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Sleep, Vitamin D, B Vitamins, jaw, etc. Dr. Gominak transcript - 2016

Interview on YouTube

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Key Takeaways (from YouTube)
02:29 Hundreds of Dr. Gominak’s patients, children, teenagers and young healthy females, didn’t have REM sleep.
04:42 Sleep apnea, fibromyalgia, chronic fatigue were not recognized in the 1960s and 1970s, because they were not epidemic.
07:21 Vitamin D and the brain stem are major players in deep sleep.
10:03 You must be paralyzed in order to achieve the proper levels of sleep.
14:21 Why would an 8 year old have more than one sleep disorder?
16:02 There has been a major historical shift from living/working/playing outside.
17:07 Once you replace vitamin D, the body slowly changes from a vitamin D deficient body to a B deficient body.
18:08 While bears hibernate, their microbiome consumes the colonic mucus, which makes all of the B vitamins to meet the bear’s metabolic needs during hibernation. Does ours?
22:05 Why Did It Take 2 Years to Become B Deficient?
23:44 Each B vitamin has an intestinal bacterial source and a food source.
26:02 Wanted: Gut Bugs
31:39 You can fix your own bacteria with vitamin D levels above 40 and take B100 or B50 for 3 months.
32:58 The sodium linked multivitamin transport system pumps 3 vitamins, pantothenic acid, alpha lipoic acid and biotin, into our digestive system and our brain.
36:24 Dr. Gominak sees a correlation between autism and vitamin D deficiency.
38:27 The development of sexual dysmorphism and sleep.
42:34 When a child cannot get out of bed in the morning, this is may be the brain demanding that they go back to sleep to get REM.
44:03 A lack of REM sleep cheats a child of their normal development.
47:15 Children and adults normally make small subtle movements and tiny vocalizations, not talking, walking or falling out of bed.
48:27 Taking the Weston A. Price westernization theory to another level.
56:02 Breastfeeding enlarges nasal passages.
57:28 Dr. Gominak believes that vitamin D is trophic to the bacteria that we are supposed to have in our gut.
59:24 Pantothenic acid not only makes acetylcholine, it makes cortisol.
60:11 Acetylcholine is a chemical used by the vagus nerve.
01:07:46 A test result of pantothenic acid levels will parallel magnesium levels. It tells you what is in the blood, but not what is in the stores.
01:09:10 Perhaps we are completely self-healing with REM sleep.
01:12:26 Dr. Gominak’s Morning Routine
01:13:31 The ketogenic diet helps people to live longer. Being ketogenic during REM sleep helps us repair. We were probably designed to go into ketosis for at least 12 hours every night.
01:15:08 A new theory is that the tricarboxylic acid/CREB cycle, which is used when you are using fats as your energy supply, may have a different purpose. It may not be about making ATP.
0101:19:33 Dr. Gominak’s desert island herb, nutrient or supplement: Her choice is vitamin D, even on a desert island.
01:30:35 Dr. Gominak’s Elevator Pitch: We can impact our children, especially children of color. It they don’t go outside, they don’t make enough vitamin D.

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0:00:00 Dr. Stasha Gominak: If you sleep better, the brain appears to remember all the deferred repairs. Patients who had lupus, who had been sick for 20 years, ended up needing bigger doses of Bs than I did. I wasn't very sick, I needed slightly more. It's almost as though when the brain says, "You know, I'm doing so well, I'd like to do three-and-a-half hours of REM." It appears to remember. That means there's a concept in the background, which is, there must be stages of sleep where you can actually repair the body and remake things that have been injured, but you must get into this very specific phase for all the pieces to be in place to do that. That means, we are completely self-healing, and that we have the opportunity to reverse really terrible things, but you do that by sleeping the right amount. And some people, they ended up in the year one, year-and-a-half after correcting their intestinal bacteria, they ended up needing more Bs, and only if they're sleeping better. So, if they're sleeping better... My theory was, they were actually making more repairs, they therefore needed slightly more Bs, they needed more than what these guys make naturally. If these guys only make the basal amount that we need, and you need more, 'cause I'm encouraging your brain to sleep even better by keeping the D perfect, you might need slightly more.
0:01:37 Mike Mutzel: Hello, friend. It's Mike Mutzel with High Intensity Health. Thanks for tuning in. I'm very excited here to be with Dr Stasha Gominak, and we're gonna talk all about sleep, vitamin D, the microbiome and much more. But before we dive into it, I'm gonna put some really awesome links where you can download some of the articles that we're gonna talk about, and I wanna thank a mutual friend of ours. So, without Dr Mark Burhenne, so thanks Dr Mark, for introducing us, and all the research that he's done in sleep-disordered breathing, and mouth taping, we're gonna talk about that on the podcast. And also, incidentally, I think this is a great launching place. My mentor, Gerard Guillory, a physician in Denver, Colorado, always told me, anecdotally... He actually did... Studied out in Boston a little bit as well, and under Dr Holick and so forth, and got inspired about the vitamin D that way, but he noticed that his patients that would take vitamin D at night, they got deeper sleep. And so, when we started talking on the phone about this connection between vitamin D, sleep, the microbiome repair, I was like, "Oh my gosh, this is like what I've been hearing anecdotally from Dr Guillory for a while." So, let's kinda launch with how you got into this. First, maybe scaling back and talk a little bit about your practice as a neurologist and looking at sleep-disordered breathing and things of that sort.
0:02:46 Dr. Gominak: Most of my patients who I was sending for sleep studies were young, healthy females, totally different group than what we were told to look for, and that group didn't have sleep apnea. They just didn't have any REM. And since we don't have any drugs and I couldn't give them CPAP devices, I'm stuck with now hundreds of little kids, teenagers, young healthy females with no REM. And then by accident, I have a patient who's got a full night's, 10 hours of sleep, so she's sleeping. So I can't give her a sleeping pill. She has a low B12, a very low B12. And so for the... And because I've been spending all this time thinking, "They're not stopping breathing. They just don't have REM. How could that happen?" So I'm spending all this time with this part of the brain stem that runs that and reading all these articles about how the cells run REM sleep. How do we get into REM? How do we come out of REM? What do we know about that? And nobody is saying anything about it. Nobody is even reporting that on the front page of the report. It's hidden in the report, and I don't even know it until later when my pulmonologist tells me.
0:04:00 Dr. Gominak: And all of a sudden, I do B12s, and then somebody says, "My vitamin D?" and I throw that in there 'cause I'm doing blood already. Then everybody has low vitamin D, and there are vitamin D receptors in these cells that I've been reading about for three years. So, it's not like I went looking for a connection. I went looking for, "Why are these cells malfunctioning in all these healthy people? Little kids, why would little kids not have any REM?" So I'm thinking, I'm puzzling for years over why these cells are malfunctioning the way they are, why they're doing it in such a huge population. If you count not only the sleep apnea, you count everybody who has interrupted sleep, who can't get out of bed, who has pain on awakening, that's three quarters of the population. It's horrifying. That means, whatever it is that's happening, it's happening throughout that huge population and in a specific timeframe. Because I was alive before this happened, and I went to medical school before sleep apnea, fibromyalgia, chronic fatigue, we never learned about those diagnoses. We all thought they were bullshit. We thought they were made up.
0:05:09 Mike Mutzel: So sleep apnea back in the '70s and '60s didn't exist?
0:05:12 Dr. Gominak: Didn't exist.
0:05:13 Mike Mutzel: Oh, wow.
0:05:14 Dr. Gominak: So, because you're younger, you don't have that framework. It did not exist. It was there, but it wasn't an epidemic. There were populations that, where you could describe that, and they actually had old paintings that they used when they first began to talk about sleep apnea. These big fat guys who were stopping breathing while sitting in a chair upright, sleeping, were the icon that they used to describe it. So, those people existed. All the diseases that we see now, and if you look back, Dickens' descriptions of the poor that worked in brick factories, so back in the early 1800s is the very first time that entire population moves into living and working indoors for their entire life. That's when big, non-healing ulcers, rickets, heart failure, diabetes, renal failure, all begin to be described. So, all the diseases that we now see an epidemic were really described in the early 1800s when a group that was raising sheep, standing outside, a pastoral life, had a house, went there only at night, moved into factories for the very first time.
0:06:30 Dr. Gominak: So all those diseases are now epidemic. And thinking of it that way means that you take out the dietary exercise to some extent, not all. But the diet that was a pastoral life 200 years ago. You look at that and go, "Hmm, is that a lot different now?" So the two major... And all the features that you've talked about, daily exercise is absolutely a big player, but it turns out that if the Maasai can live only on milk and blood of their cattle, that's a really interesting thing. So, there are certain diets around the globe that are very narrowed. They won't be able to live on blood alone or on milk alone, but they can live on that combination and thrive, as long as they live outdoors. So, that tribe has still kept tiny little huts. They have not moved indoors.
