Hey Joshua,

Thanks for the update.  It appears you're already starting to respond to this regimen.

Are you doing the vitamin D3 loading schedule?  That will speed up the increase in your 25(OH)D serum concentration to 80 ng/mL and that should help you get CH pain free as fast as possible.

Try to see your PCP for serum 25(OH)D, calcium and PTH lab tests and discuss the anti-inflammatory regimen.

Take care and please keep us posted.

V/R, Batch

Hey JK,

Thanks for the update.  Glad to hear you've got the CH beast on the run...  Keep it up and everything gets even better.

Regarding the survey, wait until you've been taking the maintenance dose of 10,000 IU/day for at least a month to let your 25(OH)D reach a stable equilibrium and then if possible, see your PCP for the 25(OH)D lab test.  Once you have the lab results back, take the survey.  If the lab test for 25(OH)D isn't doable... a month on the maintenance dose then take the survey will be just fine.

So far, the survey results have shown a clear correlation between a sustained CH pain free response and a serum 25(OH)D concentration around 80 ng/mL.

Take care and please keep us posted.

V/R, Batch

Mfocht,

Interesting question.  From my experience, I've found the anti-inflammatory regimen with 10,000 iU/day vitamin D3 plus the co-factors turbocharges my immune system...

Just as vitamin D3 triggers genetic expression in neurons in the brain and trigeminal ganglia that helps us prevent CH, vitamin D is also expressed on vitamin D receptors in immune cells (B cells, T cells and antigen presenting cells). 

As these immunologic cells are all are capable of synthesizing the active vitamin D3 metabolite, 1,25(OH)2D3, vitamin D3 has the capability of acting in an autocrine manner to support an improved immunologic response.  In simple terms, vitamin D3 can modulate (improve) the innate and adaptive immune responses.

What all this means is viral infections like colds and flu are significantly reduced after you've been on the anti-inflammatory regimen for a month or two and you've elevated your serum 25(OH)D up around 80 ng/mL.

That doesn't mean you won't catch a cold.  The adenovirus that causes the common cold mutate a lot so the adaptive immune cells may not recognize a new mutated version and react accordingly.   However as the innate immune cells also get jazzed up on vitamin D3, they act like caped crusaders and jump ugly on the adenovirus as fast as possible.

That means the common cold which would ordinarily last a week or more before you started vitamin D3, now last only a day or two...  There are several studies out indicating better than a 40% drop in influenza infections when serum 25(OH)D is >40 ng/mL.

What we've also learned over the last five years is an immune system response to an infection consumes more vitamin D3 and its first metabolite 25(OH)D.  As this can lead to a return of the CH beast, we've found its best to double the normal vitamin D3 maintenance dose while the infection symptoms are present... 

Taking a 1000 mg vitamin C tablet three to four times a day can also help shorten the infection duration.

An immune system turbocharged with vitamin D3 handles bacterial and fungal infections in much the same way.  Ultimately, it's a numbers game...  If the source of the infection is massive, it takes the immune system longer to control the infection.

In some cases with bacterial or fungal infections, an antibiotic or antifungal medicine is indicated... Your PCP should recognize the symptoms and treat accordingly.

If you do end up taking an antibiotic or antifungal medicine, they tend to be indiscriminate so wipe out friendly colonies of biota in the GI tract called the microbiome.  If this is the case, taking a probiotic is also a good idea. 

We've run the information trap line on taking antibiotics and probiotics...  The consensus is the probiotic can be taken with the anitbiotic as long as the doses of each are separated by 12 hours.

I hope all this answered your question...

Take care,

V/R, Batch

Hey Cassie,

Welcome to CH.com.  We know what your mother and you are going through and the good news is it doesn't need to be that way.  Your mother is lucky to have a proactive supporter like you.

For starters, 20,000 IU/day is a very safe dose of vitamin D3 and it may be all your mother needs to reach the tipping point towards a CH pain free response.  Accordingly, its unlikely the pain free day after taking 20,000 IU of vitamin D3 was a coincident.

There are several clinical trials indicating vitamin D3 doses up to 40,000 IU/day and 25(OH)D serum concentrations up to 164 ng/mL are beneficial for the condition being treated with no evidence of hypercalcemia or hypercalciuria... 

Hypercalcemia (a serum calcium concentration above its normal reference range) is the only real indication of vitamin D3 intoxication, a.k.a. "vitamin D3 toxicity" not a serum concentration > 100 ng/mL (250 nmol/L). 

That said, your mother needs to keep her PCP in the loop with labs for her 25(OH)D, total calcium and PTH (Parathyroid Hormone).  As long as her total calcium stays within its normal reference range, your mother should be good to go at 20,000 IU/day vitamin D3... or higher.  PTH labs should come back at the low end of its normal reference range.

As a side note, I've run my serum 25(OH)D concentration over 164 ng/mL and my total calcium stayed well within its normal reference range.  I kept my PCP in the loop during all this and all he did was smile when the lab results came back... all in the green.

Regarding the first-generation antihistamine, chlorphenamine (chlorpheniramine maleate oral) should work just fine blocking H1 histamine receptors. 

However, chlorpheniramine maleate oral and topiramate oral both increase sedation so your mother's PCP should be consulted prior to starting the chlorphenamine.  No driving while taking either of them.

As the topiramate (Topamax) appears to be ineffective in preventing your mother's CH, I suggest you or your mother discuss with her PCP a plan to stop taking the topiramate while taking the chlorphenamine.

If a week to 10 days of chlorphenamine has no effect on the frequency of your mother's CH... it's unlikely that an allergic reaction and flood of histamine is triggering her CH.

You can find suggested dosing instructions for an adult allergic reaction at the following link.  Again be sure to discus all this with your mother's PCP.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or .

Hope this helps.

