Radiation in Cali: Not Normal, Not Dangerous But Are Physiologic Doses of Iodine Warranted?

We know that 45% of survivors from the last nuclear blast in Japan had thyroid problems. I posted one week ago that potentially massive amounts of radiation could come our way on the US Left Coast if Japan's reactors had a meltdown, and we're still unsure if that may happen. Fortunately, right now the crisis seems a little less dire, or perhaps it's just eclipsed by the crisis in Libya.

Last Saturday, one week ago, I warned you of the risk of the nuclear fallout from Japan so that you would consider buying iodide before the rush emptied the shelves. The US Surgeon General agreed with me. Not take the iodide, but have it on hand.

I also owe you an apology for quoting Dr. Brownstein, who had heard estimates of up to 750 rads might show up here in California. Turns out that number was high, and for that I apologize, for any greater fear or panic it may have caused.  I didn't mean to suggest that 750 rads were here from Japan, but I did cite his numbers, which I later could not substantiate. I think it came from worse-case scenario readings from Physicians for Social Responsibility, but I'm not sure, and Dr. Brownstein has not responded to my request for clarification. I'm madly in love with transparency, so I want to be clear about my sources and lack of substantiation. I'm also not an expert at nuclear physics, but I am an integrative physician trying to protect your thyroid, and mine, and our kids, who are particularly vulnerable. It looks like massive amounts of radiation are not coming our way as of yet, at least not today or for the next two to three days. Like you, I'm still tracking the risk, the jet stream, and potential damage on a daily, often hourly, basis.

Another of my concerns is that the Japanese lead the world in how much iodine they consume. They eat, on average, 13 mg/day, mostly in the form of sea vegetables. We in the US consume 100x less. That means the Japanese are at a lower risk of radiation damage from radioactive iodine than we are. The Japanese diet, rich in iodine, reassures me as they face the frightening ongoing risk of nuclear fallout.  However, our low consumption of iodine concerns me.

While many physicians are saying: "Calm down! Don't panic! Don't take iodide!" I wonder, among the physicians who really understand the role of iodine in the body, how many of them are taking iodide at a dose lower than the CDC recommends should we be exposed in large amounts to radiation.

Should you take a low dose of iodide? We're not sure.

Here's a post from a doctor I used to work with, Beth McDougall, MD, who recommends to her patients 12.5mg/day of iodine in the form of iodoral.  I do not think we need this much, but is a lesser amount a good idea? I always, daily, take 0.4 mg of iodine; it's in my multivitamin. Should you? Now, we know that iodine is not for everyone - it can be harmful in some cases. Do you take it at a low dose? Check your multi and see. My point is that the less iodine-deficient you are, the less likely that even small amounts of radiation will be taken up into your body. And it's not just your thyroid; iodine is also taken up into your ovaries and breast tissues.

A few gentle reminders. Information on this web site is provided for informational purposes only. The information is a results of years of practice experience by me. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional. I cannot offer medical advice to those that I do not have a physician/patient relationship. But discussion is highly encouraged, along with knowledge and empowerment. 

If this crisis and spotlight on iodine gets you to increase your iodine consumption to more physiologic levels, even if that's eating seaweed more often, that's a great value add.

Let's talk it over here in the comments section.

NYT: Radiation Extremely High at Reactors

We finally have news today from a US official who has independently assessed the nuclear reactors, and states the amount of radiation is "extremely high" as reported on the front page of the New York Times this morning. Not surprisingly, the US and Japan are split on the potential nuke danger. Actual measures of radiation remain obscure, although Anderson Cooper and Sanjay Gupta, MD reported from Tokyo last night that their personal radiation dosimeters (little hand-held detectors they wear like Lawrence Livermore personnel) confirm that the radiation is 10 times normal.

What are we to do here in California, where radiation is expected to arrive tomorrow in a "not normal, not dangerous" dose, according to the New York Times? Is "not dangerous" as defined by a group of conservative, conventionally-trained physicians, the same as my definition of "not dangerous"? I'm not so sure. Many are saying: don't take iodide, such as endocrinologist Theodore Friedman as interviewed by thyroid advocate Mary Shomon.

