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From: Rod on 8 Jul 2008 17:41
Quite an interesting article in The Endocrine Society's news.

When I got to the end I couldn't help asking whether vitamin C is itself
superior in any way to apple cider vinegar, lemon juice, or other acid
that is reasonable to swallow? They mention hydrochloric acid - but that
isn't exactly the most available substance in consumable forms.

Also, this is the first mention in an endorinology context of using an
acid in people with a history of acid reflux. The majority conventional
medicine view has always appeared to be "How silly that would be."

Obviously, previous advice about separating calcium, magnesium and
aluminium medicines by several hours from thyroxine might in part be
required because of their effect on acidity.




P2-240: Absorption of thyroid drug levothyroxine improves with vitamin C
Saturday, June 14, 2008

Contacts:

Charles E. Blue
Director, Media Relations
Phone: (301) 941-0240; Cell: (202) 236-6324
Email: cblue(a)endo-society.org

Aaron Lohr
Manager, Media Relations
Phone: (240) 482-1380
Email: alohr @ endo-society . org


Vitamin C improves oral absorption of the thyroid hormone replacement
drug levothyroxine, according to a new study. The results will be
presented Monday, June 16, at The Endocrine Society's 90th Annual
Meeting in San Francisco.

Some patients taking this oral drug to treat an underactive thyroid have
difficulties with its absorption into the bloodstream, said the coauthor
who presented the findings, Sandra Licht, MD, an endocrinologist at the
University of Buenos Aires in Argentina. Paula Antunez, also of the
University of Buenos Aires, is the study's principal author.

With inadequate drug absorption, the patient's abnormally high blood
levels of thyroid-stimulating hormone (TSH) fail to decrease, and
symptoms continue, such as fatigue, depression and weight gain. When
this occurs, the patient usually needs a higher dose and further
testing, she said.

Certain medications and digestive diseases interfere with the absorption
of levothyroxine, but often malabsorption occurs for unknown reasons,
Licht said.

Past research has shown that taking an acidic substance (hydrochloric
acid) at the same time as the levothyroxine tablet may enhance the
drug's absorption. Therefore, the authors studied whether simultaneous
use of vitamin C (ascorbic acid) would improve dissolution of the
levothyroxine tablet and thus absorption.

They studied 11 patients (eight women and three men) who were taking
higher-than-average doses of levothyroxine but not reaching their target
TSH levels, as found by two different blood tests. None of the patients
had factors that interfered with levothyroxine absorption, such as
celiac disease or use of calcium or iron supplements or antacids. For 6
weeks, patients took 1 gram of vitamin C with their levothyroxine pill.
They diluted a vitamin C tablet in about 7 ounces of water.

After six weeks, all 11 patients had decreased TSH levels, with an
average reduction of about 69 percent. Nine of the patients achieved the
desired level of TSH.

The decrease in TSH indirectly shows that levothyroxine absorption
increased, Licht explained. She said that studies in larger numbers of
patients are needed to confirm their finding.

Although the patients in their study diluted the vitamin C pill in
water, Licht said she expects that swallowing the pill directly would
have the same effects on drug absorption.

“Patients with difficulties in the absorption of levothyroxine should
consider talking to their doctors about co-administration of vitamin C
with levothyroxine,” Licht said, “especially if they have a history of
kidney stones, anemia or acid reflux.”

<http://76.12.85.195/media/ENDO-08/research/Absorption-of-thyroid-drug.cfm>

--
Rod

Hypothyroidism is a seriously debilitating condition with an insidious
onset.
Although common it frequently goes undiagnosed.
<www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>
From: Jerry on 9 Jul 2008 10:42
Rod wrote:
>
> When I got to the end I couldn't help asking whether vitamin C is itself
> superior in any way to apple cider vinegar, lemon juice, or other acid
> that is reasonable to swallow? They mention hydrochloric acid - but that
> isn't exactly the most available substance in consumable forms.

hi, Rod. I'd assume they used hydrochloric acid (HCl) in order to simulate the
release of HCl in the stomach that naturally occurs after eating - plus they'd
be able to control the exact amount of HCl in all subjects and eliminate the
amount as a variable.

