A trendy new milk drink?

Fermented foods such as kimchi, sauerkraut, and kombucha tea have all been touted as the next big superfoods because they contain probiotics (another word for good bacteria). But one food seems to have been forgotten: kefir. This fermented drink is alleged to rebalance our gut and boost our overall health but what exactly is it?



Kefir is a fermented dairy milk drink, made by adding a live culture of yeast and bacteria to milk and leaving it to ferment for a few hours. The result? A tartly flavoured drink reminiscent of, and with a consistency between, milk and yoghurt. Originating from the region where Europe meets Asia, kefir has been made for over 2,000 years and is drunk religiously in countries including Russia and former Soviet states for its health benefits. The drink is rich in good bacteria, containing around 47 different strands, whereas yoghurt which contains just one or two.

It used to be known as the 'Grains of the Prophet'. Today it takes the form of a fermented milk product made with kefir 'grains' - gelatinous white or yellow clumps resembling cauliflower florets. Used as a starter culture, these grains contain a mixture of milk proteins, sugars and bacteria, mostly the Lactobacillus type, which is commonly found in yoghurt.

What's it good for?
Our natural fauna or the 'good' bacteria in our gut are vital to our health. They work to destroy 'bad' bacteria and keep our immune system in check, our digestion ticking and our overall health and vitality in good condition. Read my previous post on this: http://yaso-shan.blogspot.co.uk/2010/08/prebiotics-probiotics-antibiotics.html 

Recent studies have suggested that a Western lifestyle and diet, rich in processed foods, sugar and unhealthy fats, is destroying the good bacteria in our guts, which may explain why digestive problems such as IBS are rampant.

Maintaining a healthy weight
A tall glass of kefir drink made with milk contains more than 6g of feel-full protein, so it qualifies as high in protein. It's a nutritionally complete protein too, providing all the key amino acids needed for health. Kefir is also a source of B vitamins, which help with energy release and there is some evidence that eating dairy protein helps with appetite control.


Establishing strong bones
A study of osteoporosis patients found that those who regularly consumed kefir had denser, stronger bones after six months. The rich calcium content, coupled with doses of phosphorus, magnesium and vitamin K, could explain why it's beneficial for bones. Another reason could be that kefir boosts calcium absorption in the body, although this needs further research.

Promoting recovery after exercise
Kefir could help tackle post-exercise muscle inflammation, according to a recent US study that gave endurance runners two servings of kefir a week. The results showed that the fermented drink cut levels of C-reactive protein (CRP) after exercise. CRP levels spike during acute inflammation, and while some  inflammation is necessary in order for you to benefit from exercising, too much of it means that you aren't recovering well and it could lead to injuries.

Improving gut health
Kefir contains friendly probiotic bacteria - upwards of 30 different strains - which are believed to rebalance gut health by driving out the nastier pathogenic types of bacteria. Several recent studies have shown that including kefir in your regular diet (as a drink or with your usual breakfast muesli or fruit and yoghurt) reduces constipation, attacks a type of bacteria that causes stomach ulcers and improves symptoms linked to lactose intolerance, such as wind, bloating and diarrhoea. As the bacteria in kefir break down lactose, people who cannot tolerate dairy will most likely be able to enjoy it, too - and reap the benefits!

Other health benefits

• Digestion. Kefir is naturally very low in lactose and so easier for some people to digest. The probiotic bacteria also help to break down the ‘bad stuff’ in our bodies and support the digestive tract, which is good for those that suffer with digestive issues such as IBS.
• Nutrients. Kefir has high levels of calcium, phosphorus, vitamins and minerals.
• The skin. the skin is the map of our gut; if your gut is in good working order, it should show in your skin. It has been suggested that kefir can help autoimmune diseases such as roseca, acne and eczema.

How do I get it?
Making your own kefir drink is easy; simply grab a starter culture of kefir grains, add them to a glass jar or jug of milk or water, cover with a lid or cloth secured with a rubber band and leave in a warm dark place to grow. Shake the container every few hours. After 24 hours, strain out the kefir grains and you're left with a tart flavoured drink bursting with friendly bacteria, protein, vitamins and minerals. Keep the kefir grains and they can be used again and again to make further batches.

