Should you start taking over-the-counter hormones? A closer look at DHEA and melatonin
Taking a DHEA supplement may extend your life and make you more youthful while you are alive.
Melatonin, the sleep-promoting, anti-aging, and anti-cancer hormone is the new medical superstar in the dietary supplement world.
So goes the typical marketing copy for DHEA (dehydroapiandrosterone) and melatonin, 2 over-the-counter hormones for which popularity continues to surge. Claims for the substances say they'll not only fight aging but also improve mood and even raise the libido.
No wonder store owners are finding it hard to keep the products on the shelves public sees fit to spend $325 million a year on DHEA and melatonin combined, the scientific community remains uncertain about the effects of supplementation with these hormones. Although thousands of promising studies have been conducted, as Web sites where the products are sold are quick to point out few pass true scientific muster. Several well-conducted studies, on the other hand, indicate harmful side effects that may arise with long-term use of these supplements.
For some perspective on the relative benefits and risks of taking DHEA and melatonin, we turned to Robert Russell, MD, Associate Director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University.
Do you think people are helping or hurting themselves by supplementing with DHEA and melatonin? Or are they simply wasting their money?
Dr. Russell: I don't feel at all comfortable with supplementation of DHEA. I do feel comfortable that melatonin, when taken in small doses for short-term use, is not harmful.
Why are you concerned about people taking DHEA?
Dr. Russell: DHEA, which is a precursor to the male sex hormone testosterone, may increase the incidence of prostate cancer. DHEA has also been shown to increase the risk for endometrial cancer in women.
How can a hormone like DHEA lead to cancer?
Dr. Russell: Hormones are able to stimulate cell growth. If you stimulate the growth of precancerous cells, you can end up with a tumor you would not otherwise have had.
But levels of tooth DHEA and melatonin fall off as people age, so wouldn't it be only natural for people to restore levels of these hormones back to their original amounts,
Dr. Russell: Not necessarily. There may be biologic reasons for decreased production. If you do autopsies on 80-year-old men, approximately 80 percent of them have prostate cancer, or at least evidence of precancerous cells. If you stimulate the growth of `the cancer or the irregular cells, it can easily get out of control and advance the case of a prostate tumor that otherwise would have grown much more slowly.
Even if DHEA may pose a problem when it comes to certain cancers, supplement companies also claim it can reduce heart disease. How would DHEA influence heart disease risk?
Dr. Russell: In a negative way. DHEA is a precursor for both androgens, or `male' hormones, and estrogens, or `female' hormones. But by supplementing with DHEA, more androgens are produced. In this situation, where production of androgens is stimulated, heart disease may actually be promoted instead of prevented, as many of the products claim.
How do the androgens work to promote heart disease?
Dr. Russell: We do not know all the ins and outs of hormonal balance and heart disease. We do know that estrogen is protective against heart disease and that androgens are anti-estrogens.
What about DHEA and lupus? There has been a lot of fanfare about a legitimate study suggesting that supplements of the hormone mitigate lupus symptoms.
Dr. Russell: One little study obtained results showing that DHEA can alleviate the effects of lupus. I wouldn't make too much of that. Results need to be repeated over and over to insure the validity of findings.
Can Alzheimer's patients be helped by DHEA supplements? In labs at the National Institute of Mental Health, Alzheimer's patients were found to have 48 percent less DHEA than those without the disease.
Dr. Russell: Aluminum levels have been found to be 100 percent greater in Alzheimer's patients than in others. But that does not mean aluminum canoes Alzheimer's. When you have an association, it may be the effect rather than the cause of the disease.
As with DHEA, low levels of melatonin have been linked to a brain related disorder, in this case, depression. Can depression be relieved with melatonin?
Dr. Russell: Again, I think it's like any of these studies that associate disease with levels of a given substance. What you can see in an association does not necessarily mean the substance is involved in causation, and you may not be getting at the source of the problem. In some studies, melatonin was actually shown to deepen depression in those who have it and induce depression in those susceptible to it.
How could that be possible?
Dr. Russell: Since increased levels of melatonin in the brain cause sleep, it is possible that supplementation with melatonin causes the hormone to act less like an `upper' and more like a depressant. Or perhaps melatonin acts against rather than together with antidepressants a person may be taking. But there is no work on it, and that is where more research is needed.
Do you feel melatonin can be used successfully simply as a sleeping agent? Much of the press about the hormone is devoted to its apparent ability to make it easier to fall asleep.
