The Iodine Controversy and Thyroid Health
If you’ve researched thyroid health, you’ve heard a lot about iodine. But while some people swear by it, others warn against it, and ultimately there’s a lot of confusion about whether those with thyroid conditions should supplement with iodine or avoid it altogether.
Iodine is an essential mineral that plays a vital role in thyroid hormone production, metabolism, and more. At the same time, too much iodine can be detrimental and potentially contribute to autoimmune thyroid conditions.
Back in 2008, when I was diagnosed with Graves’ disease, iodine supplementation was a part of my natural treatment protocol that eventually led to remission. Since then, my perspective on iodine has shifted significantly due to new research and insights into the risks and benefits of iodine supplementation.
To help to clear up some of the controversies around iodine, today I’m discussing the key elements you need to be aware of when it comes to iodine and how it impacts thyroid health, including the benefits and potential adverse effects of iodine intake and why it’s essential to work with a qualified practitioner. Enjoy the episode!
During this episode, you’ll learn:
- My experience with iodine supplementation and Graves’ disease
- Why my perspective on iodine has changed over the years
- The connection between selenium and thyroid autoimmunity
- Recognizing that an iodine deficiency isn’t likely to be the main reason someone develops Graves’ disease or Hashimoto’s
- Five common reasons some people run into problems with high levels of iodine
- How much is too much when it comes to iodine?
- Benefits of iodine supplementation
- Potential risks of iodine supplementation
- Different types of iodine supplements
- What you need to know about iodine testing
- Should you restrict food sources of iodine?
- The controversy around iodine supplementation between practitioners
- My iodine testing recommendations
Mentioned in this episode
- Save My Thyroid | Q&A Episode: Is a Low Iodine Diet Necessary To Follow?
- David Brownstein’s Book | Iodine: Why You Need It, Why You Can’t Live Without It
- NaturalEndocrineSolutions.com Articles
- Hakala Labs
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Here is the transcript for this episode:
Iodine is very controversial in the world of thyroid health; therefore, there is a lot of confusion about whether those with thyroid conditions should supplement with iodine or if they should completely avoid it. I have been wanting to put together an episode that focuses on iodine for a while. While I did release a Q&A episode where I chatted about food sources of iodine, this episode will go into greater detail, as I will share my personal experience with iodine, five reasons why people don’t do well with iodine supplementation, as well as testing for an iodine deficiency.
If I sounded a little conflicted about iodine, it’s because I am. I personally had a good experience with iodine, but over the years, I have been more cautious with it, especially from a supplementation standpoint. When you first start listening, you might think I absolutely love iodine, but later, you might get the impression that I am fearful of recommending iodine to my patients. The truth is that it’s somewhere in between. I’m not concerned about iodine in most food sources and multivitamin, and this is for both those with hyperthyroidism and Hashimoto’s. I usually don’t bring up iodine when initially consulting with someone, as my focus is on finding and removing triggers and correcting underlying imbalances. In most cases, testing for iodine is not a priority, let alone supplementing with iodine.
Here is my breathtaking presentation on iodine.
I’d like to begin by sharing my personal experience with iodine. When I was diagnosed with Graves’ in 2008, I supplemented with iodine. The reason I did so is because prior to being diagnosed with Graves’, I would take nutritional courses as part of my continuing education credits. I would go to nutritional seminars. Regardless of whether someone had hypothyroidism or hyperthyroidism, they would recommend taking iodine. I attended a lot of them, but Standard Process was one of the main ones I attended. I also attended one for Biotics Research with Dr. David Brownstein, who wrote a book, Iodine: Why You Need It, Why You Can’t Live Without It. I was definitely in favor of iodine.
I ended up taking a product called Prolamine Iodine by the company Standard Process. That’s where I gained a lot of my knowledge, is attending the Standard Process seminars for my CE credits.
I did really well supplementing with iodine. I can’t say I had problems taking iodine. Now, I didn’t only take iodine, of course. I also followed a healthy diet. I did things to manage stress. I took supplements and herbs. It wasn’t all about the iodine. As a result of my experience with iodine, I commonly would recommend iodine supplementation to my patients for years after my diagnosis and after restoring my health, once I started working with other people who had hyperthyroidism or hypothyroidism.
Initially, in practice, I commonly recommended iodine testing and supplementation. I didn’t just tell people to take iodine. In my practice, when I was recommending iodine regularly, most people I recommended it to seemed to tolerate it well, but there were exceptions. Due to some people’s negative experience with iodine, as well as attending other seminars and conferences over the years and realizing that there are some negative things about iodine in the research, my perspective on iodine has changed over the years. I’m not anti-iodine by any means, but I’m definitely more cautious with iodine.
