Adapted from episode 86 of The Perfect Stool podcast and edited for readability with Stasha Gominak, MD, neurologist and sleep coach.
Lindsey:
I wanted to start by just summarizing what we went over in the last podcast. People should definitely go back and listen to it, but nevertheless, here’s a brief synopsis. Correct me if I have anything wrong on this, but basically, you as a neurologist were seeing patients who had problems with sleep, and you determined that it might be a deficiency of vitamin D. You started supplementing people with vitamin D and got them to that optimal range of 60 to 80, at which point their sleep seemed to improve and everything seemed to be going well. Some amount of time later, people started developing other symptoms like burning in their hands and feet, the sleep started going bad again, or they had arthritic like pain. Based on a book that you had read about B5 or pantothenic acid, you determined that must be a deficiency.
You figured out that there was a synergistic relationship between vitamin D as a growth factor and the B vitamins, because the bacteria are taking in the vitamin D and they’re producing the B vitamins. They then exchange the B vitamins amongst themselves between the different phyla of bacteria that are the primary residents of our guts. You then start trying to put people on just a B complex, a B100 complex*. And you saw people’s symptoms go away (with all the ones that had come back), and even saw some patients who had IBS symptoms clear up as their phyla became more balanced. You also saw that for some people, the B100 Complex (where it was 100 milligrams of most of the B vitamins) was too much. You dropped to B50* for some people, but would just keep them on the B complex for a limited period of time, (around three months), unless problems started developing again. Does that sound about right?
Stasha Gominak, MD:
It is and can I go from there?
Lindsey:
Please.
Stasha Gominak, MD:
None of these things individually make any sense. Keep in mind, I’m operating in the same belief system, as most people. We aren’t doing well because we eat wrong, we live in a toxic environment, we have IBS or food sensitivities because we have the wrong microbiome. I’m operating in that same belief system. After I start to give vitamin D, their sleep gets better. I presume that vitamin D is a growth factor to the bacteria. We had no proof of that at the time. The reason why I presume that is because IBS showed up at the same time as D-related diseases of multiple kinds, including sleep disorders in the early 80s. My thought was, “D goes low, the bacteria need D. And oh I’m going to be a hero because I’m going to give back this D and everybody’s going to lose their IBS, as well as lose their sleep disorder.” That’s not what happened.
At the end of two years, there were three things that didn’t get better with D that I thought should. One, my patients did not lose weight. They were exercising, they were energetic, they were feeling better, because they were sleeping better, but they didn’t lose weight. It turns out that’s linked directly to what’s living in your belly. The second thing was their IBS didn’t go away. So even though I thought it would go away, it didn’t go away. The thing was, golly, it wore off. The third thing that happened was this effect of improved sleep wore off at two years. So many people were complaining, “My sleep is bad, and my D is 65. I’m doing exactly what you told me, but my sleep is terrible and my joints are hurting me.” I’m about to see the rheumatologist and, personally, I’m doing exactly the same thing as my patients. I had this really weird buttock pain where I couldn’t sit down at the end of the day. It didn’t have anything to do with injury. In the build-up to this, I built in my mind this idea that sleep is about becoming perfectly paralyzed for this part.
So we’ve talked about sleep apnea, and that we can get too paralyzed here, but if you’re not paralyzed enough, your legs may still be moving. I wondered whether or not the leg movements that we see on sleep studies contribute to poor healing in certain joints. I was assuming that maybe my hamstrings are activated while I’m asleep. I’m in a fetal position and I’m holding on my butt bones. I’m making this up because I don’t really know why. So I have this urgency of thinking I’m doing something to my patients with this D that has other repercussions that I don’t understand. That makes me really uncomfortable. In two years I’m giving D, I’m left with this suspicion that something else has gone deficient, or there’s some long effect of D. It doesn’t make any sense to me that D should be causing this in two years. It’s at that point that a patient brings me a book about a B vitamin deficiency and it was well timed because I’d had two gals who had burning in their hands and feet. And the only thing they had was a headache. They didn’t have diabetes. They were already on B12. My experience in neuropathy as my specialty told me that this has a B vitamin ring to it. I read this book about pantothenic acid, and research publications from the 50s. They block pantothenic acid, a vitamin that nobody’s talking about and they caused burning in the hands and feet within two weeks. There was a scientific basis. I’m thinking, “Okay, I don’t have a good explanation for why this would happen. Why don’t I just give them this pantothenic acid.” I went to the store and I bought 400 milligrams. But at the same time, I remember them saying in medical school, “If you give one B, you should give all of them.” I have no understanding of why.
