Tensions between President Donald Trump and North Korean leader Kim Jong-Un have continued to escalate this month, with Trump tweeting, “I too have a Nuclear Button, but it is a much bigger & more powerful one than his, and my Button works!” So, yeah, people have been a little on edge—and stocking up on potassium iodide pills, it turns out.
Seriously, it appears there's been a spike in sales of the drug, which is used to protect against radiation poisoning. Demand for potassium iodide (KI) pills from the website nukepills.com soared after Trump’s comments, according to Kaiser Health News (KHN). “On January 2, I basically got in a month’s supply of potassium iodide and I sold out in 48 hours,” Troy Jones, who runs the website, told KHN. Alan Morris, president of the pharmaceutical firm Anbex, which sells potassium iodide, also told KHN that sales have increased. “We are a wonderful barometer of the level of anxiety in the country,” he added.
But do you really need to rush to buy your own supply? We talked to experts, dug into government reports and recommendations, and studied up on historical usage and distribution of KI pills to find out more.
The supplement is a salt of stable iodine that can help block radioactive iodine from being absorbed by the thyroid gland and protect it from radiation injury, the Centers for Disease Control and Prevention says on its website. Your thyroid, which produces hormones that regulate your body’s metabolic rate, heart and digestive function, muscle control, and more, is the part of your body that’s most sensitive to radioactive iodine, the CDC says.
“A nuclear bomb explosion or a nuclear power plant meltdown releases radioactive iodine into the air and nearby people inhale the radioactive iodine,” James J. Galligan, Ph.D., a professor of pharmacology and toxicology and director of the neuroscience program at Michigan State University, tells SELF.
Your thyroid gland can’t tell the difference between potassium iodide and radioactive iodine and will absorb both, Galligan explains. However, your thyroid only has the capacity to hold so much at once. So if you take potassium iodide, it blocks radioactive iodine that you might be exposed to from entering your thyroid. That's a crucial point because, if radioactive iodine does build up in your thyroid gland, it can cause thyroid cancer, Galligan says. The risk is especially high for infants and children exposed to radioactive iodine, as seen with the increased rate of thyroid cancers among children exposed through the air and contaminated milk after the Chernobyl nuclear disaster in 1986, according to the United Nations Scientific Committee on the Effects of Atomic Radiation's website.
KI pills have been used for this exact blocking purpose in the past. Most recently, in the aftermath of the Fukushima Daiichi disaster in Japan, Japanese authorities distributed 230,000 units of potassium iodide tablets to evacuation centers in the surrounding area. And on the day of the Chernobyl disaster, Soviet authorities in the nearby town of Pripyat distributed potassium iodide pills to the local population as part of their emergency response plan, which also involved a period of sheltering in place. In the aftermath, Pripyat evacuees ended up in relocation centers, where authorities tested them for radioactive iodine exposure. According to a report compiled by the United States Nuclear Regulatory Commission in January 1987, the KI pills were credited with safe levels of radioactive iodine exposure in 97 percent of 206 evacuees tested at one of the centers. From the report: "Thousands of measurements of [radioactive iodine] activity in the thyroids of the exposed population suggest that the observed levels were lower than those that would have been expected had this prophylactic measure not been taken."
However, while potassium iodide can be an important tool to help protect the general population against the effects of radioactive iodine, there are a few factors that come into play in determining how effective it is, per the CDC. Its effectiveness depends on how quickly you take it after you’ve been exposed to radioactive iodine, how fast it absorbs into your blood, and how much radioactive iodine you’ve actually been exposed to, among other factors. It isn't effective against anything other than radioactive iodine, and it isn't recommended for people over 40, which we'll get into in a bit.
The Food and Drug Administration has approved potassium iodide in tablet and liquid form, and breaks out specific dosages based on someone’s age, ranging from 16 milligrams for newborns to 130 milligrams for adults. If you’re exposed to radioactive iodine, you have to keep taking potassium iodide pills as long as the exposure lasts, Galligan says.
In the event of a radiological incident in which radioactive iodine is present, distribution of KI pills should be a critical part of the government's disaster response—but it shouldn't be the only strategy, and it also isn't necessarily going to be beneficial for everyone. In 2004, the National Academy of Sciences released a report, "Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident," in which they advise that "KI should be available to infants, children, and pregnant and lactating women" as well as "everyone at risk of significant health consequences from accumulation of radioiodine in the thyroid in the event of a radiological incident"—basically, everyone under 40 years old who lives in the immediate vicinity of a nuclear power plant. The reason for the 40-year-old cutoff: "There is little benefit in providing KI to adults over 40 years old," per the report.
