Sleep, Sunlight, and Repair | Stasha Gominak

[00:00:02] Speaker A: Hey everybody. Welcome to another episode of youf're the cure. I'm Dr. Ben Edwards and we have a really special guest, fascinating neurologist. We're going to talk about sleep, we're going to talk about vitamin D, sunshine versus supplement. We're going to talk about the microbiome, we're going to talk about B vitamins and how bacteria can make them. But more importantly, we're going to talk about the practice of medicine and the direction it's headed and how it's rare to find a clinician like Dr. Stasha Gomanak who is willing to be humble and willing to think outside the box and go against the grain and listen to her patients and observe from clinical experience outcomes and then to self course correct when you see maybe you were going the wrong direction. So it's going to be a fascinating interview, guys. And I like to just quote a quote that I often say on the show, but it's so pertinent here. Mark Twain that quote and someone emailed me that it really wasn't him that said this. So don't email me that again. I will look into that because I do want to be accurate. But Mark Twain, people say, says this. It's not what you know for sh. No, it's not what you don't know to get you in trouble. It's what you know for sure that just ain't so, so much of medicine. We think we know for sure something like cholesterol is the cause of heart attacks and we put everybody on a statin to lower cholesterol and we'll lo and behold, dementia starts to climb right? During that decade, dementia starts to take off. So could there be a connection? The brain's full of fat, cholesterol is a vital nutrient. But the point is we just, we think we know stuff and then we go full steam ahead until we hit a brick wall and then we still keep going sometimes. But we need to, like I've said on the show before, be more humble in medicine. We need to listen to our patients and I think get back to the original definition of evidence based medicine, which was take the best peer reviewed evidence based published data that you can find, combined with the clinician's experience and expertise, combined with the patient's values and wishes. And patient value and wishes actually trump the clinician's expertise and the clinician's expertise trumps that. That peer reviewed literature is how I would see it. I think the original definition guys saw it that way too. So we'll get into a Lot of great stuff. Today we may have to go to a part two because it's fascinating. Dr. Gomanek's research on sleep, sleep apnea, sleep disturbance in general, the microbiome, vitamin D, sunlight, all the above, and B vitamins too. But Dr. Gomen, welcome to the show. And I forgot I was going to read your bio real quick. Dr. Gomen, academic college in California Medical School, Baylor College of Medicine, Houston, and received her MD degree in 83. From there, she completed a neurology residency in 1989 at the Harvard affiliated Massachusetts General Hospital in Boston. And then from 1991 to 2004, she practiced as a general neurologist in the San Francisco Bay area. And in 2004, she and her husband moved to Tyler, Texas, where she still resides today. She began to concentrate more on neurological illness by improving sleep. Incredible. She published a Pivotal article in 2012 proposing that the global struggle with worsening sleep was linked to reduced sun exposure. In 2016, she followed with a second article linking the change in the intestinal microbiome to the epidemic of poor sleep and described a simple process for normalizing sleep and the intestinal bacterial population called right sleep. So we're going to get into a lot of that today. But Dr. Gomanik, welcome to the show. Thank you for being with us today. [00:04:01] Speaker B: First, let me say by agreement to what you said, I go by Stasha, I don't actually go by Dr. Gomanak. And I left my medicine. I retired in 2016 and now I am a sleep coach. And one of the reasons why I go by Stasia is I began to think in the last few years of my practice that the caste system that I think was pulled from the caste system of classes in Great Britain was hauled into medicine and has done damage. I don't think that in the current situation where every layperson who has even a minimal education has access to every medical textbook, every single article, every scientific article, and they can get any, any term that they don't understand, they can get it explained to them immediately on the Internet. That means me posing as the only expert in the room is really damaging our interaction with our patients. It's not really going to accomplish what we need to do. So this is on the same topic that you and I were talking about before, that medicine is currently needs some buffing up. I personally use my doctors. If I did not have the pharmaceutical industry and the medicines that I take for restless legs, I would not be alive today. It's not that I think that the pharmaceutical industry is wrong I think that over the last 30 years especially, I've seen a change. I've been in practice for 40 years, so I've seen a big change in how doctors are being directed to respond to patients complaints. When a person comes in and says, my foot hurts, they didn't come in to see whether or not their cholesterol needs to be checked and whether or not they need to be antihypertensive and things that the insurance companies have put in place saying that this is the right way to practice medicine. So I left medicine because I was very frustrated by the fact that I spent most of my day talking to people about things I thought that were important about their sleep. And I wasn't getting paid for that. I wouldn't get paid for talking or thinking. That was not what. That's not how the compensation works. And I also wanted to have some time to think more and write more about what I had seen in my patients. So, one. I think medicine should be more about listening to the patients. And I have to first thank all the patients that came back and said, you know, you told me to do this, and I got worse. I would go, oh, I'm sorry. And they would come back anyway. That is a really, really important. They would come back anyway and say, this really screwed me up. And then I would say, well, you look pretty good now. What did you do? Towards the end of my practice, because I started to practice in sleep where no one had the answer. There was nothing really important being written. There were no instructions about what I should do. I wound up asking my patients a lot of things, which was a really different atmosphere. And I really. And also I started to have a sleep disorder as I got perimenopausal. So the story about sleep, do you have any comments about that, or should I go on to the. [00:07:45] Speaker A: No, I just concur with you. My patients have taught me so much. And when they come back and aren't better or are worse, and the listening is the absolute most important thing, they will tell you the story, tell you the diagnosis, even if you're willing to listen. So, no, I concur completely, but you keep going. [00:08:02] Speaker B: Okay, so I fell into sleep by accident. And I just watched a podcast with Matthew Walker, and he said that he fell in love with sleep. And I thought. I