The other day I went to dinner with a friend of mine who I hadn’t seen in awhile.
She is a beautiful, smart, funny and assertive woman who has been under the care of the best doctors around and taking thyroid medications, yet she was experiencing several thyroid symptoms, including dry skin, weight gain, hormonal imbalances, hair loss, and cold intolerance.
Usually, the first question that comes to mind when a person is experiencing these kinds of symptoms is, could this person benefit from a T3-containing medication?
But she was already taking Nature-Thyroid, which is a T4/T3 combination medication that has improved the lives of so many people with Hashimoto’s!
It turns out, she was unknowingly impairing the absorption of her medications with her morning Bulletproof coffee.
“Why didn’t anyone tell me that I’m not supposed to take my thyroid medications with coffee?” she exclaimed.
Sometimes we don’t know what we don’t know, and I hope that this article will empower and inform you about some of the things you may (or may not) have yet heard about coffee and its effects on the thyroid.
This post will answer the following questions I’ve received from my readers:
- Can I take my thyroid medications with coffee?
- Is coffee bad for the thyroid?
- Does coffee cross react with gluten?
- Can I drink coffee with adrenal fatigue?
- Is coffee Autoimmune Paleo friendly?
- Dr Izabella, do you drink coffee/caffeine today?
Coffee and Thyroid Hormone Absorption
One of the things that many people don’t know is that coffee can impair the absorption of thyroid medications and therefore needs to be spaced out from thyroid medications!
Food, in general, can impair the absorption of thyroid hormones, so this is why it’s always recommended to take thyroid hormones on an empty stomach, with a glass of water.
A person with normal digestive function can take thyroid medications 15-30 minutes prior to breakfast and have the medications be well absorbed, but some people may need to postpone breakfast by a minimum of 60 minutes after taking thyroid medications for proper absorption. One study found that some people had to wait as long as 5 hours to eat breakfast to properly absorb their thyroid medications!
I recommend keeping your thyroid medications at your bedside, so you can take them as soon as you wake up. But be sure to keep them out of reach of children and pets ‒ the scent of natural desiccated thyroid is especially appealing to pets!
As far as coffee and thyroid meds go, Italian researchers found that their first-thing-in-the-morning-espresso-loving patients did not absorb their thyroid medications correctly.
This is because coffee lowers the intestinal absorption of both inorganic and organic compounds, and seems to physically interact with thyroid medications.
In an Italian study, one person who was drinking espresso within 10 minutes of thyroid medications had a consistently elevated TSH between 13 μIU/mL and 18 μIU/mL. The same person, on the same dose of medication, was later made to wait one hour to have her coffee, and took her medication with a full glass of water instead. With this new change, her TSH was now testing between to 0.03-0.1μIU/mL every time she had it tested. (The researchers followed her for another 15 months!)
Interestingly, an additional group of Italian researchers found a way for their espresso-loving thyroid patients to have their coffee with their thyroid medications. They found one specially formulated thyroid medication that may withstand the effects of coffee ‒ Tirosint, which is a gelcap formulation of levothyroxine, showed adequate absorption, even when taken with coffee.
Liquid levothyroxine also has a better absorption profile and can also be taken with coffee, though this formulation is not widely available.
While most of the studies on coffee and thyroid hormone absorption have been done with levothyroxine, anecdotally, people taking T3 and natural dessicated thyroid hormones can also have a problem with absorbing them if they’re taking them with coffee.
Other foods that may interfere with thyroid medication absorption include soy, grapefruit juice, cottonseed meal, walnuts, and dietary fiber.
The Bottom Line:
- Most people taking thyroid medications need to wait 30-60 minutes after taking their medications to have their morning coffee.
- Tirosint, a unique gelcap formulation of levothyroxine, is the only thyroid medication clinically shown to have adequate absorption with coffee.
Medications, when used appropriately, can save lives and make people feel better; however, inappropriate medication use can have dire consequences. The Institute of Medicine estimates that each year, over 1.5 million preventable adverse drug events occur. Hundreds of thousands of injuries ‒ even deaths ‒ have occurred as a result of improper medication use.
Before I became the Thyroid Pharmacist, my passion revolved around appropriate medication use, and I was a medication safety pharmacist who worked for a healthcare quality improvement organization. My job was to reduce adverse events from medications through improving the healthcare system.
My friend was taking her thyroid meds with coffee but was getting her medications delivered, so she never had a chance to talk to her pharmacist about the proper use of her thyroid medications! Even so, sadly, most pharmacists are misinformed about thyroid medications.
