Dr. Kenneth Blanchard says thyroid hormones should be taken with food. This is contrary to everything I have learned.
Do you agree?: Dr. Kenneth Blanchard says... - Thyroid UK
Do you agree?
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miglet54
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And it is against all logic too.
What’s his reasoning?
To prevent food craving, split dose up to 5 x daily.
Interesting....is it based on any research?
The only way I could get my two hypothyroid hounds (RIP) to take medication was if it was encased in a tasty morsel of food and it still worked for them.
I admit to glugging a cup of coffee and a sip of pineapple juice right before sublingual NDT dosing it appears to make little difference if I lay off the coffee and juice. I never eat before 1pm as I never feel hungry till then.
Mmmm I'm not so sure that Blanchard is wrong. I took thyroid meds with food for over forty years and felt they worked fine, then spent the last five years (on medical advice) taking without and feeling irratically unwell with a big 'rush' after dosing, so am now consequently reverting back to taking with.
Trial and error I believe and doing what feels right for your body.
nightingale-56 in reply to
Like you Hidden , in the beginning of taking T4, I was also told to take it after food. I was also told to split my 75 mcg dose into 50mcg after breakfast and 25 mcg after evening meal. This also seemed to work for me until I was told different on this forum. If only I could remember when that was. When did you revert back and is it long enough to tell how your blood levels are. It would be so much easier to take it with food and not have to wait in the morning for breakfast.
in reply to nightingale-56
Hi
I've only been doing it for a month so far and so have not had results confirmed with a blood test yet.
Actually I am steering clear of blood tests for now as I am fed up with arguing with doctors about my levels of T4.
I am determined to go on how I feel and not what is written on a piece of paper!
I cannot possibly got to work doing the job I do without a hearty breakfast, and I refuse to get up at 6am to follow their guidelines! 😀
nightingale-56 in reply to
Got too much sorting out of blood levels at the moment, but would like to think I could get back to just taking it just before breakfast.
There is some interaction, interference Levo with food, calcium, some meds etc however its moderate.
So for those who want to take it with food, drink there's not a major issue and it may require slightly higher dose or not even that.
I drink coffee with full fat milk right after my morning meds which include Levo, t3, BC taken all together. I don't eat breakfast for hours but only because I'm never hungry in the morning. But if I was it wouldn't stop me.
I always take mine at breakfast time and it doesn’t cause me problems. A few years back, I took glucosamine and cod liver oil also at breakfast time and convinced myself that I wasn’t absorbing the levo. I stopped the supplements and was fine again. Nothing scientific, but it seemed logical that an oily coating might make a difference.
Pleased to hear I am not alone in this thinking! 😊
Nutripea1220 in reply to
I do this too. On T3 only and I swallow it with my coffee/milk in the morning, take the second dose with a late morning (11) breakfast and third with afternoon snack. My doctor strongly urged me to do it this way and said if it means I take a slightly higher dose so be it- but at least I’m not disrupting my life around medication timing. I cling to his reasoning. Because I can’t cope without my morning coffee immediately upon waking ☠️🤗 Said that, when I take it on an empty stomach for whatever reason, I feel no differently.
This makes so much sense!
I also think this Blanchard guy (deceased unfortunately) is worth taking notice of.
Read his articles, I believe they are common sense and worthy of consideration.
I cannot believe the 'closed' thinking that goes in in the medical profession in this country, what exactly are they afraid of, or is it just limited knowledge being churned out and taught at med schoo? !
TSH110 in reply to
Ha ha they are afraid of us NDTers who could make them redundant! 😂🤣😂
Daffers123 in reply to
Iagree about Dr Blanchard. I have read his books and felt very sorry I was here in UK and couldn't possibly get to see him in the USA. H e made a great deal of sense!
I am female by the way!
the uptake with food will be lower than that if fasting so dose may end up being slightly higher. What is more important is taking the dosage consistently so changes in absorption aren't going to interfere with how much is actually getting through
Dr Blanchard was researching weight gain that had happened after his patients started thyroid replacement and have begun to report food cravings.
