The Melanie Avalon Biohacking Podcast Episode #78 - Dr. Alan Christianson
Dr. Alan Christianson is a Naturopathic Endocrinologist who focuses on Thyroid function, specifically Hashimoto’s, Hypothyroidism, and Graves’ disease.
He has been actively practicing in Scottsdale since 1996 and is the founding physician behind Integrative Health. He is a NY Times bestselling author whose books include The Thyroid Reset Diet and The Metabolism Reset Diet.
Dr. Christianson regularly appears on national media like Dr. Oz, The Doctors, and The Today Show. He is the founding president behind the Endocrine Association of Naturopathic Physicians. He lives in Phoenix with his wife and two children.
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10:30 - personal history
12:55 - The Iodine Project
13:50 - the lack of iodine
15:35 - why do we need iodine?
18:50 - Fibrocystic Breast Disease
21:05 - The Wolff–Chaikoff effect
21:40 - what is the role of iodine in the thyroid
23:45 - goiter belts
25:45 - historic salt fortification
26:20 - iodine and autoimmune Correlation
27:10 - is there a modern day deficiency?
28:30 - Current Wisdom Surrounding Iodine
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32:15 - Goitrogens
33:35 - Content Of Iodine In 600+ Foods
35:20 - daily iodine requirements
37:30 - iodine's function in the thyroid
38:55 - how excess iodine becomes autoimmune thyroid disease
39:40 - iodide conversion to iodine
41:10 - iodine toxicology
41:50 - Lugol's Iodine
42:45 - Thyroid peroxidase (TPO)
43:10 - Hashimoto's, Hypothyroidism, Hyperthyroidism
45:50 - Antibodies In thyroid disease
46:50 - irrefutable causes of thyroid disease
47:40 - role of age and gender in thyroid disease
48:40 - Iodine tolerance
50:00 - thyroid disease vs poor Thyroid function
51:10 - efficacy of thyroid medication
52:40 - most common thyroid disfunction
53:55 - compounded thyroid medication vs natural desiccated thyroid (nDT)
57:00 - Medication recalls
57:50 - overdosing concerns
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1:02:20 - time for clearance of iodine from the body
1:03:00 - Iodine Balance
1:04:10 - chronic exposure vs bolus dose exposure
1:06:45 - excretion with medication
1:08:50 - medication changes
1:09:55 - iodized salt and other salt types
1:15:10 - sodium needs
1:17:50 - umami
1:18:20 - Testing a low iodine diet
1:19:40 - thyroid function improvement on other diets
1:20:55 - testing thyroid levels while on the low iodine diet
Melanie Avalon: Hi friends, welcome back to the show. I am so incredibly excited and honored about the conversation that I'm about to have. This is a moment for me because this is with a repeat guest. And this guest was actually the premier first episode of this show ever. Here we are, 70 something episodes later. This is really special. This man has a really special place in my heart. The topic of today's episode is huge. It is about a condition or an issue that affects so many people, myself included. I personally have been diagnosed with hypothyroidism, and that has been quite a journey trying to figure it out. For listeners, I think it's going to really fly in the face of what a lot of people might think about hypothyroidism, particularly how a nutrient called iodine relates to that. Dr. Alan Christianson, who I am here with today. He has a new book coming out, called The Thyroid Reset Diet: Reverse Hypothyroidism and Hashimoto's Symptoms with a Proven Iodine-Balancing Plan. Listeners, I read this book, and it completely blew my mind. It was one of those books where I read it, and I was like, “Oh, my goodness, I need to tell everybody about this,” since reading it, and before this conversation. Now, every time people post in my groups about hypothyroidism, iodine, things like that, I'm like, “You might want to read this book when it comes out because it might just change your mind about a lot of things.” We will dive deep, deep into all of that. Dr. Alan Christianson, thank you so much for being here.
Dr. Alan Christianson: Hey, Melanie. Thank you so much for having me. I'm really glad to be here and have some time with you.
Melanie Avalon: A little bit about Dr. Christianson, you guys are probably pretty familiar, but for those who are not, he is a naturopathic endocrinologist, and he focuses on thyroid function, specifically Hashimoto's, hypothyroidism, and Graves' disease. He's been all over the place. You might have seen him on Dr. Oz, The Doctors, The Today's Show, and he does have a lot of other books as well, New York Times bestsellers, The Adrenal Reset Diet, The Metabolism Reset Diet, which on this show, I'll put a link to in the show notes, but the first episode was about The Metabolism Reset Diet, and we dive deep into liver health in that episode, which is really, really great. But coming back to today's topic, which is the thyroid. Before we dive into that, would you like to tell listeners, for those who aren't familiar, a little bit about your personal history? What brought you to your interest and focusing on the thyroid writing this book today? I'm really dying to know if you had an epiphany about iodine or when iodine became a focus with all of that.
Dr. Alan Christianson: Yeah, great questions. Personal history, super quick version, I had cerebral palsy and epilepsy, some complications from that. Really hit me hard in my toddler years, early school years for the bulk of it. There were some lasting orthopedic issues that have stuck with me. I was an unhealthy kid. I gained a ton of weight, and I was driven by desperation to read health books. I realized by the time I was age 12 that your diet had a huge impact upon your health, and that your health was just like everything to the quality of your life. I was like a convert in this world. I used to say when most kids were playing video games, we didn't have video games back when I was 12, [laughs] in terms like that stage of life. But, yeah, I've been in this stuff for a long time, wanting to go into medicine and do it in a way in which I could utilize the power of nutrition and lifestyle.
In my training, I don't know, I really connect with people that have thyroid disease. I saw that I knew what a big deal my weight was and how that affected me, and lifestyle helped it. I saw those with thyroid disease and lifestyle was not enough. They needed more than that. I saw radically conflicting views of the advice they were given from the natural world, in the conventional world. Some things were not safe, some things could be effective, it was hit or miss. I really wanted to pull that together and make sense of it for them. So, that was how you got focused on thyroid disease, and that was in the mid-90s.
Iodine epiphany. Definitely there was one-- I guess two big ones. For quite some time I'd been aware of iodine but hadn't given it much more thought. There were some anecdotal stories in natural medicine about iodine being a great antiseptic, expectorant, used in various ways. I had a patient who developed a rare form of thyroid disease for his age. When it does happen, it almost always occurs after someone gets a mega-dose of iodine, like from a cardiac medicine or from a contrast agent. He had neither, but he informed me that he was iodine deficient. He told me about this iodine challenge test he had done and that opened my eyes to this emerging new world that was called the iodine project. I read that, and it was fascinating. Many were pushing for high-dose iodine. In reading it, it also pushed me back to go deeper into the conventional literature about iodine and what was known. I've always had interest in that. I guess that would have been about probably 2002, or 2003 when I got deep in that iodine project.
It was within probably the last half a dozen years or so, where I started seeing more data, not just that a whopping amount of iodine was dangerous, but that amount even that one could easily get inadvertently could be relevant. So, yeah, then one study jumped out at me as really launching epiphany about how this could also be an opportunity to reverse thyroid disease.
Melanie Avalon: Yeah, this is so huge, because for listeners, I think typically the idea surrounding iodine is that people who have thyroid issues probably need iodine. It's a lack of iodine is the issue. And so, there are all these like protocols and dosing things where you dose with iodine, and reading your book. I mean, it was almost like reading a drama or something. It's crazy that there's all this literature out there about iodine and the effects of low iodine diets on the thyroid. It's actually the opposite of what a lot of people think. Quick question about you. So, yourself, you never had any thyroid issues yourself?
Dr. Alan Christianson: I have not.
Melanie Avalon: Nice. [laughs] That's wonderful. My personal history with iodine. I got diagnosed with hypothyroidism, I started doing research, and I did come across this idea of dosing with iodine to help it. My realization was that I had been paleo for quite a while. I hadn't been eating processed foods. I had cut out salt. I wasn't eating iodized salt, although you talk in your book about iodine in other forms of salt, and I wasn't eating seafood. I was like, “I probably have no iodine in me,” that was my thought. I decided to do the Lugol’s protocol that a lot of people do, where they dose with this iodine. It was the only time in my life-- because I experiment with a lot of supplements. It was the only time where I tried something, and the response that I had scared me so much that I was like, “I'm never touching this ever again.” My eyes turned bloodshot red. I think that was the main thing, but I was like, “This is really scary.” I wasn't sure what was going on, so I just never touched it again and didn't really think about it as much. With all of that being said, why is there this idea that most of us with thyroid issues need iodine? You talk about the work with breast cancer.
