The Low Iodine Diet Cookbook: Easy and Delicious Recipes and Tips for Thyroid Cancer Patients

Author and Press Release

Norene Gilletz
Downloadable Press Release (1.45 MB)

Audio

Hear author, Norene Gilletz, and internationally renowned thyroidologist, Dr. Kenneth Ain, discuss the low iodine diet on the radio show The Thyroid Cancer Show.
Download the MP3 (12.5 mb)

What are people saying about this book?

"I never thought anybody could make a low iodine diet palatable. However, Norene Gilletz has proven me wrong. ... A great resource for RDs ... also useful for RDs in pediatric oncology who work with this diet since compliance would be especially difficult with children." —Oncology Nutrition Connection, Winter 2006, Oncology Nutrition Dietetic Practice Group, American Dietetic Association

"A very useful tool for the thyroid cancer patient. It sets out very clearly and precisely what is and isn't acceptable to eat on the LID. There are so many versions of the low iodine diet out there, it can be very confusing and upsetting to patients. I know if I follow the recipes in the book that I am fine and don't have to constantly worry that I am not following the LID closely enough. My first two LIDs were definitely stressful and boring, but thanks to this book, the third time was a lot easier." —The Canadian Thyroid Cancer Support Group, Thry'vors News, Fall 2005

About the book

Thyroid cancer has risen in incidence 69% in the last few years. The Low Iodine Diet Cookbook is the ultimate cookbook for thyroid cancer patients who need to be on the low iodine diet (LID) for radioactive iodine treatment or scans. Written by a renowned cookbook author who is experienced with the issues involved with special diets and substitutions—particularly diets that don't allow dairy, or store-bought breads. This unique cookbook contains hundreds of kitchen-tested recipes, and even an exhaustive nutritional analysis chart. At last, LID recipes that are easy and delicious—by the woman critics hail as the “Julia Child” of specialty diet cooking.

Introduction: What Is the Low Iodine Diet and Why Do You Need It? By Kenneth B. Ain, M.D., Professor of Medicine, Director, Thyroid Oncology Program, Markey Cancer Center, University of Kentucky, and Director, Thyroid Cancer Research Laboratory, Veterans Affairs Medical Center, Lexington, KY

PART 1: Getting Started on the LID
Chapter 1: The Low Iodine Cupboard
Packaged Food in the Inside Aisles: What’s Okay,
What’s Not
Fresh Foods: The Outside Aisles
Stocking Up on Snack Foods
Storing and Freezing
Freeze-Ahead Recipes
If You’re On Another Diet, Too

Chapter 2: LID Meal Planning
Day One
Day Two
Day Three

Chapter 3: LID on the Town
The First Steps
Starters
Mains
Desserts
Make It Official
LID Around the World

Part 2: Cooking and Recipes
Chapter 4: Breakfasts—The Toughest Meals
Cereals
Milk Substitutes, Smoothies, and Shakes
Fruit Dishes
Egg White Dishes
Pancakes and Crêpes
Homemade Breads, Muffins, and Cakes
Desserts for Breakfast, Again

Chapter 5: Lunches—The Easiest Meals
Soups
Salads
Vegetables and Side Dishes
Pasta and Sauces
Pizza
Hearty Main Dishes

Chapter 6: Dinners—The Most Interesting Meals
Soups
Salads
Side Dishes
Poultry
Meat Dishes
Marinades and Sauces
Pasta and Sauces
Vegetarian Main Dishes

Chapter 7: Desserts
Ingredient Substitutes for Baking Cakes
Frostings and Glazes
Pies and Crusts
Crisps/Cobblers
Fruit Dishes
Cookies and Mini-Cakes
Dark Chocolate (Dairy-Free Chocolate)

Chapter 8: Snacks
Snacks You Can Buy in a Package
Homemade Carbs (Chips and Chip Substitutes)
Dips and Spreads
Other Stuff
Sweet Stuff

Chapter 9: Children’s Menu
Easy Breakfasts
Pizza
Peanut Butter
Hamburger Fare
Noodles and Dumplings
Child-Friendly Chicken
Hot Stuff They’ll Eat
Easy Snacks and Treats

Chapter 10: Nutritional Analysis Chart
Recipe Index

The basic low iodine diet

The basic LID is summarized on the following instruction sheet provided to each of my own patients and circulated widely to many physicians and patient groups. It consists primarily of a list of restricted dietary items that contain relatively high amounts of stable iodine. The assumption is that anything that isn’t restricted should be considered safe to eat as part of a balanced and varied diet. Unfortunately, these instructions make figuring out interesting foods that are appropriate to eat a matter of individual creativity.The Low Iodine Cookbook provides a solution to that problem.

LOW IODINE DIET RESTRICTIONS
Used for Preparation for Radioiodine Scans or Therapy

Avoid the following foods, starting when instructed prior to your radioactive iodine test, and continuing until after your radioactive iodine treatment is completed.

