SUNS 4315 Tuesday 3 November 1998
INDIA: DOCTORS BLAME IODISATION FOR HORMONE PROBLEMS
New Delhi, Nov 1 (IPS/Dev Raj) -- A ban on iodine-free table salt, imposed in an effort to halt iodine-deficiency diseases (IDD) in India, is under fire from politicians and physicians who say it is
killing a cottage industry as well as causing hormonal problems.
The strategy of iodising salt in the Kangra valley of northern Himachal Pradesh state began in the 1950s after studies proved that endemic goitre - the visible manifestation of IDD - in the region
was result of environmental deficiency.
After six years of supplying iodised salt in the Kangra Valley, distinguished physician, V. Ramalingaswamy recommended potassium iodate as a suitable agent for fortifying salt and the government began a full-fledged programme in the sub-Himalayan belt in 1962.
Later with most Indian states reporting endemic goitre, the government allowed private sector participation in the production and distribution of iodised salt and, more recently, banned the
distribution of iodine-free salt produced as a cottage industry by coastal people.
Politicians in several states have since been protesting against the ban saying it has taken away the traditional livelihood of hundreds of thousands of people living along India's long coastline.
Speaking against the ban in parliament, prominent politician Ram Vilas Paswan recalled how Mohandas Gandhi, India's founding father, defied a British tax on salt by leading a march to Dandi on the Gujarat coast and symbolically making 'cottage' salt.
According to Paswan, the current ban has helped only wealthy manufacturers who could afford to import iodine and add value to table salt by iodising and packaging it.
Paswan and other politicians now have an ally in endocrinologists who have been calling for a more focused iodisation programme, directed against clearly identified, iodine-deficient areas.
According to R.P. Singh, an endocrinologist attached to the two-billion dollar super-speciality Apollo Hospital here, diets in urban areas are already rich in iodine and there is little need for supplements in cities.
In fact, Singh says many of his patients suffer from hyper-thyroidism only because of excess iodide in their diets. "The iodates loses oxygen molecules and transform into iodides through mishandling, poor storage and exposure to the sun on transportation."
Singh says it is remarkable that while hyper-thyroidism and associated hormonal problems such as hirsuits in women and enlargement of breast in men are on the rise in the cities, it is unheard of in the rural areas of the Indian plains.
Iodine is volatile and rapidly degenerates and evaporates when subjected to small rises in temperature and completely disappears on cooking. "This makes it useless for people who really need it especially those who live in the sub-Himalayan hill tracts," Singh says.
Singh and his colleagues are now demanding that the government find some medium other than table salt to get iodine to people who live in iodine-deficiency belts. "At least people should be able to chose between iodised and uniodised salt," he said.
Other experts however say that the danger of hyper-thyroidism and associated hormonal problems are exaggerated. They cite studies by University of Massachusetts Medical Centre which say a person must consume more than ten times the normal daily dosage to trigger hyper-thyroidism.
Studies in India conducted by physician J.N. Berry came to the conclusion that through there is a risk of hyper-thyroidism occurring from iodine supplementation it is minimal.
Leading nutrition expert C. Gopalan who heads the Nutrition Foundation of India (NFI) says it is difficult to replace the present programme of iodisation using salt because of its sheer cheapness at less than a cent per person per year.
Gopalan points out that an estimated 64 million Indian suffer from IDD and although people in the sub-himalayan tracts are the worst sufferers, no single state is spared.
Nationally, lack of iodine in the diet now accounts from some two million cretinous children while an estimated 40 million school-going children in the endemic areas are at high risk, he said.
At the All-India Institute of Medical Sciences (AIIMS) India's premier medical research facility, doctors say that hypothyroidism caused by iodine deficiency is the single biggest cause of mental
deficiency in this country.
According to D. Umesh Kapil at the Nutrition Department of the AIIMS studies have shown that in areas of moderate to mild deficiency children have markedly lower intelligence than children in areas where there is no deficiency.
Government surveys by the Indian Council of Medical Research (ICMR) show that least 13 of India's 25 states including Assam, Andhra Pradesh, Uttar Pradesh and Rajasthan are the worst hit.
In spite of support from the UNICEF and government subsidies to salt manufacturers, periodic raids and by the agents of the salt commission have unearthed stocks with inadequate iodisation.
"All of this means that the salt iodisation programme must be vigorously pursued," Kapil says.
Under the law a manufacturer or retailer dealing in sub-standard, iodised salt faces a minimum prison term of six months in addition to fines. But so far no one has been prosecuted.