Dr. Alan Christianson: The iodine, really there's this body of evidence that we've got that goes back 100 years. It's probably the most studied nutrient on the planet. We know just tons about it. We've known that it relates to thyroid disease. We've looked at how it affects populations when it's fortified in the salt. So, we've just studied the heck out of it. In the last, well since like about 2002, late ‘98, some doctors in functional medicine proposed that pretty much all that was wrong, and we need much higher amounts. The fundamental glitch is one that is really understandable. Nutrients can work in ways as vital elements of human physiology. The way the organic world works is that there's not a whole lot of molecules that are in use. Think about it like a small box of Legos, there's just not that many different things in biochemistry. All of life uses a small list of substances. A lot of things that are nutrients can have other effects that are not related to the role of nutrients.
Case in point, niacin. It's an essential B vitamin for a lot of mitochondrial functions. By happenstance, the molecule tends to plug up a pathway called HMG-CoA reductase by which your liver manufacturers cholesterol. So, yeah, so high-dose niacin can lower cholesterol, but that doesn't mean that high cholesterol is a niacin deficiency. A doctor saw papers showing that high-dose iodine could lower the symptoms of fibrocystic breast disease, and these papers were using iodine in the order of about 5000 mcg per day. To put some quick context, the World Health Organization has argued that between 50 and 200 mcg per day is safest for most people for long-term exposure. Those that are not prone to thyroid disease, may episodically be exposed to 1100 mcg per day without complication short term. This protocol was using 5000 mcg. And about two-thirds of the women had lower symptoms of the pain of fibrocystic breast disease when they took these higher doses of iodine. The point where the doctor--the first little glitch from which all this was born, was the assumption that they had a nutritional requirement for iodine, and that they benefited, because this satisfied their nutritional needs for it.
Another example of this is, I'm looking out a window, I'm seeing some thorny plants, and I could walk outside and get a thorn in my skin and possibly get infected. That infection could be effectively treated likely with topical iodine. However, that wouldn't mean that my infection was proof of iodine deficiency. That was the glitch that he started from. From there, he built a large body of thoughts that were internally plausible, they all made sense. The analogy is house of cards that the fundamental premises were just not accurate. A little more depth on just fibrocystic breast disease.
What we now know, iodine has pumps in the body that concentrated, and the main one is in the thyroid, but they're also can be an iodine pump that concentrates it in breast tissue. The purpose for that is the amounts of iodine in the blood are generally small. So, to have enough iodine in breast milk to supply a baby's nutritional needs, the breast tissue would have to concentrate above the blood level. This is called NIS, it's a sodium iodide symporter. Yeah, so it's an appropriate thing. However, we find out is that there's a continuum of how much NIS expression how aggressively the breast cells pump iodine, and the continuum is between non-lactating breast tissue, lactating breast tissue, fibrocystic breast disease, and then culminating in breast cancer. There's basically a steady line. Women who are not lactating and don't have fibrocystic disease or breast cancer don't have an active iodine pump. But fibrocystic breast disease, the pump is really active. As part of what happens is that there's fluid retention, there's buildup intracellularly of fluids and sodium, and that's where some of the pain comes in from. Iodine actually shuts down this pump, we can talk more about that. It ends up just taking down the fluid pressure short term, but it doesn't mean that they needed it. Yeah, the highest concentrations occur with breast cancer.
Melanie Avalon: Wow. To clarify, you just said it shuts down the pump. It's not that they're filling up their iodine source in the breast, they're actually shutting it down?
Dr. Alan Christianson: Exactly, they're shutting it down. This is this paradox to where nutrients in their excess can do the opposite of what they can do in their normal states. Iodine, when there's too much of it, your body needs to prevent it from overloading the system. Thyroid hormones so strongly stimulate your heart that if you had a ton of thyroid hormones in your blood, your heart could give out and our ancestors that had no protective mechanism and had massive thyroid surges, well, they're not our ancestors because they didn't survive and reproduce very well. When we get a lot of iodine, rather than having your thyroid just go crazy and pour out a lot of hormone, your thyroid shuts off. That's true for iodine pumps elsewhere. A big flood of iodine shuts down the iodine pump.
Melanie Avalon: You talked in the book about the Wolff–Chaikoff effect, is that related to the thyroid specifically, or is that just a general effect?
Dr. Alan Christianson: No, it is. That's specifically this sodium iodide symporter, shutting down in response to high-dose iodine.
Melanie Avalon: High-dose iodine turns things off, because the body sees it as a major, major issue?
Dr. Alan Christianson: Well, I've never thought of it this way before, but the simplest way to think of it is that high-dose iodine blocks iodine. [laughs]
Melanie Avalon: Wow, that's so ironic. As a population, you just spoke about, we do need iodine, obviously. What is the role of iodine in the thyroid? Why is it unique compared to other nutrients so far as how it's being used, and its safe ranges?
Dr. Alan Christianson: Yeah, it's unique. One thing is pretty odd is that it just has one role. There's this one place where iodine is essential. We can't say that about any other nutrient. You know all about zinc and calcium, magnesium, they do a lot of things. Iodine, we know of one essential role for it. Also, the way it's concentrated, that's unique. The ranges as far as deficiency effects, if we were to go back to 1991, there was a tragic scenario in the world. There was 112 nations that were categorized as severely iodine deficient. At the time, organizations estimated that upwards of a billion people were on the planet that didn't have a chance to have their brains develop properly. Thyroid function is essential for brain development in the early years, and with too little iodine that doesn't work optimally. Somewhere around one out of seven people back then, they didn't have the full potential of their brain function, and the developmental milestones, those opportunities, those doors close and the opportunity passes, you can't really make up for that. It was a tragic thing. There was just major negative consequences from that.
So, efforts were rounded up, organizations were formed, NGOs, government organizations, and they sought to eradicate the problem. Between 1992 and 2014, they eradicated the problem. The number of nations that were categorized as severely iodine efficient went from 112 to 0, which was totally cool. It was like one of the biggest wins in public health, but the nations that were then categorized as at risk for thyroid disease due to iodine excess, that went from 0 to 52. So, that was the shift that happened the other way.
Melanie Avalon: The deficient countries in ‘92, that included the US as well?
Dr. Alan Christianson: No.
Melanie Avalon: What type of countries?
Dr. Alan Christianson: Yeah, by and large-- so funny thing, the US had pockets of iodine deficiency, and they were called the goiter belts. We'd have to go back to the turn of the last century for them. Iodine intake is conditional upon your local food, and your local soil. If you're somewhere where you're coastal, generally you're consuming seafood. Funny thing, we actually breathe some in from the air as well. If you're coastal, you might get enough by just breathing it, they've shown that. Areas that have a lot of kelp beds, people have higher iodine than they would otherwise is from breathing it. Yeah, we're good at not getting deficient. But if you're coastal, you'll often get enough. If you're inland, there's these areas of rainfall, which if you're on the seaside of a mountain, there's more rainfall closer in, but less on the far areas. Whether your rainfall is more so water that came up from the oceans or not, the mountainous soils can vary drastically, even if you're similar distances from the coast. Then the other factor is freshwater dilutes iodine in the soil. We've got these great lakes that are massive bodies of freshwater and they're quite a ways away from the ocean. Surrounding them has been historic goiter belts.
We talk about the benefits of local food, but back when that's all you had was local food. What your soil was good or bad is what your health was. In those areas, there were higher rates of neck swelling. This became a problem when they were recruiting soldiers for World War I. They would do basic exams for health, like scoliosis and goiter checks. Too many were not acceptable to be sent off for duty because too many had goiters, so that's when this came to public health attention like, “Hey, we need soldiers. We've got to fix this.” That's why the whole thing about The Little Girl with the Umbrella, Morton Salt, so fortifying. There never was a national regulation for that. It was a voluntary process. Some states went into it, some didn't. The funny thing, there was a huge controversy in medicine at the time. Many doctors were outraged at the idea. They were seeing higher rates of thyroid disease after it started. The rate of goiter went down about tenfold or more from 1914 to about 1930. That was a big success, but autoimmune disease, the rate of autoimmune disease amongst women in their 30s and their 40s in the decades following salt fortification, that went up by 26 times.
