Vitamin D, Microbiome, B Vitamins and Sleep – The Perfect Stool

Lindsey Parsons: Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons and today I’ll be talking with Stasha Gominak, MD, Neurologist, and Sleep Coach.

Dr. Gominak attended medical school at Baylor College of Medicine, completed her neurology residency at the Harvard-affiliated Massachusetts General Hospital in Boston, and practiced neurology in the San Francisco Bay area until 2004 when she moved to Texas and began focusing her practice on Sleep Disorders in 2012. In 2016, she published two pivotal articles about the global struggle with worsening sleep and the possible causes and solutions related to Vitamin D Deficiency and the intestinal microbiome which we’ll be discussing today.

She currently divides her time between RightSleep Coaching sessions for private individuals and teaching other clinicians the RightSleep method of sleep repair.

Welcome to the podcast, Dr. Gominak!

Dr. Stasha Gominak: Hi Lindsey! Thanks for inviting me.

Lindsey:  It’s my pleasure. Let me jump right in and ask you how you stumbled onto the connection between Vitamin D and the gut microbiome.

Stasha: Thank you for asking that question. Lindsey. It is really interesting. So I started with an interest in sleep. I’m a neurologist, and I was noticing that most of my neurology patients, regardless of the reason why they were referred, if we would do a sleep study, didn’t necessarily have sleep apnea, but they didn’t also have normal sleep. Then by a series of odd accidents, I found out that they all had low vitamin D. And I found substantial literature about Vitamin D affecting sleep. And that literature was written primarily by a guy named Walter Stumpf, who had already put together a conceptual framework that said, Vitamin D is not a vitamin, it is a hormone that we make on our skin from the sun. And it is meant to allow us to change three important things in relation to the season: one, our metabolism, two, our sleep, and three, our fertility. So that allows us not to have babies in the middle of winter when there’s no food, allows us to sleep, and slows our metabolism. So in essence, we hibernate.

So this was the framework that he had built, after doing lots of scientific studies of many different kinds of animals, insects, fish, birds, etc. It was his article that suggested that the D receptors throughout the GI tract were very important in things that happened to us like there are Vitamin D receptors in the islet cells of the pancreas where insulin is secreted. And it was his hypothesis that it was affecting our GI tract. Because of those articles, I just assumed that the Vitamin D that I was going to give for our sleep would help get the right microbiome back. And at the time that Walter Stumpf was writing his articles, we didn’t have an epidemic of the wrong microbiome, the GI people hadn’t been writing about the microbiome, and it didn’t even exist as a concept in the 1980s. So by the time I’m giving back vitamin D, many of my patients have irritable bowel syndrome, and the whole concept that you really have to know that your microbiome is normal has started to show up in the GI literature. I thought that the Vitamin D was just going to fix it. Because I thought that it made sense that perhaps we change our metabolism by changing the microbiome, therefore, Vitamin D should be a trophic factor for the bugs that live in the belly.

Lindsey: Could you define trophic factor?

Stasha: A trophic factor means a factor that helps things grow. Trophic means growing. So I thought it was going to be obvious that just like other bacterial growth factors that we’re going to talk about in a bit, D was going to be something that encouraged the growth of normal bacteria. It turns out that at that time that I was thinking that there were no articles supporting that however, the first article supporting that in humans was in 2020. So around the time that COVID starts to appear, and doctors start to give Vitamin D, they actually do a study where they give Vitamin D at various different doses and actually follow the blood levels, which is an important issue and document that if you can get the blood level to go up, you’re not only feeding the bugs, but your body’s absorbing it. If you can give a bigger dose, you can change which bacteria live inside you. And they show that pathologic bacteria that hurt us or are less common and help healthy, helpful bacteria were more common if you’ve got your Vitamin D level up. So we have some proof that Vitamin D is actually a bacterial growth factor. There are lots of other things in the history of Vitamin D that I can refer to also if you’re interested in that.

Lindsey: First, let me ask if you can just bring it together a little bit better that connection between Vitamin D and the B Vitamins?

Stasha: Yes, I’m going to go into the history a little bit. I’m giving them Vitamin D because I want to get their sleep better and the sleep gets better. But then it starts to fail. After two years of using Vitamin D, the beneficial effects on the sleep started to fade and lots of other things start to show up, scary things like: I have pain all over, I have burning in my hands and feet. I personally developed weird buttock pain. So now our sleep is failing and the D level is still 65. So the important thing to know about D is you have to measure the blood level, you can’t just go by a dose. It is a hormone, it’s not a vitamin, and it’s really not in the food. If you have a stable Vitamin D level, and you’ve gotten better, now you get worse again. I began to suspect that something else that the brain wanted to sleep better was not being supplied.

