NDT with or without food

[adin]

I saw different opinions on the subject. What do you think, it can be taken with coffee and food or it is good to wait a little until I take the dose ?

[SeasideSusie Remembering]

I don't take NDT, but as you've already discovered there are different opinions. Personally, if I did take it, I would err on the side of caution as I wouldn't want anything at all to interfere with my thyroid meds so I would take it the same as is advised for Levo - take on an empty stomach, one hour before or two hours after food, with water only or water only either side, and 2 hours away from other meds and supplements (bearing in mind that some need 4 hours).

If you are buying it yourself it's expensive and not always easy to obtain so why risk wasting any by potentially having to take more than you may otherwise need if absorption is affected by taking too close to food or other drinks except water.

[shaws Administrator]

Food can interfere with the uptake of thyroid hormones so it would not be a good idea to take it shortly after or shortly before eating. If food interferes with the uptake of thyroid hormones you may not be able to get to an 'optimum dose'.

Some people may take their dose if they awake during the night (maybe to go to the toilet as one of TUK's Advisers did) this ensured that nothing could interfere with its uptake in the middle of the night.

[Heloise]

Hi Adin, It's complicated if you follow all the advice; four hours between calcium or iron, one hour before any food, two hours after food, etc. Taking it at bedtime assuming you don't eat food at that time seems to work well and avoid the issues. It did for me. Others may disagree. Even if you have taken your ndt near food it's been said to possibly reduce the dose by about 20% which you can consider. Whatever you can comply with is probably the biggest part of the decision.

[Miffie]

When I started on ndt in 1960 we were just told to take the prescribed dose daily. Since then there have been lots of changes to hypothyroid treatment. However I choose to be cautious and take my ndt in the early hours when up to spend a penny. Usually around 5:00am. It makes life so much easier.

[shaws Administrator in reply to Miffie]

One of TUK's Advisers also followed your method and he was also a researcher, doctor and expert in the use of thyroid hormones. He only prescribed NDTs or T3. He himself took a large dose of T3 due to him gaving 'thyroid hormone resistance'.

[goodoldan]

How many folks do well with just one daily dose of NDT? Seems like quite a few recommend dividing the daily dose into two doses, about 6-8 hours apart. That makes all of the time before/after food and other meds rules pretty difficult to manage.

[shaws Administrator in reply to goodoldan]

One of TUK's advisers (deceased through an accident) always took his dose of T3 in the middle of the night with one glass of water when he awoke so that nothing interfered with its uptake. He only prescribed T3 for patients who had 'thyroid hormone resistance' or NDTs (natural dessicated thyroid hormones for those who didn't have resistance) the very original thyroid hormone replacements from 1892 onwards. Before 1892 we just died.

healthunlocked.com/thyroidu...

[adin in reply to shaws]

Hm, I didn't try to take the ndt or t3 in the middle of the night(at 3am) but I'm afraid I wouldn't be able to sleep afterward.

[shaws Administrator in reply to adin]

I take T3 only.

I take it when I awake with one full glass of waterand wait an hour before I eat. I found that easy to do. I feel well and have no symptoms.

[Alanna012 in reply to goodoldan]

I've recently been told by a private doc that you can take NDT once a day if necessary. Interestingly I have a bottle of Armour half grain and the instructions say take once in the morning.

[shaws Administrator in reply to Alanna012]

All thyroid hormones can be taken once daily and I agree with your doctor.

I've never split doses as we want our 'life' to be as normal as possible as we'd have to ensure stomach was empty before and after swallowing T3 or NDT or levo. Dr Lowe stated that thyroid hormone replacements should saturate all of our receptor cells and it then 'sends out waves' throughout the day.

Taking thyroid hormones once daily (stomach should be empty) with a glass of water makes our lives more normal and we have to allow at least an hour to elapse before we eat.

When I was on NDT I took it when I awoke with one glass of water and by the time I got ready an approx hour hds lapsed and I then had breakfast.

[goodoldan in reply to Alanna012]

I see the same instructions for NP Thyroid... once daily. Go figure. If you can manage the timing around meals and such, I suppose splitting the daily dose (early morning and mid-afternoon) does even things out throughout the day.

[shaws Administrator]

Some people may take NDTs with food but I doubt they will get the full benefit of the NDT. The reason being that thyroid hormones have to saturate our T3 receptor cells and then it's work begins. This is an excerpt from the following link:-

"You need to be aware of these food and drug interactions and ensure that you either take them a few hours away from taking your thyroid medication or make sure that, if they decrease your levels, you increase your dosage. Make sure you have regular thyroid function tests if you start taking any new drugs or supplements and be guided by your clinician.

thyroiduk.org/food-and-drug...

Ideally we take any thyroid hormone replacements on an empty stomach with one full glass of water and wait an hour before we eat.

[Anthea55]

Hi Adin

I take my thyroid pills with food. I was told to do this by Dr Peatfield who said it was better for the stomach.

I split my NDT between breakfast and lunch. I usually take it just before my meal. I don't take tea or coffee with these meals, but I have it mid morning and afternoon.

One advantage of this method is that it's much simpler - no counting time. Really helpful for people with busy lives.

