Sleep, IBS and the Neurotransmitters: The Link Between Acetylcholine, D and the B Vitamins

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be talking again with Stasia Gomenek, MD, neurologist and sleep coach. Dr. Gomenek attended medical school at Baylor College of Medicine, completed her neurology residency at the Harvard-affiliated Massachusetts General Hospital in Boston, and practiced neurology in the San Francisco Bay Area until 2004 when she moved to Texas and began focusing her practice on sleep disorders. In 2012 and 2016, she published two pivotal articles about the global struggle with worsening sleep and the possible causes and solutions related to vitamin D deficiency and the intestinal microbiome, which we discussed in the previous podcast. Today, she currently divides her time between Right Sleep coaching sessions for private individuals and teaching other clinicians the Right Sleep method of sleep repair. I had her on the podcast in episode 79 on August 23rd, 2022, where we talked about vitamin D and the B vitamins and how they relate to sleep, gut health, and each other. And today we're digging deeper on this topic and getting into the role of acetylcholine in the brain and how it also relates to the B vitamins, which are produced by a healthy gut microbiome. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so. And if you wanna get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter.. You'll also get my free ebooklet called Finding Your Root Cause Through Stool and Organic Acids Testing when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now onto the show.

Welcome back to the podcast, Dr. Gomenac.

Thanks for asking me, Lindsey. I go by Stasha.

Stasha. Okay, well I will call you Stasha then. Okay. I wanted to start by just summarizing what we went over in the last podcast. People should definitely go back and listen to it, but nevertheless, here's a, here's a brief synopsis. So correct me if I have anything wrong in this, but basically you as a neurologist were seeing patients who had problems with sleep and you determined that it might be a deficiency of vitamin D. So you started supplementing people with vitamin D and got them to that optimal range of 60 to 80. At which point their sleep seemed to improve and everything seemed to be going well. But then like, you know, a couple years later or some amount of time later, people started developing other symptoms like burning in their hands and feet, or the sleep started going bad again, or they had like arthritic pain. And so based on a book that you had read about B5 or pantothenic acid, you determined that that must be a deficiency. And so you gave them the dose recommended there, which was 400 milligrams of B5. But then people started developing other symptoms like agitation or anxiety in the and their sleep went bad again. And so you figured out that there was a synergistic relationship between vitamin D as a growth factor and the B vitamins because the bacteria are taking in the vitamin D and they're producing the B vitamins and then they're exchanging the B vitamins amongst themselves between the different phyla of bacteria that are the primary residents of our gut. So then you start trying to put people on a, just a B complex, a B100 complex. And they saw, you saw people's symptoms go away with all the ones that had come back and then even saw some patients who had IBS, their symptoms clear up as their phylum became more balanced. But then you also saw that some people, for some people, the B, B100 complex where it was 100 like milligrams of most of the B vitamins was too much. So you dropped to B50 for some people, but we just keep 'em on a, on the B complex for a limited period of time, like 3 months, or else problems started developing again. Does that sound about right?

It is.

And the— can I go from there?

Please.