Add kiwi, berries or peaches to offset the sour taste, or nuts to boost the protein content further still and keep you feeling fuller for longer. Having kefir several times a week will add nutritional value to your diet. If you are lactose intolerant, have it daily to replace milk products. Kefir can be kept in the fridge, ready for you to
enjoy, or at room temperature for a day or so. Or it can be frozen for as long as you like!

References
http://www.telegraph.co.uk/foodanddrink/healthyeating/11652002/Is-kefir-the-trendy-new-health-drink-in-town.html

The Herbal Approach to Mental Well-Being

The topic on this post is about Mental Health in the Workplace, examining the range of conditions which can affect employees and offering advice on how and where Herbal Medicine can play a part in supporting mental well-being.

It has become (almost) taboo to even mention the term mental health due to its negative connotations as well as the fear and panic that it can evoke. Every so often it surfaces in the public domain when high profile cases hit the media headlines. The recent and tragic death of the actor Robin Williams is an example of how opportunities and a forum for discussion appears to only arise under such circumstances and how aware we are of mental illness but how society does not embrace this nor tackle it properly.

In reality though, mental health is an issue that line managers are dealing with more and more regularly. It is encouraging to see events like this today being organised. 


The Government’s report entitled ‘No health without mental health’ states that mental health problems affect 1:4 of us at some point in our lives with 1 in 4 people experiencing a mental health problem every year. It accounts for 30% of absences in the workplace, the highest being in the NHS. 

In 2012, it was estimated that poor mental health in the workplace cost the UK £26billion every year, that’s equivalent to £1,035 for every employee in the UK workforce. The average employee takes 7 days off sick every year with 40% of this being due to mental health problems. 

Fig: Adult psychiatric morbidity in England, The Health & Social Care Information Centre, 2009

Sadly, more recent statistics are not available. There are variations in severity for each of these conditions as they are not all binary ie. you either have it or you don’t.

Mental health can fluctuate along a spectrum in the same way that physical health does and there may be times when it is better than others. Mental health problems cover a range of conditions such as (the list is not exhaustive):

• depression

• anxiety

• panic attacks

• obsessive compulsive disorder (OCD)

• phobias

• bipolar disorder (manic depression)

• schizophrenia

• personality disorders

• psychosis

For many people stress and mental health are closely associated. According to a report by CIPD / MIND, while stress itself is not a medical condition  ‘...prolonged exposure to unmanageable stress is linked to psychological conditions such as anxiety and depression...’Managing stress is therefore a key part of creating a mentally healthy workplace. 

Herbalism is the use of herbs for healing. People have been using herbs to cure diseases for centuries.  Many herbal remedies worked and many did not, it is obvious that knowledge and technology would have played a big part (and still do) in finding nature’s hidden treasures and using them to achieving health benefits.

So how would a medical herbalist tackle a mental health problem? Well, first of all, a definitive diagnosis is key. This in itself is a problem eg. differentiating between MCI and true dementia…

Herbalists do not deal with serious mental health disorders such as paranoid schizophrenia or severe psychosis because they warrant conventional medical management. However, conditions such as depression (mild to moderate), anxiety, panic attacks, sleep disorders / insomnia, stress-related symptoms, and OCD amongst others…..

Although a little more straightforward, these conditions still have negative connotations and many people don’t readily want to admit a problem given the social stigmas and difficulties in accepting mental illness.

Equally, given that many employers, private companies, insurers and government agencies have access to so much of our personal information, including aspects of our medical records, it is unsurprising many are worried about declaring they have mental health problems. 

More often than not, herbalists treat the more common symptoms such as mild to moderate depression, anxiety, insomnia, panic attacks, restlessness and the gamut of symptoms associated with stress. Let's look at some examples:

Mild to Moderate Depression	Antidepressants	St John’s Wort Rhodiola Turnera
Anxiety	Anxiolytics	Lemon Balm Passion Flower Lime Flowers
Panic Attacks	Nervine Tonics	Skullcap Wood Betony Verbena Vervain Rose
Insomnia/ Sleep Disorders	Sedatives	Chamomile Wild Lettuce Indian Ginseng
	Hypnotics	Valerian Hops Californian Poppy
Restlessness/ Agitation	Nutrients	Oats Alfalfa
	Nervines	Skullcap Wood Betony
Stress	Adaptogens	Korean Ginseng (Panax ginseng) Siberian Ginseng (Eleutherococcus senticosus) Indian Ginseng  aka Ashwaghandha (Withania somnifera)

Stress-related symptoms

This requires a special mention as modern living makes it almost impossible to avoid stress. Prolonged stress can lead to all sorts of symptoms and part of our job as a herbalist would be to examine the bigger picture and to treat the patient in a holistic context.

