Melatonin

Ronald B. Keys J.D. Ph.D rkeysphd at nyc.pipeline.com
Sat Oct 14 07:19:19 EST 1995


MELATONIN:WHEN TO USE IT: THE REQUIREMENT FOR A PATIENT-SPECIFIC APPROACH 
 
Dear colleagues,  
 
Usually, at the time of middle age, peak nocturnal melatonin
deficiency/insufficiency states start to appear.  This has been postulated
to bring about internal de-synchronization that either causes or
contributes to developmental disorders that range from subclinical to
clinical manifestations of functional declines along key metabolic
paramenters. The brain axes affected by this de-synchronization are the
hypothalmic-pituitary adrenal axis, thyroidal and gonadol axis. There is an
increasingly cumulative influence of this de-synchronization that is highly
individual from patient to patient.  There is no singular process called
aging but rather a decline in functional capacities along key biochemical
pathways that affect ranges of function.  AGING IS MULTIFACTORIAL and not
the result of any singular biochemical pathway. In evaluating the aging
phenomena of a individual patient, one has to get beyond the single
substance deficiency hypothesis and realize that multiple hormones are
involved in multiple biochemical pathways.  How are these various
biochemical pathways profiled in this particular patient? What is the
steady state metabolism of these specific pathways?  If any of these
pathways, including the melatonin, retinal pineal tract connection are
downregulated, showing a functional decline,  how much is needed for a mass
action affect in the tissues to bring back a youthful equilibrium state? 
This information can only come from knowing the patient and not something
that one gets solely from trolling the usernet groups and simply
downloading information alone.  
 
Extensive patient-databasing is necessary to answer the question of when,
enough is enough for  a particular hormone support. For example, I  had a
professional patient consult with me about how much melatonin to use
nightly.  It turns out HE/SHE  was using 12 to 18 cups of coffee per day
and had a serious caffeine addiction problem. He was also using NYTOL
everynight and wanted to know if he could still use the NYTOL while keeping
his coffee intake stable!! And start using melatonin!!! 
 
There is no substitute for extensive patient-databasing.  A  clinician has
to determine 
 
1. What is triggering the patient's condition? Is it a melatonin or some
other hormone deficiency/insufficiency state? If it isn't, DON'T USE IT. 
 
2. What are the underlying metabolic pathways? 
 
3. What are the antecedents in the patient's life? Diathesis in this
patient's family and life history? Why these symptoms here and now? What
other life style or other metabolic circuits, cascades and loops are
causing or contributing to this patient's symptoms?  Most conditions are
mediated by multiple biochemical pathways. 
 
People vary as to whether they are functionally, middle aged or not at any
given chronological age. They should be databased by a professional before
deciding to use melatonin and how much of it to use, even though it is
available over the counter. It is difficult for most people to use the
orthomolecular approach that advocates the right supplement in the right
amount at the right place at the right time and with the correct amount. 
Timing and basic precepts of circadian biology are everything in
orthomolecular strategies. Each patient is an irreproducible work of art,
special and having biochemical individuality.  
 
Sincerely,  
 
Ronald B. Keys, JD, PhD (rkeysphd at nyc.pipeline.com), Queens, NYC  &
Mineola, L.I., American Academy of Anti-Aging Medicne, Co-Director,
American Aging Association, American Academy of Clinical Gerontology,
International Association of Biomedical Gerontology, National Academy of
Elder Law Attorneys, Certified: Functional Assessments & Interventions, ART
81, NY MHL, Certified: Interdisciplinary Geriatrics: Columbia
University--NY Geriatric Education Center, Director of Clinical Services,
Forensic & Patient Support Services, (718) 460-3966 
 
 




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