2.) Rebuttal to Dr Gaby by Dr Brownstein & Dr Abraham (Iodine #980)

[Guest guest]

-- A Rebuttal of Dr. Gaby's Editorial on Iodine --

Guy E. Abraham, M.D.

optimox@...

http://www.optimox.com/

Brownstein, M.D.

info@...

http://www.drbrownstein.com

_____

Letter to the Editor:

From Townsend Letter for Doctors & Patients

October 2005

[source: http://www.townsendletter.com/Oct2005/gabyrebuttal1005.htm]

_________

Editor:

We would like to submit a rebuttal to Dr. Gaby's editorial on iodine,

published in the August/September 2005 issue of Townsend Letter.

Gaby questioned the safety and efficacy of orthoiodosupplementation in

medical practice and also the validity of the iodine/iodide loading

test we use to assess whole body sufficiency for iodine.

Our rebuttal will cover four topics:

1.) The safe and effective use of iodine by our medical predecessors

2.) The computation of the average daily intake of iodide from seaweed

by mainland Japanese

3.) The validation of the iodine/iodide loading test

4.) The effectiveness and safety of orthoiodosupplementation in

current medical practice

_____

1.)

-- The safe and effective use of iodine by our medical predecessors --

To quote Gaby: " Recently, a growing number of doctors have been using

iodine supplements in fairly large doses in their practices. The

treatment typically consists of 12 to 50 mg per day of a combination

of iodine and iodide, which is 80 to 333 times the RDA of 150 mcg

(0.15 mg) per day. "

The element iodine was used in daily amounts 2 to 3 orders of

magnitude greater than the RDA by physicians for over 150 years. Only

8 years after the discovery of iodine from seaweed by French chemist

Bernard Courtois in 1811, Swiss physician J.F. Coindet who previously

used successfully burnt sponge and seaweed for simple goiter, reasoned

that iodine could be the active ingredient in seaweed.

In 1819, he tested tincture of iodine at 250 mg/day, an excessive

amount by today's standard, in 150 goiter patients with great success.

He published his results in 1820.1 There is no question that the

amount of iodine used by Coindet was excessive. But, Coindet was the

first physician to use the newly discovered element iodine in medical

practice.

Since then, the collective experience of a large number of clinicians

from the U.S. over the last century has resulted in the recommended

daily amount of 0.1 to 0.3 ml of Lugol,2 containing from 12.5 to 37.5

mg elemental iodine, for iodine/iodide supplementation.3 This range of

daily intake for iodine supplementation was based on clinical

observation of the patient's overall wellbeing.

The Lugol solution was developed by French physician, Lugol in

1829 for treatment of infectious diseases using oral ingestion of his

preparation. The Lugol solution contains 5% iodine and 10% potassium

iodide in water.2 Iodine is not very soluble in water, with aqueous

saturation at 0.33 gm iodine/L.

The addition of potassium iodide to an aqueous solution of iodine

stabilizes the iodine by forming a complex triodide I3- and increases

the aqueous solubility of iodine in the form of a triodide complex 150

times. The recommended daily amount of Lugol was 0.1 ml to 0.3 ml,

containing 12.5 to 37.5 mg elemental iodine.3

As late as 1995, the 19th Edition of Remington's Science and Practice

of Pharmacy,4 continued to recommend between 0.1 to 0.3 ml daily of

Lugol 5% solution in the treatment of iodine deficiency and simple goiter.

British physicians recommended a similar range of daily intake of

iodine in the form of hydrogen iodide as the ranges of iodine

recommended by U.S. physicians in the form of Lugol solution. The

recommended daily intake of hydriodic acid syrup was 2 to 4 ml.5 The

syrup is prepared by the British apothecary from an aqueous stock

solution containing 10% hydrogen iodide (HI), which is diluted 10 fold

with syrups of different flavors.

When hydrogen iodide is dissolved in water, it forms hydriodic acid.

The syrup would contain 1% hydrogen iodide equivalent. This would

compute to 10 mg iodide per ml. So, the recommended daily amount of

elemental iodine was from 20 to 40 mg.

As far back as 100 years ago, U.S. physicians used Lugol solution

extensively in their practice for many medical conditions.3 In 1932,

physician B.N. Cohn6 wrote: " Öthe widespread use of compound solution

of iodine, U.S.P.,

(For the reader's information, that is Lugol solution) is the result

of a paper by Plummer and Boothby, published in that year (1923).

Since then compound solution of iodine has been used by nearly every

clinicianÖ "

Lugol solution was called then Liquor Iodi Compositus, (that is Latin

for compound solution of iodine).

Marine in 19237 used a daily average of 9 mg iodide in the prevention

of goiter in adolescent girls, an amount 60 times the current RDA for

iodine. In Marine's study, the prevalence of goiter decreased 100 fold

compared to a control group following 2 & #937; years of supplementation.

