Is Melatonin Safe for Long-Term Use?

Does it prevent our body from making melatonin on its own? Are there withdrawal effects when you stop taking it? These are all great questions we are asked often. To answer them, let’s review what melatonin is, what it is used for, and what the research is saying.

What is melatonin?

Melatonin is a hormone that is produced in response to darkness by the pineal gland. It was once thought that its sole purpose was to regulate our internal circadian rhythm (our internal 24 hour clock) and aid in sleep[1]. However, we are now discovering it has roles far beyond this. We now know melatonin has anti-oxidant, anti-ageing, immunomodulating and anticancer properties as well[2]. Research suggests that melatonin may also play roles in our levels of human growth hormone[3] [4], eye health [5] [6], Gastroesophageal reflux disease (heartburn) treatment [7] [8] [9], anxiety prevention[10] [11], and the treatment (adjunctive) and prevention of cancers such as breast cancer[12] [13].

Here's what the research says:

To date, researchers appear to agree that supplementing melatonin (including doses up to 100mg/day) is well tolerated and is not typically associated with any serious adverse affects[14] [15]. The mild adverse effects that have been reported include drowsiness, headaches and dizziness and nausea[16]. Of these mild adverse effects, research suggests they either resolve spontaneously within a few days with no adjustment in melatonin, or immediately upon withdrawal of treatment[17]. Melatonin has not been found to be addictive in nature nor cause hangover symptoms[18], which is why it has been considered as a possible alternative to many sleep medications. In addition to this, research also suggests that the supplementation of melatonin does not interfere with the bodies internal production of melatonin once treatment has ceased[19] [20]. This makes sense when we consider that the half life (the time it takes for half of a drug to be cleared) of melatonin is only 1-2 hours depending on the formulation. This means that in 1-2 hours 50% of the melatonin will be removed from the body. Therefore, in 5 hours the amount of melatonin in the body is negligible and the body knows start producing a “new batch” of melatonin in the pineal gland as soon as you are exposed to light in the morning. Given that melatonin has a short half life, melatonin only targets sleep onset and not maintenance. Because of the short half life, we see so many prolonged release formulations of melatonin to slow down the absorption into the bloodstream to ensure the levels of melatonin are maintained in blood stream for a longer period to extend its sleep benefits. Prolonged release formulas allow you to maintain higher active levels of melatonin throughout the night if your goal with supplementing melatonin is to prevent nighttime waking.

But what about our more vulnerable populations such as children or elderly people?

In children, research suggests adverse effects of melatonin supplementation were few and mild[21]. Of these adverse effects, fatigue and somnolence were mentioned and were found to resolve with dose reduction. In addition, studies on pediatric populations looking at the long term effects of melatonin supplementation (two, three and four years on average) in doses of 2mg-10mg/day, found no notable long term effects on vitals signs or measures of child growth[22] [23]. In a two year long study assessing sleep, growth and puberty in children taking melatonin, a two week placebo period was implemented after treatment to assess withdrawal effects to which there were no apparent signs of withdrawals (mallow).

A 2022 review article discussing the safety of melatonin use in the elderly found that adverse effects were similar to those found in adult populations such as dizziness, nausea and headaches[24].However, there may be an increased risk of hypothermia if melatonin levels reach above normal physiologic levels as well as fractures in those who are at risk of falling due to the possibility of daytime sedation [25]. In regards to discontinuation, research suggests there is no evidence of withdrawal effects in populations 55 years and older[26].

It is important to note that the above research does not include individuals on medications or health concerns/diagnoses outside the parameters of each individual study. Therefore, it is important to discuss melatonin supplementation with your healthcare provider before taking.

In summary, it is SAFE to say melatonin is SAFE for those who are taking melatonin long term as recommended by their health care provider for one of the many clinical benefits we see with melatonin supplementation. 

[1] Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One. 2013 May 17;8(5):e63773. doi: 10.1371/journal.pone.0063773. PMID: 23691095; PMCID: PMC3656905.

[2] Bhattacharya S, Patel KK, Dehari D, Agrawal AK, Singh S. Melatonin and its ubiquitous anticancer effects. Mol Cell Biochem. 2019 Dec;462(1-2):133-155. doi: 10.1007/s11010-019-03617-5. Epub 2019 Aug 26. PMID: 31451998.

[3] Forsling ML, Wheeler MJ, Williams AJ. The effect of melatonin administration on pituitary hormone secretion in man. Clin Endocrinol (Oxf). 1999 Nov;51(5):637-42. doi: 10.1046/j.1365-2265.1999.00820.x. PMID: 10594526.

[4] Valcavi R, Zini M, Maestroni GJ, Conti A, Portioli I. Melatonin stimulates growth hormone secretion through pathways other than the growth hormone-releasing hormone. Clin Endocrinol (Oxf). 1993 Aug;39(2):193-9. doi: 10.1111/j.1365-2265.1993.tb01773.x. PMID: 8370132.

[5] Lundmark PO, Pandi-Perumal SR, Srinivasan V, Cardinali DP. Role of melatonin in the eye and ocular dysfunctions. Vis Neurosci. 2006 Nov-Dec;23(6):853-62. doi: 10.1017/S0952523806230189. PMID: 17266777.

[6] Yi C, Pan X, Yan H, Guo M, Pierpaoli W. Effects of melatonin in age-related macular degeneration. Ann N Y Acad Sci. 2005 Dec;1057:384-92. doi: 10.1196/annals.1356.029. PMID: 16399908.

[7] Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006 Oct;41(3):195-200. doi: 10.1111/j.1600-079X.2006.00359.x. PMID: 16948779.

