Episode 12: Melatonin and Magnesium Oh My

Episode Transcript
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(00:01):
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(00:42):
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(01:04):
Enjoy the show.

Craig Canapari MD (01:11):
We're recording.
Well, welcome back to the sleep edit.
I am Craig Canapari

Arielle Greenleaf (2): and I'm Arielle Greenleaf. (01:18):
undefined

So today we're gonna cover, the, two big Ms in sleep.

Arielle Greenleaf (2) (01:27):
M and Ms
. Craig Canapari MD: Yeah.
So that would be Melatonin and Magnesium.
Two of the supplements that are,a lot of parents are interested.
For their kids' sleepissues or themselves.
A lot of people seem to be using,I can tell you it's unusual for
a parent to come to sleep clinicwithout having tried melatonin.

(01:48):
A lot of pediatricians recommend it, buta lot of parents just try it as well.
But in the last couple of years, I'veseen more and more parents having tried
magnesium or magnesium supplementationor are asking me about it as well.
so I guess we thought it'd be interestingto group these two things together.
Absolutely.

Arielle.
what are you hearing about this stuff?

I feel like the majority of my clients don't
share that they've tried these things.
I. have to imagine, given being amember of many moms groups on Facebook
and seeing what I see, I have toimagine that a lot of my clients

(02:29):
or potential clients have triedwhatever they can to help their, their
child's, their baby or child's sleep.
Hopefully we're not looking giving
melatonin to babies ormagnesium to babies.
Although I did see recently howdo I get my, you know, under
1-year-old or something to sleep?

(02:50):
Can I use something likemelatonin or magnesium?
And was, I was justblown away to see that.
and I will say also that when parents areasking for help in these groups, almost
always the first response is melatonin.
And lately it's been magnesium and mostlyI'm seeing magnesium in a lotion or cream

(03:16):
that people are claiming works wonders.

Oh yeah, we're gonna get into that.
as a provider, this is one of those thingsI just always ask now because people might
feel weird about it, especially if theirpediatrician didn't ask them to do it.
And yeah, you get some weird stuff, belike, hi, how do I get my four month
old to chew this gummy, you know?
it's always best to ask in a nonjudgmentalway, which I know that you do, but I
know the providers listen to this andI think it's valuable information.

(03:42):
Like, I'll say, what have you tried?
What medications have you tried?
What supplements have you tried?
I'd say if you're puttingsomething in your kid's body,
think about it, like medication.
I wouldn't differentiate between anatural supplement, which is what a
lot of people consider these thingsto be, and a prescription medication.
there may actually be some moreissues with these types of things
than with prescription medications.

Just because it's natural and organic doesn't mean that
it's necessarily A helpful or B, safe.

I mean, I don't know about you.
My kids got an ear infection.
That better be some free rangepenicillin they're getting,

Yeah,

Organic or a locally sourced, amoxicillin.

Homemade.

yeah, homemade.
So let's, let's start with melatonin.
'cause I feel, I still feel like melatoninis like the 800 pound gorilla here.

Yeah.
So why don't you tell us like,what exactly is melatonin?

So melatonin is a hormone that is secreted in
the pineal gland of your brain,which is the little tiny structure
at the center of your brain.
And some people call itthe hormone of darkness.
And the reason being is that.
Your body starts to secretemelatonin about an hour
before your usual sleep time.

(04:58):
before then it's undetectablein the bloodstream.
when you can detect that rise inmelatonin, that's called the dim light
melatonin onset, that is the signal toyour brain and the tissues in your body
that it is time to wind down for the day.
those melatonin secretions will stayrelatively high in the bloodstream
until about an hour after youwake up if you go to bed and wake

(05:18):
up at the same time every day.
one thing a lot of parents don't knowis melatonin is a hormone, right?
So it's kind of funny that you canjust go down to the store and buy
your kid a hormone for their insomnia.
So, imagine if your kid was likehaving a hard time in little league
and you're like, I'm getting mykid these testosterone gummies and

(05:39):
I'm gonna see how he does, right?
That's not the thing that we do.
We're not like, oh, you know, my13-year-old hasn't had our period.
Why don't I get some estrogengummies and start giving them?
But for reasons, we're gonna talkabout, melatonin is considered
in the US at least to be a foodsupplement, and not a medication.
it used to be sourcedactually from pig brains.

(06:01):
now it is, synthesized inlaboratories, which is better.
So yeah, that's maybe lessorganic, but, Probably better.
so melatonin, if you take it, the,the technical term is exogenously.
If you take it like a medication,first of all, the amount of
melatonin in your bloodstream.
Is much higher than yourbody naturally secretes.

(06:23):
and there are really two notableeffects when you take melatonin.
The first is the hypnoticor sleep inducing effect.
So this is what people are generallytrying to do when they take melatonin
'cause they have insomnia or they'regiving it to their child for insomnia.
They're giving them a dose of melatonin.
We'll get into dosing later on, withthe goal of helping to induce sleep.

(06:47):
The important thing to note is thatnot everybody gets this hypnotic effect
and the way this'll manifest as I haveparents coming in and they're giving
their kids these horrendous doses ofmelatonin, think like 10, 20 milligrams
and they're like, it's not working.
And he is waking up more at nightwith nightmares and is sleepy
during the day, which are allside effects if dose is too high.

(07:09):
it just doesn't work in everybody.
The other effect which does occurin everybody, and this is gonna get
a little bit more into the weedsof sleep physiology, is what's
called a chronobiotic effect.
So if you have someone who's circadianclock is out of sync with the schedule
they want to have, in my world,that's usually a teenager where their

(07:31):
natural sleep schedule is much laterthan they would like giving a tiny
dose of melatonin think 0.25 to 0.5milligrams about five or six hours
before they're falling asleep, can startmoving their sleep schedule earlier.
This is not what most parents aretrying to do, but honestly, this is
one of the more common reasons weare using melatonin in sleep clinic,

(07:54):
so the dosing for that is differentand the timing is different as well.

