy, but that’s not really practical.

SM: That’s a little invasive, yeah.

DR: So, if you’ve ruled out thyroid autoimmunity – and I can’t stress how important that is, because we’ve clearly shown that iodine can make that problem worse. So, you really have to rule that out first. If you rule that out, then I would run the 24-hour urinary iodine with creatinine ratio. And if you come up low, or maybe even low-normal for the lab range, that’s when you’d want to consider doing some iodine supplementation. I think a reasonable dose can really be anywhere between one-and-15 milligrams, not micrograms.

SM: It’s the RDA or the daily value is in micrograms, correct?

DR: Exactly, exactly. We’ll come back to the RDAs in a minute. But it’s important that we clarify between micrograms and milligrams. So, 1-to-15 milligrams.

SM: So, for people that are brand new to this, there’s 1,000 micrograms in a milligram. So, that’s to kind of to give them what the ratio is – from the 150 micrograms is very low compared to the 1-to-15 milligrams.

DR: Exactly. In order of magnitude it jumps. We definitely want to make sure that there’s a difference between the two. If not, you could inadvertently really overdosed yourself.

SM: Oh yeah.

DR: And I would recommend starting on the low side – 1-to-2 milligrams a day. Monitor how you feel. Maybe after a month or two, monitor your TSH and your T4. But you should also be doing that in conjunction with selenium, because selenium and iodine do have counterbalancing effects on thyroid physiology. It appears, to put it simply, that too much iodine without selenium may have an inflammatory effect on the thyroid gland.

SM: OK.

DR: So, some of the research recommends about four micrograms of selenium for every milligram if iodine. What I do to keep things simple is, most of the studies looking at using selenium to combat thyroid autoimmunity, administer 200 micrograms a day.

SM: Right, that’s, like, the standard.

DR: Right, to just to be on the safe side, I use 200 micrograms of selenium a day in thyroid patients if I’m going to be giving iodine, irrespective of the level of iodine – usually it’s somewhere between maybe 1-to-15 milligrams, again. And just monitor how you feel, and monitor your TSH and T4, and you’re looking for any significant jumps in a negative direction. Remember that iodine can cause transient hypothyroidism, so you may see a slight increase in your TSH and a slight decrease in your T4, but that should go away after a matter of weeks. If it doesn’t, then you may be taking too much.

SM: Do you have a preferred form of iodine, because I know there are different ones. Just one more bioavailable than the others? Or does it not matter?

DR: Perfectly timed question.

SM: OK.

DR: So, my original inclination on this was to try to work from the most natural framework possible, and use iodine. Or, I’m sorry, to use seaweeds – seaweed predominately containing iodine. Most seaweed has more iodine than it does iodide. So, that was my original inclination. However, there have been a number of studies, and most of these studies come from coastal Japan, where consumption of different forms of seaweed are high.

SM: Very high, yes.

DR: They’ve actually shown, and the pattern looks like iodine may be more prone to cause problems with people compared to iodide. So, that being said, little lower doses of iodine, which is kind of what we find seaweed, have been used, and haven’t caused any problems. There’s one study in particular that used up to 15 milligrams of iodine in patients with fibrocystic breast disease. And they also tracked their thyroid function, and they didn’t show any deleterious changes in their thyroid function. So, it seems like iodine can be used. But in looking at some of these studies showing that, when these populations are consuming lots of seaweed, you start seeing real jumps in hypothyroidism and/or thyroid autoimmune. I no longer recommend things like kelp chips because of that. And I prefer to use potassium iodide. OK. Again, I am totally for trying to get all of these things in through natural sources, but looking at how much of this research from coastal communities that consumed large amounts of iodine from things like seaweed, I think the safest bet for people it would be to use potassium iodide as a supplement, because it seems like it may be a little bit safer for use.

SM: OK.

DR: Now, as a segue into diet: The NIH recommends adults consumer anywhere from 150 micrograms, not milligrams – a significant smaller unit – to 1,100 micrograms.

SM: Right, 1,100 is what we call the upper limit, right?

DR: Exactly, exactly. So, the upper limit of intake would be 1,100 micrograms. Now interestingly, again going back to the Japanese research, they’ve shown – and there was one really terrific study where they surveyed all different levels of seaweed intake. And they found when people went above 450 micrograms a day, through dietary consumption of things like kelp and other seaweeds, that’s when they started seeing thyroid problems emerge.

