Iodine and plant-based diets - a narrative review and calculation of iodine content

An increasing number of food-based recommendations promote a plant-based diet to address health concerns and environmental sustainability in global food systems. As the main sources of iodine in many countries are fish, eggs, and dairy products, it is unclear whether plant-based diets, such as the EAT-Lancet reference diet, would provide sufficient iodine. This is important as thyroid hormone production requires iodine for growth and brain development; adequate iodine intake is especially important before and during pregnancy. In this narrative review, we evaluated the current literature and estimated iodine provision from the EAT-Lancet reference diet. There is evidence that those following a strict plant-based diet, such as vegans, cannot reach the recommended iodine intake from food alone and are reliant on iodine supplements. Using the EAT-Lancet reference diet recommendations for intake and iodine values from UK food tables, we calculated that the diet would provide 128 μg/day (85% of the adult recommendation of 150 μg/d and 51-64% of the pregnancy recommendation of 200-250 μg/d). However, if milk is replaced with unfortified plant-based alternatives, total iodine provision would be just 54 μg/day (34% and 22-27% of the recommendations for adults and pregnancy, respectively). Plant-based dietary recommendations might place consumers at risk of iodine deficiency in countries without a fortification programme and where animal products provide the majority of iodine intake, such as the UK and Norway. It is essential that those following a predominantly plant-based diet must be given appropriate dietary advice to ensure adequate iodine intake.