An Objective Look at Placentophagy

 

Nothing on my blog should be used as medical advice.  It is only the story of things I choose to learn about.

Pregnant belly in black and whitePlacentophagy = “Eating” the Placenta

I’ve delivered placentas.  Probably lots more placentas than babies because as a resident, staff doctors liked to deliver the babies, and then turn it over to the lowly resident to finish up.  Anyhow, placentas have a distinct smell about them and quite an unusual appearance, color, and texture.  To eat them, in my mind, is a disgusting thought.  But that’s not what I should base opinion on.  Chopping liver is disgusting, too; I won’t deny that to anyone.  And I know vegans abhor the way I eat, but choosing foods that keep me feeling well and functioning well is one of my top priorities.  So I can appreciate, although maybe not partake in the process, the motivation for women to consider consuming their placentas.  Yet as I do with all “food” now, I analyze it for unintended side effects that could be problematic.  Let’s explore placentophagy.

Why do some people do it or recommend it?

The thought is that there are hormones and minerals, such as iron, in the placenta that impart beneficial effects to the mother (or whoever else eats it–as historically it has been eaten by others, too).  It is often repeated that it:

  1. Improves milk production.
  2. Helps the uterus clamp down to its normal size after pregnancy.
  3. Helps to lessen the amount of bleeding and the duration of bleeding in the post-partum time period.
  4. Helps diminish mood disturbances post-partum (such as post-partum depression).
  5. Helps return iron levels to normal more quickly.
  6. Helps improve pain tolerance.
  7. Provides increased energy.

Advocates are quick to point out that almost all mammals, including apes and monkeys, eat their placentas, so it must be natural.  However, humans usually don’t eat their placentas, and for various speculated reasons, neither do camels, llamas, alpacas, and dolphins.  In an anthropological review, I found only one region that was documented to perhaps practice placentophagy by the mother, and that was in Chicano culture (Mexican-American).  Eating the placenta, despite what you may read elsewhere, just doesn’t seem to be a routine custom for women, even in primitive cultures, although we can’t know for sure as history is often shrouded in mystery.  (1)

However, there is a bit more documentation where the placenta is prepared in various ways (fried, puddings, roasts, teas) and then served to others such as the fathers, family members, the baby itself, or to the sick and ailing.  Historical Chinese texts record the use of placenta for remedies, although it doesn’t seem to imply that the placenta was eaten by the post-partum woman herself.  There is a report of male and female nurse-midwives in Vietnam eating the placentas of (only) healthy women, although they themselves were or Chinese or Thai origin, not Vietnamese. (2)  In addition, many cultures, although they don’t eat the placenta, encourage extra special treatment of the placenta, such as burying it, disposing of it in a lake, or placing it in recommended spot.  Improper disposal is believed to bring consequences.  (1)

Bottom line:  I don’t know about you, but I feel manipulated by those internet sites which imply that placentophagy is something that has been routinely done by post-partum women throughout the ages.  That is speculation.

Can you really take your placenta home from the hospital?

No one ever asked me to take their placenta home when I did deliveries in family medicine residency.  Usually I’d deliver the placenta into a basin, inspect it, and then hand it off, where it was put in a  red biohazard bag at clean-up.  If anything had seemed off in my inspection, the placenta would be sent to the pathology department for evaluation.  In my reading, it looks like different places will have different regulations about the placenta.

Here is a waiver I found if you are interested:  Placenta Benefits Release of Placenta and Waiver of Liability Form.

And here, from the same site, is recommendations on how to obtain your placenta in a friendly fashion:  Hospital Release of Placentas. (3)

What is done after the placenta comes out to prepare it for consumption?

It sounds like once your placenta is out, it should be placed in an appropriate clean container and immediately put on ice and gotten into  a refrigerator as soon as possible.  There are people you can contact to process your placenta for you from this point on or you can do it yourself at home.  (I was able to Google and find someone in my state who offered this service, although I never called.)  They say the placenta should be processed within three days or frozen for later use.  [Freezing doesn't seem to affect the presumed active substances in the placenta, although cooking may. For example, temperatures above 104 degrees F (40 degrees C) destroy placental opioid enhancing factor (POEF).] (4)

Processing and methods of preparation include:

  1. Eating some raw right away as is or mixing it raw into a smoothie.
  2. Cooking it into some dish, like a roast or spaghetti ragout.
  3. Cleaning it, steaming it, slicing it, and then dehydrating it to make into a desiccated powder to fill capsules with.  (Often steamed with select herbs like ginger.  This way is often referred to as the Traditonal Chinese Method because of its description in historical Chinese texts and use in Chinese medicine.)
  4. Slicing it raw and then dehydrating it without the steaming process, because steaming may inactivate certain placental substances.

What does the research show?

Let’s look.

1.  Improved milk production in humans:  Back in the 1950s, some Czechoslovakian researchers [Soykova-Pachnerova E, et. al.(1954). Gynaecologia 138(6):617-627] fed lactating mothers either dried beef or dried placenta.  Those who ingested placenta seemed to have an increase in their milk production, although this was not quantified:  “Of 210 controlled cases only 29 (13.8%) gave negative results; 181 women (86.2%) reacted positively to the treatment, 117 (55.7%) with good and 64 (30.5%) with very good results. It could be shown by similar experiments with a beef preparation that the effective substance in placenta is not protein.”

2.  Improved pain control with less perception of pain in rat study:  In 2004, DiPirro and Kristal did a study looking at placenta ingestion in rats, and they concluded that placenta ingestion regulates the pain sensation in rats (probably from a substance called placental opioid-enhancing factor–POEF).  (5,6)  Natural endogenous opioids are not actually increased by placentophagy, but instead the body’s response to natural opioids already made is enhanced, allowing for increased pain tolerance.

3.  Improved growth rate of breast-fed infants:  In 1918, Hammett published a paper in The Journal of Biological Chemistry looking at breast-fed babies from moms who did and did not ingest dried (desiccated) placenta.  He found that breast-fed babies whose moms received desiccated placenta had an increased rate of growth over those who did not. (7)

4.  Alteration of prolactin and progesterone levels post-partum in rats:  Blank and Friesen, in 1980 Journal of Reproductive Fertility, found that giving rats placenta induced an early rise (day 1) in prolactin and a later (day 6) drop in progesterone compared to the control groups, who received various treatments of estrogen injections or human or bovine placenta.  The significance of these changes could only be speculated at.  (8)

5.  Anecdotal survey of women who practiced placentophagy:  Researchers performed a survey of women who practiced placentophagy.  Although not providing much in the scientific light, it is interesting none the less. Nearly all of the 189 women were satisfied and would practice placentophagy again.  (9)

6.  Upcoming research due out in 2015 by UNLV’s Dr. Benyshek and team:  “Research professors in UNLV’s Department of Anthropology, Department of Nutrition and the School of Community Health Sciences at the University of Nevada Las Vegas are working on a randomised double-blind placebo trial for placenta encapsulation and have plans to complete the data proportion of their study by late summer 2014, and published results sometime in 2015!”
(See more at: http://www.placentanetwork.com/new-placenta-research-study-randomised-double-blind-placebo-trial-2014/#sthash.djtk1Ezv.dpuf) (10)

7.  This is not research, but benefits of placentophagy circulate around substances found in the placenta such as oxytocin, human placenta lactogen, corticotropin releasing hormone, other hormones, and iron.  Let’s look at a few:

  • Oxytocin is present in the placenta.  It is a hormone which helps promote contractions, expulsion of the placenta, uterine contraction/clamping down, and milk ejection–among other roles.  Proponents of placentophagy make a conclusion that the oxytocin in the placenta can help with milk supply and ejection and the return of the uterus to its pre-partum size.
  • Human placenta lactogen is present in the placenta.  It is presumed that this will help with the prolactin regulation in the mother.  Prolactin helps in the production of milk (whereas oxytocin is more useful in the “ejection” of the milk).
  • Corticotropin releasing hormone (CRH), usually only made in the hypothalamus, is made in the placenta during pregnancy and increases throughout pregnancy to unusually high levels in the last trimester.  This hormone stimulates the body to make cortisol, a valuable stress hormone, which is important to prepare the body for the stress of labor and delivery.  Because the placenta supplies a richCRH production, it inhibits the hypothalamus from doing its normal job.  When the placenta is expelled, it no longer providesCRH and soCRH production, and therefore cortisol production,  drops off precipitously after delivery until the hypothalamus resumes its normal production.  It is believed that this contributes topost-partum blues and anxiety in women until the body re-adjusts for the loss of the placental production ofCRH.  (11)  Theoretically,placentophagy could provide a “bridge,” not allowing the stress hormone production to just plummet after the loss of the placenta.
  • Iron is rich in the placenta.  Aside from simple anemia, there have been some studies to suggest a role of iron supplementation on post-partum fatigue and mood changes.  Critics of placentophagy, however, point out that there are other options to increase iron in women besides placenta.

We have looked at reasons why some advocate placenta consumption.  Why NOT consume your placenta?

Although nearly all mammals DO eat their placentas, human beings historically–that we can track–DO NOT and HAVE NOT.  Why?  What is the reason?  There is no answer at this time.  Is it something that became socially taboo?  Is it something that traditional, ancient cultures determined could be detrimental to health?  We don’t know.  Reading the potential positives starts to make you think maybe you should consume your placenta.  Maybe we are missing out on something here.  But let’s explore reasons why a woman would NOT want to consume her placenta because I think they are important.