He stated that thyroid hormones coming into direct contact with the wall of the stomach are not the natural process that has never occurred in the evolution of the human race until we started taking thyroid hormones just over a century ago.
This process will certainly have an effect on 'leptin and ghrelin' which are hormones produced by the stomach and which clearly have an effect on weight gain.
Once his patients started taking T4 with food, the craving went away, "the hungries are gone", and their excess weight started to drop.
Stated in his book "Functional Approach to Hypothyroidism" page 12
I've also changed over to taking my NDT with food. Dr Peatfield put me onto Metavive, which, as far as I'm concerned is a form of NDT. He said that it is better for the stomach to take it with food.
I take half while I'm preparing breakfast and the rest as I start lunch. I find it's so much simpler and more convenient. I don't have to think about leaving time before and after meds. It doesn't matter what time I have my mid morning tea and biscuit.
I think the food acts as a buffer and spreads out the effects of the meds. I can't say I've lost weight, but I've stopped putting it on.
I know there are arguments about not absorbing the same amount each day due to what food you take with it. On the other hand our needs vary depending upon activity, hot or cold weather etc so these are all variables.
I've read Ken Blanchard's books and I'm sure he's right that we have not evolved to put thyroid hormones in direct contact with our stomach walls. I wonder what other medications this might apply to.
in reply to Anthea55
Great that all makes complete sense to me! Thank you.
researcherUK in reply to
You are welcome!
in reply to Anthea55
It's midnight here and am browsing thru posts. Found this thread interesting because i"ve been taking levo since 1984-setting my alarm for 5am taking the med on a empty stomach then going back to sleep. ALWAYS wake up about 7am with a stomach ache. Have thought it might be medicine and couldn't figure out which one but now I am on very few meds which I take later in the day. Have come to the conclusion it's the levo. As a nurse we have been taught never to take thyroid with food but now I've started eating a small amt with levo as I am very tired of the morning stomach ache. Sometimes facts get ingrained in medicine and the original reason for the rule becomes lost in time. It's just the 11th commandment-"Don't take thyroid with food." I would love to know the original rationale for these directions. Might it be that the pharma company that made the first levo pill coated it so well it needed stomach acid to dissolove? Are we all forced to take this med in ways that make many uncomfortable because one Big Pharma company chose to manufacture it in a way that made absorption more difficult? Just a thought!! I don't eat a huge breakfast but I often take it with a scrambled egg. Could the manufacturing process be driving needless discomfort? Interested in what others think. Maybe it's time Big Pharma accommodated us instead of the other way around. Just thinking outside the box.
researcherUK in reply to
Those directions originated by Pharma after they have done their own tests and then released the product.
Here is a link to studies that have further investigated the interactions of Levo with other drugs, hormones, and the two elements iron and calcium. sciencedirect.com/topics/ne...
in reply to researcherUK
Hi Researcher. Thanks for the website. Pulled it up, good info, and registered. Seems like a good source for many topics and wasn't aware of this site. From what I read, I should probably go back to 'empty stomach' levo dosing. I have an endo appt with new endo this Fri. I hope it is productive as I haven't had a thyroid workup in 3 years. I have been letting my GP (PCP here in US) handle my thyroid tssues and I feel she has been lax. It's difficult to get her to order tests. I feel this is a 'sideline' for her. There is a lot of good info here- sometimes too much for me right now. I usually can understand and coordinate health info but right now I am so tired, rundown, and beset by brainfog and other thyroid sx am just hanging on til my appt. I do have a good question list based on this forum which I am prepared to do battle to get answered. I am a retired nurse and normally am on top of my medical issues. Have been dealing with a-fib issues for sometime but now that is rolling along smoothly so it is' "thyroid time". Thanks for helping me. For sometime, I have believed that many of my problems are thyroid related. I just want to get to the appt and collapse in his chair; hopefully leaving with some good care in place. I'm really worn out with our healthcare system in general. The exception is my EP who takes good care of me and has helped me find this endo. I'm rambling. Thanks for listening. Take care. irina PS One thing I want to do is get my tsh lower. Currently it is 2.6 and creeping up. It has been higher. I have had a successful ablation and currently have a pacemaker that keeps my rate at 70 so a low tsh is not a problem for Will post test results when I get the, Right now I have no other results to share.me. I just want to feel better.
researcherUK in reply to
You are very welcome and anytime! Just focus on getting well!
in reply to researcherUK
Thank you.
