Adapting iodine policies to changing diets: advancing the fortification of plant-based foods

Europe has made substantial progress in reducing iodine deficiency over recent decades. However, in 2024, WHO/Europe and the Iodine Global Network (IGN)[1] warned that iodine deficiency remains widespread and re-emerging across the European Region. Iodine is essential for thyroid function, metabolism, growth and neurological development, with adequate intake particularly important during childbearing years, adolescence and early life.

WHO/Europe and IGN[2] have also highlighted the implications of changing dietary patterns for iodine intake. As European diets become increasingly plant-forward, traditional sources of iodine, such as dairy and fish, contribute less to the overall intake. WHO/Europe and IGN have therefore explicitly called for appropriate fortification of plant-based foods with iodine alongside iodised salt policies.[3]

This creates a need for iodine-deficiency prevention policies to evolve and to consider the fortification of plant-based foods as a complementary measure to salt iodisation, helping to support adequate iodine intake.

Adapting iodine fortification to evolving dietary patterns

Milk and dairy products are important sources of iodine in many Western and Central European countries, partly because of iodine supplementation in animal feed and other farming practices. When consumers replace dairy products with plant-based foods, however, they may not replace the iodine those foods previously provided.[4] This is particularly relevant because most plant-based foods naturally contain little iodine. Fortification can therefore help address potential gaps in intake.

Many plant-based foods are already fortified with key nutrients such as calcium, vitamin B12, and vitamin D. However, iodine fortification remains limited, although a growing number of manufacturers are beginning to add iodine to their products. A recent UK study[5] suggests that appropriate iodine fortification of plant-based foods could mitigate the estimated reduction in iodine intake under the modelled dairy-replacement scenario.

National public health authorities across Europe are already increasingly recognising the nutritional relevance of iodine-fortified plant-based foods. Norway’s dietary guidelines[6] and Finland’s nutrition recommendations advise people who do not consume cow[7]s milk or dairy products to choose plant-based drinks fortified with calcium, iodine, riboflavin and vitamin B12. In 2025, Germany’s Federal Institute for Risk Assessment (BfR) concluded that products marketed as milk and dairy substitutes, as a targeted exception, could be fortified directly with iodine.[8]The UK’s Scientific Advisory Committee on Nutrition and Committee on Toxicity[9] reached a similar conclusion in 2025, recommending iodine fortification of plant-based drinks, alongside several other nutrients, at levels comparable with semi-skimmed cow’s milk.

The economic case for prevention

Beyond its direct health impacts, addressing iodine deficiency can also help reduce the associated economic burden on healthcare systems and society. While these benefits are most pronounced in preventing moderate and severe deficiency, interventions to prevent mild iodine deficiency can also be cost-effective.

A Belgian health-economic analysis[10] estimated that thyroid nodular disease linked to mild iodine deficiency generated annual costs of around €38 million in the adult population at the time of the study. The same analysis identified potential net savings of at least €14 million per year from improving iodine intake. Evidence from Germany[11] similarly suggests that the costs of iodine-deficiency prevention and monitoring are low compared with the costs of treating iodine-related disorders, reinforcing the economic rationale for preventive action.

These analyses support the broader economic case for effective iodine deficiency prevention although they do not specifically evaluate the impact of specific food fortification strategies.

Our policy recommendations

The current regulatory framework needs to keep pace with changing consumption patterns and evolving public health needs. A clear, proportionate and consistent approach is therefore needed to enable the appropriate iodine fortification of plant-based foods, as called by WHO/Europe and IGN. This requires recognising the nutritional role of appropriately fortified plant-based foods, alongside clear EU fortification guidance, effective Single Market application, clear labelling, and stronger awareness and monitoring.

1. Recognise appropriately fortified plant-based foods in EU and national nutrition policies

Public health and nutrition policies must reflect the shift towards plant-based diets by recognising fortified plant-based foods as an effective and scalable vehicle for iodine delivery.

National dietary guidelines and EU nutrition initiatives should recognise and encourage appropriately fortified plant-based foods as a source of iodine, alongside iodised salt and other dietary sources. Public procurement standards should support nutritionally adequate choices, including appropriately fortified plant-based foods in schools, hospitals, and other public institutions.

1. Promote an EU harmonised approach to iodine fortification

A more consistent EU approach to iodine fortification would support consistent public health protection, strengthen the functioning of the Single Market, and facilitate access to appropriately fortified products across Member States.

We therefore call for a more consistent EU-wide approach to iodine fortification, supported by clear EU guidance on appropriate fortification levels, eligible food categories and labelling, informed by dietary exposure assessments. Greater harmonisation would reduce regulatory uncertainty for food business operators, facilitate the marketing of fortified products across Member States, and support more consistent access to iodine-fortified foods across the EU.

