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This week's topic: Can Melatonin Help Reflux?
The go-to treatment for reflux in mainstream medicine is a proton pump inhibitor (PPI), which can be great at controlling symptoms and improving esophagitis and gastritis in many patients. However, some research highlights potential side effects with long term use of these drugs, which include increased risk of GI infection, nutrient deficiencies, cardiovascular issues, kidney disease, fractures, and cancer.
We know there are many physiologic purposes behind stomach acid, so it would make sense that long term use of PPIs (which increase the pH from 2 to 6) would have consequences! But did you know that melatonin may be helpful in addressing GERD, as well as weaning patients off a PPI?
Overview of today's email:
- Melatonin in the gut
- Practical clinical tips
Note, in functional medicine, hypochlorhydria (low stomach acid) is often attributed as a cause of GERD and reflux. This may or may not be true for a patient, but keep your "critical thinking cap" on, and think about the physiology of the LES (not just the amount of stomach acid) when working with patients experiencing GERD.
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1. Melatonin in the gut
Melatonin is mostly known for its role in supporting sleep/wake cycles. However, in addition to being made in the pineal gland, many other organs produce this hormone (including bone marrow cells, the retina, mast cells, and the GI tract).
In fact, the gut actually produces 400x more melatonin than the pineal gland!
Some other interesting facts about melatonin in the gut...
- It regulates motility of the lower gut (especially when LPS is involved)
- When taken exogenously, it may help alleviate visceral hypersensitivity in IBS
- Melatonin increases NK cell activity and Th2 cell-mediated immune response
- It protects GI mucosa and inhibits gastric acid secretion
- It stimulates the contractility of the LES (lower esophageal sphincter) (per one RCT, the LES tone may improve within 40 days)
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2. Practical Clinical Tips
I was first made aware of potential side effects of PPIs a few years ago when a coworker was admitted to the hospital for weakness and uncontrolled heart dysrhythmias. It took a few days, but ultimately magnesium deficiency associated with long term use of omeprazole was the cause (magnesium deficiency is one of the primary nutrient deficiencies associated with PPIs).
I still use a PPI short term if indicated (and always in combination with other therapies), but I mostly utilize a functional medicine approach for GERD in my clinical practice.
Some tips when recommending melatonin for GERD:
- DOSE: Start with a liquid option if a patient has not had melatonin before (often, 1 drop = 1mg), and build to a dose of 6 mg if possible
- TIMING: To decrease morning drowsiness, melatonin is best taken 2 hours before bed (I often recommend patients take it with dinner)
- DURATION: Have patients take melatonin for at least 8 weeks; however, if no noticeable improvement within 5-6 weeks (in combination with lifestyle support, in particular working on optimizing Circadian rhythms of other hormones and sleep), stop use
- ADJUNCTIVE THERAPY: Since melatonin improves LES tone, I highly recommend connecting the patient with a respiratory therapist who can teach exercises that improve tone of the LES. I don't believe patients innately have a melatonin deficiency and need to take this forever!
- SIDE EFFECTS: Some patients cannot tolerate melatonin (e.g. it's stimulating or causes nightmares). These side effects may be due too high of a dose, high inflammation, or to taking melatonin in a heightened state of stress (and melatonin increases REM sleep duration, when emotions are often processed).
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I hope this was clinically useful!
Would you mind filling out a one question survey to let me know which topics you found most helpful? Thank you!
Meg
P.S. Check out Dr. Deanna Minich's 2022 review on other roles of melatonin!
Additional resources that may be helpful
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