Women who used salt for at least two years before becomng pregnant avoided thyroid failure during pregnancy. The Italian research team found in its study of 100 women, 62 of whom were "long-term" users of iodized salt and 38 of whom were not. The short-term group had a six-fold greater incidence on thyroid failure.

The article recounts the pioneering public health efforts to combat iodine deficiency by iodizing salt, quoting Venkatesh Mannar, executive director of the Ottawa-based Micronutrient Intitiative, explaining that salt is the "food that comes closest to being universally consumed." Salt is preferred because "the risk of overdose is minimal because everyone eats a predictable amount."

Building on the success of salt iodization, salt was fortified with other additives, first fluoride to prevent dental caries and then chloroquine to prevent malaria and most recently DEC (diethylcarbamazine) to combat lymphatic filariasis. Willyard featured the World Health Organization's ongoing work with DEC-fortified salt in Haiti and Guyana.

The article also broaches the question of the adequacy of iodine nutrition in the U.S. where substitution of processed foods using plain salt for home-cooked meals using iodized salt has led to a gradual decline in iodine intake levels. Willyard includes the Salt Institute's views, noting "officials may think about adding iodized salt to processed foods, Hanneman says. The important things, he adds, is to keep monitoring."

In 1990, IDD was a public health problem affecting an estimated 2 billion people. Today, that number has been pared to about 400 million, half of them in India. Each year, 38 million children are born at risk of iodine deficiencies that can penalize them 10-15 IQ points in mental capacity.

The top three:

1. Combatting micronutrient malnutrition by fortifying foods with vitamin A and zinc.

2. Completing the Doha round of international trade liberalization.

3. Iodizing salt and fortifying foods with iron.

Micronutrient malnutrition ("hidden hunger") is the clear winner with two of the top three "solutions." Fortifying with vitamin A and zinc return $17 for every dollar invested. The benefits of iodizing salt are $9 for every dollar invested.

With the candidates for the Democratic US presidential nomination competing to bash free trade, #2 may gain some political salience. But investing in micronutrient fortification -- including universal salt iodization -- should be high on the public health agenda.

Replacing plain salt with iodized salt in bread is technologically feasible and well-tested. Relying on iodized salt, of course, is the international standard, and a step-wise approach preserves the flexibilty to go back and fine-tune the rule if ongoing monitoring shows bread alone isn't enough. But it may be enough. FSANZ's analysis estimates that currently 40% of the population is either slightly or seriously iodine-deficient. Using iodized salt in bread should reduce that to less than 10%.

Although the authors attempt to make it clear that the negative consequences of iodine fortification of foods would only occur at high levels of fortification and would never be the result of using iodized salt, they do not unequivocally state that, for all intents and purposes, whole formulated food products would never be iodized at levels that would impact the color, flavor or functionality of those foods.

If whole, formulated foods will never be iodized to those levels which can impact on the quality of the food, then the whole issue becomes moot and should not be confused with the use of iodized salt in food products.

Iodized salt can be used in formulating all food products without any fear of reducing quality.

Perhaps it would have been useful for the authors to have made that simple statement of fact.

Noting that "half truths are the most insidious," the Salt Institute responded, defending the FSANZ decision and pointing out that:

Surely the bakers have better fights to fight.

At least they said they agreed.

In the February 9 issue of The Lancet, the WASH media spokesperson for Australia, Trevor Beard, raised the issue with regard to FSANZ's proposal to require iodized salt be used in bread in New Zealand. He argued against iodizing table salt sold to consumers altogether. Backtracking on the Luxembourg agreement, Beard declared:

Meanwhile, it already seems unethical (primum non nocere)—and clearly self-defeating—to sell the public iodine by adding it to a substance we are now warning them to avoid.

It's almost like the meeting in Luxembourg never happened!

Now, a further retreat. FSANZ announced this week that it now questions the need for universal iodization in Australia because "a degree of geographic variation in the prevalence and severity of iodine deficiency exists across Australia." The health ministry will study the problem until mid-2008.