Melanie Avalon: Wow, you talked in the book, you've went through a lot of the changes that you just mentioned where the goiter went down, but the autoimmune went up. Is there any other correlational factor that could account for that or do you really think it's the iodine? At least with something like Hashimoto's?
Dr. Alan Christianson: Well, that's been looked at globally. For a little while, there was thought to be a glitch, it was strongly attributed to salt fortification. But then, one big piece of outlying data was the UK because the UK had autoimmune thyroid disease go up at a similar timeframe, but they didn't have salt fortification until decades later. Then, it was uncovered that they preceded the US in iodine fortification of cattle feed. The data that we have about expected iodine intake in the population was a strong parallel, but they didn't add it to the salt, but they added so much iodine to cattle feed and so many people were consuming dairy products that it's expected, they had a similar increase of iodine at the same timeframe.
Melanie Avalon: Basically, if you are a human being today in a country with iodized salts, I guess everything's always possible, but is it very, very unlikely that you're iodine deficient?
Dr. Alan Christianson: Just to expand upon that there's being iodine deficient and there's having it become relevant. For example, there's a paper that I'm going to be talking about shortly, it's been shown that vegans have higher rates of being low in iodine. That's been put out as a public health concern. The second level thought that now some people are writing in tutorials about is, “Hey, vegans have the lowest rates of thyroid disease. We need to rethink what's iodine deficient and what's not.” [laughs] So, yeah. You can be low in that, and is that a bad thing on paper? Well, it really matters the outcome and the overall risk of thyroid disease. There have been some really good studies that have broken down the US into subpopulations per age, gender, and ethnicity. There certainly are some groups where you'll see 7% to 12% that are considered what's below optimal for iodine, but those groups are not the ones seeing higher rates of thyroid disease. We also have, in this the classic demographic of women, 30s, 40s, and 50s, pretty much steady throughout ethnicities, many of those groups, 30% to 40%, are considered severely at risk for thyroid disease due to iodine excess, and that's where we are seeing more thyroid disease.
Melanie Avalon: The prevailing idea still today, at least in the blogospheres and the internet rabbit holes where people are doing these at home, they think they have hypothyroidism or they're diagnosed with it, and they read, take iodine. Is that still based on what we talked about the beginning with where there was this idea that iodine basically fixed the breast disease?
Dr. Alan Christianson: Well, in that blogosphere, I guess there's those statements which are coming from the nutritional circles, like nutritionists, registered dieticians, and those things are coming more of the popular health world. Registered dietitians, nutritionists, I just saw a blog before getting on this call with you in which nutritionist is talking about this topic. They're saying, “Yeah, in theory, that can be a factor, but it's really not relevant in the modern world.” If anything, it's the opposite. Now, I'm more so seeing it in the popular health, natural health space, whatever you want to call that.
Melanie Avalon: The blog that you read, she was saying that iodine is not a problem?
Dr. Alan Christianson: Well, most things that I see that are written by registered dietitians or nutritionists are saying that “Yes, in theory, low iodine can cause thyroid disease, but it's not a relevant cause at the present time.” I wouldn't say no one could ever be low because we need it. It is essential. I've seen it happen. There's one memorable case of a young boy who attended a personal growth event. The speaker at the time was endorsing a raw-foods only diet. This boy was, I don't know, 20. I remember what a zealot-- and I can be an extremist already. When I was in my early 20s, young boy, everything's times tad, is taken over the top, “Oh, this is it. I'll go with this all the way.” He was taught that raw foods were the best foods, and cruciferous vegetables were the best foods. He's like, “Alright, well, I'm going to base my diet on broccoli smoothies, and that's it.” He did. He went through about four to six pounds of raw broccoli with water per day, and that was his diet. He was brought to me six months later, because he had a goiter. He was consuming nothing else, like no salt, nothing. Yeah, those things can happen, but they're not typical scenarios.
Melanie Avalon: Yeah, well, that is one thing that is talked about, especially a lot in the paleo sphere is goitrogens and foods that act like that. It's almost ironic because after reading The Thyroid Reset Diet, it seems a lot of people might actually benefit from having goitrogenic foods to reduce--
Dr. Alan Christianson: In his case, goitrogens are relevant to the context. If he were consuming any other food, one food by itself, like any kind of a fruit or vegetable or any kind of a low iodine food, it would have been the same outcome. I think it was not that relevant even that it was happened to be a goitrogenic food, maybe that worsened it a little bit. But he was just consuming almost no iodine. That was the main issue.
Melanie Avalon: For me, for example, since I did probably go through a period, it was probably four years of no iodized salt, no seafood. I really don't know where I would have been getting a lot of iodine. So, I do wonder at that time, what my levels would have been. Since then, I went on a really high seafood time.
Dr. Alan Christianson: What else were you eating then?
Melanie Avalon: When I was not having seafood?
Dr. Alan Christianson: Yeah, during the possible low iodine time.
Melanie Avalon: It was “paleo,” without seafood. It was like chicken, steak, vegetables, things like that. Not dairy, I wasn't doing dairy.
Dr. Alan Christianson: I'm going to forward you the spreadsheet, you'll get a kick out of this, but I've listed out like the content of about 600 foods, and I've got some data around that. Almost no food has none. When I talk about-- I probably should qualify that better. Broccoli doesn't have none, it doesn't have much. Animal proteins all have low to moderate amounts. Chicken, steak, I don't really consider those relevant because within the reasonable range of a diet, you're not going to get too much from those, but you're also not going to get none. That's true of so many other foods. Just plain raw vegetables have very little. There are some exceptions to that, like potatoes, for example, the skins to be precise. But, yeah, there's very few that have foods that have none, and that's why it's hard to get too low in it.
Melanie Avalon: Yeah, I saw that about the potato skins. It is because of iodine naturally in the potato skins, not some sort of additive or something?
Dr. Alan Christianson: Well, the tough thing too about iodine in all contexts is that it's capricious, it varies, it fluctuates. The databases that I used, many would have 60 different analytes that they were averaging. I looked at not just the averages, the median, but also the mean, and also the highest maximal known sources, the lowest sources, and what the typical spread was like. In cases where the goal is to be at a low level to reverse thyroid disease, my objective was to help people avoid the big outliers. Potato skins aren't really always high, but a few samples here and there can be high. If your goal is to get down below a threshold, those are the kind of things you want to watch. Yeah, that was my mindset that I took into the exercise.
Melanie Avalon: Sounds like when I was researching mercury. I was like, “Oh, my goodness.” It can be all over the place. You could be totally fine, or you could be like saturating yourself in mercury and with the different variances in fish species specifically. Going a little bit deeper into iodine itself, and how it's working in the thyroid, it blew my mind some of the comparisons you made in the book about the amount of iodine that we actually need, like how big that like actually looks. How much iodine do we actually need? What does that look like if we could see it? Maybe we can dive into how it actually functions in the thyroid with thyroid hormones and all of that?
Dr. Alan Christianson: Well, yeah, to get some quick context, thyroid hormones and iodine, they're both things that are occurring in the world of micrograms. I've read things about what we can actually visualize and what we can't, and micrograms are clearly outside of what we can visualize. The mass of a microgram, comparing that to the mass of a paperclip is a pretty good analogy of comparing the mass of a paperclip, to the mass of a cow. [laughs]
Melanie Avalon: Oh, my goodness.
Dr. Alan Christianson: Yeah. A million-fold.
Melanie Avalon: It's tiny.
Dr. Alan Christianson: It's tiny. Yeah, the amounts are small.
Melanie Avalon: So, that's one microgram.
Dr. Alan Christianson: Yeah.
Melanie Avalon: For example, like my current thyroid medication, I think has 10 mcg of T3, so that's like 10 of those tiny little-- Well, I guess T3 is--
Dr. Alan Christianson: Yeah, 10 millions of a paperclip.
Melanie Avalon: 10 of those tiny little of a paperclip. Okay, wow, that puts things in perspective.
Dr. Alan Christianson: Halfway down, there's a grain of salt. A grain of salt is about a milligram. A paperclip is about a gram. A microgram is like a 1000th of a milligram or a millionth of a gram.
Melanie Avalon: To refresh for listeners, he said, the average daily intake of iodine or the optimal average daily intake, if everything was working the way it should be was, how many micrograms?
