Melatonin: Should You be Taking it?

Tina 0:00

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:04

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:08

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:12

But we're not your doctors

Tina 0:14

This is for education entertainment and informational purposes only

Leah 0:18

do not apply any of this information without first speaking to your doctor

Tina 0:23

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:29

Welcome to the cancer pod Hello, Tina.

Tina 0:49

Hello Leia.

Leah 0:51

Happy New Year.

Tina 0:52

Happy New Year to you. 2023.

Leah 0:54

Woo

Tina 0:56

So, so this is one of those moments where I think back to when I was young and I was born 1971 and it, it was inconceivable to think about where I might be in the year 20 20, 20 23 in this case. Inconceivable.

Leah 1:10

Did you ever watch that show space? 1999.

Tina 1:14

Mm-hmm.

Leah 1:14

So it was really cool. It was like with Martin Landow and Barbara Bain, and it was about like

Introduction

Leah 1:20

these people went and colonized the moon and then something happened and the moon tore out of Earth's orbit and it's just plumming through space. So it's like its own little like spaceship kind of, but it's the moon and people live on it. And that took place in 1999.

Tina 1:35

really Well this is funny cuz all these futuristic movies back then would, would be like only 50 years later or

Leah 1:41

I know. Well, that's what I'm saying, like we're not living on the moon and the moon is still attached in our orbit. But yeah, there was something else that was like, was it Terminator or something where like somebody was born, there was some movie trivia thing where like a main character was born in like 2022, which is just crazy that like, that seemed so far away. Yeah. 2023 far away. But it's like just in a few weeks. But actually, but yeah, I mean we're releasing this in 2023, but we're recording it ahead of time because we're, you know, we're on it.

Tina 2:15

Yeah, cuz we're so diligent.

Leah 2:16

That's right. We're professional

Tina 2:18

our New Year's resolution. That's my New Year's resolution.

Leah 2:22

I don't even know what to say.

Tina 2:24

True that. Okay.

Leah 2:26

True that. So Tina, what are we talking about today

Tina 2:28

we're gonna talk about melatonin.

Leah 2:31

Which is awesome because we have had several requests to discuss melatonin and in particular its role in cancer care.

Tina 2:38

Oh, and you know what you bringing in the moon into this conversation is actually appropriate because melatonin, in diurnal rhythms are a 24 hour rhythm of our system. It's all linked. It's all connected.

Leah 2:51

That was not even intentional. That was just because of like, yeah, it's one of those random pieces of trivia that fills the voids of my brain.

Tina 2:59

any of it random Leia really?

Leah 3:01

really isn't. Is it All right, so what the heck is melatonin? We know it's like a pill that you can buy in the store and you take it to go to sleep, but what is melatonin? Tina,

Tina 3:16

I'm not gonna get into the chemistry, and I told you before we hit the record button that I'm gonna try not to go too deep into the weeds

Leah 3:25

you're trying not to nerd out.

Tina 3:27

I'm trying not to nerd out and use chemistry, but it is, as all molecules in the body are. It is a chemical compound that we produce. It's a hormone, essentially.

What is Melatonin?

Leah 3:37

which I think is big, that it's a hormone.

Tina 3:40

Yes. It's, it's an actual hormone that our body makes. It's not just any molecule, it's a hormone and a, and a hormone. Just for the record, a hormone is a molecule that signals organ systems on a cellular level, but it still is a signal bearer that is produced in one section of the body, travels to other sections of the body, and has a, a physiological effect. So, a hormone by definition is influencing the behavior of cells and in, in influencing the behavior of organs ultimately. So I just wanna put that out there cuz it's, it's a powerful thing. When we say a hormone, you know, it's much more powerful than saying an amino acid or a protein or a sugar molecule. a hormone elicits an action within the cell that actually forces an action within the cell. So I'm just saying that cuz it's, it's very different than a vitamin.

Leah 4:25

Right. And I think that's a really important thing for people to know,

Tina 4:29

Mm-hmm. because in the United States we can buy melatonin over the counter. And in Canada as well, I believe in certain parts of the, of the world. It's not a nutritional supplement, it's not offered on the shelf.

Leah 4:39

right.

Tina 4:40

Because they consider it something that people should not be taking ready for it. Where you say it all the time, willy-nilly,

Leah 4:46

That's the first willy-nilly of the year. Yeah. I think, I think that's a really good point. And I think there are a lot of studies that have been coming out, like, should you be taking melatonin and we'll talk about why people take it and all of that stuff. But, um, where does, you said, you know, it's a made in one part of your body and it signals other organs and tissues. Um, so where in your body is melatonin made?

Tina 5:11

It's most notoriously made in the pineal gland in our brain

Leah 5:15

See, PI, pineal. That's what I was wa I was waiting, I wanted you to say it because I didn't know if it was pinel or pineal. Is it like pecan or pecan

Tina 5:24

I think there could be an emphasis wherever you wanna put it.

Leah 5:26

and a fas? I like pine cuz it makes it like pie,

Tina 5:31

So makes you sound like you're, like you're from the.

Leah 5:32

pineal. Okay,

Where is it made?

Leah 5:34

I just wanted to clear that up. Okay, so it's made in your brain in the pineal g.

Tina 5:38

and it is made in other parts of the body as well. So it does, this is what it's most notoriously known for its role in our circadian rhythm. It's known as the master hormone behind our 24 hour rhythm of various hormones. So as humans, we have a diurnal rhythm, which means that we should be sleeping at night and awake in the daytime. And that's as opposed to nocturnal rhythms, right? Of cats or rodents. They're nocturnal. They have the opposite

Leah 6:08

hedgehogs. I know people who've had pet hedgehogs and they are nocturnal

Tina 6:12

Okay, I wasn't aware of that, but that's, this is why we do the show to learn really important factoids like

Leah 6:20

from each other. Yeah. I'm here to teach

Tina 6:25

It is quickly released from the pineal gland in the dark. So I love the image of a ball rolling down a hill and you have something holding it back. And what's holding that ball back in this case is daylight. And as soon as the daylight goes away, that ball rolls down the hill. That's basically melatonin from serotonin. So serotonin is made in our brain all day long. The lights are keeping it from becoming melatonin. The lights that hit our eyes signal the pineal gland When the lights go out, the serotonin that you normally make now becomes melatonin, and it's just daylight inhibits the enzyme. So when the daylight is gone, the darkness then allows the serotonin to become Mela.

Leah 7:04

And I think that is one of the coolest things, and I told you before we started recording, I wanna find this one image that shows the serotonin pathway, which is like how serotonin is made, and you see melatonin in there. And the image I'm thinking of in particular also shows like all of the nutrients that our body needs in order to produce those hormone. And I think it's also an important connection because serotonin is what we mostly think of when we think about mood and depression. And so knowing the connection between melatonin and serotonin I think is really important.

Tina 7:39

Yeah, so a serotonin low state is connected to depression and, and serotonin and melatonin are made naturally in our bodies, ultimately from tryptophan. Tryptophan is a essential amino acid that gives rise to the serotonin, so we create the serotonin, but we need the building blocks to create serotonin and thus melatonin. The building block in this case is tryptophan, is the essential amino acid as part of that process. And there's some nutrients in here as well, like vitamin B6 that we have to have enough of to make this process go forward, um,

Leah 8:11

B12.

Tina 8:12

in b12.