Gaby used the RDA for iodine as his gold standard:

" First is the notion that the optimal daily iodine intake for humans

is around 13.8 mg per day, which is about 90 times the RDA and more

than 13 times the 'safe upper limit' of 1 mg per day established by

the World Health Organization. "

Does Gaby realize that the RDA for iodine was established very

recently in 1980, confirmed in 1989,8 and based on data supplied by

endocrinologists with thyroid fixation ignoring the rest of the body?

The goal of the RDA for iodine is the prevention of extreme stupidity

(cretinism), iodine-deficiency induced goiter and hypothyroidism, not

whole body sufficiency for iodine.

In 1930, et al9 stated: " The normal daily requirement of the

body for iodine has never been determined. " This statement is still

true today, more than 70 years later. We still don't know the

iodine/iodide requirements for whole body sufficiency.

Physician Henry A. Schroeder10 who did extensive studies on the

dietary requirement for trace elements reported in 1975 that iodine in

dog food is 20 times higher than iodine in food consumed by humans.

The amount of iodine in the food supply of humans, of pets and

laboratory animals, expressed as parts per million (PPM) are: for

humans 0.12; for rabbits 0.59; for rats 1.17 and for dogs 2.25.

Schroeder commented: " Because it is doubtful that man differs much in

his needs from other omnivorous animals, we could build up a good, if

very indirect, case that man is not getting enough. "

During the period when potassium iodate was used as a dough

conditioner (1960-1980), and prior to the introduction of the

goitrogen bromate as an alternative to iodate,3 one slice of bread

contained the full RDA for iodine.11

During this period, Oddie et al12 reported the results of a nationwide

survey of iodine intake in the U.S. at 133 locations comprising of

30,000 euthyroid subjects. The mean iodine intake in these locations

ranged from 240 to 740 ug/day.

Correlation between iodine intake and mortality rates from thyroid

diseases revealed a highly significant inverse correlation between

iodine intake and mortality rates. Oddie et al comment: " Despite this

high average, there is still a significant negative correlation (r =

-080) between iodine intake and mortality rate from thyroid diseases. "

In other words, the mortality rates would have continued to decrease

with higher intake of iodine.

In Tasmania, Clement13 reported that a daily intake of 1.4 mg of

potassium iodide (10 times the RDA) by infants and children for 16

years resulted in reduction in the prevalence of goiter, but in some

regions, that amount of iodine did not have a significant effect on

the rates of goiter. Different amounts of goitrogens in these

different regions may explain this discrepancy.

In Marine's study, 9 mg/day of iodide were required to decrease the

prevalence of goiter in adolescent girls by 100 fold.7 Currently, in

Tasmania, potassium iodate is added to bread at 2 mg per loaf of bread.

" After a preliminary survey in 1949, tablets containing 10 mg

potassium iodide had been made available to infants, preschool

children, and schoolchildren through schools and child-health centres

for weekly consumption for approximately sixteen years. State-wide

surveys at five-year intervals showed a slow steady reduction in the

prevalence of goiter, but in some regions the rates remained high. " 13

Gaby mentioned the " safe upper limit " of 1 mg/day, established by the

WHO.

As previously mentioned, prior to World War II, U.S. physicians used

routinely 12.5 to 37.5 mg elemental iodine daily for iodine

supplementation.3 Large numbers of pulmonary patients were treated

safely for years with daily amounts of potassium iodide 2 to 3 orders

of magnitude greater than 1 mg.

Fradkin and Wolff14 commented on the safety of relatively large doses

of potassium iodide: " Although there are scattered case reports of IIT

(iodide-induced thyrotoxicosis) after the use of KI, these must be

considered in the light of over 108 tablets of KI prescribed annually

in this country.

Reports of experience with KI (1.6-6.4 g/day) in large series of

pulmonary patients revealed no hyperthyroidism in 2404 and 502 patients. "

The requirement for iodine depends on the goitrogen load.

The greater the goitrogen load, the greater the need for iodine.

Bromide is a goitrogen that interferes with the uptake and utilization

of iodide by target cells.3,18 The U.S. population is exposed to large

amounts of the element bromine in its organic and inorganic forms.

The United States utilizes two-thirds of the annual world production

of bromine.15 The annual world production of bromine is 280,000 tons.

At 909 Kg/ton, we have then an annual world production of bromine of

approximately 254,520,000 Kg. The U.S. consumes 167,983,200 Kg of

bromine annually.

Out of that amount, 45,450,000 Kg are used in agriculture (food

supply) and 9,090,000 Kg for water sanitation (water supply). The

amount of bromine used in our food and water supplies compute to 21%

of the total U.S. utilization of this goitrogenic halogen.15

It does not take a rocket scientist to figure out that we, in the

U.S., are exposed to high amounts of the goitrogen bromine via our

food and water supplies in all its inorganic and organic forms, such

as methylbromide in agriculture.

Bromine competes with iodine for cellular uptake and utilization; and

has goitrogenic, carcinogenic and narcoleptic properties.3 Iodine

pulls bromine from storage sites18 and chloride increases its

excretion in urine.15 For detoxificaton of bromide, the halides iodide

and chloride are the most effective.