Common symptoms of stress include:

• headaches
• skin breakouts & exacerbation of existing conditions eg. eczema, psoriasis
• IBS & exacerbation of other gut disorders eg. ulcers
• tiredness, fatigue, lethargy
• muscle aches & pains
• recurring and frequent infections eg. colds
• sleep problems & insomnia
• menstrual irregularities
• infertility

The treatment rationale invariably involves:

·        adrenal support          one of the first glands to be compromised

adrenaline/noradrenaline

cortisol (endogenous corticosteroid)

testosterone

aldosterone

·         nerve support              adaptogens & their functions

Key herbs:       Korean

Siberian

Indian

·         immune support         boosting immune function

preventing recurring infections due to ↓ immune defence

                                                powerful immune boosters:   echinacea

astragalus

turnera

wild indigo

St. John’s Wort (antiviral)

·         addressing debility      usually with a range of stimulants, nervine tonics & nutrients

all ↑ energy levels and are excellent for debilitated states:

rosemary

turnera

astragalus

ginsengs

oats

alfalfa

·         antidepressant            St. John’s Wort (alternative rhodiola if compatibility issues)

rosemary (stimulant)

turnera

Siberian ginseng

Korean ginseng

Other important herbs include borage and licorice as there are important physiological mechanisms at play.

Stress Management

• exercise

• relaxation techniques

• hobbies & recreational pursuits

• diet

• herbal supplementation

Natural & Herbal Approaches to Menopausal Symptoms

Many women experience the discomfort of the menopause in the Western world. Typical symptoms include depression, hot flushes (also called hot flashes), weight gain, mood changes, anxiety, loss of libido, vaginal dryness (predisposing to cystitis) and insomnia to name a few. In theory, the menopause should be a relatively uneventful phase in a woman’s reproductive life because the adrenal glands (which lie just above the kidneys) are the back-up glands for producing the all-important oestrogen when the ovaries start to slow down production of this hormone. Unfortunately, the stressful life that many women lead in the Western world leaves their adrenal glands in a depleted and exhausted state so much so that their back-up system fails and their bodies suffer the inevitable consequences of oestrogen decline and hormonal imbalance. Conventional treatments can range from drug therapy (eg. HRT) to radical surgery (total or partial hysterectomy). For some women, this appears to be acceptable and can alleviate much of their discomfort. However, many are uncomfortable with drug treatment or surgery and recent concerns over the safety of HRT have forced many to consider natural alternatives and less invasive methods of controlling their symptoms.

If 50 is the new 40 and 40 is the new 20, then Peri-menopause seems to be the new PMS. It’s very common and effects women between the ages of 35 to 50 generally and we are seeing it starting to happen on a more frequent basis and in younger women.
During the years before menopause levels of progesterone typically decline, while oestrogen levels remain stable or even increase. This creates a situation commonly referred to as oestrogen dominance as the ratio of progesterone to oestrogen changes and triggers the following symptoms. Some of the symptoms that women suffer when progesterone declines include:

• Weight gain
• Increased PMS
• Breast swelling and tenderness
• Mood swings
• Poor memory
• Irritability
• Poor sleep
• Water retention
• Aches and pains
• Heavy periods
• Fibroid growth

Another hormone which is influenced is Testosterone. Testosterone levels may start to decline during this phase and can be quite difficult to observe. These symptoms can be:

• Reduced Sex Drive
• Reduced response to sex
• General sense of well-being, energy, and ambition
• Depression
• Reduction in muscle mass

If 50 is the new 40 and 40 is the new 20, then the peri-menopause seems to be the new PMS.

