The LID

The LID (low iodine diet) is something that needs to be done when taking the RAI (radioiodine) treatments. Basically, you can't eat anything in preparation of the treatments, or during the treatments. The best place to go for information is here, where it explains what you can/can't eat, and you can print off a cookbook!

General Comments

• Remember: LOW IODINE has NOTHING TO DO WITH SODIUM. The diet is a low-iodine diet, NOT a low-sodium diet. Sodium is in most foods. Table salt is sodium chloride, not sodium.
• Sodium in any form is OK, as long as it is not provided as IODIZED salt. NON-IODIZED salt is OK for the diet, as long as it is not sea salt. As noted below, you should avoid any product or ingredient from the sea. That's because sea-based products are high in iodine.
• Also, this is a "low-iodine" diet, NOT a "no-iodine" diet and NOT an "iodine-free" diet. A low-iodine diet reduces iodine consumptionc(on most diets to below 50 micrograms (mcg) of iodine per day (on some diets to below 80-100 mcg per day). The American Thyroid Association recommends that the low-iodine diet include less than 50 mcg of iodine per day. (The Recommended Daily Allowance of iodine is 150 mcg per day for adults. One teaspoon of iodized salt contains 400 mcg of iodine.)
• During your time on the diet, you may freely eat any foods that are low in iodine (up to 5 mcg per serving). There are lots of foods that you can eat. Pages 10 and 11 have lists. 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).
• For recipes and a snack list, use ThyCa’s free Low Iodine Cookbook. You can download it free from our web site and print it out.
• You also can adapt your favorite recipes from your own cookbooks to the low-iodine diet. To do this, eliminate ingredients that are high in iodine, or substitute ingredients from the list of foods and ingredients that are fine on the diet.
• If you follow other dietary guidelines due to allergies, diabetes, other medical conditions, or other reasons, you can adapt your recipes and meal plans. Use the cookbook's lists and tips.

Avoid These Foods and Additives

Avoid the following foods, starting when instructed by your physician before your radioactive iodine test or treatment. Continue as instructed until after your radioactive iodine treatment (often for about 24 hours after). These foods and ingredients are high in iodine (over 20 mcg per serving, according to researchers' presentations at our conferences).

• Iodized salt and sea salt and any foods containing iodized salt or sea salt. Non-iodized salt may be used. 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. (One teaspoon of iodized salt has 400 mcg of iodine.)
• Seafood and sea products (fish, shellfish, seaweed, seaweed tablets, kelp). These are all very high in iodine and should be avoided.
• Foods or products that contain these sea-based additives: carrageenan, agar-agar, algin, alginate, nori (these food additives are seaweed by-products).
• Dairy products (milk, cheese, cream, yogurt, butter, ice cream, powdered dairy creamers, whey, casein, other dairy products). Note: Nondairy creamers often have iodine-containing ingredients, too. 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 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. 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 2.2 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 #3 (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 0.25 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.
• 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. 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 diets say to avoid rhubarb and potato skins. 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 as the best for the diet.