Vitamin D Deficiency & Sleep Disorders – Dr. Steven Lin, DDS Oral Airway Expert
Dr. Stasha Gominak
Dr. Steven Lin, a dentist, TEDx speaker and author of The Dental Diet interviews Dr. Gominak about the connection between vitamin D, sleep, and health.
Dr. Steven Lin: Hello and thank you for joining me today. My guest today is going to speak about two topics that are very very important for everyone around the world: the importance of sleep and the importance of vitamin D Deficiency. Often, you’ll hear about these two topics but you don’t hear about how they interrelate together; how important your sleep and vitamin D is. Dr. Stasha Gominak, thank you so much for joining me today.
Dr. Stasha Gominak: Thanks so much for inviting me, Steve. It’s my pleasure.
Steve: I’ve been following your work for quite a while now and I feel there’s nobody talking about these issues in the depth and understanding that you do. Can you tell us how you, as a Neurologist, began to start thinking about or how did you begin to really start to question how people are getting sleep disorders and what we can really do to fix them?
Stasha: It was all accidental. Back in 2004-2005, one of my daily headache sufferers insisted on having a sleep study. She was young and healthy, with no fat neck, in other words, she did not look like what we’ve been told to look for in someone who had sleep apnea. She said her husband told her she “snored like a train”. I said I didn’t think it was relevant, but she didn’t care, she wanted a sleep study. We sent her for a sleep study. She put on a CPAP device and her headaches went away. She’d had a daily headache for many years and none of the medicines I used had helped her.
I had many other patients who looked just like that: young, healthy females who had a couple of kids, but nothing else was wrong with them. I was seeing them for daily headaches. What if they had a sleep disorder in the background that no one had looked for? At the time there were no articles about sleep issues and daily headaches, so I just started sending a bunch of these women for sleep studies. They did not usually have apnea. That first patient had apnea but most of them just didn’t have the normal amount of Rapid Eye Movement REM sleep. They had sleep but not the right phases of sleep.
They had other complaints: they couldn’t remember anything, they were in a bad mood, and they were tired all the time. You know if you’re a clinician and some woman with two kids and a newborn says she’s tired all the time, can’t remember anything, and can’t sleep, you just look at her funny and answer, “What do you expect, you’ve got two little kids at home?”
It’s true that it’s hard to have an infant and a two-year-old, but 40 or 50 years ago, it was not uncommon for women to have four or five babies and survive. So there’s something else going on in the background. It took several years for me to figure things out. Part of it was looking at these sleep studies, thousands of them, where the only problem was that they had reduced amounts of deep sleep. Little kids, teenagers, and young, healthy people. No one was writing about it, no one had the least bit of an explanation, and there was no treatment. I couldn’t treat them with a CPAP device because they didn’t stop breathing!
At the time, the explanations offered for why people with sleep apnea were developing diseases of various kinds was because they stopped breathing and that produced a drop in oxygen to the brain. But my patients didn’t have any drops in oxygen, and they didn’t stop breathing, but their study still wasn’t normal because they didn’t have the proper phases of sleep. We apparently need phases of “deep sleep” where we’re paralyzed. Even if we don’t know exactly what the brain is doing in deep sleep, it was a very clear clinical observation that if they didn’t have enough deep sleep, they didn’t feel good and were more at risk for other diseases.
At that point, I was using CPAP devices and sleeping pills. Both of these were very frustrating, they’re just not the whole answer. Neither continued to work over time. Then there was an accidental discovery in 2009. One of my 18-year-old patients with daily headaches had a sleep study that showed 10 hours of sleep. (She thought she “slept fine.”) But she had 10 hours of light sleep, she never once got into deep sleep. She didn’t stop breathing, there were no drops in oxygen but her brain was completely unable to get into deep sleep. It looked like her brain would try to get into deep sleep but something was blocking it. She did not wake up but she also did not have normal sleep. As far as she was concerned, she laid down, slept, woke up, and felt terrible. Something was preventing the normal deeper phases of sleep from happening. She turned out to have a B12 deficiency, which was the first time It ever really occurred to me that sleep issues might be caused by a deficiency state. The brain might be low in something it needed.
I had been reading articles about single cells that run our sleep clock; called “pacemaker cells.” They fire at a certain rate, they “keep time.” They study these pacemaker cells by dropping different neurotransmitters on them to see how the firing rate changes, in response. They fire a little faster in response to one neurotransmitter and slower in response to another neurotransmitter. How is that relevant to what’s happening to my patients? Could there be a neurotransmitter deficiency that won’t let my patient drop into deep sleep normally?
These cells in the brain sleep switches also make us paralyzed in deep sleep. We don’t know why we get paralyzed, we just know we do. But the fact that many of my young healthy patients also had knee pain, back pain, and ankle pain, for no apparent reason, suggested to me that perhaps we paralyze the moving parts in order to repair them, and if we can’t get to that phase we don’t have normal repair.
Knowing we get paralyzed while we’re in deep sleep is kind of frightening. That opens all sorts of weird questions like: Wouldn’t I drown in my own spit if I were paralyzed? It seems I must be able to get “perfectly paralyzed” so I can still swallow and keep breathing. I can get paralyzed and come out of being paralyzed, meaning I can stop being paralyzed and roll over in between. Apparently, I should be able to get paralyzed enough to repair my mouth and my tongue, all the moving parts of my throat, but still keep breathing normally.
But what if I were to get a little too paralyzed? Could that lead to sleep apnea? As I’m reading these articles about single cells that are the ones that paralyze us, I’m now thinking of it in a totally different way.
So when my patient with no deep sleep on her sleep study turned out to have a B12 deficiency I was thinking about her malfunctioning in a different way. What if her sleep cells were deficient in something they needed? What if we could give back what they needed and the cells would start to be normal again?
I’d already had the idea that apnea (stopping breathing) might be “too paralyzed,” and kicking our legs during sleep (periodic limb movements of sleep) (PLMS) could be “not paralyzed enough.”
So, instead of saying apnea is one thing and PLMS is something else they’re both about the malfunction of a cell that’s supposed to fire at a certain “perfect rate.” In this way, the literature I was reading about sleep cells made the lack of an essential chemical seem sensible in a way it wouldn’t have been otherwise.
