Conquering Type 2 diabetes: Exercise and Supplements

Over the last 2 blogs we have discussed how you can manipulate diet and lifestyle to help prevent or reverse Type 2 diabetes.  The reason hose two blogs came first is because that is where most of your efforts should lie.  Unfortunately, mot people first look to supplements and exercise to beat Type 2 diabetes and this is a mistake.  It is simply not possible to reverse the damage from an inappropriate diet and lifestyle with exercise and supplements no matter what your condition is, especially Type 2 diabetes.  The sooner people realize this, the sooner they can attain optimal health, wellbeing, and an ideal physique.  However, this does not mean exercise and supplements are of no value.  In fact, once you get the other two factors in line, exercise and supplements can be a good way to have a little more flexibility in your diet and help mitigate the damage you can cause if you go nuts on the weekend.  Let's take a look at the research.

Exercise for Type 2 diabetes

I have written extensively on this blog about the different muscle types and how they help ictate what a person with Type 2 diabetes should do for exercise.  Rather than hash out all of the research again, you can find the article that cite all of the references here and here.  Now, let's just get the crib notes version of all of that.

You have two major types of muscle fibers, Type I and Type II.  Type II fibers can be further broken down in to Type IIa and Type IIx fibers.  See the chart below of the characteristics of each fiber type.  Please note that IIx and IIb are used interchangeably to denote the fastest twitch muscle fibers so on this chart the IIx fibers are referred to as IIb fibers.

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Taken from http://general.utpb.edu/fac/eldridge_j/kine3350/chapte19n.jpg

The important thing to realize about these muscle fiber types is that the IIa and IIx fibers can more or less convert to one another depending on training status.  When a person begins exercising, over time the IIx fibers convert to IIa fibers while Type I fibers just increase their fat storing ability.  When a person stops exercising, eventually the IIa fibers convert back to IIx fibers.  This is important for Type 2 diabetes because people prone to Type 2 diabetes have a higher proportion of Type II muscle fibers.  People with Type 2 diabetes have a very high percentage of IIx fibers.  It is easy to see that the higher proportion of IIx fibers is obviously a result of not partaking in regular exercise.

As a long term adaptation to exercise, muscle fibers begin to store more energy in the form of glucose and fat.  Type I fibers use primarily fat to recharge their energy stores while the Type II fiber types tend to store more glucose, or glycogen.  Type IIx fibers store less glycogen than IIa fibers and as an adaptation to continued exercise, they begin to increase glycogen stores and convert to IIa fibers.  This has a couple of positive benefits with regard to blood glucose control.  First, by actively using the glycogen stored within the muscle, the muscle is able to take in more glucose when you eat carbohydrates and store it as glycogen.  In addition, this increases the amount of glycogen the muscle fiber can store, giving you more leeway when you decide to consume excessive carbohydrates before they begin turning to fat or accumulating in your bloodstream.

In order to get the Type IIx fibers to convert to IIa fibers, you need to activate them.  Type II fiber types are activated during high force movements such as lifting weights or performing the explosive movements common in most sports.  They are not typically activated by activities that are long and slow in duration, these activities recruit primarily Type I muscle fibers.  In addition, you want to use a full range of motion in whatever activity you are doing or you won't activate all of the muscle fibers from the muscle group you are using.  Unfortunately, most people begin jogging or biking in an attempt to help combat Type 2 diabetes.  This is a mistake because most people do not do them at an intensity sufficient to activate the Type II muscle fiber types, few people use a full range of motion when they run, and running and biking do little for the upper body.

The best bang for your buck to beat Type 2 diabetes exercise-wise is to either play a sport or strength train.  Any sport will do provided it is not an endurance event such as high mileage running or biking,  You could even do short sprints which I highly recommend provided you are doing something for your upper body as well.  My personal preference is strength training because you can do it in 30 minutes and you can get away with only doing it twice a week if you lift heavy enough weights.  You will want to work mostly compound movements such as lunges, pull ups, push ups/bench press, shoulder press, rows, and deadlifts.  Technique is important so using an experienced strength coach or personal trainer is a good idea.  In my experience, sticking to 3 sets of 12 reps for the first month to break yourself in and gradually working towards 3 sets or 4-8 reps per exercise is the best exercise option for fighting Type 2 diabetes.

Supplements for Type 2 diabetes

There are a few supplements that are beneficial for people with Type 2 diabetes.  These include:

Magnesium

Magnesium is critically important for proper blood glucose control.  Not only is it necessary for insulin secretion, it's also necessary for glucose to move from your blood in to cells once insulin has attached to the cell to let glucose in.  For a thorough discussion on magnesium, click here.  The problem with supplementing magnesium is that you want a type of magnesium that is time released so that it doesn't cause loose stool.  Magnesium oxide, the form of magnesium most typically found in supplements is poorly absorbed and normally causes loose stool.  I personally use Jigsaw Magnesium w/SRT but you can also use any brand of magnesium glycinate or citrate.

You want approximately 420mg or elemental magnesium a day as a maintenance dose.  If you are deficient in magnesium, as most people are(Especially people with Type 2 diabetes), you may need much more to become sufficient in magnesium.  You can request an RBC magnesium test from an integrative medicine doctor to determine if you have adequate magnesium levels.  In addition, if you have low stomach acid, gut dysbiosis, or leaky gut you may want to try transdermal magnesium in the form of magnesium oil or epsom salt baths as you will have problems absorbing it.  Since magnesium is water soluble, excess magnesium is simply excreted in the urine.  If you have kidney issues you should speak with your doctor before beginning magnesium supplementation.  I do not have kidney problems and have gone as high as 1500mg per day between oral (800mg) and transdermal(700mg) for a month with no issue.  However, the oil burns and you may need to dilute it with distilled water before applying.  If you have problems sleeping, this is your go to supplement.

Iodine

There is some epidemiological evidence that Type 2 diabetics take in too little iodine(1) and people with Type 2 diabetes are at an increased risk for hypothyroidism(2).  This data is certainly not a scorching endorsement for iodine in Type 2 diabetes, but in my opinion most people who don't eat sea vegetables, or ample amounts of fish are probably deficient in iodine.  In addition, high consumption of goitrogenic foods such as the cruciferous vegetables(Broccoli, spinach, cauliflower, kale) and using refined sea salt instead of iodized salt also make you more likely to be deficient in iodine.  In the body, iodine is used to make thyroid hormones which regulate metabolism in every cell.  If you are not sure if you are deficient in iodine, there is a test called the 24 hour iodine loading test which can show you whether or not you need to supplement with iodine.  For more information on supplementing with iodine, click here.