Dr. Russell: Melatonin is thought to be a relatively safe soporific, or sleeping, agent. I would recommend taking the lowest commercially available dosage, 0.3 milligrams, to induce sleep. As you know, in drugstores melatonin is available at much higher doses, even as high as 3 milligrams.
But if a little is good, can't more be better in a person who has unusual difficulty falling asleep?
Dr. Russell: No, I wouldn't use the higher doses. As a matter of fact, while we know that the lower doses can induce sleep, higher doses may actually cause more restless sleep. It's the same with other substances. Beta-carotene was shown in many epidemiologic studies to have a preventive effect on cancer, yet when taken in large doses was found to actually stimulate cancer proliferation in certain populations.
Should insomniacs take melatonin nightly before going to bed ?
Dr. Russell: I would not recommend usage over extended periods of time, since the effect of long-term use on the body remains unknown. I would especially think twice before taking the drug regularly if I were a young person, in particular, a young woman. Melatonin has been linked with infertility in women because it may interrupt the function of the pituitary gland. That's the hormonal center that controls the release of ovarian hormones, which in turn control how often, or even whether, a woman ovulates. The effects are probably less deleterious with occasional use, but women who want to have children should be more circumspect about taking melatonin on an absolutely regular basis.
Since melatonin has reportedly been found to combat jet lag, do you think it can be helpful for travelers?
Dr. Russell: I don't think it's accepted that melatonin is a fantastic drug for treating jet lag, despite claims. Furthermore, there is not enough known about it to give specific advice about timing of dosage to counter the effects of travel through time zones. I personally took small doses to help fight jet lag, and I did not find it to be very effective.
You just referred to melatonin as a drug Do you feel `drug' is a better term than `supplement' to describe melatonin and DHEA?
Dr. Russell: Yes. Usually the word `supplement' means a dietary supplement, that is, a supplement of something found in food. Of course, herbal products are now called herbal supplements. I suppose you can call these substances, if you wanted, hormone supplements. But there has to be some modifying word in front of `supplement,' because the word by itself implies that the hormones are part of a normal diet, which they are not. There should be some regulation over these terms.
Products with melatonin or DHEA suggest consulting a health practitioner before taking them. How many people do you think follow that advice?
Dr. Russell: Probably very, very few, although it is important. People are not going to spend the money to find out the answers, although they may ask as part of a visit. With the HMOs it may be brought up as part of a physical exam; the practitioners, one would hope, ask about supplement use as part of the check-up.
The FDA established a hotline doctors can call to report side effects from supplements patients are taking. But very few DHEA or melatonin side effects have been reported. Do you think doctors are using this service?
Dr. Russell: Probably few doctors use it. They don't have time. Unless they feel there is a terrible side effect that they can attribute to supplement use, they generally won't act on their feelings.
Do you think the older population is more susceptible to hype about these hormones since they carry so many promises of restored youth?
Dr. Russell: Yes, and I have a real fear that older people's vulnerability is being abused. They're getting Alzheimer's, cancer, cardiovascular disease, so there's a lot of grasping at straws. Easy things, in particular. `Take a pill and it will prevent this disease,' rather than going for changes in lifestyle--dietary habits or exercise patterns.
Do you think legislation will remain lenient toward the supplement industry and allow it to remain relatively unregulated?
Dr. Russell: I think the pendulum will swing back. In 1985, DHEA was banned for over-the-counter sales because of its potentially harmful side effects, and it was not allowed back on the market until the Supplement Act of 1994, with its relaxed rules, came into effect. Government will remain more lenient than it was, but all you need are supplements like DHEA to cause diseases such as cancer, and lengthy investigations will be conducted.
I don't feel more control happening in the next few years, but I feel mistakes made through products like DHEA pills will make stricter control necessary. Currently, the Federal Trade Commission is trying to do some regulation on the advertising side, and I think there will be a swing back in that area at the very least. People will ultimately want legitimate information.
In the meantime, what can consumers do to protect themselves from less-than-top-quality supplements if, say, they want to try melatonin on a short-term basis?
Dr. Russell: Consumers should look for the USP label on the supplement bottle. This label, from the U.S. Pharmacopeia, indicates that what is claimed to be in the product, including what doses, can actually be found in the product. It is not a law that a supplement company submit to USP standards, but if the consumer is educated to look for the USP label, more companies may opt to get the USP's blessing in order to satisfy consumer preference.