Low Iodine Diet (Oncology)

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Scripps Cancer Center

Low Iodine Diet

Medical Nutrition Therapy

About

Radioactive iodine (RAI) therapy is an effective form of treatment for thyroid cancer. The RAI is taken up by thyroid cancer cells and causes cell death. Research shows that consuming a low iodine diet (LID) for two weeks before and two days after this treatment helps decrease iodine stores in the body. This will make the treatment work better by making the thyroid "hunger" for iodine and increasing tumor uptake of the RAI.

Iodine is a mineral the body uses to make thyroid hormones and can be found in food. When preparing for this treatment, it is recommended to follow a LID and consume less than 50 micrograms of iodine per day. Iodine content in food is not commonly listed on labels, so it is not easy to track. Instead, it is recommended to focus on decreasing or avoiding foods known to have iodine before and just after treatment.

Nutrition Tips

Read food labels and check the ingredient list on all packaged foods, pills, powders, and toiletries
- Avoid these products and ingredients:
  - Salt with iodine: iodized salt and sea salt
    - Use non-iodized salt such as Morton® Plain Table Salt or Kosher salt
  - Calcium iodate and potassium iodate
    - Commonly found in commercially bought bread and baked goods
  - Red dye #3 (note: Red dye #40 is ok)
    - This is also called "erythrosine" or "E127"
    - It helps create colors such as pink, orange, brown, purple, etc.
  - Seaweed and seaweed-based ingredients
    - In the ingredient list look for 'sea' related words such as alginates, agar-agar, algae, algin, carrageenan, kelp, marine algae, nori, pearl extracts, seawater, seaweed, spirulina, etc.
    - May be used to thicken foods such as jellies, soup, ice cream, salad dressing
    - May be found in toiletries such as creams, lotions, shampoo, conditioner, toothpaste, deodorant, etc.
  - Supplements with iodine
    - Calcium supplements, if made from oyster shells
    - Fish oil
    - Multi-vitamins with iodine
    - Selenium supplements
    - Any supplement with red dye #3 - may be colored orange, red, pink, or brown
  - Cough medications, especially if red in color
  - Antiseptics with iodine, such as Betadine®
  - Iodized tablets for water purification
Decrease or avoid dining out. If dining out:
- Ask for the meal to be made without added salt, marinades, sauces, dressing, and cheese
- Consider choosing a salad with oil and vinegar dressing without croutons, bacon, olives, and cheese or a plain baked potato with olive oil, and add/bring your own non-iodized salt

