Hey JT,

Thanks for the update.  Sorry you're still having problems.  My first suggestion is to relax, maintain the vitamin D3 dose that keeps you CH pain free and enjoy the Christmas season.  Although you're now the current record holder for the highest 25(OH)D3 serum concentration at 311 ng/mL on the anti-inflammatory regimen, your serum calcium is still within its normal reference range so there's no vitamin D3 intoxication/toxicity.  That said, you should be able to control your CH at a lower vitamin D3 dose so I suspect you've another condition or conditions cooking away.

To put this in perspective, Dr. Coimbra's MS patients on his protocol (very similar to mine except they take 1000 IU vitamin D3 per Kg body weight/day) don't even have labs for their 25(OH)D3 as they're off the scale, too high to measure), but they do measure serum calcium and PTH.

What is your current weight and BMI? Are you taking any other Rx or over the counter medications? If so, what are they and why are you taking them?

What you and your doctor do need to monitor is your parathyroid hormone (PTH) serum concentration.  It;s important to keep it low, but not in the single digits without frequent monitoring.  With your 25(OH)D3 at 311 ng/mL, it's obvious your labs are being done at Quest Diagnostics or another lab that uses the same Liquid Chromatography Dual Mass Spectroscopy (LC-MS/MS) assay for 25(OH)D. 

The LC-Ms/MS assay method is capable of a maximum measurment of 512 ng/mL of combined D2 and D3. As your vitamin D2 intake is likely nil, your 25(OH)D3 serum concentration can be measured as high as 512 ng/mL. 

If your labs are being done at Quest, then you need to create an account on "MyQuest" at the following link.  Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or . It's free.  When you've registered, check for any indications of a PTH lab test.  If none are listed, call your doctor on Monday and ask for a lab order for PTH.  The labs for this regimen include the following:

• 25-Hydroxyvitamin D3 [25(OH)D3]. CPT Code 82306. Quest Diagnostics Test Name: 92888-QuestAssureD 25-OH Vitamin D (Total), LC/MS/MS

• Parathyroid Hormone (PTH) Intact and Total Calcium. CPT codes 83970, 82310

This will allow you and your doctor to monitor your serum 25(OH)D3, calcium and PTH over time as illustrated in my labs over the last three years.
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This 3-year log clearly illustrates my 25(OH)D3 has been elevated well above its normal reference range shown in greed to as high as 188 ng/mL. It's been averaging 150 ±5 ng/mL since I switched to the Bio-Tech D3-50 taking one capsule a week in January of this year.  You'll also note that my serum calcium remained within its normal reference range the entire time indicating no hypercalcemia, a.k.a., vitamin D3 intoxication/toxicity.

The interesting thing to note is my PTH trace. As you can see it mirrors the calcium serum concentration.  When serum calcium concentration goes up, the serum PTH concentration goes down.  This is a classic indication of normal calcium homeostasis.

In this case, less PTH means less 25(OH)D3 is hydroxylated in the kidneys to 1,25(OH)2D3, the hormonal form of vitamin D3 thatpulls calcium from the gut and/or bones to maintain serum calcium in its normal reference range.  As less 1,25(OH)2D3 is produced, less calcium is being pulled from the gut/bones.  In short, our parathyroid glands keep us from experiencing hypercalcemia while taking higher doses of vitamin D3.

I'm an old Navy fighter pilot so when things don't look right, I trade airspeed for altitude and climb up to look things over before making any serious decisions.  In your case, the high vitamin D3 intake and resulting high serum 25(OH)D3 concentration tells me your body is fighting inflammation and/or an allergic reaction in what I call a Calcitonin Gene-Related Peptide (CGRP) cascade.  CGRP cascades are usually triggered by histamine from an allergic reaction.  That makes histamine to a CHer like Kryptonite to Superman.

That a first-generation antihistamine like Benadryl (Diphenhydramine HCL) worked to lower the frequency of your CH is a good indication an allergic reaction is part of your problem.

As an allergic reaction is the likely culprit, the histamine released has turbocharged the neurons and glia in your trigeminal ganglia, hypothalamus and likely other parts of your brain to express CGRP, Substance P (SP), Vasoactive Intestinal Peptide (VIP) and likely pituitary adenylate cyclase activating peptide (PACAP). 

This is a cocktail of bad news to CHers as it triggers a circular chain reaction where these neuroactive peptides trigger the release of even more histamine and that histamine triggers the expression of even more of the bad news cocktail.  In the mean time, this cocktail of neuropeptides is causing neurogenic inflammation and uncontrollable CH pain.

