Diary Of A CEO Interview: Neurologist Dr. Stasha Gominak (Transcript)

Our biochemistry is like every other animal.

Okay, so these two inputs are coming all at the same time, and I’m puzzling over these sleep studies. That first gal had sleep apnea, but most of the women that I sent for those studies, they did not have sleep apnea, or it would come back on the front page, it would say, no significant apnea. There was a significant score. How many times do you stop breathing during the night? And then the next part is, what do they have that’s wrong with them?

That came about a year and a half later when the pulmonologist says, “I don’t know if you’ve noticed this, but your population has a really unusual finding. Most of them have delayed rapid eye movement sleep, no rapid eye movement sleep, or they have rapid eye movement sleep apnea, meaning they only stop breathing in rapid eye movement sleep.”

Understanding REM Sleep and the Brainstem

STEVEN BARTLETT: What’s rapid eye movement sleep?

DR. STASHA GOMINAK: So this is called a hypnogram. And on this bottom axis is time. On this axis is a representation of what phase of sleep you are in. And it turns out that when we enter sleep, we go through what we call 2 lighter stages of sleep. The first phase that we enter is— here it’s wake. A couple of times this person woke, may not even be aware that they woke up, went back to sleep. But we enter sleep in light sleep 1 and light sleep 2. These are called that because when the sleep experts started studying this in 1970, that’s relatively recently, you could easily awaken someone out of these phases. And it has a certain brainwave pattern that generates.

And then they go into a phase that’s called deep sleep or slow-wave sleep. Everyone who has a sleep tracker device, which is very common these days, is now becoming familiar with, “I have this much deep sleep, I have this much rapid eye movement sleep.” Deep sleep is really in the sleep industry called slow-wave sleep because the brainwaves are these slow, big pattern. We always go through a couple of light sleep phases, and then we go into rapid eye movement sleep, and then we go through light sleep phases, and then we go to deep sleep.

Now, the pivotal question that I asked the pulmonologist: why would my patient have stopped breathing? That’s what apnea means. Why would they stop breathing only in REM sleep? I thought this was an anatomic problem. And he said, “Well, we get the most paralyzed of all in REM sleep.” And I went, paralyzed? Holy crap. Do you mean I’m paralyzed while I’m in bed? What if I stop breathing? What if my brain doesn’t ever, like, unparalyze me? That’s terrifying.

And it turns out every animal including fruit flies, who we’re doing sleep studies on, get paralyzed in sleep. We get the most paralyzed in rapid eye movement sleep when this part needs to get repaired. It gets paralyzed too. That means you have to have an anatomy that stays where the tube that you’re trying to breathe through stays open while you are unconscious, and trying to repair everything in this area.

And I want to pull out the brain to let you know where this is happening and why it’s so important. This part that’s white is called the brainstem. This part is actually fully in control when you are asleep. There’s a little switch up here that goes, boop, Steven, you’re not conscious anymore. The brain is still extremely active. In fact, the waveforms that they record from up here look the same in rapid eye movement sleep as they do in wake, suggesting that all sorts of things are happening. Like you wake up abruptly because some noise happens and you’re in the middle of a dream. You’re traveling, you’re flying, you’ve got huge colors going on. Your brain is extremely active during this time. But you’re not aware of it.

And this part right here, it is running your heart rate, your blood pressure. It has paralyzed you. This is where the autonomic nervous system comes in. The sympathetic nervous system and the parasympathetic nervous system are centered right here. They are meant to be the automatic driver of all the processes that you use during the day. And they run sleep. This process that we’re talking about here is fully run by the brainstem.

STEVEN BARTLETT: So the sort of sleep-wake cycles.

The Sympathetic and Parasympathetic Nervous Systems in Sleep

DR. STASHA GOMINAK: Exactly. The sympathetic is called fight-flight. The other one, the parasympathetic, is called rest and digest. It also is experienced as a state of calm. It is also what happens when we have an orgasm. There are things that are happening in the brainstem that feed back to why do they fall asleep? Why do the guys fall asleep on top of her? Probably because it actually might increase the likelihood of fertilization. Maybe it has a survival risk. These are all unconscious things that we aren’t trained to connect together.

But once you get into the parasympathetic nervous system, it turns out that the parasympathetic and the sympathetic are also very involved in what’s happening here. And the basic idea is the first half of the night, and you’ll see that we’ve also broken it into 1, 2, 3, 4, 5 cycles, usually of about an hour and a half. The first half of the night till about 3:00 AM is mostly run by the sympathetic side, which is the fight or flight side. So when you’re well balanced and you have a completely normally operating brainstem, you will have a couple of branches of REM sleep. But my patients did not have any REM sleep at all in the first half of the night. And in fact, they might have been lucky to have a little half an hour here between 4:30 and 5:00, if at all.

The second half of the night from 3:00 AM to 7:00 AM is run by the parasympathetic side. That means if you look at it in a certain way, you could say, “Well, wait, maybe they’ve lost the parasympathetic driver for the second half of their night.” Seeing all these sleep studies that did not have this phase of sleep, they’re actually 1/6 of the amount of REM sleep they should have. And as I go back through all the sleep studies, I realize, well, wait, don’t we kind of do mood in REM sleep?

STEVEN BARTLETT: What do you mean, do we do mood?

DR. STASHA GOMINAK: When trying to link the comments that my patients have made and the drugs that I give them, I realize I’ve been giving out antidepressants to this group of young, healthy women with headaches because they frequently say, “I’m in a terrible mood.” So they can’t remember. Isn’t there a body of literature about memory being made permanent during REM? Yes. Memory is linked and mood is linked. If I’m allowed to go back to sleep, if I have the proper brain chemistry to allow me to fall back into REM sleep, I will wake in a better mood. Those are the sorts of things that the patients will tell you if you ask about it and if they’re able to fall back to sleep.

Because my group did not have sleep apnea and could not wear CPAP masks, what’s wrong with them? Why aren’t they in this phase of sleep? This is a neurology problem. This is not a pulmonology problem— this is not about breathing. This is about this brainstem and what is the chemistry of this. So then I go to the anatomy, me. And then I find out what are the cells in this brainstem area that make us paralyzed?

The Role of Vitamin D and Acetylcholine in Sleep

STEVEN BARTLETT: Just to make sure I’m with you, you’re asking that question because you figured out that the women who are struggling with sleep and getting headaches have less of this REM sleep, which is associated with being paralyzed. So the question you’ve then asked is, what are the chemicals that help us become paralyzed?

DR. STASHA GOMINAK: Yes. What are the cells that take us into these? What is the chemistry of that? Since I’m so focused on biochemistry, there’s actually a deficiency in a neurotransmitter that our move indoors means that we’ve lost a neurotransmitter that we must have to be normal humans. And the reason why they don’t know it is because there are no drugs that duplicate acetylcholine. There are no drugs.

But ultimately, what we found out together was that vitamin D makes the enzyme or the protein that makes a certain reaction happen that makes acetylcholine. Acetylcholine is the neurotransmitter, the chemical that the autonomic parasympathetic side uses. We hear all the time about epinephrine and norepinephrine or adrenaline and noradrenaline. That’s what happens when somebody rear-ends you. Your blood pressure goes up, your heart rate goes up. That’s all dominant here. If you’re wearing a sleep tracker, you’ll see that there’s a measure of what’s called heart rate variability that goes up as the parasympathetic becomes dominant.

STEVEN BARTLETT: As the rest and digest.

A Chemical Deficiency State

DR. STASHA GOMINAK: Exactly. So all of the messages that we have to increase the heart rate or decrease the heart rate or to have a bowel movement or be constipated or to digest our food, those are all eventually run by a chemical. And our body and our brain use these chemicals to send messages.

This is actually a chemical deficiency state that happens when you move indoors. Sunscreen, computers, and air conditioning all started in the 1980s. And the reason why it’s not as evident to you as it is to me is that I was alive before the 1980s. There were 2 kids in my class of 300 that were overweight. They didn’t go on diets. They didn’t have any trouble sleeping. They weren’t on antidepressants.

The things that weren’t common when I was a teenager that are common now are striking for those of us who are this age, because we know it wasn’t like that. What we’ve been told is it’s toxins in the food. It’s that we aren’t doing it right. I don’t think those are things — when you say I’m not doing it right, then you should be able to tell me how to do it right. And that’s what a lot of these podcasts are about. How do I change what I do so I can feel rested and be at the peak performance of my life? That interests a lot of people.

I would claim that there’s a deficiency state in the background that you can actually fix. And you can fix it, but it’s through vitamins. And our ideas about vitamins are wrong, completely wrong. We’ve been taught that vitamins are not important, or vitamins are very important, but they’re easy to use. They’ll never hurt us. You just take a certain — like, who’s your recommendation? What’s the vitamin D recommendation dose that this guy’s given out? We’ve been told things that are actually not true.

And medicine hasn’t taken responsibility for the fact that this is the core of biochemistry. It was done by physicians. These original research articles in the ’40s and ’50s that the word vitamin was used was done by medical experts. It’s unfortunately been given to the government to give recommendations. It should never be in the hands of the government. The government doesn’t know anything about our biochemistry.

So the supplement industry at the moment is a mess. And I say that only because I have seen dramatic things happen to my patients that are not what I expected. And vitamins are a form of biohacking. They’re just as dangerous as any drug you could put in your mouth. If you do not know what you’re doing with them, bad things will happen to you. And unfortunately, frequently those bad things are the same thing you had before you took the vitamin. Therefore, you should pay attention to what you’re feeling. So the pathway that I’ve built that’s on my website now has a second half that’s a journal. You have to keep notes of what’s happening to you.

STEVEN BARTLETT: How many people are experiencing sleep problems in your point of view?

DR. STASHA GOMINAK: Billions. It’s around the world. There are sleep study centers in every country that has electricity. In Germany, in Japan, in Brazil. And they’re all publishing how abnormal the studies are. This is not what it looks like. They rarely send out an article saying that we have less REM because they don’t have an answer for why. I just happen to be the only one currently on the internet that has a different way of looking at it.

Chronotypes, Night Owls, and the Vitamin D Connection

STEVEN BARTLETT: Well, I’m very curious to learn about all of this. I’ve never heard someone say to me before that vitamins are linked to sleep issues. It’s typically put on the sleep mask and close the blinds and make sure it’s cold in the room. So this is incredibly interesting to me.

DR. STASHA GOMINAK: Absolutely.

Let me add one more thing so I don’t forget. You and Matt Walker talked about chronotypes. There are many dogmatic statements that are being made about genetics and sleep that are not necessarily wrong, but they’re also not necessarily right. And I had the same training that you get from Matt Walker. He’s doing animal training. We say dogmatic things based on certain studies that we do. And then my patients don’t behave that way.

