Question about Progest-E dose

[savache27]

Hi, guys. I started having grand mal seizures 4 years ago. The first one came after I had been doing a lot of fasting, while exercising pretty heavily. I started doing intermittent fasting where I would not eat until 12 or 1 pm, sometimes later. I also would not eat at all 1-2 days a week. I kind of became obsessed with going longer and longer, and my caloric intake was very low. Anyway, I went about 6 months without a period and ended up having a seizure. I started my period the day I had the first seizure. I've had MRIs, EEGs, etc. The only thing that has ever really been determined is that I have reactive hypoglycemia, and my hormones are or have been pretty messed up. At first my seizures were kind of random and maybe 1 every 4-6 months. Then they started to come a few days before or into my period, at least once per month. When it was bad they would come every two weeks, and I’d usually have a seizure then another 3-4 hours later, then another. I saw a functional medicine doctor last Nov. He did a lot of tests and put me on an iron supplement and a b12 supplement. I went for 8 months (the longest period of time in 3 years) without having a seizure. Two weeks ago I had three more seizures. I saw another doctor, and he gave me some Progest-E. He told me to start taking it 7 days before my period and take it for 14 days. The dose he prescribed was 20 drops under my tongue before bed time. Just wondering what you guys think of this? I’ve noticed most people seem to take 3-5 drops 5 times a day. Any insight as to why he would have me take it all at one time? Does anyone see any potential issues with following his instructions?

 

[4peatssake]

Hi, guys. I started having grand mal seizures 4 years ago. The first one came after I had been doing a lot of fasting, while exercising pretty heavily. I started doing intermittent fasting where I would not eat until 12 or 1 pm, sometimes later. I also would not eat at all 1-2 days a week. I kind of became obsessed with going longer and longer, and my caloric intake was very low. Anyway, I went about 6 months without a period and ended up having a seizure. I started my period the day I had the first seizure. I've had MRIs, EEGs, etc. The only thing that has ever really been determined is that I have reactive hypoglycemia, and my hormones are or have been pretty messed up. At first my seizures were kind of random and maybe 1 every 4-6 months. Then they started to come a few days before or into my period, at least once per month. When it was bad they would come every two weeks, and I’d usually have a seizure then another 3-4 hours later, then another. I saw a functional medicine doctor last Nov. He did a lot of tests and put me on an iron supplement and a b12 supplement. I went for 8 months (the longest period of time in 3 years) without having a seizure. Two weeks ago I had three more seizures. I saw another doctor, and he gave me some Progest-E. He told me to start taking it 7 days before my period and take it for 14 days. The dose he prescribed was 20 drops under my tongue before bed time. Just wondering what you guys think of this? I’ve noticed most people seem to take 3-5 drops 5 times a day. Any insight as to why he would have me take it all at one time? Does anyone see any potential issues with following his instructions?

First off, wow, first time I've ever heard of a doctor giving anyone Progest-E.

I'd probably call and ask him or her the reason for prescribing that particular dosage.
You could reference this article when providing reasoning for your question if needed, although your doc should easily provide an explanation I would hope.

 

[tara]

savache
What 4peatssake said.
Also, have you stopped starving yourself and started regularly eating enough? Have you had help to recover from the undereating?

 

[savache27]

Thanks for the suggestion! Yes, I've recovered from my eating disorder. I don't follow the Ray Peat diet. I've been a vegetarian since I was 15. I do eat pretty healthy for the most part and make sure to get enough calories. I definitely wish I could take all that back since I'm fairly certain that had a large part to do with my current health issues, but I can only move forward and try my best.

Do either of you know if Progest-E can cause negative side effects? I've found a few articles regarding teeth/gum issues. One woman said that it caused her to have hot flashes and high blood pressure, but I believe she said she had a rare protein mutation. Anyway, I just don't want to cause myself any further issues, so I'm honestly scared to use it.

 

[HDD]

Here are a few quotes about progesterone and epilepsy from articles written by Ray Peat.

Since progesterone has none of the harmful side effects of other hormones (except for alteration of the menstrual cycle if it is taken at the wrong time of month), the basic procedure should be to use it in sufficient quantity to make the symptoms disappear, and to time its use so that menstrual cycles are not disrupted. This normally means using it only between ovulation and menstruation unless symptoms are sufficiently serious that a missed period is not important. The basic idea of giving enough to stop the symptoms can be refined by some information on a few of the factors that condition the need for progesterone.