Daffers123 in reply to
I am now wondering if taking the Levo on an empty stomach is causing my gastric troubles..for 10 years I took it with coffee/breakfast without any trouble. Since reading the 'empty stomach' stuff my gut has got worse and worse..am being checked for gastritis/gall bladder at moment. Have been looking at what contents of regular meds are (only Levo and Mirt at night)...but very interesting about Big Pharma now tuckering us up with Omeprazole etc. to sort out acid problems caused by Levo- its a win for them anyway
in reply to Daffers123
Hi Daffers, Researcher sent me an interesting website, (listed 2 posts down). After reading I've decided to go back to the 'empty stomach' route. I still don't like the morning tummy ache but want to feel better. I have decided to ask my doc Fri. about switching from generic to brand name Synthroid. Might make a difference from getting different generic brands with different fillers when I refill. Worth a try. It will cost me a higher copay but not exhorbitant. My neighbor told me she switched to Synthroid brand some time ago and has had no side effects. Maybe she's on to something. Hope this helps. Check out Researcher's website. It's got lots of info and isn't just only for thyroid.
in reply to Daffers123
Hi Daffers. I forgot something. I refuse to take any PPI's (Omeprazole, etc.) But I use an old-fashioned remedy my mother used for tummy aches and also if you have gastric reflux. I do this sometimes in the morn. Don't know why but it works. Take a teaspoon of plain yellow mustard. Just swallow and then sip a little water. Not so bad as remedies go and the ache (for me) is gone in about 15 minutes. Don't use fancy mustard-like horseradish or something-just plain yellow. My mother was the master of home remedies! LOL. Try it.
Hi Researcher, I had been thinking about posting that quote from Dr Blanchard. So glad you raised it.
Just want to make sure you see the recent reply from Irina1975 which you will find a little further down. As she replied to me (which was my reply to you...) you may not have been notified.
She has been getting stomach ache about 2 hours after taking levo ever since 1984. She wonders why we've been advised not to take levo with food.
Thanks very much, Anthea. Yes, I had not seen Irina's reply or be notified about it but I have now replied.
My Endo once asked me " When do you take your medication" ?......."About 6.15am"
" Why do you take it so early"? "Because I have breakfast at 7.15 am" " You don't need to take it an hour ahead.It will be absorbed within 20-30 minutes.You better take some extra T3 in the afternoon".
I have never asked for extra T 3 being mindful of the cost,but am much more relaxed about timing now.I just take meds as I get up in the morning and breakfast as soon as I'm downstairs and I've prepared it. I must admit I can easily dose off in the afternoons in front of TV but at 76 years old that's not an issue !! 😊
I have always taken it early and nothing to eat for an hour from when I heard that's what I should be doing so many years not but if I oversleep or run out of time to eat so bring food forward I done feel as good though I sometimes wonder if that's all in my head!
What an interesting discussion 😉
in reply to TSH110
And maybe one that could use some updated research and guidelines to enhance patient comfort!
helvellaAdministratorThyroid UK
The problems with taking thyroid hormone (specifically levothyroxine, we don't have sufficient research about liothyronine) alongside food are:
Food interacts with levothyroxine. The amount that interacts is bound to be variable. The strength of that interaction is bound to be variable.
One of the most certain interactions is with iron compounds. One common breakfast food is a bowl of cereal. One fairly common cereal product is Special K.
A standard serving of standard Special K contains 3.5 milligrams of iron. A fairly common dose of levothyroxine is 100 micrograms. So we actually have 350 micrograms of iron available to react with each microgram of levothyroxine. That is a large ratio!
So, because of this interaction, people who eat their bowl of Special K and take their levothyroxine at the same time compensate. They might end up taking 150 micrograms of levothyroxine to effectively be on the same effective dose as someone taking 100 micrograms away from food.