Steve: Stasha, that’s so fascinating. I think you’re tapping into a problem many people experience. They’re not sleeping very well and they’re not getting very good answers. Then the clinical presentations that dentists are seeing in their patients – the oral presentations of bad sleep – we see the teeth grinders and the people that clearly aren’t resting well at night but aren’t necessarily reporting sleep apnea on their polysomnograms (PSGs) (sleep studies). I wanted to get a feel for how this was, is presenting in your practice. What percentage of your patients were coming in for these kinds of conditions versus other kinds of conditions? When did you start to hone in on this question?
Stasha: In the beginning, I was just doing sleep studies on headache patients; daily headache sufferers are in a living hell where no one can help them. They go from neurologist to neurologist. They’ll let you do anything. They’ll do sleep studies, anything you ask. But soon I began to think, “Wait a minute, I never even thought to ask a daily headache sufferer if they’re tired.” We were never taught to think of sleep as a therapeutic option because there wasn’t anything to do for insomnia and they were too young to have apnea, according to the belief system of that time. So I wouldn’t ask about it. In fact, we were encouraged not to ask about sleep because the next step would be giving sleeping pills.
Though I started doing sleep studies first in my headache patients, I knew that there were genetic mutations that would predispose them to headache, vertigo, and epilepsy all in the same family or the same person. The patient would begin with headaches but then progress to vertigo and then epilepsy. Why would they progress? Could it be that there was a sleep component in the background? As the person became more sleep deprived, their ability to shore up that genetic weakness got worse and worse. Could that mean that my vertigo patients had a sleep disorder? Could that mean my epilepsy patients had a sleep disorder? Why have I never thought to ask about sleep in an 18-year-old with epilepsy? Did I say, “Hey, are you sleepy in the morning?” No, because I know my drugs are doping her up, so it didn’t even occur to me to ask.
Soon I realized almost everyone in my practice had sleep issues that I never asked about.
Over time, it became clear to me that it’s easier to tell you the things that don’t link to a sleep disorder. Being stung by a scorpion is not about having a sleep disorder. Being shot accidentally in the US by someone with a gun; (well, maybe it has to do with that person who has the gun being unstable because they have a sleep disorder). But, eventually, I began to think that every single person who comes in to see a neurologist is malfunctioning in some way that they should not.
If you step back for a moment, there are lots of people out there who never see a doctor because there’s nothing wrong with them. Shouldn’t we be concentrating on them because they’re our model of what a perfect life would be? What if they’ve never had anything wrong with them because they heal normally in sleep? What if that means all medical problems relate to not repairing the body normally in sleep? It certainly looks like if you take the sleep away from every child, teenager, and mom, they will come to the doctor with something that needs treatment. Seeing medical practice through that lens becomes kind of a burden because you become a crazy sleep fanatic and none of your colleagues really understand what the hell you’re talking about.
I’m doing sleep studies on young, healthy people during the week, and on the weekend, I’m on call and I’m doing sleep studies on stroke patients. They all have sleep disorders!
Looking through this lens I would walk into the hospital and realize that the people there were suffering the end-stage of something we’d missed. Lack of repair in sleep produces many different diseases (failures of the body’s organs) and we’ve named these diseases and developed the drugs for them, but we really didn’t do our job. We missed the fact that the body really heals itself, and it does so while we sleep.
Steve: That’s a really interesting point because you’re obviously describing symptoms that many people feel. Can you give us a neurologist’s view of the types of presentations you feel people are presenting with? The types of headaches: migraines, cluster headaches, or TMJ issues? What are the end-stage diagnoses they’re eventually getting? Just so people can get their heads around what the standard dialogue is?
Stasha: First, let me state that all the diseases I’m going to talk about are all common now. We think it’s normal because everybody around us takes medicines for things that are bothering them. But if you lived before and after this sleep disorder epidemic began – if you grew up in the 40s, 50s, or 60s the incidence of depression, suicide, sleep disorders, etc. was much lower. I’m basically going to answer you that every disease around you, everything that everybody’s complaining of, is related to not healing in sleep. It sounds too simplistic, but you have to look at it in a different way. There are populations, hunter-gatherer populations, still living outside who don’t have these problems until they’re old..
All of the diseases related to lack of repair in sleep are old diseases. They are not brand new on the planet. Covid is part of this bigger picture but, unlike AIDS which we’d never seen before, they are all old diseases. Heart disease, stroke, atrial fibrillation, dementia, staggering disorders, diabetes, neuropathy, kidney failure. They were diseases that showed up in old people. They’ve all been described in the medical textbooks of the 1700- 1800s. What hasn’t been attended to is the fact that they’ve crept up into earlier and earlier age groups so that they’re happening in 8, 10, and 12-year-olds now instead of 88-year-olds.
People who sleep normally don’t know what the heck we’re babbling about, “just go to bed, why are you talking about this?” Once you say that, you realize that sleep is really an involuntary state. It is not something we’re actively “doing”, normal people just go to sleep. Frankly, I was starting to have a sleep disorder myself at the time I’m describing because I was perimenopausal, and waking up multiple times a night. It is my belief that one must have a sleep malfunction oneself to be listening to and interested in sleep problems.
Then you can go to your question about what the other diseases look like. Basically, on the top of the list, are all the problems with the immune system not reacting normally and all the autoimmune diseases. Those are so common now that we think they’re normal, but our immune system was designed to NEVER attack us. Then the next category is mood disorders, anxiety, depression, and anger. Next are heart disease, diabetes, and other chronic illnesses. For most of these chronic illnesses, we tend to blame the patient. He did it wrong and didn’t follow the doctor’s recommendations. We used to like to try to vilify people who were smokers. Now they’ve stopped smoking so we can’t blame that, so we tell them their “lifestyle isn’t right”.
It takes looking at sleep as a primary part of healing; that we are self-assembling, living beings. We show up on this planet and we are self-sustaining. Before doctors arrived some people did still live to be 85 years old. Before the 1900’s most humans died of infectious disease, trauma, or starvation, and all three of those have, in fact, stopped being the most common killers now.
Steve: Can you go through the different ways a sleep disorder is categorized? Sleep apnea is specifically found on a polysomnogram. What other categories of sleep disorders can people have?
Stasha: To be truthful, I spend less time talking about this because I find it personally less valuable to me. But you can categorize sleep disorders into two big categories: apnea, stopping breathing or, you don’t stop breathing but don’t get into the right phases of sleep.
