Israel’s Health Ministry is neglecting to add iodine and folic acid to table salt to minimize impaired cognitive and motor development that can cause permanent brain damage and birth defects in children, according to public health experts here and abroad.
Despite success in many areas of preventive health care such as low infant mortality, it is important to keep up with other international standards, such as prevention of micronutrient deficiency, said Prof. Aron M. Troen (of the Hebrew University’s biochemistry, food science and nutrition department); Prof. Ronit Endevelt (director of the ministry’s nutrition division), ministry chief toxicologist Dr. Tamar Berman, and Prof. (emeritus) Ted Tulchinsky (of the university’s Braun School of Public Health and Community Medicine and former ministry coordinator of public health services for the West Bank and Gaza).
They noted that Israeli studies of iodine show deficiency of iodine levels in pregnant women and in school-age children and is the main cause of brain damage in childhood. It results in impaired cognitive and motor development that affects children permanently. The effect of low iodine intake levels is damaging to physical and mental development, lowering IQ by up to 12%.
One can buy iodized salt in Israeli supermarkets, but it is much more expensive than ordinary table salt, which is widely consumed. Fortification of salt has not been required by the ministry despite repeated recommendations by experts,” they stated, “but the failure to enact this has been made more severe by an increasing reliance on desalinated seawater, reducing even the limited iodine source nature provides.”
The same is true, they said, in the ministry’s “failing its duty to address many micronutrient deficiencies by failure to keep up with current international standards, such as vitamin A and D in all milk, folic acid and other micronutrients as strongly recommended in WHO in a resolution adopted in 2023.”
The public-health experts published their findings two years ago in the Israel Journal of Health Policy Research under the title “Results of the national biomonitoring program show persistent iodine deficiency in Israel.”
Their research “highlights the critical need for public health surveillance of nutritional and environmental exposures using human biomonitoring. Iodine deficiency is easily prevented at a low cost. The best and least- expensive method of preventing iodine deficiency disorder is by simply iodizing salt, which is now done in many countries.”
Meanwhile, a team of international researchers that included scientists at the University of Central Florida and at Emory University in Georgia have just published a study showing that adding folic acid to table salt could prevent birth defects. They have proven for the first time in a field study that using folic acid-fortified iodized table salt can prevent severe, life-threatening birth defects.
The importance of women having enough folic acid in their bodies before and during pregnancy to prevent permanent and life-threatening birth defects, such as spina bifida and anencephaly, has been known for decades. She recommends that all women should take supplement pills with 400 micrograms of folic acid daily from the moment they begin attempting to conceive through the first three months of pregnancy.
The importance of folic acid
Mandatory staple food fortification with folic acid is a cost-effective, safe, and equitable way to address the issue, they argued in the journal JAMA Network Open under the title “Folic acid–fortified iodized salt and serum folate levels in reproductive-aged women of rural India: A nonrandomized controlled trial.”
In May 2023, the World Health Assembly adopted promoting food fortification with folic acid to accelerate the slow pace of prevention of spina bifida and other birth defects associated with low maternal folate levels at the time of early pregnancy. Yet, approximately 260,000 births worldwide – about 20 per every 10,000 births – are still affected by spina bifida (a neural tube defect anywhere along the spine if the neural tube does not close all the way) and anencephaly (a birth defect in which a baby is born without parts of the brain and skull). These conditions have been reduced by half among Muslim, Bedouin, and Jewish sectors because gynecologists recommend that young women take folic acid pills, but they still occur, contributing to stillbirths, elective pregnancy terminations, and deaths of infants and young children.
While folic acid has been added through mandatory staple grain food fortification in about 65 countries, including the US, more than 100 countries have yet to implement fortification due to challenges that include limited capacity for large-scale fortification of staple grains in these regions or lack of political will.