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.