SM: Well, it’s got a lot, because I was looking at – curiously, I went on the internet, and 1 tablespoon of Dole’s has 750 micrograms. And one tablespoon doesn’t seem like a lot.

DR: Right, exactly.

SM: So, it is pretty high.

DR: That’s a great point. I’m glad you mentioned that for people, because it adds up quick. And so, they showed that, if consumption through dietary sources was at or below 450 micrograms a day, then it didn’t seem to be associated with any problems with thyroid. But, when people got to 673 micrograms and above, that’s when they started to see a significant increase in hypothyroid and thyroid autoimmunity. So, my interpretation of that is, anywhere from 150 micrograms to 450 micrograms a day, based upon some of the Japanese research. I’d caution against going much about 400 micrograms, especially if you have a family history of thyroid autoimmunity. If you absolutely no history, and you have no thyroid autoimmunity, you probably be able to get away with a little bit more. But, if you’re really trying to be cautious and cognizant of the autoimmune component, then I would say 450 micrograms would be your hard ceiling.

SM: So, what if you have already have an autoimmune disease or you have a family history of just straight autoimmunity – you don’t have thyroid issues yet. Would you have the same recommendations?

DR: I’d have a different one. I want to quickly outline where America seems the fall, So for people in America, they can kind of get a sense for where they might be. And then I want to come answer your question specifically. So, again from the NIH – between 2003 and 2004, the average intake ranged from 138 to 353 micrograms across all age groups and genders. Now, there has been some criticism because those figures did not account for iodized salt use. So, US intake may be even higher than that. But, what I want to stress there is that the United States does not appear to be insufficient in its iodine intake.

SM: Right, so let’s back up for everybody. So what they didn’t count – so every time people salted their food with table salt, which contained iodide, they didn’t count any of that? Just the other foods they eat that were iodine.

DR: Exactly.

SM: OK.

DR: They didn’t account for maybe one of the major sources of iodine intake – which is iodized salt.

SM: OK. Because I hear a lot of times people say, “Now that were doing a real food or paleo or ancestral (diet), we don’t use table iodized salt anymore. We’ve all moved to sea salt. That, therefore, we might be iodine deficient. But it doesn’t sound like we would be.

DR: Not from this data. No, it doesn’t. So again, if someone really wanted to objectify that, they could run the run the 24-hour urinary iodine with creatinine ratio to see. But based upon this population data from the NIH, it doesn’t look like you’re going to be in a group of iodine insufficiency. That being said, however, because dairy and bread products are two of the other most common sources of dietary iodine – because of the ionization programs, then there is that potential. So, what to do? Well, if you’re autoimmune, being on that low iodine diet that paleo might be, might be beneficial. And, more specifically, I really think that one of the mechanisms through which autoimmune paleo diet might be so beneficial for those with thyroid autoimmune is because it is, in a lot of cases, going to be a low iodine diet, because you’re going to be cutting out, in most cases, iodized salt, you’re going to be cutting out grains, which are iodized. And dairy, which is iodized. And eggs, which are another primary source of iodine in the diet. So, I’ve gone out to the NIH and I’ve grab the link to some of the highest iodine foods. And I’ve also pulled, and this will be in the show notes, a link to a low-iodine diet from thyroidcancer.org. And, in thyroid cancer, oftentimes low-iodine diets are recommended. If you look at some of the top sources, you’ll see things like seaweed, fish, yogurt, iodized salt, milk, bread, and, if you look the low-iodine diets, you’ll see the top things to avoid – iodize salt, seafood, dairy products, egg yolks, and bakery products. So, a lot of the things that we avoid on paleo, and especially autoimmune paleo are some of the top sources of iodine. So, my thinking is another mechanism, certainly not the only mechanism, but another the reason why the autoimmune paleo diet might be so helpful for those with thyroid autoimmunity is because it’s a low-iodine diet. And like we discussed in the last episode, some clinical trials have put people on low-iodine diets and seen thyroid function normalize.

SM: But, if you were doing it, say, and you are making sure to increase your seafood and sea vegetables, while taking away all the others, you might still have too much iodine.