One of my patients brought me a book about a vitamin called Pantothenic Acid that no one’s talking about: B5. It was a book written in the 1990s by a layperson about Rheumatoid Arthritis, joint pain, and Pantothenic Acid. She’s giving Pantothenic Acid in very big doses, 400 milligrams. That’s considered the normal dose at the time she’s writing this, to lay people, saying their pain got better and their sleep got better. I personally was not knowledgeable of, or that interested in, vitamins. But I was desperate. And I really didn’t know why everybody was failing. I went to the references that were in this particular book. And the references were from laboratories in the 1950s that blocked Pantothenic Acid using a specific chemical blocker. And within two weeks, the people in whom they blocked it had burning in their hands and feet, inability to sleep, belly pain, and a funny gait.

There was scientific evidence suggesting maybe this Vitamin D I’m giving is somehow making these other B Vitamins go bad. The thing that’s weird about that concept is, this didn’t show up until after two years of Vitamin D, which is strange. The second thing is, these people have no change in their diet. We have been told, and the only thing I knew, was that the B Vitamins, of which there are eight, come from the food. So if they haven’t had a change in diet, and if the only thing these people have done over the last two years is to take Vitamin D, why on earth would they now be showing up with B Vitamin deficiencies? Now I start to read about the B Vitamins. Most of the articles that are reviewing water-soluble vitamins, including B Vitamins, are saying Thiamin, which is B1, has a colonic bacterial source and a food source. Riboflavin has a colonic bacterial source and a food source. They go through all eight of these and say they come from the poop bacteria and they come from the food. My patients have started to have burning in their hands and feet, and keep in mind I’m a neurologist, neuropathy is my subspecialty. Burning in the hands and feet is not common. Burning in the feet is pretty common, but in the hands and feet of two young women already on B12, which is one of the things that can affect that, come in within a month of each other. That’s really creepy. That suggests that in my effort to make them sleep better and repair, I may have used up their B Vitamins.

The B Vitamins are really the building blocks of the things we do. Maybe I’ve made them deficient. Why would that happen? What if the real source is really the bugs? What if the fact that they have Irritable Bowel Syndrome really means they have the wrong microbiome? Because their D was not high enough to bring the healthy happy ones back. They have become B Deficient because their bugs are off. Now the weird part about that is I’ve been giving them D for two years. Why didn’t the healthy bugs come back? If I think they’re coming from the bugs, how can we get them back? What do those little guys want that they haven’t been receiving?

In the background, I’m reading all these other articles about the fact that the four healthy phyla we have of bacteria actually trade B Vitamins among themselves. There are lots of articles from the 1930s & 40s that say this particular species makes Riboflavin, this species makes Thiamin. There’s actually a whole body of literature that says we first described the B Vitamins as bacterial growth factors in the 20s & 30s. What they were doing is growing bacteria in a little Petri dish. They’re following Pasteur. They’re pouring this interesting yeast and water mixture together into a Petri dish. Then they’re watching the bacteria that grow. And then they realize over time that there are things called growth factors which are chemicals that are in there and the bacteria are actually making them.

There’s literature already that suggests these four specific phyla hang out In our GI tract because they trade eight chemicals called the B Vitamins. If you’ve never thought of it before, why do we have A? And then we have eight things called B. And then we have C. That’s weird. Why are they all grouped together? It’s because they were discovered together in this liquid that was already sitting on the counter. They’re way back in their little microscopic world doing these bacterial growth studies. And they borrowed their wife’s yeast solution that she has sitting on the counter she put brewer’s yeast in because she was going to make beer. What you do with that stuff is you let it sit on the counter at the right temperature, you can’t boil it, and you can’t let it go too low. What you’re really doing is choosing a middle temperature that promotes the growth of bacteria that are naturally in water and in the air. You let those grow for a specific period of time, depending on whether you want to make bread and what kind, and you may add certain cultures, and that’s how you make sourdough bread. The same yeast-bacterial mixture used to make beer and bread turns out to be the source of what we call nutritional yeast. Nutritional yeast actually has B Vitamins in it. So backing up for a moment, that yeast makes D2. D2 is a much, much older chemical. And it’s actually made in yeast from exposure to the sun, just like our D3 is made from exposure to the sun, but it’s a different chemical. And the bacteria that grow in that water with the yeast in it, are selected by four different groups that want D. That liquid would trade D from the yeast, with the bacterial growth factors that helped the yeast; so they help each other. They run in a symbiotic relationship, then they use that same liquid they stole from their wife’s kitchen cabinet, poured it into a Petri dish, and started to study the bacteria. Soon they found some of the Bs were heat sensitive. If they boiled the liquid, they couldn’t get certain ones to grow.