I’m completely a novice, I am not an expert like you are Lindsey. I go and I grab this B100 stuff*, because I can at least guarantee that each person I give the recommendation to will be taking the same thing. B complex is very confusing. It can have 3Bs, 2Bs or 1Bs. You never know what’s in there. I wanted to be sure I was recommending the same thing and B100 is a non-proprietary mix of 100 milligrams of each. It’s a large dose of eight B vitamins. That piece is really important. I take it myself and I give other people 400 milligrams of pantothenic acid and B100. That means I’m taking a total of 500 milligrams of pantothenic acid. It did not interrupt my sleep, but my restless legs went berserk. Immediately, I think, “Oh, it’s taken me four days to realize this. This is probably too big a dose.” Just like that vitamin D stuff, you can’t believe what’s in the literature. I stopped the 400 milligrams of pantothenic acid and I just took the B100. Everything went away. My butt pain went away in a day, which was very bizarre. I know nothing about vitamins, but I know that they’re not supposed to help your pain and make your sleep good, especially overnight. Now all my patients are coming back and they consistently answer in the negative, which is, “This 400 milligrams of pantothenic acid nearly killed me.” “I got very anxious or revved up,” or “I couldn’t settle down.” They’re using the same phrasing. I stopped it after two days because I couldn’t sleep. This is like the ADD medicines. This is a vitamin that goes right up into the brain and makes you agitated. Some people say, “I stopped the 400 milligrams, and I just took this B100.”
The surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep and our feeling of anxiety and agitation. That vitamin given in certain doses would actually cause those symptoms. It was not obvious to me what was actually happening, but it turns out the final answer is that vitamin D makes the final enzyme choline acetyltransferase, which makes acetylcholine. Coenzyme A and choline are used by that enzyme. The actual formation of acetylcholine is dependent on both D and B5. Choline is usually not deficient in most people. Making acetylcholine is how we stay focused. Not surprisingly, the epidemic of ADHD started to be reported in the 1980s. Your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it, so anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system which allows us to rest and digest. This means that side is all about GI tract motility, and is about calmness during the day and sleeping at night.
It turns out that you can become B5 deficient by losing your microbiome because the actual truth is that there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. If that means if you happen to be D low or deficient, and you don’t have the right gut bacteria, you can actually lose one of the most important parts of your body – an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. I gave the D that the microbiome wanted, but the correct four pieces of the microbiome weren’t still down there. They were missing the B vitamins that they needed from their buddies. When I happened to give them B100, as I was thinking about what I was doing, I thought, “If I’m right that these B’s are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid.” If we take this too long and the bugs grow back, pretty soon, you’re going to have two sources. You’re going to have the pill you’re taking, and your normal microbiome. Your sleep is going to fall apart and your pain is going to come back.
It turns out, if you take the B50 plus D, for three months, your bacteria come back, and you stop the pantothenic acid. It did not interrupt my sleep, but my restless legs went berserk. Immediately, I think, “Oh, it’s taken me four days to realize this. This is probably too big a dose.” Just like that vitamin D stuff, you can’t believe what’s in the literature. I stopped the 400 milligrams of Panasonic acid and I just took the B 100. Everything went away. My blood pain went away in a day, which was very bizarre. I know nothing about vitamins, but I know that they’re not supposed to help your pain and make your sleep good, especially overnight. Now all my patients are coming back and they consistently answer in the negative, which is, “This 400 milligrams of pantothenic acid nearly killed me.” “I got very anxious or revved up,” or “I couldn’t settle down.” They’re using the same phrasing. I stopped it after two days because I couldn’t sleep. This is like the ADD medicines. This is a vitamin that goes right up into the brain and makes you agitated. Some people say, “I stopped the 400 milligrams, and I just took this B100.”
The surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep and our feeling of anxiety and agitation. That vitamin given in certain doses would actually cause those symptoms. It was not obvious to me what was actually happening, but it turns out the final answer is that vitamin D makes the final enzyme choline acetyltransferase, which makes acetylcholine. Coenzyme A and choline are used by that enzyme. The actual formation of acetylcholine is dependent on both D and B5. Choline is usually not deficient in most people. Making acetylcholine is how we stay focused. Not surprisingly, the epidemic of ADHD started to be reported in the 1980s. Your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it, so anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system which allows us to rest and digest. This means that side is all about GI tract motility, and is about calmness during the day and sleeping at night.
It turns out that you can become B5 deficient by losing your microbiome because the actual truth is that there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. If that means if you happen to be D low or deficient, and you don’t have the right gut bacteria, you can actually lose one of the most important parts of your body – an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. I gave the D that the microbiome wanted, but the correct four pieces of the microbiome, weren’t still down there. They were missing the B vitamins that they needed from their buddies. When I happened to give them B 100, as I was thinking about what I was doing, I thought, “If I’m right that these B’s are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid.” If we take this too long and the bugs grow back, pretty soon, you’re going to have two sources. You’re going to have the pill you’re taking, and your normal microbiome. Your sleep is going to fall apart and your pain is going to come back. It turns out, if you take the B50* plus D, for three months, your bacteria come back, and then you stop the B50.
Lindsey:
That’s amazing that you discovered all that, and were able to help people recover their sleep and the bacteria.
Stasha Gominak, MD:
It’s pretty freaky. I have to say, I still think it’s pretty amazing.
Lindsey:
I did have one client who told me that when he first started B complex, he felt very agitated. Is it the B5 in there that could have been causing that?
Stasha Gominak, MD:
Yes, and it’s not just B5. B12, B5 and several of the Bs are working together. They never work alone. That original comment that “if you give one B you should give all of them” is usually, not always the right recommendation. Because the nervous system really uses all of the Bs to make the neurotransmitters. What we feel and what we experience is about dopamine, serotonin, norepinephrine, epinephrine, acetylcholine. The paths to make those are all linked to the B vitamins. I have patients who get agitated with B12 as well, so they’re linked in some way that isn’t completely clear to me.
Lindsey:
Do you use Organic Acids Testing at all, in your practice?
Stasha Gominak, MD:
I know what organic acids testing is, because I’m a neurologist. We did that in early childhood development diseases, but I do not use any of those tests. I use a very simple set of tests. I’m interested in the B12 and the D level and that’s it. I’m mostly focused not on what is your unique genetic problem, which is still important. I believe that people like you, Lindsey, that are expert in other areas, will get more success or greater range of success by putting back the normal microbiome and getting the D. All the stuff that you guys know about zinc, or copper, and all the specialized things that are only partially known, I’m not even sure anybody knows that yet. I’m hoping that this natural part, when we put it back, will then lead to being able to build on it have better success in the interventions that you’ve discovered.
Lindsey:
I only asked because on the Great Plains Lab Organic Acids Test, there’s a marker for B6, but I’ve literally only had one client ever who’s had a normal level of B6 on that test. I’ve heard other people talking about this as well, so I’m just curious whether B6 deficiency is a super common thing, but you don’t test B6, in any case.
Stasha Gominak, MD:
I don’t, but it’s interesting to note that B5 and B6 were studied together back when they were actually studying vitamins. Back in the 50s, 60s and 70s, they used both of those. B6 is really important because it’s necessary to make dopamine and that means it is absolutely a player in making the neurotransmitters that make us sleep. It appears to me that B5 acts like there’s no controller on the enzymatic formation of acetylcholine. To me, it’s completely sloppy and dangerous that something I should take as a supplement would mean I can either sleep or not sleep. That just freaks me out. There should be a modifier. If my bugs happen to make enough B5, or they don’t, there should be somebody up at the brain level saying, “We can still make an even amount of these neurochemicals. I think that’s the case for most neurotransmitters; that you don’t see someone make too much dopamine when you give them B6. There aren’t clinical symptoms that go along with that. To me, this is still an unexplained error. It does suggest that our gut bacteria is pivotal to making us be calm and sleep. That’s really important. It’s certainly something we’ve observed. People have gotten higher incidences of depression, anxiety and suicide over the last 40 years. At the same time, we’ve made up separate explanations for that. It would then suggest, maybe we should explore this possibility to maybe this abnormal gut biome is actually making us have these emotional states that we don’t want.
