(This rebuttal: online
The Iodine Debate so far. . .
Iodine: A Lot to Swallow
by Alan Gaby, MD
Rebuttal of Dr. Gaby's Editorial on Iodine
by Guy E. Abraham, MD and David Brownstein,
Online publication only. . .
R. Gaby, MD's Response to:
A Rebuttal of Dr. Gaby's Editorial
Online publication only. . .
Gaby's Response to this Rebuttal (#2)
Online publication only. . .
We would like to submit a second rebuttal
to Gaby's response to our first rebuttal1 which was in response
to Alan Gaby's editorial
on iodine. 2 In his editorial,
Gaby questioned the validity of the iodine/iodide loading test we use
to assess whole
for iodine 3 and the safety of our orthoiodosupplementation
program,4 which is currently used safely and effectively
by thousands of physicians and other health care professionals nationwide.
Our first rebuttal
covered the main objections by Gaby and also questioned the scientific
validation of the theory of evolution.
On the Townsend Letter web site, (www.townsendletter.com), in December
2005, Alan R. Gaby, MD posted a sequel to his editorial on iodine.
This time, Gaby
did not defend his belief in evolution and the origin of man from the "iodine-rich" oceans.
This time, he did not question the validity of our iodine/iodide loading
This time, he did not debate the method we used to calculate the average
daily intake of iodine by mainland Japanese. This time, Gaby concentrated
on the safety of iodine as used in the orthoiodosupplementation program.
Running out of scientific arguments, Gaby resorted to personal attacks. We
in a scientific manner, point-by-point and with references, including definitions
of words from an English dictionary.
"First, it does not seem appropriate to use the term 'orthoiodosupplementation'
to describe the treatment they are recommending. That term is borrowed
Pauling's 'orthomolecular medicine,' which refers to the concept
of creating the optimal molecular environment in the body ('orthomolecular'
means 'the right molecules'). Defining the optimal dosage range as
an amount that
is 40 to 320 times the usual dietary intake obfuscates any debate about whether
such a high intake is desirable or safe. Therefore, until iodine doses of 6.25-50
mg per day are proven to be optimal, it would be more logical to refer to these
doses as 'high-dose iodine therapy.'"
The prefix "ortho" is not borrowed from Linus Pauling. The English
dictionary contains hundreds of words starting with "ortho." For
Gaby's erudition, the daily amount of iodine needed for whole body sufficiency
was named orthoiodosupplementation3 from ortho = the right amount; iodo
= for inorganic non radioactive iodine; and supplementation = for
this essential nutrient.
To find the definition of "obfuscate," we consulted the Etymological
Dictionary of the English Language by Reverend Walter W. Skeat.5 It derives
from two Latin words:
ob (prefix) = over, toward, before, about, near, above
fuscate = to darken
obfuscate = to darken over
The endpoint in optimizing a nutritional program is the clinical response.
The optimal amount of a nutrient is reached when it results in optimal
mental and physical health. Having a test that confirms the optimal
amount of a nutrient that achieves whole body sufficiency, concomitant
with optimal physical and mental health in the absence of significant
side effects, is what we strive to do. In fact, it is what all holistic
physicians strive to achieve.
"Drs. Abraham and Brownstein stated that the thyroid disorders I
mentioned that resulted from iodine supplementation occur mainly
with 'organic forms'
iodine, such as amiodarone and certain iodine-containing dyes used in radiology.
However, all but one of the references I cited discussed the adverse effects
of inorganic iodine. The other article concerned the use of an iodophore, which
is a surfactant molecule that slowly releases inorganic iodine. As surfactants
would not by themselves be expected to affect thyroid function, one might presume
that the released inorganic iodine was responsible for the reported adverse
To support his contention that iodine supplementation is associated
with thyroid disorders, Gaby list five references:
10. Kasagi K, et al. Effect of iodine
restriction on thyroid function in patients with primary hypothyroidism.
11. Zimmermann MB, et al. High thyroid volume in children with excess
dietary iodine intakes. Am J Clin Nutr 2005;81:840–844.
12. Schumm-Draeger PM. [Iodine and thyroid autoimmunity] [Article in
German]. Z Arztl Fortbild Qualitatssich.
2004;98 Suppl 5:73–6.
13. Zois C, et al. High prevalence of autoimmune thyroiditis in schoolchildren
after elimination of iodine deficiency in northwestern Greece. Thyroid 2003;13:485–9.
14. Stewart JC, Vidor GI. Thyrotoxicosis induced by iodine contamination
of food: a common unrecognized condition? Br
Med J 1976;1:372–375.
In reference 10, the authors studied the effect of restricting seaweed
on thyroid functions, not iodine. Seaweed contains more that just iodine.
