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Low-Iodine Diet Quick Guide

www.thyca.org Page i

Thank you for using this Low-Iodine Diet (LID) Quick Guide and cookbook introduction. This guide

has two purposes. One is to serve as a stand-alone document for anyone who wants a quick summary of

the LID without having to download the entire cookbook. It is also designed to serve as the cookbook’s

introduction. It contains the following sections:



Welcome



About ThyCa



Invitation



About Photocopies and Use



Disclaimer



Sources



The Low-Iodine Diet



General Overview



Helpful Tips



Foods to Avoid



Foods to Enjoy, But in Limited

Quantity



Foods to Enjoy



Variations of the LID and

Editorial Remarks from ThyCa



Processed & manufactured

foods



Eating out/Restaurant

Food and Take-Out



Foods we are often asked

about, etc.



Pantry items



Reading Labels



Going Shopping



A Week’s Worth of Easy Menus



Breakfast Inspiration



Lunch Inspiration



Dinner Inspiration



Snacks



Miscellaneous topics



Vitamins/Minerals and

Supplements



Other Ways Iodine Enters Our

Bodies



CT contrast



Topical antiseptics



Skin care & toiletry items



Food dye



Drugs & OTC

medications



Handy One-Page LID Summary



Key Points



Foods to Avoid



Foods to Enjoy



Easy Snacks for Home, Work, or

Travel



Easy Quick Meals



Disclaimer

Welcome

The information we provide comes from several members of ThyCa’s Medical Advisory Council, plus a

team of ThyCa volunteers. The LID has been used successfully for decades. We are continually

updating and fine-tuning it to bring you the most comprehensive LID available.

About ThyCa: Thyroid Cancer Survivors’ Association, Inc.

ThyCa, founded in 1995, is an international nonprofit 501(c)(3) organization of thyroid cancer survivors,

family members, and health care professionals, serving people worldwide. We are dedicated to

education, communication, support, awareness for early detection, and thyroid cancer research

fundraising and research grants in support of our goal of cures for all thyroid cancer.

Visit our website www.thyca.org for detailed thyroid cancer information, videos with experts, free

publications and materials in multiple languages, links to our free online and local support groups, plus

more free services. Learn about how to donate, volunteer, or become a member. Find the latest details

about educational events, including the annual International Thyroid Cancer Survivors’ Conference.

Invitation: If you would like to comment on any recipes, or submit new ones, please write to

[email protected]. Your recipe will be reviewed for LID compatibility. We may incorporate your

recipe(s) into a future edition, feature it in our monthly bulletin, or add it to our website’s “Recipedia.”

Low-Iodine Diet Quick Guide

www.thyca.org Page ii

About Photocopies and Use: You are welcome to download and print out this Quick Guide and our

cookbook from www.thyca.org. You are also welcome to photocopy complete pages and give them to

others. Please include the ThyCa information at the bottom of the page so that others in need of support

can easily find us. Please note the material in this book is not for commercial use.

Disclaimer: The information contained here is intended for educational purposes only.

It is not intended, nor should it be interpreted, as medical advice or directions of any

kind. Any person viewing this information is strongly advised to consult their own

medical doctor(s) for all matters involving their health and medical care.

Sources:

(1) Diet guidelines provided by several members of ThyCa’s Medical Advisory Council;

(2) Presentations and handouts from our conference and workshop speakers from 2000 through Spring

2010. Speakers have included Stephanie L. Lee, MD, PhD, Endocrinologist, Boston Medical Center,

Massachusetts; Christina Reiter, MS RD, Resident Dietitian, University of Colorado, Boulder,

Colorado; and Nancy Sebring, MEd, RD, Research Dietitian, National Institutes of Health, Bethesda,

Maryland;

(3) Medical journal articles, including Pearce EN, Pino S, He X, Bazrafshan HR, Lee SL, and

Braverman LE, Journal of Clinical Endocrinology and Metabolism 89(7):3421-3424. 2004; Park JT

and Hennessey JV, Thyroid (1):57-63. 2004; and more recent articles; and

(4) USDA, FDA and ODS-NIH Database for the Iodine Content of Common Foods Release 1.0.

The Low-Iodine Diet (LID)

General Overview:



Thyroid cancer patients with papillary or follicular thyroid cancer often receive radioactive iodine

(RAI). RAI (either I-123 or I-131) is used in small tracer doses for imaging/testing/scanning. The

results can inform next steps, sometimes resulting in RAI ablation. A larger dose of RAI (I-131) is

sometimes used to destroy (or ablate) any remaining thyroid cells and thyroid cancer cells. Some

patients receive this treatment more than once.



Thyroid tissue, and most thyroid cancer tissue, naturally absorbs or “takes up” iodine, to make

thyroid hormones. Therefore, for the treatment and/or scans to be most effective, our bodies need to

have elevated TSH (thyroid stimulating hormone) along with being “iodine-hungry.” This is why

patients are often asked to go on a short-term Low-Iodine Diet to temporarily starve our bodies of

iodine. The American Thyroid Association, as well as most major medical institutions, recommend

using the LID to facilitate becoming more iodine-hungry. This allows our bodies to take up as much

radioactive iodine as possible.



We acknowledge that the word “diet” has different meanings to different people. This is not a

diet in the sense of a mechanism for weight loss or eating healthy. Rather, it is a medically

necessary short-term regimen needed to help our bodies become iodine-hungry.



Preparation for RAI can take place in one of two ways, both resulting in the necessary elevated TSH.

Both of these processes incorporate use of the LID:

Remaining on thyroid replacement hormone (usually levothyroxine—please refer to the

“Know your Pills” section at www.thyca.org for more information) while receiving

Thyrogen® (recombinant TSH) injections. Some people experience symptoms of

hypothyroidism using Thyrogen.

Withdrawing from thyroid replacement hormone for a period of weeks. Sometimes patients

spend a portion of their withdrawal time using a different drug called liothyronine. Note that

this method can cause symptoms of severe hypothyroidism, including weight gain, lethargy,

feeling cold, etc.

