Nutrition Diet: What should you eat if you have low parathyroid levels?

October 16, 2025 •

4 min read

Hypoparathyroidism is a rare condition where the body's inability to produce sufficient parathyroid hormone disrupts the balance of essential minerals, notably leading to low calcium and high phosphorus. For individuals with low parathyroid levels, adopting a specific dietary approach focused on balancing these minerals is a crucial component of long-term management.

Quick Summary

Effectively managing hypoparathyroidism involves a specific diet rich in calcium and low in phosphorus to correct mineral imbalances and support overall health and well-being.

Key Points

Balance calcium and phosphorus: The central dietary goal is to increase calcium intake while controlling phosphorus levels, as high phosphorus can exacerbate low calcium.
Prioritize the right foods: Focus on calcium-rich, low-phosphorus options like fortified plant-based milks, kale, bok choy, calcium-set tofu, and sardines with bones.
Limit high-phosphorus items: Reduce consumption of carbonated soft drinks, processed foods, excessive red meat, hard cheeses, and some nuts and whole grains.
Ensure adequate Vitamin D: Vitamin D is critical for calcium absorption, and most with hypoparathyroidism require specific supplements, like calcitriol, as directed by a doctor.
Consider magnesium: Magnesium is important for parathyroid function, and some individuals may need supplementation to maintain healthy levels.
Space out calcium intake: Take calcium supplements and consume calcium-rich foods in smaller, more frequent doses throughout the day to optimize absorption and aid kidney function.
Work with professionals: Always consult a healthcare provider and a dietitian to create a safe and personalized diet plan that complements your medical treatment.

The parathyroid glands play a critical role in regulating the body's calcium and phosphorus levels. When these glands are underactive, a condition known as hypoparathyroidism, it can lead to low blood calcium (hypocalcemia) and high blood phosphorus (hyperphosphatemia). A carefully planned diet is an essential strategy for managing these mineral imbalances alongside prescribed medication and supplements, as recommended by a healthcare provider.

The Core Principle: Balancing Calcium and Phosphorus

The central goal of a hypoparathyroidism diet is to increase the body's intake of calcium while simultaneously reducing phosphorus. The interaction between these two minerals is crucial: high levels of phosphorus can further lower already deficient calcium levels, creating a challenging cycle. By focusing on foods with a favorable calcium-to-phosphorus ratio, you can help stabilize your mineral levels and support better health. It's also vital to ensure adequate vitamin D intake, as this nutrient is necessary for the body to absorb and utilize calcium effectively.

Foods to Embrace for Better Mineral Balance

To increase your calcium intake and support overall health, consider incorporating the following foods into your diet. Always aim for a variety of nutrient sources throughout the day.

Calcium-fortified non-dairy alternatives: Many plant-based milk products, such as soy, almond, and rice milk, are fortified with calcium. Look for options that are not fortified with calcium phosphate. Fortified orange juice and breakfast cereals are also good choices.
Leafy green vegetables: Dark, leafy greens are excellent calcium sources. Kale and bok choy have high bioavailability, meaning the body absorbs their calcium well. While spinach is also calcium-rich, it contains oxalates that can inhibit calcium absorption if eaten with a high-calcium food.
Certain types of tofu: Tofu that has been processed with calcium sulfate is a fantastic source of absorbable calcium. Always check the label to confirm the type of coagulant used.
Select fish and seafood: Fish with soft, edible bones, such as sardines and tinned salmon, are packed with calcium.
Specific dairy options: While many dairy products are high in phosphorus, some lower-phosphorus options can be included in moderation. These include cottage cheese, ricotta, and cream cheese. Plain yogurt can also provide a quick calcium boost when needed.
Magnesium-rich foods: Magnesium is essential for parathyroid gland function. Good sources include magnesium-fortified beverages or supplements, as advised by your doctor.

Foods and Habits to Limit or Avoid

To help keep your phosphorus levels in check and prevent calcium excretion, it's important to be mindful of what you limit in your diet.

High-phosphorus dairy products: Hard cheeses like cheddar and parmesan, and large quantities of milk, contain significant phosphorus.
Processed foods and soft drinks: Many processed foods and all carbonated soft drinks contain phosphate additives used for preservation and flavoring. These can increase blood phosphorus levels and should be limited.
Excessive red meat and poultry: These protein sources are high in phosphorus and should be moderated. Consider relying more on plant-based protein or other lower-phosphorus protein sources.
Whole grains and nuts: While healthy for many, these foods can be high in phosphorus and phytates, which can inhibit mineral absorption. Moderation is key.
Salty foods: High sodium intake can increase calcium excretion in the urine, so it's wise to reduce your salt consumption.
Excessive alcohol and caffeine: Both can negatively affect mineral absorption and hormonal balance, impacting your condition.

