A simple 10-step arthritis treatment plan

What are the most important things we can do to stop and reverse the degeneration, and alleviate the stiffness and pain of arthritis? You can be sure that no matter how bad things are, there are many things that will help, and they don’t involve pharmaceuticals.

We looked in some detail at how to treat arthritis in Treating Arthritis I and II, and have at least one of our readers, an artist, Catherine Bath, who has been able to alleviate a great deal of her stiffness and pain, and recover a good amount of mobility and ease of movement by following the various recommendations we made there and throughout this blog.

Here, prompted by a request from a good friend who needs it, we present a simple treatment plan with the most important elements, and just the essential details needed to understand why the interventions are useful, and how to put them into practice right away.


Illustration of painful, inflamed, arthritic joints. (Image taken from Everyday Health)

1. Hydrate and alkalise

This is the most important point of all. Without it nothing will work, really. Every joint works thanks to the cartilage that allows the bones to move within it without rubbing against one another. Arthritis is always characterised by the degradation of this cartilage and the pain associated with the inflammation caused by the bones not moving properly or rubbing inside the joints. Cartilage is water (85% by weight) held together in a matrix made mostly of collagen, and chronic dehydration is the first cause of cartilage breakdown (details in Your Body’s Many Cries for Water).

Metabolic acids (mostly uric acid) can only be excreted efficiently by the kidneys when there is an excess of both water in which to dilute the acid, and salt to help carry it out in the urine. Without excess water, the kidneys will prioritise retaining as much of it as they can. Without excess salt, the uric acid will be recycled instead of being excreted in order to to maintain the concentration gradient in the medulla of the kidney that ensures its ability to reabsorb as much water as possible. Chronic dehydration and avoidance of salt, coupled with the drinking of acidic liquids and eating of acid-forming foods inevitably leads to chronic acidosis.

To maintain the pH of the blood at 7.365 in spite of the continuous flow of acids into it from the muscles and digestive system, two main coping strategies are available: 1) The body’s main acid buffering mechanism using the reserves of alkalising minerals stored in the bones and teeth to counterbalance the acid load. If you don’t quite understand the implication here, this means erosion of the bones and teeth to put into the blood some of the alkalising calcium, phosphate and magnesium as acid-buffering minerals. 2) The crystallisation of the uric acid to pull it out of circulation, but then storing it into tissues, of which the joints, regrettably for arthritis sufferers, seem to be used preferentially, even though all tissues can be used for this to a certain extent.

The strategy is simple: drink alkaline water (either naturally so, or made to be with pH drops) on an empty stomach, and allow at least 30 minutes before eating. Aim for 3 litres per day. One litre before each meal, drank over a period of one to two hours, is a simple rule of thumb and easy schedule to remember. And aim for 2 full teaspoons of unrefined salt with your meals.

2. Magnesium chloride and sodium bicarbonate baths

Magnesium is at the very top of the list of supplements for anyone in any circumstance. We explored and explained why in Why you should start taking magnesium today.

Transdermal magnesium and bicarbonate therapy is the best way to simultaneously replenish magnesium stores in the cells, while alkalising the tissues directly by transdermal absorption of magnesium and sodium bicarbonate. If you have a bath tub, do this once or twice per week, or more if you can or need it. Add two cups of each magnesium chloride and baking soda, and soak for 45 to 60 minutes.

I also recommend that in addition to this—but crucially if you don’t have a bath—you take magnesium supplements. I take a fat-bound magnesium supplement called L-Threonate. Another alternative is the amino acid-bound supplement called magnesium glycinate (using glycine). Both of these form maximise absorption. Take it with meals.

3. Silicic acid, collagen, hyaluronic acid, and proteolytic enzymes

An essential constituent of hair, skin, and cartilage. Absorption is poor and slow. This means you need to take small amounts every day for long periods of time. Every morning, first thing, with your first glass of water. You will need to do this in cycles of three months on, three month off. I take Silicea, a concentrated water-soluble silicic acid gel by the German brand Huebner.

Collagen and hyaluronic acid will help greatly in rebuilding the damaged cartilage. Look for type II collagen for better absorption. Now Foods has good products at good prices. Also, glucosamine, chondroitin, MSM have all been shown to be useful for joints.

Proteolytic enzymes are responsible for breaking down, building, and repairing tissues. They can be amazing in accelerating a healing process, no matter what it is. Therefore, this is an essential supplement to take in treating arthritis.

4. Vitamin D3 and K2

These are the two vitamins that control and regulate the availability and deposition of calcium. Vitamin D3 makes it available, and vitamin K2 directs it to the bones and teeth.  Lots of vitamin D3 without K2 will lead to calcification with calcium being deposited all over the place in the arteries and soft tissues. Lots of K2 without D3 will lead to a depletion of available calcium in the bloodstream because it will be stored away in the bones and teeth. K2 is also used to decalcify soft tissues by pulling out and redirecting the deposited calcium from the tissues to the bones.

Vitamin D deficiency is universal in the west, and so is vitamin K2 deficiency. Arthritis sufferers need large doses of both for extended periods of time (at least a year). I recommend taking a combo supplement containing both in an optimal ratio, and take as many capsules as needed to bring vitamin D intake to 20 000 – 50 000 IU per day with breakfast and lunch. For years I took DaVinci’s ADK combo, which I think is one of the best. Now I take Life Extension’s D and K combo, without vitamin A, because its presence dampens the activity of vitamin D3. However, vitamin A promotes the healing of tissues. You can take both, alternating between the two.

Another of our readers who had his entire adult life an arthritic wrist that caused him pain and trouble whenever he used his hand for anything at all, followed my suggestion of taking 50 000 IU of vitamin D3 per day, together with the appropriate amount of vitamin K2 to match in the D3 intake, for six months. Within the first month, he found incredible improvement, something he had never been able to achieve using all the methods and drugs that had been proposed to him by MDs. After three months, his wrist was completely healed. He continued for the entire 6 months just to be sure, and now, his painful, debilitating, arthritic wrist that he was living with for more than 20 years, is a thing of past, a bad memory.

5. Vitamin C

Whole food vitamin C is essential for healing and keeping tissues and cells healthy. And there is definitely a difference between whole food C and ascorbic acid. We discussed this in Vitamin C is not vitamin C. This is not specific to arthritis, but everyone with arthritis should be loading up on it. I take The Synergy Company’s Pure Radiance C. You should take at least three capsules, but better 6 capsules per day, split evenly with each meal.

6. Turmeric extract

Turmeric is one of if not the most powerful natural anti-inflammatory. And inflammation is a hallmark of arthritis. You should take an extract that concentrates the curcuminoids, but you should also think of making yourself hot turmeric drinks, adding as much turmeric to your soups and curries as the flavours and combinations of foods will allow. It always needs to be taken with a lot of fat to maximise assimilation.

7. Food

Naturally, you will have guessed that my recommendations for food are the same as always, but even more important in this case when we are trying to bring inflammation as low as possible, and maximise healing:

  • no simple or starchy carbs because they cause inflammation, tissue damage, and metabolic disorder, except for berries once in a while;
  • unlimited unprocessed saturated fats from coconut oil, butter, and animal sources;
  • enough high quality protein from healthy animals including organ meats, especially liver; and
  • as many green veggies as you like, especially leafy like spinach, kale and lettuces, watery like cucumbers, fibrous like celery and broccoli.
  • Avocados are fantastic to eat as often as you want. Walnuts and hazelnuts are excellent health-promoting nuts (either roasted, or raw and soaked, subsequently dehydrated or not).

8. Sunshine, fresh Air, exercise and sauna

Go out in the sun, go for long hike, expose your skin, breath deeply, run up the hills, work your muscles at the gym if you can, go to Pilates and yoga classes, do lots of stretching whenever you can, and go to the sauna when you can. Make sure you stay 15 minutes to get really hot and for the heat to penetrate into the tissues and joints.

9. Iodine

Iodine is the universal medicine. Everyone needs it, and everyone should be supplementing with it. You can read for yourself why in Orthoiodosupplementation. Start at 12.5 mg and work your way up to 50 mg per day. Increment by 12.5 mg each week. Take the supplements on weekdays and give the kidneys a break on weekends. I take Iodoral, and recommend that. Using the generic Lugol’s solution is as good but less convenient.

10. Melatonin and good sleep

Good sleep is absolutely essential for repair and healing. Make sure you get plenty every day. Melatonin has, in addition to its effects in helping you sleep, many other amazingly health-promoting effects that we will explore in another article sometime soon, I hope.

Last words

Are there more supplements you can take? Of course there are. I personally take all of the above and several others. I wanted to stick to the things which I believe most essential. If I were to recommend additional supplements, I would say to take

  • omega-3’s, which are useful for lowering inflammation, as well as tissue healing and repair. I take Life Extension’s Mega EPA/DHA. Don’t take more than the recommended dose. Omega-3’s are very easily oxidised, and should always be taken in very small quantities.
  • Niacin in the form of niacinamide is also a universally useful supplement because it provides molecular building blocks needed by every single cell to produce energy. I take 500-1000 mg/day, but you could take 3000 mg (1000 mg with each meal). Niacin supplements will also do wonders for your mood (see No more bipolar disorder?).
  • Ubiquinol, the active form of Co-enzyme Q10, is also essential in cellular energy. I would recommend at least 50 mg per day, but more (like 100 or even 200 mg) would probably be better.
  • Vitamin B12 is crucially important for health. And the older we get, the more critical it becomes. I get an injection of 5 mg every month, and recommend that for everyone (see B12: your life depends on it).

