Please pass the iodine!
Editor's Note: Last issue in Woods Hutchinson's classic 1925 article, American microbiologist David Marine demonstrated how small amounts of iodine introduced into hatchery waters could cure baby fish of a mysterious disease known as "trout cancer." In Switzerland, health officials dramatically reduced goiter in school-children by feeding them chocolates laced with iodine.
By now it is clear that iodine, far beyond its common use as an antiseptic, played a unique and vital role in animal and human health. Yet this essential element was chronically lacking in the diets of people living far from the sea. In his conclusion, Dr. Hutchinson addresses the simple solution that can rid the world of iodine deficiency disorders.
When Salt is Too Pure
One of the first questions which arose in our minds when we began to grasp the relation between iodine shortage and goiter was the natural one of why there appears to be, not only in America but in nearly all countries of the civilized world, such a surprising amount and apparent increase in the occurrence of simple, or mild, goiter. Part of the answer, of course, is that until the last ten or fifteen years we never looked for it on a large scale by examining large numbers of apparently healthy individuals for evidence of the disease. But the general feeling is that some other influence is at work and that the increase is real, and we are more and more steadily drifting to the view that the salt problem is the basic one of this new-found menace. In other words, that a very large part of the insistent craving for salt, which is one of our oldest instincts, was due to the iodine, which was left in the salt when it was evaporated out of the sea water; in short, that our modern methods of refining and purifying salt to snowy whiteness and crystalline purity are at the bottom of this world-wide increase of mild goiter.
This much is certain: Analysis of cheaper or inferior grades of salt today, such as are used for salting cattle, curing meat, and preserving fish, shows that they contain good quantities of iodine; while on the other hand, scores of analyses show that our nice white, crystal-pure brands of table salt, which are so beautiful to the eye, are absolutely devoid of even a trace of iodine. This, of course, at once makes the practical suggestion, Why cannot we modify our methods of salt purifying, stopping short of leaching out all the iodine? Practically, this can readily be done without much additional expense; but there is a strong trade objection to it on the--from the dealers' point of view--quite reasonable ground that salt of this type does not look so well, will not keep so well in cellars or shakers and may be objected to at times on account of its slightly bitter taste. But these are only questions of the intelligence and education of the general public on these points.
This salt modification is one of the most rational ways and the most universally effective way of making good the iodine shortage. What we have taken out of our salt with one hand in order to make it look pretty and keep better we can restore to it with the other.
Several practical movements in this direction are already on foot. For instance, by order of the state board of health and agreement with the salt manufacturers, salt offered for sale in Michigan after the first of January, 1925, will contain a certain number of parts per thousand of iodide, leaving the manufacturer to produce that condition either by shortening his process of evaporation or by making his pure white salt and then adding to it afterward this trace of equally white sodium iodide.
Curiously enough, the latter method is believed to be the most practical, because by leaving enough residue from the sea water in our table salt to carry over a sufficient per thousandage of iodine, other nonattractive and ill-tasting elements are left with it, so that the salt is less attractive both in appearance and taste. It is probable that Michigan's lead will be followed by a number of other states in the near future.
All that is needed is to give to each growing child about five grains of iodine each year, or less than one-tenth of a teaspoonful, and this incredibly small amount may be sufficient to make all the difference between his growing up goitrous and retarded in his school work and with a 2 per cent risk of the serious exophthalmic form, and being strong, vigorous, and healthy.
It is one of the striking instances of the prophetic power of true poetry that Browning, in one of his best-known lyrics, exclaimed, "Oh, the little more and how much it is, and the little less and what worlds away." Of course, he was only speaking of love or some other equally visionary influence; but if he had been up to date in modem chemistry, he might have said the same of iodine.
