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Comcom special
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CONTENT
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Iodine deficiency
"Sometimes companies can make a massive difference with really small investments. Take the case of the world's salt manufacturers. Working with the United Nations, they have made sure that all salt manufactured for human consumption contains iodine. The result is that every year, more than 90 million newborn children are protected against iodine deficiency, and thus against a major cause of mental retardation.
.. Please join in the Global Health Initiative, which this Forum has been discussing over the last few days. Please work with the new Global Fund to fight AIDS, TB and Malaria, to provide at low cost the products developing countries need for disease control......"
- Special Message from Kofi Annan, Secretary General of the United Nations, Annual Meeting 2002
INTRODUCTION
Iodine is a chemical element which is used by the thyroid gland to produce
hormones that regulate the bodily metabolism. Iodine deficiency - Inadequate intake or metabolism of
iodine. It directly affects thyroid secretions, which influence heart action, nerve response, growth rate, and metabolism. The consequences of this
deficiency include goitre (an unsightly swelling of the thyroid gland in front of the neck), reduced mental function, increased risk of still births, abortions and infant deaths.
Iodine-deficient women may give birth to babies with severe mental and neurological impairment. If this deficiency occurs during infancy or childhood, it causes irreversible mental retardation, growth failure, speech and hearing defects, among others. Even mild deficiency may cause a low intellectual capacity. Severe, prolonged deficiency can cause hypothyroidism. Lack of iodine during infancy may cause cretinism. Eating seafood regularly or using iodized table
salt will prevent iodine deficiency. Some countries have made dietary iodine additives mandatory.
THE PROBLEM
Iodine deficiency was once considered a minor problem, causing goiter, an unsightly but seemingly benign cosmetic blemish. However, it is now known that iodine deficiency is the most common preventable cause of mental handicap in the world today, constituting a threat to the social and economic development of many countries of the world including some in Europe.
1.6 billion people are at risk. IDD affects 50 million children.
100,000 cretins are born every year.
THE SOLUTIONS
The
tragedy is that iodine deficiency disorders are easily preventable. Studies in
highland Guatemala, and in the Himalayan regions of India and Sikkim in the
1950s, proved unequivocally that iodized salt -- salt treated with potassium
iodine or iodide -- dramatically reduces the incidence of IDDs. Mandatory
iodization of salt, which was introduced by Switzerland in 1922, virtually
eliminated the IDD from European, although IDD lingers on in pockets there and
is quite severe in countries such as Bulgaria and Romania. The United States and
a few other developed nations, including Australia and the Scandinavian
countries, have completely conquered the problem.
The solution is relatively simple. A teaspoon of iodine is all a person requires in a lifetime, but because iodine
cannot be stored for long periods by the body, tiny amounts are needed regularly. In areas of endemic iodine deficiency,
where soil and therefore crops and grazing animals do not provide sufficient dietary iodine to the populace, food
fortification and supplementation have proven highly successful and sustainable interventions. Iodized salt
programs and iodized oil supplements are the most common tools in the fight against
IDD.
Iodized Salt, first choice for intervention:
Salt is universally and regularly consumed. Costs only 20 Paise per person annually.
Manufactured with simple technology.
Social Mobilization, resources already available:
Existing programmes have proven success.
Videos, manuals and periodicals target policy makers, health
professionals and the public
Iodized Oil, practical supplementation:
Effective intervention for people at risk.
Easy to administer.
Research, multidisciplinary approach:
A large body of existing clinical, experimental and epidemiological studies can be applied.
Methods are proven and practical.
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MOST FREQUENTLY ASKED QUESTIONS  What are the early symptoms for iodine deficiency disorders?
ANSWER: |
The features are better seen in populations rather than in individuals. Thyroid enlargement (goiter) is probably the earliest.