We tend to make up names when we don’t know. If you’re too sleepy during the day and you don’t meet certain criteria to make the diagnosis of Narcolepsy, then you’ll get a diagnosis of Idiopathic Hypersomnia (you’re too sleepy and we don’t know why).
You can also divide sleep disorders into two big categories by ‘’clock’’ functions and ‘’paralysis” functions. “I can’t fall asleep,” “I sleep but I feel tired,” or “I fall asleep inappropriately during the day.” refer to the timing of sleep and being able to enter sleep and feel rested.
Paralysis functions are “I move around more than normal during sleep,” and I have Periodic Leg Movements in sleep. We can go into that deeply if you want, but I’m not sure that’s very relevant.
I really think the most valuable thing to know is you can have an overnight sleep study that says you do not have significant apnea, but it may still not be normal. When we don’t know why you don’t have enough REM sleep we tend not to report it to you because we’re embarrassed that we don’t have an answer for why it’s happening to you.
Steve: What about people that can’t sleep? Insomnia is kind of just its own category. How does that work?
Stasha: What happened after the patient I described with the B12 deficiency was that I discovered that all of the people I was doing sleep studies on were vitamin D deficient. There were scientific articles showing vitamin D receptors in the sleep switches we talked about earlier.
Why would there be Vitamin D receptors in sleep switches if D is supposed to be about bone? D is not just about bone, the name ‘’vitamin’’ and the insistence on bone are both mistakes that Medicine has made and has continued to talk about despite science that should teach us another way to look at D.
D links us to the seasons of our planet so we can gain weight and sleep longer in the winter (hibernate) and survive when there’s no food.
You observe a vitamin D – sleep connection and you start to think about how we started to make sunscreen, air conditioning, and computers in the early 80s, and over the last 40 years, we have all moved indoors. When I was in medical school in the 70’s there were no courses on chronic fatigue, irritable bowel syndrome, sleep apnea, or sleep disorders. There were no courses in those diseases because they all started to increase in frequency starting in the 1980s, and are now epidemic.
Insomnia has become epidemic in the same time frame. And it’s caused by several linked deficiency states.
If you look at it in a slightly different way, and ask, “What is sleep really?” It’s a change in state. You’re either awake or asleep. It is completely involuntary. We have a time clock. Every one of the cells in our body knows exactly what time it is. We sleep at specific times when that clock is working normally, based on our species. We are day hunters. We can’t see at night. Owls hunt at night so they sleep during the day. We sleep at night. That means there was always an inherent well-worked-out system that was working perfectly in the dinosaurs. It put us to sleep at a certain time and we never once thought about it as long as it was working perfectly. That means Insomnia is a malfunction of that same system.
Steve: That makes so much sense. I want to dive into these details a lot more in the second half because obviously, we’re stepping into the area where we’re getting a much better understanding of how these issues can pop up. There’s just a question popping up here that I thought is a little bit relevant to what we’re talking about here. Danique is describing that she falls asleep in seconds but cannot stay asleep. Can you describe what you think may be happening?
Stasha: That was the picture of almost all of these young, healthy females who’d had a couple of kids. Their typical complaint was, “I’m so tired. I fall asleep easily but come three o’clock, I wake up. After that, forget it. In the beginning, maybe I woke up once. I was able to go back to sleep in half an hour. Now, between three and six, I just get up because I can’t go back to sleep.” This is a specific deficiency of acetylcholine, which is used more in the second half of sleep that usually starts at about 3:00 a.m.
There are a specific set of chemicals that run this entire process. You can think of them as being analogous to a symphony with several players playing different instruments. Just as you would symphonic music, you start with a preamble. There are cells that are secreting neurotransmitters (chemicals) in certain ratios for drowsiness, which is a specific state, a warning that you’re about to become unconscious. Next, we move to sleep, we flip the switch and fall asleep. We do that with chemicals too.
Theoretically, you should never, ever be able to be asleep and awake at the same time. We were designed so that those two states could never coexist. But there are people who, as soon as you talk about it that way, know they can be in both states at once, their sleep switches are malfunctioning, they’re awake but paralyzed, they’re dreaming but still sort of awake.
There is a specific set of chemicals that leads to the first phases of sleep; light sleep and then you do the first phase of deep sleep; slow wave sleep, that’s the deep sleep of the first half of the night. Then you go back into light sleep, roll over, and listen to be sure you’re safe,(you don’t wake up to consciousness, you’re just in lighter sleep, slightly more aware of your surroundings, and not paralyzed) then back you go into deep sleep again.
There’s a different chemical mix that does the second half of the night and makes the second type of deep sleep: REM sleep.
Most of the women who I was studying with sleep studies were deficient in a specific neurotransmitter, acetylcholine, for reasons we’ll talk about later. Their first deficiency was D but their other deficiencies came from losing the normal microbiome, the bacteria in their intestines.
Steve: That makes total sense. We’re beginning to see this is a very common problem in the community. We’re seeing it present in lots of different ways. It’s very complicated and you were in your clinic, trying to work this out. You said that you began to see some literature connecting Vitamin D to some of the switches that get us into the stages of sleep. What were some of those areas that began to turn your attention to Vitamin D? I had a very similar awakening into Vitamin D that pushed me into this whole area too. What were those first steps?
Stasha: What happened was the gal with the B12 deficiency went back to her internist to get B12 shots and it helped her sleep (but only for two nights, so it needs to be given daily not as a monthly injection).Then another patient mentioned that her D was low and I started measuring the D level too. From 8/2009-12/2009 I measured both in everyone with abnormal sleep. The B12 was low in about ¼ but they all had D Deficiency.
It turns out that B12 deficiency is linked to D deficiency, you never get B12 deficiency unless you’ve been D deficient for a long time. (That’s not in the literature yet as far as I know. But that’s what happens.)
Just before Christmas, in 2009, two patients with sleep apnea and headaches came in and said “You told me that CPAP would make my headaches go away, it didn’t, but last visit, when you told me to start taking the vitamin D my sleep got better and my headaches went away”.
I had been filling out all these lab slips telling the patients that their D was low and they were to take 1,000 IUs of Vitamin D. I’m doing it every day and thinking it’s weird that everyone has a low D in the fall. But I didn’t really think about it until they told me their sleep got better and headaches went away when they started to take D. Every single one of the patients I’d tested had low D.
