Sleep Pain and Sleep Pain and VitaminsVitaminsDr. Stasha GominakDr. Stasha Gominak

ETMC Neurologic InstituteETMC Neurologic Institute700 Olympic Plaza, Suite 912700 Olympic Plaza, Suite 912

Tyler, TexasTyler, Texas(903) 596-3808(903) 596-3808

www.drgominak.comwww.drgominak.com11/5/201011/5/2010

Why don’t we doctors know much about Sleep?

We all do it. We spend 1/3 of each 24 hours doing it, Why?

We all know we feel terrible the next day when we don’t sleep well. What if we felt that way every day?

How important is it to our patients? Why don’t we learn about it in

residency? Following is my view of sleep.

Sleep and HeadacheSleep and Headache I became interested in sleep when one of my I became interested in sleep when one of my

daily headache patients had sleep apnea.daily headache patients had sleep apnea. Two years of trying medications had failed, 3 Two years of trying medications had failed, 3

weeks of of wearing a CPAP mask cured her weeks of of wearing a CPAP mask cured her headaches.headaches.

Why would that be? Could other daily headache Why would that be? Could other daily headache sufferers also have sleep disorders?sufferers also have sleep disorders?

Is something happening in the brain during Is something happening in the brain during sleep to make chemicals that are like the daily sleep to make chemicals that are like the daily headache preventative medicines we use; Ca+headache preventative medicines we use; Ca++ channel blockers or Na+ channel blockers?+ channel blockers or Na+ channel blockers?

6 years of sleep studies: 9/10 daily 6 years of sleep studies: 9/10 daily headache sufferers have abnormal headache sufferers have abnormal

sleepsleep Obstructive sleep apnea is just one of the Obstructive sleep apnea is just one of the

sleep disorders seen in my young, healthy sleep disorders seen in my young, healthy patients with daily headache. patients with daily headache.

Others have multiple unexplained Others have multiple unexplained awakenings, no REM sleep, no slow wave awakenings, no REM sleep, no slow wave sleep, or REM related apnea. They do not sleep, or REM related apnea. They do not have large oxygen drops.have large oxygen drops.

Some also kick their legs in sleep; Periodic Some also kick their legs in sleep; Periodic Limb Movements of Sleep (PLMS). Why?Limb Movements of Sleep (PLMS). Why?

Are these many different disorders or are they Are these many different disorders or are they several ways of manifesting a malfunction of a several ways of manifesting a malfunction of a certain area?certain area?

Why don’t we understand Why don’t we understand sleep?sleep?

Why is that important?Why is that important? Most physicians have not had specific Most physicians have not had specific

training in sleep.training in sleep. Most of what is written about sleep apnea has Most of what is written about sleep apnea has

been generated by pulmonologists who are been generated by pulmonologists who are not trained in the functions of the brainstem not trained in the functions of the brainstem or neurophysiology of sleep paralysis.or neurophysiology of sleep paralysis.

Most neurologist do not know the details of Most neurologist do not know the details of this either.this either.

Pulmonologists know about tubes, oxygen, Pulmonologists know about tubes, oxygen, bellows, etc and they’ve made up the story of bellows, etc and they’ve made up the story of “fat necks cause Obstructive Sleep Apnea”. “fat necks cause Obstructive Sleep Apnea”.

Even “sleep experts” say silly things like Even “sleep experts” say silly things like “you’re just not sleeping right”.“you’re just not sleeping right”.

Sleep is always involuntary Sleep is always involuntary you can’t really “do it you can’t really “do it

wrong”wrong” Our patients are unconscious and can’t really Our patients are unconscious and can’t really

report what is happening to them.report what is happening to them. Normal healthy humans all fall asleep at the Normal healthy humans all fall asleep at the

same time, all do the same things at about the same time, all do the same things at about the same time and wake up at the same time. same time and wake up at the same time.

Sleep is, by definition, completely Sleep is, by definition, completely involuntary. It is not under our control, involuntary. It is not under our control, never was. never was.

We’ve been trained to generally avoid the We’ve been trained to generally avoid the conversation about sleep because we really conversation about sleep because we really don’t know what to do to help our patients don’t know what to do to help our patients have normal sleep.have normal sleep.

What are Sleep What are Sleep Disorders?Disorders?What is normal sleep? What is normal sleep?

Are we just lying there Are we just lying there unconscious?unconscious?

Normal Sleep is an active, Normal Sleep is an active, highly organized process. highly organized process.

What is Light Sleep?What is Light Sleep? Light Sleep: We begin sleep in Light Sleep: We begin sleep in

Stage I light sleep and move Stage I light sleep and move to Stage II light sleep after to Stage II light sleep after several minutes. several minutes.

In light sleep we are asleep In light sleep we are asleep but are easily awakened. I but are easily awakened. I think think we are waiting to be we are waiting to be sure we’re in a safe place sure we’re in a safe place to get paralyzedto get paralyzed..