[8] Kandil TS, Mousa AA, El-Gendy AA, Abbas AM. The potential therapeutic effect of melatonin in Gastro-Esophageal Reflux Disease. BMC Gastroenterol. 2010 Jan 18;10:7. doi: 10.1186/1471-230X-10-7. PMID: 20082715; PMCID: PMC2821302.

[9] Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006 Oct;41(3):195-200. doi: 10.1111/j.1600-079X.2006.00359.x. PMID: 16948779.

[10] Khare A, Thada B, Jain N, Singh D, Singh M, Sethi SK. Comparison of Effects of Oral Melatonin with Oral Alprazolam used as a Premedicant in Adult Patients Undergoing Various Surgical Procedures under General Anesthesia: A Prospective Randomized Placebo-Controlled Study. Anesth Essays Res. 2018 Jul-Sep;12(3):657-662. doi: 10.4103/aer.AER_90_18. PMID: 30283171; PMCID: PMC6157235.

[11] Ghaeli P, Solduzian M, Vejdani S, Talasaz AH. Comparison of the Effects of Melatonin and Oxazepam on Anxiety Levels and Sleep Quality in Patients With ST-Segment-Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial. Ann Pharmacother. 2018 Oct;52(10):949-955. doi: 10.1177/1060028018776608. Epub 2018 May 11. PMID: 29749262.

[12] Li Y, Li S, Zhou Y, Meng X, Zhang JJ, Xu DP, Li HB. Melatonin for the prevention and treatment of cancer. Oncotarget. 2017 Jun 13;8(24):39896-39921. doi: 10.18632/oncotarget.16379. PMID: 28415828; PMCID: PMC5503661.

[13] Yang A, Peng F, Zhu L, Li X, Ou S, Huang Z, Wu S, Peng C, Liu P, Kong Y. Melatonin inhibits triple-negative breast cancer progression through the Lnc049808-FUNDC1 pathway. Cell Death Dis. 2021 Jul 16;12(8):712. doi: 10.1038/s41419-021-04006-x. PMID: 34272359; PMCID: PMC8285388.

[14] Menczel Schrire Z, Phillips CL, Chapman JL, Duffy SL, Wong G, D'Rozario AL, Comas M, Raisin I, Saini B, Gordon CJ, McKinnon AC, Naismith SL, Marshall NS, Grunstein RR, Hoyos CM. Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. J Pineal Res. 2022 Mar;72(2):e12782. doi: 10.1111/jpi.12782. Epub 2021 Dec 30. PMID: 34923676.

[15] Andersen LP, Gögenur I, Rosenberg J, Reiter RJ. The Safety of Melatonin in Humans. Clin Drug Investig. 2016 Mar;36(3):169-75. doi: 10.1007/s40261-015-0368-5. PMID: 26692007.

[16] Savage RA, Zafar N, Yohannan S, et al. Melatonin. [Updated 2021 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534823/

[17] Besag FMC, Vasey MJ, Lao KSJ, Wong ICK. Adverse Events Associated with Melatonin for the Treatment of Primary or Secondary Sleep Disorders: A Systematic Review. CNS Drugs. 2019 Dec;33(12):1167-1186. doi: 10.1007/s40263-019-00680-w. PMID: 31722088.

[18] Cardinali DP, Srinivasan V, Brzezinski A, Brown GM. Melatonin and its analogs in insomnia and depression. J Pineal Res. 2012 May;52(4):365-75. doi: 10.1111/j.1600-079X.2011.00962.x. Epub 2011 Sep 23. PMID: 21951153.

[19] Matsumoto M, Sack RL, Blood ML, Lewy AJ. The amplitude of endogenous melatonin production is not affected by melatonin treatment in humans. J Pineal Res. 1997 Jan;22(1):42-4. doi: 10.1111/j.1600-079x.1997.tb00301.x. PMID: 9062869.

[20] Hack LM, Lockley SW, Arendt J, Skene DJ. The effects of low-dose 0.5-mg melatonin on the free-running circadian rhythms of blind subjects. J Biol Rhythms. 2003 Oct;18(5):420-9. doi: 10.1177/0748730403256796. PMID: 14582858.

[21] Maras A, Schroder CM, Malow BA, Findling RL, Breddy J, Nir T, Shahmoon S, Zisapel N, Gringras P. Long-Term Efficacy and Safety of Pediatric Prolonged-Release Melatonin for Insomnia in Children with Autism Spectrum Disorder. J Child Adolesc Psychopharmacol. 2018 Dec;28(10):699-710. doi: 10.1089/cap.2018.0020. Epub 2018 Oct 11. PMID: 30132686; PMCID: PMC6306655.

[22] Malow BA, Findling RL, Schroder CM, Maras A, Breddy J, Nir T, Zisapel N, Gringras P. Sleep, Growth, and Puberty After 2 Years of Prolonged-Release Melatonin in Children With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry. 2021 Feb;60(2):252-261.e3. doi: 10.1016/j.jaac.2019.12.007. Epub 2020 Jan 23. PMID: 31982581; PMCID: PMC8084705.

[23] Kennaway, D.J. (2015), Melatonin use in paediatrics. J Paediatr Child Health, 51: 584-589. https://doi.org/10.1111/jpc.12840

[24] Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30. doi: 10.1210/jcem.86.10.7901. PMID: 11600532.

[25] Should Melatonin Be Used as a Sleeping Aid for Elderly People? Can J Hosp Pharm. 2019 Jul-Aug;72(4):327-329. Epub 2018 Aug 31. PMID: 31452545; PMCID: PMC6699865.

[26] Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007 Dec;16(4):372-80. doi: 10.1111/j.1365-2869.2007.00613.x. PMID: 18036082.

