Hey Lawrence,

Good question.  I've found that keeping the proportions/ratios of this regimen's ingredients the same is key.  If we start with the critical component, vitamin D3, a maintenance dose could be 5,000 to 10,000 I.U./day, 500 mg. calcium/day is needed. 

I chose 10,000 I.U. vitamin D3 as a conservative therapeutic dose, but I know several folks who take 15,000 to 20,000 I.U./day for therapeutic reasons. 

How much vitamin D3 you take for a maintenance dose depends on your other sources of vitamin D3 with the primary source being how much direct sunlight you get on exposed skin...  Your skin makes vitamin D3 for free...  (like 10,000 I.U. in as little as 30 minutes of direct sunlight in a bathing suit with no sun block...)

Age is also a factor in determining how much vitamin D3 we need...  As we get older, we need more vitamin D3 so the maintenance dose goes up. 10,000 - 15,000 I.U./day is not unreasonable.  My wife takes 15,000 I.U. vitamin D3 a day and claims she feels much better at that dose than at 10,000 I.U./day.  At 15,000 I.U. vitamin D3 a day she runs around the house and yard like a kid again...  and she doesn't have CH...  but she is a migraineur...

Back to your question on how much calcium citrate...  One of the many properties of vitamin D3 is it works in the gut to put more calcium into the blood stream.  Accordingly, 5,000 to 10,000 I.U. vitamin D3/day will require a minimum of 500 mg. calcium/day.  That's two of the Kirkland brand calcium citrate tablets formulated with additional vitamin D3, 80 mg. magnesium and 10 mg. zinc.  The magnesium and zinc are also essential elements and are listed as co-factors in vitamin D3 therapy.

2000 to 3000 mg. Omega 3 Fish Oil should be good for both a maintenance and therapeutic dose. 

When my cholesterol, triglycerides, and BP shot up into the red zone due to a medication I was taking that had a side effect of elevating these values, rather than taking a STATIN, my doctor and I chose a low cholesterol diet and a regimen of 3000 mg. Omega 3 Fish Oil and two of the CholestOff plant sterol tablets a day.  I was back in the green in two weeks.

The best way to accurately determine your vitamin D3 requirement is to ask for a blood test of 25(OH)D, the serum level metabolite of vitamin D3 the next time you see your PCP or neurologist.  The FDA recommended levels for this test are too low.  Nearly all the vitamin D3 gurus say our 25(OH)D levels should be in the 100 - 200 nmol/L range.

As a practical guide to diagnosis and management, Dr. Peter Lewis suggests the following (25OHD levels in nmol/L) be used as a guide:

• <100 = Deficient
• 100-200 = Optimal
• 135-225 = Normal in sunny countries
• 500+ = Potentially toxic (this would require a sustained daily intake >/= 40,000 IU)

[Note: To convert to nmol/L to ng/ml, divide by 2.5]

Hope this helps.

Take care,

V/R, Batch

Richard,

Sorry to be so slow in responding, but where's the calcium citrate?  Did I miss something?  You need a minimum of 500 mg. calcium/day if taking vitamin D3 at doses ≥5,000 I.U. day.

The calcium citrate in this regimen serves multiple purposes.  The two most important are it's part of a buffering system and also a co-factor with the vitamin D3.

Without the calcium citrate, your arterial pH can drop like a rock stimulating more vasodilation and that makes for a higher frequency of more severe CH.  Washing down the calcium citrate tablets with lemonade, limeade, or margartia mix should help.  All three of these are high in citric acid content.  When the calcium citrate and citric acid hit the stomach they buffer the stomach's gastric juices (Hydrochloric acid at a pH of 1.0 to 2.0) up to a pH of 3.9.  That's a log number so that makes the stomach roughly 80 times less acid. 

Lawrence, you might want to start pushing lemonade with your calcium citrate as well...  Everything else looks fine from here.

Take care,
V/R, Batch

Hey Jair,

Good question.  From what I've learned... unless you're a cotton picking roofer or a life guard...  i.e., someone who works for a living outside in direct sunlight...  you're likely vitamin D deficient.

I'm not a doctor so I go to the experts in this area with questions like this.

Dr Peter J Lewis, an Integrative physician in Australia is one of my favorites.  I've been in contact with him on the anti-inflammatory regimen for cluster headache and specifically on the topic of vitamin D3 maintenance and therapeutic dosing.

The simple answer is 5000 to 10,000 I.U. is a good starting point as a maintenance dose of vitamin D3 from all sources and 10,000 I.U. of vitamin D3 from all sources is a good starting point for a therapeutic dose.  Taking daily doses of vitamin D3 higher than 15,000 may not be helpful for some of us as excess oral vitamin D3 is excreted in the bile.

