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AN UNDERUTILIZED COMPONENT FOR HEALTH The missing element: IODINE By Sherri Tenpenny, DO OsteoMed II 7271 Engle Road, #115 Middleburg Heights, OH 44130 440-239-3438 www.osteomed2.com www.DrTenpenny.com 1 Review of Iodine Chemistry Hg 2 Iodine Deficiency Disorders Iodine Deficiency Disorders (IDD) refers to all ill-effects due to iodine deficiency In 1990, WHO estimated that 28.9% of global population was iodine deficient 11.2 million had overt cretinism and 43 million at mental impairment Fetus Abortions Still births Congenital anomalies Perinatal mortaility Endemic Cretinism Neonate Neonatal Goiter Neonatal hypothyroidism Mental retardation Susceptibility to radiation Child and Adolescent Goiter Subclinical hypothyroid Impaired mental function Slowed physical development Susceptibility to radiation Adult Impaired mental function Goiter Hypothyroidism Hyperthyroidism Therefore, IDD is the leading cause of preventable mental retardation in the world Mastorakos: The Iodine Deficiency Disorders Text 3 The Effect of Supraphysiologic Levels of Iodine on Patients with Cyclic Mastalgia. The Breast Journal, Volume 10, Number 4, 2004 328–33. 2004. Jack H. Kessler, PhD. Symbollon 4 Incidence of breast cancer increases with age A Woman’s Chances of Breast Cancer Increases With Age By age 30 1 out of 2,212 By age 40 1 out of 235 By age 50 1 out of 54 By age 60 1 out of 23 By age 70 1 out of 14 By age 80 1 out of 10 Ever 1 out of 8 Source: National Cancer Institute. 5-3-2002 5 Despite nearly 100 years of iodized salt, iodine deficiency still exists in the US 6 The First National Health and Nutrition Examination Survey (NHANES I) took place between 1971 and 1974 found 2.6% of US citizens were iodine deficiency NHANES III, conducted between 1988 and 1994, found 11.7% of all US citizens are iodine deficient Journal of Clinical Endocrinology and Metabolism 1998;88:3401-3408 7 Why is iodine deficiency increasing? 8 Decrease in salt consumption—due to concerns over sodium (hypertension, etc) Decrease in egg consumption—due to concerns over cholesterol Decrease in fish consumption—due to concerns over mercury Minimal access to “sea vegetables”—seaweed, kelp Soil depletion: minerals are decreased by accelerated deforestation and soil erosion Food grown in iodine-deficient regions do not provide enough iodine for the people and livestock living there. There are acute iodine deficiencies in the soils around the globe, particularly in the Great Lakes basin. 9 What about all the salt in processed food? Availability of iodine in salt varies widely due to the inconsistencies in the salt manufacturing process…. 10 Variability in the amount of iodine added during the iodization process Loss of iodine due to salt impurities and lack of chemical binding Uneven distribution of iodine within salt batches and within individual packages Loss of iodine during cooking ranges from 50-70% Loss due to open containers sitting on the kitchen counter ranges from 10-100% Iodine Deficiency Diseases WHO manual http://www.sph.emory.edu/PAMM/IDD/whomanual /factors.pdf 11 How much iodine do we really need? 12 Iodine “sufficiency” A short history Iodine deficiency as a risk factor for goiter has been known at least since 1820 1916: Dr David Marine conducted a trial in Akron, Ohio. Two groups of school girls were treated with table salt with KI added. In the treated group, 2 people developed goiters In the control group, 250 people developed goiters 1924: Iodized salt began to be used in the US— first in Michigan 13 Iodine “sufficiency” A short history Several years later, an epidemiological study concluded that if less than 5 percent of a population where iodinized salt was used developed a goiter, the amount of iodine was “sufficient” for the body. Since that time, only the impact of iodine (about 150ug/d) on the thyroid has been discussed IMPORTANT: Overt iodine deficiency is all that is considered; the impact of mild to moderate iodine deficiency is not even a consideration TO DATE, NO RDA HAS EVER BEEN DETERMINED FOR THE BODY 14 How Iodine gets into tissues The Sodium-Iodine symporter (NIS) is a membrane bound glycoprotein that transports iodine into the follicular cells of the thyroid NIS has been found on many different tissues, disproving the previously held view that it is a thyroid-specific protein The Sodium/Iodide Symporter (NIS): Characterization, Regulation, and Medical Significance Endocrine Reviews 24 (1): 48-77 15 Iodine and the rest of the body The NIS mediates active iodine transport into tissues: Pancreas, liver, gastric, small, and large intestine mucosa Nasopharynx, lacrimal glands, choroid plexus and the ciliary body of the eye (DRY EYES) Skin mammary glands salivary glands NIS activity increases in the presence of TSH, leading to increased iodine uptake Sodium/iodide Symporter (NIS): characterization, regulation, and medical significance. Endocr Rev. Feb;24(1):48-77. 