In 2009 I discovered that most of my patients had abnormal sleep because they were vitamin D deficient. You may not be aware that your sleep is abnormal, but if you have a neurologic problem that is severe enough to see a Neurologist, you probably do not heal your body in sleep as perfectly as you once did. Most of us who have headaches, tremor, balance difficulties, vertigo, burning in the feet, depression, body pain, or memory loss have abnormal sleep because our vitamin D is too low, and fixing the sleep can fix the neurologic problems. (Please go to www.vitamindcouncil.org to look at the scientific articles the following comments are based on. The only thing you won’t see there is the D effects on sleep, that’s my observation and you’re reading it here first.)
Vitamin D is not a vitamin. We’ve been taught that Vitamin D is the “bone vitamin”, but it is really more of a sun hormone. The word “vitamin” means “something my body needs that I can’t make, so I must get it from the food”. D hormone is instead, a chemical that we make on our skin from sun exposure. It is a hormone like thyroid, estrogen or testosterone. Using the proper word “hormone” reminds us that it affects multiple parts of the body and that it is not “extra”. It is essential to every cell in the body and it is not in the food. It is supplemented in milk but as a cup of milk has only 100 IU of vitamin D you would have to drink 1000 cups of milk a day to keep from being D deficient.
D hormone is unique among our hormones because we make it on our skin from a specific wavelength of light. Our planet is tilted so as we go north or south from the equator seasons result. Where there are seasons every living thing has to deal with 6 months of good weather and available food, and six months of terrible cold and no food. The farther we move away from the equator the less UVB there is in the winter light so our D hormone can fluctuate with the seasons. It goes higher in the summer and lower in the winter. Any animal that can devise a way to eat a lot and get strong in summer, and eat less and sleep more in the winter, will survive the seasons. Every animal on this planet; mammals, reptiles, birds, fish and insects use this same chemical, D3 (cholecalciferol), made on their skin from UVB light to do just that.
D hormone affects our weight and appetite. In the summer as we have more sun exposure our D hormone level climbs to 80ng/ ml, our gastrointestinal tract works harder, we eat 10,000 calories and store none. The high D message is it’s summer it’s time to build our strength. We turn all of those 10,000 calories into stronger muscle, bone, skin, eyes, hair, teeth, heart, and lungs. We sleep fewer hours, but more efficiently with a higher percentage of the sleep spent in deeper stages of sleep. In the winter the sun exposure is less, there is very little UVB light. The D we made and stored in summer starts to fall as we use it. The low D message is; sleep longer, store fat until spring. Our metabolic rate goes down (we hibernate) by lowering the thyroid hormone. Remember, there is no food in the winter, so if all we have is one piece of dried meat per day, we would survive by sleeping 14 hours and using less energy. The low winter D message, through the hormones ghrelin and leptin, tells our body that it needs to store half of our calories as fat to save it for spring. A low D level also makes us very hungry for high fat, high calorie foods because that hunger is what allowed us to survive 100’s of years of near starvation during the winter months. Now when our D is low and we go on a diet of 1500 calories, the body, still thinking it’s winter, still puts 750 into fat. Then as we try to exercise, instead of using up our fat stores, we steal proteins from other parts of our body. We get weaker and fatter while we try to lose weight.
Low D goofs up sleep. Most of the neurological problems my patients have are not directly related to D hormone, they are related to the fact that D hormone deficiency causes sleep disorders; insomnia, sleep apnea, REM related apnea, unexplained awakenings to light sleep, inappropriate body movements during sleep. All of these disorders keep us from healing our bodies during sleep. When the sleep improves the headaches, seizures, foot burning, tremor, body pain, walking difficulties, depression, memory loss, etc. all get better. (See the sleep handout for more detail about why.)
What does D hormone deficiency look like? D hormone affects the entire GI tract. There are D receptors in our salivary glands, our teeth, our esophageal sphincter, and the stomach cells that make acid. When the stomach sphincter is weak the acid moves up into the esophagus, where it doesn’t belong, causing acid reflux. The D we make on our skin goes to the liver and is the liquid portion of bile, keeping the bile acids dissolved, preventing gall stones. There are D receptors in the islet cells of the pancreas where we make insulin. Not enough D can cause diabetes and gallstones. It causes poor stomach emptying as well as bloating and constipation or “irritable bowel”. As the acid level becomes lower than it should be the H. Pylori bacteria can grow in the stomach and stomach ulcers may also result.
