Urinary Iodine Presenter; Ed Sorich Director Complete Wellbeing Solutions, Australia.

1. Urinary IodinePresenter; Ed Sorich Director Complete Wellbeing Solutions, Australia.

2. Background Iodine deficiency occurs in large areas of the world, with approx. 1 billion at risk. Leading preventable cause of mental retardation and goitre. Obesity epidemic?? Mobile, cheap, screening test needed to be developed.

5. History of Iodine • In 1811 when Bernard Courtois discovered iodine, he was not searching for a way to heal his fellow humans. ◦ KNO3 is a major component in gunpowder and requires Na2CO3 to be manufactured. ◦ Willow wood scarce so seaweed used. ◦ Excess S created so H2SO4 used. ◦ Accidentally added too much acid one day and a violet vapor cloud appeared.

6. Early 19th Century • English chemist Sir Humphry Davy in 1813; ‘Quite analogous to both Fluorine and Chlorine’. ◦ He named it Iodine from a Greek word ioeides for "violet coloured"

7. Late 19th Century • Iodine made it's leap into medical history when a Swiss physician, Dr Jean François Condet in 1860 announced that iodine could reduce goitres. • At this moment, modern nutritional science is born. For the first time in history we have a specific disorder that is relieved by a specific treatment. • Later, Jean Lugol discovered that bonding iodine to a potassium made it water soluble, and allowed for the later discovery of iodine's antiseptic qualities.

8. 20th Century • In 1917, David Marine published his findings on the study of thyroids in fish, dogs, and humans found in the Great Lakes region. • In 1927 Sunker Bisey discovered a process that would transmute the iodine into a state the body could fully recognize and fully assimilate (Atomidine) • Around 1930 US govt. began iodising salt.

9. Biological RoleI • 15-20 mg of iodine is concentrated in thyroid tissue and hormones, but 70% of the body's iodine is distributed in other tissues, including mammary glands, eyes, gastric mucosa, and salivary glands. • Iodine is an essential trace element, its known roles in biology are as constituents of the thyroid hormones, Thyroxine (T4) (65%) and Triiodothyronine (T3) (59%).  • Regulation of the metabolic process. • Brain and physical feotal development. • Continuing brain and physical development in neonates. • Its role in the other tissues is basically unknown but it has been shown to act as an antioxidant in these tissues (Indirect link to development of cancers, in particular breast)

10. Biological RoleII

11. Deficiency I • Cognitive impairment • Cretinism • Fibrocystic breast disease • Goitre • Hypothyroidism (Hashimoto’s if iodine sufficient) • Multiple miscarriages • Infertility

12. Deficiency II • Large parts of Tasmania once affected. • In areas where there is little iodine in the diet—typically remote inland areas and semi-arid equatorial climates where no marine foods are eaten—iodine deficiency gives rise to hypothyroidism, symptoms of which are extreme fatigue, goiter, mental slowing, depression, weight gain, and low basal body temperatures. • Iodine deficiency is also the leading cause of preventable mental retardation, an effect which happens primarily when babies and small children are made hypothyroid by lack of the element.  The addition of iodine to table salt has largely eliminated this problem in the wealthier nations, but iodine deficiency remains a serious public health problem in the developing world. (Australia as well!)

13. Goitre • Iodine is necessary for the synthesis of thyroxin (T4) and triiodothyronine (T3). Iodine deficiency leaves the thyroid gland unable to produce these hormones. When levels of thyroid hormones fall, thyrotropin-releasing hormone (TRH) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone (TSH), which stimulates the thyroid gland’s production of T4 and T3. It also causes the thyroid gland to grow in size by increasing cell division.

14. Dietary Sources • Iodised salt • Kelp/Nori • Fish (Hg/PCB’s?) • Eggs, meat, dairy • Garlic, sesame seeds, spinach, zucchini. NB; The absorption and/or utilisation of iodine is inhibited by goitrogenic compounds. Found primarily in cruciferous vegetables (cabbage and broccoli), soybean products, peanuts, mustard, and millet.

15. Iodised Salt • Edible salt can be iodised by spraying it with a KIO3 solution. 65g of KIO3 , costing approx. AUD$2.00, are required to iodise a tonne of salt. (AUD$0.08 per person per year) • Salt is an effective vehicle for distributing iodine to the public because it does not spoil and is consumed by everyone in the population, in fairly predictable amounts. • Australian iodised salt contains 65-80ug iodine/g salt.

16. RDA • A teaspoon of iodine is all a person requires in a lifetime. However, the thyroid gland does not have the capacity to store this amount, so small amounts of iodine must be consumed regularly in the diet. • WHO daily intake: ◦Adults 150 µg/day ◦Pregnancy and Lactation 200 µg/day ◦Children (6-12 years)120 µg/day ◦Infants (0-5 years) 90 µg/day

17. Supplements • Come in various forms; ammonium iodide, calcium iodide, potassium iodide and kelp. People who live in low soil iodine areas, restrict the salt in their diet and do not eat fish may benefit from iodine supplements. • Issues with molybdenum which is also present in kelp.

18. Complications • Maximum safe level for adults 2000ug/day, children 1000ug/day. • Individuals can tolerate a wide range of intake levels because the thyroid gland regulates the body’s level of this mineral. • Acute intakes though, can cause burning of the mouth, throat and stomach; fever; gastrointestinal illness, such as nausea, vomiting and diarrhea; a weak pulse; and coma. • In iodine-sufficient populations, chronic intakes at levels above the tolerable upper intake level (UL) have the following adverse effects: goitre, hypothyroidism (too little thyroid hormone), hyperthyroidism (too much thyroid hormone) and thyroiditis (inflammation of the thyroid gland).

19. WHO Recommendations

20. WHO Strategy

21. References Stoddard II FR, Brooks AD, Eskin BA, Johannes GJ. Iodine Alters Gene Expression in the MCF7 Breast Cancer Cell Line: Evidence for an Anti-Estrogen Effect of Iodine. Int J Med Sci 2008; 5:189-196. Boyages, SC (1993) ‘Clinical Review49; Iodine deficiency disorders’ J Clin Endocrinol Metab 3, 59-69 Eastman, CJ (1999) Editorial Comment: ‘Where has all the iodine gone?’ Med J Aust 171, 455-456 Bioclone Australia Pty Ltd, Marrickville NSW, Australia.