>
> Obviously, previous advice about separating calcium, magnesium and
> aluminium medicines by several hours from thyroxine might in part be
> required because of their effect on acidity.

very good point

also, IIRC, mineral supplements in general are recommended to be taken with
food, in order to generate an acid environment and facilitate absorption. How
does that interact?

But, I did just read that grapefruit juice (which is acid) had only a slight
effect on thyroxine absorption... so, as usual, nothing is clear.

From: Rod on 9 Jul 2008 11:43
Jerry wrote:
> Rod wrote:
>>
>> When I got to the end I couldn't help asking whether vitamin C is
>> itself superior in any way to apple cider vinegar, lemon juice, or
>> other acid that is reasonable to swallow? They mention hydrochloric
>> acid - but that isn't exactly the most available substance in
>> consumable forms.
>
> hi, Rod. I'd assume they used hydrochloric acid (HCl) in order to
> simulate the release of HCl in the stomach that naturally occurs after
> eating - plus they'd be able to control the exact amount of HCl in all
> subjects and eliminate the amount as a variable.
>
>>
>> Obviously, previous advice about separating calcium, magnesium and
>> aluminium medicines by several hours from thyroxine might in part be
>> required because of their effect on acidity.
>
> very good point
>
> also, IIRC, mineral supplements in general are recommended to be taken
> with food, in order to generate an acid environment and facilitate
> absorption. How does that interact?
>
> But, I did just read that grapefruit juice (which is acid) had only a
> slight effect on thyroxine absorption... so, as usual, nothing is clear.
>
Ah but that will be in the context of grapefruit having all sorts of
weird and unexpected effects on numerous other medicines. And, of
course, if the subjects already had sufficiently acid stomachs, the
*extra* acid probably has little or no effect. (I just read that or a
similar paper.)

Then I came across this (see below). But in what I could read, it wasn't
clear if they had actually measured acidity or just assumed that the
Famotidine had the effect they expected.


Thyroid


The Effect of Famotidine, Esomeprazole, and Ezetimibe on Levothyroxine
Absorption

To cite this paper:
Sonia Ananthakrishnan, Lewis E. Braverman, Robert M. Levin, Barbarajean
Magnani, Elizabeth N. Pearce. Thyroid. May 1, 2008, 18(5): 493-498.
doi:10.1089/thy.2007.0381.

Sonia Ananthakrishnan
Section of Endocrinology, Diabetes, and Nutrition, Department of
Medicine, Boston University School of Medicine, Boston, Massachusetts.
Lewis E. Braverman
Section of Endocrinology, Diabetes, and Nutrition, Department of
Medicine, Boston University School of Medicine, Boston, Massachusetts.
Robert M. Levin
Section of Endocrinology, Diabetes, and Nutrition, Department of
Medicine, Boston University School of Medicine, Boston, Massachusetts.
Barbarajean Magnani
Department of Pathology, Tufts Medical Center, Boston, Massachusetts.
Elizabeth N. Pearce
Section of Endocrinology, Diabetes, and Nutrition, Department of
Medicine, Boston University School of Medicine, Boston, Massachusetts.

Background:
Recent literature describing the effect of gastric acid suppression on
levothyroxine absorption has been inconsistent. Also, ezetimibe, a
lipid-lowering compound that inhibits intestinal absorption of
cholesterol, may interfere with levothyroxine absorption. The objective
of this study was to measure changes in levothyroxine absorption before
and after famotidine, esomeprazole or single-dose ezetimibe.”

