Iodine deficiency — how common is it?

As a practitioner of functional medicine, I am more and more intrigued by iodine.

How widespread is iodine deficiency? Why is it downplayed, and even overlooked
here in the US? When iodine deficiency was first recognized as a public concern in
the 1920’s, iodine was subsequently added first to flour, then to salt, and the
problem was considered solved.

In the US, it’s estimated that one in seven women suffers from iodine deficiency.

— Caldwell, K., et al. 2005.

— Hollowell, J., et al. 1998.

But many people don’t know that flour isn’t iodized anymore, and iodization of salt is
still voluntary in the US — only one-fifth of our salt is actually iodized. In reading
further, I’ve found that we’re trending back toward iodine deficiency. Iodine intake
has declined 50% in North America in the past 30–40 years, and this is consistent
with what I’m seeing in my patients.

As recently as 2004, the New England Journal of Medicine defined our iodine status
here in the US as “marginal,” based on data acquired from the International Council
for the Control of Iodine Deficiency Disorder and the World Health Organization
(WHO). More specifically, the WHO data suggest the greater risk in the US is not
iodine deficiency per se but iodine-induced hyperthyroidism (overproduction of
thyroid hormones) or iodine-induced hypothyroidism. Interestingly, both these
problems can occur when people who are already iodine-deficient are given too much
iodine, too quickly. I believe practitioners need to proceed more cautiously when
prescribing iodine supplements, slowly bringing levels up rather than overloading
right up front. (More on our treatment protocol for iodine deficiency below.) But the
WHO perspective seems to confirm that iodine deficiency does exist here in the US.

8 dietary sources of iodine

The sea is where it’s at when it comes to iodine. Seafood and seaweeds (sea “vegetables”) are
excellent sources.

Best by far...

1. Sea vegetables, sea vegetables, sea vegetables!

2. Saltwater fish and other seafood
3. Iodized seasalt

Foods that contain some iodine...

4. Eggs
5. Dairy products
6. Onions
7. Radishes
8. Watercress

Remember, even iodized salt is not as high in iodine as you may think. Also look for iodine in your
daily multivitamin-mineral complex — that’s why we put it in our Personal Program supplements!

* Dasgupta, P., et al. 2008. (Seereferences.)

Iodine deficiency may often be overlooked because the symptoms overlap with those
of other illnesses, perhaps masking the problem. The 2004 National Health and
Nutrition Survey helped dispel the assumption that iodine deficiency in women is a
myth: although there was some leveling off of the drop in overall intake, more than
a third of women of childbearing age had insufficient iodine levels. From thyroid
issues to breast concerns to cognitive function, this could have serious implications
for women’s short- and long-term health as well as that of their children. In my clinic,
I’ve noted marginal levels in my patients and am seeing a distinct downward trend of
levels in new patients.

From intake to uptake — why are some of us so iodine-deficient?

One-third of the world’s population lives in iodine-deficient areas: very little of the
earth’s iodine is found in topsoils, and even where this mineral is present, it may
remain tightly bound up in soil particles. This is the main reason why land vegetable
crops are generally not good dietary sources. Women with symptoms
of hypothyroidism should have their iodine levels evaluated, especially if they don’t
eat many iodine-containing foods (See box at right for good dietary sources of
iodine.)

Factors impacting our iodine intake

1. Iodine’s relative scarcity in most environments

2. Iodophobia
3. Changes in our diet and environment

* Kopp, P. 2008. (See references.)

But even while we humans have lived for millennia in an iodine-poor environment,
the more pressing problem may be the novel burdens our modern surroundings are
placing on our systems. Together with our lack of understanding, factors that make it
harder than ever to acquire and retain enough iodine include toxic halide chemicals
in our environment filling the iodine void in our bodies; the “demonizing” of salt;
overfishing; and ocean pollution.

Iodophobia. Iodine is one of the essential nutrients that you can get too much of.
So both excess iodine and iodine deficiency can impair thyroid function and lead to
elevated thyroid-stimulating hormone (TSH) levels. But it’s likely that if you are
iodine-replete, you’re less sensitive to excess iodine than people with chronically
depleted levels.

In the US, the recommended daily allowance (RDA) for iodine for adults is 150
mcg/day and 290 mcg/day for lactating women. More and more researchers are
saying that increasing the RDA would greatly benefit breast, thyroid, and nervous
system health in women and infants. Our current RDA is well below the US Food and
Nutrition Board’s “upper limit of safety” for iodine (UL = 1100 mcg), which is even
lower in Europe (UL = 600 mcg), where iodine deficiency is more common. In Japan,
however, where diets include lots of iodine, consumption is about 25 times more
than the median intake here, yet the Japanese do not have more thyroid iodine
toxicosis.

Do we need mandatory universal salt iodization?

If all salt in the US were iodized, a five-fold increase in iodine intake could take place without
increasing our salt intake.
* Dasgupta, P., et al. 2008. (See references.)

Individual sensitivity to iodine varies widely, but in the past 10–15 years, experts
have found that overall, we are “remarkably tolerant to high intakes of iodine.” It
appears that low or high iodine intake is something we get used to over long periods
of time — though we’ll always need a certain amount. People living in some coastal
regions of Japan regularly consume as much as 50,000–80,000 mcg of iodine daily!