0:07:27 Mike Mutzel: So the brainstem is a critical factor, shall we say, in the function of deep restorative sleep?
0:07:33 Dr. Gominak: Yes. It is the switch. So, it doesn't do all the details that happen above, but there is a basic on/off switch, and that on/off switch paralyzes us. So, there's two things that happen. One, you have to get paralyzed correctly to fix everything. And two, you have to be able to switch into and out of these different phases. So, there is a little group of nuclei that are in the brainstem and they have vitamin D receptors. I thought that was really amazing when I ran into it and then I thought, "Everybody's vitamin D is low. No one thinks of D as having anything to do with the brain." But it turns out there are articles from the 1980s, for instance, that show that if you give vitamin D to those particular cells, the vitamin D goes into the nucleus and expresses the enzyme that makes a particular neurotransmitter. It doesn't make all of them, it makes acetylcholine. Acetylcholine, oddly enough, is what makes us get paralyzed correctly in sleep.
0:08:34 Dr. Gominak: So once, looking at all that, vitamin D turned out to be a major player. It's not the only player. And ultimately, all of this stuff works with the neurotransmitters. That means you kind of have to understand that every single person who becomes deficient has a different mix of which neurotransmitters aren't right. If you look at it that way, that means they can present in all kinds of different flavors. They'll have other effects as well as to why they don't make acetylcholine, or why they don't make this other neurotransmitter. Therefore, there will be somebody who has insomnia, or someone who wakes frequently, or somebody who, "Uh-oh, can't sleep until the day." So, instead of looking at it as a list, you think of it as, "Oh, these all have the same root cause, but are manifesting in different ways." That's what changed the way I looked at the sleep disorders.
0:09:31 Mike Mutzel: Yeah, really interesting stuff. But I think some people will get confused when you say the brainstem induces paralyzation in the body temporarily, 'cause they're like, "Wait, paralyze while you're asleep? What is that?" And then how does that then tie into sleep disordered breathing, and our mutual friend, Dr Mark Burhenne, who, thank you, Dr Mark, introduced us, so we're here. Let's talk about that, and then the placement of the tongue, and then how that can have this [0:09:53] cycle on this whole sleep disordered breathing, and sleep apnea, etcetera.
0:09:57 Dr. Gominak: The first thing to think about is that our sleep is the same as the sleep of the dinosaurs. This part of the brain is exactly the same in the dinosaurs. That means it's engineered so beautifully and it's had so many chances to be changed, yet it stays the same. The idea that we have to get paralyzed while we're sleeping is bizarre. If you don't swallow your own spit, you drown. If you stop breathing, you die. So, this part of the brain is already set up to notice when you stop breathing. Patients who stop breathing, it's not their wife or the technician who runs in during the sleep study that wakes them, their brain wakes them. That means the design of getting paralyzed already thought about the option of, "Uh-oh, what if he stopped breathing? Oh, we have to pay attention to that." It wakes you to light sleep and then you're not paralyzed. We really don't know why you have to get paralyzed.
0:11:03 Dr. Gominak: I've thought about that for 10 years now and I made up an explanation which was, "Well, you can't fix a pump when it's pumping. You turn it off and you open it up, and then you fix things inside it." So, my theory is that you must get paralyzed. Every moving part must get paralyzed in order to fix tendons, muscles, arteries, anything that's being used every day gets used up, and then you have to repair it every night. And in order to get to a place where you can fix it, you have to paralyze it. I don't think the brain or the liver get paralyzed. They're not moving, but the parts that are moving, you have to paralyze them. This little nucleus I was telling you about is broken into three different groups, one that does this part, that really governs face, nose, throat, a large area, diaphragm, chest wall and all the other ones.
0:12:01 Dr. Gominak: So those cells are actually split out, so there's a little wire that goes from this particular cell in the brainstem that paralyzes your toe, and paralyzes your calf, paralyzes your thigh. And it turns out that they're grouped probably functionally, so what we see on those sleep studies is periodic limb movements. That means they're walking movements. They're periodic because they walk. That means that most of the time, the people who have pain when they wake have knee pain or hip pain or toe pain or ankle pain and they will be manifesting pain in the part that didn't stop moving last night so it never got repaired. And the reason why we say, "I have a bad knee" is because that high school injury 30 years ago shows up when the weather changes, when I don't sleep well, if I'm doing too much and I cheat. What you're really doing is cheating a repair. That piece that was injured in your body actually needs more repair every night. So, that's the one part of your body where you know, I also [0:13:10] have pain there.
0:13:11 Dr. Gominak: There's an actual mechanism for that to happen. So, what happened to me was I saw these patients come back when I was treating their headaches with a CPAP device and say, "You know what? My back pain's gone." I would go, "Whoa, that's so weird. We're blowing air up in the head. So I was still thinking oxygen, brain... Why would their back get better? And then I really started thinking about it differently. I would go, "Oh, did she have any leg movements?" Because I really had a very limited palette to choose from. I had these machines. I had sleeping pills. I had medicines that I thought affected our leg movements during sleep. So, I would throw these medicines in there, and they wouldn't usually work, and then I would be stuck with, "This gal's knees didn't get better. Why is it usually below the waist? Why are these movements usually of the legs?"
0:14:04 Dr. Gominak: And I would actually look into the neurochemistry of that and it turns out there are these walking centers that are in the same location. They are very, very primitive walking centers that may actually be, they're not repressed correctly during sleep, so that there may be a specific reason why the leg movements were there at the end. The second piece was, "Why would an 8-year-old have more than one sleep disorder? Why would they stop breathing and why would they move their legs? What if these guys paralyzed us? That means they have to be able to bring us back. They have to be able to turn the muscles on again. They have a little wire that turns the muscle on. That means, if they're kind of shaking back and forth and they're not doing cruise control, exactly paralyzed, they're going a little... Not paralyzed enough, they're going a little bit too paralyzed, you could actually form both problems. If you get too paralyzed, your limbs don't lose, but your airway does.
0:15:10 Dr. Gominak: This part then becomes too paralyzed, the airway is no longer open, and that kid, while I'm looking in their throat, looking for tonsils, and there aren't any, can still have apnea because this becomes too paralyzed only in deep sleep. But as soon as we take away his deep sleep, he doesn't grow, he doesn't develop his brain, he doesn't sexually develop, he doesn't make the neurotransmitters that make him able to pay attention during the day. So, the effect of that one stealing of being able to get paralyzed correctly, has a huge downward, downstream effect on all of the things that happen to that child afterwards. So, this idea that it could be one place affecting both, and I'm thinking that for two or three years, and I'm making up these stories so I could tell my patients why it's important to them, so I can manipulate it with drugs, but there aren't any drugs that give back REM.
0:16:08 Dr. Gominak: That means once I stumble into the fact that these particular receptors that I'm reading a lot about the basic science have vitamin D receptors, I thought, "Wow, I didn't use sunscreen in medical school. We didn't have air conditioning in common use." When I was growing up, I played outside. As soon as the air conditioning comes, this puts it right at the middle to late 1970s to 1980s, and as I get out of medical school, right at that time, we start to get reports about sleep apnea, fibromyalgia, chronic fatigue. That's the very beginning in the early '80s. So, there's a timeline where both of those are starting to appear. And then I think, "What about irritable bowel? We didn't learn about that in medical school, it didn't exist. Celiac disease did not exist as an epidemic when I was in medical school. We've learned about it, but it was rare.
0:17:01 Mike Mutzel: What about MS? 'Cause I know that's another disease correlated with vitamin D as well. Interesting.
0:17:05 Dr. Gominak: MS is a vitamin D deficiency disorder, however, there's a very important piece of what we're gonna talk about next, which is, once you replace vitamin D, the body changes slowly from a vitamin D deficient body to a B deficient body. So, the vitamin D is a major player in MS, and that was a very first neurologic illness where vitamin D was described. But what I saw was that, as you get the vitamin D perfect and their sleep gets better, two years later, their sleep goes bad again and they start to have burning in their feet, gait disorder, they urinate on themselves, they have specific things that start to show up in the second and third year that we would have told them, in fact, we have told them is MS. It's not. It's aB-vitamin deficiency state. That means the second piece, which is D runs the microbiome, and it was attached to the microbiome or we survived better if it was attached to the microbiome because what you've taught everybody with all of the podcast is, who lives in your gut determines where you put the calories you eat.
0:18:21 Dr. Gominak: So you can be the wrong microbiome, eat a thousand calories a day, and still gain weight. That was a huge survival advantage. In any species that can actually go through six months of no food, they can put on fat before, they can lie in the ground for six months, they can hibernate, they run the thyroid hormone down so the metabolism throughout the whole body is reduced. Mysteriously, they're able to run their body for six months in the ground. That means they don't eat. If the B vitamins are all water-soluble and we pee them out every day, which is not completely true, that has to mean there was a source because every single thing we do in every cell is linked to the B vitamins.