DR: That actually speaks to a question that you and I were talking about off air at the end of the last episode, which was, you had made some sort of comment like, it seems like there’s quite a few people you knew in the paleo community who were all of a sudden were developing thyroid autoimmunity. And, it’s possible that these are just people who are consuming kind of a normal amount of iodine, maybe higher than normal amount of iodine – I wouldn’t necessarily say you were going to be supremely excessive…

SM: Right, unless you pounds of sea vegetables every day.

DR: Right, but some people may be incorporating some of these seafoods, and they may be getting to the higher end of the normal intake range, and that may be enough. Remember we said that, if you went over 450 micrograms, based upon the Japanese research, then they started seeing an increased prevalence of hypothyroid and thyroid autoimmunity. So, these paleo-lites, I guess we could term that, might be cutting out all these foods that are quote/unquote bad, according to the paleo guidelines, but also bringing in a lot of iodine-rich foods because they are concerned about not becoming iodine deficient.

SM: They are nutrient-dense in themselves. Seafood is really good, easily digested protein, it’s high in omega-3. We look at all these because they are nutrient dense, not just in iodine but in general.

DR: Exactly. So, I’m not saying that’s necessarily a bad thing. But, what I’m saying is, if these people are inadvertently starting to have their iodine levels, their iodine consumption becomes too high…

SM: Right.

DR: …then it may be, kind of, predisposing an underlying factor, which then if you have kind of the underlining genetics that would, if the right environment is present, predispose them to thyroid autoimmunity. So, I don’t think we can make a one-size-fits-all recommendation here. But what I would say is, if you have someone who is going paleo because they’re trying to get healthy, but they also have an underlying inflammatory issue that they haven’t addressed, and that’s disrupting their sodium iodide symporter function, and they are also incorporating some of these iron-rich foods, and their iodine levels are becoming a little higher than would be ideal, that may be the perfect breeding ground for Hashimoto’s.

SM: Totally makes sense. It really does.

DR: And what someone in that position might want to do is describe a temporary low-iodine diet. And a low-iodine diet is typically defined as less than 100 micrograms a day. So, hopefully the narrative as to why one might want to try a low-iodine diet isn’t convoluted and people kind of get the picture. But, the bottom line – if you have thyroid autoimmunity, and you’ve been paleo, iodine might be an issue. And so, something you might want to try for someone not there yet, is to try an iodine restriction and see if that improves some of your thyroid numbers, or just improves some of your symptoms.

SM: So here’s another question: So say you Hashimoto’s and you decide you’re going to try the low-iodine diet, can having too low iodine affect anything else? So you fix one thing, and then something else happens. So, what are signs – we talked about goiter and mental issues last week. But are there any other things that people should be aware of having too low of iodine?

DR: Well, certainly you don’t want to go too low on the iodine, because that can cause overt hypothyroidism, right? That may or may not be a problem for someone. Let’s say you’re someone who’s had Hashimoto’s, and the Hashimoto’s has progressed to a point where you need to be on thyroid hormone now. Well, you don’t really have to worry about becoming hypothyroid, because you are already kind of hypothyroid, and now you’re taking medication to get yourself back into normal. So, you don’t really have to worry about hypothyroidism due to iodine deficiency because you’re already taking thyroid hormone. But, there are some secondary things that may be an issue. One of the most notable is that breast tissue is one of the secondary or, kind of, tertiary glands in, terms of how much iodine uptake those tissues take from the bloodstream. The reason why iodine has been successfully used in some clinical trials for fibrocystic breast disease is because iodine seems to, to some extent, modulate estrogen receptor and/or estrogen metabolites in the breast tissue. It seems to have, to put it loosely, have an anti-estrogenic effect in breast tissue. That may be the mechanism why iodine is helpful for fibrocystic breasts. We’re getting into the point where we’re kind of leaving the area of the realm of being able to make a generic recommendation, and getting into the turf of – you need a clinician to know what your medical history is, and what are the things you’re trying to balance out? And so, you may want to go low iodine, monitor your thyroid markers, see if it helps. If it does, I would track that person’s, periodically, their 24-hour urinary iodine with creatinine ratio, make sure they don’t dip into insufficiency. If they do, we would give low-dose, very carefully monitored iodine, along with selenium, to get them back up into normative levels, while also monitoring their thyroid. But you’re getting to a point there where it’s hard to make a one-size-fits-all recommendation. But hopefully, this information will give people enough knowledge to take to their doctor, and hopefully a doctor that’s privy to this information, to work with them to come up with a plan that will be ideal for them.