Let’s talk about the research. Some studies show a higher incidence of thyroid autoimmunity with thyroid exposure. I think mostly Hashimoto’s, off the top of my head. I don’t think there are specific studies showing an increase in Graves’. Not because iodine can’t potentially do that, but because the research focused on Hashimoto’s. One could say, “Is this due to the iodine, or maybe some of these people had a deficiency in antioxidants such as selenium?” That’s worth mentioning. Selenium is very important if someone is taking iodine. It can help to minimize any negative effects.
That’s what I want to discuss next, a connection between selenium and thyroid autoimmunity. Hydrogen peroxide plays a role in the oxidation of iodide to iodine. Hydrogen peroxide is a source of free radicals, which in turn causes an increase in pro-inflammatory cytokines. Pro-inflammatory cytokines are a factor in autoimmune conditions.
Selenium is important for the formation of selenoproteins, which are powerful antioxidants. It’s not all about selenium. If you read Dr. Brownstein’s book—and I am not saying to follow his recommendations of taking high doses of iodine—some of the things he mentions are important and legit.
If you are going to supplement with iodine, you want to make sure you’re taking selenium. As far as dosing of selenium, I won’t give specific doses here. A common dose is 200mcg of selenomethionine. To say some people might not benefit from taking more. You need to be cautious about selenium toxicity. Vitamin C, magnesium, B vitamins also could be important when it comes to preventing problems for those supplementing with iodine.
If someone does take iodine, and I’m not telling someone to take it or not to take it, that’s not really the goal of this. The goal of this episode is to educate you and allow you to make an informed decision, not to tell you what necessarily to do. If you do choose to take iodine, at the very least, I would take selenium. You might want to consider Vitamin C, magnesium, and/or the B vitamins.
A question I sometimes get asked is would I have received the same results without supplementing with iodine? In other words, would I have gotten into remission if I didn’t supplement with iodine? As a reminder, iodine supplementation was only one component of my natural treatment protocol. It wasn’t only about iodine.
You also need to keep in mind that an iodine deficiency isn’t the reason why someone develops Graves’ or Hashimoto’s. If you read Dr. Brownstein’s book, you might get the impression that’s not the case, that iodine deficiency might be the reason why someone develops an autoimmune thyroid condition. Just remember, there is that triad of autoimmunity that I have mentioned before. One factor is a genetic predisposition. A second factor is exposure to one or more environmental triggers. A third factor is an increase in the intestinal permeability, a leaky gut.
We could argue that certain deficiencies might be a contributing factor, such as selenium. Selenium is important, and there is a lot of research out there about the benefits of selenium when it comes to thyroid autoimmunity. Even a selenium deficiency wouldn’t fall under those three factors. It could be classified as an underlying imbalance that makes someone more susceptible to developing Graves’.
Would iodine also fall under that category? If someone is deficient, would it make someone more susceptible? I don’t think so. Any mineral or nutrient deficiency overall isn’t a good thing. I can’t say that if someone is deficient in iodine, that’s going to make them more likely to develop Graves’ or Hashimoto’s. That’s just my opinion.
As a reminder, all mineral deficiencies need to be corrected, but in my opinion, an iodine deficiency isn’t a reason why someone develops those conditions or other autoimmune conditions.
Next, I want to discuss five reasons why some people have problems with iodine. One reason is because they don’t have an iodine deficiency. Someone might not do testing, or they might do a blood test. To be fair, blood testing is not the most accurate test. If someone is low on the blood test, they probably are deficient. The problem is a lot of times, people look good on a blood test, not just with iodine but with other minerals, and it’s not perfect, especially if someone just does serum testing. If someone does serum magnesium or selenium, it’s not the best test for ruling out deficiencies. But some people don’t do any testing. They take iodine anyway, and maybe they don’t have an iodine deficiency, so they run into problems.
The second reason is they are taking too large of a dose. When it comes to Dr. Brownstein’s book, I interviewed Dr. Brownstein for a blog post. I didn’t have a podcast back then. I was definitely in favor of iodine then. I’m not against iodine now. What I mean by “in favor then” is I was recommending iodine to pretty much everybody. It was very pro-iodine, the conversation. I emailed him questions, and he answered them, and I posted it on my blog. I didn’t have the podcast then. You might want to check that out.
The point here is that I don’t agree that everybody needs to take 50mg of iodine. I’m not even sure if Dr. Brownstein still agrees with that. I don’t know either way. I haven’t seen anything out there from Dr. Brownstein in a while. There is no updated book on iodine. That was the only version.
