A bit of iodine in my salt
as the Union health ministry's 45-day deadline for comments and suggestions regarding the withdrawal of the ban on non-iodised salt approaches (June 24), conflicting reports in the media have created confusion in the people's minds. What has served to exacerbate matters is the fact that the reports emanate from within the government - displaying total lack of unanimity on the issue. The most recent statement is by Union health minister, C P Thakur, who says the ban on common salt will not be lifted for the time being.
The proposal has only resulted in creating two opposing viewpoints - the scientific community, who feel that such a measure would be a setback for the goitre eradication programme which has yielded good results so far, and the Sarvodaya groups which insist that compulsory iodisation of salt is not necessary since it has economic repercussions for the poor. The latter include the All India Sarva Seva Sangh, Gandhi Smarak Nidhi and Gandhi Peace Foundation. The issue also evokes a touch of patriotic sentiment: "common salt is a national heritage of the freedom struggle of India, nobody has the right to insult it," says a report issued by these groups.
Adding a new dimension to the issue is S K Sharma, former director of Defence Research Development Organisation. He claims there are flaws in the scientific community's data which shows that iodine deficiency in Delhi has dropped from around 50 to 20 per cent after the introduction of Universal Salt Iodisation (usi) programme. "Even a huge institute like aiims does not posses the manpower to conduct a study on such a large scale."
In order to combat mental retardation (one of the health effects of iodine deficiency), the government introduced the usi in 1986 and currently 75 per cent of Indian families use iodised salt. Every state, except Kerala, has banned the use of non-iodised salt for human consumption.
The proposal has greatly disappointed the medical community: noted medical experts like V Ramalingaswami, national research professor and professor emeritus, and N Kochupillai, head of the department of endocrinology at aiims who have undergone extensive research on iodine expressed shock on the government's decision. "This is totally unscientific," says Kochupillai. Ramalingaswamy expressed similar disappointment: "It is a serious blow to India's effort to eliminate iodine deficiency."
A group of renowned doctors including Ramalingaswami, Kochupillai, M G Karmarkar, president, Thyroid Association (India) and a few others have issued a statement against the decision and demanded the continuance of the usi programme. They stated that iodine deficiency in the country is the "single most preventable cause of mental retardation" and since "we are on the brink of a major health success" putting an end to the programme at this stage would be a "national disaster."
According to Chandrakant S Pandav, regional co-ordinator (South Asia and Pacific) of International Council for Control of Iodine Deficiency Disorders (iccidd), there is no scientific, legal, economic, social-educational, moral and ethical justification for the decision.
The origins of the controversy goes back to January 15, 1997, when the Government of India issued a similar notification inviting suggestions from persons likely to be affected, within 90 days. However, no objections were received even after 220 days. Pandav states, "The government is changing its notification within a span of two years and six months, we are unable to understand the circumstances that have led to the issue of such statement."
The controversy Veteran Gandhi Smarak Nidhi leader, Siddharaja Daddha, targets the government mentioning that the continuance of the ban has amounted to grave injustice to the poor. He stated that the delay by the government gives multinational companies an opportunity to lobby against lifting the ban on common salt. "After all, there is a market of Rs 2,500 crore at stake," he says. The Indian Medical Association (ima), however, denies mnc involvement.
According to the secretary, All India Sarva Seva Sangh (aisss), aptly named Lavanam, the Sanskrit equivalent for salt, all iodine used in India is imported and as a result mncs are involved. However, Pandav pointed out that the iodine used for salt is negligible compared to other industrial uses.
Daddha laments, "we are not against iodisation of salt, we are against banning common salt." He added that the people should have their choice. "There are so many other things to do than to ban sale of iodised salt." In his letter to the secretary, health and family welfare, Daddha mentions: "while banning the sale of common salt which has been used by the people for centuries, the government does not seem to have realised the economic injustice perpetrated on the people by their high-handed action." He further reasons "when other countries can solve their problem by voluntary iodisation, why can't we?"