felt. I feel like the same way I fell in love with that. I really became absolutely fascinated. And the first event was a patient experience where I had lots of headache patients. When you come to a new practice in a new town, if you're the new neurologist in town. All the headache patients show up because we're so lousy at treating them and whatever we use as treatment usually wears off. And I'd already been doing headache, not because it was my subspecialty interest, but because it's so common for 20 years and we have successes, but they don't last. So one of my headache patients said, look, these medicines are not helping me. My headaches are no better. My husband says I snore like a train. I want to sleep study. This is in 2004 and at that time we were told that elderly or middle age overweight males are the ones that get sleep apnea. And I said, well, I'm not going to send you for a sleep study. And she said, I want a sleep study. So I sent her. She turned out to have sleep apnea and she wore a CPAP mask and her headaches went away like in a month. And to me that was like miraculous. And I am very, very interested in biochemistry. That is what really lights me up. My husband thinks it's the most boring thing ever, but to me it's exciting. Okay. Biochemistry is how the chemistry of our body works. Well, blowing air up that gal's nose is not going to take her headaches away, but it did. So that really changed the whole, a whole thinking process. Well, if I can make the headaches better with this medicine that I know is a calcium channel blocker and I know that there are genetic links to migraine that are actually reported to be calcium channel mutations. This is a chemical process. But maybe the brain is making those chemicals that this gal needs so that she won't have headaches. And when is she making those chemicals while she's sleeping. All that's happened there is that blowing air up her nose has allowed her to stay in deep sleep longer. So then there were many observations about what the headaches coming back. And then there were. I started to send all my headache patients for sleep studies. That means that by the end of the first year I had about 50 sleep studies on young, healthy females because that's the most, the majority of the group, some young males, some older females. But the majority of them don't have medical problems really. They just had a couple of kids. They should be healthy and frequently have really bad daily headaches. They had very consistent findings on their sleep studies. They had no rapid eye movement sleep. They had delayed rapid eye movement sleep. They had REM related apnea. And that was really strange. And I, I had to look for an explanation for that. And my pulmonologist who was reading this study said, well, we get the most paralyzed of all in REM sleep, which was shocking to me. I didn't know we got paralyzed in REM sleep. And I thought, why don't, why don't I know that? I. Because those of us that don't do a sleep specialty maybe don't know that. And actually, most of the sleep specialists don't talk about getting paralyzed in sleep and what the implications are. So, for instance, a woman has a sleep study. It says on the front page, no significant apnea. Then you dig a little further, and you get to the third page, and it tells you she had a half an hour of rapid eye movement sleep, and she should have had two. And during that half an hour, every five minutes, she woke to light sleep. That means whatever she was trying to accomplish during that phase, it was interrupted. Well, that means they counted eight apneic episodes, and they said eight episodes over eight hours. Not significant. No. That's not really thinking about what's happening there. If we do things in blocks of time while we're sleeping, which is what we do, there's a reason for that. And we get paralyzed. That's really scary. That means that the oral airway, this part that we swallow through and breathe through, gets relaxed. And that means. Well, if she doesn't have apnea in the time when she's not paralyzed, her throat looks the same, but there's an additional thing that's happening. So we've been focusing on a fat tongue, fat neck, fat guys, little tube. But in this situation, if she doesn't have a fat neck and she's not overweight, gee, that means that there's a special event happening in sleep. That's why it's called sleep apnea. Because when you're lying on the couch, same position, watching television, you don't have apneic episodes because paralysis is happening in sleep. And then the next question is, how do I wake up and not die? I mean, I'm paralyzed. Really? That's terrifying. Really. That means your same nerves that are connected to your muscles that are being run by this little part called the brain stem, which is the base between the big brain and the spinal cord. That area can turn off the muscle movement, but it has to be able to turn it back on again. That means it could actually activate muscles too. Like, if it's screwed up for some reason now, why should it be screwed up? This is something that every animal, even worms and fruit flies sleep. Every animal sleeps they all get paralyzed in sleep. That's terrifying. But it must have a very important purpose. Now, the purpose is not known. We say things like, oh, it keeps you from crying out during your dreams. But there are other times where we think we're not dreaming, like deep sleep, where growth hormone is secreted. Growth hormone is secreted in deep sleep, which is another phase during which the muscles are profoundly relaxed. The sleep literature doesn't say you get paralyzed. It says we get paralyzed, including all this for rem. But it's my feeling that any moving part in the body can get repaired only when it's not moving. We're not repairing the knees when we're running across the basketball court. Your children are not growing when, when they're running across the basketball court. They're only growing during these phases of deep sleep and REM sleep when they're paralyzed. Now what does that mean? It means that if my child has a sleep disorder where they are cheated of the right amount of deep sleep for reasons that we're going to discuss in a minute, they will not grow the same. Their brain development won't be the same. We know lots of things about the chemicals and the patterns that we need to grow and to mature. Like growth hormone is only released during deep sleep. But the thing that we miss is if I take away my child's deep sleep, well, how do I know that that's happening? Unless he's, he or she is waking all the time or just doesn't sleep, you can't really tell what's going on inside the sleep. It's interesting that. Excuse me. One of the first lectures that really bowled me over when I first started to do sleep in my patients was one where a gal named Ev Van Cowder was talking about the endocrinology of sleep. And she gave a lecture where she said, look, growth hormone is secreted in children linked to deep sleep. But adults, after you go through puberty also have only growth hormone released during deep sleep. Now this is very oversimplified, but her next comment was that the secretion of growth hormone is now done in a pulsatile way in adults. That could imply that that particular phase