Iodine deficiency is creeping back. Vegans, vegetarians and pregnant women are most at risk

From theconversation.com

Iodine deficiency is often seen as a problem of the past, but this isn’t entirely true. During the 20th century, the iodisation of salt became one of the most effective public health interventions for preventing conditions caused by a lack of this mineral, including goiter (enlargement of the thyroid gland) and preventable damage to neurological development.

The World Health Organization (WHO) still views iodised salt as a safe and effective strategy, while UNICEF notes that it is the most widely used way of improving iodine intake worldwide.

However, the success of this simple measure means iodine has all but disappeared from public debate. And today, in several countries, signs of insufficient intake are once again being detected in certain groups, particularly in pregnant or breastfeeding women and people on restrictive or poorly planned diets.

What we are witnessing is not a dramatic resurgence of the most severe symptoms everywhere, but rather a silent risk of deficiency in contexts where vigilance has waned.

Iodine’s role in the body

Iodine is an essential micronutrient for the synthesis of thyroxine (T4) and triiodothyronine (T3), hormones that regulate metabolism, growth, and many physiological processes. Adequate intake during pregnancy and early childhood is particularly important for the normal development of the central nervous system and for the early stages of brain maturation.

In addition, the body’s needs increase during pregnancy and breastfeeding due to increased maternal production of thyroid hormones, greater renal excretion of iodine, and the transfer of this mineral to the foetus and the infant.

Why deficiency is on the rise again

The issue is not that people have stopped consuming salt, but rather that the type of salt they consume has changed, as have the sources of sodium in their diet. In recent years, iodised salt has been replaced in many households by “gourmet” or “natural” salts. These include sea salt, pink Himalayan salt, flaked salt and kosher salt, which are often perceived as more sophisticated or healthier, even though they are not always iodised.

In a way, iodised salt has an image problem. Compared to the culinary prestige of its trendy rivals, it has come to be viewed as something ordinary, outdated even.

Today, lot of our salt intake also comes from processed and ultraprocessed foods, meaning the use of iodised salt cannot be guaranteed. For this reason, the World Health Organization has called for coordination between policies that aim to reduce sodium intake and those that promote iodised salt.

The makeup of our diets has also changed a lot. Iodine is naturally present in all seafood, some dairy products and in eggs, though the quantity may vary from one region or food system to another. When a person reduces or cuts out several of these sources at once while not also consuming iodised salt or fortified foods, the risk of deficiency increases.

The result is that a basic, inexpensive, and effective micronutrient has fallen out of the spotlight just as certain groups are once again at risk of not getting enough iodine.

Plant-based diets

Vegetarian and vegan diets can be healthy, but they must take iodine into consideration. A 2023 review in the British Journal of Nutrition concluded that people following a plant-based diet, especially vegans, may find it hard to get the recommended amount of iodine from these foods alone.

This does not mean a plant-based diet is inherently lacking – and the solution is straightforward. Just as vitamin B12 is is commonly recommended for those who reduce their consumption of fish or dairy – or when people replace animal products with unfortified plant-based alternatives – so too should iodine.

Pregnancy and breastfeeding

Iodine deserves special attention during pregnancy. There is strong evidence that a severe deficiency of this micronutrient can affect foetal development and thyroid function, which is why many organisations use specific thresholds to assess iodine status in pregnant women. The US National Institutes of Health states that a urinary concentration of 150–249 micrograms per litre (μg/L) in pregnant women is considered adequate for the general population.

But there is a caveat to this. Concerns about mild or moderate deficiency are legitimate, but there is no conclusive evidence as to the cognitive benefits of supplementing all pregnant women who show a mild deficiency. Reviews and trials have indicated that there is plausible biological concern, and some studies suggest an association with poorer outcomes, but controlled experiments have not unanimously shown clear improvements in infant neurodevelopment.

Nevertheless, several scientific societies have adopted a cautious stance. The American Thyroid Association, for instance, states that women who are planning to conceive, pregnant or breastfeeding should receive 150 μg of iodine daily in prenatal or multivitamin supplements, usually in the form of potassium iodide, to help meet increased requirements.

Why ‘more salt’ is not the answer

Another important clarification is needed here. Advocating for iodised salt does not mean recommending a higher salt intake. The WHO maintains its recommendation to reduce sodium intake due to its link with high blood pressure and cardiovascular disease. In terms of public health, the solution is not “more salt”, but less – though the salt we do eat should be iodised.