Dr. Alan Christianson: The World Health Organization has tracked all these populations and how much they consume and how much thyroid disease they get. In terms of the sweetest spot for the least thyroid disease, that's about 50 to 200 mcg. The book talks about how you can possibly reverse thyroid disease, and that's starting below 100, so 50 to 100.
Melanie Avalon: My mind is just trying to envision this. When we take in the iodine, so how is it actually used in the thyroid with--? Is it thyroglobulin? How does the thyroid use iodine to form these hormones and T3 and T4, and what else happening there?
Dr. Alan Christianson: Yeah. Easy thing to think about a coat hanger. I grew up in northern Minnesota, and most homes had like a mudroom. You'd walk into a spot that maybe there's the washer and dryer, there's a coatrack or something, you put your winter clothes there, you take off your boots, and then go into the house. The coatrack, in this case, we got four hooks in the coat rack. What happens in the holidays, when everyone's over, the coat rack gets overloaded. There's coats that are on top of coats, and not just on the hooks, the hooks are full already. Thyroglobulin is a coat rack with four hooks, and it'll take on these iodine atoms, and you've got the right number of iodine atoms in place, and that's how we form T4 and T3. If you’re really precise, the molecule itself can store up to 10 or 13 in the proper [unintelligible [00:29:06] sites are called. In a high iodine state, you can jam as many as 60 iodine atoms on a molecule. All the ones in the wrong place, they are sources of free radicals. Iodine oxidizes, it's highly volatile, and they make the molecule look foreign to your immune system.
Your body's like, “Oh, there's a normal coatrack, but I don't know what that big pile is over there with all those things on it. That looks weird.” Your immune system sees this protein with all these excessive iodine atoms and they're all seeping off free radicals, and your immune system does its job and goes after it. Somewhere along the way, it starts mistaking the coatrack itself for this big nasty pile of coats, and now you're attacking thyroglobulin, and there's an enzyme called thyroid peroxidase that converts iodide, which is the form of iodine in the gut and in circulation, into iodine, which is the form within the thyroid follicles. That enzyme also gets blamed, so your body starts to attack thyroglobulin, thyroid peroxidase. And now you start damaging the cells, and now the thyroid can't work right, but that's the onset of autoimmune thyroid disease.
Melanie Avalon: Oh, my goodness, I am loving this. Okay, some questions. The iodide, which is the form in food, the first form that it's in, if it's in the bloodstream, does it have to go to the thyroid first? Why does the body choose to even convert it into iodine? Why does it stick to the TPO rather than eliminate it at the beginning?
Dr. Alan Christianson: It converts it to iodine, so it sticks, so it becomes more volatile, and it's single and ready to mingle. It's there, it's oxidized, it's ready to take on another reaction. Yeah, iodide, whenever we get it from food, or once it crosses our bloodstream or crosses our gut lining, even if a trace amount of it were iodine, it becomes iodide, and the body can then choose when it wants to make it into iodine. I imagine like the image of a scientist with a big thick face shield and massive leather gloves and the long tongs holding the smoldering cauldron. That's how we handle iodine in our bodies. We only make just the right amounts when we want it to do something. Now, there can be iodine excess, that's what we're talking about to where it makes those proteins damaged, but then there can be iodine toxicology. If you’ve ever seen like historical medicine bottle of iodine, they had skull and crossbones on those, and tragic thing, but one of the leading causes of suicide in years past was iodine ingestion. What the threshold is, is that within a certain range of exposure in the body, iodine is only formed inside compartments, like inside the thyroid. When there's overwhelming amounts, there's so much there that iodide spontaneously forms iodine, even without a pump. That's when we start seeing now with toxicology, kidney damage and liver failure and things along those lines.
Melanie Avalon: That pump that you were talking about in the beginning in the breast, is its purpose to convert iodide to iodine, is that what it does?
Dr. Alan Christianson: Yes, it's concentrating it and also converting it, and then thyroid peroxidase is also helping to convert it and make it so it's ready to stick on to thyroglobulin.
Melanie Avalon: Do you know the Lugol’s iodine, the liquid that people will do the dosing with, is that straight iodine or is it iodide as well?
Dr. Alan Christianson: There's a little bit of iodine that's in there. To be really precise, it would depend upon the age and the stability of the product, but it's somewhere around 5%. The part that freaks me out about that stuff is, like I mentioned how 1100 mcg is like the upper limit before anyone gets toxic and 200 mcg is the daily limit for those prone to thyroid disease where they get toxic. A drop of Lugol’s is 50,000 mcg. Yeah, not a dropper full, but a drop. Yes.
Melanie Avalon: No wonder my eyes went bloodshot red. Oh, my goodness.
Dr. Alan Christianson: It was never made for internal use. It's completely unsafe that way.
Melanie Avalon: Wow. That is crazy. Okay, so going back to the actual iodine in the thyroid and attaching to the TPO.
Dr. Alan Christianson: TPO is helping it attach to thyroglobulin to be precise.
Melanie Avalon: Oh, sorry. Yeah. The iodine and the thyroid TPO helping it attached to thyroglobulin. So many words here. Oh, and for listeners, there will be a full transcript of this episode at melanieavalon.com/iodine. Don't worry, you can check out the transcript to read through all of this. In the thyroid is the thinking by this iodine paradigm, because a lot of people have Hashimoto's which is the autoimmune form of hypothyroidism. Oh, and I probably should-- I've just been assuming listeners are following along, but if they're not, hypothyroidism is an underactive thyroid. Hashimoto's is the autoimmune version of that. Hyperthyroidism is an overactive thyroid. With Hashimoto's, what percent-- Well, I guess what does the literature say and what do you think as far as what percent of people with hypothyroidism do have the autoimmune version of Hashimoto's?
Dr. Alan Christianson: That's a really good question. The iodine, I mentioned how it causes autoimmune disease. Even if there weren't an autoimmune response, it slows the thyroid by the Wolff-Chaikoff effect. In the past, we thought that was like a massive dose shut it down for a while. Now, we know that a little excess can shut it down for a long time. Yeah, the hypothyroidism can be secondary to autoimmune damage, and it can occur independently from too much iodine. How much of hypothyroidism is caused by Hashimoto's? Well, the difficulty is that we've got different categories of diagnoses in medicine. Some diagnoses are, just here's the thing, like high blood pressure or broken leg. Other diagnoses are, here's a bunch of symptoms that usually cluster together, we call that a syndrome. Then, some diagnoses are based upon histology, based on cell analysis. Hashimoto’s technically is a histologic diagnosis. What that means is, the only way you can save someone does not have Hashimoto's is by removing and mincing and analyzing every little nook and cranny of their thyroid.
Many people with Hashimoto’s do not have positive thyroid antibodies. In fact, the bizarre thing that we now know is that the thyroid antibodies are not even causal for Hashimoto’s. They're often present, but they're not the exact mechanisms of the immune attack. Like smoke and fire, you can have like smoldering coals and no smoke, or you can have like little tiny fire on wet leaves and massive amounts of smoke. So, yeah, they're not even causal. Estimates are that 95%, 97% of hypothyroidism is caused by Hashimoto’s because you can rule in Hashimoto’s by the presence of antibodies, but you can't rule out Hashimoto’s by the absence of antibodies.
Melanie Avalon: If a person does not have antibodies, the immune system can still attack the thyroid without antibodies?
Dr. Alan Christianson: Measurable thyroid antibodies, yes.
Melanie Avalon: What role do antibodies play in the messaging of the immune system to attack the thyroid?
Dr. Alan Christianson: Specifically, the anti-thyroglobulin, anti-thyroid peroxidase, they're often present. It is part of the projected mechanism, but it's probably mediated through other compounds such as cytokines as far as the actual damage.
Melanie Avalon: This is so interesting, because a lot of people think with Hashimoto’s and with the autoimmune thyroid issues that-- a lot of people say that it's an autoimmune condition based on diet, like very rarely have I-- I don't think, well until I read your book, did I see anything about iodine being the cause here, but just to repaint the picture. It's basically that the excess of iodine is attaching to the thyroglobulin, and then the body is misidentifying it as a threat and starting an autoimmune response?
