IQPLUSIN.ORG :: Sustaining Elimination of Iodine Deficiency Disorder...Indian Coalition for control of iodine Deficiency Disorders...International Coalition for control of iodine Deficiency Disorders

The following terms are often used to identify the iodine compound used in fortification programmes:

a) Iodination: Fortification with any iodine compound
b) Iodisation/Iodization: Fortification with potassium or sodium iodide
c) Iodation : Fortification with potassium or sodium iodate

However, these terms are frequently used interchangeably.

In addition to iodised salt, there are other methods of iodine prophylaxis. Some of these are iodised oil (capsule and injections), iodised water, iodised bread, iodised soya sauce, iodoform compounds used in dairy and poultry, and certain food additives.

Iodine is essential for the normal growth, development and functioning of both the brain and body. A lack of iodine can give rise to a goitre and can make a person dull, listless and easily tired. Such a person is less active than a normal individual. But more importantly, without enough iodine, a newborn's brain and body can become permanently retarded and stunted. Iodine is vitally needed during early childhood, puberty, pregnancy and lactation. A woman who is deficient in iodine is likely to produce an abnormal child. If left untreated, the child's mental and physical condition worsens, as he/she grows older.

Iodine is an essential component of the thyroid hormones, thyroxine (T4 and tri-iodothyronine (T3), contributing 65% and 59% of their respective molecular weights. To meet the demand for adequate hormone, the thyroid has developed an elaborate mechanism for concentrating iodine from the circulation and converting it into hormone, which it then stores and releases into the circulation as needed. The thyroid hormones act though specific receptors to selectively regulate gene expression in target tissues, particularly liver, pituitary, muscle, and developing brain. Inadequate iodine supply leads first to inadequate hormone production and then to inadequate tissue response, i.e hypothyroidism. Thus, at present, the only physiological role known for iodine in human body is for the synthesis of thyroid hormones by the thyroid gland. Therefore, the dietary requirement of iodine is determined by normal thyroxine (T4) production by the thyroid gland without stressing the thyroid iodide trapping mechanism or raising Thyroid Stimulating Hormone (TSH) levels.

The iodine taken in the diet is absorbed throughout the gastro-intestinal (GI) tract. In whatever form, iodine is present in the diet, it is converted in the form of iodide ion before it is absorbed. This is true for all forms except when it is in the form of thyroid hormones for therapeutic purposes. The iodide ion is bio-available and absorbed totally. It enters the circulation as plasma inorganic iodide (PII). The two major organs that clear PII from circulation are thyroid and kidney. The iodide is used by the thyroid gland for synthesis of thyroid hormones. The kidney excretes iodine with urine. The excretion of iodine in the urine is a good measure of iodine intake. For determining the iodine requirements, the important indices are serum T4 and TSH levels and urinary iodine excretion. The physiological actions of thyroid hormones can be categorized into (a) Growth and Development (b) Control of metabolic processes in the body. Thyroid hormones play a major role in the growth and development of brain and central nervous systems in humans from 15th week of gestation to 3 years of life. If iodine deficiency exists during this period, resulting in thyroid hormone deficiency, the consequence is derangement in the development of brain and central nervous system. These derangements are irreversible, the most serious form being that of cretinism. The other physiological role of thyroxine is to control several metabolic processes in the body. These include carbohydrate, fat, protein, vitamin and mineral metabolism.

The average daily requirement of an adult is 150 g a day, an amount so small that it could fit onto a pinhead (1,000,000 micrograms - 1 gram). The average requirement of pregnant and lactating woman is 200 micrograms per day. An average lifetime's requirement of an individual with 70 years life span would add up to less than a teaspoonful. However, it is important that the body gets this iodine regularly every day. This is why it must form part of every person's daily diet.

The recommended amount is 150 µg/day for adults, 200 µg for pregnant or lactating women, and lower amounts for children. These recommendations stem from consensus statements by several groups, including the International Council for Control of Iodine Deficiency Disorders (ICCIDD), the World Health Organization (WHO), UNICEF, and the Food and Nutrition Board of the U.S. National Academy of Sciences. The amounts are based on the following: the calculated daily thyroid hormone turnover in euthyroidism, the iodine intake producing the lowest values for serum TSH and for serum thyroglobulin, the amount of thyroid hormone replacement necessary to restore euthyroidism to athyreotic subjects, the iodine intake associated with the smallest thyroid volumes in populations, and the lowest incidence of transient hypothyroidism in neonatal screening with blood spot TSH.