Low-Iodine Diet Quick Guide

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

This diet is generally for a short time period, usually lasting 2-3 weeks. It usually begins 2 weeks

before swallowing the radioactive iodine (either for testing or treatment) and continues through the

testing and treatment period, often for 1 to 3 days after the RAI scan or treatment. However,

recommendations for the time period can vary, depending partly on the individual patient’s

circumstances. Check with your care provider to be certain.



The diet presented here is a combination of guidelines from several ThyCa medical advisors (some

who use urine iodine testing to check patients’ iodine levels), from researchers’ findings presented in

medical journals and at ThyCa events, and from input from members of our Medical Advisory

Council. Your physician may have different guidelines. Please check with your doctor before you

start the diet.

Helpful Tips:



What may be surprising to you is that salt

permitted on this diet, so long as the salt you use has no

added or naturally occurring iodine. Therefore, do NOT use sea salt, which has naturally occurring

iodine. Use non-sea salt labeled with a statement such as: “This salt does not supply iodine, a

necessary nutrient.” We have found that Kosher salt is also safe to use.



This is not a low-sodium diet.

Most foods contain naturally occurring sodium, even if they are salt-

free. Low-iodine sometimes gets confused with low-salt since most table salt is iodized. (“Iodized”

means extra iodine has been added to table salt to help fight goiter, or enlarged thyroids, since many

people do not get sufficient iodine-rich foods in their diet.) For your awareness, table salt is

chemically “sodium chloride” and this differs from the naturally occurring sodium found in food.



Sodium in any form is OK, as long as it is not provided as

iodized

or sea salt

. Non-iodized salt is

OK for the diet, as long as it is not sea salt. Anything from the sea is iodine-rich and must be

avoided.



This is a

low-

iodine diet, not a

-iodine diet.

The LID aims to reduce iodine consumption to

below 50 micrograms (mcg) of iodine per day (which is the American Thyroid Association guideline

for a LID; some other published LIDs recommend below 80-100 mcg per day). The normal

Recommended Daily Allowance of iodine is 150 mcg per day for adults. One teaspoon of iodized

salt can contain over 400 mcg of iodine. Many people consume well over 350 mcg per day just from

their normal way of eating.



As the previous point reflects, the primary goal of the LID is limiting your overall iodine

consumption. Much like a financial budget, this means paying attention to what individual foods

“cost” in iodine content while keeping the big picture in mind. For example, if you do not eat meat,

which is moderately high in iodine (see below), you will have more room in your iodine “budget” to

consume iodine from fruit, vegetable, or grain sources.



To assist you in your iodine “budgeting,” while on the diet, you may enjoy low-iodine foods (up to 5

mcg per serving). There are a lot of foods that you can eat (see the lists below). However,

avoid

foods high in iodine

(over 20 mcg per serving). Also, many thyroid cancer specialists’ guidelines

recommend limiting foods that are moderate in iodine (5 to 20 mcg per serving).



Do not worry—we have taken the guesswork out of all this for you.

Just follow the LID to the

best of your ability.

Low-Iodine Diet Quick Guide

www.thyca.org Page iv

Foods to Avoid:

Avoid

the following foods, starting when instructed by your physician (generally two weeks) before

your radioactive iodine test or treatment. Continue as instructed until after your radioactive iodine is

administered (often for 1-3 additional days). The high-iodine foods and items on this list have over 20

mcg of iodine per serving, according to sources.



Iodized salt and sea salt

and any foods containing iodized salt or sea salt. Non-iodized salt may be

used on this diet. For example, Kosher salt is okay unless the label says that it is iodized or sea salt.

The reason to avoid sea salt is that all products from the ocean tend to be high in iodine. You can

usually find plain, non-iodized salt next to the iodized salt at your grocer. Read the label carefully—

make sure it does not contain a form of iodate or iodide. (One teaspoon of iodized salt can contain

over 400 mcg of iodine.)



Seafood and sea vegetables. Avoid anything from the sea, including:

fish, shellfish, crustaceans,

seaweed (e.g., wakame, dulse, arame, hiziki, furikake), seaweed tablets, kelp (e.g., kombu), sushi

(e.g., nori), etc. These are all high in iodine.



Foods/products that contain sea-based ingredients

: Carrageenan, agar-agar, algin, and alginate.



Dairy products (milk, cheese, cream, yogurt, butter, ice cream, powdered dairy creamers,

whey, casein, lactose, other dairy products).



A study published in 2004 in the Journal of Clinical Endocrinology and Metabolism reported

on tests of 18 brands of milk in the Boston, Massachusetts area. It reported that 250 ml of

milk (about 1 cup) contained from 88 to 168 micrograms of iodine and averaged 115 mcg.

(This means that one teaspoon or 5 ml of milk has 1 to 3 micrograms of iodine.) The study

also noted that sources of iodine in milk include iodine in cattle feed, the products containing

iodine used to clean teats and udders, and a small amount from equipment cleaning products.



All the low-iodine diets ThyCa has researched instruct patients to avoid dairy. Some low-

iodine diets allow very small amounts of milk or other dairy, if not listed in the first three

ingredients on a label. One diet says that 1 Tablespoon of milk per day is okay; however, this

could mean that one third of the day’s iodine comes from this 1 Tablespoon of milk. There is

no dairy in any of the recipes in this LID.



Red Dye #3 (E127 in the European Union/United Kingdom). However, Red Dye #40 is OK.

suggest that you avoid red, orange, pink, purple, or brown processed food, pills, capsules, cough

syrup, etc. Many food dyes contain iodine and should be avoided. The problem with food coloring is

specific to Red Dye FD&C #3 (

erythrosine

, E127 in the EU/UK) ONLY. However, the issue is that

some food labels do not specify which red dyes are used and food manufacturers may make

substitutions without notifying consumers. It is “better safe than sorry.” For medications, the best

source is the Physician’s Desk Reference (PDR), which clearly states the ingredients. For example,

Rocaltrol in the 0.5 mcg size is NOT good for the diet because it contains FD&C Red Dye #3.

However, Rocaltrol 0.25 mcg does not and is safe for the diet (you can take two of them to get to the

0.5 mcg dose). Please always check with your physician or pharmacist.



