“Iodine Deficiency in Pakistan Rumours, Truth & Reality About Iodized Salt”

Dr. Faisal Khan
MBBS, SMLE, MPH, MCPS, MRCPCH-UK (Scholar), Al-Dar Hospital Madina Munawara, Saudi Arabia

Iodine deficiency is still a considerable health issue in Pakistan even after decades of efforts to address the problem. Iodine is a most essential trace mineral, which required for the production of thyroid hormone. Iodine deficiency may result in goiter, swelling in the neck, hypothyroidism, unexpected weight gain, fatigue, weakness, dizziness, hair loss, dry flaky skin, miscarriage, stillbirth, congenital anomalies, infant and neonatal mortality, and impaired mental and physical growth.

Adequate thyroid hormone is very essential and critically important for normal growth and neurodevelopment in fetal life, infancy and childhood. iodine deficiency is considered the major leading preventable cause of intellectual deficits. In Pakistan more than one third of population remain at risk for iodine deficiency specially in mountainous areas, including upper Punjab, all rural areas of Khyber PakhtunKhwa, Naran, Kaghan, Balakot, Hazara, Wazirastan, Kashmir and northern areas of Pakistan.

First time in 1908 northern Punjab and hilly areas of KPK marked as iodine deficit areas, where a high goiter prevalence and iodine deficiency has been reported significantly.  In Pakistan children and women in pregnancy are considered as the most affected group for iodine deficiency because more iodine is needed throughout growing age and during pregnancy. Pakistan formally adopted the universal salt iodization programme in 1994.

These efforts resulted in a decline of iodine deficiency, but still Pakistan is struggling to deal with this important health issue. The major reasons for this are lack of proper planning, low health budget, lack of political will, lack of monitoring system, lack of public awareness and as well as myths regarding iodized salt.

As a medical professional I always try to educate my patients about the importance of iodized salt. There is a need to create awareness in our society regarding iodine. In all rural and urban areas of Pakistan most of people ask a lot of questions about one seemingly harmless product “table salt” if it contains iodine. About 40 percent of population still reluctant to use iodized salt, they won’t allow their families to consume what they call “mixed salt,” believing it causes infertility.

“The majority amongst them are well educated businessmen and religious people. Pakistanis of all classes have been hearing about the alleged dangers of iodized salt for nearly two to three decades. Infect insufficient iodine in the diet can cause spontaneous abortion, stillbirth, goiters, mental retardation, birth defects and other developmental problems. Sure, I will blame iodine related infertility rumours in our society, at least in part, for this massive health crisis.

How did this happen? Some experts and professionals see little mystery in the evolution of what has become one of Pakistan’s more bizarre, longer running and destructive conspiracy theories. 22 years ago, well-meaning government officials launched a maternal health initiative in the face of ever-rising birth rates. To that day, people remember a slide show was displayed on official Pakistani television (PTV) at that time the nation’s only channel, that pushed prenatal care and awareness of vital nutrients.

The 2nd last slide of that slide-show promoted one element in particular: iodine. The final slide, officials of the event recall, credited the resourcefulness and initiative to the government’s department of primary health and family planning.

“There was a big communication mistake,” People thought these last two slides were purely for family-planning initiative.” After the public conflated iodine with government-enforced birth control, rumours took off about an international scheme to limit Muslim population growth in the world through iodized salt.

The falsehoods, tales and lies became especially potent in a society, which has majority of large families and where contraception use is very low. By 2001, a mere 17 percent of Pakistani households used iodized salt, UNICEF reported, compared with Bangladesh, where the consumption rate was 78 percent. As per my research as many as 30 percent of Pakistanis still won’t allow the iodized salt to reach their tables.

According to a research published recently in the Journal of Nutrition, an estimated 242 million children worldwide don’t get enough iodine, and about 30 percent of the World’s population still has insufficient and inadequate iodine intake, “despite a remarkable progress done to create awareness about the importance of iodine.” From 2003 to 2011, the number of countries rated iodine-deficient dropped from 54 to 32.

Pakistan’s health crisis regarding iodine deficiency isn’t just the fault of rumours, the country’s soil is already deficient in iodine because of flooding and erosion. In areas where there is little iodine in the diet, typically remote inland mountainous areas, arid and semi-arid areas, where no marine foods are eaten, iodine deficiency gives rise to hypothyroidism, signs & symptoms of which are extreme fatigue, dizziness, goiter, mental slowing, depression, weight gain, and low basal body temperatures.