Yeah.
What does that, can youexplain that timing?

So

about teenagers much in this podcast, but, it is
interesting to understand the timing.

So when we think about, and actually I'll, I can link to
a video that sort of demonstrates thisgraphically, but, um, in, when you wanna
think about moving someone's schedule,if you want to move their schedule, their
sleep schedule earlier or later, melatoninwill pull the sleep schedule towards it.
So if you give melatonin in theevening, it'll make someone over

(08:30):
three or four weeks fall asleepearlier and light will push it away.
So light will make them stay up later.
and the opposite is true in the morning.
So if you are trying to get someoneto sleep later, which is generally not
something I'm worried about a lot insleep clinic, but in say, elderly who may
have advancement of the circadian phase,meaning they're falling asleep earlier

(08:52):
than they would like falling asleep atsix o'clock and getting up at three in
the morning, a tiny dose of melatoninafter they wake up can help move it,
We'll pull it towards it soit'll move the sleep schedule,
and light in the morning.
We'll move the sleep schedule earlier.
It's pushing it away.
and the magnitude of that effect, andagain, we're really getting in the weeds

(09:13):
here, it's what's called a phase response.
'cause curb, if you give melatonina bedtime, you're not gonna get
much of an effect on the bodyclock scheduling, which is actually
not what we want in little kids.
we're not trying to move theirschedule earlier or later too much.
but in somebody else, you, if you wannaget the maximal effect of moving you body
clock earlier, you want to do it five orsix hours before they're falling asleep.

Very interesting.

circadian medicine is very cool, and
kind of confusing for trainees.
So we

Can you share a little bit about
how, so a lot of times I see mychild falls asleep easily, or
I'm giving them melatonin becausethey don't fall asleep easily and
they wake multiple times a night.
Can you talk to me about the efficacyof night wakings and melatonin?

sure.
Well, most of the studies of melatonin areshowing the primary effect is shortening
what we call sleep onset latency.
And that's the time fromwhen you turn off the lights.
To when you actually fall asleep.
Now in children with autism,there is some evidence that
it might reduce night wakings.
The problem is, and this is again,don't think of melatonin as a a natural

(10:30):
supplement, think of it as a medication.
The problem with any medicationfor sleep is it's pretty easy
to help someone fall asleep.
It's harder to get them to stayasleep to miss night awakenings.
And the hardest thing of all isto get them sleep later in the
morning, especially children.
and the reason is, is just howyour body processes medicine.

(10:51):
If you take any medicine, typically you'regonna get the highest amount of it in
your bloodstream within an hour of takingit, and that's gonna fall off over time.
We use a term called the half-life.
a half life of a medicationis the time when half of it is
essentially gone from your body.
If it's gonna a longer half life,it's gonna last longer in the body.

(11:11):
If it's got a short half life.
It's not gonna last as long, and melatoninhas a relatively short half-life.
So again, like any medication,it's tricky to dose things, to
try to get kids to stay asleep.
And actually the dose is too high.
You can make night Wakings worse.

I mean, I
feel like it's counterintuitive.
you would think, oh, okay, wewant this to have a longer effect.
Let's give more of it.
But what I've heard is that in many cases,a smaller dosage is better, lower dosage.
I've actually seen thisreported in mom groups.
It's like, you know, it'shelped my child fall asleep.

(11:50):
It is not helping them not wakein the middle of the night.
They're still waking inthe middle of the night.
What do I do?
And then they're like, do I give melatoninagain in the middle of the night?
that's a little scary too.

Yeah, I mean, I think what we are seeing, and I know you
know this, but for the audience is thatlike any of these, be it a prescription
medication, a supplement, if you arehaving sleep problems, you really want to
pair this with a behavioral interventionbecause these, these medicines, they're
not magic, they're not anesthesia.

(12:25):
It's not like flipping a switchand you're guaranteeing 10 hours of
sleep for the majority of children,not all of them, but a lot of them
who are having sleep problems.
There's at least abehavioral component to that.
If you don't change your behavior, ifyou don't, if teach your your child
to fall asleep independently, if youare letting them have screens in their
room, if their schedule is differentfrom what their body needs, no amount

(12:51):
of medication is really gonna help.
And you know, I think a lot of thetimes people are using these things
because they don't want to, you know,it's easy to give your child a gummy.
It's harder to make behavior change.

Absolutely.

and really our goal for any of these tools, like
supplements, medications, whatever,is to use them as long as you need
them and to not use them anymore.
there are some of my patients who haveme take melatonin for long term, and
there are some that we are able toget them off it in the short to medium
term because they, they've learnedhow to fall asleep independently.

Arielle Greenleaf (2): So the question then is, (13:28):
undefined

I.

you know, I see it so frequently used, or parents
saying, oh, you have to try it.
I feel like it's like almostthe first response these days.
So when is it appropriate touse melatonin with a child?
Are there age considerations,dosages, specific medical, conditions

(13:52):
that it would be helpful for?

So I wanna get into some of the conditions that
are best studied for melatonin.
But first of all, I'd say recognizingthat melatonin is a hormone that
you're giving your child to helpthem fall asleep, you should tell
your child's pediatrician to it.
They don't necessarily know a lotabout melatonin, but they do know a lot
about sleep and behavior in children.
That's where pediatricians are expert.

(14:16):
So first of all, I'd say if you'rethinking about trying it, talk to
your, your child's pediatrician.
I will say in most of the world,melatonin is prescription only.
That's true for much of the EU.
In Taiwan, it's classified as a,controlled substance actually.
so it's not marketed, appearor filling up the whole.

(14:37):
I feel like there's the purpleaisle now in the pharmacy

a hundred percent

It's melatonin and sleep gummies and what have you.
There's clear evidence for, I'd say thatmost evidence is for kids with autism
that it's pretty effective for helpingwith falling asleep and staying asleep.
And a recent study actually showed thatit helps with daytime behaviors as well.
there is some evidence for chronicinsomnia in children, though most
of that is in older children.

