Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Minerals, trace elements, Vit. D and bone health

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



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 (71.0 μg/l) and 24-UIE (134.0 μg/d) were similar in the PD and NNR groups. After 6 months, 24-UIC had decreased to 36.0 μg/l (P=0.001) and 24-UIE to 77.0 μg/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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3


  1. 1

    Acheson KJ . Diets for body weight control and health: the potential of changing the macronutrient composition. Eur J Clin Nutr 2013; 67: 462–466.

    CAS  Article  Google Scholar 

  2. 2

    Lindeberg S . Paleolithic diets as a model for prevention and treatment of Western disease. Am J Hum Biol 2012; 24: 110–115.

    Article  Google Scholar 

  3. 3

    Ryberg M, Sandberg S, Mellberg C, Stegle O, Lindahl B, Larsson C et al. A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. J Intern Med 2013; 274: 67–76.

    CAS  Article  Google Scholar 

  4. 4

    Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C et al. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. Eur J Clin Nutr 2014; 68: 350–357.

    CAS  Article  Google Scholar 

  5. 5

    Klonoff DC . The beneficial effects of a Paleolithic diet on type 2 diabetes and other risk factors for cardiovascular disease. J Diabetes Sci Technol 2009; 3: 1229–1232.

    Article  Google Scholar 

  6. 6

    National Food AdministrationRiksmaten 1997–1998 Kostvanor och näringsintag i Sverige (The Second National Food Consumption Survey Dietary Habits and Nutrient Intake in Sweden 1997–98). National Food Administration: Uppsala, Sweden, 1998.

  7. 7

    Nordic Council of MinistersNordic Nutrition Recommendations 2012: Integrating Nutrition and Physical Activity. Nordic Council of Minsters: Copenhagen, Denmark, 2014..

  8. 8

    Vanderpas J . Nutritional epidemiology and thyroid hormone metabolism. Annu Rev Nutr 2006; 26: 293–322.

    CAS  Article  Google Scholar 

  9. 9

    Leung AM, Lamar A, He X, Braverman LE, Pearce EN . Iodine status and thyroid function of Boston-area vegetarians and vegans. J Clin Endocrinol Metab 2011; 96: E1303–E1307.

    CAS  Article  Google Scholar 

  10. 10

    Laurberg P, Cerqueira C, Ovesen L, Rasmussen LB, Perrild H, Andersen S et al. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab 2010; 24: 13–27.

    CAS  Article  Google Scholar 

  11. 11

    Nystrom HF, Berg G, Eggertsen R, Hulthen L, Milakovic M . Swedish iodination of salt has decreased the incidence of goiter. But low use of iodinated salt in the schools raises concerns for the future. Lakartidningen 2012; 109: 90–93.

    PubMed  Google Scholar 

  12. 12

    Höjer J . Kropfstudien Die Verbreitung des endemischen Kropfes in Schweden. Svenska Läkarsällskapets Handlingar 1931; 57: 1–104.

    Google Scholar 

  13. 13

    Andersson M, Berg G, Eggertsen R, Filipsson H, Gramatkovski E, Hansson M et al. Adequate iodine nutrition in Sweden: a cross-sectional national study of urinary iodine concentration in school-age children. Eur J Clin Nutr 2009; 63: 828–834.

    CAS  Article  Google Scholar 

  14. 14

    Filipsson Nyström H, Andersson M, Berg G, Eggertsen R, Gramatkowski E, Hansson M et al. Thyroid volume in Swedish school children: a national, stratified, population-based survey. Eur J Clin Nutr 2010; 64: 1289–1295.

    Article  Google Scholar 

  15. 15

    World Health Organization, United Nations Children's Fund and International Council for the Control of Iodine Deficiency DisordersAssessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide for Programme Managers. 3rd edn. World Health Organization: Geneva, Switzerland, 2007.

  16. 16

    Andersson M, Karumbunathan V, Zimmermann MB . Global iodine status in 2011 and trends over the past decade. J Nutr 2012; 142: 744.