Keep in mind that the timescale for improvements is long: on the scale of months. If you think that is too slow, ask yourself how old you are, and how long it took to get to the state you’re in. Now, with the answers in mind, remind yourself to be patient. You need to be determined to get better, consistent with your new regimen, and patient. But I assure you that you will get better. And please, keep me posted on your progress.

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Eat your salt, and eat your fat

A couple of months ago, I had just gotten to the locker room at the gym, when a buddy of mine came in. Changing into his workout clothes, looking at himself in the mirror with his shirt off, he said he was tired of this layer of fat over his abs, that he just couldn’t get rid of it no matter how much he tried. He’s a handsome Columbian guy in his mid thirties, super nice, friendly, and easy going, big open smile with nice white teeth. He’s well built, strong, with balanced musculature but … there’s not much definition.

Everyone wants to be cut, of course, and when you’re working out 5 or 6 times a week, like he does, and you can’t get cut, you get frustrated by that. Quite understandable. Meanwhile, I work out typically three times, and I’m “rallado” as he says to me. In english, the term is shredded: so lean that under tension, we see the muscles fibres. In my case, we can see them in every muscle, including the abs. He knew that, obviously, since I’ve been like this ever since we first met a year and a half ago. The only thing that’s changed is that I’ve put on some muscle and use heavier weights in my workouts.

And so, naturally, that was my queue:

– You just need to cut the carbs. The fat is going to melt off on its own in no time. Especially if you are working out the way you do. Just stick to meat and vegetables. Make it simple for yourself. Have eggs and avocados for breakfast, and meat and veggies the rest of the time. If you can skip breakfast, that’s even better: you’ll give your body a longer time to burn fat.

– Alright! I’ll try it!

After our workout, we said goodbye, and he told me he was going to Columbia for a while for his work (he’s part of a several-generation, several-family-member meat business based there, but lives here in Madrid with his wife and young child). He said that even though they always serve so rice, pasta, and potatoes with every meal, he would do his best to stick to the plan of having only meat and veggies. I gave him a good handshake, told him he could do it, and that it was important to be strict for the first month to allow for a good transition to fat-burning.

A few weeks later, he came back. We bumped into each other at the gym again. I was doing chest and back, he had come to do shoulders. He looked noticeably different: his face was smaller, his features more defined, his neck was thinner and more visible, his eyes were whiter and his skin was smoother. He looked 5 years younger! As soon as I saw him, I told him he looked very good, thinner in the face and neck, younger, and clearly healthier. He was happy to hear me say it, of course. He said that many people had told him that he looked younger, and obviously, he could also see it himself when he looked in the mirror. But it’s always nice when someone tells us we look good; it doesn’t happen very often. He had already lost 4 kg.

We saw each other a few more times at the gym like that, working out, but it took a while before he told me that he was feeling weak, that he couldn’t push as much weight as before, that he was often tired, and strangely, often in an angry mood. Naturally, he thought it was because he wasn’t eating carbs. That somehow he was carb-deficient.

– Do you add plenty of salt and fat with your meals meat and veggies?

– No! I don’t! I haven’t added salt to food in years. And I don’t add fat either.

– That’s the problem. You need to start right away. Lots of salt, and lots of fat with your food, whenever you eat.

– What kind of salt, and what kind of fat?

– Unrefined sea salt, organic butter and coconut oil, and olive oil with salads. With every meal. When you go low carb, you not only get rid of accumulated water in your tissues due to the chronic inflammation triggered by carbohydrate exposure (that’s why your face and neck thin out in the first week or two), but you also excrete more salt in the urine. It’s crucial to eat plenty of unrefined salt every day.


Organic butter and unrefined salt


Two days later, when I got to the gym, he was already into his workout, and he was pushing heavy weights on the benchpress, he was walking around with a spring in his step, and he was smiling. I didn’t even need to ask, but I did anyway:

– So, how are things going? Lots of salt and fat?

– Yes! And I feel great! I feel strong, I feel powerful, I’m not tired, and I’m not angry anymore.

– Fantastic! Glad to hear that. And from now on, you’ll always feel like this. No ups and downs, no weakness or lack of energy, no hunger pangs, no mood swings.

Each time we saw each other at the gym in the next weeks, I could tell he was getting more defined. The last time we met, he was again walking around feeling strong and working heavy weights with a smile on his face, and he looked ripped, a lot more defined. And he knew it too. I could tell by the self-confidence.

When we parted, I told him he looked good, that he looked more defined, and more energetic. He was happy: “Thanks a lot for all your advice. It’s really made a huge difference. I feel great, and my abs are starting to show!”

Not eating enough salt and not eating enough fat is a classic mistake that too many people do. We have been brainwashed into thinking we should avoid fats and we should avoid salt. So, when we cut the carbs, we continue to avoid fat and avoid salt. Then, we get tired and weak, and we think it’s because we don’t eat carbs. Totally not! We’re just not getting enough salt and fat.

And so, we have to repeat this, and repeat it over and over again. Eventually, it sinks in. Especially when we feel the difference it makes. Just like it happened in this case with my Columbian buddy at the gym. So, what’s the moral of the story?

You want to feel strong, and energetic? You want to look healthy and young? You want to get ripped with tight 6-pack abs? The formula is simple:

Cut the carbs. Fast intermittently. Drink alkaline water on an empty stomach. Work heavy weights 3 times a week. Eat enough protein. Eat your salt. And eat your fat. Try it. You’ll see. It works like a charm.

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Case study: old man can’t walk

Some time ago, a childhood friend of mine sent me this message:

I want to help this man. He has a problem with his tendons in both legs. In the morning, he can’ t stand up. Can you recommend some minerals and vitamins? Maybe some exercises that can help? Your advice is important.


The old man that can’t walk from the pain in his legs.

That’s all he wrote. So, I replied:

How can I give any advice? I don’t know anything about him. I help/treat people with a complete eating and drinking programme. Vitamins and mineral supplements are only used as adjuncts to correct deficiencies. So, before saying anything, I need to know some basic things:

How old is he? What work does he do or did? How long has this problem been developing for? Does he drink water and how much? What does he drink? What does he eat every day? Does he have other complaints? How is his digestion? How is his skin (any rashes or dry skin or eczema)? What kind of other problems has he had in his life? And anything else about this health that could be useful?

Here’s what I got back:

  • How old is he? What work does he do or did?  He’s 81. He was a manager.
  • How long has this problem been developing for?  The problem started when he was around 65. It has gotten much worse in the past 2 years.
  • Does he drink water and how much?  He drinks little water, 0.5 litres a day.
  • What does he eat every day?  He eats meat, potatoes, tomatoes, some cheese, and a lot of bread.
  • Does he have other complaints?  Heart, kidneys.
  • How is his digestion?  He has problems going to the bathroom every day. He goes once every three days.
  • How is his skin (any rashes or dry skin or eczema)? His skin is fine.
His doctor told him to exercise, but he can’t even stand up or move properly.

With this info, I was able to get a better idea, and I replied:

Here is my diagnosis:
This man has been chronically dehydrated for most of his life. Being chronically dehydrated is one of the most health-damaging situation we can be in, but because it is not acute, the consequences are manifested over long periods of time. 
The lack of water first leads to a deterioration of the digestive system and digestive function: of the stomach (poor digestion and ulcers), and of the intestines (damaging of the lining, ulcers, and leaky gut), constipation and from it toxins and pathogenic bacteria going back from the colon into the bloodstream. 
Second, it leads to deterioration of the kidneys and the nephrons (little filters in the kidneys), because the only way to get the acids out of the blood is to dilute them in water, but if there is a lack of water, then the kidneys do everything they can to keep this water, because water is more important to keep than to get rid of acid. Therefore, not only do the kidneys get destroyed little by little, but the body accumulates the uric acid everywhere in the soft tissues, starting in the joints, and then in the tendons, ligaments and muscles. This leads to incredible stiffness, pain, and eventually to not being able to move.
Third, because our diet is usually rich in calcium but very poor in magnesium, everyone tends to be over-calcified and to accumulate calcium everywhere in the blood vessels, soft tissues of the joints, and in the muscles. This is made much worse by over-acidification and chronic dehydration. Calcification also leads to stiffness, pain, and eventually, to not being able to move properly.
Therefore, the most important things to do in order or priority are the following:
  1. Drink a lot more water (at least 3 litres per day), on an empty stomach (at least 20 minutes before eating), and making sure it is alkaline water (high pH 9-10).
  2. Take baths with 2 cups (500 g) of sodium bicarbonate and 1 cup of magnesium chloride (or magnesium sulphate). The bicarbonate and magnesium will be absorbed into the body through the skin, and will dissolve uric acid and calcium deposits throughout the body. 
  3. Drink juice of green vegetables to remove acid buildup in the body, and clean out the intestines.
  4. Take supplements of magnesium (the best form is L-Threonate, because it is bound to fat and is 100% absorbed) in order to help remove build-up of calcium.
  5. Take supplements of vitamins A-D-K2 (I recommend DaVinci’s combo supplement because of the high concentration of K2), as these are the most important fat-soluble vitamins, and K2 is the only nutrient that can effectively de-calcify blood vessels and soft tissues.
  6. Take supplements of vitamin C and collagen to help rebuild the cartilage and heal the damaged soft tissues, especially the blood vessels and the joints. It is essential to take whole-food vitamin C, and high quality collagen.
  7. Stop eating sugar, bread, cheese, yogurt, and eat basically very big salads and fatty meats like lamb, veal and porc (only outdoor-living animals).
Good luck, and make sure to let me know how things evolve. If you don’t understand something, just ask.


