Iodine deficiency ! - falling intakes - goitregens - competition bromine and fluorine

[R.B.]

This is an interesting paper on estimated Japanese iodine intake which ties in with another report I have seen.

"By combining information from dietary records, food surveys, urine iodine analysis (both spot and 24-hour samples) and seaweed iodine content, we estimate that the Japanese iodine intake--largely from seaweeds--averages 1,000-3,000 μg/day (1-3 mg/day)."
See below

The report also recognises that pre 1950 Japanese ate a lot more kelp (Kombu) "elders ate up to four times more than those under the age of 29" so their intake figures could have been significantly higher.

It is also recognised in the paper that intakes of iodine will vary considerably on a day to day basis, which is reflected in urine output. So on some days Japanese may be consuming many grams of iodine. "Urine iodine levels can increase from 100 μg/L to 30,000 μg/L in a single day and return to 100 μg/L within a couple of days, depending on seaweed intake [39]. This is somewhat expected when varying amounts and types of seaweeds are consumed on a day-to-day basis."

An analysis of studies of iodine in urine incontrovertibly shows the Japanese have much higher iodine levels than we do in the west, the data in the paper shows at least historically they had a much lower level of many western medical conditions.

It is also clear from the report that a variety of dietary seaweeds are very much part of the Japanese life, and that the seaweeds in food vary in iodine content for a wide variety of reasons.

The full paper is free and the implications are thought provoking, both in terms of recommended western daily recommended intake, and the use of iodine at higher intakes as a medicine to correct historic imbalances.


"Japanese health statistics linked to high seaweed intake

The Japanese are considered one of the world's longest living people, with an extraordinarily low rate of certain types of cancer. A major dietary difference that sets Japan apart from other countries is high iodine intake, with seaweeds the most common source. Here are some astonishing Japanese health statistics, which are possibly related to their high seaweed consumption and iodine intake:

-Japanese average life expectancy (83 years) is five years longer than US average life expectancy (78 years) [41].

-In 1999 the age-adjusted breast cancer mortality rate was three times higher in the US than in Japan [42].

-Ten years after arriving in the US (in 1991), the breast cancer incidence rate of immigrants from Japan increased from 20 per 100,000 to 30 per 100,000 [43].

-In 2002 the age-adjusted rate of prostate cancer in Japan was 12.6 per 100,000, while the US rate was almost ten times as high [44].

-Heart related deaths in men and women aged 35-74 years are much higher in the US (1,415 per 100,000) as they are in Japan (897 per 100,000) [45].

-In 2004, infant deaths were over twice as high in the US (6.8 per 1,000) as they were in Japan (2.8 per 1,000) [46]."


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204293/


Assessment of Japanese iodine intake based on seaweed consumption in Japan: A literature-based analysis

Abstract

Japanese iodine intake from edible seaweeds is amongst the highest in the world. Predicting the type and amount of seaweed the Japanese consume is difficult due to day-to-day meal variation and dietary differences between generations and regions. In addition, iodine content varies considerably between seaweed species, with cooking and/or processing having an influence on iodine content. Due to all these factors, researchers frequently overestimate, or underestimate, Japanese iodine intake from seaweeds, which results in misleading and potentially dangerous diet and supplementation recommendations for people aiming to achieve the same health benefits seen by the Japanese. By combining information from dietary records, food surveys, urine iodine analysis (both spot and 24-hour samples) and seaweed iodine content, we estimate that the Japanese iodine intake--largely from seaweeds--averages 1,000-3,000 μg/day (1-3 mg/day).

[R.B.]

There is regular mention in literature on iodine of endemic coastal goitre in areas of high seaweed consumption.

I have finally found a paper, as against mentions of the issue. The paper is titled

ENDEMIC COAST GOITRE IN HOKKAIDO, JAPAN
By
Hoji Suzuki, Tadashi Higuchi, Kunio Sawa,
Sachiya Ohtaki and Yoshihiko Horiuchi.

The full version of the paper includes a photo of a patient with an 'enormous' goitre; this was a real and serious issue. Urinary excretion of over 20mg a day of iodine was seen in five patients. Kelp collection was a local industry, and it formed a significant part of the diet. As discussed kelp often contains large amounts of iodine.

Interestingly when they were taken into hospital and put on a low thyroid diet some patients had a regression of their goitre.

The paper seems to suggest that iodine was actively being taken up by the thyroid, so uptake by the transporters was not the issue.