While pharmacists are trained in appropriate medication use and most of the ones I know are always trying to help their patients get the best possible outcomes from their medications, pharmacists, like most MD’s, are taught that levothyroxine (T4) is superior to natural dessicated thyroid medications like Armour, Nature-Throid or WP Thyroid.
When I was a pharmacy technician, we dispensed levothyroxine, Synthroid and Levoxyl all day, every day ‒ the meds were in our fast mover section at the pharmacy where all the pills were counted out by machines. I wasn’t surprised to learn that Synthroid was the #1 prescribed thyroid medication in 2012, 2013, and 2014! Yet Armour sat on a distant, sometimes dusty shelf in the back of the pharmacy. Out of the 15-20 thousand prescriptions filled by the pharmacy where I worked each month, I only dispensed Armour a few times per month!
Of course, digging deeper into thyroid physiology, we know that in many cases, patients can really benefit from T3-containing medications!
So what’s a patient to do?
- You have to educate yourself.
- You have to become the expert of your own health.
- You have to be the expert on your medications…
- Otherwise, how will you know if you’re getting the best care?
- Don’t let another person stand between you and the care you deserve!
I don’t want you to get caught in the cracks between the medical system, so I created an eBook all about optimizing thyroid medications! As a pharmacist, I just had to create this eBook. For a limited time, the eBook (a $19.99 value) is free…
The eBook will tell you everything you need to know about optimizing your thyroid meds: how to take them, what to avoid, what to do if you’re sensitive to thyroid meds…
Should I avoid coffee if I have a thyroid condition?
This isn’t a one size fits all answer.
A small 1989 study reported that coffee consumption was protective against thyroid disease (autoimmune thyroid and thyroid cancer). However, a 2017 meta-analysis of over 1000 thyroid cancer patients determined that coffee did not have an effect on thyroid cancer. A 1984 study in humans did not find coffee to have any effects on thyroid hormone levels, while a 1983 study done with newborn rats given high doses of caffeine showed that it did stimulate TSH and T4 and caused a miscommunication between the thyroid and the pituitary.
Of note, another study reported that the dose of caffeine to produce endocrine effects in humans would need to be at minimum 500mg, or 5 cups of coffee, in one sitting! (Note: One is not likely to get this amount of caffeine from coffee, though it’s plausible that a person taking caffeine pills for weight loss or energy or energy drinks may be exposed to these amounts ‒ these high amounts are also tied to cardiac issues, so I do not recommend caffeine pills or energy drinks).
Therefore, unlike gluten and dairy for many people with thyroid disease, coffee is not something that needs to be avoided for life by those with thyroid conditions.
On the other hand, some people may have conditions and predispositions where they may benefit from avoiding coffee, short-term or long-term, for a variety of reasons.
The caffeine in coffee has an effect on our heart rate, metabolism, wakefulness, adrenal health, and urine concentration.
If you have an overactive thyroid, anxiety, insomnia, headaches, frequent urination or palpitations, you may benefit from cutting back or even eliminating caffeine.
Hyperthyroidism in general increases our heart rate and is overly “stimulating” for the body. In the case of hyperthyroidism, we want to avoid any natural stimulants like caffeine, as well as pharmacological preparations like the decongestant pseudoephedrine and amphetamines that are used for ADHD or narcolepsy.
Sometimes, our symptoms can be worsened or even induced by caffeine excess. One of my clients complained of migraines, insomnia, anxiety, and frequent urination. Upon reviewing her diet, I learned that she was drinking 8 cups of espresso a day ‒ some were even as late as 8pm!
The coffee was too stimulating for her, making her anxious and unable to sleep. It also depleted too much magnesium, which caused the headaches and migraines.
The recommendation was to wean off the coffee and start magnesium, one of my miracles for migraines ‒ and within a few weeks, her migraines, insomnia, bladder, and anxiety issues had resolved.
Public Service Announcement: Never stop caffeine cold turkey! #thingsIlearnedthehardway
But it’s not just coffee ‒ the caffeine in green tea, matcha tea, black tea, soda, and Yerba Mate can produce the same symptoms. Interestingly, you may find that you have a different tolerance for various caffeine-containing substances. In addition to the varied amount of caffeine in the substances, the other compounds found in these substances tend to affect how the person reacts to the caffeine. I have some clients that get panic attacks from green tea, coffee, and matcha, but tolerate black tea and Yerba Mate. Others can drink coffee but get anxious from black tea.
If you love coffee, but have had an adverse reaction to the caffeine, trying decaf coffee may be an option.