Taking meds with food is also recommended by Dr Kenneth Blanchard in his book "The Functional Approach to Hypothyroidism". He says that there may be a slight reduction in absorption, but in his experience it is surprisingly uncommon. Another of his comments is that "thyroid hormone contacting the stomach wall has never occurred in the evolution of the human race until we started taking oral thyroid about a century ago".

Dr Blanchard is also quoted by Dr Myhill on this page from her website.

drmyhill.co.uk/wiki/Thyroid...

See the section headed 'Timing of Dosing', where she says "Thyroid hormones should be taken with food".

I should add that Dr Peatfield was appreciated by many people on this forum. Dr Sarah Myhill is one of the Thyroid UK medical advisors.

[adin in reply to Anthea55]

Hi,I doubt that the absorption of the dose is complete, especially since I have a large dose to take (3grain+some levo). 3 grains is hard to split in two so I try in 3 (1,5+1+0,5). I have a big problem with ndt, my joint hurts, I think because of too much t3.

[radd in reply to adin]

adin,

As Anthea55 has already said Dr Blanchard had an interesting take on consuming thyroid meds with food. He said it helped prevent thyroid hormones contacting the gut walls that risked effecting leptin & insulin levels and inviting weight gain.

I must admit I haven't been brave enough to try his method, and take mine am & pm on an empty stomach.

[adin in reply to radd]

Hm, 🧐you said an interesting thing.

"He said it helped prevent thyroid hormones contacting the gut walls that risked affecting leptin & insulin levels and inviting weight gain. "

I don't know if it's related, but that's exactly what happens to me, after taking the dose on an empty stomach I feel bloated. So, I will try to take with food.

[Hidden in reply to adin]

It´s interesting that many people with hypothyroidism have insulin and/or leptin resistance. I am not sure how often the latter is routinely checked, but some doctors claim that leptin resistance could be the reason you are not losing weight but instead gaining, even after you go on thyroid hormone replacement. But, more open-minded doctors (often docs prescibing NDT/T3) tend to claim we end up with insulin and/or leptin resistance because of inadequately treated (levo only) hypothyroidism, not because of thyroid hormone replacement being taken on an empty stomach...so it´s a really interesting thought. All I know is that I always took levo at least one hour before eating or drinking anything except water, and my insulin resistance got worse and worse on it...leading to more and more weight gain. I never had leptin levels checked, though, as I have yet to see a doctor who knows anything about it...!

[Anthea55 in reply to adin]

Hi Adin, all I'm saying is that taking hormones with food is recommended. The way you make this work is up to you - I do it twice a day as I've said.

If your joints hurt, this can be caused by food intolerances. Have you tried going gluten free?

[adin in reply to Anthea55]

I don't think it's related to gluten, I think it has to do with too much t3, is one of the side effects of t3. If I divide my3grain into 3doses the pains diminish almost to disappearance, on the other hand, if I take the whole dose, my knees and wrists start to hurt.

mayoclinic.org/drugs-supple...

[helvella Administrator in reply to Anthea55]

The argument against taking with food is the interaction between many substances present.

You could imagine two extremes:

Breakfast consisting of a cereal with iron fortification and milk, followed by egg and bacon.

OR

A glass of orange juice and a small piece of fruit.

The first, we could suspect of binding to levothyroxine and reducing the total absorbable. The second, we might even suspect of enhancing absorption as against an empty stomach.

If you know you will always have the same breakfast, then it is arguable. But even switching make of cereal could be significant. Two similar products - one is fortified with iron, the other not.

This problem of consistency is at the heart of the issue. Consistent empty stomach is relatively easy. Consistent stomach contents is rather more difficult.

[Anthea55 in reply to helvella]

Hi Helvella, I appreciate your logic for consistency of dose. However, the amounts we need and use up will vary depending upon our activity such as going for a walk or run or sitting in front of the TV or computer - not much we can do about that.

I also think it may be helpful for people who find that they get stomach pains after taking thyroid meds.

[Hidden in reply to Anthea55]

This doctor also recommends taking NDT with food (although he advocates taking it twice daily):

westonaprice.org/health-top...

[Anthea55 in reply to Hidden]

Hi PurpleCat, that's really interesting. Here's a quote from your link. He's suggesting taking after meals which I hadn't thought of before.

"The major shift in thinking for most physicians is to recognize that desiccated thyroid hormone should be taken not just once a day, but at least twice daily after meals. An alternative would be dosages taken three times daily (every eight hours) without regard to meal times"

Give me time to read the rest of it! More info there.

[Hidden in reply to Anthea55]

Yes, it´s a good article I think. There is a lot of food for thought (no pun intended)

The reason he recommends taking NDT at least twice daily is to spread out the effects of T3. But I would imagine that taking NDT after meals also slows down absorption, possibly causing less spikes in T3 levels...?

[waveylines]

I take my ndt first thing in the morning and wait an hour before having breakfast. I used to split it into two doses and at one point three but once my b12 level was optimised found I didn't need to do that anymore. Making sure your vits and minerals are optimised is equally important.

[Hidden]

Some people take it with food/coffee and just take more to compensate for decreased absorption. If you have to take a drug every day for the rest of your life, it´s important to find a way that works for you. But consistency is important - if you take it with food, you should always take it with it with food, or absorption will vary.