is also being used for our physical repair. That they will use the same hormone that we use to make the growth crew that allows kids arms and legs to grow. But we don't exactly grow. What we do is repair. We use that growth hormone signal to call out these other hormones that are specific for certain tissues in order to repair. With those ideas, one, we get paralyzed. Two, why would all my patients who are young, healthy females, have no rapid eye movement sleep and no sleep apnea? Only a few of them had sleep apnea. The first one had sleep apnea, but most of them did not. That means it's not about their oral airway, it's not about their throat. So at the time, there were no sleep dentists. And by the way, sleep dentists are very important. They have actually been the major movers on looking at the anatomy of the upper and lower jaw, making sure that childhood development of the face is appropriate to allow for a nice open airway in children. That's something I knew nothing about at the beginning. But clearly I'm a neurologist. My area of expertise should be this brain stem. This particular sleep disorder is completely unexplained at the time. I'm looking all over for the literature on who else is reporting that these young, healthy women with, with headaches don't have any REM sleep. But that's a chemical disorder. That is a disorder that has to do with the sleep switches. So since no one's riding and telling me what to do and when they don't have sleep apnea, I can't put them on a CPAP device. So I start using sleeping pills. They're frustrating, and they're not the whole answer. But then I learned that many of the drugs that I've been using for prevention of headache were really helping their sleep. That means I begin to think about things in a totally different way. Wait, shouldn't I be thinking about whether or not my epilepsy patients have a sleep disorder too? Because if I'm saying that we're repairing the electrical function of the brain, we're making all these chemicals that allow us to work correctly. Things like epilepsy are often genetically based. Migraine is too. But why didn't they have headaches when they were 10? Why does this person have their first Seizure at age 25? The genetic map is the same when you're born. But now we're getting into things that really we're moving from the epoch of genetics to the epoch of epigenetics. And sleep is one of the most important epigenetic modifiers. That means if I sleep perfectly and I repair every part of my body, every fraction functional part inside that we can't see, every physical piece, then my genetic weaknesses may not show up because the body has an amazing ability to repair. So sleep should be at the very beginning of my interview with the patient. Now, one of the most important things about doing all those sleep studies, which I did for five years, was that most of the people who I was doing sleep studies on didn't think they had a sleep disorder. That's important because that means you can be sick, you can have diabetes, heart disease, lots of chronic back pain, all sorts of things wrong with you. And you can think you sleep fine, and then you do a sleep study and you go, whoa, that doesn't look good. They don't have any deep sleep. So there are many things about how to ask the question, what to ask about the timing. Do you have that pain in the morning when you wake up and it magically goes away within a half an hour? Things like that, that are really different than the way I was trained as a physician. And so I started to ask a lot more questions about things, and my patients would tell me things, and I would start to put them in little organized rows. Like, could it be that this patient who has now plantar fasciitis, who's only 32 years old and hasn't changed their pattern of walking or doing anything else, could it be that their sleep has gotten worse and that their feet are actually contracting in the phase where they're supposed to be relaxing, they're actually moving? And I happen to have a husband with a sleep disorder, and I can watch his feet moving at night. When I wake up, they're alternating. And you learn about these things called periodic limb movements of sleep. That means periodic, means it happens at a regular interval and. And they're actually alternating. There's one really important article out of turkey in the 1990s about this old walking center in the brainstem that says if that center doesn't get properly suppressed during the sleep phase, then you have these residual walking movements. If you have the idea that you must get paralyzed in order to repair, then it gives the open, well, wait, what if this guy has that foot pain because he's walking all day standing on his feet, but when he's asleep, he's unconscious, but he doesn't realize he's not making any repair? So it makes pain questions and the observation of pain and what's causing pain. And it means that instead of just doing an MRI or an X ray, I have an additional thought belief system about, oh, maybe I should ask about, has his wife ever watched his legs? Should we do a sleep study to see if he has periodic limb movements of sleep? Should we just try to improve his sleep? It's like a separate, wonderful opportunity to have treatment in addition to whatever else we're using and it's not that I don't think think we should use the medicines we have available, et cetera. It's an additional way to help my patient. So I get through five years, I'm using sleeping pills. The other weird thing is everybody wants a different one. Like if it says sleeping pill, you'd think it would just make people sleep. You know, it's a simple idea. No, it's not like that. I may have to go through 10 different sleeping pills and then we get the one that's right and they go, oh, man, this is great. The other nine, oh, I felt terrible. What does that mean? To me, that meant this is the one that their brain is missing. It is mimicking a chemical. I may not know what it is because most of the time we make up these stories about what these drugs do because we don't really know. In headache, we didn't have any medicines that were really designed for headache because we don't understand it. So, one, there could be multiple chemicals that are wrong. Like, why would all these young healthy people have things that are so goofed up? That didn't make any sense to me, but it was very common. And by the end of the fifth year, I was doing sleep studies on everyone. All the stroke patients I met on the weekend, they all have sleep disorders and they're more likely to have more severe sleep disorders. But anybody who was coming to a neurologist for something that was usually genetically based, Parkinson's disease, dementia, etc. I was doing sleep studies on them. Then one 18 year old who was about to go, oddly enough, to Lubbock to go to college. Beautiful girl, nothing wrong with her except she has to sleep longer than other people. But when you ask her, how's your sleep? She says, it's great. She can sleep longer than others. She came back after her sleep study. She was coming to see me for headaches, not because she had a complaint about her sleep. And her sleep study showed that she slept not for 10 hours because they always run in there and wake them up at 6am, which