Sensitive Midwifery - Issue 44 - October 2019

Dimensions Non-iodised salt vs iodised salt Non-iodised salt (like sea salt) is often just sodium chloride, though it may be mixed with other ingredients and/or be processed to give it a finer texture. Non-iodised salt never expires, whereas iodised salt must be used within five years. With the risks of both iodine deficiency and excess intake of iodine in mind (even if there is little evidence to show that iodine overdose can occur through iodised salt), it does seem reasonable to expect accuracy during salt iodisation. And yet, a 2001 study analysing iodine concentration in household salt in South Africa not only found considerable variation in di ff erent areas of the country, but also revealed that managers at iodised- salt production sites lacked su ffi cient knowledge regarding health aspects of salt iodisation. In 2008, the authors of a review entitled ‘Progress towards eliminating iodine deficiency in South Africa’, noted that the accuracy of salt iodisation in South Africa could be improved through better ‘internal quality control of the iodine content of salt at the production sites and by regular external monitoring of the iodine concentration in salt’. Additional ingredients in salt Iodisation involves spraying salt with a potassium iodate or potassium iodide solution, and adding dextrose (a sugar), which acts as a stabiliser and stops the potassium iodide from oxidising and evaporating. A concerning additive in table salt is chemical anti-caking agents, which retard moisture absorption and prevent clumping. While these are often classified as ‘safe’ if present below a certain threshold, Sensitive Midwifery questions what long-term health e ff ects there may be for people consuming these chemicals regularly. More research is certainly needed. The safety of supplements Health experts recommend that women take a multivitamin containing 150 mcg iodine in the form of potassium iodide, which tallies with the recommended daily intake of iodine in all adults (although pregnant and breastfeeding women have increased iodine needs). Importantly though, the WHO has stated that routine iodine supplementation in pregnancy could come with risks. Although the tolerable upper limit for iodine ingestion in adults is 500 mcg per day according to the WHO and the European Food Safety Authority (or 1 100 mcg iodine daily if you’re following the US Institute of Medicine guidelines), the upper limit during pregnancy and lactation is uncertain. Since iodine is, of course, also being consumed via iodised salt and other foods, women must stick to safe dosages and discuss nutritional supplements with their healthcare providers. Getting the balance right As there are significant risks to ingesting too little or too much iodine, getting the right amount is a matter of balance. As always, eating a healthy, balanced, and varied diet is the first step to ensuring su ffi cient nutrient intake. Of course, nutritional iodine intake can be di ffi cult to monitor, especially when food iodine content is not labelled. Processed foods may also be fortified with bromine, an element that disrupts iodine absorption. Where there are concerns that diet may not be meeting the body’s requirements, iodised salt and/or iodine supplementation are options, but women and their healthcare providers must be aware of the dangers of maternal over supplementation. Key references on page 55 32 eSensitive Midwifery Magazine Issue 44