Melatonin Supplementation & Your Heart

We previously wrote about about melatonin:

❝Melatonin is a hormone normally made in our pineal gland. It helps regulate our circadian rhythm, by making us sleepy.

It has other roles too—it has a part to play in regulating immune function, something that also waxes and wanes as a typical day goes by.

Additionally, since melatonin and cortisol are antagonistic to each other, a sudden increase in either will decrease the other. Our brain takes advantage of this, by giving us a cortisol spike in the morning to help us wake up.

As a supplement, it’s generally enjoyed with the intention of inducing healthy, natural, restorative sleep.❞

Read in full: Melatonin: A Safe, Natural Sleep Aid? ← our research review article that does cover the pros and cons, and yes, there are indeed downsides too, including some contraindications e.g. melatonin helps regulate immune function, so that’s something to bear in mind if you’re on immunosuppressants or otherwise have an autoimmune disorder. It can also interfere with blood pressure medications and blood thinners, and may make epilepsy meds less effective.

The new news

Researchers (Dr. Ekenedilichukwu Nnadi et al.) looked at 130,828 adults (of whom, mostly women, average age 56) with insomnia, and found an important association with regard to long-term melatonin use.

Specifically: in adults with chronic insomnia, documented melatonin use for ≥12 months was linked with 90% higher 5-year risk of incident heart failure versus matched non-users (4.6% vs 2.7%), plus 3.5x higher risk of heart-failure hospitalization and 81% higher all-cause mortality.

There are some limitations: this was an observational study, based on electronic health records (TriNetX), and doesn’t outright prove causation.

For example, OTC users might have been misclassified as non-users, dosing and adherence weren’t known, and further data-confounding from variations in insomnia severity, mental health, or other meds is plausible too.

Still, the association is strong, so that seems like cause for concern, when likely nobody will die from not supplementing with melatonin.

The principle here is, like in the Hippocratic oath, “first, do no harm”.

In other words: if not taking the meds is definitely safe, and taking the meds may be unsafe, then erring on the side of not taking them is likely the best option.

See also: Are You Taking PIMs? Getting Off The Overmedication Train ← “PIMs” is the medical shorthand for “potentially inappropriate medications”

And, for that matter, The Common Meds That Make You More Likely To Die From A Fall ← when, statistically speaking, after a certain age, a fall is much more likely to kill you than taking longer to get to sleep

If you have been using melatonin most nights for months, consider tapering your dose downwards and switching to things like CBT-I and more focused sleep-hygiene strategies, for example:

• How to Fall Asleep Faster: CBT-Insomnia Treatment
• Don’t Do These Things If You’re Over 50 (And Want Better Sleep) ← this about common mistakes, including one involving melatonin supplementation

Of course, do discuss any long-term use with your doctor/pharmacist—especially if you have cardiovascular risk or symptoms (e.g. breathlessness, ankle swelling, unusual fatigue).

If you’d like to read the AHA’s press release for the study we talked about (it has a lot more details than we have room for here), then here you go:

American Heart Association | Long-term use of melatonin supplements to support sleep may have negative health effects

Want to try some?

Since the above is only about chronic long-term use, perhaps you’d still like some for short term use, ideally after consulting with your doctor and/or pharmacist.

If that’s the case, then as ever, we don’t sell it (or anything else), but for your convenience, here is an example product on Amazon.

Enjoy!