Not to be confused with a thyroid protocol.
Most discussions about iodine intake revolve around Hashimoto's thyroiditis. But what about the majority of people where this condition is not an issue or even a potential issue? Hashimoto thyroiditis affects 1 to 2 percent of people in the United States.
Dr. Wentz, for example, sees people who predominantly have thyroid issues so her population is not representative of the general population. Iodine plays a broader role than just supporting the thyroid. Thus, intake of iodine must not be dictated by Hashimoto's disease. Although it MUST be a consideration.
The Holistic Primary Care website agrees.[i] Here is what this group has to say about iodine beyond the thyroid.
"Say the word “iodine” and most physicians automatically think, “thyroid.”
While the thyroid gland is an unquestionable iodine sponge, and iodine is a key constituent of thyroid hormone, it has other important physiologic effects, among them maintenance of healthy breast and ovarian tissue in women, and fostering optimal neuro-cognitive development in babies.
Less than 30% of the body’s total iodine load goes to the thyroid (note, other references indicate that 90% of total iodine goes to the thyroid). Between 60–80% of total iodine is non-hormonal and concentrated in extra-thyroidal tissues.[ii] This fact is sadly overlooked by most clinicians, to the detriment of their patients, says Sherri Tenpenny, DO, a holistic physician with a primary focus on women’s and children’s health."
“If you look at Braverman’s "The Thyroid," one of the bibles of endocrinology, it says in the very first chapter that iodine is important for the eyes, prostate, breast, ovaries. But medicine has largely ignored these tissues for decades. The FDA never even bothered to give a total body RDA for iodine beyond the anti-goiter recommendation of 150 mcg per day (in lactating women it’s 220–290 mcg) established in the 1920s,” Dr. Tenpenny told Holistic Primary Care."
“Since the early 1960s, we’ve known iodine deficiency was related to breast disease, including breast cancers. Carcinomas are most likely to develop in the ductal tissues that normally should be concentrating iodine.[iii] When these tissues are iodine-deficient, they are actually more sensitive to the stimulatory and proliferative effects of estrogen.”
Also, most discussions on iodine just consider levels of intake. However, there is inadequate consideration given to iodine loss. The point is, one must consider a "mass balance" on iodine based on:
co-factors (selenium for example),
excretion and other ways iodine is lost, and
risk for Hashimoto's.
Even the Hashimoto's risk must be weighed against benefits of iodine beyond the thyroid. In this regard, Iodine intake becomes personal so the solution has everything to do with personalized testing. It is clear that internal iodine levels are safe over a broad range, depending upon the health of the individual. The figure below shows an iodine intake "U" curve. This is not intended to be a guide to follow, but rather an illustration of how iodine levels cannot be ascribed to such a narrow range as is currently occurring, that being close to the RDA of 150 micrograms/day.
"It is not about Iodine for the Thyroid - it is about the Thyroid for the Iodine."
Thomas J. Lewis
What this means is we do not want the Thyroid "tail" to wag the Iodine "dog." Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. It was initially described in 1912, but only rarely reported until the early 1950s. However, Hashimoto thyroiditis affects just 1 to 2 percent of people in the United States.
Clearly, dictating iodine intake based on the low prevalence of Hashimoto's is inappropriate 98+ percent of the time. Further, Hashimoto's is a diagnosable and often, reversible condition. Thus, those who actually need to be restricted in iodine intake to the RDA diminishes to well less than 1%.
Autoimmune disease is defined as a condition in which your immune system mistakenly attacks your body. In most cases, there is a presumption that this just happens without some underlying pathology. If that was the case, we would not survive as a species. In reality, there are very quantifiable causes behind autoimmune diseases.
Intestinal permeability caused by:
o Incomplete digestion[vi]
o Food sensitivities[vii]
Chronic, often stealth, infections
o Bacterial diseases including Lyme disease and periodontal infections[viii]
Hashimoto's, like every other aspect of health, is best represented as a continuum. A person's position on this continuum dictates safe and optimal intake levels of iodine, Figure 2.