(15:00):
Not little kids, not like the, not likezero to three, it's think more six to 15.
ADHD, there's evidence, the bodyclock disorder, we talked about.
Delayed sleep face syndromea circadian disorder.
There's evidence and actuallythere's some studies and conditions
like blindness, like eczema whereit does seem to help as well.
I would say that there's less evidencefor normally developing children.

(15:24):
Who just need a little bit of helpmoving towards independent sleep.
it doesn't mean that, again, lack ofevidence doesn't mean it might not
be helpful in an individual child,but that's why it's so important when
you're using something like this isto also be like, Hey, you know, say to
your p say to your pediatrician, Hey,I'm struggling with my child's sleep.

(15:45):
I'm thinking of trying melatonin.
Anything else I should try with this?
Or could anything else be causing this?
You know, like, I mentioned eczema becauseeczema causes terrible sleep disruption
and the solution to it is not melatonin.
The solution is treating the eczema.
So there are many childhood conditionswhich can cause disrupted sleep.

Seek out the root cause before you
just go to the purple aisle.
And they are, it is, it's all purple.
It's, it is shocking to me becausethere is a whole section aimed at
children, and I just think it's, it'swild that it's just so accessible

(16:31):
and
it's, a hormone, you know, like,like you said, it's a hormone,
it's a synthetic hormone.
And I, I mean, natural, likeyou said, is it really natural?
Is it, I mean, it's made in a lab.
Is that what makes it organic?
Like you said, free range,free range hormones.

problem.
Yeah.
the, well, we can talk about, we talkabout overdose and stuff like that.
I would, I would say that, you know,when I would avoid melatonin is I use
it maybe sparingly in kids under three.
I'm an expert.
I wouldn't recommend.
Parents, do that, withoutguidance from a specialist.
Jodi Mindell has this great quotethat is, melatonin is like hormone

(17:13):
replacement therapy for sleep.
Right?
Like, so, you know, if you're, ifyou're in menopause, you probably don't
just get a menopause gummy, right?
You probably get hormonaltherapy, replacement therapy.
I, you know, I just wannahammer this away because

Yeah.

It's just, you know, gone to the drug store.

Right.

I got to the gas station.

next time I'm at the gas station.

I'd say the other thing is if you're not willing to make changes
to behavior, again, any sleep medication,it's not anesthesia, it's not magic.
At best, these things nudgethings in the right direction.
they're not gonna cure the problem.

Would you recommend it for jet lag or like an
overnight flight or something like that?
For
a child?

there is some evidence that melatonin, can help
with jet lag, with sleep onset.
It's tricky though becauseit depends on when you dose,
it depends on the time zone.
the direction of travel,how far you're traveling,
There are even apps that'llhelp you figure this out.
I'm a little bit less worried about peoplewho are using melatonin once in a while.

(18:20):
Like I'm, I'm gonna be honestand full disclosure here.
Uh, my older son, he's 17.
If he feels really revved up atnight, he may have a melatonin.
He has it maybe once a week.
that doesn't concern me, right?
Like, you know, he's a youngadult who's like, I know I'm
gonna struggle to sleep tonight.
'cause I'm worried about school.

(18:41):
He's generally an excellent sleeper.
I'm not that worried about that.
And I'm not that worried aboutparents who after talking to their
pediatrician, they use it once ina while, if they're traveling or if
there's something stressful going on.
so I think one of the themes willkind of close with is that using
something once in a while is lessworrisome than using it all the time.

Right.
When do you think itwould be a problem like.
Long-term use.
I'm just thinking of parents that Isee that are like, oh yeah, we've used
it since Johnny was four and he's 10.
You know?
Thoughts on, yeah.
Thoughts on long-term use,in a neurotypical child?

well there aren't really a lot of long-term
studies of neurotypical children.
The longest studies we have atmelatonin are mostly in kids with
autism, and they're the longestwe're looking at is two years.
The biggest concernwith, melatonin because.
It's a hormone is, could ithave an effect on puberty

(19:40):
could puberty happened early or latebased on these two year studies?
That does not seem to be the case.

yeah, I mean, can you become dependent on a gummy?

so you don't seem to get biologic dependence like you
do with, like, say, I know peoplearen't using opiates for this,
but like you develop a biological,

We hope not.

It doesn't seem to, if you take melatonin for a long
time, it doesn't seem to stop yourbody from making your own melatonin.
But there is psychologicaldependence, right?
Like I, I've had patients who arelike, they're just worried if, if
they, if they miss their gummy,but they really don't need it.
And often we'll kind of cut it in half.
we've even had parents substitute insome regular gummies just like candy.

(20:22):
and the, the kids seem to be fine.
Not that I generally advocatedeceiving kids, but like, I think in
a, I was in like a special situation.
there is a, there's an obstetricianand a gynecologist named David
Kennaway in Australia who's veryagainst this practicing kids.
And he talks about, he has this, thisquote, "parents shouldn't be always
be informed that one melatonin isnot registered for use in children.

(20:45):
[This is in Australia].
Two, no rigorous long-term safetystudies have been conducted by children.
And three, by the way, melatonin isalso a registered veterinary drug
used to alter the reproduction ofsheep and goats", which is true.
you know, humans don't, they're,we're not, I'm, I'm blanking on
the term, but we don't go into heatonce a season, which she goats do.

(21:08):
So like, it's a little bit of a, it'snot entirely fair comparison, but.
You know, it makes youthink right a little

Yeah, absolutely.

so I do want to talk a little bit about the dosing of melatonin.
'cause there is, there aresome guidelines about this.
generally the max doseanyone should be using.
and these are, this is from a Europeanconsensus statement, which is the best
thing we have for kids under 40 kilos.
That's 88 pounds.
The max dose should be three milligrams.
So that's a pretty big kid, right?