Food Group	Foods to Include	Foods to Avoid
Milk and Dairy Products	1 oz of milk a day Nut or oat milk, homemade	Cheese, all types Cottage cheese Cream- half & half, sour cream, whipped Drinks with milk Examples: lattes, cappuccinos, frappes, chocolate milk Ice cream or frozen yogurt Milk, cow* Milk alternatives, store-bought* Examples: soy, oat, rice, almond Milk-based drinks Examples: eggnog, kefir, milkshakes Yogurt *1 oz per day of milk is ok
Proteins	Beans - black, white, garbanzo If canned, choose ‘no salt added’ and rinse before using Egg whites, fresh or from a carton Fish, freshwater Examples: carp, lake trout, river bass, and perch Lentils If packaged or canned, choose ‘no salt added’ and rinse before using Meats - fresh, whole cuts (limit to 6 oz per day) Examples: chicken, turkey, beef, pork, lamb Nuts and nut butter, unsalted Seeds, unsalted	Egg yolks Meats - cured, canned, and dried Examples: pepperoni, salami, ham, bologna, bacon, sausage, deli meat, beef jerky, chili, turkey/chicken injected with broth Nuts and nut butter, salted Organ meats (i.e., liver, tripe) Protein powder - whey, casein, soy, or with sea/iodized salt Seafood Fish, examples: tuna, salmon, halibut, sardines, imitation crab meat Shellfish, examples: crab, lobster, scallops, shrimp Seeds, salted Soy and soy products Examples: tofu, edamame Veggie/soy-based imitation meat products
Grains Consume in moderation	Bread, homemade - without iodate conditioners, egg yolks, iodized salt Cold cereal - unprocessed, unsalted, preservative-free Examples: shredded wheat, puffed rice, puffed wheat Crackers, unsalted Hot cereal - unsalted, unflavored Examples: Cream of wheat, cream of rice, oatmeal, grits Matzo and matzo crackers Pasta, white or wheat Polenta Tortilla chips, unsalted Rice, basmati Rice cakes, unsalted Whole grains Examples: quinoa, barley, bulgur, couscous	Egg noodles Chips Cold cereals - processed, salted Crackers, salted Hot cereal, instant Rice, instant or packaged Store-bought bread and baked goods made with iodate bread conditioners Read the ingredient list, look for “calcium iodate” or “potassium iodate” **Avoid fresh baked bread from bakeries, unless guaranteed no iodate conditioners, whole eggs, dairy, or iodized salt was used
Fruits and Vegetables	Fruits - most fresh, frozen, dried, and packed in water Without food coloring or salt Vegetables - most fresh and frozen, without salt Potatoes, sweet potatoes, and yams- without skin **Wash fresh and rinse canned fruits and vegetables before using or consuming	Cruciferous veggies (eat in moderation) Examples: broccoli, cauliflower, cabbage, spinach (1/2 cup per day) Rinse with water before using Fruit, packed in syrup Fruit cocktail Fruit juices that are not 100% fruit Maraschinocherries Olives Pickles Sauerkraut Seaweed Vegetables, canned with salt added Vegetable juice, canned
Snacks and Desserts	Angel food cake, homemade Dark chocolate and cocoa powder, no salt or dairy added Desserts, homemade with allowed ingredients Examples: cookies, cakes, fruit desserts Gelatin (no red dye #3) Popcorn, air-popped with non- iodized salt and oil Popsicles and ices (no red dye #3) Sorbet (no red dye #3) **Homemade desserts must be made without iodized salt, egg yolks, dairy, and iodate conditioners	Baked goods not made at home - pies, cookies, muffins, pastries, donuts, etc. Bars or beverages made from soy or whey or with salt Candies colored red, pink, orange, brown Chips Chocolate, salted or with dairy Custard Desserts made with egg yolks, dairy products, iodized salt Ice cream and frozen yogurt Pudding Sherbet
Condiments, Seasonings, Ingredients, and Other	Baking powder and soda Herbs and spices Examples: cinnamon, basil, oregano, cocoa powder, chili powder, garlic powder, pepper Honey Jellies and jams, no salt or coloring added Ketchup, no salt added Lemon and lime juice Margarine, unsalted and dairy-free Mrs. Dash no salt blends Mustard, no salt added Non-iodized salt Examples: Morton® Plain Table Salt, Kosher salt Oils Sugar Syrup, maple Vinegar, white and apple-cider	Barbeque sauce, bottled Blackstrap molasses Butter Garlic salt, onion salt, seasoned salt if made with iodized salt Food additives Agar-Agar Algin Alginates Carrageenan Iodates and Iodides Ketchup, with salt Mayonnaise Mustard, with salt Salad dressings, store-bought Salt, iodized and sea Seafood-basedproducts Examples: fish sauce, anchovy paste, fish stock, nori, dulse, kelp Seasoning mixes made with iodized salt Soy sauce Steak sauce Vinegar, red wine
Beverages	Clear carbonated beverages Coffee, freshly brewed Fruit juice, 100% (no red dye #3) Lemonade, homemade Tea - fresh leaves or from white tea bags Water	Beverages, milk-based (see above) Coffee, instant Commercial drinks - powdered, canned, or bottled Examples: Tang®, fruit punch, sports drinks Hot chocolate mixes Lemonade, pink or store-bought Meal replacement drinks Examples: Ensure®, Boost®, Kate Farms®, Orgain®, Premier Protein® Mineral water with sodium Tea- instant, bottled, canned

Snack Ideas

Banana bread or blueberry muffins (homemade, LID) with unsalted nut butter
Fresh or dried fruit
Fresh raw veggies (i.e., bell peppers, carrots, cucumbers) with homemade LID hummus
Unsalted nuts (cashews, pecans, walnuts, almonds, etc.)
Unsalted nut butter with apples or a banana
Popcorn popped at home using non-iodized salt and vegetable oil
Unsalted rice cakes, matzo crackers, or a banana with unsalted pb, jam/jelly, and/or honey
Homemade trail mix with unsalted nuts, unsalted pretzels, raisins, dark chocolate (no dairy or salt added)

Easy Meal Ideas

Hot cereal (i.e., steel cut oats) with toppings such as cinnamon, honey, unsalted nuts or nut butter, fresh or frozen fruit, maple syrup
Pancakes (homemade, LID) with unsalted nut butter, sliced bananas and strawberries, maple syrup
Egg whites (i.e., veggie scramble, omelet) with peeled potatoes
Grilled fresh meat with veggies and basmati rice or a sweet potato with brown sugar
Fresh meat with stir-fried vegetables over rice
Salad with grilled meat or white beans and dressing using oil, vinegar and lemon juice
Chili, stews with no salt added tomato and broth products
Hamburgers, meatloaf, meatballs, etc. made at home using egg whites instead of whole eggs
Pasta with pesto and grilled chicken
Pasta with fresh veggies, olive oil, and fresh garlic
Roasted or baked fresh meat, baked potato with olive oil or basmati rice, and a side salad
Black beans, basmati rice, tomatoes, onion, cilantro, and a side of unsalted tortilla chips
Nachos with unsalted tortilla chips, black beans, guacamole, shredded chicken, and pico de gallo
Lemon pepper chicken with garlic-roasted potatoes and oven roasted asparagus

Recipe Resources

Light of Life Foundation recipes - https://lightoflife.wpengine.com/cookbook
Thyroid Cancer Survivor's Association, Inc. - https://www.thyca.org/

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