There are three ways to stop this circular chain reaction.

• Reduce exposure to the allergen to the greatest extent possible.  You've taken some steps here but there are others

• Start a week to 10 day course of a first-generation antihistamine like Benadryl (Diphenhydramine HCL) at 25 mg X4/day.  You've already done that

• Increase/titrate the vitamin D3 dose until you experience a CH pain free response.  You've done that too

I've gone over your posts so know you've already taken some steps to reduce your exposure to some allergens.  That said, I saw nothing in your last 14 posts about diet.  There's a better than even chance there's something in your diet causing an allergic reaction.  Accordingly, I would start the Atkins - Ketogenic diet asap. 

This combo diet is not as spartan as one might think.  For starters, no sugars of any kind and that includes fruit juices.  They're high in fructose and we don't need fructose.  No wheat products, bread, pasta, crackers, cookies, cakes or pizza.  Avoid grain oils like Mazola and Canola.  Not only are these the wrong kind of fats, they're also likely contaminated with glyphosate, a.k.a., the herbicide RoundUp.

Good fats include organic butter, lard, extra virgin olive oil, avocado oil and my favorite, extra virgin coconut oil.  You can eat all the organic meats, poultry and eggs you want.  A couple of servings of wild caught salmon, halibut and Ahi tuna is great.  You can also eat all the green and colored organic Non GMO veggies you want.  Limit fruits to a couple handfuls a day of dark berries like blueberries, blackberries, raspberries or grapes.

It's best to start this diet with a two day fast drinking only water and taking your supplements.  Doing this will burn through the glycogen (blood starch) stored in your liver.  Once it's gone you'll start metabolizing fat and when that happens, hunger pangs go away.

Some things you should do at this point to reduce the calcium load on your system include:

• Avoid all calcium supplements. (the 200 mg in the Kirkland Adult 50+ is OK)

• Avoid all calcium rich foods, i.e., all dairy products and most nuts

• Drink at least 2.5 liters of water a day. This helps flush any excess calcium down the dumper.

I would also start taking Resveratrol and Quercetin as illustrated below.  Take as directed on the label.
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These two supplements increase the expression of the vitamin D3 receptors that attach to DNA strands to enable the genetic expression controlled by vitamin D3 that down-regulates the expression of CGRP, SP, VIP and PACAP, the neuroactive peptides responsible for the neurogenic inflammation and pain we know as cluster and migraine headache.

I would also add CoQ10, Turmeric (Curcumin) and Liposomal (fat wrapped) Vitamin C that stays in your system longer.
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These three supplements all act as anti-inflammatory agents.  Coenzyme Q10 revs up mitochondria and is good for the old ticker. The liposomal vitamin C acts as a potent antioxidant and a natural antiviral, antibacterial and antifungal agent.   Accordingly, I would mosey over to Costco today and pick up the additional supplements and keep your headache diary up to date so you can track any trends.  You can also order them from amazon.com.

The goal of all this is to remain CH pain free, but at a lower vitamin D3 dose.  It will take time for your 25(OH)D3 serum concentration to fall.  Data I've collected so far indicates our 25(OH)D3 burn rate under normal conditions, without any vitamin D3 supplements or cutaneous vitamin D3 from sunlight, drops at a rate of 15 ±5 ng/mL/month. 

If you're unable to remain CH pain free at a lower dose, see your doctor for a set of labs including the following and any other labs he thinks you need as there may be another condition cooking away:
BASIC METABOLIC PANEL
CBC (INCLUDES DIFF/PLT)
URINALYSIS, COMPLETE W/REFLEX TO CULTURE

A consult with an immunologist for allergy skin tests is another step in finding out what's cooking.  Finally, there are several physicians trained in the Coimbra Protocol here in the US.  The following link provides a map with contact data.  There may be one near you. 
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MS patients on the Coimbra Protocol take as much vitamin D3 as you're taking and many take even more.  It's a way of life for them

Take care and please keep us posted.

V/R, Batch

Hey William,

Thank you for the update on the efficacy of the vitamin D3 loading schedule.  It's music to my ears and better yet, a testimony that will encourage other CHers to give this very safe and effective method of stopping the CH beast from jumping ugly a try.  Thank you also for reminding me about the Methyl Folate Plus.

Regarding finding a PCP/GP, great question.  My suggestion is to find a Naturopathic Physician near you by filling in the required information in the following link.

