Dear Friends,
You may have seen the recent report about a study sponsored by the American Heart Association that found long term use of melatonin by those with chronic insomnia may increase the risk of heart failure, the likelihood of hospitalization from that condition, and even increase the chances of death from all causes.
If you’ve been reading my emails for the last few years, you may recall that I’m not a fan of melatonin supplements and feel at best they should only be taken occasionally, and not in the large dosages being taken by millions of Americans.
Nonetheless, I think there’s a lot of issues with how this study was conducted, and as a result it’s not clear what we can take away and learn from it.
In this letter we’ll break it all down, and after we go through the study, I’ll summarize my thoughts and concerns about melatonin supplements - and review what I think is a better way to help your body produce the melatonin it needs in the evening.
Results Released Without Peer Review
So diving into the study, to start, this research hasn’t even been peer-reviewed and published yet, and given the alarming nature and controversary of the findings, I don’t think the American Heart Association should have rushed to release what they called “preliminary” findings without all the details.
In this melatonin study, the researchers looked at 5 years of electronic medical records from 132,000 adults with chronic insomnia from several countries, with most of the subjects apparently coming from the United Kingdom and the United States.
This is one of the biggest issues with this study as melatonin products are sold in different ways in these countries.
For example, in the United Kingdom, melatonin is only sold by prescription, so it’s very likely medical records from study participants from the UK would reflect their melatonin usage.
However, in the United States melatonin is sold over-the-counter, not by prescription.
So it may be in your medical records or may not be, depending on what was recorded by your doctor’s office.
In this study, if a US resident took melatonin supplements, but it wasn’t in their electronic records, they were classified as a non-melatonin user.
Not really accurate – and would seemingly impact the quality of the study data, as you’re going to have numerous melatonin users put into the non-melatonin user group.
And then there’s the question of precision of the data.
The thrust of this study was to focus on long term melatonin usage, defined as a year or more.
If you’re from the UK, that’s fairly easy to determine – if the medical records show six 90 day prescriptions, then it’s logical to assume that person had been using melatonin for a year and a half
Let’s say you’re from the US and your doctor noted you’re taking melatonin supplements. How precise will the length of time information be? Was it logged at all?
I know when I go to the doctor, I bring a list of the supplements I take – because I take a lot – and no one has ever asked me how long I take these products. So again this creates data quality concerns.
Results Suggest Potential Heart Health Risks
Based on these classifications, the researchers found that over 5 years, the melatonin users had a 90% higher chance of a heart failure incident than those classified as non-melatonin users.
That doesn’t mean 90% of users experienced heart failure, it was 4.6% for the melatonin users versus 2.7% for the melatonin group, and 4.6% is 90% greater than 2.7%.
Now, some knowledgeable observers noted it could be tricky using electronic records to determine heart failure incidents, as they get coded differently in various facilities – which could be another data issue with the study.
I have no idea, that’s way out of my wheelhouse, but some experts commenting on the study brought this up.
The researchers also found that melatonin users were about 3.5 times as likely to be hospitalized because of heart failure, and melatonin users were twice as likely to die from any cause during the study period- about 7.8% of the melatonin users died versus 2.7% of the non-users over the 5 year period.
These statistics sound pretty scary, but again this study wasn’t the population at large.
The study subjects were those with chronic insomnia, a serious condition.
One question I have - are UK physicians more likely to prescribe melatonin to those who are more seriously ill, and does that in part explain why more experienced heart failure (or worse)?
Another question I have, and maybe this gets flushed out in the final publication, but did the dosage taken matter?
I looked it up online and it appears that the most common prescription in the UK is 2mg of sustained release melatonin, whereas in the US, supplements contain anywhere from 1 to 10mg of melatonin. Does the form and dosage make a difference?
So while this study suffered from some significant data quality issues, and perhaps produced more questions than answers, the long-term risk of chronic melatonin use is a topic worthy of better-quality research studies to get more definitive answers.
We can’t outright dismiss this study or draw any conclusions, in my opinion.
Melatonin Supplements Should Be Used Sparingly
As I mentioned at the outset, I’m not a proponent of melatonin supplements and believe they should be used sparingly, if at all, unless you’re following doctor’s orders.
About 25% of melatonin supplement users experience grogginess as an unwanted side-effect. This means you wake up in the morning feeling groggy or experience drowsiness during the day.
And over time melatonin supplements may disrupt the sleep/wake cycle, also called the circadian rhythm.
Remember, your body only produces a small amount of melatonin in the evening as it gets close to bedtime, and you get sleepy.
Melatonin levels continue to rise as you go to bed, usually peaking at around 2am or 3am.
At this point, the body stops producing and releasing melatonin - and levels start declining as it gets closer to wake time.
And as part of the circadian rhythm, cortisol levels start to rise to help you wake up (yes cortisol in a healthy range is very important).
Now, here’s an important point - daytime levels of melatonin in your body are barely detectable.
The melatonin your body made is almost all gone so you can feel awake and energized during the day, not sleepy or groggy.
Taking extra synthetic melatonin regularly may disrupt this process. And think about the cycle this can create:
You feel tired during the day because of the melatonin supplements, so you reach for extra caffeine or energy drinks to compensate (which can hurt your ability to sleep), and then at night you start all over again. Talk about a vicious cycle.
A Better Approach for Melatonin Support
We think for many people there’s a better alternative to taking synthetic melatonin supplements.
Remember, normally your body only makes around 300mcg of melatonin at night – that’s only 3/10 of 1 mg.
If you’re coming up short as you age or because of other factors, you shouldn’t need to take 5mg of synthetic melatonin to compensate – that makes it extra hard for body to clear by morning.
You can support your body’s natural melatonin production and boost your evening melatonin with the saffron spice – and specifically with a saffron extract used in supplements called Affron.
If you’re not familiar with saffron as a supplement, there’s been a lot of research done over the last 15 years showing that it can help the body cope with stress better and promote better moods during the day.
Other compounds in saffron can have important vision and eye health benefits.
In addition, the Affron saffron extract helps the body produce enzymes used to convert the amino acid L-tryptophan into melatonin.
That’s the main way your body makes melatonin – it takes the tryptophan we get from diet and converts some of it to melatonin, and saffron has been shown to help support this process and increase sleep quality.
We think this is preferable to taking synthetic melatonin.
The bottom line is the delicate balance of the sleep/wake cycle circadian rhythm is best managed by the body.
Your body knows how much melatonin it needs, and saffron can help support melatonin production, so it’s more likely to be available when needed.
We feature the Affron saffron extract discussed today in our TrueZs supplement, along with two other complementary ingredients that can help you fall asleep faster, sleep better, and wake up feeling refreshed and more ready to take on the day.
You may start to feel a difference from the ingredients in TrueZs in the first week, but it typically takes a few weeks to feel many of the desired benefits – which many users believe is well worth it.
Yours for Good Health,
Carl Pradelli
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