The final piece to the puzzle is the reduction in oestrogen levels leading into menopause. The ovaries reduce production of oestrogen which triggers the elevation of Follicle stimulating hormones and luteinising hormone (LH) which triggers the characteristic symptoms of menopause. The ovaries continue to produce some oestrogen along with the adrenal glands however if the drop is dramatic and the adrenals cannot cope then symptoms can be dramatic until the body balances itself.

• Hot flushes
• Reduced energy
• Night sweats
• Vaginal dryness
• Depression
• Mood swings
• Dizziness
• Headaches
• Memory Loss
• Urinary incontinence
• Arthritic aches and pains

So it is critically important that from the age of 35 to 50, women are aware of the changes starting to occur and support the endocrine control centres during this phase to avoid these symptoms and ensure a healthy menopause. If these symptoms are suppressed with hormonal treatments, or ignored then the underlying attempt of the body to try and manage this transition naturally is sabotaged it leads to a range of other issues such as:

• Weight gain
• Thyroid reduction
• Skin breakouts
• Mood swings
• Depression
• Irritability
• Insomnia
• Premature ageing
• Premature menopause

The herbal approach is to consider a range of herbs that tackle the problems on a more symptomatic level as well as a combination of practical suggestions or possibly even some of the talking therapies, particularly if the menopause occurs at an early age. Herbs that will control the hot flushes include sage and black cohosh. Herbs that control mood include:

1. St. John’s Wort and other nervines such as skullcap, wood betony and damiana. 
2. Herbs for anxiety and insomnia include Indian ginseng, passion flower, lime flowers and Jamaica dogwood. 
3. Herbs that balance the reproductive hormones include false unicorn root, licorice, red clover or wild yam. 

A herbalist would prescribe the most suitable combination of herbs for each case so a consultation is strongly recommended (see http://thecpp.uk/ for how to locate your nearest herbalist).



Diet is absolutely crucial so ensuring a well-balanced diet is critical to health at this stage. Getting the right balance of vitamins and minerals is important as well as slow-release energy-rich complex carbohydrates. 

Much has been debated about soya and some of this information is confusing simply because some of it is contradictory and poorly referenced from non-reputable sources. Soya is one of the products that come under the general category of plant nutrients called phyto-oestrogens because when consumed, they exert an effect similar to the hormone oestrogen, although its action is weak. The table below gives further examples of other sources of plant oestrogens. In short, it is the fermented soya that is beneficial to health (whatever age but more so during the menopause). Fermented soya and their products such as miso, tempeh, tamari and shoyu are good examples. These reflect what is traditionally consumed in the Far East where menopause is a rare occurrence. Products such as soya milk, tofu (bean curd) and soya protein isolates are a Western invention and many argue that some of the health problems are attributed to the consumption of these products rather than the original soya preparation which are fermented. A consultation with either a clinical nutritionist or a medical herbalist is strongly recommended for comprehensive advice and guidance on this. Nutritional and lifestyle recommendation post-menopause is also advised such as preventing heart disease and osteoporosis.



Phytooestrogens
Over the last few years, there has been great interest in the role of naturally-occurring plant constituents that have a weak hormonal action in the body. These are collectively referred to as phyto-oestrogens (PO) of which there are 6 main types consumed by humans. POs occur widely throughout the plant world and can have a profound influence on human health particularly in oestrogen-deficient states such as the menopause. All types are naturally-occurring compounds and can be found in grains, seeds, legumes and medicinal plants in addition to other vegetable sources.

Classification of phyto-oestrogens; edible plants with recognised oestrogenically-active compounds:

PHYTO-OESTROGEN	COMMON SOURCES
Isoflavonoids ·         main ones = genistein & daidzein ·         glycitein in smaller quantities	·         alfalfa ·         licorice* ·         mung beans ·         whole grains ·         red clover ·         soya*
Lignans	·         linseed (flax)* ·         rye ·         legumes ·         beans ·         wholegrains
Saponins (similar structure to steroidal hormone oestrogen, progesterone & androgens. Some pharmaceutical companies use saponin-containing plants to manufacture steroid hormones) ·         many medicinal herbs in this category ·         pharmacological mechanisms may involve interaction with hypothalamus-pituitary hormones rather than interaction with oestrogen receptors	·         black cohosh – Cimicifuga racemosa ·         licorice* - Glycyrrhiza glabra ·         Korean ginseng – Panax ginseng ·         wild yam – Dioscorea villosa ·         fenugreek – Trigonella foenum-graecum ·         root vegetables ·         grains
Coumestans	·         alfalfa ·         soya sprouts* ·         green beans ·         kidney beans
Resorcylic Acid Lactones	·         oats ·         barley ·         rye
Others	·         fennel – Foeniculum vulgare ·         cabbage family ·         sage – Salvia officinalis ·         garlic – Allium sativum

*Contains high levels of phyto-oestrogens

On a more holistic level, there are 3 simple steps to treating Perimenopause naturally:

Diet and lifestyle.

Eating a low processed, alkaline and high antioxidant diet is important to allow the bodies detox and elimination systems to work efficiently. One of the reasons why oestrogen increases is because the body lacks the ability to metabolise oestrogen in particular. So it requires optimal liver and digestive function. If liver function is sluggish then many of these symptoms develop so we suggest taking an additional liver support supplement containing natural amino acids and herbal medicines. For digestion it is important to take fermented drinks and vegetables to build up the GUTs natural balance and defences. These bacteria assist in the breakdown of hormones excreted by the liver. Our 8 week program has recipes for these drinks.

Manage stress levels

Stress is a common issue with women at this stage of life with busy lives, running households and careers to manage. Often women take care of themselves last and stress impacts on the endocrine balance. The adrenals become exhausted and cannot take up the additional production of oestrogen leading into menopause and the result is the dramatic symptoms of menopause. So managing stress is critical. Ensuring adequate sleep, regular exercise, yoga and meditation are all really important to ensure stress levels are kept to a manageable level.

Balance the hormone control centre

We know hormones are starting to shift at this time of life towards menopause. It largely depends on how well your body copes with this process. Your hormonal control centre, the pituitary and hypothalamus axis is the centre which regulates your hormones. What we find is often diet and lifestyle sometimes are just not enough to correct the underlying imbalance. This is where some key herbal medicines come into play. Sage, vitex (agnus castus) and black cohosh when combined together have a unique synergistic effect that nothing else can achieve. A combination of these herbs will works directly on this control centre to allow the body to balance its own hormone levels naturally. And lets not forget this is a natural process. You should not have any symptoms. Women living traditional lifestyle and eating traditional foods such as those in Japan don’t experience menopausal or peri-menopausal symptoms. So it’s very much a western condition and we need to rely on natural medicines to allow the body to control its own hormone levels.

The current approach to treating perimenopause is to replace any deficient hormones, namely progesterone, testosterone or DHEA – another hormone which is reduced. You can read my specific post on DHEA here: http://yaso-shan.blogspot.co.uk/2016/08/anti-ageing-properties-of-dhea.html

Although there may be initial relief, the problem with this approach is three-fold.

First is when you provide the body with an external hormone, it immediately reduces its own natural production. So when menopause rolls around, the situation is only compounded.

Second is the oestrogen levels stay elevated. This does not treat the issues of oestrogen dominance and the prolonged elevation of oestrogen is not good for the body on many levels relating to cancers.

And lastly,the supplementation of hormones confuses the endocrine system leading to the body lacking the ability to control hormone levels resulting in further hormonal imbalance. It’s a slippery slope once you get onto it. However there are effective natural options that can help you to regain your health and restore a natural sense of calm and balance.

Extracts from Modern Living, Holistic Health & Herbal Medicine (2011) by Yaso Shan. Published by Booklocker Inc USA. http://www.amazon.co.uk/Modern-Living-Holistic-Health-Medicine/dp/1609106393

Is your tea 100% biodegradable?

What is not to like about enjoying a nice, tasty, refreshing cup of tea but a cup of tea is more than a soothing beverage. It is a legitimate reason to take a break from work. It is a life essential. It is emblematic of all that is grand good about the Great British mind-set. There is never a bad time to have a cuppa. Making sure your cuppa tea is 100% biodegradable is more of a challenge than one might think. Here's why......