In light sleep the brain wave In light sleep the brain wave pattern is irregular, each little pattern is irregular, each little neuron doing its own thing.neuron doing its own thing.

We are asleep but We are asleep but not doing not doing the work of sleep.the work of sleep.

Deep Sleep: Slow Wave Deep Sleep: Slow Wave SleepSleep

As soon as our brain is sure that As soon as our brain is sure that we’re in a safe place to get we’re in a safe place to get paralyzed (lying down) we enter paralyzed (lying down) we enter Stage III sleep. (Stage III and Stage III sleep. (Stage III and what was Stage IV are now what was Stage IV are now grouped together as just Stage grouped together as just Stage III) III)

Stage III is called “Slow Wave Stage III is called “Slow Wave Sleep” (SWS) because the brain Sleep” (SWS) because the brain wave pattern becomes slow and wave pattern becomes slow and synchronized. synchronized.

During Stage III sleep our body During Stage III sleep our body becomes paralyzed.becomes paralyzed.

Growth hormone (GH) is released Growth hormone (GH) is released from the brain in a pulsatile from the brain in a pulsatile fashion in SWS and only SWS. If fashion in SWS and only SWS. If you don’t get and stay in SWS you don’t get and stay in SWS you don’t get this GH.you don’t get this GH.

Growth Hormone release in Growth Hormone release in Slow Wave Sleep helps us Slow Wave Sleep helps us

heal.heal. Growth Hormone (GH) is the Growth Hormone (GH) is the

same hormone that makes kids same hormone that makes kids grow during sleep. In children grow during sleep. In children it is a sustained release during it is a sustained release during SWS.SWS.

I believe that GH acts as the I believe that GH acts as the “boss hormone” that calls out “boss hormone” that calls out all of the individual muscle, all of the individual muscle, bone, tendon, artery, nerve, bone, tendon, artery, nerve, repair hormones. They go as a repair hormones. They go as a crew and repair every injury crew and repair every injury we had during that day.we had during that day.

I think the repair crew knows I think the repair crew knows they’re only supposed to be they’re only supposed to be working while we’re paralyzed. working while we’re paralyzed. If your paralysis is frequently If your paralysis is frequently interrupted or shortened, your interrupted or shortened, your repair phase doesn’t happen repair phase doesn’t happen normally.normally.

Deep Sleep: REM SleepDeep Sleep: REM Sleep After SWS we enter After SWS we enter

REM (Rapid Eye REM (Rapid Eye Movement) sleep. Movement) sleep.

In REM sleep we’re the In REM sleep we’re the most paralyzed of all. most paralyzed of all.

This series: Stage I- II - This series: Stage I- II - III then REM, is III then REM, is repeated 3-4 times per repeated 3-4 times per night with slightly night with slightly different average times different average times spent in the separate spent in the separate stages based on age and stages based on age and prior sleep deprivation.prior sleep deprivation.

REM SleepREM Sleep REM sleep appears to be REM sleep appears to be

the most important sleep the most important sleep stage for permanent stage for permanent memory formation. memory formation.

It’s not only new It’s not only new memories, but old memories, but old memories as well that memories as well that we must buff every night we must buff every night to keep them fresh and to keep them fresh and accessible.accessible.

REM sleep also appears REM sleep also appears to have a lot to do with to have a lot to do with mood.mood.

Sleep Disorders Sleep Disorders

Anyone who does not sleep through Anyone who does not sleep through the normal 4 stages of sleep, the the normal 4 stages of sleep, the normal number of times per night for normal number of times per night for whatever reason may have a Sleep whatever reason may have a Sleep Disorder.Disorder.

Does that mean I’ll be sleepy the next Does that mean I’ll be sleepy the next day?day?

Can’t I just “catch up” the next night?Can’t I just “catch up” the next night? What happens if I can’t?What happens if I can’t?

Normal Sleep v.s. Non-Normal Sleep v.s. Non-restorative Sleeprestorative Sleep

Healthy sleepers who Healthy sleepers who miss sleep are able to miss sleep are able to “catch up” the next night “catch up” the next night or next several nights.or next several nights.

People with sleep People with sleep disorders miss certain disorders miss certain stages of sleep every stages of sleep every night for years on end.night for years on end.

When the brain and the When the brain and the body are not allowed to body are not allowed to replenish and repair replenish and repair many body functions many body functions begin to fail.begin to fail.

We are not only sleepy We are not only sleepy but can have many other but can have many other symptoms as wellsymptoms as well..

9/10 daily headache sufferers in 9/10 daily headache sufferers in my practice have abnormal sleepmy practice have abnormal sleep

CPAP for obstructive sleep apnea. CPAP for obstructive sleep apnea. But what should I do to treat the others?But what should I do to treat the others?

