MELATONIN FOR SLEEP PROMOTION: DOES THIS SUPPLEMENT LIVE UP TO ITS HYPE?

If you’ve been wandering the vitamin and supplement aisle of your local grocery store or pharmacy recently, you may have noticed an “out of stock” sign where the melatonin used to be. That’s because this supplement has become one of America’s most popular sleep aids, and demand spiked last year. According to an article published in Business Insider, US consumers spent more than $825 million on melatonin supplements in 2020—a whopping 42.6% increase in sales compared with 2019. While I usually denigrate the use of most “supplements,” this one may provide one exception.

Most of us associate melatonin supplements with insomnia but researchers are looking into new uses for this wildly popular dietary supplement. Recently, it has been promoted not just as a sleep aid, but as a way to prevent or treat certain chronic diseases—and some are even taking it to relieve pandemic-induced stress. But history tells us that what manufacturers claim their supplements can do doesn’t always match up with what they have been proven to do. And, as I have repeatably noted, because there is less FDA oversight for dietary supplements compared with OTC or prescription medications, companies could falsely advertise both the claimed benefits as well as the quantity of melatonin in each product.

So does melatonin live up to the hype? Some studies do suggest that melatonin plays other important roles in the body beyond sleep, and it’s even being studied for its effects on COVID-19. However, more research is needed to fully understand these effects.

Here’s what the most recent research tells us about possible health benefits from using melatonin.

What is melatonin?

Melatonin is a hormone secreted primarily by the pineal gland in the brain, and it helps to regulate our sleep-wake cycle (or circadian rhythm). As a dietary supplement, melatonin can be made naturally from the pineal gland of animals, however, it is usually produced synthetically. Melatonin supplements are typically used as a sleep aid to provide relief for insomnia or disrupted sleep rhythms caused by jet lag or working nights. It is generally safe for short-term use, with a very low likelihood of developing dependence, becoming habituated, or experiencing hangover effects, as can occur with many sleep medications. Meanwhile, if you suffer from insomnia, I list below a few steps that can improve sleep hygiene and help you conquer your sleep problems, or at least diminish their hold on you.

Does melatonin have therapeutic properties?

Recent research indicates that melatonin may help with more than just sleep. Studies in a review published in Antioxidants in 2020 have demonstrated that the hormone boasts antioxidant properties, anti-inflammatory effects, and immunomodulatory actions. The review’s authors note that, theoretically at least, oxidative stress is a common characteristic of various metabolic, degenerative, and cardiovascular disorders, and cancer. According to the review, studies have shown that reduced melatonin levels are a risk factor for various cardiovascular diseases, including some types of cardiac injury, hypertension, atherosclerosis, and heart failure. Likewise, evidence suggests that melatonin supplementation can help reduce nocturnal hypertension, and circulating adrenaline. One study cited by the authors found that melatonin aided heart function in a rat model. Strong evidence for the efficacy of melatonin as a treatment for cardiovascular diseases in humans, however, is still lacking.

Studies cited in the review have also demonstrated that melatonin may be effective against various bacterial and viral infections, due to its probable immunoregulatory functions. For example, lab trials have suggested that melatonin can help in fighting off certain infections, even serious ones. Melatonin can also help relieve the systemic inflammation that viruses cause. “Melatonin’s beneficial effects have been postulated against flu infections, and also against SARS-CoV-2 virus responsible for the pandemic that has hit the world in recent months,” the authors wrote, adding, “melatonin reduces inflammation and oxidative stress related to aging, cardiovascular diseases, diabetes, all conditions associated with an increased risk of mortality in patients with COVID-19 disease.” However, more research is needed to better understand the interaction between exogenous melatonin and viruses, they added.

As for melatonin’s role in fighting COVID-19, current research looking at the effects of melatonin is only in the early stages. There are few randomized controlled trials (studies evaluating melatonin in people) in progress. At this point, it is too soon to reach conclusions on whether melatonin is helpful for COVID-19.Beyond this, the authors note that melatonin may be beneficial against various disorders unrelated to sleep, but more research is required. They conclude that melatonin supplementation in combination with traditional therapies could increase the efficiency of the treatment for infectious disorders, cardiovascular disease, cancer, and neurodegenerative disorders.

According to a review published in the International Journal of Molecular Medicine in March 2021, melatonin’s anti-inflammatory and antioxidative functions mean that it likely serves as a protective agent against bone-related diseases, like fractures, osteoporosis, and osteoarthritis. The authors of the review point out that melatonin has been shown to increase new bone growth at the site of fractures.

Is melatonin safe?

Short-term use of melatonin supplementation is generally considered safe for most people, however, data on long-term use is lacking. Based on practice guidelines from the Academy of Sleep Medicine and the American College of Physicians, “There’s not enough strong evidence for the effectiveness or safety of melatonin supplementation for chronic insomnia to recommend its use.” Some health experts have expressed concern over the regulation of melatonin products. According to one article published in the Journal of Clinical Sleep Medicine, the levels of melatonin found in supplement products can vary drastically from what’s advertised. There is also concern over melatonin’s association with type 2 diabetes, with one study concluding that increased melatonin signaling is a risk factor for the disease.

That said, evidence suggests it’s not unsafe to use melatonin for temporary or minor sleep disorders. Of note, the most common side effects of melatonin are headaches, dizziness, and nausea. Melatonin isn’t recommended for those with dementia or elderly individuals, because it can cause daytime drowsiness.

Meanwhile, you can learn more below about other ways to improve your sleep, including what to eat, and what not to eat before you go to bed.

