“Thyroid Reset Diet”: Learnings from the Book to Understand the Importance of Iodine in Reversing Hypothyroidism

“Human studies consistently show two things: First, if you give people extra iodine, many of them develop thyroid disease. Second, if people with thyroid disease reduce their iodine intake, the disease often goes away.” Dr. Alan Christianson in his book The Thyroid Reset Diet

The common perception is that a lack of iodine causes hypothyroidism. But numerous studies have shown that excessive iodine is the culprit and not iodine deficiency.

Dr. Christianson talks about this in detail in his book on the thyroid. He says that by reducing iodine consumption, 80% of hypothyroid patients reverse thyroid. Not 100%, but 80%, which by no means is a small number. Especially for a disease that is supposed to be chronic. And the modern medical system does not even believe that the thyroid can be reversed.

Thyroid has risen exponentially after fortifying salt with iodine globally!

Till 1990, the world was largely deficient in iodine. And WHO categorised 112 countries as “severely iodine deficient”

With the help of the fortification of salt, this problem was completely eliminated. By end of 2014, there was not even a single country with iodine deficiency. But unfortunately, there are now over 50 countries which have more than adequate or excessive iodine. And though the problem of goitre vanished from the world, the problem of hypothyroidism and thyroid cancer grew exponentially. In fact, thyroid cancer has grown sevenfold since then.

Population studies have concluded that global iodine fortification has increased the risks of hypothyroidism.

Australia fortified salt in 1998 and cases of thyroid increased by 64%. In Hungary, the increase was 950%. In Poland and Zimbabwe, the increase was 300%. [1]

The US was amongst the first countries to fortify their salt with iodine. Mayo Clinic tracked the rate of Hashimoto’s disease in patients from 1935 to 1967. They documented a 4800% increase in Hashimoto’s disease i.e. from 2.1 per 100,000 persons, it was up to 94.1 for those over 40. [2]

What’s the Role of Iodine in the Thyroid Gland?

Iodine is a very special nutrient. Usually, all nutrients are used by multiple parts of the body but iodine is largely used in the thyroid gland and only for the purpose of producing thyroid hormones. Usually, for all nutrients, the range that the body can tolerate is quite wide, but in the case of the thyroid, the range is quite narrower. Also, unlike other nutrients, iodine can vary vastly from batch to batch; hence it’s difficult to predict how much iodine you are consuming.

Iodine is essential for life. However, just as too little iodine can cause thyroid problems, excessive iodine also causes thyroid disorders.

How much Iodine is Required?

Each day, our thyroid gland will need 50-200mcg of iodine to make the thyroid hormones. It’s an extremely small amount. Just to put things in perspective, your lifetime supply of iodine can be fitted in a teaspoon. That’s it. [3]

Not just Dr Richardson recommends lower iodine levels, even WHO recommends the same. Here is a recommended level of iodine consumption as per WHO. [4]

WHO Level	Types of Illness	Dietary Iodine Intake
1	Endemic goitre, Congenital hypothyroidism	<20 mcg
2	Pediatric goitre, low rate of adult disease	20-49 mcg
3	Lowest disease rate + reversal of autoimmune thyroid, hypothyroidism	50-99 mcg
4	Low disease rate	100-199 mcg
5	Iodine-induced hyperthyroidism, autoimmune thyroid disease, goitre, hypothyroidism	200-299 mcg
6	Hypothyroidism, goitre, autoimmune thyroid disease	>300 mcg

Almost all of us are consuming a lot more than the recommended levels.

What Happens When You Consume Excess Iodine?

“Iodine is dangerous stuff, and it is rarely found in nature. When iodine does occur in food, water, cosmetics, and nearly all other sources, it is in its less reactive form called iodide.” The Thyroid Reset Diet” book.

With excess iodine in the body, thyroid cells may become inflamed and the immune system may start attacking it. And that causes autoimmunity and then thyroid disorder.

What do Studies Say About Excess Iodine?

Test Tube Trials
Test tube studies have shown that too much iodine slows down the thyroid and causes the immune system to attack it. [5]

Interventional Trials
A recent study has shown that of people who were given 2000mcg of iodine, 31% developed thyroid disease.
Another study showed that in people who took 200mcg of iodine, over 10% of them developed thyroid disease. [6]

Wolff Chaikoff Effect: Excessive iodine is the most effective way to stop thyroid overload
Dr. Christianson explains that similar to a circuit breaker in our houses, our body also has a circuit breaker to protect us against excessive iodine. It is called the Wolff-Chaikoff effect. One of the most dangerous situations in thyroid disorder is a hyperthyroid storm: a condition in which thyroid hormones are so high that they can be lethal. The strongest way to stop overactive thyroid is to give a megadose of iodine, thanks to the Wolff Chaikoff effect.

It’s quite clear that excess iodine slows down thyroid function.

Can Hypothyroidism be Reversed by Lowering Iodine Consumption?