Methods:
We conducted levothyroxine absorption testing on 30 healthy volunteers,
excluding those with thyroid disease. Subjects were randomized to
receive one of three regimens: 1 week of either famotidine or
esomeprazole, or a single dose of ezetimibe administered simultaneously
with levothyroxine (n = 10 in each group). Baseline levothyroxine
absorption testing was performed on all subjects using 600 mcg of
Synthroid with thyroid hormone levels checked at 0, 2, 4, 6, and 8 hours
after administration, and then repeated 6 weeks later, after
administration of one of the three study drug regimens. The area under
the curve (AUC) over 8 hours for serum thyroxine (T4), triiodothyronine
(T3), and free T4 index, and the mean peak hormone levels achieved
during levothyroxine absorption testing at baseline and following
administration of one of the three study medications were compared using
paired t-tests.

Results:
Peak mean hormone levels and AUCs of T4, T3, and free T4 index during
absorption testing before and after each of three study medications did
not differ. Results for differences before and after study medication
did not reach significance even when using the subtractive correction
method of AUC calculation.

Conclusions:
No differences were noted in levothyroxine absorption after gastric acid
suppression with 1 week of famotidine or esomeprazole. A simultaneously
administered dose of ezetimibe did not significantly change
levothyroxine absorption.


<http://www.liebertonline.com/doi/abs/10.1089/thy.2007.0381>

--
Rod

Hypothyroidism is a seriously debilitating condition with an insidious
onset.
Although common it frequently goes undiagnosed.
<www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>
From: Dee on 9 Jul 2008 12:37
Thanks for the article. I was just inquiring about Vit C at the health food
store I go to all the time. I really want to get back on it, but was afraid
because of my acid reflux (and the acidity from ascorbic acid). There is
Ester-C, with added calcium to take away the acidity, so apparently this
would not be beneficial for the absorption of the thyroid medication?