How much iodine should one ingest? Does that amount vary by age or condition (i.e., if pregnant or lactating)?ANSWER:
50 micrograms for infants (first 12 months of age)
90 micrograms for children (2-6 years of age)
120 micrograms for school children (7-12 years of age)
150 micrograms for adults (beyond 12 years of age)
200 micrograms for pregnant and lactating women
What are some of the foods rich in iodine, including vegetarian foods as well?
ANSWER:
It depends on the source. Iodine is found in the soil. Hence, depending on the amount of iodine that exists in the soil, it will be absorbed by plants and animals as they eat their food. Seafood usually is a reliable source. Dairy products, meat, and poultry usually have moderate amounts of iodine, but it depends on how the animals are fed. In most developed countries animals are supplemented, but this may not be the case elsewhere. Some prepared foods have iodine added in the salt.
What are other sources of iodine, aside from iodized salt?
ANSWER:
Iodized oil, food coloring (may not all be bio-available, however); vitamin supplements; medications (e.g., amiodarone); topical antiseptics (e.g. povidone iodine); some commercial bread (iodate added as a conditioner, but in the US this technology has changed); iodine treatments for domestic animals (e.g., for footrot, etc); water purification tablets; many other sources not well identified
Is iodine excreted if too much is ingested or does it accumulate and create a toxic effect? How much iodine creates this toxic effect?ANSWER:
Most excess is excreted, and most people can tolerate fairly large amounts without problems. People with a tendency towards auto-immune thyroid disease (Graves' Disease, Hashimoto's thyroiditis), are less tolerant. Up to a milligram of iodine is probably safe for almost everyone. However, if an individual has previously been iodine deficient, he/she may be at risk for iodine-induced hyperthyroidism when the iodine deficiency is corrected; this occurs most typically in older subjects with thyroid nodules. The hyperthyroidism can usually be treated satisfactorily.
Does cooking destroy the iodine in iodized salt?
ANSWER
:It depends on the cooking conditions and the salt. Potassium iodide (KI), used in the US, Canada, and much of northern Europe, is more likely to be lost than potassium iodate (KIO3), which is used in most of the developing world. Conditions of acidity and other contents of the cooking pot can have an effect. In general, boiling salted water with KIO3 gives fairly little loss.
How long can iodine be stored?ANSWER
:It depends on conditions of storage (heat, humidity, exposure) and purity of salt. The range is so great that one can answer this only for specific conditions. In the US, iodized salt is fairly stable and little is lost in storage under normal conditions.
Can you get too much iodine via iodized salt?ANSWER:
Yes, if you take large amounts of salt and if the salt has an inappropriately high iodine content, or if you are at risk for iodine-induced hyperthyroidism (see above). For most people, even the fairly high amounts of iodine in US salt (about 76 mcg/g) are not going to give problems; most people do not eat more than 10 g salt per day, and in the US it is closer to 5 g. If we take 1000 mcg iodine per day as a safe level, then iodized salt is unlikely to provide that high of an amount. Of course, if one is getting large amounts of iodine from other sources as well, the effect is additive.
Do we need to use more iodized salt because it is iodized?
ANSWER:
Not in most countries, including the US. Countries that depend on salt as the major source of iodine (e.g., Switzerland, Austria) have simply increased the amount of iodine in salt when population salt consumption has gone down, so that an adequate amount of iodine is preserved.
Too much salt is not good for those who have hypertension. Does too much iodized salt do the same?
ANSWER:
The problem is from the salt, not the fact that it is iodized. The addition of iodine does not affect hypertension.
"When Gandhi famously defied
the British salt ban, he created an enduring symbol of purity and independence.
But today, pure, locally-grown salt is threatening the health of tens of
millions of India's children."
In 1930, Mahatma Gandhi and 78
followers marched 241 miles across the state of Gujarat to the sea. When he
reached the coastal saltpans, Gandhi scooped up and held aloft a handful of salt
-- proclaiming resistance not just to Britain's ban on the private production of
salt, but to its colonial reign. In a famous photograph taken during what became
immortalized as the Salt March he is shown being led by a child -- symbol of an
independent India that would soon be born.