Although the placenta is an organ formed in your body, it is formed from the fertilized egg and has therefore the same chromosomal make-up as your baby.  It is your baby’s organ.  You are in essence eating an organ of the baby and the cells of your baby, albeit cells that are no longer needed.

Prion formation in the placenta.  When you eat placenta, you are eating human tissue.  What medically speaking is at issue here?  There are bad diseases out there caused by these misfolded proteins called “prions.”  Maybe you’ve heard of kuru or Creutzfeldt-Jacob Disease (CJD, pronounced in my med school as kroyts-field-yah-cub)?  These are prion disease which are unpreventably lethal to the affected person.  They are acquired by ingestion of tissue which carries the prion.  In the case of kuru it was the ingestion of human nervous tissue.  I know.  It is very strange that a protein can act as a an infectious-like agent.  But now to the money, increased expression of prion protein was found in placentas from mothers who experienced preeclampsia (a syndrome characterized by high blood pressure during pregnancy).  (12)  So could eating placenta lead to prion disease?  That’s a jump.  But one that I personally can’t get out of my head.

Heavy metals cannot be detoxified by the placenta and therefore will be in the placental tissue.

There are some reported side effects.  These listed come directly cut from Placenta Network (www.placentanetwork.com):

  1. Mild headaches (reported 3 times – we believe a lower dose is recommended to solve this problem)
  2. Stomach cramping or abdominal pain (reported once – possibly the result of bacteria growth due to improper storage of capsules)
  3. Stomach cramping for those also taking iron supplements (we recommend not taking iron supplements and placenta capsules at the same time)
  4. Pruritic urticarial papules and plaques of pregnancy (PUPPS) rash returning after 3 days of consuming capsules (reported twice)
  5. Pelvic girdle pain (PGP) sufferers feel less relief (we believe this is due to the high level of relaxin hormone in the placenta, which is the cause of PGP)
  6. Unexplained lack of milk production (reported from 4 women over the last 5 years)
  7. Emotional symptoms, stress, anxiety, depression (reported 5 times)

See more at: http://www.placentanetwork.com/placenta-encapsulation-faq-for-pregnant-mothers/#sthash.tYoHOajv.dpuf

Conclusion

I hope that I gave you a good overview of what to think about as you learn about placentophagy.  Reading only the enthusiastic advocates left me thinking I should swallow my “yuck” factor or else maybe I’d be missing out on this beneficial opportunity.  Digging deeper has allowed me to see a few reasons why placentophagy is not for me.

My mind doesn’t like to wrap itself around eating human tissue of my own child.  (I am not speaking for you.)  Prions frighten me a bit, and I don’t think we know enough about the factors which can cause them to increase in the human placenta.  And lastly, I cannot even tell you how badly my hips, groins, and pelvis hurt this pregnancy, and it started at 12 weeks along.  I am ready to be done with the hormone called relaxin, which is wreaking this havoc and pain on my body, and it looks like anecdotally relaxin’s effects can be prolonged with placentophagy.

Walk wisely in this world.  Warmest wishes.

~Terri

Sources:

  1. Young, Sharon M. and Benyshek, Daniel C. (2010)  “In Search of Human Placentophagy: A Cross-Cultural Survey of Human Placenta Consumption, Disposal Practices, and Cultural Beliefs”, Ecology of Food and Nutrition, 49: 6, 467 — 484.  (Link to full text)
  2. WB Ober.  Notes on Placentophagy.  Bull N Y Acad Med.  June 1979;  55(6):  591-599.  (Link to full scanned in text)
  3. http://placentabenefits.info/specialists.asp
  4. Mark B. Kristal, Jean M. DiPirro & Alexis C. Thompson (2012): Placentophagia in Humans and Nonhuman Mammals: Causes and Consequences, Ecology of Food and Nutrition, 51:3, 177-197.  (Link to full text)
  5. DiPirro, J.M.; Kristal, M.B. (2004).  Placenta ingestion by rats enhances delta-and kappa-opioid antinociception, but suppresses mu-opioid antinociception.  Brain Research, 1014:22-33.  (Takes you to a page where you can scroll, find the article and pull up the PDF.)
  6. MB Kristal.  (1991) “Enhancement of Opioid-Mediated Analgesia:  A Solution to the Enigma of Placentophagia.”  Neurosci Biobehav Rev 15(3) 425.
  7. Hammett F.  (1918)   “The Effect of Ingestion of Desiccated (dried) Placenta on Milk Production.”  The Journal of biological chemistry.  Volume 36: 569-573.  (Link to a Free Google ebook)
  8. Blank MS, Friesen HG.  “Effects of placentophagy on serum prolactin and progesterone concentrations in rats after parturition or superovulation.”  J Reprod Fertil November 1, 1980 60 273-278.  (Link to abstract, but the full text is available.)
  9. Jodi Selander , Allison Cantor , Sharon M. Young & Daniel C. Benyshek (2013):  Human Maternal Placentophagy: A Survey of Self-Reported Motivations and Experiences Associated with Placenta Consumption, Ecology of Food and Nutrition, 52:2, 93-115.  (Link to abstract where you can further link to full text.)
  10. http://www.placentanetwork.com/new-placenta-research-study-randomised-double-blind-placebo-trial-2014/
  11. Ilona S. Yim, PhD; Laura M. Glynn, PhD; Christine Dunkel Schetter, PhD; Calvin J. Hobel, MD; Aleksandra Chicz-DeMet, PhD; Curt A. Sandman, PhD.  “Risk of Postpartum Depressive Symptoms With Elevated Corticotropin-Releasing Hormone in Human Pregnancy.”  Arch Gen Psychiatry. 2009;66(2):162-169. (Link to full text.)
  12. Hwang HS, Park SH, Park YW, Kwon HS, Sohn IS.  “Expression of cellular prion protein in the placentas of women with normal and preeclamptic pregnancies.”  Acta Obstet Gynecol Scand.  2010 Sep;89(9):1155-61. (Link to abstract.)

Splitting Apart in Pregnancy: Diastasis recti

Today marks my entry into 37 weeks of pregnancy.  Likely, at least three more weeks to go as my body’s smooth muscle doesn’tPregnant belly in black and white seem to appreciate moving spontaneously, and I don’t have a pattern of early births.  (Sigh.)  Yeah, the last month of pregnancy hurts, but I try to savor the appreciation of how my family and life is right now, knowing that although it will be better, it will never be the same again.  This week I am hoping to push out several personal posts on pregnancy because once this pregnancy is over, I plan to not be lookin’ back.  Severe joint pain, nausea, headaches, moodiness, exhaustion, and constipation are not my cuppa’ tea.  However, definitely before I leave this golden field behind and while it is still fresh in my mind, I want to write a post on diastasis recti in case anyone else out there is dealing with this.

What is this strange pain?

I had heard of and seen things like round ligament pain, symphysis pubis pain, sacroiliac joint pain, acid reflux pain, and so on in training.  But early in the third trimester of my first pregnancy, I developed a very strange stretching, burning, pulling type of pain in the midline of my abdomen.  I knew from experience it wasn’t something serious–nothing coming from my internal organs.  But, dang!  It was uncomfortable!  I felt like my midline was literally being torn apart!  I asked my girlfriends who had been pregnant about it.  Nothing.  I asked my OB about it.  Nothing.  Just one more lovely thing about pregnancy to add to the tally!  And it was uncomfortable!

Post-delivery of Baby One

After pregnancy, I noticed when I’d sit up in bed, my midline abdomen would bulge out like one of those old-fashioned water bottles!  My husband, being the musculoskeletal expert in our family, said, “Hey!  You have a diastasis recti!”  My OB confirmed that’s what I had and felt it would improve with time.  It didn’t.  Okay.  It did improve some.  But I could still shove a ball somewhere between the size of a golf and tennis ball where my belly button used to be.  Beautiful.  Simply beautiful.  The battle ground of my belly.  I will never see the belly button of my childhood days again.

What is diastasis recti?

Think of a bodybuilder with the perfect six-pack (the six-pack muscle is made of several parts and is scientifically called the rectus abdominus muscle) .  The line dividing the six-pack right in half down the middle, placing 3 “soda pops” on either side, is called the linea alba (the “white line”).  Smack dab there in the middle from the top to the bottom of your midline, where your belly button lives, there is no muscle.  All that is there is a strong layer of connective tissue between the two halves of muscle, the linea alba.

File:Gray392.png

When that strong layer of connective tissue becomes stretched wider and thinner than it ought to be, it is called a diastasis recti.  This can frequently occur in pregnancy with all the stretching due to size and hormonal changes that occur to loosen up our tendons and ligaments to allow our bodies to accommodate and deliver the baby.  It makes good sense for that sheath to be able to stretch out during pregnancy!  Unfortunately, in some women, the diastasis is quite large and doesn’t ever return to normal (or even close to normal).  These women have “mummy tummy,” distorted belly buttons, billowing out of the abdominal contents with abdominal wall contraction or gravity, and problems with core body strength!  If women don’t know about this condition, they may wonder why in the world their abdomens don’t shrink no matter how “skinny” they get!

I know for me, I was left with a large crater for a belly button, lots of extra skin right around the belly button, stretch marks only around the belly button, and a large ballooning out of the midline with trying to sit up.  On bad diastasis days, I get the “Mommy, you look pregnant” remark.  (That is–before I WAS pregnant!  In pregnancy, with a diastasis recti, you seem to really “pop” big in the first trimester and always look further advanced than you really are.  Another sigh.  How many times do you have to listen to the “Man!  You are big!” remark?)

