The Russian Ministry of Health has once again stated that it continues to work on the bill on mandatory iodization of edible salt. The idea of salt iodization is not new. The developed countries have long been on this path as a way to solve the problem of iodine deficiency.
The bill on the universal salt iodization has been sent several times to the State Duma, but each time it was rejected. Whose interests are the deputies lobbying for? And who will win this time?
Shameful third place
Iodine deficiency diseases are the most important problem of our time. In 1993, uncompensated iodine deficiency was recorded in 110 countries.
According to the WHO, people living in conditions of uncompensated iodine deficiency have lower IQ by an average of
“Eliminating iodine deficiency will be the same triumph of healthcare as eradicating smallpox or polio,” the WHO announced in 1999. 17 years have passed since then. In the meanwhile, the number of countries with uncompensated iodine deficiency has halved. And yet, the problem still exists in 31 countries of the world. The International Council for Control of Iodine Deficiency Disorders (ICCIDD) periodically publishes data on the prevalence of iodine deficiency and makes a rating of top-10 countries with the highest iodine deficiency. Ethiopia is in first place in this ranking, Sudan is the second. Russia takes a sad third place in this rating, followed by Afghanistan and Algeria. Our neighbors in this top-10 are mainly African countries, which, like us, do not have proper legislation in place for the prevention of iodine deficiency diseases.
The iodine deficiency has been practically eliminated in all the CIS countries, even those that are much poorer than Russia, simply due to a primitive iodine spraying used during salt production. Of all the countries of the former Soviet Union, only Russia and Ukraine do not currently have legislative regulation of the problem of iodine deficiency.
Soviet approach
Since the territory of former USSR was considered an iodine-deficient region, the problem of iodine-associated diseases was very acute. Endocrine surgeons had to perform numerous operations on endemic goiters which sometimes reached monstrous sizes — some patients had to carry them in front of them on a cart. However, it is unsafe to surgically remove goiter (an enlarged thyroid gland) as a person may become voiceless. In addition, after removal of the thyroid gland, the patient has to take hormonal drugs for life.
Back in the early 1930s, a famous endocrine surgeon, academician O.V. Nikolaev suggested an integrated approach to solving the problem of iodine deficiency. The suggested strategy included salt iodization for retail and a general shift to edible iodized salt. A domestic iodine-containing drug was created — antistrumin, which was given to pregnant and nursing women as well as children in kindergartens and in schools and adolescents. Anti-goitrogenic dispensaries were established for mass examination and active treatment of the population.
In
21st century Russia
With the collapse of the Soviet Union and the cessation of preventive strategies, the problem of iodine deficiency in Russia has again become acute. According to massive epidemiological studies conducted by the Endocrinological Research Center, which was headed by Academician I.I. Dedov, an uncompensated iodine deficiency has been recorded in our country. On average, Russians consume 80 mcg per litre of iodine versus the norm of at least 100 mcg per litre. The proportion of schoolchildren with goiter is 20% versus the norm of 5%. Iodized salt in the country is consumed by no more than 30% of the population compared to the norm of 90%. Surgical departments of hospitals are again filled with patients with thyroid gland nodules and endemic goiters. Ultrasound diagnostics of the thyroid gland included in the children’s medical examination is again revealing pathologies associated with iodine deficiency.
Iodine deficiency primarily affects the most vulnerable groups of the population: children, pregnant and lactating women. And here’s why. Iodine is an integral part of the thyroid hormones which impact the formation of the central nervous system in babies during the prenatal period. If a woman experiences iodine deficiency during pregnancy, the baby does not receive the required amount of iodine and is born mentally impaired. Due to the lack this simple trace element and deficiency of the thyroid hormone in the body of a pregnant woman, what was supposed to be realized does not realize, i.e. the full intellect potential of her yet unborn child, which cannot be restored later on.
Cretinism cases are being registered in Russia nowadays. Congenital iodine deficiency syndrome (cretinism) has been recorded in 7,911 people. WHO delegations visiting Russia are shocked at the sight of children with cretinism caused by iodine deficiency. Many have never seen this before, only in medical books.
Latent hunger
Iodine deficiency is called latent hunger because it is asymptomatic during a long time. The effects of iodine deficiency are like an iceberg. Visible disorders (goiter, cretinism) reflect only a smaller part of the pathology, and most of the problems are hidden. Depending on the region, cretinism makes up only
Moreover, a lack of iodine in the body provokes an increased uptake of radioactive iodine during nuclear accidents, which entails an increase in thyroid cancer, primarily in children, as demonstrated by the Chernobyl accident.
In older people, iodine deficiency leads to the development of thyroid diseases: endemic goiter and thyroid nodules.
According to the 2014 data provided by the Russian State Statistics Service, 3,878,000 adult Russians and 217,000 children seek specialized endocrinological help every year. The cause of 90% of thyroid diseases is iodine deficiency. That is, 90% of people suffering from thyroid diseases could have them had prevented had appropriate legislation be in place.
And nothing has changed...
To date, the main regulatory document determining the iodine deficiency prevention strategy remains the Government’s Decree No. 1119 of 1999 “On measures for the prevention of diseases associated with iodine deficiency”, signed by President Putin. This document dwells on the need to take measures to saturate the food market with edible iodized salt. This is followed by a series of decisions of the Surgeon General and regional prevention strategies, but the law on universal salt iodization has not yet been adopted so far.
WHO experts have done a lot of research and found that the most effective and cheapest way to prevent thyroid disease is salt iodization. No one would be taking pills every day of their life. Moreover, it is hundreds of times more expensive than the consumption of iodized salt. Today, the whole world follows this path, but not Russia.
The question of salt iodization has been raised many times. Doctors, healthcare officials say this, even salt producers agree. The law on salt iodization was discussed several times in the State Duma, but the deputies stubbornly do not accept it, citing some far-fetched arguments. They usually speak of a violation of democracy: a person has the right to choose which salt to buy — iodized or not.
The food industry stood up against the new legislation. Cheese and sausage manufacturers said that the appearance of iodized salt in their recipes will increase their costs, and their products will deteriorate from iodine. Although global experience suggests otherwise. Switzerland was one of the first countries to eradicate iodine deficiency, and at the same time, it is the homeland of some the finest cheeses. All European countries that have long solved the problem of iodine deficiency manufacture excellent sausages.
Another argument of the meat manufacturers was that the use of iodized salt would kill the export of Russian meat products to other Eurasian Customs Union countries, where it is forbidden to use iodized salt in food production. However, our partners in the Eurasian Economic Union — Belarus and Kazakhstan — have legislatively established mandatory use of iodized salt in the production of mass varieties of bread, and in retail. Therefore, the problem of iodine deficiency has been successfully handled in these two countries.
Unrealized intelligence
According to WHO standards, in order to maintain the health and intellectual well-being, newborns need to consume 90 micrograms (mcg) of iodine per day, children under 12 years of age — 120 mcg, adults — at least 150 mcg, pregnant and lactating women — 250 mcg, and the elderly — 100 mcg. 1 microgram is a one millionth of a gram. These are tiny quantities, but the residents of our country cannot receive them with water or food, therefore the health and intelligence of the nation suffers.
Iodized salt is a reliable and effective prevention of the problems associated with iodine deficiency. This is a cheap and safe method that has proven itself in most countries of the world.
If the legislation on universal salt iodization is adopted in Russia, endemic cretinism will be completely eradicated, the incidence of goiter will be significantly reduced, thyroid gland operations will be largely decreased, and most importantly, the intellectual potential of future generations will be preserved.
Iodine Deficiency in Russia: Food Industry Versus Doctors
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