Lindsey:
Yeah, it’s kind of tough nowadays to pull apart what’s happening nutritionally, the sun exposure, the social media and the devices. There are a lot of confounding factors. In your experience, was the onset of IBS symptoms after giving vitamin D or did they already have IBS, and then when you give them the B vitamins that help cleared it up?
Stasha Gominak, MD:
I never induced IBS with vitamin D. In my experience, what I saw was probably a quarter of my patients who remember, are seeing a neurologist, so they’re not coming in with IBS as a complaint. I personally became very sensitive to onions, garlic and things like that in my 30s. We were actually trading recipes for probiotics at the time. I’m taking something and they’re saying, “No, my GI doctor has something better.” That was really the only answer to IBS at the time, but it hadn’t worked, or they wouldn’t be trading recipes with me. I thought this deal was going to fix that, but it didn’t. Not everybody has complaints, but the people who had IBS still had IBS. I thought that was a good idea, but it didn’t work. This idea came to me. They’re making the B’s. Why would we have things called B’s? Maybe that’s what they’re lacking. I stumbled into this completely by accident, but it works beautifully in the people with IBS. By the end of the three months, we learned to stop the B’s and their IBS was gone.
Lindsey:
How many people are we talking about?
Stasha Gominak, MD:
1500 at the time.
Lindsey:
1500 with IBS?
Stasha Gominak, MD:
No, 1500 people total that I’m doing this with in my process; so maybe a quarter of that many. It’s been very successful since then. Here’s the problem. As soon as you get those bugs back, you have to pay attention to the fact that once you’ve gotten back the bugs, they are not the only reason why your belly may be out. If the nervous system of the belly starts to complain, that’s the same nervous system that does rest and digest. Your belly system is directly related to how your sleep is. It usually turns out if you don’t have the B’s or if you’re taking them when you don’t need them, if you’re giving your nervous system an extra one that doesn’t want them, you can see agitation, anxiety, sleep problems and a belly that feels just like IBS.
Lindsey:
That’s interesting. I have a client who stopped sleeping. Now I want to go back and make sure what’s going on with the with B vitamins. I suggest B vitamins for a lot of people.
Stasha Gominak, MD:
They are important and they work. It’s a different framework to think about them as their job to bring the bugs back. Once the bugs come back, we have to sit for a while with the B’s off board and say, “What does my body and my nervous system say about the production that my bugs are giving me now?
Lindsey:
It seems like we’re having an epidemic of sleep apnea and I know some of it is connected to obesity, but obviously some of it isn’t. What do you think is at the root of that?
Stasha Gominak, MD:
One of the things that happened to me when I went into these B vitamins was my husband handed me this article that was out of the economist journal, which was peculiar because it’s a journal about making money. This article is still, in my view, a very brilliant article about all the things that the GI doctors had learned about poop bacteria. It’s not my specialty. You can access it on my site or you can just go to the economist journal and ask for Me, Myself and Us. It’s a three page article. One of the important things they have in there is this: you take a mouse, and you do a gastric bypass on it or you’ve got to do a gastric sleeve. You take the poop bacteria from that mouse, and you transplant it into another mouse, the second mouse loses weight. It’s really not the sleeve. It’s that the bacteria that live inside us actually govern our appetite. They make small chain fatty acids that go up into these little receptors in your nose, and make high fat, high calorie foods smell better to you. They have actually been running our appetite. They also run what we do with the calories we eat. There’s a huge argument on these health and wellness internet sites about what it is that makes me fat. Some of the controls are really not in the hands of the endocrine system of the person who is obese – it is really their microbiome that is saying, “We’re in winter. Winter means I take the calories you eat, and I put it into fat.”
When you look back, I happened to go to my 50th high school reunion. There are very few people who are obese in my entire school in 1972. This epidemic is not just about what was available. Because pizza, hamburgers and cheeses were available, then, part of it is that you have the wrong microbiome. That turns out to be playing a huge role in your endocrine system. It is a part that generally all the MD’s have missed. They’re starting to pay attention to the fact that when we do fecal transplants, you better ask who your donator is, because if they’re skinny, you can get skinny. If they’re obese, you’ll get obese. There was a connection between the D that we make on our skin, which runs whether or not we’re in a winter microbiome, or a summer microbiome, there was a change. Bugs would train our body to conserve and make fat. We, oddly enough, follow bears around and collect their poop during the year. We showed that their microbiome changes throughout the year and that the bear gets into a, I’m going to put on fat mode in the fall to allow the bear to make it through the winter. And we don’t we don’t shame fat bears. We just think that it’s helping them survive. Medicine hasn’t seen it through this lens. It’s not about eating very much. Those people who are still hungry after they’ve eaten two full meals are being run chemically to still be hungry.