And then they saw other interesting things like a little lump of white stuff with little black tips on it. And that’s a particular kind of bacteria with a clear zone around it. Somebody asked if this meant that these bacteria are secreting a chemical that prevents this little yellow slimy one from growing into its territory. The answer was yes. And Penicillin is born. Penicillin is an anti-bacterial agent, it’s made by bacteria. Why would they do that? They do that to kill off their competitors. So in the background is a lot of history.

You have to start thinking that somebody way back in the 1930s, when we went from bacterial growth factors to vitamins, kind of knew that these eight chemicals were coming as an eight-pack. When I was in medical school in the late 70s, I was told if you give one B, you should give all of them. Now, in the last four years, that dogma has changed a bit in medicine. Some people in the supplement industry have not changed that dogma. But medicine has started to do single Bs by themselves, which I think is a bad idea. Ultimately then, as I’m going in to try to fix this burning in the hands and feet, I buy pantothenic acid. I don’t know much to give. And so I think if you give one you should give all and I pick up this stuff called B100. It’s actually a big dose B complex, and it’s specific doses of all of them. It’s not that I knew what I was doing, it’s that I wanted to make sure it was consistent among the people I was recommending it to. I give this B100 stuff. And I read the articles I described to you and I thought if the happy healthy guys are still down in the belly, my belly, and my patients’ bellies, I bet there was too much bad bacteria in between them. So there are piles of poop in between these healthy guys. Maybe they’re too far apart for them to trade the Thiamin and Riboflavin the way they used to. But I’ve just flooded the GI tract. I’ve made this B Vitamin soup.

Now I’m giving them a B Vitamin soup, all a big dose, and D. Theoretically, it should bring the bugs back. And it did. Ultimately, within three months of taking B100 and D, all the symptoms got better and went away; even the belly IBS symptoms go away. There’s a second idea in the background. And this is really an important piece, because now everybody’s interested in D. COVID hit the front page and everybody’s taking D. But anybody who has a D that’s low, you can pretty much assume their microbiome has gone bad. But if you do D, you need to bring back the supportive natural microbiome. My method is not the only way to do that, you’re the pro in that, and we can talk about that further, but bringing back the microbiome then means, as I use D to sleep better, make repairs on my Immune System, I now have the eight building blocks that are needed to make those repairs. Better health is actually achieved by not only taking D but converting the microbiome back to the four healthy, happy phyla.

Lindsey: Wow, that is fascinating stuff. I sort of knew about the fact that the Bs were discovered together, but I had no idea about the logistics of it. That’s amazing. Backing up a little bit to the real basics. What do you consider optimum levels of Vitamin D, and what’s the best way to get it?

Stasha: I want to circle around and give you one other way to test this concept that the Bs come from the bugs. Vitamin D is extremely controversial at the moment, there are emotion-laden fights going on between people in medicine and people in supplements. It really is one of the fascinating parts of medicine. Anybody who’s taking Vitamin D should spend some time and learn about it. You’ll find very divergent opinions. My view is, I entered this as a completely naive neurologist. I’m not an endocrinologist, I didn’t study hormones. I would never have gone down this path if I understood just how complex this is. However, I did stumble into something very important to all of us.

And in short, I’m interested in sleep, not hormones. What’s wrong with my patients? I now have hundreds of sleep studies in young, healthy females who have daily headaches; that’s the group I’m studying. They didn’t make enough Rapid Eye Movement sleep, they just didn’t have any. That can’t be because they don’t breathe, right? That’s something in the brain, then I stumbled into the fact that they all have low Vitamin D. Then I find there are scientific articles showing there are Vitamin D receptors in the actual cells, in the lowest part of the brain that do sleep. That means D is designed to run your sleep.

If it’s all low, is there a Vitamin D blood level, not a dose, but a blood level that will make my patients come back and tell me their sleep is better? There is a very specific blood level of 60-80 nanograms per mL that promotes better sleep in someone who’s had a Sleep Disorder. You have to be D deficient for a long time before you develop a Sleep Disorder. This is not really a study that answers what’s the ideal D level for a human being who’s been living outdoors their whole life. Remember, we’re animals. Every animal that hunts during the day lives outside except us and our pets. That means we’ve just done something that really goofed up our biology because the dermatologists in the 80s began to tell us being in the sun is bad for you. And we moved indoors. We got air conditioning, computers, and now COVID. We are the only animals on the planet who had a biology designed to live outdoors from the moment the sun came up until it went down who have moved indoors over a 40-year span. And that has profoundly affected our D levels.

