Handout by Dr. Gominak
- Why Vitamin D?
- Vitamin D is not a vitamin:
- Why would we make a hormone from sun exposure?
- D hormone affects our weight and appetite:
- Low D goofs up sleep.
- What does D hormone deficiency look like?
- Poor sleep causes hypertension, heart disease and stroke:
- Poor sleep causes memory problems and depression:
- D hormone, bones and calcium:
- Low D causes balance difficulties and pain:
- Low D causes infertility, polycystic ovary syndrome and endometriosis:
- Women bearing babies are the ones who are most affected:
- Some commonly used medications prevent REM sleep:
- Vitamin D and aging:
- What should my vitamin D level be?
- Why FDA recommendations are so low:
- What is the right D hormone dose?
- Practical Aspects:
- What kind of D and why so many kinds?
- “I eat a good diet, why would I have other vitamin deficiencies in addition to vitamin D deficiency?”
- Do our B vitamins really come from our poop?
- Any other vitamins?
- See also VitaminDWiki
If you have a neurologic problem that is severe enough to see a neurologist, you are probably not healing your body as perfectly as you once did. Most people who are suffering from neurologic problems such as headache, chronic pain, tremor, balance difficulties, dizziness, depression, stroke, or memory loss also have abnormal sleep. Fixing the sleep can often fix the neurologic problem.
In 2005 one of my patients with daily headache requested a sleep study because she thought she had sleep apnea. Surprisingly, her headaches went away after a few weeks of using a sleep apnea mask. Because it worked so well for her, I started to perform sleep studies on all of my headache patients, and realized that they all had abnormal sleep studies. Then I began to do sleep studies on my patients with other neurologic problems such as seizures, back pain, dizziness, stroke or balance problems, and most of them also had abnormal sleep studies, sometimes without being aware that their sleep was abnormal. After prescribing sleep medications and sleep apnea masks for several years, I accidentally discovered that most of my patients had abnormal sleep because they were vitamin D deficient. If fixing that deficiency might help them sleep normally I’d like to do that first before relying on sleeping pills, or having to wear a sleep apnea mask at night.
We’ve been taught that Vitamin D is the “bone vitamin”, but it is really more of a sun hormone. The word “vitamin” means “something my body needs that I can’t make, so I must get it from the food”. D hormone is instead, a chemical that we make on our skin from sun exposure. It is a hormone like thyroid, estrogen or testosterone. Using the proper word “hormone” reminds us that it affects multiple parts of the body and that it is not “extra” and it is not in the food. It is supplemented in milk, but as a cup of milk has only 100 IU of vitamin D you would have to drink 100 cups of milk a day to keep from being D deficient.
D hormone is unique among our hormones because we make it on our skin from a specific wavelength of light, UVB. Our planet is tilted so as we go north or south from the equator there are seasons. In the summer we are closer to the sun, in the winter, farther from the sun. Where there are seasons every living thing has to deal with 6 months of good weather and available food, and six months of terrible cold and no food. The farther we move away from the equator the less UVB wavelength there is in the winter light so our D hormone fluctuates with the seasons; it goes higher in the summer and lower in the winter. Any animal that can devise a way to eat more and get strong in summer, and eat less and sleep more in the winter, will have a better chance of survival. Every animal on this planet; mammals, reptiles, birds, fish and insects use this same chemical, D3 (cholecalciferol), made on their skin from UVB light, to do just that. Animals that can migrate go to the equator to get D in the winter, those of us who cannot migrate must hibernate.
In the summer as we have more sun exposure our D hormone level climbs to 80 ng/ ml, we eat more calories, and store less. The high D message is it’s summer it’s time to build our strength. We use our calories to build stronger bodies. We sleep fewer hours, but more efficiently, with a higher percentage of the total sleep spent in deeper stages of sleep. In the winter there is no UVB light so we use the vitamin D we made and stored in summer. As it gets used up the blood level falls. The low D message is; sleep longer, store fat for spring. Our metabolic rate goes down (we hibernate). As the D level falls the thyroid hormone goes down, we survive the winter by sleeping more hours and using less energy. The lower D level appears to change the type of bacteria in our intestine and those bacteria affect not only our appetite, but also what we do with the calories we eat. (See The Economist magazine August 18, 2012 "The human microbiome: Me myself, us" for a good explanation of how our colonic biome affects our weight.)