The chronotype story is you’re either an early bird or a night owl. And you had shared that you’re a night owl and that your girlfriend is an early bird. And what is being taught is that that is your genetic makeup. Although there are genetic mutations that lead to certain timing of sleep, it turns out everybody I was doing this vitamin stuff with would revert back to fall asleep at 10 and wake up at 6. Even the people who were working nights their whole life.

This woman that I’m seeing who is on disability now because she got a terrible disease that I believe is because she worked nights — when she is at home on disability for several years and I’m still caring for her for that disease, she’s still sleeping during the day. Well, why would she sleep during the day? And now I have a whole run of patients who say, I guess it’s because I always work nights.

It turns out that humans really can’t work nights if they have normal brain chemistry. Why? Because we’re day hunters. We are supposed to be asleep in the night, and that is our biochemistry. There are lots of animals that are designed to be awake at night. Owls — that’s why they use that as a symbol. And if you do the right thing with their chemistry, and if you insist they spend more time outside, then they actually revert to falling asleep at 10 PM and waking up at 6 AM.

It’s very difficult to operate, unless you’re international like you are, to be falling asleep at 4 AM and waking up at noon. That is a very difficult problem to operate within the normal population because the rest of the world doesn’t operate that way. And when you think about it a little bit, we actually have certain standards of when we start work and when we end work. And that’s the same all over the globe.

So there were things that happened to me that surprised me and they became consistent. And those are some of the things that we’re going to talk about. And that’s what made me think, this is around the world and it happened at a specific time.

There are many diseases that started to be reported in the middle ’80s. You guys aren’t aware of it because you think it’s normal now. But ADD, ADHD, depression, things that are affecting childhood development, fatty liver, certain things like an increase in diabetes. The things that were diseases that had been described — some of them are old diseases that have increased in incidence. But some of them for the first time — fatty liver was first described, non-alcoholic fatty liver, first described in the ’80s. ADHD is similar.

So during the time that I don’t know why we have this epidemic, I’m still thinking toxins because that’s what we’ve been told. Pesticides, glyphosate. And then we get into the area of vitamin D. And how did I find out about the vitamin D? Why was I sort of forced against my will to step into the vitamin D politics, which is a horrible morass?

Two Patient Stories: Vitamin D and Sleep Disorders

STEVEN BARTLETT: So explain to me, your assertion is that vitamin D is fundamentally linked to a lot of the sleep disorders and deficiencies that we see. How can you prove that to me?

DR. STASHA GOMINAK: I think I would prefer to give you these 2 examples. Because the people who are listening, these are at the 2 extremes, but it’ll cover a lot of the people that are listening.

The first is, let’s call her Madeline. She’s 32 years old. She’s a redhead — that turns out to be important. She’s 100 pounds overweight. She just had her first pregnancy 3 years ago, and she had been told that because she had endometriosis and polycystic ovarian syndrome that she would never get pregnant. But she got pregnant. She’s very happy about that. She had gestational diabetes, which means she had diabetes during the time that she was pregnant with her son.

And now she is pretty much a wreck. She has daily headache, which is why she’s seeing me. She’s on about 9 drugs. She has several kinds of pain. She has a terrible pain down the front of her leg that she’s been told is endometriosis growing on one of her nerves. She has terrible burning in her feet. She has terrible reflux. She poops once a week. She feels like she has to get up and go to the bathroom several times a night. She thinks that’s why her sleep is so interrupted.

So I’m treating her for her daily headaches and her pain. And then I start to think about sleep. And because we’ve been trained that fat people are fat because they’re fat slobs, because they eat wrong, because they don’t exercise, it’s their own fault — I don’t even think about the fact that many of these things might have a common source. And that she’s been tortured by this her whole life. So I sent her for a sleep study. She gets on CPAP. Over the time she’s on CPAP, she gets a little bit better. Her sleep is better. She feels better. And then I stumble into vitamin D.

Now we’re going to set that as an example of the most horrible set of things you could have, perhaps. And another example — we’re going to watch what happens to these 2 women over time.

The second one we’ll call Natalie. And Natalie is tall, statuesque. She’s a triathlete. She is also seeing me for daily headache. She grew up in a family that is of Italian origin. She is dark tan. She swims. She’s athletic. She’s outside all the time in the summer.

5 years ago, she had her first child, her daughter. She did well, no problems with her sleep. 2 years ago, she has her son. And since her son was born, she has not been able to go back to sleep, even when her son goes back to sleep. She can’t. She feels tired. She has postpartum depression. She had gestational diabetes. She’s done everything perfectly. She knows everything there is to know. She’s done paleo and keto. She is very well informed by the things that doctors tell her to do. And now her sleep is also abnormal. And she had a few headaches in high school, but now she has daily headache too.

So there’s a 5-year span here where I’m doing CPAP masks and sleeping pills. And those are some of the stories. And it’s not just limited to women, but I especially want to point out that women are more affected because they have the babies.

So the next thing that happens is, 5 years into it, I’ve got this beautiful 18-year-old who’s about to go to college. She comes to see me for daily headache. She has a sleep study that shows none of these phases of deep sleep.

STEVEN BARTLETT: So she’s having no deep sleep?

The Link Between Vitamin D and Sleep

DR. STASHA GOMINAK: No deep sleep. And every 15 minutes or so, my interpretation is her brain is trying to get into these— one of these deep sleep phases, and she wakes up to light sleep again. So every time the brain tries to do this, it breaks to light sleep, light sleep, light sleep. She thinks that she’s asleep the whole night. This shows that she’s asleep the whole night. But her sleep study, over my 5 years of experience, is horrifying because it’s not just, “oh, she’s missing a little REM.” She has no deep sleep at all.

This is a brainstem disorder of chemistry that’s going to mean she might meet me 10 years from now with a stroke. I’ve taken care of 28-year-olds who just had a stroke. 28-year-olds. We associate stroke with being old and having diabetes and hypertension and heart disease.

That means I’m looking at this, and for the very first time, I have actually started to see the diseases that my neurology patients come in with and their relationship to sleep. By the end of the 5 years, I’m doing sleep studies on anybody who will let me. So I’m doing little kids, I’m doing moms, I’m doing dads, I’m doing every single neurologic illness that comes in, they’re all abnormal. All of them.

This implies that the reason why you get a disease is because your sleep is not restorative. That implies that I should think about the body as— golly, I know people who live to be 75 years old and don’t have a doctor. They were my grandparents. And then they started to get medical problems about age 75, and then they died at 85. Why aren’t we looking at it that way? Why aren’t we saying, “oh, this means your repair system that’s designed to completely repair everything in your body every night.”

And you talked with Tara Swatt about glymphatic drainage, these things that happen while we’re sleeping. It is what makes us last. We’re not made of Teflon. We’re made of these biologic materials and they repair themselves every night. That’s a miracle.

If you view it through that lens, then you start to question, why is medicine doing what it is? I’m trained to ask questions for the thing the person walks in for. Let’s say burning in the feet. And I’m trained to make a little list of the diseases that have resulted in that, and then give a drug for it. And if we don’t find a drug that reverses it, which we haven’t for burning, but I’m going to tell you why. Then we give a drug that numbs the pain a little bit.

STEVEN BARTLETT: We just kind of plastering over cracks.

DR. STASHA GOMINAK: We’re putting Band-Aids on these things instead of saying, “well, what do you think led to this?”

Glymphatic Drainage and the Importance of Sleep

STEVEN BARTLETT: And this glymphatic drainage point, I think, is a really important one, because when I understood this glymphatic drainage idea, it had a profound impact on my relationship with sleep. I would argue more so than anything else. There’s actually a colleague of mine who’s currently sat out there, right? And I have an emoji that I send to her. She’s called Georgia Gibson. She likes to work very hard. And I sent her this particular emoji of this— I can’t even remember. She told me what the cartoon was, but it’s these little fish that come out and clean the big whale.

DR. STASHA GOMINAK: Yes.

STEVEN BARTLETT: What’s that called?

DR. STASHA GOMINAK: I don’t remember, but I know what you’re talking about.

STEVEN BARTLETT: Okay, I’ll put it on the screen. It’s from a movie, so everyone in the comments is probably going to know what I’m talking about. But I send her this emoji just to remind her that she needs to sleep because she needs to wash her brain. That’s what I say. I say to her, “you need to wash your brain,” which means go to bed. When you go to sleep at night, these cleaners— again, I’m animating this in a way that’s not scientifically accurate, but these cleaners come out and clean up your brain. And they wash it all and they clean it and they scrub it and they make it all back to normal again. So if you’re not sleeping, then you’re going to get some kind of buildup or crap. And that can lead to disease or other worse things down the line.

DR. STASHA GOMINAK: Yes. That’s a perfect description of it, actually. And that’s about the level of what we know.

So the 18-year-old with no deep sleep, she comes back and says, “hey, this drug you gave me for my headaches made my headaches better, but I’m so tired.” And I’m looking at her sleep study going, holy crap, no wonder she’s tired. This is really, really bad. And this is invisible, absolutely invisible to the rest of the physicians because she looks perfect.

So I do a B12 level and a thyroid test because I have no idea what to do. And the B12 is profoundly low, low enough that it shows up as abnormal and a little red. Now, the weird part about this is I’ve never done a B12 level in a headache patient since I’ve been doing headaches as a part of neurology, which is a large part of neurology.

I then start to give B12 recommendations, and I do B12 blood tests on all the patients who I have in my little stable of— I’ve done these sleep studies in them. They still are not sleeping well unless the sleeping pill works. So for about a month, I’m doing B12 tests. And then one of my patients says to me, “my doctor said my vitamin D was low. She gave me vitamin D and my wrist pain went away.” And I had no clue.

And I thought, I’m just doing blood tests anyway, which I never did in my headache patients. I’m just going to throw that in. I was completely naive. And because I was naive, I was not afraid to do this. But I did vitamin D levels and B12 levels in a group of about 500 patients between September and December of 2009.

And I gave you the background because I had all these thoughts buzzing around in my head. What are we looking for? We’re looking for something that controls the brainstem. Now, they’re going from August or September to December. That’s in the fall. So if you’re going to make D in the summer, which is when we’re supposed to make it because we’re out in the sun— that’s all I knew about D, is you make it from the sun. It’s about bones. They were all low. All of them are low.

2 of these guys that are on CPAP come back. They both have headaches. They both say the same thing to me in the same week. “You know, I’ve been wearing the CPAP mask for a whole year. My headaches hadn’t gone away. But that little note you sent me last time I was in here when you did my vitamin D level and you told me to get vitamin D, I took that for about a month. My sleep got better and my headaches went away.”

Now, I happen to know that all the Ds were low, but D’s about bone. Why would it have anything to do with sleep? So I go to PubMed. That’s my resource now. I hang out with PubMed all the time.

STEVEN BARTLETT: Which is?