In fact, the WHO itself has emphasised that reducing salt intake and fortifying salt with iodine are compatible, provided the concentration of the mineral is properly adjusted and salt used by the food industry is also fortified.

This point is key because it avoids two common pitfalls: turning the issue into a nostalgic defence of table salt, or the other extreme of assuming that any reduction in sodium intake will automatically solve all health problems without any nutritional consequences. But it is possible to strike a balance between preventing cardiovascular disease and iodine deficiency.

https://theconversation.com/iodine-deficiency-is-creeping-back-vegans-vegetarians-and-pregnant-women-are-most-at-risk-282163 

The only 5 supplements most vegans actually need

From vegoutmag.com 

By Avery White

After years of trial, error, and way too many pill bottles cluttering my bathroom cabinet, I've learned that vegan supplementation works best when you keep it simple

When I first went vegan at 35, I panicked about nutrition. My analytical brain, trained by years in finance, wanted to optimize everything.

I bought every supplement the internet recommended and ended up with a cabinet full of bottles I couldn't keep track of. Sound familiar?

Here's what five years of plant-based living has taught me: most vegans don't need a pharmacy's worth of pills. We need a few key nutrients that are genuinely harder to get from plants, taken consistently. The rest? Often unnecessary if you're eating a varied whole-foods diet.

Let me walk you through what actually matters.

1. Vitamin B12: The non-negotiable one

I'll be direct here: every vegan needs to supplement B12. No exceptions, no debates.

This vitamin is produced by bacteria and is found reliably only in animal products or fortified foods. Your body stores it for years, which means deficiency creeps up slowly and can cause serious neurological damage before you notice symptoms.

I take 2,500 mcg of cyanocobalamin weekly, though you can also take a smaller daily dose. The National Institutes of Health recommends adults get 2.4 mcg daily, but absorption varies, so higher supplemental doses ensure you're covered. This one isn't about perfection or optimization. It's about protecting your nervous system.

Have you had your B12 levels checked recently? It's worth asking your doctor to include it in routine bloodwork.

2. Vitamin D: The sunshine vitamin most of us miss

Here's something that surprised me: vitamin D deficiency isn't just a vegan problem. It's an everyone-who-lives-indoors problem. But vegans face an extra hurdle because D3, the more effective form, typically comes from animal sources like lanolin or fish oil.

I started paying attention to this after a particularly dark Portland winter left me exhausted and moody. My levels were in the basement. Now I take 2,000 IU of vegan D3 daily, sourced from lichen. The Harvard T.H. Chan School of Public Health notes that many experts recommend 1,000 to 2,000 IU daily, especially for those with limited sun exposure.

If you work indoors, live in a northern climate, or have darker skin, this one deserves your attention. Consider getting tested to know your baseline.

3. Omega-3s: The brain food worth investing in

For years, I thought my daily flaxseed was handling my omega-3 needs. Then I learned about conversion rates. Your body can convert the ALA in flax, chia, and walnuts into the EPA and DHA your brain actually uses, but the conversion is inefficient. We're talking single-digit percentages.

As someone who runs 25 miles a week and relies on mental clarity for writing, I decided not to gamble on conversion. I take an algae-based omega-3 supplement providing around 250 mg of combined EPA and DHA daily. Algae is where fish get their omega-3s anyway, so we're just cutting out the middlefish.

Do you notice brain fog or struggle with focus? It might be worth examining your omega-3 intake beyond just plant sources.

4. Iodine: The quiet essential

This one flies under the radar, but it matters. Iodine supports thyroid function, which regulates your metabolism, energy, and so much more. If you've ditched dairy and don't eat much seaweed, you might be falling short.

I was sceptical until I learned that plant-based diets can be low in iodine unless you're intentional about it. I use iodized salt in cooking and take a modest supplement providing around 150 mcg a few times a week. The key is not to overdo it, as too much iodine can also disrupt thyroid function.

Sea vegetables like nori and wakame are good food sources, but their iodine content varies wildly. A small, consistent supplement takes the guesswork out of it.

5. Iron: Context-dependent but worth monitoring

I debated including iron because not every vegan needs to supplement it. But enough of us struggle with it, especially menstruating women and endurance athletes, that it deserves a spot on this list.