Resistant starch

Resistant starch is a hot topic in the Paleo community.  Like soluble fiber, resistant starch is fermented in to short chain fatty acids in your large intestine which are used to heal gut damage.  Studies have shown resistant starch to lower blood glucose and impove insulin sensitivity in healthy subjects (3,4,5,6) and subjects with Type 2 diabetes(7,8).  The structure of resistant starch prevents it from being digested in the small intestine, allowing it to make it to the large intestine where it can feed good bacteria that help improve blood glucose regulation(For more on how this works click here).  There are supplements that contain resistant starch such as Hi-maize corn starch, but the most readily available form of resistant starch is unmodified potato starch which contains 7.8g of resistant starch per tbsp.  You can use it as a thickener in shakes or put it in water and drink it.  Just be sure not to heat it as heating it changes the starch in to a more digestible form.  Two tbsp per day seems to be a sufficient dose, but once you improve your gut function and blood glucose control you only really need to use it as damage control when you decide to go nuts and eat crazy.  It is best to start with a lower dose and spread it out throughout the day to prevent gas.  I have a future blog post planned on resistant starch that will go in to more detail as there is a ton of research on it.

Conclusion

So there you have it.  Over the last 3 blogs we've gone over everything you need to know about diet, lifestyle, exercise, and supplements to prevent or reverse Type 2 diabetes.  For the vast majority of people with insulin resistance or full blown Type 2 diabetes, this is more than enough to fix blood glucose control and prevent the damage caused by elevated glucose levels.  If you have done sufficient damage to your pancreas you may be dependent on some level of insulin injections for life, but this protocol will allow you to minimize the amount of insulin you need to inject and live a happier, healthier life.

Soy protein: A case study

I work with many clients to help them get healthy and to learn what food is best for them personally.  Below is a case study from a client I have been working with for 2 years who wanted to try a cleanse-stye diet that included soy protein shakes.

Client history:

Client began working with me in May 2011.  She was 54 years old and had hip and knee pain whenever she sat for any period of time and did not sleep very well.  Her energy level was also pretty low and she noted feeling "blah".  I recommended the client adopt a paleo diet and instructed the client on foam rolling, stretching, and activation of the appropriate muscles.  We began strength training 2 times a week for 30 minutes a week on top of the foam rolling/stretching/activation program.  Within the first month, her pain was gone and energy levels improved.  She also noted an improvement in her mood and happiness.

Other relevant history:

Client complained of poor sleep and leg cramps while sleeping in late 2012.  I discussed the research on magnesium and she began supplementing with Jigsaw Magnesium w/SRT.  Sleep improved and leg cramps went away.


6/3/2012
Client inquired about trying a 3 week cleanse that included soy protein shakes 3 times a day for 1 week, 2 times per day for the next week, and 1 time a day for the last week.  I discussed the issues with the proteins in grains, legumes, and dairy and how soy protein would be a concentrated form that could have deleterious effects, but that they would not be major and going off the soy protein would eliminate any issues.

6/13/2013
Client entered our session and stated that she started having intense hip pain whenever she sat or was supine for any period of time.  It was affecting her sleep and she had to take 2 advil to fall asleep.  I asked her when this started and she stated that it started 6 days ago.  I asked her if she started taking the soy protein shakes and she said she had been taking 2 per day for a week.  I asked her if she had experienced any GI distress at any point and she stated that she felt burning in her gut for the first couple of days but it went away.  I asked her if she had consumed the shake yet today and she said yes.  I told her to cease the soy protein shakes and we decided to continue the cleanse with egg protein as she has never had any issue with egg protein.  I followed up with the client by text message the next morning and, when asked if removing the soy helped, she replied, "Amazingly. yes.  I had minimal discomfort last night."  She stated that the discomfort had improved by about 70% that night and 95% within a couple of days.  She said she was surprised it was the protein and that she was only humoring me by stopping it.

Discussion:

It has been my opinion for some time that most people have a dosage of offending proteins their digestive tract can tolerate before they begin to cause problems, particularly autoimmune issues and GI distress.  With processed foods it is very easy to meet most people's tolerance level of the storage proteins in grains and legumes, and the casein in dairy because processed foods are loaded with soy and wheat.  These foods in their natural, unprocessed form either have protective aspects such as fiber that help mitigate the damage the proteins cause or, in the case of milk, the protein (Casein) is not altered in a way that makes it more damaging via pasteurization.  In a concentrated supplement, these proteins seem to be not tolerated well in some people.  In discussions with other clients, I believe any legume source of protein will tend to cause problems, particularly pea protein.  In this instance it appears the soy protein probably triggered some form of autoimmune reaction after a couple of days of shakes at a dosage of 2 times per day.  There is a potential confounder in this analysis as the shake she consumed also contained potassium iodide at an unknown dosage.  Arthritic hip pain has been implicated as a bromide detox symptom and supplementation with potassium iodide has been shown to increase bromide excretion via the urine.  I believe the dosage to be in the 400-600mcg range based on the ingredient list which would provide around 300-500mcg of iodide.  In my experience with iodine, this option cannot be discounted in this case nor can soy's action as a goitrogen.

Conquering Type 2 Diabetes: Lifestyle

When trying to overcome Type 2 diabetes, lifestyle modification trumps medicine most of the time.  If you have done so much damage that there are not enough beta cells in your pancreas to make insulin you may be dependent on insulin for life, but you can still limit the amount of insulin you need via lifestyle modification.  In the previous blog on diet we went over why you should avoid processed foods and eat plenty of fruits and vegetables to help promote good gut bacteria and a healthy intestinal lining.  In this blog we will cover other lifestyle factors that impact blood glucose control.  These factors can be broken down in to three primary categories: Sleep, physical activity, and stress management.

Sleep

Sleep is incredibly important for human health and insufficient sleep duration and/or quality can have a major impact on your health.  A study published in 2013 found that insufficient sleep affected the expression of 711 genes that help modulate the stress response, immune system, and metabolism(1).  The study found that 1 week of sleep restriction of slightly less than 6 hours per night lead to a host of problems at the genetic level including increased oxidative stress, altered circadian rhythm, and altered energy metabolism, three hallmarks of many of the chronic diseases we see today including Type 2 diabetes.  This study is a fairly good representation of the sleep habits of many Americans as a good chunk of the population gets less than 6 hours per night(2).  Other studies have found that restricted sleep lead to changes in glucose regulation, insulin sensitivity, and leptin sensitivity(3, 4).  These changes begin to occur in as little as 2 nights of restricted sleep and a single night of no sleep(Hear that night shifters?).  Typically, the progression of Type 2 diabetes begins with leptin resistance followed by insulin resistance.  Over time, blood glucose regulation becomes permanently affected and Type 2 diabetes ensues.  The research on sleep and Type 2 diabetes is pretty much settled at this point, not getting good quality sleep for 8 hours dramatically increases your risk for Type 2 diabetes(4).

Physical Activity

When most people think of physical activity they think of exercise.  This is a mistake, because an hour of exercise per day cannot make up for prolonged sedentary time in helping prevent Type 2 diabetes and the metabolic syndrome(5, 6, 7).  Even just breaking up prolonged periods of sitting with 2 minutes of physical activity every 20 minutes helps improve glucose metabolism(8).  Most of the data points to spending as little time per day sitting being more important than exercising.  Certainly exercise is also important, but try standing more throughout the day first.

