Did you know that, for some people, coffee may interfere with the absorption of their thyroid medication?
A while back, I went to dinner with a friend of mine whom I hadn’t seen for some time. Despite being under the care of the best doctors around and taking thyroid medications, she was still 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 heard about coffee — like its effects on the thyroid and the absorption of most thyroid medications, as well as possible contaminants and other implications for those with Hashimoto’s.
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?
- Does coffee contain mold?
- Can I drink coffee with adrenal fatigue?
- Is coffee Autoimmune Paleo-friendly?
- Dr. Izabella Wentz, do you drink coffee/caffeine today?
1. Coffee and Thyroid Hormone Absorption
Many people (including yours truly!) love coffee. But, one of the things that many people don’t know is that coffee can impair the absorption of thyroid medications, and thus, it needs to be spaced out from thyroid medications. (Food, in general, can impair the absorption of thyroid hormones — especially soy, grapefruit juice, cottonseed meal, walnuts, and dietary fiber — 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. (Tirosint may be an exception!)
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 another 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 (i.e. optimal!) every time she had it tested. (The researchers followed her for another 15 months.)
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.
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. Research has found that both the gel caps and liquid forms of this T4 medication are unaffected when taken with coffee (unlike tablet formulations). This is great news for those of us who need our morning cup of coffee, thanks to an active toddler! 🙂
Thus, if you are taking other forms of thyroid medications, I recommend keeping your thyroid medications at your bedside, so you can take them as soon as you wake up, at least 30-60 minutes away from your morning cup of coffee and breakfast.
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 and liquid formulation of levothyroxine, is the only thyroid medication clinically shown to have adequate absorption with coffee.
2. 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 thyroiditis and thyroid cancer). However, a 2017 meta-analysis of over 1,000 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 gland.
Of note, another study reported that the dose of caffeine required to produce endocrine effects in humans would need to be at minimum 500 mg, 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. However, these high amounts are also tied to cardiac issues, so I do not recommend caffeine pills or energy drinks.)
That said, 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.
Generally, hyperthyroidism increases one’s 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 had caused her migraines. The recommendation was to wean off the coffee and start a magnesium supplement ‒ one of my go-tos for migraines ‒ and within a few weeks, her migraines, insomnia, bladder, and anxiety issues had resolved.
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 such substances, the other compounds found in these substances tend to affect how a 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. (Public Service Announcement: Never stop caffeine cold turkey! #thingsIlearnedthehardway)
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 try 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 grass-fed butter, cream, and even ghee. (Clarified ghee is the least likely option to be reactive.)
If you happen to be dairy-sensitive like 80 percent 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 XCT oil, and not just in coffee ‒ all of these can be used in tea as well.
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 percent Arabica organic coffee with a variety of immunity-supporting mushrooms, including Reishi, to boost Secretory IgA levels (the respiratory and GI tracts’ first line of defense).
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.
3. Does Coffee Cross-React With Gluten?
There’s 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 percent reactivity with gluten, while instant café latte created an 82 percent cross-reaction with gluten. (The higher the percent 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 percent 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. Coffee powder, pure cocoa, and milk-free dark chocolate did not produce a cross-reaction to gluten either.
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.
4. Does Coffee Contain Mold and Toxins?
There is some evidence that some brands of coffee may contain mold, which can be an issue for autoimmune and thyroid diseases, as well as those with mold sensitivities. (Learn more about mold as a potential trigger of Hashimoto’s here.) In fact, one particular mycotoxin (a toxic metabolite of mold), ochratoxin A, is found in low levels in most coffee samples (though one study found elevated levels in 5 of the 100 samples tested). Ochratoxin A has previously been associated with kidney disease and tumors of the urethra in humans. It has also been associated with cancer, brain damage, and hypertension, and can have immunosuppressive effects.
Coffee, especially instant varieties, can also contain toxins like acrylamide. Most people with Hashimoto’s have an overburdened liver and an impaired ability to eliminate toxins, which is why my healing protocol always begins with liver support and eliminating toxins. Our food, water, personal care products (the list goes on!) assault our bodies with harmful toxins on a daily basis, so adding to that burden with contaminated coffee will only exacerbate the problem.
That said, there are brands out there that claim to be free of such toxins. 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. It is also tested for toxins.