Three weeks later, I got his note from him:

Today I called the old man’s wife. She told to me that since yesterday he has no pain, and can move his arms and legs a lot better.  He drinks more than 2 litres of water per day, eats and takes the supplements as you prescribed. His grandson translated your message for him. I am very impressed. Thank you so much for you help. Your method works.

It’s a nice feel-good story, isn’t it? Here’s the thing, though. How many millions of people do you think are in the same situation as the one in which this man was? Suffering like he did, for decades growing older, stiffer, less mobile, and in more pain, until the end, which by that point comes as a relief from this difficult and painful life. And from what? Dehydration. Simple dehydration. Long-standing, chronic dehydration.

How much water do you drink each day? What’s the pH of the water you drink? How much salt do you eat each day? How much bread and potatoes do you eat? How is your digestion? How often do you go to the bathroom, and how is the wipe? Such simple things, so crucial to health.
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The Iodine Papers 2 – Orthoiodosupplementation

In this paper, the authors continue their investigation and quantitative assessment of how much iodine is needed for optimal health and function of the whole body. As the title emphasises, the primary aim in this paper is to determine the ideal amount of supplemental iodine in light of the fact that it is difficult to get as much as is needed through diet alone in most of the world.

The major themes are 1) what the authors have termed iodophobia, the widespread but entirely unfounded fear of iodine, which continues to pervade in the mentality of physicians, and consequently, in that of the general population; 2) iodine needed for optimal thyroid health; and 3) iodine needed for extra thyroidal tissues. Because the effects of prolonged iodine deficiency in cells leads to cancer, and because the second-most iodine-dependent tissues are those of the mammary glands of the breasts of females, much of the discussion is concerned with cancer of the thyroid and breasts.

The conclusion is the same as in their first paper: an optimal daily amount of iodine is around 12.5 mg of which 5 mg is in the form of iodine, primarily for the thyroid gland, and 7.5 mg in the form of iodide, primarily for the breasts and other extra-thyroidal tissues.

Orthoiodosupplementation: Iodine sufficiency of the whole human body by Guy E. Abraham, MD, Jorge D. Flechas, MD, and John C. Hakala, RPh


Supplemental iodine for optimal health of thyroid, breasts, skin, and whole body. Long-term average daily iodine intake according to authors should be at least 12.5 mg, and provide both iodine and iodide.

The paper begins with the authors’ motivations, presented clearly in the first two paragraphs. They contrast, on the one hand, that it is known and recognised that iodine is the only element required for and in the synthesis of hormones; that these hormones are involved in embryogenesis, differentiation, cognitive development, growth, metabolism, and regulation of body temperature; that iodine is most concentrated in the thyroid; that iodine is the most deficient trace element in the world with more than one third of the world’s population known to be clearly iodine-deficient; and that low iodine is the world’s leading cause of intellectual deficiency.

Whereas, on the other hand, that optimal amounts of iodine for the human body have never been evaluated nor determined; that supplementation has been considered adequate if it prevented cretinism, simple goitre, and symptoms of hypothyroidism; that it has been assumed that the role of iodine was essentially restricted to the synthesis of T3 and T4, so much so that it has become dogma; and that when thyroid stimulating hormone (TSH) assays became available, iodine urine testing was abandoned as irrelevant, and eventually forgotten to the point where today, most clinical doctors will go through the entire career without ever ordering a urine iodine test.


The fear of iodine, which most likely has its roots in the work of Wolff and Chaikoff (1948), and which we will examine on another occasion, is present and widespread in the literature for all audiences. It is found in the textbooks used in medical schools, in professional journals, in non-technical publications that appear in health magazines, and in books written for the general public by medical professionals. The authors present a number of examples from different sources spanning this range of different kinds of publications intended for different audiences.

They seem to attribute much of the burden for the spread of iodophobia in the US, at least in the last few decades, to one individual, an endocrinologist by the name of Ridha Arem, who was a longtime editor of a professional periodical read by at least 25k endocrinologists throughout the country, and the author of the popular book The thyroid solution: A revolutionary Mind-Body program that will help you, first published in 1999 and currently in its third edition (2017).

In this book, on page 305 of the 1999 edition, Arem writes: “research has clearly established that the high dietary intake iodine content in some areas of the world has resulted in a rise in the prevalence of thyroiditis and thyroid cancer.” A single reference is given in support of this statement: a paper written by Harach & Williams, entitled Thyroid cancer and thyroiditis in the goitre region of Salta Argentina, before and after iodine prophylaxis, and published in 1995 in the journal of Clinical Endocrinology (43:701-6). In this paper, however, no high iodine intake is present or involved in any part of the study.

Harach & Williams (1995) measured urine iodine before and after introduction of iodised salt, and evaluated thyroiditis and thyroid cancer rates. Urine iodine was 9.3 +/- 1.7 mcg/g creatinine before and 110 +/- 13 mcg/g of creatinine after iodisation. There was no change at all in the rates of invasive forms of cancer, and for papillary carcinoma the numbers were 0.78/100k/year before and then 0.84/100k/year after iodisation, which they recognise as insignificant. Not only do these data not support Arem’s claims, but they are not even applicable to an evaluation of the potential effects of high iodine intake. Arem does not provide any other references.

On the same page Arem also writes: “to function normally, the thyroid requires 150 mcg/d … In the US, iodine consumption ranges between 300-700 mcg/d.” No reference is given to support this statement. And this statement is demonstrably false: the National Health and Nutrition Examination Survey, NHANES III (1988-1994), showed that the median iodine in urine was 145 mcg/L, and that at least 15% of US women were markedly deficient, with less than 50 mcg of iodine per litre of urine.

The reason why measuring iodine in urine over 24 hours is a good way to evaluate iodine sufficiency, is because most of it is excreted. If the body’s tissues (thyroid glands, breasts, stomach lining, skin, etc) have all the iodine they need, then we would excrete close to the entirety of the iodine we consume. The greater the discrepancy between ingested and excreted iodine, the greater the deficiency. But because it is water soluble and hard to store, a long time is needed to replenish iodine stores in the tissues. Hence, for this reason, supplementation with larger doses than those needed for optimal maintenance, and extended over many years, are usually needed to restore iodine sufficiency and balance within the body’s most iodine-dependent tissues like the thyroid, breasts, and skin.

In a review paper on iodine ‘excess’ published in 2000 and included in a reference textbook used by endocrinologists in a section entitled Iodine as a pathogen, Roti & Vegenakis the authors report the decline in iodine intake in the US, stating that in 1971-74, it was found that 27.8% of people tested excreted more than 500 mcg/L, whereas in the intervening 15-20 years, this number dropped to 5.3% (1988-1994). Having taken—entirely arbitrarily—500 mcg/L as indicative of excess iodine, the authors present these figures as encouraging and positive in the prevention of iodine ‘excess’, completely ignoring the remarkable discrepancy with the observations of mainland Japanese that show both an iodine intake that is 100 times greater than the US average, and the lowest incidence of goitre and hypothyroidism: figures presented by Finley & Bogardus in 1960, and more recently also in further studies by Thomas et al. in 1983 and 1986.

Moreover, in their review, Roti & Vegenakis note that Amiodarone, a drug commonly used to treat heart arrhythmia, contains 75 mg of iodine per 200 mg tablet (note that this is mg and not mcg), and causes hypothyroidism in 25% of patients that take it. They automatically attributed this to the iodine, but do not investigate the issue further, either by looking at studies on high iodine intakes, or by themselves organising a trial to test this hypothesis, treating arrhythmia using iodine alone without the other pharmaceuticals found in Amiodarone. No such trial has ever been carried out, by the way. Only comparisons between different pharmaceutical drugs.

As a third example of iodophobia and misinformation about iodine in the US, the authors use Dr Shames’s article in the July 2002 issue of Bottom Line Health magazine, and debunk three statements of fundamental significance:

1) Shames writes that iodine deficiency is a thing of the past. However, as mentioned above, NHANES III (1988-1994) found 15% of women to be iodine deficient.

2) Shames writes that iodised salt is sufficient to prevent iodine deficiency. However, iodised salt contains at most 75 mcg of iodine per gram, and since most people eat around 5 g/d, this makes at most 375 mcg/d. This amount may be enough to prevent cretinism and goitre, but to obtain even the bare minimum of 5 mg needed by the thyroid, one would have to eat 65 g of iodised salt per day, which is obviously absurd.

3) Shames writes that people living near coastlines could even be getting too much iodine. However, studies in several countries found no difference in iodine intake between inland and coastal regions.

The unfortunate reality is that all those people who will have read either Arem’s books, Roti & Vegenakis’s reviews, Shames’s articles, or any other published works expressing in similar terms, from a position of authority, statements unsupported by evidence or simply and demonstrably false, will rarely be in a position to question or doubt their validity, and will therefore be left with the entirely unfounded negative predisposition towards iodine transmitted by the authors of these publications.

Iodine for the thyroid gland

The cold war was a period during which the fear of nuclear war, and the subsequent nuclear fallout that would sweep across the region around the explosion was very strong. This fear was shared by most people: parents and grandparents, political leaders and scientists. It was known that the thyroid concentrates iodine: more than 100 times the concentration of other organs and tissues (modern measurements in Delange 2000). It was also known that nuclear fallout would come with a release of large amounts of radioactive iodine in the environment. The nuclear explosion was therefore, in its immediate aftermath, most dangerous for its devastating effects on the thyroid: the thyroid gland would soak up all of that radioiodine, which would destroy it, breaking down its cells from within.