Glutathione in the Treatment of Fatty Liver/NASH/NAFLD

Have you been told you have a “fatty liver” despite not consuming high amounts of alcohol? If so, you have NAFLD or NASH.

What is NASH/NAFLD?

>> Nonalcoholic Fatty Liver Disease (NAFLD, Hepatic Steatosis, NASH)

Non-alcoholic fatty liver disease (NAFLD) is a chronic and multifactorial disorder characterized by excessive fatty acid accumulation in liver cells. Associated with metabolic syndromes, NAFLD is increasingly being recognized as a major cause of liver disease. It is a spectrum of liver abnormalities that ranges from nonalcoholic fatty liver to steatohepatitis, cirrhosis, and liver cancer. It is estimated that 25% of the global population has NAFLD, a number projected to continue to rise, and as it does, it is expected that more of these cases will progress to end-stage disease states requiring liver transplantation. A larger percentage of liver cancers in these cases occur before end-stage liver failure, and thus are less likely to be screened for, increasing the tendencies for liver tumors to be larger and more difficult to treat at the time they are diagnosed. Testing and diagnosis of NAFLD may include blood tests, imaging, and biopsy.

What causes it? 

Risk Factors

•    Metabolic syndrome (strongest risk factor)

• increased waist circumference (obesity)

• insulin resistance

• elevations in:

  • blood sugar

  • cholesterol

  • triglycerides

  • blood pressure

  • uric acid

•    Diabetes (up to 75% of individuals with type 2 diabetes have NAFLD)

•    Sleep apnea

•    Gut microbiome effects

•    Genetic factors

Image: Friedman et al. 2018

Why is it important to address?

Patients with NAFLD are twice as likely to die of cardiovascular disease than liver disease as a result of these shared risk factors. NAFLD in itself is an independent risk factor for cardiovascular disease due to its impacts on vascular health and inflammation.

How does it happen & what you can do about it?

Free fatty acids from either adipose tissue (fat), or from the conversion of excess carbohydrate intake, accumulate in the liver cell resulting in oxidative stress, inflammation, and liver injury.

As such, healthy eating habits and regular exercise can reduce the amount of free fatty acids and thereby prevent or reverse NAFLD. Glutathione supplementation can also help in the recovery of NASH/NAFLD.

What is Glutathione?

Glutathione (GSH) is a tripeptide made from amino acids, that is present in every cell of the human body, though is highly concentrated in the liver. Known as the ‘master antioxidant’ it directly scavenges reactive oxygen species, protecting your body from oxidative damage, and plays a crucial role in detoxification and cellular health. Reduced levels of glutathione have been associated with increased disease risk and progression, including NAFLD and other liver pathologies.

In addition to healthy diet and lifestyle habits, preliminary studies have shown beneficial effects of supplemental glutathione in the treatment of NAFLD, demonstrating a reduction of ALT–a liver enzyme elevated in liver dysfunction and one of the principal NAFLD biomarkers–after four months of treatment. Other studies demonstrated intravenous glutathione rapidly improved liver function, also evidenced by reduced biomarkers, in the treatment of other liver pathologies including chronic hepatitis B. Various nutrients, amino acids, herbal extracts, and probiotics have also been shown to increase glutathione activity in the body, and may be used in conjunction for enhanced therapeutic effect.

Find out if Glutathione is an option for you!

At Saskatoon Naturopathic Medicine, we offer both oral and intravenous glutathione for the treatment of NAFLD and other conditions, as part of our comprehensive approach to our patients’ unique health history and needs. If you are interested in learning more about how we can assist you, give us a call or book online to connect with one of our naturopathic doctors who would be happy to assess your case and discuss treatment options appropriate for you.

*IV therapy requires a consultation and evaluation by one of our IV doctors to assess patient eligibility and treatment goals. For more information see our IV therapy page. 

Jacalyn Sieben, ND

Sources:

Friedman, S. L., Neuschwander-Tetri, B. A., Rinella, M., & Sanyal, A. J. (2018). Mechanisms of NAFLD development and therapeutic strategies. Nature medicine, 24(7), 908–922. https://doi.org/10.1038/s41591-018-0104-9

Honda et al. (2017). Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study. BMC Gastroenterology. 17:96 DOI 10.1186/s12876-017-0652-3. https://pubmed.ncbi.nlm.nih.gov/28789631/

Vairetti, M., Di Pasqua, L. G., Cagna, M., Richelmi, P., Ferrigno, A., & Berardo, C. (2021). Changes in Glutathione Content in Liver Diseases: An Update. Antioxidants, 10(3), 364. MDPI AG. Retrieved from http://dx.doi.org/10.3390/antiox10030364

Qian, L., Wang, W., Zhou, Y., & Ma, J. (2017). Effects of reduced glutathione therapy on chronic hepatitis B. Central-European journal of immunology, 42(1), 97–100. https://doi.org/10.5114/ceji.2016.65894

Make Every Day Self-Care Day!

Our busy, modern lives can sometimes make it hard for us to tune into our body’s needs. Here are some of our favorite tips on how to keep balanced while keeping busy!