If you’ve never been iodine-deficient, your thyroid will tend to stay normal in
function and size if you consume up to several milligrams of dietary iodine daily. If
you’ve been deficient, you may be hypersensitive to iodine. In my experience, this is
not a problem for most women, and even hypersensitive individuals can
just gradually adjust their levels upward.

Salt as the enemy. There is a common perception that salt itself is dangerous.
Because excessive sodium intake can increase the risk of hypertension, as many as 7
out of 10 women avoid or rarely use it. What’s more, the American Medical
Association has recently suggested the USFDA remove salt from the list of
foods “Generally Recognized as Safe” (GRAS)!

Contrary to popular belief, four-fifths of the salt in American food is not iodized. That
would be fine if we only consumed fewer over-salted, processed, prepackaged, and
fast foods (which do not contain iodine), while increasing our intake of sea foods,
alkalizing mineral salts (such as potassium citrate, calcium carbonate, calcium
ascorbate), and quality iodized sea salt. Not only would we see fewer problems with
hypertension, we’d be healthier in every way — with most of us able to excrete any
extra sodium we might consume.

The problem with other halogens. Iodine deficiency may also be related to
other halogens — non-metals such as fluoride, chloride, and bromide, which are
replacing iodine in the body. Most public water drinking supplies include the first
two. Perchlorate (which may derive from rocket propellant, Chilean nitrate fertilizers,
or other sources) is known to inhibit iodine transport in the body and thyroid function.
Some scientists believe the omnipresence of perchlorate is “putting future
generations in peril.”

Bromide is also widely present — in soil and crop fumigants as well many foods and
drugs. In the 1960’s, iodine was added as an anticaking agent to bakery products,
but because of misplaced fears of iodine toxicity (“iodophobia” ), it was replaced with
bromine in the 1980’s. So we’re ingesting a lot of these halides, which research
suggests compete with iodide for absorption and uptake in the body. This means
they function as goitrogens (substances that suppress thyroid function by interfering
with iodine uptake/accumulation).

According to leading iodine expert Dr. David Brownstein, iodine will bind to fluoride,
chloride, and bromide, as well as to mercury, so these molecules can be removed
from the body. But that process depends heavily on having adequate iodine in the
body. If you are iodine-deficient, know that other toxic chemicals have taken its
place in your body so that when you then add it back in, you’re both detoxing these
chemicals and adjusting to the new iodine.

Original Publication Date: 07/20/2009

Last Modified: 02/16/2010
Principal Author: Marcella Sweet
 References

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Kosova, W., & Wingert, P. 2009. Live your best life ever! Why health advice on “Oprah” could make you
sick. Newsweek. URL: http://www.newsweek.com/id/200025/page/4 (accessed 06.12.2009).

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Patrick, L. 2008. Iodine deficiency and therapeutic considerations. Alt. Med. Rev., 13 (2), 116–127. URL
(PDF): http://www.thorne.com/altmedrev/.fulltext/13/2/116.pdf (accessed 06.12.2009).

Hollowell, J., et al. 1998. Iodine nutrition in the United States. Trends and public health implications:
Iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971–1974 and
1988–1994). J. Clin. Endocrinol. Metab., 83 (10), 3401–3408.
URL:http://jcem.endojournals.org/cgi/content/full/83/10/3401 (accessed 06.12.2009).

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Blount, B., et al. 2006. Urinary perchlorate and thyroid hormone levels in adolescent and adult men and
women living in the United States. Environ. Health Perspect., 114 (12), 1865–1871.
URL:http://www.ehponline.org/members/2006/9466/9466.html (accessed 06.15.2009).

Patrick, L. 2008.

4
Hollowell, J., & Haddow, J. 2007. The prevalence of iodine deficiency in women of reproductive age in the
United States. Public Health Nutr., 10 (12A), 1532–1539; discussion 1540–1541. URL
(abstract): http://www.ncbi.nlm.nih.gov/pubmed/18053275 (accessed 06.15.2009).

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Dasgupta, P., et al. 2008. Iodine nutrition: Iodine content of iodized salt in the United States.Environ.
Sci. Technol., 42 (4), 1315–1323. URL
(PDF):http://pubs.acs.org/doi/pdfplus/10.1021/es0719071 (accessed 05.15.2009).

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Hollowell, J., et al. 1998.

References for text box: Factors impacting our iodine intake

Kopp, P. 2008. Reduce, recycle, reuse — Iodotyrosine deiodinase in thyroid iodide metabolism.NEJM,
358 (17), 1856–1859. URL: http://content.nejm.org/cgi/content/full/358/17/1856 (accessed
05.12.2009).

Web articles and other resources:

• http://www.heartlandnaturopathic.com/Iodine.htm
• http://www.qfac.com/articles/august/iodine.html
• http://www.med.umich.edu/1libr/aha/umioddef.htm
• http://www.vitamincfoundation.org/iodine.htm
• http://altmedangel.com/iodine.htm
• http://www.webmd.com/news/20060628/thyroid-health-how-much-iodine-helps
• http://www.prohealth.com/ME-CFS/library/showArticle.cfm?libid=14524&B1=EM050609C