I'm not happy with that message - I believe we still don't know, and that the answer is "maybe" we'll need the iodide. I agree with the US Surgeon General that it is reasonable to have it on hand. We are not yet advised to take it. Small doses may be appropriate and acceptable in some situations (discuss with your doctor), and if the frantic efforts in Japan, over 5000 miles away, do not succeed, we may need it. If we need iodide, I suspect we'll need less than the CDC recommended doses because of our distance from the crisis, but we really don't yet know. What else can you do? Stay indoors, take antioxidants such as Vitamin C. Let's see what unfolds, and as I keep saying: prepare for the worst, hope for the best.

Radiation Dilemma: Resources

Yesterday the US Surgeon General said: Get iodide. It's a worthy precaution. But don't take it yet.
Meanwhile, the California Department of Public Health says: Don't take iodide. Here's their new site of FAQ on radiation in California.
The situation continues to worsen in Japan, and an MIT CNN commenter last night was . Thousands are fleeing Japan by any means necessary.
The CDC, still not very helpful, states that if you have a thyroid condition, an allergy, or are over 40, you should not take iodide. Here's the FDA on the subject. Old (2001) but evidence-based.
This morning, Japan raised the max radiation dose acceptable for nuclear workers to 250 millisieverts from 100 millisieverts, describing the move as "unavoidable due to the circumstances," AP reports. Last check: 3/16/11 at 7am PST.
Stay tuned.

Surgeon General States Buying Iodide a Worthy "Precaution"

US Surgeon General, Regina Benjamin, told NBC that buying iodide is a worthy "precaution." She does not consider it an overreaction, and said you are right to be prepared. Meanwhile, workers at the nuclear power plants in Japan have abandoned the reactors, as reported in breaking news on the Associated Press.

We have no idea at this point how much radiation has been released, and how much more may come. We also do not know if we should take the iodide that we procure. If we need to take it, we're not sure what dose. Fortunately, we now have a hotline in California with the Dept. of Public Health. Keep it handy:  (916) 341-3947. I spoke to a live person when I called today (they say: we are not recommending iodide), and they told me their scripts are getting updated daily. I'd prefer hourly, but we're still in a budget crisis; I'll take whatever help we can get.

As expected, shelves are emptying of potassium iodide, one of the preventive therapies that I wrote about over five days ago.

The CDC recommendations for massive exposure to radioactive fallout, cited in that post, may or may not be relevant to our situation. Another evidence-based resource is this download from the FDA.

I'm finding that recommendations for lesser exposures to be very limited and, not surprisingly, lack quality evidence.

Are you currently getting any iodine from your diet or from supplements? Most folks in the US are iodine-deficient, and my quick discussion with other experts suggest that the more iodine deficient, the more likely one may be to uptake radioactive iodine from nuclear fallout.

I take a multivitamin that contains 400 MCG of iodine (1000 MCG or microgram = 1 MG or milligram). The Japanese, from their traditional diet, consume on a daily basis approximately 13 mg per day. Fortunately this protects them significantly from radioactive iodine damage. We in the US, consume about 100-fold less iodine from our diet. The RDA in the US is 125 MCG/day.

Today I read research from Dr. Brownstein's site (referenced previously) about Dr. Guy Abraham. Here's a direct quote, which I have not been able yet to substantiate (most of the data don't appear to be published in peer-reviewed journals, but if you wait for me to substantiate it fully, it may be irrelevant):

His research indicated that milligram doses (note: this is 1,000 times a microgram dose) are necessary to prevent radioactive iodine from damaging the thyroid gland. How much? Around 13mg/day prevents approximately 96% of radioactive iodine from binding to the thyroid gland. That is the approximate dosage of iodine ingested daily by the Japanese.

Keep in mind that in some people, with allergies to iodine or other thyroid conditions, iodine may cause more harm than good. Many conventionally-trained physicians are taught that more than 2 mg of iodine is dangerous.