Specific Protocol for the Intake of Optimal Iodine - Above the RDA
Step 1: Perform a complete evaluation of thyroid health. These are the biomarkers that must be obtained:
Triiodothyronine (*T3), Free
T4, Free (Direct)
Reverse T3, Serum
Thyroid Peroxidase (TPO) Antibodies
If there is no indication of Hashimoto's thyroiditis, then iodine intake above the RDA is recommended. The upper daily limit we recommend is 3 mg/day. For perfectly healthy individuals on a whole food diet, 0.5 mg/day is probably adequate. Athletes and those experiences substantial daily stressors should double these recommendations.
Step 2: If there IS an indication of Hashimoto's thyroiditis, test for and remediate causes. Even people without Hashimoto's should consider this prior to increasing their current iodine intake levels. Some applicable tests include:
Complete blood count with differential with an interpretation focused on low-grade viral or bacterial infection.
Erythrocyte sedimentation rate. The results from this test should be <3mm/hr. Anything higher than that infers some level of gut dysbiosis that may be resolved with a probiotic diversification approach.
H-pylori blood test. If this organism is found, even if below standard reference ranges, it should be treated to bring it down to lowest possible levels. It contributes to intestinal permeability and gut dysbiosis.
Oral pathogen test. Oral pathogens that may be festering below the gum line may contribute to Hashimoto's.
Stool test to determine microbiome health.
Food sensitivity testing.
Internal temperature (https://careclinic.io/thyroid-temperature-chart/)
Work with a practitioner to get these tests and correct any issue uncovered.
Step 3: After appropriate protocols are completed, retest the panels in Step 2, at a minimum. If these tests are now optimal, retest the comprehensive thyroid panel.
Step 4: Adjust your iodine intake by measuring iodine levels and excretion. This is a serum and urine test but is somewhat imperfect because some iodine is lost through sweat. This is why athletes should consider higher doses of iodine compared to sedentary people.
Test for serum iodine
Test for urine iodine (spot and 24 hour)
Adjust iodine intake
Retest for iodine levels
Continue to monitor temperature
Ideally, you should plot the iodine excretion levels versus iodine intake. This type of chart will help you determine your physiological need.
Step 5: Selenium complements iodine so take a selenium supplement or foods high in selenium like Brazil nuts. Dr. Wentz recommends 200 mcg (micrograms) of selenium. More may be appropriate as you increase your intake of iodine.
Step 6: Finally, assuming you have increased your iodine intake above the RDA, periodically test the full thyroid panel. If antibodies present, reduce iodine intake and redo testing for factors that potentially cause Hashimoto's and fix them.
Do NOT limit your iodine intake because of a reversible underlying condition.
Iodine is a crucial nutrient. Consider taking in more iodine than is dictated by the presumed need of your thyroid and the potential for Hashimoto's thyroiditis. Testing, as always, is the key to getting it right - to the extent anyone can when it comes to the complexities of human physiology.
What form of iodine should you take? Any is better than none. However, a natural supplement from kelp or, better yet, eating more sea vegetables is your best choice. The Feds supplemented potassium iodide into table salt. Your body, when it has any form of iodine, can convert it to what it needs. Some of the more popular supplements have a combination of elemental iodine and iodide salt. This may be preferred over just the iodide salt. However, in the ocean, the main form is going to be sodium iodide.
For the health nerds among us....
Brown algae of the Laminariales (kelps) are the strongest accumulators of iodine among living organisms. They represent a major pump in the global biogeochemical cycle of iodine and, in particular, the major source of iodocarbons in the coastal atmosphere. Nevertheless, the chemical state and biological significance of accumulated iodine have remained unknown to this date. Using x-ray absorption spectroscopy, we show that the accumulated form is iodide, which readily scavenges a variety of reactive oxygen species (ROS). We propose here that its biological role is that of an inorganic antioxidant, the first to be described in a living system. Upon oxidative stress, iodide is effluxed. On the thallus surface and in the apoplast, iodide detoxifies both aqueous oxidants and ozone, the latter resulting in the release of high levels of molecular iodine and the consequent formation of hygroscopic iodine oxides leading to particles, which are precursors to cloud condensation nuclei. In a complementary set of experiments using a heterologous system, iodide was found to effectively scavenge ROS in human blood cells.
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