Next, walking more throughout the day is also something that is very beneficial in preventing and reversing Type 2 diabetes.  Aside from the benefits of not being sedentary, taking a 15 minute walk after each meal has been shown to decrease the risk of Type 2 diabetes(9).  Furthermore, people who maintain their daily step count over 5 years have been shown to maintain their insulin sensitivity better than people whose daily step count decreased over that time(10).  A good goal to shoot for and the recommendation by the American Heart Association is 10,000 steps per day.  The average American tends to get about 6600, quite a bit lower than the recommended number.  Just taking a 15 minute walk after each meal will give you 4500 steps, so it's not that difficult to accomplish.

Stress

Physical inactivity can also lead to changes in the brain that can modulate the stress response in a negative way(11).  In addition, sleep restriction can cause an overactive stress response(1).  To complete the circle, sleep restriction in the face of physical inactivity has been shown to negatively impact insulin sensitivity and blood glucose regulation(12).  All three of the factors we have discussed today are interrelated when it comes to the risk of Type 2 diabetes.  While it may be easy to put yourself to bed early or make sure you get enough daily steps in, managing stress is a completely different ballgame. Fortunately, doing the other two usually helps with the third.

It's very easy to see the importance of the stress response when it comes to physical stress.  When you are out in the jungle and about to become a lion's lunch, the stress response springs in to action to partition your resources for fight or flight.  This puts all non-essential processes on hold and floods the body with stress hormones.  The stress response begins and ends in the hypothalamus.  In what is basically a game of hormonal telephone, the hypothalamus tells the pituitary gland to tell the adrenal glands to make stress hormones.  These hormones help mobilize energy, particularly glucose, to provide the body with fast acting energy.  Over time, these hormones act on the hypothalamus and tell it to cools it's jets.  Obviously mobilizing energy is key to fighting or fleeing, the problem is that there is a direct line from the amygdala to the hypothalamus and that can turn on the stress response in the face of a perceived threat.

The amygdala is the emotional center of the brain.  Under the proper circumstances, the amygdala can tell the hypothalamus to initiate the stress response.  The problem is that in today's society, there are so many psychological stressors that can initiate the stress response.  How am I going to pay the mortgage?  What if my wife divorces me?  I have a big deadline that I need to make.  Any sort of situation that we deem as stressful has the potential to initiate the stress response.  The problem is, what do you need energy for to flee an emotional stressor?  Furthermore, can you ever really flee an emotional stressor?  Even if you do, there is typically another one right behind it.  As these stress hormones and glucose enter your bloodstream, there really is no need for them because it's not energy that you need.  What you need is to stop processing this information through your amygdala.  This is the goal of mindfulness.

The reason you have been hearing so much about mindfulness and mindfulness meditation is because mindfulness is a way to alter your thought processing so that you avoid generating an emotional response to psychological stress.  Many companies have begun mindfulness meditation programs as a way to help reduce stress for their employees and top executives tout it's benefits in helping them deal with stress.  How does this relate to Type 2 diabetes?  People with Type 2 diabetes have increased sympathetic nervous system activity(13).  This basically means that their stress response is activated more often and more easily than a normal person.  This flood of stress hormones and blood glucose is not good when it isn't needed.  Just to get a firm grasp on how important the stress response is in Type 2 diabetes, one of the ways that the stress response increases blood glucose is by causing the liver to produce more of it.  One of the primary pharmaceuticals used in Type 2 diabetes is metformin and it's mode of action is...It causes the liver to make less glucose.

Developing good stress management tools is key to helping prevent or reverse Type 2 diabetes.  Mindfulness is probably the best tool out there and can provide a one-two punch combined with proper sleep to help manage stress and help prevent or reverse Type 2 diabetes.  Add in a little physical activity to make you tired, and you have a pretty good jump start on living a healthier, Type 2 diabetes-free life.

Conclusion

There is tons of research on the aspects of lifestyle that will negatively impact blood glucose regulation and increase your risk for Type 2 diabetes.  Getting enough sleep, partaking in  regular physical activity, and managing stress are all important in preventing Type 2 diabetes as well as managing your blood glucose if you have it.  Making an effort to get 8 hours of sleep every night, getting at least 10,000 steps a day, spending as little time as possible being seated/sedentary, and utilizing stress management strategies such as yoga and practicing mindfulness should be on your to-do list if you want to live a long, healthy, happy life free of Type 2 diabetes.

Part 1-Overview
Part 2-Diet

Science-based life protocols: The Monday after weekend dietary blow outs

Going forward I would like to share some of the protocols I use to keep healthy and lean in a blog series called "Science-based life protocols".  I'm not going to have references to anywhere other than this blog so if you want to know more about the "why" behind the recommendation I will send you to different areas of this site and if you don't care you can just take the advice or leave it.  In this first blog I am going to cover what you should do exercise-wise after a weekend of eating like a lunatic.

Is this what your Mondays look like post-workout?

 

Taken from: http://321delish.files.wordpress.com/2012/01/img_08811.jpg

If you are like most people you have your fair share of dietary hedonism on the weekends, especially during the summer and the month of good weather leading up to it.  The typical response for the vast majority of those looking to get in shape is to blow themselves out with a hellacious workout on the Monday following that weekend.  Of the things you could do, this is probably one of the worst.  Let's examine some reasons why.

1)If alcohol was involved, your sleep was definitely affected.

During the weekends, I indulge in some fermented liquid grains.  While it is my intention to keep that consumption as early in the day as possible to prevent it from negatively impacting my sleep, that doesn't always happen.  Alcohol consumption tends to have a significant negative impact on sleep which in turn has a negative impact on insulin sensitivity.  Sure, you may pass out pretty easily, but the sleep you get for the rest of the night is far from high quality.  Going in to a Monday with poor sleep 2 out of 3 nights makes it a less than ideal day for a blow out workout.  In your head you are thinking you will work off all of the damage, but in reality you are doing more.

2)Give your gut a chance to heal

As I've discussed many times, damage to the gut lining is a significant problem if you want to lose fat because it can induce insulin resistance.  This causes a shift where your immune system imposes insulin resistance on your muscles and fat tissue to conserve glucose to fight foreign invaders.  This is beneficial and allows your immune system to work harder and faster to rid your body of an infectious agent.  When your muscles and fat tissue are insulin resistant, excess glucose is more likely to be converted to fat.  The problem is that despite being insulin resistant, this doesn't mean your muscle tissue cannot use glucose.  Insulin is used to store glucose in muscles during inactivity by increasing glucose transporters, but when you are active this same march of glucose transporters still happens, it just doesn't require insulin.  The more intense an activity the more glucose your muscles use.  As a result, glucose is being diverted to muscles and away from the cells of the immune system.  This could lengthen the amount of time it takes to re-establish proper blood glucose control and will certainly negatively impact your ability to burn fat.