- Gordon Weiss
Goitre:
Salt Supply in India
Before 1983, iodized salt was confined to the Public Sector. Presently, there are approximately 8500 common salt producers in India, mainly in the private sector (90%), who, until recently were partially subsidized by the government (potassium iodate). There are around 650 iodization plants for commerical production of iodated salt. The installed capacity is 8 million tons. The calculated requirement is 5.5 million tons (16 g per day per person, to include coverage for animals). The major salt producing states are Gujarat (9 million tons), Tamil Nadu (2 million tons), and Rajasthan (1 million tons). The 1996 estimated iodized salt production was 4.5 m tons. Nine control laboratories have been established by the National Goiter Control Program (now the National Iodine Deficiency Disorders Control Programme) to ensure the quality of iodized salt and to make sure that all edible salt is iodized at both production and consumption levels.
Salt is produced using sea brine, sub-soil brine and lake brine. Less than 10% is produced from mines. Salt is sprayed with potassium iodate solution and packaged on site. Public producers like Sambhar Salt Lake and Hindustan Salt Limited produce salt from lake and subsoil water. Together they produce salt having a content of 98% sodium chloride. They use spray technique with potassium iodate, batch processing and submersion. Salt is fortified by iodine and iron separately and packaged in low density polyethylene.
Salt varies in quality from coarse to fine white.
A national reference laboratory has been set up in the National Institute of Communicable Diseases in Delhi. Salt iodine test kits are distributed through district health areas in the endemic states.
In May 2000, in an address at The Hague which referred to India's two-year-old mandatory salt iodization legislation, the noted Indian nutritionist Professor V. Ramalingaswami said that "India is on the brink of the elimination of Iodine Deficiency Disorders as a public health problem." But in July 2000, only two years after passing the code, the Indian government repealed it -- surrendering to pressure from the highly vocal small salt producer's lobby, as well as to widespread arguments that mandatory iodization was coercive, unfair and an act of multinational exploitation.
The decision to repeal the iodization laws appalled the nation's doctors and scientists. Some pointed out that the repeal would not affect the rich, who would continue to buy iodized salt, but the poor, who would be unaware of the risk of using the slightly cheaper salt. The Indian Medical Association, saying the repeal "re-imposes a serious public health burden," lamented that the laws should have stood "for the next century."
The international organisations representing the worlds doctors, nurses and pharmacists have launched a plea for Indian Prime Minister Bihari Vajpayee to make only iodised salt available throughout India. The World Medical Association (WMA), the International Council of Nurses (ICN) and the International Pharmaceutical Federation (FIP) have joined together to counter the recent decision of the Indian government to lift the ban on non-iodised salt.
Iodine deficiency (IDD) is the single, most preventable cause of mental retardation and iodised salt is the cheapest and most effective way to combat this scourge, said Dr Delon Human, CEO of the World Medical Association. Adding iodine to salt is a simple manufacturing process costing no more than US$ 0.04 (20 Paise) per person annually.
India has made considerable progress in its IDD control program, particularly in light of its huge size and reliance solely on iodized salt. Several publications summarize the large amount of data. A review in 10/97 by the Ministry of Health and Family Welfare reported the following:
(1) the overall goal is to reduce IDD prevalence below 10% in endemic districts by the year 2000
(2) major activities are IDD surveys, supply of iodized salt, re-surveys every five years, laboratory monitoring, and education;
(3) problems include delays in setting up monitoring laboratories, enforcement of quality controls, more emphasis on education, lack of control over non-licensed manufacturers.
International Council for the Control of Iodine Deficiency
Disorders
Recognized by W.H.O. as the expert international body on Iodine Deficiency Disorders (IDD), ICCIDD is a comprehensive
consultancy resource. ICCIDD provides services to countries pursuing the goal of virtual elimination of Iodine
Deficiency Disorders by the year 2000, as set by the 1990 World Summit for Children.