At home…

Get Outside

Being in nature has numerous mental and physical benefits. Nature therapy has gained popularity as a means to reduce stress and promote healing. Research has come to the same conclusion as nature therapy practices have been shown to reduce heart rate, blood pressure, and the stress hormone, cortisol, when compared to measurements in other environments. (1)

Connect With Loved Ones

It likely does not come as a surprise that social isolation is associated with increased risk for mental health problems–in particular, depression, anxiety, stress-related disorders, and anger. Try to make an active effort to spend time with people you love whether you are able to do so in person or via a virtual connection. (2)

Screen Time Breaks

While technology has improved our lives in an abundance of ways, there can be too much of a good thing. Studies show that increased screen time is associated with negative outcomes such as lowered self-esteem, increased incidence and severity of mental health issues and addictions, slowed learning and acquisition, and an increased risk of premature cognitive decline. Use your screen time wisely–in moderation and with intention. Consider setting time limits on your devices and cleaning up your follow lists on social media to make your social feeds more of a positive space to engage with. (3)

Balanced Nutrition

Enjoying a balanced variety of nutrient-rich, whole foods to fuel your body optimally helps to reduce inflammation and keep your blood sugar (and moods) stable. In general, you should aim for half of your plate to be vegetables, 1/4 complex carbs (whole grains, starchy vegetables), and 1/4 protein. Healthy fats should be incorporated into each meal (avocado, nuts, olive oil, etc), and fruit makes for excellent snacks or dessert. Water intake is imperative for the maintenance of good health and most healthy adults should aim for 2-3L of water daily.

Sleep

It’s not just for beauty! As neuroscientist Matthew Walker says, “There does not seem to be one major organ within the body, or process within the brain, that isn’t optimally enhanced by sleep (and detrimentally impaired when we don’t get enough).” Adequate, quality sleep (7-9 hours per night) is vital for tissue regeneration, and slacking on your sleep can increase your propensity for weight gain, chronic disease, and even cancer. If you are struggling to get a good night’s sleep, our naturopathic doctors would love to help!

At Saskatoon Naturopathic Medicine…

Acupuncture

An effective traditional therapy for many conditions including stress, anxiety, sleep, pain, digestion, and hormonal concerns.

Massage

Our knowledgeable massage therapists offer relaxing and therapeutic massage as well as myofascial release and patient self-care education such as stretching, strengthening and postural awareness.

Somatic Experiencing™

Somatic Experiencing™ is a body-based approach to treating the effects of trauma. Specifically, the symptoms that arise when trauma is held in the body, including chronic or severe pain that does not respond well to medication, headaches, digestive issues, fear, difficulty sleeping, anxiety and depression. Somatic Experiencing™ works with the nervous system and the body’s innate ability to heal and recover from the symptoms of physiological stress. Treatment is gentle, supportive and enhances the effectiveness of the traditional exercise-based physiotherapy and counselling approaches.

Nutritional IV Therapy

IV nutrient therapy is a method of administering water-soluble nutrients (vitamins, minerals, antioxidants, and amino acids) directly into the blood stream. When you infuse nutrients intravenously, you bypass the digestive system, and this achieves a higher blood concentration beyond what is orally possible, especially if digestive function is compromised. Great for many conditions as well as health optimization and energy support. (See our website or call the clinic for more details).

Targeted Therapeutics

If you are looking for a comprehensive approach to your self-care, book a consultation with one of our naturopathic doctors who will conduct a thorough assessment of your health and come up with a customized plan just for you! With a variety of treatment modalities and testing options available, a targeted treatment plan can eliminate some of the guess-work and help you reach your self-care goals more quickly.

Written by Jacalyn Sieben ND

Sources:

1. Hansen, M. M., Jones, R., & Tocchini, K. (2017). Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. International Journal of Environmental Research and Public Health, 14(8), 851. https://doi.org/10.3390/ijerph14080851

2. Henssler, J., Stock, F., van Bohemen, J. et al. (2021). Mental health effects of infection containment strategies: quarantine and isolation—a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 271, 223–234. https://doi.org/10.1007/s00406-020-01196-x

3. Neophytou, E., Manwell, L.A. & Eikelboom, R. (2021). Effects of Excessive Screen Time on Neurodevelopment, Learning, Memory, Mental Health, and Neurodegeneration: a Scoping Review. Int J Ment Health Addiction 19, 724–744. DOI: 10.1007/s11469-019-00182-2

Interested in IV therapy to help you feel on top of your game?

Here’s what you need to know:

IV therapy is available at our clinic for current patients of our clinic. If you are not a patient of the clinic, please book an initial visit with one of our doctors.

(If you are under the care of a naturopathic doctor or integrative medical doctor outside this clinic, you may reach out to our reception team to request an external IV referral form to be completed by your health care practitioner.)

If you are a current patient and you are interested in starting IV therapy, these are the next steps you need to follow:

STEP 1 : Call in to book a 30min IV consultation appointment. Please note that Dr. Reid ND does NOT perform IV therapy.

STEP 2: Bring in any blood work that you have had completed in the last 6-12months to this IV Consultation.

At this IV consultation, one of our three IV trained naturopathic doctors will want to hear what your health goals are and assess your eligibility for IV therapy.  This assessment includes a review of your medical history,  current blood work, a brief physical exam and a discussion on options available to you.  Based on the IV required, baseline health, and the review of past blood work, the naturopathic doctor may request more blood work be completed prior to the first IV booking.

When the assessment is complete and you are deemed eligible for IV therapy, the naturopathic doctor will customize an IV treatment plan with goals, expectations, and monitoring parameters set out. The naturopathic doctor will inform you of how to prepare for you IV treatment and give you information on what to expect for the process. At this point, you can proceed to book you first IV with our front reception team.

After a series of IVs are completed, you may book a follow up IV consultation with your naturopathic doctor to review evaluate your response and need for ongoing IV therapy. (Usually updated blood work and/or imaging is reviewed at this time)

Seasonal affective disorder & vitamin d

Saskatchewan is known for its long, cold winters. As the temperatures decrease, so do the daylight hours, significantly diminishing the amount of sun we might see each day. To add to that, to avoid the cold, we spend more time indoors and the time we do spend outside has us wrapped from head-to-toe to keep warm. This means less sun exposure and therefore reduced opportunity for us to synthesize vitamin D from its light. For some people, the change in seasons also brings on the “winter blues” also known as Seasonal Affective Disorder (S.A.D.). It is currently thought that a combination of physiologic, psychologic, genetic, and environmental factors play a role in S.A.D., one of them being vitamin D deficiency.

