Are you get­ting enough io­dine?

You might not re­alise it, but your body needs this essential trace el­e­ment. Res­i­dent di­eti­tian Orla Walsh takes a closer look

Irish Independent - Health & Living - - FOOD MATTERS -

Park ear­lier this year, a chal­lenge she rel­ished. Not too sur­pris­ingly, how­ever, her mum was pro­tec­tive about see­ing her daugh­ter, who’d al­ready been through so much, push her­self to the lim­its of phys­i­cal en­durance.

“There is a ten­dency for peo­ple to say, ‘Re­lax, put your feet up,’ when you’re di­ag­nosed with cancer, but you do enough of that dur­ing treat­ment,” she says. “The last thing I needed was to sit around think­ing about my cancer.

“Thank­fully, things are chang­ing in the health­care sys­tem. There’s a grow­ing recog­ni­tion of the need to be phys­i­cally ac­tive. I felt des­per­ately weak af­ter my cancer treat­ment, and sport and ex­er­cise helped me feel nor­mal again.”

But while things are chang­ing, Mairéad Cantwell sug­gests that health­care pro­fes­sion­als of­ten don’t rec­om­mend suf­fi­cient ex­er­cise to ben­e­fit their pa­tients fol­low­ing cancer treat­ment. In a study of 43 med­i­cal on­col­o­gists, ra­di­a­tion ther­a­pists, clin­i­cal nurse spe­cial­ists, GPs and sur­geons, she found that while recog­nis­ing the im­por­tance of ex­er­cise in their pa­tients’ lives, many didn’t pro­pose enough to meet the rec­om­mended phys­i­cal ac­tiv­ity guide­lines for cancer sur­vivors.

“Ev­i­dence shows that a min­i­mum of 150 min­utes of mod­er­ate in­ten­sity aer­o­bic ex­er­cise com­bined with two to three re­sis­tance [weights] work­outs a week aids cancer re­cov­ery.

“Yet many peo­ple are not ac­tive enough to reap the ben­e­fits of this sim­ple but pow­er­ful treat­ment,” says Mairéad.

It’s not a one-size-fits-all kind of ther­apy, how­ever, as ex­er­cise pro­grammes have to be tai­lored to suit the abil­i­ties of each in­di­vid­ual, and in a hard-pressed health sys­tem, doc­tors’ time is al­ready un­der pres­sure. Added to that is a chronic lack of com­mu­nity-based ex­er­cise pro­grammes to re­ha­bil­i­tate cancer sur­vivors, de­spite the proven ben­e­fits that phys­i­cal ac­tiv­ity brings.

“Ex­er­cise boosts fit­ness lev­els, phys­i­cal func­tion, men­tal well-be­ing, qual­ity of life, and helps peo­ple man­age the side ef­fects of treat­ment,” says Mairéad.

“If a doc­tor were to pre­scribe a pill that could do all that, pa­tients would be sure to take it reg­u­larly. But ex­er­cise is a pow­er­ful medicine, and cancer sur­vivors need to take a daily dose to main­tain their health.”

As part of her re­search, Mairéad con­ducted a se­ries of fo­cus groups in which peo­ple were asked to share their ex­pe­ri­ences of cancer treat­ment. While ev­ery­one’s cancer jour­ney is dif­fer­ent, one com­monly ex­pressed feel­ing was one of lone­li­ness at the end of treat­ment.

“Peo­ple spoke of a pe­riod of iso­la­tion when they were dis­charged from the hospi­tal sys­tem,” says Mairéad. “Hav­ing spent months or years go­ing from one appointment to an­other, sud­denly they were on their own, and they de­scribed that as be­ing a very lonely place. It’s not easy to go back to work and pick your life up where you left off when you’ve been through such a long, dif­fi­cult and life-chang­ing ex­pe­ri­ence.

“There’s a gap in the cancer care path­way when peo­ple have fin­ished treat­ment, and as a ve­hi­cle for re­cov­ery, ex­er­cise is very em­pow­er­ing. Af­ter pas­sively go­ing through the rigours of treat­ment, this is some­thing pos­i­tive that peo­ple can do for them­selves. They’re in charge, set­ting their own goals and find­ing ways to achieve them.”

En­list­ing friends and fam­ily to join in ac­tiv­i­ties will boost your chances of stick­ing to an ex­er­cise regime, she says. Ev­i­dence shows that peo­ple are more likely to fol­low through if they’ve com­mit­ted to meet­ing oth­ers for a walk or a work­out, and ex­er­cis­ing in a group is more so­cial than hit­ting the trail alone.

And with a re­cent up­surge in jive, céilí and step danc­ing sweep­ing the na­tion, keep­ing fit has never been more fun.