But 74.5% responded to thyroid treatment - so it looks as if something was blocking the activity of the thyroid; the thought occurred was that too much iodine as is generally suggested or something else . . .

All of which raises some important questions as to high iodine supplementation protocols, especially when reports of negative effects of high intake of iodine are limited in number. Are the negative effects of high iodine under reported or was the goitre in this instance due to to other factors? Does high iodine lead to serious thyroid dysfunction and goitre. These are very fundamental questions.

The answer to this question may lie in the unexamined issue that Hokkaido is an island with active 'volcanic' activity, and it is reported that the fumaroles are a source of both significant fluoride emissions, and fluoride deposits. Were the local water supplies, or supplies / wells / springs of individual patients high in fluorine, whereas in contrast was the hospital on a different supply?

A paper cited earlier in this thread suggests that relatively modest amounts of fouride even in the presence of iodine at 1mg/l in the water can cause fluorosis and goitre.


The Island of Hokkaido is listed as a high fluoride area (viz over 1.5mg/l), in a report called;

Fluoride in groundwater:
Probability of occurrence of excessive concentration on global scale


which cites this paper looking at volcanic fumerole activity on Hokkaido (one the most active regions in Japan) which says interalia


Acid alteration in the fumarolic environment of Usu volcano,
Hokkaido, Japan
F. Africano*, A. Bernard

The fumarolic environment studied is very rich in
fluorine. Whole rock fluorine contents range from 1 to
5 wt%. Aluminum fluorides, which are rare in nature,
are commonly observed in this fumarolic environment.
In the presence of fluorine and in acidic conditions,
the dominant aqueous Al species are fluoride
complexes, even in the presence of significant
amounts of sulfates in solution. Fluorine enrichment
in the altered silicates and in silica incrustations indicates
that fluorine plays an important role in the alteration
of the primary minerals and in the mobilization of
silica into the aqueous phase.

I surmise this could lead to high amounts of fluoride in water, which might be localised. Interestingly I could not find anything on flourosis and Hokkaido. Is or was fluorosis a problem in Hokkaido?

A combination of a diet high in marine products and volcanic activity would suggest a better than average mineral intake. I wonder if high mineral availability is protective against fluorosis.

There is no information about selenium, and apparently kelp whilst containing some selenium is not a good source, but apparently volcanoes are a significant source of selenium

It appears that goitre is not seen in all coastal Japanese communities, which would add further weight to the possibility the high fluoride rather than iodine was responsible for the goitre.

This appears to be a community that ate marine foods, seaweed, was in area that was likely to be well mineralised, probably had adequate selenium intake, and yet there was a high level of goitre. Volcanic areas are often associated with goitre so could fluoride be the cause even in a generally well nourished community. Might there be other possible contributory factors.

Might mercury have had a contributory role in the goitre incidence? Mercury poisoning in cattle in 1955 from seed treated with mercury fungicide. http://ci.nii.ac.jp/naid/110001075913 The goitre paper was written in 1965. Cranes local to Hokkaido were severely mercury contaminated. http://www.ncbi.nlm.nih.gov/pubmed/17713219Mercury Mercury deposits are found under northeastern Hokkaido.http://www.japantimes.co.jp/news/200.../#.UnV7t1N2FPI http://www.ncbi.nlm.nih.gov/pubmed/17713219 Mercury contamination of seafood in Japan reported as being at worrying levels.http://www.opsociety.org/issues/mercury-in-seafood Fumaroles may be a source of some mercury. Mercury contamination has been linked with thyroid dysfunction.

All of which raises very many questions, and most worrying of all, is fluoride sufficiently active in certain as yet unquantified circumstances to override even the effects of relatively high intakes of iodine ?

[R.B.]

More on the debate as to the requirements of humans for iodine; a paper I have just come across by Abraham whose later writing tends to be acerbic. He appears frustrated at the unwillingness of the wider medical establishment to engage with / consider the issue of iodine, and understandably so if he is right. Indeed the evidence increasingly seems to point to a greater need for iodine than is recognised in current dietary guidelines. Deficits will be exacerbated by the increasing impact of iodine blockers. The varied evidence of Japanese intake all points to intakes greater than 1mg a day and probably higher; the health of the Japanese would suggest that such intake levels are not inherently harmful and may confer significant health benefits.

I am aware that the UK advisory body is currently considering the issue of iodine intake.

It is interesting that the paper reports higher thyroid volumes in Ireland and Germany.

It is also interesting that Switzerland apparently adopted a doses of 3mg.