Very large doses that are given in vitamin E solution, allowing complete absorption, can reach the level that is sometimes achieved late in pregnancy, producing both euphoria and a degree of anesthesis. To avoid unexpected anesthesia, the correct dose should be determined by taking about 10 mg. at a time allowing it to spread into the membranes of the mouth, and repeating the dose after 10 minutes until the symptoms are controlled.

Experiments have shown that progesterone relieves anxiety, improves memory, protects brain cells, and even prevents epileptic seizures.

http://raypeat.com/articles/articles/pr ... ries.shtml

Hypothyroid people tend to lose sodium easily, and unopposed estrogen increases water retention, without an equivalent sodium retention, so low thyroid, high estrogen people have two of the conditions (edema and hyponatremia) known to predispose to seizures. Another outstanding feature of seizures of various sorts is that they are most likely to occur at night, especially in the early pre-dawn hours. Low blood sugar and high adrenalin predominate during those hours. Hypoglycemia, in itself, like oxygen deprivation, is enough to cause convulsions.

Progesterone and thyroid promote normal energy production, and their deficiency causes a tendency toward hypoglycemia, edema and instability of nerves.

If progesterone's antiepileptic effectiveness were not enough (and it is very effective even in irrational pharmaceutical formulations), the fact that it reduces birth defects, and promotes brain development and nerve repair should assure its general use in women with a history of seizures, until it is established that they are no longer "epileptic." Although thyroid, progesterone, and a high quality protein diet will generally correct the epilepsy problem, it is important to mention that the involvement of unsaturated fats and free radicals in seizure physiology implies that we should minimize our consumption of the unsaturated fats. Even years after eliminating them from the diet, their release from tissue storage can prolong the problem, and during that time the use of vitamin E is likely to reduce the intensity and frequency of seizures. Coconut oil lowers the requirement for vitamin E, and reduces the toxicity of the unsaturated fats (see Cleland, et al.), favoring effective respiration and improving thyroid and progesterone production. Endotoxin formed in the bowel can block respiration and cause hormone imbalances contributing to instability of the nerves, so it is helpful to optimize bowel flora, for example with a carrot salad; a dressing of vinegar, coconut oil and olive oil, carried into the intestine by the carrot fiber, suppresses bacterial growth while stimulating healing of the wall of the intestine. The carrot salad improves the ratio of progesterone to estrogen and cortisol, and so is as appropriate for epilepsy as for premenstrual syndrome, insomnia, or arthritis.

http://raypeat.com/articles/articles/ep ... rone.shtml

 

[ampersand]

Hi savache, I also come from a history of intermittent fasting and caloric restriction...
I'm also new here & don't know a whole lot about Progest-e and potential side effects, but I've been using high doses for almost a month and am happy with it. I have not had any side effects so far, other than feeling particularly fatigued and odd for the first few days, and some breast soreness recently.

Are you familiar with the website youreatopia.com? That site helped me a lot with learning about the process of recovery from undereating.

I wish you the best of luck in regaining your health!

 

[savache27]

HDD: thanks so much for all the info! I do appreciate all the quotes!

ampersand: thanks for responding! It's always nice to hear from someone in a similar situation, although I'm sorry you had to go through it. I have read through that site in the past, but not recently. I'll check it out again! If you don't mind my asking...what dose are you using for Progest-E? Are you taking a single dose or severs times throughout the day? Thanks!

 

[ampersand]

I'm currently taking around 3-5 drops, 2-5 times per day. I started with even more for the first 10 days. I've been a little erratic with how much I use and how frequently, but every single day for the last 26 days I've taken quite a bit, at least 10 drops spread out over the day. I've been rubbing it into my gums and also using it quite generously on my skin, mixing it with coconut oil and applying it to my face, my chest, and anywhere on my skin where I've noticed eczema or spider veins. It's definitely helped a bad patch of eczema to heal quite beautifully, and I feel like maybe the spider veins are becoming less noticeable, although it's hard to say because I've been getting more tan. Occasionally when the vitamin E oil gets down into my throat it makes me cough or gag a little, so I've just started mixing it with coconut oil before rubbing it into my gums, this seems to help.

