Iodine Fortification and the Choice of Salt in Bread as its Carrier

by Charles Fisher © Lawmedia Pty Ltd, April 2008
FoodLegal
Australian Food Lawyers and Consultants

On 28 March 2008, Food Standards Australia New Zealand (FSANZ) released the administrative assessment of FSANZ Proposal P1003 – Mandatory Iodine Fortification for Australia. The deadline for public submissions on this proposal is 6pm (Canberra time) 20 May 2008. The First Assessment Report on Proposal P1003 was released on 22 April 2008. While this consultative process continues in Australia, FSANZ Proposal P230 was gazetted for New Zealand to move ahead and introduce mandatory fortification in salt for bread in New Zealand.

This article considers some of the key issues regarding mandatory fortification of food. When FSANZ adopts mandatory fortification of any ingredient in any food, it dictates compositional requirements in food and it removes the decision from manufacturers and consumers to choose whether they want that ingredient in that food. It also can be said to involve ‘medicinalisation’ of the food supply with all the legal ramifications for the health impacts which are entailed.

1. FSANZ Proposals P1003 and P230

FSANZ Proposal P230 - Consideration of Mandatory Fortification with Iodine for New Zealand was gazetted on 13 March 2008. The policy reached in this proposal at the end of FSANZ’ consultative process resulted in mandatory fortification of salt used in bread-making with iodine only in New Zealand.

P230 was tendered by FSANZ in response to policy guidelines issued by the Australia and New Zealand Food Regulation Ministerial Council, the joint governmental body responsible for the development of policy in relation to food standards. The Ministerial Council is made up of Australia Federal, State, Territory and New Zealand Health Ministers and is chaired by the Australian Federal Minister for Health and Ageing.

FSANZ Proposal P1003 – Mandatory Iodine Fortification for Australia discusses whether Australia ought to adopt the same decision made solely for New Zealand in FSANZ Proposal P230. In March 2008, FSANZ received advice from the Australian Health Minister’s Advisory Council ‘confirming that iodine deficiency is prevalent and severe enough to warrant intervention in Australia and that mandatory fortification is considered the most cost-effective strategy to redress this’ (as per the First Assessment Report on Proposal P1003).

This policy of mandatory iodine fortification of salt in bread is given effect through amendments to the Australia New Zealand Food Standards Code (the Food Standards Code). The progress of Proposal P1003 can be followed on our FSANZ Tracker P1003.

As the object of FSANZ Proposal P1003 is to simply expand the policy of mandatory fortification reached in Proposal P230 from New Zealand only to both Australia and New Zealand, let us consider FSANZ’ decision-making process with regards to Proposal P230 to understand better the pre-requisites and procedures behind a government-enforced mandatory fortification of our food supply.

2. General pre-requisites for any ‘mandatory fortification’ proposal

The Food Standards Australia New Zealand Act 1991 (Cth) sets the procedures by which the Food Standards Code can be amended. The Act makes no specific or special provisions for mandatory fortification applications or proposals.

As mandatory fortification restricts industry practice, trade and commerce, it requires further consideration than, for example, setting a Standard for maximum residues of contaminants in food. As there are no legally enforceable issues for FSANZ to consider in relation to proposals for mandatory fortification, these further considerations are only a matter of policy as laid out by the Ministerial Council.

In its Policy Guideline – Fortification of Food with Vitamins and Minerals, the Ministerial Council stated (emphasis added) ‘that mandatory fortification should:

‘1.     be only in response to a demonstrated significant population health need taking into account the severity and prevalence of the health problem;

‘2.     be assessed as the most effective public health strategy to address the public health problem;

‘3.     be consistent, as far as possible, with national nutrition policies and guidelines;

‘4.     not result in detrimental dietary excesses or imbalances of vitamins and minerals; and

‘5.     deliver effective amounts of added vitamins or minerals to the target group to meet the health objective.’

3. Significant population health need

FSANZ Proposal P230, specifying mandatory fortification of bread-making salt with iodine only in New Zealand, was considered and gazetted separately to the issue of iodine fortification in Australia. This proposal excluded Australia because the ‘significant population health need’ had only been demonstrated in New Zealand by the time this Proposal was being considered. As the Food Standards Code governs both Australia and New Zealand, the Treaty agreeing for one body to set food safety standards for both nations (the Agreement between the Government of Australia and the Government of New Zealand Concerning a Joint Food Standards system) allows for setting separate standards for individual nations where required.

The ‘significant population health need’ considered in FSANZ Proposals P1003 and P230 is iodine deficiency, which can have a negative impact on mental and nervous system development in children and increases the risk of some forms of hyperthyroidism, especially in the elderly.

4. Existing fortification strategies for iodine in Australia

Table salt voluntarily fortified with iodine has long been available in Australian markets. Salt suppliers can choose whether or not they produce iodised salt. Clause 6 of Standard 2.10.2 of the Food Standards Code provides the maximum and minimum amount of iodine to be present in salt that is to be represented as ‘iodised salt’. Any salt with lower levels of iodine than the prescribed amount cannot be sold as ‘iodised salt’. However, the levels in Clause 6 of Standard 2.10.2 would only apply once the decision to produce iodised salt has been made by the producer. The proposed amendments under Proposal P1003 will not change this Standard for table salt; the mandatory fortification is only for salt used in bread-making.

Salt has been endorsed by the World Health Organisation, the International Council for Control of Iodine Deficiency and the United Nations Children’s Fund (UNICEF) as a carrier for iodine to supplement dietary deficiencies in the general populations. These international bodies all recommend and actively lobby for the iodisation of salt to combat iodine deficiency. Salt has been used as the carrier for iodine fortification because:

Salt production is restricted to a relatively small number of producers;
Iodisation of salt is a relatively simple technological process; and
It is cost effective.