3)Partition your resources wisely

In his book The Biology of Belief, Dr. Bruce Lipton takes a unique look at the differences between the immune system and the stress response system, aka the HPA axis.  According to Dr. Lipton, what it all comes down to is that the immune system is responsible for fighting stresses that are inside the body while the HPA axis or stress response is responsible for preparing the body to fight stresses outside the body.  The autonomic nervous system is responsible for partitioning your resources to the more pressing need and has 2 modes; rest/digest and fight or flight.  Under resting conditions the immune system gets most of the resources, but once you begin physical activity, especially intense physical activity, your resources are partitioned more toward the stress response while the immune system is put on hold.  In the same way that performing intense physical activity steals glucose away from the immune system, it also partitions your resources away from healing any damage you did over the weekend.  This is obviously not an ideal situation, and once you finish the intense physical activity you have have to go back to fighting the infection AND repairing the body from the damage of that physical effort.

Conclusion

We all like to have our fun on the weekends and throwing caution to the wind diet-wise is often a common occurrence.  What's the point in working your butt off all week just to sit inside and not enjoy yourself on the weekend?  If you do decide to kick your heals up and eat foods that are not in your best interest health-wise, it is also important to make wise decisions on what you should do on Monday.  Rather than beat yourself in to the ground with a crazy workout, why not go for a walk to burn off some of the fat and let the immune system have access to most of the glucose?  This will allow you to work some of the fat off AND heal from any gut damage you incurred over the weekend.

Conquering Type 2 Diabetes: Diet

In the first blog in this series we went over the basic outline for this series.  In this first part of the series we discuss dietary changes.  Most of the books that deal with treating Type 2 diabetes with diet tend to recommend eating basically the same types of food but in smaller quantities.  I don't mean that these books don't recommend changes, they do.  What I mean is that rather than regular bread they tell you to eat whole grain bread.  Rather than white rice they tell you to eat brown rice.  Rather than white pasta you should eat whole grain pasta.  The problem is, there really is no significant difference between any of these switches.  While they may have a minor effect on your blood glucose level, they really aren't getting at the problem.  When you are looking to repair your metabolism you need to look at food from a completely different perspective.  Not only do you need to be concerned with he sustenance you are providing to yourself, you need to look at how what you eat affects the inhabitants of your gut.  I am talking about the gut bacteria that make up your gut microbiota.

Research in to the microbiota

Clinical research tends to go in waves and currently clinical research seems to be swarming in on an area of research that was once thought to be the ramblings of charlatans and quacks.  Ten years ago you could fit all of the research studies on gut dysbiosis and gut bacteria in to a small binder, now there are thousands of ongoing research projects every year discovering more and more about the link between the inhabitants of our gut and health conditions ranging from autism to Type 2 diabetes.  There is a very strong link between Type 2 diabetes and the inhabitants of your gut.  It's so strong that within a few days of having gastric bypass surgery, patients' blood glucose control normalizes and this effect is thought to partially mediated by a rapid change in the gut microbiota(1).  Since this area of research is in it's infancy, there are certainly no hard rules written in stone but we can see some trends

How a leaky gut contributes to Type 2 Diabetes

I have discussed the relationship between a leaky gut and Type 2 diabetes multiple times on this blog.  Rather than rehash it all, you can go here to see the pathology behind how a leaky gut contributes to Type 2 diabetes.  When your intestinal barrier is compromised, LPS leaks in to the bloodstream and causes insulin resistance.  In addition, sometimes overeating certain types of foods can cause pathogenic bacteria who have LPS as a part of their plasma membrane to overgrow in the gut.  LPS shouldn't be in the bloodstream so it is up to your immune system to take care of the invader.  In the meantime, repairing the gut lining will close off the supply of LPS and take some of the burden off of the immune system.  The best way to repair the gut lining is to commission some of your friends in the microbiota to do the job, a group of friends called bifidobacteria.

Bifidobacteria are a species of bacteria in your gut that provide quite a service to you.  In exchange for a little bit of fiber, they ferment that fiber in to a short chained fatty acid called butyric acid(2).  Butyric acid is used by the cells of your intestines to heal damage to the gut lining.  While most people look to take probiotics to re-inoculate their gut, your best bet is to provide prebiotics.  Probiotics are the actual strains of bacteria while prebiotics are the substrate these bacteria ferment, aka their food.  Whether or not the probiotics make it through the acidic contents of the stomach is up for debate while the prebiotics are indigestible by humans so they most certainly do.  In addition, just dumping strains of bacteria will do nothing if they don't have food.  Not only will they not survive and just be flushed out in your feces, they'll have no way of making butyric acid and, therefore, no way of healing your gut lining.

The best dietary approach to healing your gut

Healing your gut is an important step in conquering Type 2 diabetes.  Most people go on a very low carbohydrate diet which can yield some results, but this is normally an indirect relationship.    When most people reduce carbohydrates, they accomplish this by eliminating processed foods.  Processed foods are typically high in sugar or other refined carbohydrates.  I would even consider whole grain breads, cereals and pastas in this group because the limited fiber content in the whole grain varieties don't even come close to making up for everything else that's in them.  Your goal should be to eliminate all processed foods for a couple of months and to eat lots of plants in the form of fruits and vegetables.  This will provide lots of fiber for the good bacteria to ferment and heal your gut while at the same time eliminating the sugar that tends to feed the bad bacteria.  This is by far the best and fastest way to turn the ship around with Type 2 diabetes and re-establish proper blood glucose regulation.

Even if you decide that this approach is too extreme, you should increase the amount of vegetables you eat and limit processed foods as much as possible.  Look at your gut as a battle ground with two opposing sides waging war.  On the one side you have the troops who are helping you by manufacturing nutrients and repairing your gut lining and on the other you have the troops who are trying to wreak havoc in your digestive tract and trying to gain access to your bloodstream.  You want to provide more reinforcements/food to the good guys so that they can win the war and help maintain your health and avoid Type 2 diabetes.

Is this change for life? 

While avoiding processed foods is a good practice, once you fix a leaky gut and restore a proper balance of good bacteria in your gut you should be able to indulge in some processed foods provided you are also getting gut healing veggies in as well.  There is probably a tolerable dose of processed foods you can get away with eating that won't immediately impair your blood glucose control and return you to the land of Type 2 diabetes.  This dose is probably specific to the individual and will depend on how robust your immune system is, how good your digestion is, and on your age as it affects the other factors.  There is also a genetic component as well.

Conclusion

In the war against Type 2 diabetes, you should focus on what goes in to your mouth as reinforcements for the battle.  If you focus on providing more reinforcements to the bacteria that provide a benefit to you and less to the bacteria that can cause problems, you should be able to win the war.  Once you fix your gut lining and establish a good balance of good bacteria that is beneficial to you, you may be able to indulge in foods that previously threw your blood glucose out of whack provided you maintain a constant supply of reinforcements for the good guys.

