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Low-Iodine Diet for Thyroid Cancer Treatment: Foods to Avoid and Allow, Study notes of Nutrition

International Training CareersNutrition

The low-iodine diet, a crucial part of preparing for radioactive iodine treatment for papillary or follicular thyroid cancer. The diet aims to deplete the body's iodine stores, enhancing the treatment's effectiveness. It includes a list of foods to avoid, such as iodized salt, seafood, dairy products, and soybeans, and allowed foods, like fresh fruits, vegetables, and unsalted nuts.

What you will learn

  • Which foods are allowed during the low-iodine diet for thyroid cancer treatment?
  • What foods should be avoided during the low-iodine diet for thyroid cancer treatment?
  • How does the low-iodine diet help in the treatment of thyroid cancer?

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The Low-Iodine Diet — Summary
The short-term low-iodine diet is another part of preparing to receive radioactive iodine for papillary
or follicular thyroid cancer or one of their variants. The diet, recommended by ThyCa Medical
Advisors, other thyroid cancer experts, and the American Thyroid Association, increases the
effectiveness of the radioactive iodine treatment.
•This diet lasts for about 1 to 2 weeks before your radioiodine, and for about 1 to 2 days
afterward.
•This diet reduces your consumption of regular iodine so that when the radioactive iodine is given
for treatment, any remaining thyroid cells, including thyroid cancer cells, will be “hungry” for
iodine. These cells will then more readily absorb the radioactive iodine, which will eventually
destroy them.
•A low-iodine diet has less than 50 micrograms of iodine per day. It is low in iodine, not “no-
iodine.” Iodine is not related to sodium, so this diet is different from a “low-sodium” diet. The
normal recommended daily allowance for iodine is 150 micrograms per day. Most people in the
United States consume much more than 150 micrograms daily.
•The foods and beverages you consume will have small amounts of iodine that total less than 50
micrograms each day.
•There are slight variations in guidelines from different doctors. The ThyCa diet and guidelines
have received input and review by numerous thyroid cancer specialists.
Brief Overview
Not Allowed—Avoid These Foods and Ingredients
•Iodized salt, sea salt, and any foods containing iodized salt and sea salt
•Seafood and sea products, including carrageenan, agar-agar, algin, alginate, and nori
•Dairy products
•Egg yolks or whole eggs or foods with whole eggs
•Bakery products with iodine/iodate dough conditioners or high-iodine ingredients. Low-iodine
items are fine.
•Red Dye #3, erythrosine (or E127 in Europe)
•Most chocolate (due to milk content). Cocoa powder and some dark chocolates are allowed
•Soybeans and soybean products (however, soy oil is allowed)
•Iodine-containing vitamins and food supplements
•If you take a medication containing iodine or red dye #3, check with your physician.
Allowed Foods and Ingredients
•Fresh fruits and vegetables, unsalted nuts and nut butters, whites of eggs, fresh meats (provided
no broth injected) with some diets limiting intake to 6 ounces a day, grains and cereal products
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The Low-Iodine Diet — Summary

The short-term low-iodine diet is another part of preparing to receive radioactive iodine for papillary or follicular thyroid cancer or one of their variants. The diet, recommended by ThyCa Medical Advisors, other thyroid cancer experts, and the American Thyroid Association, increases the effectiveness of the radioactive iodine treatment.

  • (^) This diet lasts for about 1 to 2 weeks before your radioiodine, and for about 1 to 2 days afterward.
  • (^) This diet reduces your consumption of regular iodine so that when the radioactive iodine is given for treatment, any remaining thyroid cells, including thyroid cancer cells, will be “hungry” for iodine. These cells will then more readily absorb the radioactive iodine, which will eventually destroy them.
  • (^) A low-iodine diet has less than 50 micrograms of iodine per day. It is low in iodine, not “no- iodine.” Iodine is not related to sodium, so this diet is different from a “low-sodium” diet. The normal recommended daily allowance for iodine is 150 micrograms per day. Most people in the United States consume much more than 150 micrograms daily.
  • (^) The foods and beverages you consume will have small amounts of iodine that total less than 50 micrograms each day.
  • (^) There are slight variations in guidelines from different doctors. The ThyCa diet and guidelines have received input and review by numerous thyroid cancer specialists.