Your beloved cup of tea is probably hiding a dark secret and much like the animal fat in £5 notes scandal, there is a bad side to your benign cup of tea, and that is plastic. Not just the plastic wrapper on the box, or the plastic pouch some teas come in, but plastic actually in the teabag itself. Let that sink in a moment – there is plastic in the teabag!

You might be wondering why there is a need for plastic to be found in teabags? Well, plastic (polypropylene to be exact) is apparently added to the paper teabag to help heat seal them during manufacture so they don’t come open in the box, or in your cup. It also means though that these tea bags aren't 100% biodegradable, which is a bit of problem.

As a lot of the information stems from a 2010 article published in the Guardian national newspaper which stated that the vast majority are only 70-80% biodegradable: 
https://www.theguardian.com/environment/2010/jul/02/teabags-biodegradeable

Teapigs advise that all of their teabags are made from a by-product of corn starch known as Soilon. The box that they are sold in does appear to contain some plastic though, so if that is an issue then this may not be your solution.


Taylors of Harrogate (who make Yorkshire Tea )advise that they are working with their supplier of teabag paper to develop a paper that is 100% plant-based, but right now our tea bags do contain polypropylene as part of the fibres.

Twinings have several different types of teabags available on the market. They advise that their standard teabags, used for Earl Grey and English Breakfast, to name a couple, and many of our infusions and Green teas are produced from a natural plant based cellulose material and contain no plastic in the fibres. However, these teabags are “heat sealed” tea bags, and so the paper also has a very thin film of polypropylene, a plastic, which enables the two layers of the tea bags to be sealed together.

Meanwhile their ‘string and tag with sachet’ tea bags, also contain a thin layer of plastic polyethylene to help seal up the sachets. The only Twinings product that does not contain any plastic is their pyramid teabag range – whereby the material is derived from maize starch and is fully biodegradable and compostable. Rather annoyingly though, many of their pyramid tea bags seem to come in plastic bags rather than boxes.


Pukka Tea advise that their teabags do not contain polypropylene or any other plastic – their teabag is sewn shut by machine with cotton thread. They further mention that their teabag paper is made of a blend of natural abaca (a type of banana) and plant cellulose fibres, and their supply of tea bag paper is also totally chlorine free and unbleached. They are staple-free and 100% biodegradable and/or recyclable. The tea bag strings are made from 100% organic, non-GMO, un-bleached cotton. Each teabag is individually packaged though (possibly in plastic), so the one downside is that there is a bit of waste from one box of tea .

PG Tips say their “teabags are made with 80% paper fibre which is fully compostable along with the tea leaves contained in the bag. The remaining packaging includes a small amount of plastic which is not fully biodegradable: this is needed to create a seal to keep the tea leaves inside the bag“. However, they didn't have the information to state whether or not this was polypropylene.

Tetley also say their round and square teabags are made with 80% paper fibre, and 20% thermoplastic. Their string & tag teabags are plastic-free but are used mostly in their catering range for individually wrapped tea bags. They advise that Tata Global Beverages has ongoing continuous improvement and environmental awareness and are working towards more sustainable and biodegradable solutions for all their products. They also advised that ripping ripping the bag and dispersing the contents should help the composting process.

Typhoo, and Clipper declined to comment. 

So whilst Teapigs, Pukka Tea, Twinings Pyramid tea bags and Tetley’s catering range are plastic free, in pretty much all cases the packaging is not. The teas are also on the more expensive side, perhaps best as a infrequent treat but may be a little pricey to enjoy as your everyday cup of tea. Especially if you have a  chronic tea habit.

If you are keen to enjoy your tea without the added plastic the other option is to switch to loose leaf tea. I’ve been hunting down some handy accessories that might come in handy if you choose to do so:

Plastic-Free Tea Alternatives

• Reusable Tea Bags (£7.98 for 5) (or make your own)
• Tea Ball Infuser (£3.25)
• A pretty fairtrade mug (£9.95)
• A cheery teapot (£24.95) with infuser basket so no need for additional tools or tea leaves floating in your tea.

