Salt & Human Health: Iodine Deficiency

Articles in the Chicago Tribune and Washington Post suggest that the World Health Organization's efforts to remain "politically correct" will be an uphill slog.

In the Sept 23 Tribune story, Julie Deardorff equates drinking increasingly-popular "nutritionally enhanced" waters which promise to deliver not only hydration but other health benefits to taking extra vitamins that "doesn't necessarily make you healthier." In fact, she says the only proven health benefit is to the profits of the beverage industry.

Whether fortified water can deliver on all those promises is still up for debate. Critics say there's no science to show enhanced water has more health benefits than less expensive tap water, while environmental organizations, religious groups and even restaurateurs argue that all bottled water -- enhanced or not -- is a wasteful and insupportable use of fossil fuels because of the costs associated with its manufacture and transportation. From a nutritional standpoint, experts maintain that it's better to get nutrients through whole foods.

She notes that

The premise behind functional water is that the public is chronically dehydrated and short on nutrients. And because it's often hard to change a person's behavior, food companies are changing the food they're eating or drinking.

And she includes fascinating quotes:

"As a nutritionist, I may not support [functional water], but as a public-health servant, I do," said Roger Clemens, the public-health specialist for the Institute of Food Technologists. "Our goal is to provide the best possible nutrition for 300 million people in the country. In this case, it may be it takes us looking at fortified water to do that."

and

"There's not a single drink out there -- from Enviga to SmartWater -- that has any proof of impact," said nutrition professor Barry Popkin, who directs the Interdisciplinary Center for Obesity at the University of North Carolina at Chapel Hill. "Just because [a nutrient] is in the product doesn't necessarily mean it will impact you or get in your body. There are all sorts of false labels promising health benefits.

The Post story, predictably, casts the issue in Inside-the-Beltway effects. Says Jane Black:

A billion-dollar battle over selling sports drinks and "enhanced" water in public schools has spilled into Congress and threatens to derail a major attempt to cut back the sale of junk food from school vending machines and snack bars.

In an attempt to limit the sale of high-calorie sodas, candy bars and other snacks in schools, Sen. Tom Harkin (D-Iowa) has introduced a bill that would have the government set new nutritional standards for the foods and drinks that schools sell to students outside cafeterias. But just what those standards should be is the issue.

Public health advocates want the standards to ban the sale of Gatorade and Powerade, which typically contain as much as two-thirds the sugar of sodas and more sodium, as well as sweetened waters such as VitaminWater and SoBe Life Water.

Sen. Harkin hopes to add his concerns into this year's Farm Bill in the form of federal standards and claims the Grocery Manufacturers (which has "historically resisted any regulation" is open to the idea. We suspect that GMA would insist on federal pre-emption; a likely deal-breaker for Harkin.

Back in Geneva, WHO may be scratching their collective heads wondering how they ever got crosswise to their normal bedfellows who are taking stronger and stronger exception to the notion that beverages be considered a significant nutrient source. So, whether the drinking water is "artesian water," "mineral water," " purified water," "sparkling bottled water," "spring water," or just plain tapwater, the view seems to be: use it for hydration, not nutrient fortification.

Which, of course, raises a whole new set of questions never addressed by the journalists: what about fluorodated water or iodized water? Both have been used instead of using salt as the carrier.

Posted by Dick Hanneman at 04:46 PM | Permalink

During our daily review of legislation related to salt, it was a pleasant surprise to come across the final filing and adoption of the West Virginia division of health nursing home licensure rule that became effective July 1, 2007. The purpose of this legislation was to implement state and federal law governing the licensing, operation, and standard of care in nursing homes located in the State of West Virginia. The goal is to help each nursing home resident attain or maintain the highest practicable physical, mental and psychosocial well-being.

Among the requirements explicitly stated are:

8.15.d. - A nursing home shall provide each resident with:
Food prepared with salt, unless contraindicated by a physician's order; and, the salt should be iodized.

Finally, legislation based on the genuine requirements of a person rather than a politically correct interpretation of populist nutrition. Time and time again we have read of the negative effects of low salt diets prescribed to nursing home residents leading to chronic dehydration and hyponatriumia (salt deficiency). Often, these low salt diets lead to other major complications including bone fragility and increased cardiovascular risk.
The insistence that the salt be iodized is an additional indication that whoever wrote up this rule did their homework. Bravo!
It is refreshing to see that there are still legislators out there willing to take on the responsibility of doing things right.

Posted by Mort Satin at 04:49 PM | Permalink

Rather than try to make too much out of a recent study in Thyroid that found significant correlations of iodine intakes with consumption of yogurt and saltwater fish, but no relationship with use of iodized salt, we'll adopt the skepticism of the study's authors, Angela M. Leung et al, who explain their research design "may not have been sufficiently comprehensive" and "further studies are warranted to determine important sources of dietary iodine in the United States."

The study used food consumption questionnaires for 46 Boston, MA-area volunteers (91% middle-aged women). Among the findings, while 89% regularly purchase salt for home use, only 56% considered using iodized salt important; only 24% reported using iodized salt during the previous day (the same percentage used a multivitamin, half of which had the recommended 150 micrograms of iodine. Eighty percent purchased based on brand and 87% based on packaging.

The article provided some valuable reminders about the importance of adequate iodine nutrition:

Globally, iodine deficiency is one of the four major nutritional deficiency disorders and is the single most common cause of preventable mental retardation and brain damage. About 2.2 billion people (38% of the world's population) live in iodine-deficient areas. Although iodine supplementation has virtaully eliminated endemic goiter in the United States, NHANES assessments over the past 30 years have suggested that dietary iodine intake has decreased, especially among women of childbearing age. Adequate maternal iodien is crucial for normal thyroid function in the developing fetus, which in turn is essential for normal neuro-cognitive development both in utero and in infancy.

Whatever the source, these study participants, mostly women in their childbearing years, consumed less than the recommended amounts of iodine (~140 micrograms/day). We need to pay attention.

Posted by Dick Hanneman at 01:45 PM | Permalink