The annual world production of iodine in 1981 was 12,000 tons or

10,908,000 Kg.16 Some 20% of the iodine used in the U.S. is for animal

feed supplement, and none for human food, except the minimal amount in

table salt. Between 1960 and 1980, iodate was used in bread with one

slice of bread containing the full RDA of 0.15 mg.3

But some 20 years ago, iodophobia resulted in the removal of iodate

from bread, replacing it withÖyou guessed itÖbromate. If you wanted to

keep a nation sick and zombified, we cannot think of a better way to

achieve this goal.3

Gaby, assuming we evolve from a Big Bang 20 billion years ago,

commented: " Since emerging from the iodine-rich oceans to become

mammals, we have evolved in an iodine-poor environment. "

Actually, the oceans are very poor in iodine, based on concentration

of this element. Although the largest reservoir of iodine is in the

oceans, because of their large volume, the concentration of

iodate/iodine/iodide in the oceans is only 0.05 PPM, very dilute

indeed, compared to bromide at 70 PPM.17

For example, to obtain the RDA for iodine from seawater, you need 3

liters. Sea salt is very low in iodide, much lower than iodide in

iodized table salt. It is understandable why someone who believes in

the theory of evolution has a problem with such high requirements for

iodine in an environment depleted of this element.

Unless sometimes in the distant past, the topsoil of planet earth

contains significant levels of iodine and meeting these high

requirements for iodine sufficiency could then be achieved with any diet.

The theory of evolution does not offer an intellectually satisfying

answer to this paradox. However, the Biblical account of the origin of

the world through creation 6000 years ago followed by the fall of man

and the flood fits very well the current situation. According to the

biblical narrative, the Creator declared planet earth and everything

in it perfect.

Therefore, the original planet earth contained a topsoil rich in

iodine, and all elements required for perfect health of Adam, Eve and

their descendants. A rebelled archangel was expelled from God's

Habitation for attempting a hostile takeover (Isaiah 14:12-15). His

name was Lucifer before the attempt (Isaiah 14:12) and Satan after his

expulsion (Luke 10:18).

Satan deceived Eve into believing that she could become a goddess by

disobeying her Creator (Genesis 3:4,5). A sequence of events followed,

culminating in the worldwide flood 4500 years ago. Following this

episode, the receding waters washed away the topsoil with all its

elements into oceans and seas.

The new topsoil became deficient in iodine and most likely other

essential elements, whose essentialities are still unknown.

Mountainous areas became the most iodine-deficient because the

receding waters were the most rapid over the steep slopes, eroding

deeper into the soil.

The Biblical account of the flood fits very well with the finding of

high concentrations of iodine in brines, which accompany oil wells and

natural gas deposits.8 By 1977, the brines associated with deposits of

natural gas in Japan accounted for 56% of the world iodine production.16

The previous existence of iodine-rich living organisms from which came

these iodine-rich degradation products strongly suggests that sometime

in the distant past, iodine was plentiful on planet earth, and some

catastrophic event resulted in washing away the iodine-rich top soil

in the oceans.

The toxicity of iodine depends on the forms of this element.

Several forms of iodine prescribed by U.S. physicians are listed in

Table I. The manmade organic forms of iodine are extremely toxic,

whereas the inorganic non-radioactive forms are extremely safe.18

However, the safe inorganic non-radioactive forms were blamed for the

severe side effects of the organic iodine-containing drugs.

For example, in reference #14 of Gaby's editorial, discussing

thyrotoxicosis induced by iodine,19 the form of iodine involved is an

iodophore, an organic form of iodine. This iodophore interferes with

iodine uptake and utilization by the thyroid gland.20

From a publication by pou, et al, published in 1992,21 it is

obvious that the cytotoxicity of the organic iodine-containing drugs

is due to the molecule itself, not the iodine released or present in

the molecule.

" We can, therefore, conclude that the effect of amiodarone,

benziodarone, Na iopanate, and other iodine-containing substances with

similar effects is due to the entire molecule and not to the iodine

liberated. It should be noted that the cytotoxic effect of amiodarone

in all cultures is also due to the entire molecule and not to the

iodine present in it. "

Table 1

Various forms of iodine/iodide used in clinical medicine and their

toxicity levels (from Reference 16)

NON-TOXIC FORMS:

A) Inorganic-Non-radioactive (Extremely Safe):

a) iodides (i.e. SSKI)

tincture of iodine

c) Lugol Solution

Organic-Natural occurring (Safe within physiological ranges):

a) thyroid hormones:

thyroidal iodolipids:

_____

TOXIC FORMS:

C) Inorganic:

a) Radioactive iodides for diagnostic and therapeutic purposes

(Carcinogenic Cytotoxic).

D) Organic-Manmade (Extremely Toxic):

a) radiographic contrast media

iodine-containing drugs (i.e. amiodarone)

_____

A new syndrome, medical iodophobia, was recently reported3 with

symptoms of split personality, double standards, amnesia, confusion

and altered state of consciousness.