Egg yolks, whole eggs, or foods containing whole eggs.

Egg whites are acceptable because they

contain little or no iodine. Some low-iodine diets allow foods with very small amounts of eggs, if not

listed in the first three ingredients on a label.



Commercial bakery products.

Avoid bread products that contain iodine/iodate dough conditioners.

Also, the salt in these products may be iodized. It’s best to bake breads and other items yourself, or

substitute with unsalted plain matzos. If you read labels closely, you also may be able to find

crackers made only with flour and water, particularly in the Kosher section of your grocer, or melba

toast and tortillas (corn and flour) that are LID-safe. Although a few commercial bakery products

have tested low in iodine, manufacturing processes can change over time. The study published in the

Journal of Clinical Endocrinology and Metabolism in 2004 reported that the iodine content of single

slices of 20 different brands of bread ranged from 2.2 micrograms to 587 micrograms of iodine.

Low-Iodine Diet Quick Guide

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Foods to Avoid (continued):



Soybeans and most soy products.

Avoid soy sauce, soy milk, tofu, soy flour, and textured soy or

vegetable protein (TSP/TVP).

However, soy oil and soy lecithin are both okay.



Potato skins

(both white and sweet potatoes). The inside of the potato is fine. The recipes in this

LID avoid the use of potato skins.



Most chocolate (for its milk content).

Cocoa powder and some non-dairy dark chocolates are

permitted. Check the label for other ingredients not allowed on the LID. This LID has recipes calling

for chocolate that is allowed on the diet.



Blackstrap molasses.

Blackstrap molasses is made by repeatedly boiling down sugar cane, which

concentrates nutrients. It is okay to use the milder, fairly sweet molasses usually used in cooking.

Brown sugar, which is white sugar with a very small amount of molasses sprayed on it, is permitted.

Note: Sulfured molasses is safe, as long as it is not blackstrap.



Organ meats

such as liver, tripe, kidney, etc.



Maraschino cherries

(if they contain Red Dye #3, erythrosine, or E127 in the EU/UK), and fruit

cocktail with maraschino cherries.



Rhubarb.

The recipes in this LID avoid the use of rhubarb.



Iodine-containing vitamins and food supplements. Also avoid food and other products

containing iodate or iodide.

Check the label and ingredients and discontinue completely if iodine is

included. Most vitamins with minerals contain iodine. Check with your physician if your vitamins or

supplements were prescribed to you. Calcium supplements are sometimes made from ground oyster

shells, and these should be avoided. Check with your doctor or pharmacist about switching to a safer

source of calcium, such as calcium citrate, if medically needed.



Cooking wine and sherry.

Regular wine is fine, but cooking wine and sherry is often salted.



Medication that contains iodine.

Always check with your physician for the best course of action.

Foods to Enjoy, But in Limited Quantity:

Some diets from thyroid cancer specialists and researchers recommend limiting the daily intake of foods

that are moderate in iodine—5 to 20 micrograms per serving. This is because consuming larger

quantities would amount to a substantial proportion of the daily iodine limit during the LID.



Fresh meats.

Up to 5 or 6 ounces per day of fresh meats such as chicken, beef, pork, lamb, and veal

are fine on the low-iodine diet (no organ meats). (One researcher noted that meat contains 25-130

micrograms of iodine per pound.) Whole cuts contain less iodine than ground meats. To be extra

cautious, buy whole cuts and ask the meat department to grind the meat for you. Always check the

package label on meats, including whole turkeys, turkey breasts, turkey cutlets, chicken, and all pork

products. Many food makers inject broths into turkey, chicken or pork or soak them in a salt-based

solution. The label may not indicate whether the broth contains iodized salt. If you are not sure, go to

a local butcher for fresh turkey, pork, or chicken. Most major grocers offer chicken that has not been

treated with anything and these are safe options. Look for terms such as “minimally processed.”

Rinse all meat before cooking.



Grains, cereals and rice.

Up to 4 servings per day of grains, cereals, pasta, rice, and breads without

iodine-containing ingredients are fine on this diet. The iodine content in grains depends on the iodine

content in the soil of the region where it was grown. Homemade baked goods and cereals are best on

this diet. If you use processed foods, read the labels carefully to avoid iodine-containing ingredients.

It is easy to find pasta that is LID-safe, just avoid egg noodles. Also, remember that labels are not

always accurate or up-to-date; therefore, it is best to use plain oatmeal, farina, etc. and avoid the

varieties with flavorings/additives. It is worth noting that some diets limit rice even more. Basmati

rice has been mentioned as the best for the diet.

Low-Iodine Diet Quick Guide

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Foods to Enjoy, But in Limited Quantity (continued):



Spinach

. The USDA database indicates spinach is moderately high in iodine. We recommend

limiting spinach to one half-cup serving of raw spinach leaves per day.



Cruciferous vegetables

. Internet research suggests this family of vegetables (broccoli, kale,

cauliflower, cabbage, etc.) may inhibit iodine absorption, which could interfere with your RAI. We

do include these ingredients in our recipes but we suggest eating them in moderation.



*Canned peaches, apricots and mixed fruits.

Data from the USDA indicates that canned peaches,

apricots, and mixed fruits, when packed in syrup, are moderately high in iodine. We recommend

limiting consumption to one serving per day.

Foods to Enjoy:

The following foods and ingredients are fine to eat. You do not need to limit the quantity, except as

noted.

•

Fresh fruits and fruit juices.

Canned,* jarred, or frozen fruit is also acceptable if there is no salt,

LID-unsafe fortification, or unsafe food dye present. *Note: See entry above on some canned fruits.

•

Vegetables

, preferably raw and fresh-cooked or frozen without added salt. In the past, it was hard to

find frozen peas without added salt. As of this publication, this is no longer an issue in U.S. or

Canadian grocery stores.

•

Unsalted nuts and unsalted nut butters; homemade nut and oat milks.

•

Egg whites.

Separate yolks from whites yourself or buy cartons of 100% liquid egg whites.

•

Potatoes without skins.

•

Beans.

