It seems like you're the go-to-guy when it comes to questions about the Vit D protocol (thank you for being so helpful to all of us!).
Anyway, I'm facing a dilemma. I had my cluster headaches return recently (8/17) and started the anti-inflammatory protocol right away (all supplements included) with the 50,000 IU loading dose. I did not get a chance to have my blood tested before starting, but I did 50,000 IU for 7 days, and then dropped to 40,000 IU for 5 days (today was my last day of 40,000 IU). I was planning on dropping down to 10,000 IU tomorrow.
However, my blood was tested yesterday and I just got the results. My Calcium levels are in the normal range (though, at the very top of the range), but my Vit D is 120 ng/mL. My doctor is urging me to stop the Vit D supplementation because of this level. If the protocol had seemed to be helping with my headaches, I would be more inclined to push back against this advice. However, my headaches have, if anything, gotten worse over the course of the past two weeks.
I'm at a loss of what to do. Should the anti-inflammatory protocol have made some beneficial difference by now? (Again, I'm following the supplement and diet instructions exactly). Does it usually take longer to notice a reduction in headaches even at a level like 120 ng/mL?
Should I stop the Vit D and get a retest in the future? Should I drop to a lower dose? I don't want to jeopardize the chances of the protocol working, but I also don't want ill-effects of too much Vit D.
Thanks so much for any advice you may have!
Your doctor is playing a CYA in response to your higher labs for serum calcium concentrations. This is a "normal" response by physicians so they can't be accused of malpractice. Acknowledge, your physician's warning and tell him you plan to continue vitamin D3 dosing to prevent your CH. Doing this takes him off the malpractice hook.
A serum calcium concentration at the top of its normal reference range, but not over, indicates normal calcium homeostasis, the mechanism by which the body controls blood calcium concentrations. There's nothing alarming about calcium levels this high and it's no reason to stop vitamin D3.
To answer your question about needing a higher 25(OH)D serum concentration than 120 ng/mL to prevent your CH, the answer is YES. Many CHers will need a higher 25(OH)D serum concentration to prevent their CH, particularly if they're experiencing an allergic reaction to airborne or food borne allergens. For reference, see my labs for 25(OH)D3, calcium and PTH over the last three years. I was taking an average of 40,000 IU/day vitamin D3 when my serum 25(OH)D3 and calcium where highest.
As you can see, my calcium serum concentration was up near the top of its normal reference range, but not over it. You can also see where my PTH goes lower in response to the higher serum calcium and 25(OH)D3 concentrations. This is also a good indication of a normal calcium homeostasis. Please feel free to share my labs with your doctor.
I needed to increase my vitamin D3 dose between 25,000 IU/day and 40,000 IU/day and resulting serum 25(OH)D3 due to allergic reactions to airborne allergens (pollen, mold spores) in order to remain CH pain free. The allergic reactions triggered a flood of histamine that reduced vitamin D3 effectiveness in preventing CH. There are two courses of action to take if you're experiencing an allergic reaction (they can be subclinical with no outward or obvious symptoms):
1. Start a week to 10-day course of Benadryl (Diphenhydramine HCL) at 25 mg every 4 hours during the day. If there's no response with a reduction in CH frequency after 5 days, discontinue.
2. Titrate the vitamin D3 dose - increasing the maintenance dose every 3 to 4 days until you experience a reduction in CH frequency. The best way to do this is to take a 50,000 IU vitamin D3 loading dose for two days then drop back to a new vitamin D3 maintenance dose of 15,000 IU/day. If there's no change in CH frequency after four days, load for another two days, but continue the maintenance dose of 15,000 IU/day. If there's still no change in CH patterns after another 3 to 4 days, repeat the 2-day loading schedule then drop back to a maintenance dose of 20,000 IU/day. Be sure to take all the cofactors daily and double the magnesium dose to 800 mg/day while loading. Split the magnesium dose by taking 400 mg with breakfast and 400 mg with the evening meal. This will help avoid osmotic diarrhea.
Once you've been at a stable maintenance dose of vitamin D3 that keeps you CH pain free for 30 days, see your PCP/GP for another set of labs for your 25(OH)D, calcium and PTH. It's very unlikely your serum calcium will go over its normal reference range. That said, should this happen, it is not a medical emergency. However, you will need to stop vitamin D3 intake for at least two weeks then resume at a lower vitamin D3 maintenance dose. Test again 30 days later.
Take care and please keep me posted,
Thank you for the thorough response.
I'm wondering if I should continue taking calcium as a cofactor, or if I should stop that for a while?
Also, is there a link to the most recent anti-inflammatory protocol?
If you're taking the suggested Kirkland brand Adult 50+ Mature Multi, you're getting the right amount of calcium at 230 mg/day.
I'll need your email address to send you the latest draft version of the anti-inflammatory regimen. It's too big to attach in this blog. It should provide what you're looking for, but it's still a work in progress and not ready for prime time so don't pass it on or post. You can also shoot me an email at firstname.lastname@example.org.
Take care and please keep me posted