Could there be a connection?
I went to the NIH search engine, pubmed.org and put in “Vitamin D and sleep”. Nothing comes up. But the next entry is “Vitamin D and Brain”. What I get into is the work of Walter Stumpf, who’s a scientist who had been working in Vitamin D and trying to teach us about Vitamin D since the late 70s and early 80s.
D is a hormone that’s made by the sun and bosses all the other hormones. It moves our entire system in relation to whether or not there is food. When there’s no food, would you like to have a baby, or wait until the baby’s going to have food to eat? What about breast milk? Is that linked? Is my fertility, metabolism, and sleep (i.e. hibernation) linked to what the planet is doing? Of course! We wouldn’t be on this planet. We’d just be living at the equator where the length of the day never changes, where there is no winter or summer.
There was an article written by Walter back in the 80s about the sleep switches that I’m now very familiar with. He actually studied the nucleus reticularis pontis oralis caudalis, the group of cells that paralyze us in sleep, there were vitamin D receptors all over it. So I actually called him up; “Hey, you don’t know me but I just had this really interesting clinical observation that suggests that D is running sleep. You’ve written so many articles about D, you’ve written hundreds of articles about postpartum depression, fertility, diabetes, and about hundreds of things that have to do with D.“What about sleep? Has anybody written about D and sleep? He said, “No, but that makes perfect sense. That’s how we hibernate.”
Walter and I published an article in 2012 using his scientific observations in the laboratory and my clinical observations. We know everybody’s D Deficient, the next question is, “Is there an ideal D blood level – not a D dose – but a blood level that will return their sleep back to normal? It was not that hard to determine a better D level . All I asked my patients was, “Hey, what’s your D level and how’s your sleep?” As the D level moved up their sleep got better. When the level got to 60-80 range they consistently slept better. Below 60, not as good, 80 and above, also didn’t sleep as well.
The biggest problem with D is nobody asks their patients how they feel. We don’t say, “If you feel better, maybe we should connect that to what your D level is.” We practice medicine that way for other hormones like thyroid. If you’re feeling bad they check your thyroid hormone level then change your thyroid dose. The doctor asks you all sorts of things about how you feel. We just haven’t made that connection for D. D affects mood dramatically, most people can tell if they feel better or sleep better related to their D level. But in order to make that connection they have to be doing D levels every month or two for about a year, and be paying attention to their body.
Steve: That makes total sense. For those of us that aren’t as familiar with the brain as you are, can you help us understand what the brainstem is doing? It’s this ancient tool we have, that the dinosaurs also had, to put us to sleep when the planet is dark? What is it actually doing as we go to sleep with all these fancy nuclei and receptors?
Stasha: That’s a really good question! I’ll try my best. We’ll use machines as an analogy, we can’t make living things, but we can make machines. All the machines we make have maintenance and repair needs. They have the raw materials they need in order to continue to function. Our body does too. Every single living thing on this planet, whether it’s a plant or an animal, has times when it’s actively making repairs, because all of us must make repairs. Our system of repair is sleep. During a 24 hour period we spend one-third in sleep and two-thirds awake. During that one-third of sleep, we have to repair everything in our bodies or it won’t continue to work properly.
We take for granted that we wake up in the morning, we get out of bed, and everything works. But the only reason it does is we actually resupplied all the little energy depots and all the chemicals we need to make every organ of our body work. If you think about it a little bit differently and concentrate on children growing, they only grow while they’re sleeping, while they’re paralyzed. Some of this is pieced together from little bits we’ve discovered and then analogy or deductive reasoning is the rest.
Children only grow in slow-wave sleep, growth hormone is only secreted in that phase. That hormone then calls out other very specific hormones. So while your kid’s arm is growing there’s a bone growth hormone, a tendon growth hormone, lymphatic, artery, and vein growth hormone. Every single one of those different tissues is very specific. There’s a crew sitting there growing, putting new cells on, and making that arm grow.
Who’s making sure that the other arm is the same length? The brain is watching, supervising both sides growing. Every single moment we open a message that allows a cell to grow, we take a big risk. You open up the genetic material and you let that cell say, “I can make 25 of myself. I can make 500 of myself. I can open up and reproduce myself and make little blood vessel cells that take over the whole body.” Every single time I let a cell open itself to making two, I have to have a supervisor tightly supervising. We are doing very specific things to remodel, grow, or repair, and that must be heavily supervised. The brain is probably anatomically organized so that every single piece of your body has a supervisor. Your thumbnail has a supervisor in a specific place that’s always responsible for the repair of that thumbnail during the night.
Even though adults stop growing, growth hormone is still only secreted in slow-wave sleep. We’re not growing, but growth hormone is still secreted only in that phase of sleep.. In adults it’s secreted in a pulsatile way at a certain rate, not a continuous release. That means we’re really changing from growth to repair. We are using the same signal but sending a signal that used to say “grow”, but now it’s a signal that says “repair”. The receptors have to be able to tell the difference between a continuous release and an episodic release. That’s mind-boggling!
If we step back for a moment, there are all these other ideas that should occur to us. If my child has a sleep disorder and he wakes up three times an hour during slow-wave sleep, does that mean he can’t grow? Yes! That’s exactly what it means. His brain has to develop, grow, learn things, put down new cells, and make new connections every night. If he is not sleeping normally -and is drowsy in the morning and doesn’t want to get out of bed – the brain is saying, “I didn’t get enough time in deep sleep. I’m not ready to get up because I had all these important things to do last night that didn’t get done”
If your child has less deep sleep than he needs, the growth and development of his brain and his ability to hit his developmental milestones is affected. This is tightly bound to increasing Autism and ADHD; all the things that we’re seeing over the last 40 years that have become epidemic.
If you take that information and then move it to an adult; “This 25-year-old was completely normal but now we’ve taken away his repair phase, and this year he became diabetic.” When you shorten his sleep, he starts to manifest his genetic weaknesses. There’ll be other people in his family that have that same disease, but they don’t manifest the disease until they can’t repair in sleep. In the past, they would have developed the sleep disorder only toward the end of their life and would have presented with diabetes at 75 instead of 25.