Okay. So none of these things individually make any sense. So I keep in mind I'm operating in the same belief system as most people. We aren't doing well because we eat wrong. We aren't doing well because we live in a toxic environment. We aren't doing well and we have IBS or we have food sensitivities because we have the wrong microbiome. So I'm operating in that same belief system. And then I start to give vitamin D and their sleep gets better. And I presume that vitamin D is a growth factor to the bacteria. We had no proof of that at the time. The reason why I presume that is IBS showed up at the same time as D-related diseases of multiple kinds, including sleep disorders in the early '80s. Okay, so my thought was D goes low, the bacteria need D, and oh, I'm going to be a hero because I'm going to give back this D and everybody's going to lose their IBS as well as lose their sleep disorder. But that's not what happened. So at the end of 2 years, there were 3 things that didn't get better with D that I thought should. One, my patients did not lose weight. They were exercising, they were energetic, they were feeling better because they were sleeping better, but they didn't lose weight. It turns out that's linked directly to what— who's living in your belly. The second thing was their IBS didn't go away. So even though I thought it would go away, it didn't go away. And then the third thing was, golly, it wore off. The third thing that happened was this effect of improved sleep wore off at 2 years. And it was so many people complaining that Not only is my sleep bad and my D is 65, I'm doing exactly what you told me, but my sleep is terrible and my joints are hurting me and I'm about to see the rheumatologist. And me personally, I'm doing exactly the same thing as my patients. And I had this really weird buttock pain where I couldn't sit down at the end of the day. It didn't have anything to do with injury. In the buildup to this, I had built in my mind this idea that Sleep is about becoming perfectly paralyzed for this part. So we've talked about sleep apnea and that we can get too paralyzed here. But if you're not paralyzed enough, your legs may still be moving. That means I had wondered whether or not these leg movements that we see on the sleep studies contribute to poor healing in certain joints. So I was assuming, well, maybe I'm activating my hamstrings while I'm asleep. I'm in a fetal position and I'm pulling on my butt bones. I'm making this up because I don't really know why. So I have this urgency of thinking I'm doing something to my patients with this D that has other repercussions that I don't understand. That makes me really uncomfortable. So at 2 years of giving D, I'm left with this suspicion something else is either gone deficient or there's some long effect of D. It doesn't make any sense to me that D should be causing this at 2 years. And it's at that point that a patient brings me a book about a B vitamin deficiency. And it was well-timed because it had two gals who had burning in their hands and feet. And the only thing they had was headache. They didn't have diabetes. They were already on B12. But my experience as a neurologist, where neuropathy is my specialty, was that this has a B vitamin ring to it. So I read this book about pantothenic acid, and there are There are research publications from the '50s where they block pantothenic acid, vitamin that nobody's talking about, and they cause burning in the hands and feet within 2 weeks. So there was a scientific basis. And I'm thinking, okay, I don't have a good explanation for why this would happen. Why don't I just give them this pantothenic acid? So I go to the store and I buy 400 milligrams. But at the same time, I remember in medical school them saying, if you give one B, you should give all of them. I have no understanding of why. I'm completely a novice. I am not an expert like you are, Lindsey Parsons. I go and I grab this B100 stuff because I can at least guarantee that each person I give the recommendation to will be taking the same thing because B complex is very confusing. It could have 3 Bs, 2 Bs, 1 B. You never know what's in there. So I wanted to be sure I was recommending the same thing. And B100 is a non-proprietary mix of 100 milligrams of each. So it's a large dose of 8 B vitamins. That piece is really important. So I give— I take myself and I give other people 400mg of pantothenic acid and B100. That means I'm taking a total of 500mg of pantothenic acid. And it did not interrupt my sleep, but my restless legs went berserk. So immediately I think, uh-oh, it's taken me 4 days to realize this, but this is probably too big a dose. And just like the vitamin D stuff, you can't believe what's in the literature. And, uh-oh, this is really bad. So I stopped the 400 milligrams of pantothenic acid. I just take the B100 and everything goes away. My butt pain goes away in a day, which was very bizarre. I know nothing about vitamins, but I know that they're not supposed to help your pain and make your sleep good, especially overnight. Like people say, oh, I got a B12 shot, I feel energetic. So now all my patients are coming back and they consistently answer in the negative, which is This 400 milligrams of pantothenic acid nearly killed me. I got very anxious or revved up, or I couldn't settle down. They're using the same phrasing. And I stopped it after 2 days because I couldn't sleep. Now, the first thing that's weird about this is this is like the ADD medicines. Like, what? This is a vitamin. It goes right up into the brain and it makes you agitated. And then some people say, you know, I stopped the 400 milligrams. And I just took this B100. So the surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep, our feeling of anxiety and agitation, and that that vitamin given in certain doses would actually cause those symptoms. So it was not obvious to me what was actually happening, but it turns out the final answer is that Vitamin D makes the final enzyme choline acetyltransferase that makes acetylcholine. And what goes into being used by that enzyme is coenzyme A and choline. So the actual formation of acetylcholine is dependent on both D and B5. And choline is usually not deficient in most people. Making acetylcholine is how we stay focused. So not surprisingly, the epidemic of ADHD started to be reported in the 1980s. So your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it. So anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system, which allows us to rest and digest. That means that side is all about GI tract motility and is about calmness during the day and sleeping at night. So it turns out that you can become B5 deficient by losing your microbiome, because the actual truth is there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. That means if you happen to be D-low or deficient and you don't have the right gut bacteria, you can actually lose one of the most important parts of your body, an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. And what had happened was I had given the D that the microbiome wanted. But the other thing that the little bacteria, the correct 4 pieces of the microbiome, the healthy, happy guys, were still down there, but they had been missing the B vitamins that they needed from their buddies. So when I happened to give them B100, as I was thinking about what I was doing, I thought, well, if I'm right that these Bs are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid. If we take this too long and the bugs grow back, pretty soon you're gonna have two sources. You're gonna have the pill you're taking and you're gonna have the normal microbiome, and then your sleep is gonna fall apart and your pain's gonna come back. And that is exactly what happened. So it was something that was a hypothesis at the time, and I was following not poop cultures, but what was happening in their nervous system. So it turns out if you take the B50 plus D, for 3 months, your bacteria come back, and then you stop the B50.

