Hey Cathlane,

Yikes!  Thanks for the feedback... You've had more than your share of stress...  You've also brought up three very important points about the anti-inflammatory regimen... Great questions too....

The three points are the importance of Omega-3 Fish Oil, it's the 25(OH)D serum concentration not the vitamin D3 dose and the role of calcium.

The first point deals with the intake of vitamin D3 and Omega-3 Fish Oil...  These are the two most important supplements in the anti-inflammatory regimen as both have powerful anti-inflammatory properties... 

Several CH'ers have commented this regimen wasn't fully effective until they added or took more than 1000 mg/day Omega-3 Fish Oil.  In short, don't be afraid to increase the dose of Omega-3 Fish Oil...  Taking 2000 to 3000 mg/day may help.

Part of the theory behind taking these two supplements is they suppress the neurogenic inflammation associated with CH... and that helps prevent the terribly painful attacks. 

The remaining supplements taken in this regimen are the cofactors that help metabolize vitamin D3 to 25(OH)D, and on to 1,25(OH)2D3, the active hormonal form of vitamin D3.  When this process takes place at the cellular and nuclear level , 1,25(OH)2D3 combines with vitamin A (retinol) making genetic expression possible.

The second point is the magic behind all the benefits of vitamin D3 isn't so much the daily intake but rather the 25(OH)D response...  As CH'ers we need to keep our 25(OH)D serum concentration in the optimum sweet spot or center of the "green zone" between 70 and 80 ng/mL. 

Given the variation in the 25(OH)D response to the same dose of vitamin D3, I chose 10,000 IU/day vitamin D3 as this dose results in 95% of us obtaining a 25(OH)D response in the "green zone" as shown in the following chart.  Data from the online survey of CH'ers taking this regimen with 10,000 IU/day vitamin D3 indicates an average 25(OH)D response of 76 ng/mL, (195 nmol/L).

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Given the majority of CH'ers who start responding to this regimen do so within the first two weeks at a vitamin D3 dose of 10,000 IU/day, it's likely the 25(OH)D serum concentration needed to prevent CH is lower than 60 ng/mL, (150 nmol/L). 

Keeping the 25(OH)D serum concentration in the optimum range of 70 to 80 ng/mL provides a reserve to guard against competition from other 25(OH)D consumers.  Roughly 20% of the 25(OH)D metabolized from vitamin D3 by the liver is further metabolized by the kidneys to maintain calcium homeostasis and BMD.  The remaining 25(OH)D is metabolized extrarenal, (outside the kidneys) to 1,25(OH)2D3 at the cellular and nuclear level throughout the body. 

Our immune system is a major consumer of 25(OH)D.  It's running 24 hours a day 365 days a year but it's 25(OH)D consumption rate varies with exposure to virus, bacteria and allergens.  As the immune response varies with the level of exposure, so does the consumption of 25(OH)D.

We've had several CH'ers, me included, report a resumption of CH symptoms during a cold, flu or allergic reaction or that they didn't experience a pain free response to this regimen until after cold or flu symptoms were completely gone.  In other words, colds, flu and allergic reactions can eat through enough of a 25(OH)D reserve to allow CH symptoms to return.

The third point is if you're eating a healthy well-balanced diet, calcium does not appear to be an essential element in preventing CH. In some cases where CH'ers are taking verapamil as a CH preventative, calcium supplements may reduce its effectiveness.   

That said, taking vitamin D3 increases the amount of calcium mobilized from the gut...  and if there's insufficient calcium in the gut, the amount of vitamin D3 we take will result in calcium being mobilized from bones... 

This isn't meant to spook anyone as it's quite normal for calcium to be moving in and out of the bones on a regular basis in order to maintain calcium homeostasis, the process that keeps calcium total serum concentration in a very narrow range... 

Taking vitamin D3 speeds up this process so taking calcium supplements helps insure more calcium goes into the bones than comes out of them.  Vitamin K2 plays a role in building bone mineral density (BMD) as well.

Now to your last question.  There are several health advantages to staying on the anti-inflammatory regimen year-round as opposed to taking it only when in cycle...

The half-life of 25(OH)D is roughly 15 days if you stop taking vitamin D3 along with the cofactors and there's no exposure to sun without sun block...  That means in the absence of any vitamin D3 from Sun or supplementation, a 25(OH)D serum concentration of 80 ng/mL will drop to 40 ng/mL in two weeks and down to 20 ng/mL in a month.

Staying on this regimen year-round also prevents needless CH pain while building your 25(OH)D back up to a therapeutic level if you're late restarting this regimen in time for your next cycle.  We've had a good number of episodic CH'ers who have been on this regimen two to three years report they've sailed through their normal cycle times completely pain free.

Hope this helps.

Take care, thanks again for the feedback and please keep us posted.

V/R, Batch