is mean. But her sleep study fell asleep right away, had eight hours of sleep, and never got into deep sleep or REM sleep. No deep sleep of any kind. And every 10 minutes, actually less than that, 35 times an hour, she would wake to a lighter phase and you couldn't even see, based on the study, that she was in a deep phase because she would come out of it so quick. And that was a sleep study that I would look at and go, this gal might meet Me again in another 10 years with a stroke. This is the sort of hidden stuff in the background that can lead to a 25 year old having a stroke and will never suspect anything that's happening. She turned out to have a B12 deficiency. And the only reason why I know that is because she came back and said, look, my headaches are much better, but I'm so tired. And you did that sleep study. Oh, is there anything you can do? Because I'm looking at the sleep study going, I don't have a clue what to do. There was no answer to this. No one's writing about it. So I did a thyroid test and a B12 because I didn't have anything else to do. And her B12 turned out to be profoundly low. That one idea, after five years of going, why are all these healthy people manifesting these abnormalities and what should I do about it? The idea that there could be a deficiency state that you could treat. I went, oh, wow, this is amazing. So I walk out of the room when I go to Google because now we're not going to the textbook anymore, and I Google what are the symptoms of B12 deficiency? And it says chronic fatigue and daily headache. And I just, I was blown away by that because I had never done a B12 level in a headache patient in the last 30 years. And it's listed in the neural. And it wasn't in the neurology literature in that way. It, if you go to B12 deficiency, it lists headache as a symptom. If you go to what do I do as a neurologist for someone who has headache syndrome, migraine or otherwise? It does not list test their B12. And the only time we ever test it is in elderly people who have dementia or somebody who has a neuropathy, et cetera. We have a whole list of things that we tested for. But it turns out that there are things in the literature that we neurologists don't use, like physicians don't use. There are hidden things in the literature that have been well explained for 20 years or 10 years or longer, 50 years that we just don't drag into the textbook. That was a really important realization for me. And over the five years I kept thinking, well, why did these pulmonologists get by with the story that it's the low oxygen that makes people have hypertension and heart disease and all this stuff when they have sleep, sleep apnea? I know that that's not true. Low oxygen to the brain causes a stroke. These people are not have, they don't have low oxygen. They do have drops in oxygen. But I have now hundreds of people who have sleep disorders, who don't have drops in oxygen, who don't stop breathing and they feel awful and they have high heart rates, they have high blood pressure. They have all these other. So how is it that pulmonologists are getting by with this? And my response was, you know what? They're making that up. They're making it up. And I was very offended. And then I thought, well, you know what? I can make up a story too. If my story fixes you better than the pulmonologist story, then that's better for the patient. And I began to really see that everything I learned, everything I learned in medical school, every book that's written is a human being writing down their best guest. Then you must take that with a grain of salt. Things are going to change over time. At the same time. Then I must make sure that I say, I'm making this up. Okay? I'm making it up. I'm making up a story. So you remember what I said. I have certain things I want to recommend to you because I had success in other patients, but that doesn't mean it's going to work for you. Okay? Not being afraid to say this is all trial and error, especially in sleep, where most of the patients had already gone to the Internet. And even if they didn't have a sleep complaint when they first came in, I've told them they have a sleep disorder. Now they're going there, reading. Being able to say, we're in this together. I'm learning. You're learning really had a great effect on what I got back from the patients. They started to. Now once I find B12, now I'm into the supplement area. And B12 has a lot of literature that talks about fatigue and sleep. It's already been published. The actual mechanism I still find obscure. I don't have a clear idea where it fits into the bigger picture, but it's already well known. And then, then the next thing that happens is that I add a vitamin D to the blood draw. I'm never drawing blood on headache patients. But now that the B12 has come along, okay, I'm going to draw blood on all my patients. Now. I have a whole stable of patients who've had sleep studies. I know what their sleep study looks like now I can draw their B12. And somebody says to me, ironically, she was a pulmonologist who ran a sleep sleep lab who was on disability because her own sleep was so bad. She had so many medical problems. She says to me, my doctor checked my vitamin D level and she gave me vitamin D and my wrist pain went away. Well, I'm completely naive to any vitamins, and I don't care about them. But I'm thinking vitamin D bone, because that's what we're all trained. And so I just throw it in there. I throw in a vitamin D level with a B12 level, and from August to December of 2009, I do B12s and Ds on everyone. And everybody's D is low. Not all the B12s are low. The B12s are low in the really, really sick ones with lots and lots of physical complaints and medical problems. And my D was 35, which is pretty low. And I thought, well, it's not below 30. Must be okay. And this was in August, Ironically, I was doing it in the part of the year when the D levels should be the highest for whoever's doing. Turns out that all the Ds were low, which in this particular day and age, nobody would think that was weird because low D is like having a cell phone. Like, everybody thinks they owe low D, and they do. But in December, two guys come back, and what was unique about them was they were both on cpap. They both had slightly higher D levels than the other females that I was treating. And they both said within the same week, you know, I've been wearing the CPAP device. You promised me that it would take away my headaches, and it didn't. But the last time I was in here, you sent me that note that my D was low, and you told me to take a thousand IUs a D. And within about three weeks, my sleep was better and my headaches went away. And they both said my sleep was better. My headaches went away. I went, wow, that's so weird, because every single person who has an abnormal sleep study has a low D. Why don't I go and look at the literature? The literature shows that since 1979, when I was entering medical school, there is literature that shows that vitamin D is active in many, many, many organs in the body. That was the first article that makes the point. It has never been a vitamin. It will never be a vitamin. It is a hormone. It's. It's. We make it. It's on our skin. It's really not in food. Yes, salmon