    CAS  Article  Google Scholar 

  17. 17

    Hetzel BS, Dunn JT . The iodine deficiency disorders: their nature and prevention. Annu Rev Nutr 1989; 9: 21–38.

    CAS  Article  Google Scholar 

  18. 18

    Rasmussen LB, Ovesen L, Christiansen E . Day-to-day and within-day variation in urinary iodine excretion. Eur J Clin Nutr 1999; 53: 401–407.

    CAS  Article  Google Scholar 

  19. 19

    Zimmermann MB . The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid 2007; 17: 829–835.

    CAS  Article  Google Scholar 

  20. 20

    Lightowler HJ, Jill Davies G . Iodine intake and iodine deficiency in vegans as assessed by the duplicate-portion technique and urinary iodine excretion. Br J Nutr 1998; 80: 529–535.

    CAS  Article  Google Scholar 

  21. 21

    Pino S, Fang SL, Braverman LE . Ammonium persulfate: a safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem 1996; 42: 239–243.

    CAS  PubMed  Google Scholar 

  22. 22

    Elnagar B, Eltom A, Wide L, Gebre-Medhin M, Karlsson FA . Iodine status, thyroid function and pregnancy: study of Swedish and Sudanese women. Eur J Clin Nutr 1998; 52: 351–355.

    CAS  Article  Google Scholar 

  23. 23

    Becker WBK, Ohlander Å, Lyhne EM, Pedersen N, Aro AN, Fogelholm A et al JI Nordic Nutrition Recommendations 2004. 4th ed. Nordic Council of Ministers: Copenhagen, Denmark, 2004..

  24. 24

    Dombrowski SU, Avenell A, Sniehott FF . Behavioural interventions for obese adults with additional risk factors for morbidity: Systematic review of effects on behaviour, weight and disease risk factors. Obesity Facts 2010; 3: 377–396.

    Article  Google Scholar 

  25. 25

    Yarrington C, Pearce EN . Iodine and pregnancy. J Thyroid Res 2011; 2011: 934104.

    Article  Google Scholar 

  26. 26

    Velasco I, Carreira M, Santiago P, Muela JA, Garcia-Fuentes E, Sanchez-Munoz B et al. Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life. J Clin Endocrinol Metab 2009; 94: 3234–3241.

    CAS  Article  Google Scholar 

  27. 27

    Zimmermann MB, Connolly K, Bozo M, Bridson J, Rohner F, Grimci L . Iodine supplementation improves cognition in iodine-deficient schoolchildren in Albania: a randomized, controlled, double-blind study. Am J Clin Nutr 2006; 83: 108–114.

    CAS  Article  Google Scholar 

  28. 28

    Andersen S, Karmisholt J, Pedersen KM, Laurberg P . Reliability of studies of iodine intake and recommendations for number of samples in groups and in individuals. Br J Nutr 2008; 99: 813–818.

    CAS  Article  Google Scholar 

  29. 29

    Vanderpump MP, Lazarus JH, Smyth PP, Laurberg P, Holder RL, Boelaert K et al. Iodine status of UK schoolgirls: a cross-sectional survey. Lancet 2011; 377: 2007–2012.

    CAS  Article  Google Scholar 

Download references


Thanks to Elisabeth Gramatkovski for invaluable help with the iodine analyzes and to Michael Hoppe for the statistical analyzes. Inger Arnesjö, Katarina Iselid and Monica Holmgren contributed with important technical assistance. Johanna Larsson helped process food records. This study was supported by grants from The Swedish Council for Working Life and Social Research (2006-0699 and 2010-0398), the Swedish Research Council (K2011-12237-15-6), the Swedish Heart and Lung Foundation, the County Council of Västerbotten and Umeå University, Sweden, and the LUA/Alf Agreement in the County Council of Västra Götaland, Sweden. Registration number at NCT00692536.

Author information



Corresponding author

Correspondence to S Manousou.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Manousou, S., Stål, M., Larsson, C. et al. A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women. Eur J Clin Nutr 72, 124–129 (2018).

Download citation

Further reading


Quick links