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Melatonin Deficiency
Pat Elliott, ND

In recent years, melatonin has been heralded as everything from snake-oil to miracle cure-all. As is often the case, the truth seems to lie somewhere in between. But make no mistake about it, melatonin is not a vitamin or supplement; despite it's over-the-counter accessibility, it is a hormone in the same category as estrogen, testosterone and thyroid hormone. Hormones, as a whole, are some of the most powerful regulatory chemicals functioning within the body. Therefore, hormone-containing supplements and medications should always be used judiciously, never indiscriminately or haphazardly.

Melatonin is secreted in infinitesimal amounts by the pineal gland which lies deep within the brain. Some of the functions of melatonin are well known; many people are familiar with it's reputation as a sleep aid. In fact, one of its physiological functions is to participate in the regulation of sleep onset and quality of sleep. Because of this prime function, melatonin is normally only secreted at night. The trigger for melatonin secretion each evening is decreased light exposure; at the end of the day, when our sunlight exposure decreases, melatonin begins to switch on. This sleep-inducing quality which melatonin possesses is why many people use melatonin supplementation to help them manage them manage nightshift work, counteract occasional insomnia, or minimize jet lag when traveling to different time zones.

Less commonly known are some of the other well-established functions of melatonin. It has strong antioxidant effects, helping us to battle the daily wear and tear effects of free-radicals and thereby slow cellular aging. It is also a powerful regulator of sex hormone production; so powerful, in fact, that for many animals it is the seasonal variability in light exposure and the resulting variability in melatonin secretion throughout the year that produces the animal's seasonal breeding patterns. Interestingly, clinical trials of a new and novel female contraceptive drug which contains high levels of melatonin, called B-Oval, are currently underway in Holland.

Like all hormones, melatonin appears to be most beneficial to those individuals who are not producing adequate levels themselves. Many, including myself, have concerns that people who do not need melatonin but choose to take it as a supplement are disturbing their overall hormonal pattern. Is there any evidence that excess supplementation with melatonin can be harmful? No - at least not yet. However, because melatonin is being touted enthusiastically and misleadingly as a dietary supplement which anyone and everyone will benefit from, because it is available over-the-counter, and because for all other better understood hormones "more" is never "better", the question of melatonin's potential toxicity when used in excess is one which concerns me. For instance, we know melatonin affects sex hormone production. In turn, we also understand that disturbances in these sex hormones can have potentially powerful effects on mood, immunity, reproduction, bone health, cancer risk, heart disease risk, etc. Does elevated melatonin have the capacity to disturb reproductive hormones? It seems logical to suspect that it might, particularly at higher supplemental doses. Regarding hormones in general, an elevated level will usually at some point begin to exert negative effects, some more immediate, and some more subtle and long term. Is melatonin an exception to that rule? It is possible.

Nevertheless, amongst hormones, melatonin has demonstrated itself to be virtually free of any significant or immediately adverse effects. Even at massively high doses given to lab animals, researchers have been unable to produce fatality; therefore a lethal dose of melatonin cannot be identified, a very rare event indeed in toxicology studies. However, more milder side effects, such as headache, morning sleepiness, fatigue, and nightmares are not infrequently experienced by average individuals when they try melatonin. Are these "side effects" of melatonin actually the effects of excessive melatonin levels in people not in need of supplementation? Maybe.

There exists a logical and obvious solution to this problem - that is for individuals to have their melatonin level checked prior to and perhaps during melatonin use, either through a doctor familiar with testing procedures or through a home testing lab open to the general public. In my practice, I test for and prescribe melatonin frequently; I rarely recommend its use in someone who has not been tested. Using this type of carefully applied therapy, the response in my patients has been overwhelmingly beneficial and free from any of the commonly reported adverse effects.  To me, this outcome is not surprising in any way. Thoughtful treatment of identified hormonal deficiency is always a beneficial process for the patient. The body simply cannot function as it was meant to without adequate levels of vital controlling substances stimulating their target cells properly.

The symptoms of melatonin deficiency are not difficult to recognize. Quite often there will be complaints of insomnia or frequent waking, but sometimes only un-refreshing sleep and fatigue are the clues which lead me to be suspicious. Because melatonin levels often decrease with age, it is often particularly useful for the sleep disturbances many people develop as they get older. When low melatonin is the cause of sleep disturbance, I have found the response to therapy in these cases to be prompt and significant for almost every patient.

Another area in which I have seen melatonin evaluation and therapy be quite useful is in conditions related to the reproductive hormones - primarily prostate, testicular, breast and uterine disorders. I suspect that in these situations, the  low melatonin production of these patients is not counter-regulating their sex hormone production adequately. In effect, their reproductive tissue is being over stimulated by the effects of sex hormones. I evaluate melatonin production in men with any chronic prostate problem, whether it is inflamed, enlarged, or chronically infected. It is also useful to check melatonin levels in women who have PMS, endometriosis, fibroids, fibrocystic breasts, and menstrual disturbances.

Research on the melatonin levels in breast and prostate cancer patient has led to support for the contention that melatonin deficiency may be linked to increased risks for these cancers. It has been my experience that a large proportion of young women with a close family history of breast cancer have low melatonin levels themselves; I consider melatonin evaluation to be a wise and crucial part of a comprehensive approach to breast cancer prevention for women at higher than average risk

Other symptoms of insufficient melatonin production can be ascribed to the drain on vitality which poor sleep quality produces over time. People with low melatonin will eventually begin to show signs of wear and tear, often taking the form of the common sleep deprivation symptoms of irritability, and poor concentration. However, when one lacks the rejuvenating effects of restful sleep, the effects can present, depending on an individual's particular weaknesses and lifestyle, in a multitude of ways. I often check melatonin levels in people with chronic diseases or symptoms. Adequate sleep is sometimes the crucial missing link needed to encourage the body to begin healing.

Melatonin is on many researchers' minds due to the beneficial effects melatonin seems to have on many types of conditions beyond insomnia. Some of the areas of current interest and research include: immune disturbances including HIV, cancer therapy, high cholesterol, high blood pressure, depression, bipolar disorder, Alzheimer's, aging, autism, epilepsy, sudden infant death syndrome, and diabetes. So compelling is the evidence, that I would urge everyone with the above conditions to check their melatonin level to determine if a deficiency may be contributing to their health problems.

Sometimes melatonin disturbance is the sole reason for insomnia or another problem. Sometimes there are many factors, some big, some small, that contribute together to create a particular illness. But, no matter how many factors are involved, each one is important for the overall working of the body. Just as one, small instrument in an entire orchestra is an essential part of the music produced; melatonin, the hormone secreted in miniscule amounts, is essential to the harmonious symphony known as the human body.

Common symptoms and signs of melatonin deficiency:
difficulty getting to sleep
difficulty falling back to sleep when awaken during the night
light sleeper/easy waking during the night
early morning awakening
un-refreshing sleep
lack of dreaming
family history of insomnia
personal or family history of breast cancer
personal or family history of prostate cancer
prostate enlargement
irregular menstrual cycle
unusual menstrual flow (light or heavy)
poor sleeping prior to menses
sensitivity to stress
neurodegerative disorder (MS, Parkinson's, Alzheimer's, ALS, etc)
elevated cholesterol
high blood pressure
blood clots
heart attack
heart arrhythmias
For more information about melatonin:
Melatonin:  Nature's Sleeping Pill by Ray Sahelian
Melatonin by Russel Reiter, Ph.D. and Jo Robinson


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Pat Elliott, ND
Elliott Health Care Associates
1155 N State ST, Suite 610, Bellingham, WA 98225

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