Dr. Alan Christianson: Yeah. In terms of what causes thyroid disease, there was one big paper that basically summed up, this was written the last few years. They said, “Look, we now know that there's three irrefutable causes of thyroid disease only. Everything else we've talked about, may have some small contribution, it may have some relevance, the data is inconsistent.” The three irrefutable causes, the first two are called existential because we can't change those. The first two are age and gender. The third one is iodine. That's the one irrefutable cause that we can address. When we look at dietary drivers of thyroid disease and medical literature, there's about three papers on food categories. If we throw in other dietary interventions, there's about five papers. If we talk about celiac and thyroid overlap, there's about a dozen and a half papers. If we talk about iodine, there's about 34,000 papers. That's just the level of this evidence.
Melanie Avalon: How is age or gender a cause of thyroid disease?
Dr. Alan Christianson: Well, age is the simplest one. Let's say that you roll the dice, and you get three 6s, and that's like-- I don't know how this works, but snake eyes is bad, I know, in some gambling. So, let's say [laughs] that's what snake eyes is. The more times you roll the dice, the more your odds are of eventually getting snake eyes. So that's the whole thing with age. Whatever set of things that go wrong, the more years you live, just another chance other year, you've gotten which that bad thing could happen. Those random events combine themselves. And that's true for so many conditions,
Melanie Avalon: Like it broke basically.
Dr. Alan Christianson: Yeah, it's not, say, something is unlikely to happen. But if you give it enough time, eventually it's going to happen, or it's more probable given a long enough period of time. That's the role of age, it's not even a wear and tear’s phenomenon. It's more sort of accumulated risk. Gender, there's three theories about that. One is that it seems at most the genes that affect iodine tolerance, we'll talk more about that. Most of the genes that affect iodine tolerance, are on the X chromosome. Women have two X chromosomes, guys have one. With men, if they have those traits, there's a greater chance those traits can be recessive. That's one. Then the other things are more relevant about-- Oh, I'm sorry, one other factor is relevant about autoimmunity in general, and it's thought that the androgenic to estrogenic hormone ratio has some roles to play in the immune errors that give rise to autoimmunity.
We think this is relevant to pregnancy. Pregnant women have to be able to not attack something foreign when they're carrying a baby. When they move out of that mode, that’s when they can attack things that are not foreign. The last theory also ties into the pregnancy thing. That's about fetal microchimerism. It's thought that wayward cells from a baby that cross the placenta, and end up somewhere in mom's body, they may start the whole autoimmune process initially, which then becomes generalized to any other parts of the body that seem suspicious.
Melanie Avalon: With the age and gender, it's things like immune errors and potential genetic--?
Dr. Alan Christianson: Yeah, X-linked things, X-linked differences, hormonal differences, and then effects from pregnancy.
Melanie Avalon: To clarify, this is thyroid disease. People who have hypothyroidism-- Well, I guess we just discussed how maybe most of it might be autoimmune, but I don't know, like a lot of people who they seem to experience low T3 levels, for example, and symptoms of hypothyroidism. Can that just come from stress? The body slowing down the thyroid for other reasons, not related to iodine and not autoimmunity?
Dr. Alan Christianson: For sure, and this would come under the heading of euthyroid sick syndrome. Just what you described, so T3 can run low. Other thyroid markers are normal. The thought is that in some states of stress, which can include what we think about as psychological stress, but also physiologic stress like impaired renal function or acute infectious disease. In states of stress, the body may intentionally slow down the output from the thyroid. Just to imagine the rationale there, if something's not working right, you'd want to be able to take a break, you’d want to not push the system harder. You'd want to downregulate the system. It's thought that that's generally an adaptive response to the state of high levels of stressors, that low T3 type syndrome.
Melanie Avalon: For people who are on thyroid hormones, and this is something you talk about in the book a lot is, how many people are treated today with thyroid medication. For listeners, oftentimes, I feel like the most commonly prescribed is a T4 only approach. Then, a lot of people especially in my whole world, might be on more specific like compounded T3, T4, they might be on natural desiccated thyroid NDT. There's a lot of thyroid options out there for medication. It was kind of dismal stats in your book about how people actually feel. For those on thyroid medication, how often is it working by the stats?
Dr. Alan Christianson: Well, this brings up the other issue that I haven't mentioned yet, it's important is that thyroid disease is a function of too little hormone being produced but it's also a function of how the body responds to the third hormones in circulation. That's another place where iodine is relevant. That Wolff-Chaikoff effect, it slows the mechanisms of thyroid hormone production from the thyroid, but also it slows the ways by which your cells and your mitochondria take up thyroid hormone. You're running around with the parking brake all the time. Once you get that part of the issue, then it makes perfect sense why not everyone would just magically feel perfect once they got some thyroid hormone back in their body from a pill, because they were already fighting their own hormone, and they're still going to fight the hormone coming from somewhere else the same way.
Melanie Avalon: Yeah, what do you see the most in your patients as far as the issues with just making these thyroid hormones work? Is it more of T4 not converting to T3, of T3 not working in the body, of just not producing enough? What do you see the most stuff that people struggle with?
Dr. Alan Christianson: The biggest factors are first off just having an adequate amount of the building blocks, T4, T3, T2. They're all physiologically important. If someone has all those hormones available, and they've got amounts that are reflective of what they would be in healthy populations, if there's issues past that point, it's often a matter of resisting those hormones, and iodine is the leading cause of that, or it's a matter of a secondary condition. There’s identified five different disease states that are prevalent in 5% or more of those with thyroid disease, and 84% people thyroid disease have at least one of these other disease states. There's things like atrophic gastritis, there's hyperthyroidism, there's various types of latent iron depletions. If one of those things is off, that can it by itself cause symptoms to persist even past the point of thyroid hormone optimization.
Melanie Avalon: I know this is a general question, but do you find-- I know we've talked about this a lot. What are your thoughts on compounded medication versus NDT? As far as how people respond, as far as the accuracy of the doses, what are your thoughts on those?
Dr. Alan Christianson: Well, it pulls up our microgram world again. My thought there is that they're hard to make well, and thyroid hormones are unstable. They're based on iodine. Iodine is not stable. Between 2012 and 2017, with the best technology we have at our disposal, there is 99 recalls for synthetic thyroid medication. They can't be made perfectly. Thankfully, there is a process by which they're analyzed post production, and then recalled, and then there's legal guidelines. My concern about the compounded medications is that when was the last recall on compounded thyroid medicine? They've never had any. That's not because they're better, it's because no one is checking. I can't imagine it would never happen, but just no one ever looks.
Melanie Avalon: Because something like Synthroid, there may be testing, right?
Dr. Alan Christianson: There have been some cases in which people have looked. There was a patient of mine who is seeing another doctor. This is such a sad story, but she called me on a weekend, she was incoherent. I got that she was panicking, and she was like, her heart was pounding she mentioned. I knew the other doctor she'd been recently seeing was a big fan of compounded thyroid. I said, “Look, I think you may be getting an overdose.” I encouraged her to call 911. I don't know how many years ago that was. Last I heard, she spent her remaining decade on a vegetative state, she barely lived through that scenario. She was given a compounded medicine, which was not an unreasonable dose, it was a sustained release T3, that the prescription was for 7.5 mcg. However, it came out of the pharmacy as 7.5 mg. Yeah, she was in a coma for months and never really regained brain function afterward.
Melanie Avalon: Oh, my goodness. Okay, every time I call the pharmacy, now, I'm going to be like, make sure it's micrograms.
Dr. Alan Christianson: I have no doubt that that's not a common problem. The idea of it being off by 10%, by 50%, by 80%, that's entirely probable. There's just no method of analyzing. I've spoken to compounders, who have advertised that they do analyze their products. When I get down to the brass tacks, they do analyze their products for pyrogens and biologic contaminants so there's no bacteria growing. That's cool. Do you guys assay the actual postproduction hormone content? Well, no, we don't need to do that. I know, that's my problem.
Melanie Avalon: Oh, my goodness, is this a potential issue with NDT at all?
Dr. Alan Christianson: Well, so NDT is a USP regulated medication. It does have to undergo postproduction analysis, and there are legal guidelines for how much variance it can have from batch to batch. We do get recalls with NDT, and that's because that whole process.
Melanie Avalon: What's so interesting is because I know that recent recall, I feel, happened with one of the big brands. The ironic thing is just talking to you right now about it, people probably see that and they think, “Oh, shouldn't take NDT, there's this huge recall, it could be wrong.” When really the takeaway that I'm having now is, you probably shouldn't be taking that because it's regulated compared to, if you're getting it compounded, there's nobody checking. People are probably going to think it's much safer now to get compounded.