Steve: The early discussion ties into that really well because you’re saying this is becoming more and more common. Then you’re showing all these different mechanisms that are dependent. As we grow and develop, during these stages of sleep, we’re hitting the right areas so we do these correct things. In your journey and understanding of this, how did you see vitamin D deficiency being the switch to how this all happens? Can you describe it in terms of what’s happening in the brain?
Stasha: Describing what’s happening in the brain is a little bit tough, but I can tell you what happened to my patients. Every day, in my office I’m listening to people who can’t sleep and who feel awful all the time. How can I help them? All I’m hearing from the experts is: ‘You don’t do it right”.” You don’t eat right”. “You don’t exercise.” “There are toxins in your environment.” “The food is less nutritious”. What help can I give to this person, not the population, but this person who’s there in the room with me? I can’t tell them what to do about the toxins or their food supply. I’d like something that they have power over that could improve their sleep and I accidently get into B12, then D. What if there’s a deficiency in the background that we missed? That might give me something that we can use.
I start to think, wow, the result of toxic exposure is an inability for the cell to repair and do its correct biological mechanisms, but the result of a deficiency state is the same. And if it’s a deficiency we can trace it back to when the dermatologist started telling us that it’s bad to be in the sun. Since I lived before and after that, I didn’t use sunscreen until the 1980s because it wasn’t available.. It’s only in the last 20 years that pediatricians tell you not to put your child out in the sun. Even in countries at the equator, getting an education and moving up the socio-economic ladder means you go to college, and then you’re no longer a banana farmer, you are now an executive, and you also don’t have any Vitamin D because better jobs are inevitably indoors.
Sleep is a cellular function of sleep switches. They’re just like the little electrical circuit breakers in our houses. “What if, when they’re missing D, their switches can’t flip correctly?” There are hundreds of switches and they’re supposed to flip in certain ways at specific times, but they’re all missing this chemical that they require to function properly. At first, I really did think it was going to be the magic answer and I started giving Vitamin D and everybody got somewhat better. Not miraculously better, but we definitely could tell the difference when their D got over 60.
Unfortunately, by the end of two years, everybody was falling apart again. D does a bunch of important things but one of the most important things it does is feed the microbiome. D is really important but it’s not the only thing that has become deficient. When the D goes low for years you lose the happy, healthy bugs in the microbiome because they require D to thrive inside us. When you lose your microbiome you’ve lost an important organ of your body. It’s like you’re walking around without a liver. You look like a normal human – but you’re not. You’re missing an organ of your body, the microbiome. It does hundreds of things for us and we get really sick without it.
Unfortunately, it’s very recently that we’ve learned about the microbiome, but to my advantage, all the GI literature is saying these bugs actually talk to the brain; the bugs talk to all sorts of parts of the body. The bugs are in a two-way dialogue with our biology. The bugs make chemicals that you must have in order to sleep normally.
Steve: I can see maybe as some papers were starting to be published on this, in the last few years, that you were doing some big jumps in the air with fist pumps because you’d been thinking about these things for so long. Then the connections with Vitamin D. It feels like the story that you’ve been trying to follow has just come out. It’s only really been only really described well in the last few years. Would you agree? This connection is between the gut and the microbiome.
Stasha: Since the 80s, Walter Stumpf was proposing that D was playing a large role in the GI tract. He didn’t say anything about the microbiome because that idea hadn’t even occurred to anyone, but he knew it was all about metabolism and the GI tract because we need to gain weight in the winter and lose it in the summer. We had no articles that said D was a trophic factor or a growth supporting factor to the microbiome until 2020. It came out last year and I thought it was wonderful! They actually did a prospective trial in humans: supplemented D, measured the species that changed in the GI tract, and proved that the D is one of the factors that determines which species occur there, and that it promotes the growth of the healthy, happy bacteria that help us.
But in my patients it became obvious that D was only part of the picture, and it did not bring back the microbiome. Despite the D that we took, the irritable bowel syndrome symptoms didn’t get better. That meant that the D alone did not bring the bacteria back. It’s important that we get them back because they make the eight B Vitamins that help us sleep. I think D deficiency alone does not make us sick, D deficiency produces a changed microbiome that then results in many deficiencies that eventually produce illness and sleep disorders.
Steve: Just to clarify for those who are listening, we’re talking about the gut microbiome and the trillions of bacteria that live in the mouth and the digestive system, and the profound connection they have to the immune system and the brain. They release all these different neurotransmitters and all these things that are running through your body. They basically run our bodies through connection to the environment. It’s fascinating.
But they also they’re also involved with other vitamins and nutrients, aren’t they? Did you find that this connection to the gut microbiome meant that Vitamin D needed support through other nutrients? What was that connection?
Stasha: Yes. That’s a really important question. There are two major bacteria-linked issues we’re talking about today but there’ll be hundreds of others we don’t know about yet. Let me just parenthetically say that the study that came out in 2020, showing that D supplementation changed the microbiome, was inspired by scientists studying how D plays a role at the level of the individual intestinal bacteria talking to our immune system. What are the interactions there? What are the chemicals the bacteria use to talk to our body? There’s a complex biochemistry behind how our immune system talks to the bugs and how they fit into the function of our body.
I arrived at a difficult point with my patients. At the end of taking D for two years everybody started to fall apart. It was clear that the D had helped. The D level was still optimal but everything began failing again. Then somebody walked in with a book about a B vitamin, pantothenic acid, B5.. Because I was trained away from vitamins I was only willing to go there as a last resort. I’m like every other physician, trained that vitamins are not important, (which is bizarre as they are the center of all of our biochemistry).
The book the patient brought in was about pantothenic acid – B5 – and it is one of the most overlooked vitamins because somewhere in the past, somebody said there was “no pantothenic acid deficiency because it’s in every food”. Since then, no one’s paid any attention to B5 but that statement turns out to be completely wrong. Along the way (and I have other videos that tell the stepwise story of that journey), it became clear that the reason we have eight chemicals called B, ( why is there a vitamin called A and then eight called B?) is because they’re all made by the intestinal bacteria.Those 8 things were found together and discovered first to be bacterial growth factors. They are very intertwined in their production and their function in our bodies.