The most vivid illustration of the tiny, almost infinitesimal amount of iodine required to prevent goiter is given by the fact that in certain progressive cities health officers are now actually trying to solve the goiter problem by adding iodine salts to the drinking water. At first blush this would almost remind us of the old legendary dose consisting of one grain of quinine dissolved in the Atlantic Ocean, but it is perfectly rational and practical. The actual proportion of iodine required is only about ten parts per billion gallons; and the amount to be added to the drinking water of Rochester, New York--whose brilliant and progressive city health officer, Doctor Goler, is actually carrying out this method today--is only about sixteen pounds of sodium iodide per day for two weeks put into the main as the water passes into the final storage reservoir, and this is repeated twice a year. This process has now been in use for two years at the enormous and heartbreaking expense of one cent per capita per annum and the percentage of goiter among the pupils in the two upper grades and high schools of Rochester has already fallen 50 per cent. And the gain in weight and improvement in school standing noted in other regions where iodine has been given will doubtless follow suit. Even the grown-ups, especially the expectant mothers, will benefit from these vicarious two trips a year to the seashore. A similar treatment with iodine of the drinking water is being carried out at Sault Ste. Marie, and other towns are getting ready to follow the example, and where America leads the world will follow.
Enriched Water Supplies
Of course, the objection is promptly raised that a great deal of the iodine is wasted; but as the total annual cost is only ten dollars per 1000 persons, that argument is of no great practical weight. The results of the method will be watched with the greatest interest. If this method of putting completely back the sea breeze into the drinking water clears up the goiter, it will be decidedly the best method yet devised for the millions of our people who are living in cities of ten thousand or more population; and as nearly 55 per cent of our citizens live in this city group, it will be a long step in advance to reach this number.
The only objection to it is some uneasiness as to the possibility of putting into the systems of those who drink it more iodine than they actually need. But as McClendon--whose beautiful studies of the relation between shortage of iodine and goiter all over the United States have been a most valuable contribution to our new knowledge--pointed out, the natural variations between iodine-rich and iodine-poor drinking water over the United States are something enormous--the richest waters, for instance, containing eighteen thousand times as much iodine as the poorest. And as hundreds of thousands of people are drinking these iodine-rich waters without the slightest disturbance of general health, and with an almost total absence of goiter, there appears to be very little reason to dread any injurious results from an artificial surplus of iodine in the water; especially as the parts per million which it is proposed to add are less than one-thousandth of the iodine contained in these richest natural waters.
For the 45 per cent of the population who live in the smaller towns and rural districts the iodization of salt by agreement between the state boards of health and the manufacturers appears to be the most effective and practical method. The addition costs only some four or five dollars a ton, which makes no appreciable difference in the price per pound.
Another illustration showing the actual practical benefit of living close to the sea and near to its storm-tossed bosom is furnished in a rather unexpected way by the experience of those firms which collect thyroid glands of sheep and cattle in order to make extracts out of them for medical use. They have found by repeated tests that the largest percent of both thyroxin and iodine is to be found in glands taken from cattle and sheep which have pastured within fifty miles of the sea. Not only so, but they have found by abundant practical experience that thyroids collected in late spring, summer, and early autumn contain larger percentages of iodine than those which are obtained in the winter, the reason for this difference being that cattle and sheep are for the most part on pasture at this time of year and that grass, green leaves, and fresh vegetables generally contain much larger percentages of iodine than grains, hay, and other dry food.
This raises at once the question, Is there a similar seasonal variation in the amount of iodine in human thyroids? An investigation was set on foot at once in the post-mortem rooms of our large hospitals and it was quickly found that an almost equally striking summer rise in the percentage of iodine was present in the human thyroid, due to the same cause.
This brings us to the final problem: How far can we hope to make good this iodine shortage by a careful selection of our foods and adjustment of our rations? The first thing, of course, is to find out what is the actual iodine content of our foods and how widely do they differ. Careful analysis of a long list of foods from various parts of this country by McClendon, and in Switzerland by Fesselman, gave prompt and interesting response--interesting both because foods were found to differ enormously in their iodine content, some containing almost a hundred times as much as others, and because the group of iodine--rich foods is the very one with which we have become almost wearyingly familiar within the last five or ten years--the so-called vitamin group.
Fruits, vegetables, sea foods, and butter, for instance, contain from seventy-five to a hundred and fifty parts per million of iodine, as against five to fifteen parts in wheat, corn, beef, potatoes, and skimmed milk, the highest notch of all, one hundred and sixty-five parts, being scored by loganberries. Not only the visit to the seacoast but the clambake and the blueberry pie and the shore dinner generally are also abundantly justified from an iodine point of view. They are the grub that makes the goiter fly.