2003 16 Physiological formation of thyroxine inside the thyroid gland Occurs inside of THYROID gland, in THYROGLOBULIN CELLS polypeptide matrix in follicular lumen of thyroid cells Triiodothyronine T3 Iodine deficiency shunts pathw ay GREATLY tow ards T3, and decreases TSH 1 Na+ TPO Iodinatoin Na-I Symporte r DIT ca n b e "recycl ed " to form u p to 8 T 4 a nd T 4 [1 Iodide + Tyrosine] [3,MIT* + iodide] TPO^ Iodinatoin TPO Iodinatoin [3,5 DIT ** + 3.5 DIT] TPO COUPLING - Alanine TSH TetraIodo thyronine T4 *MIT = mono-iodothyronine **DIT = di-iodothyronine ^ Thryroperoxidase 17 What is the relationship between low iodine and breast pathology? 18 Low iodine: Cause of breast pathology 1967: An iodine deficiency in rat causes tissue hyperplasia and atypia in mammary tissue. Eskin B, Mammary gland dysplasia in iodine deficiency. JAMA 1967; 200:115–19. Strum J. Site of iodination in rat mammary gland. Anat Rec 1978;192:235–44. 19 Low iodine: Cause of breast pathology 1976: Epidemiologic data suggest a relationship between regions of known endemic goiter —known to be related to low iodine—and increased breast disease. Stadel B. Dietary iodine and risk of breast, endometrial, and ovarian cancer. Lancet 1976; 1(7965):890–91. Cann SA.. Hypothesis: iodine, selenium and the development of breast cancer. Cancer Causes Control 2000; 11:121–27. 20 Low iodine: Cause of breast pathology 1979: Iodine deficiency in estradiol-treated rats leads to pathological changes in breast tissue including cyctic changes, periductal fibrosis and lobular hyperplasia. Strum, JM. Virshows Arch B Cell Pathol Incl Mol Pathol. 1979; 30:209 1975 to1989: Ghent and Eskin treated more than 1300 patients with a variety of breast pathology and observed that iodine lead to an improvement rate of 40–70% in subjective (pain) and objective (fibrosis) symptoms. Ghent W, Eskin B. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993; 36:453–60. 21 Low iodine: Cause of breast pathology 1995: The histological changes can be reversed by reintroduction of iodine. Eskin, B. Biol Trace Element Res. 1995;39:9-18 1996: Rat studies have demonstrated that iodine suppresses the formation of breast tumors. Funahashi, H. J. Surg. Oncology 1996;61:209-13 1997: Iodine absorption and organification occurs in the same ductal epithelium where the majority of breast cancers occur. Russo, J. Differentiation and breast cancer. Medicina. 1997;57:Suppl 2:81-91 22 How much iodine is needed to have healthy breasts? 23 Iodine and healthy breast Breast tissue is a “sponge” for iodine Studies have shown that the minimum amount of iodine to protect the breast from fibrocystic disease and cancer is 20-40 times more than is needed to prevent goiter In other words, breasts need 3-4 mg/day of iodine to be healthy Ghent, W. Iodine replacement in fibrocystic disease of the breast. Can. J. Surg. 36:453-460, 1993. NOTE: THE RDA FOR THE THYROID IS 150ug/day! 24 Iodine and diseased breast tissue Incidence of fibrocystic breast changes among women is reported to be >60% Approx. 5% of fibrocystic conditions have changes that would be considered risk factors for developing breast cancer These changes respond and reverse in the presence of 3-6mg/day of iodine for 3-4 months. Jack H. Kessler, PhD. The Effect of Supraphysiologic Levels of Iodine on Patients with Cyclic Mastalgia. The Breast Journal, Volume 10, Number 4, 2004 328–33. 2004 25 Importance of Selenium Selenium deficiency may have a profound effect on thyroid hormone metabolism and possibly on the thyroid gland itself Type I deiodinase, a selenium-dependent enzyme, plays a major role in converting T4 to T3 in peripheral tissues If both iodine and selenium are deficient, adding only selenium decreases serum T4 The enzyme increases transport of T4 into the cells Lack of iodine reduce the product on T4 PEARL: if treat a patient with selenium and their symptoms and lab tests get worse, it is because they are iodine deficient. 