Next week, however, they do any of the following:
Try a weight loss diet that skips breakfast.
Choose a cereal that is not fortified with iron.
Delay their levothyroxine because they are having a blood test.
Go on holiday and have breakfast much later - but keep taking their levothyroxine at the same time.
Get ill and be unable to face breakfast.
Each of those could have a significant impact on total levothyroxine available to be absorbed just on the basis of the iron interaction.
It is all very well saying that thyroid hormones coming into contact with the stomach wall is a relatively new phenomenon. But absorbing our full requirement of thyroid hormones through any part of our guts is a new thing.
Levothyroxine is only very poorly soluble in water and solutions. It is markedly less soluble in acidic solutions (stomach) than alkaline (intestine). How much actually can really contact the stomach wall?
The use of food to ensure the thyroid hormone doesn't come into contact with the stomach wall quite possibly also ensures that more goes straight past the parts of the gut which do absorb levothyroxine. Resulting in a higher thyroid hormone level in the lower gut with whatever effect that has.
I go back to my personal favourite suggestion for thyroid hormone dosing: an implantable device that releases thyroid hormone into the bloodstream in microscopic doses. Avoiding gut entirely.
For now, I shall continue to take my levothyroxine at bed time with a glass of water - and continue to sleep well (I hope!)
in reply to helvella
I have found your post interesting helvella.I'm having to think back to 2014 when I first went to see my Endo.He added 10mcgs T3 to my 100/75 mcgs thyroxine. I do remember him saying at some stage that he was not adverse to meds being taken at night. I could be quite keen to take mine at bedtime too. It would be interesting to see how that worked out,especially with the T3.I wonder if there would be any merit in splitting it: Levothyroxine at bedtime and T3 in the morning? I want to get the maximum benefit from the T3 and it is only a small dose.Any comments would be welcome.
.
Iron is absorbed the best on an empty stomach. Yet, iron supplements can cause stomach cramps, nausea, and diarrhea in some people. You may need to take iron with a small amount of food to avoid this problem. Milk, calcium and antacids should NOT be taken at the same time as iron supplements.May 21, 2017. It seems odd to me that iron is in cereal taken with dairy milk.
Remember that iron added to breakfast cereal is a marketing issue. The manufacturer can claim that a bowl of their cereal contains 50% (or whatever) of a person's daily requirement of iron. The manufacturer doesn't actually have to demonstrate it is effectively absorbed.
in reply to miglet54
Hi miglet. Fortifying foods with vitamins and minerals (and whatever else big companies think will help promote their product) is a BIG marketing tool in the US (I live in Georgia (US). Adding iron to a food that is usually eaten with dairy shows how little thought or regulation goes into this marketing ploy. Some added substances, IMO, don't make any sense at all. There is no standard about how the substance is added or if, indeed, it has any nutritional value left by the time it is mixed with the food. I never buy any fortified foods, and try to limit processed foods also. I read labels and sometime ago saw a jar of peanut butter that said in big letters 'contains omega 3'. Out of curiosity I read the label and the omega 3 came from 'fish cartilage.' I don't know about anyone else but I don't want fish cartilage in my peanut butter. There is no way to determine where the fortified substance came from, how it was processed into the food, or how much was added. In my opinion, I believe it's best to leave these 'hyped products' on the shelf; buy your food with the least amount of any kind of additives. And choose the simplest close to nature products as possible. US food is much more 'adulterated' than imported similar items. Marketing is king over here. I say leave the fortified foods on the shelf. If you need an supplement, find the best one for your problem, and keep it separate from your purchased food. 'BIG CORPORATION FOOD' is 'BIG PHARMA'S' first cousin. Just my opinion. Your question is a good one.
I agree about the device - after all, they have almost managed similar for diabetics
...and contraception
As a former patient of Dr. Blanchard (God rest his sweet, sweet soul), and now a patient of his predecessor, Dr. Rachel Katz, I've always taken my thyroid meds with food.