Now, if you go to hunter-gatherers in Africa, you will see that their D levels are in the 40s and 50s. I think that’s a different question. What if they’ve never gotten D deficient because they live outside and don’t actually have to push it to a place to feed a deficiency state? The 60-80 range is argued about because every clinician who uses D a lot has a different range they believe in. Mine was based on watching people sleep. I really just asked how their sleep was. When they came in and said their sleep was better, I told them to see what their D level was. That has now been consistent since 2010. In the midst of this, there are multiple questions. There is a question about people who look at supplements and want to know what’s ideal. What’s the ideal level for humans? That’s really a different question. And we don’t know that answer. So every single person who writes about D enters it from a different viewpoint. There’s one guy entering it from a dermatology standpoint, who’s showing all these amazing kinds of D that are made on the skin. Other scientists are entering it from some other standpoint. So it depends on how you ask the question. What is the best level for sleep? 60-80 nanograms per milliliter.

Lindsey: I’ve definitely heard the numbers 50-80 and 60-80. I find that my clients, to get to that level, usually have to start at 5,000 IUs of D and I always do D and K together. Usually, at some point, they hit the optimal levels, and then you can maybe reduce it to a little less or less frequently.

Stasha: Let me comment on when you’re trying to manipulate your sleep. You and I are intervening. We’re biohacking by giving things we presume the body needs. But the actual healing is extremely complex. And the sleep is the intelligent fixer of that. What that means is when I’m trying to get somebody to do D, I’m not really focusing on their bones. When you’re doing bones with D, you may get a D level once a year. When you’re trying to get your sleep perfect – so you don’t develop medical problems or you heal your medical problems – then watching your D level should be done at least four times a year so you’re aware of your summer maintenance dose because the sun is a second source. Then what’s your winter maintenance dose? And more importantly, are there physical signs when your D drops below 60? Are there physical signs when your D goes above 80? Those things have not been recognized by medicine yet. They are there in every single person, but they’re a little variable from person to person as to what they manifest when their things aren’t right. Sometimes it’s sleep, sometimes it’s pain, sometimes it’s anxiety.

There’s an odd history that with Thyroid hormone, even lay people know if you go too high, you get weird, if you go too low, you get weird. It’s the same with Cortisol,  Testosterone, and. Estrogen. When you’re taking supplements from your doctor, the doctor is focused on your symptoms. Because they know that’s a reflection of having the Estrogen level right. They haven’t done that for D, but D is exactly the same. If you keep it at a nice homeostatic middle, which I usually want to have in the 60s, for most people, you get physical symptoms that suggest it is too high or too low. Then you adjust it and you get a level. We haven’t moved to that yet in medicine, which is a shame because it’s there for us, we just have to learn about it.

Lindsey: What kind of symptoms do people manifest when it’s too high?

Stasha: The problem with that is it’s a little different in each person. Most of us around the globe now are low D and our microbiome is screwed up. Some of the symptoms you’ve had leading up to finding me will be either related to the D being low, you’re sleeping badly, or your microbiome is goofed up. Over time, as you get more D and some of those symptoms go away, they will usually be the signs of what happens when your D goes low. Now, that is particularly difficult because those are all things like waking up at 3 a.m. and not being able to go back to sleep. Or foot pain they were told was Plantar Fasciitis. Or they’ve been told they have Ulcerative Colitis. They’re all things we’ve applied names and legends to. They have these things and weren’t told it was because they had low D. When those things go away as they’re taking Vitamin D, they realize their D is better, their sleep is better, and their Lupus is better. The Ulcerative Colitis is gone. The eczema is better. Over a period of many months, they can actually show that when their D is in that 60-80 range, they don’t have those things.

But it’s variable from person to person. Many of the things that show up are actually related to another thing called Acetylcholine, which is a Neurotransmitter. That’s a very complex set of things. It’s related to a lot of the mental issues that come with having a low D and bad microbiome, especially anxiety, agitation, high heart rates, etc. I wish I could give you a specific, easy answer, but it really varies from person to person. I have a whole website dedicated to informing people about what will likely show up when they’re learning about how their body tells them their D isn’t good.

Lindsey: Let me ask you this, though, is it more important to get certain amounts of D or some of the D at least, from the sun? What do you recommend in terms of sun exposure? I jumped on the whole functional medicine idea of getting X number of minutes of sun a day. Then I got a Basal Cell Carcinoma right on my forehead. Now, I do still get some sun, but I don’t expose my face ever. I always protect my face.

Stasha: That’s a perfect setting in which to talk about this. I got a Basal Cell Carcinoma after I started to take D. When I told you that D was a pro-growth hormone, one of my fears was this: We have to understand that you and I have been living our lives with a low D. D in its primary use can actually go into the cell and correct a Squamous Cell Carcinoma. You grow a Squamous Cell Carcinoma in a Petri dish, then pour in D, and it corrects itself. It actually changes the DNA. I’m not seeing articles about Basal Cell doing the same, but there are many things that D does on our skin that were originally designed to protect us from the side effects of UVB and UVA light and the damage to our DNA. Having said that, we’ve just walked around on the planet, (for me) for around 40 years without that protection. If I already have a cell that’s gone rogue, and it’s decided it’s just going to grow the way it wants, giving D could potentially increase that growth.

