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FDM Training Program; Mod 7 * The Biochemical Effects of Iodine

Wayne L. Sodano, D.C., D.A.B.C.I. & Ron Grisanti, D.C., D.A.B.C.O., M.S.

©Sequoia Education Systems, Inc.

http://www.FunctionalMedicineUniversity.com1

Functional Diagnostic Medicine

Training Program

Module 7 * FMDT 561D

The Biochemical Effects of Iodine

(Review of Nutrient Element Status Testing)

By Wayne L. Sodano, D.C., D.A.B.C.I.

&

Ron Grisanti, D.C., D.A.B.C.O., M.S.

Various combinations of factors can add up to elemental

deficiency, as illustrated here for iron.

Diet

Poor Iron Absorption

Loss of Blood

Increased PhysiologicRequirements

+

Iron Deficiency

High Iron DemandLow Iron Supply

Ref: Laboratory Evaluations for Integrative & Functional Medicine; 2nd ed; Lord & Bralley

The Effect of Iron Deficiency on Iodine and

Thyroid Function

Studies in human have shown that moderate-to-

severe iron deficiency significantly lowers both T3

and T4 (although T3 to a greater extent) and reduces

TSH responsiveness. This is thought to be due to

impaired thyroid peroxidase activity.2





• Macro minerals are present in total-body content of tens or hundreds of grams

– Phosphorus

–Magnesium

– Calcium

– Sodium

– Potassium

– Chloride

(Sodium, potassium, and chloride are classified as electrolytes

because of their roles in maintaining ionic equilibria in

physiological systems.)

Thirteen trace elements are currently known to be

nutritionally essential for human health. (micrograms

per gram of tissue)

• Iron, copper, zinc, iodine, selenium, boron, cobalt,

chromium, molybdenum, manganese, vanadium,

silicon, and nickel

• A defining characteristic of a trace element is that

a very small amount is necessary for proper

function of the whole organism.

Major Roles of Essential Elements In Biological

Systems

• Electron acceptors in oxidative/reductive

homeodynamics

• Enzyme cofactors

• Crystalline structures (bone)

• Ionic migrations necessary for nerve signal

transmission or cell regulatory responses





Ne

ga

tiv

e E

ffe

cts

Element Concentration

Therapeutic

Range

Negative consequences usually are associated with deficiency or excess of any element. For example, copper deficiency may be associated with increased oxidative stress due to low activity of the cuproenzyme superoxide dismutase. On the other hand, excess free copper ions produce oxidative stress.

Effects of Elemental Deficiency or Excess

Ref: Laboratory Evaluations for Integrative and Functional Medicine 2nd Ed, Lord & Bralley

Nutrient & Toxicant Interaction3

• Element deficiency is common and tends to occur in multiples.

• Poor diet, poor digestion and malabsorption

• Element-deficient state can cause an

up regulation of transport proteins in

the GI tract, which can cause greater absorption of toxic elements

(element deficiency can increase

toxic element exposure)

• Excessive zinc decreases copper absorption.

• Copper deficiency increases iron deficiency

anemia.

• Iron deficiency increase the absorption of lead

and cadmium.

• Selenium mitigates the toxic effects of mercury

and arsenic.





Bioavailability of Elements

• Elements contained in food undergo several changes in chemical bonding.

• The digestive process must be in good working order.

• Digestive factors that can decrease element absorption include inadequate (or dilute) stomach acid, low alkaline pancreatic output, or low pancreatic digestive enzymes.

• Dietary supplements of elements (as elemental salts) are available in many forms.

• Complexed or chelated forms are usually

recommended

– Lactate, gluconate, citrate, picolinate or amino

acid (especially aspartate) salts

• Salt is an ionic compound, consisting of a cation

and anion. In water, the salt dissociates into ions.

Choosing the Best Specimen for Element Testing

• Blood

• Hair

• Urine

• Chelation Challenge

(provocation) Testing

• Urinary Porphyrin

Profiling





• There is no single best specimen for

simultaneous, optimal status assessment of

essential elements and toxic heavy metals.

