Given the present conflict in Europe and the possibility of others in our unstable world, it’s time to take seriously the risk of a nuclear confrontation in the uncertain future. One of the medical issues associated with nuclear events recently on this website and in our books: radiation exposure.
Recently, I explained the units used to describe radiation, the effects of various doses, dosimeters, and how to gain protection by building a shelter using various materials. I also mentioned the use of potassium iodide or KI, known by brand names such as Thyrosafe, Iosat, and various supplements to counteract the effects of a common fallout component known as radioactive iodine or I131. It’s the lightest radioactive contaminant and can affect people and food sources hundreds, if not thousands, of miles away from ground zero.
In the Ukraine conflict, the Russian leader has recklessly played the “I’ve got nukes” card and has even attacked nuclear energy plants. This is occurring in the same general area as the Chernobyl meltdown of 1986, which remains the site of elevated radiation levels today. The nuclear energy plant recently attacked is at least six times the size of the Chernobyl facility. A meltdown there or in any of the other 14 nuclear plants inside Ukraine would be a major catastrophe.
The end result of a significant exposure to radioactive iodine is thyroid cancer, often years after the original exposure. In the case of Chernobyl, thousands of cases of thyroid cancer have been recorded, mostly in those who were less than 18 years of age at the time of the event.
To prevent this from happening, we recommend potassium iodide tablets. How does potassium iodide protect against thyroid cancer? Imagine your thyroid is a parking lot and the organ’s receptors are parking spaces. When you’re exposed to radioactive iodine, it takes up the parking spaces and, once there, irradiates the gland. This leads to cancer down the road. Taking non-radioactive potassium iodide or iodate fills the parking spaces, preventing the radioactive iodine from occupying them and causing damage.
Having potassium iodide or iodate tablets on hand in these troubled times is a good idea. The current crisis, however, has led to a run on all forms of potassium iodide in both Europe and across the pond. Our own store ran out of potassium iodide within 2 days and it seems that there are few, if any, other sources selling it commercially. If they exist, they’re selling it at outrageous prices.
Let’s say. however, that you don’t have Potassium Iodide tablets. What are some other options? One is Lugol’s solution, also known as “strong iodine solution.” Lugol’s is a liquid combination of potassium iodide and iodine first formulated in 1829 by, you guessed it, Dr. Jean Lugol. It’s used for various purposes: Decades ago, I used it as a stain to identify possible cervical cancers. It can be used as an antiseptic on small wounds and even, in very small quantities, to disinfect questionable water.
It can also protect the thyroid from radiation injury. Lugol’s is most commonly available as a 2% solution. Each drop at that concentration contains approximately 2.5-3 mg of iodine. 20 drops equals a milliliter. Therefore, 1 milliliter of 2 percent Lugol’s equals about 65 mg, the same dose as a Thyrosafe tablet.
130 mg is the daily adult dose in a radiation event, so 2 ml orally should be sufficient to block radioactive iodine in those over 12 years of age and over 150 pounds (about 70 kg). For children over the age of 3- or adults less than 150 pounds, 1 ml or 65 mg should suffice as a daily dose. For small children over 1 months to three years, ½ milliliter or 32 mg iodine should be enough. For newborns, ¼ ml or 16 mg.
By the way, this product should be taken with a full glass of water or in fruit juice, milk, or broth to improve the taste and lessen stomach upset.
Be aware that radiation levels generally drop to 10% of the original level in the first day, much more after that. This means that you might need only one dose total to get adequate protection. The earlier you take it before or during an exposure, the more effect it has. In total, you should not take it for more than a few days or you can develop some pretty serious adverse reactions. Only take it until significant risk of exposure to radioactive iodine no longer exists. As I mentioned in a recent article, time spent under shelter and increased distance from ground zero are your friends when it comes to radiation.
If you can’t find Lugol’s 2% solution, you might consider a controversial but logical alternative: the antiseptic povidone-iodine, brand name Betadine. Iodine is absorbed through intact skin and wounds, and, according to the Stritch school of medicine at Loyola University, betadine solution used on the skin can contain enough iodine to help prevent thyroid uptake of radioactive iodine. Don’t drink betadine, it should be only applied to skin.
According to a 1989 study published in the journal Health Physics by researchers from Hershey Medical Center, an adult could get a blocking dose of stable iodine by painting 8 ml of a 2 percent tincture of Iodine on the abdomen or forearm approximately 2 hours prior to I-131 contamination. The study suggested that, in the absence of KI tablets, most humans would benefit from topical application of tincture of-Iodine.
10% povidone-iodine solution (Betadine) contains 1% available iodine, so use double the amount and, as it’s absorbed more slowly by soft tissues, apply as early as possible once a radiation event is imminent.
For adults, paint 8 ml of a 2 percent tincture of Iodine or double that of 1% on the abdomen or forearm daily, starting at least 2 hours prior to initial exposure. If you’re lucky, the authorities will warn you when an event is imminent.
For children 3 to 18, but under 150 pounds, paint 4 ml of 2 percent iodine, double that of 1 percent. For children under 3 but older than a month, 2 ml of 2 percent. For newborns up to 1 month old, half it again, or just 1 ml. Newborns normally receive only a single dose total. Again, stop once there is no longer a significant risk of radiation exposure.
It’s important to know that absorption through the skin is not as exact a dosing method as using tablets, but should still be effective for most. Also, be sure to first wash away any external contaminants on exposed skin with soap and water before application, and, if a nuclear event has already occurred, perform skin decontamination and discard fallout-exposed clothing.
Some people have asked about iodine crystals, but it appears that they vary in composition, so I can’t say much about them. One thing I can say is that iodized table salt and foods rich in iodine do not contain enough iodine to block radioactive iodine and are not a substitute for KI.
I have to mention that potassium iodide only protects against thyroid cancer, not against any other cancer caused by radiation exposure. Cancers associated with high dose gamma radiation exposure include leukemia, breast, bladder, colon, liver, lung, ovarian, and stomach. As those exposed as children or teens are most prone to thyroid cancer, treat them with KI first.
There’s no Good Housekeeping Seal or FDA approval on any of the strategies I mention here. You should do your own research and make your own conclusions, but as a survival medic, you must do what you can, with what you have, where you are.
Joe Alton MD
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