What is seasonal affective disorder?

Also termed “S.A.D.”, Seasonal Affective Disorder is a form of depression that typically occurs in the winter months when our exposure to sunlight is limited. Approximately 2-3% of Canadians will experience S.A.D. at some point and 15% more will experience a milder version of the condition.

There is a natural tendency to slow down in winter compared to the high-energy lifestyles we tend to carry on in summer months. However, if you notice you are feeling particularly low or experiencing the signs & symptoms below, it might be time to consider consulting a healthcare professional for an assessment.

Signs & Symptoms

• Feelings of hopelessness & sadness

• Thoughts of suicide

• Oversleeping

• Cravings for sweet or starchy foods

• Weight gain

• Fatigue/low energy

• Decreased physical activity

• Difficulty concentrating

• Irritability

• Increased sensitivity to social rejection

• Avoidance of social situations

In S.A.D., these signs and symptoms appear and disappear at about the same time each year, and the sad, despairing mood:

• is present most days and lasts most of the day

• lasts for more than two weeks

• impairs performance at work, school or in social relationships

Vitamin D - the sunshine vitamin

Vitamin D, which actually functions more like a hormone, acts on receptors in every tissue in the body including the brain and immune system. As it is a fat-soluble vitamin, we get it through diet from sources such as fatty fish (sardines, salmon, tuna), eggs, and liver; and are also able to synthesize it through our skin when we get sufficient exposure to the sun. As such, vitamin D levels have been shown to fluctuate with exposure to sunlight. Levels tend to decline from fall to winter, and are naturally lower the further north you live from the equator.

Vitamin D has many functions within the body. It is needed for calcium absorption (healthy bones, teeth), healthy immune function, and also has a role in the release of dopamine and serotonin - signalling molecules that, in the brain, are associated with drive, pleasure, and happiness.

So, how much vitamin D do you need?

Health Canada recommends a daily dietary intake of 600-800 IU’s of Vitamin D for adults. However, according to their statistics, most Canadians are not achieving this. While we also know sunlight does provide Vitamin D, here in Saskatchewan, the exposure we get at our northern location is often inadequate, especially in the winter months. Vitamin D levels also decrease with age, skin pigmentation, liver and kidney disease, obesity, certain medications, genetic mutations and other conditions.

How do I know if I’m getting enough vitamin D?

Luckily, there is a test for that! A simple blood test can assess whether you are getting sufficient amounts of vitamin D, or if supplementation may be indicated–or, in some cases, contraindicated. There can be too much of a good thing especially when it comes to supplementation. Vitamin D toxicity related to excessive long-term intake of vitamin D can cause hypercalcemia and related symptoms such as confusion, apathy, vomiting, abdominal pain, pathological calcification, increased thirst and increased urination. It is also important to note that everyone metabolizes vitamin D differently, so some people can experience vitamin D toxicity even at lower doses that are considered safe for the general population. It is always recommended to consult a healthcare practitioner before implementing any new health regimen to see if it is right for you, including vitamin D supplementation.

If you are experiencing symptoms of the “winter blues” or are curious about your vitamin D status or other natural approaches to mental health, you are invited to book a consult with myself or one of my colleagues to discuss your healthcare options.

We look forward to working with you!

In health, Jacalyn Sieben, ND

References:

1. CAMH. (2019). Seasonal affective disorder (SAD). Retrieved from: https://www.camh.ca/en/health-info/ mental-illness-and-addiction-index/seasonal-affective-disorder

2. Canadian Mental Health Association, BC Division. (2013). Seasonal affective disorder. Retrieved from: https://cmha.bc.ca/documents/seasonal-affective-disorder-2/

3. Health Canada. (2012). Vitamin d and calcium: Updated dietary reference intakes. Retrieved from: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/vitamins-minerals/ vitamin-calcium-updated-dietary-reference-intakes-nutrition.html

4. Marcinowska-Suchowierska E, Kupisz-Urbańska M, Łukaszkiewicz J, Płudowski P and Jones G (2018) Vitamin D Toxicity–A Clinical Perspective. Front. Endocrinol. 9:550. doi: 10.3389/fendo.2018.00550

5. Melrose S. (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depression research and treatment, 2015, 178564. https://doi.org/10.1155/2015/178564

Physical Activity for Prostate Cancer - HIIT it up!

Physical activity is one of the many ways in which we can optimize our health before, during and after cancer treatment. Prostate cancer patients undergoing active surveillance can benefit from optimizing their physical activity levels (missed our post on active surveillance? Check it out here)

The Canadian research study Exercise During Active Surveillance for Prostate Cancer (ERASE) trial looked at how exercise during active surveillance in men with prostate cancer influenced their cardiorespiratory fitness [1]. Prostate cancer patients on active surveillance who did a supervised high intensity interval training (HIIT) three times per week for 12 weeks had improved cardiorespiratory fitness levels and reduced PSA levels compared to the control group (prostate cancer patients on active surveillance who did not do the HIIT training) [1]. Although we don’t know the long-term effects of this training, other studies have suggested that improving fitness levels can provide benefits in heart health and weight management and may reduce side effects associated with prostate cancer treatment [2-5].

Quick ways to incorporate more physical activity into your day:

• Take the stairs instead of the elevator/escalator

• Add daily walks on your own or with family/friends

• Get up from your work desk every 20 minutes for a quick stretch and stroll, or get a standing desk

• Do household chores such as snow shovelling, raking the leaves, mowing the lawn, gardening, vacuuming and others

• Dance!