As I write this on 3/15/11 at 8:15pm PST, I would love some clear answers and to provide clear recommendations. I am getting many, many questions which I cannot possibly answer individually. I highly recommend that you speak to your primary care provider about this issue, and if you have kids, your pediatrician. Pregnant women must be very careful with iodine because the fetus can absorb it and it can affect the fetal thyroid. TALK TO YOUR DOCTOR BEFORE YOU TAKE IODINE. Keep current with the Center for Disease Control, as well as your local public health. I'm trying to share information that I find difficult to find, for the purpose of education and being proactive. I'm glad the Surgeon General agrees that prevention is never premature.

US Aircraft Carrier Detects Radiation Offshore Japan

Japanese officials insist there is no public health risk from the failing nuclear reactors in Fukushima. My read of the news: I have no idea if that is true, and suspect the opposite.

The BBC is reporting this morning that one of the US aircraft carriers detected radioactive fallout 100 miles offshore from the reactors. I do not know the amount they measured.

Why, if there is no public health risk, would the Japanese extend the evacuation zone yesterday from 10 km to 20 km? My inner skeptic is getting activated.

Drudge is reporting that 17 US Navy are suffering from radiation exposure.

Here is a report of possible days before the radiation comes to the West Coast (11 days to Los Angeles,7 to Anchorage). Totally depends on the winds and could be variable.

Consider preventive measures, such as taking iodine, with your physician. Orally-taken, non-radioactive iodine, available from Amazon and often your local health food store, may prevent binding of radioactive iodine in your thyroid. It's not for everyone, but get the details and discuss with your doctor. More info on that right here.

Nuclear Japan: Latest News

BBC this morning: "A partial meltdown did occur in reactor 1." 

According to BBC reporter Richard Black: "On Sunday, officials said the same thing was suspected in reactor 3 - although later, they appeared to retract this statement."

This morning I heard many conflicting reports about the worst of the nuclear situation in Japan being over vs the possibility of future meltdowns in the day to come. The wildly conflicting data means that the possible risks are wildly variable.

One eyewitness confirmed my concerns to the BBC: "The official line is that there is no danger of radiation exposure, but we have been hearing conflicting things from unofficial sources and we didn't want to take the risk." True this is lesser quality evidence, but I'm suspicious. Are you?

New York Times: "the developments - perhaps the worst involving a nuclear plant since Chernobyl 25 years ago." Japan is preparing to distribute iodine to the population near the nuclear power plant. For more info on iodine and preventive dosing, click here.

Please share what you're learning and your sources.

This crisis reminds me of surgery: make difficult choices rapidly with limited information.

Help, Kelp?! What to Do with Japan's Radiation (Possibly Heading Our Way)

While I'm sure you've heard of the nasty earthquake in Japan - not sure you've heard that Japanese nuclear reactors spewed significant amounts of radiation that may be heading our way here in America. 

Learn about this now: IODINE. Talk to your doctor about protecting your thyroid with supplemental iodine, my friends. Taking supplemental non-radioactive iodine prevents your body from taking up radiactive iodine. You know I'm not a fear monger, so let's roll up our sleeves and talk prevention, and the role of this preventive micronutrient.

First, a prayer for the Japanese and their arduous, terrifying few days. May all beings experience peace. As the jet streams send OVER THE NEXT WEEK the radiation to Canada and the Western US, may all do what they can to learn how to manage it as safely as possible.

Second, there is not time for a slowly-formulated, methodically-researched, evidence-based plan (the type of plan I favor). It's pull yourself up by your bootstraps with what we know, and what we've learned from previous accidents. Let's turn instead to expert opinion on WTF we're to do about the sitch.

I've read estimates that potentially significant radiation is to hit us here in the Bay Area, according to Dr. David Brownstein (but he has not yet provided sources). We really don't know. I don't know his sources and cannot find confirmation. Let's hope they're an overestimate!

Risks of radiation are listed right here.

If you are flush with iodine, it is far more difficult for radioactive fallout to bind inside of us.

Who are the thought leaders I turn to in times like these?

1. Dr. David Brownstein
2. CDC

I don't totally trust the CDC because they are a government agency and often respond too slowly to be helpful. However, here is the CDC's recommendations on iodine to prevent damage from radioactive iodine fallout.