In reference 11, the authors of this publication reported that urine
iodide concentrations greater than 0.5 mg/L were associated with increased
thyroid volume in multiethnic groups of children between six and 12
years old. Analysis of the data in Table I of that publication revealed
only children from Hokkaido, Japan showed increased thyroid volumes
of significance compared to the other groups: 2.16 to 2.59 ml for all
the other groups; and 2.86 and 4.91 ml for the two groups from Hokkaido.
This area of Japan is known to have a high incidence of euthyroid goiter.
Suzuki et al.,6 who first reported this finding in 1965 did not think
that iodine was the cause of this goiter. He commented: "Considering
the paucity of reported cases of iodine goiter with the wide spread
usage of iodine medication, we cannot exclude factors other than excessive
intake of dietary iodine as a cause of the goiter."
In reference 12 and 13, the authors reported an increased incidence of autoimmune
thyroiditis following iodization of salt. This is a common observation worldwide.
As we have previously reported, autoimmune thyroiditis cannot be induced in
laboratory animals in the absence of a goitrogen. The goitrogen used in these
experiments is an anti-thyroid drug. We previously discussed the mechanism
involved in the induction of thyroiditis following ingestion of iodized salt
containing on a molar basis 30,000 more chloride than iodide.4,7 Magnesium
and iodine deficiencies are the causes of autoimmune thyroiditis, not excess
In reference 14, an organic iodine-containing drug, polyvinylpyrolidone, induced
thyrotoxicosis, not inorganic non-radioactive iodine. This drug was shown to
interfere with uptake and utilization of iodine, similar to the effect of amiodarone.
We discussed this drug in our first rebuttal.
"I would also question the statement that our medical predecessors
recommended daily iodine intake of 12.5 to 37.5 mg from Lugol's
solution. While Dr. Lugol
did use those doses, they were recommended primarily to treat infections
(iodine is a broad-spectrum antimicrobial agent) and hyperthyroidism,
not as routine
nutritional support for the average person."
Gaby claimed that iodine was used only in infectious diseases and
hyperthyroidism. Nobel Laureate Albert Szent Györgyi, the physician who discovered
Vitamin C in 1928, commented 50 years ago8:
When I was a medical student, iodine in the form of KI was the universal
medicine. Nobody knew what it did, but it did something and did something
good. We students used to sum up the situation in this little rhyme:
If ye don't know where, what, and why
Prescribe ye then K and I.
Our medical predecessors, …were
keen observers and the universal application of iodide might have
been not without foundation.
To quote F.C. Kelley9:
In the first flush of enthusiasm for
the newcomer, physicians and surgeons tested it and tried it
for every conceivable pathological
condition. The variety of diseases for which iodine was prescribed
in the early years in astonishing – paralysis, chorea, scrofula,
lacrimal fistula, deafness, distortions of the spine, hip-joint disease,
syphilis, acute inflammation, gout, gangrene, dropsy, carbuncles, whitlow,
chilblains, burns, scalds, lupus, croup, catarrh, asthma, ulcers, and
bronchitis – to mention only a few.
According to the Encyclopedia
Britannica 11th Edition, published in
The following is a list of the principal conditions in which iodides
are recognized to be of definite value: metallic poisonings, as by
lead and mercury, asthma, aneurism, arteriosclerosis, angina pectoris,
gout, goiter, syphilis, haemophilia, Bright's disease (nephritis),
"How many patients showed a decline in their serum thyroxine level
that was judged to be clinically insignificant because it remained
in the normal range?
Abraham has, in fact, observed such decreases in thyroid hormone levels in
patients receiving iodine therapy. One should not automatically
assume that these changes
are benign. Research has shown that each person has a unique 'set point'
for serum concentrations of T4, T3, and TSH. Any iodine-induced deviation
set points may be result in suboptimal thyroid function for that person,
even if all measurements remain within the normal range."
We have previously reported11 a statistically significant decrease
in total T4 in ten Caucasian women following three months on iodine
at 12.5 mg/day.
The results are displayed in Table I.