• Enroll in leisurely sporting teams or engage in sports such as golf, tennis or others with friends or family

Talk to your doctor to make sure any high intensity types of exercises are safe for you. 

References:

[1] Kang, D.-W., Fairey, A. S., Boulé, N. G., Field, C. J., Wharton, S. A., & Courneya, K. S. (2021). Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncology, 7(10), 1487. https://doi.org/10.1001/jamaoncol.2021.3067

[2] Kim, S. H., Seong, D. H., Yoon, S. M., Choi, Y. D., Choi, E., Song, Y., & Song, H. (2018). The Effect on Bone Outcomes of Home-based Exercise Intervention for Prostate Cancer Survivors Receiving Androgen Deprivation Therapy: A Pilot Randomized Controlled Trial. Cancer Nursing, 41(5), 379–388. https://doi.org/10.1097/NCC.0000000000000530

[3] Galvão, D. A., Taaffe, D. R., Spry, N., Cormie, P., Joseph, D., Chambers, S. K., Chee, R., Peddle-McIntyre, C. J., Hart, N. H., Baumann, F. T., Denham, J., Baker, M., & Newton, R. U. (2018). Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases. Medicine and Science in Sports and Exercise, 50(3), 393–399. https://doi.org/10.1249/MSS.0000000000001454

[4] Bourke, L., Smith, D., Steed, L., Hooper, R., Carter, A., Catto, J., Albertsen, P. C., Tombal, B., Payne, H. A., & Rosario, D. J. (2016). Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. European Urology, 69(4), 693–703. https://doi.org/10.1016/j.eururo.2015.10.047

[5] Keilani, M., Hasenoehrl, T., Baumann, L., Ristl, R., Schwarz, M., Marhold, M., Sedghi Komandj, T., & Crevenna, R. (2017). Effects of resistance exercise in prostate cancer patients: A meta-analysis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 25(9), 2953–2968. https://doi.org/10.1007/s00520-017-3771-z

Active Surveillance for Prostate Cancer - How Naturopathic Medicine can help?

Prostate cancers have certain features or qualities that allow clinicians to “grade” or classify the cancer as less aggressive or more aggressive - specifically, they are given a label of risk. There are five different risk groups: very low, low, intermediate, high, and very high. Patients with prostate cancers that are very low and low risk, and in some cases intermediate risk, are usually recommended active surveillance [1].

What is active surveillance?

Many prostate cancers tend to be slow-growing, but they can be diagnosed very quickly with the use of laboratory tests and procedures. Unfortunately, what can happen with a quick diagnosis of a slower-growing cancer is a tendency to over-treat patients. Research has suggested that the outcomes of immediately treating very low to low risk prostate cancer patients are similar to implementing an active surveillance approach; also, treating prostate cancers earlier than necessary can lead to unwanted negative side effects, such as urinary incontinence and erectile dysfunction [2]. Therefore, in an effort to avoid over-treatment, active surveillance has been recommended as the first line for patients with very low and low risk prostate cancer.

Active surveillance involves regular monitoring for cancer progression, through regular testing procedures and visits with an oncologist. When there is a sign of progression is usually when various treatments are implemented. For some individuals, this can be anywhere from months to years [3].

So what can I do during active surveillance?

Understandably, it can be overwhelming and stressful for patients to be given the recommendation of active surveillance; patients often feel anxious about waiting for disease progression or delaying treatment. 

During active surveillance, there are many ways to support your health, and naturopathic medicine can help by:

• Optimizing physical activity levels for improving health and fitness

• Taking a close look at your diet, ensuring you meet optimal nutritional requirements and individualizing dietary recommendations to meet your health goals and reduce risk factors for cancer

• Analyzing environmental risk factors and making recommendations to decrease or eliminate various environmental toxins that can increase risk for cancer

• Using targeted laboratory testing to identify levels of important nutrients, as well as assessing levels of inflammation, assessing immune function and cardiovascular health

• Optimizing lifestyle factors and reducing stress levels

Remember, don’t hesitate to talk to your doctor or oncologist about the pros and cons of active surveillance and what is the best treatment option for you. 

If you are wondering about how naturopathic medicine can help you, call us at 306-664-2150!

References:

[1] Kang, D.-W., Fairey, A. S., Boulé, N. G., Field, C. J., Wharton, S. A., & Courneya, K. S. (2021). Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncology, 7(10), 1487. https://doi.org/10.1001/jamaoncol.2021.3067

[2] Romero-Otero, J., García-Gómez, B., Duarte-Ojeda, J. M., Rodríguez-Antolín, A., Vilaseca, A., Carlsson, S. V., & Touijer, K. A. (2016). Active surveillance for prostate cancer. International Journal of Urology: Official Journal of the Japanese Urological Association, 23(3), 211–218. https://doi.org/10.1111/iju.13016

[3] National Comprehensive Cancer Network. (2021). Prostate cancer (version 1.2022). Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.

October is Breast Cancer Awareness Month

October is Breast Cancer Awareness Month! 

