Adapted from episode 79 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD and edited for readability with 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 and 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 will be discussing today. Today she currently divides her time between RightSleep® coaching sessions for private individuals and teaching other clinicians the RightSleep® method of sleep repair.
Lindsey:
So let me just jump right in and ask you how you stumbled onto the connection between vitamin D and the gut microbiome?
Stasha Gominak, MD:
Thank you for asking that question. Lindsey. It is really interesting. So I started with an interest in sleep. I’m a neurologist, I was noticing that most of my neurology patients, regardless of the reason why they were referred, if we would do a sleep study, they 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 a 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 to not 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, 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 going to just fix it. Because I thought that it made sense that perhaps we change our metabolism through changing the microbiome, therefore, vitamin D should be a trophic factor to the bugs that live in the belly.
Lindsey:
Could you define trophic factor?
Stasha Gominak, MD:
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 the 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 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:
Okay, well first, let me ask you, if you can just bring it together a little bit better that connection between vitamin D and the B vitamins?
Stasha Gominak, MD:
Yes. Okay. So I’m going to go into the history a little bit. So here’s what happened next. So I’m giving vitamin D because I want to get their sleep better and the sleep gets better. But then it starts to fail. So after two years of using vitamin D, the beneficial effects on the sleep start to fade and lots of other things start to show up and they’re kind of 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, 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, it’s really not in the food. That means 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.
So one of my patients brought me a book about a vitamin called pantothenic acid that no one’s talking about, B5. He brought me a book about it. And it was a book written in the 1990s by a layperson about rheumatoid arthritis, joint pain, and pantothenic acid, and 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 and saying that their pain got better and their sleep got better. So I personally was not knowledgeable or that interested in vitamins. But I was desperate. And I really didn’t know why everybody was failing. And I went to the references that were in this particular book. And the references were of laboratories in the 1950s, that blocked pantothenic acid using a specific chemical blocker. And within two weeks, they showed that the people in whom they blocked them had burning in their hands and feet, inability to sleep, belly pain and a funny gait.
So there was scientific evidence suggesting maybe this vitamin D that I’m giving is somehow making these other B vitamins go bad. Now, the thing that’s weird about that concept is, this didn’t show up until 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 vitamins B, of which there are eight, come from the food. So if they haven’t had a change in diet, 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 if that’s what’s going on? Now I start to read about the B vitamins. And 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, oh, they come from the poop bacteria, and they come from the food. Well, if my patients have started to have burning in their hands and feet, and keep in mind, I’m a neurologist, neuropathy is my subspecialty. So I’ve been doing this for 30 years. Burning in the hands and feet is not common. Burning in the feet is pretty common, but in the hands and feet in 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 sort of 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, all sorts of things we do. So maybe I’ve made them deficient. Why would that happen? What if the real source is really from 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. And they have become B deficient because their bugs are off. Now the weird part about that is I’ve been given them D for two years. Why didn’t the healthy bugs come back? So the first question was, well, 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? Okay. In the background, I’m reading all these other articles about the fact that there are historical articles that suggest that the four healthy phyla that we have of bacteria actually trade B vitamins among themselves. So there are lots of articles from the 1930s/40s that say this particular species makes riboflavin, this species makes thiamin. So there’s actually a whole body of literature that says, we first described the B vitamins, as bacterial growth factors in the 20s and 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. I’ll tell you about that in a minute. So they’re pouring this stuff into a Petri dish. And then they’re watching the bacteria that grow. And then they realize over time that there are things called growth factors that are chemicals that are in there and the bacteria are actually making them.
So there’s a 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. And that’s kind of weird. Like, why are they all grouped together? It’s because they were discovered together in this liquid that they actually use that was already sitting on the counter. So picture they’re way back in their little microscopic world doing these bacterial growth studies. And they borrowed their wife’s yeast solution that she’s got sitting on the counter that she put brewers yeast in, because she was going to make beer. And 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. And what you’re really doing is you’re choosing a middle temperature that promotes the growth of bacteria that are naturally in water, in the air. And 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. So the same yeast-bacterial mixture that is 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 means the 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 from the sun, but it’s a different chemical. And the bacteria that grow in that water with the yeast in it are selected for by being four different groups that want D. So in actual fact that liquid would trade D from the yeast, with the bacterial growth factors that helped the yeast, so they would help each other. They run in a symbiotic relationship, then they use that same liquid that they stole from their wife’s kitchen cabinet, poured it in a petri dish and started to study the bacteria. And soon they found that some of the Bs were heat sensitive. So if they boiled the liquid, they couldn’t get certain ones to grow.