has D in it, but that's the salmon's D. They're using that to live on. We are actually designed to have to be in the sun to make D. Yes, we get a little bit of it from salmon. But if we say that there was a move since the 80s when sunscreen, air conditioning and computers came, and we know that our lives have changed dramatically since the 70s and 80s and how much time we spend outside, that means that food sources are really nowhere near what we need as humans. Stepping into the D arena is very scary because it turns out we know this much about something that runs almost everything in our body, and we fight about it. And it's very politically charged. In medicine. There are people on both sides because it has the vitamin word. There's this visceral reaction by physicians. Vitamins, well, we figured out that they were for lesser humans, females, of course, that are nutritionists and dietitians. And we're too important to worry about that. These are things that are the basis of every biochemical process that keeps all animals alive. And we're told to ignore them. So one, I find articles about the sleep switches, which is what I've been reading about for four years, because if I don't have any help from anybody, all I've got is the anatomy. And I find that a guy named Walter Stumpf has published in 1980s that the sleep switches that paralyze us and help us transition through every phase of sleep and the clock nuclei that always know what time it is, every bit of the part that allows us to enter, pass through the phases of sleep and wake up and not move appropriately and then wake up and be able to move. They all have vitamin D receptors. If they have vitamin D receptors, then D is playing a role. So I call this guy up and I say, hey, you don't know me. And luckily he's retired by now, but he's been working in vitamin D for 30 years, characterizing where the vitamin D receptors are. And within the first five years of this studies that he did, he had this belief system that he created that's so logical. So I say, hey, Walter, you don't know me, but I'm looking for has anybody written about vitamin D and controlling sleep? He says, no. That's why I called him. I thought there are no articles. If I put two search terms in, there are no articles. He said, no, but that's completely logical. It is the hibernation hormone, okay? One of the characteristics of hibernation is we have something that allows us to put all the metabolic space speed down in all of our body. That's what thyroid does. And the detox to the thyroid releasing cells that are in the pituitary it controls our reproduction so that we won't birth a baby in the middle of the winter and have no food for the baby. It has all these things. And now you have to step out of how important humans are, because humans just think they are the center of the universe. Every animal on the planet makes vitamin D. They all need vitamin D. If they don't live at the far north or far south, they won't necessarily hibernate. And humans don't necessarily hibernate when they live at the equator either. But if you think about this in an evolutionary way, we now know that there were two great dyings off the planet. There were mammals that didn't look anything like us. There was a big dying off, and it was like 500 million years ago. And there was some event that meant that all the animals died. And then the animals start to come back again. And then there's a second big dying off that's around when the dinosaurs were killed. Each time. The anthropologists that are putting this together and the dinosaur studiers are saying that the sun had to be cut off for quite some time, maybe as long as a year, by either ash or something else. That means life either came again or it came out of animals that were able to survive without any sunlight. So there are aspects to this that makes this very complicated. And there is actually vitamin D that comes before the kind that we make on our skin that is made by yeast and fungus and mold. So if you're able to use the D that they use, you could actually live through a whole year with no sun. Now, having said all that, we look at vitamin D as a vitamin. We think about it as the vitamin store. The doctor has all these political things going on in their head. You must step back and say this is a hormone that exists in every single animal, even into flowering plants. It looks like it may have first come about at the time when plants became two separate sexes. And then they had to coordinate when fertilization was going to happen using whatever it is that fertilizes them. It's a level of complexity that is true, truly overwhelming. The final message is one, you have to respect this stuff. We're fooling around with a hormone that has hundreds of actions in the body that medicine doesn't understand well, because they're afraid of it to some extent, which is weird. Science is advancing at an amazing rate. But the recommendations of what to do with it are very confusing right at the moment. The Endocrine Society, which should be taking responsibility for this hormone, has recommended that because we do not have enough clinical experience giving vitamin D and measuring blood levels that we shouldn't do any vitamin D levels. They have made a beautiful recommendation at the end of 2024, summarizing all the articles, and they say, look, we don't have a. We don't have enough data. And you know, as soon as the doctor does a vitamin D, they're going to call us up and say, well, what kind of dose should I get? This is the level. And they said, we don't have any clinical data. I had a lot of clinical data, but it was one physician trying to publish that. Forget it, not going to happen. They said not. We should all do D levels, we should all give doses and we should all correlate that data together so we know what to do because we've seen such amazing epidemiologic link to all these chronic illnesses. No. They said, no. I recommend that doctors not do D levels and they not give recommendations. That's insane. Now, any questions or comments about that? [00:39:49] Speaker A: No, ma'. Am. [00:39:50] Speaker B: Okay, now the next thing I'm going to talk about is the most important part of this lecture. Everybody's talking about vitamin D since COVID The reason why I have a website, the reason why I have a program for you to follow if you want to improve your sleep and improve your medical course over the rest of your life, is because what happened next was truly terrible. Patients and I took vitamin D and I learned about vitamin D dosing. And I had a very simple question. Walter Stump had a bunch of scientific articles showing the mechanism where the vitamin D receptors were. And I had a simple question. If everybody's D level is low, is there a vitamin D level that would help them sleep better? Pretty simple. They just come back to see me. I'm a clinician, I'm not a scientist. They come back to see me and I say, hey, how's your sleep? Now you're taking that 2,000. I use a vitamin D. It's. My sleep's terrible. I'm taking the 2000 and I go, oh, bummer. Okay, let's send you for a D level. And I learned a lot about vitamin D dosing, which is that every single person needs a different dose. It's a morass. There is some logic to it, but it's