Low Iodine Diet (LID)

The Low Iodine Diet Cookbook: Easy and Delicious Meals & Tips for Thyroid Cancer Patients
By Norene Gilletz (with an Introduction by Dr. Ain)

The Low Iodine Diet Cookbook is the ultimate cookbook for thyroid cancer patients who need to be on the low iodine diet (LID) for radiocactive iodine treatment or scans. Written by a renowned cookbook author who is experienced with the issues involved with special diets and substitutions—particularly diets that don't allow dairy, or store-bought breads.

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About the Low Iodine Diet (LID)

WHAT IS THE LOW IODINE DIET?

If you’ve had thyroid cancer (papillary, follicular, or one of their variants), you’ll likely require treatment and whole body scans using radioactive iodine. It’s important to deplete your body of the relatively large amount of non-radioactive (“stable”) iodine that is present in your food and beverages (as well as in the dye injected for CAT scans and some other radiology tests). This allows the radioactive iodine to enter your thyroid cancer cells most effectively. Your thyroid cancer cells can’t tell the difference between iodine that is radioactive and non-radioactive “stable” iodine. Since they have limited ability to take in iodine, the lower the amount of stable iodine that is in your body, the more radioactive iodine will be taken into these cells.

Stable iodine enters your body through your diet. The normal thyroid gland uses iodine to make thyroid hormones. Many parts of the developing world have problems with iodine deficiency and, as a result, people in these regions suffer from hypothyroidism and associated medical problems. In most industrialized countries, great effort has been made to prevent these problems by supplementing iodine in the diet through iodized salt. Additional iodine enters our diet from fish, seafood, kelp, dairy products, artificial red food dye (FD&C Red Dye #3) and multivitamins. This dietary iodine is considered healthy for most people; however it’s not needed in people whose thyroid glands have been removed and who take thyroid hormone as a medication.

Typical amounts of dietary iodine can interfere with the use of radioactive iodine for thyroid cancer. The reason for this is as follows:

An “average” daily amount of dietary iodine in North America is approximately 500 micrograms (mcg). This number can be lower in extreme vegetarians who don’t consume any animal products (vegans), and much higher in lovers of sushi and seafood. It can exceed several thousand micrograms in people after an injection of intravenous contrast dye for a CAT scan, and this can last for up to 11 months after a single injection. (See: Spate, V.L., Morris, J.S., Nichols, T.A., et al., 1998.“Longitudinal study of iodine in toenails following IV administration of an iodine-containing contrast agent.” Journal Radioanalytical Nuclear Chemistry. 236:71-76.)

This amount of stable iodine in your body may seem inconsequential until you learn that the amount of radioactive iodine in a treatment or scanning dose is usually only 2 mcg. These 2 mcg of iodine are highly radioactive, but don’t actually constitute much iodine. Taken within the context of the typical total body pool of iodine in one day, 2 mcg (radioactive iodine) of 502 mcg (total iodine) means that only 0.4 % of the iodine in your body is radioactive. It follows that if a thyroid cancer cell in your body sucks up 1000 iodine atoms, only 4 of them are radioactive. Certainly this isn’t a very effective way to find these cells with a scan, or treat them with the radioactive iodine.

On the other hand, if you follow a Low Iodine Diet prior to receiving your 2 mcg dose of radioactive iodine, your daily total iodine intake decreases—from around 500 mcg to less than 40 mcg. In this case the radioactive iodine constitutes 2 mcg of 42 mcg of iodine, meaning that at least 5 percent of the iodine in your body is radioactive. A thyroid cancer cell as in the paragraph above, sucking up 1000 iodine atoms, would then take in at least 50 radioactive iodine atoms. This results in more than 12 times the amount of radioactivity in each thyroid cancer cell, using a Low Iodine Diet (LID), so long as you’ve been prepared for your scan properly, and have sufficiently high TSH levels prior to the scan.

THE BASIC LOW IODINE DIET

The basic LID is summarized on the following instruction sheet provided to each of my own patients and circulated widely to many physicians and patient groups. It consists primarily of a list of restricted dietary items that contain relatively high amounts of stable iodine. The assumption is that anything that isn’t restricted should be considered safe to eat as part of a balanced and varied diet. Unfortunately, these instructions make figuring out interesting foods that are appropriate to eat a matter of individual creativity.

LOW IODINE DIET DIRECTIONS
Used for Preparation for Radioiodine Scans or Therapy

Avoid the following foods, starting when instructed prior to your radioactive iodine test, and continuing until after your radioactive iodine treatment is completed.

  1. Iodized salt, sea salt (non-iodized salt may be used).
  2. Dairy products (milk, cheese, cream, yogurt, ice cream, butter).
  3. Eggs (specifically avoid egg yolks; egg whites may be used).
  4. Seafood  (both fresh and salt-water fish, shellfish, seaweed, kelp).
  5. Foods that contain the additives (carragen, agar-agar, algin, alginates).
  6. Cured and corned foods (e.g., ham, corned beef, sausage, luncheon meats, sauerkraut, pickles).
  7. Bread products that contain iodate dough conditioners (sometimes small bakery breads are safe; better to bake it yourself from scratch).
  8. Foods and medications that contain red food dyes (specifically, FD&C Red Dye # 3; consult your physician about discontinuing or substituting for any red-colored medicines).
  9. Chocolate (because of the milk content).
  10. Molasses.
  11. Soy products (soy sauce, soy milk).

Additional Guidelines

  1. Avoid restaurant foods, since there’s no reliable way to determine what’s in the food you order.
  2. Use matzos (unleavened crackers made only of flour and water) instead of bread.
  3. Use non-iodized salt as desired.
  4. Always read ingredients lists of prepared or packaged foods carefully.
  5. Use olive oil may as a condiment or in cooking, in place of butter.
  6. Prepare low-iodine meals in advance if you wish, and freeze them for easy later use.

Important Note:
Food prepared from any fresh or frozen meats, poultry, vegetables and fruits should be fine for this diet, provided that you don’t add any of the ingredients listed above, which you must avoid. Be careful of meat or poultry that’s been injected with broth or preservative liquids. The diet is easiest when food is prepared from basic ingredients.

Strict adherence to this diet will significantly enhance the sensitivity of the radioiodine scans and the effectiveness of any radioiodine treatments.