Poor sleep causes hypertention, heart disease and stroke: Fifteen years ago the sleep disorders experts taught us that every American with high blood pressure has a sleep disorder in the background that is causing the hypertension. Therefore the real killer in America is not the long term effects of hypertension, but the long term effects of abnormal, “non-restorative” sleep. The way that vitamin D allows us to sleep longer in the winter is through D receptors in the lowest part of the brain called the “brainstem”, where we control the timing and paralysis of sleep. Sleep occurs every night to allow us to heal and make repairs. It’s when we make the chemicals that keep our blood pressure normal during the following day. While we sleep our arteries repair and stay smooth so they don’t have the cholesterol build up that closes off the vessels leading to heart attack and stroke.
Poor sleep causes memory problems: Sleep is how we make memories. During sleep is also when we make the serotonin that we use during the day to keep us happy and curious, so low D hormone can cause depression and memory problems.
Low D affects all the blood cells: There are D hormone receptors on the red and white blood cells. When the white blood cells don’t have enough D they get confused, they start attacking our body by mistake. So all of the autoimmune diseases: multiple sclerosis, lupus, rheumatoid arthritis, psoriasis, and ulcerative colitis, are related to low D hormone. Our own white blood cells travel through our bodies at night seeking out and killing cancer cells. The increases in breast, colon and prostate cancer are also believed to be related to low D. Women with breast cancer who are told they “can’t take hormones”, (meaning estrogen), should still take D hormone. The right D level helps the body’s own immune system fight cancer.
D hormone bones and calcium: Even though most of us have been told we need extra calcium, D deficiency is what causes osteoporosis, not calcium deficiency. D causes the GI tract to absorb calcium and keeps the calcium from leaking into the urine, (so low D may also cause kidney stones). Osteoporosis is a vitamin D deficiency state so if you get your vitamin D level to 60–80 you won’t need Fosamax, Evista, Boniva etc. to prevent bone loss.
Low D causes balance difficulties and pain: D deficiency also causes leg pain, burning in the feet, and difficulty with balance. Poor sleep results in body pain on awakening; fibromyalgia, arthritis, chronic low back pain, knee pain, hip pain. Every moving part of the body must get perfectly paralyzed to repair at night. If you don’t get paralyzed correctly your body doesn’t heal and you hurt in the morning.
Low D causes infertility, polycystic ovary syndrome and endometriosis: There are vitamin D receptors in the ovaries, the testicles and the fallopian tubes to help match our reproduction to the amount of food available. As the D level climbs in the fall to 80 ng/ml we make higher estrogen and testosterone levels that make us want to mate. Because our human babies develop over 9 months, the baby that is conceived in September is born in June. This guarantees that at birth the baby is in the sun making D hormone because there is no D in the breast milk. Low D suppresses ovulation so that our babies will be born when mom has food. “Polycystic ovary” describes an ovary with many eggs that are all trying to mature at once. Each month one egg is supposed to fully mature; “ovulate”, and the rest shrink down. Because ovulation is inhibited by the low D message, the ovaries are stuck at the stage of many eggs trying to ovulate, leading to abdominal pain, often accompanied by weight gain and acne (which also result from low D).
Endometriosis results from endometrial tissue going backward up the fallopian tube into the abdomen instead of out the cervix, (the opening in the uterus), during menstruation. Because the fallopian tube is open into the abdomen, the only thing that keeps the endometrial tissue heading out the cervix are wave like movements in the fallopian tube pushing toward the uterus. There are vitamin D receptors in the fallopian tubes that influence the propulsive movements, promoting or preventing fertilization depending on the D level. Also, once the endometrial cells have arrived in the abdomen, where they don’t belong, the white blood cells are supposed to find and kill them. Because the low D also affects the function of the white blood cells the proper elimination of the endometrial tissue doesn’t occur and fixed implants of endometrial tissue appear in the abdomen.
Women bearing babies are the ones who are most affected: The reason why thyroid disease, gallbladder disease, B12 and iron deficiency, obesity and sleep disorders (and therefore severe headaches) often occur in young, healthy women is because they’re the ones having the babies. Each baby sucks up mom’s vitamin D. Unfortunately each prenatal vitamin has only 400 IU of vitamin D, which is not nearly enough to provide for mom and the developing baby. Each baby uses up mom’s D and if she’s not out in the sun enough her D deficit is never corrected between pregnancies. Each resulting child is more D deficient and each baby sleeps worse than the last. Mom also sleeps badly being more D deficient herself with each baby. The chronic sleep disorder over several years can result in postpartum depression and occasionally psychosis; (abnormal thoughts and hallucinations). I believe that once the sleep is very, very abnormal, and the “sleep switches” that keep dreams isolated to sleep really start to fail, dream like experiences may start to leak into waking life.