Take care and please keep us posted.

V/R, Batch

Hey Joshua,

Thanks for the update and lab results.  The lab results are very interesting.  I'm guessing the lab printout flagged the serum calcium concentration as "High" and your PCP advised you to lower your vitamin D3 intake.

That said, your CH pain free response to doses of vitamin D3 > 10,000 IU/day is proving what I've suspected for the last few years... and that is many of the 18% to 19% of CHers who do not respond to the anti-inflammatory regimen at 10,000 IU/day and serum 25(OH)D around 80 ng/mL need higher doses of vitamin D3 with resulting 25(OH)D serum concentrations higher than 100 ng/mL in order to experience a CH pain free response.

Several CHers, myself included, have run serum 25(OH)D up to a range between 140 to 165 ng/mL, (350 to 410 nmol/L) under a physician's supervision.  In all but one case, the serum total calcium stayed within the normal reference range of 8.5 to 10.5 mg/dL.  One lab for calcium came back at 10.6 mg/dL, but dropped within the normal reference rang on a subsequent lab test a month later after lowering the vitamin D3 dose.

Your total serum calcium at 10.6 mg/dL has "bumped" the upper limit for total serum calcium.  In NASCAR speak, your motor is running a little hot.  What this really means is the vitamin D3 doses you were taking have pushed your calcium homeostasis to the limit of its capacity to maintain a serum calcium concentration between 8.5 to 10.5 mg/dL.

As you have already lowered your vitamin D3 intake, you've taken appropriate corrective action.

It's important that CHers taking the anti-inflammatory regimen to prevent their CH understand calcium homeostasis, what it is, what controls it and the role played by vitamin D3.

In simple terms, calcium homeostasis is a biological control mechanism that maintains serum calcium concentration in a very narrow range.  It's a lot like the thermostat in your car that maintains engine temperature in an optimum range by controlling the amount of radiator fluid passing through the radiator.

Vitamin D3 from supplements or generated in the skin as cutaneous vitamin D3 enters the bloodstream and passes through the liver where it is hydroxylated (metabolized) to 25-Hydroxy Vitamin D3, a.k.a. 25(OH)D. 

This name comes from the chemical naming convention meaning a hydroxyl radical [OH⁻] was added to the 25th position on the vitamin D3 molecule.

Here is where things get interesting...  Chemical sensors in the brain, parathyroids and elsewhere in the body are constantly monitoring serum calcium concentrations.  Under normal conditions, when serum calcium approaches the lower limits of its normal reference range, the parathyroid glands sense this condition and they start releasing more parathyroid hormone (PTH).

This additional PTH signals the kidneys to hydroxylate more 25(OH)D to 1,25(OH)2D3, (calcitriol), the active hormonal form of vitamin D3.  If you follow the naming convention, the kidneys have added a 2nd hydroxyl radical to the 1st position on the vitamin D3 molecule.

Serum 1,25(OH)2D3, the active hormonal form of vitamin D3 now travels through the bloodstream to the gut where it pulls more calcium into the blood stream to maintain serum calcium within its normal reference range.  If there is insufficient calcium in the gut, 1,25(OH)2D3 pulls the needed calcium from bones.

Under normal conditions, if serum calcium approaches the upper limit of it's normal reference range, calcium sensors detect the rising serum calcium concentration and signal the parathyroid glands to stop or slow the production of PTH.  This slows the extraction of calcium from the gut and bones and this allows serum calcium concentrations to drop.

Your PTH labs at 12 pg/mL are at the low end of the normal reference range 10 to 65 pg/mL.  This is consistent with your higher serum calcium concentration.

Sooo... what does this lesson in biochemistry tell us?

You'll note the above explanation of calcium homeostasis was under "normal" conditions where we take a physiological dose of vitamin D3 around 10,000 IU/day.  By physiological dose, we're talking the amount of cutaneous vitamin D3 normally produced by the skin if we were running around outside exposed to the UV B in direct sunlight like paleo man clad in skins of an animal we ate.

By taking doses of vitamin D3 greater than what would normally be generated by paleo man... we're taking what is called a supraphysiological or pharmacological dose of vitamin D3 to achieve a therapeutic response, i.e., a cessation of CH symptoms. 

What I'm saying here is the CHers who don't respond to the anti-inflammatory regimen with a physiological dose of vitamin D3 at 10,000 IU/day may need to take higher, pharmacological doses of vitamin D3 in order to prevent their CH. 

So what happens when they find a pharmacological dose of vitamin D3 that prevents CH... but it results in too much serum calcium... like above the normal reference range for total calcium at 10.5 mg/dL? 

This almost sounds like being between a rock and a hard place... but there is a solution.

The solution in this case is stop taking calcium supplements and eliminate as much dietary calcium as possible.  That means no milk, cheese, ice cream or any other food type high in calcium.

To be clear, most of the above is for discussion purposes only... 

If you are among the 18% to 19% who do not respond to the anti-inflammatory regimen at a vitamin D3 dose of 10,000 IU/day, and you want to take higher doses of vitamin D3, do not do this by yourself. 

You need to work with your PCP or neurologist if you want to take sustained doses of vitamin D3 greater than 10,000 IU/day to prevent your CH.  You and your doctor will also need to monitor lab test results for your serum concentrations of 25(OH)D, calcium and PTH.

If serum calcium gets too high, lower the vitamin D3 dose.  If you can't lower the vitamin D3 dose because your CH return if you do, then you need to stop taking calcium supplements and eliminate dietary calcium the the maximum extent possible.

Again, all this needs to be done under a physician's supervision.

Take care and please keep us posted.

V/R, Batch

Joshua,

Sounds like a great plan.  As long as you've cut back on the vitamin D3, milk and cheese shouldn't be a problem.

Please keep us posted.

V/R, Batch