Okay. That's, that's amazing that you discovered all that and, and were able to help people to recover their sleep and their bacteria. So it's pretty freaky.

I have to say, I still think it's pretty amazing.

So I did have one client who told me that when he first started B complex, he felt very agitated. So is it the B5, do you think, in there that could have been causing that?

Yes. And it's not just B5. B12, B5, and several of the Bs are working together. They never work alone. So that, that original comment that if you give one B, you should give all of them is usually, not always, the right recommendation. Because the nervous system really uses all of the Bs to make the neurotransmitters. What we feel and what we experience is about dopamine, serotonin, norepinephrine, epinephrine, acetylcholine. It's about these neurotransmitters, but the paths to make those are all linked to the B vitamins. So you can see similar things with B12. It's not common, but I have patients that get agitated with B12 as well. So they're linked in some way that isn't completely clear to me.

Okay. So do you use organic acids testing at all in your practice?

I am not trained in— I know what organic acid testing is because I'm a neurologist and we did that in early childhood development diseases, but I do not use any of those tests. I use, I use a very simple set of tests. I'm interested in the B12 and the D level and that's it. And mostly I'm, I'm mostly focused not on what is your unique genetic problem, which is still important. It's not that it's not important. I believe that the people like you, Lindsey Parsons, that are expert in other areas will get more success or greater range of success by putting back the normal microbiome and getting the D right. And then all the stuff that you guys know about zinc or copper and all the specialized things that are only partially known, like what species of bacteria makes the B5. I'm not even sure anybody knows that yet. So I'm hoping that this natural part, when we put it back, will then lead to being able to build on and have better success in the interventions that you've discovered.

Yeah.

And I only asked because on the Great Plains Lab organic acids test, there's a marker B6, but I've literally only had one client ever who's had a normal level of B6 on that test. And I've heard other people talking about this as well. So I, I'm just curious whether B6 deficiency is this super common thing, but you don't, you don't test B6 in any case.

I don't, but it's interesting to note that B5 and B6 were studied together back when they were actually studying vitamins. So back in the '50s, '60s, and '70s, they used both of those. B6 is really important because it's necessary to make dopamine. And that means it is absolutely a player in making the neurotransmitters that make us sleep. So it appears to me that B5 acts like— there's no controller on the enzymatic formation of acetylcholine. To me, it's completely sloppy and dangerous that something that I should take as a supplement would mean I can either sleep or not sleep. I mean, that, that just still freaks me out. That should mean that there should be a modifier. Like, if my bugs happen to make enough B5 or they don't, there should be somebody up at the brain level saying, okay, well, we can still make an even amount of these neuro— these neurochemicals. I think that's the case for most neurotransmitters, that you don't see someone make too much dopamine when you give them B6. There aren't clinical symptoms that go along with that. So to me, this is still an unexplained area. It does suggest that our gut bacteria is pivotal to making us be calm and sleep. That's, that's really important. It's certainly something we've observed that people have gotten higher incidences of depression, anxiety, and suicide over the last 40 years at the same time. We've made up separate explanations for that, but it would then suggest maybe we should explore this possibility too. Maybe this abnormal gut biome is actually making us have these emotional states that we don't want.

Yeah, it's kind of tough nowadays to pull apart what's happening nutritionally, the sun exposure, and then the, the social media and the devices and all of that. It's, there's a lot of confounding factors.

Well said.

So in your experience, you had, you had seen at least some people who had— was it both the onset of IBS symptoms when after giving vitamin D, or did they already have IBS and then when you gave them B vitamins that helped cleared it up?

I, I never induced IBS with vitamin D in my experience. What I saw was probably a quarter of my patients— remember, they're patients seeing a neurologist, so they're not coming in with IBS as a complaint. And I personally had become very sensitive to onions, garlic, things like that in my 30s. So we were actually trading recipes for probiotics at the time. I'm taking something and they're saying, no, my GI doctor has something better. So that was really the only answer to IBS at the time, but it hadn't worked or they wouldn't be trading recipes with me. So then I noticed that, oh, I thought this D was gonna fix that, but it didn't. Definitely didn't. Not everybody has complaints, but the people who had IBS still had IBS. And I thought, well, that was a good idea, but it didn't work. And then came this idea that, oh, they only come back. Oh, they're making the bees. Like, why would we have 8 things called B? Maybe that's what they're lacking. And so I stumble into this completely by accident, but it works beautifully. And the people with IBS, by the end of the 3 months, we learned to stop the bees. And their IBS is gone.