WAYS TO IMPROVE SLEEP: FOODS

Bedtime snacks may be a good thing, according to a study published in Nutrients, but navigating which ones will actually help—or hinder—your sleep is a trickier path than it may first appear to be. Whether it’s due to their high caffeine content or difficulties with digestion, some foods will not only interfere with your ability to drift off, but may even disrupt your sleep throughout the night. Thus choosing what you snack on before bedtime can play a large part in whether you get good night’s sleep.

Most people know that eating a big steak dinner, fried foods, or hot and spicy menu options too close to bedtime will interfere with their sleep. But here are five other foods that may also, surprisingly, cut into your beauty rest.

Foods to avoid before bed

Chocolate. Unfortunately, as delicious as chocolate is, it contains caffeine, which causes increased arousal and works to decrease your ability to fall into and sustain deeper sleep stages. In addition, chocolate—especially dark chocolate—also contains small amounts of theobromine, a bitter alkaloid found in the cacao plant. Theobromine can increase heart rate and cause sleeplessness. White chocolate, however, contains little, if any, caffeine, and no theobromine, and may be a better choice before bedtime.

Dried fruit. The high-fiber, low-water content of dried fruit can cause digestive issues, including gas and cramping during the night. The culprit is sorbitol, a sweetener found in dried fruits, including raisins and prunes, which can cause stomach bloating and flatulence, especially when eaten in larger quantities. Steer clear!

Matcha or green teas. Unfortunately, green tea contains not only caffeine, but theobromine and theophylline, both of which can increase heart rate, cause feelings of nervousness, and increase overall anxiety. Believe it or not, matcha—a type of green tea—contains caffeine but causes less of the jitters than green tea. Because the health benefits of green tea are numerous, however, drink it with abandon during the day, but stop at around 3 or 4 p.m.

Chips. The sheer fat content of any chip should be a clear sign that you should stay away, especially before bedtime. A single serving (about 18 chips) of Lays Potato Chips, for example, contains 2 grams of fat. Because it takes so much work for your body to digest fats, eating chips before bed will almost guarantee that the next few hours will have you tossing and turning. As if that weren’t enough, researchers also found that eating greasy junk foods—like chips—can even cause nightmares.

Oranges. Because of their high acid content, oranges can cause or exacerbate heartburn, especially if they are eaten on an empty stomach. Not only that, but the scent of oranges is energizing, and may keep you alert instead of relaxing you. Finally, citrus is a natural diuretic, and may cause you a few unwelcome, sleep-interrupting trips to the bathroom during the night.

Foods that help you catch some zzz’s

On the flip side, certain foods and beverages can actually help you sleep, according to the National Sleep Foundation. They include the following:

Nuts. For a quick, pre-bedtime snack, nuts are a good option because they contain melatonin, the hormone that, as noted, may promote sleep. Not only are nuts heart-healthy, but likely sleep-healthy as well.

Cottage cheese. Because it’s high in lean protein, cottage cheese contains tryptophan, an amino acid known to increase serotonin levels. And, it’s even better if you plop some raspberries on top, because they’re rich in melatonin.

Fruits. In addition to raspberries, many fruits also contain melatonin, including tart cherries, bananas, pineapples, and oranges.

Whole grains. Surprisingly, popcorn, oatmeal, or whole-wheat crackers with some sort of nut butter are much better choices before bed than complex carbohydrates like white bread, pasta, or sugary, baked items, that are unhelpful for either sleep or health.

Warm milk and herbal teas. Of course, the soothing properties of warm beverages drank before bedtime should be mentioned as well. The traditional standard of warm milk still holds up today. Some researchers have shown an association between milk’s tryptophan and melatonin content aid better sleep, but the psychological aspects of drinking warm milk at bedtime as a child shouldn’t be underestimated. In addition, caffeine-free herbal teas like chamomile, valerian, or passionflower can be just plain relaxing, especially if they are included in your nightly bedtime ritual.

IF YOU WISH TO TRY MELATONIN, SOME TIPS

Low dose: While 1 mg is a low dose, it’s best to take as little melatonin as needed to feel dozy, and just 0.3 mg can do this for some people. One product, Swanson, is inexpensive and provides exactly 0.3 mg per dose. Liquid Melatonin, also an inexpensive product, provides 0.3 mg in just 2 drops, for a mere 1 cent.

Moderate dose: If a low dose doesn’t work for you, it is okay to move to a moderate dose. A good choice for moderate dose melatonin is Trader Joe’s Chewable Melatonin 3 mg — Peppermint Flavor costing 4 cents per tablet. Be aware that it contains lactose, so if you are lactose-intolerant consider, instead, a good choice for vegans in the moderate dose category is Solgar Melatonin 3 mg at 6 cents per nugget. Although for a few cents more, NOW Liquid Melatonin, will also give you 3 mg of melatonin, for 8 cents, at its recommended serving of 20 drops. But it also gives you the flexibility to adjust your dose to the lowest that works for you by varying the number of drops you choose to use. This also make it a good choice for families in which the appropriate dose may differ by family member.

High dose: If a low dose doesn’t work for you, a good choice is Walgreens Quick Dissolve Melatonin 3 mg per tablet. Although it may not be necessary, you can get 2 mg more with H-E-B Super Strength Melatonin 5 mg. Even higher yet is Nature’s Bounty, providing 10 mg per capsule. One warning, however, this latter high-dose product should not be necessary for sleep purposes, is more likely to cause next-day drowsiness, and little is known about its long-term safety.

I conclude by stating that, while melatonin may be useful in sleep promotion, other methods such as food selection should be tried first. All other potential uses of melatonin, while intriguing, remain unproven, and as such are best avoided.