By Dr. Allison Smith, ZRT Laboratory
I would like to thank everyone who joined in our webinar on the Role of Hormones in Sleep Disturbances! There were a number of questions I wasn’t able to address due to time constraints but they were all excellent questions. I thought at least someone would be interested in a follow-up as I speak to the rest of the questions just as a little wrap-up.
Q: Wouldn't it be nice to include Dried Urine Melatonin in your ZRT Comprehensive Profile, to be able to evaluate Morning Cortisol when low? Maybe it is low while Melatonin is high?
A: It would be nice! We’ve had a flurry of inquiries about this. Stay tuned for updates on it. Currently, melatonin testing is included with the the Sleep Balance Profile in dried urine collection profiles.
Q: Do you start with 0.3mg for children, also?
A: With kids and adults alike, I prefer to start with a low dose and work up to the minimum effective dose from there. With melatonin, the lowest effective dose for most people has been established at 0.3mg. That said, there are plenty of studies with exclusively children as subjects that used pre-bedtime doses of up to 12mg. There seems to be some latitude in dosing here. As a matter of fact, there is even a trial that was done with septic newborns showing favorable study outcomes at an oral dose of 20mg! So, there you go.
Q: What dose for 5HTP do you use?
A: Here’s another case of starting low dose and working up. 100mg is an excellent 5HTP starting dose, but patients rarely get much clinical effect at this dose. Generally speaking, 300mg at bedtime is the sweet spot for most. I’ve found over the years that there are just some people who don’t seem to respond to 5HTP at all in the normal dosing range and many times, these folks do better on tryptophan (or melatonin itself). Remember though, that there is always some potential for serotonin syndrome if your patients are using 5HTP with SSRIs or other antidepressants and though there are conflicting schools of thought on whether or not they should be used together, if the benefits outweigh the risks, it’s always best to proceed with caution.
Q: Are there recommended foods that have high melatonin?
A: Apparently, there ARE foods high in melatonin! If you like kiwi, goji berries, tart cherries and walnuts, you’re eating foods that provide you with this sleep hormone. Current research is looking at animal (meat) sources of melatonin – lamb, chicken, beef, pork and fish – so far melatonin makes a good showing there too. There are also high-tryptophan foods. Tryptophan heads up the pathway to 5HTP, serotonin and melatonin. It’s an essential amino acid which means it’s necessary for life, and we can’t make it endogenously so good food sources are a must. Protein-rich foods are the main focus, but they don’t have to be animal source proteins. I’ll link to Wikipedia here for a nice chart on food sources of tryptophan that the average person actually eats: http://en.wikipedia.org/wiki/Tryptophan.
Q: Will multiple nocturnal diuresis affect the results?
A: This is a great question, and one I had to really wrap my mind around because you would think you couldn’t actually quantify melatonin production if you weren’t sampling the entire overnight production. But in fact, because of the 3-hour lag between melatonin production and the appearance of its major urinary metabolite MT6s, added to the 7-hour overnight plateau of melatonin production, it’s hard to miss it. Of course, if you’re ever concerned about a patient with a unique set of circumstances getting a good sample, you could always have him or her use a vessel to collect urine overnight and dip the urine strip in the morning after the “first morning void.” That works too.
Q: Does use of melatonin over time reduce the natural production of melatonin?
A: This is a good myth-buster question, and the answer seems to be no. You can increase your melatonin production nutritionally by feeding the body the building blocks to make it, and supplementation with melatonin itself will boost serum and urine levels but it will not change the underlying endogenous production of melatonin. This means that if you take melatonin for a period of time and then discontinue it, your body’s melatonin production will go back to the pre-treatment state.
It does seem to be safe long-term; and while there are some studies that show melatonin loses its effectiveness over time, many others demonstrate its safety and efficacy over several years of use. This lack of pineal suppression of endogenous melatonin production by exogenous melatonin supplementation may be partially due to its constant baseline production throughout the body all the time. It’s also (maybe more importantly) likely related to the fact that there is no negative feedback loop involving melatonin to the pineal gland – light/dark stimulation provides the feedback here.