Leah 8:13

So that makes me think like, so if somebody is a vegetarian or especially a vegan and they're deficient in those nutrients that helped create serotonin and melatonin. I mean, it's important to make sure that they are getting some sort, I'm not saying to take a b12, but maybe just do some more nutritional yeast or, you know, find some other sources of those building blocks.

Tina 8:35

Yes, I will. I I'm gonna give a personal story. It's a rarity, but that's how we're gonna start the year. This is me. Gloves are off.

Leah 8:44

as I'm.

Vegans/Vegetarians at risk of low levels?

Tina 8:46

You're like, this is hysterical. it's like a shooting star. Okay. So I did labs on myself because I'm a naturopath and I hadn't done the labs in many years. And so I was like, oh, I'll just do a, a wellness panel. And long story short, my b12, my serum B12 was low. Now I eat really well and I'm vegetarian, but I do eat fish

Leah 9:07

Well, we talked about, yeah, we talked in a previous episode how your like pesco,

Tina 9:10

I'm more pescatarian.

Leah 9:12

ovo, Pesco,

Tina 9:13

I eat eggs, I eat fish, I eat cheese.

Leah 9:17

chi

Tina 9:17

I think that's a lacto vegetarian one.

Leah 9:19

I'm going with chio. Cause you don't drink milk

Tina 9:21

No, I don't. That's cause I don't like it. In any case, serum B12 is not easily low. In other words, it's, it's not an easy vitamin that shows up in serum. So for it to show up low in my blood work means that it's probably been low and dipping down in low.

Leah 9:35

right? Cuz it's stored in your liver. Like when people take high amounts of P 12, like it may get stored up in your.

Tina 9:41

I'm not one of those people who does high dose B12 or B vitamins or anything like that, but I take vitamins here and there now and again, and, you know, make sure that I'm not deficient or I thought I was. Um, but I, and I eat really well, like 30 vegetables in a week. That goal, that was, I, I think I hit it in, you know, a few days no problem, because I always eat a lot of vegetables. I eat grains, I eat roots, I eat berries, I eat fruit, I eat, you know, so I was a bit surprised. Um, and I wondered if maybe I should be more of an omnivore, given my heritage. Um, so my heritage is Polish, Italian and Irish, and all of those tend to be omnivore diets. So there's not a vegetarian ancestry that I can look back on. Right. So anyways, with all of this in mind, I did it. I ate a homemade smash burger.

Leah 10:29

wait. You eat beef

Tina 10:30

I did it, I took the plunge. It's been seven years, plus I didn't, you know, I didn't even like me growing up.

Leah 10:36

I know that's what we were saying before.

Tina 10:38

No, it's not something I would do for anything but health reasons. But what I did was I took a piece of bread, I put mayo on it and then I put cheese on it and I put, I put all sorts of things to cover it up basically. And it was a smash burger, so it was as thin and well done as it could be. Um,

Leah 10:55

Oh, sounds

Tina 10:56

I know, I know. I

Leah 10:57

I just, you lost me at Mayo. But, um, and then well done. Just sealed it like I'm, if you invite me over for a smash burger, I'm gonna decline

Tina 11:06

It's all about the toppings cuz I really didn't care about the meat, but I did do it in the name of, um, respecting my heritage and knowing that my B12 is low. Maybe because that's my, you know, I'm not eating a heritage diet when I eat pescatarian.

Leah 11:18

And for anyone who's curious and hasn't listened to prior episodes, the Heritage Diet, we will put a link to, um, to that old ways, um, website if you're,

Tina 11:28

Yeah. Yeah. They've, they've done a good job of looking at various heritage diets by, mostly by continent, so that you can see the various pyramids, not just a Mediterranean diet, but what does it mean if you're from Asia or you're from Africa, et cetera.

Leah 11:41

Latin American countries. Yeah. So, okay, so we're talking about food and melatonin and tryptophan, you know, these precursors are found in foods. So some of the, like, I guess some of the foods that have the highest content would be like nuts and seeds.

Tina 11:58

Mm-hmm.

Leah 11:59

And what's kind of cool is if you soak the nuts, like something like, you know, like almonds or whatever, and if you soak them, you sprout them, then that actually makes the melatonin more bioavailable. It increases the co, I mean, I dunno if it makes it more bio bioavailable, but it like increases um, the content. And then, cuz I looked it up, mustard

Melatonin in foods?

Leah 12:17

seeds have like the highest amount and I don't think one would really eat that many mustard seeds, but that's kind of a cool.

Tina 12:24

Has the highest amount of melatonin.

Leah 12:27

Yeah, like I guess per, like if you look at the a hundred grams or something, I need to recheck the chart, but I did write down mustard seeds because I thought that was a really interesting thing. It's used a lot, um, in, I mean, obviously to make mustard, but um, I use it when I make, uh, chiri. So it's used in Indian cooking and stuff, but it's kind of a cool thing. So yeah, there's also an article that has a list of the, um, melatonin content in different foods. But, tart cherries are the other thing that people think about and doing my research before falling down the rabbit hole, um, it's a particular type of tart cherry. It's just not any random tart, tart cherry.

Tina 13:06

Did they tell us the type.

Leah 13:08

Yeah, but I can't, I, I don't know how to say it. Mon mon moen. Mon mok type. Yeah. It's in the article. But um, yeah, so different strains of like, you know, grapes or, you know, whatever the foods are that have melatonin, um, contents, like the different, I guess, strains of food. Is that the word?

Tina 13:28

Different types of food.

Leah 13:29

Well, like you could, like, if you have four different types of grapes,

Tina 13:33

Oh, okay.

Leah 13:34

you know, like species. There you go. That's the word. Yeah. So, um, mushrooms, tomatoes, grains have melatonin. And what I also thought was very cool is the darker the rice. So like black and red rices have higher contents of melatonin. Um, wheat, barley, oats, coffee beans

Tina 13:54

Woo woo

Leah 13:55

has melatonin and roasting it brings out the co, like makes a higher content. Um, not that I would recommend drinking coffee before bed, but.

Tina 14:04

do I love the, let me count the ways,

Leah 14:07

just like, one more thing.

Tina 14:09

let me put that on my list of things. Coffee. Does that benefit my health?

Leah 14:12

There you go. Look at you got your coffee, um, and then in the animal kingdom you've got like oily fish, eggs and breast milk,

Tina 14:22

That's one of the ways the babies get their melatonin,

Leah 14:24

guess so yeah. And then of course the list is much more comprehensive. I just kind of pointed out like the ones that I thought were, particularly interesting.

Tina 14:31

Well, you know, I'm, I'm super duper competitive, not so I have a list of Tripp Toan foods,

Leah 14:38

Oh, awesome. Nice.

Tina 14:40

So those who just joined us, you'll know that Leia is diligent and does her homework, and I often just show up and start talking. And so for me to come up with a list was, you know, this is my new 2023 self showing already. All right, so number one, the list is milk. And so if you don't do milk and dairy, okay, canned tuna was on the list. Turkey and chicken, not surprising. These are high protein things like tryptophan is amino

Foods with tryptophan.