And then they saw other interesting things like, here’s a little lump of white stuff with little black tips on it. And that’s a particular kind of bacteria. And it has a clear zone around it. And somebody said, Well, does this mean that these bacteria are secreting a chemical that prevents this little yellow slimy one from growing into its territory? And the answer was yes. And penicillin is born. Penicillin is an anti-bacterial agent, it’s made by bacteria. Well, why would they do that? Well, 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. And in actual fact, 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, and I buy pantothenic acid, I don’t know much. And so I think well, if they said, if you give one you should give all, I pick up this stuff called B100. That 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 (so I don’t brand my own vitamins). So I give this B100 stuff. And I read the articles I described to you and I thought, you know, the one thing, 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’s piles of poop in between these healthy guys. And 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 in actual fact it did, but because I’m following sleep and pain as a measure of whether or not they’re back to the way they were, that’s a long discussion. But ultimately, within three months of taking B100 and D, all the symptoms get better and go away an d the belly IBS symptoms go away. So there’s sort of a second idea in the background. D by itself, and this is really an important piece, because now everybody’s interested in D, COVID has hit the front page, everybody’s taking D. But anybody who has a D that’s low, you can pretty much assume that their microbiome has gone bad. And I didn’t actually have IBS symptoms; I just couldn’t eat garlic. But if you do D, and you do not bring back the supportive natural microbiome, and 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 so that the 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. And I sort of knew about the fact that the Bs were discovered together, but I had no idea about the logistics of it. So that’s amazing. So just 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 Gominak, MD:
And I want to circle around and give you one other way to test this concept that the B’s come from the bugs, okay, because there’s another approach to that. But we can come back to that at the end. Vitamin D is extremely controversial at the moment, there are emotion laden fights going on between people in medicine, people in supplements. It really is one of the fascinating parts of medicine. So one, anybody who’s taking vitamin D should spend some time and learn about it. Two, you’ll find very divergent opinions. Okay. In the background, 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 that is very important to all of us.
And in short, I had one simple question. I’m interested in sleep, not hormones, I’m interested in sleep. 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 don’t make enough rapid eye movement sleep, they just don’t have any. Okay, 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 Ds. And then I find that there are scientific articles that show that 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. Now, the next question was, 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 say, hey, you know what, my sleep is better? Like I had a very simple question. If we increase the D blood level, and we keep measuring it, so there is a very specific blood level of 60 to 80 nanograms per mL that promotes better sleep in someone who’s had a sleep disorder. Okay. In the background, you have to be D deficient for a long time before you develop a sleep disorder. So one, it’s 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, now COVID. We are the only animals on the planet who had a biology that meant we lived 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, and you say these people don’t even have a hut, they just live outside all the time. You will see that their D levels are in the 40s and 50s. I think that’s a different question. What if I’ve never gotten D deficient because I live outside and I don’t actually have to push it to a place to feed a deficiency state. Okay, so the 60 to 80 range is argued about because every clinician who uses D a lot, has a different range that they believe in. Mine was based on watching people sleep. And I really just said, “Well, how’s your sleep now?” And when they came in and said, My sleep is better, I go, “Oh, this is awesome. Let’s go down and see what your D level is.” That has now been consistent since 2010. So it’s been 12 years. All right. So in the midst of this, there are multiple questions about it. There is a question about most people who want to look at supplements and want to know, what’s the 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 mililiter.
Lindsey:
Okay, yeah, and I’ve definitely heard the numbers 50 to 80, and 60 to 80. And I find that my clients, to get to that level, usually you start them at 5000 IU of D and I always do D and K together. And then usually at some point, they hit the optimal levels, and then you can maybe reduce it to a little less or less frequently.
Stasha Gominak, MD:
Let me comment on when you’re trying to manipulate your sleep. If you see sleep as the final way that we heal our body. Okay, you and I are intervening. We’re biohacking by giving things that 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 that you don’t ever develop medical problems or that you heal your medical problems, then watching what your D level is at least four times a year, so that you’re aware of what’s my summer maintenance dose with sun as a second source? What’s my winter maintenance dose? And more importantly, are there physical signs that I get when my D drops below 60? Are there physical signs I get when my 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. So 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. Same thing with cortisol. Same thing with testosterone. Same thing with estrogen. When you go in and you’re taking supplements from your doctor, the doctor is focused on what your symptoms are. Because they know that’s a reflection of do I have the estrogen level, right? Do I have the testosterone? 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 it in the 60s. For most people, when you get physical symptoms that suggest is too high or too low, then you adjust it and you run 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:
So what kind of symptoms do people manifest when it’s too high?
