Interesting.............I still do not understand WHY or HOW Grapefruit manages to affect all the other medications.............or why Orange Juice may have a similar effect?????
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I've been on Levo for 20-25 years. The original prescribing doctor never mentioned the timing issues nor the grapefruit incompatibility. My current doctor says to take it 2 hours before eating! Thankfully, my husband still works and gets up earlier than I. He nudges me awake to take my pill and then I go back to sleep. A friend who also had a timing problem found this solution worked for her.
I'm very interested in the iodine connection since I haven't used iodized salt in years and I have been having health issues since the beginning of the year. So far, no answers and things are improving. I asked my PCP about iodine deficiency but he said that because my thyroid tests were within range, that they indicated I wasn't iodine deficient. Anyone know if that's an accurate indicator?
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It always amazes me when restaurants sneak chunks of grapefruit in to salads and fruit cups. For many people, that’s like feeding them poison.
Restaurants should never, ever use grapefruit, even if it’s listed on the menu as an ingredient. The same holds true for olives, which are vile to look at and taste awful.
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I had radioactive iodine thyroid ablation (due to Graves' disease) in 1978 and have been on levothyroxine ever since.
I was never told not to eat after I take it (in the morning, with the rest of my "morning" pills), so I have almost always eaten breakfast right after taking my morning pills.
One of my daughters-in-law began taking levothyroxine about 10 years ago and casually mentioned having been told not to eat for a half hour afterwards. I was astonished, looked it up, and . . . Well, I eat or don't eat right after, but haven't had any problems for the past 44 years. Once in a while there is a very minor adjustment in the dosage, but I don't think the eating-after has had any effect whatsoever.
While I'm on the subject: I'm the mother of four adult sons, each of whom was diagnosed with Hashimoto's in his late teens/early twenties. My endocrinologist says that this is not at all unusual, i.e., there are just families with thyroid problems - in the same family, some of them will be hyper, and others will be hypo. Needless to say, my sons are all on medication and they make sure that their own kids are tested from time to time.
So if you have "the problem," please make sure that your offspring are checked.
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I’ve been taking Levothyroxine for two yrs now and my levels dropped to .13 (yes) and after a reduction in the prescription in January, my levels are at .4 now.
I wanna get off this stuff. My former doctor- a ND- put me on Nature thyroid - a natural thyroid medicine a few years back after which my MD put me on MD put me on Levothyroxine. Anyone have experience getting off this medicine or possibly a move to a natural thyroid supplement? I hate the idea of having to take this the rest of my life.
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@Erasmus I have had to take thyroid replacement for 20 years now, due to Hashimoto's.
It seems highly unlikely that you can ever "get off this medicine" to be frank. I get not liking it. I don't like taking anything either, and don't like having to take something everyday.
However, it is keeping me alive. The thyroid is a regulator gland, and you cannot live without what it produces. I'm thankful there is treatment that allows me to continue living, even if it is not ideal.
"Natural" thyroid replacement comes from animals. Some doctors don't like it and won't prescribe it.
Good luck with your health.
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@Erasmus I have taken levothyroxine for more than 40 years. I thank heavens for the stuff. I was a very sick young lady when I started taking it. If I have to have a disease that I live with, Hashimoto's thyroid is not too bad.
I looked into the "natural" thyroid medications but because they are derived from animal s I decided to stick with the more consistent and reliable levothyroxine.
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@Erasmus Try getting more iodine and iodide in your diet - though that might be difficult as they are not found in many foods.
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One suggestion re levothroxine. Before starting taking it first ensure that you are not suffering from a shortage of iodine in your diet and secondly resist starting levothyroxine if you don't have any symptoms of hypothyroidism. My endocrinologist recommended levothyroxine because my TSH was high. I realised that I had not been consuming any iodine in my diet for the last year or two (water from my well, cooking my own food, using sea salt). I took a vitamin supplement for a few months and my TSH fell by 60 percent
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Yup, same for me. I’m a lifelong taker of levothroxin. Whenever I went a few days without taking the medication (when I was younger and dumber) my skin would get unbearably itchy, I couldn’t sleep and my hair would start to fall out. Now in my 50s, my hair was coming out in significant and startling quantities every morning in the shower even though I was being very careful to take the medication appropriately.