There are effective and affordable technologies that will prevent iodine deficiency and the problems it causes. And
ICCIDD specialists, collaborating with development agencies, governments and institutions, can provide the technical
assistance required to control IDD.
ICCIDD MANDATE
The International Council for Control of Iodine Deficiency
Disorders (ICCIDD) is the only international organization specifically constituted to promote the elimination of IDD.
ICCIDD's multidisciplinary global network of experts consists of some 400 specialists from more than 82
countries. They include scientists in the medical and nutrition fields, public health administrators, development
managers, technologists, communicators, economists, salt technologists and other industry experts. All of them are
committed to assisting governments and international agencies in developing national programs for the virtual
elimination of IDD as a public health problem.
ICCIDD
CONSULTING SERVICES
ICCIDD, a non-profit NGO, cooperates with major international agencies, particularly UNICEF and WHO, and
bilateral aid agencies in the development and execution of national IDD elimination programmes in countries with
significant IDD problems.
ICCIDD's global network of
consultants work in every area of IDD, including:
Epidemiological, experimental and clinical studies
Assessment and programme design
Iodization of salt and other technologies
Planning and training
Management and programme development
Technical assistance for quality control
Monitoring and evaluation
Communication and education
Advocacy and marketing
THE GLOBAL IODIZED SALT LOGO
The International Council for the Control of Iodine
Deficiencies Disorders has commissioned the design of a logo which can be globally recognized as an indicator of iodized
salt. There are several authorized versions which are shown below. Photo-ready, and digitized clip art (computer
applications) can be obtained through ICCIDD Communication Focal Point.
Please note that while the logo may not be modified, the words "iodized salt" in any language can be added
below the design, as shown in the lowest right version. Other production specifications are shown as well.
For information on how to obtain a copy of this particular logo, please contact ICCIDD Communication Focal Point,
Tulane University School of Public Health & Tropical Medicine, 1501 Canal Street, Suite 1300, New Orleans, LA,
70112, USA.
SECRETARY-GENERAL KOFI ANNAN URGES BUSINESS LEADERS, AT TURNING-POINT IN HISTORY
TO BE PART OF THE SOLUTION IN WAR AGAINST WORLD POVERTY
There are many positive ways for business to make a difference in the lives of the poor -- not through philanthropy, though that is also very important, but through initiatives that, over time, will help to build new markets, as well as improving the self-respect of the corporations concerned and the respect they enjoy in the wider community.
Increasingly, business leaders are recognizing that there are many small and poor countries in which they do not invest enough -- not because these countries are badly governed or have unfriendly policies, but simply because they are too small and poor to be interesting markets or to become major producers, and because they lack the skills, infrastructure and institutions that a successful market economy needs. The unpleasant truth is that markets put a premium on success, and tend to punish the poor for the very fact that they are poor.
Left alone in their poverty, these countries are all too likely to collapse, or relapse, into conflict and anarchy, a menace to their neighbours and potentially - as the events of 11 September so brutally reminded us - a threat to global security. Yet, taken together, their peoples represent a very large potential market - and many of their disadvantages could be offset if international business and donor governments adopted a common strategy aimed at making them more attractive to investment and ensuring that it reaches them.
The result is that every year, more than 90 million newborn children are protected against iodine deficiency, and thus against a major cause of mental retardation.
Let me challenge all of you to follow this example, and think of ways that your company can help mobilize global science and technology to tackle the interlocking crises of hunger, disease, environmental degradation and conflict that are holding back the developing world.
In 1994, Kiwanis International made its promise to the world's children: to raise $75 million to virtually eliminate the world's most prevalent, preventable cause of mental retardation, iodine deficiency disorders (IDD). The successful completion of this mission will rank as one of mankind's greatest health-related achievements. More than 1.5 billion children and adults will be saved from disorders that include stillbirths, cretinism, and goiter, as well as diminished academic performance and productivity.
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