Iodine is present in its natural state in the soil and in water. So our normal requirement comes from crops grown on iodine - rich soil. But when the soil of any area lacks iodine, the crops too are deficient in this essential nutrient. Consequently, those people who live on iodine - deficient land and eat the food items grown on such soils regularly, do not get their requirement of this essential element.

Goitre is only one of the many consequences of iodine deficiency. A number of physical and mental abnormalities, some serious, some mild, result from iodine deficiency. The most visible and easily recognizable sign of iodine deficiency is goitre. A goitre is an enlarged thyroid gland. It can range in size from an invisible swelling to a monstrous growth.

The iodine deficiency disorders include goiter, hypothyroidism, mental retardation, reproductive impairment, and decreased child survival. All stem from the insufficient thyroid hormone production that results from inadequate iodine supply. Endemic goiter is the first and most visible sign of iodine deficiency. The thyroid enlarges as an adaptation to the threat of inadequate hormone, a reaction mediated by TSH stimulation and perhaps other growth factors. In mild iodine deficiency, this response may be adequate to preserve euthyroidism, but at the cost of an enlarged thyroid and the attendant risks of neck compression and eventual hyperfunctioning autonomous nodules with hyperthyroidism. An insufficient adaptation in adults produces hypothyroidism with its usual clinical stigmata. The damage is greater when iodine deficiency provokes hypothyroidism during fetal or early life, because thyroid hormone is necessary for proper development of the central nervous system, particularly its myelination. Individuals who were hypothyroid at this critical period frequently have permanent mental retardation, which cannot be corrected by later administration of thyroid hormone or iodine. Child survival is also threatened by iodine deficiency, and several studies show that neonatal mortality decreases, sometimes by 50% or more, when the deficiency is corrected.

A goitre is a swelling of the neck caused by an enlarged thyroid gland. When the body does not get enough iodine, the thyroid increases in size. Not all goitres are visible. Many of them, particularly in the early stages, can be detected only by an experienced doctor. It is only when a goitre grows quite large that it can be seen and recognized by everyone. A person with a goitre may also have other hidden iodine deficiency disorders.

Iodine Deficiency Disorders (IDD) form a spectrum of abnormalities which includes goitre, mental handicap, deaf mutism, squint, difficulties in standing or walking normally, and stunting of the limbs. Table - 1 gives the spectrum of IDD. Iodine - deficient women frequently suffer abortions and stillbirths. Their children may be born deformed, mentally deficient or even cretins. All these problems are caused by a simple lack of iodine in the diet. Goitre is the least tragic of them. Goitre is only the tip of the iceberg.

Table - 1 : The spectrum of Iodine Deficiency Disorders

Stage in life

Effects

Fetus

Abortions
Stillbirths
Congenital Anomalies
Increased Perinatal Mortality
Increased Infant Mortality
Neurological Cretinism:

- mental deficiency
- deaf-mutism
- spastic diplegia
- squint

Myxedematous cretinism:

- mental deficiency
- dwarfism

Psychomotor defects

Neonate

Neonatal goitre
Neonatal hypothyroidism

Child and Adolescent

Goitre
Juvenile hypothyroidism
Impaired mental function
Retarded physical development

Adult

Goitre with its complications
Hypothyroidism
Impaired mental function

A baby growing in the mother's womb needs a steady supply of iodine for the normal growth and development of its brain and body. Only the mother's body can provide this essential iodine. But if the mother is iodine - deficient, the child too is deprived of this much - needed nutrient. If the woman's deficiency is severe, the child's brain and body are seriously and permanently stunted, and he becomes a cretin, unable to walk, talk or think normally. If the mother's deficiency is minor, the child will still be affected, even though he may look normal. The damage to his brain usually shows up years later in poor school performance and an inability to perform normal, everyday tasks. Millions in our country suffer from this form of iodine deficiency and it affects the social and economic progress of whole regions.

NO. Cretinism is permanent and incurable. Like many other iodine deficiency disorders with the exception of certain types of goitre, it cannot be cured but it can be easily prevented before it occurs. The regular consumption of iodised salt provides protection to present and future generations against the tragic consequences of iodine deficiency disorders.
Goitre in the early stages of occurrence can be "cured". However, like cretinism, regular intake of iodine easily prevents goitre before it occurs.

The areas of severest iodine deficiency lie in the great sub-Himalayan belt that extends from Jammu and Kashmir, all along North India, to the North East, covering an area of 2500 square kms. But recently IDD has been reported from Maharashtra, Gujarat, Madhya Pradesh, Andhra Pradesh, Orissa, Karnataka, Kerala, Tamil Nadu and even Delhi. In fact, no state or Union Territory in India is free from IDD as a public health problem. New pockets of iodine deficiency are being discovered every day.

