Tag Archive for: melatonin

Melatonin: Stay the Course

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As we continue to examine the results that appeared to suggest that the chronic use of melatonin in people diagnosed with insomnia could result in an increased risk of a diagnosis of heart failure, heart failure hospitalizations, and death from all causes, let’s put the unreviewed abstract in perspective. One correction from Tuesday. The researchers did not track the subjects for five years; the gathered data from the past five years. That’s an important difference

The simplest way to is to convert the percentage of risk into real percentages. The study reported that the risk of developing heart failure was over 90%. That’s true, but it’s based on the percentage of insomniacs that didn’t use melatonin at 2.7% versus 4.6% in those that did use melatonin. The same logic was used for hospitalizations (19.0% vs. 6.6%), and mortality (7.8% vs. 4.3%). It still seems like a significant risk, but there’s one more number that’s important: the total number of subjects in the study.

Insomnia: The Numbers

In the United States, the average number of adults that are diagnosed with insomnia is 12%. With 268 million adults in the U.S., that means that 32.2 million people have chronic insomnia. The percentage diagnosed is about the same in all high-income countries around the world. The researchers used a database that claims to have 150 million de-identified electronic medical records in its database, so how did the number of subjects get to only 120,000? It should have been at least 15 million.

Yes, the subjects were matched for a variety of criteria including age, gender, medications, and other factors but still, that’s an awful lot of lost subjects. Even without the diagnosis of insomnia, other diagnoses such as depression and other mental health diagnoses result in insomnia. They can also predispose people to heart failure as well. Those subjects would also have been lost.

The most significant information that was not collected was any data on over-the-counter melatonin use. To their credit, they do cite that as an issue, but there are no data as to how much melatonin was actually used by the subjects who took melatonin. There’s no record of melatonin use by people in the non-melatonin group if they didn’t report it as a supplement they use to their physician. There are more questions, but that’s enough to call the results into question.

The Bottom Line

Perhaps after the peer-review process, the data collection will be more clear. But as for right now, the best thing that could be said is that they distributed a great press release that caused a lot of concern. But as for actual research evidence? There’s no reason to modify melatonin use at this point. However, it’s always a good idea for you to report any supplements you’re taking to your healthcare provider.

What are you prepared to do today?

        Dr. Chet

Reference: American Heart Association Scientific Sessions 2025, Abstract MP2306

Melatonin: CVD Risk?

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Medical conferences are always a great source of controversy; studies are presented that haven’t been peer reviewed but have great press releases to advertise them. The American Heart Association met last week, and the Scientific Sessions didn’t disappoint. The abstract that caught my attention was based on an analysis of a large database of subjects from a variety of countries that demonstrated that melatonin used to treat insomnia could lead to an increased risk of cardiovascular disease (CVD) and hospitalization.

Researchers chose subjects who were diagnosed with insomnia and took melatonin for at least a year based on their medical charts. They were matched with control subjects on a variety of characteristics including age, height, weight, and many more variables, who were also diagnosed insomniacs but did not report melatonin use. They were tracked for five years.

The abstract stated that there was a 90% greater risk of CVD diagnosis in the melatonin group. Further, there was a 350% increased risk of being hospitalized in the melatonin group and a 100% increased risk of dying from all causes as well.

Is it time to throw out the melatonin? I’ll give you some perspective on this study on Saturday.

Tomorrow night is the Insider conference call and, wow, there is a lot to talk about! If you become an Insider by 8 p.m. tomorrow night, you can join in on the call. Protein intake. Creatine. Bike paths and medical costs. And even more.

What are you prepared to do today?

        Dr. Chet

Supplements and Safety for Kids

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The real issue with melatonin and children is not with the actual overdose. Of the 260,000 calls to the U.S. Poison Control Centers, 218,000 were about kids under five years old. Kids will put just about anything in their mouths, especially those younger than five. The issues as I see them are the delivery system and access. This doesn’t apply to just melatonin but to all dietary supplements.

The Delivery System Dilemma

Gummy vitamins are chewable vitamins with taste, flavor, color, shape, and size similar to gummy candies. Therein lies the problem. That’s the way kids see them: as gummies. And neither the candies nor the supplements are going away any time soon.

