In a bid to cut the prevalence of non-communicable diseases, especially problems of hypothyroidism, the Ministry of Health and Population has recommended the authorities to set the upper limit for iodine content in salt sold in the country.

Officials suspect high iodine content in the salt sold in Nepal could be among the reasons for thyroid disorders in the country.

“We have proposed setting the upper limit of iodine concentration in the salt,” said Lila Bikram Thapa, chief of Nutrition Section at the Family Welfare Division under the Department of Health Services. “A proposal to this effect will be sent to the Cabinet shortly.”

Iodine is a mineral found naturally in seafood and plants that grow in areas near seas. In places where iodine is naturally rare, it needs to be artificially introduced into the diet via fortified food products.

The Salt Trading Corporation, the agency responsible for importing and distributing salt in Nepal, fortifies iodine at 50 ppm (parts per million) per kilo of salt, which is higher than the recommended dosage. The World Health Organization, however, recommends iodine concentration at 15 to 40 ppm per kilo.

Officials said the higher iodine level was mandated in the 1990s under the assumption that transport and storage times were longer then as salt had to be carried on the backs of men and animals and some amount of iodine would dissipate by the time the salt reached markets. However, now with roads reaching almost all corners of the country, transport times have considerably gone down, and so there is no need for such a high level of iodine in the salt, according to doctors.

According to Thapa, a recent high-level meeting comprising representatives from the World Health Organisation Nepal’s representative, UNICEF, officials from various government ministries including the Ministry of Agriculture and livestock Development, the Department of Food Technology and Quality Control, and researchers from Tribhuvan University agreed on a proposal to set upper limit of iodine in salt.

“No decision has been taken to lower the iodine content in salt yet, but the Department of Food Technology and Quality Control could include experts’ suggestions while forwarding its proposal to this effect to the Cabinet,” said Thapa. “The proposal will include evidence from various national as well as international studies, details on iodine content in salt in other countries, and comparison of salt intake in our country compared to other countries.”

In 1993, Nepal mandated that salt be fortified with iodine to prevent health problems caused by an iodine deficiency, as salt is both cheap and used year-round.

Lack of iodine in the diet can lead to hypothyroidism, where the thyroid glands produce too little thyroxine, leading to the development of goitres, among other symptoms.

But after 30 years of iodine fortification, some of its adverse effects are now being seen.

“Excessive salt intake is a major problem in our country,” said Dr Om Murti, an interventional cardiologist. “Our daily salt intake level is much higher than what is recommended by the World Health Organisation. Reducing salt intake can also lessen intake of excessive iodine and problems caused by it.”

Several other studies—including the 2016 Nepal National Micronutrient Status Survey jointly carried out by the World Health Organization, UNICEF, the US-based Centres for Disease Control and Prevention, and the Ministry of Health and Population—have found that Nepalis consume an excessive amount of iodine, which resulted in high prevalence of hyperthyroidism.

The survey shows, over two thirds—68 percent—of the population across the country is consuming iodine in excess of the recommended level.

According to Non-communicable Disease Risk Factors: Steps Survey-2019, 5.6 percent of adults (6.5 percent of women and 4.6 percent of men) reported adding salt often or always to food right before or while eating.

Additionally, 19.5 percent of adults (18.1 percent of women and 21.1 percent of men) reported consuming processed foods that are high in salt often or always.

The study reported the perception of around 75 percent of the adult population that their salt intake is ‘just right’.

Excessive salt intake has not only increased the problem of thyroid disorder, but it is also attributed to be a key risk factor for hypertension, which is a major cause of premature deaths worldwide.

Doctors say a change in dietary patterns and increased consumption of processed foods (including packaged soups), which resulted in increased prevalence of non-communicable diseases such as hypertension, cardiovascular diseases, among others.

The UN health agency recommends less than two grams of sodium or five grams of salt per day for adults to reduce blood pressure, and cut the risks of cardiovascular diseases and stroke. It also recommends policies to reduce salt intake including food product reformation, establishing a supportive environment in public institutions, organising communications and mass media campaigns, and front-of-pack labelling, among other things, to prevent and control non-communicable diseases.

“We generally consume excessive salt than recommended by the UN health body, which is one of the major factors for the rise in several non-communicable diseases including cardiovascular conditions and hypothyroidism,” said Anil. “Along with other measures, authorities concerned should also focus on creating awareness about negative effects of excessive salt intake.”