Drug interactions diet - low iodine - patient fact sheet

Who needs to follow a low iodine diet?

A low iodine diet is recommended for people who require radioactive iodine treatment. The aim of the diet is to reduce your iodine intake which may help increase your body’s uptake of the radioactive iodine.

What is iodine?

Iodine is a mineral used to make thyroid hormones (which help control metabolism and are involved in normal development).

How much iodine am I allowed on the low iodine diet?

On the low iodine diet you should aim for less than 50 micrograms of iodine per day.

How long should I follow a low iodine diet?

You should follow a low iodine diet for two weeks before your treatment. After your treatment is finished you can return to your normal diet.

Where is iodine found in food?

Foods sourced from the ocean, e.g. fish & 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
• Food additives derived from sources of iodine (please always check the ingredients list):
  1. number 127 (also known as Erythrosine, Erythrosine Red, Erythrosine cherry red, Red no.3, E127) – a red/pink food colouring and is commonly found in glacé cherries and red-coloured foods
  2. number 401–405 (also known as alginate, E401–E405) – a food thickener and emulsifier and is commonly found in ice-cream, fruit and/vegetable juice, milk beverages
  3. number 406 (also known as agar, thickener 406, vegetable gum 406, E406) – a food thickener and is commonly found in soups, sauces, jams, ice cream, custard/puddings
  4. number 407 (also known as Carrageenan, Carrageenan gum, vegetable gum 407, E407) – a food thickener and is commonly found in jelly and dairy products
• Some food crops – due to iodine within soil.

Reducing iodine in your diet

Use this table as a guide to reducing the iodine in your diet.

It is not possible to provide a full list of all permitted commercial products; the following are general guidelines only.

Take care to read all product ingredient lists (listed on the product packaging) to look for sources of iodine or iodised salt.

	Foods Allowed	Foods to avoid
Breads, cereals & crackers	Most plain breakfast cereals, served with allowed milks only (e.g. oats, wheat biscuits, plain rice/wheat/corn based cereals, natural muesli without bran flakes or bran straws) Plain rice/corn/wheat crackers Plain rice/corn cakes Plain crispbreads	All commercial breads and gluten free bread/bread products, such as wraps, rolls, buns, English muffins, crumpets, bagels, brioche Commercial flat breads and gluten-free flat breads, including pita, naan, Lebanese, roti, focaccia, chapatti, tortilla, pappadums Fruit bread Bran cereals Pancakes, crepes
Starchy vegetables, pasta, rice and grains	Plain potato or sweet potato (steamed, boiled or roasted) Plain pasta Canned spaghetti Steamed rice Rice noodles Couscous Quinoa Legume pasta (e.g. red lentil, chickpea, borlotti bean)	Egg noodles Potato bakes Pasta bakes Rice bakes
Vegetables	All fresh, frozen, or canned vegetables other than green beans	Green beans (including vegetable mixes containing green beans) Edamame Vegetables with cheese or white sauce
Fruit	All fresh, frozen, canned, or dried fruits other than cherries	Maraschino cherries (including fruit salad containing cherries)
Meat and protein alternatives	Plain cooked beef, lamb, poultry, bacon Plain cooked chicken without stuffing Egg whites Legumes (e.g. 3 or 4 bean mix, chickpeas, butter beans, lentils, kidney beans, cannellini beans, baked beans	Ham, salami, sausages Crumbed meats, fish, and poultry Whole eggs, egg yolks & mayonnaise Egg-based dishes (e.g. quiche, frittata, omelette) Soy products (e.g. tofu, textured vegetable protein (TVP))
Seafood	None	All fish, shellfish, sushi and seaweed All dishes/products containing fish sauce, oyster sauce, fish stock and shrimp paste
Dairy and milk alternatives	Rice milk Almond milk Oat milk Coconut milk	Cow/goat/sheep milk including low lactose/lactose free products such as cream, ice-cream, yoghurt, cheese, powdered milk Soy milk, soy cheese, soy yoghurt, soy ice cream
Beverages	Tea (all types) and coffee, black or with allowed milk Juice (limit juice to 300ml/day) Soft drinks Wine, beer, spirits in moderation (check with your doctor whether alcohol is allowed)	Milk-containing beverages (e.g. milkshakes, thickshakes, smoothies, hot chocolates, milk teas)
Condiments and oils	Sauces and gravies made without milk or soy ingredients (e.g. mustard, apple sauce) Tomato and BBQ sauce in small amounts (limit to 1 tablespoon per day) Oil Margarine without soy ingredients Jam, honey and Vegemite Maple syrup	Milk- or cream-based sauce, e.g. white sauce, cheese sauce, Bearnaise, etc. Butter and clarified butter (ghee) Soy sauce Mayonnaise Tartare sauce Nut butters 100% fruit jam Marmalade
Miscellaneous	Jelly (if it does not contain Carrageenan/407 or Red 3/Erythrosine/127 – check the ingredients list) Boiled and jelly lollies Dark chocolate containing >60% cocoa solids (limit to less than 100g per day Garlic, pepper, herbs, spices, lemon, vinegar Muesli bar without chocolate or yoghurt coating Potato crisps, plain salted Nuts, plain salted or unsalted Oil Sugar, artificial sweetener	Iodised salt Chocolate (milk, white) Cakes, biscuits and pastries containing milk and/or butter and/or egg Pancakes Vitamin/mineral supplements containing iodine Sandwiches Soy crisps/crackers Flavoured potato crisps (e.g. salt and vinegar, cheese) Corn chips (all) Protein bars or powders containing milk or soy Nutrition supplement drinks or powders with milk/soy ingredients or added iodine

