Russia: Cretinism Returns

Worth More Than Its Salt

Many people today know that iodine deficiency negatively affects their cognitive abilities. But few people know that pregnant women may, unwittingly, be raising in their womb ... weak-minded children. Medicine call this condition a congenital iodine deficiency syndrome, or cretinism. But, according to Professor Ekaterina TROSHINA, deputy director of the Institute of Clinical Endocrinology, head of the Department of Therapeutic Endocrinology of the National Medical Research Center of the Russian Healthcare Ministry, member of the Russian Academy of Sciences, “all iodine deficiency-associated diseases can be prevented, unlike the damage caused by the iodine deficiency in the prenatal and early childhood periods, which is irreversible and practically not amenable to treatment and rehabilitation.”

So how to make up for the iodine deficiency among the Russian population as iodine is one of the most important trace elements for a human body? We were previously told that it is enough to use iodized salt in food. Are there any other ways? And why only Russia and Ukraine (from all countries of the former USSR) today do not have legislative regulation for the problem of iodine deficiency? Let’s try to figure it out.

According to studies conducted by the National Medical Research Center of Endocrinology of the Russian Healthcare Ministry and the International Council for the Control of Iodine Deficiency Diseases, “the prevalence of endemic goiter in Russia is between 15 and 40%. About 17% of women have disorders associated with iodine deficiency, even before pregnancy. Chronic iodine deficiency that exists throughout Russia leads to dramatic consequences: impairment of both physical and mental development among children, cretinism, thyroid disease, and infertility. Iodine deficiency increases the risk of radiation-induced thyroid diseases by a factor of hundreds.”

“The future mental development of a child directly depends on the iodine intake of its mother”

“Russia is seeing again an increase in the incidence of severe mental retardation (cretinism) associated with the prenatal iodine deficiency,” says the document of the National Medical Research Center for Endocrinology of the Russian Healthcare Ministry. “The main risk group for the development of iodine deficiency diseases includes pregnant, lactating women and children under the age of 3 years. Estimates show that about 1.5 million people in Russia may have mental retardation and related disability due to iodine deficiency in their diets.

And yet the population-based prevention of diseases associated with iodine deficiency can prevent the impairment of physical and mental development among children, eliminate disabilities associated with iodine deficiency — cretinism and mental retardation, reduce the frequency of asocial forms of deviant behavior in children due to mental impairment, significantly reduce the frequency of various thyroid diseases, many congenital malformations, miscarriage, and infant mortality. Despite these facts there is still no wide-spread, ongoing and systematic prevention campaign in the country, and the current means for prevention often do not meet international standards.

Today, less than 30% of Russians eat iodized salt with their food, in contrast to other countries of the Eurasian Customs Union, where salt iodization is introduced on mass level.”

Sad as it is...

“Indeed, iodine deficiency has serious consequences for human health,” explains our expert Ekaterina Anatolyevna Troshina. “Particular attention should be paid to the adverse effects of iodine deficiency on brain development and intelligence. According to the World Health Organization (WHO), around 50 million people in the world have severe mental impairment due to iodine deficiency. Iodine also plays a central role in the physiology of the thyroid gland, being the main component of thyroid hormones, which are important for the development of the nervous system. Especially in the prenatal period. No matter how brilliant heredity a child receives from its parents, it will not be realized due to a lack of thyroid hormones — mental development will be delayed. Therefore, the future mental development of a child directly depends on the iodine intake of its mother.”

The production of thyroid hormones during pregnancy normally increases by 30–50%, and the need for iodine increases by 1.5 times. If there are adequate amounts of the main substrate for the synthesis of thyroid hormones — iodine — the child will not have any adverse effects. But if a woman suffers from iodine deficiency, her thyroid gland, even before pregnancy, is stretching its reserve capacity to a greater or lesser extent. But even the powerful compensatory mechanisms cannot, in some cases, provide enough iodine for the production of thyroid hormones. This leads to chronic stimulation of the thyroid gland and the formation of goiter in both the mother and the fetus.

