Food sensitivities

[DaisyTed]

Hi everyone, just looking for a bit advice re food issues. I have had long term issues with constipation, which resolved when I went dairy free. I also find I feel much better on a gluten free diet so have been GF and DF for about 1 year. These are both very tricky to manage when eating out and I know people think I’m very awkward! However, more recently I have been getting bloating and stomach pains related to trapped wind, particularly after eating certain foods. I notice it with tomatoes, peppers, apples, some potatoes, other times I can’t pinpoint a cause.. I also wake up in the morning on a regular basis with painful abdominal pain which is caused by excess gas. Any tips on managing this? I don’t want to end up on a limited diet. I have considered leaky gut or sibo as possible explanations but my symptoms don’t quite fit either.. I did low fodmap in the past, and experienced a huge improvement in symptoms, but I had been on dairy before that, so thought that may have been why. Maybe low Fodmap is worth a try again? I really feel at a bit of a loss and don’t know who can help. Sorry for ridiculously long post 🙈

[SlowDragon Administrator]

yes many hypo/hashi patients react to capsicum family of plants - tomatoes, peppers, aubergine, potatoes

Low stomach acid common hypo symptom

What vitamins are you taking

your previous post shows you were needing dose increase in Levo to 100mcg

Did you get that increase

Retest 2-3 months after any dose change or brand change in Levo

[DaisyTed in reply to SlowDragon]

Hi SlowDragon, thanks for your reply. I am still on 75mg.. it was such a fight with my GP to get this increase that I chickened out of asking for another one,.They have recently switched my brand to Teva. I am currently taking iron, B12 and Vitamin D/K2 - all via spray. Also magnesium Better Sleep at night time. Last blood tests were Sept 23 via Medichecks so I will phone GP to get new blood tests.. thanks for the reminder.

[DaisyTed in reply to SlowDragon]

Thanks also for taking the time to read through my previous posts. I should have done the same and remembered the link with hypo and low stomach acid! My son is autistic and husband has OCD/anxiety so often my own health needs get forgotten in the midst of it all! I have phoned the GP to request repeat bloods to hopefully then request dose increase 😊 thanks again.

[SlowDragon Administrator in reply to DaisyTed]

Have you noticed any difference with Teva

Teva upsets many many people

Many people find Levothyroxine brands are not interchangeable.

How long have you been on Teva

Politely insist GP retest Thyroid levels

Book early morning test, ideally before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

brands of levothyroxine

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to DaisyTed]

unless extremely petite 75mcg is going to be an inadequate dose

Guidelines of dose Levo by weight

approx how much do you weigh in kilo

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Some people need a bit less than guidelines, some a bit more

[DaisyTed in reply to SlowDragon]

Thanks - I never put 2 and 2 together re Teva but have just seen another post where someone was experiencing shakiness, increased heart rate and appetite with Teva - all symptoms I have been noticing recently. I am sensitive to dairy so it’s good Teva is lactose free - but not if it’s giving me other symptoms! Will chat to my pharmacist and get blood tests done asap. Thanks again! 🙏

[SlowDragon Administrator in reply to DaisyTed]

Vencamil is lactose free

And often easier to tolerate than Teva

But currently only available in 100mcg tablets

[DaisyTed in reply to SlowDragon]

@SlowDragon I want to thank you for drawing my attention to the side effects of Teva. I ended up in A & E this morning with left arm pain, palpitations and shortness of breath. Also headache and fatigue. ECG normal. Only issues they identified were low ferritin and low potassium. I am now convinced it is all since changing to Teva! Mannitol would explain my worsening gut symptoms too. Off to speak to the Pharmacy tomorrow. Really appreciate your knowledge and your helpful advice 😊

[Forestgarden]

Have you tried taking betaine hydrochloride to increase your stomach acid? And, digestive enzymes? My son says the enzymes have helped his bloating and discomfort. For me, its the betaine hydrochloride that really helps.

[DaisyTed in reply to Forestgarden]

Thank-you for your reply. No I’ve never heard of this. I’ve recently started taking Megaspore biotic plus probiotics.. and you’ve reminded me I also have Similase digestive enzyme formula in the cupboard! I will order some betaine hydrochloride as I’ve never heard of this - thanks for the advice 😊