How can naturopathic medicine support you? No matter where you are on your breast cancer journey, from prevention to survivorship and everything in between, naturopathic medicine can be a useful integrative tool to support your health through:

• Evidence-based dietary recommendations for cancer prevention, during cancer treatments, and to reduce risk of recurrence

• Assessment of risk factors for breast cancer and recommendations to eliminate or reduce the impact of these factors on your health

• Stress reduction supports, including lifestyle recommendations, acupuncture and Traditional Chinese Medicine (TCM), and botanical/nutritional supports

• Laboratory testing and monitoring of important lab values

• Education and advocacy - naturopathic doctors (NDs) take the time to provide education and resources to patients, and can help to bridge a relationship between your conventional care team and your naturopathic team

• Support during conventional care - evidence-based naturopathic recommendations to help safely manage side effects and maintain optimal health during conventional treatments - your ND is knowledgeable on interactions between conventional agents and natural supports

If you are interested in learning about our approach to integrative cancer care and what supports we offer, call us at 306-664-2150 to set up a call for us to answer your questions!

Movement is Medicine - It's never too late to start if you have (or had) Breast Cancer!

The Importance of Physical Activity in Breast Cancer Patients

The World Health Organization (WHO) recommends 150 minutes (about 2.5 hours) of moderate to vigorous-intensity physical activity per week for adults, which has been shown to reduce the risk of developing cardiovascular disease, diabetes and depression, can improve bone health, and reduce all-cause mortality [1, 2]. Additionally, regular physical activity has also been demonstrated to support breast cancer patients before diagnosis, during treatment and in survivorship.

IMPACT OF PHYSICAL ACTIVITY BEFORE DIAGNOSIS

Research has shown that women who were physical activity before being diagnosed with breast cancer had decreased mortality from breast cancer and all-causes compared to women who were not physically active before diagnosis [4, 6]. One of these studies also found that women who were sedentary (not physically active) before diagnosis but started exercising after diagnosis had a 45% lower risk of death from breast cancer compared to women who were not physically-active before or after diagnosis [6]. This impact was achieved just by engaging in brisk walking 2-3 hours per week!

EXERCISE DURING CANCER TREATMENT IS SAFE AND EFFECTIVE

One study looked at how exercise impacts the health of patients with stage II+ breast cancer. They found that engaging in exercise was safe for these patients, and was associated with improvements in quality of life, fitness level, fatigue, strength, mental health, and weight [3]. Another study conducted on breast cancer patients undergoing chemotherapy found that more intense exercise regimens (50-60 minutes 3 times per week) were slightly better than moderate-intensity exercise regimens (25-30 minutes 3 times per week) in improving pain, hot flashes, and strength, however both regimens were effective in managing side effects from chemotherapy [5].

PHYSICAL ACTIVITY AFTER TREATMENT IS STILL BENEFICIAL

Research on breast cancer survivors has also shown benefit. One study found that breast cancer survivors who practiced 150 minutes of moderate-intensity exercise per week had a 27% decrease in all-cause mortality (ie. dying from any cause) and a 25% decrease in breast cancer mortality, compared to women who had lower levels of physical activity [2].

MOVEMENT IS MEDICINE

So, what does this mean? It’s never too late to increase your levels of physical activity! No matter where you are on your health journey, physical activity appears to benefit health by reducing risk of dying from cancer and other causes and improving side effects during treatments. As always, talk to your doctor to make sure you are engaging in physical activity that is safe for you!

WHAT CAN I DO TO INCREASE MY PHYSICAL ACTIVITY LEVELS?

There are a number of ways to increase physical activity and movement in your daily schedule! An easy way to remember the difference between moderate-intensity and vigorous intensity exercising is talking and singing - at a moderate level of intensity, you can talk but would find it difficult to sing; at vigorous-intensity, it would be difficult to talk. Here’s a few ideas:

• Take the stairs instead of the elevator

• Walk or bicycle to work, or walk the kids to school

• Go for walks before or after work, or during the day

• Take up a sport or hobby that involves movement, like dancing, tennis, swimming

• Raking the leaves, shovelling snow, gardening

• Yoga, tai chi and Qigong

• Household chores like vacuuming, mopping

• Our favourite at Saskatoon Naturopathic Medicine: 15 minute at-home dance session - just turn on your favourite song and dance!

References:

[1] https://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf

[2] Beasley, J. M., Kwan, M. L., Chen, W. Y., Weltzien, E. K., Kroenke, C. H., Lu, W., Nechuta, S. J., Cadmus-Bertram, L., Patterson, R. E., Sternfeld, B., Shu, X.-O., Pierce, J. P., & Caan, B. J. (2012). Meeting the physical activity guidelines and survival after breast cancer: Findings from the after breast cancer pooling project. Breast Cancer Research and Treatment, 131(2), 637–643. https://doi.org/10.1007/s10549-011-1770-1

[3] Singh, B., Spence, R. R., Steele, M. L., Sandler, C. X., Peake, J. M., & Hayes, S. C. (2018). A Systematic Review and Meta-Analysis of the Safety, Feasibility, and Effect of Exercise in Women With Stage II+ Breast Cancer. Archives of Physical Medicine and Rehabilitation, 99(12), 2621–2636. https://doi.org/10.1016/j.apmr.2018.03.026

[4] Lahart, I. M., Metsios, G. S., Nevill, A. M., & Carmichael, A. R. (2015). Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies. Acta Oncologica (Stockholm, Sweden), 54(5), 635–654. https://doi.org/10.3109/0284186X.2014.998275

[5] Courneya, K. S., McKenzie, D. C., Mackey, J. R., Gelmon, K., Friedenreich, C. M., Yasui, Y., Reid, R. D., Cook, D., Jespersen, D., Proulx, C., Dolan, L. B., Forbes, C. C., Wooding, E., Trinh, L., & Segal, R. J. (2013). Effects of exercise dose and type during breast cancer chemotherapy: Multicenter randomized trial. Journal of the National Cancer Institute, 105(23), 1821–1832. https://doi.org/10.1093/jnci/djt297

[6] ​​Irwin, M. L., Smith, A. W., McTiernan, A., Ballard-Barbash, R., Cronin, K., Gilliland, F. D., Baumgartner, R. N., Baumgartner, K. B., & Bernstein, L. (2008). Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: The health, eating, activity, and lifestyle study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 26(24), 3958–3964. https://doi.org/10.1200/JCO.2007.15.9822

REDUCE YOUR CANCER RISK!

