Medical Nutrition Therapy Diet: Primary Hyperparathyroidsm
1. Purpose
a. Nutrition Indicators: high levels of calcium (hypercalcemia), elevated thyroid levels,
joint pain, low bone mineral density bone loss, osteopenia, muscle weakness, adnominal
discomfort, nausea and vomiting constipation, lack of appetite, kidney stones, excessive
thirst, excessive urination, anxiety, memory loss, fatigue.
b. Criteria to Assign the Diet: Diagnosis of hyperparathyroidism/ low calcium and low
vitamin D levels.
c. Rationale for Diet: To treat the symptoms and nutrition deficiencies associated with
hyperparathyroidism. Treatment of hyperparathyroidism itself is through surgery or
medication.
2. Population
a. Overview: Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream
due to an over activity of one or more of the body’s four parathyroid glands. Parathyroid
hormones maintain proper levels of both calcium and phosphorus in the body with the
secretion of PTH
o In primary hyperparathyroidism (PHPT), an enlargement of one or more of the
parathyroid glands causes an overproduction of the hormone resulting in high
levels of calcium in the blood (hypercalcemia).
o PHPT is the most common type of hyperparathyroidism, and in 85% of patients
the disorder is caused by a single abnormal gland.
o Most common cause of PPTH is a noncancerous growth (adenoma) on a gland
 calcium into the bloodstream.
o Overactive parathyroid glands increase the concentration of calcium in the urine,
creating favorable conditions for kidney stone formation.
o Risk Factors for PHPT:
 Menopausal females
 Prolonged or severe calcium or vitamin D deficiency
 Inherited disorders such as multiple endocrine neoplasia, type 1
 History of neck radiation treatment
 History of lithium intake; drug treatment for bipolar disorder
b. Disease Process: Long-term complications include osteoporosis, kidney stones,
cardiovascular disease, and neonatal hyperparathyroidism in new born babies.
c. Biochemical and Nutrient Needs: Diagnosed by the results of a fasting blood test that
indicate elevated calcium and elevated parathyroid hormone in the blood.
3. General Guidelines
a. Nutrition Rx: There is not a defined diet prescription for hyperparathyroidism, but
consuming a diet high in calcium and vitamin D will help treat symptoms of bone loss,
osteopenia, and kidney stones.
b. Adequacy of Nutrition Rx: The adequacy of the diet can be determined by
biochemical values indicating and improvement of bone density and decreased blood
serum calcium.
c. Goals: Preventing further bone loss, increasing bone support, and preventing
development of kidney stones.
1. Decrease caffeine and carbonated beverages
a. They are high in phosphates, which can leach calcium from your
bones.
2. Increase calcium
3. Increase water intake
4. Increase vitamin D
a. To assist in calcium absorption and aid in bone remodeling and growth
d. Does it Meet DRI:N/A.
o Vitamin D, 400-600 IU daily
o Calcium, 1000-1200 mg daily
 for bone support and immunity
4. Education Material
a. Nutrition Therapy: Therapy should be provided specific to patient depending of their
symptoms and nutrition diagnosis. To increase bone density and prevent further bone
loss, patient should be educated on increasing vitamin D and calcium in their diet.
b. Ideas for Compliance: To improve patient compliance family members should be
educated and involved, short term and long term goals should be determined, and rewards
can be provided when patient complies to diet. Also to help with compliance a calcium
and vitamin D food log may be provided to track intake.
5. Sample Menu
a. Foods Recommended: Foods high in Vitamin D and Calcium. Easily accessible
products are cereals fortified with calcium and vitamin D like Raisin Bran and vitamin D
fortified milk.
b. Foods to Avoid: Coffee, carbonated beverages (high in phosphates that can leach
calcium from the bones), refined foods like white breads, pastas, and sugar, trans fatty
acids, and stimulants like alcohol and tobacco.
c. Example of a meal plan
Sample pt. 24 hr-recall
8:00 AM: 1 cup cream of wheat, 3 cups black coffee
11:30 AM: Turkey sandwich with mayo and tomato, 1 bag potato chips, 1 12 oz ginerger ale
3:00 PM: 2 cups of black tea, 2 small scones with jam
5:30 PM: 2 slices meatloaf, mashed potatoes, glazed carrots, 2 beers
7:00 PM: 1 slice cherry pie, 1 cup decaffeinated coffee
Dietitian Recommendations (based on sample pt. 24 hr-recall)
8:00 AM: 1 cup fortified cereal
½ cup blueberries
2 decafinated café au laits
1 8 oz glass water
11:30 AM: Turkey Sandwich with Swiss cheese, tomato, light mayo or hummus
1 cup carrots
4 oz orange juice fortified with calcium and vitamin D
1 8 oz glass water
3:00 PM: 2 cups chamomile tea
1 small scone with jam
1 cup low-fat yogurt
5:30 PM: 2 slices meatloaf
1 cup steamed broccoli
1 small baked potato with ½ c. cottage cheese
7:00 PM: ½ c. ice cream topped with cooked cherries
1 cup cinnamon tea
6. Websites
a. Organizations with Websites
http://www.mayoclinic.com/health/hyperparathyroidism/DS00396
http://www.umm.edu/altmed/articles/hyperparathyroidism-000086.htm
http://familydoctor.org/online/famdocen/home/common/hormone/251.html
http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/April/So_you
_have_primary_hyperparathyroidism.pdf
b. Government Websites
http://www.mypyramid.gov
http://www.eatright.org/
7. References
a. Journal articles references
Akinci, B., Comlekci, A., & Tankurt, E. (2009). Hypercalcemia of primary hyperparathyroidism
was treated by cinacalcet in a patient with liver cirrhosis. Experimental and Clinical
Endocrinology & Diabetes, 117(3), 142-145.
Larsson, K., Ljunghall, S., Naessen, T., Lindh, E., & Persson, I. (2009). The risk of hip fractures
in patients with primary hyperparathyroidism: A population-based cohort study with a
follow-up of 19 years. Journal of Internal Medicine, 234(6), 585-593.
Lips, P. (2001). Vitamin D deficiency and secondary hyperparathyroidism in the elderly:
Consequences for bone loss and fractures and therapeutic implications. Endocrine
Reviews, 22(4), 477.