Most of the neurological problems my patients have are not directly related to D hormone, they are related to the fact that D hormone deficiency causes sleep disorders; insomnia, sleep apnea, REM related apnea, unexplained awakenings to light sleep, inappropriate body movements during sleep. All of these disorders keep us from healing our bodies during sleep. When the sleep improves the headaches, seizures, tremor, back pain, balance difficulties, depression, memory loss, etc. all get better. (See the sleep handout for more detail.)
D hormone affects the entire GI tract. There are D receptors in our salivary glands, our teeth, our esophageal sphincter, and the stomach cells that make acid. When the stomach sphincter is weak the acid moves up into the esophagus, where it doesn’t belong, causing acid reflux. The D we make on our skin goes to the liver, then into the bile, it keeps the bile acids dissolved, preventing gall stones from forming. Because there are D receptors in the islet cells of the pancreas that make insulin, not enough D may contribute to the development of diabetes. Low vitamin D levels are related to poor stomach emptying as well as bloating and constipation or “irritable bowel”. The irritable bowel may result from losing our “happy, helpful” bacteria in our lower GI tract. They die off when we don’t supply the vitamin D the bacteria also need to survive. Because those same colonic bacteria supply 7/8 of the B vitamins we need on a daily basis, most of my patients have vitamin D deficiency and secondary B vitamin deficiencies. (At least 2 of the B vitamins, B5 and B12, are needed to sleep normally) So there are secondary B vitamin deficiencies that may also have to be corrected before the sleep will return to normal.
Fifteen years ago the sleep disorders experts began to report that every American with high blood pressure had a sleep disorder in the background. Therefore the real killer in America is not the long term effects of hypertension, but the long term effects of abnormal, non-restorative sleep. Vitamin D appears to affect our sleep cycles through D receptors in the lowest part of the brain called the “brainstem”, where we control the timing and paralysis of sleep. Sleep occurs every night to allow us to heal and make repairs. It is during sleep that we make the chemicals that keep our blood pressure normal during the following day. While we sleep our arteries repair and stay smooth so they don’t have the cholesterol build up that closes off the vessels leading to heart attack and stroke. The pacemaker cells in the heart heal so we don’t get atrial fibrillation that can lead to strokes.
While we sleep we make permanent memories. During sleep we also make the serotonin that we use during the day to stay happy and curious, so low D hormone can cause depression and memory problems. Low D affects all the blood cells and can cause anemia, autoimmune disease and cancer: There are D hormone receptors on the red and white blood cells. When the white blood cells don’t have enough D they get confused, they start attacking our body by mistake. All of the autoimmune diseases: multiple sclerosis, lupus, rheumatoid arthritis, psoriasis, and ulcerative colitis, are related to low D hormone. Our own white blood cells travel through our bodies at night seeking out and killing cancer cells. Thus, increases in breast, colon and prostate cancer are also believed to be related to low D. Women with breast cancer who are told they “can’t take hormones”, (meaning estrogen), should still take D hormone. The right D level (in addition to normal sleep) helps the body’s own immune system fight cancer.
Even though most of us have been told we need extra calcium, D deficiency is what causes osteoporosis. D helps the GI tract absorb calcium and keeps the calcium from leaking into the urine, (so low D may also cause kidney stones by dumping more calcium than normal into the urine). If the vitamin D level is kept 60-80 calcium is properly absorbed from the diet and Fosamax, Evista, Boniva are not needed to prevent bone loss.
D deficiency can also be accompanied by leg pain, burning in the feet, and difficulty with balance, probably through secondary B deficiencies of B12, B5 or B6. Poor sleep results in body pain on awakening; fibromyalgia, arthritis, chronic low back pain, knee pain, hip pain. Part of the problem relates to the sleep itself: every moving part of the body must get perfectly paralyzed to repair at night. If paralysis does not occur correctly during sleep that part of the body doesn’t heal and morning pain can result. The second contributor could be pantothenic acid deficiency. B 5 or pantothenic acid is a B vitamin made by the intestinal bacteria. After it is absorbed in the colon pantothenic acid becomes Coenzyme A. Coenzyme A is the enzyme that is responsible for making our own cortisol in the adrenal gland. Since cortisone is what is injected by your doctor into arthritic joints to decrease inflammation it may be that we need those shots only if we don't make enough of our own cortisol on a daily basis. Therefore there may be some D deficient patients who have arthritis (joint pain on awakening that gets better as the day wears on), that is due to a combination of poor sleep and lower than normal daily levels of cortisol production. B 5 also seems to promote good sleep but appears to have a narrow window of effectiveness with higher doses causing sleep disruption.