Even after years of dispensing gummy supplements to Riley, if you gave me two red bears, I’d find it hard to tell the vitamin from the candy. In the image above, it’s vitamins on the left and candy on the right, but other than the green and clear bear candies, they look alike. Some are shaped more like gumdrops, but multivitamins are often bears and look just like their candy counterparts. At seven, Riley knows which gummies he gets when, how many of each, and what the jars look like; if your kids and grandkids are younger, you’ve got a lot of teaching ahead of you. It seems helping kids learn the difference between packages is another element of keeping them safe.

The global gummy vitamins market size was estimated to be valued around $5.9 billion in 2020 and is projected to reach $10.6 billion by 2025. According to Market and Market, Millennials prefer consuming these gummies due to factors such as busier lifestyles, rising disposable incomes, growing awareness regarding preventive healthcare measures, and maintaining better health. But don’t blame the Millennials; every age group has seen increases in the use of gummies as dietary supplements. They’re easier to use for people who find it hard to swallow whole pills, and let’s face it, they’re just more fun.

Chewables and powders are on the increase as well. Those shakes you make? Check the labels to see if they contain vitamins or minerals. Phytonutrients from whole plants are fine, but some powders add nutrients and herbs that may not be safe for children in high quantities.

Out of Sight Is Safe

I think the key issue is that kids need to be taught that gummy dietary supplements are not candy. Even more so, they have to be kept out of reach of children, not on the counters where they’re more convenient for adults (and for kids). Multivitamin-minerals, omegas, melatonin, and others have push-tops that can challenge even adults. Still it would be best to keep them as high as possible and out of reach, especially if you also use the adult versions.

For most kids, eating too many supplement gummies may result in an upset tummy at most, but some vitamins and minerals can be toxic to children, especially under five. Everyone with small kids underfoot should know the number for the U.S. Poison Control Center for many reasons: (800) 222-1222; registered nurses and pharmacists are there to help 24/7. Most other countries have similar help available.

The Bottom Line

I think the promotion of the CDC’s Morbidity and Mortality Weekly Report melatonin article was done poorly. Pediatric melatonin ingestions are not all poisonings as the article implied. However, delivery systems and child access can be problematic, and that should have been the focus. Every news outlet likes sensational headlines, but if the writers had actually read the paper, which is free to the public, instead of reading comments by the paper’s authors, they’d not have been so sensational in their presentation. Or maybe they would have. Who knows?

Now you know the real deal about the safety issues surrounding dietary supplements for kids. If you want to know more about the safety of melatonin for children as well as comments by the authors, listen to the latest Straight Talk on Health by becoming a Member or Insider.

What are you prepared to do today?

        Dr. Chet

Reference: Gummy vitamins Market. Market and Market, 2020.

Melatonin: Is It Safe for Kids?

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Health headlines can dictate what I write about if they concern nutrition, exercise, or supplements: one article in my newsfeed, and my world gets changed. Such is the case when the CDC published an article in Morbidity and Mortality Weekly Report titled Pediatric Melatonin Ingestions—United States, 2012–2021. The resulting health headlines said Melatonin Poisoning Cases Soaring Among U.S. Kids! What???

The report in MMWR was the result of examining calls to the U.S. Poison Control Centers asking about accidental or intentional consumption of melatonin by children from birth to 19 years old. A call to the Poison Control Center is not necessarily to report a poisoning: it’s to ask what to do when your child takes a substance that may be hazardous. In a 10-year period, 260,435 calls were made inquiring about melatonin ingestion. Of that 88% were resolved with no issues. The other 12% went to a medical facility where almost 20,000 were sent home with no issues. About 4,000 were hospitalized and 287 ended up in intensive care; five kids required mechanical ventilation and two died. Those are the numbers in the report.

The issue is that medical records were not consulted to know whether the melatonin was the cause or whether it happened to be taken by someone with a serious medical condition or used as an overdose; remember we’re talking about kids up to 19, not just little ones. Was there a potentially more serious issue behind this report the authors should have focused on? I’ll talk about it on Saturday.

I don’t want to be guilty of trying to scare you, so I’ll tell you this: our grandson Riley has been taking melatonin for kids at bedtime for a couple years. Without it he takes an hour or more to fall asleep, and he needs that hour. And we’ve been obsessive with teaching him the difference between gummy candy and gummy vitamins, so we aren’t worried about it at all.