Multiple awakenings to light sleep.Multiple awakenings to light sleep. No REM sleep, no SW sleep. No REM sleep, no SW sleep. REM related apnea. REM related apnea. Periodic Limb Movements of Sleep (PLMS).Periodic Limb Movements of Sleep (PLMS).

Are these many different disorders or are Are these many different disorders or are they several ways of manifesting a they several ways of manifesting a malfunction of a certain area?malfunction of a certain area?

Where does this happen? Why does it Where does this happen? Why does it happen?happen?

Why aren’t there any medicines that give Why aren’t there any medicines that give back normal sleep?back normal sleep?

The Migraine “Brainstem Generator” and Sleep

Why do humans think headaches are “normal”?

Headache is the only spontaneous pain syndrome that we consider to be “normal”.

There are now over forty genes linked to migraine.

Why would we have all these genes to torture us? Perhaps they’re not really in the headache stripe. Perhaps the headache stripe is in an unfortunate

location. Could they be genes that have been carried

through generations because they improve the spontaneous “on- off” of the sleep stripe?

Posterior brainstem Posterior brainstem Periaquiductal Gray plays a large Periaquiductal Gray plays a large role in sleep and sleep paralysisrole in sleep and sleep paralysis

The switch that runs The switch that runs the timing of sleep is the timing of sleep is right next to the right next to the trigeminal caudal trigeminal caudal nucleus.nucleus.

There are There are pacemakers pacemakers in this in this area, thearea, the brain brain clockclock

The paralysis switch The paralysis switch is here also.is here also.

aquiduct

What characterizes these sleep disorders ?

Young, healthy headache sufferers. Some of them get too paralyzed; their

throat becomes completely paralyzed. Some are not paralyzed enough; their

legs or arms or jaw moves. Do they have two separate sleep

disorders? Why would young healthy people have

not one but two sleep disorders, could it be one producing both features?

The Wobbly Paralysis The Wobbly Paralysis SwitchSwitch

I think the young healthy I think the young healthy people with some apnea people with some apnea and some leg kicking are and some leg kicking are more likely to have only more likely to have only one disease, not two.one disease, not two.

I think they have a I think they have a paralysis switch that paralysis switch that wobbles from “too wobbles from “too paralyzed” causing paralyzed” causing apnea, back to “not apnea, back to “not paralyzed enough” paralyzed enough” causing leg kicks, causing leg kicks, talking, chewing.talking, chewing.

Not Paralyzed EnoughToo Paralyzed

Not Paralyzed Enough

If headache improves how If headache improves how about other pain?about other pain?

Some of the daily headache sufferers Some of the daily headache sufferers said their back pain got better on CPAP. said their back pain got better on CPAP.

So I started sending many of my chronic So I started sending many of my chronic pain patients for sleep studies.pain patients for sleep studies.

Then the patients who had back pain Then the patients who had back pain and abnormal sleep studies got better and abnormal sleep studies got better on CPAP. Why? on CPAP. Why?

Why does every one of my patients seem Why does every one of my patients seem to have an abnormal sleep study?to have an abnormal sleep study?

Why does everyone Why does everyone and his brother and his brother

seem to have Sleep seem to have Sleep Apnea?Apnea?Did we make it up?Did we make it up?

Has it always been there or is it Has it always been there or is it new?new?

What’s causing it?What’s causing it?Why is it more in “developed Why is it more in “developed

countries”?countries”?

All over the world 9/10 sleep All over the world 9/10 sleep studies are abnormal, with sleep studies are abnormal, with sleep

apnea comes:apnea comes: High blood pressureHigh blood pressure Heart attack, heart arrhythmia (atrial fibrillation)Heart attack, heart arrhythmia (atrial fibrillation) DiabetesDiabetes StrokeStroke ObesityObesity Daytime sleepinessDaytime sleepiness Memory problemsMemory problems DepressionDepression Daily headacheDaily headache Unexplained body pain (“Fibromyalgia”)Unexplained body pain (“Fibromyalgia”) FatigueFatigue

I thought Sleep I thought Sleep Apnea only Apnea only

happened to fat happened to fat peoplepeople

Does obesity cause Does obesity cause sleep apnea or sleep apnea or

does sleep apnea does sleep apnea cause obesity?cause obesity?

Obesity and Sleep ApneaObesity and Sleep Apnea

In patients with sleep apnea orexin In patients with sleep apnea orexin (hypocreatin) and leptin levels are deranged (hypocreatin) and leptin levels are deranged causing increased appetite and increase in fat causing increased appetite and increase in fat deposition per calorie consumed.deposition per calorie consumed.

Obesity comes with the Sleep Apnea and not Obesity comes with the Sleep Apnea and not the reverse.the reverse.

Losing weight is not the whole story of making Losing weight is not the whole story of making Sleep Apnea go away.Sleep Apnea go away.