We suggest using beans cooked yourself from the dry state, or purchasing unsalted canned

beans. (It is worth noting that at least one major medical institution advises against beans, especially

red kidney, navy, pinto and lima beans, cow peas, and lentils.) If you want to be extra-cautious, limit

beans to black, garbanzo (chick peas), and white beans. Rinse any canned beans before using.

•

Grain/pasta/cereal/rice products in moderate amounts

(see above).

•

Fresh chicken, beef, and other meats in moderate amounts

(see above).

•

Sugar, jelly (avoid unsafe food coloring), honey, maple syrup, and most molasses

(not

blackstrap molasses).

•

Black pepper and fresh or dried herbs

. Be careful of prepared spice blends that contain salt.

•

All vegetable oils

such as olive, canola, corn, and soy oil (note other soy products are unsafe). Salad

dressings, provided they only contain allowed ingredients. It is best to make your own salad

dressing. Vegetable shortening and coconut oil are good choices for baking.

•

Cocoa powder and some non-dairy dark chocolate.

•

Vinegars

such as balsamic, apple cider, and white vinegar.

•

Lemon, lime

and other citrus fruits for their juice and zest.

•

Homemade foods

. Use recipes from ThyCa’s Low-Iodine Cookbook s at www.thyca.org or adapt

your own favorites by removing or substituting ingredients not permitted on the LID.

•

Gelatin, sorbet, popsicles without Red Dye #3 (erythrosine or E127 in the EU/UK)

•

Cola, diet cola, lemonade, soda pop

(except those with Red Dye #3, erythrosine, or E127).

•

Fresh brewed coffee (not instant), tea (not instant), beer, wine, other alcohol

(be aware of unsafe

food dyes).

Food prepared from fresh meats, fresh poultry, fresh or frozen vegetables, and fresh or frozen fruits

should be fine for this diet—provided they do not contain, or that you do not add, any of the iodine-

containing ingredients noted above.

Most sources ThyCa has reviewed do not comment about water. They indicate that ordinary household

tap water is fine for the diet. One source notes that some municipalities may include added iodine to

eliminate bacteria in water, and therefore suggests distilled water is more desirable in those areas.

Low-Iodine Diet Quick Guide

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Variations of the LID and Editorial Remarks From ThyCa:

As with any subject, there are varying sources of information. While nearly all doctors and medical

institutions recommend using an LID as a key tool to help maximize the effectiveness of RAI, advice

differs from institution to institution, and even doctor to doctor, about the details of the LID. ThyCa’s

goal is to present the most comprehensive and accessible LID we can, and to share some of these

differences with you so that you can make an informed decision. The team of volunteers that worked on

this cookbook has the philosophy that it is best to be diligent with your food choices while following the

LID. The LID is for a limited period of time and it helps you best prepare for testing and/or treatment

during a rather difficult time in your life. At the same time, it is important to make the diet work for you,

considering all the circumstances of your life, your health, and your work/school and family obligations.

You should consult with your physician and health care team to make the best decisions for you.



Processed and Manufactured Foods:

Most major food manufacturers in the USA generally use iodine-free salt when salt is listed as an

ingredient. However, they are not currently required to label iodine content in food, and they may

substitute iodized or sea salt without declaring it on the label. This was recently evidenced during the

COVID-19 outbreak of 2020, when the FDA granted permission to make substitutions without the

need for labeling. Other countries have different standards, and supermarket shelves are not limited

to foods produced in one country. Therefore, we at ThyCa cautiously assume all salt listed as an

ingredient is iodized. Feel free to add your own LID-safe salt to food.

Some food manufacturers cleanse their equipment with iodine based food-grade sanitizers that

contain iodophors. These compounds help fight against bacteria, mold, and yeast, etc.

Given the issue with salt as an ingredient that may be iodized, and the use of iodine-based cleansers,

we suggest limiting processed foods to the extent that you are able. We also know that it is nearly

impossible to eliminate all processed foods. Items such as pasta, matzo, and salt-free canned items

are used in ThyCa’s LID and are processed. However, because they are less processed and do not

contain salt (or any other high-iodine ingredients), we consider the risk of using them on the LID to

be minimal.

Having said the above with regard to processed and manufactured foods, some published low-iodine

diets allow salty foods and other highly processed items. We suggest using the ThyCa guidelines

while also working with your physician to do what is best for you.

Note that food processing techniques can change, and the package labels are not always accurate or

up to date.

In the past, some people have contacted manufacturers to ask whether or not they use iodized salt in

their products, or iodine-containing cleansers or sanitizers for their equipment and surfaces involved

in food processing. For example, in 2012, staff at NIH compiled a list of U.S. manufacturers that

said that they do not use iodized salt, but the list is not being updated regularly. Additionally, trying

to maintain a list is NOT recommended for the following reasons:

Manufacturers cannot guarantee that the ingredients they receive from their suppliers do not

contain iodized salt.

Manufacturers may change procedures and may use iodine-based cleaners or sanitizers on food-

processing surfaces, utensils, equipment, and containers used in processing steps.

It is unknown whether the person responding to the inquiries about salt, iodine, etc. is actually in

a position to know.

Low-Iodine Diet Quick Guide

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Read the ingredient labels on all packaged foods and spices.

Some spice blends like chili powder and

lemon pepper may contain added salt. Some support group participants have compiled lists of brands

of processed and packaged foods that are low in iodine.

If you use these lists, be sure to check the

date on which they were compiled. Many people find it easier to eat simple unprocessed snacks,

foods and ingredients for the short period of the diet.



Eating out/Restaurant Food and Take-Out:

Similar to processed foods, commercial kitchens sometimes use iodized salt, sea salt and iodine-

based sanitizers. We suggest limiting eating-out/ordering-in as much as possible. If you must, for a

variety of reasons (e.g. travel for work, studying at university far from home, etc.) we suggest a salad

with no cheese, bacon, or croutons. Ask for olive oil, vinegar, and/or lemon juice for dressing.

Ordering an unsalted baked potato (plain or sweet) and eating the inside is safe. You can add olive

oil to it. Restaurant or cafeteria staff may not be well informed on this topic, so we suggest being

very cautious. Consider carrying some non-iodized or Kosher salt to adjust to these circumstances, if

needed.