Lindsey:
That explains some of the some of the obesity connection to the microbiome, but what about the sleep apnea?
Stasha Gominak, MD:
Oddly enough, the acetylcholine that we talked about is a chemical that allows us to get perfectly paralyzed. It’s not the only chemical. There are multiple neurotransmitters that are actively involved in not only allowing us to switch in and out of sleep. You have to fall asleep. That’s a complex process, and it’s run by chemicals. When you go from light sleep to deep sleep, you become paralyzed and there are specific chemicals that are running that process. Acetylcholine turns out to be one of those that you can come become deficient in by having a low D and losing your microbiome. That means you can actually get too paralyzed when you’re supposed to be in this space where you are perfectly paralyzed. We first found that disease in men who were post op from a cardiac surgery in the post op population. That means we found it at its most severe.
Those people that had sleep apnea for 20 years, got cardiac disease because their microbiome was screwed up, they had low D, and their sleep was bad. Sleep apnea is one of the worst manifestations, but it’s really on a continuum and it includes not being able to sleep. Insomnia is greatly overlooked. You spend all this time talking about sleep apnea and blaming the oral pharynx. There is an anatomical part to getting incorrectly paralyzed so that when you’re sleeping and deeply asleep, you’re supposed to be able to keep the airway tube open. If it doesn’t work, then you stop being able to keep the airway tube open. Part of that is anatomy, but part of it is the central controller that makes us paralyzed in certain phases, and that links back to acetylcholine, D, and the B’s that we make in our belly. Normal animals do not get sleep apnea. Those normal animals that live outside and have a normal microbiome don’t get sleep apnea.
Lindsey:
They don’t get a lot of the stuff we get.
Stasha Gominak, MD:
It is interesting, because they are exposed to the same toxins are. One of the things that struck me was if we look at this as humans just being one of millions of animals on this planet. Why is it that only the humans globally have developed sleep apnea? By the way, we’re not really the only animal. Our dogs and cats, (dogs especially) already have these legends of running while they’re asleep. They are actually acting out their dreams just like we do, because they are not paralyzed because their D is wrong, and their microbiome has changed. It’s not that the toxin stuff is not correct. It’s important for us to pursue that. In terms of what I can do personally, for myself, going outside, more getting the microbiome to the right are things that can still help.
Lindsey:
So sleep apnea sufferers: get more sun, get your D corrected, possibly go on a B complex as well.
Stasha Gominak, MD:
And go to my site and learn about how you’d want to use those two together.
Lindsey:
What relationship do you believe sleep has had to the rise in mental health issues and children?
Stasha Gominak, MD:
I think that in the background, when we don’t acknowledge that most kids who have emotional disorders during the day also have a sleep disorder. The hard part is realizing that we only see what’s normal sleep. We see what other parents say to us like, “My kid gets up twice during the night.” I’m talking to my colleagues that are 30 years old at the same time, and their kids get up the same way. My mother says, “You guys didn’t get up in the middle of the night.” We don’t pay attention to what mom says. We say, “Everybody I know has kids who get up in the middle of the night.” You really have to go back to the 1960s and ask what the sleep studies were showing then and is there something that could be affecting every pregnant mom (i.e., they’re doing what their doctor tells them), which is to put on sunscreen and not go out in the sun. They’re also not exposing their newborn to the sun. Are there things that could be going on in these last two generations that are relatively new? Emotional problems are related to how well we make our neurotransmitters, and the neurotransmitters are made while we’re sleeping. They’re made in certain deep sleep episodes. We also make growth hormones. We make all of the hormones that are important to our behavior and our well being, so the hormonal systems as well as the neurotransmitter systems are tightly linked to whether or not we sleep normally. All of us know that we feel better, we’re more patient and we just feel better about ourselves when we sleep better.