Vitamin D Receptors in the Brain: The Research

DR. STASHA GOMINAK: That’s where you register all your articles that we publish. In 2009, I put in 2 search terms, vitamin D and sleep, and there are no hits. And then I put in vitamin D in the brain, and I wind up going to articles by a guy named Walter Stumpf, S-T-U-M-P-F, who’s been writing about vitamin D for 30 years, who has actually published that there are vitamin D receptors in this little stripe along the back of the brainstem that paralyzes us. He knows the name of this nucleus. He has shown articles where the vitamin D receptors are in this nucleus that paralyzes us. And in the nucleus nuclei that are the clock nuclei that determine what time it is, what time we go to sleep, when we make these transitions. The brain always knows exactly what time it is. Those areas have vitamin D receptors.

That means vitamin D is doing something. That means I’m very interested in thinking, if this vitamin D is low— if they say 30 to 100 is normal and my patients with sleep disorders and neurologic problems have vitamin D levels in the low 30s and below, is there a vitamin D level, not a dose, but a brain or a blood level that I can measure that might make them sleep better? That would be phenomenal. Should we go down this vitamin D road? I know nothing about it.

I start sending people for vitamin D levels and giving them vitamin D. And I start reading. Walter Stumpf has already put together a beautiful belief system around vitamin D as the hibernation hormone. It allows animals to adapt their body to tolerate winter when there’s no food. It tells their body to do things like the thyroid hormone lowers the metabolic rate of all the cells in the body.

The weird part is this is written about beautifully by Walter Stumpf. And because he has a whole belief system that tells what you should expect, he’s also published many articles. The first articles in 1982 about brainstem. He publishes articles about postpartum depression, about infertility, about obesity. He’s telling us what epidemics are going to happen, but it’s before it happens because the sunscreen’s coming out in ’85. And the middle of the air conditioning computer. And when I’m talking about this during COVID it becomes much more exaggerated. COVID has brought us all indoors, and we’re starting to feel the effects of that even more exaggerated.

So Walter has this idea set. I call him up. Luckily, he’s retired, and he takes my phone call. And I say, “hey, you don’t know me, but I’m this clinician in Texas, and I have this clinical observation that I’ve done all these sleep studies on people, their brain that should be sending them through these particular steps is not. You have shown that there are vitamin D receptors all over the nuclei that should be running this. Has anybody written about sleep and vitamin D?”

And he says, “no, but it makes perfect sense. It’s the hibernation hormone. What else would you do? You sleep longer.”

And it turns out that when our D goes very low, our brain actually forgets how to sleep. That’s the easiest way to describe it. That gal that I showed you, she had not only vitamin D deficiency as the primary deficiency, and with secondary deficiency we’re going to talk about, but your brain just becomes completely scattered and it’s what it’s supposed to do because the D is doing a specific thing.

It took me a while to figure out. There are articles that actually took Walter’s articles and said, “hey, there are these D receptors.” What hormones do that’s unique is the hormone goes inside the nucleus of the cell, and the nucleus has the DNA, and it binds to the DNA. And it has a special vitamin D receptor. That’s what Walter was measuring. When it hits that receptor, there’s a specific protein that that DNA expresses. That means that little piece of DNA comes out, it makes this protein. The protein that it makes is an enzyme that makes acetylcholine. So that means I can trace through the scientific literature all the way from the receptor to the articles that use that, that showed that it was an enzyme called choline acetyltransferase.

Now, the next part is really important because what I want out of this is that Madeline and Natalie both get better. This biochemistry is my thrill. But what the listener wants is, how do I get better?

Now, since I started this, and the first time I started giving vitamin D was in 2010, this is now 16 years later. Is vitamin D any better understood or given out? No. The science is phenomenal. The recommendations for the doctors don’t go there. The Endocrine Society are supposed to be the experts in hormones. D is a hormone.

Vitamin D Is a Hormone, Not a Vitamin

STEVEN BARTLETT: I think that’s an important point, which is a lot of people think of vitamin D as some kind of— well, we think of it as a vitamin, but you’re telling me it’s a hormone.

DR. STASHA GOMINAK: It’s the most bizarre thing I’ve ever run into in medicine. It’s really bizarre.

STEVEN BARTLETT: Which part?

DR. STASHA GOMINAK: There was a mistake. There was a mistake made in calling it a vitamin. It is made on our skin. Now, it turns out animals frequently lick their fur. And they get their vitamin D that’s made in their fur from licking their fur. Some of it’s absorbed. But the thing that’s unique about us and pigs, domesticated pigs, is we’re bald. That means most of the time we’re making it on our skin. It’s never supposed to be from the food. It was not ever about the food for us. We don’t lick our skin. Therefore, we absorb it through our skin.

And we can actually have salmon. The salmon has vitamin D in it. That’s the salmon’s vitamin D. It’s not our vitamin D. It’s like saying you eat salmon, you get salmon estrogen. That should be enough estrogen for you to have a normal period. That’s crazy. If your ovaries are not making enough estrogen, you won’t have a normal period.

STEVEN BARTLETT: Okay.

The Problem with Fixed-Dose Vitamin D Studies

Dr. Stasha Gominak: They called it a vitamin. And in the early ’80s, medicine decided vitamins were for lesser humans. Therefore, D got pushed into that pile and it got given over the counter. Now, the fascinating part about that is it turns out to be a good thing that it’s over the counter because the lay public, once they hear that their whole health is actually tied to this and that they’ve been doing what their doctor recommended, which is to use sunscreen and stay out of the sun. And the original recommendation, because I was there in the early ’80s, was don’t sunburn. Every sunburn that’s a bad sunburn that you peel from will age your skin, even if you’re 10.

Steven Bartlett: Which is— is that true or not?

Dr. Stasha Gominak: That’s true.

Steven Bartlett: It’s true.

Dr. Stasha Gominak: Yeah, that piece is true. Now, the weird thing is that has been morphed over the last 40 years into don’t ever let the sun touch your skin. People are smart. If you tell them that they can use sunscreen wisely and it blocks the ability to make vitamin D. And it has turned into the combination of sunscreen plus being inside much more than we ever were before.

When you had air conditioning, people slept out on the roof in Saudi Arabia. That means you spend much more time outdoors. And it also turns out there’s a particular move in health and wellness, which is about the many forms of wavelengths of energy that we absorb that are given to us by the sun that are not UVB. UVB is the wavelength that makes D. There are— your podcast about infrared, very, very important. That means there are many wavelengths of energy. And the more time we spend outdoors, the more our body actually uses those wavelengths in our biology.

Because medicine is so conservative and so slow to change, they basically poo-poo any new ideas. So hyperbaric oxygen, laughed at. Infrared, laughed at. Made fun of. And therefore, you could actually have your license taken away. Since COVID, since doctors are now doing things across video, I am safer in my little place making my comments, making my statements. They’re made-up stories.

Steven Bartlett: What is a made-up story?

Dr. Stasha Gominak: My telling you my belief system is a made-up story. This is really an important idea. I thought that everything written in a book is true. As soon as the publications come out, as soon as I can go to PubMed, I thought those things written down were true absolutes. And then you stay in medicine for 30 years and you realize the things that you were taught are not truth anymore.

Well, that means they made up those stories. They do a scientific experiment. You and I are looking at the data. But there’s always a conclusory. My conclusions from this data are— those are always made-up stories. And in fact, they’re always humans making up stories. You and I are not listening to stories that ants make up or that cats make up. We’re very human-centric. We’re studying things that are stories that humans make up.

Steven Bartlett: And we’re arriving at a conclusion based on some factors that we can see, which is often causation or correlation, sorry, and not necessarily causation.

The Danger of Belief Systems in Medicine

Dr. Stasha Gominak: Correlation. Very important. We all have a belief system. You and I are building a belief system here. I told you that Walter Stumpf had a belief system. The reason why I’m using those terms is I was really pissed off at the pulmonologist when I realized that woman with the sleep apnea, she wasn’t a fat middle-aged male with a fat tongue. How dare they? Here are these women. They have headaches. They’re suffering. How dare they make up this story?

And then I began to realize they made up those stories. That was their best guess. That is every single person who sits on this side of the table. It’s their best guess. All of us are, or you wouldn’t have us on here, very enthusiastic about our guess. But it’s very important to realize that every belief system means you see the world through that, but it always has blinders. There are things that you won’t be able to see because of it as well. Then you must move into a point of view, which is, I need to stay flexible. What if new information comes?

So the D belief system at the moment is that it’s a vitamin. And there’s a huge political fight within the medical literature. It’s very weird.

Steven Bartlett: The D belief system? What do you mean?

Dr. Stasha Gominak: Medicine has decided that the only way you can get any important information is to have a control group, a study group. The study group gets X, a drug, in this case vitamin D, and you compare the outcome of both groups.

Steven Bartlett: And what does the other group get? A placebo. Basically, they think it’s a drug, but there’s nothing in it. Yeah.

Dr. Stasha Gominak: And then you compare the outcome. The problem is, in no biologic pathway is there only one variable. There’s never one variable. And that means when you give one a hormone, you also need to know that hormones are always done by blood levels and that the normal state for the human body and every biologic animal, including plants, is that hormones stay in a tight little narrow band. Too much and too little are both not good. It always goes towards the middle.

In the lay experience, this is why we do blood levels of testosterone. If we give you testosterone supplement, if we give you estrogen. In thyroid, even laypeople know, my aunt would get crazy when her thyroid was off, and it could be too high or too low. D is exactly the same. Yet they do these studies based on a fixed dose. So it doesn’t matter what the level is, what time of the year, how much sun they’re getting, they’re all getting 4,000 IUs.

Steven Bartlett: So they could be having too much or too little?

Dr. Stasha Gominak: No blood levels are taken.

Steven Bartlett: So you’re saying that it should be personalized, the amount of vitamin D? Absolutely.

Why Vitamin D Should Be Treated Like a Hormone

Dr. Stasha Gominak: Any hormone that you take, if you compare— that’s why the Endocrine Society is so important. They know in 2004 when they gave the final recommendation for the doctors and practice. They know that the studies that have been done so far are rarely done in the way a hormone should be studied. And they say that in their report. They spent a whole year looking at this chemical, all the research that’s done. And they say, you know, we don’t really have any good studies. We don’t have any clinical studies like mine, for instance, where we’re relating the dose that we give the person to the blood level that’s achieved.

Therefore, you would think they would say we need more studies. No, here’s what they said. Therefore, you should not do vitamin D levels and you should not give recommendations about vitamin D, taking it or not taking it. You should just avoid the whole conversation because what’s going to happen when you do a vitamin D level is you’re going to call me up and you’re going to say, what dose should I give? The D level is this and we don’t know. So they’ve said, don’t be curious, don’t do it. That’s insane.

Now, that means the lay public is coming to me and other people on the internet, and they’re coming to podcasts like this to learn about it. And there are a lot of conflicting attitudes. I may be one of the biggest recorders in my brain, which is not in a data dump that I can put into an article, of how to manage vitamin D levels, what you should do, what you should do with dosing. And that’s one of the things I have in this workbook that we’re going to talk about.