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Why a naturopath?  Simple.  They're doctors (ND not MD) who have graduated from one of the 7 accredited Naturopathic medical schools in North America. The curricula at an ND med school is roughly the same as the MD med schools with one major exception, NDs are taught a minimum of 150 hours of nutritional medicine, then there there's another class in nutritional science.  All that is followed by direct hands on work with patients. 

The MD will get at most, an hour of nutritional medicine and that is to tell patients to follow the very sad Standard American Diet (SAD).  The following two links will explain why the SAD diet is so dangerous.

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As MD med schools are heavily financed with large grants from Big Pharma, their curricula are biased to treatment of patients with a pharmaceutical solution and the majority of these pharmaceuticals treat only the symptoms, not the cause.

Accordingly, where the MD will turn to the school book solution taught in med school, to a man made pharmaceutical to treat what ails you, the naturopath will take a holistic approach to look for the cause of that ailment with a complete exam, lab tests, and a lot of questions to get a total picture of your overall health. 

With that information in hand, the ND will likely suggest a lifestyle change complete with diet, sleep and exercise.  The ND will also suggest or prescribe vitamin and mineral USP supplements to augment the diet.  The naturopath will only turn to a pharmaceutical as a last resort.

If push comes to shove - depending on your state's laws, you may be able to go to a medical diagnostic lab to request these three serum assays without a physicians lab order.  Some of these diagnostic labs have a resident physician who will write the lab orders. 

Accordingly, I would do an Internet search using the search terms "medical diagnostic lab" plus your zip code.  In some cases, the cash price for these labs is less than what they charge the medical insurance companies. Accordingly, when you do find a lab to do these three lab tests, it doesn't hurt to ask about their cost.

Hope this helps.  Take care and please keep us posted.

V/R, Batch

Hey Stefan,

There's no need to avoid calcium rich foods or calcium supplements at the maintenance doses called for in this treatment protocol.  It's when you start going over a vitamin D3 maintenance dose of 500 IU/Kg ~ 40,000 IU/day that reducing the calcium load becomes prudent.

Regarding hypercalcemia, in the 10 years I've been providing information outreach to thousands of CHers and their doctors on this vitamin D3 treatment protocol, I have yet to see a report of hypercalcemia.  The 25(OH)D3 serum concentration is a very poor indication of hypercalcemia, a.k.a., vitamin D3 intoxication/toxicity.  The only commonly used laboratory assay used to determine hypercalcemia is a serum calcium concentration greater than the normal reference range.  A 24 Hr urine collection can also be used as a secondary measure.

I've routinely kept my 25(OH)D3 around 150 ng/mL and recently as high as 277 ng/mL, yet my serum calcium concentration has always remained within its normal reference range as illustrated in the 4-Year chart of my labs for 25(OH)D3, calcium and PTH (Parathyroid Hormone).

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My PCP has no problem with my 25(OH)D3 serum concentration even at 277 ng/mL as my serum calcium has always remained within its normal reference range.  A 24 Hr Urine collection found my urine calcium well within its normal reference range so I wasn't dumping calcium in urine.

I try to maintain my PTH serum concentration between 10 and 15 pg/mL as this indicates I'm getting the maximum therapeutic effect from vitamin D3.

It's strongly advised to take all the vitamin D3 cofactors illustrated by brand and dose in the following photo of supplements I take and suggest to other CHers.

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One of the more important vitamin D3 cofactors is magnesium.  We need at least 400 mg/day while taking vitamin D3 as the enzymatic processes that hydroxylate vitamin D3 to 25-Hydroxy vitamin D3 consume magnesium rapidly.  Without magnesium supplements, vitamin D3 will decrease serum magnesium concentrations rapidly leading to a poor calcium-magnesium ratio resulting in muscle cramps.

Take care and please keep us posted.

V/R, Batch

Hey Andy,

Sorry to hear the CH beast is jumping ugly and knocked you out of CH pain free bliss.  This happens and it has happened to me with my 25(OH)D3 serum concentration at 150 ng/mL.  The likely reason is an immune system response to allergens.

The first step is to see your PCP and ask for labs of your serum 25(OH)D3, calcium and PTH.  I would also ask for the hs CRP (High-sensitivity C Reactive Protein) assay.

it's a safe bet you're battling an immune system response to allergens.  When insulted by allergens, the immune system's Mast Cells degranulate (spit open and dump their contents) releasing large quantities of inflammatory mediators as illustrated in the following graphic.