Iodine deficiency exists in all States and Union Territory of India. It is much more prevalent in hilly regions (more than 40%). It was believed for a long time that coastal areas do not have iodine deficiency. However, the recent survey showed that in Goa, Goitre is 27%. In Kerla it varies from 4.7 to 21.43% (13 out of 14 districts considered to be endemic). Thus, almost whole population is exposed to the risk of iodine deficiency. Thus, everyone is exposed to the risk of iodine deficiency.

Except for certain types of seaweed, there are no foods that are inherently rich in iodine. All food derives its iodine from the soil on which it grows. If the soil is poor in iodine, all the food grown on it will also be low in iodine. Therefore, in areas of iodine deficiency, the most common method is to ensure a steady intake of essential iodine is by adding it to the diet in the form of iodised salt.

The iodine content of food-stuff depends on the iodine content of the soil on which it is grown. The iodine present in the upper crust of earth is leached out due to glaciation and repeated flooding and is carried to the sea. The sea water, is, therefore, rich source of iodine4. The sea-weeds located near coral reef have inherent biological capacity to concentrate iodine from the sea. The reef fish which thrives on sea-weeds is rich in iodine. Thus, population consuming sea-weeds and reef fish have high intake of iodine, as the case in Japan. The amount of iodine intake by the Japanese is to the tune of 2,000 to 3,000 micrograms per day5 (Remember! recommended the daily intake is only 150 g/day. However, there are several areas in Asia, Africa, Latin America and parts of Europe, where iodine intake varies from 20 to 80 micrograms per day. In USA and Canada and some parts of Europe, the intake is around 500 micrograms per day.

The average iodine content of foods on fresh and dry basis is given in Table - 2 .

Table - 2 Average iodine content of foods (in g/gm)

Food	Fresh basis		Dry basis
	Mean	Range	Mean	Range
Fish (fresh water)	30	17 to 40	116	68 to 194
Fish (marine)	832	163 to 3180	3715	471 to 4591
Shellfish	798	308 to 1300	3866	1292 to 4987
Meat	50	27 to 97	-	-
Milk	47	35 to 56	-	-
Eggs	93	-	-	-
Cereal grains	47	22 to 72	65	34 to 92
Fruits	18	10 to 29	154	62 to 277
Legumes	30	23 to 36	234	223 to 245
Vegetables	29	12 to 201	385	204 to 1636

YES. It is important to note that iodine content of various food-stuffs varies with geographical locations, as there is a large variation in the iodine content of inorganic world as shown in the Table 3.

Table-3 : Iodine content of the Inorganic World.

Different aspects of the Inorganic World	Iodine content
i) Terrestrial air	1.0 mg/liter
ii) Marine air	100.0 mg/liter
iii) Terrestrial water	5.0 mg/liter
iv) Sea water	50.0 mg/liter
v) Igneous rocks	500.0 mg/kg
vi) Soils from igneous rocks	9,000.0 mg/kg
vii) Sedimentary rocks	1,500.0 mg/kg
viii)Soils from sedimentary rocks	4,000.0 mg/kg
ix) Metamorphic rocks	1,600.0 mg/kg
x) Soils from the metamorphic rocks	5,000.0 mg/kg

Thus, the average iodine content of foods shown in Table can not be used universally for estimating iodine intake.

Contrary to the popular belief, sea salt does not contain adequate iodine. It contains only 2 g of iodine/gm. of salt.

It is generally believed that all sea foods are rich in iodine. However, not all food available from sea is rich in iodine. It is important to note that NOT all organisms in sea has the ability to concentrate iodine. Only sea-weeds and that too of a particular variety have the inherent biological ability to concentrate iodine. These sea-weeds are located near the coral reefs. Therefore, reef fish which feed on these sea-weeds are a very rich source of iodine as compared to the deep sea water fish. Further, consumption of fish after chopping the head does not supply enough iodine. The head of fish contains maximum iodine due to the presence of the thyroid gland as compared to the rest of the parts of the fish.

An important fact about iodine is that although it is needed in tiny amounts, it is needed regularly, everyday. While it could be taken every day like a medicine or a vitamin tablet, this would involve taking a tablet every day for the rest of our life. Salt, however, is something that is used by all every day. On an average, the same amount of salt 10 to 15 grams a day is consumed every day. If this salt is iodised, then the population will automatically get the required amount of iodine.