These 8 chemicals, the B vitamins all came from a bacterial-yeast culture that was sitting on the kitchen counter fermenting before it was going to be used to make bread or beer. Yeast sitting in warm water letting bacteria grow and secrete things into the water. The original microbiologists studying bacteria were using this mixture to grow bacteria so they could study them under the microscope in the 1920’s. Those eight chemicals, made by bacteria were all originally reported to be bacterial growth factors. They’re some of the most basic elements used to make our biochemical pathways work too.
The next piece was to realize that the Bs don’t really come from the food. They come from the bacteria. If you lost your bacteria because your D was too low to support them, you just lost the supply of 8 B vitamins as well.
Everybody who comes into my office has a sleep disorder, yes. But what’s behind that is they’ve all lost two things: their D is low and they’ve lost the GI tract bugs. The B Vitamins are a major part of what they’ve lost but there are other things that have become deficient as well. There is an important article from 2020 by a gal named Francesca Guida in Italy. She lowered the D supply to mice and showed that the microbiome of the mouse suffers and certain species die. Those species are the ones making the raw materials that become the endocannabinoids.
The endocannabinoid system is a set of chemicals that overlap hormones and neurotransmitters. They are an integral part of a normal nervous system. That means when you don’t have the normal bugs, you don’t have a normal nervous system. The endocannabinoid system was delayed in scientific discovery because we vilified marijuana and didn’t realize that similar chemicals were a normal part of our nervous system. Those are two pivotal parts of how our brain is linked to the chemicals that the bugs make. But that’ll just be two of hundreds that we don’t even know about yet.
Steve: We started to talk about B5. How did you find that connection because B5 really isn’t talked about?
Stasha: No one talks about it.
Steve: The way I started to think about B5 is they’ve got a cream with B5 in it that they put on newborns and it’s like it’s like magic. It’s like they’ve got a really bad, red rash and you put the B5 on and it’s like magic. You look at the literature and it talks about how it’s this barrier function; very similar to Vitamin A, and it converts to Coenzyme A.
Stasha: B5 is needed to make Coenzyme A, which makes cortisol in the adrenal gland. That was the explanation for pain improvement in patients with rheumatoid arthritis in the book the patient originally brought me about B5. In the nervous system Coenzyme A makes something different, acetylcholine. But there is yet another system called the “acetylcholine anti-inflammatory pathway” that requires only B5 itself, and that is how the kid got the rash in the first place. Low B5 increases skin inflammation. The baby’s B5 is low because mom doesn’t have the normal microbiome that would be supplying her baby B5 in her breast milk.
So, I would never have gotten to the B vitamins without my patient who brought me a book about giving pantothenic acid. The book was written in the 90s by a layperson who had rheumatoid arthritis and was giving pantothenic acid in large doses to other people with pain and rheumatoid arthritis. My patient brought it to me because the author says not only does their pain improve but their sleep improves. She made a clinical connection between sleep and this chemical. And the book had references about studies that were done in the 1950s that were very peculiar. They were done on convicts; weird things that nobody would do again. They showed that if you blocked pantothenic acid, you’d get four things in only two weeks: insomnia, burning in the hands and feet, a funny puppet-like gait, and their bellies bothered them.
That literature then emboldened me to say, “I’ve just had two women come in with burning in their hands and feet and I don’t have a good explanation.” I’m a neurologist and my sub-specialty is neuropathy. Burning in the hands and feet is extremely uncommon and if these two people, who have nothing in common except that they’re seeing me, present within a month of each other with the same symptoms, that suggests that what I’m doing with this Vitamin D is actually pushing their bodies toward becoming B deficient (without a change in diet). So I was willing to open my mind to the possibility that my patients had a second deficiency that we needed to treat.
So the introduction to this book about B5 was really important. We weren’t sleeping again and many of us had new pain that didn’t have an explanation. So I decided to try the B5, the 400 mg that was recommended in the book, to see if my patients’ sleep would improve again. What I found out was that someone who’s been on D for two years or ten years has a very different response to pantothenic acid than a person who’s not taken D.
Remember that my explanation for why the patients in the book had rheumatoid arthritis in the first place was that they were D and microbiome deficient. The author had great success with giving 400 mg of B5, but when I gave my patients (who had been on D for two years) 400 mg of B5 it made them agitated and they couldn’t sleep. The same dose caused insomnia instead of better sleep. So there was a very surprising dose effect. It seemed like D and B5 were synergistic in some way. When I figured out the reason it turned out to be linked to the production of acetylcholine. D makes choline acetyltransferase in the sleep switches, the final enzyme that makes acetylcholine. That enzyme uses two raw materials; choline and Coenzyme A, and B5 is required to make Coenzyme A. So my patients, on D for two years, already had a great supply of choline acetyltransferase and they needed far less B5 to make a lot of acetylcholine. Not enough acetylcholine causes sleep issues, but too much acetylcholine causes the same sleep issues.
Steve: People often don’t talk about this but acetylcholine doesn’t often get described with its role in –
Stasha: Nobody talks about acetylcholine because there are no drugs. Nicotine is the only drug that mimics acetylcholine. Nobody wants to talk about nicotine. It’s “bad”. The book the gal brought me, about treating patients with rheumatoid arthritis, said coenzyme A made cortisol in the adrenal gland. Well, cortisol is all about managing the immune system and not being hyper-responsive to immune challenges. So it makes perfect sense that it’s related to improving rheumatoid arthritis, but cortisol does not cause insomnia in a dose-related, immediate way.
The B5 was acting more like amphetamine, the drugs we give for ADD. So I searched “What does Coenzyme A do in the brain?”. Well, it makes acetylcholine.
To most people “acetylcholine” has no significance at all. And it shouldn’t for a layperson. But for me, I’m a neurologist and I didn’t know what acetylcholine did in the brain. That’s really weird, why don’t I know? I know it’s at the neuromuscular junction, that it makes our muscles move.Then I realized that in m y practice as a neurologist I’d actually learned what the neurotransmitters do by using drugs that mimic them. There are no drugs that mimic acetylcholine, except nicotine.
When you go into the scientific literature to see what the brain scientists are writing about acetylcholine you get into ADHD. ADHD is really an acetylcholine deficiency state in the frontal lobes.When you get to the end of the article, where the scientist is saying we should really be giving these kids with ADHD nicotine not amphetamine. What, they’re going to go smoke a cigarette at recess? No way! But that’s what’s happening on the basic science side, everybody’s writing about acetylcholine-deficiency related diseases..