(21:37):
That's a 90 pound kid.
above 90 pounds, five milligrams.
In our clinic, we start at half amilligram and we go up by half a
milligram to a milligram once a week.
And we stop at either when the, the issueis better or when they hit the max dose.

(21:58):
And there's two reasons for that.
First of all, as you said, alot of people actually do better
with less melatonin than more.
the other thing is it givesa chance for the behavioral
effects to take effect, right?
Like if you start to make some behavioralchanges, maybe, for our kids, a lot of the
patients we're seeing, they're too youngto have an ADHD or an autism diagnosis,

(22:19):
but they may be headed that way.
So a little bit of melatonin often canhelp the behavioral changes take root.

what age range are we looking at there?

I'd say it's, I still try for three and
up sometimes younger though.
But again, I'm an expert.
I work with a sleepbehaviorist in my clinic.
we are screening kids for medical issues.
I'd say for parents andpediatricians, generally less than
three I'd, I'd really think twice.
Again, no, me, you know, there's not alot written on this, but I just sort of
feel like You have to be cautious, right?

(22:51):
Little kids have a longer time to develop.
We don't know what the effect of addinghormones is to a developing brain.

Right.

the other thing is timing is that a
lot of people give melatonin.
A lot of kids actually do better,and the studies of chronic insomnia,
melatonin, we're looking at givingmelatonin about an hour and a
half or two hours before bedtime.

Interesting.

So parents have to fiddle with this a little bit.
Some will say it has to be 30 minutesbefore bedtime, or it doesn't help, but
others will say, oh, it works better.
Got a seven 30 bedtime.
It works better if Igive it at like dinner,

Yeah.

and then later on it, it kicks in.
side effects, important to knowabout, with anything, nightmares
are common or vivid dreams,especially if the dose is too high.
Also, nighttime awakenings, that'swhy we'll see people coming in.
They're giving their three-year-oldlike 10 milligrams of melatonin.
These kids are waking upin the middle of the night.
They're having horrible dreams.
because the, the amount you'regetting in the bloodstream is so

(23:50):
high, you can also get what we call
you know, technical termis, is, uh, residual daytime
sleepiness, or sleep inertia.
Think of it like a hangoverfrom the medication.
bedwetting can happen.
and, there is a real overdose risk.

Natural.

A couple of things.
It is now the most common accidentalingestion in children, five and under.
because it is regulated by the FDAas a food supplement, it is not
required that, there be a childprooflid on your melatonin bottle.
So, there's this problemI think in medicine.
I think of it, the"gummification" of medicine.

(24:27):
Like no kid is dying to drink abunch of amoxicillin something that
is packaged as candy, looks likecandy comes in a fun purple bottle.
There's a risk there ofyour child getting into it.
a a, a study that cameabout from the CDC, in.
I believe it was a 2022 show that therehad been a 530% increase in calls to

(24:49):
poison control centers over melatoninwith a marked uptick during the
pandemic when kids were sleeping poorly.
and actually there were some ICU staysand even a few deaths reported on this.
Now because this is, we don't, you know,we don't really think of melatonin as
something you can easily overdose on.
So I don't know anything about thoseother kids, those few kids that died.

(25:10):
I know that they wereyoung from this data.
We don't know if they hadother medical conditions.
We know what, don't know whatthe magnitude of the overdose
was, but it's not zero, right?
Like your kid
could up in the emergencyroom or the hospital.
the other group of kids that areoverdosing, this are on teenagers who are
making, suicidal attempts or gestures.
they may take it with other medications.
So again, like all medication,whether or not it's a supplement,

parents (25:33):
have control of it.
Keep it someplace safe.
Do not let your kid have access to it.

Mm, mm-hmm.
I did see that CDC study,
a few years ago, andI was just blown away.

couple other issues I wanna highlight with melatonin
specifically in the United States,because this is regulated as a food
supplement, it is not subject to thesame level of scrutiny that, like, say
a generic form of ibuprofen would be.
There was one study looking at overthe counter melatonin prescriptions
and found that compared with a doseon the label, the actual dose that

(26:10):
was in the medication was betweennegative 83 to 478% of the label dose.

oh my Lord,

So like if you were giving your kid a one
milligram gummy, they might begetting a 0.25 milligram gummy.
They might be getting a five milligramgummy this is another reason to start low.
Go slowly and increasing your dose.
'cause we really, youknow, it's poor quality.
in the UK they have some wonderfulpreparations that we know work.
There's some that come onquickly that are very, you know,

(26:39):
it's a pharmaceutical there.
We have long-acting metaformthat seem to work well in autism.
The long-acting forms in the USreally don't seem to be that helpful
because they're not, we don't knowanything about the delivery system.
It's not tested like a pharmaceutical.

As a physician, our, are there specific
brands that you would recommend?

I'm a little reluctant to get into that,

Yeah, I agree.

anything.
I mean, you can look for like NSPcertification, that's a third
party certifying program.
If there's third party certification,it's a little bit better.
Your drugstore brands areactually usually pretty good.
Another issue for parents tobe aware of, and this is true,
we'll get into magnesium as well.
Parents will come in the office,they have no idea how much
melatonin they're giving their kids.

(27:29):
Because I'll always ask ifparents say, I tried melatonin.
I don't know why it didn't work.
My first question is, what was thedose and what time did you give it?
And parents will say, oh, Igave them three milliliters.
Or I gave them a gummy.
Well, you could get a half a milligramgummy, you could get a 10 milligram gummy.
three milliliters of what?
So I'd say to parents, look on the label.

(27:50):
Look at the number of milligrams.
That's the number that you need to know.

Yeah.

companies that are responsible tend to have the
melatonin gummies we get for my kid.
Again, I'm not gonna endorse anybody.
Two gummies is like two milligrams, right?
It's one milligram per gummy.
Honestly, I take a littlemelatonin at night.
It helps me fall asleep.
I take a half a milligram.
It's great.
there are like 20 milligramgummies out there.
it's nuts.

20

Yeah, it's great.
It's crazy.
so those are the things I wanted toshare about melatonin, but, what other
questions do you have or other thoughtsyou have based on what you've seen?