The formation of thyroid gland begins during the 3–4 weeks of fetal development but it will only begin to function in the second half of pregnancy. This suggests that the thyroid effect, which determines the formation and functioning of the most important brain functions, in the first half of the pregnancy depends entirely on the level of thyroid hormones in the mother, i.e. the functioning of her thyroid gland. The defect of maternal thyroid hormones at the fetal stage of development leads to mental and hearing impairment in the future child and its motor disorders. It is known that the psychoneurological disorders that occurred at this stage of brain development cannot be eliminated later on.

“The higher the iodine deficiency in the region, the lower the population’s intelligence coefficient (IQ)”

“The adequate intake of iodine by newborns is very important,” emphasizes our expert Ekaterina Troshina. “The high sensitivity of children to the adverse effects of iodine deficiency in the early postnatal period is due to a combination of fairly low iodine content in their thyroid gland. Since in early childhood the only food is mother’s milk, a nursing mother who lives even with slight iodine deficiency and does not receive additional iodine is unable to provide her baby with this microelement.”

Therefore, the problem of iodine deficiency (endemic) cretinism is very relevant for regions with severe iodine deficiency. Cretinism is characterized by mental impairment similar to moronity, associated with impaired brain development due to a pronounced deficiency of thyroid hormones during the prenatal period. But the adverse effects of iodine deficiency on mental development are not limited to cases of cretinism. Population of iodine-deficient areas demonstrates general mental deficiency apart from the obvious cases of cretinism.

Studies conducted in recent years in different countries of the world have shown that the average values ​​of the intelligence quotient (IQ) in people living in regions with severe iodine deficiency are 15–20% lower than those in regions without iodine deficiency. Moderate iodine deficiency is sometimes not expressed externally. Therefore, it is called “hidden”. At the same time, a number of studies suggest some important conclusions: school-age children without thyroid dysfunction who were born and lived in the regions of Europe with moderate iodine deficiency, had mild or even obvious intellectual deficit compared to children who received iodine prophylaxis and lived in populations similar in ethnic, demographic, national and socio-economic conditions. These changes have the same nature as mental impairment in case of severe iodine deficiency.

In areas with moderate and even mild iodine deficiency, a decrease in the average values ​​of the intelligence quotient is also observed in the local population. Thus, in conditions of iodine deficiency of any severity, borderline intelligence disorders become important at the population level as the entire population of an iodine-deficient region are likely to be at risk. This problem has high social and economic importance as it translates into a significant loss of educational and professional potential, the expert believes.

MK’s reference: According to the studies, about 90–95% of cases of enlarged thyroid gland (goiter) (up to 99% in children) are associated with iodine deficiency in endemic regions. The main reason is iodine deficiency. The prevalence of diffuse nontoxic goiter among schoolchildren of 8–10 years today exceeds the previous records 10 times! (Data from the Endocrinological Research Center of the Russian Ministry of Healthcare, on behalf of the Ministry of Healthcare, 2000–2014) So, what should be done in this case? The eternal Russian question. Where to get this scarce iodine? Oddly enough, the answer has long been found, and it is blatantly simple. Iodine deficiency can partially be made up for by eating food that has high concentration of iodine: fish oil (700 mcg per 100 g), cod liver (240), flounder, salmon (200), shrimps (190), cod (130), herring (90), apples (70), persimmon (30), dairy (18–20 mcg per 100 g).

How much exactly iodized salt you need?

According to experts, many iodine deficiency diseases can be prevented “by taking iodized salt and additives containing a physiological dose of potassium iodide”. Such prevention is primarily needed for people who are at the highest risk: pregnant women, nursing women, newborns and children under 3 years of age. A newborn’s thyroid gland can only produce enough iodine if it receives 15 mcg of iodine per 1 kg of body weight per day (almost twice less by the end of the first year of life); for premature babies it is 30 mcg per each kg. In general, the adequate level of iodine intake for newborns is at least 90 mcg a day, and for children older than 6 months — 110–130 mcg a day. The need for iodine decreases with age. Although children do suffer from iodine deficiency syndrome up to the age of 14 — they can develop endemic goiter, which can impair not only their intelligence, but also their hearing, nerves, etc.