Lap band or gastric bypass may help Lap band or gastric bypass may help temporarily but it does not fix the original temporarily but it does not fix the original cause of sleep apnea.cause of sleep apnea.

Sleep disorders can Sleep disorders can result in Painresult in Pain

If we don’t sleep we don’t heal.If we don’t sleep we don’t heal. When we stop sleeping normally we When we stop sleeping normally we

start to age.start to age. Most people think “I don’t sleep well Most people think “I don’t sleep well

because I have pain”because I have pain” In fact it is usually “ You have pain In fact it is usually “ You have pain

because you don’t sleep correctly”because you don’t sleep correctly” How can I sleep correctly? Can I How can I sleep correctly? Can I

change my sleep?change my sleep?

Why is the CPAP experience Why is the CPAP experience important?important?

I just spent the last 5 years trying to help I just spent the last 5 years trying to help patients “tolerate” their CPAP mask. patients “tolerate” their CPAP mask.

It is very hard to do, therefore has very It is very hard to do, therefore has very little placebo effect in my opinion.little placebo effect in my opinion.

Despite being hard to do, miraculous Despite being hard to do, miraculous things do happen when it’s successful.things do happen when it’s successful.

Pain goes away, blood pressure goes Pain goes away, blood pressure goes down.down.

Diabetes gets better, headaches better, Diabetes gets better, headaches better, mood better, tremor, walking disorders, mood better, tremor, walking disorders, seizures better.seizures better.

What’s happening here that’s What’s happening here that’s goofing up my patients’ sleep?goofing up my patients’ sleep?

Periaquiductal gray

Why don’t we fix the sleep Why don’t we fix the sleep instead of patching it?instead of patching it?

In July 2009 one of my 18 y/o patients In July 2009 one of my 18 y/o patients with daily headache and 35 with daily headache and 35 awakenings/hour turned out to have awakenings/hour turned out to have B12 deficiency. B12 deficiency.

Adding back a Adding back a vitaminvitamin to fix the sleep? to fix the sleep? The brain still remembers what to do, The brain still remembers what to do,

but it is lacking an essential element? but it is lacking an essential element? In August one of my patients In August one of my patients

mentioned her doctor gave her vitamin mentioned her doctor gave her vitamin D and it made her pain better.D and it made her pain better.

Vitamins and SleepVitamins and Sleep From 8/09 to 12/09 I measured B12 and Vitamin D From 8/09 to 12/09 I measured B12 and Vitamin D

levels on every single patient who had a bad sleep levels on every single patient who had a bad sleep study.study.

A few had B12 deficiency but every single D was A few had B12 deficiency but every single D was low.low.

In December 2 of my CPAP patients came back In December 2 of my CPAP patients came back and said “after three weeks that vitamin D made and said “after three weeks that vitamin D made my sleep better and my headaches went away.” my sleep better and my headaches went away.” What?What?

What is vitamin D and what could it have to do What is vitamin D and what could it have to do with sleep?with sleep?

I thought D was all about bones and calcium.I thought D was all about bones and calcium. Are there vitamin D receptors in the brain? Why?Are there vitamin D receptors in the brain? Why?

Vitamin D receptors in Vitamin D receptors in periaquiductal grey, lateral periaquiductal grey, lateral

ventricles and ventricles and pituitary/hypothalamuspituitary/hypothalamus

What is Vitamin D What is Vitamin D anyway?anyway?

IT’S NOT A VITAMIN!!!IT’S NOT A VITAMIN!!! It’s a HORMONE that we make, like thyroid, It’s a HORMONE that we make, like thyroid,

cortisol, estrogen, testosterone.cortisol, estrogen, testosterone. We make it on our skin from cholesterolWe make it on our skin from cholesterol.. UVB light hits the skin and changes cholesterol UVB light hits the skin and changes cholesterol

on our skin to D hormone; cholecalciferol.on our skin to D hormone; cholecalciferol. Every animal on the planet; hamsters, birds, Every animal on the planet; hamsters, birds,

reptiles and insects use the exact same chemical reptiles and insects use the exact same chemical made on their skin from UVB light.made on their skin from UVB light.

This implies that the Dinosaurs used Hormone D.This implies that the Dinosaurs used Hormone D. What’s it for?What’s it for? Could it have anything to do with sleep?Could it have anything to do with sleep?

Dr. Walter Stumpf and D Dr. Walter Stumpf and D hormonehormone

Dr. Walter Stumpf and D Dr. Walter Stumpf and D hormonehormone

Stumpf WE, Sar M, Reid FA, Tanaka Y, DeLuca HF. Stumpf WE, Sar M, Reid FA, Tanaka Y, DeLuca HF. Target cells for 1,25-dihydroxyvitamin D3 in intestinal tract, stomach, kidney, skin, pituitary, and parathyroid. Science. 1979 Dec 7;206(4423):1188-90.. Science. 1979 Dec 7;206(4423):1188-90.