While iodised salt is available in both Australia and New Zealand markets, several factors have lead to iodine consumption becoming insufficient, namely:

Reduction of iodine intake from other sources, such as milk, vegetables and seafood.
Reduction of salt in diet due to health concerns and hence the reduction of iodine in salt being consumed; and
Market trends show consumers moving away from table salt to un-iodised sea salt.

FSANZ considered research that found that in developed countries, 75 – 80% of dietary salt comes from manufactured foods, not table salt. Therefore, voluntary iodisation of table salt was considered no longer sufficient to combat iodine deficiency.

5. ‘Universal Salt Iodisation’ rejected

FSANZ considered Universal Salt Iodisation (USI) in all processed foods, the route recommended by the World Health Organisation and UNICEF. Ultimately, the Final Assessment Report on Proposal P230 found that USI was impractical for several reasons such as the health risks from over-exposure to iodine; however there were predominantly commercial reasons for rejecting USI. These were said to include:

The limitations on importation of processed food products containing salt that was not iodised that would arise;
Changes to product labelling; and
That USI would not present the consumer with much choice.

The latter two reasons are the usual ones given by FSANZ whenever a decision has been made to reject a proposed new food compositional or labelling Standard.

6. The Decision – Iodised Salt in Bread

The most controversial aspect of any decision with regard to mandatory fortification is the carrier of the vitamin or mineral. It is this carrier that, as per the abovementioned policy guidelines, is supposed to be the ‘most effective health strategy’ and ‘deliver’ the iodine to the target group. In Proposal P230, FSANZ has chosen salt in bread as the delivery mechanism and that mandatory fortification is the ‘most effective public health strategy’.

Several of the studies FSANZ considered stated that in Western countries, 75 – 80% of dietary salt comes from processed foods. In the Draft Assessment Report, FSANZ found that 50% of salt that came from processed foods came from cereals, cereal products (including bread products, pasta, noodle and rice) and cereal based products.

In the Final Assessment Report, FSANZ has reduced the food vehicle for iodine fortification from all processed food, to cereal based foods and then to bread alone, not including breakfast cereals, biscuits, pastas, noodles or rice.

7. The FSANZ Decision-making Process

Does bread ‘deliver effective amounts of added vitamins or minerals to the target group to meet the health objective’?

The target health groups for the New Zealand proposal (P230) and the forthcoming Australian proposal (P1003) are children, pregnant women and lactating women. The First Assessment Report of P1003 states that 88% of Australian children aged 2-3 consume bread; FSANZ also reported that there was little research available on the diets of pregnant and lactating women.

The Ministerial Council Guidelines state that the objectives in developing food regulatory measures are the protection of public health and safety, enabling consumers to make informed choices and the prevention of misleading and deceptive conduct. In respect to getting iodine to children, bread may be the right carrier. However:

The Final Assessment Report refers many times to the case of Tasmania where the population had been mildly iodine deficient. This deficiency was cured through iodine fortification of salt in bread but this was achieved by a voluntary fortification. The industries signed a Memorandum of Understanding with the Tasmanian Government and the fortification, while not legally enforceable, managed to counter the mild deficiency.
Salt from bread was found to be only a fraction of the salt consumption through processed foods; therefore dietary salt in bread comprises only a small part of all dietary salt consumed by people in Western societies according to FSANZ data. As such, the question arises as to how targeted salt in bread really is. It is the dietary intake of iodine, not salt, that is the issue. FSANZ does not appear to have fully considered whether the intake in iodised salt in bread will sufficiently redress the iodine deficiency in the target groups, simply stating that there is widespread consumption of bread. USI along with mandatory iodine fortification of cereal-based products such as breakfast cereals and biscuits were discarded for predominantly commercial decisions without fully considering the likely result in iodine intake.
The removal of other products as vehicles for mandatory fortification appears to have been made almost entirely on commercial arguments. Bread is mostly manufactured locally and so would not affect imports, whereas a requirement for mandatory fortification of imported biscuits and cereals would have impacted adversely on imports.
Finally, the fact that iodine deficiency is making a resurgence in Australia and New Zealand is as a result of changes in dietary habits. The mandatory fortification of bread-making salt does not appear to consider any trends in dietary habits. The question as to how long bread may remain the most effective carrier of iodine was not addressed.

8. Conclusion

The decision to target salt in bread alone for mandatory fortification seems to go against the very evidence that FSANZ has used to justify mandatory fortification. Fortification of table salt was always (and remains) a voluntary, commercial decision rather than a mandatory fortification. Bread only makes up a fraction of dietary intake of sodium. Furthermore, not enough research to see if bread is consumed in sufficient quantities by a large part of the target group (namely pregnant and lactating women) for the vehicle to correct the iodine deficiency in the population.

This article is not saying that iodine fortification is bad; it simply questions the manner of mandatory fortification in the chosen product against common internationally-endorsed practice. Mandatory fortification, by its very nature, places economic burdens on industry, restrains trade and removes consumer choice. The Ministerial Council Guidelines state as much. The decision to limit mandatory fortification to one industry instead of all processed foods may indicate a bias, especially when compared to the international experience of other countries where a variety of carriers have been used.

The decision by FSANZ to only use bread as a food vehicle was a decision largely based on being cost-effective and that it would present no barrier to trade. FSANZ stated at a number of points in the Final Assessment Report that the consumers would still have a choice as the Standard would not apply to organic bread. It is the manufacturers’ choice that has been removed and simply on the basis that their product is largely manufactured locally, not imported, and bread is supposedly cheaper to fortify through iodised salt than by other carriers.

It would appear that when making such strict impositions on one particular industry, in this instance the bread industries, FSANZ may have been guided by other political considerations as the data suggests potential ineffectiveness of the policy’s likely public health outcome.

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