Tina 15:04

acid. Um, we don't need a lot of it. We just, it's actually the lowest amount of required amino acid of all the essential amino acids anyways. Turkey and chicken, I said oats, cheese, nuts and seeds. Chocolate and some fruits have a little bit, but you know, fruit doesn't have much amino acid in general, so it's certainly not gonna have as much tryptophan as high protein foods. But I wanna mention one more thing. Since tryptophan is the essential amino acid that eventually can become serotonin and melatonin. Tryptophan is also used to make a type of vitamin b3. So if the body is low in b3, there are priorities to every pathway in the body. It will prioritize the production of B3 over the production of serotonin. So if someone is low in b3, your body will probably not be low in B3 or niacin. Um, it will probably sacrifice the production of serotonin in order to make enough B3 or niacin for your reactions in your body where that vitamin is needed. So it's an interesting thing cuz the body always has certain priorities to everything and ultimately survival is the top priority. So it will reshuffle its use of amino acids so that you can stay alive. It doesn't care about your mood at that point.

Leah 16:14

No, that's really cool. And speaking of b3, that kind of leads us into um, just a quick little brief, review of why one would use a supplement instead of using food. Cuz we are always food first.

Tina 16:28

Mm-hmm.

Leah 16:29

Um, because food is so much more complex than an isolated nutrient in a supplement. go back to episode number 20 and listen to supplements 1 0 1, the basics. We'll put a link in the show notes and, okay, so why do we use supplements? Just brief overview to prevent or treat an acute nutrient deficiency. So like you were saying, like

Why do we take supplements?

Leah 16:52

vitamin b3, um, that would be preventing pellagra. Um, vitamin C prevents scurvy, B one berry, berry. And to prevent rickets, you take vitamin D. And these are very low amounts. These are not high amounts. These are just low amounts that typically you can get from food

Tina 17:08

Mm-hmm. or the sunshine? Vitamin.

Leah 17:10

or the sun, right? Um, the second reason we would use a supplement is to prevent delay or to treat a chronic nutrient de.

Tina 17:17

Mm-hmm. Mm-hmm. So fish oil might be a classic example of.

Leah 17:21

Right. Yes. Taking fish oil. Um, and then the third reason, and we kind of differ on our views of what green pharmacy is, but it's basically using it, um, in place of, or alongside conventional medicine, a prescription in order to address a specific, um, issue. So for melatonin, we most likely think of it for sleep.

Tina 17:44

right? Cuz people are unlikely to have a deficiency per se of melatonin. But that doesn't mean that taking a little extra for sleep isn't appropriate.

Leah 17:53

right. So let's take a quick break and then we'll come back and we will talk about the use of melatonin for sleep. And after that we're gonna talk about the use of melatonin for cancer.

Tina 18:02

All right. See you on the other side,

Leah 18:11

All right, we're back. I'm kind of getting sleepy.

Tina 18:13

Just talking about it.

Leah 18:15

Oh yeah. You know, and I had a little bit of chicken with my lunch. So it's all, that trip to fan is converting fast and I had chocolate.

Tina 18:22

Oh, see, oh, you, you need some more bright lights.

Leah 18:26

I know the sun is shining, but I'm in my closet. Okay, so

Tina 18:30

the sun's not shining in your closet.

Leah 18:32

it's not, it's my recording closet. My recording booth. Okay. We are back and we are talking about melatonin for sleep.

Tina 18:41

Yeah, so, so I think

Does melatonin help you sleep?

Tina 18:43

we can all agree. Let's start with common ground. There's decent evidence on the use of melatonin for sleep at doses that are somewhere very low dose, all the way up to, I think the, the highest dose I've seen for sleep was six milligrams, but that's pretty unusual. It's usually one to three m.

Leah 18:58

And there's a lot of controversy because people are able to buy up to 10 milligrams in the store. And I think because of our, the way that we think where if a little is good enough, then more is better. That doesn't really necessarily apply with melatonin cuz it's not like melatonin is a sleeping pill and it's not for everybody who has a sleep disturbance. As we discussed in our Sleep Disturbances episode

Tina 19:26

Right

Leah 19:27

I don't remember which ones those were. There were two episodes, nine and 10 I think. So links below in our show notes, links below, like I'm on like YouTube. I did point. I'm like ready for YouTube, but okay. So

Tina 19:43

on that. Uh, what we talked about and we need to mention for sleep is first and foremost, optimize your own production darkness. Every little light counts in your room. So the easiest thing to do, you can go out and buy a nice mask. The Bucky Mask is my favorite brand, but there's a bunch of 'em out there that keep the mask off of your eyelashes so you don't feel like your eyes are being pressed on. But really just reach in your drawer, find a soft T-shirt and put it over your eyes and see if, if you're waking up a lot, see if that helps because you might roll over and finally the t-shirt's on one side of the pillow, you're on the other, and you wake up and you can kind of surmise that every time you're waking, there's some light coming through. Cause it goes right through your eyelid, even if there's a little ambient light.

Leah 20:23

Yeah. It's pretty amazing what I, whoops. What I have done, if I wash my eye mask and it's air drying, is sometimes I'll just use like a knit cap, like just, you know, a fleece.

Tina 20:36

you mean you put it on your head and then just cover your eyes.

Leah 20:38

Yeah, it works best in the winter when it's a little chilly. I try to keep my, my sleeping area, you know, cold. But yeah, there, there are other things that you can try, but I just ordered a sleep eye mask. I tried a different kind. It's got the little cups for your eyes, but it doesn't have clips on the side cuz I'm a side sleeper and that makes a big difference cuz I would wake up cuz those clips were digging in my scalp. And so yeah, I like this one. But, um, we could put links somewhere of our favorite eye masks that we

Tina 21:06

That's a good idea.

Leah 21:07

but yeah, so patients will say, yeah, my room is really dark. And sometimes it is, and sometimes there is that ambient light. Like if you have to like fumble your way to get to the bathroom in the middle of the night because there's no light, that's what makes a big difference

Tina 21:21

Yes. That's dark enough you're saying. Yeah. And sometimes you can't control the light coming in or you're sleeping with someone else in the room who really doesn't want it to be pitched dark because they wanna fumble through the night and find the bathroom So, so the masks are some way of, you know, making it dark while you're actually trying to sleep is. And I think there's another thing we have to mention about melatonin, whether you're making it yourself or you're taking it as a supplement, the half-life is pretty short. In other words, the time it takes for you to metabolize melatonin is only 30 to 60 minutes. So as your body is making it, it needs to continue making it through the night for you to have a sustained amount of melatonin that keeps you asleep into a deep restorative sleep. Um, this is true when you take it as a supplement too. I should also say, when you take it as a supplement, the most I've ever seen in its absorption rate was about a third of it being absorbed. So if you take a three milligram capsule orally, a one milligram will make it into your bloodstream. Now, that's still a pretty good dose compared to what your body is making.

Leah 22:19

Right, because your body makes it in pico picograms, I wanna say like Pikachus in Picograms. Um, yeah. So Picograms, which I was like, how small is a picogram? I looked it up and it is 1 trillion of a gram. And during the daytime, your body produces between zero to 20 picograms per milliliter, and at night it's 40 to 200 picograms per milliliter. So that is like the teeniest of tiniest, of like infinitesimal, like small amounts.

Tina 22:50

1000000000000th. Can I just, I, I, I wanna say 1000000000000th, that's nine zeros, no. 12 zeros. So that means if 1.0 is one, it's 0.1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0 1.

Leah 23:06

So taking one milligram suffice, sometimes you can find a half milligram, but they're harder to find. It's hard to find low doses these days because everybody wants to take a five or a 10 and you don't need it for sleep.