Mary Schulman, who has a lot of knowledge and a number of different books related to thyroid health, I believe she had a conversation with Dr. Brownstein. I could be wrong, but I think he admitted that there could be some problems with people with Hashimoto’s with large doses of iodine. I don’t think he was saying people shouldn’t take iodine; he wasn’t going against what he wrote in the book. Like I said, I haven’t seen him present. The only time in person I saw him present was when I attended that Biotics Research seminar years ago.
Arguably, if someone is taking too large of a dose. What is defined as too large of a dose of iodine? 50mg is definitely a large dose of iodine. Is it too large? For most people, I would say yes.
Again, there are some practitioners, and I don’t want to say old-school. I have been a practitioner now for over 20 years, but as far as focusing on thyroid health, it’s been since 2009, so 13/14 years. I’ll change my opinion if I don’t agree. I try to keep an open mind. I’m not saying other practitioners don’t. But there are practitioners who don’t. There are some people who don’t want to be proven wrong. They might have been recommending iodine for years and then realize maybe they shouldn’t, but may be in denial. There are some practitioners who would completely disagree with what I’m saying right now.
I’m not saying there is not a time and place for iodine supplementation. It might sound like I’m against iodine, but I’m talking about really high doses here. Arguably 12.5mg, which at least in the past is what Dr. Brownstein recommended as a maintenance dose of iodine, is too high. I’d love to get Dr. Brownstein on the podcast here.
A future interview will be with Dr. Jacob Teitelbaum, who has a wonderful book From Fatigue to Fantastic. We chatted on Facebook, which will be converted to a podcast episode after this episode is posted. It sounds like he is definitely pro-iodine. He actually brought up Dr. Brownstein and said they are friends. He mentioned Dr. Brownstein appearing on this episode. If he listens to this episode, I don’t know if he would want to. But I was fully on board with everything years ago. Now I am more cautious.
I am not against iodine by any means, but arguably, even taking 5mg per day is a lot of iodine. Some people would do fine. Some people won’t do fine. I am kind of rambling here.
The first two reasons why some people have problems with iodine is 1) they don’t have an iodine deficiency or 2) they are taking too large of a dose.
The third reason is they might have low levels of antioxidants such as selenium. I already covered this. That’s why people would want to consider taking selenium or Vitamin C for example, if they are supplementing with iodine.
A fourth reason why some people have problems with iodine is they don’t really have a problem with iodine itself, but they experience a detox reaction. Iodine competes with other halides, such as bromide for example, chlorine, fluoride. If you’re supplementing with iodine, your body is going to release some of these other halides. You might have more of a detox reaction. Someone might feel bad not because of the iodine but because they are getting rid of bromide from the body.
A fifth reason is because they react to another ingredient or contaminant in the supplements. It’s not necessarily the iodine itself, but maybe a filler, something not related to the iodine. We could argue and say that’s probably not the case most of the time, but something to consider.
Those are five common reasons (not the only reasons) why some people have problems when supplementing with iodine, or even eating larger amounts of iodine in food, which I’ll talk about shortly.
I’d like to talk about some of the benefits of iodine supplementation. Iodine is important for the production of thyroid hormone. Larger amounts of iodine can have antithyroid effects. If someone is deficient in iodine, they either need to make sure they’re eating enough food that has iodine or taking supplementation.
Too little iodine can cause problems, as one of its main roles when it comes to thyroid health is producing thyroid hormone. It sounds weird saying that if someone takes larger amounts of iodine, it could have antithyroid effects. It could cause problems like hyperthyroidism if you take too much iodine. There are people with hyperthyroidism/Graves, and that includes myself when I dealt with Graves’.
I didn’t mention the dosage. Back then, Prolamine Iodine was 3mg. Now they have changed it, so I think it’s 600mcg these days. I started slowly with one tablet, and every week, I increased it to one tablet. Eventually, I was taking three tablets three times a day, which was 27mg back then.
That was the case with me. I started out by taking bugleweed. When I was taking bugleweed, I wasn’t taking iodine. I knew that bugleweed was working. Then I took motherwort. Then I eventually introduced iodine. It was also helping. It was pushing things a little bit more toward the hypo side, which is common. Doesn’t work that way with everybody.
I mentioned that iodine can also help with the detoxification of halides, so that is another potential benefit of supplementing with iodine.
Also, iodine has antimicrobial properties. That’s why when someone has a cut, they might apply iodine in liquid form to the cut. Iodine also taken in oral form can have antimicrobial properties.
Iodine can also prevent damage from radiation exposure. You can always keep some iodine on hand just in case we have a nuclear meltdown or something like that. Iodine in that case would be in high demand.