0:19:08 Dr. Gominak: There's already a literature that suggests that the microbiome in the bear eats the colonic mucus that the bear creates. That small colony makes all the B vitamins that allows the bear to have all the metabolic needs matched for the six months it's in the ground. So, that system meant, is it possible that the B vitamins are actually playing a role here?
0:19:39 Dr. Gominak: What happened to my patients was, as I got them to sleep better, I don't want them to be unconscious; that's not why we're doing this. I want them to make repairs. Those repairs are the things that make us feel better. So physical repairs mean we don't have pain. Mental repairs mean we don't have headaches and we can think normally. All of those repairs are linked to the B vitamins. At the end of the second year, my patients started to deteriorate again; their sleep went bad, the headaches came back, the pain came back, and in fact, three things importantly were still there after really good management of the D; pain was terrible and was increasing of many kinds, arthritic, muscle pain, back pain. Their IBS was no better, and I was really depressed by that, 'cause I was still taking probiotics, and they're all still taking probiotics, and we're trading stories about probiotics. And the third was that they didn't lose weight. They were exercising more 'cause they felt better. They were clearly very inspired by the fact that they slept better, but they didn't lose weight. Then I had a couple of patients who also had really scary things that I couldn't explain to young women with burning in their hands and feet that occurred within about a month of each other, and they didn't have anything else in common, except they were both taking my vitamin D.
0:20:58 Dr. Gominak: One of my patients brought me a book about a B vitamin called pantothenic acid, and even though I'm not very knowledgeable in vitamins, I eventually read that book. And then the references for that book described that pantothenic acid is pivotal in sleep. So that's why she brought it to me. So B12, I'm already supplementing. We know that B12 plays a big role in sleep; there's good literature about that. So I'm already treating... The two gals with the burning, they were on B12. They had good B12 levels. So there was something else showing up, and this burning in their hands and feet is a very peculiar neuropathy, and that... Neuropathy is my subspecialty, so that's something that I've been practicing for 30 years, that did not walk in the door commonly. We see it all the time now, and we say it's diabetes, but it's not. These women did not have diabetes. Especially burning in the hands, it's a very unusual thing.
0:21:51 Dr. Gominak: The articles about pantothenic acid back in the '50s, where they took pantothenic acid out of the diet, showed within two weeks, they developed burning in their hands and feet; gait disorder, couldn't sleep, burning in their hands and feet, and belly discomfort. So, all of a sudden, I think, "Wow, could this be what's happening to them?" And then the next question is, they haven't changed their diet, why have they changed to a B-deficient person? And why did it take two years? That's very different than what we've been taught about the B vitamins. Not knowing what else to do, I gave back large doses of B complex and the burning went away in two days.
0:22:30 Mike Mutzel: Wow.
0:22:31 Dr. Gominak: The pain went away in two days. Now, there's one other really important thing that happened. The book is referenced as a lay person treating other people with rheumatoid arthritis, trying to teach them. This is way back in the '90s, when we're just beginning to use vitamins and nutrition, or it's not as common that people are seeking that. They described that the dose for pantothenic acid was 400 milligrams. So I took 400 milligrams, I gave my patients the recommendation of 400 milligrams, but I also remembered that when you give one B vitamin, you should give all of them. I didn't know anything about them, so I gave out the recommendation to B-100 and 400 milligrams of pantothenic acid. Within about a week, many of the patients came back and said that they were agitated and couldn't sleep at all, so they stopped the 400 milligrams, and they took B-100, and when they did that, they felt great. That means there's a dose response which is very upsetting because nobody knows what the right dose is. This is a vitamin that's completely overlooked, but that means if you give too much, you're gonna goof people up.
0:23:42 Dr. Gominak: That had me very frightened. I started reading, and what I fell into was articles that say each one of these B vitamins has an intestinal bacterial source and a food source. And after about the third time reading that article, I thought, "Well, wait a minute. This is where the bear gets that stuff. This is why, if our bacteria makes these B vitamins... I know their guts are a mess. IBS is all over the place in this population. Could it be that some of our B source is only from the gut? And as we goofed up the gut, we've actually... Oh, that also implies that maybe we had stores. Maybe the articles about the Bs aren't completely right. Could there be stores of these Bs? And two years of increased repair leads to a depletion of them, finally, and these new symptoms come forward?" Okay? So I'm thinking that, but I don't know if it's true, and it takes me about four years of giving out different doses to finally put together, reading into... There are several authors, one in particular who's been very involved in pantothenic acid in the pumps, that pump in pantothenic acid in the GI tract, who tentatively makes this statement, but won't come out and say "Oh, the primary source is really from the GI tract."
0:25:13 Dr. Gominak: He's getting braver in his articles, but he hasn't come out and said that. So ultimately, I thought, "Well, if the bacteria were the original source, that means that they know what the right dose is. So, then I don't have to worry about it. If we can get the bugs to come back, they're gonna make all the bacteria." So, what I began to think about then was, why didn't they come back? If these two epidemics of the GI tract with the sleep are in parallel, which they are completely documented to be in parallel, then the vitamin D should have brought the bugs back. I know my patients have plenty of vitamin D down in their intestinal tract now, yet the IBS is still there. What did those guys want? And is it really about supplying the right bacteria? Because we're all taking probiotics. One of the articles that I stumbled into to review was a really good article out of The Economist that says that if you go around the world and you sample the bacteria of three-month-olds, you'll see these four main species in outside living, healthy, three-month-old humans. Those four species didn't get in there because of probiotics. They're not giving them probiotics.
0:26:31 Dr. Gominak: That means they wanna be there. They would get there spontaneously. In fact, the baby gets inoculated with mom's bacteria as he passes through the birth canal. And soon after that article was published, National Geographic has a cover story that says, "Kids delivered by C-section have a harder time colonizing." Well, what if mom is vitamin D deficient and she has the wrong colonies? That means she can only inoculate her baby with these wrong bacteria populations. And that same Economist article describes that you have to have these four happy, healthy, to be able to dissolve specific glycans in mom's milk. We don't have the enzymes for that. That means those bacteria are responsible for making that baby happy with breast milk. If they don't have the right bacteria, they get colicky with breast milk. How's that gonna work? That means that baby actually dies. So there are survival advantages. Now, if they get in there spontaneously, could that mean that we're focusing on giving back the bacteria, when what we should be focusing on is making the environment specifically encouraging those species and not others?
0:27:50 Dr. Gominak: If those four guys make eight B vitamins, maybe those four are down there, but there's piles of poop in-between their buddy that used to provide the B vitamin that they needed. So, there was this hypothesis in my head. These four exist as a commensal foursome, and they make B vitamins, and they're not making them for us, they're making them for each other. They make the environment around it. They make this B vitamin soup around them, and then we came upon this planet using their Bs. So every multi-celled organism... So the bacteria came way before us. Every multi-cell organism has poop inside that has these cultures of bacteria, and we don't need to make the Bs because we have a constant source. So, now I think, "Oh no, I'm giving B-100. I'm flooding the intestinal tract with these eight Bs. Is that gonna induce them to grow back?"
0:28:56 Dr. Gominak: "I just had the bad experience of giving a dose that was too high. If they come back and they keep taking my pill, are they gonna notice that their pain comes back and their sleep falls apart?" And the fact was, it did. That's what happened at three months. I missed my own instructions and actually went four and a half months on the B-100, and wound up really stiff, couldn't quite move, felt really old in the morning, and then finally put it together with one of my patients telling me, "You know, that B-100 made me ache all over, and I took it to B-50 and I didn't ache all over," and I thought, "Maybe my bacteria are back. Maybe I want double dose." And you stop it, the pain goes away in a day. It's bizarre, a really weird experience.
0:29:41 Mike Mutzel: Once we get this microbiome, is it the phyla or these actual species that we're talking about?
0:29:46 Dr. Gominak: I can name them for you, but I'm not knowledgeable enough as a microbiologist to tell you. But there are four general species: Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes. And aside from knowing that those four always hang out together, I'm not that knowledgeable about the specifics. But the interesting thing is also all the stuff that we know about the right bacteria protecting us from the autoimmune diseases, there are many things that we don't know about what they do. That means what we really want, ultimately, is to get back to what the original survival advantage was. There are probably many chemical things that we'll learn about them later. I mean things like ghrelin and leptin that we know now, and short-chain fatty acids, and short-chain fatty acid making me hungry for donuts. Those are all things that weren't known 20 years ago. I bet there are many other things that we'll find out about what roles the bacteria play, but for right now, what I personally want is to get those foursome back. I don't have data that was based on bacterial cultures. Okay?