 

[tara]

Yes, I've recovered from my eating disorder. ... I do eat pretty healthy for the most part and make sure to get enough calories.

:)
Even if you don't follow all the ideas some of us here use, I think it is worth applying a few key principles, like keeping PUFA consumption as low as practical, and getting enough protein and carbs. No reason why you can't do well on a vegetarian diet if it includes milk and eggs.

I think there is something written by Haidut saying that progesterone can increase sodium loss. So making sure to eat enough salt (by following taste/cravings) may be important.
Some people feel relaxed and sleepy with progesterone - which may be a sign that the body needs rest.
Large doses can be anaesthetising - how much varies from person to person.

Have you read Peat's articles on estrogen and progesterone on his web site?

If you take it and it feels good, I'd assume it is doing you good. If you don't feel good when you take it, you could experiment with dose.

My key issue is migraine, which has some similarities to seizures. I used a few drops 5x/day for quite a long time, experimented with more during migraines, then more recently just twice a day. It has not reduced my migraine frequency, but I think it gave other benefits.

You can use cronometer or similar to get a rough idea of what nutrients you are getting from your food, and whether there are any significant gaps. Don't trust it on calories or PUFA. Peat recommends getting more calcium than phosphorus.

 

[tara]

I'm currently taking around 3-5 drops, 2-5 times per day. I started with even more for the first 10 days. I've been a little erratic with how much I use and how frequently, but every single day for the last 26 days I've taken quite a bit, at least 10 drops spread out over the day. I've been rubbing it into my gums and also using it quite generously on my skin, mixing it with coconut oil and applying it to my face, my chest, and anywhere on my skin where I've noticed eczema or spider veins. It's definitely helped a bad patch of eczema to heal quite beautifully, and I feel like maybe the spider veins are becoming less noticeable, although it's hard to say because I've been getting more tan. Occasionally when the vitamin E oil gets down into my throat it makes me cough or gag a little, so I've just started mixing it with coconut oil before rubbing it into my gums, this seems to help.

Hmm. Maybe I'll give it a go on the eczema-like rash too. Thanks for that idea.

 

[savache27]

Thanks for all the info! This doc just told me to put the drops under my tongue and all a bed time. I guess I'm gonna have to call and question his reasoning for that. It seems that everyone else spreads it throughout the day.

 

[4peatssake]

Anyway, I just don't want to cause myself any further issues, so I'm honestly scared to use it.

This article by RP may help ease the fear. I agree with his view that progesterone therapy is safe.

Progesterone: Essential to Your Well-Being By Raymond F. Peat, Ph. D.

Editor's Note; In her "Of Many Things" column this January, Betty Franklin introduced Dr. Raymond Peat's work with natural progesterone, applied externally. Response from readers has been tremendous, so we invited Dr. Peat to write a follow-up, more comprehensive report on the subject. His doctorate, from the University of Oregon, is in biology and he has taught courses in immunology, endocrinology, biochemistry, brain physiology}~ nutrition and humanities at several universities and colleges.

The hormone progesterone participates in practically every physiological process, in both men and women. Its tremendous increase during pregnancy serves to stabilize the organisms, both mother and child, during that crucial time. At levels reached just before delivery, progesterone produces anesthesia and contributes to tissue elasticity. The fetus requires large amounts of glucose, and progesterone makes it possible to be provided in abundance for ideal brain growth, by promoting the mother's ability to use fat for her own energy. It is this efficient use of fat which gives women greater long-range endurance than men. When progesterone is deficient, there tends to be hypoglycemia, often combined with obesity.

The stabilizing action of progesterone is especially visible in muscle tissue, such as the uterus, blood vessel walls, the heart, the intestines and the bladder. Less visibly, progesterone stabilizes and normalizes nervous, secretory and growth processes. Biochemically, it provides the material out of which all the other steroid hormones (such as cortisone, testosterone, estrogen and salt-regulating aldosterone) can be made as needed. Progesterone's simple molecular structure allows it to balance either an excess or deficiency of those other hormones, even when there is a defect in their synthesis.

Many factors, including poor nutrition, climate, emotional or physical stress (even excessive running) and toxins, can cause a progesterone deficiency. Use of estrogens, birth control pills and even IUDs can also bring about a deficiency. Animal studies and clinical experience suggests that the prenatal hormonal environment (a mother's excess of estrogen during pregnancy) can incline a person toward a deficiency of progesterone relative to estrogen.