usually not reported in most of the articles. Now, the next thing that happened was we got really good at it. We found that 60 between 60 and 80 was the best place for your vitamin D level to be for the you to have better sleep. This is a very important, very narrow idea set. If you've had a sleep problem, that means your D has been low and you must get it up into the 60s for your sleep problem to be obviously better by your reporting. Simple, simple concept. That does not mean that a D level of 65 is the ideal level. It might actually mean that you have to overshoot in someone who's been low long enough to have this important thing. Sleep, it's the core of our repair. If you get to the point that that's screwed up, you're kind of circling the drain. I mean that is a long term problem that's been many years and coming. So there's a lot of confusion about what's ideal, but we got really good at it. Everybody's got a d in the 60s now and at the 2 year mark my patients start to come back and say, hey, I've been taking this vitamin D for you. My sleep is better, but I've got this bad joint pain now. And my doctor just sent me to the doctor to a rheumatologist and they tell me I'm developing lupus and I got this peculiar buttock pain. I could not sit down on my chair at the end of the day. That is bizarre. I didn't fall, I didn't bruise anything. I'm running the normal amount that I was. I didn't injure myself. So I have this peculiar pain that doesn't belong there. I've got other people coming back with things like burning in their hands and feet. I've been a neurologist now for 35 years. By the time this happens and burning in the hands and feet is extremely rare. I've been a peripheral neuropathy specialist in large clinics where I'm getting the referrals. Doesn't happen. I got two gals who walk into my office within a month of each other saying, what about this burning in my hands and feet? Is this due to vitamin D? It's two years after we started. There's no change in the dosing. Their vitamin D levels are the same and I'm completely baffled. But I have this creepy feeling that there's something that's happening over a longer term that is making something else go deficient. Because burning in the hands or burning in the feet, and it's usually not both, is frequently related to B12. That's what I would usually whip out the first time I'd see somebody. The hard part was they were already on B12, both of these gals. So I'm Stuck. I don't have an answer and I'm avoiding the question because I'm embarrassed. But I'm really thinking if I'm inducing a state where the brain, brain is driving the body to sleep more and make more repairs because I don't want them to be unconscious for more time, I want them to make more repairs. That's what we're supposed to be doing. If we're making more repairs, then we're using more of these building blocks. And that's what these B vitamins are on all the other things we call vitamins, they are the building blocks of cellular repair. So a woman brings me a book within two months of this event. And it's a book about pantothenic acid, a vitamin, God forbid, another. They're going to think, you know, they're bringing me essential oils, candles, all sorts of things that I think are totally wacky. But I try to be polite now because everybody thinks I'm a whack job. My colleagues are really kind of pissed at me and they think I'm nuts. She brings me this book about vitamins. At first I wouldn't read it, of course, but it turns out that this book is written by a woman who had rheumatoid arthritis. And it's called the Pain Free Promise of Pantothenic Acid. And she's actually taking 400 milligrams of B5. It's one of the B vitamins. Her pain gets much better. She's recommending B5 to all these people and she has a bunch of references. And it turns out when you go back into the literature of the 1950s, there's this weird lab that's run by the Iowa University of Iowa that's next to the Iowa State Prison. And they are doing really creepy experiments on convicts. And they are studying panethenic acid, pyridoxine, several other vitamins. They're doing muscle biopsies, skin biopsies, all these creepy things that they really shouldn't be doing. They have studies where they've taken out the pantothenic acid in the food by making a fake diet and tube feeding the convicts. It's not even real food. And they put a blocker of pantothenic acid in there. And the report is within two weeks they have trouble sleeping, they have belly complaints, they have a funny puppet like gait and they get burning in their hands and feet. And I'm like, whoa, this is creepy. But I don't know why these gals have burning in their hands. And feet. We're going to go try it to make things shorter. What happened was I went, I got 400 milligrams of panothenic acid. I picked up another thing called B100. The B vitamins, in short, are really made by the bacteria that live in our belly. That is not the belief system that we've had for the last 40 years. But the fact that they are all called Bs, that's kind of weird. Like, there's A and then there's eight things called B and then C. That means the original discovery of these were actually from a yeast bacterial mixture that was in the mixture that you'd make bread or beer. They used that mixture. Let's just say that Pasteur's wife is making bread. He steals that, he pours it into a petri dish, puts some agar in there, and he starts growing bacteria. And looking at it under the microscope, it turns out that the yeast extract, which you must, when you make bread or beer, set the yeast at a particular temperature. The reason why it has to be a medium temperature is if you boil it, you kill the bacteria. The bacteria are sitting in there with the yeast and they bubble around and. And the yeast provides D2 that the bacteria needs. And the bacteria make all these other growth factors that the yeast needs. And it is actually those B vitamins, oddly enough, that are happening in the fermentation process of beer, bread, and you can buy nutritional yeast. That means the fermentation part of what we're recommending now, fermented foods are good for you. What we've learned over time is if you don't do it right, you ferment certain bacteria that make Botulinum toxin and you die. If you do it right, you get very healthful things out of fermented food that are actually very similar to the B vitamins. In fact, most of them are the B vitamins. But now that the microbiome has become so important, we are. Every single week, there are new articles about new metabolites that bacteria make that humans must absorb and use in our biochemical pathways to be normal humans. If we did not have that GI literature in the background, then people would not really catch on to what I'm talking about. But what I then concluded was, oh, I thought the D was going to correct the microbiome problem, because we all knew we had the microbiome problem lurking. But we were trading stories for probiotics. Give the bacteria and they make a. It turns out the probiotics are not the answer. They're not bad, but you need the growth factors that when you give that bacteria, which is what the probiotic is, you must have the growth factors that are required by them, which are specific and many, for them to