Iodized salt, sea salt (non-iodized salt may be used).
Dairy products (milk, cheese, cream, yogurt, ice cream, butter).
Eggs (specifically avoid egg yolks; egg whites may be used).
Seafood (both fresh and salt-water fish, shellfish, seaweed, kelp).
Foods that contain the additives (carragen, agar-agar, algin, alginates).
Cured and corned foods (e.g., ham, corned beef, sausage, luncheon meats, sauerkraut, pickles).
Bread products that contain iodate dough conditioners (sometimes small bakery breads are safe; better to bake it yourself from scratch).
Foods and medications that contain red food dyes (specifically, FD&C Red Dye # 3; consult your physician about discontinuing or substituting for any red-colored medicines).
Chocolate (because of the milk content).
Molasses.
Soy products (soy sauce, soy milk).

Additional Guidelines

Avoid restaurant foods, since there’s no reliable way to determine what’s in the food you order.
Use matzos (unleavened crackers made only of flour and water) instead of bread.
Use non-iodized salt as desired.
Always read ingredients lists of prepared or packaged foods carefully.
Use olive oil may as a condiment or in cooking, in place of butter.
Prepare low-iodine meals in advance if you wish, and freeze them for easy later use.

Important Note:
Food prepared from any fresh or frozen meats, poultry, vegetables and fruits should be fine for this diet, provided that you don’t add any of the ingredients listed above, which you must avoid. Be careful of meat or poultry that’s been injected with broth or preservative liquids. The diet is easiest when food is prepared from basic ingredients.

Strict adherence to this diet will significantly enhance the sensitivity of the radioiodine scans and the effectiveness of any radioiodine treatments.

Low iodine diet FAQs

Q. Is the Low Iodine Diet the same as a Low Sodium diet?
A. No; this is a very common misperception. The Low Iodine diet does not restrict sodium or salt. It only restricts IODIZED salt or sea salt (very likely to have iodine). Any salt that is labeled as not being iodized may be used freely.

Q. I read in some Thyroid Cancer Survivor's (ThyCa) materials that rhubarb, potato skins, and certain kinds of beans and rice are not allowed on the LID. Is this true?
A. As Dr. Ain says in the book's Introduction: "Some patients and physicians, although well intentioned, have mistakenly taken this diet to unnecessary extremes. They claim that specific types of beans, rice, vegetables or fruit (e.g., rhubarb) should be avoided. Sometimes they grow un-duly concerned about tap water and potato skins. One problem is that many of the tables and assays for the iodine content of foods, beyond the stipulations of the basic LID, are unreliable due to the difficulties in testing for iodine. Another problem is that a good LID is not a no iodine diet. As long as the basic LID is followed (as aided by The Low Iodine Diet Cookbook), the amount of iodine ingested in a 24-hour period should be under 50 mcg. I’ve measured urine samples in many patients following the basic LID and found it to be highly reliable without unnecessary additional restrictions. In this cookbook you’ll find recipes with all types of beans, potato skins, and rhubarb, which you should enjoy and not worry about."

Q. I've heard that soy lecithin is not allowed on this diet. Is this true?
A. As Dr. Ain explains in the book’s Introduction: “Soy lecithin is extracted from soy oil, rather than the protein parts, and has just trace amounts of soy proteins (only enough to bother people with soy allergies). Soy oil, in reasonable amounts (usually as part of a vegetable oil mixture or a minor ingredient) won’t add any discernible iodine to the diet and is not goitrogenic. There is no reason to think that soy lecithin is in any way unsafe for the LID. The major reason for misconceptions regarding lecithin and iodine has to do with the term “iodine number.” This is an organic chemistry term meaning “a number expressing the percentage of iodine absorbed by a substance; performed as a measure of the proportion of unsaturated linkages present and usually determined in the analysis of oils and fats.” The “iodine number” has nothing to do with content of iodine and is merely a laboratory test used when analyzing lecithin. So, don’t worry if the label of your food item lists lecithin.”

Q. If dairy is not allowed on the LID, are there any milk substitutes I can use?
A. There are close to two dozen milk substitute recipes and/or variations (shakes and smoothies) in The Low Iodine Diet Cookbook. You’ll find the following recipes: Almond Milk, Cashew Milk, Rice Milk, Melon Milk, Banana Shake, Almond Banana Milk, Almond Strawberry Milk, Apple Banana Milk, Almond Fruit Shake, various chocolate milks made with Easy Chocolate Syrup (such as Cocoa-Nut Cocoa), Coconut Milk, and a Dairy-Free Smoothie.

Q. Does this book have recipes for daily condiments, such as ketchup or mustard? I rely on these items in my daily cooking.
A. This book has several homemade condiments and “basics”, including Low Iodine Ketchup, Low Iodine Mustard, Low Iodine Peanut Butter, and much more!

Q. One of the real problems on this diet is finding good snacking food. Does this cookbook devote any space to that?
A. An entire chapter is devoted to snacks give you more ideas than you can use on the typical two weeks on this diet. Not only are there dozens of home-made “carbs” recipes (ever tried crisp lasagna chips?), but this book will guide you in making your own seasoned non-iodized salts (including Kosher salts) for salt free crunchables you can buy in a package. Lots of great ideas for sweet things, too!

Q. As the parent of a child with thyroid cancer, it’s difficult to find recipe ideas for kids on the LID. Any suggestions?
A. This cookbook devotes an entire chapter for kid-friendly meals, snacks and desserts on the LID. The chapter is divided into the following sections for parents: Easy Breakfasts, Pizza, Peanut Butter, Hamburger Fare, Noodles and Dumplings, Child-Friendly Chicken, Hot Stuff They’ll Eat, Easy Snacks and Treats.

Excerpt

If you’ve had thyroid cancer (papillary, follicular, or one of their variants), you’ll likely require treatment and whole body scans using radioactive iodine. It’s important to deplete your body of the relatively large amount of non-radioactive (“stable”) iodine that is present in your food and beverages (as well as in the dye injected for CAT scans and some other radiology tests). This allows the radioactive iodine to enter your thyroid cancer cells most effectively. Your thyroid cancer cells can’t tell the difference between iodine that is radioactive and non-radioactive “stable” iodine. Since they have limited ability to take in iodine, the lower the amount of stable iodine that is in your body, the more radioactive iodine will be taken into these cells.

Stable iodine enters your body through your diet. The normal thyroid gland uses iodine to make thyroid hormones. Many parts of the developing world have problems with iodine deficiency and, as a result, people in these regions suffer from hypothyroidism and associated medical problems. In most industrialized countries, great effort has been made to prevent these problems by supplementing iodine in the diet through iodized salt. Additional iodine enters our diet from fish, seafood, kelp, dairy products, artificial red food dye (FD&C Red Dye #3) and multivitamins. This dietary iodine is considered healthy for most people; however it’s not needed in people whose thyroid glands have been removed and who take thyroid hormone as a medication.

Typical amounts of dietary iodine can interfere with the use of radioactive iodine for thyroid cancer. The reason for this is as follows:

An “average” daily amount of dietary iodine in North America is approximately 500 micrograms (mcg). This number can be lower in extreme vegetarians who don’t consume any animal products (vegans), and much higher in lovers of sushi and seafood. It can exceed several thousand micrograms in people after an injection of intravenous contrast dye for a CAT scan, and this can last for up to 11 months after a single injection. (See: Spate, V.L., Morris, J.S., Nichols, T.A., et al., 1998.“Longitudinal study of iodine in toenails following IV administration of an iodine-containing contrast agent.” Journal Radioanalytical Nuclear Chemistry. 236:71-76.)

This amount of stable iodine in your body may seem inconsequential until you learn that the amount of radioactive iodine in a treatment or scanning dose is usually only 2 mcg. These 2 mcg of iodine are highly radioactive, but don’t actually constitute much iodine. Taken within the context of the typical total body pool of iodine in one day, 2 mcg (radioactive iodine) of 502 mcg (total iodine) means that only 0.4 % of the iodine in your body is radioactive. It follows that if a thyroid cancer cell in your body sucks up 1000 iodine atoms, only 4 of them are radioactive. Certainly this isn’t a very effective way to find these cells with a scan, or treat them with the radioactive iodine.

On the other hand, if you follow a Low Iodine Diet prior to receiving your 2 mcg dose of radioactive iodine, your daily total iodine intake decreases—from around 500 mcg to less than 40 mcg. In this case the radioactive iodine constitutes 2 mcg of 42 mcg of iodine, meaning that at least 5 percent of the iodine in your body is radioactive. A thyroid cancer cell as in the paragraph above, sucking up 1000 iodine atoms, would then take in at least 50 radioactive iodine atoms. This results in more than 12 times the amount of radioactivity in each thyroid cancer cell, using a Low Iodine Diet (LID), so long as you’ve been prepared for your scan properly, and have sufficiently high TSH levels prior to the scan (see the introduction to the Low Iodine Cookbook.

About the author

Norene Gilletz is a popular author of specialty cookbooks in North America. Her recipes are developed for a wide audience, but have been long revered for their Kosher sections (many of her recipes use dairy alternatives) and Passover sections (recipes using matzo or matzo products instead of leavened bread) by her devoted Jewish readership. Norene is a food consultant, food writer and columnist, cooking teacher and lecturer. She specializes in Recipe Makeovers for food-related websites, magazines, newspapers, cookbooks and the food service industry. Norene is a Certified Culinary Professional (CCP) with the International Association of Culinary Professionals (IACP).

Norene’s body of work includes: The Food Processor Bible; Second Helpings, Please! MicroWays (a microwave cookbook); and Pleasures of Your Food Processor (a staple in almost every North American household). Healthy Helpings (2004) was launched in Los Angeles at a cooking show, and won "Best of Show" Award in the Cookbook category. Hailed by renowned registered dietitian Lisa Drayer, M.A., R.D., CNN's nutrition expert, as "A delicious, nutritious compilation of recipes that every health conscious individual will savor!"

Always keeping her motto that "food that is good for you should taste good!" in mind, Norene’s take on the LID is no exception. This book will change the lives of thyroid cancer patients.

For more information about Norene Gilletz, visit www.gourmania.com

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