No, it will not. All of us need only a certain amount of iodine to function normally. If this iodine is already available to the body, it will simply reject any additional quantities and excrete it unused through the urine. On the other hand, if you are deficient in iodine, the thyroid gland will use as much iodine as it needs and reject the rest. This makes iodine safe for everyone.

YES, iodised salt can be used by everyone. Every person-young, old, sick or healthy-needs iodine every day. Pregnant women, lactating mothers and young children need it even more than others, so it is not only safe but also necessary for them to use iodated salt every day.

Yes. Iodised salt can be used in cooking or at the table the way we always used salt. Just make sure that iodised salt is NOT washed before use, as this will removes all the iodine.

Yes. Iodised salt improves the health and productivity of animals and reduces the number of stillbirths and miscarriages. Also, cattle who are fed iodised salt produce milk that is rich in iodine.

Storing iodised salt involves a few precautions. The iodine in the salt can be destroyed by prolonged exposure to direct sunlight and moisture. Therefore, it is important to store the iodised salt in an airtight container made of plastic, wood, glass or clay, with a well-fitting lid. Make sure that iodised salt is consumed within six months of buying it.

The Government of India has decided to make iodised salt available in a phased manner all over the country. If the local market does not stock iodised salt, write to the nearest Salt Commissioner's Office, the address of which is given on the last page of this booklet.

If one lives in an iodine-deficient environment, there is no likelihood of the deficiency being corrected at the source, namely, in the soil. On the contrary, the increased degradation of our environment is making the problem worse. Large - scale deforestation, among other things, has led to increased flooding and erosion of the top soil, which carries away the precious iodine. With the environmental deficiency growing worse day by day, iodine fortification will have to become part of our everyday lives. Most countries in Europe and America have been iodising salt continuously since the 1920s, for this is the only safe, long-term answer to a problem that threatens the physical and mental well-being of millions of unsuspecting people. Using iodised salt every day is the only way to protect ourselves and our children from the tragic and completely preventable effects of iodine deficiency. It is a small investment towards helping our children and their children to get the best chance to grow up with healthy minds in healthy bodies.
Iodine deficiency is present in almost all parts of developed and developing world. As mentioned above, environmental iodine deficiency is the main cause of Iodine Deficiency Disorders (IDD) in all these areas. Unlike nutrients like iron, calcium, vitamins, iodine does not occur naturally in specific foods; rather it is present in the soil and is imbibed through foods grown on that soil. As mentioned above, iodine is irregularly distributed over the earths crust, resulting in acute deficiencies in areas like mountainous regions and flooded riverines. The problem is aggravated by accelerated deforestation and soil erosion. Thus, the food grown in iodine deficient regions can never provide enough iodine to the population and livestock living there. The iodine deficiency results from geological rather than social and economic conditions. It can not be eliminated by changing dietary habits or by eating specific kinds of foods. Rather the correction has to be achieved by supplying iodine from external sources. It has , therefore, been a common practice to use common salt as a vehicle for iodine fortification, for the last 75 years. Salt is consumed approximately the same level through out the year in a given region by all the populations. Universal salt iodisation is now widely accepted strategy for prevention and correction of iodine deficiency disorders.

NO. There is no ban either on production of common salt OR on sale of common salt. There is a ban ONLY against the sale of common salt for direct human consumption unless the same is iodised.

YES, there is a ban on sale of common salt for direct human consumption. This is because : a) Iodine deficiency is widely prevalent in our country. There is not a single state or union territory where it has not been reported as a public health problem. b) Common salt has been identified as a vehicle for carrying iodine, an essential food item.

The latest notification is as follows :

In the Prevention of Food Adulteration Rules, 1955 -

i) in rule 42, -

a) for sub-rule (V), the following sub-rule shall be substituted, namely :-

"(v) Every container or package of table iodised salt or iron fortified common salt containing permitted anti-caking agents shall bear the following label, namely:-

TABLE IODISED SALT / TABLE IRON FORTIFIED COMMON SALT* CONTAINS PERMITTED ANTICAKING AGENT
* Strike out whichever is not applicable.

b) in sub-rule (zzz), after cause (10), the following clause shall be inserted, namely:-

"11) Every container or package of common salt shall bear the following label, namely:-

COMMON SALT FOR IODISATION/IRON FORTIFICATION/ANIMAL USE/PRESERVATION/MEDICINE/INDUSTRIAL USE*
* Strike out whichever is not applicable."

ii) after rule 44F, the folowing rule shall be inserted, namely:-

"44G. Registration on sale of common salt - No person shall, sell or offer or expose for sale or have in his premises for the purpose of sale, common salt for direct human consumption unless the same is iodised.

