Hey Jerry,
Thanks for the update… and sorry to be so slow in responding… I've been trying to compile some of the anti-inflammatory regimen survey data for the last few days…
Regarding how much vitamin D3 to take… It's dealer's choice on whether to take 15,000 or 20,000 IU/day of vitamin D3. The higher daily dose might push you into remission a bit faster, but in either case, it's wise to have the 25(OH)D lab test every month until it reaches equilibrium and stabilizes around the six month mark.
If you can tell me the number of days you were taking 10,000 IU/day vitamin D3 before your last test for 25(OH)D I can work up an estimate on the rate you're building this metabolite and where it will reach equilibrium and stabilize at a given dose of vitamin D3.
It's not surprising that your physicians got antsy about your 25(OH)D serum concentration going over 100 ng/mL. Staying within the "normal" reference range for medical diagnostic lab results is generally considered a safe medical practice.
The best information available indicates the vitamin D3 intoxication lower threshold for 25(OH)D concentration is 200 ng/mL. That would take a vitamin D3 dose >40,000 IU/day for at least 3 months...
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Read through the References at the bottom of this page...
To put the "risk" of hypervitaminosis from vitamin D3 in perspective... There was one death in 2004 attributed to vitamin D3... it was a child and mistakenly given over 1,000,000 I.U. vitamin D3. None since...
At nearly the same time, there were 59 confirmed deaths due to aspirin poisoning in 2003 and 147 deaths known to be associated with acetaminophen-containing products (Tylenol).
Health risks from a vitamin D3 deficiency are far greater...
It's also not surprising that your physicians opined that an oxygen flow rate of 40 liters/minute is too high when it comes to oxygenation of hemoglobin… That's entirely true, but unfortunately that opinion doesn't consider carbon dioxide levels that require a greater level of lung ventilation to reduce than provided by an oxygen flow rate of 15 to 25 liters/minute.
If you challenge most physicians why the upper boundary of the 25(OH)D reference range is set at 100 ng/mL, most will give you a blank look like you're speaking in tongues… Many physicians are frequently a little confused at who to believe when it comes to interpreting 25(OH)D lab results and it's not their fault.
Testing for vitamin D metabolites has exploded over the last few years with some diagnostic labs reporting an increase from a few hundred tests for 25-Hydroxyvitamin D a month three years ago to over 12,000 a month in 2011.
Add in the confusion factor of whether or not to use total Vitamin D or D2/D3 and the number of questions starts going up. Immunoassays and protein binding assays can only report total. Total vitamin D has been the only measurement available for years and it appears to be the most widely accepted. However, chemical assays can report both vitamin D2 and D3. Whether or not that’s needed is controversial.
Compound that with at least five different assay methods and no clear standards until 2009 when NIST stepped in. The National Institute of Standards and Technology (NIST), in collaboration with the National Institutes of Health's Office of Dietary Supplements, developed a new reference sample for vitamin D in blood serum to help laboratories validate the accuracy of their test methods. The NIST Standard Reference Material (SRM) 972, “Vitamin D in Human Serum,” represents a first step toward standardization of vitamin D testing.
From the limited research I've done on the topic of interpreting 25(OH)D results, the lower category where Deficient is less than 20 ng/ml, (50 nmol/L) and Insufficient is defined as 20-30 ng/mL,. It appears these categories are based on epidemiological studies of bone malformation in children (rickets) and bone weakness, softness, or fracture in adults (osteomalacia) relative to vitamin D3 intake. It also appears the "Normal" reference range of 30-100 ng/mL is based on population samples of "Normal" people…
Unfortunately, that begs the question… Which population of "Normal" people? A population sample from Southern California or Arizona can have a "Normal" reference range that will vary significantly from a population sample from Massachusetts or Main simply due to the difference in available incident UV-B in sunlight and lifestyle.
Now for the good news… There are a growing number of vitamin D3 experts like doctors Heaney, Garland, Vieth, Cannell, Hollis and Holick who are trying to bring about a better understanding of vitamin D3 testing, dosing, deficiency and the pharmacokinetics of vitamin D3. More importantly, how best to treat vitamin D3 deficiency, and how to interpret lab tests for 25(OH)D in concert with related lab tests for calcium, magnesium, phosphorus and parathyroid hormone (PTH).
Google any of the names of any of the above along with "vitamin D" and you'll find the results from a number of studies conducted over the last 10 years with some very compelling conclusions that support higher doses of vitamin D3 and the safety of higher concentrations of 25(OH)D.
It's no secret that I favor the use of safer and more natural non-invasive methods of controlling our disorder as opposed to the very powerful prescription medications with all their side effects. That's why I've spent over five years explaining why oxygen therapy at flow rates that support hyperventilation is safe and so much more effective than oxygen therapy at the lower flow rates.
What I've been trying to do over the last year is try to establish a causal link between our cluster headache disorder and a vitamin D3 deficiency… At this point, thanks to well over 150 CH'ers here at CH.com and another group of CH'ers at ClusterBusters… that causal link had gone well past being anecdotal… It's very real.
The next challenge has been to try to establish the 25(OH)D concentration threshold where most of the CH'ers who responded to the anti-inflammatory regimen either experienced a significant reduction in the frequency and severity of their CH or went pain free. So far CH'ers who have had this lab test while still experiencing active CH have mostly seen their results come back at < 30 ng/mL, (75 nmol/L), but a few have tested as high as 42 ng/mL, (105 nmol/L) 25(OH)D while still experiencing active CH.
The lower threshold for CH'ers who started the anti-inflammatory regimen and experienced a favorable CH response to this regimen with vitamin D3 at 10,000 IU/day with a significant (>60%) reduction in the frequency and severity of their CH, appears to be at a 25(OH)D concentration of ≥ 60 ng/mL, (150 nmol/L).
However, having said that, there have been a few chronic CH'ers, previously diagnosed as intractable to all the mainstream preventatives and abortives except for oxygen therapy at flow rates that support hyperventilation. who took much longer to experience a favorable response to this regimen and their 25(OH)D concentration has tested > 100 ng/mL.
Given the data collected so far, the optimum target therapeutic range for 25(OH)D concentration to be free CH pain or at least significantly a reduced number of CH that require only a few minutes of oxygen when they do occur… appears to be 60-100 ng/mL, (150-250 nmol/L) as shown in the following chart.
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Enough for now… Take care and please keep us posted.
V/R, Batch