Kac Para Yarismasi

Arthritis Diet and Exercises

If PTH is mid-normal, do I need a calcium supplement?


Marcus Mathiason says, “My calcium intake
is low, around 400 milligrams a day, because I don’t tolerate many calcium-rich foods. My blood calcium is normal. PTH is midrange. Vitamin D is 48 nanograms per milliliter. Hair calcium is high. RBC calcium is in the third quintile. Do you think my calcium status is sufficient
or should I take a supplement?” I think the overwhelmingly important marker
here is the PTH. You said that PTH is in the middle of the
normal range, which means to me that it’s at the high end of the optimal range or maybe
a little bit outside it. I believe that PTH, outside the context of
clinical issues with tumors and medical problems in the parathyroid gland that are not relevant
to nutrition, most of the time, what PTH is signaling is the body’s own perception of
the calcium-vitamin D ecology is deficient. The vitamin D requirement or the marker, the
optimal range is for 25(OH)D which is the marker of vitamin D adequacy that’s used,
are set on the basis of population levels of maximal suppression in PTH. I look at this as if you want to individualize
the vitamin D calcium requirement, you look at individual suppression of PTH in a person. I don’t know for sure where the cutoff is. I suspect based on the data that I’ve seen,
which I don’t think are adequate, but there’s enough data out there from randomized controlled
trials to get a general sense of what the average point of maximal suppression is, and
that seems to be around 30. I’ve seen some data that make me think maybe
it’s around 20. I also have reasons to speculate that maybe
it’s different in every person, and maybe that the point of maximal suppression is a
range between 20 and 30. What I would do is, first, my suspicion is
that your intake is probably fine for you. I’m assuming that by midrange you mean it’s
30. If you mean it’s 40, then no, you’re deficient
or you’re probably deficient. You need to test whether how you respond. But what I would say is, it would still be
good for you to try increasing that and see if the PTH goes down anymore. Because my baseline for where I suspect that
someone’s PTH is maximally suppressed is 30. But the evidence that it’s maximally suppressed
is that it doesn’t get suppressed by more calcium and vitamin D. If it goes down in
response to calcium and vitamin D, then it wasn’t maximally suppressed. Where you want to be is not 30 to 20. It’s the point of maximal suppression. Then the final thing is magnesium deficiency
can compromise your ability to make PTH. I don’t think that the average person in our
society is deficient enough in magnesium for that to be relevant on the basis that population-wide
most people have too much PTH. That contributes osteopenia and osteoporosis. But the big caveat here is if you are magnesium-deficient,
then that might invalidate most of what I said if you’re deficient enough to affect
PTH. Everyone, if you’re posting up a follow-up
to your current question that is relevant, make sure you do it as a reply. If it’s a new question, then do it as a new
question. Anyway, Marcus, my suspicion is if your PTH
is around 30 and not higher than that, you’re probably fine. But it’s good to know your magnesium status
because if it’s really bad, that could change that interpretation. It’s also good to know if adding more calcium
suppresses your PTH further, because if it does, that’s probably calcium that you need.

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