Re: Question for /Dr. Brownstein - Patch Test Reliability & Dr. Abraham

[Guest guest]

Yes I do know this. He doesn't put much stock in it. When I did it he kind of shrugged it off and said that he already knew I was deficient because of my tests.

Question for /Dr. Brownstein - Patch Test Reliability & Dr. Abraham

Hi, & Everyone...I have a question for Dr. Brownstein, .A recent post linked to Dr. Abraham's paper on his findings that theskin patch test is not reliable for determining iodine need.http://www.optimox.com/pics/Iodine/updates/UNIOD-02/UNIOD_02.htmI am interested to hear Dr. Brownstein's opinion on the patch test.(If you already know Dr. B's opinion on the patch test, no need to askthe question...please just let me/us know.)Thanks!Warmly,The bioavailability of iodine applied to the skinGuy E. Abraham, M.DI have decided to write a series of manuscripts on the most commonlyasked questions about iodine. These manuscripts will be displayed onour website. This report is the first of this series. I have oftenbeen asked: 1) Is the application of iodine to the skin an acceptableway to supplement iodine? 2) Are there any data confirming thevalidity of the iodine skin patch test to assess body sufficiency foriodine? The interpretation commonly used to assess the results of theiodine skin patch test: The faster the yellow color of iodinedisappears from the skin, the more iodine deficient the person tested;and vise versa: if the yellow color lingers, the more sufficient iniodine the person tested.A review of the published literature is required to answer the abovequestions. The bioavailability of iodine applied to the skin is wellknown. Over 100 years ago, application of iodine to the skin was usedextensively for iodine supplementation. In 1932, Nyiri and Jannitti(1) from the College of Pharmacy of Rutgers University wrote:"Iodine is being used extensively as a prophylactic and therapeuticagent by application to the outer integument, (For the reader'sinformation, that is the skin) and has maintained its place inmedicine for many decades. Its use by external application is merelyon an empirical basis; very little proof of its efficacy has beenobtained by experimental work. The main question as to whether or notiodine passes through the unbroken human and animal skin has not beenconclusively answered."In order to assess the bioavailability of iodine applied to the skin,these investigators used 44 rabbits and 6 dogs, not human subjects."Although the question of iodine penetration has been studiedextensively especially during the second half of the last century, nosatisfactory conclusion has been reached because the techniques of thevarious experiments were not fully reliable. Considering theincreasing biological significance of the outer integument (Klose(30), Unna (31), Vollmer (32), Urbach (33)) and the wide spreadmedicinal use of iodine on the skin, we made a series of experimentsabout the fate of iodine applied to the skin; thereby studying thepossibility of penetration of free iodine, its fate in the body, itselimination, and its conditions of evaporation for the surface. Wecarried out the experiments on six dogs and forty-four rabbits."To summarize the results of their experiments:1. Free iodine penetrates through the unbroken skin.2. Approximately 88 per cent of the iodine evaporate from thesurface within three days.3. Colloidal iodine evaporates somewhat more quickly than tinctureof iodine; Lugol's solution is more stable than either of them.4. The influence of ambient temperature on the evaporation ofiodine is significant: within the first minute, the losses of iodineby evaporation are: 10-15% at 9° c; 18-25% at 24° c; and 35% at 37° c.5. The remaining iodine on the skin following evaporation of 88% ofthe total iodine, approximately 12 per cent, is at the disposal of thebody, and penetrates through the skin. The bioavailability of theremaining 12% of the skin iodine is very gradual.6. The fate of iodine in all above experiments is the same whetheriodine is applied to the skin in the form of an alcoholic solution orin colloidal suspension. (For the reader's information, the alcoholicsolution is tincture of iodine and the colloidal suspension is asaturated aqueous solution of diatomic iodine, I2 ). The authors concluded (1):"Our quantitative determinations prove that iodine which penetratesthrough the skin is removed only slowly from within this area into thebody, thus forming an iodine depot in the skin for several days. Inthis prolonged retention of iodine within the skin, we see a favorablecondition for a possible local prophylactic and therapeutic action."The above conclusions apply to rabbits and dogs, but not to humansubjects. The best study of the bioavailability of iodine applied tothe skin in normal human subjects was reported by et al in 1989(2). The purpose of 's study was to assess the effectiveness ofskin application of iodine in blocking radioiodide uptake by thethyroid gland. The subjects used in this study were 24 adult malevolunteers aged from 21 to 51 years. These subjects were divided into4 groups of 6 subjects each. One groups served as control and did notreceive stable iodine. The other subjects in the remaining 3 groupsreceived respectively 130 mgm KI orally equivalent to approximately100 mg iodide; 80 mg iodine (tincture) on the skin; and 160 mg iodineon the skin. All 24 subjects ingested 131I labeled NaI and radioiodidethyroid uptake was measured at time 2 hr, 6 hr, and 24 hr post-ingestion of radioactive iodide and stable iodine. Serum inorganiciodide levels were measured at time zero, 2 hr, 6 hr and 24 hr postintervention. 