Stasha Gominak, MD:
The problem with that is it’s a little different in each person. Okay, so really, the way you should look at this is if someone’s coming to me with problems, and we say most of us in this world around the globe now are D low 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 to your sleeping bad, or your microbiome being goofed up, okay. And then over time, as you get more D and some of those symptoms go away, they’ll usually be signs of what happens to you when your D goes low. Now, that is particularly difficult, because those are all things like oh, I wake up at 3 a.m. and I can’t go back to sleep. Oh, I have foot pain. I was told I have plantar fasciitis. Oh, I’ve been told I have ulcerative colitis. They’re all things that we’ve applied names and legends to. Okay, so I have these things because blah, blah, blah. And we weren’t told it was because we had low D. Then when those things go away as you’re taking the vitamin D, as they go away, then you realize, oh, my D is better my sleep lupus better, I all sort of colitis is gone. And oh, by the way, my eczema is better, then you start to list the things that are responding. And then over a period of many months, as long as a year, you can actually show that when my D is in that 60-80 range, I don’t have the following 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 a low 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 you about what will likely show up when you’re learning about how your body tells you your 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 world of get your X number of minutes of sun a day and went and 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 Gominak, MD:
Okay, 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 when you and I have been living our lives with a low D, and D, by the way, in its primary use can actually go into the cell and correct a squamous cell carcinoma. So you, grow a squamous cell carcinoma in a petri dish, you pour in D, it corrects itself and 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 light and UVA and the damage to our DNA. Now, having said that, we’ve just walked around on the planet, (for me) around 40 years without that protection. That means 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.
Now, I want to say to each person, you have to do what you’re going to to deal with the 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, one, should be examined all the time by the dermatologist, and two, should be pretty careful about sunscreen. Now, I want to circle back to your original 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 a literature that suggests 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 that do things to our mitochondria deeply in our body that help our health.
Okay, so then I want to back up to say, I still support your idea that being outside is the best thing you can do for yourself. Now, 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 are in fact 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 a D325OH. Well, 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, one 1,000,000th of what we should know about this chemical.
That means when we want to biohack, we should really just go back to what is the evolutionary model that we’re following. All other animals live outdoors. All other animals have fur, feathers, scales, so we are kind of unique. We 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 Neanderthall, who were furrier. We actually slept better, reproduced better and got smarter. We have a kind of a unique situation. Now, if you look at it through that lens, it’s still much better for you to be outside.
And frankly, I suspect that we’re going to see more and 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 that 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 all at the same time. We can use Lindsey’s belief system, about toxic environment, functional medicine, detox, the GI tract is the center. We can use Stasha’s if it’s about sleep; we can use routine medicine also. We can take from all of them the things that are valuable to us.
Lindsey:
So I guess to sum it up, go outside, use sunscreen to keep from getting burnt, and get some of your D from supplements as well.
Stasha Gominak, MD:
I think that’s a good summary statement that each individual person has to use their judgment to which one they’re going to do and that they should still observe what’s best for them.
Lindsey:
Yeah, and might it be a good idea to increase your D levels with supplements before launching into your “I’m going to go get regular sun every day without sunscreen” project?
Stasha Gominak, MD:
Actually, that is a great idea. My view is some people really can’t tolerate that this is the temperature that’s outside in Texas right now.
Lindsey:
I mean, in Arizona, so similar.
Stasha Gominak, MD:
Yeah! It’s very difficult to tolerate 100 to 110. Now, one of the fascinating parts about that is our autonomic nervous system, the nervous system that 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. So our ability to manage our internal temperature is directly related to that. That means humans have actually lived in Arizona, like I was recently down to near Big Bend. It was 110. I was like, “How did these people live here 100 years ago, without even a tree? How did they make it?” They did make it! And that means that 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 have lost that control. When we lost our D in our microbiome. That means your question is, what should I do to get out there first, 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. I supplement first. I get my sleep better. I get my nervous system better. That’s when I start to go out and I do things according to what my body says it can tolerate.
Lindsey:
Okay, sounds like a good plan. So can you talk a little bit about how vitamin D is important in autoimmune disease?
Stasha Gominak, MD:
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 my unique immune system reacts to it. So now we have information that says, they really die of an autoimmune storm that affects the ability of the lung to tolerate what my own immune system is doing. Okay, and then we get into the science of it. But ultimately COVID is not just about the virus, it is about the virus and the host. We were never designed to attack our own body. Our immune system is extraordinarily well developed to never attack our own body. Also, parenthetically, that bit that I said about this bacteria makes an antibiotic. We’ve been taught that the reason why we lost our microbiome was the use of antibiotics, but there are actually two or three generations of humans between the early 40s (1940’s) and the mid 80’s, 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 Gominak, MD:
Yes, I’m simplifying it. On the first, 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 D’s 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 on us are not just inside, they’re in our sinus cavities. They’re inside our nose, they’re on our scalp, 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. That means if you picture those Africans wandering around without even a hut, and 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 garbage dump, the guys that are in 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.
