Iodine Deficiency Disorders (IDD) is a public health problem and in India, no state is free from iodine deficiency. About 200 million people are ‘at risk’ of IDD in India.

A few salient facts

o IDD affects over 740 million people, 13% of the world’s population; 30% of the remainder are at risk.

o IDD preys upon poor, pregnant women and preschool children, posing serious public health problems in 130 developing countries.

o Iodine deficiency is a problem for the developing brains of foetuses and young children. According to the WHO, it is the single greatest cause of mental retardation. In the first 12 weeks of pregnancy, the foetus relies on its mother directly for thyroid hormone. After that, it uses iodine from the mother to make its own.

o Iodine-deficient people may forfeit 15 IQ points.

o Nearly 50 million people suffer from some degree of IDD-related brain damage. Yet we have the means to prevent it – small quantities of iodine at low cost.

The answer to iodine deficiency disorders is iodized salt. A spectacularly simple, universally effective, wildly attractive and incredibly cheap technical weapon – IODIZED SALT.

Calcium is present in a wide range of foods. Dairy products, leafy green vegetables, nuts and seeds (almonds, brazils, sesame seeds), tofu, and dried fruit are all good sources of calcium for vegetarians. Most flour is fortified with calcium carbonate so cereals can also be a good source. Hard water may also provide calcium. Meat is a very poor source of calcium.

Calcium balance can be affected by a range of other factors. Vitamin D is essential for absorption of calcium from the gut. This is because calcium is transported into the body by a special carrier protein which requires vitamin D for its synthesis.

A number of substances can inhibit the absorption of calcium. Phytic acid, found in bran, whole cereals and raw vegetables is one of these. Uronic acid, a component of dietary fibre, and oxalic acid, found in certain fruits and vegetables can also bind calcium. However, diets habitually high in these acids are not thought to have a major effect on calcium absorption. Saturated fats can also lessen calcium absorption.

Calcium is lost in the faeces, urine and sweat. Calcium loss is roughly equal to dietary calcium in adults. Calcium loss is reduced if dietary calcium is low. Adaptation to both high and low calcium intakes occur. Reduced intake leads to increased efficiency of absorption. In infants and children calcium is retained for new bone growth. Calcium is also lost during lactation in breast milk.

Foods rich in calcium are :

• Ragi, a millet, is a rich source of calcium and known as poor man’s milk.

• Green leafy vegetables are very rich sources of Vitamin B, carotene, iron, calcium, Vitamin B complex and Vitamin C .

• Milk is a good source of protein, calcium and vitamins.

• Yogurt (Curds), paneer, fenugreek leaves, drumstick leaves, Almond, Dried Figs (Anjeer) are great source of protein, riboflavin and calcium.

• Pineapple is tropical fruit. It is a good source of Vitamin A and B and rich in Vitamin C and calcium. It also contains phosphorus and iron.

• Sea Food: Small fish like sprats and sardines can be a useful source of calcium when eaten whole together with bones and may supply up to 400 mg of calcium/ 100 gms. Fish also contains fair amount of copper.

A calcium rich diet and weight bearing exercise play a critical role in helping to build and maintain strong bones.

Calcium requirements should be met everyday: however the majority of women fall far short of this.

On an average, women get only 500-700mg of calcium from their daily diets, while the National Institutes of Health’s Consenses Conference on Optimal Calcium Intakes recommends 1000-1500mg for women over 50 years. Based on these average levels most women require calcium supplementation.

DIET

• Throughout life, dietary intake of calcium is essential for bone formation and maintenance
• Vitamin D, which aids in the absorption of calcium, is also essential

• Maintaining a healthy diet which includes a sufficient amount of calcium and Vitamin D is very important

A diet that includes an adequate amount of calcium, vitamin D and protein should be maintained. This will not completely stop bone loss, however it will guarantee that a supply of materials tha body uses for bone formation and maintenance is available.

EXERCISE

Regular exercises can reduce the likelihood of the bone fractures associated with osteoporosis. Exercises, requiring muscles to pull on bones, cause the bones to retain and perhaps even gain in density.