So basically, get your kid out in the sun and go to my website to learn about D, because you’re going to have a very difficult time talking to your physicians about putting your kid in the sun. You have to learn more about it. There’s a huge controversy right now about taking D as a supplement versus going out in the sun. If your child has an autoimmune disease, has food sensitivities, is very anxious and has lots of things that we’re talking about in adults, those things are linked to the microbiome. You’re going to want to do the D plus this B complex for a while. It’s a little bit bigger. If you just have a kid and he wakes up once a night to ask for a glass of water, and everything else is fine, then I would just put that kid outside more. If it’s much more complex than that, then there’s a bit of depth that you have to understand. I actually have a set of videos that help with pregnancy, fertility and first year of life because you’re giving breast milk to that baby. You have to know about the B’s and the D through breast milk. There’s another set of videos about how to do this in a child, what age groups and what is really normal sleep for toddlers or teenagers.
Lindsey:
You mentioned as you were talking about children that D is something the mother is giving to the child. Is the child not getting sufficient D from the mother?
Stasha Gominak, MD:
Yes, the child is not getting sufficient D from the mother. Most women now are trying to get pregnant when their Ds are quite low and D by itself is a major player in infertility. That’s in the OBGYN literature on fertility and early premature delivery. The D covers the placenta. You are really carrying another being inside you. You do not want your immune system to recognize that other being as not belonging there and D is heavily involved in what the immune system sees, doesn’t see and tolerates. Low D leads to increased delivery at prematurity. Low D is also now in the literature about pre-eclampsia and, unfortunately, things that have to do with physical malformations of the baby. Mostly, it’s about being able to carry your baby to term that is in the OBGYN literature, yet, the fertility experts are not using it. All you really have to do is get your D above 40 and you will get pregnant (for a great majority of women). It also probably affects fertility in males, but predominantly in females. When the D is low, it suppresses the ability of the ovary to ovulate. It doesn’t make the woman able to have babies. Once the woman gets pregnant, the only D that baby will get is coming from the mom through the blood into the fetus.
The second piece is that the only B source is not the prenatal vitamin. There are some B’s in there and the prenatal vitamin is a disaster, but the gut bacteria of the mom are the primary supply for the Bs for the baby. That means in early development, the first 12 weeks where all the basic functional development of the arms, legs, heart, etc. takes place. That means we already have a whole body of literature that talks about cleft lip, cleft palate being related to B vitamin deficiencies. The neural tube defects are related to B vitamin deficiencies. That means all you have to do is get the moms D above 40, get her on a B50 and get her microbiome back – her risk of early natal development issues in the baby goes way down. Once you know that, you can actually listen to things people tell you about their experience in the delivery of their first, second and third kid having these additional problems. The birth order also plays a role – by the time mom is having her third child, if she hasn’t been going out in the sun, her D is even lower than it was before. Her Bs are now depleted and that child is more likely to grow up starting with problems with waking up frequently and having microbiome problems. A lot of the interesting stuff the other practitioners who are working with me say, “This kid isn’t sleeping. You give them iron, and they start sleeping.” That’s because the microbiome is naturally set up to help you absorb the small charge ions. The mom is iron deficient because she’s been walking around since the second kid with a microbiome that doesn’t allow her to absorb iron. It’s much more complex than just the B’s and the D – there’s a bunch of other things that the microbiome is doing. When you don’t have the normal microbiome, you’re at risk for all sorts of things.
Lindsey:
Interesting. It’s also is interesting, because I think about how I went through infertility for many years, and I’m sure that nobody tested my D or looked at that. At some point I got into eating organic foods and I’m not sure if, I don’t recall taking many supplements, but I eventually got pregnant. So something went right.
Stasha Gominak, MD:
Sometimes you can trace back to going on vacation and a sun-filled environment. I have one friend who had five miscarriages and then went to the Bahamas. Oh, got pregnant. It’s really straight D related.
Lindsey:
You were saying above 40 and I’ll tell you this. I have clients get their D tested if they were not supplementing with D and without fail, it’s somewhere between 20 something and early 30 something. I don’t think I’ve ever seen a level in the 40s from somebody who’s not supplementing.
Stasha Gominak, MD:
That’s correct. You can occasionally see it in somebody who’s 17 who just was at the tanning booth for the last three weeks because she’s just about to get married, but that’s really the only occasion where I’ve where I’ve seen that happen.