I feel like
anytime I see melatonin as thefirst course of action, it makes
me cringe, it is so much easier.
I. To say, give a gummy then to changehabits and enforce habits, because
children don't like to do that.
They like to take a piece of candy.
but they don't necessarily like theway you're doing the bedtime routine

(28:49):
or what time it's going to happenor how you're addressing any middle
of the night wakings if you changethat, if perhaps they are used to you
coming into their room and sleeping intheir room or bringing them into bed,
The family's struggling here,take a whatever dose of melatonin.
So that's, those are my only thoughts.

(29:09):
I don't feel like people are, I thinkpeople are sometimes ashamed and so they
aren't forthright about saying, yeah, I'vebeen using melatonin with my 4-year-old.
sometimes they are, but in manycases I feel like they probably did
try it, and it didn't work well.
so the more you can educate, the morewe can talk about it, the better.
Because I just want parents to beinformed about what they're putting in

(29:32):
their child's body, rather than just, youknow, grabbing something off the shelf.

Well, and I wouldn't say to anyone listening to this, if
you're giving your kid melatonin,you don't have to freak out, right?
generally we have found that for peoplethat are taking it as far as we can
tell, seems to be reasonably safe.
That being said, ask yourself, doesyour child really still need it?
are there other changes you can maketo make them less dependent on it?

(29:59):
are there issues that you mightnot be addressing that are,
you're addressing with this, likeanxiety or something like that?
so again, if you're listeningto this, don't freak out, but
maybe ask your pediatricianabout, make sure that they know.
and you know, even for our kidsthat we have taking melatonin long

(30:19):
term, we often will do, you know,what's called a drug holiday.
So usually over like summerbreak or something like that.
If they're in school with the stakesare kind of low, let's say stop it for
a couple of days, see what happens.
You know, like, and a lot of parentsare pleasantly surprised that it doesn't
really matter once they, once they stopit, or if their kid was falling asleep at

(30:42):
seven 30 on their melatonin and they takeaway their melatonin, they're, they're
going to bed at one in the morning.
And I have patients like this.
You can feel pretty good about thefact that your child actually needs it.
They're deriving a realbenefit from it, right?
If you stop it and they're like a littlebit more annoying and whining at bedtime,
but then in a couple of days it's backto what it was then, you know what?

(31:05):
Save the money.
This stuff isn't cheap.

Right.
I think maybe the answer is more, havea conversation with your pediatrician.
It's not necessarily, don't freakout, don't panic, but, you know, have
a discussion with your pediatricianso that everyone's on board dosage is
being looked at, and things like that.

Yeah, absolutely.
Well, shall we move on tothe new kid on the block?
the new hotness magnesium?

magnesium.

I always like to look in Google Trends and
sort of see when things are.
Popular,
and this really started touptick in early 2022, in terms of
searches for magnesium, for sleep.
I could not figure out whatkicked this off it's sort of like
gradually increasing, comparedto melatonin and theanine, which

(31:58):
we're not gonna get into today.
But another supplement iscommonly marketed for sleep.
magnesium in the last couple of years,there's quite a bit of interest in it.
I see that reflected inwhat people ask me about.
I take a little magnesiumglycinate for me.
I sleep better.
I'm gonna do an article in thesupplements that I take for sleep and
Oura ring data with and without it toshow you the diligence that I've done.

(32:20):
But, you know, I'm not sure what's drivingthis other than the fact that people are
stressed in it and not sleeping well.

I mean, I think you had a good point about, oh, the
overdoses of, of, melatonin and thatstudy coming out in 2022, which we were
still sort of in the Covid era there.
I think children didstruggle a lot with sleep.
Parents struggled with, everybodystruggled with sleep over covid.

(32:47):
and I think what I see sometimes toonow is what can I, what supplements
can I give my kids that aren'tmelatonin to help them sleep?
I also feel as though marketers marketing.
People who are creating newproducts picked up on the fact

(33:10):
that parents were starting to feela little uneasy about melatonin.
As much as I still see it, I still am.
I'm starting to see more of a trendof what else can I give my kid?
and I would say in the pastcouple of years is when I've
seen this uptick in magnesium.
Now, like you said, for yourself, Iactually discovered magnesium glycinate

(33:33):
when Ashley was like 10 months oldand my acupuncturist recommended
it for, milk supply actually.
'cause she was getting older and Iwas working and I remember I took
it and I had the best night ofsleep I'd had since I'd had her.
And I, I texted her in the morning, Isaid, is this supposed to help sleep too?
And she said, yes.

(33:54):
Did you sleep well?
And I said yes.
So I have taken it sporadicallyover the last 10 years.
It has worked.
I feel like it's worked well.
Perhaps it's, you know, in my head.
But, I'm so interested in, youknow, talking about what you've
found out in your research.

This is one of those things I meant to look at for a while.
And then I started looking and it keptbecoming more and more complicated.
'cause I don't, you know, honestly, youknow, it's, it's, most of the time the
people think about magnesium or eitherendocrinologists or renal specialists,
kidney specialists, in my world.
So it's, it's, you know, magnesium, it,it is number 12 on the periodic table

(34:39):
for the chemistry nerds and the audience.
usually when you are takingit, you're taking, essentially
you're getting the cation of it,sort of the positive ion for it.
and magnesium is actually involved in 80%of the enzymatic functioning in the body.
So this is.
It's a hugely important mineralfor the way that we function.

(35:00):
Clearly, if someone waved their magicwand and hoovered all of the, magnesium
out of your body, you would be dead.
if someone took away all your,all your melatonin, you, you
wouldn't sleep that night.
So like
in the hierarchy of stuff Yeah,it's, it's kind of important, right?
And it has a lot to do with theeffects of muscle relaxation.