Provided that common salt may be sold or exposed for sale or stored for sale for iodisation, iron fortification, animal use, preservation, manufacturing medicines, and industrial use under proper label declarations as specified under clause (11) of sub-rule (zzz) of rule 42."

iii) in rule 49 of the said rule, in sub-rule (10), for the words "Table salt or iron fortified common salt", the words "Table iodised salt or table iron fortified common salt" shall be substituted.

Iodine is an essential requirement of the body. It is normally available from natural food items that are grown on iodine rich soils.
However, in certain areas of the world, as a result of glaciation and due to repeated flooding; rivers changing their course over a period of time, there is leaching of iodine from soil. The food crops grown on such soil are deficient in iodine thereby leading to iodine deficiency.
Further, iodine rich foods are not commonly consumed as there are very few such food items. Hence, it is essential that some food item which consumed by one and all and in more or less fixed quantity has to be fortified with iodine. In this regard, in developing countries salt is the most suitable vehicle for iodine fortification. This mode of fortification has been effectively used and continues to be used NOT ONLY in many developing countries but also in many industrialized countries.

The iodisation of salt is done by either spraying potassium iodate or potassium iodide, in certain proportions, so as to ensure a minimum of 150 micrograms of iodine per day. Both, these forms of iodine are absorbed as iodide ions and are completely bio-available.

In many countries specially industrialized ones, there is an option of buying iodised and non-iodised salt. This is possible because in these countries in addition to iodised salt, iodine is used in baking, food processing and dairy industry. Hence iodine is being supplied through bread, milk and processed food items which are widely consumed in these countries. However such a situation does not exist in several developing countries. Therefore, the use of iodised salt is the main method which has been used for providing iodine to the population in such countries. In India, if there is an option for iodised and non-iodised salt, the population is more likely to purchase and use non-iodised salt for the following reasons:
1) Iodised salt and non-iodised salt are perfectly substitutable products. The appearance, taste, colour etc. of both iodised and non-iodised salt are the same.
2) In general, iodised salt is more expensive than non-iodised salt. In India, we are still in the process of an effective information, education communication efforts regarding the benefits of iodised salt. In such a situation, consumers are likely to purchase non-iodised salt, which is cheaper, to which they have been traditionally using it for years. In general, they are also not aware of the benefits of consuming iodised salt.

No. it does not curtail i.e. this was well argued in the Hon'ble High Court of Madras and in their judgement delivered on Oct. 10, 1995. The court viewed that consumption of salt by all is the most suitable, long term and sustainable solution to prevent the wide spectrum of IDDs.

In fact all State Government have issued notifications under the provisions of prohibiting the sale of salt other than iodised salt for edible purposes in their entire state or part of their jurisdictions even before the issue of nation wide notification dated November 27, 1997. Even now, non-iodised salt can be freely sold for non-edible purposes such as industrial uses, fish-curing, hide-curing, water softening etc.

Far from truth. So far 795 salt iodisation plants with the annual capacity of 112 lakh tons project have been set up in different categories, as indicated below. - By small common salt manufacturers (upto 10 acres) = 256 - By medium common salt manufacturers (1 to 100 acres) = 87 - By other common salt manufacturers (above 100 acres) = 122 - By Traders ----------------------------------------- = 306 - By Refineries ------------------------------------- = 24 TOTAL = 795 Out of the above list there is not even a single multi-national Company. However, one multi-national company is providing marketing assistance to some salt refineries. The country is self-sufficient in common salt. Iodisation plants are fabricated indigenously. All iodine is imported. Manufacturing of KIO3 (potassium iodate) is done in India by 18 Indian firms. There is no involvement of multinational or big company among the manufacturers of potassium iodate.

Any one can put up a refinery, which requires high investment. However, all these refineries buy salt from the same small scale producers. Thus, the small producers can continue to produce iodise salt as such there is no danger of loss of income to them.

Different varieties of iodised salt present in the market are baragara salt, phoda salt, crystal salt, crushed and powered salt and refined variety salt.

The cost of iodisation is not more than 10 paise per kg. Crushing costs at 10 paise and powdering 20 paise per kg. One kg polythene pouch costs about 30-50 paise.

Not correct. There are about 1600 small producers in the organised sector and 6500 in the unorganized sector whose individual holding does not exceed 10 acres. The ban order in no way interferes with their traditional method of manufacture of salt nor with their trading practices.