1. Encourage Member States to enable and encourage appropriate iodine fortification of plant-based products

Regulatory fragmentation remains a key barrier to scaling up iodine fortification of plant-based products across Europe. While EU legislation permits the addition of iodine to foods under Regulation (EC) No 1925/2006, national approaches to permitted fortification levels and eligible product categories vary. These differences create uncertainty for manufacturers and make consistent, large-scale implementation more difficult.

For example, in the Netherlands, iodine policy relies primarily on salt iodisation, prohibiting the direct addition of iodine to plant-based products. In Denmark, the regulatory framework differentiates between product categories: flavoured plant-based drinks and yoghurt alternatives may contain added iodine at 22.5 µg/100 ml, while unflavoured plant-based drinks cannot be fortified at the same level. Such inconsistencies can limit manufacturers’ ability to apply comparable fortification strategies across markets and product categories.

We therefore call for greater regulatory alignment across Europe, including broader authorisation for the fortification of plant-based products with permitted iodine compounds (e.g. potassium iodide and potassium iodate).

1. Ensure consistent application of Single Market rules and mutual recognition

Where national requirements continue to apply, the EU mutual recognition framework should be implemented consistently. Regulation (EU) 2019/515 provides that goods lawfully marketed in one Member State should, in principle, be able to access the market of another Member State, subject to justified and proportionate restrictions in the public interest.

We therefore call for the effective application of mutual recognition to reduce intra-EU trade barriers and provide greater legal certainty for food business operators. Products with iodine levels that are lawfully marketed in one Member State should be able to be marketed across the EU, even where national requirements differ.

1. Simplify labelling requirements for added iodine

Clear and accessible labelling is important for consumers. Current EU ingredient labelling requirements can require iodine compounds to be listed by their specific chemical names (e.g. potassium iodide), which may be less easily understood by consumers.

We therefore call for simplified labelling requirements that allow food business operators to use the term “iodine” on-pack, rather than the specific chemical compound used for fortification. This would improve label clarity and consumer understanding.

1. Strengthen awareness and monitoring of iodine nutrition

Low awareness of iodine nutrition remains an important barrier to prevention. As highlighted by the Euthyroid2 project, there is a need to strengthen knowledge and practical guidance, particularly among adolescents, young adults and women of childbearing age, as dietary patterns continue to evolve.

Sustained and targeted awareness-raising should therefore become a stronger pillar of iodine deficiency prevention policies, including by integrating iodine education into school curricula and preconception and maternal health communication, developing public awareness campaigns on the importance of adequate iodine intake, equipping healthcare professionals with practical evidence-based guidance and communication tools, and promoting coordinated communication among public authorities, health organisations and other relevant stakeholders, including retailers, to ensure clear and consistent messaging on iodine nutrition.

Monitoring should assess both inadequate and excessive iodine intake. National surveillance should consider iodine derived from fortified foods, iodised salt, supplements and other dietary sources, as well as consumption levels among children, adolescents, pregnant and breastfeeding women and high consumers of fortified products. Fortification policies and permitted levels should be reviewed periodically in light of changes in iodine status, dietary patterns and market availability.

[1] World Health Organization Regional Office for Europe (2024), Prevention and control of iodine deficiency in the WHO European Region: adapting to changes in diet and lifestyle, Copenhagen: WHO Regional Office for Europe. link

[2] Ibid

[3] Ibid

[4] Ibid

[5] Nicol K, Nugent AP, Woodside JV, Hart KH, Bath SC (2024), The impact of replacing milk with plant-based alternatives on iodine intake: a dietary modelling study. Eur J Nutr. 2024;63(2):599-611 https://doi. org/10.1007/s00394-023-03286-7

[6] Norwegian Directorate of Health. (2024). Dietary guidelines for the population. link

[7] German Federal Institute for Risk Assessment (BfR). (2025). Proposed maximum levels for iodine in foods, including food supplements. link

[9] Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT). (2026). Plant-based drinks: Health benefits and risks. UK Government. link

[10] Vandevijvere, S., et al. (2010). Projected Reduction in Healthcare Costs in Belgium After Optimization of Iodine Intake: Impact on Costs Related to Thyroid Nodular Disease. Thyroid, 20(11), 1301–1306. https://doi.org/10.1089/thy.2010.0133

[11] Schaffner, M., et al. (2021). The economic impact of prevention, monitoring and treatment strategies for iodine deficiency disorders in Germany. Endocrine Connections, 10(1), 1–12. https://doi.org/10.1530/EC-20-0384