How many people are we talking about?

1,500 at the time.

1,500 with IBS?

No, 1,500 people total that I'm doing this with. They're my, in my practice. So maybe a quarter of that many. And yeah, so it was very, it's been very successful since then.

Excuse this brief interruption, but I wanted to remind you that if you've been struggling with IBS, IBD, reflux, gastritis, SIBO, dysbiosis, candida, diarrhea, constipation, and all that gut health stuff. That's my specialty. So I work with clients not just here in Tucson, Arizona, where I live, but also virtually on video chat. And I offer single appointments as well as a 5-session gut health program for people with tougher gut health issues or mental health or autoimmune challenges that go along with that, who likely require testing and longer-term follow-up. As well as 12-week programs for weight loss. If you think that a 5-session or longer course of health coaching might help you meet your health goals, you can set up a free 30-minute breakthrough session with me to talk about what you've been going through, and I'll listen and hear if it sounds like I have something in my toolkit that you haven't already tried and let you know if I think that health coaching would be appropriate for you. You can find a link for that in the show notes, and I hope to hear from you.

Here's the problem. As soon as you get those bugs back, you have to pay attention to the fact that once you've gotten back the bugs, they are not the only reason why your belly may be unhappy. So if the nervous system of the belly starts to complain, that's the same nervous system that does rest and digest. So your belly system is directly related to how your sleep is. And it usually turns out if you don't have the Bs right, or if you're taking them when you don't need them. So if you're giving your nervous system extra when it doesn't want them, you can see agitation, anxiety, sleep problems, and a belly that feels just like IBS.

Mm-hmm. Okay. That's good to know. That's interesting because I have a client who stopped sleeping and I'm not— now I want to go back and make sure what's going on with the, with B vitamins because I've put a lot of people on Yeah, I suggest B vitamins for a lot of people.

Yeah, yeah. And they, and they're important and they work. It's a different framework to think about them as their job in this setting is to bring the bugs back. But once the bugs come back, then we have to sit for a while with the bees off board and say, what does my body and my nervous system say about the production that my bugs are giving me now?

Right. So it seems like we're having, you know, an epidemic of sleep apnea. And I know some of it's connected to obesity, but obviously some of it isn't. What do you think is at the root of that?

So one of the things that happened to me when I went into these B vitamins was my husband handed me this article that was out of The Economist journal, which was peculiar because it's a journal about making money. And this article is still, in my view, a very brilliant article about all the things that the GI doctors had learned about poop bacteria. That's not my specialty. One of the very important things they had in that article, which you can actually access on my site, or you can just go to The Economist journal and ask for Me, Myself, and Us. It's a 3-page article. One of the important things they have in there is that if you take a mouse and you do a gastric bypass on the mouse, or you go to do a gastric sleeve, and then you take the poop bacteria from that mouse and you transplant it into another mouse, the second mouse loses weight. It's really not the sleeve. It's that the bacteria that live inside us actually govern one, our appetite. So they make small-chain fatty acids that go up into these little receptors in your nose and make high-fat, high-calorie foods smell better to you. They have actually been running our appetite, and they also run what do we do with the calories we eat. So there's a huge argument on this health and wellness internet sites about what is it that makes me fat? And some of the controls are really not in the hands of the endocrine system of the person who is obese. It is really their microbiome that is saying, We're in winter. Winter means I take the calories you eat and I put it into fat. When you look back at— I'm happy to go to my 50th high school reunion. There are very few people who are obese in my entire school in 1972. This epidemic is not just about what was available because pizza and hamburgers and Cheez-Its were available then. Part of it is that you have the wrong microbiome that turns out to be playing a huge role in your endocrine system. It is a part that generally the MDs have missed. They're starting to pay attention to the fact that when we do fecal transplants, you better ask who your donator is because if they're skinny, you can get skinny. If they're obese, you'll get obese. So there was a connection between Oh, the D that we make on our skin runs whether or not we're in a winter microbiome or a summer microbiome. There was a change, and those bugs would train our body to conserve and make fat. We, oddly enough, follow bears around and collect their poop during the year, and then we show that their microbiome changes throughout the year and that the bear gets into a I'm going to put on fat mode in the fall to allow the bear to make it through the winter. And we don't, we don't shame fat bears. We just think that they're help— it's helping them survive. Medicine hasn't seen it through this lens. But, and it's not just, oh, I just don't eat very much. Those people who are still hungry after they've eaten 2 full meals, are being run chemically to still be hungry.