I want to say to each person, you have to do what you have to do to deal with sun exposure based on your own personal history. So your decision not to expose your face, I think, is a smart one. And any of us who’ve had a Basal Cell Carcinoma should be examined all the time by a dermatologist and should be pretty careful about sunscreen.

Now I want to circle back to your question. More and more research is showing that being outdoors is one of the most important things for your health. Even if you’re not in the direct sun. There’s a whole bunch of literature about infrared light that we can get indirectly, not even when we’re outside, but from incandescent lights. So there’s now literature that suggests when we changed from incandescent lights to halogen and LED, we screwed ourselves even further. Because there was actually infrared light coming from those lighting sources that would penetrate our body to two or three inches. These very unusual energy types do things to our mitochondria deeply in our body that help our health.

We actually have an advantage in having sunscreen. That means you can actually modulate what you do. You can be outside a lot, put on sunscreen, and still try to move your D level around with oral D. There is a rainbow of types of Ds that are made on the skin when we’re exposed to UVB light, not just the one we take. We take one type, we take D325OH. It turns out there are many other OH types. There’s 3OH, there’s 17OH, there’s 23OH, there’s a whole array, so that is very complicated. What I want to tell you about it is we humans know 1/1,000,000th of what we should know about this chemical.

When we want to biohack, we should really just go back to the evolutionary model we were following. All other animals live outdoors. All other animals have fur, feathers, or scales, so we are kind of unique. Humans and pigs are really some of the only bald animals on the planet. That may, to some extent, have given us an advantage, because most animals get their D from licking their fur. They make the D in their fur, but it’s not 100% absorbed directly. That could mean that we actually made more D than the Neanderthals, who were furrier. We actually slept better, reproduced better, and got smarter. We have a unique situation. Even if you look at it through that lens, it’s still much better for you to be outside.

And frankly, I suspect we’re going to see more and more literature about the actual science of what happens to us when we’re outside. You and I have been, as everyone else has been, fed the idea that we live in a toxic environment. That’s not wrong. And I’m glad there are people out there trying to do something about it, but I personally may not be able to do anything about my neighbor using Roundup. We’ve used that explanation because we don’t have a good answer for why do I feel so shitty all the time? Why can’t I sleep? Why am I infertile? We supply these answers. But what if they aren’t the whole answer? We should still be curious. Are there other things I might be able to do that would be able to add to my health, just like what you’re doing, and then modulate it? What I like is being able to say we can actually hold two or three belief systems at the same time. We can use Lindsey’s belief system, about the toxic environment, functional medicine, detox, and the GI tract is the center. We can use Stasha’s if it’s about sleep, and we can use routine medicine. We can take from all of them the things that are valuable to us.

Lindsey: To sum it up, go outside, use sunscreen to keep from getting burnt, and get some of your D from supplements as well.

Stasha: I think that’s a good summary statement. Each individual person has to use their judgment as to which one they’re going to do and they should still observe what’s best for them.

Lindsey: Might it be a good idea to increase your D levels with supplements before launching into the “I’m going to go get regular sun every day without sunscreen” project?

Stasha: That is a great idea. Now, one of the fascinating parts about that is our Autonomic Nervous System. The Nervous System keeps our belly pooping on the right timeframe – that we poop every morning. It really has a time clock. And we sleep at a certain time. That Autonomic Nervous System that runs all of that is actually tied tightly to vitamin D and the Bs from the microbiome. Our ability to manage our internal temperature is directly related to that. That means humans have actually lived in areas where it was 110. How did people live there 100 years ago without even a tree? How did they make it?” They did make it! And that means their ability to defuse the temperature and find a way to make their internal temperature normal in 110 degrees was actually normal. Many of us lost that control when we lost our D in our microbiome. Your question is, what should I do to get out there? If you go out in the sun and you feel like you’re going to pass out, you don’t do that right off the bat. You start to work with exactly what you said. Supplement first. Get your sleep better. Get your Nervous System better. Then start to go out and do things according to what your body says it can tolerate.

Lindsey: Sounds like a good plan. Can you talk a little bit about how Vitamin D is important in Autoimmune Disease?

