The low-iodine diet

[Fat Guy]

Have you ever wondered what it would be like to go a week without eating any foods containing iodine? Me either, until recently.

To make a long story short, I had thyroid surgery at the end of November. Next Wednesday, for follow-up, I need to take a dose of Iodine-131. In preparation for that I need to cut iodine out of my diet for a week -- the basic idea being that if I deprive my cells of iodine they will more readily suck up the I-131. That's all I'll say about the medical aspects of this, however from a culinary standpoint there is much to discuss.

When I was thinking in the abstract about a diet without iodine, I figured how hard could it be? I mean, it's not like I crave iodine, sprinkle it on my food or even have any around. But then I started reading the booklet my endocrinologist gave me.

The first thing you have to avoid is iodized salt. This sounds simple, and when it comes to home cooking it is: you can just use non-iodized salt. But everything prepared in a restaurant, commercially, or in anybody else's home is suspect. Basically, for the week I can't eat any restaurant food, any packaged food, or any food anybody else cooks unless it is supervised by me with great rigor.

The salt issue is compounded by a ban on sea salt -- anything from the sea is banned. That does still leave non-iodized kosher salt, though. I guess all salt, even rock salt in mines, ultimately traces back to the sea, but after checking with multiple authorities I learned that my bottle of David's kosher salt is okay for the diet.

The salt restriction also applies to salt variants like garlic salt and onion salt -- not that I care.

Then you're not allowed to eat any milk products. I don't know why this is exactly, and some sources have led me to question the restriction, but I'm not going to start being a difficult patient about it when it's just for a week.

And no fish, at least not fish (or seafood) from the sea. Freshwater fish are theoretically allowed but it's not like I'm going to seek out any fish.

The ingredients iodates, iodides, algin, alginates, carrageen, agar, and kelp are forbidden.

The iodate restriction rules out all commercial bread products. It may be that some are made without iodate but it's a blanket restriction because there's no way to know.

No eggs.

No vitamin or dietary supplements.

Nothing with red, orange or brown dye.

No iodine on cuts.

No soy products.

No canned foods.

That's the short version of the list. If you unpack each item you get much more detail. So for example the brochure I have elaborates on the commercial-bread restriction thus: "Avoid: All commercial breads and rolls, processed boxed cereals, salted crackers, potato chips, pretzels, bagels, bialys, Melba toast, all other crackers, egg noodles, packaged rice and pasta mixes."

It goes on like this about everything.

Now, a sane person would probably just avoid bread for the week. But I decided to bake. Heckers says there's no iodate in their flour, David's says the kosher salt is neither from the sea nor iodized, Red Star yeast is approved, as is tap water. I decided to give the Jim Lahey/Mark Bittman no-knead recipe a try. My son and I made the dough last night and will bake this afternoon after school.

Last night we had a farewell-to-iodine supper at Dinosaur Bar-B-Que in Harlem. I made the joke, "This iodine is so great!" a few times too many. The group ordered me to stop. I even tried a little salmon, because I could.

So, join me this week for a chronicle of the low-iodine diet. If you happen to be on a low-iodine diet, or have expertise in this area, or even if you don't, I'd love to hear your ideas.

[Kerry Beal]

How does the poor bastard who doesn't cook do this?

[Fat Guy]

Well, luckily there are some DELICIOUS sample menus provided that require only basic cooking. Although, some demands ("2 slices homemade white bread") seem a bit unrealistic for most people. Here's a day's helpful sample program:

Sample Menu for a Low Iodine Diet

BREAKFAST

1 Fruit: 1⁄2 cup orange juice

3 Breads: 1⁄2 cup oatmeal (no milk)

1 plain unsalted matzah

1 Meat: 1 egg white omelet

Misc.: 2 teaspoons sugar

1 Beverage: 1 cup brewed coffee

MID MORNING SNACK

1 Fruit

2 Rice cakes

1 teaspoon unsalted butter

1 cup water

LUNCH

1 Meat: 3 oz fresh turkey breast

2 Fats: 2 tsp oil

2 Breads: 2 slices homemade white bread

1 Vegetable: 1 cup Romaine lettuce

1 Beverage: 1 cup fresh lemonade

MID AFTERNOON SNACK

1 Fruit: 1 fresh apple

1 Meat: 2 tablespoons unsalted peanut butter

DINNER

1 Meat: 3 oz roast beef

2 Breads: 1 baked potato (no skin)

2 Vegetables: 1 cup fresh broccoli

2 Fats: 2 tsp oil (used in cooking)

1 Fruit: 1 orange

1 Beverage: 1 cup white tea

BEDTIME SNACK

1 Fruit: 1 small pear

1 Beverage: 1 cup tea made from fresh tea leaves

I think we can do a bit better.

[rooftop1000]

Too bad it isn't summer you (well I) could live on steak and roasted potatoes topped with tomato salad for a week....

The problem for this challenge is that for you it's too easy, you have the power and the skills.

tracey

[nibor]

If you followed that sample menu for very long you would have to change your handle to something like pencil guy.

[Fat Guy]

Too bad it isn't summer you (well I) could live on steak and roasted potatoes topped with tomato salad for a week....

Trouble is, no potato skins allowed, and potatoes without skins are just weird unless they're french fries. Also, no vinegar except white vinegar. Makes salad dressings awkward.

[jgm]

One of my favorite dinners is to put about 3 cans of low-sodium chicken broth in an electric skillet (you'd probably want to use homemade broth, but the "3 cans" gives you an idea of quantity). Each person is assigned one corner of the skillet; kids can put stuff in but parents probably want to retrieve it. It goes without saying the children should be supervised as to food safety issues. After the broth comes to a simmer, into one's corner go chunks of chicken, beef, or whatever protein you like, and I usually do offer a variety; plus chunks of whatever vegetables you like. I usually offer sliced mushrooms, onions, carrots, and celery, plus chunks of broccoli. No reason you couldn't use green beans or bok choy or some other green. When fully cooked, the mixture is pulled out with whatever appropriate utensil you have, and enjoyed with the rice of your choice.

While many people would have to put soy sauce on this, I think it's fantastic just the way it is. You can use a little broth to moisten the rice if you like.

Save the broth for chicken soup tomorrow night, made whatever way will work within your restrictions.

I also think that various kinds of soup could be on your menu, and many would work well within your restrictions. Obviously, steak or roasted chicken with roasted vegetables is a possibility. You could always make your own hummus, if you don't already, and pita bread can be homemade and would be a nice break from regular homemade bread.

[Fat Guy]

Those are great suggestions (minus the canned stock -- no cans allowed). I think part of my problem is that I've been so focused on what I can't eat that I haven't given enough thought to what I can eat: meat and vegetables galore.

[NadyaDuke]

You can make salad dressing with lemon as well - it looks like citrus is permitted. And when your bread goes stale you can make croutons :-).

[Fat Guy]

Why didn't I think of lemon?

[JAZ]

Trouble is, no potato skins allowed, and potatoes without skins are just weird unless they're french fries.

Hash browns, or other fried potatoes?

[Fat Guy]

I vastly prefer them skin-on, and fried potatoes benefit greatly from butter, but for a week I can adapt and use peeled with just olive oil. I was actually thinking home fries for tomorrow.

[Fat Guy]

I did not do well today.

The thing about the low-iodine diet, as I have started to learn, is that it's very difficult to eat outside the home. If you're at home and you have a little sense, you can make it work just fine. But once you're out in the world there's precious little to eat. Everything seems to contain salt of unknown provenance, and everything that doesn't breaks some other rule.