There are vitamin D receptors in the ovaries, the testicles and the fallopian tubes to help match our reproduction to the amount of food available. As the D level climbs in the fall we make higher estrogen and testosterone levels that make us want to mate. Because our babies develop over 9 months, the baby that is conceived in September is born in June. This guarantees that at birth the baby is in the sun making her own D hormone because there is no D in the breast milk. Low D suppresses ovulation so that our babies will be born when mom has food. “Polycystic ovary” describes an ovary with many eggs that are all trying to mature at once. Because ovulation is inhibited by the low D, the ovaries are stuck at the stage of many eggs trying to mature and cysts develop, leading to abdominal pain, often accompanied by weight gain and acne (the triad of symptoms called polycystic ovarian syndrome). Endometriosis results from endometrial tissue going backward up the fallopian tube into the abdomen instead of out the cervix, (the opening in the uterus), during menstruation. Because the fallopian tube is open into the abdomen, the only thing that keeps the endometrial tissue heading out the cervix are wave-like movements in the fallopian tubes pushing toward the uterus. There are vitamin D receptors in the fallopian tubes that influence the propulsive movements, promoting or preventing fertilization depending on the D level. Also, once the endometrial cells have arrived in the abdomen, where they don’t belong, the white blood cells are supposed to find and kill them. Because the low D also affects the function of the white blood cells the proper elimination of the endometrial tissue doesn’t occur and fixed implants of endometrial tissue appear in the abdomen, causing abdominal pain during menstruation.
Thyroid disease, gallbladder disease, B12 and iron deficiency, obesity, sleep disorders (and therefore severe headaches) often occur in young, healthy women because they’re the ones having the babies. Each baby sucks up mom’s vitamin D using it for development. Unfortunately, each prenatal vitamin has only 400 IU of vitamin D, which is not nearly enough to provide for mom and the developing baby. When we all lived outdoors mom would get pregnant again as soon as she made enough D to sleep normally and get her body ready for the next baby. Now, each baby uses up mom’s D and if she’s not out in the sun enough after delivery her D deficit is never corrected between pregnancies. Each resulting child is more D deficient and each baby sleeps worse than the last. Mom also sleeps badly, being more D deficient herself with each baby. The chronic sleep disorder over several years can result in postpartum depression and occasionally psychosis; (abnormal thoughts and hallucinations). I believe that once the sleep is very, very abnormal, the “sleep switch” (which is designed to be sure that we never dream while we’re awake) may start to malfunction, and dream-like experiences (hallucinations) may start to leak into waking life.
Unfortunately many of the commonly used antidepressants, though they keep the serotonin up during the day to make us happier, also make the serotonin stay up inappropriately at night. High serotonin levels at night suppress REM sleep, paradoxically preventing the very phase of sleep that might give us back normal production of our own serotonin. Long term REM deprivation is probably the most common cause of depression. Over the last thirty years there has been a dramatic increase in the incidence of depression, sleep disorders and vitamin D deficiency in all of the developed countries of the world, I believe these three conditions are linked.
Even under perfect circumstances, with perfect sun exposure, we don’t live forever. Humans live about 90-100 years. Every decade our vitamin D production (per hour of sun exposure) goes down. At age 70-75 the vitamin D production on our skin goes so low that four complaints become common in the elderly; “my bowels don’t work”, “I’ve got rheumatism” (I wake up stiff and in pain), “I don’t sleep well”, and “my nose runs all the time.” When the sleep starts to fail we begin to get hypertension, diabetes, high cholesterol, heart disease, stroke or cancer and die 5-10 years later. Therefore our ability to sleep normally is linked to our life span.