What Happened to Madeline and Natalie

Steven Bartlett: I’m very curious about Madeline and Natalie still.

Dr. Stasha Gominak: Great.

Steven Bartlett: What happened to Madeline and Natalie?

Dr. Stasha Gominak: For 2 years, I’m talking to Walter on the phone and I start giving vitamin D to my patients. And I learned that every single person needs a unique amount. Very scary. That means everybody else is saying, oh, take 5,000, take 10,000, take 20,000. I take 100,000 once a month. And I find out also that if you get past about a level of 60, that’s when they come back and say, you know what? My sleep is better.

Now, importantly, I still was operating under the false belief that there’s only one variable. I came up in medicine using drugs. That means you match the drug to the complaint. Oh, that one didn’t work. And then we do this one and then we do this one. I’m ashamed that I looked at it that way, but that was my training. So I thought vitamin D was going to fix everything. Within the next 6 months, my patients start to come back and say horrible things like, my joints ache all over and my doctor’s about to send me to the rheumatologist who does autoimmune diseases.

Steven Bartlett: Like arthritis.

The Connection Between Vitamin D, B Vitamins, and the Microbiome

DR. GOMINAK: Exactly. Then the next person comes in and says, “I’ve got this terrible burning in my hands and feet.” And another woman comes in the same month with burning in her hands and feet. Two women, same month. They have nothing in common except they both have headaches and they’ve been doing vitamin D with me for 2 years.

And they say they want to know, “Is this related to that vitamin D that I’ve been taking with you?” And now I’m very freaked out because I’m afraid that what I’ve been doing, even though their sleep is better and we’re all happy about that, headaches were better — now they’re a little worse again. I’ve put them in a situation where they are now using more of whatever these building blocks are. And I’ve actually forced them into another deficiency state. I’m making them make more repairs and now they’re deficient in something else and I don’t know what.

Now, a patient walks in with a book. This is why I’m telling you that my patients are the ones that taught me all this stuff. And I’m telling you these embarrassing stories because they come in and they say, “Did you do this to me?” That’s very uncomfortable. And I don’t know, but I feel a commitment that I better find out.

And a woman walks in with a book that’s called The Pain-Free Promise of Pantothenic Acid. God forbid it’s another vitamin. So I happen to have developed over the same time period this weird buttock pain. I can’t sit down to talk to my patients at the end of the day because my butt hurts. So I feel like I have the same thing. So I read this book.

It says pantothenic acid is a chemical that makes this thing called coenzyme A. Coenzyme A is responsible for making cortisol. And I think, I don’t think that’s causing this burning, but this is something I need to know about. And cortisol is big in sleep. We talk about cortisol all the time, the timing of it. And it’s huge in inflammation.

I go to the vitamin store, I find pantothenic acid. The book says 400 milligrams is the right dose. So I pick up the 400 milligrams and I go to the B complex. I find something called B100, which means each one has got 100 milligrams or 100 micrograms. I go home with these 2 things. I start taking them. And I give recommendations to anyone who comes in in that one week — where I have a sleep study, they have a new complaint — I give a recommendation of B100 and B5.

What the book did was it sent me to the references. The articles that she references are from the 1950s in this creepy lab next to the Iowa State Prison where they’re doing these creepy experiments on prisoners before it becomes illegal. They published this article saying if you block pantothenic acid for 2 weeks, you see 4 things: they can’t sleep, they have belly complaints — bloating and all sorts of things — they have a funny puppet-like gait, and they have burning in their hands and feet. And I go, “This is wonderful.”

So that was one of the motivations. So the cortisol link to pain and the burning in the hands and feet. Now I’ve got it in my head that I’ve made them use more of the B vitamins.

STEVEN BARTLETT: So let’s just pause there. So you’re saying that by asking your patients to take more vitamin D, you’re saying that the body has also started to use more B vitamins, which means that by taking more vitamin D, they’re now deficient in B vitamins?

DR. GOMINAK: Yes.

STEVEN BARTLETT: And so when you use vitamin D, you also use more B vitamins?

DR. GOMINAK: There’s another point that I’m about to make, but you summarized it perfectly. So the next question would be, okay, I’m taking 400 milligrams because that’s what it says in the book, and that’s the only dose that was on the shelf in the vitamin store. I get to the end of the week and I realize I have restless legs, and my restless legs has been much worse this week. This is probably too big a dose. And I stopped the 400 milligrams and everything goes away. My butt pain goes away like in a day.

STEVEN BARTLETT: 400 milligrams of B5.

Too Much or Too Little: The Delicate Balance of B Vitamins

DR. GOMINAK: So pantothenic acid is called B5. All the patients who come back say, “Were you trying to kill me? This 400 milligrams here, I got so agitated, I stopped it after 2 days. I felt like I was crawling out of my skin and I couldn’t sleep at all.”

If you block B5, you get insomnia. That means it has power in sleep. D has power in sleep. But it turns out if it has power in sleep, your body has a very specific amount that it wants. If you give it too much, it’s not happy. If you give it too little, it’s not happy. And it turns out that instead of giving you one thing when it’s low and another thing when it’s high, which is what I would have anticipated, it goes back to the same thing. When it’s not happy, it just stops sleeping.

Now, a couple of them come back and say, “You know, I stopped the 400 milligrams because I was so agitated, I couldn’t sleep at all. But I stayed on B100. I feel great. My sleep is perfect. My pain is gone.” And I said, “That’s what happened to me.” It’s just too weird. This chemical is doing something, and what I would say to my patients is, “Be very careful with this because I don’t really know what dose you’ll need. If it’s too much, it’ll act like caffeine. It’ll keep you up at night.”

Then the next thing that happens is a gal comes in and says, “You know, you gave me that B100, and I ached all over. I would get up in the morning and I’d go, oh, oh, ah, ah.” And she said, “You know, I broke it in half and I’m taking that and I feel great.” What you’ll see here is B50, which is 50 milligrams of each, but all 8 Bs, has 50 milligrams of B5 in it.

It turns out if you’ve been taking D for 2 years, you’ve actually worked your way into a place where your body has been using more Bs and you are now very profoundly deficient. But she did not take 2 years. She was a new patient to me. She had not been on D for that period of time.

The reason why this discussion is important is there are millions of people who started taking D in COVID, who by the 4th year after taking it, started to have burning in their hands and feet. They’re not even taking it anymore. They took it from 2020 to 2023. Their levels got into the 60s. Their doctor said, “Hey, 60 is enough, stop taking the vitamin D,” but they still show up with the B vitamin diagnoses. And they go to their doctor and they say, “Oh, well, you’ve developed lupus. Oh, or you have this. Oh, or you have that.” These are all diseases that have been described already, but they haven’t been described as B vitamin deficiency states, which is bizarre, but that’s the historical point.

All of the literature says B5 deficiency doesn’t exist because it’s in every food. Now I’m reading that literature, and it says thiamine, which is B1, has a poop bacteria source and a food source. B2, poop bacteria and a food source. All of them come from the poop.

STEVEN BARTLETT: What do you mean come from the poop?

The Microbiome as the Body’s B Vitamin Factory

DR. GOMINAK: These 8 chemicals called B, all of them are made by bacteria, and we absorb them. Everybody knows that we have the wrong microbiome. And we’ve all been told that it’s toxins. Antibiotics are the major thing that are blamed. But we now have a huge body of literature about the microbiome being abnormal.

STEVEN BARTLETT: The gut microbiome?

DR. GOMINAK: Yes. The other weird part about it is there are these guys in Oklahoma, GI surgeons, who are giving poop transplants.

STEVEN BARTLETT: Give me context on what that is.

DR. GOMINAK: They take poop from one person and they push it up the other person’s butt. We’ve spent 100 years saying, “Stay away from the poop. It’s bad for you. Don’t go from the poop to your mouth.” We’ve made this idea that the bacteria — we’re fighting against them. They’re trying to take us over, and they’re bad, and we’re fighting against them. But as people are dying of things like Clostridium difficile — which C. diff is the way it’s shortened — they’re dying of C. diff infection, and they’re doing poop transplants. And they live.

It turns out that the 8 B vitamins were first described as bacterial growth factors. They are chemicals that one bacteria is able to make, and it pushes it out of its cell into the environment. And this one next to it, that’s a different one, goes, “Oh, goody! Give me that!” And those guys live together as a group, a commensal — meaning each one of them derive benefit from having the other one there.

So there are 4 big groups of bacteria that is the normal human microbiome. Well, why are there 4? Why is it always this 4? And how come we only know about 2% of them? If we’re saying all these things that the microbiome is wrong, it turns out we only know 2% of 200 bacteria that are normal occupants from the mouth, from the lips all the way to the anus. We only know 2%. But we have the genetic footprint of every single one. We are able to take them out of the poop or out of the small intestine or out of the mouth, and we can say these are the genetics, and we’ve named all of them. So we know there are 200.

And the article that they write is, “You know, it looks to us like the reason why this foursome of groups hang out together is because they all at least need one B vitamin, and they produce at least one. So they all have a relationship to the B vitamins, and we should start thinking about the microbiome as the production system that supplies the B vitamins to the body.” I didn’t find that article until after.

But here I am back again with one big question. These 2 women with the burning in their hands and feet — why did they get B vitamin deficient? If the Bs come from the food, they’ve had the same diet all along. And I haven’t controlled their diet. I haven’t made them change their diet. Why did all of these people come back with these complaints? The one thing we know is many of them have IBS symptoms, which are a signal that the bacteria isn’t right.

STEVEN BARTLETT: IBS? What’s that?

DR. GOMINAK: Irritable bowel syndrome.

STEVEN BARTLETT: Yeah.

DR. GOMINAK: Diarrhea, constipation, bloating. “My belly isn’t right.”

STEVEN BARTLETT: Yeah.

DR. GOMINAK: Because I had assumed that D was going to fix everything. Vitamin D was going to fix their belly. And it didn’t. There were several things that did not get better. One, their IBS didn’t get better. Two, they didn’t lose weight. That was really weird because they were out exercising more. They were out exercising in the middle of the day, but they didn’t lose weight. That means there’s still something wrong in the background where they didn’t lose weight.

So I’m stuck with, okay, why didn’t the D fix the B thing? Oh — these were all described as bacterial growth factors. I had assumed that vitamin D was a bacterial growth factor because Walter talked about the GI tract having all sorts of receptors for vitamin D. And so I assumed that the bacteria that lived inside us needed vitamin D to be normal. And therefore, I assumed that IBS showed up in the 1980s because we went into D deficiency, and that D deficiency caused this IBS.

There were no articles about that in humans until 2020, when COVID came, and they actually started to realize that the people who were D deficient died in COVID. And they started to actually look at, “Oh, is the microbiome playing a role in our immune system? Yes. If I give vitamin D, will the bacterial makeup of my stool change in a positive way?”

STEVEN BARTLETT: My poop.