• Adults and breastfeeding women should take 130mg of potassium iodide (available at health food stores)
• kids 3-18 should take 65mg of potassium iodide
• kids 1 month to 3 years should take 32 mg

The World Health Organization states that the radiation released is not significant, yet 9 people have tested positive in Japan as of 10:30pm PST on March 12, 2011 for severe radiation exposure. Let's hope we've seen the worst of it.

Yesterday I was on the phone with my grandfather to wish him a happy 92nd birthday, and he warned me (before it hit the news) in his entirely cogent, commanding, MIT-graduate voice that there was tremendous danger with the Japanese nuclear reactors exploding or otherwise releasing nuclear fallout into the atmosphere. Thanks, Gramps, for the heads up.

Dr. David Brownstein does not recommend starting the iodine now, he suggests we start 1-2 days before the the expected fallout. The oral potassium iodide lasts for 24-72 hours, so duration depends on how long we remain exposed. Follow the news, as he suggests, and plan accordingly. Keep checking back here to see what's next.

Non-radioactive iodine, such as the potassium iodide recommended by the CDC is relatively safe. Excess doses can cause palpitations and uncomfortable sensation of the heart beating but is usually tolerated well. Most of us are iodine deficient unless you mindfully take a supplement. You can also call my office at 510-893-3907 and check your urine iodine level if you have the luxury of time before the nuclear fallout arrives. Iodine is found naturally in sea vegetables, but you probably cannot get enough through food sources to prevent damage.

Thanks to Helayne Waldman for connecting me with Dr. David.

Share any concerns or questions you have here in the comments section, and please spread the word to your loved ones on the West Coast.

What If... Breast Cancer? Dr. Sara's Prevention Top 10 List

With every mammo I get, I think about what I would do if diagnosed with breast cancer. First, I'd wig. Then I'd get all empowered and put on my big girl face, and get down to biznuz. Patients and friends have asked me to post on this topic, usually because they've been diagnosed with breast cancer or pre-cancer or have an increased risk based of family history, or... are just female and concerned.

Kris Carr makes an important point: we all have cancer. What she means is that we all have aberrant cells or oncogenes looking for some action. While we don't fully understand all the ins and outs, it's basically your lifestyle, genetics, immune functioning and nutrition that determine whether those cancer cells grow or get removed by your personal army. Kris has a more metaphorical point here too -- we all have cancer if you look at it as anything about which you feel powerless, see as an extreme struggle, it could be compulsive overeating, grief, a failing marriage. While her message is a little scary, it's also a fab wake-up call to get with the program, or step up to a better program.

Another reason to post is the empowerment piece. I can't sit by and listen to my patients tell me of the disempowering message from breast surgeons which goes something like this: "There, there, I've taken out your cancer, now you go on and live your life."

And to that I would say, "But what can I do to turn the tide - there must be nutritional, hormonal, environmental risks that I can modify."

At that point, Breast Surgeon rolls their eyes and wishes I would go away.

Fortunately, there are many things you can do to turn the tide. It's all about prevention: radical prevention of your first breast cancer, prevention of recurrence, using food as medicine, modifying your risk factors, monitoring your progress.

