Hey Michael,
Thanks for the update. Glad to hear you're CH pain free.
Regarding your question about adjusting the vitamin D3 dose. The short answer is you don't need to adjust it just yet.
For starters, I listed 10,000 IU/day vitamin D3 as the standard maintenance dose for a few good reasons. 1. It's very safe. 2. It results in an "average" 25(OH)D response of 80 ng/mL. 3. It results in > 80% of CHers who take it experiencing a significant reduction in the frequency, severity and duration of their CH in the first month of use.
With that in mind, it's not the vitamin D3 dose that's important but rather the 25(OH)D response... particularly if it's associated with a cessation of CH symptoms...
You're doing exactly what I suggest and that's to have your 25(OH)D tested until it reaches a "relatively stable" equilibrium concentration. I say relatively stable equilibrium concentration as there's ample data from the Grassroots Health *D Action survey of 1550 people taking 10,000 IU/day vitamin D3 and having the 25(OH)D lab test every six months that shows frequent fluctuations in 25(OH)D up to 25 ng/mL.
I listed the "target" serum concentration at 80 ng/mL... I should have stated it as 80 ± 15 ng/mL.
Using the above rule of thumb, a 25(OH)D serum concentration of 90 ng/mL means no adjustment is needed as long as your 25(OH)D is between 65 ng/mL and 95 ng/mL... AND you're CH pain free. The actual distribution of 25(OH)D serum concentrations reported by CHers in the online survey having a favorable response to the anti-inflammatory regimen is illustrated in the following graphic.
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There's another good reason why we shoot for a target 25(OH)D serum concentration of 80 ng/mL... It provides us with a sufficient 25(OH)D reserve to handle most immune system responses to antigens, allergens, surgery and trauma.
For example, there are at least two studies done on serum 25(OH)D response to arthroscopic knee surgery where the 25(OH)D serum concentration dropped by as much as 40% by the third day after surgery.
If the 25(OH)D serum concentration is near the lower threshold for a favorable response to this regimen, a cold, flu, infection, surgery or trauma could cause a drop in the 25(OH)D serum concentration below this threshold and CH would resume.
If the 25(OH)D serum concentration is above 100 ng/mL (and some CHers may need a serum concentration this high), neurologists and PCPs will call for additional lab tests for total serum calcium and PTH to ensure there is no hypercalcemia.
Hope this makes sense.
Take care and please keep us posted.
V/R, Batch