26 Iodine and Selenium Deficiency Elevated TSH, in the absence of iodine supplementation, indicates an insufficient saturation of the T3 in the receptors in the brain T3 in the brain is produced locally, not derived from circulating T3 Therefore, a normal T3 and elevated TSH indicates iodine deficiency in brain tissue In moderate and severe iodine deficiency: T4 is low but T3 can be variable; It can also be high This is due to preferential production of T3, considered a “protective” for the rest of the body Endocrinology 103 :1196-1207. 1978. 27 Iodine and Selenium Deficiency Prolonged selenium deficiency coupled with iodine deficiency may lead to tissue hypothyroidism and impaired brain function. Eur J Endocrinol. 1997 Mar;136(3):316-23. Selenium deficiency lowers concentrations of the enzyme, glutathione peroxidase. Glutathione peroxidase is important for T4 synthesis and for detoxification of H2O2 from the thyroid gland. When a person is also iodine deficient, accumulation of H2O2 may lead to thyroid cell death. PEARL: This is why mild selenium deficiency can contribute to the development and maintenance of autoimmune thyroid diseases (Hashimoto disease) Selenium and thyroiditis. J Endocrinol. Jul;190(1):151-6. 2006 28 Iodine and Salivary Glands The Na/I symporter found on the thyroid as been found to salivary glands Iodine concentrations in salivary glands can reach 30 to 40 times that seen in plasma Fluoride and bromide inhibit iodide transport into saliva Thiocyanate inhibit iodide transport and utilization Thiocyanate: mostly from cigarette smoke Also found in cabbage, broccoli, almond, horseradish, corn Food sources found to be insignificant contributors Specificity of salivary thiocyanate as marker of cigarette smoking is not affected by alimentary sources. PMID: 8990245 Selenium decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002 Apr;87(4):1687-91. 29 Concerns about excess iodine… ….are they real? 30 Concerns about supra-physiological doses of iodine 1948: Wolff and Chaikoff reported that organic binding of iodine in the rat thyroid in vivo was blocked when iodide plasma levels reached some “critical high threshold”, a phenomenon known as the acute Wolff-Chaikoff effect. Wolff J, Chaikoff IL. Plasma inorganic iodide as a homeostatic regulator of thyroid function. J Biol Chem 174:555–564. 1948. 31 Not commonly known about the Wolff-Chaikoff effect 1949: The maximum duration of the inhibitory effect that iodine had on the thyroid was 50 hours Within 2 days, an escape or adaptation occurs, so that normal hormone biosynthesis resumes Wolff J, Chaikoff IL, Goldberg RC, Meier JC. The temporary nature of the inhibitory action of excess iodide on organic iodide synthesis in the normal thyroid. Endocrinology 45:504. 1949. 32 Not commonly recognized about the Wolff-Chaikoff effect 1963: The Wolff-Chaikoff effect is an auto-regulatory system to protect the thyroid from iodide overload The amount of thyroid inhibition is determined by the level of depletion in the person. The more depleted, the more the thyroid shuts down during initial loading Since the amount of depletion is often unknown, when replacement is started, the effects are highly individualized. Braverman LE, Ingbar SH. Changes in thyroidal function during adaptation to large doses of iodide. J Clin Invest 42:1216–1231, 1963. 33 How much iodine is safe? 34 Testing for Iodine Deficiency No consensus exists about the best way to measure for iodine deficiency. Blood: not possible Skin spot iodine: qualitative, at best Spot urine iodine: an estimate 24 hr urine: inconvenient but really a measurement of dietary intake 24 hr urine with challenge: several problems Loading molecule issue Fat absorption in breasts/body 35 How much iodine is safe? There is considerable controversy about the maximum safe iodine dose and duration of use when ingested in excess of the RDA. Problem: Thyroid chemistry is complex and a clear, linear dose-response relationship between iodine intake and thyroid function does not exist. Backer, Howard. Use of Iodine for Water Disinfection: Iodine Toxicity and Maximum Recommended Dose. Environmental Health Perspectives, Vol.108, No.8 August 2000. 36 Braverman et al. showed that almost ALL people remain euthyroid in the face of large amounts of iodine. Braverman LE, Ingbar SH. Changes in thyroidal function during adaptation to large doses of iodide. J Clin Invest 42:1216–1231. 