Re: Hypothyroidism is still prevalent in India despite promotion of iodised salt, study shows
Dear Editor,
Lack of iodine does have its effect, and therefore supplementation of salt with iodine as a prophylaxis is a justified practice, but then only in iodine deficient areas of India. That said, what is actually happening on ground is the provision of iodine supplemented dietary salt for all over India, whether or not a deficiency of iodine actually exists everywhere.
We have so far failed to take notice that an excess of iodine could also have a deleterious effect on the health in so many ways. Just a little excess in thyroid hormone levels may produce unwanted effects. Now this does not mean that everyone who is consuming excess of unwarranted iodine supplemented dietary salt would manifest with overt signs and symptoms of thyrotoxicosis. But if the population that is not living in a geographically defined iodine deficiency areas, and is continuously exposed to iodine supplemented dietary salt, then there possibly would be more chances of unexplained problems in that general population due to excess of iodine. We had said that in our earlier write up to you in May 2013 on this subject [1].
We do think that many cases of ‘essential’ hypertension (in non-iodine deficient areas) could possibly be a result of this unnecessary use of fortified common salt with iodine. In such non-iodine deficient areas that are perpetually been subjected to excess of supplemental iodine, there could also be a higher incidence of rapid heart rates (just short of being labelled as tachycardia), and higher incidences of arrhythmias, etc. While Cretinism is a known complication of hypothyroidism, related to iodine deficiency, we do think that conversely an excess of iodine sourced through fortification of dietary salt with iodine thus provided to expectant mothers who are not staying at places with iodine deficiency, could possibly be playing up someway or be causing or leading to ADHD (attention deficit hyperactivity disorder).
Possibly it is the time to dig deeper into related medical issues that might be an inadvertent result of continued and unnecessary exposure to excess of iodine, through fortification of common salt with iodine. We assume that almost to a tune of roughly 60% of population THAT IS NOT LIVING IN IODINE DEFICIENT GEOGRAPHICAL REGIONS OF INDIA continues to consume iodine supplemented common salt. Probably the Government of India should take a notice of these possibilities of excess of iodine being unnecessarily provided to the population who are NOT residents of iodine deficient regions, and who do not have any medical reason of consuming fortified salt with iodine. At least they should order, suggest and advocate use of just normal dietary salt in non-endemic areas of goiter, and especially if they have 'essential hypertension' where accompanying hypothyroidism has been excluded. At least the Government of India should insist that a regular dietary salt, which is not fortified with iodine, be also made available as an informed choice with immediate effect to the population that is NOT living in iodine deficient areas. This will also save the exchequer from unnecessary waste of money in iodinization of salt for the population that does not require such fortification, and this in turn could also rein in unnecessary epidemic of essential hypertension, ADHD, and other such medical issues that could be a result of excess of iodine.
In other regions of the world, wherever iodinization of salt is being practiced, possibly it does call in for a thorough review, and see if there are any excess cases of such illnesses that could be attributed to iodine excess and consequently to the thyroid issues that may be thrown up as its unwarranted consequence. Shouldn't we therefore start providing an informed choice to consumers staying in non-goitre regions of our country, as also in many other parts of the world, or is it that we continue to find just iodized salt across the board, whether one really requires it or not?
Best regards.
Reference:
1. Parihar AKS, Chauhan S, Chauhan R. Could an unbridled use of ‘IODIZED SALT’ have any direct or indirect role in increased incidence of HYPERTENSION, CONDUCTION DEFECTS, THYROID ISSUES, OBESITY, ADHD, etc . BMJ 22 May 2013. http://www.bmj.com/content/344/bmj.d7541/rr/646735 (Accessed on 01 Jan 2014)
Competing interests:
Had been the first to point out, on 22 May 2013 here in BMJ, that wide spread and unchecked dietary supplementation of iodine in INDIA may possibly be leading to some adverse consequences, which might be passing off unnoticed.
02 January 2014
Dr (Lt Col) Rajesh Chauhan
Consultant Family Medicine & Hon' National Professor (IMA CGP)
Dr. Ajay Kumar Singh Parihar; Dr. Shruti Chauhan; Sandeepa Chauhan; Shivendra Pratap Singh Chauhan.
