Drug interactions diet - iodine - low
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
To provide a diet low in iodine (<50µg/day) to promote maximal uptake of radioiodine (131I) for diagnosis and/or treatment of thyroid cancer.
Severely reduces iodine derived from food, avoids soy foods (due to the potential for interaction with radioiodine uptake), and avoids the following additives:
- Red 3/Erythrosine/Erythrosine Red/Erythrosine cherry red/E127 (127) – a red food colouring commonly found in glacé cherries
- Alginate/E401-405 (401-405) – a food thickener and emulsifier that may be within ice-cream, fruit and vegetable juices, and milk beverages
- Agar/E406 (406) – a food thickener that may be within soups, sauces, jams, ice-cream, and custard/puddings
- Carageenen/Carageenan gum/vegetable gum 407/ E407 (407) – a food thickener that may be within jelly and dairy products.
Where is iodine found in food?
- Foods sourced from the ocean, e.g. fish and seaweed
- Iodine-fortified foods, e.g. iodised salt and bread
- Milk and eggs – iodine is added to animal (cow and chicken) feed and is contained within some cleaning agents that may be used by the dairy industry
- Soy products – can interfere with the uptake of iodine into thyroid cells
- Some food crops – due to iodine in the soil
- Food additives derived from sources of iodine (as described above).
It is not necessary to remove all traces of milk, soy or egg from the diet. That is, products labelled as ‘may contain traces of milk/soy/egg’ are suitable for inclusion if they are otherwise considered a low iodine food.
Where appropriate, clinicians may consider ordering this diet for patients:
- undergoing radioiodine treatment (ablation) for thyroid cancer
- requiring radioiodine as a diagnostic tool for thyroid cancer.
This diet is not nutritionally adequate - it is intended to be utilised for short-term use only.
It is not possible to provide a full list of all permitted commercial products; the following are general guidelines only. Care should be taken to read all product ingredient lists to look for iodine within ingredients. If ‘salt’ is listed as an ingredient, it should be clarified with the manufacturer whether it is iodised.
This diet requires supervision by a dietitian if utilised >21 days.
To stay within the 50ug limit, it is important to adhere to course code maximums. In addition, this diet should not be combined with a ‘large’ or double serve/serving size without Dietitian consultation.
Not suitable for use in paediatrics.
Specific menu planning guidelines
|Allowed (but check label)||Not allowed|
|Hot main dishes|
Plain cooked beef, lamb, pork, poultry, bacon
Mixed dishes containing allowed ingredients
All fish, shellfish, crustaceans or seaweed, including fish sauce, oyster sauce, fish stock and shrimp paste
Dishes containing eggs or milk/cheese (e.g. quiche, frittata, omelette, risotto)
Ham, corned beef, salami, sausages
Crumbed meats, fish and poultry
Soy products e.g. tofu, textured vegetable protein
|Sauces, gravies||Sauces and gravies made without milk or soy ingredients, maximum serve size 40ml.|
Tomato sauce and barbecue sauce (limited to 1 tablespoon/day)
|Milk or cream base sauce, e.g. white sauce, cheese sauce, bearnaise sauce, tartare sauce|
|Starchy vegetables / pasta / rice||Plain rice, pasta, couscous, quinoa, rice noodles|
Plain potato or sweet potato, steamed, boiled or roasted
Potato/pasta/rice with added milk or soy
|Vegetables||Plain boiled/steamed or roasted vegetable, such as carrots, broccoli, cauliflower, etc.|
Plain or boiled/steamed green beans or vegetable mixes containing green beans
Vegetables and vegetable dishes served with milk or cream based sauces e.g. white sauce, cheese sauce, etc.
|Soups||Clear broth made without soy or fish ingredients|
Milk or cream based soups
Fish, seafood or seaweed soups
Salad using allowed ingredients
Egg, cheese or fish containing salad
Plain rice/corn or wheat crackers/crispbreads/cakes Rolled oats made with water
Flakes of corn
Natural muesli without bran
All bread and bread products, including gluten free (e.g. wraps, flat bread, rolls, buns,
English muffins, crumpets, bagels, brioche, fruit bread)
All other cereals
Seaweed flavour rice crackers
Margarine without soy ingredients
Butter and clarified butter (ghee)
Peanut or nut butters
|Hot breakfast choices|
All eggs and egg based dishes
|Fruit||All other fresh, canned (inclusive of juice) or dried fruit|
Processed fruits containing erythrosine (e.g. Maraschino cherries)
Processed fruit salad containing cherries
Jelly (gelatine based)
All milk or soy-based puddings and desserts
Cakes, pastries and crumbles containing milk, butter or egg
|Milk and cheese||Rice, oat, coconut or almond milk: 150ml at breakfast, and within tea/coffee|
Cow/goat/sheep milk or soy milk, including low lactose/lactose free milk products
Cow/goat/sheep cheese or soy cheese
Tea (black, green, herbal) and coffee
Apple juice (limit of 300ml/day)
|Cow/goat/sheep milk or soy milk, including low lactose/lactose free milk products|
|Biscuits||Plain rice/corn or wheat crackers/crispbreads/cakes||Biscuits containing milk, butter or egg|
Non-iodised salt, pepper, herbs and spices
Sugar and artificial sweeteners
Dark chocolate containing >60% cocoa solids (limit to less than 100g per day)
Lollies, jelly & boiled
Muesli bar without chocolate or yoghurt
Potato crisps, plain salted
Sugar, artificial sweetener
Oral nutrition supplements or enteral formulae containing milk or soy ingredients
Chocolate (milk, white)
Cakes containing milk, butter or egg
Flavoured potato crisps, e.g. salt & vinegar, cheese
Corn chips (all)
Vitamin and mineral supplements containing iodine
- Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
- Food Standards Australia New Zealand, 2018. NUTTAB 2018 Online Searchable Database. Foods that Contain Iodine (I).
- Food Standards Australia New Zealand, 2018. AUSNUT 2011-13 food nutrient database.
- Food Standards Australia New Zealand, 2018. Food Additives- Alphabetical List (updated 2016).
- Predebon Morsch E, Vanacor R, Furlanetto TW & Schmid H, 2011, ‘Two weeks of a low-iodine diet are equivalent to 3 weeks for lowering urinary iodine and increasing radioactive iodine uptake’, Thyroid, vol. 21, no. 1, pp. 61-7.
|Specific menu planning guidelines - Milk and Cheese||In Allowed, added oat, coconut or almond milk|