Below is my top 10 list: Breast Cancer Prevention 101

1. Check my 2/16 ratio. This is a measure of how you are metabolizing estrogen. Are you making more of the good, protective estrogens or more of the nasties that increase your risk of breast cancer? There's good science to support this as a key marker of your risk of breast cancer, and since there's a dearth of markers for breast cancer survivors (and their female relatives) to follow, this is a good one to measure periodically. If I had breast cancer, I'd check it every 3 to 6 months. Here's the two labs (Genova and Meridian Valley) I typically use to run the test. As part of my organic experiment, I'm testing this quarterly to find out if wearing 100% organic improves my estrogen metabolism.
2. Join the Crazy Sexy Cancer community. If I'm going to be dealing with un-fun things like chemo and hair loss and dry vagina - let's do it with some good company and big irreverence! Plus Kris Carr's Diet is very sound nutritionally. See her video on it below.
3. How's your insulin and glucose? I routinely test my patients fasting glucose (want less than 99) and insulin (want less than 7). High glucose feeds cancer cells. My glucose was elevated 6 years ago (even though I'm lean - that's because of my adrenal problems, see below) when I first started getting insulin-obsessed and I reversed it in 6 months.
4. While we're talking sugar, across the board, the white stuff is pretty bad. White flour, white sugar. Either avoid it (best) or use stevia, xylitol, agave nectar, and gluten-free flours.
5. Minimum: 7 servings of fresh fruits and vegetables. Do you know how rare this is? Frightening. Yet those anti-oxidants are preventing mutation. Bite into your organic apple. If you have a tough time with this one, do your boobs a favor and order a greens powder. Email my assistant for some of this stuff and add it to smoothies for breakfast.
6. Check your Vitamin D. Based on observational studies, I recommend a level of 52-90.
7. It's all about inflammation - reduce it, baby. Measure your C-Reactive Protein to track inflammation. Eat turmeric on your food, the world's most potent anti-inflammatory. Keep yourself on the alkaline side of the tracks (Note to self: before you go all Atkins on me, recall that cancer loves acid environment - meats, coffee, peanuts). Alkalinizing foods: pumpkin seeds, persimmons, brocoflower, seaweed, kambucha, just to name a few.
8. Pamper your adrenals. Those little endocrine glands that sit on top of your adrenals like hats and they run the "fight/flight/collapse" show? Yes, those guys. Calm 'em down. Daily. Meditation, yoga, massage, tai chi, whatever it takes. High or low cortisol is a pro-cancer environment.
9. Iodine. Most of us are deficient. It's not a glamorous nutrient but give it the notice it deserves. Check your level, and supplement if necessary. Crucial to breast health (and your thyroid).
10. Speaking of thyroid - stay on top of that lil butterfly in your neck. Ideal is TSH between 0.3-1.0. Underactive thyroid has been linked with greater risk of breast cancer.

Hope that helps. Don't wait for a diagnosis to get you on the path, the path to radical wellness. Act now. With what creds do I write all this? As a gynecologist who saw her first patient in 1989. As a breast cancer prevention researcher. As a woman living through an epidemic of breast cancer. As a human slogging my way through the toxic soup we live in. Who isn't fearful of breast cancer? Best antidote to the anxiety of breast problems? Knowledge. Humor. Greens.

And while you're at it, learn more from Breast Cancer Nutritionist Dr. Helayne Waldman, who is offering a workshop on March 10 and 17 at our office at the Gottfried Center, noon to 2pm.

More from Kris Carr on her Crazy Sexy Diet right here.


Crazy Sexy Diet with Kris Carr from Danielle LaPorte on Vimeo.

Memo to Your Thyroid: Role of Adrenals & Estrogen/Progesterone, etc

Somehow I made it through med school, residency and years of medical practice before I figured out a key epiphany: interdependence of the glandular systems of thyroid, adrenals and sex hormones (estrogen, progesterone, testosterone). Turns out I needed to teach it to myself - it's not in the medical textbooks or even conventional medical discourse. Once I got "it," meaning how all these crazy thryoid, adrenal and sex hormones fit together, much of my thryoid chaos fell away, for myself and more importantly, for my patients.

Here's the memo I never got.

1.   Got estrogen? Got too much estrogen? Estrogen dominance is common with hypothyroidism. Symptoms are: moodiness, cysts (ovarian, breast), weight gain, night sweats/hot flashes, irregular cycles. Too much estrogen raises thyroid-binding globulin, and this in turn can bind your free thyroid hormones, even if they are present in the right amounts. Think see-saw: if estrogen is high, free thyroid hormone is low. And vice-versa.

2.   Conversely, hypothyroidism causes sex-hormone binding globulin (SHBG) to decrease – this raises both free testosterone and estrogen. Note the significant overlap between estrogen dominance and hypothyroid symptoms – there is both redundancy in this system and crossover. Best fix: balance both systems simulataneously or sequentially. Most conventional docs will look at you like you’re nuts if you mention estrogen dominance – find an integrative doc here or test yourself.

