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The University of Maryland Medical Center’s Complementary Medicine website provides an assessment of some recent studies on melatonin as an adjunct treatment for breast cancer. Of course melatonin is best known and has been most researched for its effects on sleep and its potential to address sleep disorders. Most of these investigations have focused on people whose circadian rhythms are disrupted by factors such as jet lag or work schedules, but there have also been studies looking at melatonin as a sleep aid for the elderly or for those with HIV (see other “Melatonin” entries on this Blog).

This excerpt from the UMMC article on Melatonin indicates, however, that this supplement may be eliciting additional interest as an auxiliary to certain cancer treatment regimens. We have highlighted the last sentence in this passage, which repeats one of the crucial guides in using supplements: be sure to consult your health care professional.

“Several studies indicate that melatonin levels may be linked with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. In addition, laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells, while adding melatonin to these cells inhibits their growth. Preliminary laboratory and clinical evidence also suggests that melatonin may enhance the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (administered 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy, known as thrombocytopenia that can lead to bleeding.

In another study of a small group of women whose breast cancer was not improving with tamoxifen (a commonly used chemotherapy medication), adding melatonin caused tumors to modestly shrink in over 28% of the women. People with breast cancer who are considering taking melatonin supplements should consult their doctors before beginning supplementation.“

As we were mulling over the recent New York Times piece on the billions of dollars Americans spend each year on sleep aids that are only mildly effective (see today’s other post under “Melatonin”), we thought we’d reprint this article from the NYBC newsletter THE SUPPLEMENT, which appeared earlier this year.  It deals with the constellation of health concerns, from fatigue to depression, that often affect people with HIV, and gives an overview of some of the dietary supplements that have been used to address these issues.

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Sleeping poorly? Energy low? Feeling down?

Dietary supplements may have something to offer

Sleep disturbances are the third most common complaint among people with HIV seeking medical attention. Everybody knows what it’s like to sleep poorly, then feel cranky and fatigued the next day. But persistent insomnia, followed by chronic fatigue, can become major medical issues for people with HIV (we’re talking about lower CD4 counts and poor medication adherence), so it’s worth reviewing options for dealing with these problems.

A 2005 research presentation suggested that melatonin supplements can improve sleep patterns in people with HIV. Melatonin, a hormone secreted by the pineal gland, has long been studied as a sleep regulator—levels increase in response to darkness, then fall during daytime. It’s also been investigated as an anti-cancer agent, where it has shown the capacity to combat solid tumors. (But melatonin should not be taken by people with cancers affecting immune cells, such as lymphoma or leukemia.)

Good news: a recent trial indicates that low-dose melatonin (0.5 to 1.0 mg) may be perfectly effective as a sleep promoter, making it a very inexpensive option for this purpose.

Fatigue can stem from other causes besides sleep disturbances. Anemia, a shortage of red blood cells, is another leading cause of fatigue among people with HIV, and is especially common among women. (A recent large study found that about 30% of people on HAART had moderate anemia. Women had an 80% greater risk of being anemic than men, and African-Americans had a risk of anemia 2.6 times higher than whites.) It’s important to learn the source of anemia in people with HIV (taking Retrovir, AZT, is a drug-related factor). Treatment options include increasing intake of iron, vitamin B12 and folic acid. Note that NYBC stocks multivitamins with iron for those concerned about their intake of this mineral. You’ll also find folic acid and B12 in our multis, and may want to consider adding a separate vitamin B supplement as well.

While for some people with HIV treating anemia can be a key to helping them overcome fatigue and its frequent companion depression, there are other cases where low energy is not connected to low red blood cell levels, and where the treatment options are therefore different. Particularly in HIV+ men, steroid hormones (testosterone and DHEA) have proven to be useful in combating the fatigue-depression combination. Recent federally-funded research on DHEA showed it to be an effective anti-depressant, with the added interesting feature that it can enhance sex drive (rather than undermining it, as do certain common prescription anti-depressants).  And a Columbia University study of DHEA for fatigue and depression in people with HIV has found it to be a successful treatment for some, with the added bonus that, unlike some prescription energy boosters, it doesn’t carry the risk of addiction.

We were amused to see the recent New York Times article about how many billions of dollars Americans spend on popular sleep drugs like Ambien, yet how little effect these medications actually seem to have:

Sleep Drugs Found Only Mildly Effective, but Wildly Popular  NYT Oct. 23, 2007

Meanwhile, there have been a number of studies over the years pointing to the dietary supplement melatonin as a useful sleep aid, providing comparable effects to the prescription meds.

For example:

 Psychopharmacology (Berl). 1996 Jul;126(2):179-81.

Low dose melatonin improves sleep in healthy middle-aged subjects.

There are also current studies funded by NIH on melatonin for sleep disturbances in the elderly, and in people with Alzheimer’s.

But getting back to the New York Times piece: while the article reported prices of prescription sleep aids in the $2-4 range per dose, the typical melatonin dose can cost just a few cents. See, for example, the Douglas Labs Melatonin stocked by NYBC.