How much would my body make normally out in the sun? When we sit in the summer sun, at noon, with chest, face, and arms exposed we make 10,000 IU of vitamin D. Whole body exposure produces 20,000 IU in 2-4 hours. The rate of production is dependent on the skin color. Darker skinned people make D more slowly for equal time spent in the sun. Because we don’t have fur or feathers covering our skin, the melanin coloration in the skin keeps us from making too much D. Lighter skinned humans began to appear in far northern and southern latitudes because their lighter skin color did not block the D production. They were stronger and could reproduce in lower sun environments where D was scarce. However, those bright white or freckled people have a disadvantage when they move to a high sun environment, they don’t have the natural melanin protection and they burn. When humans are adapted to their latitude with the “proper” coloration, and their internal D level is high enough, some of the pro-D on the skin is converted to D 1,25 OH, the active hormone which goes into the nuclei of the skin cells to repair the UVB induced DNA damage, thus helping to prevent skin cancer under normal circumstances. As most of us don’t receive “sun D” every day, our supplementary vitamin D requirements are much higher than the FDA recommended 800 IU per day, and are probably closer to 5,000-10,000 IU per day just to stay the same. To sleep normally the vitamin D blood level must be 60-80 ng/ml. The vitamin D25OH that we measure in the blood is “storage D”. We make the active chemical; D 1,25 OH every minute of the day, in each organ in relation to its need. When your doctor measures your D blood level it should be the D 25 OH, not the D 1,25 OH.
Cholecalciferol is a hormone not a vitamin. We would never dream of putting estrogen or testosterone or thyroid hormone into the milk. Because it was incorrectly called a “vitamin” the FDA has been put in the very difficult position of making “recommendations” for hundreds of thousands of people who have different D levels from year to year depending on their lifestyle, where they live and their skin color. The FDA knows that high vitamin D levels can cause medical problems and death, they just don’t really know why. (I think it is because vitamin D makes the sleep just as abnormal when it goes over 80, as it does when it’s under 60, therefore everything I have described above results from a high vitamin D just as easily as from a low vitamin D). The FDA has appropriately recommended a dose of vitamin D, 400-800 IU/day, that is unlikely to hurt anyone. This does not mean that 800 IU is what you need. Each person must find out what dose they need by measuring their blood level. Everyone who takes this hormone in bigger doses must follow their vitamin D blood level. Ask your doctor to measure your vitamin D 25OH level. Most doctors do not know what the “normal” D level really is, so ask for the number, it should be between 60-80 ng/ml. Medicare will pay for vitamin D levels four times per year if a billing code of 268.9 (vitamin D deficiency) is used on the lab slip. If you don’t have insurance www.vitamindcouncil.org will do your level for $75.00. All your questions about vitamin D are answered at www.vitamindcouncil.org. It is a site started in 2003 to teach you and me about this hormone. It has thousands of scientific references linking vitamin D deficiency to various diseases, and teaching about how to use vitamin D safely and effectively.
For most people the daily supplemental D dose will be 1-5000 IU per day in summer, 5-7,000 IU per day in winter, but if your level is 30 or below and it’s winter, I recommend that you take 10-15,000 IU for 2-3 weeks to get your level back above 50 more rapidly. Then check your level again in 4 weeks to be sure it is above 60. Over 1-2 years measure your D levels every 6 to 12 weeks and make sure that you are taking enough to provide a D level between 60-80 ng/ml all year long. Don’t take extra D when you’re using a tanning bed or out in the sun in the summer, you’ve just made your daily supply on your skin. Never take doses over 1000 IU/day without checking your levels regularly.
Leg cramps or increase in headaches when you’re starting extra D can be caused by low magnesium, go to www.vitamindcouncil.org and read about magnesium supplementation or eat a handful of sunflower or other seeds per day if this happens to you.