Stumpf, WE and O'Brien, LP. Stumpf, WE and O'Brien, LP. 1,25 (OH)2 Vitamin D3 sites of action in the brain: an autoradiographic study. Histochem.87:393-406, 1987.. Histochem.87:393-406, 1987.

Stumpf, WE, Clark, SA, O'Brien, LP and Reid, FA. Stumpf, WE, Clark, SA, O'Brien, LP and Reid, FA. 1,25 (OH)2 vitamin D3 sites of action in spinal cord and sensory ganglion. Anat. Embriol. 177:307-310, 1988.. Anat. Embriol. 177:307-310, 1988.

Stumpf WE, Denny MEStumpf WE, Denny ME. Vitamin D (soltriol), light, and reproduction. Am J Obstet Gynecol. 1989 Nov;161(5):1375-84. Am J Obstet Gynecol. 1989 Nov;161(5):1375-84.

Stumpf WE, Privette TH. Stumpf WE, Privette TH. Light, vitamin D and psychiatry. Role of 1,25 Role of 1,25 dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal affective disorder and other mental processes. Psychopharmacology affective disorder and other mental processes. Psychopharmacology (Berl). 1989;97(3):285-94 (Berl). 1989;97(3):285-94

Bidmon HJ, Gutkowska J, Murakami R, Stumpf WE. Bidmon HJ, Gutkowska J, Murakami R, Stumpf WE. Vitamin D receptors in heart: effects on atrial natriuretic factor. . Experientia. 1991 Sep 15;47(9):958-62. Experientia. 1991 Sep 15;47(9):958-62.

Why a hormone linked to Why a hormone linked to UVB?UVB?

UVB only wavelength present in summer not in UVB only wavelength present in summer not in winter.winter.

D hormone adjusts metabolism to the two very D hormone adjusts metabolism to the two very different states of weather and food availability.different states of weather and food availability.

In the summer we eat lots of perishable food, till In the summer we eat lots of perishable food, till the soil, gather food, build things, sleep little.the soil, gather food, build things, sleep little.

In the winter there is no food. We In the winter there is no food. We hibernate, we sleep more, channel more of hibernate, we sleep more, channel more of the calories we eat into fat.the calories we eat into fat.

Any animal that can eat very little and still put Any animal that can eat very little and still put on a little fat in the winter has a survival on a little fat in the winter has a survival advantage.advantage.

Where are the Hormone D Where are the Hormone D Receptors?Receptors?

Where they are suggest what they Where they are suggest what they do, GI tract:do, GI tract:

Teeth, salivary glands, tongue, Teeth, salivary glands, tongue, esophageal sphincter, esophageal sphincter,

Stomach cells that make acidStomach cells that make acid Liver cells that make bileLiver cells that make bile Pancreatic islet cells that make Pancreatic islet cells that make

insulininsulin

Summer: high D message Summer: high D message (70-85)(70-85)

Eat 10,000 calories per day, digest it all Eat 10,000 calories per day, digest it all easily.easily.

Put all of those calories into building the Put all of those calories into building the body.body.

Sleep fewer hours, deep, paralyzed, work Sleep fewer hours, deep, paralyzed, work sleep done in 6-8 hours.sleep done in 6-8 hours.

The estrogen and testosterone follow the D. The estrogen and testosterone follow the D. September is harvest time, the D is at its September is harvest time, the D is at its highest, it’s time to mate and make a baby.highest, it’s time to mate and make a baby.

Thyroid follows the D also. All cellular Thyroid follows the D also. All cellular energy increases.energy increases.

Winter: lower D message Winter: lower D message (50-70)(50-70)

Because there is only UVB in the summer, Because there is only UVB in the summer, after September we start to depend on our D after September we start to depend on our D hormone stores. hormone stores.

Sleep longer, paralyzed phases much less Sleep longer, paralyzed phases much less consolidated.consolidated.

Eat less but put half of everything I eat into Eat less but put half of everything I eat into fat. Remember those hormones that make you fat. Remember those hormones that make you hungry and tell your body to store more fat?hungry and tell your body to store more fat?

Americans have been in a permanent winter Americans have been in a permanent winter for the last 30 years, and the spring never for the last 30 years, and the spring never comes.comes.

Very low D may lead to very goofed up sleep. Very low D may lead to very goofed up sleep. Could this be the cause of sleep apnea?Could this be the cause of sleep apnea?

D Hormone and SleepD Hormone and Sleep

This implies there may be a This implies there may be a natural natural reasonreason and and curecure for for obstructive sleep apneaobstructive sleep apnea

There is no Proof of this yet, There is no Proof of this yet, it is only my hypothesis.it is only my hypothesis.