reproduce and take over the entire population. Going from your mouth to your anus, that means one. This used to happen spontaneously. It's happening in all the other animals. They aren't on cpap, they don't have ibs. Why don't the squirrels fall out of the trees and hold their belly? Okay, why are humans only. So there's a connection between D deficiency and. I presumed that the D deficiency would be fixed by giving D, but it wasn't. The IBS was still there. And therefore what happened was I gave B100, which is a balanced high dose Bs. And there was a lot of stumbling. The two women with the burning needed much bigger doses. But when we got the dose correct, the pain went away and it went away really fast. When you got the dose right, the pain went away like in a day, which was very creepy. We've established that one D, when it's low, produces over a long span of time a D deficient microbiome. The D deficient microbiome is manifesting in our patients and ourselves in various ways that, that we call chronic illness. And there are many deficiencies. It's not just B vitamins. All of the minerals, every single mineral was first used by the bacteria. They were the ones that were able to dissolve a stone and absorb the. I'm making this up so you can remember it, but they were dissolving stones that had iron in them and using an iron atom or an iron ion in a biologic setting in a metabolic pathway. That has still been the case. And it turns out that probably all of the minerals that we need to operate normally have a intermediary that's run by the microbiome that you must have something that they make. We absorb it and it's part of our pathway. Just in the last three years, there are now very well established scientific articles that show this particular chemical called reuteri, named after Lactobacillus rudai. I don't even know how to pronounce it, but they're now naming those metabolites and showing in the pathway of absorbing iron where that is taking the role that then opens this whole idea of our supplements really going into our body and doing things. Or are supplements helping the bacteria to make things that we then absorb deeper into it. The next conversation might be about acetylcholine which turns out to be the final pathway that's really important. And you need a microbiome to make that. But every single one of the B vitamins has a bacterial origin. And it turns out that there are probably 100 other chemicals that we need those bacteria to be integrated into our body. But especially for the immune system, especially for child development, both [00:52:40] Speaker A: while they're in [00:52:41] Speaker B: utero and during childhood. It also implies that if the mom's microbiome is not right, she looks like a normal human, she looks like a normal mom. She's got a baby inside her, but her microbiome is not right. She is not able to supply all these cofactors for that infant's development in utero. The endocannabinoids are another thing that are supplied. Or actually the building blocks that become. Become the endocannabinoids are supplied by the microbiome. And that means if you don't have those, they are intermediaries in the release of neurotransmitters, and they're very important in development. So there's a picture, a general picture now that says, okay, if I take vitamin D and I don't bring back my microbiome, and the piece that was important to bring them back was B100. And that is because there are four phyla, four substantial phyla in the human microbiome. Every single animal has its own type of microbiome. Those four are feeding each other B vitamins. And that's been published elsewhere. Now, I was actually the second to have that idea that the bees all came from the poop. They were published from the yeast bacterial mixture, but somebody probably knew they were coming from poop before we got to the point where we're like, oh, my God, poop, it's bad for you. So at the time I'm having these ideas, the guys from Oklahoma are doing poop transplants because they're desperate. Like, who would do that, except they were dying from C. Diff in the hospital. Looking at it in a totally different way, you can say, okay, well, if I can bring back the microbiome, there can be a huge impact from this and all the things that got better. The sleep needs the microbiome because there are so many things that are needed for normal sleep that come from the microbiome. Many things that I don't even know about yet. Acetylcholine turns out to be one of the key chemicals. And I want to mention it briefly, and then we'll close and we can pick it up again if you want to later, it turns out that d when it hits those receptors that I told you about in the brainstem, it makes a particular protein. All of the hormones in our body are designed to go into different organs and make different things. That's one of the things that distinguishes the name hormone. Think of, like estrogen or testosterone. There are parts of the man's body that respond to testosterone. The hair. It's not about developing genitalia. It's about the secondary sex characteristics. That means every part of the body that's affected by a hormone may have a different protein that's expressed, goes into the nucleus, it binds to the nuclear DNA, and it makes a protein be expressed. The protein that is expressed in the sleep switches. Oddly enough, we have an article from the 80s, following Walter's articles, that shows that that protein is choline acetyltransferase. Choline acetyltransferase. Nobody's talking about it. There's like two or three people who do research on it. It is really important. It makes acetylcholine. When I finally get to that article, I think acetylcholine. I'm a neurologist. I should know exactly what this does, right? Neuromuscular junction. It makes it strong. I have patients with myasthenia gravis. They don't have acetylcholine working correctly. And then I go, well, what does it do in the brain? Why did it make my patients? If this makes acetylcholine, if D plus B5, and I'm going to talk about that in a minute, makes acetylcholine, why don't I know about it? And it turns out there are no drugs that duplicate acetylcholine, so don't know about it. And what I learned was I, as a neurologist, really learn what neurotransmitters do by the drugs I use. I know about dopamine. I know about serotonin. I know about serotonin reuptake inhibitors. But there are no drugs for acetylcholine that are acetylcholine mimickers. Except nicotine. Now, the odd thing about that is when you and I did early pharmacology, we learned about the receptors for acetylcholine are nicotinic and muscarinic. That was done, like 1930s, 1940s. Well, that was because we had those chemicals. Oddly enough, the people with the men with Parkinson's disease who smoked did better. So ultimately, this led to reading articles that discovered that when I added this pantothenic acid, this B5 stuff, as a group of B vitamins. I had actually allowed the enzyme choline acetyltransferase to act on a thing called coenzyme A. So choline plus coenzyme A with the enzyme make acetylcholine. That means what I've done is I made the enzyme. The enzyme used up all of the supply of B5 in a person's body, making more acetylcholine to make them sleep better and do better, because