(35:22):
there's an interesting table thatI put in my article on this that is
sort of looking at the, the, re theoverlap in symptoms between magnesium
deficiency and the symptoms of stress.
So top symptoms of magnesium deficiency,tiredness, irritability, anxiety,
muscle weakness, top reported symptomsof stress, fatigue, irritability,

(35:46):
feeling nervous, lack of energy.

Sounds like being a 43-year-old woman.

Yeah, it sounds like being a citizen of America.
specifically in the realm of sleep.
it does a couple of thingsthat are interesting.
It stimulates GABA receptors.
GABA is a neurotransmitter that'sassociated with relaxation and sleep.
it is actually important inthe production and release of
melatonin from the pineal glands.
So it may actually be a little bitupstream of melatonin release and

(36:12):
it mediates the stress response.
So if you have less magnesium than youneed, you're gonna feel more stressed.
interesting stuff, right?
Like in a lot of people with,anxiety or stress, struggle to sleep.
So I thought that was actuallya compelling relationship
to look at, especially.
We found that magnesium deficiencyis actually thought to be incredibly

(36:35):
common in the population at large.
And, I was really surprised by this.
let me jump ahead and say it'sactually very difficult to diagnose
magnesium deficiency per se.
And the reason is, is because it is soimportant in your body, your, the level
of magnesium you have in your blood.
If we do a blood test to measureyour magnesium, it is almost always

(36:58):
gonna be normal for two reasons.
First of all, the vast majority ofyour magnesium is in your bones, in
your muscles, in your brain tissue.
So that does, it's not movingin and outta the bloodstream.
And second of all, because it'sso important, the, it's really
closely regulated in the body.
The way that they've looked atmagnesium deficiency in the population

(37:19):
is they look at intake of dietarystudies of what, what are people
are logging, what they're eating.
And a lot of people, like somethinglike 70, 80% people are not getting
enough magnesium in the diet.
and there's, there's some twointeresting reasons for this.
I mean, first of all is that peopledon't have particularly healthy diets.
So processed food, has a lot lessmagnesium than, say eating a, you

(37:42):
know, a bunch of spinach, right?
Versus a Reese's peanut butter cup.
If you're drinking soda, itreduces magnesium absorption.

Soda

soda.
I think soda specifically, what I saw.
Maybe it's all the seltzeryou're drinking, I don't know.
In the last hundred years, the amountof magnesium, calcium, and phosphorus in
produce has gone on down substantiallybecause of the way that we farm.
there's a lot less magnesium in thefood supply than there used to be,

(38:13):
which is fascinating.
and a little bit concerning too, right?
Like,

Yeah.

the, so, but I think we're, so, we're in a world where we have
a lot of stress people, a lot of people inmy world, they can't sleep, their children
can't sleep, and a lot of reasons whypeople might not have as much magnesium
in their bodies as they would for tofunction as well as they wanted, right?

(38:40):
So, like, it seems like a setupfor a good idea that taking
magnesium might be a great idea.
So.
Here's the problem.
There are probably around 20studies looking at magnesium
supplementation for sleep.
In adults, about seven or eight ofthese studies were fairly compelling.

(39:01):
They were in elderly people andthey showed that magnesium helped
with sleep onset latency, whichis time to fall asleep, nighttime
awakenings, and total time sleeping.
There was one study from 2002 where theyactually gave elderly adults magnesium
and they had more slow wave sleep.

Hmm.

ask me how many studies of magnesium kids have been performed.

How many studies of magnesium and kids have been performed?

One that was in infants in the nicu and this was
really giving them as part of their
food, and it showed that they had morequiet sleep, which is the analogous thing
to slow wave sleep, which is active sleep.
It was like 15 infants.
there have been studies that lookedat this indirectly, specifically kids
with ADHD or autism where magnesiumhas helped with daytime functioning,

(39:52):
but those authors didn't look at sleep.

Hmm.

it's hard to recommend magnesium in children where we don't have
any evidence that really helps with sleep.
So we have a situation which I wouldsay has biological plausibility, right?
A lot of people don'thave enough magnesium.
That likely includes children as well.
that low magnesium can be associatedwith sleep problems and having

(40:17):
enough magnesium helps with sleep.
But we haven't made that final step to saygiving magnesium seems to help with sleep.
Whereas in melatonin, we actuallyhave a lot of studies that it
actually helps with sleep, right?
So like, it's not that it couldn't helpand it does potentially help in some kids.
And we'll talk about who mightbe more likely to benefit.

(40:38):
It's hard to recommend it whenwe don't have any evidence.

it's interesting that the studies that you found
to be viable were all in elderly.
because I feel like people my ageand your age, you know, young people,
talk about using magnesiumglycinate and other things like
that, to help them with sleep.
So.

(41:01):
I'm wondering where the, you know,if it's popular right now or becoming
popular in the pediatric worldand, and parents, of a certain age,
why, why is, you know, is itjust that they, you know, it's
not worth studying or, you know,where, what was the lack of, of

(41:24):
scientific,

here, here we get into the problem of.
Pharmaceutical trials, first of all, inthe world of pediatrics is very common for
drugs to be tested in adults versus kids.
The adult market's a lot bigger.
Most children don't needany medications, right?
Like they're, most children arehealthy or they take one medication.
A lot of elderly adults aretaking a ton of drugs, right?

(41:45):
Like, so they have a lotmore health problems.
the other problem is how doyou make money on it, right?
Like, so a, a well powered pharmaceuticaltrial costs hundreds of millions
of dollars for something that isalready available at low cost.
Who's gonna pay for that study?

(42:07):
maybe I'd say before youknow, January, January 20th.
NIH don't know.
but like, you know, there's not a lotof wood behind the arrow with this.
Uh, but it's very common for us to use.
Because I'm a specialist, I dealwith kids with complicated medical
problems who don't have easy solutions.

