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Fortified Rice Must Carry Health Warning For Thalassemia Patients: Govt

Fortified Rice Must Carry Health Warning For Thalassemia Patients: Govt

Fortified rice distributed under the government-run food schemes may do more harm than good to those with blood disorders like sickle-cell anaemia and thalassemia, say experts.

Written by Longjam Dineshwori |Updated : May 24, 2022 3:10 PM IST

Fortified rice distributed under the government-run food schemes in India must carry health warnings for people with blood disorders such as sickle-cell anaemia and thalassaemia, the Centre has said in a statement. The announcement follows reports of adverse health impact among Adivasi people with thalassemia in Jharkhand, where iron-fortified rice is being given in a pilot project.

During his 2021 Independence Day speech, Prime Minister Narendra Modi had announced his government's plan to distribute only fortified rice by 2024 in all food schemes to tackle malnutrition in the country. On April 8, 2022, the Union government approved a programme to supply fortified rice to nearly 800 million beneficiaries under the public distribution system.

Under a pilot project, fortified rice is being distributed to indigenous Adivasi people in Jharkhand. However, a fact-finding team of well-known activists and medical practitioners who visited a tribal belt in the state earlier this month found fortified rice being given to indigenous people with thalassemia which poses health risks. They also found some fortified rice packets without any mandatory labels.

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Why iron-fortified food is bad for thalassemia patients?

Some patients with thalassemia may be advised to avoid iron supplements and foods that are rich in iron as too much iron may build up in the body.

"People with thalassemia can get too much iron in their bodies, either from the disease or from frequent blood transfusions. Too much iron can result in damage to your heart, liver and endocrine system, which includes hormone-producing glands that regulate processes throughout your body," writes Mayo Clinic.

Dr. Monica Gulati, Executive Dean and Head School of Pharmaceutical Sciences, Lovely Faculty of Applied Medical Sciences, LPU, explained, "Thalassemia is a congenital defect of globulin chain synthesis. There are four globulins' chains, 2 alfa and 2 beta. If 1 beta chain is absent, the body of patients will produce less amount of blood and usually their hemoglobin level remains low. But if both beta chains are absent then the body of the patient is not able to produce the blood, and they need blood transfusion on regular basis."

"For hemoglobin synthesis, body needs iron and Vit B12. Due to the deficiency of iron, patient may show microcytic hypochromic anemia. So sometimes patients may be affected with thalassemia minor (single beta chain deficiency) and physician may prescribe the iron therapy which may cause the toxicity instead of increasing the hemoglobin. In case of the major thalassemia where both chains are absent, the body of patients is not able to utilize the released iron from old red cells, leading to iron overload."

So, in both cases iron-fortified food to be cautiously given otherwise instead of benefit it may cause the joints pain and excessive iron accumulation in the body, she added.

Dr. Ganesh Jaishetwar, Consultant Hematologist, Hemato-Oncologist & Bone Marrow Transplant Physician, Yashoda hospitals Hyderabad, commented, "Thalassemia major patients should not be given iron-rich foods as they already had iron overload from regular blood transfusions and adding iron rich food can worsen their iron overload related various complications. It is recommended that patients going through blood transfusion should opt for a low iron diet."

Dr Shyam Rathi, Consultant Haematologist, Wockhardt Hospital, Mumbai Central, added, "Each ml of blood contains one miligram iron. Thalassemia patients are prone to develop iron overload because of regular blood transfusion and so they need medicines to reduce the body iron. Iron fortified food will add further to iron toxicity."

Iron deficiency and anaemia are fairly widespread in India, and the prevalence of anaemia among children under five years has only worsened, as revealed by the National Family Health Survey (NFHS).

However, the fact-finding team suggested that distribution of iron-fortified rice may not be a solution to improve such deficiencies, and it may affect the health of people with these blood disorders. The experts pointed out that iron-fortified might do more harm than good to the tribal communities or the indigenous people in the country, who are genetically prone to these ailments sickle-cell anaemia and thalassemia.

Some experts suggest that a diversified diet is the best answer to malnourishment.

FSSAI guidelines for fortified food

In its statement, the Food Safety and Standards Authority of India (FSSAI) has made it clear that it will be mandatory for state-run food agencies and commercial manufacturers of fortified food to carry the "+F" logo along with a health warning on packaging for patients with thalassaemia or other blood disorders. Rice is usually fortified with three micronutrients iron, folic acid and vitamin B12.

The food-industry regulator had, in 2018, fixed the standards of fortification for five staple product categories (milk, edible oil, rice, flour and salt). It stated that packages of food fortified with iron shall carry a message cautioning thalassemia patients to consume such iron-fortified food under medical supervision.

However, the fact-finding team reported that neither the consumers and nor the dealers of subsidized grains were aware of the health warnings.

Responding to the fact-finding's reports, the government had recently said that it was stringently overseeing the quality of the fortified products and ensuring that manufacturers and suppliers strictly follows the guidelines of FSSAI and that packages are imprinted with the +F logo and a message related to thalassemia.

With inputs from agencies