Another option is to change how the caffeine is absorbed in your body. The anxiety produced by caffeine is often due to spikes in caffeine levels all at once, followed by a crash when all of the caffeine is dumped out. Drinking your caffeine with fat, à la “Bulletproof Coffee”, is a way to smooth out and extend the absorption of caffeine in the body.
If you’re not dairy sensitive, you can do Dave Asprey’s original Bulletproof coffee recipe, using grass fed butter as your fat.
Please note that butter still contains dairy proteins, and some people may still react to tiny amounts of dairy proteins from grassfed butter, cream and even ghee. (Clarified ghee is the least likely option to be reactive).
If you happen to be dairy sensitive like 80% of Hashimoto’s patients, there’s still a way to make caffeine absorption smoother with different fats.
You can use coconut milk, coconut oil or Bulletproof MCT oil, and not just in coffee ‒ all of these can also be used in tea.
A special note: start low and go slow with adding fat into your caffeine ‒ too much fat, too fast, can produce a side effect known as “disaster pants”, as coined by Dave Asprey.
Four Sigmatic offers yet another option for coffee with a line of mushroom coffees. Their mushroom coffees combine 100% Arabica organic coffee with a variety of immunity-supporting mushrooms.
The Bottom Line:
- You do not need to avoid coffee long-term if you have Hashimoto’s or thyroid disease; however, you may benefit from limiting/eliminating caffeine or adding fat to your caffeine if you have anxiety, insomnia, urinary frequency or migraines.
- You may want to avoid all stimulants including caffeine if you have hyperthyroidism.
- Decaf coffee is always a suitable option if you love the taste but don’t tolerate the caffeine.
Does Coffee Cross React With Gluten?
There’s also some potential for coffee to cross react to gluten, but there’s a caveat ‒ it’s not likely to be because of the coffee, per se, rather it’s because the coffee may be contaminated with gluten.
In their groundbreaking 2013 study “Cross-Reaction between Gliadin and Different Food and Tissue Antigens”, Aristo Vojdani and Igor Tarash found that instant coffee had a 23% reactivity with gluten, while instant café latte created an 82% cross-reaction with gluten. (The higher the % of reactivity, the stronger the gluten cross-reaction to the product). The researchers determined that some of the “reactivity” in instant café latte could have been produced by the dairy proteins in the latte. Dairy protein is a known, highly cross-reactive food for gluten, and 80% of people with Hashimoto’s feel better dairy free as well.
In contrast, fresh espresso made from coffee beans did not produce any gluten reactions. Additionally, coffee powder, pure cocoa, and milk-free dark chocolate did not produce a cross-reaction to gluten either.
There is some evidence that some brands of coffee may contain mold, which can be an issue for autoimmune and thyroid diseases. I personally like the Bulletproof coffee brand I mentioned above because it was developed by Dave Asprey, a Hashimoto’s patient who has made sure his coffee is gluten free and free of mold.
Full disclosure ‒ Dave sent me some of his coffee for Christmas last year, and I’m hoping he will send me more this year, but that’s not why I’m recommending his coffee 🙂 I also buy it myself when he forgets to send me free samples.
The Bottom Line:
If you have Hashimoto’s, celiac disease and/or are gluten sensitive, you should avoid instant coffee, which may be contaminated with traces of gluten. However, drinking pure coffee is likely safe for individuals with gluten sensitivity and celiac disease as long as you don’t have other types of reactions to it.
Can I Drink Coffee with Adrenal Issues?
One of the fastest ways to get into adrenal fatigue is through sleep deprivation… One of the most helpful interventions to get out of adrenal fatigue is to get plenty of rest!
Caffeine in coffee and tea can prevent us from resting when we should be, and this can put our bodies in a fight or flight mode instead of a rest and digest setting. We want to give the adrenals every opportunity to heal.
If you can’t function without caffeine, and are drinking multiple cups a day just to stay awake, this could be a sign that your adrenals are compromised and that you may benefit from weaning off and rebalancing to a healthier level.
Furthermore, a high intake of caffeine can impact cortisol levels.
One of the quick things you can implement in your morning routine is delaying your first cup of caffeine 1-2 hours after waking up. This will allow your adrenals to start rebalancing.
Additionally, you may want to consider a caffeine wean…
If you’ve been drinking caffeine for a while, you may want to wean yourself off instead of going cold turkey, as caffeine is an addictive substance. Reducing your intake by 50% every day can be helpful. For example, if you usually drink two cups of coffee per day, dropping down to 1 cup, then ½ cup, and ¼ cup, then discontinuing, may be a gentler process.