DR. GOMINAK: Exactly. Does the poop bacteria makeup change in a positive way? We know we’ve seen people who don’t have inflammatory disorders and they have this bacterial makeup. Will giving vitamin D change the population? And yes, that’s the answer.

Now, I realized now I’m giving 2 bacterial growth factors — D, and now I’m giving B100, and I’m giving a large dose of all 8 Bs. Remember that — give all 8? That means by accident, I have actually given 8 bacterial growth factors that are necessary for bringing the poop bacteria back to the normal human makeup that it’s supposed to be, that it has always come to be spontaneously. That’s a really important point. All the other animals in the world, they’re not obese. There are no obese squirrels in my backyard. The only obese animals are our cats and dogs that we keep inside.

STEVEN BARTLETT: So to summarize for me, what is the link between vitamin D and the B vitamins?

DR. GOMINAK: It turns out that all the Bs come from the microbiome.

STEVEN BARTLETT: Yes. Okay. I understood that.

DR. GOMINAK: In order to have the correct microbiome, we are actually commensal organisms with our microbiome. That means we have to provide D, they in turn provide us with Bs.

STEVEN BARTLETT: Okay. So isn’t that a good thing that you gave them D then? Because then their body makes B.

The B Vitamin and Gut Microbiome Connection

DR. GOMINAK: Yes, but it didn’t make B on its own. Otherwise, those side effects like my butt pain wouldn’t have been there. So let’s bring that into focus. The D by itself did not correct the microbiome.

STEVEN BARTLETT: Yeah.

DR. GOMINAK: So when I took 5,000 of D between 2020 and 2023, and I took it for 3 years because my doctor told me it was okay. But in 2025, I started to have rheumatoid arthritis symptoms. The D did not correct my microbiome. It actually made me deficient. “I’m going to give you the drug for rheumatoid arthritis. I’m not going to picture it as, oh, you need B50.”

STEVEN BARTLETT: So you gave B50, but then didn’t they have another problem?

DR. GOMINAK: Most of the time, what happens after the B50 is everything comes back to normal. The GI tract corrects. You have to take it only for 3 months. I was taking it for 4 and a half months, and I started to wake up and feel old.

STEVEN BARTLETT: Yeah.

DR. GOMINAK: And everything I just parenthetically told you about the GI tract was percolating around in my brain. And what I had told my patients was, “I think we’ve stumbled on the growth factor that the right microbiome needs. And I think the reason you became B vitamin deficient was because it was the wrong microbiome. But when we give them what they need, they’re going to grow back.”

They’re going to grow back and they’re going to do their job. So they’re going to produce B50. They’re going to make that.

STEVEN BARTLETT: Let me summarize that. So by giving them B50 for a short period of time, you’re kind of jumpstarting the gut microbiome. And then you don’t want to keep giving it to them or else they’re going to become dependent or not do their job properly. So you want to give it to them for 3 months, let them jumpstart, and then they’ll do their job and then you leave them alone.

DR. GOMINAK: Yes. And I want to add one more thing. The way you think about it is probiotics are bacteria. You dump the bacteria down and you swallow it. It goes into your small intestine. But if it does not have the growth factors that it needs — which every bacteria has its little set of growth helpers it needs to be able to absorb from the actual juice that’s down there — if it doesn’t have that, it can’t reproduce.

Every bacteria that’s sitting in my small intestine right now, 12 hours from now is going to be in a different place. A day from now, I’m going to poop it out. Who’s up here now? The great-great-granddaughters of the bacteria that are sitting there while you and I are talking. They reproduce rapidly. You have to picture them like a river. We’re sitting and we’re looking at the river, and the water looks like this. And 10 minutes later, the water looks the same. But that’s not the same water that we were looking at 10 minutes ago. That water is downstream.

That means the level of reproduction that they are expected to do requires constant production of these growth factors. Now, it turns out that you don’t have to think about that. All you have to do is have the normal bacteria that was generated spontaneously when you were born because mom was giving you D in her breast milk. And it also had 8 Bs. Those 8 Bs came from her normal microbiome in the breast milk. That means you had everything you needed and then you were out in the sun. You were born in June or July in the summer, and then you got D on your skin. And that process has replicated for 300,000 years. For 250 million years, the dinosaurs had a microbiome in their intestines. This is so old, it’s unimaginable.

Madeleine’s Recovery Journey

STEVEN BARTLETT: So what is the conclusion here then? Because I do want to bring this back to Natalie and Madeleine. I still haven’t figured out what you told them to do.

DR. GOMINAK: Steven, you are so smart, and it’s such a pleasure to talk to you. These are difficult points. Madeleine is struggling with all these things. She’s slowly getting better. Then we do the D. She’s slowly getting better. Then we do the B100, and then it’s friggin’ awesome. She starts to lose the pain that she had down her leg. The burning in her hands and feet goes away. Her sleep gets much better.

Now she’s into year 3 and 4 of what becomes the Right Sleep Program. And she’s still on 30,000 IUs of D a day. That’s an immense dose. Most people are taking 5 to 10. She’s been taking 30,000 a day for 4 years. Her D level has stayed the same. It’s in the 60s. She’s doing a great job of keeping everything the same. That really means that her body is using 30,000 IUs of vitamin D a day for 4 years. That’s a very important concept because it means she is using so much more than anybody else is using in my practice. Most people are on 10,000. But she’s making these amazing repairs.

Her depression is gone. She’s stopped 3 medicines that we’ve been using for pain control. She now gets up in the morning and she feels energetic. She’s starting a program that the Texas state has for going back to work. I was like, “This gal’s never going back.” She wants to go back to work. She is a totally different person now.

Importantly, she is not 100 pounds thinner. She’s still 100 pounds overweight. And that is one of the things that happened in most of my patients and clients. The body will not lose that weight until it’s really made every repair it thinks is necessary. And then it decides that it’s not going to need this fat anymore.

STEVEN BARTLETT: So with her, did you take her off the B vitamins?

DR. GOMINAK: The routine is that one, they have to do D, and this will become the Right Sleep Program.

STEVEN BARTLETT: But they have to do D because they’re not getting sunlight.

DR. GOMINAK: Correct.

STEVEN BARTLETT: None of us really get enough sunlight.

DR. GOMINAK: Correct. So we can talk about supplement versus sun, but the D is pivotal to the entire program and it has to continue. And if you have a sleep problem or medical problems, you will do better if you get your D above 60 and keep it around there. That is not the same as saying, “What is the ideal D level for a human who wants to overachieve?” It is not the same.

So she’s on D, she stays on D the rest of her life as long as she needs it, and she’s always checking her D levels. Then she goes on B100. She happened to be one of the ones that was on D by itself for 2 years. If you have been on D for 2 or 3 or 5 years in the past and have developed B vitamin deficiency states, then you will have to go back on D with the B50. And you will do that for 3 months. And then you will stop and you go down to a much lower dose. That’s a multivitamin.

The Bacteria’s Role in Minerals and Iron Regulation

One of the things in the background that we haven’t talked about yet is there are actually hundreds of things that the bacteria are doing for us that are just starting to be reported. But they have been pivotal all along in all the minerals — all the minerals that show up in a multivitamin, all the magnesium, calcium, selenium, manganese, all these things that nobody’s really interested in. And they all are in lists on their multivitamin.

All through the same timeframe, people are developing iron deficiency and iron overload. And it turns out that the bacteria have been a pivotal part in our intestines, speaking to our body about whether or not our iron level is low or high in the liver or in the blood system, in our bone marrow, or in our brain. And if you do not have a specific bacteria called Lactobacillus reuteri, you will be missing a brand new metabolite or chemical that was named after that bacteria just in the last 3 years. That’s called reuteri. That is one of the chemical messengers that our body uses.

So that means many of the deficiency states that the naturopaths and the functional medicine people are studying are all linked to the fact that this bacterial tube has been doing all these things for us all along. And when you lost them, each individual person has its own set of specific deficiency states that must be addressed for their sleep to get better.

Does Vitamin D Deplete B Vitamins?

STEVEN BARTLETT: I want to go back to Madeleine. My question was, because the research that I’m reading says that vitamin D does not cause, trigger, or create a B vitamin deficiency.

DR. GOMINAK: No, it’s not in the literature except my article.

STEVEN BARTLETT: Taking vitamin D supplements will not drain your body’s B vitamins.

DR. GOMINAK: Let me read my title. “Vitamin D deficiency changes the intestinal microbiome, reducing B vitamin production in the gut. The resulting lack of pantothenic acid adversely affects the immune system, producing a pro-inflammatory state associated with atherosclerosis and autoimmunity.” This is a brand new discovery made by someone who’s not a scientist, who’s not working in the primary lab, who is a clinician, and the impact of this is only as strong as I can get the ideas out there and talk about what happened to my patients.

STEVEN BARTLETT: Now, is it plausible that there’s a sort of an intermediary link between the two? I’m reading some things here that say people are very frequently both low in vitamin D and vitamin B12 at the same time, and this is because they share the same root cause, like a poor gut absorption, aging, or a restrictive diet, not because one vitamin is destroying the other.

DR. GOMINAK: That’s what we’ve been told. We’ve also been told that old people don’t need as much sleep and that old people get a bad gut as they get old. It is my belief now that there is an absolute link between the production of D — and I don’t have the articles for this, even though this is dogma at the moment — that our production of vitamin D goes down as we get older.

So if you look back to that person who was 75, who didn’t get sick until they were 75, their skin production, even though they’re still out there with their truck farm and still raising their own food, their skin production rate of vitamin D goes down. And this is probably true for every animal. And then as their D goes low, they lose their microbiome, and then they die of one of the multiple diseases that are linked to this multiple deficiency state.

It’s a different lens to look through that says there is actually a system that allowed us to live without medical problems that weren’t either related to epidemics of childhood illness or starving to death. And as long as we had good diets, you can actually look at 1945 to about 1985 and say, “What was the ideal for the humans that lived rurally in the United States? Did they live to be 75 years old and then get diseases?”

So it’s my claim that those people didn’t go to the doctor because there weren’t any around them. And then things started to happen to them. And instead of looking at it through the lens of “this disease means this drug,” instead we say we should be preventing this by paying attention to what vitamin D does in the body and what the Bs do in the body. And ultimately, that is linked to most of our diseases.

The Right Sleep Protocol

STEVEN BARTLETT: Okay, so I’ll read the conclusion of your study here, which was published in 2016.