Family Healthcare Centre, Agra, INDIA.
Family Healthcare Centre, 154 Sector 6 - B, Awas Vikas Colony, Sikandra, AGRA -282007. INDIA.
Rapid Response:
Re: Hypothyroidism is still prevalent in India despite promotion of iodised salt, study shows
Dear Editor,
Lack of iodine does have its effect, and therefore supplementation of salt with iodine as a prophylaxis is a justified practice, but then only in iodine deficient areas of India. That said, what is actually happening on ground is the provision of iodine supplemented dietary salt for all over India, whether or not a deficiency of iodine actually exists everywhere.
We have so far failed to take notice that an excess of iodine could also have a deleterious effect on the health in so many ways. Just a little excess in thyroid hormone levels may produce unwanted effects. Now this does not mean that everyone who is consuming excess of unwarranted iodine supplemented dietary salt would manifest with overt signs and symptoms of thyrotoxicosis. But if the population that is not living in a geographically defined iodine deficiency areas, and is continuously exposed to iodine supplemented dietary salt, then there possibly would be more chances of unexplained problems in that general population due to excess of iodine. We had said that in our earlier write up to you in May 2013 on this subject [1].
We do think that many cases of ‘essential’ hypertension (in non-iodine deficient areas) could possibly be a result of this unnecessary use of fortified common salt with iodine. In such non-iodine deficient areas that are perpetually been subjected to excess of supplemental iodine, there could also be a higher incidence of rapid heart rates (just short of being labelled as tachycardia), and higher incidences of arrhythmias, etc. While Cretinism is a known complication of hypothyroidism, related to iodine deficiency, we do think that conversely an excess of iodine sourced through fortification of dietary salt with iodine thus provided to expectant mothers who are not staying at places with iodine deficiency, could possibly be playing up someway or be causing or leading to ADHD (attention deficit hyperactivity disorder).
Possibly it is the time to dig deeper into related medical issues that might be an inadvertent result of continued and unnecessary exposure to excess of iodine, through fortification of common salt with iodine. We assume that almost to a tune of roughly 60% of population THAT IS NOT LIVING IN IODINE DEFICIENT GEOGRAPHICAL REGIONS OF INDIA continues to consume iodine supplemented common salt. Probably the Government of India should take a notice of these possibilities of excess of iodine being unnecessarily provided to the population who are NOT residents of iodine deficient regions, and who do not have any medical reason of consuming fortified salt with iodine. At least they should order, suggest and advocate use of just normal dietary salt in non-endemic areas of goiter, and especially if they have 'essential hypertension' where accompanying hypothyroidism has been excluded. At least the Government of India should insist that a regular dietary salt, which is not fortified with iodine, be also made available as an informed choice with immediate effect to the population that is NOT living in iodine deficient areas. This will also save the exchequer from unnecessary waste of money in iodinization of salt for the population that does not require such fortification, and this in turn could also rein in unnecessary epidemic of essential hypertension, ADHD, and other such medical issues that could be a result of excess of iodine.
In other regions of the world, wherever iodinization of salt is being practiced, possibly it does call in for a thorough review, and see if there are any excess cases of such illnesses that could be attributed to iodine excess and consequently to the thyroid issues that may be thrown up as its unwarranted consequence. Shouldn't we therefore start providing an informed choice to consumers staying in non-goitre regions of our country, as also in many other parts of the world, or is it that we continue to find just iodized salt across the board, whether one really requires it or not?
Best regards.
Reference:
1. Parihar AKS, Chauhan S, Chauhan R. Could an unbridled use of ‘IODIZED SALT’ have any direct or indirect role in increased incidence of HYPERTENSION, CONDUCTION DEFECTS, THYROID ISSUES, OBESITY, ADHD, etc . BMJ 22 May 2013. http://www.bmj.com/content/344/bmj.d7541/rr/646735 (Accessed on 01 Jan 2014)
Competing interests: Had been the first to point out, on 22 May 2013 here in BMJ, that wide spread and unchecked dietary supplementation of iodine in INDIA may possibly be leading to some adverse consequences, which might be passing off unnoticed.