(42:28):
We're often using drugs wherewe call them being off-label.
They don't have pediatric evidence,but we need to do something.
I think the main problemis the financial one.
going back to melatonin, these wonderfulpreparations, and they have in the UK
for, to help with autism, for that to getapproved by the FDA as a pharmaceutical
would literally require an act of Congressto say that melatonin is a pharmaceutical,

(42:53):
it is no longer a supplement.
And that it seems prettyunlikely right now.
so it's not gonna be for sale here'cause there's no money in it.

Yeah.

That being said, there are some conditions in kids which are
clearly associated with low magnesium.
And if I saw a patient with theseissues, I might actually be more
likely to consider magnesiumbecause I know that these kids are
more likely to have low magnesium.
Again, highlighting the fact thatit's actually difficult to measure
magnesium without using like radiotracerstudies where you're measuring

(43:27):
it in the muscle, in the bone.
Blood tests aren't particularly useful.
those conditions are type one diabetesand celiac, Or kids on a gluten-free
diet, first of all, parents, ifyour kid doesn't have celiac, don't
put them on a gluten-free diet'cause it has downstream effects.
which is a thing that I see that happensactually obesity common, maybe associated
with low magnesium and picky eaters.

(43:49):
And I, when I think of picky eaters,I often think of my patients with
autism who have very, restricted diets.

Sensory issue type diets, like they
don't wanna eat specific things.

I had, one young man I cared for who literally ate flurries
and french fries for McDonald's.

Sounds good.

so yes, delicious, but like, you know, you don't want
to have the whole basis of your diet.
and, you know, that was areal hardship for his family.
I, and I think that I woulddefinitely, if if someone with type
one diabetes or a picky eater washaving difficulty, I might consider a
magnesium supplement in those patients.
and I mean, here's the thing aboutmagnesium is if you take too much

(44:33):
of it, you're just gonna pee it out.
You eliminate it through your kidneys.
So as long as you, you don'thave kidney disease, it's a
little bit hard to overdose on.
It could not find any poison controldata about magnesium overdose
like we have with melatonin.
Doesn't mean it's not there, but.
It doesn't seem to be as big a problem.
the other thing is that there's,only one case report of a child

(44:57):
that died from excess magnesium.
And this was a child with cerebral palsy.
The parents were doing all these megadoses of vitamin, typical magnesium
glycinate, like you might take, mighthave like 90 milligrams of magnesium.
So like, you'd have to goout of your way to do that.
that being said, for most parents,and most parents are like, oh, I would
like my kid to have more magnesium.
See if it helps with their issues.

(45:19):
I would say make some dietary changes.
I'll actually post in the, show notes.
The NIH has a wonderful, worksheet that,and also in a article I wrote on this,
with high magnesium foods, I'd say beans,green leafy vegetables, and guess what the
number one magnesium containing food is.

No idea.

Pumpkin seeds,

of course.

pumpkin seeds.
So seed the nuts actually havea lot of these trace minerals.
So if you could, again, in littlekids, you don't want to give them
nuts 'cause there's a choking

Yeah.

You could try nut butters like almond
butters, something like that.
In older kids who are old enough tosafely chew this stuff, you know,
pumpkin seeds are nuts, may be helpful.
So I'd say for most parents, makingdietary changes is gonna have
some other downstream benefits.
In terms of magnesium supplements,actually when I was writing this,
the, again, the NIH came throughbecause they have this wonderful

(46:17):
sheet by age on what the dose maxdose bias supplementation should be.

Awesome.

so for parents, I would say that.
First of all, I would trydietary changes first.
Second of all, I'd say thatthis is not magic, right?
We don't know if this helps or not.
Dietary changes, likely they havemore benefits, but if you're really
struggling with this, you could try this.
But I would ask that with any changethat you make, again, also make

(46:46):
behavioral changes and track your child'ssleep and see if it actually helps.
Because the fact is, these thingscost money and a lot of these
supplements are quite expensive.
And I sort of feel like there'sa lot of chicanery out there.
when I was looking at the number ofmagnesium and sleep gummies on Amazon,
I was a little bit shocked, honestly,at how many products are market there.

(47:08):
And they usually don't justhave, it's not just magnesium.
It's like a, like a littlechamomile, a little this, a little
that, you know, like it's all I.
How do you know you have any of that stuffis even in there unless you have like a
mass spectrometer in your house, you haveno idea what's actually in that stuff.

yeah.

So, Arielle, let's talk about your favorite topic, the
thing you recommend to all your clients.

I sent it to them, didn't, you know, as soon as they, as soon

company, magnesium lotions and sprays.com.

well, I

I don't see this, so I wanna hear from you
what you're seeing out there

yeah.

in the streets.

and out in the streets, you know, like I said, I
feel like a lot of parents are saying,what can I do aside from melatonin?
And so, what I'm seeing, and somepeople are, you know, they don't wanna
give a gummy or something like that.
So I see lots of people talking aboutlotions and creams, and I even saw

(48:11):
someone who said she makes her own.
magnesium lotion,
I am trying to figure outhow that is even a thing.
And how do you make it, do you crushup the magnesium and put it in lotion?
here's someone we tryto lo a roller recently.

a roller, like a lint roller.
Like

probably like a, you know, almost like
a perfume roller or a, a,

Oh yeah.

Yeah.
Yeah.
I used mag, so I'm lookingat what I've, what I've seen.
I used magnesium lotion and spray.
I bought the magnesium spray from X anduse it on my son's feet every night.

Stuff is wild.

yeah, there's, there's a whole, yeah.
Someone swears by the lotion on the feet.
I find magnesium cream on mytoddler's feet really helps.
So I'm really curious about, youknow, how does it really help?

I looked into this, there's no studies,
to support this practice.
and again, like, I don't want,I feel like I'm punching down a
little bit here, but like, yeah,this is like obviously BS, right?
so I think there's three issues here.
First of all, there's little tono evidence that magnesium helps.
Anyway.
Again, we talked about the factthat it might help some people.

(49:34):
This is not an evidence-basedpractice at this time.
Second of all, the way youabsorb magnesium is through
the gut, not the skin.
So like, imagine like if you're like,oh, I need more sodium and chloride
in my body, I'm gonna go for a swim.
Does your body get filled up withsalt when you go in the ocean?