0:31:01 Dr. Gominak: I have clinical observations that were based on several suppositions and clinical observations about pain and sleep disruption. So from my point of view, what I have to offer is a hypothesis that then needs to be proved in other ways using bacterial growth, actual colonic samples and that sort of thing. So we have the framework in which to believe this could be true, but I personally don't wanna wait until they finally get around to that. So I'm making contact with other scientists to try to get these ideas in their head so that they start to design experiments that will prove it. But ultimately, if all you have to do is get your vitamin D level up to above 40 and take B-100 for three months, or B-50 for three months, and you know the general idea, you can fix your own bacteria.
0:31:53 Mike Mutzel: Yeah.
0:31:54 Dr. Gominak: That would be nice in that we don't have to wait another 10 years. That, and the impact of knowing that the microbiome plays a huge role in the sleep. You don't fix it, the sleep falls apart. That means all the sleep apnea, all the insomnia, all the sleep disorders are not just one thing that went wrong. It's the D plus these Bs. I suspect that there are other Bs like pyridoxine that play a role in sleep that haven't been reported yet. So one of the things that I always say in my literature is, "You always give all eight." We don't know what the doses are. We have certain sources, but we don't really know how those doses came about. It's very difficult to get to that literature. They're all pretty arbitrary. Most people are concentrating on, "This B vitamin does this."
0:32:39 Mike Mutzel: Yeah.
0:32:40 Dr. Gominak: I think that's the wrong concept. I think we need all eight always. And no one has ever determined the doses or the ratios of one another, of those eight, and we really don't even know whether it's the colon or the small intestine. Almost everybody is concentrating on the colon. To enlarge this just slightly, the guy who wrote the articles about there's a colonic bacteria source and a food source, has spent most of his life studying the pumping and the absorption of vitamins. He's been pivotal in describing the sodium-linked multivitamin transport system that pumps in three vitamins. It pumps in pantothenic acid, alpha-lipoic acid and biotin. Now, the importance of that is, if you know that and you take a huge dose of biotin, you may actually worsen your sleep. And I've had a few headache patients who had... Their headaches had come rushing back and they just started biotin. So there are a few things about that detail.
0:33:42 Dr. Gominak: The second piece is, what's written in all the books right now is pantothenic acid deficiency doesn't exist because it's in every food. That's not right, it turns out. That was an assumption made back in the '80s. Someone, and I can't find the literature, assumed that Coenzyme A, which is in every single food, is the same as pantothenic acid, but it takes five enzymatic steps to go from Coenzyme A to pantothenic acid. And pantothenic acid is a very peculiar chiral molecule; it has a right-handed form and a left-handed form. All of... Even the bacteria, all of biology uses the right-handed form of pantothenic acid. None of them use the left-handed form. We have to have those five enzymes in order to take the Coenzyme A from our food and make the pantothenic acid that that pump pumps in. That same pump that pumps it in at the GI tract, pumps it in our brain, same exact pump, yet it turns out that the only study, there was one study done, and it measured those enzymes in a rat, with a tube in the rat's intestine, with an intact microbiome.
0:34:52 Dr. Gominak: That means if we've really been using the microbiome to make that conversion all along, and we know that there are multiple species of bacteria that have those enzymes and make pantothenic acid... We know there are other species like lactobacillus that use the pantothenic acid of these other species. That means if we flood our system with lactobacillus, they compete with us for the little bit of pantothenic acid that the one or two or three little guys are still making. So there are implications that grow out of that. Ultimately, there are many assumptions that are wrong.
0:35:27 Dr. Gominak: There are many assumptions about the B vitamins that were generalized from B12. There are scientific articles that show that we have stores of pantothenic acid, stores of vitamin C, and stores of pyridoxine. That means we can run out of them slowly over time. So lots of the ways that we look at how we use the B vitamins and that we throw them around with this level of freedom, I've actually seen some of my patients have terrible pain because of the B-complex they just started, and if you're doing more than one thing, you won't be able to know. Plus it's usually something you've had in the past. So you had back pain, then you've done this, then you've done this, then you get fat, and then you're not exercising, and then you go in this weight loss program and you start exercising, you start this big B-complex, it turns out it's causing your pain and there's no way for you to tell.
0:36:21 Mike Mutzel: Yeah, too many variables going on at the same time.
0:36:23 Dr. Gominak: Absolutely.
0:36:23 Mike Mutzel: Really interesting. Are you familiar with James Adams? He's at University of Arizona... ASU, Arizona State University, sorry. He's done a lot of research with autism, and so he's really looked at, of all the different B vitamin deficiencies, they found a lot of the methylation-related B12 and folate in individuals with high levels of Clostridia and so forth. So I remember hearing that for the first time, thinking, "Wow, this was a few years ago, really novel that there was a commensurate level of B vitamin deficiency correlated with symptoms in autistic spectrum disordered children and are correlated with microbiome imbalances. So...
0:36:57 Dr. Gominak: And vitamin D. So there's a parallel literature about autism and vitamin D. And what we're really looking at is these are children who do not have enough time spent in deep sleep. The effects are varied because what the brain is doing is it has to triage every night. We don't pop out, ready to go. We have to develop each part of our brain. So it's my conclusion that if you shorten the amount of the developmental time, the brain has to triage what it will develop. And based on the epidemic of autism, I would say that social interaction has been left for last. It's more likely that the individual will survive based on developing speech, math, and all the basics, but you take out the social interaction, that individual will probably not mate and probably not produce offspring, but they'll still be able to survive. But what I've seen in my patients is, you give back everything the brain needs, even at age 16, and you will see that the brain knows what was left off.
0:38:12 Dr. Gominak: It keeps a record of every single thing it has not had time to do. And if you let that child sleep as much as the brain wants to, all of those deficiency states are given back everything they need, it fixes everything, That child's social development catches up, their sexual development catches up, the area of sexual discontent or dysmorphism, where "I don't feel like my body fits... What I feel about myself doesn't fit my genitalia," comes out of the same place, I think. You're born with your genitalia, but the sexualization of your brain happens every night while we sleep. That means endocrine development of the brain is related to estrogen levels that are secreted in your brain while you sleep. The things that we've seen happening, autism and sexual feelings of not being right, have all increased around the same timeframe. So I think that the different reports of autism from D, sleep, B-vitamins, are all drawing together, and all you need to do is see how they connect, and you put that together, and then you can fix them.
0:39:28 Mike Mutzel: So even things like homosexuality potentially, and things like that. We're saying that because there's an early life... You did mention this, that there's an early life disorder within the sleep system, so the nightly repair is not occurring like it should. So certain parts of the brain are not being watered, if you will, like they should be and so there may be not developing that could potentially be...
0:39:51 Dr. Gominak: I wanna distinguish between humans who pick a sexual partner, and I don't feel that I'm an expert in that area nor do I have any good ideas about it, but that's a different feeling than feeling dysphoric about your sexuality. So we know that sexualization of the brain happens slowly in the same developmental spheres that growing happens that, for instance, there are people who are born with a testosterone receptor that is unable to receive the message. Those people in development in utero, have testes have an XY but they come out female because the actual body parts that are supposed to receive that input don't have a testosterone receptor.
0:40:47 Dr. Gominak: However they are completely female, they act female, they otherwise are completely female, they are sexualized with estrogen throughout, even though they're XY. So you take that as one example and then you look at, there are several other examples where the development of the body and the brain are actually somewhat separate. We do go through this big boost in the sexual hormones in puberty but we're all being sexualized two, three, four or five years old. Anybody who's raised a kid know that boys and girls are different from the beginning and that isn't from mom's hormones affecting their brain, that's from that child making hormones that affect how the brain looks at the world even at age one. So I have a hypothesis that that sexual dysphoria is related to not having the proper time. And the reason why that's important is, if you change the genitalia of that person and they think that their dysphoria is gonna completely go away, the depression and anxiety that comes with sleep deprivation is still there.
0:42:00 Dr. Gominak: Instead, you may fix their genitalia, but you fix their sleep, you pay attention to the fact that this occurred because they are not sleeping normally. And if you look at the growth curves of those kids, a lot of times their growth curves are limited as well, so that's a much bigger picture. It's like, what are we looking at in terms of the development? Could all of these things be different flavors of not developing correctly between age zero and 20?
0:42:28 Mike Mutzel: So, it's a spectrum of sorts and so.
0:42:30 Dr. Gominak: I think, so.
0:42:30 Mike Mutzel: Very interesting. And so if we wanna again, talk like root cause resolution of that spectrum of neurologic aberrations, shall we say, it stems from poor quality sleep.
0:42:41 Dr. Gominak: Yes.
0:42:41 Mike Mutzel: Or lack of...