References

1. http://moralfibres.co.uk/is-there-plastic-in-your-tea/
2. Most UK teabags not fully biodegradeable, research reveals (Guardian article 2010)

The dark side of melatonin

Twenty-one years ago, MIT neuroscientist Dr. Richard Wurtman introduced melatonin as a new solution to sleep problems. His lab patented supplements in hopes of curing insomnia in the older population, whose melatonin receptors calcify with age.

“Researchers say pills of the natural hormone...will bring on slumber quickly without the addictive effects of drugs,” the New York Times reported at the time. In the same article, Judith Vaitukaitis, then director of the National Center for Research Resource, said the hormone “offered hope for a natural, non-addictive agent that could improve sleep for millions of Americans.”

Wurtman himself wasn’t quite so cavalier. In that same article, he warned, “People should not self-medicate with melatonin.”

Nonetheless, melatonin was a hit. In the last two decades, the all-natural sleep aid has earned a spot in medicine cabinets across the country. Inexpensive, easily accessible, naturally occurring and considered safe, melatonin appeals to the those who’d rather avoid prescribed pills. Naturopaths, chronic insomniacs, shift-workers and frequent fliers pop milligrams of melatonin without thinking twice.

According to the National Center for Complementary and Integrative Health, nearly 1.3 million American adults reported taking melatonin in February, 2015. Parents are even handing it out to their kids — 419,000 as of February — believing melatonin to be a harmless, naturally produced hormone.

Melatonin is indeed naturally produced, but the hormone is one of the murkiest supplements on the market, unsubstantiated by incomplete and developing research. Only in the U.S. is melatonin available over-the-counter as a dietary supplement, and long-term usage can alter natural hormone levels and even sabotage sleep. Given to children, its potential side effects are even more concerning.

The Real Sandman
Melatonin, secreted by the pineal gland, is the messenger that announces bedtime to our brains. Darkness stimulates its release into the bloodstream; light inhibits it. Once released, it binds to hormonal receptors located in the brain’s suprachiasmatic nuclei — a cluster of nerves that regulates the body’s internal clock and circadian rhythms — and travels into cerebrospinal fluid and the bloodstream.

Our bodies naturally produce “endogenous” melatonin (or, “growing or originating from within an organism”). What ends up on pharmacy shelves in synthesized “exogenous” melatonin — growing or originating from outside an organism. Its most common application is that of sleep aid; users are told to take their dose directly before bedtime, when endogenous levels are already on the rise. Frequent fliers swear by its effectiveness in recovering from jet lag recovery, saying the hormone helps reset their biological clock in a new time zone.

Studies also suggest melatonin can help prevent sleep disorders in children suffering from ADHD and autism (though its use in kids remains controversial).

The FDA classifies melatonin as a dietary supplement. Dr. Wurtman sees this as a marketing ploy to circumvent the bureaucratic web of research and patents that typically burden the process of bringing drugs and hormones to market.

And that’s where the problems arise.

A Dosing Problem
Given the lack of apparent side effects, it may seem harmless to label melatonin as a dietary supplement. But the classification matters for consumers, because the FDA doesn’t require supplements to include warnings of overdose risks on their labels, as is mandatory for drugs and hormones.

Perhaps even riskier, the classification allows companies to sell melatonin in varying dosages.

In 2001, researchers at MIT concluded that the correct dosage for melatonin falls between .3 and 1 mg. Yet, walk down the pharmacy aisle and you’ll see stacks of sleep aids packing as 10 times that amount.

It’s easy to take too much, and most of melatonin’s side effects are the result of just that. While there’s no evidence that too much melatonin could be fatal, or even remotely life-threatening, exceeding the proper dosage can upset the body’s natural processes and rhythms.

“With some hormones, if you take too much you can really put your body in danger,” says Dr. Wurtman. “With melatonin, you’re not in danger, but you’re also not very comfortable. It won’t kill you, but it’ll make your life pretty miserable.”

And, despite common perception, melatonin can cause next-day drowsiness, according to Michael Grandner, a sleep researcher at the University of Pennsylvania.

More importantly, melatonin is a hormone. With children, according to Grander, it can affect puberty, disrupt menstrual cycles and impede normal hormonal development.  