Part 1 -Overview
Part -Lifestyle

Iodine part 3: Factors affecting iodine status, testing and supplementiation

Over the previous two parts of this blog series we've discussed the roles of iodide/iodine in the body as well as how changes to the food system have negatively impacted iodine status.  In the final blog in this series we will discuss how certain things impact iodine status, how you can test your iodine status, and what you need to know about supplementing with iodine.  This information is directly from the protocol used in the Iodine Project and is the work of Dr. Abraham, Dr. Flechas, and Dr. Brownstein.  If you are considering iodine supplementation and have any sort of thyroid issues you should use iodine under the care of a doctor of integrative medicine.

At the end of the last blog we discussed the removal of iodine from bread back in the 70s.  As a result, Americans are excreting 50% less iodine than they did back then.  To make matters worse, they replaced iodine with something called bromine.  Bromine, iodine, fluorine, chlorine, and astatine belong to a class of chemical elements called halogens.  The halogens are highly reactive elements that can react with other compounds by stealing an electron.  When they do this they are called halides and can interchangeably bind to the receptors on your cells.  Chloride and iodide are both important for health, fluoride is often used to prevent cavities, and bromide doesn't appear to be necessary and can be potentially harmful.  Whether bromide is toxic or not, I believe it is, it is certainly problematic for people low in iodide, as is fluoride.  While there is no hard evidence to indict bromide at very low levels, high levels are certainly toxic.

Where do we find bromide?

As mentioned above, you can find bromide in bread and other bakery products since iodine was replaced with bromide.  You can also find brominated vegetable oil(BVO) in citrus flavored soft drinks like Mountain Dew, some energy drinks, and formerly in Gatorade.  In 2013, an online petition asked PepsiCo to stop putting BVO in Gatorade.  The impetus for the petition was that Europe, India, and Japan do not allow BVO for use as a food additive as they regard it as unsafe.  Since Gatorade is sold in those countries, there is already a formula without BVO so there is no reason to put a potentially toxic substance in it.  The petition was successful and Pepsi removed the BVO from the citrus Gatorade flavors in 2013.  Bromide-based pesticides are also used on the food supply, mostly in strawberries.

Despite there being some uses in the food supply, bromide is primarily an environmental toxin.  Bromide can be found in plastics, certain medications(Atrovent and some anesthetics), bromine pool and hot tub treatments, and as a fire retardant in mattresses, carpets, and upholstery/car upholstery.  Adding evidence that bromide is primarily an environmental toxin, a study performed in 1997 found that in healthy adults living in Beijing, the lungs had the highest tissue levels of bromine(1).  Furthermore, the authors stated that the tissue levels of bromine in subjects from this study were significantly lower than people from other countries.  While it is certainly possible that the lungs just happen to be an area where bromine accumulates, it seems unlikely that an ingested substance would specifically accumulate in the lungs, especially one that can interchangeably bind to iodide receptors in the body.  Since Asian cultures tend to eat high levels of iodide in the form of seaweed, iodide may "boot" bromide from the body with the exception of bromide's point of entry or areas where the sodium iodide symporter(NIS) is lacking.

Bromide toxicity

Bromide was used over the counter as a sedative and remedy for headaches until 1975 when it was removed from over the counter use as well as prescription medicine due to chronic toxicity(2).  Bromide's extremely long half life in the blood of 12 days causes levels to build up in the body over time and makes it difficult to dose.  Most of the acute side effects associated with bromide use are neurological in nature, but chronic toxicity affects the endocrine and reproductive systems in animals(3).  In rats and mice, bromide toxicity has been shown to effect the pituitary gland, adrenal gland, thyroid gland, prostate gland, testes, and ovaries with very high doses.  Probably the most important gland to look at in regard to bromide toxicity is the thyroid gland given bromide's classification as a goitrogen.

Goitrogens

Goitrogens are substances that interfere with thyroid function and can lead to goiter.  In the case of bromide and the other halides, low intake of iodide causes the other halides to take up space on the NIS, blocking iodide uptake.    Studies in rats have shown bromide to take the place of iodide in the thyroid with a concomitant drop in thyroid hormones with high bromide intakes(4, 5) as well as reducing the half-life of iodine by 2/3rds(5).  Cruciferous vegetables such as broccoli, kale, and cauliflower are also considered goitrogens.  Their effects are mediated by glucosinolates that can form thiocyanates that compete with iodide at receptors on the symporter or goitrins that directly interfere with thyroid hormone synthesis(6). In addition to competing with iodide at the thyroid, bromide also causes elimination of iodide from the skin(7), but there is no evidence cruciferous vegetables do the same.  Cooking inactivates some of the goitrogens found in cruciferous vegetables.

One has to be careful to not put the horse before the cart when looking at the goitrogenic effects of food.  There are many beneficial effects to eating cruciferous vegetables including cancer prevention(8) as well as meeting your nutrient needs for the day.  High exposure to goitrogens merely means your iodine needs increase and that low to moderate iodine intake is not sufficient(9, 10, 11).  Since there are no beneficial effects to being exposed to bromide, it should be avoided altogether and your exposure to elements that may contain it(Pools, plastics in computers, and fire retardant materials in furniture and upholstery) should be considered when calculating your daily need for iodide.  In addition, while fluoride appears to be beneficial when applied to the teeth, there is no evidence of it being beneficial when ingested.  This is a problem because most of the water supply in the United States is fluoridated.

Testing for iodine sufficiency

All of this evidence points to the importance of determining whether you are iodine sufficient or not.  There are far too many factors to make a blanket recommendation for an RDA for iodine.  People who eat high levels of goitrogenic foods, work in in the furniture industry, work with bromide-based chemicals, use Atrovent, or spend a lot of time in their car probably have a higher iodine requirement than people who don't fit any of that criteria.  One of the least effective ways to measure iodine is in the serum.  Iodine, like magnesium, is primarily found inside cells.  Measuring your iodine levels by measuring the amount of iodine in your blood would be like measuring the amount of gas in your car by how much is in your fuel line.  Your fuel line will be full up until the point your gas tank becomes empty, at which point your fuel line will empty almost immediately.  The current standard for measuring iodine sufficiency is the urinary iodine spot and 24 hour loading test.

The urinary iodine spot test measures the iodine level in your urine upon awakening and is used as a reference value.  The 24 hour urinary iodine loading test involves taking 50mg of Iodoral after the spot test and collecting your urine for 24 hours, including the first urination on the next day.  The amount of iodine in your urine is used to determine what percentage of the iodine you retained in your body.  Healthy people excrete 90% of ingested iodine in the urine, so people with levels lower than that are said to be deficient in iodine as their body attempts to retain more.  In addition, you can also measure bromide and fluoride levels in the urine to identify whether or not you have high levels of either halide.  There are no randomized clinical studies supporting the use of this test to determine iodine sufficiency.  However, the physicians in the Iodine Project who have been using this test as well as treating patients with iodine find that the level of iodine excreted in the urine is inversely related to the severity of symptoms and that the test and symptoms improve over time with proper supplementation iodide/iodine(12, 13, 14,) (Note: Dr. Abraham, referenced in 12 & 13, makes Iodoral and therefore has a financial interest in both iodine supplementation and the test, which uses 50mg Iodoral as the iodine load).  You can order the 24 hour urinary iodine lading test from FFP laboratories and do not need a doctor's prescription.