Foods We Are Often Asked About, etc.

Rice:

Some LID diets do not permit rice, and some do. We suggest limiting your intake as noted

previously. We suggest basmati rice as the safest option.

Quinoa:

While technically a seed and not a grain, quinoa is becoming very popular as a rice-type ingredient.

ThyCa has found one reputable diet that permits quinoa. We note that, per the UDSA, it has about

twice the iodine as pasta and other grains have, but the amount is still relatively low and therefore it

is safe to use in moderation, as with all grains.

Breads, Bagels, English Muffins, etc.:

The issue with bread, in addition to disallowed ingredients such as egg yolks, butter, and salt, is that

some commercially baked breads use iodine/iodate-based dough conditioners (mainly potassium

iodate and calcium iodate). We have found some diets permit English muffins and bagels if limited

in quantity. ThyCa’s philosophy is to avoid anything commercially baked containing salt, soy, milk

products, etc.; therefore, we do not recommend English muffins or bagels. The safest option is to

bake your own bread using our recipes (or ask a friend to bake for you). You may use unsalted

matzah (matzo or matza), LID-safe crackers, or LID-safe tortillas as a substitute. Unsalted matzah

crumbs are a nice breadcrumb substitute.

Fresh meats:

Diets vary, but in general limiting to 5-6 oz. per day is a good choice. Some diets suggest no turkey

since it is often injected with broth and other ingredients. Avoid liver/organ meats. Pre-packaged

ground meats are higher in iodine, so if you want ground meat, we suggest you buy whole cuts and

ask the meat counter to grind the meat for you. Rinse whole cuts before using.

Cured meats:

Diets vary from institution to institution and our recommendation is to avoid all cured meats (cold

cuts/deli meats, bacon, cured ham, sausage, salami, chipped beef, hotdogs, etc.), since recent testing

by the USDA indicates that cured meats are high in iodine.

Dairy:

Avoid milk and all dairy products. While some diets permit a small amount (e.g., 1 Tablespoon per

day), even that amount can have 36% of the targeted daily amount of iodine. Additionally, iodine

content varies from cow to cow based on feed, supplements, etc.

Low-Iodine Diet Quick Guide

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Non-Dairy “Milks”:

Today you can find “milk” products made from oats, almonds, cashews, coconut, rice, soy, etc.

Avoid milks made from rice and soy for the reasons listed above. For products like oat milk, almond

milk, cashew milk, etc. you must read the labels very carefully. In general we suggest avoiding these

products since they often contain sea salt, carrageenan, and are sometimes fortified with non-LID-

safe ingredients. We provide recipes to make your own LID-safe nut and oat milks in ThyCa’s LID

Cookbook. If you do purchase and use one of these products, make sure it is LID-safe.

Coffee creamer:

Some diets permit use of non-dairy creamers if they do not contain soy or carrageenan. Just as with

the “milks,” there are a wide range of non-dairy coffee creamers available on the market today, but

many (though not all) are made with iodine-containing ingredients. We suggest reading labels very

carefully to avoid salt, soy, dairy-based products such as whey, carrageenan, and other iodine-rich

ingredients. Melting a marshmallow, or using marshmallow fluff (check ingredients, as some contain

carrageenan or fish gelatin), may be a good substitute to lighten and sweeten your coffee.

Soy:

Soybeans and soy products should be avoided. The exceptions are soy oil and soy lecithin because

they do not contain soy protein. Avoid tofu, texturized soy protein (TSP), soy milk, soy sauce,

edamame, soy/veggie burgers, etc. The American Thyroid Association indicates that while soy is

low in iodine, based on animal studies it can interfere with radioactive iodine uptake.

Canned goods:

Years ago, cans were sanitized using iodine-based solutions. Most modern canning uses steam.

Some diets suggest avoiding all canned goods, partly due to the old sanitizing process and partly due

to the salt content. Today it is easier to find no-salt-added canned goods. We do use some canned

products in our LID since the diet needs to be user-friendly and have some elements of convenience.

To be extra-cautious, rinse your canned goods when practical.

Some Varieties of Beans:

The NIH and other diets no longer limit beans. As of this publication, one major medical institution

was still limiting beans and lentils. Beans are an essential form of nourishment, especially if you are

vegetarian or vegan.

We suggest using beans cooked yourself from the dry state, or purchasing

unsalted canned beans. If you want to be extra cautious, focus on using black, garbanzo (chick peas)

and white beans and limit your servings to typical serving sizes. Rinse canned beans before use.

Condiments:

Generally condiments such as ketchup/catsup, mustard, etc. contain a lot of salt. Look for no-salt-

added varieties. We have identified two diets that suggest avoiding ketchup and we believe this is

presumably because of its typical salt content. ThyCa does provide a recipe to make your own

ketchup and mustard, if desired.

Salt:

This can be a confusing product to shop for while on the LID, so be very careful with labels.

ThyCa’s LID does not allow sea salt or any iodized salt. Look for Kosher salt and plain table salt—

be sure it indicates no added iodine, including any form of iodate or iodide. Also avoid pink

Himalayan salt and other gourmet salts. As noted above, the label may say something like “this does

not supply iodine, a necessary nutrient,” but be aware that some sea-salt labels have this same

statement, and they are

not

LID-safe. Most diets indicate use of iodine-free salt is OK in any

quantity, so long as it fits your overall health needs and is not sea salt. See examples of salt labels

found in this document.

Low-Iodine Diet Quick Guide

www.thyca.org Page x

Fat/Oil/Margarine:

All vegetable oils are safe, including soy oil. Butter is not permitted, as it contains dairy. Most

margarine is not safe, since it often contains whey (dairy) and salt. However, there are some brands

of margarine that are unsalted and dairy-free. This is a good option, and can be “doctored up” with

some safe salt for additional flavor. Coconut oil is another solid fat that can be used similarly for

baking, etc. Vegetable shortening is also available at most grocers and is even available in a butter

flavor; this is an acceptable option to use.