My Subsequent Pregnancies and Discovery of an Umbilical Hernia

I didn’t really get any more of that horrible stretching sensation where it felt like I was splitting apart with Baby 2 or Baby 3.  I guess I was as split as I could be.  Shortly after Baby 3, I developed a kidney stone, requiring an abdominal CT scan.  The scan, aside from the kidney stones, showed that I also had an umbilical hernia–an actual hole in the linea alba right there at the belly button.  After a visit to my general surgeon for consultation, it was decided that the hernia was large enough that it would not “strangulate” any bowel.  With an umbilical hernia, sometimes loops of intestine can squeeze through the hole and get their blood circulation cut off.  The intestinal tissue strangulates and dies, leading to an exceptional emergency situation.  My hernia was big enough to let my intestine slip in and out unimpeded.  Yippee.

I carried on.  For me, it was a cosmetic issue only.  No bikinis or half-tanks.  Carefully chose apparel.  It never interfered in my ability to exercise and work-out.  I didn’t do traditional sit ups.  I wore Spanx if I had to for special occasions.  No biggie for me.  (I know other women have different stories to tell.)

Don’t Touch My Midline…

Then, I became pregnant again with Baby 4.  Ooh-la-la.  Ouch.  At about 13 weeks, when horrible bloating hit, my midline felt that horrible stretching sensation again.  Kind of like someone taking your ankle or shoulder and contorting the ligaments and tendons in positions they aren’t meant to go.  And it hurt and has only let up here and there throughout the pregnancy.  Coughing, bloating, laughing, trying to get off the couch or bed, and sometimes just sitting are painful events.  Pain like my kidney stone?  No.  But painful still.  And PLEASE don’t touch my belly in the midline!  The sides, where I still have good tissue support–fine, touch and push like the dickens.  But please not the midline!  Another wonderful blessing of a diastasis recti is the visibility of the uterus and baby parts right there seemingly under your skin!  Like it’s going to fall out of there or something!

The Belt

Baby Belly BandTo help with the pain, I invested in a belt after researching a bit on-line.  The belt helps.  Not completely.  I don’t wear it all the time because I don’t want to lose the core abdominal strength that I do have.  But when I feel the tearing pain increasing, I put it on and it kind of lifts up my belly, taking pressure off of the damaged linea alba.  Sometimes I wear it at night after a bad day.  Sometimes I wear it on a long walk.  If I’m having bad bloating, which also hurts it, I will wear the belt, too.  It comes with extra attachments.  (Doesn’t that sound so funny!?  Attachments.)  I have the “suspenders” and the “extra cinch” piece.  Here in the last 6 weeks I have just started needing to occasionally use the suspenders and extra cinch.  Before this point, simply the belt seemed like enough, as it is adjustable and has grown with me.  The belt is soft, but my pregnancy belly is itchy no matter what so I always wear the belt over a cami or undershirt.  A last point on the belt:  I have found that it helps my sacroiliac joint pain also.  Again, it doesn’t remove all the pain, but it really does reduce it.  I have never had another belt to try, so this is the only one I can vouch for.  To me, it has been worth it.  The belt I purchased was Baby Belly Band.  This is NOT a thin, stretchy type band to use for aesthetics or mild support.  I have those, too, and they are not the same deal.

Precautions I take

Although I’m an independent cuss, this pregnancy, with that ripping sensation resurfacing (at least in my mind telling me that my hernia is probably enlarging), I have turned over most all lifting so as to not make matters worse.  Makes me so mad to have to have others lift my water jugs.  To lift me up.  To move the furniture around.  To lift my sick 5-year-old.  But I know that is best and probably should have been standard with Baby 1!  I remember being in fine nesting mode with Baby 1, moving the couch here and there and snowblowing after a blizzard in the last trimester.  If this is you, stop it now!  :-)

I try to not use my abdominals to get up off the couch, bed or floor (when I make it down there).  I either wait for help up or use every ounce of arm strength to push myself up to some position where I can use my legs.  In addition to asking for help with pretty much all that requires abdominal use, I’ve rigged up a rope system to use to help me pull myself up out of bed at night for the standard 5 trips to the bathroom.  (I hide it when the cleaning lady comes.  Who knows what she might think that’s for!  As if!  LOL!)

Is there a way to fix it?

As this is a personal post, speaking off the top of my head, I’m not going to go into much detail.  There are surgical procedures that can be done.  The technique offered will differ based on many factors, including whether or not you have a hernia and even what kind of surgeon you seek out to do your procedure.  Many insurances will not cover this unless you are having some medical issues related to the diastasis/hernia.  Also, many doctors don’t recommend fixing them unless you are done with pregnancies.  So if I HAD had my diastasis/hernia repaired, the result could have been compromised by my current pregnancy.

Alternatively, there are physical therapy programs out there which try to address the diastasis.  There are a few of them which I’ve read about.  Some people report good success and some don’t.  (Imagine that.)

There are binders out there.  This is not a fix, but I know that my diastasis is hugely apparent during the months after delivery.  At this time, I do often wear a binder to “hold it all in.”  It doesn’t work permanently for me, and again, I like to make sure I’m never putting my own core abdominal strength in peril due to a binder, but it does “bring it all in” temporarily for me.  This is different from the belt/band I describe above.  It is much wider to wrap around your entire midline section–or at least much of it.

Closing

So if you have this splitting feeling in your midline with pregnancy which you’ve discussed with your doctor to rule out the “bad stuff,” maybe check out the term diastasis recti on a computer search.  Or, if after reading this you think, “Yeah!  That’s me!  I have a diastasis recti still!”  Search.  You’ll find a lot more than I’ve got summarized here.  This post was not for diagnosis or treatment.  It was a sharing of my story to heighten awareness.  Wishing you joy in parenthood and life.

~Terri

 

How Do You Eat That Vegetable? Parsnips.

Vegetable Series: When we changed our eating two years ago, I resolved to be afraid of no vegetable. Not knowing how to cut it or cook it was NOT going to keep it out of my cart. For a long time I’ve wanted to do a series of posts on all the different vegetables we have tried and what we do to the poor things. May you, too, vow to try any and all vegetables in your supermarket! Go get ‘em, tiger.

 

“I LOVE those French fries!”Parsnips in basket edited

Have you tried parsnips?  Have your kids tried parsnips?  Do you or your family like parsnips?  Do you have a great parsnip recipe?  Do you know what parsnips are?

For my kids, I often find keeping dishes simple and flavors not too complex suits their taste buds more at this young age.  Plus, when you’re eating a whole, real foods lifestyle, faster and easier is much better for the cook, too!  We made parsnip “fries” to prepare for this post.  When my husband and kids came into the kitchen, I was frantically grabbing fries to stash and hide behind the coffeemaker so I wouldn’t have to make more to photograph!  I was glad the “fries” were a gastronomical success!  M5 year-old daughter said, “I love those French fries, Mom.”

This wasn’t always the case.

If you can do it with a potato…

As I’ve pointed out, we’ve only been eating this way for about two years now.  The word out there is:  If you can do it with a potato…you can do it with a parsnip.  So I tried parsnips in soups, roasts, mashes, and casseroles.  (“What is this, Mom?”  As in, they didn’t approve.)  I even made parsnip fries, which you could tell they didn’t mind, but they didn’t really eat many.  My kids were just too close to their potatoes.  Near removal of the potato and addition of parsnips on occasion, and my kids can now tally parsnips to the growing list of vegetables they’ll eat!

What am I saying?  If at first you don’t succeed, try, try again!  Kids need repetitive exposure and a great example.  Persist in a vegetable-rich diet for your family.  Understand it may take years.  Accept it and don’t give up.  In the meantime, just be prepared to eat a lot of vegetables yourself…

What is a Parsnip?

It is a root vegetable which looks like a fat, white carrot (one of its relatives).

  • Commonly cultivated and eaten in Europe before the potato was introduced.  (Do you know where potatoes originated from?  The mountains of Peru.)
  • Usually thought of as a fall and winter vegetable, but since it stores so well, it is available year round.
  • It is a starchy vegetable and has a sweet, nutty taste and a potato-like texture when cooked.
  • Frost and refrigeration bring about a sweeter taste.
  • Neck to neck, there’s not much nutritional difference between a parsnip and potato.  Parsnips have a little more calcium and a little more fiber.  Parsnips are a little (not much) lower on the “net carb” ladder than a potato.  The only real difference I can think of is that a potato belongs to the family called a “nightshade” and a parsnip doesn’t.  (Nightshades are excluded for people who follow an anti-inflammatory diet because some minor research indicates they may be detrimental to the lining of the GI tract, may increase the body’s production of inflammation-producing chemicals, and increase arthritis and achiness in people.  So someone on an anti-inflammatory diet could easily replace the potato with the parsnip.)

Parsnips are nice because they keep in your refrigerator forever.  I choose them and store them like I do carrots.  Often they come coated in a waxy material, so I always peel my parsnips with a potato peeler before using them to get this strange stuff off.

Then, do what you’d do to a potato!  Here’s one to try, but don’t stop here!