Once you see a path that could lead to acetylcholine deficiency you look at disease in a totally different way. Over the last 40 years, by losing the microbiome and losing the D, we’ve developed an acetylcholine deficiency epidemic. How would that manifest? Where is it used? It turns out that rash on the newborn? That’s about the Acetylcholine Anti-inflammatory Pathway now described only in the last 10 years. Direct connection: brain – vagus nerve – spleen. In response to vagal stimulation the splee releases T-cells. The T-cells release choline acetyltransferase. That enzyme goes throughout all the tissues, looks for B5 and choline, and then makes this anti-inflammatory chemical that makes your kid not have a rash.
Steve: It makes total sense when you just go through and follow as a neurologist. Obviously following pathways in the brain gives you this kind of logical way of looking at it, but following these pathways makes so much sense, doesn’t it? Then the descriptions and the way people are presenting with it, how did you start to use these? Can you describe the connection between the Vitamin D, B5, and B Vitamins that you began to use with your patients? What did you find clinically helped people who were struggling with their sleep?
Stasha: That’s a really important question and you have to see this event coming from a complete naivete. I would never have gotten near Vitamin D if I knew then what I know now. It’s dangerous. It is politically fraught. It’s really very difficult. And I knew nothing about it. I had this simple question, “Hey, could there be a Vitamin D blood level that would make us sleep better?”
The next step is the B vitamins. They’re even more complicated. My patient brought me the book at a time when my patients were complaining of new pain. And I had developed this peculiar butt pain, I couldn’t sit down at the end of the day. That happened at the same time that my patients were telling me “I came in here for headaches and now I ache all over”. So I was beginning to feel responsible for what they were experiencing, even if it was something I didn’t understand, and I was willing to try vitamins.
Our sleep was crummy again so I went to the vitamin store and picked up pantothenic acid. The dose in the book was 400 mg. I picked that up but the only thing I remembered about B vitamins from medical school was “if you give one B, you should get all of them”. So, not really knowing much, I searched through all the “B complexes” and realize that they were all different doses. Some had three Bs, some had five, and they all had different doses. How are my patients supposed to make sense of this?
On the B complex shelf I found something called B100, which is 100 mg or 100 micrograms of all 8 B’s. I settled on that because then at least I’d know that they’d have a specific dose of the B’s (and all 8) instead of just saying “get a B Complex”.
I started B100 and 400 mg of pantothenic acid for one week to see if my sleep and my butt pain would get better. For one week I gave the same recommendation to about 40 patients in my office who have had a return of their sleep issues despite a good D level.
By the end of the week, I noticed that my restless leg syndrome, which is my sleep disorder, is much worse. This is a problem because it means that there’s probably a specific “right” dose and a “wrong” dose and despite the books recommendation of 400 mg (and that’s the only dose on the shelf in the vitamin store) that I’m probably on too much. So I stopped the 400 mg of B5 but continued on B100, and in a day, my butt pain was gone and I felt great. Very weird experience!
Then in the months following I had all these patients coming back to my office. Thirty out of 40 of them noticed that the 400 mg of B5 was too much and caused, not sleep improvement, but insomnia! “This B5 400 mg made me so agitated and I couldn’t sleep at all.” There had to be something unique, something different about my patients, taking D for two years, that gave them the opposite reaction; not better sleep, worse sleep!. What’s different about them? They’ve been taking D for two years, they are biochemically different than the people with rheumatoid arthritis in the book that I was following.
A few people came back having done what I did, they got insomnia, decided to lower the B5 dose, stopped the 400 mg but continued the B100 and in a day, all their pain went away and they started to sleep really well. I thought “Nobody’s gonna believe me about this. The only person who’ll ever relate to it is someone else who has just gone through it because it is just too wacky.”
I published these observations in 2016, but I’ve been doing D plus B100 or B50 in my patients since about 2014. This is still the pattern, you have to view the D and the B5 as working together. The dose of one determines how much you’ll need of the other, and they work together to make acetylcholine.
The biggest surprise for me, once I understood that they make acetylcholine, was that acetylcholine is responsible for two very different things during wake and sleep. During the day it provides the ability to stay focused, be alert, and be calm. At night, when we’re asleep, the same chemical determines our ability to enter the proper phases of sleep and become perfectly paralyzed. It basically runs everything that’s important to us. Acetylcholine deficiency is in the background for most of the chronic illnesses that are common today.
Some of the acetylcholine deficiency disorders, Parkinson’s, Alzheimer’s are ‘’degenerative” diseases, things that are common in old people so we think the body’s just “wearing out”. But there’s a specific mechanism causing them and they’ve crept up into younger and younger people over the last 40 years. It happened so slowly that we didn’t notice that things that used to happen only in old people are now happening in children.
If D/microbiome deficiency caused something entirely new, for example, a purple horn growing out of your forehead, then we’d be wondering “why has this new thing just started to happen?”, but all of the medical issues that come from these deficiencies are old diseases. We’ve named them, we’ve ‘’treated’’ them, but we didn’t really understand that they were linked to D and microbiome.
It sounds a little crazy, to say that so many issues: high blood pressure, heart disease, diabetes, autoimmune disease, joint pain, inflammation, memory disorders, sleep problems, GI problems, are all linked to the same combined deficiencies, but the truth is that Medicine responds to what walks in the door. We make medicines for the things that walk in the door. We don’t make medicines for a purple horn growing out of your forehead because it’s not happening.
When I give my lectures now, I say acetylcholine will turn out to be the most important neurotransmitter of the decade and it’s going to make a huge impact. The piece that’s hard is that medicine is so conservative. Doctors are the most conservative scientists on the planet. We are just not designed to take and run with some new idea. I’m not either. I’m just a normal MD. I color inside the lines, I’m not much of an independent thinker. But since no one was writing about what to do to help my patients and these new ideas made a day-night difference in my patients, I, and they, were willing to experiment with something new.
Steve: Do you think your personal experience taking the same vitamins yourself fueled the way you mentioned this connection with your patients, sharing symptoms? There’s something about that isn’t there? A practitioner having personal experience.
Stasha: Yes! You have to be doing the same thing as your patients to be able to believe it. I think my own struggles shaped my willingness to try things with my patients. My sleep still isn’t perfect now. As a clinician I had to be a patient too, experiencing the same shortfalls of Medicine to actually see it from the patient’s point of view.