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Leading this pack of inflammatory mediators is Histamine.  Histamine to a CHer is like Kryptonite to Superman - Bad News as none of the standards of care preventatives like verapamil, MM or vitamin D3 will work when we're insulted by histamine.  That means you need to treat the immune system response to allergens.  This is where the Antihistamine Full Monty comes into play.

The Antihistamine Full Monty is a collection of supplements with antihistamine properties that include 3 grams/day each as a loading dose of Turmeric (Curcumin), Resveratrol, Quercetin and Omega-3 fatty acids.  It also includes 200 mcg/day Selenium, 8 grams/day vitamin C and 5 mg/day Melatonin taken at bed time.   If there's no response in a week, I would add 200 mg/day CoQ10 and 5 grams/day D-Ribose.  Both boost mitochondria health. You can mix the D-Ribose with water and drink it.  As a sugar, it will taste slightly sweet.

Take the loading dose for five days or a significant reduction in CH frequency whichever occurs first, then taper to 2 grams/day for another five days then taper to 1 gram/day.  I tapered to 1 gram/day of the first four supplements in March and I'm still taking them.  Dealers choice on the Selenium, but I still take the Melatonin occasionally at bedtime and 8 mg/day vitamin C daily.  If you're wondering about vitamin C, watch the video of Linus Pauling titled Preventing Illnesses and Diseases with Vitamin C at the following link.

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I buy the bulk powdered vitamin C in 1 Kg bags and stir 2 level teaspoon measures in 8 ounces of water and take sips all day until it's gone by bedtime.  This is the least expensive form of vitamin C and dosing throughout the day is best as our kidneys filter vitamin C rapidly.

I realize this is a boatload of pills to take, but the Full Monty is proving to be very effective in achieving a CH pain free response during allergic reactions as an alternative to Benadryl.  Most CHers respond to the Antihistamine Full Monty during the first week.   You can discontinue the Antihistamine Full Monty following at least two weeks CH pain free, but keep these supplements handy.  You never know when the next allergic reaction will happen.

Take care and please keep us posted.

V/R, Batch

Andy,

You're fighting two devils.  The cluster beast is bad enough, but manageable for most Chers following the anti-inflammatory regimen treatment protocol.  Three jabs of the COVID-19 mRNA biologic coupled with an infection likely by the omicron mutant variant, doubles the degree of difficulty in controlling and preventing CH with this treatment protocol. 

The COVID-19 mRNA jab and an omicron infection both cause inflammation and on top of that, they weakening your innate and adaptive immune systems.  Accordingly, you're going to need larger loading doses and maintenance doses of vitamin D3. You'll also need the Full Monty supplements.  Adding at least 200 mg/day CoQ10 and 1000/day mg NAC (N-Acetyl Cysteine) will also help.

You've already see your PCP to obtain assays of your serum 25(OH)D3, calcium and PTH.  That's great! You'll also need the hs-CRP (High-sensitivity C-Reactive Protein) assay the next time you see your PCP.  It's a safe bet your CRP will be elevated.  Once we have the results of your assays, we can compute a new total loading dose and schedule.  You'll need the Bio-Tech D3-50 and also the Micro D vitamin D3 nano emulsion.

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In the mean time I would up the vitamin D3 maintenance dose to 50,000 IU/day with the Bio-Tech D3-50 along with all the cofactors and continue the Full Monty supplements plus the CoQ10 and NAC.

Take care and please keep up posted.

V/R, Batch

Hey Andy,

Howz the head now?  Hope you had a wonderful Thanksgiving.  We sure did. 

The reason you were still getting hit with a 25(OH)D3 >150 ng/mL was the elevated hs-CRP.  As suspected, the hs-CRP indicated you were battling inflammation.  We're not sure of the actual mechanism of action associated with inflammation triggering CH and making CH more difficult to control. 

I'll make a SWAG it's an immune system response where the immune system's white blood cells consume available vitamin D3 and its first metabolite 25(OH)D3 more rapidly leaving too little to control CH.  We've seen this happen many times.  When it does happen, the best course of action is to increase the 25(OH)D3 serum concentration with loading doses and a higher maintenance dose.  SWAG = Sophisticated Wild-Ass Guess.

Take care and please keep us posted.

V/R, Batch

Andy,

You've made a sound choice based on the available credible information.  Have a Very Merry Christmas and a Happy and Healthy New Year.

V/R, Batch