Stasha: Yes, the first thing I would like to list under that is… All we’ve seen about the articles hitting the front page about COVID are not about the virus, but how each unique Immune System reacts to it. Now we have information that says they really die of an Autoimmune Storm that affects the ability of the lung to tolerate what the Immune System is doing. Ultimately COVID is not just about the virus, it is about the virus and the host. We were never designed to attack our own bodies. Our Immune System is extraordinarily well developed to never attack our own body. Also, parenthetically, that bit I said about this bacteria makes an antibiotic? We’ve been taught the reason we lost our microbiome is the use of antibiotics, but there are actually two or three generations of humans between the early 1940s and the mid-80s, who took a lot of antibiotics. I was alive then. We took antibiotics for strep throat and we did not develop IBS.

Lindsey: But were they as broad-spectrum?

Stasha: Yes, I’m simplifying it. It’s not that antibiotics are not to blame, because they absolutely do change the microbiome. But there is a suggestion that it wasn’t just the antibiotics – that something started to happen in the middle 80s. That is when IBS started to show up and that’s when Ds started to go low. In the background, I want to make the point that when we get our normal microbiome back in the belly, the bacteria that are supposed to be in us are not just inside. They’re in our sinus cavities. They’re inside our noses. They’re on our scalps. They’re in our pits. They’re in our perineal area. They have very specific bacteria that are supposed to grow there. And all of the bacteria and viruses and fungus that naturally grow on us when we live outdoors and have a good D level, actually make antibiotics. They make antivirals. They make antifungal agents. It turns out, if we use COVID as an example, the people who still live outside even though they’re poor – like in India – the guys that are collecting garbage actually made it through COVID better than the software engineers, because they still have an outdoor life, which implies that our natural microbiome plays a huge role in protecting us from infection. That means as we get this infection with COVID, if we don’t have a normal microbiome, we don’t have our own Immune System helping us.

What’s happened to the Immune System, and what showed up at the same time is a higher incidence of Autoimmune Disease and a higher incidence of not being able to protect ourselves from this simple virus. If you look at what we put on the front page, it’s that if you’re obese, you have a higher likelihood of a bad outcome. If you have dark skin or other underlying diseases, it’s the same thing. Those are all things that really point to a Sleep Disorder, the microbiome isn’t right, and D is low. It describes a population where 60% does not have a normal Immune System and has a higher incidence of Autoimmune Disease because of these changes with D and the microbiome.

Now, stepping back a little bit. If I have an Autoimmune Disease, how do I use this knowledge about D and the microbiome to make it better; that’s really what I would want as an individual. So it’s nice to know these things are linked scientifically. It is my belief that what I saw in my patients – five years with CPAP devices and sleeping pills – I saw Autoimmune Disease and my patients getting better – without drugs. It wasn’t with D. I personally believe the vitamins are tools. They’re bricks. They’re things our body was missing. But in order to have a coordinated healing of a complicated system – the Immune System is extraordinarily complicated – you have to be sleeping right. You have to be sleeping a normal amount. It’s really not as simple as taking these vitamins, getting your microbiome back, and then your Immune System will be okay. That’s not what I saw.

What I saw was when I got into the vitamins side of this, if the person still needs a CPAP device, they will get better faster with my vitamin regimen. If they have an Autoimmune Disease, and I never really get them sleeping, they don’t get better. So I still think that the core of healing our Autoimmune Disease is normal sleep. And the way we get to normal sleep is through multiple paths. Do I have a GI issue? Do I have something wrong with my oral airway that my dentist should work on? Do I have Sleep Apnea? Do I have a Vitamin D deficiency and the wrong microbiome? These are all different paths to consistently work toward getting the best sleep I possibly can. Then I can actually repair some of these problems.

So I don’t see it as a simple recipe. I’ve seen dramatic improvement in Autoimmune Diseases by using these vitamins. But there are still several things about it. Let me give you an example. One of the people that joined my program had Ulcerative Colitis that was cured with the medications his doctor was giving him. So he didn’t have GI tract issues anymore, but he had bad Eczema since he was three. So I’ve sold him my program, which is called the RightSleep Program, of these vitamins and getting sleep better. He really has the intention to get his Eczema better. And it didn’t fully work. It got better and then worse again, and then better and worse again.  It was linked to the vitamins, but he also had a Sleep Disorder where he couldn’t fall asleep until 4 am. His sleep schedule would be 4:00 am until about 2:00 pm. He lives in Great Britain, outside of London, so he has poor sun exposure. He decides, because he is financially able to do so, to take a six-month vacation and go to every single place where he can be on the beach the whole time. And like other people who describe this about sleep, his falling asleep time moves forward. It’s really linked to being out in the sun, not only driving with the eyes being exposed to sunlight and being fixed to the 24-hour cycle, but his Eczema got remarkably better as well. And I suspect that I’ve seen multiple other people with Eczema that goes completely away. But there are going to be some subtypes where you have to have this array of these different kinds of D that are really only made from the sun. So I think it’s more complicated, but it’s a path that you can start learning about to arrive at where we would like to be.