So step one, the question is: one, what’s happened to the immune system, and what showed up at the same time is higher incidence of autoimmune disease and a higher incidence of I can’t protect myself from this simple virus. So if you look at what we put on the front page, it’s if you’re obese, you have a higher likelihood of a bad outcome. If you have dark skin, same thing, if you have other underlying diseases. Those are all things that really point to I have a sleep disorder and actually my microbiome isn’t right and D is low. So in the background, it describes a population that is 60%, not having 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. The next question would be if I have an autoimmune disease, how do I use this knowledge? You’re telling me about how do I use this knowledge about D and the microbiome to make it better, because that’s really what I would want as an individual. So it’s nice to know that these things are linked scientifically. Now, it is my belief that what I saw in my patients, which was I spent five years with CPAP devices and sleeping pills, okay, I saw autoimmune disease and my patients getting better and it wasn’t with any drugs. It wasn’t with D. I personally believe that the vitamins are tools. They’re bricks. They’re things that 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 lot; you have to be sleeping a normal amount. It’s really not as simple as take these vitamins, get your microbiome back, and then your immune system will be okay. That’s not what I saw. What I saw was when I get 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 CPAP. 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 about normal sleep. And the way we get to normal sleep is 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 if I consistently work towards getting the best sleep I possibly can, 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’s 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 Right Sleep Program, of these vitamins and getting sleep better. He really has an 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 4am. His sleep schedule would be 4:00 am until about 2:00 in the afternoon. I finally said, “Look, you know what, I think that the D we’re using orally”, he lives in Great Britain. So he lives outside of London. So he has, you know, poor sun exposure. He decides because he is financially able to take a six month vacation and go every single place where he can be in 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 like to be.
Lindsey:
Interesting. Yeah, no, that’s great information, because I do have a number of clients with eczema. I’ll be thinking about that. So in terms of supplementing with the B vitamins, I know there are some such as B6, for example, that can accumulate in the muscles, I believe and cause toxicity. What are the signs that you’re taking too many B vitamins or what are the dosages that one should reasonably take over an extended period of time or should we be testing, etc.?
Stasha Gominak, MD:
Excellent question. This is a really complicated question. So the first question would be, do we really have stores of B’s, because what we were told was that you don’t have to worry about getting extra B’s because we pee out the excess. Okay. And 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 pea 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. Now, having said that, we are told that we pee out the excess.
My first foray into B vitamins was using this B5. I’m going to answer your B6 question ultimately, but I want to give you how complicated it is in the background. So I go out and I buy 400 milligrams of B5 and B100 and I start taking it myself. And I recommend for one week to any of my patients who’ve been with me for two years, taking D for two years and now have these new pain complaints and sleep complaints, that they should take 400 milligrams of pantothenic acid and B100. Around day five, I realized that my restless leg syndrome, which is my sleep disorder which makes me very sympathetic to other people who have sleep problems, is terrible now, and it’s gotten infinitely worse since I started this now 500 milligrams of B5. So immediately, I think, uh oh, this is like vitamin D, where they tell you to take 400 milligrams, but they really don’t know what they’re talking about. And I just overdosed. I went down from 400 milligrams, took away the 400, took B100 just by itself, and it was immediately so much better in a day, which is really weird. Then my patients who I recommended it to about 30 out of 40 started to trickle back in and said, “this stuff, this 400 milligrams, this nearly killed me. It made me so agitated, I couldn’t sleep at all and only took it for two days.” This is sitting there innocently in the health food store, 400 milligrams, and that is the recommended dose of pantothenic acid. That means one, you can’t really believe every article you read. Two, each individual has a different background on which this chemical is falling.
It turns out that D makes an enzyme that makes acetylcholine. That acetylcholine can either make you sleep like a baby, or if it’s too high or too low, it makes you unable to sleep. And it can cause anxiety when it’s too high and too low. It acts kind of like this hormone type thing. Too much and too little both affect you. That means it took me several years to piece together that there’s a synergy between B5 and D. Now what does that mean? It meant that I was right, that I’d actually use 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. And in actual fact, there’s scientific articles that show we have stores of B5, B6, B1 and vitamin C. Okay. And there’s some logic to that. Now, 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. So in the background, there are also articles about if you take grams of B6, so I’m coming back to your original question. So as a neurologist, I’m trained, somebody comes in with burning in their feet, look for them to be taking too much B6. We’ve been told that B6 overdose produces burning in the feet. But what if, and this is just a what if, what if huge doses of one B means that all the little B packs that are supposed to be actually eight chemicals coming in, the ratio gets screwed up? 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 one, 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.