Tina 23:23

I let people figure out their dose by starting with a half a milligram for sleep and then working their way up to five milligrams. Some of it, cuz some of it's going to depend on their absorption rate and such.

Leah 23:34

Sure. Sure.

Tina 23:35

if it doesn't work at five and six milligrams for sleep, it's probably not going to work.

Leah 23:39

Right. It's probably not what they need for their sleep.

Tina 23:43

It's probably not the issue. Yes, it does cross the blood-brain barrier very easily. It's considered, um, lipophilic, you know, pass your fat membranes very easily. Um, so you should, once it reaches the bloodstream, or let's just say you have great absorption, and you do absorb one third of that one milligram, so now you've got 0.3, three milligram that goes into your bloodstream. It should at that point, cross into the blood-brain barrier without a problem. And that's still, you know, 1 trillion times more than your brain would be.

Leah 24:13

So as we discussed in the sleep episodes, this is why it's important to, I usually say around eight o'clock, start to turn lights down. You start to turn down, at least, you know, dim your phone, have your phone switch over to a different light, not the blue light, but like the more yellowy light that can, um, be on your electronic devices, your Kindle, whatever. Preferably reading a book, not a Kindle, um, but start to avoid light so that your body can start to produce melatonin because melatonin is your body's way of preparing for sleep. You know, like we said, it's not a sleeping pill.

Tina 24:51

Right, right. so yes, this is why melatonin is considered the master hormone of our rhythm, of our night and day rhythm. It's a lot like the ocean. So going back to this whole moon circling the earth, we know that tides are governed by the moon and the magnetism between the moon and the earth, and the tides come in and the tides go out. Well, your hormonal cycles are a lot like that on a 24 hour, roughly 24 hour cycle, where you should be having these ups and downs of certain different hormones throughout the day. We're talking about cortisol being higher in the morning when you wanna be awake. Cortisol

How is Melatonin a "Master Hormone?"

Tina 25:25

should be very low when you go to sleep at night. Melatonin should be very low during the day. It should peak during the night. So we have all of these rhythms of various hormones in our body, and this includes these steroidal hormones as well, the estrogens and testosterones and such. So there's this idea that the clock itself in our clock genes, now we have these clock controlled genes in all of our cells. Genes literally turn on and off in our, in our cells. They're keeping track of time. So there's this whole set of genes called clock genes that do go awry in a lot of cancers. And so they're looking at clock genes in cancer. Um, and they're different. The clock genes that are expressed in a tumor are different than those in the normal tissue nearby. So CLO genes are thought to be one of the many ways in which cancer cells are different than normal cells. The clock genes will start behaving differently. So instead of being quiet at night, they might. not be quiet. They might be causing the cells to proliferate in the middle of the night, that kind of thing. So clap chain's a whole topic that I would love to dedicate a whole episode to because it's the most fascinating thing that the body keeps track of time. Melatonin is one master hormone in the whole story, but it's, it's a much more intricate story with a lot of other players in it. See, this is me not geeking out. I did pretty good.

Leah 26:40

You did pretty good. Yeah, and I'm just thinking like this would be something if we get our Patreon set up, that would be a really nice, um, you know, bony thing for a Patreon site. If we if we continue with this motivated, uh, attitude that we have right now.

Tina 26:57

Yes. If we continue this momentum, yes.

Leah 27:00

Yeah. So, um, as we kind of mentioned before the break, having those precursors to produce melatonin and, you know, serotonin, um, is important. So making sure you are eating a well-rounded diet with some of the foods that we recommended, um, practicing good sleep hygiene is important. And I just saw an article which I saved on my phone, I didn't read it yet, but it talked about how weighted blankets may actually work by helping your body to produce melatonin.

Tina 27:32

Oh yeah. So weighted blankets have been used to reduce anxiety in general. There was even a, a small pilot study using weighted blankets in the chemo room and showing that it calmed people down and was useful to reduce anxiety. So I didn't know it was actually calming in that sense too.

Leah 27:48

Yeah, like I said, I just, it was something that popped up in my, my newsfeed and so I saved it to read later, but, um, I will read it and then we'll put a link as.

Tina 27:56

Great.

Leah 27:57

Um, that would be fantastic in infusion rooms because I know I do have a weighted blanket and I can't sleep with it because halfway through the night I have to turn over and it's too heavy for me.

Tina 28:08

Mm, mm-hmm.

Leah 28:09

I feel like I'm like working out in the middle of the night to lift it, to roll underneath it, but in the infusion room it's cold. I mean, you do have to get up and go to the bathroom, you know, sometimes, several times. But, um, yeah, I guess it would just be hard to keep them clean.

Tina 28:23

Yeah. There was a, there was a brand that was made by a nurse somewhere. I wanna say she was in Ohio and they did a small clinical trial. Um, I'll look it up cause I, I had a link to that and then we can put that link in the show notes as well. But it was specifically made for the chemo room because she was an oncology nurse and she wanted to know if this might help cuz it was so simple.

Leah 28:41

No, that's awesome. Yeah, I guess someone could bring their own weighted blanket, but yeah, I'm just thinking like if infusion rooms had them, um, they always have those white, super, super linty blankets that they'll just have in the warmer and you pull it out and then it's warm and then it's not. Um, and then if you're wearing black, you get like lin all over you Um, but a weighted blanket would be nice because it's warm and it's anti-anxiety and it's just soothing and all of that. So, what else would we think about melatonin?

Tina 29:08

Put your doorbell.

Leah 29:09

Oh yeah. Hold. So is there anything else that, um, we can add in terms of melatonin for sleep? You know, like making sure that there's not light disrupting it. And conversely, if you do wake up really groggy, whether or not you take melatonin, you wake up groggy, turn on light open windows if it is the time of year when there's light outside, when you wake up.

Tina 29:38

Mm-hmm. Yeah. And, and that whole like, you know, who can sleep right through all of that, of course is teenagers, but they have much higher levels of melatonin. So young people and through their teenage years and even in their early twenties, they much have much higher levels of melatonin in their body and they're not as sensitive to the light. Their enzymes are just more hearty to that light so they can just sleep right through it. it's kinda a fascinating reason that everyone knows who has teenagers. They generally need more sleep.

Leah 30:04

Well, and I mean, we were all teenagers and.

Tina 30:07

I don't recollect what I did then though.

Leah 30:09

I remember being able to sleep, you know. I do wanna say that I do kind of encourage lower doses. I know that, um, you know, like you go up to six milligrams, but for people who think that the lower doses kind of help, there are extended release ones as

Tina 30:25

Mm-hmm. Yeah. I like some of those extended release ones because the halflife is so short. So, and then if it depends when, do you have trouble falling asleep in the first place? Like you know, at 10 or 11 at night? Or do you have trouble because you wake up at three or that those are two different issues, right? And so you wanna time the melatonin to be peaking when you have your issues.

How Much? When take it?

Tina 30:44

And so you might take it just before bed for an instant release. Or if you're just someone who, I fall asleep, fine, but I wake up at two or three every night. You might wanna do the extended.