0:42:43 Dr. Gominak: Not getting into the right phases. And unfortunately, most children do not report that they don't sleep. You have to be really, really disordered not to sleep. Most of the time, the fall back for 90% of the kids I see can't get out of bed in the morning. So, they're D-deficient to an extent that what their brain was designed to do was to sleep 18 hours. When the D is that low, they're supposed to be hibernating. So they have twice as many things to do as we do. We have to do, remembering everything we did today, they have to do all that and grow, and develop their brain. They have so much to do there. I don't know what this chemical is, but there's an additional chemical force that is keeping them asleep, that's what bed wetting is about. They're asleep, but they're not making anti-diuretic hormone, that means they're not getting into deep sleep, bed wetting means they're not getting into deep sleep. If they were into deep sleep, they would make anti-diuretic hormone, and they would stop the production of urine and their bladder would be able to hold it.
0:43:44 Dr. Gominak: So there are many things that we see, leg movements, leg pain, sleep walking, sleep talking, they're all related to this but the more important impact is, oh, if that kid can't get out of bed, the brain is really saying, "Go back to sleep. I was supposed to do three hours of REM. And we haven't even gotten into it yet."" You're cheating that child of their normal development, and that is something that we can impact without doing blood tests, and without giving pills. All we have to do is tell the kids they can go outside more. All we have to do is impact what we tell people about putting sunscreen on their children. I have kids who are African-American and their parents are putting sunscreen on them. That's crazy.
0:44:28 Mike Mutzel: In Portland. [chuckle]
0:44:29 Dr. Gominak: Yeah. That means we have to adapt what we do with the sun screen to the skin type of the child. So I don't want my kids to have to have blood draws, I don't want them to have to take pills, I would like them to make all the vitamin D they need every summer. And if I knew how to do that naturally from the sun, you cannot go too high by sun exposure. That means I take out all the dangers that I see when I have to supplement. If you do that in the population before they develop a sleep disorder, then we never have to do any of this stuff. So if we can impact our children, their level of being able to learn and pay attention in class, and development of autism and the development of our own self-view is so linked to how well we do in school, that all of these kids are affected by "Golly, I'm not normal." If you could just put your kid in the pool more often and change that, and you had some parameter to measure.
0:45:32 Dr. Gominak: The key is, if you can see a kid who's in September, spent the entire summer outside, you go into his room at 6 AM, he's awake, he's got his school lunch box, doesn't have anything in it yet, but he's got his lunch box, he's got his clothes on, he's ready to go to Kindergarten, he's not driving you crazy. He's not climbing on the furniture. He's calm, he's happy, he's interested. That child just had a perfect night's sleep. He woke up at 6 AM before you went in there. Any kid that is not doing that you can intervene just by putting them out in the sun more, just by using what you know. You don't want them to burn, but you want them to make all the vitamin D, and then once you see them in September, you don't just say, "Oh, he's all relaxed because it was the summer." You think, "Oh, he made a bunch of vitamin D." And then February rolls around, and you can't wake them up in the morning, then you think, "Oh maybe we need to give a little vitamin D between February and May, when he goes out in the sun again." So you can do this in children in a very easy way. It's not without its difficulties, but you can give a framework in which to do this with children that's not about blood draws or pills. It's really amazing.
0:46:47 Mike Mutzel: That's fantastic. What are the other symptoms? Morning fatigue and developmental delay, and things like that we talked about. But you know, sometimes you take a nap or whatever and you kinda wake up with a twitch. Or sometimes I see my daughter... She's five years old and she loves her sleep. So this is really kind of hitting on a personal level although she is outside a fair amount. But anyway, that being said, sometimes I see her like twitching and moving her arms and legs. So, what's kind of going on with that to give parents and then people if that happens to them, what is that?
0:47:15 Dr. Gominak: So, there are normal movements that we all make, and we can watch our animals do this, too. We watch our dogs running when they're asleep. So, normal people, normal children, should make small movements, little tiny vocalizations. They shouldn't talk. They shouldn't scream. They shouldn't walk. They shouldn't move enough that they fall out of the bed and many of the bed partners to people who have sleep disorders, say they kick, they move too much. There are subtle movements that are still, I believe, that are within the range of normal but those subtle movements don't wake the bed partner. They don't goof up the bed clothes. And if you're watching your child you'll see these little tiny subtle movements. Anything bigger than that means that the paralysis center is lacking what it needs to get perfectly paralyzed. That can be either D or it can be pantothenic acid. It can be either one. Both of them make acetylcholine. pantothenic acid is the raw material to make coenzyme A. Coenzyme A makes acetylcholine. Acetylcholine is the primary player in getting us paralyzed. Vitamin D expresses the enzyme that makes acetylcholine. So, those two chemicals actually work together.
0:48:28 Dr. Gominak: The other thing that you'll see on the other side of it is, if they get too paralyzed, they snore. I had mentioned Weston Price earlier. Weston Price was the first dentist to give beautiful, actual living videos of primitive populations, before and after, the incursion of western culture. His summary was that their palate, which was not normally formed once the western lifestyle came in, was related to nutrition. What he missed was, I believe... What he showed was, that the palate becomes narrower and the teeth become irregular. There was also changes in dental caries, so their actual health of their teeth were different. It's not that he's wrong completely. It's that we now know that the shape of the upper part of the mouth and the jaw are both determined by sleeping. Deep sleep... The tongue is sending all sorts of sensory messages to the brain, so that as the face grows, there is a message telling that both sides of the face grow at the same time.
0:49:42 Dr. Gominak: If you take away the tongue's ability to do that because the kid has to open their mouth, so as soon as the child becomes D-efficient, they get a runny nose. They get increased allergies, and they're not able to breathe through their nose. That means they're what's called obligate mouth breathers. Obligate mouth breathers turn out to have a different formation of their lower face over time. Because they're sleeping with their mouth open, the tongue can't give the input back and they get a retrognathic, less developed jaw and a narrower palate, and their teeth grow in the same way. The teeth don't know and then they get crooked. The dentists who are dealing with those kids now are fascinated by the fact that they can move the palate. They can put in a piece. Now what they're doing, instead of removing the teeth, is they're widening the upper palate with the idea that they're opening the airway. That has a limited applicability. If the kid is still an obligate mouth breather, there's still a problem. That's why Dr. Burhenne wants them to tape the mouth.
0:50:45 Dr. Gominak: But there is a root cause in the background. The reason why the kid is breathing through their mouth is because their nose is all stuffed up and their nose is all stuffed up because D and B's affect the allergies so much, and they affect the development of the inside of the nose and nasal secretion. So, if you fix the palate, yes, you make the face better but you haven't really answered why are they breathing through their mouth? So, if you fix the root cause and move the palate, then you've just given this kid a permanent fix. It's great. The thing that Weston Price missed, I believe is, the original western intrusion into these tropical cultures brought not only a difference in food, but they brought shame of nakedness.
0:51:30 Dr. Gominak: So what you see happening is tropical cultures start to put on clothing, because the people that come from a different climate are used to wearing clothing, they tell them it's shameful. So you see these movies about the Hawaiian culture as they moved into leprosy and the Catholic church is there, and the Catholic church is... There's this beautiful movie about Father Damien. What you see in that movie is that there are these Hawaiian girls with black dresses on. They go from their neck to their ankles, and they're swimming in them, they're in the water. So the second thing that happens is the vitamin D production in the skin goes down, you take somebody who is bare from the waist up, and is only wearing something around their genitalia and you change them, and they're all dark skinned, there skin is perfectly suited so that they won't make too much vitamin D but you've just taken away their vitamin D source. So he's showing the things that we now know or have to do with obligate mouth breathing in primitive populations in the 1930s.
0:52:32 Dr. Gominak: But I think the piece that he missed is not just the food, it really is the amount of sun exposure at the same time. And that's my hypothesis, I have no proof of that, but I think it fits together nicely for what we're seeing now. All these people that aren't changing what they wear in Western populations have changed their vitamin D exposure and their teeth are getting crooked and their actual dentition are decaying. So the typical idea of the middle America that is obese with terrible dentition, that's all related to that vitamin D exposure. That means that's a population that's living inside In air conditioning all day long, never go outside, never play outside.
0:53:14 Mike Mutzel: Yeah, it's a really interesting perspective. I think a lot of people, when they think Weston A. Price, they think of a sugar, like "Oh, it's just too much sugar and then that's what caused it." But there's gotta be more to the mechanism there, and so I like your overall nutrient depletion possibly, and the vitamin D deficiency...
0:53:28 Dr. Gominak: Plus the microbiome of the mouth.
0:53:30 Mike Mutzel: Yes.
0:53:32 Dr. Gominak: The dental literature is now moving towards the microbiome of the mouth determines dental carries. If you bring the microbiome and they need vitamin D too, I don't know that as a fact, but I do know that the microbiome of the mouth is still part of the GI track, that means that the microbiome or the mouth goes bad, your likelihood of dental carries and all your teeth falling out goes way up.
0:53:54 Mike Mutzel: Mm-hmm, wow, that's really key.
