Chris Kresser: Okay, let me take the first one first. Since you’re on the call, Adam, maybe you could let me know if the parathyroid markers are high or low because those are different circumstances. High parathyroid hormone is often a sign of hyperparathyroidism, not always, but it can be, and as I mentioned in the blood chemistry unit, or maybe we’re not there yet, I’m not sure, parathyroid hormone can be a marker for vitamin D deficiency. If parathyroid hormone is high, that could be hyperparathyroidism, or it could be vitamin D deficiency. The first thing to do is to retest because that can fluctuate, and you want to make sure you’re seeing a consistent pattern, and then you would also look at some of the other markers. If you’re doing the comprehensive blood panel, calcitriol may be elevated in hyperparathyroidism. Calcium may be elevated in hyperparathyroidism, so you kind of look at some of the other markers to assess the likelihood of that. Note that in hyperparathyroidism, PTH isn’t always high. It can actually be normal or high normal, and if you see serum calcium elevated and PTH is in the normal or high normal range, you can’t rule out a hyper, hyperparathyroidism as a cause for hypercalcemia because as I said, it’s not always elevated. In something like 20 to 30 percent of cases or more, it’s going to be within the normal range and maybe even at the lower end of the normal range, although that’s less common.
Why would iron be functionally high and ferritin is low, at, like, 15? Inflammation or need for molybdenum. You’re going to see a lot of weird stuff in iron panels that don’t make sense according to the textbook. Serum iron is the least reliable marker of all of the iron markers. If you see ferritin low and iron saturation is low and maybe TIBC is high and UIBC is high, those are inverse markers or high normal, and then serum iron is high, that’s still likely iron deficiency. As I said, the serum iron is the least reliable marker. Iron metabolism is extremely complex and changes a lot. Again, if you see … just like with PTH, if you see abnormalities with the iron panel, I would retest right away, actually, before you do anything or make any assumptions about iron status. I would also consider adding a soluble transferrin receptor, which we discussed, which is a marker for iron status that’s not affected by inflammation. If you see any weirdness with ferritin, where ferritin is really high and the other iron markers are normal, in that situation, you’re wondering whether ferritin is high because of inflammation or excess iron storage. Soluble transferrin receptor can help you resolve that. In this case, I might not start supplementation right away, although I would, like I said, ferritin, I think, is more reliable. But if you do, I would generally give it at least six weeks before you retest, depending on the dose you’re using.