Plant-based iron is non-heme iron, which your body absorbs less efficiently than the heme iron in meat. Pairing iron-rich foods like lentils, spinach, and fortified cereals with vitamin C dramatically improves absorption. I eat this way intentionally and my levels stay solid without supplementation most of the time.

However, during heavy training cycles or particularly stressful periods, I've needed a low-dose iron supplement. The research suggests that vegetarians and vegans should monitor iron status and consider supplementation based on individual needs rather than blanket recommendations.

Get tested before supplementing iron, as too much can be harmful. Know your numbers.

Final thoughts

When I look back at my early vegan days, I wish someone had told me to slow down and focus on what actually matters. Five supplements. That's it. B12 and vitamin D are essential for nearly everyone. Omega-3s and iodine fill common gaps. Iron depends on your individual situation.

The rest of your nutrition? It can come from food. Beautiful, delicious, whole plant foods that you actually enjoy eating. Supplementation should support your diet, not replace the joy of nourishing yourself well.

What does your current supplement routine look like? Sometimes the most powerful change is simplifying, trusting the process, and paying attention to how your body responds. That's been my path, anyway.

https://vegoutmag.com/food-and-drink/s-bt-the-only-5-supplements-most-vegans-actually-need/

Nutrient deficiencies vegans need to watch out for

From which.co.uk

We run down the vitamins and minerals that are harder to get from plants alone, and how to keep them topped up 

Going vegan or veggie is increasingly popular, but it could put you at risk of nutritional deficiencies that impact your health if you don't plan your meals carefully.

If you've started following a vegan diet as part of your 2023 resolutions it's important to be aware of the nutrients that are harder to source from solely plant-based foods, and make sure you're getting enough. 

We've rounded up the vital vitamins that are harder to get hold of via a plant-based diet, why they matter, and how to get more into your meals.

Which nutrients are harder to get from a plant-based diet?

Vitamin B12

We only need a small amount of B12 in our daily diet but it's really key. Not getting enough can cause tiredness, headaches and vision problems.

If left unchecked, it can cause more severe symptoms including issues with memory and cognition, vitamin B12 deficiency anaemia, increased risk of heart disease and nerve symptoms such as numbness.

Vitamin B12 only occurs naturally in animal-derived foods such as meat, milk, eggs, fish and shellfish, so vegans can struggle to get enough of it.

Vegan B12 food sources:

• Fortified breakfast cereal and / or fortified plant-based milk. Most cereals have vitamin B12 added to them but check before buying (and watch out for sugar content). Some plant-based milk alternatives are also fortified with B12. See how they compare in our guide to plant-based milks. 
• Yeast extract. Whether it's Marmite or an own-brand version, these spreads are fortified with vitamin B12. 
• Nutritional yeast. Nutritional yeast flakes can be used instead of cheese when you're making vegan dishes like mac and no-cheese.

However, even if you add fortified foods to your diet, you'll likely need a B12 supplement to ensure you're getting enough.

Calcium

Calcium is found in dairy foods such as cheese, yoghurt and milk and it's needed for strong bones and teeth, as well as regulating heart rhythm.

If we don't get the average 700mg we need per day from our diet it can lead to reduced bone density. This is particularly important for women, who are at higher risk of osteoporosis in later life.

A 2020 study in BMC medical journal showed that those following a vegan diet had a higher risk of fractures in all areas of the body, especially the hip bones. Vegetarians and fish eaters were also at increased risk of fracture compared to meat eaters.

Vegan calcium food sources:

• Choose calcium-fortified foods. Calcium-set soya bean curd or tofu, fortified cereals and fortified plant-based milk alternatives are all useful options.
• Pack in green leafy veg. Some are better than others. Kale and spring greens are good sources.
• Don't eat too many oxalate or phytate containing foods. Although dried fruits, beans, seeds and nuts contain calcium they also contain oxalates and/or phytates. These reduce the body's ability to absorb calcium, so try to avoid having these foods at the same time as other calcium sources. The same applies to some dark green leafy veg, such as spinach.

Iron

If you're often tired, breathless and pale,  you might have low iron - the nutrient needed for healthy blood cells to carry oxygen to every cell in your body.