Okay.

So that, that explains some of the, some of the obesity connection to the microbiome, but what about the sleep apnea?

So oddly enough, the acetylcholine that we talked about is a chemical that allows us to get perfectly paralyzed. It's not the only chemical. There are multiple neurotransmitters that are actively involved in not only allowing us to switch in and out of sleep. So you have to fall asleep. That's a complex process and it's run by chemicals. But when you go from light sleep to deep sleep, you become paralyzed. And there are specific chemicals that are running that process. Acetylcholine turns out to be one of those that you can become deficient in by having a low D and losing your microbiome. That means you can actually get too paralyzed when you're supposed to be in this phase where you were perfectly paralyzed. We first found that disease in men who were post-op from a cardiac surgery in the post-op population. That means we found it at its most severe. Those people that had sleep apnea for 20 years, they got cardiac disease because their microbiome was screwed up and because they had low D. And because their sleep was bad. So sleep apnea is one of the worst manifestations, but it's really on a continuum, and it includes not being able to sleep. So insomnia is greatly overlooked. We spend all this time talking about sleep apnea and blaming the oropharynx, and there is an anatomical part to getting incorrectly paralyzed so that when you're sleeping and deeply asleep, you're supposed to be able to keep the tube, the airway tube open. If it doesn't work right, then you stop being able to keep the airway tube open. Part of that is anatomy, but part of it is the central controller that makes this paralyzed in certain phases. And that links back to acetylcholine, D, and the bees that we make in our belly. So normal animals do not get sleep apnea. Those normal animals that live outside and have a normal microbiome don't get sleep apnea.

They don't get a lot of the stuff we get.

Which is interesting because they are exposed to the same toxins we are. One of the things that struck me was if we look at this as humans are just one of millions of animals on this planet, why is it that only the humans globally have developed sleep apnea? And oh, by the way, we're not really the only animal because our dogs and cats dogs especially, that we feel sorry for and we keep them indoors, they start to snore and they get foul-smelling farts. And we already have these legends about our dogs running while they're asleep. They are actually acting out their dreams just like we do because they are not paralyzed because their D is wrong and their microbiome has changed. So it's not that the toxin stuff is not correct. It's important for us to pursue that. But in terms of what I can do personally for myself, going outside more, getting the microbiome to be right, are things that can still help.

Okay. So sleep apnea sufferers, get more sun, get your D corrected, possibly go on a B complex as well.

And go to my site and learn about how you want to use those two together in the correct way.

Okay, perfect.

And what relationship do you believe sleep has had to the rise in mental health issues in children?

I think that in the background, when we don't acknowledge that most kids who have emotional disorders during the day also have a sleep disorder— and the hard part is realizing that we only see what's normal sleep. We see what our other parents say to us. Like, if my kid gets up twice during the night, And I'm talking to my colleagues that are 30 years old at the same time, and their kids get up the same way. And my mother says, "You guys didn't get up in the middle of the night." We don't pay attention to what mom says. We say, "Oh, everybody I know has kids that get up in the middle of the night." You really have to go back to the 1960s and say, what were the sleep studies showing then? And is there something that could be affecting every pregnant mom, i.e., they're doing what their doctor tells them, which is to put on sunscreen and not go out in the sun. And they're also not exposing their newborn to the sun. So are there things that could be going on in this last two generations that are relatively new? So emotional problems are related to how well we make our neurotransmitters, and the neurotransmitters are made while we're sleeping, and they're made in certain deep sleep episodes. We also make growth hormone. We make all of the hormones that are important to our behavior and our well-being. So the hormonal systems as well as the neurotransmitter systems are tightly linked to whether or not we sleep normally. And all of us know that we feel better and we're more patient and we just feel better about ourselves when we sleep better. So it's not a hard concept. It's just that, oh, what if my kid doesn't have the basic necessary raw materials to sleep like a normal person? I would like to know that, and I would like to have the opportunity to put back those things and see what my child might be like.

So basically, get your kid out in the sun.