Water:

Most sources say that tap water is safe. Some municipalities are known to add iodine to water to kill

bacteria; therefore, distilled water is the safest option there. If your water is softened using a salt-

based process, you need to call the salt manufacturer and see if the salt is iodized or not. Reverse

osmosis-purified water is safe. However, some of the popular brands of bottled water first use

reverse osmosis (RO) and then add back salts and minerals for flavor—watch out for these products

and avoid them. Most diets do not mention water.

Beverages:

Avoid instant coffees and teas. Lemonade and fresh-brewed coffee and tea are all considered safe.

Soda pop, including diet soda, is safe so long as it does not contain unsafe ingredients (e.g. red dye).

Prunes, strawberries, and cranberries:

ThyCa often gets calls about these food items. Prunes and strawberries are low-iodine foods and safe

on the LID. Cranberry juice is safe per the NIH database. We cannot find data on whole or dried

cranberries and therefore suggest eating them in moderation.

Cruciferous vegetables:

We do include these ingredients in our recipes. Nonetheless, we suggest eating them in moderation

because, while low in iodine, they may have a slight impact on iodine absorption, which could affect

your RAI.

Sulfured foods:

We are often asked about this due to molasses. Sulfur itself is not an issue on the LID. Blackstrap

molasses is not LID-safe because it is boiled down so much that the nutrients, including iodine, are

concentrated. Blackstrap and regular molasses are both available sulfured and unsulfured. Sulfured

molasses and unsulfured molasses are both LID-safe, so long as it is not blackstrap molasses.

Etc.:

The iodine content of many foods is simply not known at this time. Governmental agencies around

the world, including the USDA, maintain food-content databases—some of which measure iodine,

others do not. As of this publication date, the Food and Agriculture Organization of the United

Nations hosts a directory of the databases known to it at: http://www.fao.org/infoods/infoods/tables-

and-databases/en/ (also available in French and Spanish). The USDA’s database has iodine contents

for some foods, but many simply have not been tested. We offer two principal suggestions when

using these databases: (1) be sure to convert the raw numbers in the database to a standard serving

size for the food in question, and (2) try to eat a variety of foods while on the LID, which helps to

spread the risk related to variations in iodine content.

When in doubt, we recommend avoiding the food item. ThyCa is here to help: you can ask questions

at [email protected].

Low-Iodine Diet Quick Guide

www.thyca.org Page xi

Pantry Items

So often we can be overwhelmed by what we cannot have on the LID. This section focuses on what you

can have, helps you stock your pantry to get ready for the LID, and helps you learn how to read labels

when shopping so that you buy LID-safe items.

How to read salt labels to find LID-safe salt:

Salt without iodine is safe to use, so long as it is not sea salt. Here are some examples of what to look

for, and what to avoid when shopping:

Safe salt options: Salts to avoid:

Low-Iodine Diet Quick Guide

www.thyca.org Page 12

General Tips for Reading Food Labels:

Start by looking at the ingredients. You will see

nothing other than tomatoes. There is no added

salt. Next, you will note that there is sodium in

this product. Sodium and salt are not the same

exact thing, although salt does introduce a large

amount of sodium into the diet since chemically

it is “sodium chloride.” Looking at sodium

content alone in the “Nutrition Facts” chart is not

going to help you with the LID. Instead, look at

the listed ingredients. If the ingredients contain

salt or sea salt, pick a different product.

Here are two different ingredient lists for ketchup. One is LID-safe, the other is not:

Suggested Ketchup: Tomato Concentrate, High

Fructose Corn Syrup, Distilled Vinegar, Corn

Syrup, Less than 2% of: Sugar, Onion Powder,

Garlic Powder, Natural Flavors

Ketchup to avoid: Tomato concentrate, distilled

vinegar, high fructose corn syrup, corn syrup,

salt

, spice, onion powder, natural flavoring.

Finally, here are two labels for non-dairy coffee creamer products. One is LID-safe and one is not.

This label is

an example

of a carton

of diced

tomatoes

that are safe

to use on

the LID.

Low-Iodine Diet Quick Guide

www.thyca.org Page xiii

This coconut

milk-based

creamer is

LID-safe. It has

no high-iodine

ingredients and

no salt of any

kind.

This oat milk-

based creamer is

not LID-safe. Oat

milk itself is fine,

but, like many

non-dairy milk

and creamer

products, this one

contains sea salt.

This is why you

have to read

labels carefully!

Low-Iodine Diet Quick Guide

www.thyca.org Page xiv

Going shopping:

You may be going hypothyroid for your scan and/or treatment with radioactive iodine. If so, you will

give up your thyroid hormone medicine and you may feel miserably hypothyroid. (Hopefully you are

avoiding this and using Thyrogen® to increase your TSH.) Nonetheless, it is best to shop for the shelf-

stable items on this shopping list while you are still feeling well, or ask a friend to help. Since you might

be prepping for RAI radioactive-iodine treatment post-surgery, you may want a friend to help carry

groceries for you. With all items on this list, check the labels carefully so you avoid salt, all forms of

dairy, sea-based products, and soy products that can be lurking in the ingredient list. We are listing foods

here that are generally safe for the LID.

Helpful tips: Ingredient lists can change—always read the label to be extra sure!! Shopping in the

Kosher section of your grocery store can be helpful while on this diet.

Shop-ahead list

—buy your fruits, vegetables, meats and eggs (for the whites or buy a carton of liquid

egg whites) when needed, but the list here are items you can purchase well in advance:



Pasta: treat yourself to a variety of shapes and sizes. Be wary of noodles; they often contain eggs.



Wheat flour: avoid self-rising flour; regular flour is generally safe



Corn meal



Tortillas, tortilla chips and/or tortilla crumbs with LID-safe ingredients



Matzo and matzo crackers (salt-, egg-, and dairy-free)



Canned coconut milk



Salt-free, dairy-free margarine (sometimes this is difficult to find, but it is available)



Solid vegetable shortening, regular and/or butter flavor; use as spreads or for baking/cooking



Baking potatoes, boiling potatoes, sweet potatoes (the skins have iodine; the inside is LID-safe)



Dried beans



Puffed wheat cereal (ingredient: wheat) from the health food store or health food aisle



Unsalted nuts (pecans, almonds, walnuts, peanuts, etc.)—look in the baking aisle



Vanilla extract, baking powder, baking soda, other LID-safe baking essentials, etc.