Some of the historical references are fascinating


Effect of daily ingestion of a tablet containing 5 mg iodine and 7.5 mg iodide as the potassium salt, for a period of 3 months, on the results of thyroid function tests and thyroid volume by ultrasonometry in ten euthyroid Caucasian women.

Guy E. Abraham M.D., Jorge D. Flechas M.D., and John C. Hakala R. Ph.

http://cypress.he.net/~bigmacnc/drflechas/IOD1.htm

"Considering the importance of this element for overall well-being, it is most amazing that no study so far has attempted to answer the very important question: What is the optimal amount of daily I intake that will result in the greatest levels of mental and physical well-being in the majority of a population with a minimum of negative effects?"

[R.B.]

This is a particularity interesting 1955 ! paper where the authors have clearly grappled with the issue of the interaction of flouride and iodine, and as to whether adequate iodine will overcome excess fluoride, when considering thyroid function. They were clearly well ahead of their time.

They starkly conclude that iodine will not negate the inhibiting effects of high fluoride on thyroid function.

They also emphasise the importance of other inhibitors of iodine metabolism.

It is somewhat ironic that this observation was made over 50 years ago.



The Relationship Between Fluoride Exposure & Goitre in South Africa - March 1955

http://fluoridealert.org/studies/steyn-1955/

Abstract - several pages of excerpts from the paper are cited

"Prophylaxis and Treatment of Simple Goitre. – It is generally accepted that man’s physiological requirements of iodine is approximately 2.0 ug. per kilogram per day, i.e. if man daily ingests this amount of iodine there should be no significant enlargement of the thyroid gland. However, recent researches into the problem of thyroid enlargement have revealed to us various interesting and important factors upon which the normal function and size of this gland depend. These factors have been discussed under III and VIII B. It has become obvious that we cannot lay down a single definite figure for man’s daily iodine requirement as it depends upon various factors, e.g. goitrogenic foods, goitrogens in the drinking water, goitrogenic medicines, bacterial infections, and vitamin deficiencies. Fortunately, as a general rule simple goitre, irrespective of the cause, can be very, or fairly, satisfactorily combated by an adequate increase in man’s daily iodine intake, except when the enlargement of the gland is due to the ingestion of excessive amounts of fluorine, as happens in areas where the subterranean waters are heavily contaminated with this halogen. The only correct solution to fluorine-induced endemic goitre is the removal of this element from the drinking water. Also from the point of view of general health this is the correct procedure…"

[R.B.]

Widespread iodine deficiency in breast milk in the US ?

It is often suggested in material that iodine status in the US is better than the UK; I have not looked for data so have no data to back this up. The above figures from the Avon study would suggest levels of iodine in breast milk are also likely to be low in the UK

Temporal Patterns in Perchlorate, Thiocyanate, and Iodide Excretion in Human Milk

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1817678/

"Breast milk–iodine content is considered sufficient when levels are 150–180 μg/L (Delange 2004). Milk samples provided by most women in our previous study (Kirk et al. 2005) fell far short of this standard. The median iodide level in human milk from 23 donors residing in 15 different states (Kirk et al. 2005) was 33.5 μg/L, and only 4 samples fell within the recommended level. We have therefore been concerned that lactating women in the United States may not be consuming sufficient iodine to meet the needs of their breast-fed infants."

The paper also expresses concerns about the effect of perchlorate on the iodine content of breast milk and the potential effect of perchlorate in breast milk. The paper observes that little is know about the issues.

It appears that perchlorate on a unit weight basis is a comparatively powerful competitive inhibitor of iodine uptake; the effect will depend on the amount taken up - so other blocking factors by be more important if and when present in much greater quantity eg food goitrogens - the effect will also depend on the amount of iodine in the diet; the lower the amount the great susceptibility to competitive blockers - fluoride appears to work by a different blocking mechanism (see above).

"Exposure to perchlorate and other iodide transport inhibitors may increase the risk of iodine deficiency among infants. The sodium–iodide symporter (NIS) is 30-fold more selective for perchlorate than for iodide and is reportedly 9–100 times as potent as thiocyanate in inhibiting iodide uptake (Dohan et al. 2003; Tonacchera et al. 2004). Perchlorate and other iodide transport inhibitors such as thiocyanate thus likely reduce transfer of iodide to breast milk at the mammary NIS."

[R.B.]