Leah 30:52

So do you recommend people take it? I think we talked about this in the sleep issue, in sleep issue, sleep episode. Um, timing when you take the melatonin, because if you look at the packaging, it'll say take it 30 minutes before you go to bed. And so I will have patients if they have a hard time falling asleep, take it 30 minutes before bedtime. But when you brush your teeth, make sure your lights are low, like keep those lights low. Like just put on a nightlight in the bathroom to brush your teeth and to, to get ready for bed. Um, so as opposed to like taking it once you're in bed.

Tina 31:23

Right, right. I find most people, well this is not true of everyone, but uh, it seems to me the majority of people have trouble when they wake up in the night and getting back to. So the, the other option that you could try and I, you know, it's all trial and error, um, because melatonin is fairly inexpensive. I just have people try different ways of doing this, but there is melatonin in sprays and there's melatonin in drops as well. And so you could, instead of doing an extended release rollover, especially if you can afford a couple more hours at least, um, and put it under your tongue and just see if you hit, get an immediate release. Cuz again, it's 30 minutes to an hour or so. You should burn through that in, you know, two to four hours easily. When we say a halflife, just so we're clear, a halflife is a literal term. That means in that time, let's just say it's 30 minutes for melatonin. In 30 minutes, if whatever dose you have at point at time, 0.0 in 30 minutes, you'll have half that dose.

Leah 32:15

So if you take one milligram in 30 minutes, you have half a milligram in your body,

Tina 32:19

Yes. If you absorbed one milligram for whenever you're. And that's what it's in your bloodstream about 30 minutes later, you should have half of whatever was circulating 30 minutes ago, and that happens every 30 minutes, right? So essentially in, you know, five half lives or seven half lives, it's completely gone. So that's why you have to continue the production through the night to have enough to get you through the night. You have to keep producing the melatonin. And so, yes, if you're doing a supplement, you might keep that in mind.

Leah 32:43

And again, I mean, melatonin isn't always our go-to when somebody has sleep issues. So it's not like we're saying, oh, go out there and take melatonin for sleep because that might not be what's going on with you. Yeah. So, and we do cover that in our, side effects sleep disturbance. Episodes. Episodes. It was a two-parter

Tina 33:07

It was a two-parter because we, we got down, we got down with some details,

Leah 33:11

That's right. We nerded out. All right. So, um, we're good with.

Tina 33:17

Yes, I think we can all agree that melatonin is well proven in human clinical trials for sleep at a given dose. We'll talk about cancer and even side effects that can happen after the break.

Leah 33:28

Perfect.

Sleep Disturbance Episodes

Leah 33:41

and we are back, we are talking about melatonin and melatonin for cancer in particular.

Tina 33:48

Yeah, so we have to give our hats off to a listener whose name is Tim

Leah 33:53

Oh, Tim. Yeah, I mean he, like, you know, there were several people who wanted us to talk about melatonin, like since we first put out our, um, our podcast. But we have been having a behind the scenes conversation with this one listener, Tim, and it's by we, I mean Tina

Tina 34:11

It's okay. Everything we do is we,

Melatonin & Cancer

Tina 34:13

it's

Leah 34:13

I know, I know. It's, you know, it's how it is. But yeah, and I've been having fun reading the emails between the two of you and yeah, he sent us some articles, which I couldn't see most of them because they were abstracts and I don't have access. Like I think you have a little more access than I do to certain articles. Um, but yeah, we just wanna thank you, Tim, for engaging us in conversation and this is what we love about doing the podcast.

Tina 34:40

Yes. Yeah. And, and we were talking about this off camera, off mic, about how, whether it's patients or listeners, you know, pushing the envelope of of knowledge, of our knowledge is really a good thing. I mean, that's part of the fun is saying, okay, let's revisit this topic cuz I already have an opinion. Tim sent us a bunch of papers, I delved into those. Um, and kind of just revisiting things cuz things change, evidence changes. And in this scenario, I think that it's a debatable topic, the role of melatonin in cancer care specifically because there's just not conclusive research. I mean, one of the articles that we will link to in the show notes is from a journal called Pineal, Research. Pan research, um, and it talks about melatonin and its role in cancer care. Pull that up just a second.

Leah 35:36

pineal, pecan, pineal.

Tina 35:40

All right, there's an article in the Journal of Pineal Research in October of 2020, and its title is Melatonin Controversies and Update. So the fact that this is a controversial subject, even in a journal that's for PhDs who do research in the field, tells you how complex the data must be if they can't make a consensus agreement on some of the rules of melatonin. So this was a nice paper, so it'll be in the show notes. And the reason I like it is because it, as of two years ago, tells you consensus. Everybody agrees on certain things. You know that melatonin is certainly in the cytoplasm. it's probably in the

Leah 36:16

that's part of a cell that's like the, the, the soupy surroundings inside of a cell wall. Soupy, surroundings,

Tina 36:23

Yeah. Okay. Yeah, it's, we can picture a soupy

Leah 36:27

I'm like, I'm like the.

Tina 36:30

So yes, you have a cell that has a membrane around it. So think of it like a ball or a sphere with a fatty membrane on the outside. And then inside you have mitochondria and, and a plasma reticulum. You have goul J apparatus, you have a nucleus. These things have to be, you know, in something. What's between all of these organelles is the cytoplasm, the soupy stuff,

Leah 36:51

It's the bro.

Tina 36:52

The consensus of the physiological role of melatonin. There's definitely certain roles, right? We have melatonin receptors on cells. We have melatonin receptor one, melatonin receptor twos. They're on so many cells in the body. They're not just in the brain. And so this melatonin is having a net effect in cells all over the body. There's certain receptors that are agreed upon. There's others that we think there's certain receptors on other cells that melatonin binds to, but melatonin is difficult to study. So I'm gonna saying this because there's a lot. Controversy over, does melatonin have an effect on just certain disease states or is it virtually every disease there is because there's receptors throughout the body. Seems to me that makes sense that it pretty much affects everything. Is there a toxic dose? Um, when controversy is, some people will say there's no toxic level. Technically that's not been proven. and what are we defining as toxicity? Because we don't have anything on long-term toxicity. So if you take supra physiological doses, doses that far, exceed anything your body could make and even far exceed, what would we use for sleep? So we're talking about out there, some people are doing a hundred or 300 milligrams, super, super physiological doses, way more than the body could possibly make. There is no safety studies on that. So there is an assumption when people do that that there is no toxicity. Now, whether that's true or not We can't prove that there's no toxicity. There could be a toxicity at a certain dose for a certain length of time that someone takes it, but we don't have any studies on the other side of that to say, yay your nay on that. So this whole paper goes into all of this stuff and goes into it in great detail, including the crux of my whole. should we or shouldn't we? With melatonin, it's certainly an antioxidant at low doses. So the amount in your body makes likely the amount we use for sleep are considered lower end doses, it acts as an antioxidant in both scavenging free radicals, most likely. There's mostly consensus on that, and it acts as an antioxidant by encouraging your cells to make powerful antioxidant enzymes like glutathione, so it's acting as an antioxidant at those levels, and this is why we have enough research to say, okay, at these lower levels, it's likely to protect us from ionizing radiation, right? So from, from an x-ray or gamma rays, which is the x-ray and ct.

Leah 39:09

So, something I did find interesting is that, um, and it shows you how recent this melatonin research has been going on. Like, how recently is that? It was in 1993 that melatonin was identified as a free radical scavenger. And so that really wasn't that long ago now that we are in

Tina 39:30

2023.

Leah 39:32

That's right. So just to kind of put it out there, like, you know, we're, we're still learning a lot about Mela.

