Which order should i take supplements?

[jonbon000]

Ive been diagnosed HYPO

Im currently on 125/150 levothyroxine which take at night to avoid any other interactions.

Supplements i'm taking

d3 1000ui*7 (7000ui weekly dose)

vitamin k 200ug

omega 3 fish oil 1000 mg

Selium 200ug

b12 2000 ug

Iron20 mg+ 40mg vitamin C

Magnesium l-thronate 500mg

Im waiting on b complex to arrive in the post

cheers for any advise

[SeasideSusie Remembering]

jonbon000

Iron should be taken 2 hours away from all other supplements and 4 hours away from thyroid meds.

B vitamins should be taken 2 hours away from thyroid meds and no later than lunchtime, this is because they can be stimulating and if taken later in the day can disturb sleep.

No Vit C within 2 hours either side of B12.

Vit D should be taken 4 hours away from thyroid meds. This is a fat soluble vitamin so should be taken with some dietary fat (fattiest meal of the day or chunk of cheese or full fat yogurt, etc). If oral spray can be taken any time.

Vit K should be taken 2 hours away from thyroid meds. This is another fat soluble vitamin so will compete for fat if taken at the same time as Vit D so maybe take at opposite ends of the day. Needs dietary fat to be absorbed.

Selenium 2 hours away from thyroid meds.

Magnesium 4 hours away from thyroid meds and is best taken in the evening as it is calming and may make you too relaxed/drowsy if taken in the daytime.

You might find this article useful, click through the different slides.

webmd.com/vitamins-and-supp...

**

I'm just wondering a few things though.

d3 1000ui*7 (7000ui weekly dose)

You told us in your last post

25-OH Vitamin D 32 nmol/L.

Different areas have different levels for deficiency. In some areas it's 25nmol/L and in others it's 30nmol/L. So you are very, very close to deficiency and 1,000iu D3 daily is not going to help, that's just a maintenance dose for someone who already has a good level. What you really need to do is follow the NICE guidelines for deficiency ify our GP wont prescribe loading doses:

NICE treatment summary for Vit D deficiency: cks.nice.org.uk/vitamin-d-d...

(click on Management > Scenario:Management)

"Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 25 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.

* Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

You can either follow that or take 5,000iu D3 daily to speed up your improvement.

The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L. Once you've reached this level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3. There is no real need for you to take 200mcg daily, I would take your K2-MK7 on alternate days.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

From previous post:

Vitamin B12 208 ng/L 120 - 650

Did you check for signs of B12 deficiency:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

Did you get tested for B12 deficiency and Pernicious Anaemia?

Iron20 mg+ 40mg vitamin C

From previous post:

Serum Ferritin. 61 ng/mL 24 - 336

A ferritin level of 61 is unlikely to be iron deficiency. Have you done an iron panel to see if you have iron deficiency? Your full blood count posted previously doesn't show anaemia. If you haven't done an iron panel you wont know your serum iron level, if it's already good and you take iron tablets then it will take your serum iron level too high and too much iron is as bad as too little. If your serum iron is good then the way to raise ferritin is through diet, eg regularly eating liver (200g per week maximum due to high Vit A content), liver pate, black pudding, etc.

[Baggiesfan in reply to SeasideSusie]

Sorry to jump on post but I take my magnesium as I go to bed, often 10pm but I usually take my 2nd T3 about 7pm so only 3 hours. Is this so bad and shall I try to take earlier. It's difficult to get the timing right and eat too as evening meal about 6pm.

[SeasideSusie Remembering in reply to Baggiesfan]

Some people say that T3 isn't as fussy as Levo so the time gap may not be as crucial, so it's up to you.

[jonbon000 in reply to SeasideSusie]

Hi seaside suzi,

thanks so much for your feedback

On your queries

On my Test results it states 25-OH Vitamin D 32 nmol/L.

(<25 nmol/L: Deficient,25-50 nmol/L: Insufficient)

Im current taking altivta d3 on a weekly dose of 7000 iu.

would it be better to get a daily dose or does it matter ?

So more less my weekly dose should be a daily does , Ive a feeling I wont convince my Gp to raise my prescription on that one.

Vitamin B12 - 208 ng/L which on the lower end of the scale 120 - 650

My main symptoms are relating to pins and needles an tingle itchy skin, brain fog, memory loss and they tend to fluctuate Im guessing that if i increase my b12 that they might resolve.

I waiting to see my doctor about Pernicious Anemia. my next appointment at very earliest is next week.If i did have it, wouldn't my B12 be alot lower ?