The 'haem' variety of iron - found in animal products such as beef, lamb, pork, eggs and poultry - is more easily absorbed by the body than plant-derived 'non-haem' iron, which is what animal-free diets depend on.

Vegans have been shown to have lower blood cells counts and higher levels of iron-deficiency anaemia than people who get iron from animal sources.

How to get enough iron when you're vegan:

• Combine it with vitamin C. This improves absorption of iron, so combining vitamin C rich fruit and veg, or a glass of OJ, with your iron-based sources (beans, pulses, nuts, seeds, dried fruit, wholemeal bread) can help. 
• Avoid drinking tea or coffee with meals. Tea and coffee contain plant compounds called polyphenols which can bind to iron and reduce how much you absorb, so try to avoid drinking them near to mealtime. 

Zinc

Animal sources of zinc include meat, shellfish and dairy foods, and it supports immunity, healthy hair and skin, and wound healing.

It's known as a trace mineral, meaning we only need small amounts, but our bodies can't store it, so we need regular intakes. 

Plant-based sources of zinc include wheat germ, beans, nuts, seeds, mushrooms and fortified breakfast cereals, but phytate (found in plant fibres, especially in seeds and nuts) can inhibit zinc absorption.

Vegan zinc food sources:

• Try fermented foods like tempeh and miso. The fermentation process in these soya foods produces the enzyme phytase, which breaks down the phytates in plant foods that can get in the way of zinc absorption.
• Sprouted beans, chickpeas and lentils. Sprouting also leads to the breaking down of phytates, but cook thoroughly if they're being eaten by people in vulnerable groups including those who are pregnant.

Omega-3 fats

The omega-3 fats ALA,  EPA and DHA have to come from our food because we can't make them ourselves.

EPA and DHA, which are are needed for heart, lung and blood vessel health, are found in oily fish such as salmon, mackerel, herring and sardines (ideally two portions per week) so if you're vegan you rely on these being converted from the ALA you get from certain nuts and seeds.

Foods rich in the omega-6 essential fat LA  (linoleic acid) include walnuts, sunflower and pumpkin seeds and some vegetable oils including sunflower and corn.

Vegan sources of Omega-3 fats:

• Chia seeds, ground linseed, hemp seeds and walnuts. All are good daily sources.
• Use rapeseed oil. The Vegan Society recommends using this instead of oils containing a lot of LA, such as sunflower, corn or sesame oils.

Iodine

Iodine is needed for healthy thyroid function, which impacts many processes in the body including metabolism and temperature control - as well as being essential for healthy pregnancy.

The 140 micrograms of it that we need each day is usually derived from dairy products and seafood, but if you're a vegan, or don't eat much of these food groups, you may be at risk of being deficient.

A 2021 study published in Cambridge University Press found that both vegans and vegetarians are at risk of inadequate iodine nutrition.

Vegan iodine food sources:

• Eat seaweed, but not too often. Although seaweed foods such as sushi, nori, wakame and kelp contain iodine it can be in variable amounts so guidance states that you shouldn't eat sea vegetables more than once a week.
• Don't rely on iodised salt. Experts say that as we are being encouraged to cut down on salt to prevent conditions such as high blood pressure we shouldn't rely on iodised salt as a means of increasing intake.
• Use iodine-fortified plant milk. The ingredient to look out for is potassium iodide, but read the label as some milk alternatives contain it while others don't. 

Are vegan diets healthy?

A well-balanced vegan diet is low in saturated fat and rich in dietary fibre and plant proteins - all of which combine to benefit health in a variety of ways, including weight loss, reduced risk of some cancers, managing blood sugar levels and reducing levels of bad cholesterol.

However, it's also possible to have an unhealthy vegan diet. Some ultra-processed foods labelled as vegan, such as meat substitutes, aren't always as healthy as their image may suggest.

Some have unexpectedly high levels of sugar, salt and fat - for example, Which? compared a vegan Beyond Burger to a standard beef burger and found more calories, fat and salt per 100g in the non-meat version. They can be pricier too.

So, don't assume any food labelled vegan is good for you. You'll still need to watch out for additives, and high sugar or salt levels.

Who's most at risk of nutrient deficiency?

Certain groups are more at risk of lacking key vitamins and minerals:

Women and teenage girls

The National Diet and Nutrition Survey shows that one in four UK women and almost half (49%) of girls and young women aged 11-18 have a low intake of iron, which can increase the risk of iron deficiency anaemia.