Non-iodized or Kosher salt (not sea salt)



Hot wheat (not instant) farina cereal: look for brands that do not contain salt



Oatmeal (not the flavored packets): old-fashioned oats, quick oats or steel-cut oats



Salt-free natural peanut butter (or almond/cashew butter)



Jellies and jams (no food coloring and no salt)



Olive and canola/vegetable oil



Fresh garlic and onions, or garlic/onion powder



Apple cider vinegar



Cocoa powder (salt-free, dairy-free)



Salt-free, dairy-free dark chocolate chips or bars



Plain unsalted popcorn



Frozen veggies and fruit



Dried fruit: cherries, blueberries, raisins, etc. (watch for food coloring and salt)



White sugar



Pure maple syrup/corn syrup/agave syrup (light and amber-colored—whichever you prefer)



Honey (plain and whipped)



Marshmallows (read ingredients—no salt, carrageenan, or fish gelatin): for some they work well

as coffee creamer (melt one into your cup) and/or marshmallow “fluff”



Coffee and tea (not instant varieties): brew your coffee, use tea bags for tea



Soda (soda-pop) in various varieties—diet is OK; avoid red food dyes and salt



Distilled water (if necessary)

Low-Iodine Diet Quick Guide

www.thyca.org Page xv

A Week’s Worth of Easy Menus

Breakfast

Lunch

Dinner

Sunday

Egg white veggie

scramble

Pasta with LID-safe pesto

and frozen/canned no-salt

peas

Roasted chicken, baked

potato (no skin), side

salad

Monday

Oatmeal with maple

syrup, unsalted nuts, and

dried fruit

Leftover roasted chicken

with avocado on matzo

with side salad

Pasta with white beans

and LID-safe pesto topped

with crushed walnuts

Tuesday

Farina/hot wheat cereal

with sliced banana, salt-

free nut butter

and honey

LID-safe peanut butter

and sliced banana on

matzo

Pork chop, baked sweet

potato (try the microwave

—

easy)

and string beans

Wednesday

LID-safe corn muffins

with egg white scramble

Leftover pork chop and

string beans on a big salad

with avocado and LID-

safe dressing

Baked chicken legs,

basmati rice, and steamed

carrots

Thursday

Potato, egg white, and

ground beef scramble

Leftover chicken leg meat

on a big salad with LID-

safe

dressing

Roast beef, dairy-free

mashed potatoes, and

mixed veg

etables

Friday

Oatmeal topped with

unsalted walnuts, LID-

safe dark chocolate chips,

and

LID

safe

jelly

Leftover roast beef on

matzo or LID-safe bread,

mashed avocado, lettuce

and tomato “sandwich”

Black beans with basmati

rice and salt-free diced

tomatoes

Saturday

LID-safe pancakes with

maple syrup

Pasta tossed with fresh

vegetables, olive oil, and

garlic

Small steak, baked potato

(no skin), and summer

squash

Snacks:

•

Fresh fruit: apples, grapes, bananas, melon, peaches, etc.—keep these on hand and ready to eat

•

Salt-free applesauce

•

Raisins and other dried fruits

•

Refrigerator oats (refer to recipe in cookbook) enjoyed cold or warmed when eaten.

•

LID-safe muffins (swap shortening for butter, egg white for egg, use non-iodized/non-sea salt, etc.)

•

No-salt tortilla chips with avocado or homemade LID-safe guacamole

•

Homemade LID-safe hummus

•

Raw carrot and celery sticks

•

Unsalted peanut butter (great with apple slices, carrot sticks, etc.)

•

Unsalted matzo crackers (found in the Kosher section)

•

Homemade popcorn (air pop or use oil and non-iodized/non-sea salt)

•

Unsalted nuts: pecans, walnuts, almonds, etc., found in the baking aisle, or dry-roasted unsalted

peanuts found in the snack food aisle

•

Matzo or homemade bread/muffins with honey or LID-safe jelly/jam

•

Frozen bananas blended with cocoa powder for an ice cream like treat

•

Trail mix made from raisins, salt-free pretzels, unsalted nuts, and LID-safe dark chocolate chips

•

Sodas, including colas, and lemon-lime clear soda pop, ginger ales, etc. (read labels, as caramel- or

cherry-colored sodas may have Red Dye #3, erythrosine, or E127

•

Sorbet (check label to be sure no salt, dairy, carrageenan, or Red Dye #3/erythrosine/E127)

Low-Iodine Diet Quick Guide

www.thyca.org Page xvi

Miscellaneous Topics

Vitamins/Minerals and Supplements:

Please always check with your doctor about stopping any necessary supplements they have prescribed.

Many multi-vitamins contain iodine in their formulation. Please avoid these. Some supplements use

artificial coloring such as Red Dye #3, erythrosine, or E127 in the EU/UK and also need to be avoided.

The most common mineral we hear about is calcium. Some calcium formulations are made from

ground-up oyster shells, which are rich in iodine. This type of formulation should be avoided. Check

with your doctor about whether or not it is safe to stop calcium supplementation during the LID. If you

must continue with calcium, talk to your pharmacist about safe formulations (one option to ask about is

calcium citrate).

Many people take a variety of supplements for different reasons. Please do your research to determine if

what you might be using is iodine-rich. If so, please avoid during the LID.

Other Ways Iodine Enters Our Bodies:

•

CT Contrast: radiographic dye, or an intravenous radiocontrast agent, contains iodine. This helps to

visualize structures and organs within the body. If you have had a recent CT scan, with contrast, it is

important for you to call the radiography department to determine if the dye used contained iodine.

If so, please contact your physician. Iodine from this type of contrast can take a very long time to

leave our bodies, and therefore, may have an impact on the timing of your treatment. (If you are

unsure if you had any such tests in the past several months, have your doctor review your files.)

If you have a CT scan coming up, and it is before your LID, please contact your physician to see if it

is acceptable for you to avoid the contrast, or possibly reschedule the appointment.