An­other ac­tiv­ity that’s gained in pop­u­lar­ity in the past decade is dragon boat rac­ing, a Chi­nese-in­spired ac­tiv­ity that’s been shown to help breast cancer sur­vivors build mus­cle strength and re­cover from lym­phoedema and other side ef­fects of surgery. Since the first club, Dublin’s Plura­belle Pad­dlers, was set up in 2010, a net­work of sim­i­lar clubs con­tin­ues to spread across the coun­try, pro­vid­ing a plat­form for breast cancer sur­vivors to pad­dle their way to re­cov­ery.

Bríd O’Con­nell, who set up the Shan­non Drag­ons in Lim­er­ick last year, says it’s been a life-saver in more ways than one.

“We bring the best ver­sion of our­selves to the wa­ter,” she says. “There’s a kind­ness afloat. We carry each other and laugh with each other, and that’s more life-giv­ing than you can imag­ine.”

Mairéad Cantwell says the dragon boat rac­ers are an in­spi­ra­tion to other cancer sur­vivors.

“Our fo­cus groups have shown that cancer sur­vivors en­joy ex­er­cis­ing with peo­ple who’ve been through a sim­i­lar ex­pe­ri­ence,” she says. “Through that shared ex­pe­ri­ence, they don’t feel self-conscious and it gives them a safe, en­cour­ag­ing and sup­port­ive en­vi­ron­ment to re­gain their phys­i­cal and emo­tional strength.”

Us­ing the in­for­ma­tion from MedEx stud­ies with both health­care pro­fes­sion­als and fo­cus groups, Mairéad and the re­search team set about de­sign­ing a pro­gramme that could in­crease cancer sur­vivors’ phys­i­cal and men­tal well-be­ing, op­ti­mise their qual­ity of life and support them to make phys­i­cal ac­tiv­ity part of ev­ery­day life.

“In ad­di­tion to the twice weekly ex­er­cise classes, par­tic­i­pants re­ceived ad­di­tional re­sources, in­clud­ing a home ex­er­cise guide and in­for­ma­tion ses­sions on how to in­cor­po­rate ac­tiv­ity into their lives,” says Mairéad.

“We’re now in the final stages of this study and hope to have the re­sults ready in early 2019.”

◊ The Ir­ish Cancer So­ci­ety is hold­ing a ‘De­cod­ing Cancer’ pub­lic talk on the ef­fects of ex­er­cise on cancer and how phys­i­cal ac­tiv­ity can help a per­son go­ing through cancer treat­ment. ‘Keep­ing Fit, Stop­ping Cancer’ takes place this Wed­nes­day at 1pm in the Wis­dom Cen­tre, Cork Street, D8.

IO­DINE is an essential trace el­e­ment, and it is one of the most im­por­tant and most over­looked min­er­als your body needs. Although found in a range of foods, the rich­est sources are fish and dairy. Io­dine de­fi­ciency is a ma­jor pub­lic health prob­lem through­out the world. Re­cent re­search was con­ducted to in­ves­ti­gate the di­etary in­take and sta­tus of io­dine in the Ir­ish pop­u­la­tion. While this study found that the over­all di­etary in­take seems to be ad­e­quate, the av­er­age in­take was at the low end of the range iden­ti­fied as suf­fi­cient by the World Health Or­gan­i­sa­tion (WHO), so it’s worth ex­plor­ing fur­ther.

Io­dine has be­come a fea­ture of nu­tri­tional chitchat in the last num­ber of years be­cause chil­dren and preg­nant women ap­pear to be at risk of de­fi­ciency, lead­ing to se­ri­ous con­se­quences.

So what do we know about this min­eral and the ma­jor im­pact it has on our health?

IO­DINE DUR­ING PREG­NANCY

Re­search con­ducted on Ir­ish women set out to de­ter­mine di­etary io­dine sta­tus in moth­ers dur­ing the first trimester of preg­nancy. They ob­served that val­ues sug­ges­tive of io­dine de­fi­ciency were found in 55pc of preg­nant women tested in sum­mer months and 23pc in win­ter months. This is a con­cern as io­dine is essential dur­ing preg­nancy. De­fi­ciency dur­ing preg­nancy can re­sult in ir­re­versible brain dam­age for the foe­tus.

The WHO con­sid­ered io­dine de­fi­ciency to be the sin­gle most im­por­tant pre­ventable cause of brain dam­age world­wide. In fact, in pop­u­la­tions that are io­dine de­fi­cient the IQ is 13.5 points lower than pop­u­la­tions with an ad­e­quate io­dine in­take. Not only is io­dine sta­tus in preg­nant moth­ers linked to lower IQ , but also read­ing scores and neu­rocog­ni­tive func­tion­ing. Af­ter birth and early in life, io­dine re­mains essential for neu­rode­vel­op­ment.