I assumed ferritin was Iron ?Schoolboy error Im fond of liver its so hard to get in my super market.I'll have venture further field .

[SeasideSusie Remembering in reply to jonbon000]

johnbon000

On my Test results it states 25-OH Vitamin D 32 nmol/L.

(<25 nmol/L: Deficient,25-50 nmol/L: Insufficient)

Im current taking altivta d3 on a weekly dose of 7000 iu.

would it be better to get a daily dose or does it matter ?

So more less my weekly dose should be a daily does , Ive a feeling I wont convince my Gp to raise my prescription on that one.

So you're a little above deficiency.

I've just checked out my link (which no longer works) and on finding the new guidelines I have noticed that they changed them in September 2021 which explains why your GP has given you such a low dose. The new guidelines state:

If rapid correction of vitamin D deficiency is needed, for example in people with symptoms or about to start treatment with a potent antiresorptive agent (zoledronate, denosumab, or teriparatide), prescribe a fixed loading dose followed by regular maintenance vitamin D therapy 1 month after loading.

The loading regimen should provide a total of approximately 300,000 international units (IU) of vitamin D, given either as separate weekly or daily doses over 6–10 weeks. See the section on Loading dose regimens in Prescribing information for more detailed information.

Maintenance therapy of vitamin D equivalent to 800–2000 IU daily (up to a maximum of 4000 IU daily for certain conditions such as malabsorption following specialist advice), given either daily or intermittently at a higher equivalent dose.....

If correction of vitamin D deficiency is less urgent and when co-prescribing vitamin D supplements with an oral antiresorptive agent, maintenance therapy (800–2000 IU daily) may be started without the use of loading doses.

I really don't understand why they would lower the dose and create a long and very drawn out recovery from deficiency, making the patient suffer longer than necessary. However, it is the same sadistic approach they put on thyroid treatment so I shouldn't really be surprised.

I treated my own severe Vit D deficiency of 15nmol/L using Doctor's Best softgels. In 2.5 months my level was 202nmol/L and now I maintain it as close to 150nmol/L as possible, still using Doctor's Best.

It's up to you what you do. Personally I would just buy my own D3, take 5,000iu and get on with getting your level up as quickly as possible. All the information you need is in my first reply if you want to do that.

Vitamin B12 - 208 ng/L which on the lower end of the scale 120 - 650

My main symptoms are relating to pins and needles an tingle itchy skin, brain fog, memory loss and they tend to fluctuate Im guessing that if i increase my b12 that they might resolve.

I waiting to see my doctor about Pernicious Anemia. my next appointment at very earliest is next week.If i did have it, wouldn't my B12 be alot lower ?

Many, many people with a B12 level in the 300s have been found to need B12 injections. With B12 it's not the numbers that are important, it's the symptoms that should take precedence over the result. From the current B12 deficiency guidelines (you could read through all the topics)

cks.nice.org.uk/topics/anae...

How should I interpret investigation results?

Vitamin B12 level — interpret the results of the serum cobalamin test taking into account clinical symptoms, other laboratory findings and the following limitations:

The clinically normal level for cobalamin is unclear, although it is thought that serum cobalamin of less than 200 nanograms/L (148 picomol/L) is sensitive enough to diagnose 97% of people with vitamin B12 deficiency.

If you have Pernicious Anaemia then this affects absorption of nutrients, so it's important to test for this if you have symptoms.

I assumed ferritin was Iron ?Schoolboy error Im fond of liver its so hard to get in my super market.I'll have venture further field .

Ferritin is your iron store, it's a protein that stores iron and releases it when the body needs it. A ferritin level less than 30ug/L is classed as diagnostic of iron deficiency but an iron panel would be needed to confirm it.

Any butcher should be able to sell you liver. I live in a rural area and it's delivered weekly to our butcher. Lamb's liver is often the one most easily available, it's mild tasting. Chicken liver is also mild. Ox liver is the strongest I think. You're probably more likely to get British liver from a butcher whereas some supermarkets sell imported liver.

[jonbon000 in reply to SeasideSusie]

Thanks for you help i appreciate ..I will say to my doc about the d3 increase but my gut is telling me that i'm not goin to get what i ask for.so ill take your advice and source it myself .I wont find many butchers selling british liver in my parts I assume Irish liver will do as I live the emerald isle thanks Susie

[SeasideSusie Remembering in reply to jonbon000]

I'm sure that Irish liver is every bit as good as British liver, it may be even better, after all Kerrygold butter is the best in my opinion

[jonbon000 in reply to SeasideSusie]

Kerrygold butter was the best ..now that im hypo it gone down the charts