•

Topical antiseptics: Iodine is used as a topical antiseptic, such as that commonly swabbed on the

skin before surgery (including thyroid surgery). If you are having surgery prior to your radioactive-

iodine treatment, ask your surgeon to use an alternative cleanser. Avoid Betadine

soaps and

shampoos and other products containing povidone-iodine, polyvidone iodine, or iodopovidone.

•

Skin care & toiletry items: We put many things on our bodies, and in our mouths, for skin care and

grooming. Items such as toothpaste, soap, deodorant, shampoo, conditioner, skin creams, etc. may be

rich in iodine. Check toiletry labels for Red Dye #3 (erythrosine or E127). Also look for seaweed

and other sea-derived ingredients in your toiletries. Look for words such as marine algae, Dead Sea

minerals, fish roe enzymes and extracts, seawater, and pearl extracts.

•

Food dye: Check everything for Red Dye #3 (erythrosine or E127). A good rule of thumb is that if

you are unsure, and the item is artificially colored, avoid it. Remember that red dye is used in

formulations to make other colors such as pink, orange, brown, purple, etc.

•

Drugs, including OTC medication: Food dye is also used in pills and other medications such as

cough syrups. Check with your doctor or pharmacist if you are unsure whether any of your current

medications contain Red Dye #3, erythrosine, or E127. Always check with your physician before

suspending or switching any medication while on the LID.

Handy One-Page LID Summary

www.thyca.org Page xvii

For the detailed

Free Low-Iodine Cookbook

with hundreds of delicious recipes,

visit www.thyca.org.

Key Points



This is a Low-Iodine Diet (“LID”), not a “No-Iodine Diet” or an “Iodine-Free Diet.” The American Thyroid

Association suggests a goal of under 50 micrograms (mcg) of iodine per day.



The diet is for a short time period, usually for the 2 weeks (14 days) before a radioactive iodine scan or

treatment and 1-3 days after the scan or treatment.



Avoid foods and beverages that are high in iodine (>20 mcg/serving). Eat any foods and beverages low in

iodine (< 5 mcg/serving). Limit the quantity of foods moderate in iodine (5-20 mcg/serving).

Foods to AVOID

•

Iodized salt, sea salt, and any foods containing

iodized salt or sea salt

•

Seafood and sea products (fish, shellfish, seaweed,

seaweed tablets, calcium carbonate from oyster shells,

carrageenan, agar-agar, alginate, arame, dulse,

furikake, hiziki, kelp, kombu, nori, wakame,

and other

sea-based foods or ingredients)

•

Dairy products of any kind (milk, cheese, yogurt,

butter, ice cream, lactose, whey, casein, etc.)

•

Egg yolks, whole eggs, or foods containing them

•

Bread and bakery products containing iodine/iodate

dough conditioners or high-iodine ingredients such as

dairy, eggs, salt

•

Red Dye #3 (erythrosine or E127 in the EU/UK)

•

Maraschino cherries (due to the red dye)

•

Fruit cocktail (due to the Maraschino cherries)

•

Chocolate that contains dairy

•

Blackstrap molasses (other types are OK)

•

Soybeans and soybean products such as tofu,

TSP/TVP, soy milk, soy sauce, soy flour; except soy

oil and soy lecithin, which are OK.

•

Rhubarb

•

Potato skins

•

Vitamins and food supplements that contain iodine



If you are taking medication or supplements

containing iodine, check with your doctor.

Foods to ENJOY

•

Fruit, fresh, frozen, or jarred, salt-free and without

red

food dye; canned in limited quantities; also fruit

juices

•

Vegetables: ideally raw or frozen without salt, except

soybeans

•

Beans: unsalted canned, or cooked from the dry state

•

Unsalted nuts and unsalted nut butters

•

Egg whites

•

Fresh meats (uncured; no added salt or brine

solutions) up to 6 ounces a day

•

The insides of white and sweet potatoes (no skins)

•

Low-iodine homemade (and some commercial) baked

goods

•

Grain and cereal products up to 4 servings per day,

provided they have no high-iodine ingredients

•

LID-safe pasta (remember to avoid egg noodles)

•

Sugar, jelly, jam, honey, maple syrup, molasses (not

blackstrap), agave nectar—avoid red food dyes

•

Black pepper, fresh or dried herbs and spices

•

Vinegars free of salt and red dye

•

Lemon, lime, and other citrus (for their juice & zest)

•

All vegetable oils, including soy oil

•

Vegetable shortening (i.e., the white solid variety)

•

Sodas (except with Red Dye #3, erythrosine, or

E127), cola, diet cola, non-instant coffee & tea, beer,

alcoholic beverages (except cooking wine), lemonade

•

Cocoa powder and some non-dairy dark chocolates

**Remember to check the ingredient list on all packaged foods**

Easy Snacks for Home, Work, or Travel

Easy Quick Meals

•

Fresh fruit or fruit juice

•

Raisins and other dried

fruits

•

Unsalted nuts and nut

butters

•

Homemade low-iodine

bread or muffins

•

No-salt tortilla chips

•

Fresh raw vegetables

•

Salt-free applesauce

•

Popcorn with non-

iodized/non-sea salt

•

Unsalted matzo

and other

unsalted crackers

•

LID-safe soda pop or

lemonade

•

Freshly cooked oatmeal

with toppings (cinnamon,

honey, salt-free

applesauce, maple syrup,

unsalted nuts, fruit)

•

Fresh meat with

vegetables, fresh fruit,

and baked white or sweet

potato (no skin)

•

Salad topped with grilled

chicken, beef or pork, oil

& vinegar dressing.

•

“PB&J” with LID-safe

peanut butter, jelly, and

salt-free matzo or fresh

baked LID-safe bread

•

Baked apples for dessert

(can be microwaved)

Our thanks to ThyCa’s medical advisors and conference speakers for the information and input.

Disclaimer:

This information is intended for educational purposes only. It is not intended, nor should it be

interpreted, as medical advice or directions of any kind. Any person viewing this information is strongly advised

to consult their own medical doctor(s) for all matters involving their health and medical care.