The only way to prevent the thyroid from soaking up all that radioactive iodine from the nuclear fallout would be to fill up the receptors of its cells with normal iodine, and thereby minimise the capture of the radioactive isotopes from the explosion. Because iodine is water soluble and not stored very well, to both provide the thyroid with the iodine it needs and protect it from radioactive iodine in the case of a nuclear accident, one would have to take moderately high amounts of iodine every day, or a very large amount as soon as possible before, during or after exposure, and continue for the early period following the explosion, until the levels of radio iodine contamination have dropped. The iodine receptors in the thyroid, breasts, and other tissues being occupied by normal iodine, the radioactive isotopes would have nowhere to latch on, and would therefore simply be excreted in the urine.

Studies were carried out to determine the amount needed to suppress uptake of radioactive iodine. A defined amount of supplemental iodine would be taken, and then a fixed amount of radioiodine administered. Measuring the amount of radioiodine retained by the thyroid in proportion to the amount administered would give the protection factor associated with the amount of supplemental iodine.

Several groups did such experiments. The results of five groups are presented in Figure 1 below. On the x-axis, we have the amount of iodine in mg consumed per day. On the y-axis, we have the percentage of radioiodine taken up by the thyroid. Naturally, the less iodine is consumed, the higher the percentage of radioiodine retained by the thyroid, and conversely, the more supplemental iodine is taken, the lower the percentage of radioiodine uptake.


Figure 1.  Percentage of radioactive iodine absorption as a function of daily iodine intake. The data are those presented in Table 1 and Figure 1, and the original papers from which they were taken are listed and represented with different symbol. The RDA range is shown by vertical lines at its lower and upper limits of 150 and 290 mcg. The data are presented on a log-log scale. The best fit power-law model is shown as the dashed line, and its parameter values are given.

The greatest protection is conferred by the highest amounts of supplemental iodine, as we can see on the right end of the scale: taking 100 mg/d results in a mere 0.5% uptake, and implies excretion of 99.5% of the radioactive isotope of iodine. At 50 mg/d, uptake is around 1.5%, and excretion around 98.5%. At 20 mg/d, uptake is still below 2% with excretion over 98%, and even at 3 mg/d, uptake is only around 5%, with 95% excretion of the radioactive iodine.

The scale, both on the x-axis and on the y-axis, is logarithmic. This means they have equal spacing in powers of 10. And so, the tick marks between 0.1 and 1 represent steps of 0.1, those between 1 and 10, represent steps of 1, and those between 10 and 100 represent steps of 10 units. The units are mg on the x-axis, and percentage points on the y-axis. A linear relationship (a straight line) in log-log space, as the one we see in this plot, shows to a power-law relation, and power-laws tell us that change is very fast.

In this case, this tells us that increasing iodine intake from nothing to even a little bit, makes a big difference in terms of decreasing the uptake of the radioactive iodine. On the other hand, it also means that as we keep increasing the amount of supplemental iodine, the decrease in uptake becomes less and less significant. Hence, it is very easy to protect the thyroid against nuclear fallout by decreasing uptake of radioiodine from 100% to 20% by taking just 0.7 mg of iodine per day, but to get maximum protection, we need to take 50–100 mg/d. The great news is that we can get full protection, without having to worry about a thing from all this supplemental iodine, because it is basically harmless, and excesses are eliminated.

The authors present these data (together with other data that we don’t discuss here) in a table, and then in a graph, which is logarithmic only in x, but linear in y. Therefore, they interpret the relation—which is clearly linear in log-log space, but not in semi-log space—as showing evidence of four different parts with different slopes and different physiological meanings. I believe the single power-law is both simpler and more natural a model to characterise the relationship between supplemental iodine and radioactive iodine uptake by the thyroid. I therefore skip reporting on the details of their analysis of the slopes and x-axis intercepts and interpretation of their meaning.

In addition, the authors rightly point out that none of these studies were intended to measure the optimal amount of supplemental iodine. They were motivated by providing a framework for crisis management in the event of a nuclear war. Nevertheless, their scientific value in understanding iodine needs for optimal thyroid function is indeed great. Other studies intended on measuring thyroid absorption of iodine are mentioned: those of Thompson et al (1930), Wagner et al. (1961), and Fisher et al (1965), all pointing to a maximal absorption rate of iodine of about 600 mcg/d. This is interesting, but not enough because absorption rate will depend on state of deficiency or sufficiency, and will also evolve as iodine levels are replenished, assuming more iodine is provided than is absorbed. But two other cases stand out.

Plummer, a clinician who treated people suffering from Grave’s disease, a severe form of goitre, hypothesised that the hyperthyroidism associated with this condition was caused by iodine deficiency, and furthermore, that it was this deficiency that also caused such a high post-operative mortality rate. He therefore gave his patients 20-30 drops of Lugol’s solution before and 10 drops after operations—that’s 125-187.5 mg before and 62.5 mg after—and happily saw the mortality rate drop to zero. Of course, this didn’t prove his hypothesis as correct; this is never really possible in science. But it is strong supporting evidence, and did show that it was highly likely to be the case. And given that he knew iodine supplementation was harmless, he also knew that it could only help. He was right, and the benefit to his patients couldn’t have been greater: it was life over death. It was, naturally, an easy decision to make. He knew that, and now, so do we.

Koustras et al (1964) performed extensive studies with meticulous accounting of iodine balance on people to quantify the relationship between the amount ingested and retained over a period of several weeks with daily supplementation. This is what they concluded: “From our evidence, it appears that, from all the doses we used, the thyroid took up about 6-7 mg of iodine before an equilibrium in plasma inorganic iodine was reached.” This seems to be, from several lines of evidence, a good estimate of what the thyroid needs.

Iodine for the mammary glands and other tissues

Having established that the thyroid needs 6-7 mg of iodine per day, the authors need to estimate how much is needed by the rest of the body. Because breast tissue concentrates as much iodine as the thyroid, and because, as reported previously, goitre is six times more—that’s 600% more—common in teenage girls as it is in teenage boys, it is essential to consider iodine needs of the mammary glands. Here are some facts the authors present that are associated with the problem of iodine deficiency in women:

  • Japanese have the world’s highest intake of iodine (14 mg/d from 5 g of seaweed, on average), and the lowest incidence of goitre, hypothyroidism, and breast cancer (Finley & Bogardus 1960; Thomas et al 1983, 1986).
  • There is a strong inverse correlation between iodine intake and cancers of the breasts and ovaries, and a strong positive correlation between thyroid volume and breast cancer incidence: 13 ml in Irish women without versus 20 ml in women with breast cancer (Thomas et al 1983, 1986).
  • There is a strong inverse correlation between free T4 and breast cancer. In 5 different ethic groups from Hawaii, Britain and Japan, the highest levels of free T4 in Japan were associated with the lowest incidence of breast cancer. But T4 therapy doubles incidence of breast cancer. Therefore, it is obviously not T4 that protects against breast cancer in Japanese women, but iodine, which, at the same time, ensures optimal T4 levels. (Ghandrakant, Kapdim & Wolfe 1976; Hinze et al. 1989)
  • The amount of iodine needed to prevent FDB and breast cancer is at least 20-40 times greater than what is needed to prevent goitre (Esquin et al. 1995).
  • Thyroid and skin concentrates iodide; breast concentrate iodine. Both are needed.
  • US intake is about 100 times less than in Japan. In the 1960’s iodine was used as an anti-caking agent in flour, which made the average intake approximately four times greater than it is today. Incidence of breast cancer was then 1 in 20. Iodine in flours was replaced by iodine-displacing bromine. Incidence of breast cancer in 2000 (publication date) reported as 1 in 8.
  • Iodine deficiency is without a doubt just as important a cause of thyroid cancer as it is of breast cancer. In 2001 in the US, there were 19500 new cases of thyroid cancers, and of these, 14900 were in women. That’s 75%. Now, in 2017, estimates are for 56870 new cases of which 42,470 will be in women. That’s still 75%, and it’s also about 400% more cases than 15 years ago.

To determine with the greatest precision where iodine is most concentrated within the tissues of the body, and how much is kept, Berson and Yallow (1954) used traceable radioiodine to determine, in addition to what has already been discussed about iodine being most concentrated in the thyroid, breasts, and skin, that the total exchangeable pool of inorganic iodine ranged from 7 to 13 mg across their study. This means, that besides those most iodine-dependent tissues that trap and concentrate it, the body as a whole uses at least this amount on a daily basis.

Given this large amount used by the whole body, iodine must have several other functions besides protecting the structure and ensuring the proper physiology of the thyroid and breasts. Derry (2001) reviewed iodine’s general properties and benefits to a healthy body. He found that iodine works in organs as an antimicrobial agent, that it has a potent apoptotic function in the body’s surveillance mechanisms against abnormal cells, that it has the ability to trigger differentiation, and that, in addition, iodine has powerful antioxidant properties, which confer it equally powerful protective effects on the DNA of cells, because it enhances the singlet to triplet transition, and because the most damaging reactive oxygen species that damage our DNA and other large molecules are usually singlets.