Medical iodophobia has reached pandemic proportion and it is highly

contagious (iatrogenic iodophobia).

A century ago, non-radioactive forms of inorganic iodine were

considered a panacea for all human ills, but today, they are avoided

by physicians like leprosy.18 We have previously discussed the factors

involved in this medical iodophobia.3,18

_____

2.)

-- The computation of the average daily intake of iodide from seaweed

by mainland Japanese --

Over 95% of the iodine consumed by mainland Japanese comes from

seaweed. If you want to prove that the intake of iodine by mainland

Japanese is within the same range as consumed by the U.S. population

or maybe slightly above, just tell your Japanese study subjects to

abstain from seaweed during the study period. It's that easy and this

technique has been used effectively in several publications.

As a general rule, mainland Japanese living in the coastal areas of

Japan, consume more seaweed than inland dwellers.22-24 Among the

coastal areas, the inhabitants of Hokkaido ingest the largest amount

of seaweed.25 Hokkaido produces 90% of the seaweed consumed in

Japan,25 further processed by drying and flattening for sales in food

stores.

Statistics compiled by the Japanese Ministry of Health is based on the

dry form of seaweed.26 Seaweed contains predominantly the inorganic

form of the element iodine, mainly iodide.27 Seaweed also concentrates

other halides such as bromide, which possess goitrogenic, carcinogenic

and narcoleptic properties.3

Seawater is very poor in iodide and relatively rich in bromide with

0.05 PPM iodide and 70 PPM bromide. There is 1400 times more bromide

than iodide in seawater.

Mainland Japanese consume large amounts of iodine from seaweed and

they are one of the healthiest nations.11 Based on extensive surveys

performed by the International Agency for Research on Cancer and

published in 1982,28 mainland Japanese, at least up to 1982,

experienced one of the lowest incidences of cancer in general.

Mainland Japanese have the longest lifespan in the world.29

Although seaweed has been the main source of iodine for the Japanese

population, inorganic iodine/iodide in supplements (liquid or tablets)

seems a much purer, safer and more accurate form for supplementation

of this essential element than seaweed.

It is more difficult to titrate the amount of seaweed needed to

achieve whole body sufficiency for iodine than the amount of a pure

standardized solid dose form of this essential element.

The reported seaweed-induced goiter with normal thyroid functions 40

years ago in Hokkaido, Japan,25 was not caused by iodine. This

seaweed-induced goiter eventually disappeared.22 Suzuki et al25

questioned whether seaweed itself was the cause of this goiter, since

much larger amounts of iodide in pulmonary patients did not induce

goiter.

Suzuki et al commented: " Considering the paucity of reported cases of

iodine goiter with the wide spread usage of iodine medication, we

cannot exclude factors other than excessive intake of dietary iodine

as a cause of the goiter. " Also, residents in Tokyo, Japan, who

excreted similar levels of iodide in their urine (around 20 mg/24h)

did not experience goiter.

Contamination of seaweed with bromide is the most likely explanation,

since bromide is a goitrogen,3 and there is 1400 times more bromide

than iodide in seawater.17 The presence of excess goitrogens in the

diet would require greater amounts of ingested iodine to prevent the

goitrogenic effect of these substances.11,18

In assessing the intake of iodine by mainland Japanese based on

urinary excretion of iodide, keep in mind that urinary iodide levels

are not a good index of intake unless whole body sufficiency for

iodine is achieved and the form of iodine consumed is highly

bioavailable.

For example, only 10% of sodium iodide present in table salt is

bioavailable, due to competition with chloride for intestinal

absorption.8 On a molor basis, there is 30,000 times more chloride

than iodide in iodized salt. The % of ingested iodine excreted in the

24 hr. urine collection can be as low as 10% of the ingested amount in

iodine-deficient subjects,3 due to body retention of iodine.

With this in mind, let us review some published data. Konno et al22

measured iodide in morning urine samples of 2,956 men and 1,182 women,

all normal and healthy, residing in Sapporo, Japan. The 95% confidence

limits were from 1.14 to 8.93 mg/L.

Assuming an average 24 hr. urine volume of 1.5 liters, the daily

iodide excretion would range from 1.7 to 13.4 mg with an average of 5

mg. As discussed previously, these amounts are an underestimate of

iodine intake. Yabu et al30 from Osaka measured iodide levels in

morning urine samples obtained from 39 male and 88 female local

residents. He reported a range of 0.6 to 17.4 mg/L.

If those iodine levels are expressed as mg/24 hr. and assuming an

average 24 hr. urine volume of 1.5 liter, the range of iodine

excretion per 24 hr. would be from 1 to 25 mg in these 163 Japanese

subjects.