Tina 39:39

Yeah, we didn't say that in our intro,

Melatonin, a history

Tina 39:41

but we probably should have. It was discovered technically in 1958, the molecule

Leah 39:45

And what is its actual name?

Tina 39:47

melatonin n acetyl five Methymine.

Leah 39:52

I don't know why it's not called nam. Right?

Tina 39:53

Well, I'm gonna read from a paper, because I came across this and I was like, oh, there's always tidbits of information that no matter how much you read, you're like, huh, well, there's a little trivia I didn't know. So this compound of inal structure and acetyl five methyl tryptamine is synthesized from serotonin. We said that already. This is directly from a paper, this aspect and the fact that it lightens the frog's skin by contracting Melan fours led to the naming of this molecule as melatonin as in mefor contracting hormone. In Greek, mela means black and toin means tension or contraction.

Leah 40:29

That's why melanin melatonin.

Tina 40:33

Yes, unfortunately, some people cross wires with that. They are no way chemically related. Totally different.

Leah 40:39

The, the word is related.

Tina 40:41

Yes, because of a frog skin experiment in the beginning of this, in the 1950s or sixties, whatever it is, Melan four contracting hormone, bad name.

Leah 40:50

yeah.

Tina 40:51

Well, come on, we're talking about a frog skin experiment. This was, this was kind of cool.

Leah 40:54

I suppose, so I, the, the, the big thing that I think many people, maybe not everybody, but people have heard about, and it, this is kind of a segue of sleep and cancer. So there was the big nurses study, right, that showed that night shift work may be related to a higher incidence of certain cancers like breast cancer.

Tina 41:17

Yes. It's to the point where it's been classified by the World Health Organization as a human carcinogen sleep cycle disruptions, uh, is considered a probable human

Leah 41:28

Yes. So, so I think like that's where, where most people think about, like with melatonin and cancer, but we use it with our patients in different ways. there is, um, a role for melatonin in terms of immune.

Tina 41:42

Mm-hmm. Yeah, and there's actually some evidence, I mean, we kind of harp on the pineal gland cuz that's what we've looked at for decades. Um, but immune cells have been found to produce melatonin inside their cells too. So how immune cells are affected by melatonin is, I think it's a hot topic in research right now. We're trying to figure it out. It may explain why melatonin seems to be useful as an adjuvant alongside immunotherapies

Melatonin & Immune Function

Tina 42:07

in cancer care. Some of the early studies showed it was useful alongside immunotherapies.

Leah 42:13

Yeah, I know when we had patients receiving high dose i l two. For melanoma, which was getting i l two inpatient, like the patient had to be monitored cuz it was a really intense treatment. Um, melatonin was part of, you know, as naturopathic doctors, that was part of the protocol that we would use. Um, it's also used alongside certain chemotherapies to help to support white blood cell count. it has been looked at in conjunction with fish oil to help with maintaining weight. I dunno if it was in particular muscle mass, but, and I don't know, I don't know how definitive, I don't remember how definitive those studies were. I don't think we used the Mela. Uh, I don't use the melatonin anymore. I think of more just using fish oil without the melatonin aspect. But, um, I do remember learning at one point 20 milligrams melatonin plus I don't remember how many grams of fish oil together. That's kind of what was being used when I was going through my training to help to reduce the risk of cachexia and weight loss.

Tina 43:16

Yeah. And so, because I went through my residency back in 2000 to 2002, the 1990s studies, and we were using melatonin 20 milligrams on a pretty regular basis, um, because of some studies that came out from the Lason group over in Italy who used 20 milligrams and showed there was less fatigue during chemotherapy or there was less platelet, deficiency.

Leah 43:37

Right. Blood abnormalities. Yeah,

Tina 43:39

myelosuppression or bone marrow damage. And so we we're using it routinely at that level. and 20 milligrams to me is already a huge dose considering what our body already makes. So this, in the last, I wanna say last year, not more than that, is when we've suddenly are talking about a hundred to 300 milligrams. And I think what's happening is people are extrapolating from rodent studies for the most part. and there is a way to extrapolate from rodent to human in the dosage. And it's not a one for one, it's not a linear thing. You can put in their little calculator online. We'll put a link in our show notes. Again, for anyone who's interested in this, I'm not advocating doing it because the one thing we don't know is, you know,

Mega doses = how much?!

Tina 44:17

our different enough that I wouldn't say extrapolating from a rodent to a. Is advisable when it comes to experimentation, Now we're clinicians and so experimenting with other people's bodies is unethical, in my opinion, and it is an experiment.

Leah 44:35

I think in many people's opinion,

Tina 44:37

No, we have plenty of colleagues and plenty of practitioners out there doing various bits and pieces.

Leah 44:44

oh, that's true.

Tina 44:46

Functional medicine that are doing this and advising people. And ultimately when there is no study telling you what happens over a long term, you are experimenting at people. I think we need to be more honest about it, because I think you're right. I think if people really thought about it, they may not advise these things, I think that there's this almost unwillingness to look at a negative side of things because you don't wanna think that what you've been doing for the last 10 years or 20 years is negative. It's so you kind of put up your blinders and just keep going forward. Um, and I mean this in the, in the best sense of it's our human nature. I don't think this is a, you know, in any way malevolent. I just think it's human nature to not see your own blind spots. Um, but I do think that there's too much experimentation going on in this. We get a whole, whole nother discussion on therapies that I think are experimentational. But if someone says, I'm gonna do that with my body. I've looked at all the literature and I'm doing this, that's very different than me saying you should do that. Those are two different decisions. So I think the 2022 paper that you had referenced earlier, Leia was the, uh, the one that has the title use of melatonin in cancer treatment. Where are we? And that came out in April of 2022. And that has all of the clinical trials as well as a lot of the rodent data in it. Um, that has, that has been done thus far on melatonin in cancer care. So whether or not someone should be taking melatonin is a case by case basis. I could say right now, I don't think I would advocate that huge doses. I don't see why taking more than 20 milligrams should be done unless it's proven to be safe. I don't feel like there's a good safety parameter around it yet. Um,

Leah 46:22

And you said the 20 milligrams came from those lason studies.

Tina 46:25

Yes, yes. That's where it originated, as far as I know, as far as clinical trials. So he did a lot of small clinical trials. They were criticized for not being rigorous enough their design was criticized as well. but in any case, it became kind of the high dose that we use. So this whole new, I would say mega dose is fairly new in the last year or so.

Leah 46:44

there are studies that show melatonin being synergistic with chemotherapies. It's not used as an alternative to treatment, but it's supposed to be, or, you know, synergistic with conventional therapies, I should say. And one of the ones I think of the most is with Tamoxifen, having that synergy with Mela.

Tina 47:05

Yeah, there was a small trial alongside Tamoxifen and they took women who were progressing on Tamoxifen. So they had metastatic breast cancer. I think it was 14 women. And they progressed on Tamoxifen.

