Iodine Debate Continues:
Rebuttal #2
by Guy E. Abraham, MD and
David Brownstein, MD

(This rebuttal: online publication only)

The Iodine Debate so far. . .

Editorial: Iodine: A Lot to Swallow
by Alan Gaby, MD
(Aug/Sept 2005)

A Rebuttal of Dr. Gaby's Editorial on Iodine
by Guy E. Abraham, MD and David Brownstein, MD
Online publication only. . .
(October 2005)

Alan R. Gaby, MD's Response to:
A Rebuttal of Dr. Gaby's Editorial on Iodine
Online publication only. . .
(November 2005)

Alan R. Gaby's Response to this Rebuttal (#2)
Online publication only. . .
(April 2006)

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 body sufficiency 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 test. 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 his attention on the safety of iodine as used in the orthoiodosupplementation program. Running out of scientific arguments, Gaby resorted to personal attacks. We will respond in a scientific manner, point-by-point and with references, including definitions of words from an English dictionary.

Gaby:
"First, it does not seem appropriate to use the term 'orthoiodosupplementation' to describe the treatment they are recommending. That term is borrowed from Linus 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.'"

Comment:
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 oral intake of 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.

Gaby:
"Drs. Abraham and Brownstein stated that the thyroid disorders I mentioned that resulted from iodine supplementation occur mainly with 'organic forms' of 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 effects."

Comment:
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. Thyroid 2003;13:561–567.
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 iodide.

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.

Gaby:
"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."

Comment:
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 1910-1911¹⁰:

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), and bronchitis.

Gaby:
"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 from these set points may be result in suboptimal thyroid function for that person, even if all measurements remain within the normal range."

Comment:
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 11)

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.

Gaby:
"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."

Comment:
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 patients/day x 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 endeavor.

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, just as we are looking for positive effects. To insinuate poor medical care was given is not appropriate, nor is it fair.

Gaby:
"It is also worth considering that the positive results observed in Michigan might not be reproducible in other geographical areas."

Comment:
These positive results are observed nationwide by many physicians and other health care professionals. In fact, elevated toxic halogen levels have not been found to be solely associated with Michiganders. We have seen elevated toxic halides nationwide.

Gaby:
"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 side effects."

Comment:
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 with fatal outcomes. The literature shows that iodine used in gram amounts to treat lung disorders was not associated with serious complications.¹² We have previously quoted 8-10 our predecessors extolling the widespread use of iodine in several clinical conditions. The past literature does not support Gaby's claim that deaths have been associated with the use of gram amounts of iodine.

Guy E. Abraham, MD and David Brownstein, MD
5821 W. Maple Road
Suite 192
W. Bloomfield, Michigan 48322

References
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. Aug/Sept 2005.
3. Abraham, G.E. The safe and effective implementation of orthoiodosupplementation in medical practice. The Original Internist. 2004;11:17-36.
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. p. 231.
6. Suzuki, H., Higuchi, T., Sawa, K., et al. Endemic coast goiter in Hokkaido Japan. Acta Endocr. 1965:50:161-176.
7. Abraham, G.E. The concept of orthoiodosupplementation and its clinical implications. The Original Internist. 2004:11:29-38.
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 Internist. 2002:9:5-20, 2002.
12. Gennaro, AR. Remington: The Science and Practice of Pharmacy. 19th Edition. Mace Publish. Co. 1995;976, 1276.