FSANZ contrasted the situation in Australia with that in New Zealand where

there is general acknowledgement of a population-wide iodine deficiency....Health Ministers have noted that the prevalence and severity of iodine deficiency in New Zealand is significant and that mandatory fortification with iodine is considered that most effective strategy to address it.

The countries share administration of a "Joint Food Standards system" that permits different regulations in the two countries if there are "exceptional health and safety or environmental reasons." FSANZ has made the determination that this "exceptional" situation exists and has finalized a mandate for iodized salt in New Zealand alone.

Titled “A triumph in the making,” the session was conducted by The Network for the Sustained Elimination of Iodine Deficiency and featured presentations by Network partners, including the Salt Institute, responses from UN delegations and general discussion.

Dr. Gerard Burrow, chairman of the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) led off, explaining the physiological implications of iodine deficiency and highlighting the 10-15% mental handicap imposed on children of iodine deficient and the great achievement of raising worldwide access to iodized salt to 70%.

Network chairman Alan Court of UNICEF estimated that 20-25% of the children in developing countries are impacted by iodine deficiency and that 28 million babies are born each year with the mental handicaps imposed by iodine deficiency, explained how The Network is targeting 14 high priority countries and congratulated the private salt-producing sector for their role in fashioning national coalitions to pursue salt iodization.

I represented the salt industry and reminded the group that the joint efforts culminating in the formation of the Network began at the industry-sponsored Salt2000 symposium and that a key to sustainable salt iodization is involvement not only of health ministries in the national coalitions, but ministries of commerce and industry. I emphasized that while technical assistance may be required to launch salt iodization, sustainable salt iodization requires an effective regulatory system with “level playing field” enforcement (the “biggest challenge”).

The Canadian International Development Agency (CIDA), Global Alliance for Improved Nutrition (GAIN) and Kiwanis International spoke of their funding commitment to the worldwide campaign to iodize salt. CIDA noted that global salt iodization costs only $12 million a year, so the problem is not money, but other barriers.

The ambassador from Egypt expressed recipients’ appreciation for support and outlined her country’s strong efforts to promote iodized salt. Delegates from India, Pakistan, Indonesia, Ghana, the Philippines, China and Bangladesh also delivered reports and expressed thanks for support from The Network and its partners. Among the interesting points raised were that some Ghanaians have a cultural aversion to iodized salt , that private producer involvement in Indonesia is responsible for a breakthrough achievement of 73% having access to iodized salt and Pakistan’s delegate voicing concern that his countrymen might shun iodized salt in their efforts to follow public health advice to cut salt out of their diet (I responded that salt was a necessary nutrient and suggested reviewing the online video of the 2006 presidential address from the International Society of Hypertension) which discusses the controversy among medical researchers on salt and its health consequences.

The session concluded with a stirring address from UNICEF deputy executive director Kul Gautam who commended the salt industry as the catalyst for sustainability and noted that because the cost of global iodization is quite modest, the challenge is being overlooked by those focusing on “big ticket” items like AIDS/HIV. The return on investment for salt iodization is $30 for every dollar invested, he noted, but that ROI is treated “like a state secret.” Gautam challenged the group to address the remaining 30% of the world’s population lacking access to iodized salt (“the most needy and vulnerable”), with “a new strategy” to iodize salt.

IDD is the single greatest cause of preventable mental retardation. Severe deficiencies cause cretinism, stillbirth and miscarriage. But even mild deficiency can significantly affect the learning ability of populations. Scientific evidence shows alarming effects of IDD. Even a moderate deficiency, especially in pregnant women and infants, lowers their intelligence by 10 to 15 IQ points, with incalculable damage to social and economic development of nations and communities. Today over 1 billion people in the world suffer from iodine deficiency, and 38 million babies born every year are not protected from brain damage due to IDD. These 38 millions, or nearly 30 percent of the world’s newborns, come from families that are the least educated, most isolated and economically disadvantaged. The mark of a civilized society is how well it takes care of its most vulnerable and deprived communities. If we continue to fail to reach these newborns, we will be consigning them to an inter-generational cycle of poverty and injustice.

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.