The above paper references this paper, which provides further information on the iodine requirements to preterm babies. Have formulas been updated; I do not know but this abstract highlights the importance of iodine in preterm infants


http://www.ncbi.nlm.nih.gov/pubmed/16398457

J Pediatr Endocrinol Metab. 2005 Dec;18 Suppl 1:1257-64.
Neonatal iodine deficiency: clinical aspects.
Ares S, Quero J, Morreale de Escobar G.
Source

Neonatology Unit, University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain sares.gapm05@salud.madrid.org
Abstract

Iodine is a trace element which is essential for the synthesis of thyroid hormones. The thyroid hormones, thyroxine (T4) and 3,5,3'-triiodothyronine (T3), are necessary for adequate growth and development throughout fetal and extrauterine life. The iodine intake of newborns is entirely dependent on the iodine content of breast milk and the formula preparations used to feed them. An inadequate iodine supply might be especially dangerous in the case of premature babies. The minimum recommended dietary allowance (RDA) for different age groups has recently been revised. The iodine intake required is at least 15 microg/kg/day in full-term infants and 30 microg/kg/day in preterms. The iodine content of many evaluated preparations for feeding premature infants appears to be inadequate. Premature infants are now in a situation of iodine deficiency, precisely at a stage of psychomotor and neural development which is extremely sensitive to alterations of thyroid function.

[R.B.]

Interestingly Dr Flechas reports that patients low in iodine have difficulty perspiring.

Between maybe 19 - 40micrograms per liter (and more in those with high iodine intake can be lost in sweat). The 19 mcg was lost in Irish subjects who are reported as having low iodine.

The second summary below suggests that considerable quantities of microminerals can also be lost in sweat.

The amount of iodine in sweat is fairly stable http://www.ncbi.nlm.nih.gov/pubmed/2086989

This reference book is the most comprehensive single source of information on sweating and iodine I have found - pages 569 onwards http://books.google.com/books?id=7v7...ciency&f=false

The first paper showed that very active sports persons were at much higher risk of grade 1 goitre that sedentary students.

So it appears that those low in iodine who take significant exercise are at greater risk of iodine deficiency. A high intake of iodine blockers would add to the problem - viz flouride chloride and perchlorate in the water they use to replenish the sweat loss.




Arch Environ Health. 2001 May-Jun;56(3):271-7.
Electrolyte loss in sweat and iodine deficiency in a hot environment.
Mao IF, Chen ML, Ko YC.
Source

Institute of Environmental Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
Abstract

The authors studied electrolyte loss from profuse sweating in soccer-team players and evaluated the relationship between this source of iodine loss and iodine deficiency. Thirteen male soccer-team players and 100 sedentary students from the same high school were evaluated for 8 d, during which the players were training. The authors analyzed 208 sweat samples to determine losses of iodine, sodium, potassium, and calcium in sweat. Excretion of urinary electrolytes by the subjects was also measured. The mean losses of iodine, sodium, potassium, and calcium in sweat following a 1-hr game were 52 microg, 1,896 mg, 248 mg, and 20 mg, respectively; the ratios of sweat loss to urinary daily loss of the four electrolytes were 0.75, 0.2, 1.88, and 0.92, respectively. Urinary iodine was significantly (p < .02) lower than the normal level of 50 microg/gm creatinine in 38.5% of the soccer players, compared with 2% of the sedentary students. Forty-six percent of the players had Grade I goiter, compared with a mere 1% of the sedentary students (p < .01). The results of the study suggest that loss of iodine through profuse sweating may lead to iodine deficiency, and loss of electrolytes through sweating may have a dietary significance for heat-stressed individuals or for individuals who perform heavy workloads.


Accession Number : AD0447382

http://oai.dtic.mil/oai/oai?verb=get...fier=AD0447382

Title : THE TRACE MINERAL LOSSES IN SWEAT,

Corporate Author : ARMY MEDICAL RESEARCH AND NUTRITION LAB DENVER CO

Personal Author(s) : Consolagio, Frank C. ; Nelson, Richard A. ; Matough, Leroy O. ; Hughes, Ronald C. ; Urone, Paul

Report Date : 18 AUG 1964

Pagination or Media Count : 14

Abstract : The results of this study show that considerable quantities of the trace minerals, including zinc, selenium, copper, cobalt, iodine, strontium, molybdenum, nickel, lead and chromium, are excreted in sweat, under conditions that produce profuse sweating. These losses are extremely important since they reflect losses that should be included in balance studies, which would greatly aid in evaluating more realistically the minimal daily requireents. As in previous studies, the excretion of these trace minerals in sweat decreases appreciably during acclimatization to hot environments. (Author)