No. For edible purpose, the salt is required to be iodised. Otherwise, they can sell their salt without iodisation to industries and other non-edible purposes (as they do now) such as chlor alkali industries, soaps and detergents, fish-curing, tanning, water softening etc.

An iodisation plant (Drip feed system) costs about Rs. 40,000/- A group of manufacturers can collectively make use of it, if it is costly for an individual. However, it is pertinent to note here that small producers do not normally trade themselves.It is the middlemen traders who purchase their produce and supply to wholesalers/retailers. The middlemen/traders can put up iodisation plants and iodise salt for edible purpose. However, 40 iodisation plants (each of a capacity of 15,000 tons per year) have been donated with the iodizing chemical for one year, free of cost to associations/cooperative societies of small salt producers in various states.

Far from truth; on the contrary, iodisation has created more employment opportunities towards iodisation, crushing powdering and packing of salt.

The ban notifications really helps the consumers to have access to quality iodised salt for their better health. In a number of states the people especially those below poverty line get iodised salt through public distribution system or fair price shops at a reasonable rate.

It is important to note here that one must always compare like with like. In terms of price difference, one must compare the price difference between loose common salt and loose iodised salt. Similarly one must compare packed common salt with packed iodised salt. At salt production centres, iodised salt is available in loose and crystal form at about 40 paise per kg. and crushed / powdered about Re. 1/- per one kg. Transportation charges by rail/road and whole-sailors/ retailers margin form a big share of final retail price. The retail price of iodised salt even in far flung areas are as follows:- Crystal loose : Rs. 1.50 - 2.00 Powdered/Crushed loose : Rs. 2.00 - 2.50 Powdered/Crushed packed : Rs. 2.50 - 4.00 Refined (Branded) : Rs. 5.50 & Above. Free trade is prevalent in salt marketing in the country and no body is compelled to purchase at higher prices. As stated above, iodised salt is made available at a reasonable rate through Public Distribution System (PDS) / fair price shops in several states. In any case, looking to small daily requirement of iodised salt viz 10 gm a day a monthly budget will be about Rs. 1.50/-. This is too small a price for the enormous benefit one gets in being free from IDDs. In case, there is a fear the big companies are trying to monopolies the iodised salt production and sale, this should be controlled rather than curtailing the benefits of Universal Salt Iodisation programme.

NO. Iodine and potassium iodate are totally safe in quantity consumed. Iodine is not added in elemental form for iodisation of salt. A compound of iodine is used. The chemical chosen in our country is potassium iodate (KIO3) due to its high stability in tropical weather. Its melting point is 560 C. The shelf life of packed and stored iodised salt is reported to be one year. It is has been reported that the average salt consumption in India is 10 gms per day per capita. At the salt iodisation level of 30 parts per million of KIO3, the consumption of 10 gms of iodised salt will provide maximum of 600 g of KIO3. This quantity is 50,000 times less than lethal dose low of KIO3.

A safe daily intake of iodine has been estimated to be 1000 micrograms. The daily iodine intake will be in the range of 150 to 300 g of Iodine. This iodine intake is 3 to 6 times less than the safe upper limit of iodine intake. Thus consumption of iodised salt is NOT harmful. It is totally safe. About 90% of iodine is eventually excreted in the urine. The median urinary iodine concentration in casual samples, expressed as micrograms per liter (g/L), is currently the most practical biochemical laboratory marker of community iodine nutrition. It is more useful and much simpler than measuring 24-h samples of calculating urinary iodine/creatinine ratios. Recommendations by the International Council for the Control of Iodine Deficiency Disorders, WHO, and UNICEF (4) set 100 g/L as the minimal urinary iodine concentration for iodine sufficiency; this figure corresponds roughly to a daily intake of 150 g iodine. The upper limit for safe iodine intake is uncertain and varies widely among individuals and populations, as discussed below. Intakes up to 1 mg iodine per day are safe for most people, and much higher amounts are usually tolerated without problem.

No. To date, there has been no report of allergy to iodine when it is consumed in food products. In response to general appeal in the Annals of Allergy in 1974 to report cases of allergy to iodine, no such case has ever been reported. However, Intravenous use of iodine in radiographic contrast has been occasionally reported to cause allergic reaction.

No. Only a very large dose of iodine (200 mg = 200,000 micrograms) can lead to "Iodide Goitre" and very rarely cause hypothyroidism. This is 1300 times more than the average intake of individual consuming iodised salt. Thus it is impossible to have any problem due to iodine supplementation given in salt iodisation programme.

