Cow's milk interferes with absorption of thyroid supplement levothyroxine

[Apple]

What the heck ...
Doesn't milk contain thyroid and is good for thyroid gland ?

Cow's milk interferes with absorption of thyroid supplement levothyroxine

Taking the common oral thyroid hormone medication levothyroxine with a glass of cow’s milk significantly decreases the body’s ability to absorb the drug, a preliminary study finds.

www.endocrine.org

“The main message of this study is that patients managed with thyroid hormone replacement therapy should be advised to avoid taking levothyroxine simultaneously with cow’s milk, given its interference,” Chon said.

 

[Hans]

What the heck ...
Doesn't milk contain thyroid and is good for thyroid gland ?

Cow's milk interferes with absorption of thyroid supplement levothyroxine

Taking the common oral thyroid hormone medication levothyroxine with a glass of cow’s milk significantly decreases the body’s ability to absorb the drug, a preliminary study finds.

www.endocrine.org

“The main message of this study is that patients managed with thyroid hormone replacement therapy should be advised to avoid taking levothyroxine simultaneously with cow’s milk, given its interference,” Chon said.

If you look at the graph, it's actually only a very minor reduction.

 

[Yann]

Could it be that the body is using T4 more rapidly (converting to T3) given the cofactors in milk?

 

[FitnessMike]

bimp

 

[PeskyPeater]

calciumcarbonate does reduce the absorption of t4 tablets around 40 percent I believe, unless you take liquid t4

 

[FitnessMike]

calciumcarbonate does reduce the absorption of t4 tablets around 40 percent I believe, unless you take liquid t4

so dairy with meds are ok you recon?

 

[PeskyPeater]

so dairy with meds are ok you recon?

If it decreases the pH of gastric juice, then it may decrease absorption of t4, likely when one already has low stomach acid issues. Depending on the additional composition of a meal, in general t4 tablets can have a 50% reduced absorbtion contrary to t3. And iron seems to inhibit absorption. This dinnt seem to be an issue with liquid t4/t3 though.

take a look here:
Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review

2.2. Aspects of Levothyroxine Pharmacokinetics

l-T4 is absorbed in the small intestine, more precisely in jejunum and ileum, and to a small extent also in the stomach [5]. In patients with short bowel syndrome l-T4 absorption may be reduced due to increased intestinal passage [6].

Pharmacokinetic parameters of l-T4 differ in euthyroid and hypothyroid subjects. In patients with hypothyroidism, time to achieve Cmax (tmax) delays from 2 h to 3 h, the volume of distribution decreases from 14.7 l to 11.6 l, and the bioavailability can be higher than standard 60–80% [6,7,8].

Concomitant gastrointestinal diseases, such as celiac disease, H. pylori infection, lactose intolerance, inflammatory bowel disease, and even parasitic infestation (G. lamblia), etc. may cause l-T4 malabsorption [5,6].

Increased gastric pH is known to alter l-T4 absorption as well [9]. Several studies confirmed that patients with impaired gastric acid secretion, either due to the disease, or using pomp proton inhibitors (PPI), may need higher l-T4 doses to achieve the desired TSH level [10,11]. The interaction is clinically significant for chronic PPIs administration [12]. Pantoprazole and esomeprazole do not seem to alter pharmacokinetic parameters of l-T4, though the evidence is insufficient to prove its safety [13,14].

Apart from the tablets (Euthyrox, Levoxyl, Synthroid), l-T4 is also available in other forms such as soft gel capsules (Tirosint), oral liquid (Tirosint-SOL), and powder to prepare an intravenous solution (Synthroid). Changing the drug formulation may solve the problem of l-T4 malabsorption caused by the diseases, increased gastric pH, and drug-food interaction related factors as well.

Liquid l-T4 is absorbed faster than its solid form [15], it was also found to be less dependable on gastric pH and conditions causing malabsorption [9,16]. Liquid l-T4 lowers TSH levels more effectively in comparison to the tablets with the same dose, both in patients with and without malabsorption [16,17,18]. Switching from the tablets to the oral liquid formulation has improved l-T4 treatment efficacy in 24 patients ingesting PPI [19] and 11 ingesting other interfering drugs [20].

l-T4 in soft gel capsules dissolves better in increased pH [21] as well. This formulation, when compared to the tablets, can improve TSH levels both in patients with gastric diseases (H. pylori infection, chronic gastritis, etc.) and with no proven malabsorption [22,23].

 

[FitnessMike]

If it decreases the pH of gastric juice, then it may decrease absorption of t4, likely when one already has low stomach acid issues. Depending on the additional composition of a meal, in general t4 tablets can have a 50% reduced absorbtion contrary to t3. And iron seems to inhibit absorption. This dinnt seem to be an issue with liquid t4/t3 though.

take a look here:
Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review

Thanks for help,

Well its a bit of a funny situation im in, on below screen you have right results with only 15mg of ndt for awhile already, and left side you have almost 4 weeks later, 4 weeks on 45mg NDT, lower ft4 and total t4 as well as higher ft3 would indicate that high carb diet i changed to actually is working on promoting convertion, but i was expecting higher levels of hormones in general, its the bigest dose i have ever tried and now i doubled it to 90mg of NDT and plan testing soon agaon in few weeks.

in the past i have have had problems with tolerating thyroid and even tiny doses -wayy lower than im taking now would acumulate to very high levels in the serum due to excessive convertion into rt3.