Table 1: Effect of
iodine supplementation in daily amount of 12.5 mg for three consecutive
months on thyroid volume and
thyroid function tests in ten Caucasian normal women (From reference
There was a drop from a mean T4
of 8.8 ug/dL before to a mean of 7.1 ug/dL after three months
on iodine. No change occurred in Free T3
and Free T4. In the Discussion section,11 we stated:
The significant decrease in serum T4 observed in the present study,
concomitant with the absence of significant changes in the mean values
for TSH, FT3 and FT4, following one supplementation at 12.5 mg/day
(Table VII), could be due to either a decreased secretion of T4 by
the thyroid gland; or it could be due to lower levels of thyroxine
binding globulin (TBG). The synthesis of TBG occurs in the liver and
this synthesis is stimulated by estrogens.48 In the female rat, I-deficiency
increases the sensitivity of mammary tissue to estrogens.37 I-supplementation
to these female rats in amounts equivalent, based on body weight, to
amounts of I required in women with FDB for subjective and objective
improvement of FDB,10 had an attenuating effect on estrogen stimulation
of the mammary tissue in those female rats, decreasing their response
to estrogens.41 Therefore, the decreased T4 levels following I-supplementation
could be due to a similar mechanism on hepatic synthesis of TBG, by
decreasing the sensitivity of hepatic receptors to estrogens, resulting
in decreased synthesis and release of TBG by the liver and decreased
T4 levels. Since we did not include serum TBG levels in our thyroid
profile, the explanation for this decrease of serum T4 levels must
await future research.
The subjects studied above did not exhibit any adverse effects to the
change in thyroid levels. In fact, they experienced a significant clinical
improvement in many of their symptoms, including symptoms commonly
associated with hypothyroidism such as fatigue, headaches, etc. It
is well known that relying solely on thyroid function tests to diagnose
and treat hypothyroidism will often lead to a suboptimal outcome.
"For a three-doctor practice to initiate high-dose iodine therapy on 4,000
patients over a two-year period seems like a daunting endeavor, and one wonders
how meticulously these patients were monitored for adverse effects."
Let's do the math. We see patients 4.5 days per week. On average,
we each see approximately 15- 20 patients per day. Lets take 15
four days per week = 60 patients per week/doctor. 60 patients/week x 50
weeks/year = 3,000 patients/year/doctor. If we multiply that number
by three doctors,
we see approximately 9,000 patients per year. These numbers are very similar
to most busy family practice offices throughout the country. We started
using orthoiodosupplementation approximately three years ago. Not
such a daunting
Not every patient was treated with orthoiodosupplementation. As with any
therapy, a history and exam were completed, and a clinical diagnosis was
made. As all
good clinical physicians, we not only monitor our patients, we see them
back in follow-up. We are always looking for adverse effects of any therapy,
as we are looking for positive effects. To insinuate poor medical care
was given is not appropriate, nor is it fair.
"It is also worth considering that the positive results observed
in Michigan might not be reproducible in other geographical areas."
These positive results are observed nationwide by many physicians
and other health care professionals. In fact, elevated toxic halogen
not been found to be solely associated with Michiganders. We have seen
elevated toxic halides nationwide.
"High-dose iodine therapy is of great value in some circumstances.
We should not forget, however, that this treatment was abandoned
in the past, because
it caused many deaths from heart failure, as well as a long list
of other side effects.
The doses used then were higher than those currently being advocated.
However, it is premature to assert that more modest doses do not
cause more modest
Where is the reference(s) to support the above statements? We are
not aware that iodine, even in gram amounts, has been reported
to be associated
fatal outcomes. The literature shows that iodine used in gram amounts
to treat lung disorders was not associated with serious complications.12
quoted 8-10 our predecessors extolling the widespread use of iodine
in several clinical conditions. The past literature does not support
that deaths have been associated with the use of gram amounts of
Guy E. Abraham, MD and David Brownstein, MD
5821 W. Maple Road
W. Bloomfield, Michigan 48322
1. Abraham, G.E., Brownstein, D. Validation of the orthoiodosupplementation
program: a rebuttal of Dr. Gaby's editorial on iodine. The
Original Internist. 2005;12(4):184-194.
2. Gaby, A.R. Iodine: a lot to swallow. TLfDP.
3. Abraham, G.E. The safe and effective implementation of orthoiodosupplementation
in medical practice. The Original Internist.
4. Abraham, G.E. The historical background of the iodine project.
The Original Internist. 2005;12(2):57-66.
5. Skeat, W.W. Etymological Dictionary of the English Language.
6. Suzuki, H., Higuchi, T., Sawa, K., et al. Endemic coast goiter
in Hokkaido Japan. Acta Endocr.
7. Abraham, G.E. The concept of orthoiodosupplementation and its
clinical implications. The Original Internist.
8. Szent-Györgyi, A. Bioenergetics.
New York: Academic Press, 1957.
9. Kelly, Francis C. Iodine in medicine and pharmacy since its discovery – 1811-1961.
Proc R Soc Med. 1961:54:831-836.
10. Encyclopedia Britannica,
11th Edition, 1910-1911:Vol. XIV;725-726.
11. Abraham, G.E., Flechas, J.D., Hakala, J.C. Optimum levels of
iodine for greatest mental and physical health. The Original
12. Gennaro, AR. Remington: The Science and Practice of Pharmacy.
19th Edition. Mace Publish. Co. 1995;976, 1276.