BRAIN HEALTH

Although the im­por­tant role of io­dine in brain health might be news to some peo­ple, its role in me­tab­o­lism is prob­a­bly bet­ter known. Io­dine is a ma­jor com­po­nent of thy­roid hor­mones T3 (tri­iodothro­nine) and T4 (thy­rox­ine). These hor­mones are re­quired for many func­tions in­clud­ing nor­mal growth, me­tab­o­lism and the cre­ation of new cells.

There­fore, io­dine de­fi­ciency can lead to an un­der­ac­tive thy­roid. Io­dine de­fi­ciency can re­sult in a whole host of health con­se­quences — from thy­roid en­large­ment or goitre to de­fec­tive re­pro­duc­tion, growth im­pair­ment and neu­rode­vel­op­men­tal

FOOD

Sea­weed Haddock Crab Cod Mus­sels

Yo­ghurt Milk Eggs Cheese

HOW MUCH

30 grams 140 grams 140 grams 140 grams 40 grams

150 grams 200 ml 2 large 40 grams

SO HOW MUCH IO­DINE IS NEEDED?

PLANT-BASED IO­DINE

PRO­VIDES

1000-76,000 590

305 210-225 100

50-70 60-65 65-70 20-25

dam­age. Re­sults sug­gest that ap­prox­i­mately one in ev­ery 3,500 ba­bies born in Ire­land has con­gen­i­tal hy­pothy­roidism — an en­docrine con­di­tion — which re­sults from fail­ure of the thy­roid gland to pro­duce thy­roid hor­mones.

The RNI for io­dine is 60 mcg per day for in­fants and in­creases to 140 mcg per day in those above the age of 15 years. How­ever, the WHO rec­om­mends slightly higher lev­els of 150 mcg to 250 mcg per day.

Fish is one of the best sources of io­dine. Un­for­tu­nately, a shock­ingly low num­ber of peo­ple eat fish. The av­er­age con­sump­tion of fish in Ir­ish adults aged 18 to 64 years was a measly 23 grams per day, with an av­er­age por­tion size of 120g for fresh cod and 100g for fresh sal­mon fil­let.

There are many rea­sons why Ir­ish peo­ple re­port not eat­ing fish, which in­clude ex­pense, the pres­ence of bones, smell, a per­cep­tion that fish is dif­fi­cult to cook and tastes bland and a be­lief that fish needs to be eaten on the day of pur­chase. In Ire­land, milk is the main food source of io­dine.

The amount of io­dine in plants and other foods does change de­pend­ing on the amount of io­dine in the soil, the time of year and farm­ing tech­niques. For ex­am­ple, the io­dine in milk is higher in win­ter when compared to sum­mer. Ad­di­tion­ally, there will be more io­dine in the milk if the farmer pro­vides cat­tle feed that con­tains io­dine and if the farmer uses io­dine as an an­ti­sep­tic for the cows. In a sam­ple of 22 milks, there was no dif­fer­ence in io­dine con­cen­tra­tions be­tween or­ganic and reg­u­lar milk.

The grow­ing in­ter­est in a plant-based diet may have an im­pact on the io­dine sta­tus of the Ir­ish pop­u­la­tion as dairy and fish are of­ten ex­cluded. A study was con­ducted in the Univer­sity of Sur­rey which ex­am­ined the io­dine con­tent of 47 milk-al­ter­na­tive drinks in­clud­ing soya, al­mond, co­conut, oat, rice, hazel­nut and hemp and compared it with that of cows’ milk. They found that the ma­jor­ity of milk-al­ter­na­tive drinks did not have ad­e­quate lev­els of io­dine, with con­cen­tra­tion lev­els found to be around 2pc of that found in cows’ milk. There­fore, it’s im­por­tant to check your milk al­ter­na­tive to see if it has io­dine added to it. Some are for­ti­fied with io­dine and may be the more suit­able choice.

An­other op­tion for those that are fol­low­ing a plant based or ve­gan diet is to con­sider en­joy­ing sea­weed in their diet reg­u­larly. With the avail­abil­ity of sushi this shouldn’t be too dif­fi­cult.

For the rest of the pop­u­la­tion, if you are con­sum­ing the rec­om­mended three por­tions of dairy a day as well as eat­ing fish a few times a week, it is likely that you are meet­ing your io­dine re­quire­ments.

There is a ten­dency for peo­ple to say ‘re­lax, put your

feet up when you’re di­ag­nosed

with cancer

Di­eti­tian, Orla Walsh

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