The natural sleep remedy melatonin: is it safe and effective?

There’s no doubt that getting enough sleep is key for good health. Too little shut-eye, besides making you feel lousy, is linked to weight gain and a higher risk for today’s common illnesses such as diabetes and heart disease. As a result, sleep aids are hot sellers. For some, melatonin is the remedy of choice as it’s considered to be a natural and drug-free option. But is it really as harmless as many think?

First of all, let’s banish for once and all the concept that because something is natural, it’s safe. After all, arsenic is natural. So is hemlock which was used as a drink in executions.

The use of a melatonin supplement is a perfect example of the 16th century wisdom “the dose makes the poison”. While melatonin is certainly not considered to be lethal or poisonous, the dose is critical when it comes to potential side effects. Melatonin can also interact with other medications. And yes, it is a medication in the strictest sense of the word. While it is a hormone our bodies naturally produce when exposed to darkness, when you take it by mouth, for health’s sake, that’s the way you should think of it.

All too often, when I ask individuals how much melatonin they’re taking, the answer is simply “one melatonin tablet”. Just check out the photo on this post. The display at my local Costco is what prompted this post in the first place. To say I was shocked to see a 10 milligram tablet of melatonin being sold on a huge display is an understatement. (More on why I reacted this way later.)

The most common dose of melatonin on store shelves is 3 mg, in spite of the latest research suggesting that users initially start of at 0.3 mg. That’s just one-tenth of the amount. If necessary, increasing dosages slightly may be helpful to some but higher doses may bring some surprising and unwanted side effects.

One such lesser known side effect may be aggressive behaviour – something I looked into while on vacation a while ago. One of my travelling companions was suddenly reacting quite strangely at common aggravations. He was ready to punch out someone who accused him of stealing their parking spot. There were a few other angry outbursts as well. As he was quite surprised himself at how angry he was getting, a discussion followed and the recent use of melatonin came up.

A quick search of the research revealed that there had indeed been reports of aggressive behaviour with the use of melatonin. The most recent involved 63 healthy male volunteers either given melatonin or placebo and then provided with the opportunity to administer high or low punishments to an opponent. Those subjects given melatonin selected the high punishment more often than those who took the placebo. Clinicians recommend that for aggressive or irritable patients taking melatonin, a trial period of discontinuation may be indicated.

For my travelling companion, stopping the use of melatonin brought an immediate return to normal reactions to these types of situations.

For some melatonin users, this potential side is definitely worth noting.

Higher doses, even the popular 3 mg one, may be less effective in providing the results you may be after. For one, you may experience a “hangover” the next morning and feel groggy. Others report having very vivid dreams. For me personally, anything more than 0.5 mg yields a restless sleep of non-stop nightmares so when I do take melatonin, I am very careful about how much I take. But that’s just me.

There are conditions where higher amounts may be used or when the body’s own melatonin production may be impaired. Jet-lag, shift work and or in some elderly, melatonin shortages may occur. Higher dosages are also used to treat some ailments but this is done under medical supervision. A few examples include Alzheimer’s disease or dementia, bipolar disorder, some cancers, chronic obstructive pulmonary disease (COPD), beta-blocker-induced insomnia, endometriosis, seasonal affective disorder (SAD) and migraine and cluster headaches.

In the case of jet-lag, those travelling eastbound through at least five time zones may benefit from melatonin, when it’s taken at local bedtime on the day you arrive and then continuing it for a few nights afterwards. But forget about taking melatonin before travelling as it doesn’t prevent jet lag.

Before you pop a natural melatonin tablet, here are a few other facts to consider:

• Some research shows it may interact with medications for diabetes and result in higher blood sugar readings. Other research doesn’t back this up so until more is known, it’s best to proceed with caution.

• In high doses, it may inhibit ovulation so women who are planning to become pregnant may want to avoid taking a melatonin supplement. As it’s not yet known whether lower doses also have a contraceptive effect, it’s best to avoid if you’re thinking about getting pregnant, or are currently pregnant or breastfeeding.

• It interacts with blood thinners such as warfarin (Coumadin) so anyone taking this medication should steer clear of melatonin.

• Anyone taking the medication fluvoxamine (Luvox) for depression or anxiety should also avoid melatonin.

• Melatonin may interfere with immunosuppressant medication so those taking these medications should check with their physician.

• There may be interactions with the herb Echinacea and result in a decrease in immune system function.

The bottom line here is melatonin may indeed be effective but as with any medication, natural or otherwise, do your homework before you take it.

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Categories: Food Safety, Food Trends

Author:Rosie Schwartz

Rosie Schwartz is a Toronto-based consulting dietitian and writer.

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