Supplementing with iodine

Seaweed, fish, eggs, dairy and iodized salt are the primary sources of iodine in the diet.  The iodine content of seaweed varies by the type of seaweed and the iodine content of dairy depends on the diet of the animal was well as the type of teat cleanser the farmer uses as iodine based teat dips cleansers absorb in to the udder and get in to the milk.  However, chlorine can also be used and may increase competition with iodine as it is also a halogen.  While I think seaweed is probably sufficient for getting your iodine needs, the other foods are probably not going to get you to an adequate intake.  If you don't eat seaweed, the only way you are going to meet your iodine needs is through supplementation.  If you are deficient in iodine, supplementation is probably your only option.  I tend to recommend food over supplementation in most cases; magnesium, fish oil, and iodine are the only exceptions.  Let's take a look at supplementing with iodine.  (Note:This information is taken from the recommendations of Dr. Abraham and Dr. Brownstein of the Iodine Project. This is from their practical experience working with thousands of patients, there are no randomized clinical trials supporting this protocol.  I have experience with it and will discuss that in part 4)

Dosage

The dosage of iodine you choose is dependent on many factors including exposure to goitrogens.  There are iodine deficient people supplementing with 150mg of iodine(3 orders of magnitude higher than the RDA) with no ill effects.  This level of intake is pretty severe and more than likely unsafe unless doing so under the supervision of a physician.  The smartest approach to determining your dosage of iodine is to start a little above the RDA(200mcg) and double it every couple of weeks.  As long as you also take the companion supplements that will be discussed later you can probably start safely at double this number.  Since you will be starting at such a low dosage, it will probably not be possible for you to use Iodoral until you reach 4mg of iodine(1/4 of a 12.5mg Iodoral).  You can use any brand of potassium iodide until then, just make sure you determine your dose by the amount of iodide and not the total amount of potassium iodide.

Research by Eskin et al, found that iodide and iodine each seem to accumulate more in different tissues with iodide accumulating more in the thyroid and iodine accumulating more in the breast tissue of rats(15).  Because of these findings and the fact that so may tissues seem to require iodine/iodide, the best course of action is to supplement with both as soon as possible.  The only products I know of that contain both are Lugol's solution and Iodoral, but there are more than likely other options or combinations you can use to get both in supplement form.  As always, you should discuss supplementation with your doctor and if you have a thyroid condition you should be using iodine supplementation under their supervision.

One of the primary determinants of the dosage that is best for you is the presence of bromine related detoxification symptoms.  The bromine related detoxification symptoms can be found here.  If you experience any of these symptoms, you are clearing bromine from your tissues faster than your detoxification system can remove them.  Many people ignore these symptoms if they are minor(I did) and work up to a dosage of 50mg over time.  At a dosage of 50mg, the doctors of the Iodine Project state that most people will reach iodine sufficiency in 3 months.  Of course, there will be variability in this number and that will be dependent on your score on the 24 hour iodine excretion test.  Taking this test at regular intervals is a good idea to make sure iodine supplementation is working.  In some instances there are other issues such as a defective symporter that can increase the time it takes to reach iodine sufficiency.  There are companion supplements to take that cover these issues and some of the other issues that may arise.

Companion supplements

Selenium
Selenium plays an important role in the thyroid.  It supports efficient thyroid hormones synthesis and is also needed to convert T4 to the active T3.  Supplementing with iodine while deficient in selenium can make a thyroid problem worse and vice versa.  Chris Kresser wrote a terrific article covering the use of selenium that can be found here.  You will want to get approximately 200mcg of selenium.  It's best to get a selenium complex that contains multiple forms of selenium.

Vitamin C
Vitamin C is a powerful antioxidant and is very useful in supporting the liver while the body detoxes.  Based on case reports and the experience from physicians in the Iodine Project, vitamin C also helps improve a defective sodium iodide symporter(16).  Aim for 3000mg or more of vitamin C per day depending on the severity of your detox symptoms and be sure to spread the dosage out throughout the day as much as possible.  If you take too much vitamin C at one time you could experience loose stools.  It is also important to taper down your dosage slowly if you decide to stop taking it as a sharp drop in vitamin C intake can simulate the symptoms of vitamin C deficiency.

Magnesium
Magnesium helps the body detox and is used in over 300 enzymatic reactions.  Since most people are probably deficient in magnesium it is a good idea to take it in supplement form.  Aim for 500mg of elemental magnesium per day of a more time released form of magnesium.  I use Jigsaw Magnesium w/SRT which is dimagnesium malate but other people have gotten good results from magnesium glycinate or citrate.  Magnesium oxide often causes loose stools so use it at your discretion.  If you have any sort of kidney pathology you should discuss magnesium supplementation with your doctor.

Vitamins B2 & B3
The doctors in the Iodine Project have found that supplementing with vitamins B2 and B3 help increase the absorption of iodine.  Aim for 100mg of B2 as riboflavin and 500mg of B3 (Not niacinamide) in a time released form per 50mg of iodine.  The doctors of the Iodine Project have a formula called ATP cofactors that they use with their patients.  This dosage of B2 and B3 will definitely turn your urine bright yellow.

Salt
Salt is used to help support the adrenals and speed up the excretion of bromide.  The doctors of the Iodine Project have found that supplementing with 1/2 tsp of unrefined celtic sea salt dissolved in to a glass of water 2 times a day has helped with bromide detox symptoms.  In addition, bromide half-life has been shown to be dependent on sodium intake in rats(17).  The sodium in salt is also used to increase iodide uptake by powering the sodium iodide symporter.

Conclusion

Over the course of this three part series on iodine we have discussed why the RDA for iodine is low, how environmental exposure to bromide increases iodine needs, how factors in the diet can contribute to low iodine status, how changes to the food system have decreased the amount of iodine we consume, and how to safely supplement with iodine.  The protocol used by the doctors in the Iodine Project is based off their practical experience treating thousands of people as well as the experience of thousands more from the Curezone and Yahoo Iodine groups.  I am currently halfway through using this protocol and will give my personal take in part 4 of this blog series once I have completed the high dose phase and enter a maintenance dose.  The results thus far have been pretty amazing.  If you decide to implement an iodine protocol it's wise to consult a physician familiar with using high dosage iodine.

