Colin,
Great post and tantalizing topic... Dosing changes and resulting lab data while taking this regimen always grab my attention.
This topic also hits the top of my list of things to do... and that's to come up with a simple rule of thumb regarding the maintenance of a CH pain free status while taking the anti-inflammatory regimen.
Posts here at CH.com and data from the online survey of 127 CH'ers taking the anti-inflammatory regimen provide us with important findings. For example, nearly all CH'ers with active bouts of CH have a vitamin D3 deficiency with a 25D serum concentration less than 30 ng/mL, (75 nmol/L).
This same data set also provides us with important data on the average "sweet spot" in 25D serum concentration that keeps us pain free at 80 ng/mL, (200 nmol/L). This 25D serum concentration requires an average daily vitamin D3 intake of 10,000 IU/day.
Moreover, although this 25D serum concentration is likely higher than what is actually needed to maintain a CH pain free state, it does provide sufficient reserves to handle relatively minor cases of inflammation.
We've also found from the empirical data provided by CH'ers taking this regimen, that there are a number of medical conditions that result in a generalized increase in inflammation that can be overcome by increasing the vitamin D3 intake.
Examples include viral and bacterial infections, surgery and trauma. In other words, comorbid medical conditions that compete for the same available serum substrates of vitamin D and 25D needed to stay CH pain free.
The simple course of action/rule of thumb is to increase vitamin D3 intake and if possible, treat the comorbid condition.
This is an easy thing to do if the source of inflammation is a bacterial infection easily and effectively treated with an antibiotic. Of course we'd need to repair the collateral damage caused by antibiotics by taking probiotics to recolonize friendly bacteria in the GI tract that were destroyed by the antibiotic.
There are no silver bullets for viral infections and the only defense is maintaining a healthy immune system... That makes taking additional vitamin D3 and magnesium to boost the immune system, the prudent course of action. Trauma and surgery fall into this category as well. Both conditions have been linked to a drop in serum 25D concentration upwards of 40% within a week of the trauma or surgery.
I've found there is one general medical condition that can't be easily overcome by taking more vitamin D3... and that's an allergic reaction. The likely reason for this is an allergic reaction generates a flood of histamines that overload the capacity of this regimen to prevent CH.
Roughly 17% of CH'ers who start the anti-inflammatory regimen don't respond with a decrease or cessation of CH symptoms... Data from the online survey of CH'ers taking this regimen indicate comorbid medical conditions in roughly a third of these cases.
There are also a number of CH'ers taking 10,000 IU/day or more and maintaining a 25D serum concentration between 100 to 150 ng/mL, (250 to 375 nmol/L) and are still getting hit.
In many cases, there are no outward symptoms to help in the identification of possible underlying medical conditions and that suggests the presence of a possible sub-clinical allergic reaction.
Starting at the first of March, I began titraing my vitamin D3 from a maintenance dose of 10,000 IU/day up to 50,000 IU/day to combat the high pollen count in an attempt to stay pain free. This worked for the first two weeks... However by mid March the pollen count got so onerous I started to get hit... and I was taking 50,000 IU/day vitamin D3. You can see why in the following photos of my formerly black pickup coated with Alder pollen...
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Not to be outdone, as the Alder pollen drop decreased... the Bigleaf Maples have started their pollen drop... and it looks to be even more onerous...
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That's not new leaves on the Bigleaf Maple tree shown above... It's Bigleaf Maple blooms loaded with bright yellow pollen shown below.
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I've never been troubled by pollen allergies... That said, when the airborne pollen is blowing around like a dust storm and you can see it sifting into the air... all bets are off.
Fortunately, a solution exists for this case, at least for me and a few other CH'ers, and that is to start a course of benadryl (diphenhydramine) at 25 mg four times a day... Start this course with a 50 mg loading dose of benedryl.
The rational for taking benedryl has to do with its capacity as first-generation antihistamine, to pass through the blood brain barrier in order to block histamine receptors in brain cells... where CH'ers need this capability most.
The down side of benedryl and other first-generation antihistamines is they're a CNS depressant so cause drowsiness. Second- and third-generation anti-histamines cannot pass through the blood brain barrier so do not have this problem.
Accordingly, if you do start taking benedryl, don't drive if at all possible as you will get drowsy. Not surprisingly, this drowsiness can also be a benefit in most cases as most of us have lost quality sleep due to the night hits and the benedryl will help get that badly needed sleep.
Hope this helps...
Take care,
V/R, Batch