This morning I was up at the crack of dawn and had to rush out to take our son PJ to see a school he might go to. It's actually the school where I went. While the kids were in their play session, we had a tour and then we sat down around a table with the admissions director. On the table was a platter of muffins. I know from back in the day that the cafeteria at the school bakes good muffins. I started reaching for one and then caught myself: muffins break the rules in several ways (eggs, potentially iodized salt, etc.). I had no other serious opportunity to eat all day, so I muddled through with fruit, walnuts and a couple of unsalted rice cakes I found at my mother's apartment. Yum.

By dinnertime I was so hungry I was ready to gnaw off my paw. Luckily there was a dinner plan in place: my mother and I had engineered some Swedish meatballs with egg-white binder that were quite edible. Had them over my house-blend red-and-brown rice. I was so delirious with hunger that I forgot to take a photo until I had eaten a bunch.

I also made a couple of salads, but nobody had come up with the lemon-juice idea so I had my salad just with olive oil, salt and pepper. I'll use the lemon-juice trick tomorrow.

PJ and I also baked our first loaf of bread. The dough had risen mightily overnight. We punched it down, let it rise another two hours, and baked in a Dutch oven.

I'm resolved to plan better tomorrow.

[NadyaDuke]

Glad to help. I use lemon juice a lot because it's more wine friendly, and you know, sometimes I like a glass of wine with dinner and am not serving in courses!

[haresfur]

So no egg yolks but whites are ok? What about pasta? You could make that at home if the commercial isn't allowed.

[Fat Guy]

Commercial dry pasta -- the kind that's just flour and water -- is allowed. I've got spaghetti with olive oil and garlic on my list of potential dinners.

This morning I've got a breakfast date with my rabbi, so I'm going to have to eat a meal in a restaurant. I took a look at the menu online and it looks like my only option on the entire menu is a fruit plate and black coffee.

[Kerry Beal]

"Thursday, the guy with the rabbi went hungry"

[Katie Meadow]

Although I am not on a low-iodine diet, I have some awful diet restrictions right now that coincide with some of yours. I do not use iodized salt for the most part, and although I can eat seafood, I don't eat much of it, so I sympathize. I easily go a week or two without eggs, and eat very little dairy.

If you make your own stock, there are endless soups you can make in large quantities. Soups with barley are really satisfying. How about rice 'n' beans? (Dried beans of course, not canned.) If you can find edible fresh tomatoes that would be great, but I make a sort of simple Southwestern style pot of beans without any tomato products. You can use lime juice to brighten it up. I like the skin on regular potatoes, but not particularly on yams. Baked yams with butter and salt? Since I can't eat tomatoes right now (fresh or canned), I've learned to eat pasta without it. Saute radicchio or fennel or chard (or any greens) in ample amounts of olive oil and garlic, then toss with the pasta. Toast some pine nuts and throw them on.

Your bread looks good!

[Fat Guy]

A mouse ate my bread!

More later.

[Fat Guy]

In the food-blogging class I teach at the International Culinary Center, I had a student named Mindy who did a wonderfully depressing blog called Mindy's Recipe for Disaster. A female Vietnamese-American Woody Allen of sorts, Mindy always had some sort of existential culinary crisis going on. For example:

I’m at a crossroads trying to figure out what to do with my culinary life. One road leads to potential disaster, and the other road leads to even greater potential disaster… So typical. I know what you’re thinking: “Mindy, just see what your gut tells you to do and then do the opposite.” I’ve tried that, but then I second guess myself and think, wait, is that what my gut is actually telling me? Or is doing the opposite of what my gut is telling me what my gut is telling me, thereby making the second gut choice the wrong one?

Today I must have been channeling Mindy because so many things went wrong.

Last night PJ and I baked a loaf of iodine-free bread and I left it out to cool overnight. This morning he had a slice, buttered, for breakfast, and I tasted a small bit off the end. It was quite decent.

I'm not going to get caught out of the house with no food, I thought, so I asked PJ to pack me two thick slices of bread in a zipper bag. I threw the bag into my shoulder bag (which Ellen calls my Jack Bauer bag, long story) alongside PJ's lunch and we headed off to school for dropoff.