Recent studies show that progesterone prevents stress-induced coronary blood vessel spasms in aged hearts-probably explaining women's relative freedom from heart attacks, so long as they retain functioning ovaries. Other studies suggest that progesterone has a role in regeneration of damaged brain cells and prolonged growth of the brain. Delayed aging and longer life span have been very clearly related to extra progesterone. Many types of tumors have been prevented and helped with progesterone. Excessive blood cloning caused by excess estrogen alleviated by progesterone. Pregnancy toxemia and tendency to miscarry or to deliver prematurely are often corrected by progesterone. When epilepsy occurs premenstrually, or first appears around puberty, it is often stopped by progesterone therapy. The hormone has been used successfully in suicidal depression, Reynaud phenomenon, Meniere's disease, agoraphobia (especially when associated with porphyria, an abnormality of liver metabolism), Bright's disease (a kidney disorder) and, used as a lotion, in a variety of genital skin problems in children, adults and postmenopausal women. Hot flashes and other menopause problems respond to progesterone therapy.

Since progesterone normalizes the immune system (it causes thymus regeneration, for example) it is very effective in autoimmune diseases (which result from adverse reactions to one 5 own tissues) and in those degenerative disease which have an autoimmune component.

In several ways both progesterone and thyroid hormone can be considered primary regulatory hormones. Both of them regulate metabolism directly at the energetic and synthetic levels: both have a normalizing, anti-stress action on the pituitary gland; and each has a promoting action on the other. Both are blocked (and consumed) by stress and promoted by light and good nutrition. Both are nutrients in cultures that eat the whole animal, including ovaries and thyroid, butter, cream and milk contain small amounts of progesterone and shellfish seems to be a good source.

Disregarding most of the information promoted by pharmaceutical companies and the medical texts and journals which for 30 years have reflected the opinion of those companies (especially regarding the patented synthetic estrogens and glucocorticoids), we can trace a line of research and ideas on the sex hormones, from pioneers such as Loeb, Korenchevsky, and Selye, through a generation that continued to demonstrate the toxicity of estrogen, and the value of progesterone including people like Lipschutz, Dalton and Goderwall.

In my dissertation research under Goderwall, I had the opportunity to collect and assimilate data indicating an increased estrogen effect in aging animals and recently, with newer techniques, I have seen similar changes in many menopause women. My research showed that the probable mechanism by which estrogen excess causes infertility is through limiting the availability of oxygen. I showed that anti-estrogenic substances, such as progesterone or vitamin B, increased the oxygen content of the uterus. This anti-oxygen effect of estrogen suggests a convergence of reproductive aging research with Warburg's theory that damaged respiration is the primary defect in cancer and also with Selye's observation that estrogen's effect resembles the first shock phase of stress reaction.

Early research had also shown that estrogen diminishes liver glycogen storage while progesterone increases both blood sugar and liver glycogen. It is well known that hypoxia (oxygen deficiency) damages the fetal brain, but probably less well known that hypoglycemia -either chronic or acute- can cause brain damage and retardation. Oxygen deficiency, by lower metabolic efficiency, will cause hypoglycemia. Estrogen causes hypoxia at every imaginable site, from lung, through vascular fibrin (clot material lining blood vessels and red cells) and extracellular collagen (a glue-like part of connective tissue) and edema, to intracellular metabolism. Estrogen is also a promoter of insulin release and action, lowering blood sugar and promoting fat synthesis. Estrogen and another common anti-oxygen material, excessive unsaturated fats (vegetable or fish oils) have both been demonstrated to cause the birth of small-brained, retarded animals. Recent studies imply that about half the children identified as hyperactive have experienced prenatal stress. The most urgent need for progesterone therapy, I think, is preventing a continuing epidemic of brain damage. Beyond that, many studies have found that the use of natural progesterone increases a child's IQ, typically by around 35 points and produces personalities that are more "independent, individualistic, self-assured, self-sufficient and sensitive" (J.M. Reinish, The Female Patient, April, 1978, p.87).