I have a question. I take my dessicated thyroid sublingually, so since I'm
bypassing the gut (mostly, I do swallow a small amount) would the Vit C
still help with absorption, I wonder; since I'm presuming the thyroid is
going directly into my bloodstream? Does the absorption happen in the
digestive system, or does it take place in the liver, or all throughout the
body? I take it sublingually for a couple of reasons - the acid reflux I was
experiencing; and my celiac (which causes malabsorption, usually, through
the digestive system).
"Rod" <polygonum(a)ntlworld.com> wrote in message
news:6di57kF2mic0U1(a)mid.individual.net...
> Quite an interesting article in The Endocrine Society's news.
>
> When I got to the end I couldn't help asking whether vitamin C is itself
> superior in any way to apple cider vinegar, lemon juice, or other acid
> that is reasonable to swallow? They mention hydrochloric acid - but that
> isn't exactly the most available substance in consumable forms.
>
> Also, this is the first mention in an endorinology context of using an
> acid in people with a history of acid reflux. The majority conventional
> medicine view has always appeared to be "How silly that would be."
>
> Obviously, previous advice about separating calcium, magnesium and
> aluminium medicines by several hours from thyroxine might in part be
> required because of their effect on acidity.
>
>
>
>
> P2-240: Absorption of thyroid drug levothyroxine improves with vitamin C
> Saturday, June 14, 2008
>
> Contacts:
>
> Charles E. Blue
> Director, Media Relations
> Phone: (301) 941-0240; Cell: (202) 236-6324
> Email: cblue(a)endo-society.org
>
> Aaron Lohr
> Manager, Media Relations
> Phone: (240) 482-1380
> Email: alohr @ endo-society . org
>
>
> Vitamin C improves oral absorption of the thyroid hormone replacement drug
> levothyroxine, according to a new study. The results will be presented
> Monday, June 16, at The Endocrine Society's 90th Annual Meeting in San
> Francisco.
>
> Some patients taking this oral drug to treat an underactive thyroid have
> difficulties with its absorption into the bloodstream, said the coauthor
> who presented the findings, Sandra Licht, MD, an endocrinologist at the
> University of Buenos Aires in Argentina. Paula Antunez, also of the
> University of Buenos Aires, is the study's principal author.
>
> With inadequate drug absorption, the patient's abnormally high blood
> levels of thyroid-stimulating hormone (TSH) fail to decrease, and symptoms
> continue, such as fatigue, depression and weight gain. When this occurs,
> the patient usually needs a higher dose and further testing, she said.
>
> Certain medications and digestive diseases interfere with the absorption
> of levothyroxine, but often malabsorption occurs for unknown reasons,
> Licht said.
>
> Past research has shown that taking an acidic substance (hydrochloric
> acid) at the same time as the levothyroxine tablet may enhance the drug's
> absorption. Therefore, the authors studied whether simultaneous use of
> vitamin C (ascorbic acid) would improve dissolution of the levothyroxine
> tablet and thus absorption.
>
> They studied 11 patients (eight women and three men) who were taking
> higher-than-average doses of levothyroxine but not reaching their target
> TSH levels, as found by two different blood tests. None of the patients
> had factors that interfered with levothyroxine absorption, such as celiac
> disease or use of calcium or iron supplements or antacids. For 6 weeks,
> patients took 1 gram of vitamin C with their levothyroxine pill. They
> diluted a vitamin C tablet in about 7 ounces of water.
>
> After six weeks, all 11 patients had decreased TSH levels, with an average
> reduction of about 69 percent. Nine of the patients achieved the desired
> level of TSH.
>
> The decrease in TSH indirectly shows that levothyroxine absorption
> increased, Licht explained. She said that studies in larger numbers of
> patients are needed to confirm their finding.
>
> Although the patients in their study diluted the vitamin C pill in water,
> Licht said she expects that swallowing the pill directly would have the
> same effects on drug absorption.
>
> "Patients with difficulties in the absorption of levothyroxine should
> consider talking to their doctors about co-administration of vitamin C
> with levothyroxine," Licht said, "especially if they have a history of
> kidney stones, anemia or acid reflux."
>
> <http://76.12.85.195/media/ENDO-08/research/Absorption-of-thyroid-drug.cfm>
>
> --
> Rod
>
> Hypothyroidism is a seriously debilitating condition with an insidious
> onset.
> Although common it frequently goes undiagnosed.
> <www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>


From: Dee on 9 Jul 2008 12:39
I wanted to add on to something I said: "There is
> Ester-C, with added calcium to take away the acidity, so apparently this
> would not be beneficial for the absorption of the thyroid medication?

.... and since calcium is supposed to be avoided when taking the thyroid
medication, it would probably cancel out the benefits of the Vit C anyway?