You have to live through it yourself to really have compassion for other people. To tell you the truth, the only MDs that are really all about this are the ones that have sleep disorders themselves. Some are sleep specialists themselves, they run a sleep lab, and they recognize that everything they know, and everything they see in their continuing education at their meetings does not answer why they still can’t sleep. They’re desperate and looking for something else and they become interested in the new ideas that I’m offering..
Steve: Then they’re interested when you say, “Hey, I took this and slept better.”
Stasha: Yeah, we’re all interested once we experience a positive change, even if we didn’t expect it.
Steve: There’s obviously so much to your work that it’s a little bit overwhelming at points but I feel we’ve hit a good overview of the understanding of why you think Vitamin D is so important for sleep. You mentioned the level 60 to 80. What did you find in terms of dosages? Did you always couple that with the B100?
Stasha: Thank you for introducing that idea. I have a website and a workbook because this is complicated. I wish it weren’t. It’s complicated on many levels. The first is just trying to figure out how to get a Vitamin D level of 60 to 80. The dose can be anywhere from 400 IUs a day to 40,000 IUs a day. You can never predict what the right dose is going to be for one person. There’s a whole body of misinformation about how to use D.
Calling it a vitamin is a real problem. It’s not a vitamin; it never was. It’s a hormone. You have to picture it that way. You have to treat it with great respect. You would never say, “Steve,
I think you’re tired, it’s got to be your thyroid. Why don’t you just run to the pharmacy and buy yourself some thyroid hormone and I’ll see you back in a year.” Even lay people know there’s a special mindset for how you treat hormones, you have to dose according to the blood level.
There’s a lot of misinformation, very well-informed scientists who work in D say things like, “I just take 100,000 IUs once a month.” “ It’s a fat-soluble vitamin.” They say it’s a hormone one second and two seconds later say it’s a fat-soluble vitamin. That’s not correct, it is a hormone. Hormones are designed to stay in a specific range or blood level. When the level changes it affects our behavior.
Even more important, and the reason why I’m here with you talking about it, is that taking D by itself, without bringing back the microbiome, can produce secondary B vitamin deficiencies that leave you feeling worse than before you started D. That’s why I tell the story of what happened to me and my patients. If you take D you encourage your body to make more repairs but if it doesn’t have the right amounts of the B vitamin building blocks coming from the healthy bacteria then really bad things can happen to you; things that are painful, things that change your immune system.
This means that half the world is going to start on D during Covid and then three, four, or five years later many B vitamin deficiency diseases will be increasing.
When you start taking D you must get blood levels done and you must bring back the microbiome by taking D plus B50. It’s simple, it takes three months and is not about probiotics. It is about providing the growth factors the bugs need to come back to the four healthy groups of bacteria..
My website and the RightSleep workbook are there to help guide you. You really do need to learn a little bit in order to be using vitamins and D hormone safely. The workbook takes you through an entire year, reminding you to observe what your body tells you and write it down. It’s easy for me to describe to you that “these are the deficiencies that have resulted from moving indoors” but there’s a second issue in the background. If you’ve had an inability to repair your body in sleep for the last 20 years, then your own sleep switches have also been failing.
This means that you’re using those same failing sleep switches to fix yourself. That means you have to be patient. The vitamins are the tools but the sleep is what heals the body, and the sleep switches.
But what I observed in my patients was that even if their sleep switches are not optimal, they still know what to do. They’re designed to fix themselves. They’ve been doing that forever. You just have to picture the process of healing your sleep with a little more patience
The RightSleep Workbook is your personal assistant: “My sleep just got bad again. What does she say I’m supposed to do now?” There’s a path to follow for a year to two years. Then there’s an idea set about always trying to make sure your sleep stays better. The vitamins are just part of the whole picture. There are many other deficiency states induced by not having the right microbiome.
It turns out the microbiome has also been responsible for absorbing minerals. No matter what we ate, the microbiome was able to break down a little bit of this and that, take the zinc out of it, and absorb just enough and not too much. Many people have other deficiencies in the background that they’ve developed over 20 years. That’s why there’s also a multivitamin as part of this with very specific parameters.
You have to picture this as being willing to dedicate two years to putting your body back together by watching your sleep get better over time.
Steve: I love the idea that sleep is really the vessel and you have to get yourself there, get your ticket ready, and then jump on board. Then you go on the healing journey. It’s always a journey because these things don’t heal overnight. I agree with that sentiment that we need to see this as a perspective change. We’re going to go on this journey of healing.
Dr. Gominak, I love your work so much, and thank you for spending time with us today. We’re going to have to do this again because you’ve opened so many cans of worms I’m personally interested in that I know can help a lot of people out there. We’ll definitely plan another session on this. For those who would like to continue to follow your work, where can they find you? What have you got out there that can help people sleep better?
Stasha: My website is www.drgominak.com. I have the RightSleep Workbook there that acts as your personal assistant. The ‘why’ we’re doing this is on the website. It’s free. The “how”, the actual path to follow over a year- you are encouraged to write your observations down once a week because you personally are responsible for noticing what’s changing. The Workbook also has a journal so you can connect how your body feels to the changes you make. That’s how you get better. You’re in the driver’s seat.
I also have a series of videos about pregnancy and fertility. All, or nearly all, the infertility we’re seeing in the last 40 years is about a low D. D directly runs ovulation. It has direct effects on sperm motility and sperm health. That’s all over the OB/GYN literature but the fertility experts choose not to look at it. Running your own fertility and getting a normal pregnancy where your D level is healthy so your baby actually goes into a sleep-wake cycle at 30 weeks of gestation. Then you get a baby that sleeps through the night at three months. They wake up to feed for the first three months and they start to sleep through at six months.
There are also videos on how to use the RightSleep program for kids..
Steve: We’re going to schedule that talk very soon because I really believe those issues are associated with what you’re talking about in terms of the influence Vitamin D has throughout the whole body. We’re just not seeing it. We’ve got to change our perspective on these things.
Dr. Gominak, thank you so much for giving your specialized perspective on this and spending time with us. It’s been so fascinating to hear your story, not only with your patients but also with yourself. I’m really looking forward to following your work further. Thank you very much.Stasha: Thanks for inviting me, Steve. It was my pleasure.