• For each element, there are merits and

limitations of the specimens commonly tested.

• The ‘best’ specimen for detecting essential

element deficiency depends on the element.

Comparing results from multiple

types of specimens can

provide a more complete

picture of elemental

status.

Blood

• Whole blood or RBC specimens are valuable when assessing nutrient status.

• Whole blood is commonly used for baseline, non-challenged toxic element status.

• Since each essential element functions synergistically with other elements and nutrients, multi-element profiles coupled with functional biomarkers can provide the best insight into abnormalities in mobilization, utilization and excretion.





It may be difficult to

demonstrate chronic exposure to

toxic metals in samples of hair,

blood, and urine despite

clinically significant body

burdens because they tend to

accumulate in specific tissues

• Bone

• Liver

• Kidneys

Hair

• Hair specimens can be useful in routine screening for toxic metal exposure.

• Keratin, which is rich in sulfur, contains cysteine residues, is the major component of hair.

• When elements, circulating in the blood, reach the hair follicle, they bind with high affinity to keratin.

• Hair concentrates toxic metals at least 10-fold above concentrations found in blood.

Urine

• Urine elements can vary with recent dietary intake.

• Over 90% of most chelating agents are cleared by the kidneys in a few hours. Thus, a six to eight hour urine specimen collection is not only more convenient, but also may be superior for assessment of toxic element excretion following a chelation challenge when results are expressed in micrograms per milligram of creatinine.





Iodine

• Adequacy Assessment:

– urinary iodine, TSH, TT4 , TT3 , FT4 , FT3 , RT3

• Optimal forms:

– Potassium iodide, molecular iodine (iodine I2) (iodide I-)

• Clinical indications of deficiency:

– Goiter, hypothyroidism, hyperthyroidism, fibrocystic

breast disease

• Food sources:

– Seaweed, shellfish, marine fish, iodized salt

Iodine Function, Absorption and Metabolism

The normal adult human body contains about 15-20

mg of iodine, of which 70-80% is concentrated in the

thyroid gland.

Iodine is an essential element required for normal

function of the thyroid gland, immune system, and

the integrity of the thyroid and breast tissue.

Suboptimal total body iodine status is associated

with insufficient intake of the essential element

and excessive intake of the highly antagonistic

halides: bromide and fluoride.

Thyroid Goiter

http://www.britannica.com/EBchecked/topi

c/237190/goitre





Specific tissues in the body require adequate iodine

and the reduced form of the element iodide for

normal metabolism and optimal health. Adequate

iodine uptake and organification of iodine by the

thyroid gland is required for the production,

storage, and release of thyroid hormones.

Triiodothyronine (T3) regulates metabolism in

several tissues by affecting energy production and

neuronal and sexual development.

Iodine insufficiency is associated with ‘subclinical’

thyroid deficiency, weight gain, loss of energy, goiter

and impaired mental function. Iodine is also

concentrated in breast tissue, where it elicits anti-

proliferative effects and protection against

fibrocystic breast disease and cancer. Iodine and

organic iodine compounds are also concentrated

and secreted by the gastric mucosa, salivary glands

and the cervix.

Iodine toxicity

• Although up to 1000 ug of iodine daily is considered safe,

therapeutic does of iodine are not agreed upon, making

iodine testing very important.

• Excessive intake of iodine reduces organic binding of iodine,

resulting in hypothyroidism, goiter, thyroiditis, and thyroid

nodules.





Assessing Iodine Status

• Direct Iodine Measurements

– Approximately 10 to 20 ug of iodine are lost daily

in the feces, and 100 to 150 ug as urinary iodine in

iodine-sufficient populations.

