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Thyroid Health

Cow’s milk contains a mix of sugar (lactose), protein (whey and casein) and fat (ghee). People can be sensitive to any of the three components of dairy. However, reactions to lactose and the dairy protein casein are the most common.Some people with Hashimoto’s may be able to tolerate butter and clarified butter (known as ghee) because they contain very small amounts of dairy proteins, but even tiny amounts of butter caused me to have a reaction at the start of my Hashimoto’s journey. I’ve written about the dairy protein associated reaction in Hashimoto’s before. Casein, and to a smaller degree, whey, which was a really big trigger for me, and going dairy free resolved three year’s of acid reflux in three days. You can read my Hashimoto’s and dairy story.

But I have not written about the impact of the dairy sugar lactose on Hashimoto’s, and even tiny amounts of it can have a profound impact on our ability to absorb thyroid medications. Worse of all, some thyroid medications actually contain lactose, inhibiting their own absorption! An August 2014 study published in the Journal of Clinical Endocrinology and Metabolism by Cellini and colleagues found that lactose intolerance increased the requirement for thyroid medications. The researchers found that the average person with Hashimoto’s required a median dose of 1.31 mcg/kg/day of levothyroxine to get to an average TSH right around 1 mU/L (that would be right around 90 mcg of levothyroxine for a 150 pound person), while a person with Hashimoto’s and lactose intolerance who continued to consume lactose needed a dose of 1.72 mcg/kg/day to reach the same goal (that would be like 116 mcg of levothyroxine for the same 150 pound person- big difference).

Furthermore, patients who had another gut disorder in addition to lactose intolerance required an even higher dose to get to their goal TSH 2.04 mcg/kg/day, or around 140 mcg for a 150-pound person, or 1.5 times the average dose. 2014 study by Asik and colleagues found that lactose intolerant Hashimoto’s patients who were taking levothyroxine showed a decrease in TSH after lactose restriction. Whenever I see people whose TSH levels fluctuate and who have a
hard time adjusting their medication up and down, I always suspect lactose intolerance unless the person is dairy free. I imagine the changes in TSH occur as a result of varying amounts of lactose a person may have on various days.


October 8, 2018
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