Get your kid out in the sun and go to my website and learn about D, learn more, because you're going to have a very difficult time talking to your physicians about putting your kid in the sun. You have to learn more about it. There is a huge controversy right now. About taking D as a supplement versus going out in the sun. And then there's a little bit more to know if your child has an autoimmune disease, has already has food sensitivities, is very anxious, and has lots of things that we're talking about in adults. Then those things are linked to the microbiome. Then you're going to want to do the D plus this B complex for a while. So it's a, it's a little bit bigger if you're just have a kid and he wakes up once a night to ask for a glass of water and that's it and everything else is fine, then I would just put that kid outside more. If it's much more complex than that, then there's a bit of depth that you have to understand. And I actually have a set of videos that help with pregnancy, fertility, and first year of life because you're giving breast milk to that baby. Therefore, you have to know about the Bs and the Ds through breast milk. And there's another set of videos about how to do this in a child and what age groups and what is the— what's really normal sleep for toddlers or teenagers, that sort of thing.

Okay. So you mentioned, as you were talking about children, that something the mother is giving to the child. What is— is the child not getting sufficient D from the mother?

Okay. Yes. The child is not getting sufficient D from the mother. So the problem is that most women now are trying to get pregnant when their Ds are quite low. And D is a— by itself is a major player in infertility. That's been well published now. That's in the OB-GYN literature. Infertility and early premature delivery. So the D covers the placenta. The D covers a lot of the issue of you are really carrying another being inside you. You do not want your immune system recognize that other being as not belonging there. And D is heavily involved in what the immune system sees and doesn't see and tolerates. So low D leads to increased delivery at prematurity. Low D is also now in the literature about eclampsia and about, unfortunately, things that have to do with physical malformations of the baby. But mostly it's about being able to carry your baby to term. That is in the OB-GYN literature, yet the fertility experts are not using it. All you really have to do is get your D above 40 and you will get pregnant. Great, great majority of women. It also probably affects fertility in males, but predominantly in females. When the D is low, it suppresses the ability of the ovary to ovulate. So it doesn't make the woman able to have babies. Once the woman gets pregnant, The only D that baby's going to get is coming from the mom through the blood into the fetus. The second piece is that the only B source is not the prenatal vitamin. There's some Bs in there, and the prenatal vitamin is a disaster. But the gut bacteria of the mom are the primary supply for the Bs for the baby. That means in early development, first 12 weeks where all the basic functional development of the arms, legs, heart, et cetera. So that means we already have a whole body of literature that talks about cleft lip, cleft palate being related to B vitamin deficiencies. The neural tube defects are related to B vitamin deficiencies. That means all you have to do is get the mom's D above 40, get her on a B50, get her microbiome back. Her risk of early natal development issues in the baby goes way down. So once you know that, then you can actually listen to things people tell you about their experience in the delivery of first kid, second kid, third kid has these additional problems. So the birth order also plays a role. By the time mom is having her third child, if she hasn't been going out in the sun, her D is even lower than it was before. Her Bs are now depleted. And that child is more likely to grow up starting with problems with waking up frequently and having microbiome problems. A lot of the interesting stuff that we may not have time to, but some of the other practitioners who work with me say, this kid isn't sleeping. You give them iron, they start sleeping. That's because the microbiome is naturally set up to help you absorb the small charged ions.. And the mom is iron deficient because she's been walking around since the second kid with a microbiome that doesn't allow her to absorb iron. So it's much more complex than just the Bs and the Ds. There's a bunch of other things that the microbiome is doing. When you don't have the normal microbiome, you're at risk for all sorts of things.

Interesting. It also is interesting because I think about it in the context of, I, I went through infertility for many years and I'm sure that Nobody tested my D or looked at that. At some point I got, you know, into eating organic foods and I'm not sure if I, I don't recall taking many supplements. So eventually got pregnant, so something went right. But yeah, so, okay.

Sometimes you can trace back to going on vacation in a sun-filled environment. I have one friend who had 5 miscarriages and then went to the Bahamas and Oh, got pregnant. Interesting. Because it really is straight, straight D related.

Yeah. And it, and you were saying above 40, and I'll tell you this, when I have clients get their D tested, if they were not supplementing, they are without fail somewhere between 20-something and early 30-something. I don't think I've ever seen a level in the 40s from somebody who's not supplementing.

That's correct. You can occasionally see it in somebody who's 17 who just was at the tanning booth for the last 3 weeks cuz she's just about to get married. But that's really the only occasion where I've, where I've seen that happen.

Right. I mean, I just think with, unless, or maybe somebody perhaps who works outdoors and has decided not to wear sunscreen, but that's, it's pretty unusual.

