Melatonin for Reflux & Gastro-Esophageal Protection

The current issue of Alternative Therapies in Health and Medicine is full of great articles (read: articles that I'm interested in).

In the Case Report section, Melvyn R. Werbach, MD, writes about Melatonin for the Treatment of Gastroesophageal Reflux Disease. However, he first makes the case that too many people are on proton pump inhibitors (PPIs).

PPIs, while generally considered safe, are in fact associated with a 44% increase in hip fracture risk in folks over 50 (when taken for more than a year), a 50% increase in community-acquired pneumonia, and an increased risk of bacterial infections in the gut -- and also of getting that dastardly bug, clostridium difficile, which causes diarrhea and can even be life-threatening.

According to a McGill University researcher, "Gastric acidity constitutes a major defense mechanism against ingested pathogens, and loss of the normal stomach acidity has been associated with colonization of the normally sterile upper gastrointestinal tract."

In addition to negative side effects, because PPIs suppress gastric acid, critical nutrients are not absorbed properly, leading to deficiencies and cellular dysfunction.

Dr. Werbach makes the case that there's a "far safer approach to treating GERD" -- namely, melatonin. Yep, that little item folks use for jet lag or restful sleep and/or immune system support (melatonin is a powerful antioxidant in addition to being a diurnal rhythm regulator!).

What's interesting is that while most folks think of melatonin as being produced by the pineal gland, Werbach shares what professionals often don't know -- that much more melatonin is produced in the gut. He writes:

"In fact, the quantity of melatonin secreted by the enterochromaffin cells in the gastrointestinal (GI) tract is 400 times that of the pineal."

If melatonin is secreted in the gut, there's a reason, and research continues to show that melatonin acts as a gastroprotective agent, proving in clinical trials to help with functional dyspepsia and also irritable bowel syndrome (IBS). Abdominal pain has been reported to be significantly reduced for IBS patients on melatonin.

Melatonin also protects against esophageal damage. Turns out, esophageal lesions are associated with decreased melatonin secretion and thus decreased protection against harsh reflux acids.

Werbach article goes on to document a case of a 64 year old Caucasian female who received a variety of treatments for her GERD (both pharmaceutical and nutritional). Combination formulas, which included 6mg melatonin, were used to good effect, and then researchers decided to reduce and eliminate ingredients to see what ingredient(s) offered the most protection.

Interestingly, the pharmaceutical, Omeprazole, as well as the B vitamins, calcium, taurine, betaine and 5-HTP (a precursor to circulating melatonin) could all be dropped and even eliminated, but attempts to reduce the melatonin dose to 3mg caused the woman's painful symptoms to return.

Werbach's article concludes that "melatonin 6mg at bedtime may be an effective treatment for GERD with fewer and less serious adverse effects than acid-reducing medications so long as anti-GERD medications are (1) continued during the first 40 days of treatment and (2) resumed for at least 1 dose whenever symptoms recur. Further studies, including randomized controlled trials, are needed to validate and extend these early findings."

While some professionals are uncertain about melatonin's safety, Dr. Werbach cited a safety analysis study -- with 487 participants in 10 studies, 9 of which were randomized controlled trials-- that showed doses as high as 60mg melatonin daily were safe, with adverse effects at high doses being no different from placebo.

Dr. Werbach does caution that "due to its immunostimulating effects, however, melatonin should be avoided by people with autoimmune disorders."

Research on melatonin continues, and melatonin's potential for gastroesophageal protection is considered promising yet still preliminary by many professionals.

On a personal note, Melatonin is always in my travel bag. I like to take it with our B-100 Plus before bedtime. Many people say that B's would keep them up at night, but I find the combo works well when I am on the road, eating out a lot, enjoying espressos (caffeine depletes B's as well as disrupts sleep rhythms), and crossing time zones!