Well my next question would be probably whether milk ahve a potential in lowering stomach acid, and i do have sometimes still burbs from meal with milk, which could be symptom of low stomach acid according to my readings.

I also do 2 teaspoons of baking soda in the evenings for months already to flush my digestive track before i go to sleep. I might start taking betaine and super enzymes witch each meal i guess.

 

[PeskyPeater]

@FitnessMike

Be careful upping dosage too fast. Brona barnes upps the dose every 4 weeks I believe. the t4 half life is 2 weeks.
From what I gathered from Dr Peat and mr Roddy. If you take a dose of thryoid containing t4 you should devide it so it does not give more than 10mcg of t3 afer conversion, for about 60% of t4 converts into t3. and should seperate the dose of t4 from any extra t3. Or the liver enzymes could downregulate resulting in a hypothyroid state.

-edit- the excess t4 turns into rT3, and to remedy this you may only take t3 and in a couple of hours you shold feel better.

when the burping up feels like acid, then yes its low stomach acid.

bicarbonate is good on empty stomach but not so much with a meal for it neutralises the pH and takes some time to recover. but it eventually adds to making more stomach acid

betaine HCL may help to increase stomach acid acidity and may have a choline sparing effect

it's not good to rely on digestive enzymes too long, maybe until thyroid fynction has been improved.

and I cannot say much about your thyroid hormones here, I do not consider the free t4 t3 values as useful, only the total values but it's hard to convice your doc to do them

 

[FitnessMike]

Bump

 

[FitnessMike]

If you take a dose of thryoid containing t4 you should devide it so it does not give more than 10mcg of t3 afer conversion, for about 60% of t4 converts into t3. and should seperate the dose of t4 from any extra t3. Or the liver enzymes could downregulate resulting in a hypothyroid state.

i thought supplemental t4 is accumulated in the body and converted as needed by the organs and in the cells, People take an absurd amount of T4 at one time right?

About no more t3 than 10mg at one-time iv heard, but then NDT is digested slower and t3 is absorbed slower than synthetic meds, so the peak of t3 should be lower and slower after the NDT dose, isn't it?

 

[Funnywhensunny]

i thought supplemental t4 is accumulated in the body and converted as needed by the organs and in the cells, People take an absurd amount of T4 at one time right?

About no more t3 than 10mg at one-time iv heard, but then NDT is digested slower and t3 is absorbed slower than synthetic meds, so the peak of t3 should be lower and slower after the NDT dose, isn't it?

But many are taking desiccated thyroid in larger doses, and their thyroid has become normalized. Mine is best when I use T4 20 minutes after coffee in the morning, and a drop of T-3 2x a week in the afternoon.

 

[FitnessMike]

But many are taking desiccated thyroid in larger doses, and their thyroid has become normalized. Mine is best when I use T4 20 minutes after coffee in the morning, and a drop of T-3 2x a week in the afternoon.

yes im now wondering whether taking 2grains at once will be ok, assuming that the absorption of the T3 is a slower process due to digestion

 

[rayban]

I take the t4 at night because having to wake up 30 minutes earlier and take it annoys me. I take 88mcg of euthyrox. My hands are still often cold, and i have some stomatch bloating and gas. I also have elevated antibodies which docs don't pay attention to. Im going to have to trial and error other doctors until I see someone more involved. I had my TSH elevated at around 8, in previous one it was lower, but not sure if making the test at 8:00 in the morning when I wake up at 14:00 gives unrealistic results. So im going to pay a clinic to get a test in whatever hour I want instead of having to wake up in the middle of my sleep to get a test for social healthcare. Im also going to get a bunch of stuff tested.
The thing is your ***t should not leave any traces when wiped, and when I have this bloating, the piece of paper is not clean, this i've read means that you are not absorbing all nutrients or something. I've read some stuff on another thread that says suboptimal thyroid could lead to such stomatch problems.

Anyone ever cured severe dysbiosis with bifido bacteria?

So, have you fixed your gut issues? I just started chelation, gut issues don't disappear until you're done with chelation.

raypeatforum.com

As far as milk, I havent drink milk in like 3 years. I miss it but when I bouguht some sheep milk to test milk with A2 protein, for some reason i felt my thyroid became a bit inflamed on the third day and had to discontinue. Now im not sure if milk is good or not. It sucks because milk with cookies was always nice.

And as far as T3, here in europe you cannot buy it, so im only on T4, and I don't trust some dodgy online gurus selling NDT with random dosages.