Brief Overview

Not Allowed—Avoid These Foods and Ingredients

  • (^) Iodized salt, sea salt, and any foods containing iodized salt and sea salt
  • (^) Seafood and sea products, including carrageenan, agar-agar, algin, alginate, and nori
  • (^) Dairy products
  • (^) Egg yolks or whole eggs or foods with whole eggs
  • (^) Bakery products with iodine/iodate dough conditioners or high-iodine ingredients. Low-iodine items are fine.
  • (^) Red Dye #3, erythrosine (or E127 in Europe)
  • (^) Most chocolate (due to milk content). Cocoa powder and some dark chocolates are allowed
  • (^) Soybeans and soybean products (however, soy oil is allowed)
  • (^) Iodine-containing vitamins and food supplements
  • (^) If you take a medication containing iodine or red dye #3, check with your physician. Allowed Foods and Ingredients
  • (^) Fresh fruits and vegetables, unsalted nuts and nut butters, whites of eggs, fresh meats (provided no broth injected) with some diets limiting intake to 6 ounces a day, grains and cereal products

without high-iodine ingredients (some diets limit to 4 servings a day), pasta without high-iodine ingredients

  • (^) Sugar, jelly, jam, honey, maple syrup, black pepper, fresh or dried herbs and spices, all vegetable oils (including soy oil),
  • (^) Sodas (except with Red Dye #3 or E127 in Europe), cola, diet cola, non-instant coffee, non- instant tea, beer, wine, other alcoholic beverages, lemonade, fruit juices
  • (^) Read the ingredient list on all packaged foods. Check with your physician about any medications you are taking. Note that sodium is not an issue. What is to be avoided is the added iodine found in iodized salt, which is widely used, especially in processed foods. It’s preferable to avoid processed foods while on the diet, if possible, because food manufacturers are not required to list the iodine content. Therefore, if salt is a listed ingredient, you have no way of knowing whether it’s iodized or non-iodized. This does not apply to foods that naturally contain sodium without salt as an ingredient. There are many foods you can eat while on the low-iodine diet. It is a good idea to cook meals yourself, using fresh ingredients, including fruits, vegetables, and unprocessed meats.

Low-Iodine Diet Details

Many thyroid cancer patients with papillary or follicular thyroid cancer receive a dose of radioactive iodine (RAI) about two months after their surgery in an attempt to destroy (ablate) any remaining thyroid cells in their bodies. These thyroid cancer patients may also undergo whole-body radioiodine scans at periodic intervals, using a “tracer” dose of RAI. If their scan is not “clean,” they may then receive treatment with a larger dose of RAI in an attempt to eliminate remaining thyroid cells. In preparation for an RAI scan or RAI treatment, patients are usually asked to go on a low-iodine diet. The diet is to prepare for the RAI. The patient follows the diet when preparing for RAI either by temporarily stopping levothyroxine (withdrawal) or by receiving injections of Thyrogen® (recombinant TSH) while continuing on levothyroxine. The purpose of a low-iodine diet is to deplete the body of its stores of iodine, to help increase the effectiveness of the radioactive iodine scan or treatment. The premise is that when the radioactive iodine is administered, the thyroid cells will “suck” up the iodine, because the body has been so depleted. This diet is intended for short term use. The usual time period is around two to four weeks. The diet usually begins around two weeks before testing and continues through the testing and treatment period. However, recommendations for the time period can vary, depending partly on the individual patient’s circumstances. The following is a combination of diet guidelines from several sources. Your physician may have different guidelines. Please check with your doctor before you start the diet.

on tests of 18 brands of milk in the Boston, Massachusetts area. It reported that 250 ml of milk (about 8 ounces, or 1 cup, or 16 Tablespoons) contained from 88 to 168 micrograms of iodine and averaged 115 mcg. It 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. (Some low-iodine diets allow very small amounts of milk or other dairy, if not listed in the first three ingredients on a label. There is no dairy in any of the recipes in this cookbook.)

  • (^) Egg yolks or 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. The recipes in this cookbook use only egg whites.)
  • (^) Commercial bakery products unless you check the label to make sure that the ingredients are allowed. Avoid bread products that contain iodine/iodate dough conditioners (usually small bakery breads are safe; it’s best to bake it yourself or substitute with Matzos). If you read labels closely, you may also be able to find crackers made only with flour and water. While 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. mcg to 587 mcg.
  • (^) Red Dye #3. However, Red Dye #40 is OK. We suggest that you avoid red, orange, or brown processed food, pills, and capsules. Many red, red-orange, and brown food dyes contain iodine and should be avoided. The problem with food colors is specific to Red Dye FD&C # (erythrosine) ONLY. However, the problem is that some food labels do not specify which red dyes are used. 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. 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.
  • (^) Most Chocolate (for its milk content). Cocoa powder and some dark chocolates are permitted. Check the label for other ingredients not allowed on the low-iodine diet. The ThyCa cookbook has recipes with permitted chocolate.
  • (^) Some Molasses. Most molasses is okay. Avoid if sulfured or blackstrap, which is concentrated and has a bitter taste. It's okay to use the milder, fairly sweet unsulfured molasses usually used in cooking and that is the type most often available in grocery stores in the USA. Sulfur is not related to iodine. However, it's a term used on molasses labels. Some diets don't make distinctions between kinds of molasses and say to avoid all molasses.
  • (^) Soybeans and most soy products (soy sauce, soy milk, tofu). However, soy oil and soy lecithin are both okay.
  • (^) Some beans besides soybeans. The National Institutes of Health diet says to avoid these beans: red kidney beans, lima beans, navy beans, pinto beans, and cowpeas. Other diets do not limit beans.
  • (^) Some diets say to avoid rhubarb and potato skins. They note that the inside of the potato is fine.
  • (^) Iodine-Containing Vitamins, and Food Supplements. Also products containing iodate or iodide. Check the label and ingredients and discontinue completely if iodine is included. Most vitamins with minerals contain iodine. If you are taking a Medication that contains iodine, check with your physician.