MK’s reference: Today, the actual average consumption of iodine by an average Russian is still only 40–80 mcg per day, which is 3 times less than the established norm (150–250 mcg). Every year more than 1.5 million adults and 650 thousand children seek medical help with various diseases of the thyroid gland. In 65% of cases in adults and 95% in children the main cause is a lack of iodine in their diets.

So, it appears that salt iodization is a panacea for all ills associated not only with the thyroid gland, but also with the intellect of the nation. And it’s not a joke. As early as the beginning of the 1990s, the World Health Assembly adopted a resolution that reflected the extremely high medical and social significance of iodine deficiency in the nutrition of the world’s population. WHO recommended universal salt iodization as the most effective method of mass prophylaxis of iodine deficiency diseases. In 1990, at a world meeting in New York, world leaders adopted an action plan to implement the Convention on the Rights of the Child. The countries that signed and ratified the Convention, including the Russian Federation, committed themselves to eliminating the diseases associated with iodine deficiency.

Today, 95 out of 130 countries of the world where iodine deficiency was recorded have established legislation for universal (compulsory) salt iodization (including the CIS countries). But from all countries of the former USSR, only Russia and Ukraine still do not have legislative regulation for the problem of iodine deficiency. True, some regions in Russia have salt iodization strategies. But, according to the Integrated Data and Statistical System, the number of diseases associated with iodine deficiency in Russia grew from 2.2 million in 2011 to 2.5 million in 2015. More than 60% of the population live in regions with a naturally bound deficiency of this trace element. In 30 constituent entities of the Russian Federation, the incidence rate of diffuse goiter associated with iodine deficiency among the entire population is recorded at a level higher than the nation’s average.

Over the past 20 years, Russia has conducted epidemiological studies of iodine deficiency diseases the results of which indicate the need for population-based iodine prophylaxis with iodized salt. But, according to experts, such a daunting task can only be tackled on the legislative level: a proper regulation would significantly reduce the incidence of various forms of goiter, eliminate endemic cretinism, reduce the number of surgical interventions on the thyroid gland, minimize reproductive losses and the incidence of radiation-induced thyroid cancer.

Interestingly, attempts to prevent iodine deficiency with iodized salt and iodine containing drugs were first made in the USSR back in 1956. The USSR established anti-goitrogenic centers across the country, and by the end of the 70s, they reported that “the endemic cretinism was completely eliminated” then. But at the beginning of the 80s, the anti-goitrogenic centers were redesigned into endocrinological clinics, and the prevention system ceased to exist. The average prevalence of endemic and other forms of non-toxic goiter among the adult population of the Russian Federation from 2009 to 2015 amounted to 931 cases per 100,000 population (data from the Federal State Statistics Service of the Russian Federation “Data on diseases associated with micronutrient deficiency”).

MK’s reference: The most unfavorable regions in terms of iodine deficiency are: the republics of Tuva, Sakha (Yakutia), Arkhangelsk, Tyumen, Voronezh, Tambov, Bryansk and other regions — 30 in total. The annual costs of the treatment and medical and social rehabilitation alone for patients with thyroid diseases associated with iodine deficiency are at least 275 billion rubles, which is more than 5 times the cost of all prevention, diagnosis and treatment of all iodine deficiency diseases in the Russian Federation and 780 times (!) more than the cost of eliminating all iodine deficiency diseases through universal salt iodization.

As for the law that would regulate the problems of iodine prophylaxis in Russia, they have been working on it for more than ... 13 years, since 2003. In this regard, the regulatory framework includes a Government’s Decree “On measures to prevent diseases caused by iodine deficiency”, published in October 1999 (almost 20 years ago). Worse still, this is not a law.

“A state that has made a political decision to eliminate iodine deficiency diseases should ideally enforce this decision through legislation,” said our advanced expert Ekaterina Anatolyevna Troshina. “Only legislation that provides clear implementation mechanisms can protect the country’s population from the negative effects of iodine deficiency.” Think: from dementia.

Alexandra Zinovieva
mk.ru/social/health/2017/11/09/v-rossii-vnov-registriruetsya-rost-sluchaev-kretinizma.html
Newspaper headline: “Worth More Than Its Salt?”
Published in the newspaper Moskovsky Komsomolets Issue No. 27542 dated November 10, 2017