Hey Jackie,

Thanks for the feedback with lab data and great question.  Please discuss the following with your PCP or neurologist, whoever ordered your labs.

Your serum 25(OH)D concentration of 109 ng/mL is just fine as long as your serum calcium stays within its normal reference range. As long as you're CH pain free and your serum calcium stays within its normal reference range (8.5 to 10.5 mg/dL), I wouldn't change a thing... but I would test again for serum 25(OH)D, calcium and PTH in a month. 

That said, I strongly suggest anyone needing to maintain a 25(OH)D serum concentration above 100 ng/mL in order to remain CH pain free, do so under a physician's supervision with frequent labs for serum 25(OH)D, calcium and PTH.  By frequent, I'd suggest monthly for a couple months to make sure these lab values are stable and every six months after that.

In response to your question, the following normal distribution curve comes from data reported in the online survey of 187 CHers taking the anti-inflammatory regimen to prevent their CH. 

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As you can see there are several CHers (~ 35) with serum 25(OH)D concentrations above 100 ng/mL... and more importantly, none of them reported a serum total calcium concentration above its normal reference range >10.5 mg/dL, that would be the real indication of vitamin D3 intoxication/toxicity... not a serum 25(OH)D above 100 ng/mL.

As long as your PTH is low, 18 to 24 pg/mL, (Normal Reference Range 17 to 70 pg/mL) while your 25(OH)D is above 100 ng/mL, there's little risk of your serum calcium going above 10.5 mg/dL.

Lets put this topic in perspective...

1.  The 25(OH)D serum concentration normal reference range of 30 to 100 ng/mL is a statistical average based on hundreds of thousands (if not millions) of 25(OH)D lab tests. 

2.  Current estimates indicate 60% to 70% of the population is either vitamin D3 insuficient < 30 ng/mL or deficient < 20 ng/mL.  That means the normal distribution curve used to determine the Normal Reference range is skewed to the left.

3.  The real indication of vitamin D3 intoxication/toxicity, i.e., Hypervitaminosis D, is a total serum calcium concentration > 10.5 mg/dL.  Serum 25(OH)D is only a general biomarker. 

4. There are several studies of vitamin D3 that concluded a vitamin D3 dose of 10,000 IU/day is safe and the actual 25(OH)D serum concentration associated with vitamin D3 intoxication/toxicity is > 200 ng/mL and likely closer to 300 ng/mL.

5.  If you had MS and were on the Coimbra protocol, you would be taking 1000 IU of vitamin D3 per Kg of body weight a day.  For a sleek rascal like me weighing in at 95 Kg, I'd be taking 95,000 IU/day vitamin D3 if I had MS.Most MS

MS patients on the Coimbra protocol can't use the 25(OH)D lab test because their actual serum concentration of this vitamin D3 metabolite exceeds the maximum upper measureable value for most commercial 25(OH)D assay methods.  Their physicians use PTH as the primary biomarker. 

That protocol also calls for the complete avoidance of calcium supplements and food types rich in calcium like all dairy products plus additional vitamin B12... and they must drink 2.5 liters of water a day to flush any excess calcium from their kidneys...  Otherwise, the Coimbra protocol is the same as the anti-inflammatory regimen.

6.  In the history of the FDA's Adverse Events Reporting System (FAERS), that's been running for over the 12 years, there has yet to be a single death attributed to vitamin D3...  You can't say that about Verapamil... Between 2004 and 2012, FAERS indicates 229 deaths attributed to verapamil.

7.  If you do exceed a total serum calcium concentration of 10.5 mg/dL, all you need to do is stop taking vitamin D3 for three to four weeks, (keep taking the rest of this regimen) and your total serum calcium concentration will fall back within its normal reference range.  When you resume the vitamin D3, keep taking 10,000 IU/day only skip a day. That will bring your total vitamin D3 weekly dose from 70,000 IU/week down to 60,000 IU/week.

8.  There's a risk - reward ratio for every course of pharmaceuticals and nutriceuticals (vitamins and minerals) taken at pharmacological doses to treat medical conditions.  Like the rest of us, you suffer from an a horribly painful and disabling disorder.  This begs the question, is the benefit of remaining CH pain free worth the relatively low risk of vitamin D3 intoxication?

After all that... If you're still uncomfortable maintaining a serum 25(OH)D above 100 ng/mL with your serum total calcium within its normal reference range... keep taking 10,000 IU/day vitamin D3 only skip taking it one day a week.

BTW, I maintain a 25(OH)D serum concentration between 120 and 160 ng/mL with my serum total calcium within its normal reference range during the heavy pollen season.  My wife has maintained a 25(OH)D serum concentration between 120 and 140 ng/mL for the last five years with her total calcium in the green... and she turns 80 in December...

One question... Are you taking vitamin K2 or the Super K with advanced K2 Complex?

Take care and please keep us posted.

V/R, Batch