The Vitamins' Secret
This coincidence is extremely interesting from two points of view. In the first place it enables us to kill two birds with one stone, and do whatever can be done toward the prevention of goiter by food at the same time that we are keeping up an adequate supply of the priceless vitamins, so that in the language of the ring, we can't lose either way. Secondly, because it raises the fascinating speculation as to whether these potent and much studied vitamins, "A," "B," "C," "D," "E," and of late "X," may in themselves consist of or depend upon small amounts of some other of the sea-water elements, which we have long known to be present in our food but in such infinitesimally small amounts as to have been passed over as of no importance or even to have escaped recognition entirely. There are a dozen such "airy nothings" known in our make-up already--copper, manganese, arsenic, zinc, gold, and radium, for instance.
Now that practically all the powerful influences upon growth and intelligence and remarkable curative effects of the thyroid gland have been found to be due to minute traces of iodine, why is it not possible that several of the other endocrine, or ductless, glands, may depend upon, say, arsenic or radium for their potent activities? And it is even more conceivable that the vitamins may depend for their beneficent influence over growth and health upon some tiny trace of some metal or salt hitherto disregarded.
Ever since their first discovery and naming by Funk we have beaten our heads against a stone wall in a fruitless endeavor to isolate vitamins and discover what kind of protein or life-tissue stuff they may be. Why not look for some suspicion of a metal or mineral as their life source? We know already, of course, that it is the iron in our blood which plays the largest part in keeping the body supplied with oxygen from the lungs, and also it is the iron in the green chlorophyll life essence of plants which enables them to enslave the sunlight and use it to build up their leaves, seeds, and fruits. And what is still more significant, the latest findings point strongly to the fact that one or more of the vitamins at least act very much more vigorously and effectively in the presence of sunlight. Given sunlight, in fact, the body may even build its own vitamins upon a diet which is deficient in them. The vitamins may possibly be mineral suncatchers, enabling us to eat the sunshine at first hand just like plants.
However this may be from a practical point of view, we are justified in urging the vital importance of good amounts and abundant variety of fresh fruits, fresh vegetables, eggs, butter, and full milk in the diet. Even the rapturous affection of the chorus lady for the crimson crustacean, which has given the name "Lobsteria" to the white lights of Broadway, has good justification in terms of iodine. And the unspoiled enthusiasm of unregenerate humanity for blue points on the half shell, steamed clams, oyster stew, fish and clam chowders which grace the beginnings of our most momentous feasts, has been abundantly justified against the prosaic and calculating pessimists who regard all foods according to their fuel value in shovelfuls of coal and uphold as their ideal comestible that which contains the most calories for a cent.
And again the finger of scorn is pointed at our most useful single food--white bread--because of all the listed foodstuffs examined it holds one of the smallest percentages of iodine, just as ten or fifteen years ago it used to be denounced because it contained less nitrogen than whole wheat flour, or even bran.
As a matter of fact, the scorn in both cases was utterly undeserved and unfounded and for the same reason, that though it was undoubtedly true that a considerable amount of nitrogen was lost in the process of bolting and screening and thrown away in the shape of bran, all that surplus of nitrogen and bran was utterly indigestible in the human stomach and might just as well have been sawdust or chopped straw as far as any food value is concerned.
The same is probably true of the iodine shortage in bread. Nearly half the iodine of the wheat grain goes into the bran; but it would have been lost just the same if it had gone into the human stomach, because it would never have been absorbed.
Furthermore, in both cases the amounts lost of both nitrogen and iodine from bread are so small that the one would be made good for a whole loaf of bread by a single teaspoonful of milk and the other by a single large lettuce leaf. So, unless anyone is fool enough to try to live on just bread and water, neither the nitrogen nor the iodine deficiency need worry him in the least. We are, in the language of the day, literally "sitting pretty" as far as both iodine and vitamins are concerned. Follow our own natural appetites and those of our children for fruits, green vegetables, butter, eggs, and sea food and we will get all the benefit that is to be got by dieting for the prevention of goiter. It might also be well to choose the various forms of gelatin made from seaweed, such as agar or Irish moss, in making puddings, jellies, and stews, as these seaweeds contain the largest percentage of iodine of any foods which come upon our tables.
But when all is said and done it would appear that diet at best is only able to play a second or third role in the increase of iodine and the prevention of goiter. The real heavy artillery of the campaign is the iodine treatment of salt and the iodine dosage of the drinking water.
