The Protective Effects of Sleep and Melatonin on the Stomach

Heartburn is a prevalent complaint. It is the commonly used term for GERD or gastroesophageal reflux disease. The reflux is from the stomach acid going up in the chest due to the laxity of the esophageal sphincter. The esophagus has a delicate lining compared to the stomach, which makes it prone to reflux and acid injury.

Excess acid production and loss of the protective barrier against the acid also contributes to the pain in reflux disease. What is worse, GERD can lead to esophageal cancer.

The presence of the bacteria, Helicobacter Pylori, reduces a hormone called somatostatin. This results in the increased production of stomach acid that does not follow a circadian pattern. The continuous production of stomach acid prevents the repair and recovery of the lining of the stomach.

That is why antibiotics and proton-pump inhibitors or PPIs like omeprazole are used together with antibiotics to treat GERD. However, PPI use has been associated with slightly higher death rates among users.

PPI Use Tied to Higher Death Risk

A VA study of 214, 467 patients published in March 2019 showed that patients who take PPIs have a higher death rate (45.2 excess deaths per 1,000 users) from cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. It should be emphasized that the study is about the association of the use of PPIs and higher mortality and not causation.

My take on this is that patients who use PPIs tend to have GERD. GERD is a manifestation of metabolic syndrome. Metabolic syndrome is a constellation of high blood sugar (diabetes), obesity, hypertension, high triglycerides, and low HDL. All of whom are risk factors for many other conditions like heart disease, kidney disease, and cancer.

Diet and exercise have been proven to help manage GERD and metabolic syndrome. In addition, melatonin from the diet and adequate sleep are essential in the maintenance of stomach health and the prevention of gastric reflux

Melatonin and its Benefits for the Gastrointestinal Tract

Melatonin has Several Sources.

1. The pineal gland in the brain responds to the absence of light to produce melatonin as presented in the article The Circadian Rhythm: Timing is Everything
2. The entero-endocrine cells of the inner lining of the gut also produce melatonin and circulated in the blood.  In this situation, the melatonin in the stomach is influenced by food rather than light
3. Tryptophan in the diet can be converted into melatonin. Tryptophans in proteins are converted by enzymes into serotonin and melatonin. The subject of tryptophan is usually brought up around Thanksgiving to explain the sleepiness after eating the holiday turkey. That sleepiness is induced by the double team of serotonin and melatonin.
4. Citrus fruits like oranges and clementines contain tryptamine, the precursor of serotonin and melatonin, and an enzyme that converts tryptophan into serotonin and melatonin.

The Beneficial Effects of Melatonin in the Gut

1. The primary effect of melatonin in the gut is to provide protection for the stomach against acid, bile, cytotoxins in the ingested food, alcohol and non-steroidal anti-inflammatory drugs or NSAIDS like ibuprofen. This protection is made possible by several enzyme systems (COX-1/COX-2 and NOS) that are influenced by melatonin.
2. Melatonin maintains gastrointestinal health by neutralizing free radicals that can adversely affect normal secretion, intestinal movement, digestion, and absorption.
3. Melatonin prevents damage to the mitochondria. The power source of all cells.
4. By decreasing gastric acid, melatonin increases the gastrin and normalizes the sphincter tone of the lower esophagus and prevents acid reflux.
5. Melatonin makes the production of many substances possible that increases blood flow in the gut lining to give it more protection.
6. It improves the regeneration of the cells of the inner lining of the stomach.

In this regard, it has been proposed that adequate sleep or melatonin pills can be used to treat some gastrointestinal problems like GERD. This article, 30 Ways For a Good Sleep Without Drugs, is a good read for anyone with sleep problems.  It is also worth mentioning that there common substances that can negate the effects of melatonin.

What Counters the Beneficial Effects of Melatonin?

1. Capsaicin in peppers
2. Cigarette smoking
3. Alcohol
4. Non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen, indomethacin, and ibuprofen

Take-Away Message

• Sleep is essential for stomach health.
• Melatonin has many protective benefits for the stomach.
• Be aware of metabolic syndrome that may be hiding behind GERD and the common substances that can cause damage to the gastrointestinal tract.

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Don’t Get Sick!

Related Reading:

1. The Circadian Rhythm: Timing is Everything
2. 30 Ways For a Good Sleep Without Drugs
3. How Does Sleeping Protect the Brain?
4. Using the Circadian Rhythm for More Effective Blood Pressure Control
5. 25 Stress-Reduction Techniques
6. The Metabolic Syndrome
7. GERD/Heartburn and Metabolic Syndrome
8. Gallbladder Diseases and Metabolic Syndrome
9. Metabolic Syndrome and the Pancreas
10. How to Do Intermittent Fasting
11. Early Time-Restricted Feeding is Intermittent Fasting In Sync with the Circadian Rhythm
12. The Surprising Benefits of Sweating
13. How to Perform High-Intensity Interval Training

References:

1. Vaughn, Brad & Rotolo, Sean & Roth, Heidi. (2014). Circadian rhythm and sleep influences on digestive physiology and disorders. ChronoPhysiology and Therapy. 2014. 67. 10.2147/CPT.S44806.
2. Al-Aly et al. Estimates of all-cause mortality and cause-specific mortality associated with proton pump inhibitors among US veterans: a cohort study. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1580 (Published 30 May 2019)
3. Majka, Jolanta et al. “Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett’s Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives.” International journal of molecular sciences vol. 19,7 2033. 13 Jul. 2018, doi:10.3390/ijms19072033
4. Luigi De Masi, Domenico Castaldo, Domenico Pignone, Luigi Servillo, Angelo Facchiano. Experimental Evidence and In Silico Identification of Tryptophan Decarboxylase in Citrus Genus. Molecules. 2017 Feb; 22(2): 272. Published online 2017 Feb 11. doi: 10.3390/molecules22020272

Image Credits:

• By BruceBlaus – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44923646
• Melatonin Effects from “Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett’s Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives.” International journal of molecular sciences vol. 19,7 2033. 13 Jul. 2018, doi:10.3390/ijms19072033. This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).

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