From the National Academy of Sciences report: "People over 40 probably should not take KI tablets after a nuclear incident as they are at virtually no risk of developing thyroid cancer from the radiation, and are more likely than younger people to develop side effects from the KI." Side effects include thyroid disfunction, such as hypothyroidism, especially in people who already have thyroid conditions. (Non-thyroidal side effects of potassium iodide are very rare, and can include nausea, vomiting, diarrhea, and stomach pain; skin rashes; and potentially rare allergic reactions like itching, swollen lymph nodes, and general swelling.) For infants, children, pregnant and lactating women, and people under 40, however, the potential benefits of KI pills certainly outweigh the possible side effects in the event of a nuclear incident that involves radioactive iodine.
As we mentioned before, though, KI pills will only be helpful if there is radioactive iodine present—and they won't help protect against other types of radioactive isotopes. Although it's possible for radioactive iodine to be present in most things that would release nuclear material, like a nuclear bomb, dirty bomb, or accidental or intentional release or leak, there are many other radioactive isotopes that may be present as well and can pose serious effects, Dustin J. Calhoun, M.D., F.A.E.M.S., an assistant professor in the Department of Emergency Medicine at the University of Cincinnati, tells SELF. And, although the "greatest threat" is indeed to the thyroid, he says, other parts of your body can also absorb radiation. "[Potassium iodide] is a reasonable treatment, but it is certainly not the entire story," he says. "People must protect themselves from the other risks."
Still, in the event of a nuclear incident that does involve radioactive iodine, taking potassium iodide early should help lower your risk of developing thyroid cancer—which is especially true for infants and children, Galligan says.
For the record, neither the FDA nor the CDC recommends that families stockpile the supplement to help in the event of a nuclear fallout, but they don't discourage buying it either. And the National Academy of Sciences report does recommend that state and local governments should stockpile it and develop distribution plans, based on their own local needs. From the National Academy of Sciences report: "KI distribution should be included in the planning for comprehensive radiological incident response programs for nuclear power plants. KI distribution programs should consider pre-distribution, local stockpiling outside the emergency planning zone, and national stockpiles and distribution capacity."
The bottom line on KI pills: They're important to have around in the event of a nuclear emergency, especially for vulnerable populations. But they should only be one component of an overall emergency response plan, not the only measure taken. According to the United States Nuclear Regulatory Commission, "The tablets are to be used, if necessary, to supplement evacuation or sheltering."
So let's talk about what else you should do to protect yourself and your family, beyond taking KI pills.
The CDC has very specific and basic instructions for dealing with a radioactive emergency on its website. If an attack happens, seek shelter inside, preferably in the middle of a building or basement, away from doors and windows. “Sheltering in place for at least 24 hours is crucial to saving lives and reducing exposure to radiation,” the CDC says in a recent public health response.
If you're outside and you're aware that there's been a nuclear detonation in your area, you have about 15 to 20 minutes to get to shelter safely, Irwin Redlener, M.D., director of the National Center for Disaster Preparedness at Columbia University, tells SELF. "Being on the street is the absolute worst," he says. However, the CDC notes that radioactive material settles on the outside of buildings and the tops of cars, so the absolute best place to be is deep inside a concrete or brick building, preferably one with a basement.
Once inside, stay there. Close and lock all windows and doors, take a shower or wipe down exposed parts of your body with a damp cloth, and drink bottled water and eat food in sealed containers. The organization also recommends using radios, TV, computers, and phones to get information from emergency officials, who will provide information on where to go to get screened for radiation contamination.
If you were outside when the emergency took place, you may be contaminated, so you'll need to remove your outer layer of clothing, taking care not to shake any radioactive particles loose. Then, place your clothes in a sealable plastic bag or container and put it out of the way of other people. Next, take a shower if you can, using warm (but not hot) water and taking care to be gentle with your skin, which is protecting you from radiation. Also be careful to not use conditioner, which can actually cause radioactive material to stick to your hair. And, as you're showering, Dr. Redlener advises to try to stay away from the runoff if possible, because it can also be contaminated.
The final step is to stay tuned for updates, which may prove a little difficult. The CDC recommends using texts because it might be hard to make calls or get online.
If you have potassium iodide in your house, don't take it until you're told to by a credible source. "You should take KI only if you have been specifically advised to do so by local public health officials, emergency management officials, or your doctor," an EPA spokesperson tells SELF. But if the worst happens and you don't have any potassium iodide on hand, Dr. Calhoun says that taking "reasonable amounts" of antacids (such as Tums) may also help reduce absorption.
Here's hoping this isn't something you'll ever have to actually worry about.
Update, 1/15: This post has been updated to provide additional contextual information, including historic use, distribution, and benefit of KI pills, potential side effects, and recommendations from both the National Academy of Sciences and the United States Nuclear Regulatory Commission. We also updated the headline to more clearly align with the overall tone of the article.
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