I take Levothyroxine in the afternoon (typically 5:00pm, along with a small snack of raw nuts or crackers, but it could easily be rice cakes, toast, fruit, cheese, etc.), When I was taking thyroid extract (compounded capsules of slo-release T3), I did that in the am with my breakfast (times varied). I've never had the dreaded weight gain so many patients experience while on his protocol.
Dr. B's thinking was that IF there were any absorption lags (which would show in blood work as well as in how the patient reported back on how they were feeling), it usually was very slight and could easily be rectified with increasing the dosage accordingly.
Dr. B was a progressive thinker who actually listened and learned from his patients. He saved my life, my sanity and I will always be grateful.
That's very interesting!
Thanks for sharing - brilliant bit of info straight from the horse's mouth
What are you taking now? Only levo or low dose t3 too?
I currently take 100mcg Tirosint (Levothyroxine) daily. Next week I will be adding in a small amount of custom compounded T3 transdermal cream since I was experiencing side effects to the filler ingredients in the slo-release compounded T3 capsules and had to stop. Fingers crossed the small amount of T3 will provide a bit of energy boost.
Hello milkwoman
I read Dr Blanchard's book, Functional Approach to Hypothyroidism and I plan to buy his other book too, have been really inspired by his book and what he says he learned in his years of practice. I have been struggling, like so many to regulate my thyroid levels. I have been doing as much scouring of the internet as I can to find information on Dr Blanchard and how he treated his patients. Right now I am on Tirosint 150 and 5 mcg of Liothyronine. I have been down the road of Levo only, then trying NDT and trying to mix levo and NDT, it has just been a mess. I decided I needed to just start over and at least go more back to where I started and wasn't quite so messed up. And that was starting over with Levo but with Tirosint. Anyways it is a long story I am sure just like everyone else. I was tired on T4 only and I don't convert well so I know I need some T3, It seems the more T4 I take the less T3 my body feels ok on, but the less T4 I take and the more T3 I am just riding a yoyo all day. I have struggled with my body liking the T3 always going from hypo to hyper back to hypo in a matter of hours. I definitely feel more steady and solid with a good T4 dose which leads me to want to try Dr Blanchard's way of dosing the T3. I go in for a recheck on my labs next week and I am hoping to talk to my doctor about possibly trying a small slow release dose of T3, but I saw your post about the transdermal cream and I am curious if you have had a chance to try it and if it is working for you, how you feel on it and possibly what it costs you. Sorry this got to be longer than I anticipated. Thank you 
Hi - I didn’t feel any better on the T3 cream so my conclusion is that using only T4 (levothyroxine in the form of Tirosint) is currently the way to go for me.
I recently received the results of a slew of functional medicine tests and, tho I’m still digesting them, the results show I have adrenal insufficiency (low cortisol), leaky gut, gut bacterial imbalance, low values in some key vitamins/minerals and I don’t process proteins and fats well.
So the next step is to get all that sorted. If after that I’m still not optimal on my thyroid health, I will revisit.
I hope you find the answers you are seeking! Hormone balance is sooooo complicated and there is no one solution. I thought for sure by now I’d have a handle on things but it seems to be one thing after another. I’m still hopeful that one day I will get there.
Thank you, I hope you get it straighten out. I too have lowish cortisol, which makes all of this that much harder to figure out. I just finished a round of treatment for SIBO myself. I know getting that treated helped my gut function ALOT. Although I am scared it will come back I have thought about getting some Oil of Oregano and taking that for a while to possibly keep the SIBO in check. Have you ever heard of this book? thyroidpharmacist.com/book/ Dr Isabella Wendtz? You probably have if you have been struggling with this for a while as well. I just wanted to mention it to you if not. Alot of very good information about gut health, vitamins and nutrients etc. I wish you well. Thank you for the reply
My test for SIBO came back negative which actually surprised me since I was certain I had it.
I have not read that book. I will take a peek. I am finding that at times, I’m easily overwhelned by information do I have to be in the right frame of mind to do so. Still reeling from all the test results and not exactly sure what to do first. Clarity will come (I hope!)
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