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What no iron and no calcium food do you eat for breakfast?
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What no iron and no calcium food do you eat for breakfast?

I have just been put on levothyroxin (levothyroxine) (50 mcg) for hypothyroidism. The instructions say to take levo an hour before breakfast, but FOUR hours before having any iron or calcium. All the usual breakfast foods have iron and/or calcium in them, even fruit! So what can I eat for breakfast? What foods have no iron and no calcium? I've also read I should avoid soy and walnuts. Help!
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Avatar_f_tn
I think what they mean by no iron or calcium for four hours after levo is supplements.  If you wait the hour after taking your pill before breakfast, you can have whatever you want for breakfast.

Soy is basically cattle feed and undigestible unless it is fermented...soy sauce, tempe, etc.  Some of us hypos have a hard time with it, others not.  

You are going to be dealing with this condition for the rest of your life.  My philosophy is to change as little as possible from what you were doing prior to diagnosis.  If you notice something bothering you, then by all means, discontinue it.  Otherwise, have at it!
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Avatar_m_tn
I think those instructions are mainly to prevent having any interaction or absorption problems, so that you get the full benefit of your dosage.  Some people just go ahead and have their normal breakfast and take their meds at the same time.  If you lose some of the T4 that way, it will only mean that your dosage may have to be adjusted slightly higher after next blood test.  The main thing is consistency in your approach.  Some people have avoided the issue by just taking their thyroid meds at night.  This can work fine, unless you have some immediate reaction to the T4 med, which interferes with your sleep.  This isn't usually the case since T4 is more of a storage hormone that has to be converted to the far more active T3.

For future reference, please note that the best way to treat a thyroid patient is to test and adjust the levels of the biologically active thyroid hormones, FT3 and FT4, with whatever meds are required to alleviate symptoms, without being constrained by resultant TSH levels.  Symptom relief is all important.   Frequently we hear from members that this requires that FT3 is adjusted into the upper part of its range and FT4 is adjusted to at least midpoint of its range.  FT3 is four times as active as FT4 and FT3 correlates best with hypo symptoms.  TSH is a pituitary hormone that is affected by many variables and it does not correlate well at all with hypo symptoms.  Also, just in case you should incur a low TSH while taking thyroid meds, that does not mean that you are automatically hyper.  Only having hyper symptoms makes you hyper.  

Sorry if this was more than you wanted to hear, but we hear so many times from patients who are misdiagnosed and undertreated that I thought I should make you aware of all this as you proceed with your treatment.
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219241_tn?1357815389
You must not have any supplements like the iron or calcium four hours after taking your medication.  The thyroid medication binds to the iron or calcium and is no longer usuable in your body.  Having a cereal with milk however is not going to cause any problems. The level of calcium and iron in these is not in the form of a supplement and has little values of amounts to cause problems.
   There are many juries still out on the soy issue. Some say don't have it, some say do.
Soy is fermented soy bean and whilst grown in the ground, it does have amounts of oestrogen in it. This oestrogen can interact with some people's levels in their body causing issues whilst on thyroid medication.  
  I have never heard of walnuts being an issue for thyroid patients. If anything they are a little power pack of essential fats and vitamins!  Personally I don't like walnuts they make my tongue get little blisters.
  
So get up in the morning, take your meds, do some housework, have a shower whatever to fill in the hour, have a nice healthy brekky and get on with your day!


  
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2127613_tn?1335365029
I too am on levothyroxine and was concerned about the same thing.  So I was taking the pill at night so I could eat regular foods.  Today I took it in the morning and am starving, but my doctor did say just supplements 4 hours after the pill. So now I'm getting something to eat.  Thanks for information.
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Avatar_m_tn
No, no, no, no. You can't EAT any calcium, or take supplements with calcium or iron. The advice of taking your pill and just trying to eat the same amount of calcium every day so they just up your dosage is terrible. This medication controls your heart rate and body temperature. What happens if you ingest calcium and it blocks 25% of your medication uptake, then one day you're running late and miss breakfast? Your heart rate and blood pressure is going to increase for the day, causing a dramatic risk for heart attack or stroke. I specifically asked my doctor about this during my testing after 90 days, and she was horrified that anyone would give that as advice. Especially since you sound like you're a medical professional. I had thyroid cancer and now that that's gone and I'm moving into a more long term treatment plan (since my thyroid was completely removed), I asked my new endo the same questions and he was just as appalled. It was hard at first, but now that I've found foods that work it's not too bad to have a calcium free breakfast...