Gaby mentioned that the calculation we used to estimate the average

daily intake of mainland Japanese was based on dry weight whereas the

data in Nagataki's publication23 on iodine in seaweed was reported per

wet weight. Quoting from that article: " For example, the dry weight of

such food as " tangle " (Laminaria) contains 0.3% iodine1 and this may

be eaten in quantities as large as 10 g daily. " 23

This daily intake would compute to 30mg of elemental iodine. However,

on page 643 of the same article, Nagataki et al23 misquoted their

Reference #13, that is our Reference #26, when they stated:

" Öaccording to the statistics of the Ministry of Health and Welfare,13

the average daily intake of seaweed was 4.6 g (wet weight), " when in

fact, that Organization confirmed by a phone interview (6/21/05) that

their data on seaweed are always expressed as dry weight.

For example, in table 8 of Nagataki's Reference #13, values for

seaweed consumption for several years from 1950 to 1963 are listed in

gms of dry weight, confirmed by the Japanese Ministry of Health and

Welfare. We have compiled some of these data in our Table II, taken

from reference 13 of Nagataki's article.

The value of 4.6 g that Nagataki quoted as wet weight was actually

expressed as dry weight and Nagataki used the value for the year 1963

only, that is, 4.6 gm. Nagataki et al mentioned correctly dry weight

on page 638 at the beginning of their article, and for some unknown

reason, they erroneously mentioned wet weight on page 643 of the same

publication, which is confusing.

We have relied, therefore, on the original information supplied by the

Japanese Ministry of Health and Welfare, that is Nagataki's Reference

#13, and our reference #26.

The average daily intake of iodine by mainland Japanese in 1963 was

13.8 mg, based on information supplied by the Japanese Ministry of

Health, which used only dry weight in their calculations, confirmed by

a phone interview of one of us (GEA) on June 21, 2005, with officials

of this organization (See Table II).

Table II

Annual change of intake of food by food groups in Japan

[For this table consult the original Link:

[source: http://www.townsendletter.com/Oct2005/gabyrebuttal1005.htm]

Compiled from tables 6 and 8 of the official publication, Nutrition in

Japan, 1964, Nutrition Section, Bureau of Public Health, Ministry of

Health and Welfare, Tokyo, Japan, March 1965.

* In a phone interview with Guy E. Abraham, M.D., on June 21, 2005,

using Miss Hisa Izumi as an interpreter, the interviewees Miss Nichi

and Mister Arai at the Japanese Ministry of Health and Welfare confirm

that, in the nutritional surveys published in 1965, the average daily

amount of seaweed consumed is expressed as gms of dried seaweed.

One can see that iodine intake was even higher during the years 1954,

1956, 1958 and 1960. The mean value for the 8 amounts of seaweed

displayed in Table II is 4.5 gm and at 0.3% iodide, this average daily

amount would contain 13.5 mg iodide.

During that phone interview (6/21/05), Miss Nichi and Mr. Arai stated

that the last survey for which statistics are available was for the

year 2001 (Heisei 14), with an average daily intake of 14.6 gm of

seaweeds (dry weight).

Obviously, the consumption of seaweed by mainland Japanese has

increased significantly over the past 40 years. The exact amount of

iodine consumed in 2001 would depend on the concentrations of iodine

in the seaweeds involved.

Since the surveys performed by this organization do not report the

amount of elemental iodine and only tabulate the sum of all seaweeds

consumed per capita per day for 2001, it is not possible at this time

to calculate exactly the true daily iodine intake by mainland Japanese

in 2001.

If the concentrations of iodine in seaweeds during the year 2001

remain the same as in the 1960s, the average daily amount of iodine

consumed by mainland Japanese in 2001 would be: 3 mg iodine/gm x 14.6

gm = 43.8 mg.

We must emphasize however, that the orthoiodosupplementation program

is not based on consumption of iodine by the Japanese population, but

on whole body iodine sufficiency assessed by the iodine/iodide loading

test, which brings us to our next topic.

_____

3.)

-- The validation of the iodine/iodide loading test --

Gaby questions the validity of the iodine/iodide loading test and

presents some valid arguments, " Before the iodine-load test can be

considered a reliable indicator of tissue iodine levels, it needs to

be demonstrated that only negligible amounts of iodine are excreted in

the feces after an oral iodine load. "

Inorganic iodine is an ideal element for an oral loading test.

Inorganic forms of iodine are quantitatively absorbed by the

gastrointestinal tract and highly bioavailable. Less than 5% of

ingested inorganic iodine/iodide are excreted in the feces and

sweat,31 with most of that amount in sweat.

The data in reference #9 of Gaby's paper dealing with low

bioavailability of ingested iodine in cows, which are ruminants,

should not be extrapolated to humans. Since data obtained with the

iodine/iodide loading test revealed that 90 to 100% of the ingested

iodine/iodide is recovered in the 24 hr. urine collection when

sufficiency is achieved,3,18 it is obvious that the ingested

iodine/iodide in the tablets used for the loading test is highly

bioavailable.

