Sullivan challenges ATA: iodize salt, don't rely on supplements |
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Sullivan's letter-to-the-editor came in response to recommendations released last October by the Public Health Committee of the American Thyroid Association on iodine supplementation for pregnant and lactating women in North America. Noting that the World Health Organization had increased its recommended daily intakes to 250 micrograms of iodine daily and that 7.3% of pregnant Americans are ingesting less than 50 micrograms -- the minimum safe level -- the ATA called for all pregnant and lactating women to take iodine supplements of 150 micrograms/day.
Sullivan rejected this strategy, arguing:
The Committee should be applauded for their efforts to prevent irreversible fetal brain damage as a result of iodine deficiency. While an important and useful step, the iodine supplementation during pregnancy recommendation has some limitations. First, currently the Institute of Medicine recommends multivitamins for some groups of pregnant women and the recommended vitamins and minerals do not include iodine, therefore many prenatal multivitamins do not include iodine. The Public Health Committee recommended efforts to encourage manufacturers to include iodine in all vitamin and mineral preparations for use during pregnancy and lactation. Second, many women will not use supplements on a regular basis as has been found with folic acid supplementation. Women who do not use supplements on a regular basis tend to be younger, of lower education, and of certain ethnic/racial groups. In addition, much of the damage caused by iodine deficiency occurs early in the pregnancy, therefore, by the time a woman realizes she is pregnant and seeks prenatal care, damage may have already occurred.
It would seem that the focus of preventing the negative effects of iodine deficiency in the developing fetus should focus on all women of childbearing age. Efforts should be placed on fortification of salt for human consumption as recommended by the International Council for Control of Iodine Deficiency Disorders (ICCIDD), United Nations International Children’s Emergency Fund (UNICEF), and WHO and implemented in many countries. In the United States, all household salt (as well as salt substitutes) and salt used in the food industry should contain iodine at levels to assure an adequate iodine intake in the vast majority of the population. Through careful study of urinary iodine levels, the iodine content of salt and salt substitutes can be adjusted to assure that there is not too much or too little iodine in the diet, similar to the approach used in Switzerland. To prevent excess iodine intake, the iodine levels in other foods, such as dairy products and bread, may need to be regulated.
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