“I hypothesize, and it’s important to say this is a hypothesis, that the parallel epidemics of abnormal sleep and abnormal intestinal microbiome are linked to one another through vitamin D deficiency. Proper supplementation doses of vitamin D plus all 8 B vitamins appears to return the intestinal microbiome to normal in 3 months. Reinstating the normal microbiome not only treats IBS symptoms, it returns the supply of vitamin Bs to their natural daily doses. The B vitamins are neither good for us nor unnecessary. They are good for the person who needs them, and only until the normal source picks up again. Both sleep disruption and pain can be caused by large doses of B vitamins once the intestinal microbiome has returned to normal. The B vitamins are very biologically intertwined, both in their intestinal production and cellular use. This suggests that B vitamins, aside from B12, were not meant to be used individually, and returning to restorative sleep with normal supply of the building blocks of cellular repair has the potential to repair the pro-inflammatory state seen in association with atherosclerosis, as well as the hyperadrenergic state associated with hypertension, heart disease, and stroke. It appears that given the proper essential elements for normal sleep, the body is designed to repair every physical injury that occurs during normal daily use and may even retain a memory of long-deferred repairs.”

So essentially, you’re saying that if you can return the body’s vitamin D and B levels to normal, then the body will kick back up and start producing everything it needs. I guess the scientific consensus at the moment is saying that there’s not a link between vitamin D and a vitamin B — well, it’s saying that vitamin D does not cause a vitamin B deficiency.

DR. STASHA GOMINAK: Correct.

STEVEN BARTLETT: And you disagree with that?

DR. STASHA GOMINAK: Absolutely.

STEVEN BARTLETT: And now, could it be the case that there’s some intermediary link, i.e., if I take lots of vitamin D, it disrupts my magnesium production and the magnesium production is having an impact on vitamin B. Could it be the case that it’s something else?

DR. STASHA GOMINAK: Yes, of course. And in fact, it’s way more complicated than you and I have talked about. And where you finally arrive is actually at coenzyme A deficiency. And that is a very important chemical. It runs our mitochondrial health and our ability to make energy. And it’s linked to all the degenerative diseases, etc.

So it’s not that I don’t understand the idea that once you’re a hammer, everything’s a nail, because that’s what I was told by all of my colleagues — that you’re trying to explain everything. It’s that I saw Madeleine go back to work. And we haven’t even talked about what happened to Natalie.

STEVEN BARTLETT: What happened to Natalie?

DR. STASHA GOMINAK: Natalie got better and actually—

STEVEN BARTLETT: How?

DR. STASHA GOMINAK: She first with the D, like most of the patients, she started to sleep better. But at the end of 2 years, she stopped sleeping better. She actually lost weight, which was the case with several of the women that were postpartum who had complained about that.

So in some — my interpretation was in someone who’s less affected than Madelyn was — the D, B50 combination, especially in the setting of being after the pregnancy, is really all somebody who was relatively normal at the start of their life needs. And then she got better. Her antidepressant went away. Her postpartum depression cleared. Her high heart rate — so the other thing that we didn’t mention is many of these women who are very interested in exercise and doing exercise had high heart rates of 110 or above sitting quietly, and had not been like that before. Their high heart rates come down. So she came back to being her normal self again.

STEVEN BARTLETT: And did she have to come off the vitamin B?

DR. STASHA GOMINAK: She only took it for 3 months.

STEVEN BARTLETT: Okay.

DR. STASHA GOMINAK: And then she did a multivitamin. And then eventually almost everybody needs to be off the multivitamin completely. It is my belief that if all of this happens spontaneously in every other animal on the planet, then we shouldn’t have to take supplements either. The squirrels are not going to GNC to buy supplements. That means if there’s a mistake made, like we move indoors, and we give back what is needed to get the normal microbiome, then you should assume that your body will go back to supporting itself.

STEVEN BARTLETT: And Natalie — she’s good again?

DR. STASHA GOMINAK: Natalie’s back to being a triathlete and doing great.

Advice for Better Sleep

STEVEN BARTLETT: If we zoom out for a second, what is the advice you’ll give to all of my listeners now? There might be millions of them all over the world, some of which are struggling with sleep. Some of them just want to optimize their sleep a little bit. What is the overarching advice, the thing that all of them could do to make sure they sleep better in your view?

DR. STASHA GOMINAK: One, do the behavioral cognitive stuff first. Make the blackout curtains, do the whole thing. If you haven’t done that with the eye cover, then go ahead and do that. And if that’s all you need, do not mess around with supplements.

Two, if you’ve already done the behavioral changes, then go to my website, read about the ideas, or listen to this podcast and see whether or not the ideas there feel like they apply to you.

STEVEN BARTLETT: You’ve come up with this protocol called the Right Sleep Protocol. What is that? And can you walk me through it?

DR. STASHA GOMINAK: Sure. So the Right Sleep Program is a process of taking your D to a certain level, supplementing B12 if your B12 is below a certain level, taking B50 for 3 months, and then taking a multivitamin. And that is until your body says, “Gee, I might need more Bs.”

This is a diagram and you have a beautiful stepwise visual assist here. The first 3 months, if your B12 is low, you will take B12 as a separate supplement. And keep in mind, there’s a lot to be learned about multivitamins. For instance, many multivitamins say multivitamin on the front, but they actually have the equivalent of B50 in them. They have 50 milligrams of all these B vitamins. In fact, if you go to an expensive vitamin store, they put up the doses of these. The doses of these vitamins are extremely important for the way you feel every day. If you get it right, you feel energetic, perky, and wonderful all day. If you get it wrong, you feel awful in the same way you did before. You have to look at the back. You have to learn some of the names of these vitamins. Most people are not that interested in that. If you want to get better, that’s what you have to do.

So the first step is you’re taking all 4 of these. Then in the second step, for a period of usually 3 to 4 months, you’re still taking B12 if you were B12 deficient. You’re still taking vitamin D and you’re adjusting your vitamin D dosing based on recommendations, based on your D levels that you’re doing every month. And I show you how to get them done properly because the vitamin D levels that your doctor is doing are not accurate, unfortunately. Nor do they know that or care. And you’re still taking a multivitamin.

Then after the 3 months that are depicted here, it turns out if your sleep is much better, you will actually get to a place where your body will stop sleeping well again. And it turns out that your brain is asking for more additional Bs.

The basic bottom line is the sleep is a thing that once you learn how to use it and once you learn the concept that — if in the 3rd or 4th month of this program my sleep gets much better and then in the 6th month it gets worse again — what you should take from that is, “My brain really knows how to do this. It was able to get me to sleep from 10 to 6 with one brief wake-up, went back to sleep, didn’t get up to pee, and I have no pain when I wake up and I feel energetic all day long. It knows how to do that.” When it doesn’t do it again 2 months later, the message is not, “Oh man, I knew it wouldn’t work because everything else I’ve tried didn’t work.” Instead, it means what my brain is asking for is something else. Then you address that.

On my website, I also have multiple videos of Q&As addressing questions like, “I’m in the 5th month and this happened to me,” etc.

So what I would give as advice is: one, supplementation is only good for you if there’s something wrong with you that you’re trying to correct. Two, keep a log of what happens to that thing, because we tend to forget. All my headache patients forget that they had headaches when they go away. That’s challenging to a clinician because they come back and they say, “Yeah, I still have headaches.” And then their husband says, “Wait, we were in Vegas 2 weeks ago and you said you didn’t have any headaches at all.” And she says, “Oh, I know, but they’re back now.” We view it as it should have fixed me and now it hasn’t.

This is a different belief system where the answer is, “Your brain is asking you for something.” Interpreting what it’s asking for is difficult but possible.

So number 1 was if you do not have something wrong with you, do not mess with supplements, especially D. Number 2, read more. Think about it a little bit. Think about whether or not there are things that are bothering you.

STEVEN BARTLETT: Okay. Number 3.

DR. STASHA GOMINAK: Number 3 is if there’s something bothering you, then decide you’re actually going to take some time and you’re going to learn about a system which allows you to give supplements that lets your body be fully replete — which means fills up all the deficiencies — and that your final outcome will be great sleep, great repair, and you will be doing things that will allow your body to prevent degenerative illness.

Sunlight vs. Vitamin D Supplements

STEVEN BARTLETT: Why don’t I just, instead of taking supplements — be this, be that, be the other D, whatever — why don’t I just go outside in the sun and have a better diet?

DR. STASHA GOMINAK: I think that’s a great question. And here’s the problem.

STEVEN BARTLETT: So I’ve got all these things, these wonderful things here. I’ve got some kimchi, which is good for the gut microbiome, I’ve heard. I’ve got kombucha. I’ve got some yogurt thing here. I can’t even pronounce that.

DR. STASHA GOMINAK: Sauerkraut.

STEVEN BARTLETT: Sauerkraut. And I’ve got some kefir. Why don’t I just have all this stuff, which is great for my gut microbiome, and then go outside and spend the morning in the sunshine, getting up, improving my vitamin D levels? Presumably this is going to help my gut and the sunshine is going to help my vitamin D. Voilà.

DR. STASHA GOMINAK: I think you could actually do that. If there’s not much wrong with you, I think that’s the better path, frankly. Supplementing with vitamin D is not the same as being outdoors.

STEVEN BARTLETT: Okay, explain that to me.

DR. STASHA GOMINAK: It’s not the same.

STEVEN BARTLETT: What do you mean it’s not the same? How is it different? Because my doctor did a blood test recently, and I did 2 blood tests, one at NicoHealth. And the NicoHealth test that I did said I was vitamin D deficient, which doesn’t surprise me because I live in this dark bunker. I never leave the Diary of a CEO studio. People just walk in and I live in here and I eat in here. But I am vitamin D deficient, it said. So I went to the store and I just started taking vitamin D. I assume that’s fixed it. Why is vitamin D supplementation different from being out in the sun?

DR. STASHA GOMINAK: There is a lot of literature about — by a gal named Stephanie Seneff — who says that the vitamin D that we make on our skin is sulfated, which is different than the vitamin D we’re taking as supplemented, and it has a different behavior in the body.

Number 2, it turns out there’s a lot of literature that shows that vitamin D is not the only thing made by UVB hitting your skin. And what it’s hitting is cholesterol. And that cholesterol is changing into this chemical called D3. But there are probably 15 to 20 other chemicals that are being made at the same time.

STEVEN BARTLETT: Oh, okay.

DR. STASHA GOMINAK: They are not being taken with that pill of vitamin D3. That is a separate literature that’s just gotten some attention in the last 10 years. There are all these other things that prevent inflammation, that do things to your skin, that were actually being made by the sunlight that you’re being exposed to that protects you from the damaging effects.

STEVEN BARTLETT: So why can’t someone who is really struggling with their sleep — why can’t the prescription just be improve your diet? Have you tried that with patients where you said—

DR. STASHA GOMINAK: No.

STEVEN BARTLETT: You’ve not?

The Role of Fermented Foods and Sunlight in Health

DR. STASHA GOMINAK: One of the reasons why these are effective, the fermented foods, okay? Fermented food means you’re eating rotting food. That’s not the way we call it because it sounds disgusting, okay? But bacteria are growing in here. And they’re secreting things like B vitamins and reuteri. They’re making a yeast-bacterial mixture. So there’s fungus growing in there, there are viruses in there, there are many microbiomes.

STEVEN BARTLETT: Microbes.