Serum iodide is rapidly cleared by the kidneys with a daily clearance

rate of 43.5 liters.8 The renal clearance of iodide remains constant

with intake from 0.001 mg to 2,000 mg iodide.32 The gastrointestinal

tract has the capacity to absorb quantitatively large amounts of

iodine/iodide.32

Studies performed with a sustained release form of iodine, amiodarone,

give further support for the validity of the iodine/iodide loading

test. Amiodarone is a benzofuranic derivative containing 75 mg of

iodine per 200 mg per tablet. It is widely used for the long-term

treatment of cardiac arrhythmias.33-35 Broekhuysen et al36 using

balance studies of amiodarone and the non-amiodarone inorganic iodine

released from amiodarone, reported the following:

In 2 subjects treated with 300 mg of amiodarone/day containing 112.5

mg iodine, the total amount of iodine measured in urine and feces was

very low during the first 3 days, with a mean of 19% and 7% of the

total iodine ingested, suggesting that as much as 93% of the iodine

ingested was retained in the body, or 105 mg iodine per day was

retained by the patient.

After 25 to 27 days of therapy with 300 mg amiodarone/day, the mean %

iodine excretion of combined urine plus feces in these 2 subjects

increased 48% and 75%. Therefore, after approximately one month, the

percent of iodine retained by the body had decreased to 25% and 50%.

No inorganic iodine/iodide was found in feces, only the organic form,

amiodarone, whereas only inorganic iodide was excreted in urine.

In 2 other subjects treated with 300 mg amiodarone/day for 7 weeks,

balance studies revealed that at the end of the study, the total

excreted iodine in urine and feces averaged 97.4% and 96.9%. Again,

only the organic form amiodarone was found in feces and only the

inorganic form in urine. Based on the balance studies, the amount of

iodine retained by the body following 7 weeks on amiodarone at 300

mg/day containing 112.5 mg iodine, was estimated at 1.5 gm.

The authors commented: " These results suggest that iodine is retained

in the body until a mechanism is triggered that adjusts the excretion

of iodine to balance completely the intake. " They estimated that the

body retained 1.5 gm of iodine before the ingested iodine in

amiodarone is completely excreted, and before therapeutic efficacy.

In 3 patients who eventually died following long-term treatment with

amiodarone, the levels of inorganic iodine (not amiodarone) present in

various organs and tissues were measured. The total body

non-amiodarone iodine content was estimated at approximately 2 gm with

the greatest amount found in fat tissues (700 mg) and striated muscle

(650 mg). Iodine was present in every tissue examined.

The highest concentrations of non-amiodarone iodine were found in

descending order: thyroid gland, liver, lung, fat tissues, adrenal

glands and the heart. We previously reported a double peak of serum

inorganic iodide levels, 8 hours apart, following ingestion of a solid

dosage form of Lugol.37 This pattern is indicative of an enterohepatic

circulation of inorganic iodine, which could explain the high iodine

content of the liver.

When a tablet form of Lugol is ingested at a daily amount of 50 mg

elemental iodine, whole body sufficiency is achieved in approximately

3 months and the estimated amount of iodine retained in the body is

approximately 1.5 gm.8 This is the same amount of iodine retained in

patients on amiodarone following 7 weeks at 300 mg/day containing

112.5 mg iodine.

Clinical response to amiodarone is observed after the same period of

time on amiodarone therapy. Some comparisons between amiodarone, an

organic form of iodine, and inorganic iodine/iodide are in order. In

the patients who ingested 300 mg amiodarone for 7 weeks, the total

amount of iodine ingested is: 112.5 mg & #9674; 49 days = 5.5 gm. The

patients retained 1.5 gm, that is 1.5 gm / 5.5 gm & #9674; 100 = 27% of the

total dose.

In patients of orthoiodosupplementation at 50 mg elemental iodine/day,

sufficiency is achieved usually in 3 months and 1.5 gm of iodine is

retained. The total amount of iodine ingested during 3 months at 50

mg/day = 50 mg / day & #9674; 90 days = 4.5 gm. The patients retained 1.5 gm,

that is 1.5 gm / 4.5 gm & #9674; 100 = 33% of the total dose.

Roughly 30% of the total dose of iodine is retained at iodine

sufficiency in both cases, but the time required to achieve

sufficiency decreases as the daily amount of iodine increases. Whether

this inverse relationship between the daily dose of iodine and time

required for whole body iodine sufficiency will persist with daily

intake of iodine greater than 100 mg would require further investigation.

Since iodine mobilizes toxic metals and goitrogenic halides from their

storage sties,3,18 it may not be wise to achieve whole body

sufficiency for iodine too rapidly since mobilization of these toxic

substances may increase their peripheral levels high enough to cause

symptoms.

A complete nutritional program combined with increased fluid intake

will help the body eliminate these toxic elements more safely.3 To be

discussed later, in cases of increased mobilization of bromide from

storage sites by orthoiodosupplementation and elevated serum bromide

levels high enough to cause bromism, the administration of sodium

chloride (6-10 gm/day) increases the renal clearance of bromide by 10

fold and minimizes the side effects of bromism.