PROGESTERONE VS. HYPOGLYCEMIA

Protection against hypoglycemia is probably the main mechanism. Diabetic mothers often have precocious children, if they aren't damaged by drugs and irrational diets. Ten to 15 grams per pregnancy, at increasing dosage, seems to be the optimal amount, when there is some sign of excessive estrogen or unexpected toxemia. The American Medical Association Department of Drugs, which warns against certain sex hormones being used during pregnancy, has specifically excluded progesterone from those others which are "now contraindicated in early pregnancy" (Journal of the American Medical Association, 239 (3), p.236).

Hypoglycemia (which can result from any respiratory defect) can produce malfunction of any tissue, but brain dysfunction and immune dysfunction are very common effects. Adamkiewics has shown that allergic reactions to a given substance will decrease from 100 percent to zero, when the blood glucose increases from, for example, 50 mg. to 150 mg. or more. Soviet research shows a similar involvement of blood sugar level in various "psychosomatic" ailments. Progesterone (and thyroid) will help in most allergic diseases, including the autoimmune and "collagen diseases," because it helps to maintain blood sugar (promoting respiration and improving use of fat-sparing glucose) and also because it stabilizes lysosomes (enzyme packets in cells, which are involved in inflammation processes).

The group of enzymes known as superoxide dismutase (SOD) are probably involved in the protective effects of progesterone, since one of my assays to determine the action of estrogen turns out to be an inverse indicator of SOD-that is, progesterone would seem to turn on this protective enzyme.

Although progesterone and cortisone both raise blood sugar and stabilize lysosomes, their effect on the brain is very different. In large doses, progesterone is sedative and anesthetic, while cortisone is stimulating and causes changes in the brain, which resemble aging. An excess of cortisone also tends to elevate estrogen, which was found (in animal experiments) to interfere with memory. High estrogen traits can be acquired by environmental stress and can be passed on to offspring, as discovered by L.C. Strong in his mice, and as confirmed recently in rats that were stressed during pregnancy.

It has been observed that the ratio of brain weight to body weight corresponds directly to longevity. The brain has a nourishing, trophic influence on other tissues. A stable, efficient brain is an anti-stress agent. The hormones of stress age various tissues, including connective tissue. Good nutrition, including the anti-stress substances found in certain foods, will simultaneously optimize intelligence and increase the healthy life span. Congenital defects are increased by stress and poor nutrition during pregnancy and, conversely, reduced by good nutrition hormone supplementation and stress reduction.

An excessive estrogen/progesterone ratio is more generally involved than either a simple excess of estrogen or a deficiency of progesterone, but even this ratio is conditioned by other factors, including age, diet, other steroids, thyroid and other hormones. The relative estrogen excess seems to act by producing tissue hypoxia. Symptoms in cycling women are most common around ovulation and in the premenstrual week, when the estrogen/progesterone ratio is normally highest. The early 20's, late 30's and menopause are the periods when the ratio is most often disturbed. These are also the ages when thyroid disorders are commonest in women.

I have observed the use of progesterone transdermally (applied to the skin in about 400 women suffering from the full range of peri-menstrual symptoms, including migraine, acne, depression, mastalgia (breast pain), edema (water retention and swelling), and lethargy. I found that nearly all the women who apply the lotion themselves, are able to find the appropriate dosage for controlling their symptoms. Occasionally, thyroid therapy, weight reduction: or change in some aspect of lifestyle is necessary for complete relief from symptoms. When some women said the progesterone had no effect, it turned out that they were applying it as sparingly as they would a rare perfume-just touching it to their wrists.

Anesthesia (or drunkenness) from a very large overdose is the only negative side effective reported in the literature. Experimenting with very large doses of natural progesterone on myself, for migraine, I found that there is a temporary antagonism to testosterone, causing small symptoms, including a slight sense of gregariousness, an urge to socialize. However, synthetic progestins do have harmful side effects including breast tumors. Unfortunately, most physicians do not yet know the difference between natural progesterone and synthetic progestins.

At our health resort/clinic, we're finding that most women respond dramatically to progesterone support, but don't remain chronically dependent on it. During their stay, clients are provided specialized, indulgent care, along with progesterone and other therapies. We consider it essential, as well, to teach them the principles of maintaining optimum health through good nutrition. Results are impressive and usually permanent.

