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		Getting It Right ! Written for the July 2001 issue of A Grain of Salt, the quarterly newsletter of The Grain and Salt Society A woman in her mid-forties called me in a panic.  She was suddenly having hot flashes.  She had never had hot flashes before nor had she had any other menopausal symptoms.  In fact, she is still menstruating regularly.  However, she was  experiencing other symptoms  --heart racing, weight loss, agitation, sleeplessness, increased body temperature--  all pointing to hyperthyroidism, i.e., too much thyroid hormone.  Since her thyroid tests and physical examination were both normal, her doctor wanted her to take estrogen for the hot flashes.

I recommended she do a simple test for iodine deficiency.  This consists of "painting" a patch of Tincture of Iodine on the skin over the biceps.  In her case the color of the Tincture of Iodine completely disappeared in less than two hours.  This indicates a severe iodine deficiency.  If there is no iodine deficiency the full color of the tincture will last at least 6 hours.  I then recommended she take a tablet of protein-bound iodine per day.  Within six days her hot flashes markedly decreased.

This case highlights several paradoxes of iodine deficiency.
(1) A goiter often signals iodine deficiency.  A goiter is an enlargement  of the thyroid resulting from the thyroid gland's attempt to concentrate iodine in itself.  This woman had no thyroid enlargement.
(2) Iodine deficiency is most commonly known to cause hypothyroidism, i.e., too little thyroid hormone.  Hypothyroidism results in fatigue, weight gain, excessive sleeping, constipation, dry skin, mental sluggishness and decrease in body temperature.  However, a more severe deficiency as seen here can indeed cause hyperthyroidism.
(3) Iodine deficiency can appear as something else.  In the case presented here, the iodine deficiency appeared as the "onset of menopause."  Another unfortunate mask of iodine deficiency  is intellectual deficit.  Iodine deficiency impairs neurological development during pregnancy and in early infancy.

There is yet a fourth paradox of iodine.  Excesses of iodine intake can cause both hypo- and hyperthyroidism.

How much iodine do we need?  And, how much iodine do we get?  An adult needs 150 micrograms (.15 milligrams) of iodine each day.  A pregnant or lactating woman needs 200 micrograms.  Many people consider iodized salt as the main source of dietary iodine for the US population.  Iodization of salt began in 1922 in response to endemic goiter in the upper Midwest.  The campaign to promote "voluntary" use of iodized salt did solve the endemic.  However, iodine is not only added to salt.  Other sources of iodine in the American food supply include use of iodine products in processing of dairy products and breads as well as supplementation of beef and chicken, resulting in variable amounts of iodine in meat, eggs and milk.

Here is the punchline.  Although the prevalence of goiter declined to near zero, "Within 50 years the country had excessive iodine intake to the extent that other forms of thyroid problems, namely iodine-induced hypothyroidism, autoimmune thyroiditis, and hyperthyroidism, had become more common than deficiency disorders."  This conclusion is published in the 1998 Journal of Clinical Endocrinology and Metabolism in an article entitled "Iodine Nutrition in the United States."

As the story continues to unfold, the above article, and an article, "Too Much Versus Too Little: The Implications of Current Iodine Intake in the United States," published in Nutrition Review in 1999, both document a significant decline in iodine intake in the last twenty years, a decline in intake in all ages and both sexes.  The highest incidence of deficiency of iodine is in women 40-49 years of age and secondly in women 30-60 years of age.  Further, 6.7% of pregnant women and 14.9% of women of child-bearing age have documented  iodine deficiency, posing enormous risk of impaired neurologic development to unborn children.

This decrease in iodine intake is attributed to lack of public awareness of the necessity of iodized salt, decreased salt consumption due to concern for hypertension, deceased egg yolk consumption secondary to cholesterol restriction and decreased use of iodine in dairy processing and commercial bread production.

All of the above calculations and documentations of dietary deficiency and excess of iodine are based on processed foods.  Can an individual get enough iodine from whole, unprocessed foods.  YES!!!  Here are the calculations.  The RDA for sodium is 2400 milligrams, or 2.4 grams.  (Most Americans ingest between 4 and 6 grams.)  Celtic unprocessed salt is .000045% iodine.  If you use 2.4 grams of Celtic salt daily you will get 108 micrograms of iodine daily.  That is more than one-half the daily requirement for a pregnant or lactating woman (200), and more than two-thirds the daily requirement for other adults (150).  The remainder of your daily requirement can easily come from kelp (more iodine than iodized salt) and seafoods.

Medically, thyroid function is determined by measurements of the T3 and T4 hormones and the TSH (thyroid stimulating hormone) produced by the pituitary.  These are necessary and appropriate tests whenever there is suspicion of hypo- or hyperthyroidism.  There are many cases and causes of both high and low thyroid that do not have iodine deficiency.  The tests however miss many diagnoses of both low and high thyroid.  They do not measure iodine.  The most accurate measurement for iodine status is iodine in the urine.  This test is not readily available.  A readily available and easy to repeat test is the Tincture of Iodine skin absorption test.  Tincture of Iodine is at most a few dollars from the drugstore.

If you are a woman between 30 and 60, and especially if you are planning a pregnancy, are pregnant or are nursing, do a Tincture of Iodine patch test.  If you are a peri- or menopausal woman, do a Tincture of Iodine patch test.  If the test indicates an iodine deficiency, it will probably be difficult to correct with food alone.  If you need supplemental iodine, I recommend taking a protein-bound iodine.  This is the form of iodine used by the thyroid.  Moreover, symptoms --mouth and gastric irritation, acne-like skin erruptions, a brassy taste, increased salivation-- which may occur from iodine supplementation that is not protein-bound will not occur from protein-bound iodine.  Protein-bound iodine supplementation is available through health professionals knowledgeable in the use of Standard Process Whole Food Supplements.

The real question is whether it is better to get iodine from natural unprocessed sea salt (Celtic Salt), seafoods, kelp and egg yolks than it is to get it from processed iodized salt.  The answer is YES!!!  The answer is "YES" for iodine, for sodium, and for every nutrient known and unknown.  There is no nutrient that occurs alone in nature.  Isolating a nutrient  or synthesizing a nutrient takes the nutrient out of context, out of nature.  Now we have a drug, not a nutrient.  Each nutrient exists within a complex of many other nutrients, all synergistic with each other.  We can quantitate and replicate each component of a nutrient complex.  We can neither quantitate nor replicate synergy in nature, in food.