Parsnip Fries

Parsnips, washed and peeled
Olive oil
Salt as desired
Garlic powder and onion powder if desired

Preheat oven to 375-400 degrees Fahrenheit (191-204 degrees Celsius).  Cut the parsnips so that they resemble French fries.  Toss in just enough olive oil to lightly coat.  Sprinkle with salt and other seasonings.  Lay each cut fry on a baking sheet so that the fries have space between them.  You may need to use two baking sheets if you’re making a lot.  (If you get them too close together, they steam each other and get soggy rather than crispy.  Uck.)

Baking times seem to vary immensely.  The best idea is to just watch.  I start by baking in the preheated oven for about 10-15 minutes (but still watching them), and then I take them out and flip the fries.  I bake for another 10-15 minutes or so.  The goal is a fairly golden brown fry that isn’t burnt and isn’t soggy.  Sometimes I remove the ones that look done before the rest.Taste before serving and add more seasoning as desired.  Serve hot.  Nobody likes cold fries of any kind.  Do they?

Parsnip fries edited Cutting parsnips edit

 

Family “gustar” report: 5/5 ate these fries all gone. Will definitely try to include these more in our repertoire.

Note: Parsnips are discouraged for the GAPS/SCD diets.

So what vegetables are YOU all eating?  ~~Terri

Other vegetables in The Vegetable Series:  Rutabagas, artichokes, kohlrabi, and jicama.

Iodine Post 4, Pregnancy

Personal Anecdote

One of the most serious effects of iodine deficiency are damage to a fetus.  Echo:  Damage to a fetus…damage to a fetus…damage to a fetus.  Iodine deficiency wasn’t on my radar when I conceived last fall!  I had had no dairy, no eggs, and no iodized salt for at least a year and a half, and I was taking no iodine supplementation, prenatal vitamin or otherwise.  So I have to wonder about my iodine status prior to pregnancy and in early pregnancy.  Early in pregnancy, I was too sick to tolerate a prenatal vitamin, and both my doc and I agreed that all I probably really needed to be sure to choke down was a folic acid supplement to prevent neural tube defects.   (Strangely enough with the food and smell aversions, in my first trimester, I could not get over the urge to eat any and all kinds of seafood, which is a good source of iodine:  sardines, oysters, mussels, clams, mahi mahi, tuna, shrimp, scallops, soft-shelled crabs, Nori, and dulse–you name it.  I threw seafood cautions to the wind and gobbled that stuff down, since nothing else sounded good!  Anecdotal but interesting.)

I wish someone would have told me that my best sources of iodine had all been removed from my diet, and even with them included, I would still have been at risk for iodine deficiency.  So if you’re dairy-free, skipping iodized salt, vegan, intolerant or allergic to eggs, autoimmune Paleo, or follow a crazy diet (I can say that because I follow a crazy diet.), please just make it a point to make sure you’re getting sufficient iodine.  And as always, don’t use anything on my blog as medical advice.

Not good.  Statistics show that pregnant women’s iodine intake and levels are not sufficient and are continuing to decrease.

In the United States, there is a periodic survey which evaluates how our iodine intake is doing, the National Health and Nutrition Examination Survey (NHANES).  NHANES has revealed that urinary iodine levels for pregnant and non-pregnant women in the United States have dropped significantly since the early 1970s.  Adequate urinary iodine levels for pregnant women should be 150-249 micrograms/L (based on the World Health Organization standards).  The United States has hovered around and then dropped below this point:

  • 1971-1974:  327 micrograms/L
  • 1988-1998:  141 micrograms/L
  • 2001-2006:  153 micrograms/L
  • 2005-2010:  129 micrograms/L  (Goal is greater than 150 micrograms/L) (1, 2)

In the most recent survey, some regions such as California and Pennsylvania were alarmingly low, 105 and 125, respectively.  And this doesn’t even take into account the interfering factors of halides in our food and environment which interfere despite levels of iodine!

So what does low iodine mean for pregnant women and their babies?  (Not good.)

IodineIodine deficiency can lead to what is called “reproductive failure” in the female, which simply refers to repeated miscarriages and increased stillbirths.  The more severe the iodine deficiency, the more the risk increases.  One study showed that the frequency of reproductive failure was directly proportional to the severity of the iodine deficiency.  Women who had iodine deficiency had twice the risk of reproductive failure.  (There are many causes of “reproductive failure” besides iodine deficiency.  Other nutritional factors such as selenium deficiency could also be responsible for reproductive failure.  And aside from nutritional factors, there are many other causes, as well.  So I am not saying, “Iodine is it.”  Please don’t think that.) (3)

Known iodine deficiency effects on the fetus are numerous and include:

  • Increased miscarriages (loss before 28 weeks of pregnancy)
  • Increased stillbirths (loss after 28 weeks of pregnancy)
  • Increased premature births
  • Congenital anomalies (birth defects)
  • Increased perinatal morbidity and mortality (increased bad outcomes and death occurring shortly before or after delivery)
  • Cretinism (mental retardation with changes in stature, hearing–often a high tone defect, and sometimes the inability to use arms/legs due to severe rigidity)
  • Goiters in newborns
  • Hypothyroidism in newborns
  • Mental retardation
  • Lower IQ (3, 4, 5)

Medical literature supporting iodine’s role in producing a healthy, in utero fetus and subsequent neonate is NOT hard to find!

All degrees of iodine deficiency…affect thyroid function of the mother and the neonate as well as the mental development of the child. The damage increases with the degree of the deficiency…

Iodine deficiency results in a global loss of 10–15 IQ points at a population level and constitutes the world’s greatest single cause of preventable brain damage and mental retardation. (5)

When a mom is iodine deficient, iodine deficiency is passed on to the developing fetus who has NO way of getting iodine or thyroid hormone except through the mom.  You are it, Mama.

When a woman becomes pregnant, her baby absolutely relies on the mom’s thyroid hormone, which requires iodine to be made.  The baby cannot make its own thyroid hormone until later in the pregnancy, and even then, it still needs iodine provided by mom as the raw material for its own thyroid hormone production. 

Iodine is 100% necessary for the production of thyroid hormone, and if it is not sufficient, then the mother and baby will be exposed to hypothyroidism (lack of thyroid hormone).  Thyroid hormone is necessary for probably the function of all cells and is critically important for brain development, especially in a fetus and newborn.  Thyroid hormone helps to make sure that the fetus’s cells grow, develop, differentiate, and express the right genes.

Most health organizations recommend about 150 micrograms of iodine daily for non-pregnant adults, but iodine needs increase when a woman becomes pregnant.   To make more thyroid hormone to cover the baby’s needs, the woman needs more iodine.  She also needs more iodine because during pregnancy, the blood filtration through the kidneys increases and extra iodine is lost in the urine during pregnancy.

It doesn’t end with pregnancy, either.  Nursing mothers need more iodine because the iodine is transferred to the baby Saltby her milk.  The baby still needs iodine. (6)

The developing brain of the fetus is probably the most vulnerable target organ for iodine deficiency.

First Spurt of the Brain

The developing baby’s brain has two major “growth spurts.”  The first one is at 12-20 weeks (months 3-5).  During this first one, the brain cells (neurons) are rapidly multiplying, moving to their correct places, and organizing themselves appropriately.  Studies indicate that iodine repletion should occur by three months of pregnancy to prevent cretinism (severe mental retardation, deaf/mute, and effects on the arms and legs).  Most of us in developed countries probably won’t fall into iodine deficiency enough that cretinism would develop, but I think it may be revealing on the other neurological conditions as well, that getting the iodine levels back up in the first trimester is probably optimal.  However, even if the first trimester is missed, iodine supplementation still shows beneficial effects in pregnant women and their fetuses.

Second Spurt

The second spurt of brain growth occurs in the third trimester and doesn’t finish until the child is 2-3 years old!  This spurt allows the cells that support the brain’s neurons (knows as “glial cells”) to multiply, move to their appropriate places, and to become coated with myelin.  By the time of the second spurt, the baby has a functioning thyroid, so it doesn’t rely on mom for thyroid hormone anymore, per se, but it relies on mom for its source of iodine.  If mom is not eating enough iodine, baby still can’t make thyroid hormone for itself and its brain.  If mom didn’t get enough iodine in the first trimester, damages can still be minimized.

“Correction of iodine deficiency during the second trimester reduced neurological abnormalities, increased head growth, and improved the development quotient in a severely iodine-deficient area of western China. Correction at a later period did not improve neurological development, although there was a trend toward slightly larger mean head circumference and higher development quotients than in untreated individuals. ”  (6)

There is a spectrum of how not enough iodine affects the fetus.

“Mental retardation from iodine deficiency is not limited to the extreme form of cretinism, but instead extends over a broad continuum to mild intellectual blunting that may go unrecognized unless carefully investigated. Thus, iodine deficiency puts virtually everyone in the affected population at some risk for brain damage. Many studies have compared performance of iodine-deficient children with that of iodine-sufficient peers on standardized intelligence tests…iodine deficiency lowered a mean intelligence quotient by 13.5 points. In view of the many people living in iodine-deficient areas and their vulnerability to its effects on the developing brain, these numbers indicate a staggering public health problem. This and neonatal mortality, rather than goiter, have become the main reasons for advocating urgent correction of iodine deficiency.”  (6)

Severe iodine deficiency and cretinism:  The most notable and sad outcome of iodine deficiency, as it is completely preventable, is cretinism.  I have read that early Alpine explorers would come across entire villages of “cretins” isolated in the mountains.  These local pockets of population lived off of iodine deficient land, and it wasn’t until food started coming in from elsewhere and iodine supplementation was implemented in the 1900s that the incidence of cretinism was reversed.  At the time, doctors and people in general felt it was something “in the air”  or “in the water” of the valleys or perhaps a “genetic fault.”  Cretinism presents with:

  • Short stature
  • Mental retardation
  • Deaf and mute
  • Spasticity of limbs (the arms and legs can draw up tight and not extend properly)

Mild iodine deficiency:   Mild iodine deficiency effects are more pervasive and not as concrete to pinpoint.  Children from low iodine pregnancies have been found to have:

  • Lower IQs
  • ADHD
  • Elevated hearing thresholds/ hearing loss (4, 7, 8)

Dr. Jerome Paulson, chairman of the American Academy of Pediatrics council on environmental health says this in May, 2014 for NBC News:

“The brain development issues are very subtle and are not likely to be noticed in an individual child.  It’s an issue for society as a whole when you have a large number of children who are not reaching their full potential.” (9)

If iodine deficiency is increasing in our pregnant women, wouldn’t congenital hypothyroidism in the newborn be increasing?