CANCER PREVENTION

Prevention is the action of stopping something from happening. We often focus on how to support a person who has already been diagnosed with a health condition, however a big focus on health should be ways in which we can prevent the condition from occurring in the first place. Although cancers can develop for many reasons outside our control, there are many factors which we can change (called modifiable factors), which may alter our risk for developing cancer and other chronic diseases. By addressing these modifiable factors, we can focus on prevention.

As you can see from the table above, there are a number of influencing factors that we have the ability to change. In this article, we will briefly touch on some of these modifiable factors and how they impact our health with respect to cancer prevention, and how naturopathic medicine can help!

Diet

Although the information isn’t very clear regarding the impact our diet has on the risk of developing cancer, there are a few associations that have been found between certain dietary factors and cancer risk, according to the World Cancer Research Fund/American Institute for Cancer Research [1-4]:

• Eating whole grains and high fiber foods (such as fruit, vegetables and legumes) is associated with a protective effect against developing colorectal cancer

• Diets high in “fast foods” or processed foods (which are typically higher in trans/saturated fats, salt and sugar) are associated with increased risk of developing obesity, which is associated with increased risk of cancer

• Higher intakes of red and processed meat are associated with an increased risk in developing colorectal cancer

• High intake of sugar, including in beverages such as soda pop, can contribute to overweight/obesity, which is a risk factor for developing many cancers

Eating a diet high in fruits, vegetables, legumes and whole grains, healthy fats and lean proteins, and limited intake of processed foods and sugar is a great step toward cancer prevention, as well as prevention of other health conditions like obesity. At Saskatoon Naturopathic Medicine, we work with patients to develop an individualized diet plan addressing these risk factors and recommend healthier alternatives.

Physical Activity

Being physically active is associated with a reduced risk of developing colorectal, breast and uterine cancer, and also helps prevent excess weight gain and obesity.

The World Health Organization (WHO) recommends that adults should be physically active most days of the week, for at least 150 minutes of moderate-intensity physical activity per week. Some examples of moderate-intensity exercise include shovelling snow, jogging, swimming, bicycling, and dancing. By incorporating more physical activity into our week, we are also reducing the amount of time we spend sitting (called sedentary activity), which on its own is a risk factor for developing other conditions like obesity [5].

Toxic Exposures and Lifestyle Factors

Toxic exposures refers to exposures of substances that have the potential to cause harm in high amounts. Exposures can occur through our occupation, the environment (ie. pollution, contaminated water, etc), our diet, and even the hygiene and cosmetic products we use every day (ie. deodorants, perfumes, etc). For example, there are chemicals known as endocrine disrupting chemicals (EDCs) which can interfere with our own hormonal (endocrine) system, and can result in an increased risk of developing hormone-associated cancers such as breast cancer. EDCs can be found in plastics, shampoos and other cosmetics, pesticides and others [6].

Two other important toxic exposures to discuss are cigarette smoking and alcohol intake, both of which are strongly associated with increased risk of developing cancer. At Saskatoon Naturopathic Medicine, we assess what exposures to toxic substances you may have been or are currently exposed to, and offer recommendations and tools to help reduce exposures and support the body’s own ability to naturally detoxify.

For more information about reducing your exposures to environmental risk factors, check out this webpage by the Canadian Cancer Society: https://cancer.ca/en/cancer-information/reduce-your-risk/know-your-environment.

Immune Health and Stress

In addition to decreasing the risk of infection, our immune system plays an important role in the development of cancer. A type of white blood cell, called a natural killer (NK) cell, is one of the main immune cells responsible for recognizing cancer cells and preventing them from growing and moving to other areas in the body [7]. Some factors that play a role in how well our immune system functions are adequate sleep, a healthy diet, physical activity levels, sources of inflammation, nutrient deficiencies, and stress levels. It is important to look at any reasons why our immune system may not be functioning optimally, and address these factors to support our health.

The impact of stress on cancer development is still unclear, however there are indirect associations with stress on risk of developing cancer. As mentioned above, stress can impact how well our immune system functions, and can also impact our sleep quality. There are ways in which we can reduce the impact stress has on our health, including meditation, yoga or other restorative exercises, acupuncture, journaling and counselling. Naturopathic Doctors are trained in acupuncture, and are knowledgeable in many stress supports including lifestyle modifications and nutrients/botanicals to manage the body’s stress responses.

There are many ways in which we can make healthier changes to help in the prevention of chronic diseases such as cancer and others like cardiovascular disease and obesity. At Saskatoon Naturopathic Medicine, our Naturopathic Doctors are well-trained in assessing the overall health of patients and identifying where support may be needed. Prevention of disease is not commonly discussed, however it is one of the guiding principles of naturopathic medicine [8] and vital to our overall health.

References:

[1] https://www.wcrf.org/dietandcancer/eat-wholegrains-vegetables-fruit-and-beans/

[2] https://www.wcrf.org/dietandcancer/limit-fast-foods/

[3] https://www.wcrf.org/dietandcancer/limit-red-and-processed-meat/

[4] https://www.wcrf.org/dietandcancer/limit-sugar-sweetened-drinks/

[5] https://www.wcrf.org/dietandcancer/be-physically-active/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731339/

[7] https://molecular-cancer.biomedcentral.com/articles/10.1186/s12943-020-01238-x

[8] https://aanmc.org/6-principles/