That's very unusual.

Tell me a little bit more about the acetylcholine. I'm, I'm interested in this cuz I'm not very familiar with the topic. Okay. It's You touched on it again, but I need to hear it again. So about its role and origin in the body, what disorders are associated with the lack of it?

Okay. So first off, acetylcholine is something that no layperson should be familiar with. Nobody talks about it. Okay. I'm a neurologist. I should know. When we're taught early pharmacology, we are taught about the parasympathetic nervous system, Laypeople know about the sympathetic nervous system because we talk about it. You're in sympathetic overdrive, your heart rate's too high. But the autonomic nervous system is two halves, one of which calms you down and runs the GI tract, and the other one is the sympathetic. So the parasympathetic is basically run by this chemical called acetylcholine. Now, what happened to me was I see all these things I just described to you in my patients. And I'm a neurologist, but I don't really understand why they're getting agitated and anxious and can't sleep. I just really don't have a chemical basis for that. But when I'm starting to give lectures about it, I think I really have to come up with a better answer than, oh, it acts like caffeine. So I just type into Google coenzyme A in the brain. What was in the book I told you about was coenzyme A, which is B5 becomes coenzyme A, is pivotal in making cortisol. So that was the underlying reason why they were giving B5 to people with rheumatoid arthritis. We knew that they had a problem and we give them prednisone, they get better. So maybe there's a cortisol link. But I really didn't understand why would be giving B5 cause people to be agitated, anxious, etc. So I type into Google coenzyme A in the brain, and what it says is coenzyme A is pivotal to make acetylcholine. And I think, I'm a neurologist, acetylcholine, what does it do in the brain? I don't even know. I mean, I know it's related to Alzheimer's disease. I know it's at the neuromuscular junction because we have myasthenia gravis and people get weak. But what does it do? So then I start to look around and it turns out these sleep diagrams that show us how we get paralyzed have acetylcholine as a player there. And the next thing I realize is, why don't I know what acetylcholine does in the brain? I know what serotonin does. I know what norepinephrine does. And it turns out we learn as neurologists what neurotransmitters do by giving the drugs. I have dopamine. I give it to Parkinson's disease. I have a serotonin reuptake inhibitor. That means it prolongs the action of serotonin. I give it to somebody who's sad. There are no drugs for acetylcholine? There's none except nicotine. Nicotine turns out to be one of the oldest drugs we have available. And early on in the early 1910, 1920, when we're studying the nervous system, we start to realize that there are nicotinic receptors for acetylcholine and muscarinic receptors. That means we've actually written our textbooks with nicotine as part of it. And it turns out that acetylcholine acts like nicotine in some receptors. It acts like this other drug. And I'm looking at this going, this is weird. Does that mean that the people who smoke a cigarette and feel better could have an acetylcholine deficiency state in their brain? Does that explain why I smoked a cigarette and immediately felt agitated and threw up? Could it mean that the people who get addicted to this chemical are actually feeding their brain with a chemical they're deficient in? Much like I'm taking a serotonin reuptake inhibitor, they're smoking something. And if you've been around smokers, if they're really addicted, they get up in the middle of the night and they smoke a cigarette and go back to bed, which for those of us who don't smoke is bizarre. Like, what? It means that they are actually treating themselves with a chemical that we have vilified. But we should really start thinking of it in a different way. Now, the next thing that leads to is I'm reading these articles about the frontal lobe and the ability to concentrate. And those articles are actually— some of these articles are sent to me by clients. And they say, hey, have you looked at this? This is about acetylcholine. And I learn about it and I'm like, oh my goodness. It turns out that the basic scientists have been studying acetylcholine and its actions in the frontal lobes. And they say acetylcholine is what allows us to get distracted and come right back again. And then you get to the conclusion of the article and they say, you know, this really means we really shouldn't be giving ADD kids things like methamphetamine, which is what we're giving them. The amphetamines up the epinephrine, norepinephrine. They say we should really be giving them nicotine. And I'm like, no, no way am I going to convince a 32-year-old mom with 2 kids to give their kid a cigarette at recess. But it means that we've missed an opportunity because there are no drugs. And there are now studies using nicotine patches in kids with ADD and in autistic kids. So one, it turns out once you know that acetylcholine is actually a neurotransmitter that you can develop a deficiency state of looking like a normal human, but really not being because you don't have the organ of the body, the poop bacteria that you need. And it turns out there are multiple different acetylcholine deficiency states. Parkinson's is one of them. Alzheimer's disease is another one. There are other ones that are, that grow out of that, that have to do with tremor and gait disorders that are important to neurologists that are really have been documented by pathology and by various studies using MRI and other imaging studies that show that the acetylcholine tone, or how much of that chemical you have, is actually deficient. Oddly enough, in the last 3 years, there have been a couple of articles out of a specific lab that's actually studying B5 deficiency states at autopsy in both Huntington's disease and Alzheimer's disease. I, I thought I wouldn't be alive when they finally got around to that, but they kind of stumbled into it by accident. So there are many acetylcholine deficiency diseases. It turns out that anxiety is one of those. And it may turn out that in autism, some of the features of autism are related to that.