Okay, now 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, in fact, 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, which says, the reason why the B6 is high in your blood is because it’s not going into the cells that are being used. It does not have the complement of the other Bs that it needs and all of these other responsibilities that the Bs have. So it’s not being used in the cell correctly. Having said that, this is really hard. Because if you can’t use the blood level, and it’s been my experience, that for the Bs, the only one you can really use the B1, the B12 blood level. Even that is a little suspect, because there were similar readings about oh, my level is over 2000 and I’m not supplementing, what does it mean?
Stepping back, there is still I think a problem with not having a way to measure what are my B vitamin stores in my 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 information, clinical information, from your experience with clients. And when something gets a little bit weird, you then go to the literature and you read a bunch. And then you’re seeing some other human being’s experience, then you’re seeing certain biochemical pathways in rats, and they were trying to put them together. It’s difficult. And my final answer is, you have to have a client who’s willing to listen to their own body. And you have to have a relationship that says, I’m giving you suggestions, but you’re a unique individual with your own unique history. And when you do this suggestion, if it makes you feel worse, we immediately back off, and we 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, truthfully.
Lindsey:
Yeah. So are 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 Gominak, MD:
Excellent question. So what happened next was, I tried to get B100. So I’m doing D for two years and I’m getting really good with where’s the level and now when the patient walks in, I’m giving three things: I’m giving a multivitamin, and we can talk more about, that with very small doses of B’s. I learned that over time, I’m giving B100 and within the first couple of months, a couple of people said, “You know that B100 you gave me made me ache all over. Made me feel like I was 100 years old. I got out of bed and I couldn’t move.” That is one of the symptoms that comes when the B5 dose is too high and it really is about the B5. So what you and I both do is what are 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 recently told they have lupus, that person has a very long, clinically profound case of one, 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, just daily headache, and you don’t have anything else, how sick are they? Then I started to use B50. Almost everybody did fine with B50. It’s 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’s 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 and COVID and four years later, they have burning in their feet or they’re just diagnosed with lupus, 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 vitamins stores, because they didn’t fix their gut bacteria at the same time.
Lindsey:
Interesting. So we are running out of time, I want to ask maybe one more question about prebiotics and probiotics to help recover the gut microbiome or are you just doing the vitamins?
Stasha Gominak, MD:
I love that question. I was using a lot of probiotics myself, I was 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 their raw materials that they require. And they’re constantly duplicating themselves. So you have to picture our microbiome is like a river, they start up at the duodenum. And they’re constantly reproducing them, you know, 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. And the cool thing is, all this stuff was happening way before humans ever came. That means 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, bacteria and they will be self sustaining. The amount of B’s that they make are perfect for human biology, and they’re perfect for the squirrels and the 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. Okay, so you can do prebiotics when you have the wrong phyla, and not get the sort of outcome you’d like. So 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 what part of the GI tract. Whey’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:
So do you believe in supplementing with prebiotics or simply changing the diet to get it from your food?
Stasha Gominak, MD:
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 then you’ll get better outcomes from the things that you want to pursue to fine tune this than you have so far and we still need Lindsey and we still need the naturopath and we still need all these people who are really knowledgeable in that area.
Lindsey:
Okay, fair enough. Well, this has been a fascinating discussion and I think I could easily have you back on to go into a whole other level of discussions.
Stasha Gominak, MD:
I would love to do that and about children and early development?
Lindsey:
Yes, 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 Gominak, MD:
My pleasure, Lindsey, I’m thrilled that you’re interested in this.
Lindsey:
Where can people find you?
Stasha Gominak, MD:
My, my website is Drgominak.com. And if you just put in gomaflagy or something like that, something that sounds similar and vitamin D, my website will pop up. And I have a whole workbook that’s designed. 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, gives you a journal of writing the things down that you need to observe about yourself.
Lindsey:
This is the Right Sleep program.
Stasha Gominak, MD:
Yes.
If you are struggling with gut issues, fatigue or other or chronic health problems, I work with clients to uncover the root causes of these issues educate you on how to fix them naturally. So if you want to talk to me about what you’ve been dealing with and see if I think I can help, you can set up a free, 30-minute breakthrough session with me. I can let you know if I think I can help you and tell you about my 5-appointment gut or autoimmune healing program and you can decide it that seems like a good fit for you. Or you can just sign up for a single appointment.