Some commonly used medications prevent REM sleep. Unfortunately many of the serotonin reuptake inhibitor antidepressants that we use, though they keep the serotonin up during the day to make us happier, also make the serotonin stay up inappropriately at night. The high night serotonin levels apparently suppress REM sleep, paradoxically preventing the very phase of sleep that might give us back normal production of our own serotonin. Long term REM deprivation is probably the most common cause of depression, and the last 30 years has seen a dramatic increase in the incidence of depression, sleep disorders and vitamin D deficiency in all of the developed countries around the world.
Vitamin D and aging: Even under perfect circumstances, with perfect sun exposure, humans don’t live forever. We live about 90–100 years. At age 70–75 the vitamin D production on our skin begins to decrease, even if we still live outdoors. What results are four complaints that used to occur only in the elderly: “my bowels don’t work”, “I’ve got rheumatism” (I wake up stiff and in pain), “I don’t sleep well”, and “my nose runs all the time.” Then when sleep starts to fail we begin to get hypertension, diabetes, heart attack, stroke or cancer and die 5–10 years later. Our sleep and therefore the D level, is linked to our life span as well.
What should my level be? How much vitamin D should I take? What would my body make normally out in the sun? When we sit in the summer sun, at noon, with chest, face, and arms exposed we make 10,000 IU of vitamin D, whole body exposure produces 20,000 IU in 2–4 hours. The rate of production is dependant on the skin color. Darker skinned people make D more slowly for equal time spent in the sun. Because we don’t have fur or feathers covering our skin, the melanin coloration in the skin keeps us from making too much D. Lighter skinned humans survived in far northern and southern latitudes because they did not block the D production with melanin. They were stronger and could reproduce in lower sun environments where D was scarce. Those same bright white or freckled people have a disadvantage when they move to a high sun environment, they don’t have the natural protection and they burn. White skinned humans have had a higher incidence of skin cancer than dark skinned peoples up until recently for this reason. When humans are adapted to their latitude with the “proper” coloration the internal D is high enough for most of the year and a portion of the pro-D made on the skin is converted to the active D 1,25 OH and actually goes into the nucleus of skin cells and helps prevent skin cancer.
As most of us don’t receive “sun D” every day, our supplementary vitamin D requirements are much higher than the FDA recommended 800 IU per day, and are probably closer to 5,000–10,000 IU per day just to stay the same. Now that we’re not using the sun and we’re using pills our level should stay between 60 and 80 ng/ml to sleep perfectly. If you are below 50 ng/ ml you have no stores of D hormone to call on in emergency. The vitamin D25OH that we measure in your blood is your storage D. We make the active chemical; D 1,25 OH every minute of the day, in every organ, in response to what we are doing. If we get sick we use up more D hormone.
Why FDA recommendations are so low: This is a hormone not a vitamin. It makes no sense to put hormones into food, we would never dream of putting estrogen or testosterone or thyroid hormone into the milk. Because it was incorrectly called a vitamin the FDA has been put in the very difficult position of making “recommendations” for hundreds of thousands of people who have different D levels from year to year depending on their lifestyle, where they live and their skin color. The FDA knows that you can kill people with this hormone, but they don’t really know why. (I think it is because this hormone makes the sleep just as abnormal when it goes over 80, as it does when it’s under 50, therefore everything I have described above results from a high vitamin D just as easily as from a low vitamin D.) Because they know it’s dangerous the FDA has appropriately recommended a dose, (400−800 IU/day) that’s unlikely to hurt anyone. This does not mean that 800 IU is what you need, it just means that’s all the FDA will recommend to a person who is taking D hormone without checking blood levels.
Everyone who takes this hormone in bigger doses must understand the importance of following the D blood level. Ask your doctor to measure your vitamin D level. Most doctors do not know what the “normal” D level really is, so ask for the number, it should be between 60–80 ng/ml. Because the vitamin D test is expensive, if you don’t have insurance www.vitamindcouncil.org will do your level for $75.00. All your questions about vitamin D are answered at www.vitamindcouncil.org. It is a site started in 2005 to teach you and me about this hormone. The one thing you won’t see there is the relationship to sleep because that is a new discovery.
