Hey Gregg,

Good question.  It turns out loading doses of vitamin D3 are most effective when serum 25(OH)D levels are low, like < 30 ng/mL where the 25(OH)D response to dose is highest.

For example, in one study conducted in 2010, Forty-eight (48) youths classified as vitamin D3 deficient were given a single oral loading dose of 600,000 IU vitamin D3.  Their average 25(OH)D response was a gain of 60 ng/mL in three days.

Results:

The 25(OH)D level was:
15.8 +/- 6.5 ng/ml at baseline and became
77.2 +/- 30.5 ng/ml at 3 d (P < 0.001) and
62.4 +/- 26.1 ng/ml at 30 d (P < 0.001).

PTH levels concomitantly decreased from 53.0 +/- 20.1 to 38.6 +/- 17.2 pg/ml at 3 d and to 43.4 +/- 14.0 pg/ml at 30 d (P < 0.001 for both). The trends were maintained in a subgroup followed up to 90 d (P < 0.001). Mean serum Ca and P significantly increased compared to baseline, whereas serum Mg decreased at 3 d. 1,25-Dihydroxyvitamin D significantly increased from 46.8 +/- 18.9 to 97.8 +/- 38.3 pg/ml at 3 d (P < 0.001) and to 59.5 +/- 27.3 pg/ml at 60 d (P < 0.05).

Conclusions: A single oral dose of 600,000 IU of cholecalciferol rapidly enhances 25(OH)D and reduces PTH in young people with vitamin D deficiency.

PMID: 20660032

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In my discussions with Dr. Robert Heaney, MD about the anti-inflammatory regimen loading doses, he referred to the following chart and indicated the 25(OH)D response to a constant daily dose of vitamin D3 decreased as 25(OH)D  serum concentrations increased.

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Based on this chart, it's reasonable to assume that vitamin D3 loading doses also become less effective as the 25(OH)D3 serum concentration rises. 

Dr. Heaney also pointed out that when 25(OH)D3 rises, so does 1,25(OH)2D3, (calcitriol).  When that happens, another enzyme comes into play that enables the kidneys to convert increasing amounts of 25(OH)D3 into 24,25(OH)2D3, an inactive metabolite with respect to calcium homeostasis.

This metabolite is part of the body's vitamin D3 self regulation mechanisms that prevents the buildup of serum calcium, the primary indication of vitamin D3 toxicity.

Based on this information and other data on loading doses, I selected a once a week loading dose of 50,000 IU vitamin D3 on top of 20,000 IU/day as a conservative dosing schedule to elevate 25(OH)D serum concentrations into the therapeutic range of 60 to 110 ng/mL where the favorable responses to the anti-inflammatory regimen have been reported.

You can find a lot more info and medical evidence on vitamin D3 loading doses at the following link:

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The takeaway from this discussion is loading doses of 50,000 IU vitamin D3 once a week on top of 10,000 to 20,000 IU/day are safe and conservative, but lab tests should be done each month until the 25(OH)D serum concentration is up around 85 ng/mL when the dosing schedule should be reduced to a maintenance dose of 10,000 IU/day.  Without a lab test, you're shooting in the dark.

Higher loading doses are also reasonable as long as they are used under a physician's supervision.

The final takeaway is the body consumes more magnesium with higher doses of vitamin D3 so it's reasonable and prudent to up the daily intake of magnesium to the RDA of 400 mg/day when taking loading doses of vitamin D3.

Hope this helps...  We'll be in Las Vegas for Thanksgiving...  I look forward to see you and Zurich.

Take care,

V/R, Batch

Judge_Smails,

Thank you for the wonderful update and kind words.  It's updates like yours that encourage CH'ers sitting on the sideline in a quandary over what to take next to avoid the terrible pain of our condtion, to give the anti-inflammatory regimen a try. 

It's particularly encouraging to hear of a response like yours to this regimen from an episodic CH'er.  All too often, end of cycle or use of another preventative clouds the causal relationship between taking the anti-inflammatory regimen with vitamin D3 and a cessation of cluster headache symptoms.  Sailing pain free through a regularly scheduled cluster headache cycle while taking this regimen is strong evidence of its efficacy.

Your 25(OH)D level is great and it's clearly a good therapeutic level for you.  Yes it's a little higher than the "normal" reference range of 30 to 100 ng/mL, but you need to realize the hundreds of thousands of tests for this vitamin D3 metabolite that were used to determine the "normal" reference range for 25(OH)D were taken from a population of people, the majority of whom are vitamin D3 deficient... That shifts the bell shaped, gaussian distribution (normal) curve decidedly to the left resulting in a lower reference range.

The estimates vary among the experts, but the incidence of vitamin D3 deficiency (a 25(OH)D serum concentration ≤ 30 ng/mL, [75 nmol/L]) here in the US is likely North of 50%.

The bottom line is keeping your 25(OH)D serum concentration up in the range you're presently enjoying, buys you a week to 10 days of reserves in case you miss a dose or catch a viral bug that consumes available 25(OH)D and the active vitamin D3 metabolite 1,25(OH)2D3 at much higher rates than normal.

Take care and thanks again for the wonderful update.

V/R, Batch

Frank,

I'm neither a doctor nor a nutritionist so I cannot and will not suggest something contrary to your neurologist's prescribed treatment for your cluster headaches.

What I can do is provide you with information you can discuss with your neurologist.
'
The first thing to discuss is your serum concentration of 25(OH)D.  25(OH)D is the serum level metabolite of vitamin D3 that's used to measure its status.  You need this lab test and your neurologist should be obliged to honor your request for it. 


The normal reference range for 25(OH)D is 30 to 100 ng/mL.  Less than 30 ng/mL is classified as vitamin D3 deficient.  If your lab test for 25(OH)D comes back less than 30 ng/mL, your neurologist should address this deficiency...  Not doing so is a breach of medical ethics.

Survey data indicates the average 25(OH)D serum concentration before starting the anti-inflammatory regimen is 28.7 ng/mL, (71.75 nmol/L).

If your lab results come back between 30 and 60 ng/mL, and this is highly probable given you've already started vitamin D3 therapy, your neurologist will likely interpret this result as "normal" and say nothing about vitamin D3 therapy.

While 25(OH)D serum concentrations in that range may be sufficient to prevent rickets, osteoporosis and osteomalacia...  data from other CH'ers here at CH.com and the online survey of CH'ers using this regimen, indicate serum concentrations of 25(OH)D below 60 ng/mL are not sufficient to prevent cluster headache.  See the following chart and show it to your neurologist.

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Regarding the calcium citrate... you can skip it for now... but be sure to take up to 400 mg/day magnesium in the form of magnesium malate, magnesium glycinate or magnesium citrate in that order of preference, 10 mg/day zinc, 1 mg/day boron, and Vitamin A (Retinol) at 900 mcg/day (3,000/day IU).  I've found that Centrum Silver is formulated to cover the above supplements in adequate amounts.

The Omega-3 Fish Oil is also an important part of this regimen... It acts as an anti-inflammatory agent and also aids in vitamin D3 absorption.

10,000 IU/day vitamin D3 is adequate for most CH'ers.  That said, some have used an accelerated vitamin D3 dosing schedule of 20,000 IU/day plus a 50,000 IU loading dose once a week on top of the daily dose of vitamin D3.

An aggressive vitamin D3 dosing schedule like this builds 25(OH)D serum concentrations at a faster rate and that usually results in less time to a favorable response... like going pain free.

Take care and please keep us posted.

V/R, Batch

Hey TeeJ,

Howzit going?

Take care,

V/R, Batch