Ironing out Iodine Deficiency

01 Jun 2017

Author: Angela Saurine

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Professor Creswell Eastman has been dubbed ‘the man who saved a million brains’ for his work ensuring pregnant women in the developing world get enough iodine to prevent them suffering miscarriages or giving birth to babies with deformities.
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When Professor Creswell Eastman visited a remote, mountainous region of Tibet in the 1980s, he was shocked by what he found. While researching the extent of iodine deficiency disorders, he came across entire villages filled with people with low IQs, large goitres (enlarged thyroid glands) and other deformities, many of whom were deaf and mute.

“It was like some kind of medieval scene,” he says. “It was hard to believe that we were living on the same planet.”
When he returned home to Australia, he couldn’t stop thinking about what he saw, and felt compelled to do something to help. 
In the decades since, Eastman has led many projects to abolish iodine deficiency – the most common preventable cause of brain damage throughout the developing world. His work with populations in remote areas of China led him to be dubbed ‘the man who saved a million brains’, but in reality he and his team have  saved countless more, including in Malaysia, Laos, Thailand, Vietnam and Indonesia.

“The numbers are in a sense not measurable,” he says. “When we started our work in China there were tens of millions of people with cretinism1 – now there are virtually none. When Professor Mu Li and I began work in Tibet, 10 to 15 per cent of children we examined had signs of cretinism. The last survey following on from our work there in 2007 found no new cases of cretinism in children under the age of five. We saved the brains of 30,000 children born there every year for the next 10 years. It’s allowed children to achieve the IQ they naturally inherit.”

A simple solution

Iodine is an essential micronutrient required to make thyroid hormones, which control the growth and development of the brain of foetuses and infants and children. Humans only need one teaspoon over their entire lifetime. When people who live in areas where the soil, water and food are iodine deficient, their thyroid gland swells, causing goitres. Pregnant women with a severe iodine deficiency are likely to miscarry, suffer stillbirths or give birth to babies with a low IQ, who are deaf, mute or have severe neurological disorders such as cretinism. 

“You have to get iodine into the diet and the simplest way is to add it to salt,” Eastman says. But unfortunately, it isn’t always that easy. In Tibet, villagers have been harvesting raw salt from high altitude lakes and trading it for centuries, and rely on it to make a living. 

Instead, Eastman and his team gave women and children oil capsules containing iodine. They asked monks to spread the word about iodine’s importance, and had it introduced in the school curriculum. In other countries, they’ve worked out a system of getting iodine into the water supply. 

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Professor Cres Eastman with monks affected by Iodine Defficiency Disorder in Tibet in 2004.

Finding his passion

Eastman was inspired to specialise in endocrinology – the branch of physiology and medicine concerned with endocrine glands and hormones – by Dr Leslie Lazarus when he was a student at St Vincent’s Hospital. He later went to work with Lazaruas at the Garvan Institute of Medical Research in Sydney. 

After doing field studies in Malaysia and Thailand in the early 1980s, he was approached by Chinese scientists to help find a solution to iodine deficiency issues in China. At that time, a quarter of China’s population – around 300 million people – had goitres.

“In Tibet in the late 90s and early 2000s, the average IQ was only 85. It should be over 100,” Eastman says. 

Over the years, Eastman – a Professor of Medicine at Sydney Medical School and Consultant Emeritus at Sydney’s Westmead Hospital – has worked with organisations including WHO, UNICEF, the World Bank, AusAID and government health authorities. During his time abroad, he slept in villages with former headhunters in Sarawak, on the island of Borneo, and was so ill with altitude sickness in Tibet he nearly died. He’s also poured a lot of his own money into projects that tackle iodine deficiency.

While he still provides some advice to countries in Asia, in more recent years Eastman has been focusing his work in the Pacific Islands and Australia, founding the not-for-profit organisation Australian Centre for Control of Iodine Deficiency Disorders (ACCIDD). 

ACCIDD is advocating for all pregnant women, especially women from Indigenous communities, to take an iodine supplement, in light of research published by the Menzies Institute for Medical Research in Hobart that showed a link between mild iodine deficiency and poorer educational outcomes, particularly in literacy. Eastman believes supplementation will help improve developmental outcomes in children, and lead to health and social benefits. 

Hope for the future

An estimated one billion people worldwide suffer from iodine deficiency. While it’s an alarming number, it’s half what it was a decade ago, and Eastman hopes to see it eliminated in his lifetime. 

“I’m forever the optimist,” he says. “If I live long enough, I’m 99 per cent sure we will achieve it. In my time working with iodine deficiency disorder around the world, we have gone from it being in 100 countries down to 20 or 30. You are never going to eradicate it because it’s not like smallpox or polio where you get rid of the virus. You have to be vigilant about it, forever.

“I haven’t changed the world, but I have helped to change the lives of millions of people.”

1. Cretinism is a congenital condition caused by deficiency of the thyroid hormone during prenatal development and is characterised by small stature, intellectual disability, deafness, mobility disorders and other forms of brain damage.