Dr. Alan Christianson: Well, there was just a study done not that long ago looking at how much patient's blood levels fluctuate when they're on NDT versus on synthetic T4 only. This was done by a conservative medical group. They found no differences that there was no problems that way, it was not an inferior product as far as the variability from batch to batch or patient's blood levels over periods of time.
Melanie Avalon: Are the issues overdosing on the T3 aspect of it compared to T4, since T4 is inactive?
Dr. Alan Christianson: Both can be a concern. When T4 is overdosed, it's cleared to T3 as it's broken down, but there's a chance to make some of it into reverse T3. The body normally makes most T4 into reverse T3. It's not like we have two lungs and two kidneys, we have more than we need. Normally in a healthy system, we make more T4 than we need and we waste the majority of it. Reverse T3 is a normal byproduct. T4, we've got one more backup mechanism if there's too much, but that's to a point, that doesn't really scale forever. We can certainly get too much of it as well.
Melanie Avalon: There's just so much. There's that whole aspect of the medication. Going the route that you propose in The Thyroid Reset Diet and trying a low iodine diet to address everything--you've had one shocking statistic that I wrote down. There was one study that showed a low iodine diet cured 78.3% of patients with Hashi’s. TSH went from 14 to 3.18.
Dr. Alan Christianson: 3.18. Yeah, 14.1. That was within three months. The bizarre part, Melanie, was that, so one fascinating takeaway was that pre-diet, they did partition the patients based upon their iodine levels, their iodine excretion levels. Post-diet, that did not predict who would and would not respond. So, the question I get is, should I test my iodine before I do this to see if it'll work or not? I'm like, “Well, no, because it's not predictive of if it'll work or not.” Of those that didn't respond, so the 78.3% that what like, so 28%, so 27.7% of people who didn't respond, they were in two categories. The biggest category by far was people that they did respond, but they weren't yet normal. They had a starting TSH of 50 to 100. They were down by 50% or more, but they weren't yet normal within three months. The last group was a couple-- I'm sorry, there was two other groups. The second group, which was a few people, they were not at an iodine target. The iodine levels didn't predict who would get better, but of those who didn't get better, it did predict who wasn't complying, or maybe they weren't educated well enough, whatever. The thing is, you’ve got to play to win and they were playing. [laughs]
Then, the last group was about half a percent of people whose TSH has never budged, and they were on target for their iodine. It doesn't work for everyone, but it was pretty darn close in those studies. They were people that were not yet on thyroid medication, they had disease for an average of four years, it had been quite a while. But with thyroid medicine, it's more involved. It is also a matter of the fact that as the thyroid gets better, the medicine has to be adjusted. There's still the benefits, even for those on thyroid medicine to where they don't see radical changes in their blood level by doing the Thyroid Reset diet, we see so many stories about symptom improvement, and this comes back to the whole take, the body responding better to thyroid hormones.
Melanie Avalon: It's really interesting what you said about, it didn't really matter their starting level of iodine as to how they responded. If we are oversaturated in iodine, like how long does it take the body to clear it, especially if you go on your low iodine diet, what does that timeline look like?
Dr. Alan Christianson: Yeah, great question. A lot of the things we know about low iodine comes from medical procedures. There's iodine uptake scans and there's iodine ablative treatments. Those are situations in which we want the thyroid to be like a dry sponge that's going to just suck up all the water that's dropped on it. We want it to be hungry for iodine so it takes it up very readily. What we've seen is that most people with typical ambient levels of iodine, they can actually get-- I'm going to back up on that more. You can think about the iodine balance in three categories. You can think about it to where there's enough to where the thyroid is staying steady on its iodine levels, good or bad. There's a lower level to where the amount of iodine is-- the thyroid is losing iodine, it's like at a negative iodine balance. There's a positive balance where there's so much coming in that the amount in the thyroid is increasing past some physiologic state.
People who are at typical iodine status, they can be at negative iodine balanced where they're eliminating iodine their thyroid, making their thyroid hungry, that can happen in a week or two normally, but there certainly are outliers. I've had people that have been in our programs and courses that they had done things like taken a lot of that Lugol’s for periods of time, or they had a lot of iodine from contrast or from a medication called amiodarone. There's cases where it might be a matter of months and months and months before they can even get to a balanced state. Yeah, in most typical scenarios, it's a few weeks to first reach that state of negative iodine balance.
Melanie Avalon: Is it a situation where-- you just mentioned people who have done mega-dosing or say, for some reason, you take in a huge amount of iodine at one acute moment, do you automatically take it all in and it sticks, and then you have to deal with it? Or is it a situation where you take some of it in? So, the difference between like chronic exposure to less compared to one-time exposure to a huge amount?
Dr. Alan Christianson: Yeah, so bolus exposure. This has been studied quite a bit. There's really not much variation in terms of iodine requirements. There's no genetic variations where someone needs 10 times as much, but there is variation in how we respond to bolus dose iodine. This has gotten a little theoretical, but the thought is that we have different traits that were prevalent in human ancestors that were coastal versus those that were deeply inland. Coastal people never had lack of iodine, and they occasionally had bolus exposure to iodine. Then, inland areas were the opposite. They were often trying to do their best to conserve what they had. We think that's relevant to some of this.
But, yeah, bolus exposure, it does also engender eliminative mechanisms through the intestinal tract. NIS is also active in the gut lining, and to some extent, it does adjust based on iodine needs. If we're already sufficient, we don't take in quite as much. That doesn't protect us as much from bolus doses. We absorb about 92% to 94% of oral iodine across our gut lining in normal circumstances. That can change slightly. We can also eliminate a little bit more in our stool and our sweat, but there are limitations. Those are things that change it by just a few percent. By and large, though, yeah, we get a big bolus dose, we mostly have to deal with it. A lot of that still does end up in the thyroid.
Melanie Avalon: People who are not genetically from a sea-based population ancestry, are they the ones that are more susceptible to being damaged by bolus because their body's like, “Ooh, save it!”
Dr. Alan Christianson: Exactly, they're so busy sucking it in that an extra just floods them, they get much more than they need. And then one more point about just the excretion is that the thyroid gets rid of iodine by making thyroid hormone almost exclusively. It gets rid of just a trace of iodine outside of thyroid hormone called the nonhormonal excretion, but that's a few fractions of a percent. That's why when the thyroid has a lot, it can't just dump it all out, because it can't make unsafe amounts of thyroid hormone, the body blocks that.
Melanie Avalon: When you're on thyroid medication, getting your thyroid hormones, how does it ever get rid of the iodine?
Dr. Alan Christianson: That's why medicines changed that. That's why it makes it even more imperative to be thorough about avoiding it once they correct their thyroid function.
Melanie Avalon: Oh, my goodness. I'm sure this is not the route to go, but what if you were on thyroid medication, and then you went off your thyroid medication, and went on a low iodine diet, would that make you get rid of it faster?
Dr. Alan Christianson: Well, it's possible. But the concern is that-- this is an extreme example, say someone never needed thyroid hormones at all, they were just put on them, and they were taking them. Now to a point up to about the point of what your body would normally make, you will accommodate that. To illustrate that example, say, talking about 100-pound adult menopausal woman for easy math and her body would make about 77 mcg of T4 per day. Let's say she's taking 77 mcg of T4 per day, and she was just given this dose. Well, she's now making none. She would make none to make room for that. Let's say that, that she was on that for six months and it wouldn't appear to be too much because her body is now making none to make room for that. If that were discontinued abruptly, her body would aggressively ask for more thyroid hormone because it's about three to six months to get things back online. Again, let's assume her thyroid can work again, that it wasn't suppressed for too long, her TSH levels will be through the roof. The signal telling her thyroid to work will be so high and so dramatic that that's harmful to it. That high TSH itself can trigger thyroid disease and trigger thyroid harm. There certainly are times when we see this where people can have appropriate tapers to their medication, but if it is too fast and too abrupt, it ends up blocking the chance for their thyroid to heal.
Melanie Avalon: I'm glad we're having this conversation, so I don't do something drastic, be like, “Well, I never needed to be on thyroid hormones anyway, so bye.” [laughs] And stop taking iodine or stop eating iodine. Okay, so listeners, work with a practitioner, have your thyroid monitored.