Melatonin and estrogen

Tina 47:17

And they took, those same women added melatonin and a good number of them to started to respond better. So the Tamoxifen plus melatonin led to a better response. And these were people who were already progressing on Tamoxifen. And that was the, the kind of amazing thing about this, melatonin does have aromatase inhibition in its mechanisms of action. There's a lot of different mechanisms that melatonin can do within cells lowering, uh, the aromatase enzyme action and aromatase is the enzyme that allows your body to take precursors of estrogen and make them into estrogen molecules. And. Blocking aromatase. You know, as you know, the drug, there are aromatase inhibitors approved on the market. It doesn't do it anywhere near as effectively, cuz those aromatase inhibitors inhibit the aromatase enzyme by up to 97, 90 9%. So those inhibitors that are pharmaceutical are incredibly strong inhibitors where aromatase enzyme melatonin is considered in comparison a mild inhibitor, but it does inhibit aase enzymes.

Leah 48:14

So would somebody who's taking an aromatase inhibitor need to avoid melatonin?

Tina 48:19

I don't think so. But what they're doing, it's, it's like, you know, putting a drop in the ocean kind of thing. It's not gonna do anything. It's the drug is such a potent inhibitor of that enzyme.

Leah 48:29

I was just thinking if somebody needed it for sleep,

Tina 48:31

Oh yeah, it's,

Leah 48:32

because I know that's gonna be a question out there. I, that's just, I was just putting it out. I'm trying, I'm trying to think of like, you know, like, like questions. Um, I'm trying to think of other things where like melatonin might actually be, um, contraindicated or cautions. Caution would be, I know that, you know, it's often a warning if somebody is taking something that makes them drowsy. It may potentially like potentiate drowsiness. So that's, that's one of the warnings you commonly hear.

Tina 49:00

I have definitely had people react poorly to 20 milligrams. Even that, that dose has led to some people getting headaches. and some people

Any negatives?

Tina 49:08

just feel like they can't wake up in the morning, so for whatever reason, their body does not metabolize it quickly. They wake up and they can't wake up. They feel groggy, and sluggish, and they don't really like waking that way. in which case, you know, obviously doing a lower dose might get rid of that. Some people have epic and deeply visual dreams.

Leah 49:27

Mm-hmm. That's what I heard.

Tina 49:29

these are, these are side effects and it's fascinating that the literature is not stronger about all of this. Like I came across a little bit that mentioned, nightmares, irritability. I don't even think nightmares is what I get reported. I get people reporting that their dreams were like epic length and incredibly visual and colorful and

Leah 49:46

Vivid. Yeah. I've heard vivid and disturbing. I haven't necessarily heard nightmare, but just where it's like, yeah, really vivid.

Tina 49:54

I'm fascinated by that.

Leah 49:55

So, so yeah, it's not something that everyone can take, um, back to cancer. I know that there were some studies that looked at it to see if it did reduce mucositis, you know, the mouth sores that you can get from treatments. it's been looked at alongside radiation to help to reduce some of the effects of the bone marrow, where like, you know, you can, your blood counts start to go down, um, for some who get radiation, and so it's supposed to help to counter that as well. If someone is taking a lower dose of melatonin, though I do tend to stop it with radiation because of it's action as an antioxidant.

Tina 50:33

Yeah, this is where it becomes a bit of a conundrum, doesn't it? Because we know melatonin can be protective from ionizing radiation, from damaging the bone marrow when you take a animal and you radiate it. Ionizing radiation is what is used for therapy. It's also what is used for x-rays and it's used for CT scans. Melatonin is one of those, one of those things that's fairly well proven to protect the body from ionizing

Radiation & Melatonin

Tina 50:56

radiation. So using it in some way. If you're someone who's gonna be getting a lot of CT scans, because It will have a cumulative effect. I can see justification for using melatonin

Leah 51:07

And that was, that was one of the studies that Tim had sent us, and that was one that I. Read the study. It was just the abstract. But that was interesting cause I never thought of the use of melatonin for that. And that was a higher dose from what I could tell, that was used in that, um, study. And it's just for a short period of time. It's like prior to getting a CT scan.

Tina 51:26

Yeah, and, and just for the record, CT scans are recognized as having a cumulative effect and the industry of course answers that with how do we make a lower dose machine? So the CT scans of today are a much lower dose than, you know, 20, 30, 40 years ago. So I wanna say, put that out there because some of the data that we're looking at looked at the use of CT scans a long time ago. And so it's apples and oranges if we look at it now. But in any case, there's a role for it in that. Then you flip that coin and say, if you're getting radiotherapy or radiation therapy for your cancer, do you want melatonin in your system? If it's been a tried and true protectant of cells, and I think this is one of those where we say, yeah, maybe not, maybe we just put that to the side and make sure you get what you wanna get outta that radiation and, uh, find another way to get you to sleep. And don't take that.

Leah 52:17

And the studies that I saw years ago that looked at melatonin with radiation, it was taking high dose melatonin for several days prior to starting radiation, and then the person would get their radiation. Um, again, the halflife of melatonin is 30 minutes, but the halflife of radiation is a lot longer So even on, you know, on weekends if somebody's like, can I just take my three milligram melatonin on the weekends to go to sleep? You're still taking a potential antioxidant supplement. Um, so yeah, but if somebody is take, you know, is taking a higher dose of melatonin, you know, 20 plus milligrams, then um, it's not necessarily something that I will hold. And sometimes I talk to people about that, with their chemotherapy with radiation, if it's a higher dose. But, um, it is expensive.

Tina 53:05

is it? I don't, I don't remember

Leah 53:07

The 20 milligrams, um, can be ex, you know, just in, in general it can be expensive. I mean, there are people who take five milligrams and will take four of 'em, and they're fine with that. But, um, yeah, it's just all kind of like, it's, for me, it's, uh, case by case determination. It's not like across the board everyone's getting the 20 milligrams of melatonin or whatever, you know.

Tina 53:28

Mm-hmm. Yeah. And I think some of the reason I'm hesitant is because of the unknown, and anyone who knows me knows that I do not extrapolate information easily because it gets us in a lot of trouble. If it was as easy as extrapolating from animals to humans, we would've solved a lot of diseases by now. So I'm really cautious. Melatonin has many other targets and physiological effects than just the melatonin receptors. And so it looks like we're gonna find out more and we're gonna learn more, and we. figure out exactly what it's doing to the immune cells, to the macrophages, and exactly what it's doing to everything and at what dose. Um, but like, so, so many things, what it does at low dose could be not identical to what it does at high dose. Where the line is drawn between high dose and low dose is also being debated in the literature. Cuz answering that question is not easy. I delved into the literature, I've been doing this o on and off for years with melatonin. Finally, we're getting closer. but it's still tough to, to translate it to what you put in your mouth and say how many nano molars or how many micro molars does it take to have an oxidative effect? Cuz it, it does probably oxidate at some level. Can we get there with an oral dose at all? I don't know, but I'm not gonna take that chance with people taking, you know, hundreds of milligrams at a. Back the radiation, one of the confusing aspects of anything we talk about during radiation is if you layer on another oxidative therapy, then it's okay. But what we don't know is when melatonin goes from antioxidant to oxidant. So we don't know at what dose that happens. If we knew with any kind of confidence that it happens, certainly at such and such dose, 200 milligrams, 500 milligrams, whatever, it's gonna be your intravenous melatonin. I don't know what it's gonna take. But at whatever dose, if you knew you were layering on another oxidative therapy, that's fine. As far as theoretical, you know, outcomes, you're not gonna get in the way of the radiation. With more oxidation, you might have more side effects, but you won't get in the way to variation. So the conundrum here is we don't have enough information to answer the question we need to answer, which is when melatonin becomes an oxidant, at what dose does that happen? When if we can answer that question, then we can be more definitive about dosing at higher ends.