Naturally, these effects strongly depend on the concentration of the available iodine circulating in the fluids of the body. Using fluid concentration measurements in the work of Szent-Gyorgy (1957), the authors estimate that an average daily intake of 12.5 mg of iodine, which at the same time, they underline, would offer protection from nuclear fallout at the 3-4% level, would also be sufficient to confer all of iodine’s antimicrobial, apoptotic, antioxidant and DNA-protecting effects.


The paper ends with an epilogue where the authors express some difficulties in understanding, in the context of evolution, why humans would have evolved needing so much iodine while recognising how hard it is to obtain as much as is needed. In my opinion, there is no difficulty there from the perspective of evolutionary theory. The first homo sapiens in our lineage, those that developed speech, swept across the world, and came to dominate every last part the planet, in all likelihood evolved on a coastline somewhere in south western Africa eating seafood and seaweed. Many believe that it was their diet, rich in animal foods from the sea that gave them this advantage over other species and even other sub-groups of sapiens scattered here and there on the continent. In fact, it is very likely that it was their iodine-rich diet that conferred to them this evolutionary advantage, which was the intelligence for which sapiens are known.

For most of our evolutionary history, bands of humans would have continued to live near coastlines because of all the obvious advantages this offered. As local and global populations grew, bands would scatter in search of more readily available resources and less competition in their ability to access and use them. Those groups that stayed on the coastlines or in areas where the soil was rich in iodine, became the most successful because they were the most intelligent. Those groups that went further inland or lived in areas where the soil was poor in iodine, grew progressively less intelligent and less successful from one generation to the next.

There is no problem at all with such a scenario, and, in fact, modern observations and data collecting techniques confirm this: areas where iodine deficiency is common, have the highest incidence of hypothyroidism, goitre, breast cancer, thyroid cancer, but also cretinisms and intellectual deficiency. As attested by a joke used in some towns in the goitre belt when someone does or says something stupid: “Are you iodine deficient, or something?”

It wouldn’t at all be surprising if, with sufficiently large data sets, we found a strong and tight correlation between iodine intake and IQ levels within populations from the same genetic pool, but also globally across diverse populations from different gene pools. Many other factors come into play. Nevertheless, iodine during pregnancy and childhood is certainly one of the most important for proper intellectual development.

For us, each with our own particular genetic makeup and recent ancestral evolutionary history, each with our personal and family history, each with our time in our mother’s womb, our childhood and teenage hood upbringing and diet, what this means is that we better make sure we take all the iodine we need to first correct, and then prevent the wide spectrum of problems that iodine deficiency and iodine insufficiency bring about. Might as well maximise our health as well as intellectual potential in this simple way. The costs are insignificant, the risks quasi non-existent, and the potential benefits are tremendous.


This paper is very similar in spirit and purpose to the authors’ first paper. In this second paper, they recall and restate several points they had made in the previous, and extend their detailed investigation of how much iodine is needed for optimal health and function of the whole human body. The main points to remember are that:

  • The fear of iodine is widespread, but wholly unjustified and unfounded.
  • Iodine is most highly concentrated in the thyroid gland.
  • Iodine is essential and crucial for the normal development, and subsequently, normal function of the brain through its action on the thyroid gland.
  • Iodine deficiency is the world’s leading cause of intellectual deficiency.
  • In females, iodine is equally concentrated in the breasts as it is in the thyroid.
  • Iodine deficiency is known to cause cretinism and intellectual deficiency, hypothyroidism and goitre, nervousness, anxiety and restless leg syndrome, fibrocystic breast disease, thyroid cancer, and breast cancer.
  • Iodine deficiency causes goitre in women 6 times more often than in men.
  • Breast cancer now affects 1/8 women. In the 1960’s it affected 1/20.
  • Thyroid cancer rates have quadrupled in 15 years from 2001 to 2016.
  • 75% of thyroid cancer cases are in women.
  • The thyroid gland needs approximately 6 mg of iodine per day.
  • The mammary glands and rest of the body need approximately 6-8 mg per day.
  • The Japanese are the only known population with iodine sufficiency from diet, which provides on average 14 mg of iodine from seaweed.
  • Minimum average requirement for iodine sufficiency is around 12.5 mg/day.
  • As is the case for most micronutrients, some people need more, some less.
  • It will often be necessary to consume a lot more for extended periods in order to overcome and/or reverse the effects of a long-standing insufficiency or deficiency.
  • Maximum protection of the thyroid from nuclear fallout is gotten at 50-100 mg/day.

We will continue this series with an article by the same three authors entitled: Measurement of urinary Iodine Levels by Ion-Selective Electrode: Improved Sensitivity and Specificity by Chromatography on Anion-Exchange Resin.

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No more bipolar disorder?

Our world is replete with diseases of all sorts, illnesses of all kinds, ailments countless in numbers. Modern medicine views these in isolation, and therefore also attempts to treat them in isolation: we have a headache, we take an aspirin; we have high blood sugar, we take insulin injections; we have high cholesterol, we take statin drugs to disrupt the manufacturing of cholesterol in the liver; we have cancer, we are given toxic poisons that kill our cells and hope the cancer will be weakened; we have arthritis or multiple sclerosis, and we are given immune suppressants because it is thought that our own immune system has turned against us, attacking the very body it is intended to protect. We have no idea why, but this is what we do, and this is also what we believe we should be doing.

In psychiatry, we treat so-called mental illnesses. But because we are even more clueless in this realm of the subtle functioning of the brain and mind than we are of the subtle functioning of the body and its organs, we look for drugs that suppress the behaviours which are symptomatic of the “illness” we have been diagnosed with. It’s very simple: we take uppers and stimulants when we are down and low, and downers and sleeping pills when we are high and excited. Because we all do it, we think it’s perfectly normal.

When we take a close look, we see that there are no diseases, no illnesses, no ailments that are not caused by biochemical imbalances, we see that all of our health problems are rooted in problems in the biochemistry, and we see that the functioning of the body and the functioning of the mind cannot be considered independently, because they are both nothing other than the functioning of the whole body-mind.

Surely a most striking example of this is the now almost forgotten disease condition called pellagra. The name comes from the contraction of the Italian pelle (skin) and agra (sour), and was first used by Francesco Frapolli treating people in the 1880’s in Italy where more than 100k suffered from it. But this wasn’t unique to Italy. The same was true in Spain and in France in the late 19th century. In the US, it reached epidemic proportions in the American south where it was estimated that between 1906 and 1940, more than 3m  were affected, and more than 100k actually died from it. Can you image that? That many people, millions of people, in quite a restricted region, walking around in manic states, delusional states, paranoid states, seeing and hearing things, talking or even yelling to themselves and others around them, completely incoherent and, in addition, covered in red, sore, flaking and bleeding skin on the arms, neck, face? What a nightmare it must have been.

In all countries and all cases, pellagra was associated with poor nutrition, and more specifically, associated with corn-based diets in which the maize was not treated with lime in the traditional way. Similarly, in all countries and all cases, it was found that a nutritious diet based on fresh animal foods very quickly resolved the problems that afflicted the sufferers of this disease. So, even in the late nineteenth century, they had figured out how to treat and prevent it. But didn’t know why if they replaced the corn and starches with meats and vegetables people got better.

Pellagra would usually first manifest as skin problems: eczema and psoriasis-like irritations and lesions. Then, it brought about anxiety, depression, irritability and anger. And eventually, periods of full blown mania, visual and auditory hallucinations, extreme fear, paranoia, bipolar and schizophrenic behaviours.


Now, if you know someone, if you have been close to someone diagnosed with bipolar disorder, with schizophrenia, with anxiety disorders, depression, or paranoia, you will immediately recognise in this list of symptoms those you saw in this person, surely to different degrees, and surely in the most extreme during a full blown crisis. Without a doubt, at least for bipolar disorder, these symptoms are all present, often simultaneously, and sometimes in close succession. And do you know what pellagra is? It’s vitamin B3 deficiency.

Yes, pellagra, this terrible disease that caused such awful skin conditions and straight out madness in people, this disease that made these poor people act in ways indistinguishable from those of manic-depressives and schizophrenics, was a simple vitamin B3 deficiency.

When this was understood, niacin fortification was mandated, and the epidemic affecting millions of people in the southern United States was resolved almost instantly. After decades of rampant “mental illness” among so many, so fear, so much anxiety, so much terror within families and communities, so much pain and suffering, and tens of thousands of deaths, a little added niacin ended this national disaster that was the pellagra epidemic almost overnight. The fact that you have most likely never heard of pellagra goes to show how effective niacin fortification has been in preventing it. But something else happened.

Following the introduction of niacin fortification, half the patients held in psychiatric wards were discharged. Just like that, they got better, and went home. There was at least one psychiatrist who noticed this remarkable coincidence: his name was Abram Hoffer. He wondered why so many got better, but also why only a half? What about the other half? Could it be that they just need a little more niacin? Hoffer was an MD, a board-certified psychiatrist, and a biochemistry PhD. He was also the Director of Psychiatric Research for the province of Saskatchewan in Canada, a position he held from 1950, when he was hired and appointed by the department of public health, until 1967, when he opened a private practice.

What he did to check this hypothesis—that maybe more of the psychiatric patients were not mentally ill at all, but just in need of greater amounts of niacin—was to conduct a study. He chose schizophrenics because they are among the most difficult to treat, and also because together with bipolar patients, they have many of the symptoms associated with pellagra. The results were stunning: 80% of the schizophrenics given B3 supplementation recovered. And these results aren’t anecdotal—the word often used in a pejorative or derogatory manner to dismiss important observations or evidence that fall outside the narrow realm of the conventionally accepted. These were the results of the first double-blind placebo-controlled nutrition study in the history of  psychiatry.

