“When the cure becomes the cause, we have failed. Blanket iodisation without targeted evaluation risks creating more health problems than it solves.” Dr. Basil Hetzel.
For decades, artificially iodised salt has been heralded as a public health success story, particularly in landlocked regions where iodine deficiency disorders (IDDs) such as goitre and cretinism were prevalent. However, in coastal countries like Ghana, where access to iodine-rich seafood and natural sources of iodine is abundant, the widespread use of iodised salt may pose hidden risks to health and the environment.
In the 1990s, Ghana, like many other countries, adopted a universal salt iodisation (USI) programme to combat iodine deficiency. The initiative, supported by the World Health Organization (WHO) and UNICEF, mandated the fortification of all edible salt with iodine. This policy was highly effective in reducing IDDs, particularly in inland areas where dietary iodine sources were scarce.
However, in coastal regions, where seafood, a natural source of iodine is a dietary staple, the need for artificially iodised salt is less clear. Whilst iodised salt has been a lifesaver in iodine-deficient regions, its widespread application in coastal zones may lead to extreme iodine intake, which can have harmful health consequences. Iodine is essential for thyroid function, but too much iodine can be as harmful as too little. Excessive iodine intake has been linked to a range of health issues, including:
Thyroid Dysfunction: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can be triggered by excessive iodine.
Autoimmune Thyroid Diseases: High iodine levels may increase the risk of conditions like Hashimoto’s thyroiditis and Graves’ disease.
Iodine-Induced Goitre: Paradoxically, too much iodine can cause goitre, the very condition iodised salt aims to prevent. A striking example of iodine excess can be found in Japan, where a diet rich in seaweed a natural iodine source has led to increased cases of iodine-induced hyperthyroidism. Similarly, in Sri Lanka, a study found that excessive iodine from both food and iodised salt contributed to thyroid dysfunction among coastal communities. These findings raise concerns about a blanket approach to salt iodisation in countries where natural iodine levels are already sufficient.
Thyroid Cancer: While iodine deficiency is linked to goitre and hypothyroidism, excessive iodine intake has been associated with a higher incidence of thyroid cancer, as observed in regions of South Korea where iodine-rich diets combined with iodised salt intake have led to rising thyroid cancer cases.
In Ghana, where fish and seafood are widely consumed, the additional iodine from fortified salt may push intake levels beyond the recommended daily allowance of 150 micrograms for adults. This is particularly concerning for vulnerable populations, such as pregnant women and children, who are more susceptible to the effects of iodine imbalance.
The production and distribution of iodised salt also raises environmental and economic questions. The chemical additives used in the iodisation process, such as potassium iodate, require energy-intensive manufacturing and transportation, contributing to greenhouse gas emissions. Additionally, the reliance on imported iodised salt undermines local salt production, which is a significant economic activity in coastal communities like Keta, Ada and their ilk.
A salt farmer in the Volta Region, laments, “The government’s focus on iodised salt has marginalised traditional salt producers. Many of us have been forced out of business, even though our natural sea salt is healthier and more sustainable.”
Public health experts argue that iodine supplementation should be tailored to the specific needs of different regions. In a coastal country like Ghana, where natural dietary sources of iodine are readily available, the universal fortification of salt may be unnecessary and even harmful. Instead, targeted interventions, such as iodine supplementation for at-risk populations in inland areas, could be more effective and cost-efficient. Ghana should consider promoting natural sea salt, which contains iodine in its natural form, alongside public education campaigns to ensure balanced iodine intake.”
Natural sea salt, harvested through the evaporation of seawater, offers a viable alternative to iodised salt. It contains trace amounts of iodine along with other essential minerals like magnesium, calcium, and potassium. While its iodine content may vary, it is generally sufficient to meet the needs of coastal populations with access to iodine-rich diets.
Moreover, natural sea salt production is environmentally sustainable, relying on solar evaporation and minimal processing. By supporting local salt producers, Ghana can revive a traditional industry while promoting healthier and more eco-friendly food choices.
The Ghanaian government needs to reconsider its universal salt iodisation policy and adopt a more context-specific approach. Several interventions could be made, including the following.
Regional Iodine Assessments: Conducting surveys to determine iodine levels in different parts of the country and adjusting supplementation policies accordingly.
Promoting Natural Sea Salt: Encouraging the consumption of natural sea salt in coastal areas while maintaining iodised salt for inland regions, based on empirical studies.
Public Education Campaigns: Raising awareness about the risks of excessive iodine intake and the benefits of a balanced diet.
In conclusion, while iodised salt has played a crucial role in addressing iodine deficiency in Ghana, its universal application in coastal regions may no longer be justified. The hidden risks of excessive iodine intake, coupled with environmental and economic concerns, highlight the need for a more tailored approach to iodine supplementation.
By embracing natural sea salt and adopting context-specific policies, Ghana can protect public health, support local industries, and promote sustainable practices. As the global conversation around food and health evolves, it is time for coastal countries to rethink the role of iodised salt and explore alternatives that align with their unique needs and resources.
“Excess iodine intake may initially go unnoticed, but the long-term rise in autoimmune thyroid diseases could be the hidden cost of overzealous iodization.” Dr. Robert Delong.
