Original Article

European Journal of Clinical Nutrition advance online publication 13 September 2017; doi: 10.1038/ejcn.2017.134

A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women

S Manousou1,2, M Stål3, C Larsson4,5, C Mellberg6, B Lindahl6, R Eggertsen2,7, L Hulthén3, T Olsson6, M Ryberg6, S Sandberg6 and H F Nyström2,8

  1. 1Department of Internal Medicine, Kungälv’s Hospital, Kungälv, Sweden
  2. 2Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  3. 3Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  4. 4Department of Food and Nutrition, and Sport Science, University of Gothenburg, Göteborg, Sweden
  5. 5Department of Food and Nutrition, Umeå University, Umeå, Sweden
  6. 6Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  7. 7Mölnlycke Health Care Center, Mölnlycke, Sweden
  8. 8Deparment of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden

Correspondence: Dr S Manousou, Department of Internal Medicine, Lasarettsgatan Kungälv’s Hospital, Kungälv SE-442 34, Sweden. E-mail: sofia.manousou@vgregion.se

Received 18 May 2017; Revised 28 June 2017; Accepted 18 July 2017
Advance online publication 13 September 2017





Different diets are used for weight loss. A Paleolithic-type diet (PD) has beneficial metabolic effects, but two of the largest iodine sources, table salt and dairy products, are excluded. The objectives of this study were to compare 24-h urinary iodine concentration (24-UIC) in subjects on PD with 24-UIC in subjects on a diet according to the Nordic Nutrition Recommendations (NNR) and to study if PD results in a higher risk of developing iodine deficiency (ID), than NNR diet.



A 2-year prospective randomized trial in a tertiary referral center where healthy postmenopausal overweight or obese women were randomized to either PD (n=35) or NNR diet (n=35). Dietary iodine intake, 24-UIC, 24-h urinary iodine excretion (24-UIE), free thyroxin (FT4), free triiodothyronine (FT3) and thyrotropin (TSH) were measured at baseline, 6 and 24 months. Completeness of urine sampling was monitored by para-aminobenzoic acid and salt intake by urinary sodium.



At baseline, median 24-UIC (71.0μg/l) and 24-UIE (134.0μg/d) were similar in the PD and NNR groups. After 6 months, 24-UIC had decreased to 36.0μg/l (P=0.001) and 24-UIE to 77.0μg/d (P=0.001) in the PD group; in the NNR group, levels were unaltered. FT4, TSH and FT3 were similar in both groups, except for FT3 at 6 months being lower in PD than in NNR group.



A PD results in a higher risk of developing ID, than a diet according to the NNR. Therefore, we suggest iodine supplementation should be considered when on a PD.

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