Levothyroxine replacement and Ramadan fasting
A full paper in this subject available here:
To fast for a month or break an important religious practice must be a difficult dilemma for a Muslim suffering horrible symptoms through mismanaged hypothyroidism. I always thought those suffering illness were excempt from Ramadam fasting and would think a month of not eating vital nutrients could only cause further nutritional difficiencies.
I know the report claims to only use results from well managed hypothyroid people and there were still interesting variations on TSH levels when Levothyroxine was taken at bedtime. This heavily supports the empty stomach protocol.
I have always thought morning is better because varying carbs, proteins and fats eaten at dinner would have to impact on Levothyroxine absorbtion in varying degrees.
Thank you for posting
My experience in a Muslim country was that the people actually ate more food during Ramadan than the rest of the year. But many of them stayed up much of the night in order to do so in accord with the restrictions.
There is a reason that bed-time dosing might be better independently of all the other factors, it probably more closely follows the variations of thyroid hormone seen in healthy people.
Yes I totally agree that the circadian rhythm and synthesis of hormones in the liver at specific times is hugely important.
However, I would still maintain that if taking Levo at night, one must weigh up the chance of varying absorbtion levels as talked about above or stick with a rigid diet and meal timing.
I know in my busy household, this just would not be possible.
Funny they eat more. I guess without regular daytime meals they think they might get extra hungry.
At sunset, people start to eat, then have a meal often in company and with an element of entertaining guests, and many make sure they eat another meal before sunrise to make sure they can last the daylight hours. The actual sales of food rise markedly before and during Ramadan.
Interesting study- I'm currently into day 4 of fasting and agree that finding the right intervals to allow after meals -leaving 2 hours after sunset meal for thyroxine dose- and vitamin supplements a bit difficult to say the least. Whilst trying to keep oneself hydrated during the night hours, getting some rest as most people work. I'm fortunate not to worry about that side and can rest after sunrise. So basically the whole pattern has changed fir eating / sleeping etc!
However, remarkable as it seems, I seem to be clearer, less brain fog and even have more energy!. The spiritual side of more praying during the time not worrying about preparing meals etc is most refreshing. Intermittent fasting as a concept has been receiving mostly positive benefits as written by Chris Kessler and Dr Josh Axe - predominantly resting the digestive system the key.
Unfortunately, As someone commented it does feel like you are consuming more food in a short space of time as fasting this month is around 19 hours. I can't get around this full feeling and prefer the feeling light on an empty stomach. My teenagers who only fasted this last weekend - definitely appreciate their food now. They told Me
I will let you know how these feelings progress at the end of Ramadan.
With best wishes - Thanks Shabana.
Odd that the majority of patients were male.
It's just during daylight hours that you can't eat or drink. I often do that myself (though not for a month). I always though the not drinking was more of a health problem. Easier to wake up before dawn and take levo then, I'd have thought.
From 21:25 to 04:45 today - so a long time. (It doesn't last as long in, for example, Mecca.)
It also turns upside-down the usual patterns.
Surely you can drink water?
No, apparently not. I invigilate competency exams and many of the people taking them are Muslims, so I run into this quite often (well, once every year). It's OK to splash water on your face but not to drink it.
Unbelievable, especially as a lot of muslims live in a hot country.
Very interesting learning about other religions. We looked after an Iranian girl for a year and she was muslim but was obviously too young to fast during Ramadam.
I have read that it is actually worse for many in the temperature to polar regions. Imagine the problems in the land of the midnight sun... Fasting is (apparently) especially unpleasant and difficult if your environment is cold.
Oh yes, zero calories equals no warmth whatsoever.
I couldn't bear it.
I have fasted and still took my medication.
I didn't understand what this paper meant by 'bedtime'. Does it mean at 9:25 pm you would start to eat, then have to wait 2 additional hours before you can take your medication? When are the participants getting any sleep at all!
Lack of sleep is a problem in Ramadan! Exactly as you suggest, sun sets, eat, eat a bit more, try to sleep, get up early to have some food and drink before sunrise, ...
Trying to avoid levothyroxine being consumed close to food, etc., is going to have to end up with compromise somewhere.
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