Egg WHITES only
Margarine (I use Country Crock original)
Coffee / tea
Coffee Creamer (I use liquid Coffee Mate flavors)
Whole Grain Bread (Check the nutrition facts though, only some are full whole grain. I eat Natural Ovens Sunny Millet bread)
Lots of cereal (again, check the nutrition facts, and obviously don't eat with milk. I've found Corn Pops, Crunch Berries, Frosted Shredded Wheat, and Crunch Berries. I saw more in the store but don't remember now)
Marshmallows
Kashi Granola Bars
SOME canned fruit and vegetables, if you want to stay low calorie get No Sugar Added fruits
SOME canned soup, most of condensed, even creamy soups
Rice
Pasta
Boxed mashed potatoes (made without milk)
Sauerkraut
Pepperoni / Turkey Pepperoni
Turkey Breakfast Sausage (probably pork too, I don't eat it so I never checked)
WonTon / Egg roll wrappers
Lettuce (but don't get mixed salads without looking at nutrition fact since lots of leafy greens have calcium)
Italian dressing
Maple syrup

There's more I'm sure. The biggest thing is to check the labels, even during other meal times just so you know. It's not always the things you think that will be calcium free, and you might be surprised by things like creamer and margarine and breakfast cereals. I usually have egg whites, toast, and sausage for breakfast, but you could also make french toast, or make cereal bars with cereal and marshmallows.
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Avatar_f_tn
You might want to talk to a dietician about this.  Doctors tend to not have a real grasp on nutritional matters.

I wait 0.5-1.0 hours after taking my meds to eat, but when I have breakfast, I eat anything I want. If you are having an absorption problem, you might have to be more careful, otherwise not.

"What happens if you ingest calcium and it blocks 25% of your medication uptake, then one day you're running late and miss breakfast? Your heart rate and blood pressure is going to increase for the day, causing a dramatic risk for heart attack or stroke."

I think you're being just a bit dramatic.  Adjusting your thyroid meds by 25% for one day just does not have that kind of effect on your HR and BP.    

If you watch your calcium intake not only at breakfast, but at other meals as well, how's your calcium level?
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649848_tn?1357751184
I, too, wait 0.5 to 1.0 hrs after taking my med, then eat whatever I want.  I can't imagine sitting down to a bowl of dry cereal for breakfast, especially, corn pops, frosted shredded wheat or crunch berries, that are loaded with sugar.  

Calcium is necessary for strong bones and teeth.  As you age, you're going to need that calcium to prevent osteoporosis.  Iron prevents anemia, provides energy and is necessary for the metabolism of thyroid hormones.  
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6555161_tn?1382385462
Um...forgive me if I'm reading this wrong, but are you saying that people taking levothyroxine shouldn't  need calcium and iron at all?? Or do you mean in the morning for breakfast? Thyroidless or not, everyone needs iron and calcium for their body to function properly (unless they have some sort of disease or problem that makes too much of these in your body naturally.) If you're going to eat a breakfast that's a bit higher in calcium and iron and know you are, then it's perfectly fine to adjust your dose just a bit that morning to compensate for it. A day here and there of adjusting your meds to make sure you're getting the right amount of levo isn't putting you at risk for heart attack or stroke. I could see if you consistently took too much "just in case" could put your heart at risk since you're over-medicating yourself, or not adjusting at all if you're one to eat a lot of iron and calcium rich foods in the a.m. constantly, since you can get problems with your heart from hypothyroidism as well, but seriously, I have to agree here-you're not going to hurt yourself adjusting accordingly if you know you're going to have a breakfast rich in these, and you're honestly pretty much fine eating iron and calcium rich foods throughout the day as long as everything else in order.
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649848_tn?1357751184
Adjusting T4 dose on a daily basis to accommodate your breakfast is a lesson in futility, since it takes approximately 4-6 weeks for an adjustment to take effect.  

Just take your med and eat what you're going to and don't take supplements w/in 4 hrs... it really is that simple.
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Avatar_f_tn
I agree, let's not overcomplicate this.  I don't think there's any possible way that you can adjust meds on a daily basis to compensate for the food you eat and how it might affect absorption.