If orthoiodosupplementation results in elevated urine lead levels,

together with increased bromide, ammonium chloride is preferable to

sodium chloride since it is the chloride that increases renal

clearance of bromide. The ammonium is metabolized to urea and has an

acidifying effect, which increases renal clearance of lead also.

The above comparison of the data obtained from amiodarone

administration and orthoiodosupplementation is suggestive of an

important role of inorganic iodine released from amiodarone in the

therapeutic effect of this drug, and that whole body sufficiency for

iodine is a requirement for optimal cardiac function.

Since the amount of iodine used in the amiodarone study is twice the

amount of iodine used in orthoiodosupplementation, the time required

for whole body iodine sufficiency was only 7 weeks for amiodarone and

12 weeks for orthoiodo- supplementation. In order to achieve whole

body sufficiency for iodine in 6 weeks using orthoiodosupplementation,

the daily intake required would be 100 mg.

One more argument in support of the validity of the iodine/iodide

loading test follows. Serum inorganic iodide levels measured under

steady state conditions are a good index of bioavailability of the

iodine preparation.8

We have previously calculated that the serum levels of inorganic

iodide at equilibrium would be the daily amount of iodine ingested

divided by 43.5 liters if the form of iodine ingested was completely

bioavailable.8 At 50 mg iodine/day, the expected serum inorganic

iodide level at equilibrium would be: 50 mg/43.5 L = 1.15 mg/L.

In 8 normal subjects who achieved whole body iodine sufficiency, the

fasting serum inorganic iodide levels 24 hrs after the last intake of

iodine, ranged from 0.85 to 1.34 mg/L.8

_____

4.)

-- The effectiveness and safety of orthoiodosupplementation in current

medical practice --

Physicians who use holistic therapies are always on the search for

safe and effective natural therapies that have minimal adverse

effects. The experience of several physicians with iodine/iodide in

daily amounts from 6.25 to 50 mg, using a solid dosage form of Lugol

(IodoralÆ) for over three years in several thousands of patients has

shown it to be safe and effective, with minimal adverse effect.18

Effectiveness

The Center for Holistic Medicine in West Bloomfield, MI (office of D.

Brownstein, M.D.) has tested over 500 patients for iodine deficiency

using the iodine/iodide loading test, developed by one of us.3 Based

on the experience of the Center, the loading test provides an accurate

and reproducible picture of the iodine status in the body.

Retesting many of these patients has shown the changes in the test

correlates with the changes in the clinical picture. In other words,

as the loading test improves, the clinical picture improves.

Our experience at the Center for Holistic Medicine has shown that

patients with the lowest urinary iodide levels on the loading tests

are often the most ill. Many of these patients with very low urine

iodide levels following the loading test have severe illnesses such as

breast cancer, thyroid cancer or autoimmune thyroid disorders.

All of these conditions have been shown in the literature to be

associated with iodine deficiency.3 Positive clinical results were

seen in most of these patients after supplementation of

orthoiodosupplementation within the range of 6.25-50mg of

iodine/iodide (1/2 to 4 tablets of Lugol in tablet form).

One of the most satisfying effects of orthoiodosupplementation has

been in the treatment of fibrocystic breasts and thyroid nodules. The

treatment of fibrocystic breasts with iodine has been reported for

over 100 years.

Iodine/iodide supplementation has resulted in significant improvement

in fibrocystic breast illness for nearly every patient treated.

Thyroid nodules also respond positively to iodine/iodide supplementation.

Serial ultrasounds usually show decrease in the size of the thyroid

cysts and nodules and eventual resolution of the lesions. When

orthoiodosupplementation is combined with a complete nutritional

program, it is rare not to see improvement in the palpation and

radiological examination of thyroid nodules and cysts following

iodine/iodide therapy as described here.

The effectiveness of orthoiodosupplementation has not been limited to

the very ill. In fact, most patients treated with

orthoiodosupplementation have quickly experienced positive results

although optimal responses are observed when whole body iodine

sufficiency is achieved based on the iodine/iodide loading test.

Our experience has shown that a wide range of disorders have responded

to orthoiodosupplementation including thyroid disorders, chronic

fatigue, headaches, fibromyalgia and those with infections.

Additionally, our clinical experience has shown that iodine/iodide

supplementation has resulted in lower blood pressure in hyper- tensive

patients. The blood pressure-lowering effect is seen when sufficiency

of iodine is achieved.

Occasionally, individuals on thyroid medication will develop signs and

symptoms of hyperthyroidism on orthoiodosupplementation. This

situation has been easily rectified by lowering or discontinuing the

thyroid medication.

Of those individuals taking thyroid medication, approximately 1/3 of

them will need to discontinue or lower their thyroid medication upon

taking iodine/iodide due to increased thyroid function and improved

receptor responsiveness.16 The remaining 2/3 of the thyroid treated

patients will maintain their thyroid dosages while taking

iodine/iodide without side effects.