 

[savache27]

I just wanted to thank you guys again for all the info you gave me. I decided against taking the Progest-E last night. Then, this morning I woke up with a very heavy headed feeling. I immediately felt dizzy/off balance, nauseated, and hot (like hot flash type heat). Unfortunately, this is similar to the feeling I get right before I go into a seizure. Not necessarily a dizzy feeling, but I normally will have a rush of heat and nausea flow through my body. This morning it didn't flow through, it was just an overall feeling. I got out of bed and was definitely off balance. My husband and I were trying to figure out what to do. I took some magnesium with a little GABA, and my normal morning vitamins/supplements. My husband kept trying to get me to at least try the Progest-E, so finally I agreed and took about 6-7 drops. I decided to attempt a short workout since one of my doctors suggested that it may help due to the release of endorphins. The nausea subsided somewhat and I was able to do a short workout. I was still feeling a little nauseated and dizzy afterward so I decided to take a few more drops of the Progest-E. I'm not sure that it's actually doing anything, but at least I haven't had a seizure. I think I'm going to continue to use it and at least see if it helps. Hopefully I won't see any type of negative side effects. Thanks again for all the info/advice.

 

[HDD]

This is a thread about using progesterone for seizures that you might find very informative.

viewtopic.php?f=52&t=3552&hilit=Epilepsy&start=15

 

[Peata]

When I first started Progest E with a few drops, I got a drunk feeling, sort of dizzy and not right. It went away. Then I eventually decided to hit the Progest E hard to get past the estrogen problems and see results. I had read it can cause estrogen to be released from tissues if you're not taking enough, so I kept taking more until the estrogen dominance symptoms went away. Sometimes this meant taking 300 mg. or more daily in divided doses. I took it all month long and it never stopped my periods. Now I can take a lot less. I don't measure drops anymore though, I just use a "strip" on my gums, top and bottom.

 

[savache27]

Thanks for the advice, Peata. This morning I just woke up dizzy, but I was still feeling that way after the first 6-7 drops. After I worked out I took a few more drops and the dizzy feeling has gone away. I have still felt slightly headachy and nauseated throughout the day, but not nearly like this morning. I'm just hoping I don't have a seizure.

HDD: thanks so much for the thread on progesterone and seizures. I'm still reading through it, but there seems to be a lot of wonderful information on that post!! I truly hope that progest-e can help stop these seizures. Hopefully my body and hormones will eventually heal enough that I no longer have them.

 

[savache27]

Hey guys,

I tried to search, but didn't find anything. Forgive me if I just missed it. My doctor advised me to take the progest-e beginning 7 days before my period, and take it for 14 days. He told me 20 drops at night, but I decided to just take 3 drops three times a day, and a few days I took a little bit more. Anyway, do you know if it can push your period back? Recently my period had been coming between day 24 - 26 of my cycle...I think for 4 months. Then last month it came on the 22nd day, when I had the 3 seizures. I'm on day 28 right now and still haven't started. Obviously, 28 days is a normal cycle, I'm just wondering if it's typical for progest-e to push the cycle back.

Shanna

 

[bailadora]

I've been using progest e for about 2 years. I use it day after ovulation which is appx day 15'right up until onset of menstruation. If I have any pre-m symptoms then I will up the dose from1/2 drops to 3/4 drops. Sometimes I will go right into day 1-2 until symptoms go away.
I'm probably peri-meno (mid 40s). My period is usually off usually early by 1 or 2 days but I'm ok with that.
Edit
If you have a lot of problems then you can take the progest e for the entire month. This seems to help some people but I've never had to do that myself.

 

[treelady]

savache27, I was getting grand mal seizures too. Here is my experience.

I would go over a month or 2 and then when I got them I would keep getting them until they took me to the hosp and they gave me drugs to stop it. I was on seizure meds for a short time and that was horrible for my body. Now I have a doctor who is receptive to alternative solutions. She feels I have catamenial epilepsy. I am am hypo thyroid and my Dr thinks that thyroid is involved with the seizures. I would always get them at night. I had been taking my thyroid in the morning but changed it to 1/2 pill in the morning and 1/2 at night. I also started Progest-e, 3 drops at night. Since I am 71 I just take it all the time with no breaks. After those 2 changes I still got seizures(or migraines with memory loss - not sure which) but stopped getting grand mal seizures. So that was an improvement. The Dr also gave me an rx for 0.5 mg Lorazepam (Ativan) that I take with the first seizure and that stops them.

 

[treelady]

Also forgot to say I started taking T3 at the same time I split my thyroid and took 1/2 and night and 1/2 in the morning.