Part 1    Part 2

Conquering Type 2 Diabetes: What the research shows part 1

Unless you live under a rock or are part of some hunter-gatherer tribe that has a computer lab you know someone with pre-diabetes or Type 2 diabetes.  In modern Western society, Type 2 diabetes is as ubiquitous as McDonald's and pharmacies, two establishments that see their fair share of Type 2 diabetics.  The sad part about this is that there seems to be enough research available to the general population that Type 2 diabetes should be completely avoidable.  It is my belief that if that vast majority of people took the research and used it to their advantage, most Type 2 diabetics could reverse the disease and everyone else could avoid it altogether.  That is not to say that this can help everyone, some people have done so much damage to their pancreas that they may be stuck taking diabetes drugs forever.  In other instances, people just aren't willing to change their lifestyle in a way that will prevent this largely reversible metabolic state.  For those people willing to put in the time and effort, this blog series should provide everything you need to know to conquer Type 2 Diabetes.  In this first part, we will provide a general overview of the plan.

What is Type 2 diabetes?

Type 2 diabetes is a metabolic disorder where high blood glucose is accompanied by high levels of insulin and cellular insulin resistance.  People with Type 2 diabetes tend to have an exaggerated blood glucose response to foods, particularly foods high in carbohydrate.  Over time, consistently high blood glucose levels cause damage to the organs and tissues of the body.  This can lead to blindness, neuropathy(Nerve pain), heart disease, and Alzheimer's to name only a few.

Type 2 diabetes is diagnosed in a couple of ways.  It used to be primarily diagnosed with fasting blood glucose levels, which is a test of your blood glucose level after not eating for 8 hours.  A fasting blood glucose level between 100 and 124mg/dL is considered pre-diabetic and fasting blood glucose above 125mg/dL is considered diabetic.  The problem with using fasting blood glucose levels as the primary means of diagnosing Type 2 diabetes is that you can have a normal fasting blood glucose reading but still have an abnormal blood glucose response to food, called the postprandial glucose response.  The more appropriate test given now is called your A1c, or hemoglobn A1c.  Your A1c is basically a 3 month average of your blood glucose levels determined by your level of glycated hemoglobin, hemoglobin damaged by sugars in the body.  An A1c below 7% is considered in the healthy range.

Once diagnosed with Type 2 diabetes, the best means for controlling progression of the disorder is via lifestyle intervention.  I believe very few people know this and the ones that do are not given enough of a slap upside the head to realize it's serious business.  A good portion of people are also looking for the easy way out and immediately go the pharmaceutical route rather than change what they are doing, which is more than likely causing the problem in the first place.  Whatever the reason, one of the dumbest things you can do health-wise is to go after the symptoms rather than the root causes of the problem.  This can be broken down in to 3 steps and will be covered in three separate blogs.

Fixing your gut

Of every step you are going to need to take to win the battle of Type 2 Diabetes, this one is the toughest.  Not only will it require you to avoid many of the foods you love to eat, it will require you to change your entire approach toward food.  Most of us look at what we eat as a way to provide energy and resources to our body.  While this is certainly a big part of it, the research also shows we need to consider the inhabitants of our guts as well., aka your gut bacteria.  These little guys aren't just freeloaders along for the ride, they provide many useful functions that we are dependent on for optimal health.  In addition, people with Type 2 Diabetes almost have a signature microbiota, another name for the inner society of bacteria that reside in your gut.  This signature microbiota can lead to a greater energy harvest from your food, gut inflammation, an inability to repair gut damage, and a host of other problems seen in Type 2 diabetes.

Most people who try to tackle Type 2 diabetes go immediately to a low carbohydrate diet.  While it may be a good idea to reduce carbohydrate intake initially while your mechanism to control blood sugar is faulty, realize this is merely a symptom.  We want to reduce carbohydrate to prevent your blood glucose from skyrocketing, but going to low on carbohydrates can actually make the problem worse.  Instead, you want to focus on eating the right types of carbohydrates to heal your gut, establish a healthy gut microbiota, and give you long lasting energy throughout the day.  Once you do this it may be possible to eat small amounts of foods that once caused major blood glucose fluctuations without any problem.  To what extent this is possible is more than likely individual and dependent on how much damage you've done.

Lifestyle factors

There are many lifestyle factors that can push your blood glucose and insulin levels high.  Most of these lifestyle issues will have a negative impact on your stress response.  One of the major roles of your stress response is to mobilize glucose to provide your muscles with energy to fight or flee.  Study after study has shown that people with Type 2 diabetes have higher levels of stress hormones in their body than people with normal blood glucose control.  This is because their stress response becomes altered in a way that always puts them in flight or flight mode.  In the lifestyle factors section we will discuss the effects of each factor on blood glucose control as well as techniques you can use to get yourself moving in the right direction.  It is important to note that we will cover physical activity in this section but exercise in the next.  Physical activity and exercise are two separate things and should be viewed in that way.  Most people get all of their physical activity in the form of exercise at the gym which is completely inadequate.

Exercise/Supplements

There are many benefits to exercise.  In Type 2 diabetes, exercise can be used as a "condiment" that allows you to speed up progress as well as have a little more flexibility in your diet.  In the same way, certain supplements can be used to improve nutritional deficiencies that are common in Type 2 diabetics. However, most people put most of their effort in to these two areas, treating them as if they are the main course rather than a condiment.  Putting most of your efforts in to the main dish(Diet and lifestyle) while using the condiments to optimize your results is the best approach to battling Type 2 diabetes.  In this section we will look at the best types of exercise to perform as well as supplements you may need to take to beat Type 2 diabetes.

Conclusion

Over the course of the next 3 blogs we will use research as our guide to learn how to fight Type 2 diabetes.  The vast majority of people who follow this advice will get their blood glucose levels in check if they are out of whack or will avoid Type 2 diabetes altogether if they are just looking to be healthy.  Whether you have Type 2 diabetes or not, this will more than likely be a significant lifestyle change, so let's get started.

Part 2: Diet 
Part 3: Lifestyle

Iodine part 2: Where did it go and and why the RDA may be inadequate

In my last blog on iodine located here, we went over the many functions of iodine in the body and iodine's potential role in cancers of the stomach, ovaries/cervix, and the breast.  Needless to say many people may wonder if they are getting enough iodine in their diet.  While you may get enough iodine based on the very low RDA value, if you aren't eating seaweed or plenty of salt you are probably deficient from an optimal health standpoint.  The truth of the matter is, iodine has been slowly removed from the diet and our health has suffered as a result.  Let's take a look at how our diets have changed with regard to iodine.

Where did the iodine go?

In the early 1900s, landlocked areas in the US (the Great Lakes, midwest, and northwest mountainous regions) experienced an epidemic of goiter, swelling of the thyroid gland due primarily to iodine deficiency.  These regions have soil that is deficient in iodine as there is no access to the sea, the predominant source of iodine.  Since the soil is deficient in iodine, plants grown in that soil are deficient in iodine as well.  As a result, the people in these areas became iodine deficient and, in response, their necks swelled as their thyroid glands grew to trap more iodine from the bloodstream.

Map of the goiter belt

Taken from learnendocrinology.blogspot.com

In order to fight this goiter epidemic, iodide was added to salt because salt consumption was fairly stable at the time.  This successfully solved the goiter epidemic, but did it solve the iodine deficiency problem?  There is no way of knowing for sure, however, a study done in Italy in 2006 found that despite there being a very low prevalence of goiter in Piedmont school children, 39% had low urinary iodine excretion levels suggesting that the absence of goiter may not indicate iodine sufficiency(1).  There are a couple of important ways iodine has been removed from the diet and levels are lower today than they were 40 years ago.

