Analia Camarasa asked this question on Facebook:
Ever since you’ve mentioned PTH on your podcast we’ve been measuring it in the office. It’s nice to see that when patients come in on high doses of D supplementation their PTH is maximally suppressed, as it should be. I wish you could talk about the outliers briefly, normal D at 31 ng/mL and PTH outside of the range eating a healthy WAP diet, for example.
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In the last video, I talked about how we can use PTH to better understand our vitamin D status so that we truly understand the situation before we go taking supplements that we may not even need. But what if your D is normal and yet your PTH is high anyway?
Hi, I’m Dr. Chris Masterjohn of chrismasterjohnphd.com and you’re watching Chris Masterjohn Lite where the name the game is “Details? Shmeetails. Just tell me what works!” and in this video we’re going to talk about what to do if your D is normal and your PTH is high. Analia says, “Ever since you’ve mentioned PTH on your podcast, we’ve been measuring it in the office. It’s nice to see that when patients come in on high doses of D supplementation their PTH is maximally suppressed as it should be.
I wish you could talk about the outliers briefly, normal D at 31 ng/mL and PTH outside of the range, eating a healthy Weston A Price diet for example. Analia, if PTH is high then the body perceives a deficiency of some kind and either it’s perceiving that correctly or it’s perceiving that incorrectly. If the D has reached normal levels and the body still perceives a deficiency in the system, the first thing that I would look at is calcium. As I mentioned in the last video, you can measure calcitriol and the higher it is the greater the probability of calcium deficiency. Further, you can look at diet analysis and if their diet analysis suggests that they don’t get enough calcium and their bloodwork agrees, then the proper interpretation is calcium deficiency. Nevertheless, what if they are getting enough calcium? What could be other reasons?
Well it may be that what is normal D for many people is not normal for this person. For example, maybe this person has a vitamin D receptor mutation that actually requires them to need more calcitriol? Then calcitriol will probably be high but it’s not suppressing PTH because they actually need more. Or maybe there are other genetic factors or other metabolic factors that interfere with the system in some way that make us less sensitive to calcitriol or even less sensitive to PTH that we don’t really understand well right now. If there are metabolic differences, then it makes it harder and harder to interpret the blood markers because if the person’s metabolism is different then what those markers are doing and meaning may also be different.
So what you have to do in that situation is test it to see whether it’s responsive to diet. Maybe this person needs more vitamin D than the average person. Maybe this person needs more calcium than the average person. If PTH goes down in response to more D or more calcium or more of both, then test which one of those factors or whether the combination is the best way to reduce it in that person.
Alternatively, the PTH may be high for reasons that are not related to nutrition, and if that’s the case it’s very important to identify the cause. Non-nutritional elevations in PTH are called primary hyperparathyroidism and there are three major causes of primary hyperparathyroidism. The first one is a non-cancerous tumor in the parathyroid gland called an adenoma. That’s the most common cause. The second most common cause is an enlargement of normal cells in the parathyroid gland called parathyroid hyperplasia, and the least common cause is parathyroid cancer.
That’s less than 1% of all non-nutritional reasons for elevations of PTH. If it’s nutritionally responsive we want to modify it with nutrition but if it’s not it’s really important to refer that person to the appropriate specialist. Now for everyone watching at home remember I’m not a medical doctor. My PhD is in Nutritional Sciences. I’m not treating anyone or diagnosing anyone of any kind of disease on this show. So if any of these things sound like they may apply to you make sure that you discuss them with the appropriate healthcare practitioner. All right I hope you found this useful.
Signing off, this is Chris Masterjohn of chrismasterjohnphd.com. You’ve been watching Chris Masterjohn Lite, and I will see you in the next video.