So as I typed this post up, I thought, well–if iodine deficiency is creeping up among our pregnant patients, then our babies should have a higher risk of hypothyroidism (low functioning thyroid).  In fact, a month ago, my hairdresser was telling me about her good friend whose baby just wasn’t very active.  They checked and it was hypothyroid.  I’ve never really looked at or been notified about increases in newborn hypothyroidism (congenital hypothyroidism) in any of the journals I subscribe to, so I Googled it.  (Because low thyroid function is SO detrimental to a newborn’s health and brain function, one of the tests mandated by every state in the newborn screening poke includes a test for congenital hypothyroidism.)  Sure enough, there is a rise of congenital hypothyroidism.  I cannot and will not say it is due to maternal iodine sufficiency because I think most health problems are usually caused by a combination of factors, but I certainly am suspicious about iodine deficiency’s role in this.  In Krakow, Poland, before the introduction of iodized salt, 1 in 3920 newborns had transient hypothyroidism, and after the introduction of iodized salt, the rate dropped to 1 in 48,474. (2)  Experts are also considering the roles of perchlorate (a toxic byproduct of rocket fuel and fireworks production) exposure, as these seem to be contaminating our environment and entering our bodies, interfering with thyroid use of iodine, and whether use of iodine-containing disinfectants at the time of birth could contribute. (2, 10)

So why don’t we just put our pregnant women on iodine and crank her up good?

Case studies show reports of hypothyroidism in significantly iodine supplementing moms:  So you’re a natural person.  You’re not afraid of supplements.  You’re pregnant and you think you’re going to run out and start loading up on iodine.  Not so fast.  There have been cases of congenital transient hypothyroidism in newborns from maternal iodine supplementations, at doses of about 12.5 mg.  Whoa.  I would never want a baby to have hypothyroidism from over-supplementation!  On the other hand, I think this area should be explored better.  Was the mom supplementing other important nutrients needed along with iodine?  How transient would the hypothyroidism have been in the baby?  If the mom had kept supplementing, would the thyroid disorder have stabilized naturally?  But we don’t know the answers to these nebulous questions, and so I accept that too high of a dose of iodine in pregnancy may be dangerous to the baby as well!  On iodine deficiency in pregnancy, it is probably best for the iodine naïve woman to err on the side of recommended amounts. (11)

Prenatal vitamins:  Slowly, recommendations are moving toward making sure women get iodine in their prenatal vitamins and word is getting out there. NBC News had a little blurb on their site about it in May, 2014. But, in my opinion, the information still is not out there to women OR their obstetricians.  I just don’t think obstetricians are aware of iodine deficiency numbers in pregnant women, and I would venture to say many (most?) obstetricians don’t look at the prenatal vitamins their patients take!  Only about 50% of prenatal vitamins in the United States contain iodine!  And if they do contain iodine, the iodine content may vary by up to 50% of what is on the label. (1, 12)  The American Thyroid Association recommends that all prenatal vitamins contain iodine, 150 micrograms. (13)

Best to get iodine optimized BEFORE pregnancy:  This is good, but I feel iodine sufficiency needs to be in place WELL BEFORE pregnancy!  If our pregnant women are low, that must mean that our child-bearing population is riding completely on the edge.  In addition, it may be that some of the ill effects seen with iodine supplementation have to do with the iodine status of a person in the long-run!  So the more iodine sufficient a person is their whole life, the more they tolerate extra supplementation without conversion to hypothyroidism.  Dr. Elizabeth Pearce et al report on a study from Sicily which shows that moms who re-introduce iodized salt in the first trimester after having been off of it for two years have markedly increased risk of mom being hypothyroid!  However, in patients who had used iodized salt routinely prior to pregnancy for two years, the risk of hypothyroidism in mom was much less (although not absent). (14)

Conclusion:

Iodine deficiency is absolutely a problem in many pregnant women.  Iodine should optimally be sufficient in the first trimester, and unfortunately this is often a period when women are not aware that they are pregnant or they are too ill to take a prenatal vitamin with iodine or eat iodine containing foods.  I think that brings us back to the idea that we are functioning, many of us as a population, on a near empty tank of iodine to begin with.  Adequate iodine intake should occur BEFORE pregnancy.  I hope you are taking note and continue to take inventory of you and your family members’ sources of iodine.  Eventually, after I summarize why in the heck we need iodine, I will do a more detailed post on iodine content of foods.  You can see some basic summaries of this in my previous iodine posts.

I want to tell you your doctor, especially your obstetrician, is up on this.  And maybe they are.  But I have a sinking feeling most are not.  If getting pregnant is possible for you, it is best to start thinking about iodine intake today.

Sorry for the long post.  Hope those interested found some tidbits to ponder.

~~Terri

 

 

Citations:  

1.  Kathleen L. Caldwell, Yi Pan, Mary E. Mortensen, Amir Makhmudov, Lori Merrill, and John Moye.  Iodine Status in Pregnant Women in the National Children’s Study and in U.S. Women (15–44 Years), National Health and Nutrition Examination Survey 2005–2010.  Thyroid.  Volume 23, Number 8, 2013.  (Link to full text)

2.  John S Parks, Michelle Linn, et al.  The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States.  PEDIATRICS Vol. 125 No. Supplement 2 May 1, 2010. pp. S54 -S63.  (Link to full text)

3.  Dillon, J. C. and Milliez, J. (2000), Reproductive failure in women living in iodine deficient areas of West Africa. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 631–636. doi: 10.1111/j.1471-0528.2000.tb13305.x.  (Link to full text)

4.  Cresswell Eastman and Michael Zimmerman.  Chapter 20:  The Iodine Deficiency Disorders.  Thyroid Disease Manager.  Online.  Updated February 12, 2014.  (Link to online text.)

5.  F Delange.  Editorial:  Iodine deficiency as a cause of brain damage.  Postgrad Med J 2001;77:217-220 doi:10.1136/pmj.77.906.217 (Link to full text)

6.  John Dunn and Francoise Delange.  Damaged Reproduction: The Most Important Consequence of Iodine Deficiency.  The Journal of Clinical Endocrinology & Metabolism. 2001 86:6, 2360-2363.  (Link to full text)

7.  DeLong GR, Stanbury JB, Fierro-Benitez R. Neurological signs in congenital iodine-deficiency disorder (endemic cretinism).   Dev Med Child Neurol. 1985 Jun;27(3):317-24.  (Link to abstract)

8.  Alida Melse-Boonstra, Ian Mackenzie.  Iodine deficiency, thyroid function and hearing deficit: a review.  Nutrition Research Reviews.  2013 Dec;26(2):110-7. doi: 10.1017/S0954422413000061. Epub 2013 Jun 12.  (Link to abstract)

9.  NBC News Online.  Link:  http://www.nbcnews.com/health/womens-health/pregnant-women-need-iodine-supplement-doctors-say-n113326

10.  Richard S. Olney, MD, MPHa, Scott D. Grosse, PhDa, Robert F. Vogt Jr, PhDb.  Prevalence of Congenital Hypothyroidism—Current Trends and Future Directions: Workshop Summary.  PEDIATRICS Vol. 125 No. Supplement 2 May 1, 2010
pp. S31 -S36 .  (doi: 10.1542/peds.2009-1975C)  (Link to full text)

11.  Kara Connelly, MD, Bruce Boston, MD, Elizabeth Pearce, MD, David Sesser, David Snyder, MD, Lewis Braverman, MD, Sam Pino, Stephen LaFranchi, MD.  Congenital Hypothyroidism Caused by Excess Prenatal Maternal Iodine Ingestion.  The Journal of Pediatrics.
Volume 161, Issue 4 , Pages 760-762, October 2012.  (Link to full text)

12.  Angela M. Leung, M.D.,  Elizabeth N. Pearce, M.D., Lewis E. Braverman, M.D.  CORRESPONDENCE:  Iodine Content of Prenatal Multivitamins in the United States.  N Engl J Med 2009; 360:939-940February 26, 2009DOI: 10.1056/NEJMc0807851.  (Link to full text)

13.  Public Health Committee of the American Thyroid Association, Becker DV, Braverman LE, Delange F, Dunn JT, Franklyn JA, Hollowell JG, Lamm SH, Mitchell ML, Pearce E, Robbins J, Rovet JF.  Iodine supplementation for pregnancy and lactation-United States and Canada: recommendations of the American Thyroid Association.  Thyroid. 2006 Oct;16(10):949-51.

