Iodine, an often maligned and misunderstood mineral, is enjoying something of a resurgence in recent years for treatment of hypothyroidism, chronic fatigue, and a host of metabolic conditions including insulin resistance and diabetes.
The renewed interest is driven in part by introduction of Iodoral, a standardized tablet form of Lugol’s solution, the iodine/iodide formula widely used by physicians prior to World War II. It has also been prompted by Guy Abraham, MD, former professor of Obstetrics, Gynecology and Endocrinology at UCLA, and a growing cohort of clinicians who are putting Dr. Abraham’s iodine testing method and his “orthoiodosupplementation” approach into practice.
Lugol’s formula, 5% iodine and 10% iodide derived from underground brine deposits, is “one of the most effective therapies I’ve found in all my years of practice,” said David Brownstein, MD, a holistic physician in West Bloomfield, MI. “I’ve been able to get about one-third of my thyroid patients off thyroid hormone completely, and another third are able to reduce their doses,” he told Holistic Primary Care.
He has used Lugol’s to treat chronic fatigue, arthritis, rheumatic and other autoimmune diseases, cancer, and a host of endocrine/metabolic disorders, including type 2 diabetes. In some diabetic cases, he has been able to obviate the need for insulin or other medications. “In 11 years as a holistic physician, this rivals the positive effect of anything I’ve ever seen,” said Dr. Brownstein, who began exploring iodine therapy 3 years ago. “I assess everyone in my practice for baseline iodine levels, and the vast majority are low.”
A Long History
Iodine therapy goes back to the early 1800s, when French physicians discovered the element in seaweed. Jean Lugol developed the solution that bears his name in 1829, and used it extensively to treat infections. By the 1930s, Lugol’s solution was a mainstay medical therapy across Europe and the US, used to treat both hypo- and hyperthyroidism, and a host of infectious conditions. Albert Szent Gyorgyi, MD, the Hungarian physician who discovered vitamin C, reflected a common clinical view when he called iodine, “the universal medicine.”
By mid-century, though, iodine therapy had fallen out of favor for anything but extreme deficiency reflected by frank goiter. According to Dr. Abraham, the shift reflected a convergence of forces: Development of thyroid hormone therapies which became a near obsession among endocrinologists; Publication in 1948 of the “Wolff-Chaikoff Effect,” an animal study never replicated in humans showing consumption of more than 0.2 mg/L inorganic iodide actually led to goiter; and the assumption that iodization of salt was sufficient to eliminate iodine deficiency.
He believes the resultant “iodophobia,” which became conventional medical wisdom passed down for several generations now, is wholly erroneous and has profoundly negative public health consequences. He also believes the issue is one of economics, not science. “If iodine can reduce hypertension, diabetes, thyroid disease, chronic fatigue, breast cysts and lots of other things, do you realize the billions of dollars in drug sales that would be lost?” he said in an interview with Holistic Primary Care.
He became interested in iodine in the mid 1990s, while researching new approaches to fibrocystic breast disease. “There was only one really unique paper, by a Canadian gynecologist named Ghent, looking at iodine at high doses. I was taught anything over 1 mg was toxic, and the levels he described should have killed people. Yet he was reporting efficacy in nearly 1,000 patients. I didn’t think he was making this all up, so I decided to look into it” (Ghent WR, et al. Can J Surg. 1993; 36(5): 405).
“By 1997, I was starting to look at this very seriously, and two years later, I became convinced that we were being grossly deceived about iodine in mainstream medicine.”His investigations became a full-time project, undertaken with near missionary zeal and significant personal investment. Dr. Abraham has been working on a clinical testing method for evaluating patients’ iodine status. The test is based on urinary excretion of iodide following an iodine/iodide load.
The Hierarchy of Iodine Absorption
To understand Dr. Abraham’s testing method, one must understand that while iodine is essential for thyroid health (the gland cannot produce T4 without adequate iodine levels(it is not the only tissue that requires this element. In fact, all the tissues of the body require iodine. The liver, skin, muscle tissue, ovaries, and breasts all require sufficient levels of iodine and iodide to function optimally. Dr. Abraham believes conventional medicine has become myopic in its focus on the thyroid when it comes to the issue of iodine.
“All cell surface receptors for hormones contain tyrosine, and when the tyrosine is iodinated, the receptors function much better. They are better able to bind hormones, so you have better overall metabolism and endocrine function when there is whole body iodine sufficiency,” Dr. Abraham explained.
However, obtaining whole body sufficiency is a progressive and stepped process, because physiologically, different tissues preferentially absorb available iodine and iodide at different rates. “The amount of iodine going to the thyroid is only about 3% of total body iodine, but when you become deficient, the thyroid preferentially grabs all of it. As you become more sufficient, the levels in other tissues go up as well.”
By measuring urinary excretion following a standardized loading dose of iodine, you obtain a picture of the degree to which the tissues are trying to retain the iodine. Deficient individuals tend to retain more iodine and iodide until tissues are saturated, at which point they begin to excrete more in the urine. According to Dr. Abraham, anything under 90% urinary iodide excretion is an indicator of deficiency.
It is also important to bear in mind that some organs have a preference for iodine, while others have a preference for iodide. This is why it is necessary to supplement with a compound that contains both.
“When I first started exploring iodine, I was treating a lot of thyroid problems and using potassium iodide solution. I saw very few positive effects,” said Dr. Brownstein. “I kept trying it, but never saw good results. It was only when I began using Lugol’s solution, which combines iodine and iodide, that I started seeing a difference.”
Because it influences the function of hormone receptors on the surfaces of many different kinds of cells in a wide variety of tissues, iodine can improve many different metabolic processes. Hence, the positive effects iodine advocates are reporting for conditions as diverse as hypertension, diabetes, chronic fatigue, premenstrual syndrome and other common disorders.