The needs of women aged 19-50 are greater than those of men and older women because of menstruation, which can use up your iron reserves, especially if your periods are heavy or your diet is low in iron.

Around one in ten adult women also have inadequate intakes of calcium, which may leave them at higher risk of osteoporosis, and there is evidence that teenage girls and young women don't get enough iodine. 

Older people

As we get older it becomes harder to absorb vitamin B12 so experts recommend boosting levels by eating fortified breakfast cereals, yeast extract and meat.

The NHS says that both vitamin B12 deficiency and folate deficiency are more common in older people, affecting around 1 in 10 over 75 and 1 in 20 people aged 65 to 74 so if you're concerned see your GP.

Vegetarians

How strictly vegetarian you are will impact which nutrients might be lacking (e.g if you still eat fish or eggs). However, with the emphasis on plant foods, vegetarians should be thinking about how they meet their vitamin B12 needs, for example from fortified foods or from a supplement.

People with gastrointestinal issues or on certain medications

Some gastric conditions can make it hard for your body to absorb nutrients from food.

For example, people with coeliac disease, where the digestive system works less effectively than it should, need to make sure they have enough iron, vitamin B12 and calcium. And some reflux suppressing medications can limit B12 uptake.

What about supplements?

It's best to get your nutrients from your diet where possible, but supplements may be helpful for some groups or where it's harder to get from diet alone. See our guide to vitamin and mineral supplements you do and don't need for more.

https://www.which.co.uk/news/article/nutrient-deficiencies-vegans-need-to-watch-out-for-axmFn7x81sMa

For a vegan diet to be healthy and complete, you really need to understand your food

From abc.net.au/news/health

In a world where "meat-free meat" sits next to the beef sausages in the supermarket and ordering an almond milk latte brings nary a flicker to a barista's eye, the once-fringe vegan movement seems to have gone mainstream.
For the uninitiated, followers of a vegan diet eschew all animal products, including dairy, eggs, honey and, of course, meat.
So for an eating pattern that cuts out so many foods traditionally considered essential, is it possible for a vegan diet to meet all your nutritional needs?
Yes, says Clare Collins, professor of nutrition at the University of Newcastle — but it requires you to understand food better than the average omnivore, or even vegetarian.
Here are four main nutrients to look out for.

Vitamin B12

Let's start with this one, because vitamin B12 is something we humans can really only get via animal foods — such as meat, fish, dairy and eggs — or in the form of supplements.
It's an important vitamin too, essential for making DNA, fatty acids, red blood cells and chemicals called neurotransmitters which help to pass signals around the brain.
"That's the really big one. You don't want to end up with a B12 deficiency," Professor Collins said.

B12 deficiency manifests at first as vague but unpleasant symptoms like heart palpitations, light-headedness, tiredness and bowel or bladder changes, so it's important to keep on top of it.
In severe cases, it can progress to mood changes like depression and paranoia, and nerve problems like numbness, pain and loss of taste and smell.

While trace amounts of B12 have been found in some plant foods such as mushrooms, fermented soybeans and things that have been contaminated by soil or insects, if you're following a vegan diet you should be looking to supplements or fortified foods to ensure you're getting enough.
It's often added to non-dairy milks, but not all, so check the label.

Calcium

Most people know about the importance of calcium for your bones, but it also plays a role in other parts of your body, including your heart, muscles and nerves.
What's more, your bones actually act as a calcium bank, so if you're not getting enough from your diet, your body will make withdrawals from that bank, which can affect your bone health.

         Almonds are a dairy-free source of calcium

               (Unsplash: Juan Jose Valencia Antía)

Dairy is often touted as being an important source of calcium, but it's by no means the only source. Plenty of plant-based foods contain it, including some tofu and some nuts, legumes and seeds.
But interestingly, vegans and vegetarians often need even more calcium than omnivores, because some plant foods have chemicals that make it harder for your body to access it.

For example, spinach and beans contain oxalic acid, and some grains, nuts and legumes contain phytic acid, which both interfere with calcium absorption.

You can bolster your calcium intake with fortified plant milks and fortified breakfast cereals — again, check the label to make sure the product you are choosing is actually fortified, because not all are.