Leah 55:42

And that's why I wanted to be able to have access to that one article because it does talk about, um,

Tina 55:49

What's the name of it? Maybe I have it.

Leah 55:50

um, the article. I mean it's from 1999, but it says the oxidant antioxidant network role of melatonin. And so if you have access to that, send it to me because, um, I don't have access to it. I think what we're basically saying is that there is benefit for melatonin in cancer care. Timing probably is a big part of it. Would you agree?

Tina 56:14

Timing in what sense of the word?

Leah 56:16

In, in terms of like when somebody would take the melatonin? um, I have had patients who take it during the day to help them to relax. Um, I think it's not something that necessarily, like, like one of the big questions that I get with melatonin is if I take it all the time, is it going to make my body stop producing it's natural melatonin? Is it gonna, you know, is there that feedback loop that's gonna stop it?

Tina 56:44

No, no. I think that was something that I ran into a lot for a long time, is I would prescribe melatonin for people. Then they go to the nutrition store or the grocer or whomever get their melatonin and somebody tells them, you know, if you take this, you're gonna get hooked on it. It's gonna stop your own production. Completely not correct. Which is why I kind of think of it like like the ball rolling down

Can my production of melatonin shut down?

Tina 57:04

a hill. This just, this is gonna happen. You're gonna make, serotonin's gonna become melatonin when there's darkness. You can't affect that enzyme with anything but light and dark taking melatonin will not down-regulate that enzyme. You don't have to worry about that. There is no negative feedback loop with melatonin, which is what you would have to have for that to be the case.

Leah 57:22

I'm trying to think of other oncology related, um, uses for melatonin and I, there is that study showing that patients who took five milligrams of melatonin prior to getting, I think it's hysterectomies, that it helped with postoperative pain, um, morphine usage, and. So was like an anti-anxiety. If somebody is taking melatonin prior to getting surgery, it's always best to talk to the anesthesiologist and say, Hey, guess what? This is something that I take. Like if you took it the night before surgery,

More indications...

Leah 57:55

it's even a good idea to, to mention these things. Um, trying to remember other melatonin things, but I think about like, it's kind of cool because it's not just look being looked at in cancer, it's being looked at in um, a covid. It was a big thing with Covid in terms of, were people taking melatonin or not. Um, it was looked at with, patients with Alzheimer's to see its effect on cognitive function. I mean, it's just kind of like, I don't know how to say that it's hot cuz I don't think that this is a current thing. I think this has been ongoing to look at the effect of melatonin on a lot of things like traumatic brain injury and sleep disturbances, you know,

Tina 58:34

Yeah, I. Call one that was for cardiovascular surgery too, had to do with, uh, stents and better outcomes post-surgically. That was just this year came across. But, you know, whenever you're supporting normal physiology, I think that you can expect better outcomes. In other words, you know, especially when you're talking about surgical interventions or things that are gonna throw off your diurnal rhythm, maybe melatonin is useful in just supporting normal physiology. So I think that's a, like we always talk about, it's a different thing to support normal physiology than it is to give a supra physiological dose, in which case you're trying to elicit it in action. A lot like a drug action.

Leah 59:11

Right. So that would be like the number three green pharmacy, you know, reason to take something.

Tina 59:17

So, so some of our take home points are taking lower doses for sleep can be indicated no matter where you are in the cancer continuum.

Leah 59:24

Unless, unless you're getting radiation.

Tina 59:27

Right, unless you're getting radiation, in which case, remember that melatonin is considered supporting your antioxidant pathways. So that can be risky. There's nothing proven to say that it interferes, but at the same time, you're committing to a toxic therapy that you don't wanna undo in any, and I not even theoretically undo. So you can do a lot to repair tissues

Take Home points

Tina 59:52

afterwards and that's what you should concentrate on and not do anything that could even possibly get in the way during the treatment itself. Now, again, if and when we have levels that tell us, oh, it's no longer acting as an antioxidant, it's now being oxidative cuz it's dose dependent, generally that's a different story. But we do not know where that line is right now. We don't know how much it would take to. So abundance of caution, um, post-treatment, sleep issues are, are big in the survivorship population. So well over a third of patients who have had a diagnosis of cancer and have gone through treatment have sleep disturbances. So, uh, melatonin's high on my to-do list, you know, and those sleep amounts. And I consider 20 milligrams a really high dose. And so that's already a high dose super physiological dose. So I don't see any reason to experiment with hundreds of milligrams in people until we know what we're doing.

Leah 1:00:42

Yeah, and the 20 milligram dose, people will take that for sleep. Um, and I will often take them off of that and put them on a low dose and kind of pulse it between doing a high dose, like 20 and a low dose, um, because the 20 milligrams isn't necessarily only supporting sleep. So yeah. So I kind of play with, with the dosage as well, and with patients.

Tina 1:01:06

That makes sense. And yeah, so you can think of it like you would any drug, you take the lowest dose to achieve your desired response. So there's no reason, you know, it says on the bottle, take two Advil. But if one works, why would you take two?

Leah 1:01:18

So that kind of concludes our episode on melatonin. I hope we answered some questions and we probably brought up some more. So send us a letter, uh, the cancer pod gmail.com. Um, you can follow us on Instagram, which is where I am the most. If you happen to be on the Facebook, you can look for us as well. We are the cancer pod on almost all. Uh, well not, we're not on all modes of social media,

Tina 1:01:45

So yeah, hit that follow button. Um, we have plenty of episodes coming up right to us if you're interested, and we'll

Wrap up

Tina 1:01:51

have more interactive material as the year goes on. That's our big goal for 2023, is to have more interaction and to get to know some of our listeners as we have gotten to know Tim a.

Leah 1:02:00

And we're gonna have a couple more episodes, coming up on supplements. Supplements 1 0 1. so, and I know, I know we decided what they're gonna be, but I'm not thinking of them right now because it's getting a little late. And so it'll be a surprise to watch all of us to everyone involved.

Tina 1:02:17

We'll

Leah 1:02:18

That's right. Um, if you enjoy what you are listening to, remember to buy us coffee, um, help us to cover our expenses of having a website and, um, just doing all of the behind the scenes stuff. And like we mentioned, um, we have been planning a Patreon, and so we'll have more content available on that.

Tina 1:02:41

Yeah, keep an eye out for the Patreon because if supplements 1 0 1 is our podcast, then that may be the opportunity to go to 2 0 1 and 4 0 1 and

Leah 1:02:50

4 0 1 for the Totally. Um, and I feel like the more I mentioned Patreon, the more we're gonna feel like, oh, we really gotta get on this

Tina 1:02:58

Yeah, let's just put the promise out there and that's way, that way we'll have to meet the

Leah 1:03:01

Yeah. We, we have to be, he held accountable. So, um, yeah. And, um, happy New Year, I guess to all of y'all out there in, uh, in the listener's world,

Tina 1:03:12

Yeah. Welcome. 2023. Here we go. Here we go. Here we go again,

Leah 1:03:22

oh, on that note, I'm Dr. Leia Sherman,

Tina 1:03:25

And I'm Dr. Tina Kaser.

Leah 1:03:26

and this is the cancer.

Tina 1:03:27

Until next time.

1:03:28

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr. Lea Sherman. And by Dr. Tina Caer music is by Kevin McLeod. See you next time.