What are you prepared to do today?

        Dr. Chet

Reference: MMWR Weekly / June 3, 2022 / 71(22);725–729.

Using Melatonin to Treat COVID-19

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Today’s research paper is a type of study that uses large datasets to examine the relationship between successful treatments for people with COVID-19 and related viral infections. Let’s take a look.

Network-Based Drug Repurposing

To say that this is complicated is a tremendous understatement, but let’s give it a go. Researchers identified specific targets for the many different strains of COVID and SARS viruses, including all of the research on the receptor targets in the body for every COVID-related virus, such as the ACE2 receptor. Then they examined each drug that has been used to treat people with the virus to see how effective it was, along with drugs that had specific receptor targets when used for other reasons. Researchers weren’t looking for a cure; they wanted to determine whether specific symptoms in various parts of the body improved such as the lungs, the heart, fatigue, etc.

They started with dozens of receptors and over 2,000 FDA-approved medications, and after running the initial analysis, they reduced the number of drugs to 135. They ultimately came up with three pairs of medications that could be effective in treating COVID-19: sirolimus plus dactinomycin, mercaptopurine plus melatonin, and toremifene plus emodin. I would wager that five of those are medications you’ve never heard of, but you’re probably acquainted with melatonin. That’s what caught my attention, so let’s take a look at why melatonin would be included in a potential treatment for COVID-19.

Melatonin as an Antiviral

In their explanation, researchers said melatonin has been reported to have a potential for treating antiviral infection because of its anti-inflammatory and antioxidant effects. As suggested, melatonin can indirectly impact the ACE2 receptor, which is a key target of the COVID-19 virus. Mercaptopurine blocks specific papain-like proteases such as the ACE2 receptor; the hope is that the combination will block the ACE2 and other target receptors from the virus and reduce the inflammatory response.

The Bottom Line

The researchers say there’s a long way to go before this combination can be used to treat COVID-19—pre-clinical and clinical trials for sure to test whether this combination actually works to treat the virus.

When it comes to melatonin, it makes sense to add it to our immune-boosting regimen. Its mechanism of action is different from the zinc, vitamin D, and vitamin C we may already be taking. The question is how much? I don’t have a specific answer because there’s still so much research to review. But I’m going to begin with 6 mg. That’s not too much and even if it doesn’t work for immune boosting, the potential benefits for memory, etc., make it worth taking; take it at night, of course, because of its ability to help you sleep. When I’ve reviewed more research, I may be able to give you a more definitive answer. In the meantime, there’s no apparent downside to taking melatonin. If you feel you need the additional immune boosting—and who doesn’t—give it a try.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. https://doi.org/10.1038/s41421-020-0153-3

How Melatonin Affects Memory

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Most people understand that melatonin functions as a neurotransmitter and can help with sleep. What is now apparent is that melatonin also has powerful antioxidant capabilities, especially as it’s related to the mitochondria, as well as other neurological functions related to memory, according to new research papers.

Researchers used an interesting test of memory in this study. When mice are exposed to a new object, they spend a lot of time examining it on first exposure; when they’re familiar with objects, they have a tendency to ignore them. Researchers exposed young and older mice to new objects and then gave some of the mice a dose of melatonin and two of its metabolites. All the young mice treated the new object as something familiar the next day. The older mice that were not given melatonin said, “Huh? What’s that?” However, older mice that were given melatonin 15 minutes after exposure seemed to remember the new object up to four days later.

The conclusion was that this is a first step to see if melatonin can help with memory in people with cognitive decline, an initial stage related to Alzheimer’s disease. There’s not enough research to say it will work the same way in humans, but there seems to be no downside to taking melatonin on a regular basis with the exception that we don’t know the dosing. If you’ve been taking melatonin for sleep, you may be getting side benefits.

Insiders and Members
In the New Year’s Day memo, I talked about assessing your current health and fitness. I’ve just posted a new Straight Talk on Health that delves into the details of how to assess each category of health. When you log in at drchet.com, follow the Straight Talk on Health link and check it out.

What are you prepared to do today?

        Dr. Chet

References: J Biochem Mol Toxicol. 2020 Feb;34(2):e22430. doi: 10.1002/jbt.22430.