Dr. Alan Christianson: Yeah. I encourage that so thoroughly when someone's going on the diet, because they may well need some changes. If they don't make the change they need, they can get too much thyroid, but also they can block the chance for their thyroid repairing. When the thyroid starts to work better, the first change on the panel is the TSH starts to drop. It starts dropping below the range, and that's a sign that “Hey, yeah, you now can start tapering with your doctor's guidance.”
Melanie Avalon: My doctor has played around with my dose a lot. If they ever add more T3, they tell me that it'll be normal if you have for the first time or so, heart palpitations. It might feel like too much at the beginning. Now I'm just thinking, if it feels like too much at the beginning, would that sort of insinuate that it is too much, then it's just that thyroid adjusted to it?
Dr. Alan Christianson: Yeah, exactly. Then over time, you start to make less of you-- you duck down to make room for that, so to speak. You're put into a room with a low ceiling and you get used to walking bent over. But at first, like, “Hey, this is weird.” So that's what's going on inside your body.
Melanie Avalon: Iodide salt, especially now that we have this whole idea in our head that we can't quite grasp as far as the size of things, but iodized salt, which was put forward to “solve” this iodine deficiency issue. How much iodine is in iodide salt compared to a low medium or high iodine food?
Dr. Alan Christianson: In terms of amounts, it's 1 part per 10,000 of salt is fortified with potassium iodide. Some of that gets lost along the way. Normal daily salt intake, in practical terms, you'll end up with about 200 to 300 mcg of iodine from typical salt. Now, if you're doing something like Pink Himalayan salt, that's about three times as high, two to three times as high. Yes, if some salts have quite a bit.
Melanie Avalon: The pink one, that's not fortified, that's just natural iodine?
Dr. Alan Christianson: It's just naturally occurring. Intuitively, I wouldn't have thought that because it's an earth-based salt, not a sea-based salt. The assays I've read and I've talked to manufacturers, “Are you guys sure about all these decimals and zeros? Are you totally positive? Because this is a lot.” Like, “Oh, yeah, this is right.” I'm like, “Okay.”
Melanie Avalon: I know you talk about the salts in the book, but Redmond sea salt? Well, it's not sea salt. Well, it was an ancient seabed.
Dr. Alan Christianson: To my memory that one did also-- either I didn't see an assay on it, or it came back high. I know that I did investigate it and I did not end up adding it to the list of safe salts. Either there was no data, or the data was not good.
Melanie Avalon: I bet they would answer. I'm going to send them an email because that's the salt that historically I've used, and I think a lot of people in this-- and my audience probably use.
Dr. Alan Christianson: The funny thing is that the argument for using something besides just plain salt is that you're getting more minerals. You are, but you look at the actual amounts. Potassium is a great case in point. There's potassium in sea salt, for sure. Our bodies need 3000, 4000 mg of potassium per day. If you consume 5 grams of salt from sea salt, you get about 0.001 mg of potassium. It doesn't change your day. That same thing is true of all the minerals and sea salt with the exception of magnesium. A normal day's intake of sea salt, you might get an extra 50 mg of magnesium. That's not nothing, but, yeah, other than that, all the minerals in there, they are there, but when you say that they're there, there's also all the bad minerals there. You're also getting aluminum and arsenic and gold and mercury. They're present in trace amounts, in amounts quite similar to what you find for iron, not magnesium, but selenium or zinc.
Melanie Avalon: Just can't win.
Dr. Alan Christianson: Then another funny thing is that you look at the culinary circles and all the chefs say that iodized salt tastes bad, that they notice the flavor that it imparts. All the chefs use kosher salt and actually Diamond brand kosher salt is by far the favorite of all the chefs. Morton's brand kosher salt is good. It has prussiate, yellow soda of Prussiate, which is harmless enough, but some wish to avoid that. Diamond brand sea salt, it's a diamond-shaped crystal, so I'm not an expert in the kitchen, but it apparently is a really good physical effect of how it sticks to things and holds on to things properly.
Melanie Avalon: I think you also mentioned like the Celtic brand of light gray salt. Is that a sea salt though?
Dr. Alan Christianson: For sure. Yeah. It is. They've assayed their products repeatedly. Their light gray, which comes in a fine, and a coarse ground is basically devoid of iodine. It's got very minimal amounts. They make a lot of other salt products. That's not true of their other products, but it is true of their light grey sea salt. There's also Maldon sea salt, which is also pretty low. I've got a crush on this stuff. I'm learning the tricks. Here's what chefs do with salt, is that they do kosher salt when they're cooking, add that to the water, add that to the dishes, but they always intentionally leave a little bit short. And then, they do a finishing salt at the final stage of delivery. The finishing salt, like Maldon’s finishing salt, it's these crystals that are-- I don't know probably about like half a centimeter, like quarter of an-- up to a quarter of an inch in width like a disc so to speak in their width, and then almost nothing in their depth. Almost like discs, like frisbees, like little shapes of frisbee, but more like angular shaped.
Melanie Avalon: Wait, what type of salt? What is this?
Dr. Alan Christianson: Finishing salt, Maldon’s brand finishing salt. You sprinkle this on top of things and it's not all that much of a massive salt, but you get the texture, you get this crunch, and you get these bursts of taste from it here and there. They've got a smoked version of their finishing salt, which is so insanely good. Yeah, so when I'm cooking, I'm using Diamond’s salt for cooking, and then I'll do a little sprinkle of the finishing salt. Karen doesn't like the smoked one as much. I love it, but I'll sprinkle some of the finishing salt, then on the way to the table, and that's just so phenomenal.
Melanie Avalon: Yeah, I looked at a picture of it. I actually saw a new salt at Whole Foods the other day, and I was like, “What is this?” It was ice salt.
Dr. Alan Christianson: Huh?
Melanie Avalon: Have you heard of this?
Dr. Alan Christianson: Not at all.
Melanie Avalon: It just looked really alluring. I just read your book, I was like, “Well, nope.” [laughs] Can't try any new salts. Yeah, it said it was from like ice. I don't know. Ice glaciers somewhere.
Dr. Alan Christianson: I'll let you know. I'll check it out.
Melanie Avalon: One more last question for you. It's not really thyroid related. But what are your thoughts on salt as far as, I feel like that's another thing where there's people on one side who say we need to get rid of all, like salt. We don't need salt. Then on the flipside, we have people, especially in the keto world where they're like, “Oh, we're actually salt deficient. We need to be ramping up the salt.” I'm just like, “Ugh, I don't know.”
Dr. Alan Christianson: Well, so the simple thing is that keto diets cause hyponatremia. [laughs] They make you excrete all kinds of minerals, including salt.
Melanie Avalon: On a keto diet, that might be the case?
Dr. Alan Christianson: Yeah. I have looked at the arguments about salt’s role in overall heart disease. It's something that's very true for some people, it's less true for others, the effect size is not nothing, but it is smaller. There have been some arguing that everyone's really salt efficient. That's not congruent with literature. But, yeah, for some people it is quite relevant to blood pressure, and there can be some effects with excessive amounts on cardiovascular disease, for sure, especially in an overall low magnesium context, or low magnesium and low potassium context.
Melanie Avalon: Yeah, I'm just so fascinated by it, because, like I said, there's this whole idea where it is linked to blood pressure and heart disease and things like that. Then there's this other narrative saying, “Oh, it's not involved at all, and maybe we actually need more to prevent that.” I'm just like, “That's the complete opposite.”
Dr. Alan Christianson: I’ve talked to that author in a lot of detail about it and not come away impressed from the idea.
Melanie Avalon: I'm haunted by this. Okay, so thank you.
Dr. Alan Christianson: I'm sorry, just short answer, I would say about that is, have a lot of plant foods in your diet for potassium, magnesium, and lots of different food categories, and salt your food to taste reasonably, and you'll come out good,
Melanie Avalon: Because the thing I've noticed, and this is just me, but I've gone through periods of higher salt, because I was eating not super processed meats, but like deli meats that have salt in them. I just noticed that I did seem to adjust to whatever salt intake I was taking, but if I cut out the salt, and don't really add salt, I feel good like that. Then I only crave salt like a little bit compared to if I bring back the salt, then it's like I feel I need to have this massive amount of salt every single time. I seem to just adjust to whatever. I just feel healthier, not at the higher salt level.
