Levothyroxine and eating

[mids_thyman]

Hi,

Can you help me please? I'm trying to improve my levels and one measure is trying to tighten up when I take my Levo around food/drinks.

I must admit I've been pretty slack with this over time. I began first of all a few years ago by getting up early and taking an hour before food and drinks. That was surrisingly difficult and slipped over time. I found that I really missed a coffee in the morning to get me going, so eventually I moved my Levo to night-time just before bed.

To make life more coplicated, I'm a T1 diabetic. So sometimes I can either wake up with low blood sugar and need to eat either in the night or first thing. And sometimes I need some supper to get my blood sugar to where it needs to be before I sleep.

I'm a pretty bad sleeper, so what I'm doing now is taking taking advantage of that and having the Levo when I come around inthe early morning hours, usually about 4am-ish. But this is also causing problems sometimes because I'm waking myself up and not getting back off sometimes.

So I have a couple of questions:

1. What is the time between Levo and food I need? My tablets currenly just say half an hour before caffeine and food. Is that long enough? I'm sure it used to say an hour, and some on here say 2 hours.

2. Is it all food that inteferes with absorbtion? I can treat my low blood sugar with jelly babies (quicker effect because they contain glucose, not sugar) or a fruit juice. Would these intefere? Are there any suitable foods?

3. Are there any drink that are OK to take with Levo? I've now moved entirely to caffeine-free coffee. But am I right in thinking the milk also effects absorbtion? Is squash OK? Or is it just water that's OK?

Thanks in advance,

JC619

[tattybogle]

interestingly . vitamin C is one of the few things that are known to increase absorption of T4 eg orange juice/ lemon juice .

[tattybogle in reply to tattybogle]

yes . milk will probably reduce absorption a bit because Calcium in known to reduce absorption.

[tattybogle in reply to tattybogle]

healthunlocked.com/thyroidu.... where-and-how-is-levo-absorbed-....-a-collection-of-information.

[Anthea55]

There's another option. I was advised by Dr Peatfield to take my thyroid meds with food and I have done this for several years. This is also recommended by Dr Myhill and by Dr Blanchard. See this link from Dr Myhill and the section on 'Timing of Dosing'.

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

Other people also do this. There was a discussion about it a few years ago. It simplifies the timing problems. I think the main thing is to stick to doing it this way and not mix both systems.

I don't know anything about type 1 diabetes, but I wonder if it would mean that you could stick with your diabetes regime and slot in the levo into that?

[mids_thyman in reply to Anthea55]

H Anthea, that's interesting. It reminds me of when I was once describing the problem to a friend a few years ago. When I said that the tablets were only 50% effective when taken with food, he glibly replied "So, why don't you take twice as much then?". Kinda makes sense (just the problem of getting my docs to up my dose!).

[Anthea55 in reply to mids_thyman]

In Dr Blanchard's book he says that he has "switched many patients from taking T4 on an empty stomach to taking it with food and most of them do not seem to notice any effect on their thyroid balance. However a few have become underdosed,... so one must be aware of this".

I wonder where that 50% figure came from!

You may find Blanchard's book worth a read. 'The Functional Approach to Hypothyroidism'. On the cover it says that he is also the author of "What Your Doctor May Not Tell You About Hypothyroidism". Ah, yes, been there!

By the way I never take tea or coffee with my meals - just the way I was brought up, but makes sense. I've also changed to taking decaf coffee whenever I have it.

[jamesal0]

I don't have time for all that faffing about. I take with food all the time, just add alittle more thyroid to make up for any mal-absolution.

[mids_thyman]

Some interesting comments here, thanks everyone.

The 50% absorption is something I think I read online ages ago. What do people think the difference actually is?

[helvella in reply to mids_thyman]

I saw 50% quoted in an article the other day.

More often, I see something like 60 to 80% levothyroxine absorption on an empty stomach.

But that could, obviously, be significantly lower if food or other factors apply.

The biggest trouble I see from taking levothyroxine with food is the inconsistency. A trivial example:

Two cereals - even seemingly identical - eaten for breakfast. One has iron fortification, the other doesn't.

Just swapping makes, something many do without thinking, could make a significant different due to the very strong effect of iron and iron salts have on levothyroxine. (Even if all other factors are unchanged.)

[tattybogle in reply to mids_thyman]

under ideal circumstances (empty stomach , healthy gut etc) then about 80 % of T4 from levo tablet is absorbed.

under less than ideal circumstances it will obviously be less than 80% , but 'how much less ' will be very dependant on the individuals digestion, and what the foods it etc etc .

That's the main issue with taking it with food ...it's not that you loose a bit .... it's the VARIABILITY of the bit you loose .

if you were consistent all year (same time gap / same food etc ) then your dose would end up being prescribed at a level that suited whatever % you personally absorbed ... but if one day you have meal that gives 30% and another day you have a meal that only gives 10% ... then finding the correct dose is going to be pretty random affair .

~that's not a problem if you are one of those lucky folk who feel ok on pretty much any old dose and don't even notice if they miss a day or so ... big problem if you are already having difficulties and trying to fine tune your dose to rule that out .

i always have my levo WITH a cup of tea(rooibos with milk) which will almost certainly compromise the absorption , but the point is ,i ALWAYS do .. so my dose has always been based on that level of absorption , whatever it is.

if i had it with water , then i may have ended up on a slightly lower dose for 20 yrs , but it doesn't matter if i take 150 or 125 or 100 , does it .. it only costs pennies.

[McPammy]

Try taking your thyroid medication going to bed. This can also help improve absorption. I’ve recently tried this and my blood results increased even though I was taking the same amount as during the day.

[mids_thyman in reply to McPammy]

Thanks McPammy,

It's really interesting that it seems like an absolute mixed bag - some say take it in the mornng. Some at night. Some say with food. Some say without food.

[McPammy]

I’d definitely keep it away from food for maximum absorption. All depends on your daily regimen really. At night going to bed is good I’d say. Just leave the pills by your bedside with a glass of water. The end 😀👍