Recent studies show that up to 64% of Americans drink about a cup of coffee each and every day (1).
This isn't a problem by itself (although it could be as we will soon see) but it can be a major problem if you are consuming your coffee with your prescription medications.
In particular, I'm talking about Synthroid (or levothyroxine which is the generic version of Synthroid).
Synthroid is the most commonly prescribed prescription drug in the United States with an estimated 114 million prescriptions being filled in 2016 (2).
And coffee has been shown clinically to potentially reduce the effectiveness of thyroid medication IF they are consumed at the same time.
When you put these things together it's easy to see why this is an important topic worth discussing.
Does Coffee Negatively Impact your Thyroid Medication?
The answer is yes (not in every case, but in enough cases for there to be studies on the topic).
Drinking coffee at the same time (or near the same time) as your thyroid medication has been shown to reduce how much of that medication you are absorbing into your body (3).
This is a huge deal if you have thyroid problems.
Because you can take all of the thyroid medication that your body needs by mouth but it does absolutely nothing for you if it doesn't make it into your bloodstream.
The only way it can make it into your bloodstream is if it's absorbed by your intestinal tract.
And thyroid medications, of all types, tend to be some of the most volatile prescription drugs on the market.
Meaning, pretty much everything has some impact on whether or not you will absorb your medication.
Simply waiting at least an hour after you drink your coffee may be the difference between feeling better or not (more on this below).
But why does coffee interfere with thyroid medication absorption?
We are not 100% sure but it probably has to do with the stimulatory effect from the caffeine found within the coffee.
Caffeine, the major stimulant found within coffee, does exactly what it is supposed to.
It stimulates your mind, it stimulates your heart, it stimulates your adrenal function, and it also stimulates your intestinal tract.
This stimulation is the very reason why so many people love their coffee but it's also the main reason why coffee probably inhibits thyroid medication absorption.
Ever wonder why so many people have a bowel movement after they have a cup of coffee? This is why.
But this stimulation of the gastrointestinal tract is NOT good for the absorption of your thyroid medication.
The faster that your intestinal tract moves the shorter amount of time your medication will spend in your intestines.
And thyroid medication, especially Synthroid and levothyroxine, take a while for your body to breakdown completely.
So, to paint a better picture here, you might be losing a small (or large) portion of your thyroid medication in your stool if you take it with your coffee.
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How to Take Your Thyroid Medication
All of this begs the question:
How should I actually take my thyroid medication so I can avoid absorption issues?
It's actually not that hard, but the problem is that there isn't a single place that patients can get all of the information they need.
Consider these guidelines to be that information and use these tips to help you absorb more of your thyroid medication when you take it:
- Take your thyroid medication either FIRST thing in the morning or RIGHT before you go to bed - There have been studies which show that taking your thyroid medication at night is not only equivalent to taking it in the morning, some studies suggest that it might be better.
- Wait 4 hours before you take your thyroid medication IF you are taking iron or calcium supplements - Iron and calcium are notorious for binding to thyroxine (the active component of your thyroid medication) and rendering it inactive. Be VERY cautious if you use either of these supplements anywhere near the time of day that you take your thyroid medication.
- Wait 30-60 minutes before you take your thyroid medication IF you are taking other supplements - Other supplements, which includes thyroid supplements, can also potentially interfere with thyroid medication absorption. Just be sure to wait 30-60 minutes and you should be good to go. This includes things like fish oil, vitamin D, and so on.
- Wait 60 minutes before taking your thyroid medication after you consume coffee - The general guidelines for coffee would be to wait at least 1 hour (or 60 minutes) before you take your medication. If you place your medication RIGHT by your bed with a glass of water you can take it basically RIGHT when you wake up and before you get ready for the day. If you are drinking your coffee right after this then you might try taking your medication at bed right before you go to bed.
- Wait 30-60 minutes before you take your thyroid medication after you eat breakfast - Food, in general, can also limit thyroid medication absorption (4). Be sure that breakfast isn't also interfering with your medication schedule. This is another reason I like the-taking-your-thyroid-medication-at-night approach because most people don't eat RIGHT before they go to bed. Dinner is usually at 7 pm and bedtime is hopefully a few hours after.
If you follow these tips then you should limit the chance that there is any interference in absorption.
Now, this doesn't mean that you will necessarily feel great just by following these guidelines.
On the contrary, there are many people who need a different type and dose of thyroid medication to get back to 100% but this should definitely help you.
Tirosint vs Levothyroxine and Coffee
What if you are someone who HAS to have their coffee in the morning and it's the only time that you can take your medication? Is there a way to take your coffee and your thyroid medication at the same time?