Why are foods listed on this education sheet different to what I have found on the internet?

The iodine content of soil, feed provided to livestock, and cleaning methods in food production differ around the world. Because of this, it is important that you use information about the iodine content of food which is from the Australian food supply.

Why is bread excluded?

By law in Australia all commercial breads must be made with iodised salt to reduce iodine deficiency in the population. You should not consume commercially manufactured bread while following a low iodine diet. Homemade bread from flour without added iodine is likely to be low in iodine. Please check with the dietitian at the hospital where your radioactive iodine treatment will occur.

Can I have iodised salt? Iodised salt should be avoided on a low iodine diet.

Noniodised salt (e.g. rock salt, table salt or sea salt) is safe to use in small amounts. Be careful when eating out, as restaurants may use iodised salt.

What about dietary supplements?

Some nutrition supplements (e.g. fish oil tablets or vitamin/mineral supplements) are high in iodine. Please check with your doctor a few weeks before your treatment if it is safe for you to continue taking dietary supplements during this time.

Meal suggestions

Breakfast

• Rolled oats made with allowed milk (see above), topped with grated apple, maple syrup, cinnamon, and nuts
• Cereal made with allowed milk, topped with banana
• Baked beans with mushrooms, spinach, tomato, hash brown

Lunch

• Rice cakes or plain wheat crackers with salad vegetables, BBQ chicken (without stuffing) or grilled chicken breast and mustard
• Cold salad, with cucumber, lettuce, tomato, avocado, snow peas and red onion topped with chicken breast, olive oil and vinegar
• Warm salad, with rice/couscous/quinoa, roasted vegetables (zucchini, capsicum, pumpkin, mushroom) and cashews/almonds and fresh parsley

Dinner

• Spaghetti bolognaise (lean mince or lentil & mushroom) with grated zucchini and carrot
• Grilled meat with potato, broccoli, carrots, and squash/ other vegetables as desired
• Stir fry with lean meat, rice and frozen vegetable mix
• Coconut milk curry with chickpeas, mixed vegetables, and potatoes or homemade flat bread
• Meat and lentil casserole/stew with sweet potato, peas and carrot
• Risotto (no cheese) with chicken, pine nuts, pumpkin, spinach, and a side of broccolini
• Roast meat with gravy and roast vegetables

Snacks

• Fresh/tinned fruit
• Vegetable sticks/rice crackers with hummus or salsa
• Dried fruit and nut/seed mix
• Popcorn/potato chips
• Homemade muesli slice or bought muesli bar
• Dark chocolate containing >60% cocoa solids (limit to less than 100g per day

More information

If you have any questions regarding your low iodine diet, please contact the dietitian at the hospital where your radioactive iodine treatment will occur.