Fact sheetDiet specifications

Published on 1 Nov 2019 ; Partial revision Nov 2020


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.

Aim

To provide a diet low in iodine (<50µg/day) to promote maximal uptake of radioiodine (131I) for diagnosis and/or treatment of thyroid cancer.

Characteristics

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.

Nutritional adequacy

This diet is not nutritionally adequate - it is intended to be utilised for short-term use only.

Precautions

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.

Paediatrics

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

Legumes

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, graviesSauces 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 / ricePlain rice, pasta, couscous, quinoa, rice noodles

Plain potato or sweet potato, steamed, boiled or roasted

Potato/pasta/rice with added milk or soy

Egg noodles

VegetablesPlain boiled/steamed or roasted vegetable, such as carrots, broccoli, cauliflower, etc.

Plain or boiled/steamed green beans or vegetable mixes containing green beans

Edamame

Vegetables and vegetable dishes served with milk or cream based sauces e.g. white sauce, cheese sauce, etc.

SoupsClear broth made without soy or fish ingredients

Milk or cream based soups

Fish, seafood or seaweed soups

Croutons

Meat extracts

SandwichesNone 
Salads, dressings

Salad using allowed ingredients

Salad dressing

Egg, cheese or fish containing salad

Mayonnaise

Breads, cereals

Plain rice/corn or wheat crackers/crispbreads/cakes Rolled oats made with water

Rice cereal made with water

Flakes of corn

Puffed rice

Wheat biscuits

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

Spreads

Margarine without soy ingredients

Jam, regular

Honey

Marmalade, regular

Vegemite

Butter and clarified butter (ghee)

Peanut or nut butters

Hot breakfast choices

Baked beans

Spaghetti

All eggs and egg based dishes

Pancakes

FruitAll other fresh, canned (inclusive of juice) or dried fruit

Processed fruits containing erythrosine (e.g. Maraschino cherries)

Processed fruit salad containing cherries

YoghurtNone-
Desserts

Jelly (gelatine based)

Sorbet

Ice-cream, cream

All milk or soy-based puddings and desserts

Cakes, pastries and crumbles containing milk, butter or egg

Milk and cheeseRice, 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

Beverages

Tea (black, green, herbal) and coffee

Apple juice (limit of 300ml/day)

Orange juice

Lemonade, cola

Cow/goat/sheep milk or soy milk, including low lactose/lactose free milk products
BiscuitsPlain rice/corn or wheat crackers/crispbreads/cakesBiscuits containing milk, butter or egg
Miscellaneous

Non-iodised salt, pepper, herbs and spices

Vinegar

Lemon wedge

Sugar and artificial sweeteners

Nuts

Marshmallow

Dark chocolate containing >60% cocoa solids (limit to less than 100g per day)

Lollies, jelly & boiled

Oil

Muesli bar without chocolate or yoghurt

Potato crisps, plain salted

Sugar, artificial sweetener

Iodised salt

Oral nutrition supplements or enteral formulae containing milk or soy ingredients

Chocolate (milk, white)

Cream

Mayonnaise

Cakes containing milk, butter or egg

Soy crisps/crackers

Flavoured potato crisps, e.g. salt & vinegar, cheese

Corn chips (all)

Soy sauce

Vitamin and mineral supplements containing iodine

References

  1. Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
  2. Food Standards Australia New Zealand, 2018. NUTTAB 2018 Online Searchable Database. Foods that Contain Iodine (I).
  3. Food Standards Australia New Zealand, 2018. AUSNUT 2011-13 food nutrient database.
  4. Food Standards Australia New Zealand, 2018. Food Additives- Alphabetical List (updated 2016).
  5. 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.

Change log

November 2020

Section updatedChange
Specific menu planning guidelines - Milk and Cheese In Allowed, added oat, coconut or almond milk
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