The answer is yes, but it will require a little bit of work on your part.
This can be done by simply switching which type of thyroid medication that you take.
Each thyroid medication (and there are several of them) has different advantages and disadvantages.
Likewise, some are more easily absorbed than others.
In particular, the gel/liquid formulations of levothyroxine and Synthroid are very easily absorbed by the intestinal tract.
These medications are considered to be levothyroxine/Synthroid equivalents in that they both contain the exact same active ingredient (thyroxine) but they carry an additional bonus.
That bonus is the fact that they do not contain very many fillers or binders.
For instance, Tirosint has only 3 inactive ingredients and 1 active ingredient (5).
Tirosint-Sol has only 2 inactive ingredients and 1 active ingredient (6).
You can compare this to Synthroid which has at least 7+ inactive ingredients and 1 active ingredient (7).
All of these ingredients play a role in how quickly your body can absorb and break down your thyroid medication.
In general, the fewer the inactive ingredients the easier it will be to absorb it (not universally true for all cases).
In addition, there have actually been clinical studies which show that taking coffee with liquid levothyroxine does NOT seem to affect serum T4 levels (8).
As an added bonus, Tirosint can also be taken with breakfast (making it great for certain people) without interfering with serum T3 and T4 levels (9).
Just because you CAN take your medication with coffee doesn't necessarily mean that you should, however.
Coffee and Adrenal Health
I understand that coffee may be a mainstay for many of you and its something that you may not think you can live without.
But, is it something you should consider taking a break from?
The answer may be yes.
Coffee not only has a potentially negative (notice I said potentially) impact on your thyroid and medication absorption but it also may affect other hormone systems in your body.
The caffeine found within coffee has a stimulatory effect on your body and may help increase the secretion of certain adrenal hormones from your adrenal glands (10).
Hormones such as norepinephrine and epinephrine, otherwise known as adrenaline, are increased after caffeine consumption.
These catecholamines impact a number of important cells in your body including heart cells, brain cells, and so on.
It's felt that the release of these metabolites probably plays a significant role in why consuming caffeine leads to increased alertness and focus.
But there's one potential problem with this.
Constant consumption of caffeine may put a supraphysiologic demand on your adrenal function.
Put another way:
Caffeine may be trying to force your body to create more adrenaline and hormones than is healthy for your body.
In addition, consuming caffeine is great but it can have a negative impact if it's constantly used to keep yourself awake during the day due to decreased sleep at night.
This sort of scenario is one in which you are robbing Peter of pay Paul.
Eventually, this will catch up to you and when it does you may experience a crash in your energy levels which will not be alleviated by further coffee/caffeine consumption.
The exact mechanism for why this occurs is not well understood but it probably has something to do with the amount of stress that your body can safely tolerate and the constant pressure from outward sources that stress and other hormones place on your body.
When your stress load becomes too high for what your body is capable of reacting to, you may start to experience symptoms consistent with adrenal fatigue or burn out syndrome.
Thyroid patients, by the way, seem to be extremely sensitive to this condition most likely owing to the connection between thyroid function and adrenal hormone function.
My recommendation for thyroid patients out there reading this is to try and cut back on your coffee/caffeine consumption, at least temporarily, to see if you can reduce the stress/strain on your body.
At the very least, you will NOT want to take both Synthroid and coffee together but cutting back on your coffee consumption by 50% or more is probably a good idea as well.
This will give your body a break and allow your body to reach a normal equilibrium on its own and without additional forces acting upon it.
Putting it All Together
The main takeaway is this:
If you are taking Synthroid or levothyroxine for your thyroid then you should NOT be taking it with your morning cup of coffee.
If you do, you risk limiting how much of that medication can get into your body which may affect your symptoms.
Waiting at least 60 minutes after your cup of coffee is probably enough time to limit this effect.
If your schedule doesn't allow for this 60-minute break then you should look into other alternatives such as Tirosint or Tirosint-sol which are thyroid medications that can be taken with breakfast foods and morning coffee.
With all this said, there is a legitimate case to be made against the use of coffee if you have thyroid disease as it may put extra strain on the body and lead to issues such as insomnia (both of which are bad for your thyroid).
As always, there is no general consensus or rules to follow. You must find what works for your body through trial and error.
Now I want to hear from you:
Have you been taking your medication with coffee in the morning?
Have you also been feeling poorly?
Or does it not seem to affect you?
Do you think coffee is causing any other issues in regards to your adrenal health?
Leave your questions or comments below!
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