0:53:56 Dr. Gominak: That also has to do with why old people lose their teeth, they don't just wear out. If there are people who have all their teeth at age 90, then why is this person losing their teeth at age 60? And it turns out that I've had a few patients who have become profoundly D deficient, who over a one-year span begin to lose all their teeth and it's not because they're not brushing their teeth, it is absolutely related to this cascade of D, then the microbiome, then they don't even have the trophic factors that keep the teeth growing and they just fall out. We saw that happening as part of what we thought was normal in an 85-year-old. We just don't expect to see in a 45-year-old, but there's a mechanism for it.
0:54:36 Mike Mutzel: Gosh, this is fascinating. We can go on all day, I think. But I think an important point were that everyone listening should be familiar with, is this obligate mouth breather. I think it's really important for people to understand. And by the way, just as a side conversation, Dr. Burhenne has been just an amazing... He's been on the podcast twice.
0:54:54 Dr. Gominak: He's really great.
0:54:55 Mike Mutzel: He's a good influencer. He taught me this mouth-breathing tip, and I've been doing it for myself and the experience benefited and then my wife, and then our daughter, who was four at the time, and I took a picture and put it on Instagram, and then it got... It's the most controversial thing I've ever...
0:55:07 Dr. Gominak: You put tape over your kid's mouth?
0:55:09 Mike Mutzel: Yes, but she loves it. So, interestingly, you were talking about moving... It goes back full circle, and I wanted to bring this up anyhow, a little movement is okay but too much while sleeping is not good. So she would sleep with us periodically and we would wake up, she was in the middle of Dianna and I, my wife, upside down, feet... It's like, "How did this even happen? What is going on here?" So after doing the mouth tape, she's totally... She moves a little bit, but none of this 360 tumbles. So anyway, a lot of parents jumped in and said, "What if she vomits while she's sleeping?" And all this, I'm like, "Well, she's sleeping with us, we would hear it right?" but anyway." As a neurologist, just curious now, how common is vomiting while you're sleeping, in children?
0:55:53 Dr. Gominak: I don't know the answer to that. As soon as you said that, I thought, "Oh my gosh, they're gonna get all excited about that." Ultimately though, then we step back and say, why we have to tape the mouth shut, and then we wanna explore the root cause that led to not keeping the mouth closed. There's a whole body of literature in dentistry about babies that are able to breastfeed and what's different about being able to get milk from a bottle that you don't actually have to make a seal, you can just lift the bottle up. That means that babies who are not able to breastfeed can't breathe through their nose, and what their literature says is if you have an obligate mouth breather, they actually don't develop their nasal passages the way they should. If you enlarge the palate, what you've actually done is enlarged the base of the nasal passages. So all of a sudden, the nasal passages become more open also. So not only are they obligate mouth breathers, but they have a smaller opening to breathe through their nose and you can fix it by that, and you can fix it by this as well. But you'd still like to not have to do that.
0:57:03 Mike Mutzel: Yeah, right. Interesting. So we just have a few minutes left, and then some personal questions I'd love to ask you, but before I forget, so you got some great papers here that are on your website so if people wanna dive deeper. And if we could summarize just a little bit, so the vitamin D deficiencies affecting the brain stem, affecting sleep, and then that's affecting the microbiome and so forth. Am I missing any major?
0:57:26 Dr. Gominak: I think that the one piece that I've hypothesized that isn't proven yet, is I think that vitamin D is trophic to the bacteria that we're supposed to have in our belly. No one's asked that question. I thought because there was such a connection to the GI tract that the bacteria were just gonna need vitamin D. No one's actually documented that, but what we talked about earlier was the fact that we know that there are 100 species in the GI tract by their DNA footprint, but we've only grown 2% of them in a petri dish, and I suspect that that's because we never thought of giving vitamin D as a trophic factor. I don't know that to be true. It's true that we have both epidemics coming as vitamin D goes down. It's also true that vitamin D supplementation by itself did not bring the microbiome back and that has a really, really important impact.
0:58:22 Dr. Gominak: As all the doctors start to replace vitamin D and we're giving low doses, let's say you're on 2000 a day, and you're on 2000 a day, and your level is slowly climbing from its pitiful 22, and five years later, it finally climbs to 60 and you start to sleep a little bit better, you will not connect it to the vitamin D supplementation that you took. Then two years later, your D level is staying at 70 'cause it's going up so slowly and all of a sudden your repairs have meant that you become B deficient and you start to have burning in your feet and pain all over, you would never attach it to that vitamin D.
0:59:06 Dr. Gominak: I was doing this in big enough doses with enough people over a shorter span of time that I could actually say, "I think this is something that I'm inducing in these people, 'cause I'm moving only one thing at a time." That means that the most important message is being B deficient with pantothenic acid causes horrible pain. It not only... pantothenic acid not only makes acetylcholine which allows us to get paralyzed in sleep, but it makes cortisol. That means you don't have enough pantothenic acid, you don't make cortisol. What does that result in? Inflammatory markers are up all over the place. So one big problem is everybody who's gonna develop an auto-immune disease, the cortisol is what tells the white blood cells to calm down. You don't have enough cortisol over a 10-year span, all of a sudden they start to attack their own body. The second piece is you don't have any cortisol to move up and down in response to stress. So you really don't have any reserve in that cortisol system to help you. At the same time, you have not enough acetylcholine. Acetylcholine turns out to be the chemical that the vagus nerve uses. You get to the autonomic nervous system, it's two intertwined reciprocal nervous systems. Fight/flight uses adrenaline, rest and digest uses acetylcholine.
1:00:30 Dr. Gominak: If I deplete your stores of acetylcholine making vitamin, so you can't make acetylcholine, what are you left with? You're left with someone who's in fight/flight all the time. Even though you've done all the things I've told you, you meditate, you've got this great diet, you're exercising all the time, I can still show that my 28-year-old with daily headache is sitting on my examining table with a resting heart rate of 110. She's thin, she exercises all the time, she feels like crap, she doesn't sleep and her entire autonomic nervous system is goofed up. Her GI tract doesn't work, she feels anxious all the time because the adrenaline level is too high. If you go back into these heart rate variability studies, what they're measuring throughout all the populations who have sleep disorders, is that the sympathetic is dominant, that the parasympathetic is way too low.
1:01:27 Dr. Gominak: Since I don't have any proof that this pantothenic acid is the cause, but I do have beautiful recordings of the fact that the sympathetic is way out of line, compared to the parasympathetic, in postpartum depression, in depression, in PTSD, in hundreds of diseases. There's beautiful literature that documents that the autonomic nervous system is not working right in all these diseases. I suspect, that as we give more and more D throughout the population, you're gonna see this worsening, because we've missed this piece, which is pretty simple. Get the bugs back. The autonomic nervous system now has its supply to feed back to the vagus, to make it work.
1:02:06 Mike Mutzel: Mm-hmm. Because the bugs are helping with the acetylcholine synthesis...
1:02:10 Dr. Gominak: Exactly. The bugs are... I think, that the only source for pantothenic acid in our body, in anything that we eat, there is no pantothenic acid. It is only from the bugs, and I think that the bacteria make an hourly or a minute-by-minute supply. If you look at the textbooks about sleep, it says acetylcholine manages our level of alertness during the day and our deep sleep at night. The same exact chemical makes us alert, and able to direct our attention. You flip a switch, that's so different than the way we think about...
1:02:45 Mike Mutzel: Yeah.
1:02:46 Dr. Gominak: What makes us sleepy. Same exact chemical makes us able to get in and out of slow-wave sleep, and REM sleep.
1:02:52 Mike Mutzel: Wow. This is really fascinating stuff. I wanna highlight a few things that you said in that last segment of it... I think they're eloquently spoken, and I think people need to appreciate the healthy properties of cortisol. You mentioned that cortisol is anti-inflammatory... And we can demonize cortisol and talk about adrenal fatigue, and excessive cortisol, promoting weight gain. But I love how there's a U-shaped curve for all these different things.
1:03:17 Dr. Gominak: Yes. Absolutely.
1:03:18 Mike Mutzel: We need some cortisol. It gets us up out of bed in the morning and helps energize us. So that's important. And there's this interesting emerging anti-inflammatory reflex arc, called the cholinergic anti-inflammatory reflex arc, needed from the brain via that person's nervous system, through the spleen, and it's all acetylcholine-driven. And so, so many people are inflamed, and have [1:03:37] and all these things that we've been talking about, and here we go. We're just bringing back full circle what we've been saying... This pantothenic acid... Acetylcholine helps us stay alert, helps us go to sleep, and it's involved in both in anti-inflammatory pathways, from two different mechanisms. I think it's really, really fascinating. So...