As a researcher and scholar, I would like to mention few common signs and symptoms of iodine deficiency. Swelling in the front portion of the neck is the most common sign of an iodine deficiency. This is called a goiter and it happens when the thyroid gland grows too big. The thyroid gland is a small, butterfly-shaped gland in the front of neck.

It produces thyroid hormones upon receiving signals from the thyroid-stimulating hormone (TSH). When blood levels of TSH increase, the thyroid gland uses iodine to produce thyroid hormones. However, when body is low in iodine, it can’t make enough of them. To compensate and reimburse, the thyroid gland works more harder to try to produce more. This causes the cells of thyroid gland to multiply and grow, eventually this situation leads to a goiter.

Surprizing weight gain and unexpected obesity is another sign of an iodine deficiency. Low iodine level is a major cause to make slow metabolism and encourage food to be stored as fat, rather than be burned as energy. This may lead to weight gain. Fatigue, tiredness and weakness are also a very common symptoms of an iodine deficiency. Low iodine levels may leave an individual feeling tired, sluggish and weak.

This is because body needs the mineral to make energy. Thyroid hormones help also control the growth of hair follicles. When thyroid hormone levels are low, hair follicles may stop regenerating. Over time, this may result in hair loss. Dry, flaky skin may occur with an iodine deficiency, as the mineral helps our skin cells regenerate. It also helps body sweat and hydrates skin cells, so an iodine deficiency can cause an individual to sweat less.

Sensation of cold is a common sign of an iodine deficiency. In fact, some research and studies have found that more than 80% of people with low thyroid hormone levels may feel more sensitive to cold temperatures than usual. Since iodine is used to make thyroid hormones, so low levels of it may leave the patient feeling colder than usual. An iodine deficiency may slow our heart rate, which may leave us feeling weak, fatigued, dizzy and at risk of fainting.

An iodine deficiency also may affect our ability to learn and remember. A study over 1,000 adults found that those with higher thyroid hormone levels performed more better on learning and memory tests, compared to those with lower thyroid hormone levels. Infect an iodine deficiency at any age may cause us to struggle to learn and remember things. One most possible cause for this might be an underdeveloped brain.

iodine deficiency also may affect our ability to learn and remember. A study over 1,000 adults found that those with higher thyroid hormone levels performed more better on learning and memory tests, compared to those with lower thyroid hormone levels. Infect an iodine deficiency at any age may cause us to struggle to learn and remember things. One most possible cause for this might be an underdeveloped brain.

Pregnant women are at a higher risk of having iodine deficiency. This is because they need to use enough to meet their own daily requirements, as well as the needs of their growing baby. The increased need for iodine continues throughout lactation period, as babies receive iodine through breast milk. Not using enough iodine throughout pregnancy period and lactation may some cause side effects for both the mother and baby.

Mothers may suffer from signs and symptoms of an underactive thyroid, such as a goiter, weakness, fatigue and feeling cold. Moreover, severe iodine deficiency may increase the risk of stillbirth. Using enough iodine is more important for pregnant and breastfeeding women, as they have higher needs. An iodine deficiency may cause severe side effects, especially for growing kids and babies, such as stunted physical growth and mental retardation.

Heavy bleeding and irregular menstruation cycles may occur as a result of an iodine deficiency. Like other most symptoms of iodine deficiency, this is also related to low levels of thyroid hormones. In one research, 68% of women with low thyroid hormone levels suffered from irregular menstrual cycles, compared to only 12% of healthy women.

Research also shows that women with low thyroid hormone levels experience more frequent menstrual cycles with heavy bleeding. This is due to low thyroid hormone levels disrupt the signals of hormones that are involved with menstrual cycle. It is strongly recommended that if someone have above discussed symptoms of iodine deficiency, it’s best to talk to a doctor. They will check for visible and noticeable signs of iodine deficiency, like a goiter, or take a urine sample.

We should keep in mind that there are very few good sources of iodine in our routine diet. This is the basic and major cause why iodine deficiency is most common worldwide. The recommended daily intake is 150 mcg (micrograms) per day. This quantity should meet the needs of 97 to 98 percent of all healthy adult population.

However, breastfeeding or pregnant women need more iodine intake. Pregnant women need daily 220 mcg, while breastfeeding women need 290 mcg per day. Smaller amounts of this iodized minerals are found in a variety of foods like fish, shellfish, beef, chicken, lima and pinto beans, milk, yogurt and other dairy products.

The best way to get enough iodine is to add iodized salt to our meals. To avoid an iodine deficiency, half a teaspoon (3 grams) of iodized salt over the course of the day is enough in our food.