Well, here we are – four months since I declared I was going to put my health first. TL;DR – it’s not going well. Interpersonally, there have been challenges (the impending death of my partner’s formerly estranged father, the ending of friendships, the lingering pandemic, crushing depression, the threat of World War III looming on the horizon–you know, the 2020-style usual.)

But, I started thinking today that there’s more to it than that — I have double trouble when it comes to prioritizing my health. On the one hand, there’s the getting-starting-and-stopping issues with ADHD, but on the other, there are the realities of living with Hashimoto’s Thyroiditis.

So, I ask:

What are the rules I must follow with Hashimoto’s Thyroiditis?

These rules must be followed, or I will not be a functioning, alert human–let alone one happily pursuing health goals.

Rule #1: Take your levothyroxine first thing in the morning on an empty stomach with a full glass of water.

In order to actually absorb this medication properly, your stomach must be empty. The full glass of water is required to prevent choking, apparently, and to help push the medication into your small intestine where it is absorbed. Okay, that’s simple enough, what’s next?

Rule #2: No coffee or breakfast for one hour after levothyroxine.

A heartbeat symbol with a coffee mug symbol in the middle.

Caffeine & other stomach contents can inhibit the absorption of the medication, and without absorption, I will have no energy. Kind of frustrating, since my ADHD makes me prone to being a night owl (something about delayed onset and limited reaction to my own body’s melatonin).

Speaking of things that inhibit absorption / effectiveness…

Rule #3: Save Your Vitamins & Favorite Foods Until the Afternoon

I might as well just skip breakfast and fast until one in the afternoon.

Why? Well… Calcium, fiber, and iron, mostly. My favorite breakfast foods are full of them.

a. Multivitamins

Fun fact: Levothyroxine will not be properly absorbed if you take any form of calcium or iron within four hours. So even though having Hashimoto’s Thyroiditis often makes people prone to having vitamin deficiencies, WHEN you take your multivitamin matters.

This also means I can’t have my favorite breakfasts until noon, as things like yogurt and cottage cheese have higher levels of calcium. Guess I’ll skip the red meat too, because YAY IRON.

Speaking of calcium, don’t take Tums (they’re basically pure calcium) or other antacids either within four hours. Lord help me if I have to have my gallbladder removed, like my partner.

Oh, and don’t forget: as with many medications, eating grapefruit and drinking grapefruit juice is out entirely.

B: Be careful with fiber & walnuts.

Fun fact: poorly controlled thyroid levels cause high cholesterol. You know what’s been proven to help reduce high cholesterol levels? High-fiber diets and heart-healthy poly and mono-unsatured fats. However, once again, it’s important not to eat a high-fiber breakfast (and especially not one with walnuts!) because both of those things (and a few others) can keep you from absorbing your medications. Awesome.

The verdict is in: this is why I basically force myself to intermittently fast every day. It simplifies these rules quite a bit.

Rule #4 – Strength Train, but not like that.

I used to think everyone else was tougher than me — at some point, after enough exercise, their DOMS (delayed onset muscle soreness) would get better. They’d push themselves hard in their weight training, see massive gains, and feel the full effects of energizing exercise.

It was only after a dear friend of mine couldn’t relate to constantly waking up at 3 a.m. in agonizing pain, swollen and uncomfortable to the point of tears, feeling like I constantly had a bad case of the flu, that I started researching what the hell was going on with my body.

If I’m not careful, my entire body swells — fun Hashimoto’s inflammation at its worst–and I’ll pay for it for days in damaging joint pain and stiff muscles that go well beyond a normal person’s definition of DOMS. Exercise puts the standard wear and tear on your body, but if your body freaks out and piles on tissue-destroying inflammation? Yeah, you may do more harm than good.

A heart symbol made of people doing yoga poses.

Rule #5 – Gotta Do Your Cardio – But You’ll Pay For It For DAYS

Forget a runner’s high — if I am not exceptionally careful while doing cardio, I will burn through my energy reserves, and, fun fact, with my thyroid as messed up as it is? I won’t produce any more of that sweet T3/T4 that I need. Because I can’t. My thyroid is broken and doesn’t DO that.

So, I have to wait for my trusty little levothyroxine pill to build up those hormones for me again.

My body doesn’t give me gas on demand as it should; so, if I’m going to do my cardio, I better be especially mindful of how I’m feeling, and often stop long before the standard exercise recommendations suggest I should.

Those are the basics; we’re all different too, and have different physiological needs.

For example, there are my own nutritional deficiencies I have to address – I won’t get into details, but other things I’m balancing are: a brazil nut, berberine 3x a day, 30+ grams of fiber, vitamin D and calcium supplements (paired with the right amount of poly/mono-unsatured fats).

Is it any wonder I don’t dare try to throw some ADHD meds into the mix?

The Bottom Line

Someone stands defiantly on the grass next to a sign that says, "Please keep off the grass".

It’s hard to juggle all these rules; it takes rather a larger amount of my precious mental energy than I think it should.

I do, however, appreciate that if I quit following these rules here and there (or even for a couple of weeks or months at a time), I’m not going to die. Sure, I’ll pay for it in health, wellness, and productivity, but: I will live. There is privilege there that isn’t afforded to everyone, for sure, and I acknowledge that.

I suppose toxic positivity culture would say that I should focus on what I can do: so… that’s what I’ll do for today. I’ll write down my three daily gratitudes, focusing on doing what I can–as opposed to trying to control the things I can’t.

No one said I had to smile while I do it, though. 🙂


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