it's all over the place, doing hundreds of things. And I forced them into a place where they became B5 deficient. What all of the literature says currently is that B5 deficiency doesn't exist because it's in every food. Now, if B5 is in every food, why did my patients immediately get anxious, agitated, and couldn't sleep at all when I got the dose too high? Can't be in the food that way. So the final end of the story is all of my patients were forced into a place of having a worse acetylcholine deficiency state by taking D their presentation. Except for my butt pain, which was so peculiar, I would not go to my doctor and say, would you take an MRI on my butt, please? Okay. All of the other diseases are things that we see all the time. We have names for them. Oh, autoimmunity. You go to the rheumatologist. Turns out that in the 70s and 80s there were all these clinical trials using B5 to try to treat the autoimmune diseases. Because we found out that coenzyme A was necessary to make cortisol. We started to have prednisone. We realized that cortisol was low in these people and we tried to use B5 to treat it. It was unsuccessful. So it got lost in our memory. It turns out that B5 deficiency is all over the place. Pantothenic acid deficiency, that's another name for it. If you have been on D for two or three or four or five years since COVID started, you can show up at your doctor's office with new complaints that are really a vitamin deficiency state and they won't recognize it as such. [00:59:44] Speaker A: So to summarize and kind of the take home message that I'm hearing, that vitamin D you initially gave had some benefit, symptomatic relief. But as you said, it's a hormone, not a vitamin. Hormones have tremendous effects all through the body and in the microbiome. And some of those effects on the microbiome and the B vitamin levels in the microbiome caused further imbalance that over time, over years, led to other symptoms. So we're chasing one symptom with a supplement slash vitamin hormone, not understanding the full consequence, unintended consequence of the full picture. But, and I don't want to put words in your mouth, it seems like, and this is kind of simplistic, but if we just had a lifestyle and a diet that encouraged a diverse microbiome and we had a diet and lifestyle, or more lifestyle that encouraged sunshine exposure and just being out in nature in general, that's where the microbes are at. Get, get to the mountains, the desert, the ocean, the barnyard, the everywhere. Get back to nature like your ancestors. Get to real food like your ancestors, nutrient dense food, hopefully locally grown, regenerated, farmed, get plenty of sunshine, that we should be healthy and sleeping good. Is that too simple? [01:01:15] Speaker B: No, it's exactly what we need to do for prevention. Then we have to. If we, if we're going to meet again, we'll discuss. Well, if Stasha says we have to take B50M D, that's not natural, that's not. Supplements are only 50 years old. So there are lots of other historical examples of people who went into the Tower of London and came out five years later in the 1500s because they were on the wrong side of that king. And then they come out and they look terrible. And then we have articles that they wrote when they were in their 70s. That has to mean that my idea that we have to give back the B vitamins is a shortcut, but we're still able to do it. Then we have to talk about fermented foods and what food was like 300 years ago. Were we really eating rotting food in comparison to what it's like now? There are aspects to this where you can do exactly what you said. And those are my recommendations. Do exactly what you said. And anybody who raises their own food does not get compulsive about washing it. They were just out there picking the food out of the dirt. And that is part of the experience. And they must be outdoors in order to raise food because you cannot grow food without sun exposure. Similarly, humans cannot live without sun exposure exposure. So everything you said I completely agree with. Then we could talk a little bit about if I want a shortcut where it will happen faster. So what you said is really about prevention and if I don't have anything wrong with me, all the things you said is the better route. You should never be supplementing and biohacking. If there's nothing wrong with you because bad things will happen. But there are shortcuts. For somebody who already has rheumatoid arthritis or already has the these complaints that you can follow to get better and then finally where you wind up is just what you said, be outside every day. [01:03:28] Speaker A: Yeah, well we'd love to have you back to talk about some of those shortcuts and your clinical experience of how did you find those and where are you at on that journey now? But guys, you can go to Dr. Gomanak, that's D R G O M as in mother, in as in Nancy a k dot com and hear all about her journey and learn more and get the right sleep coaching sessions going and anything else you or you can explain that more than I could. How can people connect with you, follow with your consult with you? [01:04:02] Speaker B: I have a YouTube channel also. Okay, I'm the only Goldmanak on the planet because it's actually kind of a made up name that was distorted and it used to be Goominiak but if you just go to stasia Gomaniak on YouTube. I have a YouTube channel that has multiple interviews, some lectures as well about this and about other things such as headache. And then I have a program called Right Sleep that gives you step by step what you should do, what levels to get, what things to buy, what to do for this length of time and how to journal, how to observe what your body is telling you. Because the second part of this is none of this would have been obvious to me by doing blood levels, the D is linked to the blood level and there's still debate about that. But none of the other things that happen are really related to the blood levels because the brain is a different compartment and the blood levels that we do do not tell us what the brain wants or needs. But you will be able to tell because you will learn what symptoms your body talks to you with. That's another thing that has fallen out of favor in medicine. That is is wrong. We need to listen to what those symptoms are and then we have to learn what they mean. [01:05:20] Speaker A: Yeah, I agree. That's awesome. Well, I definitely want to have you back. We want to talk about some of these shortcuts and guys, if you can't wait till then, go to drgomanak.com get on YouTube page Stasha Gomanak, check out the right sleep courses and go sleep better. That's when you repair, that's when you heal. And the name of this shows you're the cure. It's hard to be the cure if you're not getting good sleep and allowing that growth hormone, slash, repair hormone to do its job. So y' all get out there, keep stewarding your health, keep learning, and we'll be back next week with another great show. Thank you, Dr. Stasha. Thank you, Dacha, for joining us today. [01:05:58] Speaker B: Thank you, Ben, for asking me. This is a really great opportunity. [01:06:02] Speaker A: Well, you're welcome. Love to have you back. Okay, guys, we'll see you next time. Bye. Bye.