Full disclosure ‒ Dave has sent me some of his coffee for Christmas in the past, 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:
Certain brands of coffee may contain mold, while instant coffee is likely to contain toxins that are harmful to thyroid health. Look for coffee varieties that have been tested for mold and toxins.
5. Can I Drink Coffee with Adrenal Issues?
One of the fastest ways to get into adrenal fatigue is through sleep deprivation… and 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. This can be counterintuitive, as we want to give the adrenals every opportunity to heal. Furthermore, a high intake of caffeine can impact cortisol levels.
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.
Something quick that you can implement in your morning routine right away, is delaying your first cup of caffeine by 1-2 hours after waking up. This will allow your adrenals to start rebalancing themselves. Additionally, you may want to consider a caffeine wean. (This is something that I recommend in my Adrenal Recovery Protocol in Hashimoto’s Protocol!)
Due to the possibility of experiencing serious withdrawal symptoms (which may especially be possible if you’ve been drinking a lot of coffee and for a long time), I do not recommend going “cold turkey.” Symptoms of caffeine withdrawal include headaches, nausea, irritability, diarrhea and even vomiting, and may be more pronounced if you eliminate caffeine quickly. Instead, I recommend the 25 percent reduction method, over a period of four weeks.
The 25 Percent Reduction Method:
- Week 1 – reduce your regular caffeine intake by 25 percent, for one week
- Week 2 – reduce your regular caffeine intake by 50 percent, for one week
- Week 3 – reduce your regular caffeine intake by 75 percent, for one week
- Week 4 – reduce your regular caffeine intake by 100 percent
Instead of caffeine, you may consider trying the following:
- Hot lemon water first thing in the morning and throughout the day, will wake you up better than any tea or coffee. It will also 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. (Note: While it does contain barley, the water extracts of it are gluten-free.)
- Mushroom Hot Cacao is a caffeine-free combination of mushrooms and antioxidant-rich raw chocolate.
- Pique Tea Crystals provide clean, sustained energy and six times the antioxidants of regular tea bags. They have some tasty caffeine-free, herbal options. Plus, their Reishi Calm Elixir provides Secretory IgA support, which may help boost your immune system’s defenses.
- Spa water or purified water with added cut-up fruit is a fun way to quench your thirst.
However, simply 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 formula 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 Recovery Protocol in Hashimoto’s Protocol is one month long and eliminates caffeine. After this period, the caffeine can be added back in (unless you’re doing another protocol or find yourself reacting to caffeine). 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 for your healing journey.
6. Is Coffee Autoimmune Paleo-Friendly?
The coffee bean is technically a seed, so even decaf is off the menu with the Autoimmune Paleo (AIP) 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 will 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 that the Autoimmune Paleo diet is a short-term protocol, not a lifelong diet!
7. Do You Drink Caffeine, Dr. Wentz?
My readers often wonder what life looks like for me today, knowing that I have tried and recommended 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 been able to balance my coffee intake, 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 SuperWoman, 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 to recover.
My adrenals rebalanced after that, but I had to cancel and say no to a lot of commitments, to properly heal them! Until I had my son, I would drink 1-2 cups of tea on a daily basis, and that amount kept me balanced and did not interfere with my health.
My coffee consumption increased when my son hit his four-month sleep regression… For those of you without kids, this is when babies start waking up every 1-2 hours, all night long! This regression can last anywhere from a few days to a few years — we are going on two years now, but who’s counting. 😉 Since his sleep regression, I began to regularly drink coffee for the first time in my life. I now drink 1-2 Bulletproof coffee almond lattes daily and 1-2 cups of tea most days, to keep up with my toddler… because I am the one that wakes up with him during the night. Somewhat surprisingly, my Hashimoto’s still seems to be in remission (I think all of the good food, gut work, quality supplements, and oxytocin seem to help. I’ll share the things I’ve done postpartum in a future post!), though I am dreaming about the day my son will sleep the night through.
The Bottom Line:
I do drink caffeine without it having a negative impact on my health, but I don’t drink too much of it ‒ if I drink too much, my adrenals get too stressed, and I start thinking I am Superwoman. 🙂
Coffee (and caffeine) consumption is fine, within boundaries, for some people with Hashimoto’s, while others may need to avoid it. Like so many things in life, there is no one-size-fits-all approach, and you will need to determine what level of caffeine supports your own health goals.