DR. STASHA GOMINAK: Microbes, thank you.

STEVEN BARTLETT: Look at me. Look at me.

DR. STASHA GOMINAK: You’re awesome. That means you’re eating bacteria — you’re basically eating a food that has B50 in it, which is great.

STEVEN BARTLETT: So why didn’t you give that to me?

DR. STASHA GOMINAK: Because I have no idea what the time frame will be for this having that success for you. This is the easy way. This is the fast way. This is the way I can tell you that I’ve had more experience with my clients over time. And if you want to fix something that’s really badly off, by the time you get a sleep disorder—

STEVEN BARTLETT: For those that can’t see because they’re just listening on audio, you’re pointing at the vitamins.

DR. STASHA GOMINAK: I’m pointing at the vitamins and the stepwise approach, which is right for you.

STEVEN BARTLETT: So that’s the fast and easy approach.

DR. STASHA GOMINAK: Exactly. And if you don’t want to use supplements, I would support you all the way.

STEVEN BARTLETT: In doing what?

DR. STASHA GOMINAK: In going outside, just what you described. I think the healthier approach to all of our diseases is to be outside much more and to include these fermented foods.

Sunlight, Skin Pigmentation, and Vitamin D

STEVEN BARTLETT: Now, on this point of being outside much more, some people live in cloudy places. I spent a lot of my life living in places like London in the UK. And there’s not much sunlight. So what do I do about that?

DR. STASHA GOMINAK: Remember how I said that Madeleine was a redhead?

STEVEN BARTLETT: Yeah.

DR. STASHA GOMINAK: That turns out to be important. So melanin is the pigment that humans have in their skin. You have more than I do. I put more melanin in as I stay out in the sun more and I tan. That melanin is absorbing energy. It’s there to protect you from overexposure to sunlight and damaging effects on the DNA of your skin.

The redhead gene usually comes with freckles, which means that there’s only little tiny parts of the skin that have melanin. And the redhead gene came about in the far north — Viking Scotland. And those places don’t get much sunlight. That means it cleared out the blocker of the thing that collected that energy and allowed people who lived in very overcast environments to make D, because the melanin didn’t block the conversion to vitamin D and all these other things that it does.

STEVEN BARTLETT: So redheads actually have a bit of a superpower when it comes to their relationship with the sunshine. They can make significantly more.

DR. STASHA GOMINAK: That depends. Now, if you pick up all the Scotsmen and you put them in Texas and Oklahoma, which is where I live, and many of the people there have red hair and they came from Scotsmen — the problem is they’re now in an environment with very high sun levels. It’s very hot in the summer, and they cannot tolerate the level of sun.

That means if you get to a point on the world where you pick up big populations and you move them into another weather type, they have not had enough time to adapt. There are things about melanin amounts and our survival that make a difference. So I still recommend that supplementing with D is not the whole answer. Supplementation in and of itself is not what we want. What we want is our kids to be outside much more. There are now new learning environments for kids where they’re out in the forest, where they’re not enclosed in schoolrooms.

The Downstream Effects of Vitamin D Deficiency

STEVEN BARTLETT: There’s some interesting stats I found which says that 90% of Americans spend close to 22 hours inside every day. That was from USA Today. And roughly 20% of Americans never go outside, regularly spending 24 hours indoors. And downstream from vitamin D, there’s not just sleep disruption, there’s lots of problems, isn’t there?

DR. STASHA GOMINAK: Yes, I can start listing them, and they’re all related in the background to what we’ve talked about. But diabetes — even though you’ve had lots of really interesting shows about that — diabetes is happening in parallel with the sleep disorder. It’s not caused by the sleep disorder. It has similar chemical in the background. There are many types, but diabetes just means there’s a mismatch between the amount of insulin for the amount of sugar.

Let me say that I’m not trying to say that America doesn’t eat badly. America eats badly. I was just in Europe and the eating patterns in the US are terrible. But there are other things that are playing a role, and diabetes shows up. Remember how Madeleine had gestational diabetes? And so did this wonderful Natalie, who did everything we told her to. Why would Natalie show up with gestational diabetes when she’s not fat? Her supply of this thing called coenzyme A is not enough to keep up with supplying the child and herself. So for a while, she really has a deficiency state, and you start to see it.

But we’ve learned to measure the sugar. And measuring the sugar is one of the signs of a deficiency state that’s in the background that actually affects 100 things in the body. It makes acetylcholine, which allows our whole autonomic nervous system to sleep nor to react normally. So it affects all of those things that we do when we’re training. And it also affects cortisol levels. You must have coenzyme A to make cortisol. You must have coenzyme A to make melatonin.

STEVEN BARTLETT: So the things linked to vitamin D are everything from bone disorders, autoimmune diseases, mental health, brain disorders, cardiovascular, metabolic issues, immune infections, and then certain cancers. I imagine at this stage in the conversation, the audience are very much looking for actionable advice. So we’ve talked about the right sleep protocol, which is this sort of vitamin approach. And then the other approach is to get outside in the sunshine more.

DR. STASHA GOMINAK: And you don’t have to be in direct sunlight. You have to be in direct sunlight to make vitamin D on your skin.

STEVEN BARTLETT: Okay.

DR. STASHA GOMINAK: But you should limit the amount that you do so you do not burn your skin. And it’s important that UVA — if you’re going to use a tanning salon, if they’re using UVA, you are not making vitamin D from that. So there are different kinds of beds. UVA will still tan you, but it will not make D.

Making Vitamin D: Direct Sunlight vs. Overcast Conditions

STEVEN BARTLETT: So you don’t have to be in direct sunlight. So if I’m at a window and I can’t see the sun and it’s overcast, am I still making vitamin D?

DR. STASHA GOMINAK: No, you can’t make anything through the window.

STEVEN BARTLETT: Okay, so what — I go outside, I can’t see the sun because there’s clouds, I’m still making vitamin D?

DR. STASHA GOMINAK: Maybe. It can be that you will actually still get a burn, okay, that is from UVA and UVB penetrating that cloud.

STEVEN BARTLETT: Okay.

DR. STASHA GOMINAK: So that does mean that you can make some vitamin D on a day that it’s cloudy. And the only way to know how much vitamin D you are actually making is to do your vitamin D levels over time.

STEVEN BARTLETT: Looking at some data here, it says that you can make a little bit of vitamin D during overcast times. Up to 80% of UV radiation still penetrates light cloud cover. So you can absolutely still make vitamin D, though it might take a few minutes longer than it would on a completely clear day. When it’s thick, dark, and overcast, or dense storms or clouds, that can block up to 70 to 90% of UVB rays. On these days, it’s incredibly difficult for your skin to produce any meaningful amount of vitamin D.

You know these lamps that they put on desks and stuff? Can you get vitamin D from that?

Infrared Light, Incandescent Bulbs, and Energy from Sunlight

DR. STASHA GOMINAK: No, but let me make you a point here that’s not in my field, but in the infrared field. There are so many other wavelengths of energy that you receive when you’re outside. So you can be sitting on a porch, where you’re not in direct sunlight, and you are still receiving infrared. And infrared is one of the most important wavelengths that we know about that penetrates the body several centimeters and actually gives energy to the mitochondria. Our bodies are like little batteries that we receive energy from sunlight. And we can do that sitting on the porch without being in direct sunlight.

And fire also — the reason why it looks red is because it has infrared. And incandescent bulbs, which we’ve now stopped using—

STEVEN BARTLETT: So what’s the advice here?

DR. STASHA GOMINAK: Some people believe that you should use incandescent bulbs on the lamp that’s on your desk.

STEVEN BARTLETT: What’s an incandescent bulb?

DR. STASHA GOMINAK: It gives you rays of light. Like LED is an electron-producing light source, which the government has suggested is better than incandescent lights. It’s very difficult to buy incandescent bulbs, like the bulbs that we used to use. Now you’ll get halogen or LEDs, and they do not give off infrared light energy.

STEVEN BARTLETT: So an incandescent bulb is the old-school glass light bulbs, the kind Thomas Edison used to use. It creates light by running an electrical current through a metal filament until it gets so hot that it glows. Because it relies on raw heat, an incandescent bulb behaves exactly like a miniature fire or a tiny piece of the sun. So yeah, those incandescent bulbs, they’re harder to come by these days. But my fiancée, she’s a big fan of them. And she’s trying to fill our house with them.

DR. STASHA GOMINAK: She’s right.

Probiotics, Prebiotics, and the Gut Microbiome

STEVEN BARTLETT: So is there anything else? Also, I’ve got these prebiotics here — prebiotics, probiotics. A lot of people say that you should take prebiotics, probiotics. Have you tried giving them to your patients?

DR. STASHA GOMINAK: I was on probiotics and so were my patients when we started, and it had not corrected the microbiome. It was just a try. We’re going to dump the bacteria down there. And maybe they’ll get back to normal. Okay? That is what a probiotic is considered. They have the actual bacteria freeze-dried, and you eat the bacteria. Kind of gross when you think about it as being poop bacteria, but that’s what it is.

Now, what prebiotic has that’s different is that you feed the bacteria, and they feed you. That’s really what happens. What I love about this is, there are different things that they’re feeding the bacteria. We’re kind of interested in what they think. How do we know what they think? Well, what if I change to carnivore and all of a sudden my belly gas goes away?

STEVEN BARTLETT: The carnivore diet where you just eat meat?

Diet, the Microbiome, and Sleep

DR. STASHA GOMINAK: Carnivore, where you eat mostly meat, let’s say 90% meat. And most of my belly complaints go away and I poop regularly, then you’ve just been very successful at making your bacteria very happy. What if the next client who I have is mostly plant-based? Then I have to change the way I think and the way I help them and encourage them to recognize that when we’re feeding mostly plant-based, we have a different set of bacteria.

Now, let me propose something to you. Humans cover the globe like cockroaches. We are very successful and we have a hugely varied diet. I would claim that that means you should eat the diet that works for you.

The place where you see something that is really important for the US is the original articles about vitamin deficiency states were in 2 groups that ate a pure carbohydrate diet. So the claim right now for most of the people that are interested in healthy diets is if you eat a fully carbohydrate diet, you’re set up for failure in a million different ways. And then they talk about the diet you should eat.

There are 2 incidences from the 1940s where the first vitamin deficiency states were described, and both of them turn out to be purely carbohydrate diets. One of them was in the Japanese prisoner of war camps and the Bataan Death March in World War II, where they ate rice, rice, rice. That’s it. And they’re outside all the time. They’re not vitamin D deficient. They’re discovered to have beriberi. And beriberi is an old disease described in Japan when you take off the rice casing. So ultimately, they gave back meat and vegetables. And beriberi is described as heart failure, non-healing ulcers of the legs, bright, shiny red skin and burning in the feet that we see in the elderly in the US all the time in the hospital.