What is the right D hormone dose? For most people the daily supplemental D will be 5000 IU per day in summer 10,000 IU per day in winter, but if your level is 30 or below and it’s winter, I recommend that you take 15–20,000 IU for 2–3 weeks to get your level back above 50 rapidly so you have stores of D. Then check your level again in 4–6 weeks to be sure it is above 60. After that you want a daily dose that keeps the level 60–80. Over 1–2 years measure your D levels every 6 to 12 weeks and make sure that you are taking enough to provide a D level between 60–80 ng/ml all year long. Don’t take extra D when you’re using a tanning bed or out in the sun in the summer, you’ve just made your daily dose or 2–3 daily doses on your skin. Never take doses over 5000 without checking your levels regularly.
Practical Aspects: Leg cramps when you’re starting extra D can be caused by low magnesium levels go to www.vitamindcouncil.org and read about magnesium supplementation or eat a handful of sunflower or other seeds per day. Rarely my patients get diarrhea from D hormone, if you do, get D suspended in oil, open the gel cap and rub it on your skin. As hairless animals we were not actually made to take D by mouth, but instead absorb it through our skin. Furry animals and birds lick or preen themselves to get the D from their hair or feathers.
The largest dose of vitamin D3 locally available over the counter is 5,000 IU. Walmart, Sam’s Club, Drug Emporium all have it. We doctors have been, incorrectly, taught that it’s safe to give vitamin D2, (ergocalciferol) as a once a week pill of 50,000 IU. D2 Ergocalciferol is not the same as D3 Cholecalciferol, and may be dangerous for some people, in fact the majority of my patients felt that it made their sleep and headaches worse. Make sure what you buy is D3. This important mistake resulted from using the rat as the experimental model to look for the “vitamin” that prevented the bone disease of rickets in the 1930’s. Rats are nocturnal animals. That means they, in order to spend their lives in the dark, had to have a mutated vitamin D receptor that allowed them to use a different chemical, D2. D2 is similar but not identical to what you and I, and all other animals, make on our skin. It does come in the food, (which is why the “vitamin” word was originally applied to this chemical incorrectly). D2 is a chemical made by fungus that grows on grain. The rat’s ability to use this “fake out” chemical meant the rat was able to live at night and run about our houses eating our food at night. This is why humans don’t like rats and find experimentation on them less objectionable than on other animals. It also means that rats are easier to keep alive indoors. Once D2 was discovered it did, in fact, help the disease of rickets in children, but it is not what our body really wants. The original “anti rickets” chemicals D1 and D2 were found together first on grain, then several years later, D3 was discovered on the skin of pigs, made only by UV light exposure. Because D3 acted similarly to D2 at bone receptors and the scientists were focusing only on the bone promoting actions of D they did not study the actions of D2 at all the other places where D acts. D2 appears to be a “fake out chemical” for most humans, especially in the brain, where it appears to knock off the “real D”, D3 from its receptor making the sleep worse for many patients.
Vitamin B12 deficiency and iron deficiency are common secondary deficiencies (that also affect sleep). They result from D deficiency in about 1/30 of my patients. B12 helps the pacemaker cells, the timers of sleep, do their job, and iron is a cofactor in making dopamine, one of the chemicals that run the timing and paralysis of sleep. When D, B12 and iron deficiency all exist together the sleep becomes especially bad. Those two additional deficiencies usually mean that the D has been low for many years. The reason why these two accompany D deficiency is related to D’s function in the stomach. When the D hormone is low we’re supposed to be in winter, i.e. there is no food. That means the low D makes the stomach acid production go down. (Paradoxically it usually feels like there’s too much acid because it’s also up in the esophagus, where it doesn’t belong, because the sphincter is weak too.) When the acid in the stomach is too low to dissolve meat the B12 goes low. (It’s the only B vitamin that is predominantly in meat.) The iron deficiency results in the same way. So, people who are meat eaters can still become iron and B12 deficient when their D is low. Ask your doctor to check your B12 blood level when you check the D the first time. The B12 level for normal sleep is 500 or greater. Again you want to know the number. If the B12 blood level is <500 it should be given as a daily pill of 1000 mcg/day to help the sleep normalize. Monthly shots are not as effective as daily pills. The B12 supplement and your D should be taken with a multivitamin or a multivitamin with iron if you are iron deficient. When you have the right D level your body starts to make 100’s of repairs in sleep so you need all the real vitamins to give the cells what they need.
SGominak 09/11