Iodine Global Network (IGN)

The Iodine Cookbook: a recipe for thyroid health

December, 2018
Under the academic guidance of Prof. Margaret Rayman and Dr. Sarah Bath, three students at the University of Surrey (UK) recently cooked up a storm with a new evidence-based cookbook of iodine rich recipes. We ask two of the student authors what inspired them to take on this project, and which recipes are their favourite.

Where has your interest in nutrition come from and what inspired this cookbook?

Joanne Tattersall: My interest stemmed from an article in The Evening Standard, linking iodine to the IQ of children. At the time, I was looking for the basis of a college project, so this was perfect! I had always had a 'medical mind' and a love of cooking, so the two married up perfectly towards a career in Dietetics. The more I researched into the importance of iodine during pregnancy, the more interested I became and was keen to pursue it into my degree.
Mariana Dineva: Nutrition is a constantly evolving field and there are so many questions yet to be answered. Nutrition is multi-faceted, encompassing many areas of knowledge from chemistry and biology to behavioral and social science, which makes it very complex but also exciting to work in.
Prof. Margaret Rayman: In the UK, iodine deficiency has been reported in several population groups, most notably in pregnant women, young women, and those who exclude certain food groups, e.g. vegans. We decided to create a basic cookbook of iodine-rich recipes relevant to the UK situation with the aim of increasing the iodine intake in at-risk groups, particularly prior to and during pregnancy.

Our intention was reinforced by the Horizon 2020 EUthyroid project, which aimed to improve iodine intake across Europe. We gathered data on the iodine concentration of foods from the UK food-table database. Foods with an iodine concentration greater than 20 µg/100 g were defined as iodine-rich and were therefore suitable recipe ingredients.
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All donations made until 6 January will be entered into a draw to win a copy of the Iodine Cookbook. The winner will be announced on Monday, 7 January and will be contacted by email.

How was each recipe created? Did you test each dish yourself?

MR: Existing recipes were adapted and new recipes created to give 28 easy-to-make dishes that catered for a variety of dietary requirements. Each recipe was analyzed using Nutritics, the online nutrient-analysis software, to provide a nutritional breakdown of iodine, iron and selenium. Nutritional content per portion of recipes was rated against the European Food Safety Authority (EFSA) recommendations for adults and pregnant women.

Recipes have symbols indicating their suitability for those following a gluten-free, vegetarian or vegan diet or their unsuitability for pregnant women. As the main sources of iodine are not suitable for vegans, an iodine-fortified milk-alternative drink has been used in some recipes to optimize iodine intake for individuals who exclude the key iodine source of cows’ milk.
JT: My friends and family were involved throughout the development of the cookbook, being chief taste-testers - most weren't even aware of iodine as a nutrient, so it certainly raised conversation!
Students Joanne Tattersall, Declan Henderson, and Mariana Dineva developed the book.

Which is your favorite iodine-rich recipe?

JT: I don't know if I could pick a favorite, but possibly the Nori-coated fish cakes or Nasi Goreng with sardines... In terms of its high iodine content, I think crab surprised me most! It's not a food I consumed much but I do enjoy it and look for it more now.
MD: All the recipes with fish and seafood, such as the ‘Haddock in Tomato and Basil Sauce’, are my favorites. I really enjoy eating fish, which is a very good source of iodine.
Haddock in Tomato and Basil Sauce

400g x 1 can tomatoes, canned, whole contents
400g haddock, flesh only, raw
250g aubergine, raw
1 large onions, raw
1 tablespoon oil, olive
1 teaspoon sugar
2 average cloves garlic, raw
4-5 leaves basil, fresh
2 teaspoons paprika

1. Heat the olive oil in a large non-stick frying pan and stir-fry the onion and aubergine. After about 4 minutes the vegetables will start to turn golden but won’t be soft yet, so cover with a lid and let the vegetables steam-fry in their own juices for 6 minutes – this helps them to soften without needing to add any extra oil.

2. Stir in the paprika, garlic, tomatoes and sugar with ½ teaspoon salt and cook for another 8-10 minutes, stirring, until onion and aubergine are tender.

3. Scatter in the basil leaves then nestle the fish in the sauce, cover the pan and cook for 6-8 minutes until the fish flakes when tested with a knife and the flesh is firm but still moist. Tear over the rest of the basil and serve with a salad and crusty bread (unless gluten intolerant).

Per serving
"324 mcg iodine = 216% of adult adequate intake/162% of pregnant adequate intake;
35 mcg selenium = 50% of adult/pregnant adequate intake;
176 kcal; 4 g fat; 1 g saturated fat"

Do your patients know how much iodine they should be consuming? What advice do you give them?

JT: As with my friends and family, very few people appear to be aware of iodine as a nutrient and its importance, rather than a method of antiseptic or chemical test for starch.

I advise that iodized salt can be purchased but, as you know, it isn't the default salt option in the UK. If an individual does not avoid iodine-rich foods for medical or other reasons, I always encourage incorporating foods that are readily available such as white fish, milk and cheese. Iodine supplements have cropped up on numerous occasions; I am always careful with how to approach these with regards to the low regulation of those containing seaweed and kelp and advise obtaining through diet if possible.

How can the book be adapted for other countries?

MR: We already know from our EUthyroid research that the dietary factors that have the biggest contribution to iodine intake and status (as measured by urinary iodine concentration) vary between the UK, Spain and the Netherlands, the three countries from which we have data. Bread is an important iodine source in the Netherlands as iodized salt is used in its preparation.

For Spain, fish is a very important source while for the UK, milk and dairy products are the major source. The UK has a higher concentration of iodine in milk, averaging 60 µg per 200 ml, than the other three countries.

Countries such as Chile, China, Ecuador, Peru and New Zealand, where iodized salt is available to over 80% of households, could emphasize the use of adequately iodized salt in recipes as this can make a significant contribution to daily iodine intake. However, this strategy is not applicable to the UK as iodized salt is poorly available and only iodized to 11.5 mg/kg.
Joanne Tattersall:
"Very few people appear to be aware of iodine as a nutrient and its importance, rather than a method of antiseptic or chemical test for starch."

What are you working on now?

MD: I’m currently in the last year of my PhD and I am working on a few projects related to iodine deficiency in pregnancy. A few examples include identifying the dietary and other determinants of iodine status during pregnancy, investigating the usefulness of thyroglobulin as a biomarker of iodine status in pregnant women, as well as exploring the trajectories of change in iodine excretion over the course of gestation.
JT: I am now working as a Community Dietitian but shared the concept of cookbook with my colleagues to a very positive response and have since shared the virtual cookbook for recipes to be passed on to patients. I'm really enjoying my clinical work and would like to continue this alongside returning to research in the future. I would love to see the cookbook printed for commercial sale to reach as many people as possible.
Joanne Tattersall and Declan Henderson worked on the development of the Iodine Cookbook in the course of their BSc final-year student projects. Mariana Dineva worked on the book as part of her PhD project on iodine.