The Ministry of Health has prepared a project on the prevention of iodine deficiency

The Ministry of Health of the Russian Federation has prepared draft amendments to the law “On the Fundamentals of Protecting the Health of Citizens” to solve the problem of iodine deficiency in Russia. The department proposes to use iodized salt to make bread for educational and medical organizations, social service organizations, military units and penitentiary authorities. This project is much softer than the law “On the Prevention of Diseases Caused by Iodine Deficiency” proposed in 2019. Then the Ministry of Economy criticized the document, pointing, among other things, to the huge costs of trade.

The Ministry of Health has made another attempt to establish the prevention of iodine deficiency diseases. The agency proposes to use iodized salt in the preparation of food products, including bread for educational and medical organizations, social service organizations, military units and penitentiary authorities. Amendments to the law “On the Fundamentals of Protecting the Health of Citizens” were published on the portal of draft regulatory legal acts.

The medical department also wants to visually highlight iodized salt in stores; the method of isolation is determined by organizations independently, as specified in the document. However, the project does not provide for the universal mandatory fortification of food products with iodine compounds. The explanatory note states that all regions of Russia are, to a greater or lesser extent, iodine deficient. This leads to serious consequences: every year more than 3 million adults and about 400 thousand children with thyroid diseases need specialized endocrinological care.

In 2019, the Ministry of Health already came up with a similar initiative – a draft law “On the prevention of diseases caused by iodine deficiency.” Thus, the document obligated manufacturers of bakery products to use exclusively iodized salt from June 1, 2020. A year later, “extra”, highest and first grade (mostly finely ground) table salt itself must be enriched with iodine. And from June 1, 2022, it was proposed to extend the requirements to all food products, if technologically possible. The Ministry of Health sent the document for approval to the Ministry of Economy four times, receiving responses about the developers’ failure to comply with the required procedures and “incorrect determination of the degree of regulatory impact.” Having rejected the document for the fifth time, the Ministry of Economy indicated that trade costs alone would amount to 17 billion rubles. per year, while there are no clear requirements for the enrichment of salt with iodine. The project did not take into account the special needs of risk groups, pregnant women and children, and other provisions of the law were violated. In March 2021, the Ministry of Economy stated that the bill is not consistent with the provisions of the Treaty on the Eurasian Economic Union, and does not comply with the requirements of the technical regulations of the Customs Union “On the safety of food products”, “Safety requirements for food additives, flavorings and technological aids” (TR TS 029/2012), as well as Russian legislation on technical regulation, giving a negative opinion on the document.

Kommersant sent a request to the Ministry of Economy with a request to comment on the new version of the bill, but did not receive a response at the time of publication.

Deputy Director of the National Medical Research Center for Endocrinology of the Ministry of Health, Director of the Institute of Clinical Endocrinology, Ekaterina Troshina, in an interview with Kommersant, noted: thyroid diseases occupy second place among all endocrine disorders after diabetes mellitus, and up to 80% of them are caused by chronic iodine deficiency in the diet. These are diffuse nontoxic goiter, nodular and multinodular colloid nontoxic and toxic goiter (with the development of functional autonomy and thyrotoxicosis), hypothyroidism (in case of severe iodine deficiency). In conditions of persistent iodine deficiency, leading to thyroid dysfunction, the risks of worsening cardiovascular pathologies significantly increase, Ms. Troshina clarified.

“It is known that the greatest danger is posed by insufficient intake of iodine into the body at the stage of intrauterine development and in early childhood,” added Lyubov Drozdova, head of the outpatient therapy laboratory of the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health, chief freelance specialist in medical prevention of the Ministry of Health. “Changes caused by iodine deficiency During these periods of life, irreversible defects in the intellectual and physical development of children manifest themselves.”

Ekaterina Troshina emphasized that among the countries of the former USSR, only the Russian Federation and Ukraine still do not have legislative regulation for the prevention of iodine deficiency diseases. Moreover, over the past 30 years, 126 of the 130 countries in the world where iodine deficiency existed have adopted legislation aimed at the massive use of iodized salt in the diet. The adoption and implementation of such laws made it possible to eliminate iodine deficiency and significantly reduce the incidence of iodine deficiency diseases, she believes.

The Russol company told Kommersant that they support the Ministry of Health project. They noted that iodized salt is the most effective, safe and at the same time simple and cheap means of preventing iodine deficiency, capable of increasing the IQ of the population by 15–20%.

Deputy Chairman of the Board of the Rusprodsoyuz Association Dmitry Leonov indicated that the organization considers it necessary to iodize all table salt. He cited as an example the positive practice of Kazakhstan, where 100% of salt both for the needs of the population and for the food industry has been subject to mandatory iodization since 2003. “If we talk about production, we do not see any problems with the introduction of iodization technology; it does not have a significant impact on the rise in price of products. The difference in price for iodized and non-iodized salt is within 1–2%,” said Mr. Leonov.

However, the President of the Russian Union of Bakers (RSU, which unites producers of more than 50% of all bread and bakery products in the country) Dmitry Semenov pointed out that in industrial baking salt is supplied in the form of a solution, so producers will need to organize this process, for example, build a separate pipeline, which will affect the cost of the product. In addition, he noted that this would violate the rights of consumers who have contraindications to the use of iodine.

Anastasia Pikalova, an endocrinologist at the Nearmedic clinic, however, assured that iodized salt is safe for most people: “The only objective contraindication is an iodine-free diet in preparation for radioiodine therapy after treatment for thyroid cancer.”

Natalia Kostarnova