The Iodized Salt Fallacy
Iodization of common salt, at an average iodide concentration of 75 parts per million, began in the 1930s, to reduce incidence of goiter. It is based on an estimated daily salt intake of 10 g. At that level, the average American gets 0.75 mg of iodine, adequate to prevent goiter. But iodized salt delivers iodide along with chloride ions, which outnumber iodide by a factor of 30,000. In the intestines, chloride vastly out-competes iodide for absorption. Dr. Abraham estimates only 10% of all iodide in iodized salt is actually bioavailable.
It may be that, overall, iodide in salt is sufficient to prevent goiter, but this is not the same as ensuring full body sufficiency. But keep in mind that many people have undertaken salt-restricted diets in an effort to reduce their blood pressure and prevent cardiovascular disease. These people may not even be getting the small amounts of iodide they once obtained from table salt.
Dr. Abraham and other iodine advocates believe people with chronic diseases require between 12.5 mg to 50 mg elemental iodine daily over a period of weeks to months. This is far greater than the current dietary reference intake (DRI, aka RDA) level of 150 mcg.
In Dr. Brownstein’s experience, there are no hard and fast dosing rules when working with Lugol’s. “You really have to individualize the treatment. People with cancer, chronic fatigue and diabetes generally need higher doses. And you need to monitor patients carefully.” Ideally, iodine therapy should be accompanied by supplemental magnesium and vitamin C to improve cellular iodine transport. Dr. Abraham stressed the importance of magnesium. “People who are magnesium-deficient tend not to respond well to iodine, so you really need to make sure the magnesium level is sufficient as well.”
Battling with Bromine
Bromine, a ubiquitous element in food additives and industrial chemicals, is iodine’s prime competitor for intracellular absorption. It literally crowds out iodide, further contributing to iodine insufficiency. Unfortunately, bromide-containing compounds are everywhere. They’re used as conditioning and anti-caking agents in breads and baked goods, and they’re common in soft drinks. Dr. Brownstein stressed that when working with patients to increase their iodine/iodide levels, it is essential to reduce their intake of bromine-containing chemicals. This means minimizing commercially-prepared baked products, sodas, and other processed foods.
One of the most noticeable effects of intensive iodine therapy is a massive increase in urinary bromide excretion. Many patients also release large quantities of toxic heavy metals. Not surprisingly, they can feel pretty lousy during this detoxification process. Advanced warning, a slow upward iodine/iodide titration, and plenty of water can minimize the negative impact of this process.
Dr. Abraham explained that because iodine improves the function of both the liver and the kidneys, you tend to see this increased detoxification. Over time, most patients will show increased bile flow and better kidney function. “They digest their food better, they have more regular bowel movements.” In other words, iodine can jump-start sluggish digestive and excretory functions. But the initial stage of this process can be a bit disconcerting for patients, especially if these processes have been sluggish for a long time.
Working with Iodine
Dr. Brownstein routinely uses the test developed by Dr. Abraham in assessing new patients. The vast majority, he says, have very low iodine/iodide levels. “I basically assume a patient walking in the door will be iodine deficient,” he said. Women tend to be more deficient than men, a phenomenon he attributes to the greater iodine demand from breast and ovarian tissue. “I think this is one of the reasons why we see so many more hormonal imbalances, autoimmune problems, and depression in women.”
For patients with signs of hypothyroidism, iodine therapy is a no-brainer. “I’ll give a treatment trial of iodine (Lugol’s) before I even consider trying thyroid hormone.”
In his experience, iodine supplementation is very fast-acting. “In general, you’ll start to see effects and improvements within two weeks, though some patients, like those who have cancer, take longer.” In general, the rapidity of iodine’s effects is inversely related to the baseline level of toxins a patient carries. The greater the burden of bromine, other halides, and toxic metals, the longer the detox phase will take, and the longer it will take to achieve full body saturation.
Dr. Brownstein said that the development of Iodoral makes it a lot easier for patients to take iodine. They no longer have to work with messy, staining liquid iodine, and because Iodoral provides standardized iodine/iodide doses, it is a lot easier to titrate and regulate daily intake.
Though advocates of orthoiodosupplementation make a strong case for re-evaluating iodine, not everyone is convinced that physicians should be putting vast numbers of patients on high-dose iodine. In a heated written debate with Dr. Abraham in the Townsend Letter, functional medicine pioneer Alan Gaby, MD, noted that while high-dose iodine therapy can be of great value in some circumstances, it is premature to make blanket recommendations.
“Before one could confidently conclude that high-dose iodine is safe for 99% of the population (as stated by Abraham and Brownstein) … a systematic toxicity study would be necessary,” Dr. Gaby writes. So far, such studies have not been done. While he stressed that he is not a strict opponent of iodine supplementation, Dr. Gaby believes a lot more work needs to be done to validate Dr. Abraham’s testing methodology, and to establish optimum target levels.
What is clear, however, is that iodine warrants a fresh look from medical practitioners. It is relatively inexpensive, safe when used carefully, and holds the potential to positively influence a number of different organ systems. With his ongoing work, Dr. Abraham has opened up an important line of investigation, one that would benefit from large-scale, well-funded clinical studies.
Iodoral, the tablet form of Lugol’s Solution is available from Complementary Prescriptions, the medical division of Vitamin Research Products (1-888-303-6151). Most of Dr. Abraham’s papers on iodine were published in a small independent journal called The Original Internist (Tel. 573-341-8448). An archive of these papers can be found at Dr. Abraham’s website (www.optimox.com), under the “Iodine Research” heading.” 