1:03:57 Dr. Gominak: And it explains why things like meditation, and mouth pieces... It turns out, if you put an oral appliance in a person's mouth, you can measure that their heart variability in a minute, changes. The sensory system of the back of the palate is the glossopharyngeal nerve that goes directly to the vagus. It's part of the system, that as you roll over and put your face into a pillow, your brain has to have a way to know that the pressure is building up. Uh-oh. Something's wrong. And that sensory system inside your mouth then changes your position and makes you be able to breath again. So there's part of that sensory system that goes directly to the vagus, that then changes your level of sleep, and does a bunch of other things. But oddly enough, what we're seeing now is, we're using more and more of these techniques that have been designed to up the vagus output. That's why meditation makes us feel better. It decreases our anxiety. It actually changes. We're using things like breathing to tell our nervous system, "Gee, I don't have enough of the parasympathetic." And we're using these methods that are very old, but the reason why they're in such increasing use is because we're depleted. And what's gonna happen eventually is, I tell the vagus to give more and more output. If it runs out of its raw material, it's gonna fail.
1:05:21 Mike Mutzel: I think that's really important, because so many people are not eating right, but they think, "Oh, I meditate, or I do yoga, so I'm cool. I don't need to worry about the food, or whatever." So, that's really, really important that you highlighted that. So, meditation... If someone responds really, really well to meditation or heart rate variability biofeedback, that might be a signal to say, "Oh, maybe I do have this vitamin D, pantothenic deficiency going on, potentially."
1:05:48 Dr. Gominak: Mm-hmm.
1:05:48 Mike Mutzel: You know, because their level of autonomic tone could be imbalanced.
1:05:52 Dr. Gominak: Mm-hmm.
1:05:52 Mike Mutzel: Yeah.
1:05:53 Dr. Gominak: I think that the important part is, if you're healthy and you have no complaints, and you feel good every morning when you wake up, and you have enough energy at the end of the day, that even though you work all day, you go out and you exercise, then you really don't need to mess with this. But that's probably 10% of the US population, you know?
1:06:10 Mike Mutzel: Yeah.
1:06:11 Dr. Gominak: And that also means that you still have to be cautious. Once you fix all of this, it turns out, if you take large doses of B vitamins, when your bacteria are back, you can get terrible arthritic pain from it. And I now have friends, and I have clients, that I've had to spend my time convincing them that, yes, you're right. This B-100 that you're taking twice a day, that you've been taking for four years... It did fix you. You're right. It's not that your naturopath is wrong. The vitamin D that you're on... You just walked into my office with burning, and terrible headaches, and you can't sleep. And that's why you went to the naturopath four years ago. In the midst of getting better, we didn't realize that your vitamin D is now exactly where it needs to be.
1:06:53 Dr. Gominak: Your bugs came back, and now you're really on 300 of B, and actually you've gone through the phase where you needed more.
And it takes me a lot of work to convince them to come off the B-100. The only good part is, when you stop it, the pain goes away in two days. If that is making you not get paralyzed correctly and your pain in your muscles or your joint, is because you're doing these weird things during your sleep, it goes away very fast. As long as your D-level's in the right place, you take away that source, the Bs are really active within the day or the day after, that you take them. You can move them around and say, "Oh, I feel better, I feel worse." And it will tell you, the only important thing to know is... Too much and too little both do the same thing. That makes it a little bit hard.

Note: B-100 contents from one supplier: Thiamine 100 mg 6667%, Riboflavin 100 mg 5882%, Niacinamide 100 mg 500%, Vitamin B-6 (as Pyridoxine HCl) 100 mg 5000%, Folic Acid 400 mcg 100%, Vitamin B-12 (as cyanocobalamin) 100 mcg 1667%, Biotin 100 mcg 33%, Pantothenic Acid 100 mg 1000% (as Calcium Pantothenate)

1:07:36 Mike Mutzel: Yeah. So, that's where... Where the clinical practitioner getting the labs is key?
1:07:39 Dr. Gominak: Yes. The one comment I would make is, we can get a pantothenic acid laboratory result. We can get a blood level of pantothenic acid. Unfortunately, it's very parallel to the magnesium level. It tells you what's in the blood, but it does not address the stores. That means we really need a better way of measuring pantothenic acid stores. So there are a couple of articles that talk about dosing as an experiment... Dosing people with very large doses and very small doses, measuring the blood level and the urinary excretion. As you dose really high, the blood level doesn't change, but the urinary excretion goes up.
1:08:16 Dr. Gominak: So there are ways to trace that. Those experiments are from the late '70s or early '80s, but that is why the group suggested that there were stores. There's a delay in what the body does with it, and I suspect that that's the case, probably for pantothenic and pyridoxine. And those two chemicals overlap an awful lot. So there's still some things that we don't know about using the individual Bs, and using the blood tests for them.
1:08:41 Mike Mutzel: Interesting.
1:08:42 Dr. Gominak: Pyridoxine is interesting, because it's one of the few Bs that has a reputation. There are articles that suggest, if you increase the dose, you can cause burning in the hands and feet. So, there was a neuropathy associated with large dose pyridoxine. I think that those two... B5 and B6, behave somewhat similarly, in that there's a dose range where it wants it every day, at this little, tiny dose range. There's one other concept, which is when I saw my patients, as I got them better... As we stopped the B-100 at three months... If you stay with them another six months, if you sleep better, the brain appears to remember all the deferred repairs. Patients who had lupus, who had been sick for 20 years, ended up needing bigger doses of Bs than I did. I wasn't very sick. I needed slightly more. It's almost as though when the brain says, "You know, I'm doing so well, I'd like to do three and a half hours of REM because I have all these... " It appears to remember everything. That takes you one step further to say, "Gee, if there are stem cells in the pancreas and in the brain, and in the kidney, they weren't put there so that humans can find them."
1:09:56 Dr. Gominak: They were put there because that means that given the right setting... And keep in mind that every time you make something in your body, it has to be tightly supervised. There has to be somebody saying, "Okay, you made two Beta... You made two pancreas islet cells, make five of them, but don't make 250,000 of them." So you have to make sure that growth, using a stem cell, is very dangerous. If it gets loosed, it can take over the whole body. That means there's a concept in the background which is there must be stages of sleep where you can actually repair the body and remake things that have been injured, but you must get into this very specific phase for all the pieces to be in place to do that. That means we are completely self-healing, and that we have the opportunity to reverse really terrible things, but you do that by sleeping the right amount. And some people, they ended up in the year one, year and a half, after correcting their intestinal bacteria, they ended up needing more Bs. And only if they're sleeping better, so they're sleeping better. My theory was they were actually making more repairs, they therefore needed slightly more Bs, they needed more than what these guys make naturally.
1:11:18 Dr. Gominak: If these guys only make the basal amount that we need, and you need more 'cause I'm encouraging your brain to sleep even better by keeping the D perfect, you might need slightly more. And the only way I could figure to judge that was by their pain.
1:11:34 Mike Mutzel: Like you mentioned, the auto-immune disease, maybe
[1:11:37] ??? share of cancer, whatever, osteoarthritis, once their deep sleep... They're getting the good sleep, their brain's like, "Alright, well, we gotta take advantage of this repair repair," so they're cranking up more Bs. Got it, okay. That's a really good kind of closing segment here. I think it's brilliant. So we got a lot of papers that are published on your website. The one in medical hypotheses I think is brilliant. I don't know how you got that title approved 'cause it's very functional medicine oriented.
1:12:00 Dr. Gominak: I don't either, but I'm really glad. It took me a lot of work to get it into one article.
1:12:06 Mike Mutzel: That's awesome. So we'll talk a little bit more about that, we have four final questions we ask every guest on this show. So the first question would be about your morning routine. So you're a practicing neurologist, you don't really see patients as much anymore, as I understand, but you're in Portland, Oregon. What does the first couple hours of your day look like?
1:12:22 Dr. Gominak: I get out of bed and I think to myself, "How was my sleep and do I have any pain anywhere?" And recently, I hurt my back, so I'm thinking, "Oh I can't exercise yet today" which makes me sad 'cause I really like to exercise. And then I have a cup of coffee, and I start working, which is usually on the internet now.
1:12:43 Mike Mutzel: Doing research?
1:12:44 Dr. Gominak: I'm actually starting my business, which is to try to teach other clinicians about this. My goal now is to get this in wider use. It's so simple, it's so easy, and it could make such a huge impact and it's really about training in deficiency state. That to me was like, "Oh if we're not sleeping right, because there's something lacking, why don't we just replace that first?"
1:13:09 Mike Mutzel: So, in Portland, there's a lot of great coffee. What type of coffee is it? Is it French press, just what's your...
1:13:15 Dr. Gominak: We grind our own coffee and put it in a little filter and make one cup with it. So I have a fabulous cup of coffee with heavy cream in the morning. So, we haven't talked about this, but I believe the ketogenic diet and the move towards meat, vegetables, and less in the way of carbs is as important as what I just told you. I really think that ketogenic diet is one of the things that makes people live longer. And getting back into normal sleep, the reason for that, what repairs us is also being ketogenic during that phase, that we're probably designed to go into ketosis for at least 12 hours every night while we're doing this. So, I think that's probably equally important. I think we won't see the kind of repair that I'd like to see... And my sleep is still not perfect so I'm still exploring. I still have restless legs. One the reasons why I'm in this field is if I don't take my medicine, which really irks me, that I can't go to sleep without my medicine, I have restless legs.