Iron

Iron is used inside your red blood cells to carry oxygen around the body, so a deficiency can leave you feeling lethargic and tired, as well as lowering your immunity.
While omnivores usually get their iron delivered ready-to-use, via red meat, plant-based sources of iron require your body to do a bit more work.

You can help your body absorb your plant-based iron, found in foods like legumes and beans, by eating it at the same time as vitamin C.
That can be as simple as putting veggies like red capsicum and broccoli next to the lentils on your dinner plate.

"The other thing you can do is not have any cups of tea straight after meals because the tannins and the phytates in the tea actually interfere with the absorption of the iron," Professor Collins said.

              Combining plant-based iron sources like chickpeas with vitamin C-containing veggies like                                               capsicum helps your body better absorb the iron

                                                         (Unsplash: Edgar Castrejon)

Iodine

Iodine helps your thyroid to function — that little gland in your neck that controls your metabolism, among other things.
Seafood is a source of iodine, and it's also found in some dairy products in Australia, but the main source of iodine for people who avoid animal products is via iodised salt, which is used in commercial breads and some breakfast cereals.
As for some of the other essential nutrients, the symptoms of deficiency can be vague but hint at something serious, Professor Collins said.
"How do you know if you're iodine deficient? It's things like tiredness, weakness, lethargy, and then other things like constipation, heartbeat [changes], facial puffiness and so on."

Iodine deficiency is a particularly big deal for women of childbearing age, as it can affect the brain development of babies during pregnancy and increase the risk of miscarriage and stillbirth.
Pregnant women have other specific nutritional needs beyond the four mentioned here, and so do children. So talk to your doctor if your kids are on a vegan diet or you're planning to become pregnant.
And for people who follow vegan diets for a very long time, there are other nutrients, such as omega-3 fatty acids, that can become an issue.
If you're following a vegan diet, its worth mentioning it to your doctor so they can check for deficiencies.

Is veganism the optimal diet for health?

                           Meals based around plant-based whole foods aren't just for vegans

                                                            (Unsplash: Maddi Bazzocco)

While most people who choose vegan diets do so because they want to minimise harm to animals or cut down on their environmental impact, others talk about the potential health benefits of being entirely plant-based.
The recent documentary The Game Changers promotes a diet free of animal products as performance-enhancing and implies it might even be the optimal diet for humans.
So ... could a vegan diet be even better for you than a healthy omnivorous one?

It's not as simple as that, Professor Collins explained.

There are plenty of animal-free products that are highly processed, high in salt and fat and low in other essential nutrients.
"People are getting a message that, hey, you're supposed to be a little bit vegan now, and they're just buying these products that are appearing … without thinking through what it has really taken to manufacture those things.
"The lazy way to be a vegan is to just leave the meat out and leave the dairy products out and make no effort to bring back in the foods that you need to replace the nutrients that you're missing out on."

So while it's certainly possible to have a healthy, complete vegan diet, it's not the only healthy way to eat, Professor Collins said.
If you're looking for a guide, she recommends the Australian Government's Eat For Health website.

"I know it's boring but it actually does outline how many serves of the five food groups you need, based on age and sex, to meet your nutrient requirements.

"You can have a normal, healthy vegetarian pattern and unhealthy vegan eating pattern and you can have an unhealthy omnivore eating pattern."

More veggies, less junk would benefit us all

There are definitely things that most of us could learn from veganism though, especially when it comes to plant-based "whole foods".
Many vegan protein sources, such as pulses and nuts, do double time by also being rich sources of fibre and healthy fats.

"One of the movements that I think can benefit everyone is what's called flexitarian, which is like being a part-time vegetarian or even a part-time vegan," Professor Collins said.
"So a few days a week, you are consciously trying to boost your intake of vegetable sources of nutrients."

Swapping out a few meals a week with whole-food vegan protein sources is not going to do you harm and will probably do you good.
"It's really about stepping back and saying, hey, what are the things I'm eating? Am I eating nutrient rich foods? And am I not going overboard on ultra-processed junk food?"

Plus, if your impact on animals and the environment is important to you — goals that motivate many people to go vegan in the first place — then going some of the way is arguably better than going none of the way.

https://www.abc.net.au/news/health/2019-12-04/veganism-is-a-vegan-diet-healthy-b12-calcium-iodine-iron/11698020