My doctor sister explained the complex workings of the thyroid and the clunkiness of how we test thyroid levels as well as the importance of iodine and selenium for the uptake of the medication. I realized that since I don’t eat processed foods and had switched to fancy sea salt in my cooking, it was likely I wasn’t getting enough iodine to facilitate processing of the thyroid medication. I started using iodine-treated salt with my oatmeal each am and forced myself to take the medication with a large glass of water each am and wait at least an hour before consuming anything else. The hair loss stopped within days. I also got into the practice of eating a handful of Brazil nuts for the selenium, but couldn’t keep it up as I find them rather revolting. However, I didn’t notice the nuts made any difference, but the switch to iodine salt? Huge.
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@ianstuart Lots of folks do not have hypothyroidism caused by iodine deficiencies. They thyroid issues could be autoimmune related (e.g. Hashimoto's) and additional iodine could actually be harmful.
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The endocrinologist whom I saw when I first starting taking levothyroxine gave me the sensible advice to find a pattern of eating and taking the medication that I could live with, and he would adjust the dosage as necessary depending on test results. When it seemed necessary, he increased my dosage, and I've been at that dosage for the past 15 years or so. It has worked well. I do try to wait at least an hour after taking the medication before eating, but if it is a little less once in a while I don't sweat over it. Like some of the other commenters, I often end up taking it in the middle of the night when I wake up. I will take it anytime after 3:00 am.
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I believe this applies to industrially-processed grapefruit juice, not the fruit or the fresh juice. The most relevant inhibitor of cytochrome P450 enzymes appears to be naringenin, a derivate of naringin, which causes the typical bitter flavor of grapefruit. In order to remove the bitterness, juices are treated with an enzyme that converts naringin into naringenin. While some of the naringin is turned into naringenin by our own livers, the effect of naringenin after drinking industrial juice is mostly upon intestinal cytochrome enzymes, not liver enzymes. In any case, if taking a drug that is modified by cytochrome enzymes (specifically CYP3A4) and a narrow therapeutic window, it is better to avoid grapefruits. On the other hand, the notion of taking a lesser dose along with grapefruit juice may sound like a nice way to circumvent high prices; but it is very difficult to calculate the right combination of drug and juice to achieve the desired result. This would vary between drugs, individuals, and perhaps even juice brands.
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@Carlos Amabile Additionally, varieties of grapefruit can differ in their potential to affect the enzymes discussed. The variety of grapefruit used by even a single manufacturer may vary throughout the year. Why risk it?
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Best not to eat any fruit or its juice. Processed foods are best.
Unless they taste good, then they are bad for you too. A week from now there will be a different article saying grapefruit is fine.
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@Ken This has been known for many years.
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Three different PCPs and one cardiologist never mentioned this to me. And I take thyroid med in am (pharmacist said wait 30 min before eating) and a statin at bedtime. I'm not as worried about a drug under performing as I am about the seriously dangerous interactions. So much to keep track of.
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URL to Canadian list not working for me.
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The link for the list of affected drugs does not work.
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I almost never drink grapefruit juice, but I sometimes eat whole grapefruit. I wish this article (or the medical profession in general) could be more specific about HOW LONG you have to wait after eating grapefruit before taking medications. There obviously has to be be some point after which it has no effect, but I've never seen this mentioned.
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I learned new thing from this article that we should wait at least four hours after taking levothyroxine before taking antacids or vitamins or supplements containing iron or calcium. This article helps us to have the better health better lives.
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@Cam Phuong Ly
No one ever mentioned that to me. Will check with my doctor. Turns our I have been doing that anyway except during travel.
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I wish there would be a standard recommendation for how long to wait before eating after taking levothyroxine. Though I was told an hour, my aunt was told to take hers with breakfast.
This article is the first notice I've had that soy and fiber can interfere with absorption. I use soy milk with my cereal and eat a high fiber diet.
My conclusion: make sure your doctor tests your levels so you know if you are absorbing enough medication.
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@Barbara
I agree. I’ve been taking levothyroxine for eight years. Originally, the instructions from my doctor and that came with the medicine, and on the label, said twenty minutes before eating. About three years ago it changed to thirty minutes. I have never heard of one hour.
I eat Oatmeal with walnuts almost everyday for breakfast. My TSH levels have always been within range.
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@frank If you don't mind, what is your actual TSH level and dosage of Levothyroxine? I just tossed 2 lbs of walnuts because of this article. Maybe that wasn't recessary. David
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@Barbara I take my Levothyroxine right when I get up. I have it with a cup of coffee with a non-calcium, non-diary, non-soy, "creamer." My levels have been great every time I get them tested (twice a year).I do wait one hour before eating.