What double-blind placebo-controlled means is that he took two equally sized groups of people diagnosed with schizophrenia, and then randomly and blindly, both on the patient’s end as well as on his end, gave half of them 3000 mg of flush-less niacin per day in three doses (niacin has a flushing effect that would be noticed, but either inositol hexanicotinate or niacinamide can be used instead). He gave the other half a placebo, which would have been a pill that looked identical, but contained no niacin or anything else that could have any significant effect on them (like powdered sugar or a starch of some kind). And in the end of the trial, when they looked at which patient got what, they found that 80% of niacin-treated recovered, whereas none in the placebo group showed significant improvements.

Over the years, Hoffer treated thousands of people with remarkable success. With simple vitamin B3 supplementation he continued to successfully treat people suffering from schizophrenia, but also people suffering from attention deficit disorder (ADD), general psychosis, anxiety, depression, obsessive-compulsive disorder (OCD), and bipolar disorder. In fact, he considered pellagra, bipolar disorder, and schizophrenia to be the manifestation of niacin deficiency on different scales, and the sufferers to be niacin-dependent to different extents. Obviously, this is the only natural conclusion he could have drawn given how effectively niacin resolved psychiatric symptoms in these people, but also in light of the fact that each individual seemed to need somewhat different amounts to have these positive effects.

The expression niacin-dependent was used to emphasise that they needed to take it on a daily basis. Naturally, an essential vitamin is not only essential in the sense that it is absolutely needed, but also in the sense that it needs to be consumed regularly because it is not manufactured within the body-mind. Deficiencies develop when the diet lacks in these essential nutrients, and grow more severe as time goes on. When the nutrients are then reintroduced, the deficiencies can be corrected. Some nutrients are abundant, some are rare. Some are easily absorbed, some are not. Some are more easily stored, and some cannot really be stored at all.

In addition, besides the fact that in any given population there is always—for the very same essential nutrient—a range of nutritional needs that vary between individuals based both on their genetic predispositions and on what they do, countless other factors influence and affect the amounts of essential nutrients that each needs to be healthy. These include various kinds of injuries the body-mind, and in particular the gut where absorption of nutrients take place, may have incurred at one point or another from an infection, a virus, a bacteria, a bad diarrhoea we had when we were babies, a childhood disease we don’t even remember, and really anything that could have damaged a specific part of the intestine where a specific family of nutrients are absorbed.

Any such injury could result in a greatly increased need for a particular nutrient that, without knowing about it, could not be supplied in adequate amounts from diet alone, and would inevitably develop into a progressively more severe deficiency whose effects on the body-mind would eventually appear as dysfunctions that would, without a doubt, have physical as well as psychological or psychiatric manifestations. Why? Because there is no body that functions independently of the mind, and there is no mind that functions independently of the body. There is only this single body-mind.

Niacin and B vitamins in general are water-soluble. This means that we pee most of them out, and therefore it also means that we need to have them every day, or nearly, in order to prevent the development of deficiencies. The experience from the last decades of the nineteenth and the first five decades of the twentieth century in Spain, Italy, France, and  in the US, showed that a single vitamin deficiency, a simple niacin deficiency, could cause extreme symptoms that included severe psychiatric dysfunctions. It also showed that even very small amounts of B3 added to the otherwise nutrition-less white bread that was eaten as a staple could cure millions of pellagra sufferers, and prevent the disease from developing in the bulk of the population.

Unexpectedly, niacin-fortification coincided with a large number of the psychiatric ward patients getting well enough to go home. This observation prompted a study with niacin supplementation which showed that in 80% of the schizophrenia patients treated with niacin, symptoms disappeared in the same way they had in pellagra sufferers, but with higher doses of niacin. It was also shown that a similarly high cure rate was seen in people suffering from ADD, psychosis, anxiety, depression, OCD, and, in the point we wanted to emphasise in this article, bipolar disorder. In almost all cases, niacin supplementation resolved the dysfunctional behaviours and psychiatric symptoms. What varied were the amount of vitamin B3 needed to achieve recovery, and the speed with which symptoms would come back upon interruption of the supplementation.

Therefore, whether you are among the lucky people who never were niacin deficient, among the lucky people who need very little niacin, or among the less lucky ones who are deficient, who do need more of it than most, or who are suffering from anxiety or depression, schizophrenia or bipolar disorder, doesn’t it make sense to just start taking a little bit of extra B3 each day? Doesn’t it make sense to give your body-mind the amount of vitamin B3 it needs, recognising that for each one of us this amount may be different, that for some it will be a lot more than for others, but resting in complete assurance that no ill effects will come from it, because niacin supplementation is harmless, and that the only disadvantage of it being harmless, even in large doses, is that we need to take it daily.

And given how inexpensive any form of niacin is, shouldn’t we be giving it in large amounts to every patient in every hospital, psychiatric ward, and medical institution? We should, but this will probably never happen. What we can do is take care of ourselves, of those people closest to us like our children and spouses, siblings and parents, of those people we care about like our friends, colleagues, and even simple acquaintances who come to us for advice or just to share their concerns about a health issue. And one of the simplest and most effective things we can to improve our own health and the health of those around us is by taking a little B3 supplement every day. It could just make you feel more relaxed, more focused, calm and at ease, as it does for me, or it could completely transform your world, bringing you from a state of hyper-anxious, paranoid, delusional and hallucinatory mania, back to a relaxed, helpful and trusting, conscientious and reasonable self, giving you the gift of your own life back to yourself.

Could it really be this simple and this amazingly miraculous? No more pellagra, no more schizophrenia, no more bipolar disorder, just with a little B3 supplementation? Well, maybe. You try it, and let me know.

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The Iodine Papers 1 – Optimum iodine for the whole body

I will review a collection of research papers written by Guy Abraham (mainly), several of them with David Browstein, Jorge Flechas, John Hakala, individually and in different combinations, one paper with Nicholas Calvino, and another with Roxane Handal. They were published in The Original Internist between 2002 and 2008.

These papers form the backbone of the science and clinical evidence that has brought about the resurgence of the therapeutic use of iodine in natural medicine, and together with it, tremendous benefits to thousands of people who have recovered their health from supplemental iodine. I will, in the process, probably review some of the papers that are referenced. My intention is to present a detailed summary of each one of these papers as a series that we’ll call The Iodine Papers. This is the first:

Levels of Iodine for Greatest Mental and Physical Health  by Guy E. Abraham, MD, Jorge D. Flechas, MD, and John C. Hakala, RPh


The question posed by the authors is a simple one:  what are optimal levels of iodine for overall health. But seeking the answer in the published literature, they discovered that there wasn’t one. This paper has three logical parts. The first is a long introduction that includes a review of several historical studies in which they seek to find clues as to what would be the optimum amount to take on a daily basis; optimal meaning not too little, and not too much. The second part is the presentation of the results of a three-month study they did on ten American Caucasian women taking supplemental iodine. And the third is the discussion and conclusions, that naturally includes their proposal for what constitutes the optimal amount of iodine we should have daily.

For those (like you M) who are not interested in the details, but just in the answer, in this case it’s 12.5 mg per day, in the form of 5 mg of iodine and 7.5 mg of potassium iodide because the two different forms are needed by different tissues. For those of you who are interested, I’ll present the contents of the paper in the structure outlined in the previous paragraph.

Introduction and previous studies

In a 1998 editorial in the Journal of Clinical Endocrinology and Metabolism entitled What’s happening to our iodine?, it is stated that one third of the world live in iodine-deficient areas, and that iodine-deficiency is the leading cause of intellectual deficiency (mental retardation).

The earliest studies that are reported are from the 1920’s, one by Marine in Ohio, and one by Klinger before him in Switzerland. Klinger’s was performed in an area of the country that had, at the time, an 82–95% incidence of goitre in its population. Goitre is an enlargement of the thyroid gland due to iodine deficiency. Obviously a very serious problem. The study comprised 760 teenagers, of which 90% (684) had goitre. They received between 10 and 20 mg of iodine per week, which equated to an average of 1.4 to 2 mg/day. Fifteen months later, none had experienced adverse effects of any kind, 472 (69%) had recovered, but 212 (28%) still had an enlarged thyroid. The government therefore opted for a slightly higher dose, advising supplementation with 3–5 mg of iodine per day.

Marine did his study in Akron, Ohio, where the incidence of thyroid enlargement was not as high, but still 56%. Goitre appeared most often in puberty and six times more often in girls than in boys, and six times more often means 600% more. That’s a huge difference. They therefore used only girls. This study was much larger, and everyone started the programme with no signs of thyroid enlargement. 2190 received iodine supplementation, and 2304 were used as controls and didn’t get any.

The programme ran for 2.5 years, with 5 periods of supplementation, one in the spring and one in the fall, in which the participants were given 200 mg of sodium iodide per day for 10 days. If we calculate a daily average out of those total of 4 grammes per year, it gives 11 mg of sodium iodide, and thus something like 8 mg of iodine. At the end of the 2.5 years, 495 out of 2304 (that’s 22%) in the control group had developed goitre, compared to only 5 out of 2190 (that’s 0.2%) in the supplementation group.