3.   Adrenals operating properly? Adrenal function and thyroid function have a relationship also like a see-saw: when one is up, the other is down. Get both systems balanced so the see-saw is even.

4.   More on cortisol: correct amount of cortisol (not too much, not too little) helps the conversion from T4 (inactive thyroid hormone with 4 iodine atoms) to T3 (active form – 3-4 times more potent than T4, 3 iodines). You can check a questionnaire to assess for this, or even better, get it tested right here. Another benefit of balanced adrenal hormones is less thyroid inflammation.

5.   Polycystic ovaries? Another key aspect of interdependence is the dance between PCOS, your adrenals and your thyroid.  While the cause isn’t well-delineated, I believe most of PCOS begins with the stress cascade of overtaxed adrenals and too much cortisol in the fight-flight-collapse response, and leading to insulin resistance (typically defined as fasting insulin > 7), which is toxic to the ovary and makes progesterone levels drop. This leads to irregular cycles and imbalanced hormones (high androgens, high estrogens). One treatment is more progesterone, preferably the natural flavor as Chastetree Vitex, progesterone cream or prometrium. But that’s another blogpost for another day. Key point is that high cortisol when stressed can block your progesterone receptors, keeping the progesterone you make from doing its job. Another cause of high cortisol? HYPOTHYROIDISM! Oy, interdependence is a vicious cycle until you understand it. But know this: women with PCOS are four times more likely to have hypothyroidism due to autoimmune thyroiditis

6.   Speaking of inflamed thyroids, have you been tested for thyroid antibodies? Know your titers? Crucial, my friend. More often than not, your under-active or over-active thyroid is a result of autoimmune thyroiditis. What makes autoimmune thyroiditis worse? You guessed it, adrenal dysregulation and estrogen dominance. Oh, and digestive inflammation.

7.     Iodine, as the differentiator between thyroid hormones, is essential to the right balance of thyroid. I find most of my patients are deficient in the Bay Area of California, but too much can cause problems too. Best plan of action is to perform a iodine challenge test, available through Meridian Valley Labs in Washington among other places.

8.     Nutrition – what does that have to do with hormones? A ton. Just going gluten-free reduces estradiol (the key estrogen of our reproductive years and bioidentical hormone therapy in women 40+) by 30-40%. Big help if you’re estrogen-dominance.

9.     Got goitrogens? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as broccoli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.

10.  Polyendocrinopathy? Long word, key concept – refers to more than one endocrine gland malfunctioning at a time. Sometimes the thyroid is the first to manifest (or perhaps more commonly, the only one to be tested and/or recognized by your doc), yet one or more endocrine glands is on the wane. This can cause a more complex array of symptoms that are harder to treat. This is where a root cause analysis and step-wise or multi-system hormone treatments can be helpful.

You maybe wondering with all this complexity and interdependence, which is the chicken and which is the egg? Often we don’t know. That’s where balancing all three systems either simultaneously makes the most sense.

For more info, visit my website and like my Facebook page, all available right here.

Originally posted on the fantastic site for thyroidistas, Dear Thyroid.

10x10: Dr Northrup's Top 10 Women's Health Findings: 2000-2010

 

Dr. Christiane Northrup MD is a mentor of mine. She is a pioneering gynecologist who attunes to women's wisdom underlying the issues we face. She caught my attention on PBS when I was in college with her focus on empowering women during surgery to get regional anesthesia, so they could be awake during a hysterectomy and participate in the decision-making, rather than anesthestetized objects on a table.

Here is a link to Dr. Christiane Northrup's top 10 findings in Women's Health over the past decade, complete with details. A summary:

1. End of One-Size Fits-All Hormone Therapy
2. Fetal Monitoring Doesn’t Improve Pregnancy Outcomes
3. Early Detection of Breast Cancer is an Imperfect Solution
4. Fish Oil Proven Protective Beyond a Shadow of a Doubt 
5. Optimal Vitamin D Level is Critical for Robust Health
6. Stem Cells Discovered in Menstrual Blood
7. Natural Progesterone Holds Great Promise for Heart Health
8. Iodine Reduces Breast Pain
9. Breast is Still Best
10. Educating Girls is the Key to Planetary Health