When we walked into the classroom, PJ announced to his teachers, Liz and Steve, that "Daddy and I made you bread!" PJ had interpreted my request to bag two slices as an indication that we were making a gift of bread to his teachers. So I lost my bread.

I then had enjoyable conversation and a poor breakfast with Rabbi Josh. The pastries at Cafe Lalo looked terrific, and I know from experience that they are, but I couldn't eat any. Instead I had a paltry, overpriced, out-of-season fruit platter and a cup of tea. Rabbi Josh had scrambled eggs with goat cheese and avocado, which looked amazing.

I decided the only way to get through the day would be to make an unscheduled stop back at home to restock my Jack Bauer bag with new bread before heading back to the West Side. But when I got home, something had gone terribly wrong with the bread.

The bag in which I'd placed the bread now had a series of ragged holes in it. There was a chaotic trail of crumbs leading away from the location. Further examination revealed that a mouse had been feasting on my bread.

I had some Trader Joe's salt-free tortilla chips instead, which were not nearly as satisfying.

And don't even get me started on the skinless potato situation at dinner.

[onrushpam]

Wow! I think I'd have been brave enough to just whack/toss the part of the bread the mouse nibbled and still consume the rest of it.

[KarenDW]

I then had enjoyable conversation and a poor breakfast with Rabbi Josh. The pastries at Cafe Lalo looked terrific, and I know from experience that they are, but I couldn't eat any. Instead I had a paltry, overpriced, out-of-season fruit platter and a cup of tea. Rabbi Josh had scrambled eggs with goat cheese and avocado, which looked amazing.

could you not have ordered an egg white omelette with NO SALT?

Each year I spend 10 days eating only what is GROWN within 10 miles of my home (downtown Vancouver). I have 5 "exceptions", which usually include basics like salt, coffee, olive oil, rice, milk. My preference is to focus on what IS available and yummy, rather than on what is on the "no fly list".

You will find many options.

But I agree. Eating out is a challenge. For 10 days, I usually only eat out once or twice, compared to the 4 or 5 meals I would typically eat out.

[Jenni]

Ok, first of all, I really hope that mouse was on a low-iodine diet, because otherwise he's got some serious explaining to do!

On a (slightly) more serious note, you are allowed potatoes without the skins, no? In which case, a steaming pile of mashed potato is called for. You don't have to use butter - in Bengal mashed potatoes are flavoured with mustard oil and chillies and I believe in Greece olive oil is used. I see no mention of olive oil (or mustard oil) not being allowed...What could be more comforting than some lovely, fluffy, spuddy goodness?

Edited February 5, 2010 by Jenni (log)

[Shalmanese]

Can you take a small salt cellar with you and order foods with no salt?

[Fat Guy]

I've been in enough restaurant kitchens to know that ordering anything cooked in a restaurant would be unreliable. There's the issue of not really knowing everything that goes into a given dish, and there's the issue of the kitchen not necessarily following instructions carefully enough. So, for example, you ask for something cooked without salt but it contains an ingredient that already has salt (the meat was brined, or the egg mixture was salted, or the cooking water was salted...) or they cook using butter (not allowed) or soybean oil (also not allowed). Cooked restaurant food is pretty much out of the question unless it comes from someplace like a hospital commissary where they're particularly rigorous about these sorts of things.

I think mashed potatoes without the dairy ingredients are just not that great. I thought about fork-crushed potatoes with olive oil, salt and pepper but I'm probably not on the diet for long enough to justify going there. Last night I wanted to do home fries but as I was peeling the potatoes PJ insisted on oven-baked french fries. Oven-baked french fries turn out to be better when you make them with the skins on, but the skinless ones were decent.

I need to figure out a way to get some of the kosher salt ground down to a finer consistency. I guess I can use the Cuisinart mini-prep for that. The coarse kosher salt crystals, I learned last night, are sort of too big to use as table salt on something like fries.