In some countries where there was severe iodine deficiency, sudden introduction of increased quantity of iodine in daily diet of the population has led to minimal and mild increase in occurrence of thyrotoxicosis. This was observed in old people who had long history of goitre because of prolonged iodine deficiency and are now suddenly exposed to increased amount of iodine. This is called "Iodine Induced Hyperthyroidism". Usually such a condition is self limiting and not very common. One should also note that when iodine deficiency has been eliminated in the community, then over years this problem will cease to exist. There is no evidence that iodine supplementation in any way leads to increase in occurrence of thyroiditis or thyroid cancer.

Tolerance to iodine is highly variable. Most people can be exposed to large amounts without apparent problems. Important exception to this statement are preexisting iodine deficiency, autoimmune thyroid disease, and papillary cancer. In communities where recent iodine deficiency has been rapidly corrected, iodine-induced hyperthyroidism is a predictable event . It occurred in the United States in the early part of this century and is now showing up in many other countries as they become iodine sufficient. The principal victims are older subjects with autonomous nodules because they are unable to regulate the newly available iodine properly, and instead produce excessive thyroid hormone. The frequency and complications of iodine-induced hyperthyroidism are heightened by poor monitoring of salt iodine concentration, which permits high and uneven rations of iodine, and also by inadequate medical attention, which delays diagnosis and treatment. Without trivializing its seriousness, most observers agree that the risk of iodine-induced hyperthyroidism should not obscure the many benefits that iodine sufficiency has for women and children, and should not slow the pace toward proper correction of the deficiency in a community.

Iodine intake appears causally related to autoimmune thyroid disease. Injection of thyroglobulin into experimental animals induces a thyroiditis similar to human autoimmune thyroiditis, and the immunological response is more vigorous with iodine-rich thyroglobulin. Administration of iodine to goitrous humans provoked a reversible thyroiditis and antibody elevation in some . Epidemiological studies have shown that an increased incidence of autoimmune thyroid disease frequently parallels an increased dietary iodine intake.

The cost of salt iodisation is approximately 5 US cents per person per year - less than the price of a cup of tea. Using the most conservative estimates, the cost benefit ratio of IDD elimination programmes is 1:3. If benefits related to education and livestock populations are included, the ratio would be 1:8. Thus, IDD elimination programmes provide a convincing opportunity of a worthwhile investment in improving the health and nutrition of populations.

Almost one third of the world's population lives in areas of iodine deficiency and risks these consequences. Most of these people are in developing countries, but many in the large industrialized countries of Europe are also affected. Correcting this public health problem is the goal of a massive global campaign that is showing remarkable progress so far.

Like all health problems, we can learn from the history of IDD elimination in other countries. In the 1950s, Guatemala had severe iodine deficiency. Then the country developed a model salt iodization program and by 1972 could claim the eradication of endemic goiter. Following that, the program lapsed, monitoring of iodized salt became lax, and endemic goiter reappeared (19). Similar failures of initially successful programs occurred in Colombia, Thailand, and Mexico. In each, the problem could have been avoided by appropriate monitoring. Many previously deficient countries are now reaching iodine sufficiency, certainly a major achievement, but most still have weak or nonexistent plans for long-range monitoring. In others, e.g. the United Kingdom, iodine sufficiency has been achieved by silent prophylaxis, under circumstances somewhat similar to those in the United States but without iodized salt. Both countries lack any regular monitoring system, and thus can fail to recognize suboptimal iodine nutrition, either too much or too little.

There are areas where consumption of goitrogen in staple diet like cassava affects the proper utilization of iodine by the thyroid gland. For example, in Congo, Africa, as a result of cassava diets, there is an overload of thiocyanate. To overcome this problem, appropriate increase in the salt iodisation levels are required so as to ensure the recommended dietary intake.

Iodine loss occurs due to improper packaging, humid and moist conditions and transport in open trucks and railway wagons exposed to sun-light. In order to compensate for these losses; at the iodised salt production level, higher levels of iodine are used. There are losses of iodine during cooking process varying from 20% to 40%, depending on the type of cooking used39.

Iodine is essential for the normal growth, development and functioning of both the brain and body. Lack of iodine can cause iodine deficiency disorders. Iodine is particularly essential during early childhood, puberty, pregnancy and lactation. A woman who has deficient iodine nutriture is likely to produce a child with compromised physical and mental development. If left untreated, the child's mental and physical health can worsen as he grows older.

Iodine has relatively wide margin of safety. Acute and chronic toxicity studies with sodium iodate have been carried out. Results of these long-term experiments of administration to man and to animal of doses comparable to those which would be used in prophylaxis programme have failed to produce any toxic signs.