That is now ignored, but you can actually get to a state where you’re feeding only carbohydrates. But now the lens you’re looking through is, I was feeding my bacteria a purely carbohydrate diet. I therefore selected for bacterial populations that were not producing the B vitamins that I needed. It’s seeing it through a slightly different lens.

The same thing about pellagra, which is actually a niacin deficiency in adults and children that were institutionalized in the South of the United States in the ’30s and ’40s and fed corn gruel as their only food. So there’s still a piece of information there that is your diet absolutely affects who lives inside you.

And once you have a purely carbohydrate diet for many years and you’re D deficient, it is very likely you’re going to have to do something more aggressive, either change your diet and do fermented foods and change to a meat and plant diet, and you’re going to have to watch what your body does. And my claim would still be the sleep that you have should still be your best measure of whether you’ve succeeded in what you’d like to do.

Tracking Sleep and Key Takeaways

STEVEN BARTLETT: And again, to track your sleep, there’s lots of different ways to do that. Obviously none of them are perfect, but you can buy sleep trackers and those kinds of things and see how you’re doing.

DR. STASHA GOMINAK: Yes. And I would also say, use your sleep tracker. I don’t use mine regularly because I get obsessed by it. I start to think, oh, I only had an hour and a half of REM, I’m dying. And I just get spiraled downward. So what your body is saying to you is still very important. I didn’t have sleep trackers when I was seeing all these things that were happening to Madeleine and Natalie. I would listen to what they said about their sleep.

STEVEN BARTLETT: I imagine a lot of people clicked on this conversation because they are struggling with sleep, or they have a partner or friend, or maybe just because they want to optimize their sleep a little bit. And what I’ve really taken away is that a lot of sleep-related issues start in the gut microbiome.

DR. STASHA GOMINAK: Yes.

STEVEN BARTLETT: We want to try and fix the gut microbiome. And how we fix the gut microbiome is, can be dietary. It can be through supplementation, but we want to try and do it through diet first and fermented foods. And then the other thing is sunlight plays a big role. You’re smirking again.

DR. STASHA GOMINAK: You’re doing a fabulous job.

STEVEN BARTLETT: Oh, you’re so sweet. The other thing is sunlight plays a big role because it produces vitamin D, amongst other things, which also can improve that balance and help us sleep better.

DR. STASHA GOMINAK: Yes.

STEVEN BARTLETT: And we also want to try the stuff that everybody talks about. Matthew Walker, he talks about temperature and eye masks and all that kind of stuff. I guess the big insight here is that vitamins play a really important role in sleep.

DR. STASHA GOMINAK: Yes.

STEVEN BARTLETT: As you’ve seen through the thousands of patients that you’ve spent time with and helped to restore to a healthy sleep state.

DR. STASHA GOMINAK: Yes. That’s a beautiful summary.

Narcolepsy, Sleep Apnea, and Acetylcholine

STEVEN BARTLETT: What is the most important thing we haven’t talked about that we should have talked about? Is there anything at all?

DR. STASHA GOMINAK: We have skipped the people who have been told they have a disease, narcolepsy or sleep apnea, where they’re told there’s a specific like, this is a genetic thing and you have to do these specific things. For instance, for narcolepsy, this is an attack of sleep that takes you out and you become— I’m sitting here talking to you and I fall asleep. That turns out to be treatable in the same way.

STEVEN BARTLETT: You’re saying a lot of it can be about vitamins?

DR. STASHA GOMINAK: Yes. You can sleep deprive anyone to the point of falling asleep when I talk to them. All you have to do is 2 or 3 nights that you miss and you can still become taken down by an attack of sleep. That really is what narcolepsy means. That means medicine, in its attempt to classify things, have said this is a disease. And the idea that they are all about our body falling out of its normal state.

What’s different about people who have a specific diagnosis like sleep apnea and narcolepsy, is they are unlikely to be able to cure that with going outside and kimchi. They are at an end stage. Your body was really set up to be able to deal with different diets, getting up in the middle of the night, take care of your baby, traveling long periods of time, all these stressors that we’ve had for the last 300,000 years. It was set up to do that and to get back to sleeping again. And people lived for long periods of time. That wasn’t the average, but there were people that lived to be 75 years old 20,000 years ago. That means that’s the best we can do.

If you have a disease of your sleep switches, you are really severely affected. And my experience would say that that person is not going to be able to approach it by just going outside and doing kimchi. That person is going to need some extra help. And they’re going to need sometimes professional help with someone who’s seeing it through this lens. Because they go through changes. For instance, when you get them a little bit better so that they’re sleeping at night, they actually start to have nightmares. What that means in a setting like that is they’ve actually gotten into REM sleep, but they haven’t gotten perfect chemistry so that they sleep through the REM phase, finish up, go into light sleep, and then go to the next. They’ve awakened, so they can’t keep themselves in REM.

There are transition states where they actually feel like they’re getting worse. So there are all sorts of things that I’ve been able to see that are not talked about at the sleep meetings that are totally fascinating, that are halfway better, and that people can cure their narcolepsy.

I have one gal right now who just called me to become a client. She has narcolepsy and she has completely cured herself by using nicotine patches around the clock. Why? Because there is only one drug that duplicates acetylcholine completely, and it’s nicotine. So she stopped smoking and she uses nicotine patches. Nicotine is the duplicate of acetylcholine. Acetylcholine allows us to focus, pay attention, be distracted, and come right back during the day. It is in control of our ability to concentrate. At night, it allows us to get into REM sleep. That one chemical does wake and sleep. Does it in different parts of the brain.

That means she is using something that has been terribly vilified. Tobacco is considered to be the cause of all evil. It turns out, oddly enough, the guys with Parkinson’s disease who smoked throughout the last 30 years have been shown to do better because Parkinson’s disease is an acetylcholine deficiency state first.

The Modern Sleep Epidemic

STEVEN BARTLETT: To give a bit of background on, I guess, the problem we’ve really talked about, I have this little paragraph here, which I thought summarizes the nature of the problem and the sleep epidemic. It says,

“While industrialization first disrupted our natural rhythms by moving society indoors, the true explosion of sleep disorders occurred in 2 modern phases, a medical boom in the 1980s and a digital epidemic in the 2000s. In the 1980s, the formal recognition of sleep medicine and the intervention of the CPAP machine diagnosed millions with obstructive sleep apnea, sparking a surge in clinical treatments. The medicalization transformed into a cultural crisis by the 2000s as sedentary indoor lifestyles starved us of natural daytime sunlight. Sunlight exposure is vital because its high-intensity brightness resets the brain’s master internal clock and suppresses daytime melatonin, which establishes a definitive biological countdown for deep sleep at night. Deprived of this anchoring cue and bombarded by a 24/7 hustle culture and smartphones pumping blue light into our bedrooms, society succumbs to a devastating double-edged sword: too little sun by day to synchronize the brain and too much artificial light by night to allow it to rest. The modern circadian mismatch culminated in an acute spike during the 2020 pandemic lockdowns, solidifying an era where our indoor environments are fundamentally at war with our evolutionary sleep biology.”

DR. STASHA GOMINAK: I love that. Who wrote that? Is that AI?

STEVEN BARTLETT: It was AI that wrote that. Yeah.

DR. STASHA GOMINAK: Now, that’s the fascinating part of this. AI doesn’t care whether or not my colleagues think I’m crazy. AI is not affected by what the Endocrine Society says about D. AI is just giving the raw data.

Okay, then if you put in there something like, what does Dr. Gominak think about whether or not sun exposure is the whole story for sleep, you’ll start to see my stuff leaking through there saying, yes, it’s true that the pineal gland makes melatonin and that that’s part of how we get to the 10 PM to 6 AM, but it’s also true that vitamin D has receptors in the brainstem.

That means that we are at the edge of about a big change where some of these ideas that we talked about today that are very deep and very wide are going to be there available in a beautifully written way by AI. And I think in this particular case, we’ve jumped around medicine and its craziness and its conservative feeling. It’s been taken over by an electronic thing that’s not affected by our cultural ideals of who’s smart and who’s not.

The Central Idea Mainstream Medicine Ignores

STEVEN BARTLETT: What is the central idea that you believe that most of the mainstream industry don’t believe? I will do as you say, and I will ask the AI.

DR. STASHA GOMINAK: Most of the sleep disorders, including sleep apnea, narcolepsy, all the ones that the neurologists have described, are really related at basis by D and multiple things that are made by the microbiome, that the microbiome and the D deficiency are very much linked, and that there are hundreds of things that are playing a role in our sleep switches that are supplied by the microbiome.

STEVEN BARTLETT: So I’ll summarize that as, are many of the sleep disorders caused by the microbiome? I’m using Gemini Pro, which is the most advanced model. I always use it for fact-checking and stuff. So it says, you are completely wrong. I’m joking. I didn’t say that.

It says,

“Yes, the connection is massive. While we can’t say the microbiome is the sole cause of every sleep disorder, scientists now know that a damaged gut is a major hidden driver of poor sleep. Sleep, because both the melatonin pipeline starts in the gut, manufacturing the calm-down chemical is in the gut, and the cortisol alarm system is linked to the gut. The trickiest part of the microbiome-sleep connection is that it is a bidirectional loop. A bad microbiome causes poor sleep, poor sleep alters the microbiome. So while anatomical issues, like a narrow airway, causes sleep apnea, or light mismatch, like the lack of near-infrared light, play huge roles, fixing chronic insomnia often requires healing the gut just as much as fixing your bedtime routine.”

DR. STASHA GOMINAK: “The lack of near-infrared light” — that’s amazing. Medicine will not be talking about that anytime soon. It’s too wacky, it’s too woo-woo.

STEVEN BARTLETT: And yet that means those ideas are available to us. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they’re leaving it for. And the question left for you is more, yeah, I guess it is a question. It says, describe the best day of your life.

A Perfect Day

DR. STASHA GOMINAK: I’m going to have to stick with what pops into my mind first. Which is relatively recently. We were in Sevilla, I think, and it was very hot. And my husband and I had been traveling for 3 or 4 weeks together, which is the longest time we’ve spent together in a long time. And we were sitting playing canasta outside underneath an umbrella that had little misters. And we were just sitting there playing canasta together. And it was not about accomplishment. It was about having this marvelous circumstance where we’re just hanging out together and having a very pleasant time together. That was my best day in recent memory.

STEVEN BARTLETT: Dr. Stasha, where should people go to learn more from you?

DR. STASHA GOMINAK: Drgominak, no period after dr, .com. And I have a YouTube channel where I have lots of, I have a whole series of 50 things called Sleep Chats, where I talk about if I have carpal tunnel syndrome, will Right Sleep Program help me? If I have this, will Right, and why?

STEVEN BARTLETT: I’ll link all of that for you below so everybody can go to those resources. They’ll be linked in the description below of this episode. Thank you so much.

DR. STASHA GOMINAK: Thank you, Steven.

STEVEN BARTLETT: It’s been wonderful to talk about it.

DR. STASHA GOMINAK: It’s been wonderful.

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