Lindsey:
Right? I just think unless or maybe somebody perhaps who works outdoors and has decided not to wear sunscreen, but that’s pretty unusual.
Stasha Gominak, MD:
Very unusual.
Lindsey:
Tell me a little bit more about acetylcholine. I’m interested in this because I’m not very familiar with the topic. You touched on it, but I need to hear it again – about its role and origin in the body and what disorders are associated with the lack of it.
Stasha Gominak, MD:
First off, acetylcholine is something that no layperson should be familiar with. Nobody talks about it. I’m a neurologist, I should know. When we’re taught early pharmacology, we are taught about the parasympathetic nervous system, lay people know about the sympathetic nervous system, because we talk about it. The autonomic nervous system is two halves, one of which calms you down and runs the GI tract. The other one is the sympathetic. The parasympathetic is basically run by this chemical called acetylcholine. I saw all these things I just described to you in my patients, and I’m a neurologist, but I don’t really understand why they’re getting agitated and anxious. I just really don’t have a chemical basis for that, but when I’m starting to give lectures about it, I think I really have to come up with a better answer than, “It acts like caffeine.” I just typed into Google “coenzyme A and the brain.” What was in the book I told you about was: coenzyme A, (B5 becomes coenzyme A) is pivotal in making cortisol. So that was the underlying reason why they were giving B5 to people with rheumatoid arthritis. We knew that they had a problem. We gave them prednisone and they got better – so maybe there’s a cortisol link.
I really didn’t understand why giving B5 caused people to be agitated, anxious, etc. I found, “Coenzyme A is pivotal to make acetylcholine,” and I think, “I’m a neurologist. Acetylcholine, what does it do in the brain? I don’t even know.” I mean, I know it’s related it to Alzheimer’s disease. I know it’s at the neuromuscular junction, because we have myasthenia gravis, and people get weak, but what does it do? I started to look around and it turns out these sleep diagrams that show us how we get paralyzed, have acetylcholine as a player there. The next thing I realize is, why don’t I know what acetylcholine does in the brain? I know what serotonin does. I know what norepinephrine goes. It turns out we learn as neurologists what neurotransmitters do by giving them drugs. I have dopamine, I give it to Parkinson’s disease patients. I have a serotonin reuptake inhibitor. That means it prolongs the action of serotonin and I give it somebody who’s sad.
There are no drugs for acetylcholine. There’s nothing except nicotine. Nicotine turns out to be one of the oldest drugs we have available, and early on in the early 1910-1920s we were studying the nervous system. We started to realize that there are nicotinic receptors for acetylcholine, and muscarinic receptors. That means we’ve actually written our textbooks with nicotine as part of it and it turns out that acetylcholine acts like nicotine. In some receptors, it acts like this other drug, and I’m looking at this going, “This is weird. Does that mean that the people who smoke a cigarette and feel better could have an acetylcholine deficiency state in their brain? Does that explain why I smoked a cigarette and immediately felt agitated and threw up? Could it mean that the people who get addicted to this chemical are actually feeding their brain with a chemical they’re deficient in – much like I’m taking a serotonin reuptake inhibitor, they’re smoking something. If you’ve been around smokers, if they’re really addicted, they get up in the middle of night, they smoke a cigarette and go back to bed. For those of us who don’t smoke, it’s bizarre. It means that they are actually treating themselves with a chemical that we have vilified, but we should really start thinking of it in a different way.
Now, the next thing that leads to is, I’m reading these articles about the frontal lobe and the ability to concentrate. Some of these articles are said to be by clients and they say, “Hey, have you looked at this? This is about acetylcholine.” It turns out that the basic scientists have been studying acetylcholine and its actions in the frontal lobes. They say acetylcholine is what allows us to get distracted and come right back again. When you get to the conclusion of the article, they say, “This really means we really shouldn’t be giving ADD kids things like methamphetamine”, which is what we’re giving them. The amphetamines up the norepinephrine. They say, “We should really be giving them nicotine.” There’s no way I’m going to convince a 32-year old mom with two kids to give their kid a cigarette at recess, but it means that we’ve missed an opportunity, because there are no drugs. There are now studies using nicotine patches in kids with ADHD and in autistic kids. Acetylcholine is actually a neurotransmitter that you can develop a deficiency state of, looking like a normal human, but really not being, because you don’t have the poop bacteria that you need. It turns out there are multiple different acetylcholine deficiency states, Parkinson’s is one of them.