Our whole study of iodine and goiter opens up a most fascinating and hopeful vista. If we are able to produce such widespread improvements in the health of a whole nation simply by the intelligent control of tiny amounts of one mineral element in our drinking water, our condiments, and our foods, what other victories over human ills may not the future have in store for us?
And what an extraordinary and cheering light is cast upon the sound intelligence, good sense, and judgment of unspoiled humanity, first, in insisting upon having at all hazards and expense a few pinches of a salt-tasting, otherwise unattractive, white mineral upon every dish of food that we eat, without knowing in the least why it is good for us; and in the second place, exalting into luxuries and most highly prized titbits of every menu, sea foods, fresh fruits, fresh vegetables, pie, and ice cream, which are both most difficult to secure and richest in this vitally necessary element.
To sum up very briefly, wherever man goes too far inland from his native sea beaches he pays the penalty in the form of goiter, unless he makes good the deficiency by means of salt. Salt has uses of its own in the economy with which we are not here concerned; but it seems almost certain that a very large share of the salt-craving which the human race has shown in all stages of its history and which is illustrated by such familiar phrases as "not worth his salt," "bread and salt," as the necessities of life, "salary," which is simply salt allowance, and so on, has been due to the traces of iodine present in all impure salts.
As our demands have become more fastidious and our standard of whiteness and snowy purity higher, we have lost this vital element; and this deficiency would appear to have been largely concerned with the widespread appearance of goiter in the inland regions of all civilized countries.
Fortunately we have discovered the situation in time, for the common types of enlargement of the thyroid known as simple goiter are hardly at all dangerous to life, although they may interfere with both comfort and efficiency. Indeed, they should hardly be regarded as a disease, but only as an unbalanced or abnormal condition; and if taken in time--that is, when the sufferer is under eighteen years of age--95 percent of them can be cured completely by the administration of iodine. To put it very briefly, goiter of high degree in parents may result in birth goiter of the child, known as cretinism, in which case the unfortunate infant grows into a stunted, idiotic, club-featured, thick-tongued dwarf and remains so all the rest of his life. A similar cretinism is the cause of a high death rate among lambs, calves, colts, and puppies in our American goiter belts. If the iodine deficiency is of lower degree it will manifest itself in the form of simple goiter and is promptly curable by iodine.
In a small percentage of the cases, these goiters, without causing any pain or disturbance of health, go on increasing steadily in size until they reach the size of a clenched fist or even that of a muskmelon. In these cases they begin finally to cause trouble by pressing upon the great veins and arteries and muscles of the neck. But this, happily, can be relieved completely by surgical removal.
The Wise Beast of Scripture
Another portion of the simple goiter cases, usually about 1 per cent, takes on another type of development, and while increasing in size begins to pour into the system a toxic secretion which has a very injurious effect upon the blood vessels, the heart, and the sympathetic nervous system. The eyes protrude, the neck throbs and swells, the heartbeat becomes pounding and incredibly rapid, and if nothing is done to check the progress it may end in death, either by the breaking of the muscles of the overdriven heart or by hardening of the arteries.
But even this disastrous situation no longer daunts us. Taken at a reasonably early period, we have now found that the steady administration of large doses of iodine, described graphically as flooding the system with iodine, will bring about a striking improvement in a large percentage of cases. Should this relapse or lose its effect, then we can turn to the surgeon with full confidence of a cure in from 70 to 90 per cent of all cases taken at a reasonably early period. The operation simply consists of skillfully removing fractional amounts of the gland, taking care never to cut out more than about 40 per cent of the total. In some cases great improvement can be got by simply tying one or more of the arteries which supply the gland.
We have long jeered at the wild ass of Scripture for "snuffing up the east wind," and scores of sermons have been preached of the infinitesimal amounts of nutrition that he obtained by such procedure. In fact we have put it down as simply another illustration of the general stupidity of that extremely intelligent animal. This stupidity is simply due to his being far too intelligent to be either bullied or trained or coaxed like the noble horse into doing anything which is not for his own benefit. And in the instance cited in Scripture, he may have simply been making up his iodine shortage from the spray of the, Caspian Sea or the Persian Gulf.
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|Title Annotation:||part two; reprinted from Saturday Evening Post 1925; health effects of dietary iodine|
|Publication:||Saturday Evening Post|
|Date:||Jul 1, 1997|
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