I’m not telling people to run out and supplement with iodine, but I wanted to, besides giving some of the problems with iodine, also give some of the benefits of iodine supplementation. I’ve had patients who had a goiter, and iodine decreased the goiter when they supplemented with it. In some cases, it could also increase the goiter. There can be good and bad. There might be some people listening who were thinking they felt great, or their goiter decreased. Goiter is a swelling of the thyroid gland. It’s not something that works for everybody. If someone for example has thyroid eye disease, I have seen people supplement with iodine, and it gets worse. It’s hard to know who will do well and who won’t do well.
Let’s talk more about some of the risks, specifically with iodine supplementation. Risk #1 is large doses of iodine potentially can be an autoimmune trigger. Again, the research shows that large amounts of iodine can be problematic and at least potentially cause Hashimoto’s and arguably also Graves’, but the research doesn’t show that. I have seen people have issues with the antibodies spiking up after supplementing with iodine. If it’s not causing thyroid autoimmunity, we could say maybe it’s exacerbating thyroid autoimmunity. Maybe it’s not a true trigger, but the straw that broke the camel’s back.
Also, large doses of iodine can induce hypothyroidism. Even though someone is deficient in iodine, that can cause hypothyroidism. Also, large amounts of iodine can induce hypothyroidism. That’s not always a bad thing. If someone is taking it for the purpose of lowering thyroid hormone levels, obviously that would be good. That’s why they’re taking it in the first place. It doesn’t always work that way. For some people, it works the opposite.
Large doses of iodine can induce hyperthyroidism. You just never know how someone is going to respond with iodine.
Different forms of iodine supplements:
- There is Lugol’s iodine.
- Ioderal, which is what Dr. Brownstein recommended. It’s a form of potassium iodide.
- There is nascent iodine.
- Prolamine iodine is what I took.
- There is one called Tri-Iodine.
I am not going to get into detail when it comes to different iodine supplements. Personally, I’ve had experience with Prolamine Iodine. The Ioderal is something I have taken in the past. I’ve heard some really good things about nascent iodine. Tri-Iodine, I have heard some things about.
I am not recommending taking this. I know I keep on saying that. I just want people to realize I am not completely against iodine, but I am also not recommending for people to run out and take iodine. I’m just trying to be somewhat comprehensive here.
Testing for an iodine deficiency. From what I have experienced and researched; urinary testing is the most accurate method. There are different types. There is an iodine loading test. That’s the test I did when I had Graves’. That is controversial because it involves taking a 50mg tablet of potassium iodide, collecting your urine over the next 24 hours, and measuring the excretion of iodine. If you have 90% excretion or more, that means your body doesn’t need it. That’s what you’re looking for. If someone has 50% excretion, that means they’re retaining a lot of the iodine, and that is supposed to mean the person has a deficiency.
There is controversy over this. Some will say this test is not valid. There are also some risks with taking the potassium iodide dose, especially if someone has never been supplemented with iodine before. It’s a risky test.
There is an iodine spot test. This does not involve supplementing with large doses of iodine prior to doing the collection. It’s a single urine collection. It’s not the best test. If someone does it and gets a low, they are probably low. If they are looking good, it might be a false negative.
If I recommend this test, I recommend testing for the halides, especially bromide. If someone is high in bromide, that competes with iodine, so that might mean someone has an iodine deficiency, even if the iodine is looking good. I would always consult with a health care practitioner. I wouldn’t do this test and make any assumptions on your own.
I mentioned blood testing earlier, which I don’t find to be accurate.
There is also a marker, thyroid globulin. Some might be familiar with thyroid globulin antibodies. Thyroid globulin is essentially part of the thyroid gland. If someone has elevated thyroid globulin levels, not the antibodies, as those are the antibodies associated with Hashimoto’s. But just the elevated thyroid globulin could be associated with elevated thyroid globulin antibodies.
Let’s say someone has negative thyroid globulin antibodies but elevated thyroid globulin. That could be due to an iodine deficiency. Arguably, it’s the most common cause, according to the research. It could also be thyroid cancer, so you want to be cautious about that. Not likely, but just something to think about.
The iodine patch test, where you are rubbing iodine on your skin. Ideally, after 24 hours, it should still be there if someone is not deficient. It disappears relatively quickly to almost everybody. Not the most accurate test. I used to do the iodine patch test.
These days, I don’t do a lot of iodine testing period. If I were to recommend iodine testing, it would be the iodine spot test, and then the iodine loading test. It’s something I am cautious about. The iodine patch test is not something I recommend.
Blood testing, some people do it on their own. If someone does a blood test on their own and are showing up as low, it’s not like I immediately supplement with iodine. It very well might mean that someone has an iodine deficiency.