14.  Elizabeth N. Pearce.  Iodine in Pregnancy: Is Salt Iodization Enough?  J Clin Endocrinol Metab. Jul 2008; 93(7): 2466–2468.  doi: 10.1210/jc.2008-1009.  PMCID: PMC2453047  (Link to full text)

 

Great overview of hypothyroidism in pregnancy adn a section on iodine:

http://elib.fk.uwks.ac.id/asset/archieve/matkul/Biokimia/The%20Regulation%20of%20Thyroid%20Function%20in%20Pregnancy.pdf

Iodine Post 3: Preconception and conceptual fertility, male and female

See also Iodine Post 1 and Iodine Post 2.

Females:  Pre-conception, conception and iodine

Bottom Line:  I could find nothing concrete that convinced me that intake of iodine beyond commonly recommended doses improved the occurrence of conception, the regularity of periods, ovulation patterns, or menstruation abnormalities per se.  However, without enough iodine, we are brought back to the fact that hypothyroidism can develop, and hypothyroidism can cause these fertility alterations.  So females DO need to be getting enough iodine from somewhere and/or eliminating environmental factors that can affect iodine’s use in the body (a later post).

I easily found research supporting hypothyroidism (low thyroid function with symptoms and clear-cut lab abnormalities) and subclinical hypothyroidism’s (lab values not clear cut and patient not all-out symptomatic) roles in issues leading to conception, with both disorders affecting levels of sex hormones, ovulation patterns, menstrual patterns, and the ability to conceive even with the occurrence of ovulation.

  • In the International Journal of Applied and Basic Medical Research (2012), of 394 infertile women, 23.9% were found to be hypothyroid (TSH > 4.2 μIU/ml). After treatment with thyroid hormone (thyroxine) for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year.  Recommendations in the article boiled down to this:  “Thyroid evaluation should be done in any woman who wants to get pregnant with [a] family history of thyroid problem or irregular menstrual cycle or had more than two miscarriages or is unable to conceive after 1 year of unprotected intercourse. The comprehensive thyroid evaluation should include T 3 , T 4 , thyroid stimulating hormone (TSH), and thyroid autoimmune testing such as thyroid peroxidase (TPO) antibodies, thyroglobin/antithyroglobin antibodies, and thyroid stimulating immunoglobulin (TSI). Thyroid autoimmune testing may or may not be included in the basic fertility workup because the presence of thyroid antibodies doubles the risk of recurrent miscarriages in women with otherwise normal thyroid function.”  (1)
  • From Human Reproduction, 2003, a follow-up study on infertility found that never achieving a TSH <2.5 with thyroid replacement medication resulted in lower conception rates. (2)  I find this interesting because lots of women with a TSH in the normal range (0.5-5) are told their “thyroids are fine,” and yet this study indicates optimal fertility occurs with a TSH< 2.5!  So if 2.5 is optimum, I know a lot of women aren’t at this level.

Well, we’ve digressed to hypothyroidism rather than iodine!  Hypothyroidism can be caused by iodine deficiency because iodine is essential for making thyroid hormone, but we are taught as medical doctors that hypothyroidism in the United States and developing countries is not due to iodine deficiency–although how we would know for absolute I can’t say.  I NEVER once ordered or saw ordered tests for iodine levels.  So I wonder about the iodine status in the patients in these and other studies.  Could they have had lower levels of iodine contributing to their hypothyroidism?  We have to have suspicion of iodine deficiency to diagnose it, and if we miss it, we’ve stuck a patient on thyroid hormone replacement probably for life.

From The American Thyroid Association website (phrases bolded by me):

“As iodine levels fall, hypothyroidism may develop, since iodine is essential for making thyroid hormone. While this is uncommon in the United States, iodine deficiency is the most common cause of hypothyroidism worldwide…How is iodine deficiency treated?  There are no tests to confirm if you have enough iodine in your body. When iodine deficiency is seen in an entire population, it is best managed by ensuring that common foods that people eat contain sufficient levels of iodine. (3)”

 

I think this is a little backwards.  We check for iodine deficiency as a population, knowing that some of the population will fall outside the realm of sufficiency, and then we have the balls to look people in the eye as individuals and say “Your hypothyroidism is not caused by iodine deficiency.”  I am not saying it is or it isn’t!  I’m saying, based on my reading, WE DON’T KNOW!  Neither are we educating doctors to have suspicion!  On the other hand, many iodine-promoting websites tout iodine as a cure for things like infertility and menstrual abnormalities.  I don’t think this is fair, either, since aside from its connection to hypothyroidism (which is not always due to low iodine), there isn’t much documentation to support this.

However, I did find some animal studies to look at regarding iodine and female fertility (I know animal studies shouldn’t be used as a substitute for human studies, but we don’t have those available.):

  • Increased fertility in sheep:  One study looked at mating ewes and rams in an iodine deficient area.  One group of ewes and rams received iodine injections, and the control group did not.  The study showed that 100% of the treated ewes mated with treated rams were pregnant versus only 37% of the control ewes mated with control rams.  (I don’t know the breakdown of events, perhaps the untreated ewes and rams conceived 100% of the time too, but the ewes had miscarriages later.  Iodine sufficiency is shown to decrease miscarriages, which will be covered in the next post.) (4)
  • Increased fertility in horses:  Reportedly, a Russian study (Kruzkova, 1968) indicated that mares which had shown anovulatory cycles responded to iodine supplementation. (5)
  • Decreased fertility in chickens:  In chickens, increasing iodine actually DECREASED some of the fertility markers, such as egg production and follicle production without ovulation, and normal fertility returned after iodine supplementation removal.  Normal egg production returned after removal of iodine. (6)

Overall, improved fertility prior to conception seems to be related to iodine’s relationship to the production of thyroid hormone.  Both too much iodine and too little iodine may be a problem (although there are questions out there about if iodine is accompanied by certain co-factors will this alleviate the problems know to be associated with iodine repletion/supplementation) and affect fertility.

But what about men?  What does iodine have to do with their virility?

We can again see, as in female fertility, that HYPOTHYROIDISM plays a strong role:

  • Thyroid hormone is important to help the Sertoli cells in the seminiferous tubules of the testes make sperm (spermatogenesis).
  • Hyperthyroidism and hypothyroidism have been shown to affect the release of sex hormones from the pituitary in some studies (although not all studies).
  • If hypothyroid, males can have an increase of prolactin levels, affecting libido, hypogonadism, erectile dysfunction, gynecomastia, and galactorrhea.
  • Hypothyroidism also brings about decreases in testosterone and other male hormones.
  • Young males who have hypothyroidism during the congenital period and early childhood period present with reproductive issues later in life.  Please note:  The fact that hypothyroidism during the congenital period affects the male offspring’s reproduction is very important to remember.  What a mother eats (or doesn’t eat) during pregnancy has lasting consequences on the fetus.
  • Hypothyroidism, if prolonged, before puberty, can cause increased testicular size due to effects on the Leydig and Sertoli cells.  These cells will increase in number but decrease in their maturity.  There is a resultant drop in mature germ cells (sperm). (7)

Here again, these stated above results are for hypothyroidism–not iodine.

What about iodine deficiency and its supplementation’s effects on male fertility?  In the Japanese Journal of Veterinary Research (2004) a statistical analysis explored whether the institution of iodine supplementation (such as in iodized salt in the 1920s in the US) could be responsible for the decline in sperm counts which affect developed nations such as the US.  Through a complicated series of deductions and statistical analysis, these researchers felt that iodine supplementation WAS responsible for decreasing sperm counts.  However, fascinatingly enough, it was noted that regions with perpetually high iodine intakes (Toulouse France on the Mediterranean Sea and Japan) have not experienced any decline in sperm counts. (8)  [Please note that later in my reading, I saw that Toulouse, France had increasing occurrence of iodine deficiency in pregnant women. (9) ]

What questions does this raise?  Are iodine saturated societies (such as Japan) protected from the decreasing sperm counts that seem to be seen elsewhere?  In mild hypothyroidism from iodine deficiency, does the body then increase the cells which produce sperm to try to preserve reproduction, yet produce more immature sperm cells?   Could there be something else besides iodine supplementation that decreases the sperm count?  Clearly, there are a  lot of factors introduced at the time which could decrease in sperm count.

Playing devil’s advocate in a weak fashion, the mentioned study concluded that sperm counts dropped significantly between 1965 and 1969 and attributes it to iodine supplementation.  Another theory about the sperm fall revolves around hormone disruptors in the environment.  What else was introduced and was all the rage about this time in America and Europe?  Tupperware.  Plastic.  Potential hormone disruptor increasing estrogen-like effects in the body, and not just the BPA plastics, either.  (10)  So I will tuck this iodine and low sperm count thought away until perhaps more research comes along.

In animal studies:  We can also take a look at an animal study specific to IODINE, rather than hypothyroidism.  It has been found that administration of iodine to bulls improved the ejaculate volume and that in regions where iodine deficiency occurs, bulls’ fertility is affected due to decreased libido, ejaculate volume, sperm motility and sperm cell concentration; supplementing iodine to these bulls improved the libido, ejaculate volume, sperm motility and sperm cell concentration. (11) 

So where are we left off?  Hypothyroidism affects male fertility.  Yes.  Iodine supplementation we just don’t know about.  A statistical analysis stretched and said iodine supplementation decreases sperm counts.  An animal study showed benefits of iodine in bull fertility.  What really happens in human males?  I don’t feel there is enough out there for me to decide.  If you speculate that iodine may improve the synthesis of thyroid hormone and perhaps help reverse hypothyroidism, then you can arrive at the conclusion that mild iodine deficiency in a male may decrease male fertility.  There are other micronutrients (such as zinc and selenium), too, besides iodine that can affect sperm counts and male fertility, and perhaps these are all needed more as a person is iodine repleted to make sure there are no (or at least, less) adverse effects from the iodine supplementation.  Don’t know.  Wish I could deduce more.