1963 37 Potential Side Effects from taking iodine 38 Side effects from taking Iodine Iodism: A mildly toxic syndrome resulting from use of iodine Characterized by skin rashes, acne, stomatitis, unpleasant metallic taste, gastritis, nausea, frontal headache, hyper-salivation, fatigue, coryza, sneezing, conjunctivitis, laryngitis, bronchitis Delange, FM. Iodine Deficiency. The Thyroid. Lippencott Williams, Wilkens, 2000. p. 295-329 39 What about iodine allergy? Ioderma: a rash and called an iodide "sensitivity" reactions are possibly cell-mediated immune reactions usually dose-dependent; but can occur low doses There are no reported anaphylactic reactions known to iodides alone There are no in vitro tests that can reliably document intolerances to iodides From “Ask the Expert” column of the AAAAI website. Authored by Dr. Burton Zweiman of the University of Pennsylvania http://www.aaaai.org/aadmc/ate/drugallergy.html 40 Working Theory by “me”: Iodism may REALLY be cellular displacement of bromine, fluorine and chlorine by replenishing iodine 41 Bromine toxicity: Skin rashes, severe acne, appetite loss, fatigue, metallic taste Bromine inhibits both, T4 and T3 production and can lead to hypothyroidism Sources: PBDE is a bromine-based fire retardants used in carpets, mattresses, upholstery, furniture and various electronic equipment. Hot tubs use bromine instead of chlorine. Medications: Atrovent Inhaler, Atrovent Nasal Spray, Pro-Banthine (for ulcers), anesthesia Foods: All bakery products have bromine. Brominated vegetable oil is vegetable oil that has had atoms of the element bromine bonded to it. Brominated vegetable oil is used as an emulsifier in citrus-flavored soft drinks such as Mountain Dew, Gatorade, Sun Drop, Squirt and Fresca to help fat-soluble citrus flavors stay suspended in the drink and to produce a cloudy appearance. 42 Fluoride toxicity: Skin rashes, acne, gastritis, migraine-like headaches; stomatitis Medications: 5-Fluorouracil, Anesthesia, Flonase, Flovent, Paxil, Prozac and other SSRI anti-depressants Removed from market: Baycol, Fen-Phen, Omniflox, Posicor, Propulsid Others: Fluoride dental tablets, public Drinking water, tooth paste Chloride toxicity: headache, sinus inflammation, taste disturbances Sources: public drinking water, Splenda (Sucralose), hot tubs, propellants in spray cans, swimming pools 43 Recommended Iodine Dosages Doses of 250mcg-50mg can produce symptoms of hypothyroidism even if the gland is normal The optimal daily intake for iodine is 3mg to 6 mg New research from Kessler shows minimal thyroid suppression in large population at 3mg/day Adding iodine can increase the TSH level Not a concern unless hypothyroid symptoms, then manage appropriately! 44 Iodine support recommendations Be sure that the patient is loaded with selenium for at least 6-8 weeks before starting iodine. Include L-tyrosine and magnesium. Start slowly; remember the worse side effects occur in those who are the most deficient If the patient demonstrates any signs of hypothyroidism, including elevated TSH and suppressed T4: Stop the iodine for 1 week and restart at a lower dose Symptoms of resolve within 48-72 hours of stopping iodine Give chlorophyll tablets 3 TID from the health food store Can add Armorthyroid 0.5-1 gr daily or Synthroid 0.01ug Support detoxification of bromine, fluorine and chlorine, known carcinogens. 45 A short word about activism… 46 What can you do?… 47 Get involved… There are issues now that really are about life & death Mandatory “poisons” being promoted as “protection” are upon us 48 Stay informed… Please go to http://sayingnotovaccines.blogspot.com/ for daily vaccine updates and http://drsherri.wordpress.com for daily updates on breast health and thermography. Get involved: We are getting short on time… 49 You still have the right to JUST SAY NO… but maybe not for long "When we give government the power to make medical decisions for us, we, in essence, accept that the state owns our bodies." ~U.S.Representative Ron Paul, MD 50 Spread the word… 51 Thank you … Safe Travels… 52 OsteoMed II 7271 Engle Road, #115 Middleburg Hgts, Ohio W-440-239-3438 F-440-239-3440 www.OsteoMed2.com New Medical Awareness Seminars 440-239-1878 www.nmaseminars.com BOOKS-DVDS-MORE! Sherri J. Tenpenny, D.O. Vaccine Blog: www.SayingNoToVaccines.blogspot.com Breast Health Blog: www.DrSherri.wordpress.com My Space: www.MySpace.com/drtenpenny © 2007 All Rights Reserved 53