Limit the Amounts of these Foods

Some diets from thyroid cancer specialists and researchers recommend limiting the daily intake of foods that are moderate in iodine: 5 to 20 mcg per serving.

  • (^) Fresh meats. Up to 5 ounces per day of fresh meats such as chicken, beef, pork, lamb, and veal are fine on the low-iodine diet. (Up to 6 ounces, according to one of the researchers, who noted that meat contains 25-130 mcg of iodine per pound.) Whole cuts tend to contain less iodine than do ground meats. Also, 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 or chicken or pork. The label may not indicate whether the broth contains iodized salt. If you are not sure, go to your local butcher for fresh turkey, pork, or chicken.
  • (^) Grains, cereals. Up to 4 servings per day of grains, cereals, pasta, and breads without iodine- containing ingredients are fine on this diet. The iodine content depends on the iodine content of the region where the grain 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. Also, remember that labels are not always accurate or up to date.
  • (^) Rices. Like grains, rices vary in the amount of iodine depending on the region where grown, so rice should be eaten only in limited amounts. Some low-iodine diets recommend avoiding rice. Basmati rice has been mentioned by some as the best for the diet.

What About Restaurant Foods and Fast Food?

Although restaurants generally use non-iodized salt, it is not possible to know whether a particular restaurant is using iodized salt or sea salt. The manager or serving staff may not know what product is being used, or whether butter or other dairy products are present in foods. The ingredients that chain and fast-food restaurants use may change. Therefore, we suggest that you avoid restaurant foods other than plain juices or soft drinks, or the inside of a plain baked potato. For most restaurant foods, there is no reasonable way to determine which restaurants use iodized salt. Avoid them if in doubt.

  • (^) Fresh chicken, beef, and other meats in moderate amounts (see above).
  • (^) Sugar, jelly, honey, maple syrup, and unsulfured molasses.
  • (^) Black pepper and fresh or dried herbs.
  • (^) All vegetable oils. Salad dressings provided they contain only allowed ingredients.
  • (^) Homemade foods (see ThyCa’s free Low-Iodine Cookbook, available online at thyca.org).
  • (^) Cola, diet cola, lemonade, sodas (except those with Red Dye #3), non-instant coffee and tea, beer, wine, other alcohol. Food prepared from fresh meats, fresh poultry, fresh or frozen vegetables, and fresh fruits should be fine for this diet, provided that you do not add any of the iodine-containing ingredients listed above. The cookbook also has a handy snack list.

What if it's not on the "okay" list here?

  • (^) There are minor variations in low-iodine diet guidelines provided by different thyroid cancer specialist physicians. These guidelines combine the recommendations of several thyroid cancer specialists whose patients have successfully used their guidelines.
  • (^) Some guidelines say just to avoid certain items or certain food categories, and do not give details within categories.
  • (^) Other diets list foods and ingredients that are allowed, without limits on quantities consumed.
  • (^) Many of our web site visitors and correspondents request details as given here, so that they can plan their menus with their own preferences in mind.
  • (^) If your health care professional has recommended that you follow a low-iodine diet, please discuss your diet guidelines with him or her.

Final Notes

The key to coping well with this diet is being prepared ahead of time, especially if you are preparing for RAI by stopping your levothyroxine pills and becoming hypothyroid. Before you start becoming hypothyroid, prepare the basics and freeze them. You do not want to be making chicken stock while you are hypothyroid. Remember also the handy snack list. We suggest that you stock up on snack items from the list for times when you do not feel like cooking. We encourage you to use theca.org's Low-Iodine Cookbook for variety and enjoyment of low-iodine meals and snacks.