24 hr radioiodide uptake by the thyroid gland as percentof dose administered was used to assess the effectiveness of iodine inblocking radioiodide uptake by the thyroid. The 24 hr percentradioiodide uptake by the thyroid gland were: control: 10.9 ± 2.9 (SD)oral KI: 0.34 ± 0.26; skin 80 mg iodine = 7 ± 5.5%; and skin 160 mgiodine = 2.0 ± 2.5%. Prior to administration of stable iodine the meanserum iodide in the 3 intervention groups were: 0.024 mg/L; 0.033mg/L; and 0.02 mg/L. The mean of the 3 mean values is 0.026 mg/L.Under steady state conditions, the computed daily intake of iodinebased on serum iodide is equal to the product of serum iodide times43.5 L/day, which is the renal clearance of iodide (3). The estimatedaverage daily intake of iodine by this group of men is: 0.026 mg/L ×43.5 L/day = 1.13 mg/day. This daily intake may be due to theiodization of bread in the 1960's, 1970's and in some states in the1980's. The estimated daily intake of iodine during that time in theU.S.A. was 1 mg (4). This computed daily intake in 's subjectsis in agreement with the mean percent radioiodide uptake by thethyroid gland in this group of subjects with a mean of 10.9. Byinterpolation on Fig. 2 of Reference 5, 10.9% uptake corresponds to anaverage intake of approximately 1.5 mg iodine (See Fig. 1).The two questions mentioned previously can now be answered:1. Is the cutaneous route of iodine supplementation practical andeffective?2. Does the skin iodine patch test give a reliable indication ofwhole body sufficiency for iodine?To answer the first question, we will use the data in the six subjectswho were exposed to 160 mg iodine via cutaneous application, becausethe mean serum iodide levels were relatively constant over the 24 hrperiod: 0.27 mg/L at 2 hr; 0.2 mg/L at 6 hr and 0.24 mg/L at 24 hrpost intervention. The mean value of the 3 means is 0.24 mg/L iodide.The average amount of iodine bioavailable in these 6 subjects would bethe product of the serum iodide levels by the renal clearance ofiodide, that is 43.5 L/day (3). 0.24 mg iodide/L × 43.5 L/day = 10.4mg. The percent of bioavailable iodine from 160 mg applied to the skinis 10.4 x 100 / 160 = 6.5%. If the data reported by Nyiri and Jannitti1 in dogs can be extrapolated to humans, that is 12% of the appliediodine was available for utilization by the body, with 88% evaporated;then some 50% of the remaining skin depot of iodine was availableduring the first 24 hrs following skin exposure to iodine. One canconclude that skin application of iodine is an effective if notefficient and practical way for supplementation of iodine with anexpected bioavailability of 6 to 12% of the total iodine applied tothe skin. The serum iodide levels were 10 times higher 2 hr postintervention with oral ingestion of 100 mg iodide than with 160 mgiodine applied to the skin(Fig. 2) .From the published data, the skin iodine patch test is not a reliablemethod to assess whole body sufficiency for iodine. Many factors playa role in the disappearance of the yellow color of iodine from thesurface of the skin. For example, if iodine is reduced to iodide bythe skin, the yellow color of iodine will disappear because iodide iswhite. In order to regenerate iodine on the skin, one needs to applyan oxidant such as hydrogen peroxide, complicating the test further.The evaporation of iodine from the skin increases with increasedambient temperatures and decreased atmospheric pressure due to weatherconditions and altitude. For example, the yellow color of iodine willdisappear much faster in Denver, Colorado at 5,000 feet above sealevel then Los Angeles, California at sea level, irrespective of theamount of bioavailable iodine. The iodine/iodide loading test (4) ismuch more accurate and it is now available from two laboratories:FFP Laboratories80 Doctors Dr., Suite 3ville, NC 28292Phone: 887-900-5556 / Fax: 828-684-3253Doctor's Data Inc.3755 Illinois AvenueSt. , IL 60174Phone: 800-323-2784 / Fax: 630-587-7860References1. Nyiri, W., Jannitti, M., About the fate of free iodine uponapplication to the unbroken animal skin. An experimental study. J.Pharmacd. Exp. Ther., 45:85-107, 1932.2. , K.L., Coen, P.E., White, W.J., et al, Effectiveness ofSkin Absorption of Tincture of I in Blocking Radioiodine from theHuman Thyroid Gland. Health Physics, 56:911-914, 1989.3. Abraham, G.E.: The concept of orthoiodosupplementation and itsclinical implications. The Original Internist, 11:29-38, 2004.4. Abraham, G.E., The safe and effective implementation oforthoiodosupplementation in medical practice. The Original Internist,11:17-36, 2004.5. Abraham, G.E., Flechas, J.D., Hakala, J.C.,Orthoiodosupplementation: Iodine sufficiency of the whole human body.The Original Internist, 9:30-41, 2002.

[Guest guest]

, here is the response from Brownstein to Pat on the Patch Test from email 163:

I sent Dr Brownstein copies of the remarks byPeat and Derry questioning the validity of theIodine Skin Patch Test.I asked if he agreed with themDr Brownstein replied (Jan. 23, 2006):"I agree: it is a useless test.Doesn't correlate clinically or via lab testing."

----- Original Message -----

From: angesc2001 I have a question for Dr. Brownstein, .A recent post linked to Dr. Abraham's paper on his findings that theskin patch test is not reliable for determining iodine need.http://www.optimox.com/pics/Iodine/updates/UNIOD-02/UNIOD_02.htmI am interested to hear Dr. Brownstein's opinion on the patch test.