Safety

Dr. Gaby's editorial claims that the relatively high doses of

iodine/iodide used in orthoiodosupplementation may lead to

hypothyroidism, goiter or autoimmune thyroid problems. This just is

not the case.

A review of the literature revealed that the organic forms of iodine

were involved in most of these complications.3 Iodine intake has

fallen over 50% in the U.S. over the last 30 years.38 During this same

time, increases in diabetes, hypertension, obesity, breast and thyroid

cancer, and other thyroid disorders, have been reported.

It appears to us that iodine deficiency, not iodine excess may be

responsible for the increase of these conditions.3,18

As of this writing (7/12/05), the clinical experience with

orthoiodosupplementation in approximately 4,000 patients at the Center

for Holistic Medicine has clearly shown that orthoiodosupplementation

at daily dose of 6.25 to 50mg elemental iodine has not been associated

with increases in hypothyroidism, goiter and autoimmune thyroid problems.

On the contrary, the use of iodine/iodide has been effective at

treating the above conditions with minimal adverse effects.

Dr. Gaby points out that " some people are especially sensitive to the

adverse effects of iodine. " He is correct. Just as some people are

sensitive to Vitamin C, some are sensitive to iodine/iodide.

Few holistic physicians would deny the effectiveness of mega doses of

Vitamin C, in amounts thousands of times greater than the RDA for

Vitamin C, in the treatment of wide range of illnesses. Just as with

Vitamin C therapies, individualized doses and proper follow-up visits

can help minimize adverse effects of iodine/iodide therapies.

Dr. Gaby writes, " The relative absence of side effects may be due to

the use of iodine as part of a comprehensive nutritional program. " He

is correct. With orthoiodosupplementation the best results do occur

when used as part of a comprehensive nutritional program, as do all

holistic therapies. We favor a magnesium emphasized total nutritional

approach.3

The most common adverse effects of iodine/iodide supplementation

observed at the Center for Holistic Medicine has been metallic taste

in the mouth and acne. Based on the experience of three clinicians at

that Center, with a combined patient population of some 4,000, the

prevalence of these side effects is about 1%.

This is probably due to a detoxification reaction. The release of

bromide may be one cause of this detoxification reaction. Clinical

experience has continually shown that iodine/iodide supplementation

results in a large urinary excretion of bromide.3,18

When bromide levels begin to decline, the above mentioned adverse

effects begin to decline as well. Chloride increases renal clearance

of bromide15 and the use of NaCl or ammonium chloride shortens the

time required for bromide detoxification with orthoiodosupplementation.

Oral administration of sodium chloride (6 to 10 gm/day) increased the

renal clearance of bromide by 10 fold with mean serum half-life of 290

hrs in control subjects and 30-65 hrs after chloride administration.

Intravenous sodium chloride gives the same results as the oral route.15

In the practice of medicine, we have seen very few natural therapies

as safe and effective as orthoiodosupplementation. In the proper forms

of iodine (inorganic non-radioactive forms), in daily amounts of

iodine for whole body sufficiency and properly monitored,

orthoiodosupplementation is not only safe, it is an effective tool for

the clinician.

Prior to the availability of assays for thyroid hormones and without

any test for assessing whole body sufficiency for iodine, our medical

predecessors recommended a range of daily iodine intake from Lugol

solution (12.5-37.5 mg) exactly within the range required for

achieving whole body sufficiency for iodine.3,16

Relying on clinical observation of the patient's overall wellbeing,

our predecessors have given us useful information, which we have

discarded in favor of preconceived opinions of self-appointed

pseudoexperts.

This has resulted in pandemic iodine deprivation. Iodine deficiency is

misdiagnosed and treated with toxic drugs.

Orthoiodosupplementation may be the simplest, safest, most effective

and least expensive way to help solve the health care crisis crippling

our nation.8

Correspondence:

Guy E. Abraham, M.D.

Optimox Corporation, Torrance, California

1-800-223-1610 / Fax: 1-310-618-8748

optimox@...

http://www.optimox.com/

Brownstein, M.D.

Center for Holistic Medicine, West Bloomfield Michigan

1.248-851-1600 / Fax: 1-248-851-0421

info@...

http://www.drbrownstein.com

_____

Financial Disclosure

Guy E. Abraham, M.D.

is the owner of the company that developed and distributes IodoralÆ, a

tablet form of Lugol solution, to healthcare professionals.

Although he developed the iodine/iodide loading test at his own

expense, including the procedure to measure urine iodide levels and

the positive displacement manifold, which allows semi automation of

this procedure, he has no financial interest in the Lab that performs

the loading tests.

Neither did he receive remuneration for passing this technology to

others. He serves as a consultant to this Lab without pay.

Brownstein, M.D.

has no financial interest in IodoralÆ or the Lab that performs the

loading test.

_____

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Best wishes,

Pat

(Feb. 1, 2006)

HormonesandHealth-Naturally/

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