FT4 levels build slowly (and decrease slowly as well), so minute differences in what you absorb are easily going to be compensated for.  It takes weeks for a legitimate dosage adjustment to affect levels enough to cause symptoms or symptom relief.  

If you have a demonstrated absorption issue, i.e. meds just aren't getting into your blood stream, by all means check your habits.  Otherwise, just wait half to one hour before eating or drinking and take any supplements 3-4 hours away as stated on the bottle.  
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Avatar_m_tn
First off, a person shouldn't go trying to adjust their own meds on their own, especially since you don't know just what it should be adjusted to. And as both Barb and goolarra said, it take about 6 weeks for the levels to adjust.  Each person is different on how they handle the meds and food. Personally, since it has been hard to get my levels straightened, I have to be careful what i eat, and it isn't easy. Beadheadblonde, it isn't that we can't have it.. it is a matter of being told we can't have it for 4 hrs, because it will bind with the medication, and the body won't absorb enough, throwing the levels off
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Avatar_m_tn
I talk to pharmacist yesterday and it means no foods or supplements for  four hours after taking levothyroxine.
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649848_tn?1357751184
Your pharmacist is incorrect!!  

This is from Mayo Clinic:  "It is best to take this medicine on an empty stomach. Take it with a full glass of water at least 30 minutes to 1 hour before eating breakfast."

Also:  "This medicine should be taken at least 4 hours before or 4 hours after these medicines: antacids (Maalox®, Mylanta®, Tums®), calcium supplements, cholestyramine (Prevalite®, Questran®), colestipol (Colestid®), iron supplements, orlistat (Alli®, Xenical®), simethicone (Gas-X®, Mylicon®), and sucralfate (Carafate®)."


This from Synthroid: "Take Synthroid alone. Do not take Synthroid within 4 hours of ingesting medications, supplements, or foods that may interact with Synthroid. Antacids, iron, and calcium supplements, dietary fiber, soy, and even walnuts can affect your body's absorption of Synthroid. Talk to your doctor to learn more."

Note that both sites clearly say to avoid antacids, iron and calcium "supplements" for 4 hours.  There's not enough iron OR calcium in most foods to warrant not eating them, because of thyroid med.
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Avatar_f_tn
As you stated, the manufacturer of Synthroid says "Do not take Synthroid within 4 hours of ingesting medications, supplements, or **FOODS** that may interact with Synthroid."   (emphasis added)  So this is not just about supplements.


My FT4  got out of whack after I started eating tahini in the mornings.  So my endocrinologist told me specifically to stop putting tahini (sesame seed paste) on my bagels because it contains too much calcium.  She told me to wait 4 hours after my synthroid if I wanted to eat it.  She said to avoid foods high in iron for 4 hours as well.  





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649848_tn?1357751184
Foods "high" in iron are not necessarily the same as those "containing" iron.  Everything has to be within reason.
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Avatar_f_tn
I agree, Barb.
Personally I wait 4 hrs to eat after taking meds during the week basically because I wake up to get my husband ready for work (5am) then eat breakfast with the kids (9:30am) later. It's the weekend that screws me up cause my husband is home and we all sleep in so no supplements for me, unless I set my alarm to wake me up at 5am to take my med but that's nutty. Haha!
Totally agree, I think it has to be within reason, I highly doubt breakfast foods are super "high" in iron or calcium. My husband was born without a thyroid and has been on Synthroid/Levothyroxine since then and up until December of last year when he switched to Armour. A few weeks before going on Armour, He found out he should've been waiting an hour to eat and that's when he started experiencing hyperthyroid symptoms so they lowered his dose and eventually moved to Armour.
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Avatar_f_tn
My dermatologist prescribed Doxycycline for my cystic acne. The warnings regarding iron and calcium intake while using Doxy are virtually identical to those given for the thyroid meds discussed in this thread.  My GO TO calcium and iron-FREE food I take to help with any nausea is the #InkaChips brand of Plantain Chips... They are all natural, no trans fat and gluten free...AND they are delicious.  They are manufactured in Peru, but I find them at Gelsons Grocery Store in Los Angeles.  The number for their US Customer service is 800-808-0858.  Hope this helps.    
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