Alzheimer’s disease is another one. There are other ones that grow out of that, having to do with tremor and gait disorders that are important to neurologists – that have been documented that pathology and by various studies using MRI and other imaging studies that show the acetylcholine tone, or how much of that chemical you have, is actually deficient. Oddly enough, in the last three years, there have been a couple of articles out of a specific lab that’s actually studying B5 deficiency states at autopsy in both Huntington’s disease and Alzheimer’s disease. I thought I wouldn’t be alive when they finally got around to that, but they kind of stumbled into it by accident. So there are many acetylcholine deficiency diseases. It turns out that anxiety is one of those and it may turn out that in autism, some of the features of autism are related to that. Absolutely. ADHD is basically a description of this person not having the right chemistry minute to minute. A lot of my clients now will be able to say, “When I get my B5 dose to this, I’m just calm and organized. I reorganized my entire basement and I’m not yelling at my kids.” It’s just weird and it really is something that lasts for eight hours before it goes away. Some of my clients have to add an additional tiny dose towards the afternoon.
Lindsey:
Of B5? It’s what’s bringing up the acetylcholine in the context of a B complex.
Stasha Gominak, MD:
Usually I use it in the B complex. There are certain people who wind up in huge doses of B5. Here is the part I left out for you. On that original group of people, there’s 40 people I see in a week. I recommend 400 milligrams of panothenic acid and B100. There were a couple of outliers who didn’t come back and say, “Were you trying to kill me?” The two gals with a burning in their hands and feet were much better in two days. There were two or three people who had a little bit of a tremor and a little bit of signs that looked kind of Parkinsonian. They came back six months later, still on 400 milligrams of pantothenic acid, suggesting that there are some circumstances in which 400 milligrams of pantothenic acid is exactly what their nervous system needs. That’s really a big topic and there are all sorts of genetically related things. There’s a whole bit about choline, iron, and a few other things that are necessary to make acetylcholine. Iron is actually a regulatory cofactor also, and I’m just starting into that path.
Lindsey:
What’s the relationship chemically between choline and acetylcholine?
Stasha Gominak, MD:
I can show you the equation if you’d like, but there’s choline, then Acetyl Co A. Those two have an enzyme that’s called choline acetyl transferase. That enzyme is made by D. When D hits two receptors in the brainstem sleep receptors, choline acetyl transferase is made. It’s the final enzyme. So you need the two basic pieces, the enzyme and you get acetylcholine.
Lindsey:
Okay, so not the exact same things. They’re not just like the active form, but actually chemically different.
Stasha Gominak, MD:
There’s another piece to this: within the last 15 years, there’s another process called the acetylcholine anti-inflammatory pathway. That is related to vagus nerve stimulation, which is the big wire that makes the parasympathetic. Vagus Nerve Stimulation was being used to control epilepsy. When they stimulated it electrically, they saw that the spleen responded to that stimulus by secreting T cells out into the body. Those white blood cells (a specific type) secrete choline acetyl transferase. They secrete the enzyme that makes acetylcholine. That means there are pathways that adjust our inflammation minute to minute in our body. I saw a bunch of things with people that I didn’t understand. We get to D and B5 to a certain place and now they have eczema and a rash. Now they have weird skin stuff that I can’t even understand. What about all those people with that joint pain? What was that about? It turns out the inflammatory system is also in controlled minute to minute by acetylcholine as well, but it’s a completely different pathway that doesn’t even involve D.
Lindsey:
Can you supplement directly with acetylcholine? I feel like I’ve seen supplements.
Stasha Gominak, MD:
The problem is that it will be broken down as soon as you take it. It needs B5 to become coenzyme A, and it needs enough choline, which is deficient in some people, that it needs this enzyme.
Lindsey:
A lot of choline in egg yolks.
Stasha Gominak, MD:
Egg yolks. It’s famous for that.
Lindsey:
I know we’ve run out of time and again, I’ve really enjoyed getting into the geeky level science stuff on this and perhaps we’ll have to have you back to get into the whole endocannabinoid stuff.
Stasha Gominak, MD:
Yes, I would love to do that because that plus the B vitamins, childhood development and autism are really important.
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