Vimal Bhai of National Alliance of People's Movement (napm) is extremely critical: "first there was the tobacco lobby, then the liquor lobby, now the salt lobby." Similar sentiments were expressed by Jagdish Shah of the aisss: "the government is insulting the people by doubting their intelligence."
Both the groups have approached the government justifying their stands. The ima has written to the government and spoken to C P Thakur, regarding the issue. "We are totally against this," says Prem Aggarwal, honorary secretary general, ima, "health should not be politicised." He mentioned that prime minister A B Vajpayee was a party to the salt symposium, "but he is turning back on us now." Vinay Aggarwal, honorary joint secretary, ima, spoke along the same lines: "Just as the success of iodisation is beginning to emerge, the government is rethinking its decision, ignoring the scientific aspect." Prem Aggarwal says, "This decision will make us a laughing stock in the eyes of the world."
Iodine is essential to human life for the proper development and functioning of the brain and body. It is particularly important for pregnant women as insufficient intake could affect the growing child's mental and physical health, leading to problems like low iq and cretinism as it grows older. A cretin cannot walk, think or talk normally and has coarse skin and facial features due to the lack of the hormone thyroid. Scientists claim that iodine deficiency is present in every state. "An adult requires an average daily consumption of 150 micrograms (mg) a day," Prem Aggarwal points out.
Should the ban be lifted or not? Experts on both sides have contrasting views on the health effects of iodine. The ima doctors on one side claim that even a small amount of iodine deficiency can reduce mental functioning, while the other group claim that continued or excessive use of iodine may result in mental depression, nervousness, insomnia and sexual impotence. They say that hyperthyroidism (over activity of the thyroid gland due to overgrowth of the gland) is prevalent even in places that are iodine deficient, particularly among people above the age of 40.
Vinay Aggarwal claims: "We have never had a single complaint of excess iodine at aiims." Ramalingaswamy states that the toxicity of iodine has been studied for more than 50 years, the risk-benefit ratio was looked at and the risk found to be minimal. However, the Sarvodaya leaders feel that the ill effects of iodine are exaggerated. They asserted that there is no need for a total ban on common salt when just 0.2 per cent of the country suffers from iodine deficiency. However, Kochupillai says that the figure is incorrect. Ramalingaswamy comments: "It is unwise to create a noise about things that are already studied."
According to a report by iccidd, 200 million people in India are at risk of iodine deficiency while 70 million show signs of goitre (the swelling of the neck caused by an enlarged thyroid gland resulting from an iodine deficiency). The report also says that a survey recently conducted in 282 districts showed that iodine deficiency was endemic to 241 of them.
Though Shantilal Kothari, National Academy of Nutrition Improvement, Nagpur states that even 100-150 mg can cause hyperthyroidism, the ima claim that consumption of even 1,000 mg a day is not harmful. Kothari states: "this is totally wrong and unscientific." He also explained: "a diet of an ordinary adult has enough iodine."
Kothari also pointed out that salt requirement varies from person to person according to the region, and that "there is no safe level of iodine." Citing a report by who, unicef , iccidd, he mentioned that lowest levels of iodine should be used in salt to minimise the risk of hyperthyroidism. Though Pandav states that deficiency of iodine even in small amount can reduce the iq by 10-13 points. But, according to Kothari, there is no proof.
Economic aspects and solution
The Sarvodaya leaders argue that the business of small salt manufacturers, particularly in Gujarat and Tamil Nadu, is suffering due to the ban. However, Pandav denies it. He says, "The cost of iodisation per person per year is 50 paise. Iodised salt is costly only because of the refining, packaging and advertising." He added that over 83 per cent of the 42 lakh tonnes of iodised salt currently sold in the country is crystal salt sold in 50 kg bags and the "price is between Rs 1.50 to 2.00". He also mentioned that this misconception needed to be cleared.
He explains: "No law in India prevents the production and sale of common salt as it a raw material for iodised salt, besides it also has industrial usage and for livestock." The salt department gives financial and technical assistance to form co-operatives.
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