1:14:17 Dr. Gominak: So, I'm still... I'm taking iron now and I go to the sleep meetings and try to figure out what kind of restless legs do I have. But I have a sleep disorder too, and I still think that after accomplishing all I've done, I think there will be personal places that we can intervene and fine tune. I think that's what the naturopaths have already developed. I think once they put this piece in there, then they'll begin to see full cures, with the details of what they've worked out around it. I'm really excited about that.
1:14:47 Mike Mutzel: Just curious about the ketogenic diet, what component or element or metabolic pathways, in brief, synergistically operate here to enhance sleep or that you're particularly excited about?
1:15:00 Dr. Gominak: Stop me if it gets too detailed, but the tricarboxylic acid cycle...
1:15:06 Mike Mutzel: The Krebs cycle.
1:15:07 Dr. Gominak: The Krebs cycle, is a cycle that... And I'm not the expert in this, right? We talked about who the expert is. It's a cycle that actually takes a four carbon piece, becomes a six carbon piece and goes back to a four-carbon piece. That is the cycle that is used in short chain fatty acids and it's used...
1:15:30 Dr. Gominak: In preference, in terms of making energy, it's used when you're using your fats as the supply. There's a new theory now that, that cycle actually has a different purpose. It's really not about making ATP. That's the part that we've concentrated on. It's really about making water molecules that didn't come from water. So, when you drink water, it has a certain amount of deuterium in it. That cycle makes water that doesn't have deuterium in it. So there's a going theory now, that what we're doing with ketosis, is we're preferentially using this particular cycle that has a dramatic effect on how well our mitochondria act. And I don't know the details enough to make it intelligent, but that's where I think the ketogenic part is going to make the impact. I think that piece is just as important. So that's kind of in the area that I'm gonna be educating myself, as time goes by.
1:16:41 Mike Mutzel: Okay. So, in that final stage of the electron transport chain, the water that's created is molecularly different than just water that we drink.
1:16:50 Dr. Gominak: Yes.
1:16:51 Mike Mutzel: Wow.
1:16:53 Dr. Gominak: We probably age, based on the percentage of our water, that is a deuterium molecule. So, it looks exactly the same. It's two hydrogens and an oxygen, but one of those hydrogens or sometimes two of those hydrogens, actually has a neutron. That means it's not the same size. That hydrogen, when you break it off... And there is this very complex system of allowing hydrogen to be in different concentration outside the mitochondria and inside the mitochondria, so the water that's in the mitochondria never passes across as a water molecule. What happens is, hydrogen breaks off, goes through a little pump... Another hydrogen comes in here and then it makes water inside, always with hydrogen that doesn't have deuterium in it. Every time a deuterium molecule hits that little pump, that's called the ATP synthase nanomotor, it screws up the pump. It gets stuck in the hole. That pump has to stop working. You have to take out that piece, and replace it.
1:17:57 Dr. Gominak: That means all the metabolic demand... Everything shuts down in that pump. You have to regenerate that piece. The amount of repair... So, they were actually able to correlate the amount of expression of the genes that make the proteins, that make the nanomotor are directly related to how much deuterium there is. That means our aging is linked to the aging of our mitochondria. All the stuff you did with the telomeres, just recently... That's linked to this, in some way. That is a newly developing set of ideas, but it's heavily linked to this idea that there's a reason why people live longer when they fast. It's not just about eating less. It's really about what you eat. So the whole movement towards meat, fat, vegetables, as getting ketotic, turns out to be extremely important. And you can do that several ways, but getting ketotic every night. So, what I'm doing personally, is... I might eat breakfast and lunch, but I'll miss dinner. Or, I'll do no... I really try to make sure that I might be ketotic for 12 hours a day. I may not accomplish that, but I think that may turn out to have a different effect on the sleep. That's the part I'm kind of exploring in my own body now.
1:19:12 Mike Mutzel: Sure. Wow, really, really fascinating. So, we're diving into the molecular biology of the cell, which is complex for some people. But I think it's where this is all going. The knowledge is moving so quick. So, going back to the final questions, and stuff like that, if you were stranded on a desert island, there's one herb, nutrient, botanical whole food substance that you have to bring... You have to bring with you, just because you love it so much. What is that and why?
1:19:36 Dr. Gominak: If I'm on a desert island, I probably don't need my vitamin D.
1:19:38 Mike Mutzel: Don't need vitamin D. So, maybe B complex... What?
1:19:42 Dr. Gominak: I take very little now. I still take B12, because every time I try to stop it... So, I never did my level, 'cause I really didn't think any of this stuff applied to me when I was starting. And then I realized, "Oh, I have all the same things all my patients do." So, I still take B12. I still take D. I probably would take my vitamin D with me, because I'm probably not making very much vitamin D, even though I'm a sun-worshipper and I do use sunscreen, I notice that in the summer, my vitamin D requirement is very similar. Even if I lie out in the sun. That worries me, because that means that I've reached the point where I'm not making very much vitamin D on my skin. I'm going around that by taking it orally. But that's still an important message, that still might be related to this deuterium.
1:20:27 Mike Mutzel: So, final question here: If you were in the elevator with a politician, or someone from the World Health Organization. They turned to you and said, "Dr. Stasha, what sort of lifestyle health tip would you want me to know about, that maybe I can influence a large... Numbers of people?" What sort of big picture policy or something, would you share with them?
1:20:47 Dr. Gominak: I would especially talk about our children, because as I told you earlier, we can have an impact in all children, but especially in children of color, because if they don't go outside, they don't actually make enough vitamin D. All of us are affected, but those of color are more affected, and it affects the mood. It affects how you feel about yourself. It affects your ability to pay attention. That means everyone with a vitamin D deficiency who can't sleep, cannot get educated. They are at a huge disadvantage in the school room. If they don't develop, they're autistic. Even if they do develop, they don't have what they should have every night to remember what they were just taught. That puts all of our children at a huge disadvantage, and it could so easily be treated by saying sunscreen is really good, but you need to use it in a logical way.
1:21:47 Mike Mutzel: Really powerful stuff. I have a lot of questions for you on that, but I really enjoy this conversation. You have some great PDFs and articles, and things like that. If folks wanna connect with you online and practitioners, if they wanna learn more about what you're doing, where can they find you?
1:22:00 Dr. Gominak: I'm at drgominak.com.
1:22:02 Mike Mutzel: Brilliant.
1:22:02 Dr. Gominak: No period between the doctor. And I really wanna teach other clinicians how to do this.
1:22:08 Mike Mutzel: And so you have... Is it Sleep Smart... You trademarked something.
1:22:12 Dr. Gominak: I trademarked RightSleep...
1:22:13 Mike Mutzel: RightSleep.
1:22:14 Dr. Gominak: As a description of a set of ideas. So, one of the things we didn't talk about is all the literature right now, is suggesting that you don't sleep right, it's your fault. When you go... If you just type in, "I have insomnia," they tell you things like, you're not doing it right.
1:22:29 Mike Mutzel: Yeah.
1:22:30 Dr. Gominak: You don't do this right. You don't do that right. Everything about you is a bad person. And many people will not talk about insomnia with their doctor or with other clinicians, because they feel like there's something wrong with them. And they're responsible for that. Yes, there's something wrong with them. There's something chemically wrong with them. Their brain is not functioning normally, and you can fix it. So, there is a whole bunch of ideas that I want to get out to people that say, "It's not your fault." That's really important because when someone comes to me and I say, "I don't know what's wrong with you. I can't fix you. And by the way, it's your fault, anyway."
1:23:08 Mike Mutzel: Mm-hmm.
1:23:09 Dr. Gominak: That really doesn't serve that problem... It doesn't fix the problem, and it doesn't serve that person. It makes them feel bad. So, there are lots of things about... Sleeping is the right thing to do. If you have to sleep during the day, then you sleep during the day. And until we fix the chemistry, your brain is only sleeping during the day. If you sleep long enough during the day, slowly your brain will move around to sleeping at night. I would never have known that, except my patients were willing to come back and try this stuff, and they wound up sleeping at night again, even though they'd been sleeping during the day for the last 20 years. So there are a lot about the ideas, the dogma surrounding sleep, that I'd like to dispel. And I wanna show the public, and the clinicians how to do this. It's pretty simple. You have to record things. You have to pay attention to what's happening to your body, and the patient has to be committed to, this is their body. They have to notice what's going on in their body.
1:24:06 Mike Mutzel: Sure. Brilliant. So we'll put the links in the show notes. So, I really appreciate you coming on the show. Thanks for tuning in, guys. If you liked what you saw, please give it a thumbs up, and subscribe to the channel. I'll put the show notes in the description below, and we'll see you on another video.
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