SM: Yeah, definitely you want to get a practitioner run these tests. You don’t want to go too low iodine on yourself, are too high iodine by yourself. There’s too many things; it’s very intricate.

DR: Exactly, exactly. But hopefully, people are getting what might be a little bit of a refreshing view on iodine, which is it certainly has its time and its place. But, it seems like the view that has kind of been popularize up until now, which is iodine is kind of like this thyroid pancium nutrient. We may really want to rethink that. We may want to be a little bit more cautious in our iodine recommendations.

SM: I also want everybody to read labels, because there are there a lot of thyroid support supplements out there you could get at Whole Foods, you get on Amazon, and a lot of them do have iodine, So, be super careful – read your labels.

DR: Exactly, exactly. So, I’ve got a few concluding remarks for this section. Anything you want to add, Susan, before I jump into that.

SM: No, I think I we’re getting close to time. So why don’t we wrap it up with your closing comments?

DR: So, for these last two episodes, I hope we’ve clearly shown that iodine has been consistently shown to increase the incidence of autoimmune thyroid whatever it’s been added to the food supply. Also, that the sicker you are, and the worse your diet, the more dangerous iodine supplementation is probably going to be, because those who are inflamed or exposed to certain toxins may react much more negatively to iodine, because they’ve lost, or potentially lost, their sodium iodide symporter function – which helps the body adapt to higher low-iodine intakes. So, before starting iodine segmentation, inflammation and toxins should be addressed. Too much or too little iodine can cause thyroid disease. However, the US is not deficient. And to maintain sufficient iodine, normal dietary intake will be fine for most. However, like we’ve discussed, iodine restriction may be helpful for other groups, specifically the autoimmune thyroid group. Specifically with dietary intakes, 150-to-1,100 micrograms, with a potential sweet spot around, or not above, 450 micrograms seems to be best, with the caveat – those with thyroid autoimmunity that has not responded to other therapies yet, may want to try a short-term low iodine diet of less than 100 micrograms per day and see if that’s beneficial to their condition. If you are insufficient, and you’ve ruled out thyroid autoimmunity, you may want to try supplementation with between 1-to-15 milligrams of potassium iodide per day, along with 200 micrograms of selenium. Also, many of the popular tests like the iodine skin patch test, the iodine loading test, or iodine challenge test, don’t really have much in the way of scientific validation. But the urine test, ideally the 24-hour urine test for iodine with creatinine ratio is a good way to go. And halogens – things like fluorine, chlorine, and bromine, don’t appear to major issues as long as you’re avoiding things like fluoridated water, and eating organic foods, and adhering to good dietary and lifestyle practices; then you’ll probably be okay in that regard. So, that’s kind of the summary thus far. And then the next episode we will be discussing iodine and how it specifically relates to nodule and goiter, which is little different than what we’ve been discussing thus far. So, that’s it.

SM: Quick question. I have one thing – when you we’re doing your summary, it came up when we were talking about the low-iodine diet. Now, how long, like what time period would someone try this for? A week? Two weeks? A month? Six months? Do you think people would notice something right away?

DR: Well, there’s nothing I’ve read that has given us specific recommendation on that, outside of some of the clinical trials that have just withdrawn and put people on low-iodine diets and monitored. In those clinical trials, what they’ve observed is, they just arbitrarily chosen, in most cases it appears to be about anywhere from 2-to-3 weeks up to four-to-six weeks.

SM: So, not a huge long period of time. So it’s really easy to try out then.

DR: It doesn’t take a long period of time for these changes take effect. So, I think about a month would be a reasonable reassessment window, and then figure it out from there.

SM: So then next week we’re going to tackle the thyroid nodules, the goiter. Anything else?

DR: No, I think that’ll be it for next week. Certainly nodular goiter not as common as thyroid autoimmunity, but it’s surprisingly prevalent. You know, some of the recommendations change actually when you have nodular goiter. So, the issue is a complex one. Hopefully you guys are getting a lot out of this and hanging with us. And we’ll provide some clarity with how to use iodine in the context – I should said iodine in thyroid hormone, in the context of treating nodular goiter, to hopefully prevent a lesion from becoming cancerous and/or preventing some kind of the thyroidectomy or partial thyroidectomy. So, that will be next week.

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