If you are taking thyroid medications, you will want to make sure you wait at least 30-60 minutes before consuming your first cup of coffee, to make sure your thyroid meds are fully absorbed. The exceptions to this may be those people taking Tirosint or naturally desiccated thyroid medications.
If you are sensitive to gluten, you will also want to avoid instant coffee, which may cross-react with gluten. Knowing the source of your coffee can help you avoid mold and other contaminants, while those with adrenal issues — which is many of us with Hashimoto’s — will want to consider weaning from, or even eliminating, caffeine for a period of time, until the adrenals are healed.
Additionally, if you are on an AIP diet, you will need to avoid coffee for the duration of the diet, to determine if you are sensitive to it or not.
I hope this answers your questions about coffee and Hashimoto’s! If you have any other questions for me, please drop them below!
As always, I wish you only the best on your journey to health!
P.S. Be sure to sign up for my email list and weekly newsletter to get a free book chapter, recipes, Thyroid Diet Starter Guide, information about Rootcology supplements, and notifications about upcoming events and my latest research.
- Friedrich N, Pietzner M, Cannet C, et al. Urinary metabolomics reveals glycemic and coffee associated signatures of thyroid function in two population-based cohorts. Motta A, ed. PLoS ONE. 2017;12(3):1-17. doi:10.1371/journal.pone.0173078.
- Spindel E, Wurtman R, McCall A, et al. Neuroendocrine effects of caffeine in normal subjects. Clinical pharmacology and therapeutics. 1984;36(3):402-407. Available at: https://www.ncbi.nlm.nih.gov/pubmed/6467801. Accessed November 9, 2017.
- Linos A, Linos D, Vgotza N, Souvatzoglou A, Koutras D. Does coffee consumption protect against thyroid disease? Acta chirurgica Scandinavica. 1989;155(6-7):317-320. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2816215. Accessed November 9, 2017.
- Han M, Kim J. Coffee Consumption and the Risk of Thyroid Cancer: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2017;14(2):129. doi:10.3390/ijerph14020129.
- Marko S, Lucijanić T, Klarić D, et al. Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review. Clinical Therapeutics. 2017;39(2):378-403. doi:10.1016/j.clinthera.2017.01.005.
- Fallahi P, Ferrari S, Ruffilli I, et al. Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update. Expert Opinion Drug Delivery. 2017;14(5):647-655. doi:10.1080/17425247.2016.1227782.
- Bernareggi A, Grata E, Pinorini M, Conti A. Oral liquid formulation of levothyroxine is stable in breakfast beverages and may improve thyroid patient compliance. Pharmaceutics. 2013;5(4):621-633. doi:10.3390/pharmaceutics5040621.
- Vita R, Fallahi P, Antonelli A, Benvenga S. The administration of L-thyroxine as soft gel capsule or liquid solution. Expert Opinion Drug Delivery. 2014;11(7):1103-1111. doi:10.1517/17425247.2014.918101.
- Vita R, Saraceno G, Trimarchi F, Benvenga S. A novel formulation of L-thyroxine (L-T4) reduces the problem of L-T4 malabsorption by coffee observed with traditional tablet formulations. Endocrine. 2013;43(1):154-160. doi:10.1007/s12020-012-9772-2.
- Benvenga S, Bartolone L, Pappalardo M, et al. Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid. 2008;18(3):293-301. doi:10.1089/thy.2007.0222.
- Vojdani A, Tarash I. Cross-Reaction between Gliadin and Different Food and Tissue Antigens. Food and Nutrition Sciences. 2013;4:20-32. doi:10.4236/fns.2013.41005
- Spindel E. Action of the methylxanthines on the pituitary and pituitary-dependent hormones. Progress in clinical and biological research. 1984;158:355-363. Available at: https://www.ncbi.nlm.nih.gov/pubmed/6396647. Accessed November 9, 2017.
- Clozel M, Branchaud C, Tannenbaum G, Dussault J, Aranda J. Effect of caffeine on thyroid and pituitary function in newborn rats. Pediatric research. 1983;17(7):592-595. doi:10.1203/00006450-198307000-00015
Note: Originally published in December 2017, this article has been revised and updated for accuracy and thoroughness.