Iodine deficiency causes mental handicap

Chandrakant Pandav , additional professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, is a leading member of the International Council for Control for Iodine Deficiency Disorders, Office of the Regional Coordinator, South Asia and Pacific. He spoke to Manisha Rawat on iodine deficiency and related disorders in India

 
Published: Sunday 31 May 1998

On the importance of iodine in our body:
Iodine serves as a raw material for making thyroxin, a hormone, which is produced by the thyroid gland. Since iodine and thyroxin are required for the development of the brain, the single most important cause of mental retardation today is iodine deficiency. It is also the single most preventable cause. Various studies have shown that iodine deficiency is not merely a cosmetic problem but a problem of child survival and child development.

On the status of iodine deficiency in the last 10 years in India:
The current status of iodine deficiency is that it is not too widespread. The government has carried out, through its national and state level machinery, various surveys in different parts of the country. In the early 1980s, surveys showed that goitre was a public health hazard. Lack of iodine in the body was cited as the single most important cause of the disease. Subsequently, the Government of India launched a campaign to supply iodised salt.

Initially, the policy was to supply iodised salt to only those districts which had Iodine Deficiency Disorders ( idd ). But as the entire country was at the risk of idd , universal iodised salt was taken up in 1984. The campaign for iodine helped to a large extent in improving the situation of iodine deficiency in various parts of India. These disorders have been progressively on the decline.

On how the demand for iodine can be met for the whole country:
Today 93 per cent of the iodised salt is made in the private sector. The requirement of iodised salt is about five million metric tonnes. The private sector's participation is an excellent example of partnership between private sector and government in terms of solving the public health problem.

On the negative health effects of iodine deficiency:
Iodine deficiency leads to a number of disorders -- goitre is only the tip of the iceberg. Many disorders are invisible and are associated with the development of the brain. In the 1980s, iodine deficiency was only associated with goitre. Since goitre causes painless swelling, people did not take it seriously. But with the launch of the iodine campaign, awareness about the importance of iodine has gradually spread.

The western countries have instituted neo-natal screening of hypothyroidism, which is to detect the deficiency of thyroid hormone at birth. The incidence of neo-natal hypothyroidism was very high in India in the 1980s. It was about 10 per cent of the total population -- which is about 80 to 300 times more than those found in the western countries. Studies conducted recently in India have shown lower iq levels in children as a result of iodine deficiency. These studies reveal that there is a difference of as much as 3.5 points in the iq levels between children who stay in an iodine deficient environment and those who don't.

On the risks of consuming excess iodine:
The benefits of iodised salt far outweigh the minuscule risks of iodine toxicity. The body has an inherent mechanism -- any excess iodine is excreted into the urine that is the in-built safe mechanism. About 150 g of iodine is recommended through the intake of salt. But even with an intake of 500 g, there will be no health problems. In Japan, where the staple diet is seaweeds -- which is very rich in iodine -- the intake of iodine is 3,000 g every day. So there is no cause for alarm. The toxic effects are very rare in the form of skin rash and allergy. Even people suffering from high blood pressure may reduce their salt intake but should increase their iodine intake.

On why iodine depletion in the environment takes place:
About 10,000 years ago, iodine was present in the top layer of the soil. But it was leached away due to the formation of glaciers. Large-scale deforestation is another important factor that resulted in the leaching of iodine from the soil. Natural disasters such as floods also result in the depletion of iodine in the soil.

On what measures can be taken to conserve iodine in the soil:
First of all deforestation must end. Since the 1920s, the Russians have been using seaweeds, which are usually rich in iodine, as a fertiliser to enrich the soil with iodine. But this is an expensive strategy.

On the other ways to consume iodine:
One can take iodised capsules which are effective for a few months. Intramuscular injections are effective for four or five years. Iodised bread is another way by which iodine can be taken. The Netherlands had introduced iodised bread during World War ii . Countries such as Australia are still using iodised bread. Milk is an important source of iodine in the western countries where compounds rich in iodine are used to sterilise the udders of the cows. But salt is the most common way of consuming iodine.

On the policy measures taken in this area:
Quality check of iodised salt at the production level is essential. We are also seeking partnership from the private sector by introducing universal salt iodisation. We are also trying to involve Non-governmental organisations ( ngo s) and school children by modifying the school curriculum and also making it a part of the medical curriculum. The government is also involving salt traders and the salt industry to make them participate in the programme.

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