Sarah Myhill and Dr Blanchard are proponents of taking thyroid replacement with meals

[Noelnoel]

Not sure who Dr Blanchard is/was but apparently Sarah Myhill agrees with his theory on taking thyroid replacement with/after meals

Does anyone have any experience of this or can provide any links to this theory?

Thanks

[helvella Administrator Thyroid UK]

This has been discussed a few times (and it is fine to discuss again!)

My problem is one of consistency. If your diet varies, your absorption might well vary simply due to the food present.

For example, breakfast with milk, iron-fortified cereal, tea and toast might have a significant impact due to calcium, iron, tannins, and indeed, any cereals (bowl type and bread).

Whereas just bacon and egg, or fruit only, might have minimal impact - or even improve absorption!

If we were testing very frequently, we could adjust. But with many only getting tested once a year, that means we could go months without seeing a test result to alert us.

[Noelnoel in reply to helvella]

That’s a fair point Hellvella

[TiggerMe]

Dr Myhill advocates a keto diet so presumably that is part of her reasoning? As Helvella says it surely must depend on what else your stomach is dealing with at the time?

[SarahJane1471]

Is it possible that taking with food could help prevent that midday slump because it absorbs slowly?

Just a thoughts 💭

[Noelnoel in reply to SarahJane1471]

Thata also a fair point!

[Lalatoot]

Dr Ken Blanchard doesn't advocate this for everyone and he admits that taking it with food may require a higher dose of T4 to make up for the malabsorption though he states that this is uncommon though he has seen patients become underdosed because of this.

He bases his idea of taking it with food on his observations of his patients. He says that many gain weight and that when folks take their T4 meds as they immediately have cravings and feel hungry. He wonders if this is the effect of the T4 coming into contact with the walls of an empty stomach altering the production of of leptin and ghrelinn, which are known to affect weight in humans. He says:

" I had such patients take their T4 with food and most of them reported that the hungriest are gone."

'The Functional Approach to Hypothyroidism' Kenneth R Blanchard ISBN 978 -1- 57826 - 387 - 551500

[helvella Administrator Thyroid UK in reply to Lalatoot]

I take my levothyroxine at bedtime. And do not feel cravings for food either immediately or through the night.

(Mostly, I sleep through. And the most frequent reason for getting up at any time is for a drink of water. Not frequent but if I were feeling hungry, I'd notice.)

As usual, one observation does not constitute proof!

[TSH110 in reply to helvella]

I dont feel like eating till 2pm even tho I get up for work at 5am. It makes no difference if I take meds first thing or at night. I just follow my inclination. I can’t see the point of eating if you have no appetite.

[Eliota in reply to Lalatoot]

Wow. This is fascinating. Thanks for sharing.

[shaws Administrator]

I don't split dose of T3 as I take full dose with one glass of water when I awake. I then wait one hour before I eat. I also feel well and have no symptoms.

I am fortunate that T3 has resolved all of the clinical symptoms and I feel my health is 'normal'.

I follow the method advised by Dr John Lowe (RIP) who was a scientist/doctor also an Adviser to Thyroiduk before his death caused by an accident. He stated that one daily dose saturated all of the T3 receptor cells and the 'effect' sends out 'waves' that can last up to three days.

I trialled this myself i.e. took one dose on first day, none on day 2 or day 3 and I still felt fine and now I take one daily dose when I awake..

[jimh111 in reply to shaws]

Dr Lowe mainly dealt with cases of severe hypothyroidism that needed high doses of T3. In this case what he says is reasonable but in general I would suggest splitting doses to mimic the way we normally secrete T3. Dr Lowe was trying to overcome a form resistance to thyroid hormone and I suspect things behave very differently in these cases. Unfortunately he died just before I could discuss my ideas on endocrine disruption with him.

[shaws Administrator in reply to jimh111]

I've not changed how I take T3 for a number ofl years now and am fortunate to have all symptoms relieved by a low dose.

Dr Lowe also stated that the effect of one daily dose of T3 could last up to three days.

On levothyroxine it was an awful experience (for my husband as well as myself ) as it gave me terrible palpitations - particularly during the night - and a cardiologist had to record them to try to 'see what was going on'. I also had to sip ice-cold water and wrap a frozen towel around my neck to try to control them.

It is a welcome relief to have my symptoms relieved and It also means we have a more 'normal' life.

[jimh111 in reply to shaws]

Doctors confuse 'pharmacokinetics' with 'pharmacodynamics'. The latter looks at how long the effects of the drug last. So, although much of the T3 may disappear from the blood it is still working its way to the cell nucleus, once there thyroid hormone receptors need to be saturated in T3 for several hours before they respond.

Then we have to consider the effects of thyroid hormone. Some things like cognitive function seem to respond quickly to T3 whilst others such as bone formation take a very long time.

Water has a very short half-life, half of it is eliminated within a few hours. Yet we can have a drink in the evening and be fine until the next day. Strangly endocrinologists do not call for a ban on drinking water due to its very short half life. Nor do they have problems prescribing carbimazole which has a five hour half-life.

[Pearlteapot in reply to jimh111]

does the need to saturate the cell nucleus suggest that it may be better not to split a dose? I am on 10mcg which I take in two tiny 5 mcg crumbs one at 7am and the other at 2pm. Maybe if I took it all at once I might have a better chance at saturating the cells before it leaves my blood?

[jimh111 in reply to Pearlteapot]

I don't think so. In health we have fairly steady T3 levels and Dr Lowe was talking about quite severe cases where they may take e.g. 100 mcg T3.

[Lotika in reply to Pearlteapot]

I get a better effect by taking 10 mcg T3 together; I think we’re all different! It’s worth a try to see whether it helps you.

[shaws Administrator in reply to jimh111]

Dr Lowe also stated that the effect one dose of T3 could last for about 3 days. I've trialled this too, i.e. took one dose of T3 early a.m. None on day 2 or day 3 and I had no recurrence of symptoms and still felt well and have taken one daily dose for a long time now and wouldn't change. Sometimes, of course, if we feel symptomatic I believe it could be some change within the tablet.

[jimh111]

I take my liothyronine and levothyroxine just before my breakfast of orange juice and porridge. As I take mainly liothyronine which is well absorbed I may be an exception. The danger of taking it with food is inconsistent absorption, not a problem in my case as I am very consistent with breakfast. I would take it away from food, especially levothyroxine, perhaps at bedtime.

[Brightness14]

I have the book my Kenneth Blanchard and the taking medication with food is mostly to do with patients who have put on lots of weight taking it on an empty stomach. This according to him stops patients feeling so hungry. He states that patient may have to increase thier dosage when taking it with food. He often prescribes T3 in very very small amounts added to Levo. This is slow release T3 specially compounded in a capsule. I have never tried most of his ideas, I am not overweight and cannot obtain the T3 slow release capsules. Buy the book it is an interesting read.

[Eliota in reply to Brightness14]

Sold. Will buy his book. Thanks for the insights.

[Imaaan]

When I was taking mono t4 and was fasting for the month of Ramadan, I would take my med after I had eaten. To curb any loss from absorption, I'd just have an increased dosage.

[Noelnoel in reply to Imaaan]

I just wanted to try to work out how important it is to take thyroid replacement on an empty stomach because it’s not always convenient to do so