In 1966, two Russian scientists hypothesised that pathologies of the breasts in women could be caused by excess oestrogen from ovarian cysts due to insufficient iodine. They took 200 patients with what they called “dyshormonal hyperplasia of the mammary glands”, and gave them 10–20 mg of potassium iodide per day for periods that varied between six months and three years. Within three months a majority experienced significant improvements with decrease in pain, swelling and nodularity. In the 167 who completed the programme, 72% experienced significant improvements. Five patients who had ovarian cysts saw them reduce in numbers and size.

Then in 1976, a group of Canadian researchers led by Ghent, extended this study on women with breast disease, and tried different forms of iodine supplements in different amounts on three different groups. They had 233 women on 30–60 mg/day from a 5% Lugol’s solution for 2 years, 588 women on 10 mg from iodine caseinate for 5 years, and 1365 on 3–6 mg/day from saturated aqueous iodine solution for 1.5 years.

Clinical improvement—both subjective in terms of pain, swelling, discomfort; and objective in terms of reduced fibres and nodules—were seen and measured in all three groups, but with different success rates:  74% in the group using the saturated aqueous iodine solution (3–6 mg/day), 70% in the Lugol group, and 40% in the iodine caseinate group. Moreover, different numbers of women reported adverse effects from the supplementation: 11% in the aqueous iodine group, 7% in the Lugol, and 9.5% in the caseinate group.

Notably, the authors reported on the results of autopsies performed in 1928 and in 1973. Evidence for fibrocystic disease of the breast (FDB) was present in 3% of women in 1928. In 1973, FDB was present in 89% of women. That’s 9 out of 10 women back in 1973. Do you think the magnitude of the problem has decreased since? Not likely.

In Japan, Nagasaki and colleagues published in 1967 the results of their investigation of the relationship between iodine consumption and disorders of the thyroid and breasts. They surveyed different regions, some mainland and some coastal, and found an average daily consumption of seaweed of 4.6 g in mainland areas, which translated into 13.8 mg of combined iodine and iodide. Inhabitants of coastal areas had an even higher daily consumption of iodine. Investigation into the function of the thyroid supplied iodine in the amounts ingested in coastal areas showed that it absorbs more than it secretes as T3 (triiodothyronine) and T4 (thyroxine) whose levels remain in a narrow physiological range, and that the rest, the amount unused in making T3 and T4, is secreted as inorganic iodine, presumably to be available in that form to other tissues. The reason why this was an important study is that Japanese women consuming this amount of iodine, have very low rates of thyroid and breast disorders.

Finally, maybe as a remnant and reminder of the importance of iodine in medicine up to our current era of drug-based medicine, the authors make note of the fact that in the 1995 version of the standard reference Remington’s Science and Practice of Pharmacy, the 19th edition of this work (now in its 21st), which “for over 100 years has been the definitive textbook and reference on the science and practice of pharmacy”, the recommended daily intake of Lugol’s 5% solution is between 0.1 and 0.3 ml. Lugol’s 5% contains 125 mg of iodine per ml. Therefore, 0.1 ml has 12.5 mg, and 0.3 ml has 37.5 mg of iodine. The authors point out that today, the recommended daily intake in North American and Western Europe varies between 150 and 300 micrograms per day. That’s a factor of 83 and 125 times less, respectively, two orders of magnitude less.

The study

Based on these studies and observations, the authors move on with their own investigation to determine the amount of iodine needed for breast normality, using an amount of 12.5 mg of iodine in the same form as in Lugol’s solution, providing 5 mg of elemental iodine and 7.5 mg of potassium iodide (KI) in a calibrated, silica-coated tablet to ensure precise dosage, and prevent any possible kind of digestive upsets experienced by some taking Lugol’s solution. (The molecular weights of iodine (I) and potassium (K) are 127 and 39. Therefore, their contribution in KI by weight is 76.5% I and 23.5% K. Hence 7.5 mg of KI contains 5.74 mg of I and 1.76 mg of K, and thus a 12.5 mg tablet contains 10.74 mg of I and 1.76 mg of K.)

Ten caucasian women with normal thyroid volume (< 18 ml), and a range of BMIs statistically representative of the general population based on the NHANES III study (1988-94) in which 25% were overweight, and 25% were obese. Five of the subjects had normal BMI (18.5–24.9), two were overweight (25–29.9), and three were obese (> 30). BMI is defined as the weight in kg divided by the square of the height in meters. So that if you weigh 60 kg and measure 165 cm, your BMI is 60/(1.65*1.65) = 22. Underweight is defined as BMI < 18.5.

An interesting observation about thyroid volume measurements, is that the upper limit for a “normal” thyroid is taken to be 18 ml. These ten women’s average was 7.7 ml (with standard deviation 3.6). That’s almost half. Moreover, looking at national averages in a number of countries, the authors report they are found to be as follows (in increasing order): Sweden – 7.7 ml, Holland – 8.7 ml, Hong Kong – 8.9 ml, Ireland – 12.9 ml, and Germany – 16.5 ml. Not surprisingly, the countries with the highest average volumetric measurements are those with the lowest intake of iodine, and are those with the highest incidence of goitre.

After 90 days of supplementation, the most significant improvements that were noted by the participants were decrease in breast sensitivity or pain, decrease in tremors and in restless leg syndrome. There was no significant effect on blood pressure, body temperature, or body composition except for a small amount of fat loss. From the urinalysis, the only significant difference was that the average pH of the ten participants was 6.05 (+/- 0.69) at the start of the trial, and 7.00 (+/- 0.85) at the end of it. This was attributed by the authors to iodine’s antioxidant properties that would naturally reduce the concentration of reactive oxygen species in the cells, and thereby decrease the acid load on the system, leading to an increase in overall pH that would be manifested by an increase in urinary pH as well.

Blood chemistry was monitored using 17 markers. All stayed within their reference range. But although no significant changes were seen, qualitative improvements were seen in 9 of them (e.g., drop in creatine, drop in calcium, drop in albumin, rise in sodium, rise in carbon dioxide).

TSH (thyroid stimulating hormone) stayed within range for most, except for two participants (#1 and #10) who showed remarkable improvements with a drop from 7.8 to 1.4, and from 21.5 to 11.9 mIU/L. These two participants also showed the most significant change in T4 from 9.2 to 7.9 and 8.3 to 5.4 micrograms/dL, while none of the others saw much change in these values. Free T4 and free T3 stayed more or less the same in everyone. Hypothyroidism is defined as having TSH > 6 mIU/L, and it is estimated that of the order of 8 million American women are hypothyroid, but most of them are unaware of it, what is referred to as subclinical hypothyroid.

Breast pain (mastodynia) significantly decreased in 7 out of the 10 participants, and these improvements persisted for at least 3 months after the end of the supplementation. The authors suggest that the potential mechanisms by which iodine can improve breast health and prevent cancer is by neutralising DNA-damaging reactive oxygen species in the cells, by ensuring proper regulation of the cell’s apoptotic function, and by its ability to trigger differentiation (Derry 2001), therefore stopping or reversing the process by which cells lose their specialised functions as they become cancerous. Obviously, these are crucially important properties of iodine that are independent of thyroid hormones.

Discussion and conclusions

The goal of this pilot study was to evaluate the effect of iodine supplementation in American caucasian women, a population with a high incidence of FDB and breast cancer, with a daily iodine intake comparable to that of women living in Japan with a very low incidence of both FDB and breast cancer. A key aspect of the study was to measure thyroid function and investigate evidence of toxicity. They identify and discuss three potential adverse effects of iodine supplementation: iodism, iodine-induced hyperthyroidism (IIH), and iodine-induced goitre (IIG).

Iodism—an unpleasant brassy/metal taste in the mouth, increased salivation, nausea, and headache in the frontal sinuses—was reported in previous studies on several occasions by people taking 150 mg/day or more. The authors mention that it could have been due to traces of bromine or iodate in the supplements. None of the participants reported signs of iodism in this study.

Iodine-induced hyperthyroidism (IIH)—a condition that occurs in iodine-deficient people in the early stages of iodine supplementation—is described in The Thyroid (8th edition, 2000) by Werner & Ingbar in the following terms: “iodine deficiency increases thyrocite (thyroid cells) proliferation and mutation rates. Possible consequences are the development of autonomous hyper-functioning nodules in the thyroid…and hyperthyroidism. Therefore, IIH is an iodine-deficiency disorder.” None of the participants developed IIH in this study.

Iodine-induced Goitre (IIG) and hypothyroidism—a condition that occurs only under very high doses around 2 g/day (2000 mg/day), and seen in some patients when iodine is used as an expectorant in treating asthma, chronic bronchitis, and emphysema—was not seen in any of the patients of this study. It is noted that people with normal thyroid function taking up to 150 mg/day will see decreases in plasma T3 and T4 concentrations with small compensating increases in TSH but all remaining within normal range. However, in people with thyroid disorders, supplementation can induce IIG, and therefore, supervision through regular blood testing of thyroid markers is important.

It has been obvious for a long time that women need more iodine than men. Evidence of this was seen in Marine’s study in Ohio in the 1920’s, where goitre was 6 times more prevalent in teenage girls than in boys of the same age. Marine also showed that supplementation with the equivalent of 9 mg/d of iodine prevent goitre almost completely, although a few still developed it over the 2.5 year period of the experiment. It has also been known for some time that iodine deficiency leads to abnormalities of the mammary glands.