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What about lemon juice?
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@Timshel Yes, what about the rest of the citrus family? All these articles I have read were just about grapefruit and never say anything about oranges, lemons and all the rest of citrus fruit.
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This raises hope that some Americans who can't afford to take the prescribed doses of their medications might get more mileage out of certain ones by drinking perhaps a quarter or half a cup of grapefruit juice with them...
If only there were some guidelines to help Big Pharma's victims tweak a half-dose (all they can afford) toward a nearly-full dose!
The trick of course would be to balance the potential positives (the much-needed effects of the prescribed medication) against the potential negatives (damage to various organs and/or death).
But at least doing this would fit with the right wing's Personal Responsibility mantra, which leaves corporations free to do as they please and the rest of us scrambling to survive.
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@MLChadwick Levothyroxine is a fairly inexpensive medication, especially with insurance. No one should try to cut back on it due to cost. Instead, ask the doctor if there is a way to get help in affording the medication. Many companies will help.
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I have insurance and it is the most expensive one of the bunch of 5!! Walmart sold low dose for $10 years ago. Don’t know if they still do
Seems to me to be a link here, didn’t know so many people had thyroid problems. Companies gouging like they do for insulin’s??
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I get up at least once during the night and that’s when I take Synthroid. Occasionally if I sleep through and my choice is breakfast or the pill, breakfast always wins. I don’t feel any different and things have a way of working themselves out.
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@Bev Kagan I do exactly the same thing and have no issues. I turn the bottle upside down after I take it so in the morning I remember that I had my dose.
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@CRE such a helpful idea. I also sometimes put the pills out so I don't have to mess with the bottle when half asleep. If they're gone when I wake up then I know I've taken my daily dose. It's then clear for me to have coffee and breakfast whenever I want.
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@CRE
I have been on thyroid medication for over 25 years and am 80plus now. No issues but the idea of turning the bottle upside down after the dose is great. Thanks
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I'm taking a daily statin (and have been for many years). I occasionally ate grapefruits and tangelos before I started the drug regime. I haven't eaten either since that day. No great loss-there are other citrus fruits to enjoy instead.
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@vacciniumovatum
It says right on the statin drug label not to eat grapefruit.
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I recently came across my grapefruit knife, which I haven't used since I was diagnosed with Type 2 Diabetes 19 years ago. Used to love grapefruit. Ditto, red grapefruit juice. A minor problem, I guess.
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Interesting because I give my horse levothyroxine in her feed at night as my vet said to, I would have trouble giving it with water before breakfast.
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Say it ain't so! One of our special Sunday morning rituals is a small glass (1.9 dl) of freshly squeezed grapefruit juice. It tastes sooooo goooood, and since we do not drink any orange juice, it something we look forward to.
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So if I have guacamole, made with lime juice, and an hour or so later take my statin before bed, is this an issue? Hadn't heard about lime juice and pomelos, only grapefruit. What about other citrus fruits?
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@mary,
People may well drink a 8 oz or more of grapefruit juice. You probably consume 1/10th of that volume or less when you eat guacamole. In addition to that, grapefruit juice has different concentrations of the different chemicals that cause the drug interactions when compared to lime juice, specifically grapefruit juice is more of a problem. (https://www.ncbi.nlm.nih.gov/pubmed/12811362).
Additionally, some statins are quite sensitive, yet others show little to no effect. (eg. Lipitor...watch out, Crestor, no worry....here is a reference for that: https://www.health.harvard.edu/heart-health/grapefruit-juice-and-statins
So, if you are drinking margaritas and having a cup of limey guacamole every single night and are on high dose Lipitor, this is certainly something to look into. Otherwise...well, you get the idea.
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I’m thinking it wasn’t a good idea to give me grapefruit juice as my first thing to have when I was in the ICU, had just had a nasogastric tube removed after 4 days, was recovering from septic shock with 105.9 fever and still fighting sepsis. Though the only drugs I was taking were antibiotics, my stomach got rid of the grapefruit juice immediately. It seems it was a very poor choice for a stomach that had been violently ill and han’t seen food in 4 days.
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I have been reading the NYT for many decades, and frankly, your articles on medicine are very, very skimpy...they feel "edited"-cut short-as if someone decided to leave a large portion of the article on the editing floor.