(49:54):
No, because your skinis impermeable to ions.
Magnesium, sodium chloride, itcannot pass through your skin.
Your skin is a barrier, right?
So there's no way it'sactually getting into the body.
Interestingly, when I, in myresearch, I did come across a
trial looking at Epsom salt bathsfor which do increase magnesium.

(50:17):
The way that they do that isprobably being through, absorbed
through the anus and rectum.
So

Oh wow.

a practice I would, I, I would recommend in
a child for the simple reason.
Is that like, how muchdose are they getting?
I don't know.
You know, or if you put like a creamor a lotion on your kid, how do you
know that they're not eating it right?
Like, and then what's the dose?
Right?
like my friend's dog just had tohave her leg cut off and they're
like, yeah, she has to wear the cone'cause she's got a fentanyl patch on.

(50:46):
'cause they don't wanther to eat it, right?
if your child has a medication on that hasa me what's purportedly a medicine in it?
They might eat it, right?
I don't know, I guess you put footypajamas on, but guys save your money.
Like this is just like,

I,

again, like the placebo effects does work, right?
Sometimes doing something isbetter than doing nothing and
it gives you a sense of power.
But like, this stuff is not cheap.
And this is the sort ofthing that makes me angry.
you know, when I look on Google and thetop eight search results for magnesium,
sleep of kids are like lotions.
It's bananas.

Marketing preying on tired parents, and they know that
they're going towards parents who wantnatural remedies and perhaps trying to
stay away from melatonin or the market ofchildren who are too young for melatonin.
So let's try this.
it's just, you know, there's sucha huge market out there for things

(51:47):
that are going to help a normallydeveloping child's sleep when
in actuality, they really don't.

I mean, let's be real.
The reason these things exist is'cause this is a hard problem.
If your child won'tsleep, you're stressed.
life is difficult, right?
Parents don't have supports likethey did a couple of generations ago.
That being said.
Parents, you've got a certainamount of money and a certain amount
of time, spend it on things thatactually have evidence for them.

(52:18):
What pediatricians do know a lotabout is kids and how to help kids.
And I think that's, you know, again, don'tthink about these natural supplements
or tools as having no side effects.
Because the fact is there's nothing thatworks, that has no side effects, right?
Like, if you wanna think aboutit as being as powerful as a

(52:40):
medicine, you have to think aboutit having side effects as well.
You know, we see what, Idon't know, readers my age
will remember Fen-fen, right?
The, weight loss supplement thatwas very popular in the nineties.
Everybody was taking it.
They were losing their like weight.
Like crazy was great, but then a lotof people were getting cardiomyopathy
and dying, so that came off the market.
not that military and magnesium isgonna kill your kid, but like, you know,

(53:02):
honestly, you gotta think about everythingyou're doing just because it's natural or
a supplement subjected to the same amountof scrutiny that you would anything else.

Yeah, and just because it's on the store shelves doesn't
mean it's necessarily safe or effective.

Or they have a beautiful website, or there's
a great Instagram account.
again, we're all, Ibought stuff on Instagram.
I'm not perfect.
Marketing works right.

Yeah.

So listen, I think we're kind of at the end here, but there's
a couple of things I wanted to highlight,which is if you're considering magnesium
or melatonin, talk to your pediatrician.
If you're trying these things.
start low and slowlyincrease the dose over time.
Generally, and I'm talking kidsthree and up, for gummy medications
specifically, keep them someplace safe.
And gummies are a choking hazard,really for a gummy, I'd say like a five

(53:56):
or 6-year-old at the youngest, right?
they should take it under supervision.
Some nights are a little bitbetter than every night, right?
Like in terms of reducing yourperception that you need it.
any supplements you use make somebehavior changes to go with it.
This is your opportunity.
And with melatonin, rememberthe dose timing matters.

(54:16):
you gotta fiddle around with it.
Sometimes a little bit earliereven will be more helpful.
We've got a lot of great stuff.
We're gonna put in the show notes on this.
I think on YouTube for this too, Ihave a lot of graphics I can put up
which might be helpful for people.
And I'll link to that video on howthe timing of melatonin matters.
so that's what I've got.
Arielle, what you got?

I am just really glad we dug into this, or
I should say you dug into this.
because, you know, again, there'sso much misinformation out there.
So as long as we're, sharing the truthand evidence and, educating people,
I'm feeling really good about that.
And hopefully we can atleast reach a few people, so

(54:59):
that they don't waste their money.

Honestly, like, again, if you tried these things, parents,
you haven't harmed your kids, but like,you know, just be careful out there.
there are a lot of evidence-based.
treatments for sleep problems.
it's probably worth more, youknow, worth thinking about.
what's our email again?
'cause I can never remember it.

The Sleep edit show@gmail.com.

Are you sure?

Yes.

Okay.

Now you're making me second guess,

that's our email address forever.
Okay guys, well, thanks forlistening and, if you find this
useful, share it with your friends.

Thanks so much.

Bye-bye.
Thanks so much forlistening to the Sleep edit.
You can find transcripts atthe web address Sleeped show.
You can also find video of theepisodes at that address as

(55:58):
well as in my YouTube channel.
You can find me at Dr. Craigcanna perry.com and on all social
media at D-R-C-A-N-A-P-A-R-I.
You can find Ariel atInstagram at Ariel Greenleaf.
That's A-R-I-E-L-L-E-G-R-E-E-N-L-E-A.

(56:22):
If you like the flavor of the advice here.
Please check out my book.
It's Never Too Late to Sleep.
Train the Low Stress Way to high QualitySleep for babies, kids, and parents.
It's available whereverfine books are sold.
If you found this useful, pleasesubscribe at Spotify or Apple Podcast
and share it with your friends.
It really helps as we're tryingto get the show off the ground.

(56:43):
Thanks.

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode 12: Melatonin and Magnesium Oh My