It is wrongly believed that all sea foods are rich in iodine. It is also wrong to say that salt made from sea water is rich in iodine. All sea animals do not have the ability to concentrate iodine. Only sea weeds located near coral reef have the inherent biological ability to concentrate iodine. The reef fish which feed on these sea weeds are rich source of iodine as compared to the deep sea water fish. In fish, thyroid gland is located in the head, which is rich in iodine as compared to the rest of the parts of the fish. The consumption of fish after cutting the head does not therefore supply enough iodine (The head of the fish is usually not consumed by people).

No, cretinism is permanent and incurable. It cannot be cured but it can be easily prevented by regular consumption of iodised salt by pregnant mothers.

No. Iodine deficiency is widely prevalent not only in hilly regions but also in the plains and even ocastal areas or our country. Surveys conducted by the Government of India and other national institutions indicate that no state is free from iodine deficiency (Please see Table I). Of the 275 districts surveyed till date, 235 have been found to be endemic for iodine deficiency.

Our body needs only a small amount of iodine to function normally. If this iodine is available through food to the body, additional quantities consumed will be excreted along with urine. About 90% of iodine consumed is eventually excreted in the urine.

A safe daily intake of iodine has been estiamted to be 1000 micrograms. When iodised salt is consumed the daily iodine intake will be in the range of 150 to 300 g of iodine. This quantity of iodine intake is 6 to 3 times less than the safe upper limit of iodine intake. About 90% of iodine consumed is eventually excreted in the urine.

No. To date, there has been no report of allergy to iodine when it is consumed is physiological levels. In response to general appeal in the Annals of Allergy in 1974 to report cases of allergy to iodine, no case have ever been reported.

No, only a very large dose of iodine 2,00,000 micrograms can lead to "Iodide Goitre" and very rarely cause hypothyroidism. This is 1300 times more than the average intake of an individual consuming iodised salt.

It is important to nate here that one must always compare like with like. In terms of price difference, one must compare the price difference between loose common salt and loose iodised salt. Similarly one must compare packed common salt with packed iodised salt. At salt production centres, iodised salt is available in loose crystal form at about 45 paise per kg. and powdered iodised salt at about Rs.1/- per kg. Transportation charges by rail/road and whole sellers/retailers margin form a big share in deciding the final retail prices. The retail prices of iodised salt per kg even in remotest areas of the country are as follows:- Crystal iodised salt loose Rs. 1.50-2.00 Powdered iodised salt loose Rs. 2.00-2.50 Powdered iodised salt packed Rs. 2.50-4.00 Refined iodised salt (Branded) Rs. 5.50 & Above Only a samll quantity of iodised salt is required daily viz. 10 g per day (300 g/person/month i.e. 1.5 kg for a family of 5 members). The monthly expenditure of a family of 5 persons will be about Rs. 3/- to 6/-. This is a small price for the enormous benefits a family gets from being free from IDD.

The additional expenditure of iodine in salt iodization is 4.5 to 5 paise per kg. Other expenses like power, labour etc., work out to 5 paise per kg. Thus, if common salt is iodised in the crystal form i.e., without curshing or powdering and sold in loose, the price would increase only by about 10 paise per kg. Cost of Salt Rs. 350/- per M.T.* Cost of Iodisation Rs. 100/- per M.T. Cost of bags Rs. 150/- per M.T. Freight Rs. 450/- per M.T. Total Rs. 1050/- per M.T. OR Rs. 1.05 per kg. *MT : Metric Tonnes

No. There are about 1600 small producers in the organised sector and 6500 in the unorganized sector whose individual holding does not exceed 10 acres. The ban order does not in any way interfere with their traditional method of manufacture of salt or with their trading practices.

No, Iodisation of salt has created more employment opportunities by employing people in process of iodisation, crushing, powdering and packing of salt.

In India as on 31st March, 1998, there are 809 salt iodisation plants with the annual capacity of producing 115 lakh tonnes of salt. The details of them are as follows:- Small common salt manufacturers = 256 (upto 10 acres) Medium common salt manufacturers = 87 (10 to 100 acres) Other common salt manufacturers = 122 (above 100 acres) Traders = 320 Refineries = 24 Total = 809 There is not even a single multinational Company in salt production. However, one multi national company is providing marketing assistance to some salt refineries. The country is self sufficient in production of common salt. Iodisation plants are also fabricated indigenously.

Using a field kit, level of iodine in salt could be checked. A drop of test solution when added to iodised salt turns it blue. Depending on the intensity of colour, using the colour comparision chart given on the kit, the approximate range of iodine could be found out.