"Dee" <jlmacdougall(a)eastlink.ca> wrote in message
news:9P5dk.2890$1o6.2887(a)edtnps83...
> Thanks for the article. I was just inquiring about Vit C at the health
> food store I go to all the time. I really want to get back on it, but was
> afraid because of my acid reflux (and the acidity from ascorbic acid).
> There is Ester-C, with added calcium to take away the acidity, so
> apparently this would not be beneficial for the absorption of the thyroid
> medication?
>
> I have a question. I take my dessicated thyroid sublingually, so since I'm
> bypassing the gut (mostly, I do swallow a small amount) would the Vit C
> still help with absorption, I wonder; since I'm presuming the thyroid is
> going directly into my bloodstream? Does the absorption happen in the
> digestive system, or does it take place in the liver, or all throughout
> the body? I take it sublingually for a couple of reasons - the acid reflux
> I was experiencing; and my celiac (which causes malabsorption, usually,
> through the digestive system).
> "Rod" <polygonum(a)ntlworld.com> wrote in message
> news:6di57kF2mic0U1(a)mid.individual.net...
>> Quite an interesting article in The Endocrine Society's news.
>>
>> When I got to the end I couldn't help asking whether vitamin C is itself
>> superior in any way to apple cider vinegar, lemon juice, or other acid
>> that is reasonable to swallow? They mention hydrochloric acid - but that
>> isn't exactly the most available substance in consumable forms.
>>
>> Also, this is the first mention in an endorinology context of using an
>> acid in people with a history of acid reflux. The majority conventional
>> medicine view has always appeared to be "How silly that would be."
>>
>> Obviously, previous advice about separating calcium, magnesium and
>> aluminium medicines by several hours from thyroxine might in part be
>> required because of their effect on acidity.
>>
>>
>>
>>
>> P2-240: Absorption of thyroid drug levothyroxine improves with vitamin C
>> Saturday, June 14, 2008
>>
>> Contacts:
>>
>> Charles E. Blue
>> Director, Media Relations
>> Phone: (301) 941-0240; Cell: (202) 236-6324
>> Email: cblue(a)endo-society.org
>>
>> Aaron Lohr
>> Manager, Media Relations
>> Phone: (240) 482-1380
>> Email: alohr @ endo-society . org
>>
>>
>> Vitamin C improves oral absorption of the thyroid hormone replacement
>> drug levothyroxine, according to a new study. The results will be
>> presented Monday, June 16, at The Endocrine Society's 90th Annual Meeting
>> in San Francisco.
>>
>> Some patients taking this oral drug to treat an underactive thyroid have
>> difficulties with its absorption into the bloodstream, said the coauthor
>> who presented the findings, Sandra Licht, MD, an endocrinologist at the
>> University of Buenos Aires in Argentina. Paula Antunez, also of the
>> University of Buenos Aires, is the study's principal author.
>>
>> With inadequate drug absorption, the patient's abnormally high blood
>> levels of thyroid-stimulating hormone (TSH) fail to decrease, and
>> symptoms continue, such as fatigue, depression and weight gain. When this
>> occurs, the patient usually needs a higher dose and further testing, she
>> said.
>>
>> Certain medications and digestive diseases interfere with the absorption
>> of levothyroxine, but often malabsorption occurs for unknown reasons,
>> Licht said.
>>
>> Past research has shown that taking an acidic substance (hydrochloric
>> acid) at the same time as the levothyroxine tablet may enhance the drug's
>> absorption. Therefore, the authors studied whether simultaneous use of
>> vitamin C (ascorbic acid) would improve dissolution of the levothyroxine
>> tablet and thus absorption.
>>
>> They studied 11 patients (eight women and three men) who were taking
>> higher-than-average doses of levothyroxine but not reaching their target
>> TSH levels, as found by two different blood tests. None of the patients
>> had factors that interfered with levothyroxine absorption, such as celiac
>> disease or use of calcium or iron supplements or antacids. For 6 weeks,
>> patients took 1 gram of vitamin C with their levothyroxine pill. They
>> diluted a vitamin C tablet in about 7 ounces of water.
>>
>> After six weeks, all 11 patients had decreased TSH levels, with an
>> average reduction of about 69 percent. Nine of the patients achieved the
>> desired level of TSH.
>>
>> The decrease in TSH indirectly shows that levothyroxine absorption
>> increased, Licht explained. She said that studies in larger numbers of
>> patients are needed to confirm their finding.
>>
>> Although the patients in their study diluted the vitamin C pill in water,
>> Licht said she expects that swallowing the pill directly would have the
>> same effects on drug absorption.
>>
>> "Patients with difficulties in the absorption of levothyroxine should
>> consider talking to their doctors about co-administration of vitamin C
>> with levothyroxine," Licht said, "especially if they have a history of
>> kidney stones, anemia or acid reflux."
>>
>> <http://76.12.85.195/media/ENDO-08/research/Absorption-of-thyroid-drug.cfm>
>>
>> --
>> Rod
>>
>> Hypothyroidism is a seriously debilitating condition with an insidious
>> onset.
>> Although common it frequently goes undiagnosed.
>> <www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>
>
>


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