Reply To: 44 yo F with suspected secondary hyperparathyroidism

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#3005
Antony Haynes
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Hello Oliver,

Thank you for posting this case in which there are multiple variables, with historical medical conditions and yet current symptoms of fatigue and gut issues. I note that you ask specific questions which I will do my best to provide an answer to.

I am not familiar with the reference range for all of the test results but the level of iron at 3 appears quite low, although the ferritin is well in the normal range. The level of PTH at 9.9 appears normal too. Is the haemoglobin 127 or 12.7?

With a thalassaemic trait this will be present over this woman’s lifetime, and it can be challenging to raise iron levels. It is a question about how much this is an influence on her energy.

Low iron and hyperparathyroidism
Given that this woman’s iron is low at 3 (albeit her ferritin is fine) and she has normal levels of PTH, suggests that the low iron is not a strong influence on the parathyroid condition.

This research study did not find a relationship between hyperparathyroid condition and anaemia. “We conclude that PTH over a range of concentrations seen in vivo does not affect erythrocyte osmotic fragility or cause anaemia.”

• Foulks CJ, Mills GM, Wright LF. Parathyroid hormone and anaemia–an erythrocyte osmotic fragility study in primary and secondary hyperparathyroidism. Postgrad Med J. 1989 Mar;65(761):136-9. http://tinyurl.com/kbnwyd2

Health Goals
In order to know what approach to take I would listen carefully to this woman’s health goals, which may well be to be free of gut symptoms and to have great energy all day. With her weight of 100 kg and a height of 163 cm then there appears to be a real need to lose body fat too. Are these the aims that she declared when she met with you?

If this were the case, then I would conduct a careful assessment of her diet in order to identify any possible culprits or causative factors from specific foods. Wheat is strongly implicated in heartburn and reflux and I would examine her diet for the amount and frequency of this food, therefore. Gluten grains or other grains could also be involved in her upper GI symptoms so I would consider a trial elimination of these foods.

H. pylori?
The presence of H. pylori, or the excess level of H. pylori, could help to explain the upper GI symptoms, and may be needed to be ruled out.

Food combining may also help to achieve the same effect but it seems logical for her to avoid wheat, nonetheless.

As was discussed in the Weight Loss seminar entitled ‘The Guts of the Matter’, – http://tinyurl.com/n762vhg – which I presented in November 2014, the microbiome plays a key role in weight maintenance. Therefore, the correction of her digestive symptoms may well be a necessary precursor prior to her being able to lose body fat.

A stool test would probably not identify what was causing the stomach issues, and therefore a trial of a change in diet may be helpful in determining a food trigger or lend more weight to conducting a stool test. Or, a stool test may be of more value once a dietary experiment has been conducted.

Given that she has reactive hypoglycaemia, it may be best if she were to consume some protein at each meal, particularly the start of each meal. This needs to be factored in to her existing diet and the wheat free trial, if this embarked on.

Her cortisol, and DHEA, may well be out of balance and whilst elevated cortisol is associated with insulin resistance, given what she has been through, there may be logic to suspect that she has too low a level of this vital hormone. With any test, I ask the question “will it alter the therapeutic intervention?”. I note that she is due to have a Synacthen test which is a method for ruling out Addison’s but her cortisol levels have increased from 77 to 248. Do please give the reference ranges so that it can be known where this is within that range, thank you.

Bone Health & Vit D
It is important for her bone health with the history of elevated PTH to ensure an optimal level of Vitamin D. Whilst a Bone Mineral Density test gives an indication of whether she has any degree of osteopaenia or osteoporosis, the use of a urine DPD test (Bone Resorption Test – http://tinyurl.com/odl2gfb) can help determine the efficacy of bone support treatment with vitamin D and other nutrients, should this be considered.

Summary
Given the information you have provided, and I do not know what her existing diet is, the most sensible focus is to resolve her digestive symptoms. Rule our H. pylori and then consider a wheat or gluten free trial, and you could consider these supplements should you adopt this approach.

Yes, to support blood glucose, smaller and more frequent meals may be best, but this approach still maintains a relatively high requirement of insulin, and may not ultimately be the most appropriate long term food frequency for this woman.

The value of any other lab tests may be all the greater once this process has been followed for a month or so.

SUGGESTED SUPPLEMENTS

The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the patient.

For support of the acid reflux

• HCL-Ease (BRC) – 2 caps 20 mins before 2-3 meals a day

Do watch Joe Buishas LDN, CCN, Tuesday Minute video on this product: http://tinyurl.com/n4lch3a.

• Sano-Gastril Lozenges (ARG) – 2 lozenges sucked 20 mins after lunch & dinner – http://tinyurl.com/37deycf

Vitamin D (emulsified)

• Bio-D-Mulsion Forte (BRC) – 1-2 drops per day, with re-testing to be considered after 2-3 months – http://tinyurl.com/mvqc6nx. .

For comfortable daily bowels

• Caricol Papaya Concentrate – 1 sachet after two meals per day – http://tinyurl.com/p5gjrkk

I hope this response helps

Antony

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