Some of the recommended exercises include:

• Weight bearing exercises
• Riding stationary bicycles
• Using rowing machines
• Walking
• Jogging

It is important to remember that any exercise that presents a risk of falling should be avoided

There are no symptoms associated with the onset of the disease

Symptoms occuring late in the disease
• Low back pain
• Neck pain
• Bone pain or tenderness
• Loss of height over time
• Stooped posture
• Fractures of the spine, wrists or hips
Investigations :Your doctor would make the diagnosis of Osteoporosis based on investigations such as Bone mineral density, Spine CT, X-ray, etc. among other findings.

• Asian women
• Menopause
• Old age
• Family history of osteoporosis
• Smoking
• Eating disorders
• Diet deficient in calcium
• Alcohol consumption
• Use of certain medications such as steroids

There are a number of causes of osteoporosis, however hormone deficiency(oestrogen in women and androgen in men) is a leading cause.

Other causes include
• Low calcium in diet
• Excess of corticosteroids (Cushing’s Syndrome)
• Hyperthyroidism
• Hyperparathyroidism
• Immobilisation
• Bone malignancies
• Certain genetic disorders

Osteoporosis is a common type of bone disease. It occurs when the body fails to form enough new bone or when too much of the old bone is being re-absorbed by the body.

Calcium is essential for normal bone formation. Throughout youth, the body uses calcium to produce bones. If calcium intake is not sufficient, or if the body cannot absorb enough calcium from the diet, bone formation and bone tissue may suffer. Calcium may be reabsorbed into the body from the bones in which case the tissue is made weaker. Both situations can result in brittle fragile bones that are prone to fractures.

Vitamin B12 and Folic Acid – both are needed for the normal formation of red blood cells. An inadequate dietary intake of either of these two B vitamins results in faulty cell division and large, misshapen red blood cells that are unable to transport oxygen.

1. A deficiency of folic acid may contribute to megaloblastic anemia
2. A deficiency of vitamin B12 may contribute to megaloblastic anemia
3. Copper, Vitamin C, and Vitamin B6 – are needed for the formation of hemoglobin and red blood cells, and a long-term deficiency of one or more of these nutrients results in anemia. Vitamin C is necessary for optimal absorption of iron.
4. A deficiency of copper may contribute to early hypochromic anemia or microcytic anemia
5. A deficiency of vitamin C may contribute to anemia as a symptom of scurvy. An abundant supply of vitamin C is needed to hold iron in the body
6. A deficiency of vitamin B6 may contribute to microcytic anemia
7. A deficiency of vitamin E may contribute to hemolytic anemia

Vitamin E – is necessary for the protection of red blood cells once they are formed. This antioxidant protects red blood cell membranes and inadequate dietary intake of this fat-soluble vitamin results in hemolytic anemia.

Anemia is often the last stage of iron deficiency. An iron deficiency is the most common cause of anemia. Most of the body’s reserves of iron are stored in the liver. Consider working on improved liver function.

Ideally, supplementary iron should be taken by itself or with vitamin C between meals for maximum absorption. Calcium, particularly calcium phosphate, zinc, and antacids interfere with the absorbability of iron and should be taken separately. Available iron supplements include ferrous fumarate, ferrous sulfate, ferrous gluconate and carbonyl iron, also know as micronized elemental iron. Carbonyl iron is a good delivery form of iron but requires hydrochloric acid for its absorption and therefore needs to be taken with meals. Other iron supplements are best absorbed on an empty stomach. Excess iron has been linked to cancer.
Chelated Iron contains the mineral already bound to amino acids for improved assimilation.

A deficiency of iron may contribute to hypochromic anemia or microcytic anemia.
It may be best to take others minerals, especially calcium and zinc which reduce iron absorption, at a different time than your separate iron supplement. You need adequate stomach acid to assimilate iron. Do not use iron supplements if anemia is thaltassemia, a hereditary form common in Mediterranean and Southeast Asia populations.