AGRA || Is universal iodization of salt be the chief cause of hypertension assuming epidemic proportion? A recent study by retired Col Dr Rajesh Chauhan, (Kargil war hero), appears to indicate a strong possibility of a link between hypertension and iodine in the common salt. His book on the subject has been published by Lap Lambert Berlin, Germany.
Chauhan said “this study was carried out in Agra Region on the incidence of hypertension in the geriatric age group. The study had included patients who were consuming iodized salt regularly and was compared with another group who were not using packaged iodized salt but were using pebble salt, which is also iodized but the iodide content is washed off in running water before use thereby minimising or avoiding iodides in the salt. Results indicated that the people who were consuming iodized salt were far more at risk for suffering from high blood pressure than the ones who were using pebble salt which was washed before use.”
Chauhan clarified that Iodine supplementation was required in certain specified geographical areas around the world. These areas are generally well recognized. For instance, the Himalayan belt which includes Nepal, Bhutan, and many states of India; the Andes region, etc, have a deficiency of iodine. It is in these areas that supplemental iodine is required to control goitre, which is a condition related to a deficiency of iodine.
Here in India, the Union Government accepted the recommendations of the Working Group and Study Group, and on the advice of the Central Council of Health in 1984 took a historic decision to iodize the entire edible salt in a phased manner by 1992 and included this in the Seventh Five Year Plan (1985-1990) of Government of India.
It was also included in the 20 Point Programme announced in 1986. In order to control iodine deficiency disorders around the world, the WHO had issued a statement on August 1994 which had stressed upon universal salt iodization is the principal public health measure for eliminating IDD (Iodine Deficient Disorders).
India has been using iodized salt, irrespective of the fact whether the region is actually deficient of iodine or not. WHO has also stated unequivocally that, “Monitoring of sodium (salt) intake and iodine intake at country level is needed to adjust salt iodization over time as necessary, depending on observed salt intake in the population, to ensure that individuals consume sufficient iodine despite the reduction of salt intake”. They have gone on to say that, “The concentrations of iodine may need to be adjusted by national authorities responsible for the implementation and monitoring of universal salt iodization, in light of their own data regarding dietary salt intake”.
Chauhan said India had perhaps failed to monitor the consequences. “In my book, and from the references that I have used therein taken from the domain of the British Medical Journal, we have raised the possibility of a global rise in the incidence and prevalence of hypertension, possibly due to regular consumption in the diet of only the iodized salt. This excess consumption of iodine can also perhaps cause various forms of rhythm disturbances in the heart, especially tachycardia, and also precipitating angina and heart failure. Whereas in children who suffer from a deficiency in iodine, a condition called Cretinism is usually more likely, wherein the suffering child is lazy, crying, potbelly, with intellect problem of varying grades.”
On the other hand, we suppose that this iodine excess through universal salt iodization could be causing ‘attention deficit hyperactivity disorder’ (ADHD) in children, which could be representing the other end of the spectrum. The incidence of ADHD is on the rise, and it is a global trend. There could be more problems like the rising incidence of hypertension in pregnancy, seizures in pregnancy especially eclampsia, and in pre-term delivery as well.
Obviously, there is a lot of scope for further research on the subject. In view of the rising incidence of hypertension in our population research should clear our doubts and establish that continued iodine use was safe for everyone.
Surely more research is required, and which must include the overarching necessity of continuing with enforcing consumption of iodized salt even in such regions as the Agra region which, unlike the Himalayan belt, is not deficient in iodine.
Immediate corrective steps are needed at national and global levels, and supplemental iodine to be used only in areas which are deficient in iodine. More importantly, non-iodized salt must also be made available in the market, which has been missing from the shelves for the past two decades and more.