Dr. Alan Christianson: There's a threshold for sure where our salt taste is based on our salt exposure. They've also shown that above some threshold salt does correlate with satiety, saltier things end up making us hungrier, and they put-- and thirsty, of course, which is why they put pretzels out at bars.
Melanie Avalon: I read or saw the other day, I went on a tangent researching umami, because normally that is thought to increase appetite.
Dr. Alan Christianson: Oh, no. [laughs]
Melanie Avalon: But yeah. I was reading that it actually is the opposite. I was like, “What?” Now, I have no idea.
Dr. Alan Christianson: That's been well studied, glutamates. That's a fascinating topic.
Melanie Avalon: I guess people associate like MSG. For listeners, definitely get The Thyroid Reset Diet. It has an entire protocol to follow to attempt to reverse your thyroid disease with a low iodine diet. Is this a diet that anybody-- You mentioned that you don't need to test your iodine levels beforehand. Could anybody potentially benefit from trying the low iodine diet? Is there any reason not to try it if you suspect that you have thyroid issues?
Dr. Alan Christianson: Well, there's not. I wrote it to where it was a pretty healthy diet overall, to where there is no big exclusions-- Yeah, you are still covering the bases nutritionally, for those reasons. Low iodine diets were written for medical procedures, they were only meant for use of a week or two. They just said, only eat this and don't eat everything. They're very restrictive. To make it simple for a brief process, I don't blame them. But for a longer period of time, 3, 6, 9 months, then I wanted it to be easier to do and nutritionally complete. There's two stages to it. It's the first one is that reset stage, and that's where you're just working to get your thyroid to work better again, and you're watching it function improve. And then past that point, there's the maintenance stage. Once your third function has gotten better, then you now have more leeway. You've got a certain higher amount of iodine tolerance back. Then I talk about ways you can add in some of the foods you've been avoiding or reducing.
One thing that was a really big epiphany for me, I've heard so many times where people will talk about, they've gone paleo or they've gone vegan, or they've gone gluten-free, and their thyroid’s improved, and I've struggled to find data supporting other reasons why that would happen. Then as I was looking at what are the popular things that are commonly eliminated in those diets, they're often cutting out a lot of the iodine outliers. I've done some assays in the book showing like, here's a popular autoimmune paleo menu, here's a popular vegan menu. Then, I put what the actual iodine content would have been from those foods. In both cases, people could have easily found themselves in a therapeutic level for reversing thyroid disease just based on the iodine.
Melanie Avalon: Right, because some of the big categories were obviously the processed foods, the salt, the dairy.
Dr. Alan Christianson: The processed grains, like you mentioned, egg yolks.
Melanie Avalon: Yeah, that was so fascinating about the dough conditioners, and apparently, we're not supposed to be using them, but are they still there or something?
Dr. Alan Christianson: Well, this is weird.
Melanie Avalon: You talked about the testing.
Dr. Alan Christianson: Yeah, they've shown that some commercial baked products do list iodized dough conditioners, some do not. But when you assay, you go by the store and buy a slice of bread and you bring it to a lab and measure the iodine content in there, the labeling is not predictive. You can't say commercial products that are not made of iodized dough conditioners are low in iodine, and it's not even a gluten issue. Even gluten-free commercial products can have issues that way.
Melanie Avalon: Sneaky, sneaky, sneaky. Some very last quick questions. It's not a long protocol for the initial first phase of your diet, how often do they need to be checking their thyroid levels during that?
Dr. Alan Christianson: I would encourage to do so within the first month. If there is ever a lot of change showing up, and then repeat in a month. If it's stable, give it two months. Same thing, the more it's changing, the more closely you want to monitor it. As if it is changing rapidly, then, yeah, you want to check that monthly and speak with your prescriber and make adjustments that are appropriate.
Melanie Avalon: Okay. And then the last thing, so I did get my iodine levels tested, and if you test your iodine, it's urinary. I'd sent them over to you, but mine was the total volume was 2450. The iodine 24-hour urine was 162, creatinine was 0.71. You had told me that that means I fell-- I think I was like, was I high or--?
Dr. Alan Christianson: You were high. What happens is that urinary iodine, by itself, it is a very good tool for a population’s iodine status, for 500 or more people. There's so much personal variation that it's not meaningful for an individual status. There's actually a big paper that just came out showing that if a given person tests themselves 10 times, they can be within 20% accuracy, which is pretty abysmal. If you test yourself 300 or more times, you can be within 90% or 95% accuracy. But by calibrating it based upon your creatinine, you can see how active your kidneys were in that moment, and you can get a better sense. You can't really tell someone's nutritional status, but you can tell-- I talked before about their iodine, whether they're at a positive balance or gaining it or a negative balance or getting rid of it, or they're holding steady, you can tell which category someone is in pretty accurately based on their urinary iodine to creatinine ratio. Once we factored yours in-- and the funny thing is that before you factor it, urinary iodine might even say that it's low, but once you correct for creatinine, it can be completely different. Yeah, you were in that positive state of iodine balanced based upon your level at that time.
Melanie Avalon: Well, this is very relevant to me, and probably so many of my listeners. Well, thank you so much. This is absolutely wonderful. I've been dying to have this episode, because basically, every time people have been now even remotely mentioning anything about hypothyroidism, or anything thyroid-related, I'm like, “Go ahead and preorder this book right now, because you're definitely going to want to read it.” When this comes out, I bet the book will probably be out. For listeners, I will put links to everything in the show notes. Definitely get the book, it dives deep into all of this. It has the actual plan to follow, recipes, it's got you covered.
Thank you so much, Dr. Christianson, I appreciate you so much. Oh, yeah, that was something I wanted to say in the very beginning. One of the things I just really, really love about you is, in the whole health world, there's so many different ideas and concepts and debates and arguments. There's a lot of cherry-picking and there's a lot of people trying to drive agendas because-- or trying to skew data or interpret data to fit their preconceived ideas about whatever their idea is. I so respect you, because I always just get the sense that you are really looking at all the literature, you are looking to see what it really says, and you're not trying to fit any preconceived notions. I feel you are so trustworthy. So, thank you so much for everything that you're doing.
Dr. Alan Christianson: Well, I just want your audience to know that you're one of my all-time favorite conversation partners. We've had all these great email exchanges and great talks over the years now it's been. But no, you're bright, you understand these things, you're trying to figure it out. I really appreciate you taking the time today for us to have a detailed conversation. It's fun to go into it at the depth of deserves and not just hit the high points. Thank you so much for that for giving this to your audience and giving us the time.
Melanie Avalon: Well, thank you. I am so grateful. I don't know if you remember this because it was so long ago now, but the last question that I always ask every guest at the very end, and it's just because I realize more and more each day how important mindset is surrounding everything. What is something that you're grateful for?
Dr. Alan Christianson: I'm grateful for the ability to train well, the ability to exercise well. I've not always had that. I'm 52, I'm really at the best health in my life and just really having a blast with that, so yeah, that's it. I think there's nothing, no single habit that has more broad benefits to our health than just movement exercise, time outside. So, yeah, thankful for that.
Melanie Avalon: It's wonderful. I love it. Do you have any other books in the works now?
Dr. Alan Christianson: I'm toying with that, and actually, I should get your feedback on a couple of the ideas. [laughs] I do, I'm just debating. I'm just like three, four that I'm playing with, and, yeah, I'll run that by you and get your input.
Melanie Avalon: Oh, my goodness. Oh, I'm excited. What links would you like to put out there for listeners? You'd mentioned something about you have a link for your free program, invisibleiodine.com?
Dr. Alan Christianson: Yeah. It's a docuseries. It's a series of videos that just trains about this exact scenario and gives some more depth about what are these big outliers and how this has affected people and where they can find the sources of it. It's a great starting place for those that want to learn more about the concept.
Melanie Avalon: Perfect. Again, I'll put all the information in the show notes. This has been absolutely wonderful. Hopefully, you can come back for a third time in the future, maybe about that magical third book that I'm really excited-- fourth. Fourth, it will be your fourth book?
Dr. Alan Christianson: It’d be my seventh actually.
Melanie Avalon: Oh, seventh. I guess I've read three of yours, off to read the other ones. Seventh, oh, my goodness. [laughs] That's incredible. All right. Well, I will talk to you soon.
Dr. Alan Christianson: All right. Take care, Melanie. Thank you.
Melanie Avalon: Bye.