Lindsey: Interesting. That’s great information. I have a number of clients with Eczema. I’ll be thinking about that. In terms of supplementing with the B Vitamins, I know there are some, such as B6 for example, that can accumulate in the muscles and, I believe, cause toxicity. What are the signs you’re taking too many B Vitamins? What are the dosages one should reasonably take over an extended period of time? Should we be testing?

Stasha: Excellent question, and a really complicated question. So, do we really have stores of Bs because what we were told was that you don’t have to worry about getting extra Bs because we pee out the excess. When you get it as a B complex, Thiamin is bright yellow, it almost fluoresces. And as soon as you take a big enough dose your pee is yellow, so it’s really easy to support the idea that we pee out the excess. And when you hang it in a bag in the hospital, it’s yellow also.

My first foray into B Vitamins was using this B5. I’m going to answer your B6 question ultimately, but I want to show you how complicated it is in the background. I buy 400 mg of B5 and B100 and start taking them myself. And I recommend to any of my patients who’ve been taking D for two years and now have these new pain and sleep complaints, that they should take 400 mg of Pantothenic Acid and B100. Around day five, I realized that my Restless Leg Syndrome, which is my Sleep Disorder that makes me very sympathetic to other people who have sleep problems, is terrible now. It’s gotten infinitely worse since I started this now 500 mg of B5. Immediately, I think this is like Vitamin D, where they tell you to take 400 mg, but they really don’t know what they’re talking about. And I just overdosed. I went down from 400 mg, took away the 400, and took B100 just by itself. It was so much better in a day, which is really weird. Then my patients to whom I recommended it, about 30 out of 40 started to trickle back in and tell me this 400 mg nearly killed them, made them so agitated and they couldn’t sleep at all after only two days. This is sitting there innocently in the health food store, 400 mg, and that is the recommended dose of Pantothenic Acid. That means you can’t really believe every article you read and each individual has a different background on which chemical is falling.

It turns out that D makes an enzyme that makes Acetylcholine. Acetylcholine can either make you sleep like a baby or if it’s too high or too low, it makes you unable to sleep. It can also cause Anxiety when it’s too high or too low. It acts kind of like a hormone-type thing. Too much and too little both affect you. It took me several years to piece together that there’s a synergy between B5 and D. What does that mean? It meant that I was right. I used this D to make their sleep better and I had actually sucked up all their B5 stores. And it took them two years to manifest a B5 deficiency state. That kind of undermines the whole concept that we don’t have stores. There are scientific articles that show we have stores of B5, B6, B1, and Vitamin C. The problem is they aren’t just sitting around in a lump under your skin. We don’t have any idea where the stores are.

As a neurologist, I’m trained that when somebody comes in with burning in their feet, look for them to be taking too much B6. We’ve been told that a B6 overdose produces burning in the feet. But what if – and this is just a what if – what if huge doses of one B Vitamin means that all the little B packs that are supposed to be eight chemicals coming in screws up the ratio? So if I overdose on B6, it actually means it has an effect on the amount of B5 I’m using. The person who took B6 by itself anyway had a reason why they were taking it, so it’s still possible that what we’re seeing is that I was able to treat burning by giving B12. But the two gals that walked into my office with burning in their hands and feet were already on B12. Now, that’s the only reason why I would up with B5. What that means to me is these eight chemicals are so tightly intertwined in our biology, that you really are taking a bit of a risk giving individual ones.

There’s a second portion of this, which is there’s a whole body of literature suggesting that if I’m not taking B6 supplements, I’m not taking B Vitamins at all. Why would I have a B6 blood level that’s too high? And there are a whole bunch of symptoms that are listed with that. There’s a minority opinion that says the reason B6 is high in your blood is that it’s not going into the cells that are being used. It does not have the complement of the other Bs that it needs for all of these other responsibilities the Bs have. So it’s not being used in the cell correctly. Having said that, this is really hard because you can’t use the blood level. It’s been my experience – for the Bs – the only one you can really use is the B12 blood level. Even that is a little suspect because there were similar readings about levels over 2000 without supplementing. What does that mean?

Stepping back, there is still, I think, a problem with not having a way to measure the B Vitamin stores in the body. We don’t really even have a good idea about that. And to be truthful, I feel like I’m out on the frontier, kind of like you are. You’re acquiring clinical information from your experience with clients. And when something gets a little bit weird, you go to the literature and you read a bunch. Then you’re seeing some other human being’s experience, certain biochemical pathways in rats, and then trying to put them together. It’s difficult. So my answer is that you have to have a client who’s willing to listen to their own body. And you have to have a relationship where they know you’re giving them suggestions but understands they’re unique individuals with their own unique history. And when they do this suggestion, if it makes them feel worse, we immediately back off and do something else. I don’t think there’s a good answer. I wish it were simpler, but I’ve seen people who have B6 that’s elevated. And they have a lot of symptoms that are the same ones that someone uses my program for, and they still get better. There were also people who have other mutations and other places in their biochemistry that I’m suspecting will wind up with B6 being high because they’re not using that chemical properly because of these other mutations. So what you and I are doing is infinitely complex.