The largest dose of vitamin D3 locally available, over the counter is 5,000 IU. Walmart, Sam’s Club, Drug Emporium all have it. We doctors have been, incorrectly, taught that it’s safe to give vitamin D2, (ergocalciferol) as a once a week pill of 50,000 IU. D2 Ergocalciferol is not the same as D3 Cholecalciferol, and may be dangerous for some. In fact the majority of my patients felt that it made their sleep and headaches worse. Make sure what you buy is D3. This important mistake resulted from using the rat as the experimental model to look for the “vitamin” that prevented the bone disease of rickets in the 1930’s. Rats are nocturnal animals. In order to spend their lives in the dark, they had to have a mutated vitamin D receptor that allowed them to use a different chemical, D2. D2 is a chemical made by fungus that grows on grain. D2 is similar but not identical to what you and I, and all other animals, make on our skin from sun exposure. D2 does come in the food, (which is why the “vitamin” word was originally applied). The rat’s ability to use this chemical allowed it to be nocturnal, active at night and able to run about our houses eating our food at night. This is why humans don’t like rats and therefore find experimentation on them less objectionable than on other animals. Once D2 was discovered it did, in fact, help rickets in children. The first “anti-rickets” chemicals were D1 and D2, found on grain. Several years later, D3 was discovered on the skin of pigs, (but only after UVB light exposure). Because D3 acted similarly to D2 at bone receptors it has been assumed that it would behave the same at all receptors. D2 appears to act differently than D3 in the brain, it usually does not improve the sleep, and may make it worse.
“I eat a good diet, why would I have other vitamin deficiencies in addition to vitamin D deficiency?”
B12 deficiency and iron deficiency are common secondary deficiencies that also affect sleep. Vitamin B 12 deficiency results because there are Vitamin D receptors in the stomach cells that make “intrinsic factor”. Intrinsic factor is the chemical that binds to B 12 in our diet and allows us to absorb it. When the D is so low that the intrinsic factor production also becomes low we are less able to absorb B12 from our food. I believe B12 also helps produce normal sleep. Iron is a cofactor in making dopamine, one of the chemicals that runs the timing and paralysis of sleep, so when D, B12 and iron deficiency all exist together the sleep becomes especially bad. Those two additional deficiencies usually mean that the D has been low for many years. Ask your doctor to check your B12 and iron level when you check the D for the first time. The B12 level for normal sleep is above 500. (Again you want to know the number). If the B12 blood level is below 500 I recommend a pill of B12 of 1000 mcg/day. Shots are not better than the pills and it will be absorbed as long as the D dose is increased at the same time.
It’s important to know that 7/8 of the B vitamins that we need daily are supplied by our intestinal bacteria. This allowed humans and other animals to go several weeks without food, because they carried with them an internal store of the B vitamins. The B vitamins are not stored, they are very short acting and eliminated within 1-2 days but we need them daily for proper cellular actions throughout the body. Therefore, it is possible that when the normal colonic bacteria die off we might become low in some of the B vitamins, despite eating a good diet. If you have pain, arthritis, irritable bowel, or burning in the hands or feet you may have pantothenic acid (B5) deficiency. I believe this secondary deficiency develops after many years of D deficiency because our intestinal bacterial populations change. Our intestinal bacteria need our vitamin D to thrive. They use the D that we make on our skin, passed down to them in the bile. When they don’t get enough D to survive, other species of bacteria begin to dominate the gut. ( See The Economist magazine August 18, 2012 "The human microbiome: Me myself, us" to learn about the epidemic of the "wrong" colonic bacteria and how this change in our colonic organisms may be contributing to multiple diseases that are epidemic today.) A normal daily supply of pantothenic acid produced by the gut bacteria, appears to be necessary for normal sleep. If you feel this refers to you do not take large doses of the individual B vitamins, take B-50 (B complex that has 50 mg of each of the 8 B vitamins) daily but only for 3 months. Supplying enough D and B complex vitamins together allows the “right bacteria” to grow back in the gut. AFTER 3 MONTHS, when the intestinal bacteria are making the B vitamins again we need to STOP THE B 50, as large doses of pantothenic acid appear to disrupt the sleep and will keep you from getting better.
Most authors believe that you should always take a multivitamin along with vitamin D, there are several cofactors that vitamin D must have to do its job properly and these are all contained in the routine multivitamin. Larger B doses are not necessarily better, and may actually harm your sleep if your intestinal bacteria are making the right amounts for you already.(see above)
- All items in category Sleep
- 7 improvements in lives of veterans with chronic pain with 50,000 IU vitamin D weekly – June 2012
- Many sleep disorders cured with vitamin D levels of 60 to 80 nanograms – May 2012 Gominak
- Sleep disorders cured by 60-80 ng of vitamin D and some B vitamins – March 2013 by GominakVitamin D and Neurologic Disorders (overview of vitamin D) - handout Dr. Gominak April 2013
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