One of the ways that iodine has been removed from the US diet is via poor food recommendations given out by the USDA.  It is currently considered good practice to reduce salt and egg consumption to help improve the risk of heart disease.  Removing these two products from the diet greatly diminishes the iodine content of the diet as they are 2 of the more significant sources of iodine.  In addition, most people have made the switch from iodized salt to sea salt because they have been told that sea salt is better.  The sea salt most people consume does not contain any source of iodine or iodide, which is plainly written in small letters on every bottle. It's also ironic that most people who consume sea salt are consuming refined sea salt which can be seen when looking at the color of the salt.  If it's white and clean looking you are essentially just eating rocks of table salt without iodine added, all of the beneficial minerals that make sea salt healthy have been removed in the refining process.  So not only are you not getting any iodine, you aren't getting any of the benefits from sea salt either.

Another interesting fact that people don't realize is that up until the 1970s, iodated bread conditioners were used in breads to increase shelf life.  Each slice of bread contained 150mcg of iodine, an amount equivalent to the RDA for adults.  However, due in large part to a study performed in 1948 on rats by Wolff and Chaikoff(2), iodine was slowly being removed from the medicine cabinet and our food supply.  In the study, the authors concluded that when serum levels of iodine reached a certain level, the thyroid stopped making thyroid hormones, an effect now called the Wolff-Chaikoff effect.  This is a temporary phenomenon, perhaps being an artifact of the body adapting to a change in the internal environment that reverses itself in 2 days.  The problem is that they never measured blood levels of the thyroid hormones in this study, and these findings have never been confirmed in humans.  So while the thyroid gland may have temporarily stopped making thyroid hormones, we have no idea if this reflected a drop in circulating serum thyroid hormones.  In addition, attempts to reproduce the Wolff-Chaikoff effect in rats have failed.

Two of the biggest problems with the findings of the Wolff and Chaikoff studies is that iodine had been used liberally in medicine up until that point successfully for many conditions and the Japanese, who are considered much healthier than most populations, consume enormous quantities of iodine from seaweed in comparison to the RDA and the findings of the Wolff-Chaikoff study.  In a later paper published by Wolff when he was with the National Institute of Health(NIH), Dr. Wolff identified consumption of iodine in excess of 200mcg as problematic and levels above 2000mcg(2mg) as potentially harmful(3).  What is odd about these recommendations is that the vast majority of Americans would consume well above 200mcg by simply eating 2 slices of bread, and there was no epidemic of thyroid disorders back when this was the standard.  In fact, thyroid disorders have actually increased since iodine consumption has been reduced.  It doesn't end there, when you look at the levels of iodine consumed by the Japanese, these recommendations look even more foolish.

It is currently estimated that the Japanese consume an average of 1-3mg of iodine per day in the form of seaweed(4).  Judging by the data they compiled, two things are evident.  First, while the average consumption of iodine by the Japanese is between 1-3mg/day, there appears to be large variability in consumption levels.  The largest study in this review contained 4138 subjects and found a mean urinary iodine content of 3300mcg/L.  Since the average person urinates 2L/day, this would lead to a daily urinary excretion of 6600mcg of iodine per day which would indicate an intake of 7333mcg/day, 37 times what is considered harmful in the Wolff paper.  Secondly, as the Japanese have adopted more of a Western diet, iodine consumption has dropped considerably as can be seen by the fact that iodine consumption is much higher in the older Japanese generation in comparison to younger ones(4).  In addition, Japanese people who move to the United States have much higher rates of the diseases reported in part 1 of this blog than do Japanese people remaining in Japan(4).

One final example of the use of high levels of iodine can be found by perusing the iodine forums on curezone.  Led by Drs. Abraham, Brownstein, and Flechas; many people are ignoring the recommendations of Wolff-Chaikoff and using very high doses of iodine to reverse many of the issues discussed in part 1 of this blog series.  These people are using 50mg, 100mg, and even 150mg of iodine successfully to help with a range of issues.  This has spawned many books including Dr. Brownstein's, Iodine: Why you need it, why you can't live without it as well as The Iodine Crisis by Lynne Farrow.  In the Iodine Crisis, Farrow reports many of the cases of successful use of high dose iodine found on curezone as well as at her site www.breastcancerchoices.org.

There is no doubt iodine consumption has decreased substantially since these changes have been implemented to our food system.  The National Health and Nutrition Examination Survey (NHANES) has looked at nutritional intake since 1971.  Between 1971 and 1999, urinary iodine excretion dropped by 50%(5).  However, researchers consider the US population to be iodine sufficient because the level of iodine found in the urine indicates that iodine consumption approximates the 150mcg RDA for adults.  That is, of course, assuming you believe 150mcg to be an adequate amount of iodine.  One of the odd things about this data, however, is that the urinary iodine excretion from the 1970s would indicate significant iodine excess by the Wolff criteria.  Despite the potential iodine excess back then and more appropriate iodine intake according to Wolff now, thyroid disorders as well as breast cancer rates have increased substantially over this time period.  Breast cancer rates in the 1970s were 1 in 20 and have increased to in 1 in 7 today.

If iodine sufficiency is attained at 150mcg or iodine per day, you would assume that higher intakes would just lead to more iodine excretion in the urine.  A study done by Koutras et al. in 1964 found that with increasing iodine intakes up to 800mcg/day, the body accumulates up to 7mg of iodine over the course of 12 weeks with no change in thyroid output(6).  This would indicate that not only is 150mcg of iodine per day not adequate to become iodine sufficient, the iodine is being used by tissues other than the the thyroid gland.

Conclusion

Changes to the food system have substantially decreased the iodine intake of people in the United States.  While urinary iodine excretion levels indicate iodine sufficiency, the data currently used to recommend iodine intake is not adequate.  It seems foolish to use a single study performed in rats as a basis for recommending the intake of any nutrient for humans.  While it seems safe to say that the RDA of iodine is adequate to prevent goiter, it seems like a pretty big jump to use it as the basis for total body iodine sufficiency based on a study in rats.  Further studies are needed to identify the level of iodine in the diet necessary for optimal health.  Given that the Japanese as well as other Asian cultures consume far more iodine than Americans and tend to have better health outcomes indicates that higher levels of iodine intake are, at the very least, tolerated very well and, at best, better for your health.  This wide range of tolerable iodine intake coupled with the temporary nature of the Wolff-Chaikoff effect indicates that this effect may merely be the body adapting to a rapid change in iodine intake and not due to the damaging effects of high iodine intake.

In the final installment of this series we will look at the iodine loading test, how to safely use high levels of iodine from food or supplements, and factors that may increase your iodine needs.  While removing iodine from bread may have been a bad idea, what they replaced it with may have made matters far worse.

Part 1