Lindsey: Yeah. At this point, are you still giving that B100 as the starting dose and then going from there, or have you changed what you do?

Stasha: Excellent question. What happened next was, I’ve been doing D for two years and I’m getting really good with where the levels are. When the patient walks in, I’m giving a multivitamin with very small doses of Bs. I learned that over time that giving B100 made a few people say it made them ache all over within the first couple of months; made them feel like they were 100 years old. That is one of the symptoms that comes when the B5 dose is too high and it really is about the B5. What you and I do is look at the clinical characteristics of this person because we’d like to get it right the first time instead of making it worse.

So if the person walks in the door with daily headache, Depression, Fibromyalgia, Endometriosis, three miscarriages, and was recently told they have Lupus, that person has a very long, clinically profound case. They were D deficient and they lost the microbiome. Now they have multiple B deficiencies and they’re a mess. That person is likely to do well with B100. But what I learned next was, if you walk in the door with just daily headache, and you don’t have anything else, I started them on B50. Almost everybody did fine with B50. Not everyone, but almost everyone does fine with B50. They don’t feel anything, their sleep doesn’t get better right away and their pain doesn’t magically go away. I think what that means is, when we did D for two years, we actually sucked up our B stores. We actually did better on B100, because we forced this deficiency state on ourselves. That’s important because there are literally going to be millions of people who have B Vitamin Deficiency States because they started on D in COVID and four years later, they’ll have burning in their feet or they’ll be diagnosed with Lupus, or they start to have joint pain. It happens for years after you started D. And you will never hear anyone tell you that it was related to the fact that they started D, started to grow, get better, repair, sleep better and they sucked up their B Vitamin stores because they didn’t fix their gut bacteria at the same time.

Lindsey: Interesting. I want to ask maybe one more question. Are you using prebiotics and probiotics to help recover the gut microbiome or are you just doing the vitamins?

Stasha: I love that question. I was using a lot of probiotics myself and trading recipes for probiotics, I was spending 60 bucks a month. I don’t think that dumping the bugs down there is the answer. I think the bugs have to have the raw materials they require. And they’re constantly duplicating themselves. So you have to picture our microbiome is like a river. They start at the duodenum and they’re constantly reproducing themselves within 10 minutes. It’s the daughter bacteria of the guys that are here now. They’re being replaced and we’re pooping them out. That means they have some raw materials that they absolutely need minute-to-minute. The cool thing is, all this stuff was happening way before humans ever came. These four phyla have been self-establishing in the baby from the dirt and mom’s breast before we ever figured any of this out. If the D is strong enough, you will establish these four phyla and they will be self-sustaining. The amount of Bs they make is perfect for human biology, and they’re perfect for the squirrels and raccoons and everybody else out there. Dumping bacteria down is not the answer. I don’t think they help; however, prebiotics is a really important idea. Ultimately, we feed the bacteria and then the bacteria feed us. You can do prebiotics when you have the wrong phyla and not get the outcome you’d like. It’d be nice to get the four healthy phyla back. You can fine-tune who lives inside you and more and more information is going to come. At the moment, I have no idea which species makes this B5 stuff or in what part of the GI tract. They’re just starting to study those things, but I think prebiotics and the idea behind it, that we can change our biology by changing what we feed them, is profound and important.

Lindsey: Do you believe in supplementing with prebiotics or simply changing the diet to get it from your food?

Stasha: I am not knowledgeable in either. What I say is I’m going to give you this wedge of the pie that I know about and you’ll get better outcomes from the things you want to pursue to fine-tune this than you have so far. We still need Lindsey and we still need the naturopath. We still need all the people who are knowledgeable in that area.

Lindsey: Fair enough. This has been a fascinating discussion and I think I could easily have you back to go into a whole other level of discussion.

Stasha: I would love to do that, especially about children and early development.

Lindsey: Yes. We’ll definitely have to set that up, but we’re going to wrap it up for today. Thank you so much for coming on and sharing all your knowledge with us.

Stasha: My pleasure, Lindsey, I’m thrilled that you’re interested in this.

Lindsey: Where can people find you?

Stasha: My website is Drgominak.com. This is a pretty complicated system and it’s not just about vitamins. It’s really about recognizing things about your body and how it talks to you. So there’s a Workbook that takes you through a whole year and gives you a journal of writing the things down that you need to observe about yourself.

Lindsey: This is the RightSleep program.