Excess melatonin can also induce hypothermia, as body temperatures reduce during melatonin release, and stimulate overproduction of the hormone prolactin, which can cause hormonal problems and even kidney and liver issues in men.

The Insomnia Clause
When used occasionally and at the correct time, melatonin is a fine means of encouraging sleep. But, ironically, with prolonged use, it can actually amplify insomnia. Having too much melatonin in the system, the theory goes, overwhelms the receptors, changing how a patient reacts to the hormone — whether it’s endogenous or exogenous.

According to Dr. Wurtman, melatonin supplements may work at first, but soon “you’ll stop responding because you desensitize the brain. And as a consequence, not only won’t you respond to the stuff you take…you won’t respond to the stuff you make, so it can actually promote insomnia after a period of time.”

Mauricio Farez, an Argentinian sleep researcher, has similar reservations. “I have some issues, in terms of the pharmacology, and…it’s really hard to have stable levels of the drug in our blood.”

Grandner agrees. “Taking melatonin for an extended period of time your body may acclimate and re-adjust and produce less over time which will work against you.”

When it comes down to it, taking melatonin to fall asleep sooner doesn’t even work. “When it’s nighttime and melatonin levels are high,” says Dr. Wurtman “taking melatonin supplements is like putting a drop of water into an empty bucket; when it’s daytime, it’s like putting a drop of water into a full bucket.”

This doesn’t mean melatonin is without potential benefits. Farez wants to see more research on its immunologic potential, as his most recent study suggests melatonin could play a role in managing multiple sclerosis. It’s also widely used to fight certain types of cancer, as it combats tumour cells.

Both Farez and Wurtman believe melatonin’s potential benefits outweigh the drawbacks. But that’s largely in a clinical, controlled environment under professional supervision. Allowing melatonin to sit on our shelves, unregulated and sold as freely as aspirin, is a problem waiting to happen.

How safe is melatonin to take regularly for sleep problems? Are there more risks for children versus adults?

There’s a dearth of safety data for melatonin, but there are a number of potential concerns, especially for children.

“I think we just don’t know what the potential long-term effects are, particularly when you’re talking about young children,” said Dr. Judith Owens, director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “Parents really need to understand that there are potential risks.”



The pineal gland in the brain ramps up production of the hormone melatonin in the evening, as light fades, to encourage sleep, and it turns down production in the early morning hours. Synthetic forms of the hormone are also sold as a dietary supplement; because melatonin is found in some foods, like barley, olives and walnuts, it is regulated as a nutritional supplement rather than a drug, as most other hormones are.

In adults, studies have found melatonin to be effective for jet lag and some sleep disorders. It is also hugely popular as a sleep aid for children and can be useful for sleep disorders among those with attention-deficit disorders or autism, Dr. Owens said. “I rarely see a family come in with a child with insomnia who hasn’t tried melatonin,” she said. “I would say at least 75 percent of the time when they come in to see us” at the sleep clinic, “they’re either on melatonin or they’ve tried it in the past.”

While short-term use of the hormone is generally considered safe, it can have side effects, including headaches, dizziness and daytime grogginess, which could pose a risk for drivers. Melatonin can also interfere with blood pressure, diabetes and blood thinning medications.

Less is known about this potent hormone’s effects in children. Some research suggests it could, at least in theory, have effects on developing reproductive, cardiovascular, immune and metabolic systems.

If you do turn to melatonin, Dr. Owens says, do so under the guidance of a health care professional and buy melatonin from a reputable source. “Pharmaceutical grade” melatonin, she said, may have more precise dosing levels than off-the-shelf brands. A study published in November in the Journal of Clinical Sleep Medicine found that 71% of melatonin samples were more than 10% off the stated dose, with some lots containing nearly five times the listed dose.

There are of course, number of more natural, herbal and holistic approaches to sleep problems. read my previous post if you want more information about natural alternatives if you want to avoid exogenous melatonin altogether: http://yaso-shan.blogspot.co.uk/2013/10/a-good-nights-sleep.html

References

1. https://well.blogs.nytimes.com/2017/01/06/is-the-sleep-aid-melatonin-safe-for-children-and-adults/?_r=0
2. http://www.huffingtonpost.com/van-winkles/the-dark-side-of-melatoni_b_8855998.html