Instead of caffeine, you can have the following:
- Hot lemon water first thing in the morning and throughout the day will wake you up better than any tea or coffee, and will help support your stomach acid and your liver’s detox pathways.
- Green juice will give you plenty of nutrients and energy in a broken-down, usable form.
- Herbal teas and decaf coffee can be another option.
- Dandy Blend is a gluten-free herbal mix that tastes like coffee.
- Mushroom Hot Cacaos is a caffeine-free combination of mushrooms and antioxidant-rich raw chocolate.
- Spa water or purified water with added cut up fruit is a fun way to quench your thirst.
However, just excluding caffeine won’t heal our adrenals…
In addition to resting, I recommend relaxing activities like yoga, baths, deep breathing and/or meditation (whatever floats your boat!), balancing your blood sugar, magnesium, and the ABC’s of adrenal support!
The ABC’s of adrenal support are:
- Adrenal Adaptogens like maca, ashwagandha, and others
- B Vitamins including pantothenic acid and thiamine
- Vitamin C
I developed the Rootcology Adrenal Support to help you support your adrenals. This is a blend of the ABC’s in one formula 🙂 (I do recommend getting an additional thiamine supplement in many cases as well).
My Adrenal Protocol in Hashimoto’s Protocol is one month long and this month long exclusion eliminates caffeine. After the one month (unless you’re doing another protocol), the caffeine can be added back in. If you have not recovered your adrenals within the month long protocol, I also cover advanced strategies for adrenal support (like addressing past traumas and using low dose hormones) in Hashimoto’s Protocol.
The Bottom Line:
In the case of adrenal fatigue, avoiding coffee short-term may be beneficial on your healing journey.
Is Coffee Autoimmune Paleo?
Coffee is technically a seed, so even decaf is off the menu with the Autoimmune Paleo diet. That said, the Autoimmune Paleo diet is meant to be an elimination diet where you discover your reactive foods and allow your body a break from too many difficult-to-digest proteins as you work on a comprehensive plan to heal your body.
The Autoimmune Paleo diet is meant to be used for 4-12 weeks, and is not meant to be a lifelong diet. Seeds are some of the least reactive foods in Hashimoto’s, so most people are able to reintroduce coffee successfully. That said, if you happen to be sensitive or allergic to coffee, you would want to exclude it long-term.
In my experience, for most people, dietary interventions can produce a tremendous amount of improvement but do not heal all. We may also need to look at using protocols to address infections and toxins, such as herbal and supplement based interventions and even mind-body interventions!
I have a blog post on the Autoimmune Paleo diet that you can read for more information, and you can learn about the other synergistic protocols in Hashimoto’s Protocol if you feel stuck with just diet alone.
The Bottom Line:
As a seed, coffee is off the menu of the Autoimmune Paleo diet, but keep in mind the Autoimmune Paleo diet is a short term protocol, not a lifelong protocol!
Do You Drink Caffeine?
My readers often wonder what life looks like for me today, knowing that I have tried and recommend a lot of interventions, that I am living symptom free with my Hashimoto’s in remission, and that I’m feeling healthy and happy on most days.
I grew up drinking caffeine. Children in Poland are given black tea in their bottles! My kindergarten breakfast consisted of coffee and bread! I fueled myself on soda during college and pharmacy school, and by my mid twenties I had a heavy duty addiction, drinking 6-8 cups per day ‒ which led to anxiety, palpitations and being an extremely light sleeper.
I had to wean off caffeine completely during my healing journey, and stayed off of it for as long as 8 months in 2012.
Weaning off and even cutting back dramatically changed my anxiety and sleep!
Since that time I’ve mostly had a balance with caffeine, but I did have a few relapses of drinking 4-8 cups per day because of documentary and book deadlines! I hope you loved The Thyroid Secret and Hashimoto’s Protocol– a lot of love, blood, sweat, tears, and late nights went into creating both of them! <3 Although caffeine made me feel like Super Woman, I certainly was not. The combined stress, lack of sleep and caffeine overload led to my own adrenals becoming compromised, and I had to wean off the caffeine and follow my own adrenal protocol this past summer!
My adrenals have rebalanced since then, but I had to cancel and say no to a lot of commitments to properly heal them! Now, I personally have 1-2 cups of tea or coffee on a daily basis and that amount keeps me balanced and does not interfere with my health.
The Bottom Line:
I do drink caffeine without it having a negative impact on my health, but not too much ‒ if I drink too much, my adrenals get too stressed, and I start thinking I am Super Woman 🙂
I hope that this article was really helpful on your healing journey!
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