Meal Planning for Hypoparathyroidism

Spreading your calcium and phosphorus intake throughout the day is a smart strategy for managing hypoparathyroidism. Rather than consuming a large amount of calcium at once, which can overwhelm the body's absorption capacity, aim for smaller, regular meals and snacks. This approach can help maintain more stable mineral levels and support your kidneys. Taking calcium supplements with food also improves absorption.

Navigating Food Combinations and Supplements

Certain plant compounds, like oxalates and phytates found in foods such as spinach, nuts, and whole grains, can bind with calcium and reduce its bioavailability. While you don't need to eliminate these healthy foods, being mindful of when you consume them is helpful. For example, avoid eating a spinach salad alongside a large source of calcium. Instead, schedule these foods at different meal times to maximize calcium absorption from other sources.

For most individuals with hypoparathyroidism, prescription-strength vitamin D (like calcitriol) is often necessary, as the body can't convert inactive vitamin D to its active form without PTH. Always discuss your supplement regimen with your doctor to ensure the proper dosages and types.

Comparison Table: High vs. Low Phosphorus Calcium Sources


Feature	High-Phosphorus Calcium Sources	Lower-Phosphorus Calcium Sources
Dairy Examples	Hard cheeses (cheddar, parmesan), milk	Cottage cheese, ricotta, cream cheese, plain yogurt (in moderation)
Vegetable Examples	Potatoes, sweet potatoes, beans, lentils	Leafy greens (kale, bok choy, low oxalate), broccoli
Protein Examples	Red meat, poultry, processed meats	Tofu (calcium sulfate variety), sardines with bones
Fortified Foods	Some fortified foods with calcium phosphate additives	Fortified non-dairy milks (soy, almond), fortified orange juice, cereals
Other Considerations	Many processed foods, carbonated soft drinks, nuts	Dried figs, non-carbonated drinks, limited salt

Conclusion: Partnering with Your Healthcare Team

Diet is a powerful tool for managing hypoparathyroidism, but it is not a cure. It works in concert with medical treatments such as calcium and vitamin D supplements, and potentially PTH replacement therapy. Your healthcare team, including your endocrinologist and a registered dietitian, can provide personalized guidance tailored to your specific needs, helping you create a sustainable and effective nutrition plan. Consistent monitoring of your blood mineral levels is necessary to fine-tune your treatment plan, which may evolve over time.

For more information on hypoparathyroidism, consult a reputable medical source such as the Mayo Clinic.

Frequently Asked Questions

Parathyroid hormone (PTH) is responsible for regulating calcium and phosphorus. When PTH levels are low, less calcium is released from bones and reabsorbed by the kidneys, causing low blood calcium. At the same time, the kidneys excrete less phosphorus, leading to high blood phosphorus.

No, diet is a crucial part of management, but it cannot cure hypoparathyroidism. It works alongside lifelong medical treatments, including calcium and vitamin D supplements, to balance your mineral levels. A healthy diet helps stabilize these levels and support overall health.

Vitamin D is essential because it helps your body absorb calcium from your food and supplements. Without sufficient vitamin D, your efforts to increase calcium intake will be less effective. Most patients require special, activated vitamin D supplements prescribed by a doctor.

You don't need to eliminate all high-phosphorus foods, but you should aim to limit them. A balanced approach focuses on moderation, reducing processed foods, and being mindful of intake from sources like red meat and nuts to avoid overwhelming your kidneys.

To get the most calcium from vegetables like kale and bok choy, which are naturally low in oxalates, eat them regularly. For higher-oxalate vegetables like spinach, consume them at a different meal than your main calcium source to prevent absorption issues.

Getting calcium from food is generally easier on the gut and kidneys than relying heavily on supplements. However, because hypoparathyroidism requires a higher daily calcium intake than normal, a combination of food and a limited number of supplements, as directed by your doctor, is typically recommended.

Hard cheeses and aged cheeses typically have a much higher phosphorus content than softer cheeses like ricotta, cottage cheese, and cream cheese. Limiting hard cheeses helps reduce your overall phosphorus load.

Since magnesium is crucial for parathyroid function, your doctor may check your magnesium levels and recommend a supplement if they are low. Good dietary sources can be limited when also restricting phosphorus, so supplementation is common.