D Hormone: the future for all of us

The sleep connection is the only new observation, everything else that is affecting your practice every day are things that have been written about for the last 30 years but you don’t know about them.

When the word “vitamin” was applied to this chemical it became overlooked by Medicine and has not been taught to those of us who should be conveying this to our patients.

Epidemiologically related to Epidemiologically related to D deficiency- (same list as D deficiency- (same list as

sleep apnea)sleep apnea) High blood pressureHigh blood pressure High cholesterol High cholesterol Heart attack, atherosclerosisHeart attack, atherosclerosis Heart arrhythmia ( Atrial fibrillation)Heart arrhythmia ( Atrial fibrillation) StrokeStroke ObesityObesity Memory problemsMemory problems DepressionDepression Daily headacheDaily headache Unexplained body pain (“Fibromyalgia”)Unexplained body pain (“Fibromyalgia”)

Disorders of GI tract Disorders of GI tract related to D deficiencyrelated to D deficiency

Gastric refluxGastric reflux B 12 deficiency; not enough stomach acid, can’t B 12 deficiency; not enough stomach acid, can’t

break the B12 off the meat. Iron deficiency the same.break the B12 off the meat. Iron deficiency the same. Poor stomach motilityPoor stomach motility Gallstones, (D and cholesterol are liquid component Gallstones, (D and cholesterol are liquid component

of bile)of bile) Diabetes (islet cells have D receptors)Diabetes (islet cells have D receptors) Decreased “good” colonic bacteria with bloating etc.Decreased “good” colonic bacteria with bloating etc. ConstipationConstipation Esophageal cancerEsophageal cancer Colon cancerColon cancer

Cholesterol and D Cholesterol and D HormoneHormone

If we make vitamin D on our skin from If we make vitamin D on our skin from cholesterol does that mean that everyone in my cholesterol does that mean that everyone in my practice with high cholesterol has a low D? practice with high cholesterol has a low D?

There is conflicting literature concerning this. There is conflicting literature concerning this. Are there really two ways to treat this high Are there really two ways to treat this high

cholesterol? cholesterol? Give the natural D hormone that’s lacking or give Give the natural D hormone that’s lacking or give

a statin?a statin?

7 dehydrocholesterol Pre vitamin D

Cholesterol and D Cholesterol and D HormoneHormone

When the statin lowers the cholesterol does When the statin lowers the cholesterol does that mean that 7 dehydrocholesterol, the that mean that 7 dehydrocholesterol, the raw material that makes vitamin D, is lower raw material that makes vitamin D, is lower on the skin too? If so does that imply that I on the skin too? If so does that imply that I won’t be able to make vitamin D now when I won’t be able to make vitamin D now when I go out in the sun? go out in the sun?

Might this also mean that my sun exposed Might this also mean that my sun exposed areas are now exposed without the areas are now exposed without the protective effects of vitamin D producing protective effects of vitamin D producing more wrinkling, color changes, and more wrinkling, color changes, and bruising?bruising?

Arthritis and Arthritis and RheumatismRheumatism

There are D receptors all over the WBC’s. There are D receptors all over the WBC’s. Low D appears to increase proinflamatory Low D appears to increase proinflamatory

actions, leading to joint inflammation that in actions, leading to joint inflammation that in combination with lack of repair in sleep leads to combination with lack of repair in sleep leads to Knee replacementKnee replacement Hip arthritis, replacementHip arthritis, replacement Rotator cuff surgeriesRotator cuff surgeries Spine surgeries from disc diseaseSpine surgeries from disc disease

D is needed not only for bone health but also for D is needed not only for bone health but also for fibroblast, skin and vertebral disk health.fibroblast, skin and vertebral disk health.

Probably the time that we do most of the Probably the time that we do most of the maintenance using this hormone is during sleep, maintenance using this hormone is during sleep, so the effect of it’s absence is doubled or tripled so the effect of it’s absence is doubled or tripled by the disrupted sleep.by the disrupted sleep.

Muscle Weakness, Pain

D hormone receptors in the anterior horn cells

The CPK elevations and muscle pain caused by statins are linked into this somehow that is not yet clear, to me at least.

Most of the patients I see with unexplained high CPK’s found in preparation for starting statins have very low D’s.

D Bosses other Steroid D Bosses other Steroid HormonesHormones

D receptors in the testicles, ovaries and fallopian D receptors in the testicles, ovaries and fallopian tubes.tubes.

Mate in September when the D is high guarantees the Mate in September when the D is high guarantees the baby is born in June, so he’s out in the sun.baby is born in June, so he’s out in the sun.

Could this contribute to infertility, male and female?Could this contribute to infertility, male and female? Endometriosis?Endometriosis? Polycystic ovary disease?Polycystic ovary disease? Males with OSA often have low testosterone levels.Males with OSA often have low testosterone levels. ““Lo T” (low testosterone) the new “ED” (erectile Lo T” (low testosterone) the new “ED” (erectile

dysfunction) caused by this too?dysfunction) caused by this too?