Another question you might have: Are there concerns with food sources of iodine? I do have a separate Q&A episode on my podcast on this topic. I won’t get into great detail here.
For most people, food sources of iodine are not a concern. This includes most people with thyroid and autoimmune thyroid conditions. Now, there might be a concern with really high doses, like really high food sources of iodine, including sea vegetables, especially kelp. I’m not saying it’s going to be a problem for everybody if someone eats seaweed, kelp, or other sea vegetables. That’s where you might run into trouble. Just remember, everyone is different. Someone might do better with a lower daily iodine intake. Just something to keep in mind.
That is really what I want to discuss. Why don’t I give a summary here? Iodine without question is very controversial in the world of thyroid health. Not everyone has a negative reaction to iodine supplementation, but some people don’t do well. There are different reasons why some people don’t do well with iodine. Everything comes down to risk versus benefits.
As far as testing for iodine, if you are going to do it, I will recommend urine. Some people do it through the blood. I didn’t mention hair tests. There are some, but I definitely don’t rely on hair testing for iodine. I do hair mineral analysis testing in my practice, but the company I use does not test for iodine. I would not rely on hair testing for iodine.
When it comes to food sources of iodine, just eat regular food sources, like eggs. If someone is following AIP, they are avoiding eggs. If someone is paleo, they are eating eggs, which have iodine. I am not too concerned about the iodine in eggs.
I also mentioned how all minerals are important. Any mineral deficiency needs to be corrected eventually. I am very cautious about iodine. If someone is deficient, I still wouldn’t say jump into the iodine supplementation. You would eventually want to correct it.
Even though it may sound like I’m more negative when it comes to iodine, there are definitely practitioners who would really avoid all sources of iodine. Some will say between supplements and food, make sure you are getting 200mcg or less of iodine per day. I’m not saying there are some people who don’t fall into that category, which is why you have to listen to your body. I would say that’s not the case for most people.
One example I will give is multivitamin. If I recommend a multivitamin, I am not usually recommending an iodine-free multivitamin. I don’t usually see problems with iodine in multivitamins. Usually there is anywhere between 75-150mcg of iodine. One could say, “If I’m eating food sources of iodine, then maybe that’s a problem.” Again, I can’t say I see a problem in most people. But if someone’s thyroid numbers aren’t improving, and their antibodies aren’t improving, then maybe try to make sure that all sources of iodine between food and supplements is 200mcg or below. I don’t see that with most people.
One other thing I’ll add is that if someone has hyperthyroidism or Hashimoto’s, and they are thinking about getting pregnant, you definitely want to take a pre-natal. I don’t know of any pre-natals that don’t have iodine. The reason Is because it’s important for the brain development of the developing fetus. Everything is risk versus benefit. Honestly, even if my wife had Hashimoto’s, which she doesn’t, and if she were pregnant, and if there was risk of iodine causing problems with the Hashimoto’s, it would be a tough situation. I would want to make sure the baby gets enough iodine.
I definitely don’t recommend for women who are pregnant and who have Graves’ or Hashimoto’s to completely avoid iodine. I’m not saying to supplement with iodine separately, but I am saying to take a pre-natal with iodine for the purpose I just mentioned.
That is all I want to discuss with regards to iodine. As usual, I hope you learned a lot. I hope you’re not repelled by iodine, but I also hope that you’re not ready to run out and take large doses of iodine. Like I said, I am more in favor of iodine overall. I am not against it. I am very cautious because over the years, I have seen a number of people not do well.
As I mentioned, in my first few years of practice, I was having everybody test for an iodine deficiency. If deficient, which most people tested to be, I would have them supplement with iodine. A lot of those people did okay, but some of them didn’t. Even if it’s 5-10% who don’t do well, that’s not super small. Definitely wasn’t rare for me to see people not do well with iodine, which is why I don’t take the same approach today.
That’s all I’ll say here. Maybe I’ll do another episode. It would be great for me to interview someone like Dr. Brownstein or even someone else with a different perspective who is against iodine, or maybe has both perspectives. Maybe some of the things I said were negative about iodine, someone for iodine may be able to give me a good explanation. Someone who is against iodine could talk about why. It’s always good to get different perspectives. I always try to keep an open mind. Obviously, we all have our own biases. It’s nice to get different perspectives. I don’t always agree with everyone who I interview, for example. But if I don’t agree with someone, a lot of times in the post-episode chat, I will give my opinion and expand on what I agree on or not.
For real, I am going to end this now. Hope you found this episode to be extremely valuable. As usual, I look forward to catching you in the next episode.