There are very few food sources for iodine. The main ones are dairy products, seafood, eggs, as well as meat and poultry. In some countries, grain products like bread are made with iodized salt, but this is usually not the practice in the US.

Part of the problem is that now there are a lot of trendy salts—Himalayan, sea, kosher, and others—so people have moved away from eating iodized salts. Organic dairy also has less iodine, and processed foods and bread usually lack it as well. You also have patients with restricted diets like veganism, dairy intolerance, food allergies, and autism spectrum disorder, which increase the risk. Children and pregnant or breastfeeding women are more susceptible, as their iodine requirements are higher.

There is no public health mandate for iodization in the US, so many salts don’t have iodine and the salts that do have varying concentrations. The public health messaging has been so strong against salt due to blood pressure issues, and people appear to be hyper aware of it. In the clinic, we have noticed there is confusion, where patients think that iodized salt specifically is bad for your health, as opposed to all types of salt.

In our pediatric endocrine practice at Hasbro Children’s Hospital, we are educating our patients about the risks of an iodine-free diet. We’re also educating pediatricians, as well as trainees who work with us in the clinic.

To avoid deficiency of iodine and other micronutrients, we encourage patients to have increased dietary diversity. If you have a mix of foods in your diet including seafood, eggs, chicken, and dairy, you are likely OK in terms of iodine intake. But especially for patients who have a low dietary diversity, we recommend that they use iodized salt when cooking, in moderation and in the context of a healthy diet.