Multiple Autoimmune Multiple Autoimmune Diseases due to Vitamin D Diseases due to Vitamin D

deficiencydeficiency Rheumatoid arthritisRheumatoid arthritis LupusLupus Ulcerative ColitisUlcerative Colitis PsoriasisPsoriasis Celiac DiseaseCeliac Disease AsthmaAsthma AllergiesAllergies Multiple SclerosisMultiple Sclerosis

Bone Marrow Components all have D receptors

Bone marrow disorders epidemiologically linked to low D:

Multiply myeloma Thromocytopenia, thrombocytosis Anemia Pancytopenia is often B12, iron and D

deficiency. D is first, low B12 and iron come as the stomach acid goes down.

How do replace the D to fix How do replace the D to fix the sleep?the sleep?

I had given everyone 1000 IU of vitamin D3 I had given everyone 1000 IU of vitamin D3 because that is what the FDA recommends.because that is what the FDA recommends.

But in January none of my patients were But in January none of my patients were better. better.

They couldn’t sleep and had a headache daily.They couldn’t sleep and had a headache daily. Their vitamin D3 25OH levels were all 10 Their vitamin D3 25OH levels were all 10

points lower after 4 months of winter (taking points lower after 4 months of winter (taking 1000 IU/day).1000 IU/day).

So what is the right dose? 2000 IU, 5000 IU?So what is the right dose? 2000 IU, 5000 IU?

What’s the right level?

If the “normal” is 30-100 and there is no symptom to follow is 32 as normal as 82?

What do I ask my patient? “How’re your bones doin’?”

With the symptom of normal sleep there’s a symptom to ask about that really determines a thriving human’s level.

If my level’s 28 how do we get to 78?

What is the right level ?What is the right level ? By February I was giving 2,000 IU/day. By February I was giving 2,000 IU/day.

“Call me back about your sleep.”“Call me back about your sleep.” And what is a normal D? (30-100) If all of And what is a normal D? (30-100) If all of

my patients with a level of 28 have lousy my patients with a level of 28 have lousy sleep and a headache is 30 really sleep and a headache is 30 really “normal”?“normal”?

www.vitamindcouncil.org believes the www.vitamindcouncil.org believes the level should be 80 ng/ml in September level should be 80 ng/ml in September and no lower than 50 at the end of winter.and no lower than 50 at the end of winter.

www.vitamindcouncil.org believes that www.vitamindcouncil.org believes that people leading what is now a normal people leading what is now a normal “interior life” it takes 10,000 IU/day to “interior life” it takes 10,000 IU/day to STAY THE SAME. STAY THE SAME.

What is the right dose to GET BETTER? What is the right dose to GET BETTER?

What’s the right dose? We make 20,000 IU on our skin in 1-6 hours in the sun

middle of the summer middle of the day based on skin type.

Very light skinned people lose because they burn, but very dark skinned people lose too because they may need 6 hours to make the same amount.

Skin whiteness evolved to help survive at lower sun exposure latitudes. Albinism led to better baby survival.

If it’s 10,000 IU to stay the same how long will it take at this dose to get to where I want to stay?

Why do prenatal vitamins have only 400 IU? Is this why all the women have 2 kids then get B12, iron deficiency, hypothyroidism and then get their gallbladder out?

Is this the cause of post partum depression and psychosis?

In the last 30 years most In the last 30 years most babies have been born to D babies have been born to D

deficient momsdeficient moms Children of D deficient moms have Children of D deficient moms have

increased incidence of:increased incidence of: AsthmaAsthma AllergiesAllergies ADD (kids who can’t sleep normally)ADD (kids who can’t sleep normally) Autism (babies brains develop Autism (babies brains develop afterafter

their born while they’re sleeping).their born while they’re sleeping). Do any of our children or grandchildren Do any of our children or grandchildren

know what it’s like to wake up rested, know what it’s like to wake up rested, alert, curious?alert, curious?

Depression Psychosis and D

We all know that if you sleep deprive someone for 4-5 nights they go “crazy”, we see it on TV as a torture technique.

There is a brain switch that assures that we are never, ever, ever, awake and asleep at the same time.

What would that look like? Dreaming while I’m awake? Isn’t that pretty similar to psychosis?

The SSRI’s suppress REM sleep, high serotonin is a message to the brainstem that we’re awake so when serotonin is up at night it suppresses REM sleep.

Antipsychotics finish the job because dopamine is what runs normal sleep.

All the psych hospital patients are up walking at night for this reason, they can’t sleep. When they can’t sleep they can’t get better. None of our “sleep medicines” give back normal REM.