Guidelines of Appropriate Limits For Spot Urine Iodine Testing

Median urinary

iodine (ug/L)Iodine intake Iodine nutrition

<20 Insufficient Severe iodine deficiency

2-49 Insufficient Moderate iodine deficiency

50-99 InsufficientMild iodine deficiency

100-199 Adequate Optimal

200-299More than

adequate

Risk of iodine-induced hyperthyroidism

within 5-10 years following introduction

>300 ExcessiveRisk of adverse health consequences

(iodine-induced hyperthyroidism, autoimmune thyroid disease

Ref: Laboratory Evaluations for Integrative & Functional Medicine;2nd ed; Lord & Bralley

• Twenty-four hour Urine Iodine testing is preferred for its reliability.

• Normal iodine 24-hour urine collections are 100-460 ug/d.





Iodine Plasma/Serum

• Values only measure circulating thyroid hormones

• Normal values 40-92 ug/L

Iodine/Iodide status is greatly influenced by dietary intake, but also by exposure to goitrogens that inhibit the absorption and binding of iodine. Goitrogenic substances include chlorine (tap water, pools/hot tubs, cleaning products), fluoride (water toothpaste, mouth wash, some medications) and bromide (pools/hot tubs, baked goods, soft drinks, pesticides, medications).

Functional Iodine Tests

• Iodine patch (skin) test

– 2% iodine solution (must be color based; not clear

iodine solution) is painted on the skin.

– Observe the time interval for fading of the color.

– Rapid fading indicates a need for iodine.

– There are no accepted norms for the time of fading,

and the observation is complicated by darker skin

tones.

– Most Functional Medicine practitioners use the 24 hour

mark (ex: color should stay on the skin for 24 hrs). Early

fading is a sign of deficiency.

Urinary Iodine Load Test

(Not Recommended By FMU)

This test is not recommended by FMU due to the

fact that validity of the test depends on the

undocumented and erroneous assumption that the

average person can absorb at least 90% of a 50 mg

dose.1





Indirect Iodine Measurements

• Serum Thyroglobulin

• TSH

• T4

• T3

Iodine Intake Serum Tg Concentration

Eufunction

(normal thyroid output)

Deficiency

Adequate

Excess

Increased

Normal

Normal or increased

hypothyroid

Deficiency

Adequate

Excess

Decreased

Decreased

Decreased

hyperthyroid

Deficiency

Adequate

Excess

Increased

Increased

Increased

Iodine Deficiency: Thyroid Function Tests

Adaptive mechanisms are as follows:

– Increased serum TSH

– Increased iodine trapping of the thyroid

– Preferential synthesis of the thyroid of T3

– Increased peripheral conversion to T3

– Increased thyroid volume





Iodine Excess: Thyroid Function Tests

Acute iodine excess can cause:

– Decrease in iodine transport

– Decreased intrathyroidal organification

– Decreased release of thyroid hormones from the gland

The effect of 15 days of 80 mg oral iodine on thyroid

function:

– Increased serum TSH

– T4 slightly decreased

– T3 slightly decreased

Effects of Iodine Nutritional Status on Thyroid Function Tests2

TSH Free T4 Free T3 Other

Iodine deficiency Increased Decreased IncreasedDecreased rT3,

increased TG

Acute iodine excess Increased Decreased Decreased

Acute iodine excess in

nodular thyroid glandDecreased Increased Increased

Possible development

of thyrotoxicosis

Chronic iodine excess*May appear

normal

May appear

normal

May appear

Normal

Cordarone Increased Increased Decreased Increased rT3

Clinical Protocols for Lowering Bromide And

Fluoride in the Body

• If your patient is iodine deficient, prescribe

iodine/iodide accordingly

• Stop ingesting bromide & fluoride containing foods

and medicines





The Reactivity Trend of the Halogens

(Group 7 of the Periodic Table)

• Fluoride is more reactive than chloride.

• Chloride is more reactive than bromide.

• Bromide is more reactive than iodide.

Repletion of Iodine

• Thyroid function should be monitored during

aggressive dosing. Always retest urine.

• Forms: a mixture of iodine and iodide is

recommended

Summary

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