Conclusion

So what did I decide about all those internet claims about improving male and female fertility with iodine?  I think if iodine deficiency is causing a hypothyroid state, which may be overlooked by the medical community, then improving the thyroid function with iodine supplementation (and appropriate co-nutrients) could improve the chances to conceive.  I don’t think I can safely assume and write more than that right now.  In the next post, I will describe iodine effects in pregnancy.  In the sense that iodine sufficiency helps cut down on miscarriages and stillbirths, it is true to say that iodine improves post-conceptual fertility.  Pre-conceptual and conceptual fertility in males and females, I just haven’t decided.

 

Sources:

1.   Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J App Basic Med Res 2012;2:17-9.  (http://www.ijabmr.org/article.asp?issn=2229-516X;year=2012;volume=2;issue=1;spage=17;epage=19;aulast=Verma)

2.   Thyroxine treatment modified in infertile women according to thyroxine‐releasing hormone testing: 5 year follow‐up of 283 women referred after exclusion of absolute causes of infertility.  Raber W, Nowotny P, et al.  Hum. Reprod. (2003) 18 (4): 707-714.  (http://humrep.oxfordjournals.org/content/18/4/707.long)

3.  American Thyroid Association website:  Iodine Deficiency.  June 4, 2012.  (http://www.thyroid.org/iodine-deficiency/)

4.  Iodine supplementation restores fertility of sheep exposed to iodine deficiency.  Ferri N, Ulisse S, et al.  Journal of Endocrinological Investigation. November 2003, Volume 26, Issue 11, pp 1081-1087.  (http://link.springer.com/article/10.1007/BF03345254#page-1)

5.  Iodine in the horse:  too much or too little. ( http://www.4source.com/technical/iodine1.shtml) (Could not find the actual abstract or article referred to.)

6.  Effects of Excess Dietary Iodine upon Pullets and Laying Hens.  Arrington, Santa Cruz, et al.  The Journal of Nutrition.  February 1967.  325-330.  (http://jn.nutrition.org/content/92/3/325.full.pdf)

7.  Thyroid Hormones in Male Reproduction and Fertility.  Rajender Singh, Alaa J Hamadaand Ashok Agarwal.  The Open Reproductive Science Journal.  2011.  3; 98-104.(https://www.clevelandclinic.org/reproductiveresearchcenter/docs/agradoc414.pdf)

8.   Iodine intake as a possible cause of discontinuous decline in sperm counts:  Ar e-evaluation of historical and geographic variation in semen quality.  Kentaro Q Sakamoto, Mayumi Ishizuka, Akio Kazusaka, Shoichi Fujita. Jpn. J. Vet. Res. 52( 2) : 85-94,2004. (http://eprints.lib.hokudai.ac.jp/dspace/bitstream/2115/10513/1/52(2)_85-94.pdf)

9.   Clinical and Biological Consequences of Iodine Deficiency during Pregnancy.  Glinoer D., Van Vliet G, Polak M (eds): Thyroid Gland Development and Function.  Endocr Dev. Basel, Karger, 2007, vol 10, pp 62–85.  (http://www.iccidd.org/cm_data/2007_Glinoer_Consequences_of_ID_during_Pregnancy.pdf)

10.  Estrogenic chemicals often leach from BPA-free plastic products that are replacements fro BPA-containing polycarbonate products.  Bittner G, Yang C, et al.  Environmental Health 2014, 13:41.

(http://www.ehjournal.net/content/13/1/41)

11. The Effect Iodine Supplement on the Sexual Activity And Semen Characteristics of Friesian Bulls.  Barakat T.M. Benha Vet. Med. J., Vol 15, No 2, Dec 2004.  (http://www.fvtm.bu.edu.eg/fvtm/images/Animal_dept/pdf-Magazines/2-barakat2.pdf)

 

 

Iodine Post 2, More Iodine Introduction and Review to Lead Up to Iodine in Fertility

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Today continues on in the long, arduous, controversial trek that is iodine.  For this post, I had wanted to take a critical look at how iodine affects fertility, both male and female, and pregnancy.  The post was too long, so I am splitting it into three parts.

  1. More iodine introduction and review today because I want to stress again how iodine deficiency may be present despite the common medical community saying it isn’t in industrialized/developed countries.
  2. Iodine and pre-conceptual/conceptual fertility tomorrow or so, as time allows me to get my citations in somewhat presentable documentation form.
  3. Iodine and post-conceptual fertility/pregnancy the post or so after that.  (Notice the “or so”?  Moms always learn to be wishy-washy on timing of events, right?)

I spent a long time searching about fertility and iodine, and thus my absence in publishing blog posts lately.  One article and question always leads to another and another.  Despite looking high and low, I will make no great conclusions regarding iodine and fertility.  Sorry.  Hypothyroidism (low functioning thyroid gland) and hyperthyroidism (over-functioning thyroid gland)  clearly do play a role in male and female fertility, but connecting the dots to iodine has not been performed much yet in research studies.  However, we DO know that iodine deficiency is one cause of hypothyroidism.

My take, off the  cuff, without sources and science, regarding iodine

Although we absolutely need iodine, our bodies seem to become adjusted to regulating our thyroids and bodily systems based on how much iodine we give them.  Our bodies make do, down-regulating this pathway and up-regulating that pathway, until a critical iodine low point at which the system fails and you see the serious consequences of overt hypothyroidism and offspring with severe deficits, such as mental retardation.  Before that severe iodine deficiency crisis hits, there are varying degrees of “normal” a body can manage to function at in different people with the iodine amount provided–which probably aren’t really “completely normal” functioning states but good enough to sustain life and reproduction with little noticeable compromise.

To significantly replace iodine at this point, when a person is “low in iodine” but functioning “okay” (where the body has managed to find a nice “homeostasis” regarding iodine use), can do one of three things.  It can:

  • 1)  Benefit the body without negative thyroid side effects (the goal and the most common outcome).
  • 2)  Bring about a hypothyroidism.
  • 3)  Bring about a hyperthyroidism.

If a person is already hypothyroid from low iodine intake, even if mildly so, hopefully iodine replacement will allow the body to start optimizing its iodine use for improved thyroid function and the functioning of other tissues that use iodine, such as the ovaries, breasts and prostate without any ill effects.  In fact, most people do fall under the umbrella of tolerating iodine supplementation just fine and benefitting from it, but doctors worry a lot about iodine bringing about hypothyroidism and hyperthyroidism in what were observably “normal” people.  And this does happen.  Cruise the internet for research studies and iodine supplementation anecdotes, and you’ll see good and bad outcomes.  (To optimize replacement with the least amount of negative thyroid response, iodine supplementation needs to be taken along with some other important co-nutrients, selenium, vitamin C, and zinc.  This is a topic for another post.)  Iodine is a mixed, controversial medicine bag.

As an obvious reminder, don’t use anything in my posts as medical advice, only use it for introductory informational purposes.  The internet is a not a doctor.  And there can be huge risks from implementing what you find on internet health sites.  Walk cautiously and find a healthcare person you DO trust to talk things over with.

Let’s remind ourselves of why a person would be iodine deficient from the last Iodine Post and then eventually move on to what I could find regarding iodine on male and female pre-conceptual/conceptual fertility tomorrow…

Iodine deficiency erratically riddles the population of developed societies.  Why?  Who is at risk?  Am I?  Are you?  Why do they say we are “iodine sufficient” if we are not?

Why would well-fed people be iodine deficient?

(I am omitting the discussion of goitrogenic foods and halides, which put people at risk for iodine deficiency disorders, Grand Caymandespite adequate iodine intakes.  I will discuss those in later posts.  It is an important topic which needs its own post.)

Iodine real food sources primarily include dairy, eggs, ocean seafood, and seaweed.  Iodine can be a dietary toughie to get because levels of iodine fluctuate greatly EVEN IN THESE REAL FOODS.  I would like to contrast this with nutrients such as B vitamins and magnesium, which although they are diminished in our modern food sources, they are abundant in MANY, diverse food sources which people eat, especially real food advocates.

  • Milk iodine content will vary depending on if the grass cows eat has iodine (Are they grazing on coastal pastures or iodine-deficient Great Plains grass?), if cows are supplemented with iodine-containing feed, and if iodine containing washes are used prior to milking.
  • Egg iodine content will vary depending on if the chickens are fed iodine supplemented chicken feed or not.
  • Vegetables and plants have no need for iodine, although they will take it up from the soil, passing it graciously on to us.  Most soils away from the ocean coasts are iodine deficient (iodine is most abundant in ocean water, which falls on the land in the form of the rain cycle, replenishing coastal soil and plants with iodine from the sea ), so eating “locally grown” food from iodine deficient soils will provide less iodine content.
  • Meat iodine content will vary, again based on what animals are fed or where they are grazing.
  • Sea salt mostly has only trace amounts of iodine.
  • Bread products use bromine rather than iodine-type dough conditioners, like they used to.  (Heck, homemade bread doesn’t use either!)  I realize to some readers that bread is a processed food, but it is eaten by most people.  And the replacement of iodine-based dough conditioners for bromine-based dough conditioners, which interfere with iodine utilization in the body, plays a significant role in iodine deficiency disorders and the decreasing amount of iodine intake in the United States.
  • Seafood and seaweed’s iodine content vary by the kind of seafood but is usually a lot more predictable than the foods listed above.