A study has shown that people suffering from Hashimoto’s disease were assigned a low-iodine diet. And 78.3% of them were cured of Hashimoto’s within 3 months. The group’s TSH average came down from 14 to 3.18.

Another study was done on patients who suffered from hypothyroidism but not Hashimoto’s. Even for these people, 63.6% of participants returned to normal thyroid function. [7]

Which Items are High in Iodine and Should be Avoided?

Iodized salt is the first thing that should be ruled out. Each gm of iodized salt contains 45mcg of salt. A typical person eats anywhere between 5-10 gms daily. Which is 200-400mcg of iodine just from salt. Whereas our body needs much lower.

Even sendha namak/rock salt, Himalayan pink salt contains iodine. Dr. Christianson recommends Kosher Salt, which is easily available on Amazon.

Here is a list of some daily-use food items with a high dosage of iodine:[8] [9] [10]

Food	Maximum Iodine per serving
White Bread, enriched	610 mcg
Whole Wheat Bread	530 mcg
Multigrain Bread	440 mcg
Skim Milk	360 mcg
Milk, low fat (2%)	150 mcg
Sugar cookie	750 mcg
Cake with icing	1300 mcg
Boiled whole eggs	230 mcg
Donut	350 mcg
Cod (fish)	315 mcg
Pollock (fish)	280 mcg

Not just foods, but even cosmetics may have high doses of iodine. Human studies have shown that long-term exposure to topical iodine products can cause thyroid disorders. It was found that of the medical staff using iodine-based products, 39% had unsafe iodine levels. Hence, FDA has thankfully banned all iodine-containing antiseptics. But it has still not been done for cosmetics, which is a cause of concern for us. [11]

Several ingredients in personal care products contain iodine and the most common one is PVP. PVP is 12% iodine and many moisturisers, conditioners contain .5-5% PVP. One single application of moisturiser can lead to 2430 mcg of iodine being absorbed by the body. That’s more than 10 times the daily requirement.

Apart from PVP, look for the following ingredients:

• Ammonium iodide
• Potassium iodide
• Sodium iodide
• Iodoform
• PVP – iodine
• Hydroxypropyl bistrimonium diiodide
• TEA- hydroiodide
• Ethiodized oil
• Iodopropynyl butylcarbamate
• Seaweed extracts

Products like mascara, hair sprays, and eyeliners are not of concern. But we should be careful with shampoos, conditioners, sunscreen, and skin moisturisers.

What’s an Iodine Balancing Diet?

Dr. Christianson has created an iodine-balancing diet, which is divided into 2 phases: The Reset Phase and Maintenance Phase.

In Reset Phase, the doctor recommends 50-99 mcg of iodine. In the maintenance phase, the recommendation is 100-199 mcg.

Some key points of the Iodine Balancing Diet are:

• The reset phase should be followed for a minimum of 3 months. This phase is responsible for reversal. 
• Avoid dairy as it has high amounts of iodine. Find plant-based substitutes like almond milk and oats milk. 
• Take 2 brazil nuts daily as it is high in selenium, one of the key nutrients required for better functioning of the thyroid gland. 
• Get yourself tested for iron and zinc. It’s important to have optimal levels of both nutrients. 
• Use kosher salt.
• Choose whole grains.
• Check for iodine levels in your cosmetics. 
• Minimise sea vegetables and fish high in iodine levels. 
• Avoid or minimise egg yolk. Egg whites are totally safe.

How to Check for Iodine Levels in the Body?

Dr. Christianson mentions that the only effective and reliable test is the iodine-to-creatinine ratio. Unfortunately, Indian labs are not conducting this simple test.

What If I Become Deficient in Iodine?

It’s very difficult to become deficient in iodine given the amount of iodine in so many products. And as you can see in the table above, even if you get iodine>20mcg per day, you are largely safe if you are an adult. Only for a kid, that low iodine is a bigger problem. Most of us are consuming way higher than desired 50-200 mcg range, hence it’s difficult to be deficient in iodine. Try cutting down on iodine for a few months to see how your body reacts and whether you feel better.

Conclusion

This book presents a very different approach to thyroid management. It presents facts and research papers to substantiate its suggestions. It’s worthwhile to lower our iodine intake to manage thyroid disorders better. If you want to know more about the subject, I would highly recommend the book.

Appendix: (Technical Stuff: Additional reading for nerdy ones) 

TSH: Thyroid stimulating hormone. It is the signal from the pituitary gland to the thyroid gland to produce more thyroid hormones. So when the thyroid gland is producing less thyroid hormone, the pituitary gland produces more TSH. Hence, in the case of hypothyroidism, the body has elevated levels of TSH. 

Thyroglobulin (Tg): It is the main protein from which thyroid hormones are made. Dr Christianson says if thyroid hormone is a car, then thyroglobulin is the chassis and iodine atoms are the wheels that are fitted at the final stages of assembly.