While I understand that "space" was important when newsprint was perhaps the major expenditure for a newspaper, now we read online, so space should be a much less prevalent concern, especially when dealing with the subject of science and medicine.......or have you come to the conclusion that your readers cannot "take" longer and more in depth articles?
If this were the case, may I suggest that you run fully informative articles, preceded by an "executive summary" to replace or add to the subtitles?
These are important topics to many of us, your readers deserve a much more nuanced and detailed treatment of a complex matters, so that we, the readers, might be better informed and not left with questions that the article raises without answering them!!!!
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@plv
Thank you for expressing so well this much needed advice to the Times Health section. I often finish Health pieces with many questions raised by the piece but left unanswered, leading to lengthy searches online. So frustrating that I nowadays often skip the short Health pieces.
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@plv
I love the WELL articles - and if I want to learn more I go into Google, which usually has more answers !
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@muz
Google? When it comes to reliable information and research in medicine , technology and science, the plain vanilla version of Google is never a satisfactory substitute for Google Scholar, PubMed and Cochrane Reviews.
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Due to the exorbitant cost of many drugs in America, many cut pills in half and take them with grapefruit juice to stretch their dollars. The thanks for this dangerous trend can go to Big Pharm.
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Been on daily Levothyroxine since turning 50 over 20 years ago. Produced a textbook,years long TSH history my doc is happy with.What, when ,how to eat, is secondary.Daily routine is key.
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@John Arthur Feesey Yes. I can't take Levothyroxine in the morning because it then keeps me awake at night; my levels are fine but I'm buzzing. I take mine before bed, at the recommendation of my mother—who has the same issue—and an NP who said that routine is far more important than time of day. She also said that about half of her patients on a thyroid medication found taking it at night worked better for the same reason. Levels are fine at either time, but sleep is better with the nighttime routine.
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I take generic Levothyroxine tablets for Hashimotos Disease. I drink coffee with plant based milk before an hour is up after my dose.
Otherwise, I am very compliant.
I can't be good all the time.
Fortunately, for me, my #'s are always good when I go in for my doctor/blood checks.
We are asked to do so much regarding health care: How far and long to walk, what to eat, what to do - it becomes exhausting and subtracts from enjoying however many short years I have on this planet. So, I pick and chose.
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@Lizzy
old age isn't for sissies.
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Take your thyroid med at night so there’s no absorption problem due to food. I take my daily dose at night.
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@Lizzy
Take it at night
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Levothyroxine has a half-life of about a week, so each dose makes only a small contribution to the blood level. Small variations in absorption from one day to the next tend to get averaged out. The body also has ways to compensate for minor changes in blood level by adjusting how its organs activate the hormone. So, it makes little sense to distort one's routine in order to maximize absorption. I tell my patients to take it when they brush their teeth in the morning and just go about their normal routine. If the absorption averages out to be too low, I prescribe the next higher dose. This works out much better than making it so difficult for patients just to have them on a lower dose. What difference does it make whether one needs a white pill or a pink pill? As long as it averages out ok, why make it harder than necessary? Sometimes theory gets in the way of common sense.
There are clearly some drugs (especially Carafate) and foods that are problematic, and patients need to know how to deal with that.
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@Bart
100% agreement. Take your thyroid med anytime you want. It will average out and, like Burt says, your pill can be adjusted to you rather than the other way around.
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@Bart: Thank you for this information. What about liothyronine? I'm guessing it's different, perhaps very different, in this regard. Is it faster acting, with a much shorter half life? Does anyone know?
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@Tara
Rational people don’t take liothyroxine. As you say it’s half life makes it much less desirable than l-thyroxine. So only supercilious doctors prescribe it. (Oooh, that will get a rise from the righteous.)
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My endocrinologist has prescribed calcium when I take levothyroxine to improve absorption in the stomach! Confusing article. He is part of a large research study at the moment studying this problem with Calcium showing positive results!!!
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One of my pet peeves: airlines often serve grapefruit. In my opinion, they shouldn't. Ever.
It is also a mystery to me why pharmacists, when dispensing medications influenced by grapefrui, are not required to say so.
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Which birth control pills are affected?
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@JR Right!? The side-effect of pregnancy is NOT good.
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@JR Right?! Uh yeah that was quite the medication to just casually throw in that list.
And is it that it increases or reduces absorption?
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I'm confused. Is it okay to eat grapefruit instead of drinking the juice?
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@Catherine No (see first sentence in the article).
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@Catherine Eating a 1/2 grapefruit is much safer than drinking a glass of grapefruit juice.
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