A team of experts that visited salt factories in India’s Gujarat state a few days ago is most likely going to recommend lowering of the iodine content in salt, which is being blamed for an alarming rise in non-communicable diseases in Nepal.

A nine-member team led by the director general of the Department of Food Technology and Quality Control visited India from October 1 to 7 and studied salt-making and the iodine fortification processes.

“We saw a detailed process of salt making and iodine fortification during our visit to Gujarat,” said Lila Bikram Thapa, chief of the nutrition section at the Family Welfare Division under the Department of Health Services. “We found an excessive amount of iodine fortification in salt, much more than our requirement.”

Iodine is a mineral found naturally in seafood and plants that grow in areas near the 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 kilogramme of salt, which is higher than the recommended dosage. The World Health Organisation, however, recommends iodine concentration at 15 to 40 ppm per kilogramme.

Officials said the higher iodine level was mandated for Nepal in the 1990s under the assumption that transport and storage times were longer at the time as the 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, mainly in the remote parts of the country.

However, now with roads reaching almost all corners of the country, the transportation time has significantly gone down, so there is no need for such a high level of iodine in salt, say doctors.

“We found 60 to 70 ppm per kilo of fortification of iodine in the salt manufactured for supply to Nepal, which is higher than our existing requirement,” said Thapa. “We have been preparing our report, which will be furnished to the standard fixation committee.”

Apart from the director general at the Department of Food Technology and Quality Control, the visiting team included the deputy director general and two officials from the department, two from the concerned agencies under the Ministry of Health and Population, one independent expert, and an official from Salt Trading Corporation.

Only 40 ppm of iodine per kilogram of salt is fortified for India, as it is assumed that the population from India does not need as much iodine as the Nepali people, since they also get iodine content from foods produced near the ocean.

“We also held discussions with experts and officials from India who have the expertise in related subjects about high iodine content in salt and our eating habits,” said Thapa. “They too suggested that the upper limit of iodine could be lessened in salt.”

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

The survey showed that more than two-thirds—68 percent—of the population across the country is consuming iodine far in excess of the recommended levels.

According to Non-communicable Disease Risk Factors: Steps Survey-2019, 5.6 percent of the 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 the adults (18.1 percent of the women and 21.1 percent of men) reported consuming processed foods that are high in salt often or always.

Doctors in Nepal suspect that the high iodine content in the salt being sold in Nepal could be among the reasons for the high prevalence of several non-communicable diseases, including thyroid disorders and hypertension.

A change in dietary patterns and an increased consumption of processed foods (including packaged soups), have resulted in an increased prevalence of non-communicable diseases such as hypertension, and cardiovascular diseases, they added.

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

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

The World Health Organisation 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 to prevent and control non-communicable diseases.