And ADHD as well.

Absolutely. ADHD is basically a description that this person doesn't have the right chemistry minute to minute. And a lot of my clients now will be able to say, when I get my B5 dose to this, I'm just calm and organized. Like, I reorganized my entire basement and I'm not yelling at my kids. And it's just weird. And it really is something that lasts for 8 hours and then goes away. Some of my clients have to add an additional tiny dose towards the afternoon.

Of B5.

Yes.

Or is what's bringing up the acetylcholine. Yes. In the context of a B complex.

Usually I use it in the B complex. There are certain people who wind up in huge doses of B5. So the part I left out for you on that original group of people, so there's 40 people I see in a week. I recommend 400 milligrams of pantothenic acid and B100. There are a couple of outliers who didn't come back and say, were you trying to kill me? The two gals with the burning in their hands and feet, much better. 2 days immediately. There were 2 or 3 people who had a little bit of a tremor and a little bit of signs that looked kind of Parkinsonian. And they came back 6 months later, still on 400 milligrams of pantothenic acid. And I was all freaked out, suggesting that there are some circumstances in which 400 milligrams of pantothenic acid is exactly what their nervous system needs. So that's really a big topic. And there are all sorts of genetically related things. And then there's a whole bit about choline, iron, and few other things that are necessary to make acetylcholine. So iron is actually a regulatory a cofactor also, and I'm just starting into that path.

And so what's the relationship chemically between choline and acetylcholine?

So in order to make— I can show you the equation if you'd like, but there's choline and then acetyl-CoA, and those two have an enzyme that's called choline acetyltransferase. That enzyme is made by D. When D hits its receptors in the brainstem sleep receptors, what happens when D hits the receptor is choline acetyltransferase is made. It's the final enzyme. So you need the two basic pieces and the enzyme, and then you get acetylcholine.

Okay. So not the exact same things. They're not just like the active form, but actually a different, chemically different.

Then, then there's another piece to this, which is Within the last 15 years, there's another process called the acetylcholine anti-inflammatory pathway. And that is related to vagus nerve stimulation. Vagus nerve stimulation, which is the big wire that makes the parasympathetic. Vagus nerve stimulation was being used to control epilepsy. When they stimulated it electrically, what they saw was that the spleen responded to that stimulus. By secreting T cells out into the body. And those T cells, white blood cells, specific type, secrete choline acetyltransferase. They secrete the enzyme that makes acetylcholine. That means there are pathways that adjust our inflammation minute to minute in our body. Because I, I'd seen a bunch of things with people that I didn't understand. Like we get to D and B5 to a certain place. And now they have eczema, and now they have a rash, and now they have weird skin stuff that I can't even understand. And what about all those people with that joint pain? What was that about? It turns out the inflammatory system is also controlled minute to minute by acetylcholine as well, but it's completely different pathway that doesn't even involve D.

And can you supplement directly with acetylcholine? I feel like I've seen supplements. Nope. You can't. It's not—

the problem is it'll be broken down as soon as you take it.

Ah, okay.

So it, it needs B5 to become coenzyme A, and then it needs enough choline, which is, is deficient in some people.

Yeah.

Then it needs this enzyme.

Choline's good. A lot of choline in egg yolks.

It's famous for that.

Yeah. Okay. I know we've run out of time and again, I've really enjoyed getting into the, uh, the geeky level science stuff on this. And perhaps we'll have to have you back to get into the whole endocannabinoid stuff.

Yes, I would love to do that because that's, that plus the B vitamins and the development in childhood and autism are, it's really important.

Okay. Well, thank you so much and until the next time.

Okay. Thank you, Lindsey Parsons. Great questions.

Once again, super interesting stuff, understanding how this all relates to your gut microbiome and your mental health at the chemical level. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as check me out on Twitter, Instagram, and Pinterest. Links for all those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.