What is the right daily dose What is the right daily dose

1,000 IU or 10,000 IU?1,000 IU or 10,000 IU? The right dose is the dose that allows you and The right dose is the dose that allows you and

your patients to sleep normally and wake up your patients to sleep normally and wake up rested without a pill.rested without a pill.

That dose is much higher than what is being That dose is much higher than what is being tried in most clinical trials, but we do have tried in most clinical trials, but we do have one article in Neurology June 2010, showing one article in Neurology June 2010, showing doses as high as 40,000 IU/day for weeks on doses as high as 40,000 IU/day for weeks on end end with no calcium or parathyroid with no calcium or parathyroid hormone elevationhormone elevation..

(But I’ll bet their sleep was terrible- see (But I’ll bet their sleep was terrible- see below.)below.)

Vitamin D Toxicity. Why the FDA’s not crazy

In 1930’s and 40’s the dosing was completely unknown and they made some people very ill and dead on very high daily doses.

Because of this experience FDA wisely chose to undercut the doses for supplements.

All of the “toxicity” that is referred to quotes hypercalcemia. But all of my patients had “toxicity” symptoms way before the calcium went up.

THE SLEEP DISORDER CAME BACK with a high D just like low D.

In most patients the symptoms of fatigue, pain and poor sleep start to return above a level of 90-95. The movements in sleep come back leading to pain on awakening again.

As with every hormone: go too high things go wrong, go too low things go wrong.

D Hormone and D receptors D Hormone and D receptors multilayered complexitymultilayered complexity

““Vitamin D” will turn out to be a multi level endocrine system Vitamin D” will turn out to be a multi level endocrine system with at least 3 separate forms that are active with different with at least 3 separate forms that are active with different effects. effects.

There are species differences in receptor subtypes and organ There are species differences in receptor subtypes and organ differences in receptor subtypes, within the same person.differences in receptor subtypes, within the same person.

Different organs in the body make their active D at the rate Different organs in the body make their active D at the rate they need it .they need it .

D 1,25 OH is D 1,25 OH is notnot the only active chemical and D25 OH is the only active chemical and D25 OH is notnot just a storage chemical. just a storage chemical.

In higher “summer” doses D25OH is probably active on In higher “summer” doses D25OH is probably active on mood and sleep the day it is given.mood and sleep the day it is given.

The right test is D25OH. Don’t test D1,25 OH it fluctuates The right test is D25OH. Don’t test D1,25 OH it fluctuates differently and does not reflect the amount of D stores.differently and does not reflect the amount of D stores.

If the patient has been on D2 your measurement has to test If the patient has been on D2 your measurement has to test D3 25OH separately from D2 25OH or your level does not D3 25OH separately from D2 25OH or your level does not really reflect the patient’s D3 level.really reflect the patient’s D3 level.

Are D2 and D3 really the same?Are D2 and D3 really the same?

Why the “vitamin” mistake and what’s with the

numbers? The original rickets model was established by

narrowing down a rat’s diet until their bones got funny.

Oops, rats are nocturnal animals, they don’t go out in the sun. They had to evolve a D receptor that could use the D found in food.

The first chemicals found that corrected the bone disorder were from fungus on grain and they were D1 and D2. They appeared to be vitamins. They were, in fact, in the food.

Unfortunately what we make on our skin is D3, a different chemical, it’s not found in the food. (Except cod liver.)

D2 may have variable effects in different species and different individuals, in my patients it seems to worsen the sleep.

What should I do for myself What should I do for myself and my patients?and my patients?

If your D is very low and has been low for a If your D is very low and has been low for a long time don’t expect to feel better rapidly, it’s long time don’t expect to feel better rapidly, it’s not a drug. not a drug.

If it’s been 10 years since you felt good, expect If it’s been 10 years since you felt good, expect it to take months to feel better.it to take months to feel better.

Never let it your D fall below 60, get levels Never let it your D fall below 60, get levels done in the spring and fall for a couple of years done in the spring and fall for a couple of years to determine what replacement to take winter to determine what replacement to take winter and summer based on your own measurements. and summer based on your own measurements.

Everyone in the family makes D at their own Everyone in the family makes D at their own rate, you can’t assume yours based on other rate, you can’t assume yours based on other people in the family.people in the family.

How to know when it’s right?

Like every hormone it should stay in a range; probably 50-80.

Try to achieve restful sleep with no pain on awakening. Dosing with vitamin D once a week is not the same as

daily. The B12 definitely helps sleep also and needs to be >500.

Given as a daily pill. The shots don’t work as well, we don’t store it.

Watch the sleep…. After it’s better for months then it gets worse it’s either a medication having a new side effect or the D is too high or too low, check the level.

Stop the extra Calcium. Osteoporosis is caused by Vitamin D deficiency not Evista or Boniva or Fosamax deficiency. With normal D Ca++ absorption is normal

www.vitamindcouncil.org

Our healthy vitamin D Our healthy vitamin D futurefuture