Who is at risk?  Examples.

If you stop and think, you can easily identify why people would be iodine deficient:

Case 1:  An American woman who is dairy-free, doesn’t like seafood, and who has switched over to non-iodized sea salt because she thinks it tastes better.  She still eats bread, but her bread has no iodine, and in fact does use a bromine derivative for dough conditioning.  Hopefully she eats eggs and lives on the coast.

Case 2:   An American college student who eats only bagels, cereal bars, or Pop Tarts for breakfast, sandwiches with chips at Subway for lunch, and some freezer-kits for supper.  All these processed foods may not provide enough iodine, since non-iodized salt is used.  Hopefully, some iodine is sneaking in through the cheese and eggs used in the products chosen.  But we don’t know.

Case 3: A family in Australia who eats strictly organic, without realizing that studies show that organic dairy has less iodine, organic bread in Australia has no iodine, and their fruits and vegetables are grown in an iodine depleted area.  They worry about mercury and radiation in seafood, and one child has an egg intolerance/allergy, so they shy away from eggs.  I’m not sure where this family gets enough iodine.  Maybe they take a multivitamin.

Case 4:  A 67-year-old man who has lactose intolerance, who shuns salt because of blood pressure issues, who only eats the egg whites (not high in iodine) due to cholesterol concerns, and whose wife doesn’t like fish at all.

Case 5:  A vegan who eats no dairy, no eggs, no meats, and no seafood.  She could eat seaweed but doesn’t like the taste.  Iodine intake is not lookin’ good.

Why do they say we are “sufficient” if we are not?

(Emphasized phrases are bolded by me.)

From The Proceedings of the Nutrition Society, 2010:

The WHO [World Health Organization] prevalence data emphasise that iodine deficiency is not only a problem of developing countries; the highest prevalence of iodine deficiency is in Europe (52.0%), where the household coverage with iodised salt is the lowest (approximately 25%), and many of these countries have weak or nonexistent control programmes for iodine-deficiency disorders. (1)

and The American Journal of the Medical Sciences, 2009:

IDD [iodine deficiency disorder] can occur in iodine replete-environments. A high index of suspicion is needed to recognize these cases. It is pertinent that the correct diagnosis be made to avoid unwarranted life-long thyroxine therapy in patients presenting with goiter and hypothyroidism, which is easily treatable with iodized salt. These cases underscore the need for considering iodine deficiency in the etiologic diagnosis of goiter and hypothyroidism, even in iodine sufficient regions. (2)

From my research, I am concluding that iodine deficiency is insidiously surfacing in individuals and small subpopulations (for example, pregnant women, vegans, or those with multiple food intolerances) in many developed countries, probably riddling whole populations like a shot-gun due to unique dietary patterns and habits of individuals and their families.  How is it that the medical community, chomping on their brominated office donuts, sipping their Coffee-Mate tainted coffee, and brushing their teeth with fluoridated Crest, may be slow to recognize this?  (Yes.  This was me.)  Well, when the scientific community prudently checks to see if an area is getting enough iodine, they look at levels as a POPULATION, not in individuals.  To determine the iodine sufficiency of an area, “on-the-spot” urines are checked for iodine in a sample of hopefully “representative” people.

Swimming with sting raysSpot checks of urine for iodine content are known to be erratic and insensitive, so they can’t be used to determine true iodine status of an individual, but when they are collected and pooled together an overall snapshot of the area (or population) in question can be gained.  The median (That’s the number that occurs in “the middle” when all the result values are lined up from smallest to greatest–it is not the average/mean.) is then used to determine if the tested population is iodine sufficient.

The median value determined can still “hide” a significant amount of the population who may be deficient.  What values are on the low side of the median?  How low do they go?  If most people in the community who are checked use iodized salt and drink milk, well, those folks are probably iodine sufficient and pooled results tell the researchers that “all is well.”  However, if you and your family don’t drink milk and skip iodized salt, plus you all hate seafood, your low urinary iodine spot check will be lost on the low side of the median.  You’ll be told your community or population is iodine sufficient, and you won’t change a thing you eat.  Iodine deficiency affects us as individuals, but unfortunately, iodine evaluations are made based on populations.  True, accurate testing in individuals is pretty intensive.  It requires a 24-hour urine collection, and so just getting “eyeball” spot urine results and pooling them together makes the most sense for determining a society’s iodine status. (3)

Bottom Line

So as I did in the last post, I encourage you to take inventory of your family’s commonly eaten foods to see if you may be at risk for mild iodine deficiency despite your government and medical societies saying: “There is no concern of iodine deficiency in the United States (or Australia, France, etc.).”  I’ll bring a wealth of information eventually on iodine to the blog, but it takes me time.  Meanwhile, just explore your diets and make sure you’re getting some foods which usually have decent sources of iodine.

Remember, food counts.  It really matters.  It matters for you and your family and their families to come.  Let’s move on to iodine and fertility tomorrow-ish…

Terri

Sources:

1.  Iodine deficiency in industrialized countries.   Zimmerman M.  Proceedings of the Nutrition Society:  Conference on ‘Over-and undernutrition:  challenges and approaches.    2010; 69: 133-143.  (Full text link.)

2.  Iodine Deficiency Disorders in the Iodine-Replete Environment.  Nyenwe EA and Dagogo-Jack S.  The American Journal of the Medical Sciences.   Jan 2009; 337 (1):  37-40.  (Full text link.)

3.  Estimation of iodine intake from various urinary iodine measurements in population studies.  Vejbjerg P, Knudsen N, et al.  Thyroid. Nov 2009; 19(11):1281-6.  (Abstract link.)

Hobos

The Favorite HoboHey there!  How are ya’?  Good to have you drop by!  Do you make these?  Hobos.  Probably my kids’ favorite summer meal.  Super easy and leaves the kitchen pretty darn spotless.  Not to mention a great way to work through the ground beef you have boatloads of when you buy beef in bulk!  It is also a GREAT recipe to let the kids help with, layering on vegetables, sprinkling on spices, tearing off aluminum foil, and folding up the foil.

We use onions, potatoes, carrots, and ground beef.  But you can use sweet potatoes, green beans, chicken, pork, or mix and match!  We do these on the grill for great flavor and low mess, but you could also do them in an oven, too!  My kids don’t eat sweet potatoes all that well, so I usually opt for potatoes.  I peel them, which deprives them of some of the mineral nutrients, but right underneath the peel are “lectins.”  Lectins can lead to increased intestinal permeability (“leaky gut”) and some people have sensitivity reactions to lectins.  Since I’m working hard to reverse some of these issues (with finally some fair success, I think), I choose to peel them if I eat potatoes.  Also, for a make-ahead meal, these could be prepped ahead of time and stored in the fridge until ready to cook.  Or cooked ahead of time and reheated in the oven.

Here is how we make our hobos or “hot pockets.”

Hobos

This makes five packets for me, but it could EASILY make more!  I just get lazy.

2 pounds ground beef (grass fed beef imparts some extra health benefits)
1 and 1/2 onions, sliced into circles or as desired
1/2-1 potato or sweet potato per person, sliced
1 carrot per person, peeled and cut into coins, not painfully thin, but not so thick it takes them forever to cook
Salt
Pepper
Garlic powder, optional
Onion powder, optional
Olive oil, just enough to lightly coat the vegetables
Aluminum foil
Parchment paper, optional (I recently learned to use it to minimize aluminum transfer to foods cooked in foil.  Compliments of salixisme.wordpress.com)

1.  Mix all of your vegetables together in a large bowl.  Toss with just a little olive oil to coat, and sprinkle if desired with salt, pepper, garlic and onion powders.  I found if I don’t use a tad of oil, the vegetables want to stick to the foil or parchment.

2.  In a medium-sized bowl, place your ground beef.  Season it with salt, pepper, garlic powder, and onion powder to taste.  I probably use a teaspoonful of salt, 3-4 shakes of ground pepper, and a couple shakes each of garlic and onion powder.

3.  Lay out large rectangles of aluminum foil and line with parchment paper if desired!

4.  Place a pat of ground beef (remember this makes 5 pats for us, but it can easily be divided into more) on each rectangle of aluminum foil.  I push the pats down into irregularly shaped patties.  Top with the mixed vegetables.

5.  Fold the packets such that all the contents will stay enclosed, or draw up all the sides like a “hobo” bag.

6.  Place on hot grill for about 20-30 minutes.  (Sometimes I cheat and open one up, checking to make sure the beef is done as I like it.)  If you make them in the oven, it takes about twice as long.  You just want to make sure your carrots and potatoes are tender and the beef is done.  Steam escapes when you open so be very careful!

7.   Remove from heat, and serve in packet or transfer onto a plate.  I usually divide one in half for each of my kids.

8.  My kids like to top with mustard and ketchup.

Family “gustar” report:  100% success (5/5 of us)!  When a friend asked about what in the world to do with all of her ground beef, I suggested these.  Her family of six loved them, too!

Certainly hope you’re having a great week!

photo (7) Hobos

~~Terri