Again, these are starting points.  I know several folks including myself who use a daily maintenance dose of 10,000 I.U. vitamin D3.  My wife takes 15,000 I.U. vitamin D3 daily with no adverse effects...  She claims it makes her feel better...  The only problem I have with her taking that dose is it gives her so much energy it's difficult for me to keep up with her.

The only real way to determine optimum dosing is to see your doctor and have your blood tested for 25(OH)D, the vitamin D3 metabolite. 

As a practical guide to diagnosis and management, Dr. Lewis suggests the following (25OHD levels in nmol/L):

• <100 = Deficient
• 100-200 = Optimal
• 135-225 = Normal in sunny countries
• 500+ = Potentially toxic (this would require a sustained daily intake >/= 40,000 IU)

[Note: To convert to nmol/L to ng/ml, divide by 2.5]

As Dr. Lewis treats vitamin D3 deficient patients and monitors their 25(OH)D levels regularly, he comments, "It is my experience that an ongoing dosage of 5,000-10,000 I.U. of cholecalciferol daily may frequently be required to maintain optimal 25(OH)D levels, especially in obese, elderly and darker skinned patients."

I've attached a hand out Dr. Lewis sent me last week that he provides to his patients that covers much of this.

The Vitamin D Council recommends that optimal health is supported by blood levels of 50-80 ng/mL (125-200nmol/L) as identified in a 25(OH)D3 vitamin D blood test.   Get this test along with a regular blood electrolyte (chem panel) test to make sure your calcium level is ok then repeat these tests after a month of higher vitamin D3 dosing to ensure dosing is sufficient. 

The vitamin D3 council also recommends calcium supplements containing magnesium and zinc be taken when supplementing with vitamin D3.  From my experience, 500 mg. to 1000 mg. calcium is a reasonable dose.  I find the calcium citrate form is well tolerated and easiest on the gut.

You can find a lot more information on vitamin D3 at the following links:

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Hope this helps.

Take care,

V/R, Batch

Gardengal,

Unless you do your landscaping in a bathing suit without any sunblock...  in which case, please come help me... you may not be getting as much natural vitamin D3 from UVB as you think.

Dr. Lewis dismisses claims that folks living in Northern Australia get enough natural vitamin D3 because they live so close to the equator...  He sees folks with farmer's tans that still test below 100 nmol/L 25(OH)D.

The 10,000 I.U. vitamin D3 I took along with the Omega 3 Fish Oil and calcium citrate as a therapeutic dose for my cluster headaches and still take today is a conservative dose... 

Per my post above listing the optimum levels of 25(OH)D as suggested by Dr. Lewis, most of us would need to take & make ≥40,000 I.U. vitamin D3/day for up to three months before our 25(OH)D would reach the potentially toxic level ≥500 nmol/L of 25(OH)D.

The only way to know for sure is to see your doctor and have your 25(OH)D level checked...  ask also for the chem panel & cbc test so you can make sure your calcium, other key minerals and electrolytes are in the normal range. 

This same test will also give you cholesterol and triglyceride levels...  If you've been taking the Omega 3 Fish Oil and vitamin D3, your cholesterol and triglyceride levels will likely be in great shape.

Take care,

V/R, Batch

Jair,

Send your friend the pdf hand out file prepared by Dr. Lewis that I attached to my reply to your post on what's a toxic dose of vitamin D3. 

Dr. Lewis is one of a growing number of physicians who recognize the importance of maintaining healthy levels of vitamin D3 that are significantly higher than the FDA's outdated MDRs.

The Vitamin D Council at Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or covers this topic best with the following statements: 

"Can too much vitamin D be harmful? Yes, it certainly can - though anything can be toxic in excess, even water. As one of the safest substances known to man, vitamin D toxicity is very rare. In fact, people are at far greater risk of vitamin D deficiency than they are of vitamin D toxicity."

and

"Toxic doses

What exactly constitutes a toxic dose of vitamin D has yet to be determined, though it is possible this amount may vary with the individual.

Published cases of toxicity, for which serum levels and dose are known, all involve intake of ≥ 40000 IU (1000 mcg) per day. 1 Two different cases involved intake of over 2,000,000 IU per day - both men survived.

Serum levels: upper limit and toxicity threshold

Upper limit for a substance is the amount up to which is considered safe and without risk of adverse effects in the majority of the population.

Toxicity threshold for a substance is the amount beyond which over-saturation occurs and symptoms of toxicity manifest.

These values for 25(OH)D are as follows:

    Toxicity threshold level - 200-250 ng/mL (500-750 nmol/L)
    Upper limit - 100 ng/mL (250 nmol/L)

The large range between 25(OH)D’s upper limit and its threshold value implies a degree of safety at serum levels up to 100 ng/mL (250 nmol/L), since concentrations twice this amount have yet to ever be associated with toxicity.

In animal models, serum concentrations have reached as high as 400-700 ng/mL (1,000-1750 nmol/L) before toxic effects (severe hypercalcemia) were observed."

Take care,

V/R, Batch