Studies on female rats by Esquin et al. showed that iodine supplementation was essential to prevent FDB and cancer, and using molecular tracing techniques, also showed that the thyroid preferentially concentrates iodide, whereas breast tissue concentrate iodine. Thrall & Bull (1990) confirmed Sequin’s findings, and in addition, showed that skin cells, as the thyroid, concentrate iodide, whereas the stomach cells, as the mammary glands, concentrate iodine. Therefore, these two forms—iodine and iodide—are not interchangeable as it was believed for a long time, and both forms are needed and essential for healthy physiology.

To establish how much is needed for the breast and thyroid separately, having at this point established that the amount needed for mammary gland sufficiency must be around 12.5–13.8 mg/day, involves establishing the amount of iodine needed for proper thyroid function. For this, the authors refer to the work of Saxena et al. (1962) who define thyroid iodine sufficiency as the minimal daily dose required to decrease the uptake of radioactive iodine by the thyroid to at most 5% of the total radioactive dose administered. The rationale and protective strategy is simple: if there is enough normal iodine to fill the thyroid, its cells will not absorb the radioactive iodine (and it will be excreted); but if there isn’t, it will, and that radioactive iodine, lodged in the cells of the thyroid, will, within days, destroy the gland. Saxena and colleagues established that for an adult this minimal effective daily dose is 3–4 mg.

This implies that the thyroid needs at least this much daily in the form of iodide, and that the breasts therefore need at least around 9 mg daily. But note that this is the amount needed to maintain proper function and health. Correcting deficiencies and overcoming disorders of the thyroid like goitre or hypothyroidism, of the breasts like FDB or cancer, or of the skin like psoriasis or eczema, will require more, sometime a lot more, and usually for extended periods of time.

Moreover, for complete protection of the thyroid against radioactive iodine exposure, Sternthal et al. (1980) showed that further suppression can be achieved using higher doses over at least 12 days: 4% absorption at 10 mg, 1.9% at 15 mg, 1.6% at 30 mg, 1.2% at 50 mg, and 0.6% at 100 mg daily, with no risks at all from the supplementation that remains below the 150 mg/day threshold beyond which some adverse effects can sometimes occur.

Abraham, Flechas and Hakala conclude by stating their intention to expand this pilot study and build a database to develop a protocol for iodine supplementation in FDB and other conditions such as subclinical hypothyroidism.

What is clear from reading this paper is that everyone, but especially girls and women, would benefit from taking more iodine and iodide in amounts of at least 12.5 mg/day. For some this could be lifesaving. And because there are no risks, there are no reasons not to. Furthermore, it was also made clear that much larger doses up to 150 mg/day can be taken, still without risks of adverse reactions, and with the potential benefits of much improved health and powerful healing of very serious conditions such as breast cancer.

We will continue this series with an article by the same three authors entitled Orthoiodosupplementation: Iodine sufficiency of the whole human body.

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Tenderly fragile

A few days ago we had our biweekly science operations meeting. Towards the end of it, one of my colleagues mentioned that the INTEGRAL Picture of the Month for December would be the obituary. “Obituary!?! For whom!?!”, I asked, with surprise and a little anxiety. “You didn’t know? Mike died last week”. It came as a slap in the face. I had no idea he was ill. And obviously, I had no idea he was dying. He was 42.

Mike and I met in Moscow in 2006 at the 6th INTEGRAL Workshop. I had read his papers, and he had read mine, but we had never met. There was a tension between the Russians and the rest of us. The reason is mostly related to the fact that 1) Russian scientists, formally can, and in practice do, work and share data or analysis results only with other Russians; 2) the Russian space agency put INTEGRAL into orbit, and in return, negotiated with ESA to get one quarter, 25%, of the observing time for the lifetime of the mission; and 3) more specifically related to the topic of my own research, the Galactic Centre, the head of the Russian delegation, the great and famous Professor Sunyaev, had negotiated to get half the observing time on this region, and therefore, share all the data half way down the middle with the official Principle Investigator for the Galactic Centre, my PhD co-supervisor, Andrea Goldwurm. So, there were subtle but definitely palpable tensions.

Professor Sunyaev gave a stunning presentation in which he talked about the science that could be and was being done with INTEGRAL data, he drew on his vast mastery of all fields of physics, making analogies, explaining connections, and clarifying issues that most of us could not even see, freshly and spontaneously, without any arrogance, in a simple matter-of-factly kind of way. I was immensely impressed. His was a 40-minute review talk. Mine, on the same day, was a 30-minute presentation, which was also a long one, since the programme contained mostly 20-minute presentations, invited review talks of 40 minutes, and a handful of 30-minute presentations. I gave a shortened version of the talk I had presented in the main amphitheatre of the CEA two months before to my PhD defence committee, and the public in attendance.

Everyone was very impressed, I think because, unlike anything I’ve ever seen at such a scientific conference, the first 10 minutes were spent with my narrating a Discovery Channel video of an voyage through the Galaxy, from the Earth to the Galactic Centre, that I slowed down to give myself enough time to describe the large scale structures and global features of our Galaxy, the distribution of stars and gas that make up its visible contents, talk about their formation and dynamics, about open and globular clusters, types of stars and their different life cycles, about planetary nebulae and supernovae remnants, magnetic field structures betrayed by particles trapped spiralling along them and seen at radio wavelengths, and on and on.

It was during the break after that session that Mike came up to me for the first time. He was bright, quick, sharp as a whistle, energetic and curious, open and friendly, but serious. He had a kind of grave seriousness to him. All these qualities appealed to me. He complimented me on the presentation, and we talked for a few minutes. What struck me most was that he was simple and straight forward: not puffed up, not arrogant, not condescending; and not cautious, hesitant, distant, or reserved either. Just open, simple, and straight forward: nothing hidden, nothing fake. I’m like that too. We connected.

Later that night, we had the banquet dinner, and we spoke a lot more together after eating. Naturally, given that we were in Moscow, everyone (or almost) drank plenty of wine with dinner, and everyone (or almost) was now drinking vodka. Conversations and laughter flowed freely and echoed in the large hall. Mike invited me to come out in the evening, and meet him with other people at a bar where we could watch, while chatting, the football game. It was the time of the 2006 Football World Cup, and this is what defined the plans for the evenings. I agreed, and we spent the evening together.

When it was time to call it a night, after all buses had stopped their service, he offered to walk back with me from the bar to the hotel. I gladly accepted. It was a 45 minute walk across the city, which I didn’t know at all, but which was his beloved home town. So somehow, in those few days in Moscow, we became friends. Friends who didn’t really know much about one another, but friends that connected on a deeper level. These things are hard to explain, and have to do with personal traits and upbringing, tendencies and sensitivities, affinities and outlook. The few other times we saw each other, either at conferences or meetings, it was always the same. We saw each other for a short time,  didn’t really have much to talk about because neither of us liked small talk, but we felt happy to see one another. We exchanged a few Skype chats over the years, but that was the extent of our relationship.


And when I heard that he was dead, I was shocked. What first struck me with sadness is that there was no way for me to express to him how I felt about him, and how sorry I was that he was gone. We often hear of someone’s passing after they have already passed. This makes it impossible for us to express anything to them: no expression of kinship or feelings of empathy, no sentiments of understanding at what they are going through, no words of support, comfort, or warmth. Nothing more can be expressed to them because they are gone. Tears welled up in the eyes. Impossible to say anything. Impossible to write anything. Impossible to reach him. Impossible, now and forever. Feeling sad and helpless, I sat in silence, tender and fragile.

This is what we are: tender and fragile. It’s just that most of the time we don’t realise it, nor do we think about it. When it hits us, and we feel it for a fraction of a second, we push it away, push it down under the shell that we think hides and protects us.

Looking at people every day, friends, colleagues, and strangers, I see so many signs of illness: I see people with the white of their eyes a yellowish colour, with the skin of their face a pale grey; I see dry and dull skin, rashes on the face, or the neck, or the scalp; I see hands and fingers that tremble with uncontrolled tremors when they should be still and unmoving; I see teeth that through a smile can be discerned to be capped by crowns, because they are too white, sitting on top of what are surely devitalised, nerveless, root canal treated teeth, whose dark colour lines the base of the tooth; I see young women with white faces, blueish hued skin under their eyes, sparse and thinning hair, feeling cold and looking down; I see young men with pudgy little man boobs, and men in their 50’s with sparse, balding eyebrows; I see bodies, full of fat, fat that is pressing in, compressing their vital organs, their heart, their liver, their stomach and pancreas. And on, and on. So much disease everywhere, and nothing to be done for these poor people. Nothing to be done because they don’t know, and because they don’t want to know.

Could I have helped Mike? I’m sure I could have. Did he ever share with me anything about his illness? Did he even know I knew anything about health and disease? No, he didn’t. And all these people I see every day? All these people with dehydrated bodies filled with accumulated metabolic wastes, acids and toxins, with undiagnosed intolerances and allergies, with severe B12 and magnesium deficiencies, with bacteraemia from toxic teeth, with serious iron and iodine deficiencies, with testosterone deficiencies and oestrogen overabundances, with extreme insulin resistance and metabolic syndrome, all sick and unaware of it. And what about all those with diabetes and cancer, diagnosed and yet undiagnosed? Is there anything I can do for them, no matter how sad I feel, or how much I would like to? No, there isn’t, because it is they who need to look for it, they who need to want to do something about it. And how can they if they don’t know, or even worse, don’t want to know?

And so, little by little, a little better every day, I learn to live with this. This which we all fundamentally are, whether we allow ourselves to realise it or not, whether we allow ourselves to feel it or not, and whether we want to or not, this is what we are: tender and fragile, tenderly fragile.

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