TPO: Thyroid Peroxidase is an enzyme which makes iodine stick to the thyroglobulin faster. When there is excess iodine in the system, then body functions start behaving abnormally. A healthy person may have 8-10 iodine atoms on each molecule of thyroglobulin. But when there is excess iodine, then this number can go up to 60. In such cases, the immune system can start attacking the TPO or Tg. And that’s the start of autoimmune thyroid disease. That’s why it is extremely crucial to do an antibody test for TPO and Tg. [12]

T4: T4 is a piece of Tg molecule with 4 iodine atoms. 

T3: T3 has 3 iodine atoms and is the active hormone.

References:

• [1] Sun X, Shan Z, Teng W.effects of increased iodine intake on thyroid disorders. Endocrinol metab 2014;29(3)240-247.
• [2] Harstock Cl. Iodized, salt in the Prevention of Goiter: Is It a Safe Measure for general use? JAMA.1926;86(18):1334-1338.dot:10.1001/jama.1926.02670440008005
• [3] Ahad F, Ganie SA. Iodine, Iodine Metabolism and Iodine Deficiency Disorders Revisited. Indian j Endocrinol Metab. 2010;14(1):13-17.
• [4] WHO. Urinary lodine Concentrations for Determining lodine Status in Populations. World Health Organization. 2013; Chung JH. Low lodine Diet for Preparation for Radioactive lodine Therapy in Differentiated Thyroid Carcinoma in Korea. J Clin Endocrino/ Metab. 2013:28(3):157-163. doi:10.3803/EnM.2013.28.3.157; Park JT., Hennessey JV. Two-Week Low lodine Diet Is Necessary for Adequate Outpatient Preparation for Radioiodine rhTSH Scanning in Patients Taking Levothyroxine. Thyroid. 2004;14(1):57-63. do:10.1089/105072504322783858; Luster M, Clarke SE, Dietlein M, et al. Guidelines for Radioiodine Therapy of Differentiated Thyroid Cancer. Eur J Nuc/ Med Mol Imaging. 2008;35(10):1941-1959. doi:10.1007/00259-008-0883-1; Henjum S, Brantster AL, Kurniasari A, et al. Suboptimal lodine Status and Low lodine Knowledge in Young Norwegian Women. Nutrients.
  2018;10(7):941. do:10.3390/nu10070941; Delange F. lodine Requirements During Pregnancy, Lactation, and the Neonatal Period and Indicators of Optimal lodine Nutrition. Public Health Nutr. 2007;10(12):1571-1580. do:10.1017/51368980007360941
• [5] Rhee CM, Bhan I, Alexander EK, Brunelli SM. Association between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism. Arch Intern Med. 2012;172(2):153-159. doi:10.1001/archinternmed.2011.677
  Leung A.M, Braverman LE. Consequences of Excess Iodine. Nat Res.2014;10(3):136-142.doi:10.1038/nrendo.2013.251
• [6] Sang Z, Wang PP, Yao Z, et al. Exploration of the Safe Upper Level of lodine Intake in Euthyroid Chinese Adults: A Randomized Double-Blind Trial. Am. J Clin Nutr. 2012;95(2):367-373. doi:10.3945/ajcn.111.028001
• [7] Kasagi K, Iwata M, Misaki T, Konishi J. Effect of Iodine Restriction on Thyroid Function in Patients with Primary Hypothyroidism. Thyroid.
  2003;13(6):561-567. do:10.1089/105072503322238827
• [8] Sources: U.S. Food and Drug Administration. Total Diet Study: Elements Results Summary Statistics-Market Baskets 2006 through 2013. USDA, 2014; Mason R. Chlorella and Spirulina: Green Supplements for Balancing the Body.
  Altern Complement Ther. June. 2001;28(2020):161-165; National Institutes of Health. lodine: Fact Sheet for Health Professionals.NIH. lodine-Health Professional Fact Sheet. Nat/ institutes Heal. 2011:1-6.https://ods.od.nih .gov/factsheets/lodine-HealthProfessional/.Accessed August 14,2020
• [9] Sources: U.S. Food and Drug Administration. Tota/ Diet Study: Elements Results Summary Statistics- Market Baskets 2006 through 2013. USDA, 2014; Mason R. Chlorella and Spirulina: Green Supplements for Balancing the Body.Altern Complement Ther. June. 2001;28(20201:161-165: National Institutes of Health. lodine: Fact Sheet for Health Professionals. NIH. lodine-Health Professional Fact Sheet. Nat/institutes Heal. 2011:1-6. https://ods.od.nih gov/factsheets/lodine-HealthProfessional/.Accessed August 14, 2020.
• [10] Source: U.S. Food and Drug Administration. Total Diet Study: Elements Results Summary Statistics-Market Baskets 2006 through 2013. USDA, 2014
• [11] Erdogan MF, Tatar FA, Unlutürk U, Cin N, Uysal AR. The Effect of Scrubbing Hands with Iodine-Containing Solutions on Urinary Iodine Concentrations of the Operating Room Staff. Thyroid. 2013,23(3):342-345.
  doi:10.1089/thy.2012.0325
• [12] Robbani I, Dhaar GM. foundations of community medicine. Noida, Uttar Pradesh, India: