Sunday, January 1, 2012

The Low Iodine Diet

The Low Iodine Diet is also known as the LID. So, I will refer to it as such in the remainder of this post. Okay, so for starters I'll answer the question, "Why do you have to be on a low iodine diet?".

This is an excerpt from the ThyCa website that says it best.

The Low-Iodine Diet
Thyroid cancer patients with papillary or follicular thyroid cancer often receive a dose of radioactive iodine (RAI) about two months after their surgery in an attempt to destroy (ablate) any remaining thyroid cells in their bodies.
Most of these thyroid cancer patients also undergo whole-body radioiodine scans at periodic intervals, using a “tracer” dose of RAI. If their scan is not “clean,” they may then receive treatment with a larger dose of RAI in an attempt to eliminate remaining thyroid cells.
In preparation for an RAI scan or RAI treatment, patients are usually asked to go on a low-iodine diet (LID). The diet is to prepare for the RAI. The patient follows the diet when preparing for RAI either by temporarily stopping levothyroxine (withdrawal) or by receiving injections of Thyrogen (recombinant TSH) while continuing on levothyroxine (Synthroid).
The purpose of a low-iodine diet is to deplete the body of its stores of iodine, to help increase the effectiveness of the radioactive iodine scan or treatment. The premise is that when the radioactive iodine is administered, the thyroid cells will “suck” up the iodine, because the body has been so depleted.
This diet is for a short time period. The usual time period is around two weeks (14 days) or slightly more. The diet usually begins around two weeks before testing and continues through the testing and treatment period. However, recommendations for the time period can vary, depending partly on the individual patient’s circumstances.

It is a VERY restrictive diet and it is tough. Parts of it are great, like being forced to eat better, lol. But it wears on you for sure. When you are already 4 weeks into withdrawal from your thyroid replacement medicine, it really just adds insult to injury! If you want to read the extensive list of foods to avoid, foods to limit, allowable foods, and some tips on managing this diet, you can get the full list here

I think the biggest misconception is that this is a no SALT diet. It isn't that at all. It is a low IODINE diet. You can have salt as long as it is non-iodized or kosher. All we use at home is kosher salt, so it was great to be able to still salt my foods! You are not allowed to have iodized salt and/or sea salt. 

You can NOT have any:
* dairy (& dairy alternatives b/c the all seem to either contain soy or sea salt)
* egg yolks or whole eggs (egg whites are ok)
* soybeans and soy products
* seafood
* cured meats (sausage, bacon, lunchmeat, etc)
* commercial baked goods
* Red Dye #3

What you CAN have:
* fresh fruits
* fresh vegetables (a few exceptions here)
* fresh meats (6oz or less daily & not the ones mentioned above)
* unsalted nuts & nut butters
* up to 4 servings a day of cereals, grains, pasta, & bread made from allowable ingredients
* some rice (basmati is best for this diet)
* sugar, jelly, honey, maple syrup, 
* pepper and herbs
* vegetable oils
* cola, diet cola, lemonade, sodas (except those with Red Dye #3), non-instant coffee and tea, beer, wine, other alcohol
* homemade foods made with allowable ingredients

So, basically if you want a meal, you need to make it yourself!

I'd like to share with you some of the foods I bought, some of the meals I made, and some of the products I found that you can use. I will add recipes I used as well. I hope someone finds this helpful! The Thyroid Cancer website has an awesome and amazing pdf cookbook that is such a nice and valuable resource (some of the recipes below are from there). BUT, over 100 pages is just plain overwhelming to me- even when I'm not hypothyroid! Should you pre-plan and pre-made foods before you start on this little hypo journey? Heck YES. Does that ever really pan out for me? Nope. At least not yet! 

Here's my big shopping haul. I started with this and got the basics. There's some fresh, organic chicken breasts and ground beef in there as well.
I started out the week with a batch of LID pancakes. I thinned out half of the batter further and made them into crepes. Both of these kept well in the fridge (These also freeze well if you are a go-getter and wanted to make these in advance). 
Griddle Cakes
Beat 2 egg whites with
2 Tablespoons sugar
Add: 1 teaspoon vanilla
Stir in:
1 cup flour
2 teaspoons baking powder
1 teaspoon salt
1 teaspoon cinnamon
1 teaspoon vegetable oil
Then add 1/2 cup water (more as desired for batter thickness).  Stir until the batter is the consistency of thick cream. Spoon batter onto hot griddle which  has been greased with a bit of vegetable oil. Excellent hot with homemade jam or
real maple syrup.
You can eat the crepes plain, with maple syrup, or get crazy and add unsalted pb, bananas, maple syrup (the real stuff, not pancake syrup!), and powdered sugar like I did!
That's a whole lot of yum right there!
I was able to find one type of tortillas that was LID safe. These are the Southwest Tortillas from Central Market. They make a variety of tortillas there fresh throughout the day. This variety was the only one that didn't have iodized salt added to them. They were very tasty!.. even better when I added things to them! This meal was a tortilla with mashed avocado, seasoned with a little kosher salt, pepper, and egg whites.
Fresh salad greens, a sliced cucumber (sprinkled with salt-free lemon pepper), topped with organic chicken breast (that was seasoned with salt free Mrs. Dash, an apple, and iced tea. I also found one salad dressing freshly made at Central Market that is REALLY good! It was a lemon garlic oil & vinegar dressing that was also sweet. They use kosher salt in it! Yay! So, I just got some from their bulk bar and used that throughout the week.
I lasted a few days before I needed something sweeter than a piece of fruit! So, I made no bake cookies (oatmeal, peanut butter, and cocoa). 

No-Bake Cookies
1 cup sugar
1 cup unsalted peanut butter
a little plain salt (start with 1/4 teaspoon)
4 Tablespoons oil
1/3 cup unsweetened cocoa
3 cups oats
You can adjust ingredients to your liking (for
example, more chocolate—cocoa—or more peanut butter).
Stir first 5 ingredients over low heat. When it is
mixed well and creamy, add oats 1/2 cup at a time.
Drop on waxed paper till cool........enjoy!

I made these twice. My son (allergic to egg, milk, & nuts) LOVED these as much as I did. This was also my go-to recipe last time I did this diet. These are good enough to make when you just need a good cookie recipe for any time! He would walk into the kitchen a few times a day, point to the bag and say "cookie". "Cookie!!". By the end of this diet I pretty much survived on cookies alone. Seriously. Nothing sounded good, I had no energy to make anything and really had no appetite. These are easy to just grab and snack on. They are the best mixture of crunchy on the outside, but chewy on the inside.
Best Oat Cookies That Ever Existed
1 mashed banana (I always used 2)
1 cup brown sugar
1/2 cup regular sugar
1/4 cup plus 1 teaspoon oil (or slightly less than 1/3 of a cup)
1 1/2 teaspoons vanilla extract
1 1/2 teaspoons cinnamon
1 1/2 cups flour
1 teaspoon baking soda
1/2 teaspoon non-iodized salt
2 1/4 cups oats
3 Tablespoons water plus maybe a few more drops
Mix the brown sugar, sugar, oil, and water. Add the banana and vanilla. Then mix in the already premixed flour, baking soda, cinnamon, and non-iodized salt. Stir in the oats. If it is too thin, let stand a bit so the oats can absorb the excess liquid. Drop them by the tablespoon. Bake at 350 degrees Fahrenheit for 13 minutes. To check if they are done, flip one over and it should be browned. Let them sit a bit before taking them off the cookie sheet.

I made my own tortilla chips. A few times. So, SO good! That brand and variety of white corn tortillas is the ONLY one I found out of the 2374923784 different ones I looked at that had zero sodium (and I'm in Texas so there's LOTS of options)! There was another one with very small amount that would probably be ok to use as well if you can't find these exact ones.

All you do is add some vegetable oil,  heat it up and add your cut tortillas. I stacked several and cut each one into 1/8ths. You don't realize how many tortillas you eat when you much mindlessly on tortilla chips until you make them yourself!

Make in batches. Drain on paper towels and season with kosher salt right when they come out so the salt sticks to the hot oil.

Or add cinnamon and sugar!

I also made fresh salsa (DELISH!). I just put a bunch of cilantro, several tomatoes, some onion, kosher salt, and a seeded jalapeno into a blender and whirled it all up. It kept really well and was great as a dip for chips or on my burritos.

If you can find the 100% Natural, NO SALT ADDED Hunt's ketchup get it! It is great, a little sweet. I had picked this up a while back when I saw it, knowing I'd need it eventually. I'm glad I did b/c I couldn't find it this time at Wal Mart (didn't check other stores beyond that though, so I think it is still out there). This meal was great. Organic beef burger topped with onions & mushrooms sauteed in evoo, pan fried (w/out the skins) potatoes cooked with sauteed onions and garlic and served with my black bean & corn salad.

If you want chicken broth/ stock you have to make it yourself. Bonus? Make it using a whole, organic fryer and you will have plenty of chicken for a while (I ended up freezing most of the chicken b/c after all of this I was just not even in the mood to eat the chicken. True story). All I did was coarsely chop some celery, onions, and threw in some baby carrots.

I added my fryer (remove the gooey bits inside... gross!), covered it with water, added my veggies, some kosher salt, and whole peppercorns. Then I let it boil, turned it down and let it simmer away for hours.

The chicken just fell off of the bone. I was left with lots of chicken and LOTS of stock. I used some of the stock to make a bean soup and froze the rest of it to use later (I'll use this even when I'm not on the LID).

I let my broth cool completely then popped it in the fridge for a couple of days. Then I skimmed the fat off, added 2 cups (equal to one can) of broth to ziploc bags, placed them on a cookie sheet, and froze them. Then I stacked them in the freezer for easy storage. 

Another tortilla. More chicken. More of my black bean & corn salad. More avocado. Reisling. Raspberries.

How do you know you LOVE your husband? You make him ^^ (Chicken & dumplings) even though you can't have any of it yourself! Super delicious & easy recipe by the way!

Some smiles! My girls! xoxo!

Another great snack is popcorn. Make it in a stock pan. Cover the bottom with oil, add a few kernels. When one pops, cover the bottom of the pan with one layer of kernels, cover, and shake away. Season with kosher salt and store. YUM!

Another tortilla. More egg whites, homemade salsa, & avocado.

Here's the black bean and corn salad I kept referring to ^^. I used this recipe with a few variations. For starters, I had to make my own beans. I got a bag, soaked them overnight, then cooked them the next day and cooled them. (I used the rest of them to make a bean soup).  I only used green bell pepper, as that is what I had and used green onions. I omitted the jalapeno. This was GREAT, stored well, and was a fantastic dip for my chips as well as good to eat alone or added to a burrito.

More crepes.

Smoothies. A must for me. When nothing else sounded good, I just whipped one up. This particular concoction is 1c orange juice, 1 banana, a handful of fresh pineapple, a little water, and a handful of ice cubes. Fantastic. I also made an orange juice, banana, & blueberry version. Would have made one with strawberries if I had them. Another one that was AWESOME and filling was made with unsalted peanut butter, banana, oats, and apple juice. Sounds weird, I know, but OMG yum! I also threw some flax seed in there. YUM! I think it is hard to get smoothies wrong. If you make one with oats, just put the oats in the blender and pour your juice on top. Let it sit a few minutes for the juice to soften the oats before adding the other ingredients and blending. Oats are also good with strawberries in a smoothie.

I made apple pie oatmeal. This was ok. Some will love it, some won't. I was on the fence (just mostly not in the mood for it once I made it). The recipe is here.

It was nice that it cooked in the crock pot!

Homemade french fries were part of my Christmas dinner. Jealous? They were VERY good and crispy. To get them that way, cut up your skinned potatoes. Let them sit in a bath of iced water for a little while. Drain them, rinse them. Let them sit a bit to dry off some. Plop them into  your frier in batches. Drain them. Move to another batch. Then put the ones you have already cooked once, BACK into the fryer. This second time is what makes them crispy. When you take them out the second time (cooking time is much shorter this time), season with kosher salt. So good! You can do the same thing using sweet potatoes.

^^ Steak. Yum.

My boys! xoxo!

There's not many pre-packaged products that are safe. Frosted mini wheats are though! :) Check your labels, the fruit-filled ones aren't ok, but these are, the regular ones are, and the brown sugar ones are as well. You have to eat them plain since no milk is allowed, but they make a decent snack.

I made a yummy bean soup using the leftover black beans I had from making my corn and bean salad. I just used a bag of frozen corn.

Diced tomatoes.

Some of my chicken stock and beans. I used this recipe as my inspiration, but made the necessary LID changes (no cheese or yogurt topping), and omitted the jalapeno and chili paste (I did season it with some chili powder though).

Really good!
I am a member of a Thyroid Issues board on Babycenter. I posted there asking for input on this post and here's some of the things the wonderful ladies over there contributed!

"My friends made me the butternut squash soup recipe from the online cookbook and with a little non iodized salt, pepper and dried onions added, it was great. I also used the chicken stock from the cookbook, added dried onions, a can of drained cannelloni beans, a can of no salt organic tomatoes, diced organic chicken that had been baked, some diced sun dried tomatoes, basil, non iodized salt and pepper and made was great and has become my go-to lunch with a salad."
"I make homemade dill pickles and jalepeno slices and instead of pickling salt I used non-iodized salt in my recipe so I could still have my pickles & peppers. I also made my own tortillas, beans, and hummus."

Low Iodine Turkey Chili

1 lb ground KOSHER turkey breast
1 cup white wine
6 cups LI recipe, no salt chicken stock (from thyraca cookbook)
2 Tblsp dried onion flakes
2 cloves garlic, minced
1 can no salt diced tomatoes
2 cans no salt white kidney beans (cannelloni beans)
2 tsp non iodized salt
1 tsp fresh ground pepper
2-3 Tblsp ground cumin
1 tsp dried oregano
2-4 tbslp ground chili powder (I found this in the Hispanic foods aisle in cellophane bags...all the "regular" chili powder actually is a mix of several ingredients and has salt)
Olive oil
1 small can no salt tomato paste

Generously coat the bottom of your pan (cast iron or le cruset type pan work best) and put in the turkey, breaking it up. Brown it well, letting it sit much lnger between stirrings than regular ground meat. You want a nice crust of browning on the bottom of your pan. Add your garlic and cook for a cople minutes. Once your pan is super dark golden brown, add your white wine slowly, stirring and scraping all the brown off the bottom of the pan (brown = more flavor!). Add your stock and can of tomatoes, juice and all. Rinse your beans well and add them. Add dried onion flakes. Simmer 10 minutes. If you need more liquid, add water, stock or wine. Then add your spices, adjusting to your personal taste preference. Go easy on the non iodized salt and adjust, allowing a couple minutes of cooking and stirring after each adjustment to ensure your taste is accurate before adding more spice. Once you are pretty happy with the taste, stir in your tomato paste and adjust again as necessary. Let simmer 30 minutes...enjoy!

List of LI items by brand purchased at Whole Foods:
Fresh corn tortillas, made in house - no salt
Los Chileros Organic Red New Mexico Chili Powder-no salt
Eden Organic White Kidney Beans (cannellini)- no salt
365 (Whole Foods 'house' brand) no salt added Garbanzo Beans
365 no salt added black beans
Spectrum Organic all vegetable butter flavor shortening (no soy, no dairy, no salt, 0mg sodium)
Streit's 100% Whole Wheat no salt Matzohs

To make these LID compliant I subbed oil for the butter and of course used non-idoine salt. This recipe came from King Arthur Flour's website.
Beautiful Burger Buns
3/4 to 1 cup lukewarm water
2 tablespoons butter
1 large egg
3 1/2 cups King Arthur Unbleached All-Purpose Flour
1/4 cup sugar
 1 1/4 teaspoons salt
1 tablespoon instant yeast
1) Mix and knead all of the dough ingredients by hand, mixer, or bread machine to make a soft, smooth dough.
2) Cover the dough, and let it rise for 1 hour, or until it's doubled in bulk.
3) Gently deflate the dough, and divide it into 8 pieces. Shape each piece into a round 1" thick (more or less); flatten to about 3" across. Place the buns on a lightly greased baking sheet, cover, and let rise for about an hour, until very puffy.
4) If desired, brush buns with melted butter. Or brush lightly with egg wash (1 egg beaten with 1 tablespoon water), and sprinkle with sesame seeds.
5) Bake the buns in a preheated 375°F oven for 12 to 15 minutes, till golden. Cool on a rack.
Recipe summary
Hands-on time: 25 mins.
Baking time: 15 mins.
Total time: 2 hrs 40 mins.
Yield: 8 buns

I am allergic to tree nuts, so these are out for me, but they sound really good if you aren't allergic!

New recipe that I created tonight based on the Nestle Toll House Cookie recipe.  If you like almonds, these are super yummy!
Low iodine coconut almond cookies
2 cups + 2 Tblsp all purpose flour
1 tsp baking soda
1 tsp non iodized salt
1 cup Spectrum organic all vegetable butter flavored shortening
1 cup granulated sugar
½ cup brown sugar
2 Tblsp unsulfurated molasses
½ tsp vanilla extract
½ tsp almond extract
5 large egg whites
1 ½ cups unsweetened flake coconut
1 ½ cups chopped, toasted unsalted almonds
Preheat oven to 375.  Line 2 cookie sheets with parchment paper.
Combine flour, baking soda and salt in a small bowl.  Beat shortening, granulated sugar, brown sugar, molasses, and the vanilla and almond extracts until creamy.  Add egg whites, beating well.  Add flour, baking soda and salt and beat in.  Stir in almonds and coconut.  Bake for 12 minutes, rotating pans in oven and racks half way through baking time.  Cool on baking sheets for 3 minutes and then transfer to cooling racks to cool completely.  Makes about 40-45 cookies.  
 "Malt O 'meal--- 2 1/2 minute cooking variety, original flavor only."
Variation on the griddle cake recipe I posted earlier in this post: 
I used 1/3 cup egg whites
Added 2 tsp. Unsulfurated molasses
1/4 tsp nutmeg
3/4 cup thick cut rolled oats and let it sit for 30 minutes

Right before cooking, I added
2/3 cup chopped and toasted unsalted walnuts
3/4 cup fresh organic blueberries
2 Tblsp. Golden toasted whole flax seeds (Trader Joes)

Served with just a little maple syrup.

I took part of the batter (about 1/3 of it) and added 4 egg yolks that were in the fridge and made those for my dh and he declared them seriously the best pancakes he has ever eaten!

Anyway, thought I would share my variation on your pancakes because they were super hearty and tasted great :) -Tonya

A great big THANK YOU to the ladies who took the time to send me their suggestions and recipes! :)

The bean soup was the last LID meal I made for myself before my RAI. Then I headed out to my parents and this magazine was on the table. *drool*.

This was the last LID meal I ate actually. I had this for lunch after my RAI then was too nauseous to eat again until after 24 hours, at which time I was able to discontinue the LID! Woo-hoo! I have to say that it is VERY nice having someone else prepare all of your meals. I could SO get used to it! My parents left all of my meals on this tray at my door. They are the best in the world. Seriously. For so many reasons. I could not have done this without them.

My Phergan pills that got me through the first 24 hours.

Ahh! My first non LID meal! Bacon, eggs, toast, and coffee with cream! I caution you though. Your gut isn't used to such things. So, be forewarned.

My parents saved these for me from Christmas! I ate a couple here and there. Very good, but mostly just pretty to look at!

Cheese! Oh, how I missed thee!

Ahh Pork Tenderloin. I used to like it, but it was my one post RAI, pre three days of nausea meal that I had the last time when I had my big dose. I haven't really liked it since as it conjures up those nasty memories. I wasn't able to eat much of it, but the salad and green beans were good!

It's hard to see, but my parents moved a table into the living room down there so they could talk to me! Cute!

My mom did most of my meals, but she was getting ready to go out to dinner w/ my dad and their friends, so my dad brought me this. This is my mom's homemade vegetable beef soup. It is SO good! He probably gave me a good 32oz of it (it's in a red Solo and the big green cup), and another Solo cup of crackers & cheese. LOL. Needless to say, the one Solo of soup was plenty!

The cookie tin had two layers!

My parents went to visit my kids and give my husband a break. But, before leaving they left me this. A make-your-own sandwich plate and a piece of cake! SOO good!

That cake deserves a close-up!

My mom's famous Mexican Salad!

I rang in 2012 with my Riesling... in my Red Solo Cup!

So, if you can suffer through a couple (or a little more) weeks on the LID just think of the yumminess ahead! I am heading home today and I can't wait to be back home with my family. I have had a good run out here and have been beyond blessed with the best parents in the world!

I won't get my results from all of my tests until this Friday and I have to remain off of my Synthroid until then. If given the all clear I can resume my meds and get those going again. Sucks that it will take another 4-6 weeks for them to get back into my system, but I look forward to it!

I hope that my posts in these last few days have been helpful to you! As always, feel free to leave a comment and ask a question if you wish!
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