Dr. Amy Nett: Okay, so let’s break this down a little bit more. Okay, so when people have trouble sleeping, what’s the best sleep support? Or do you experiment? Yes, you experiment. I generally start with my favorite supplements, give those a try, and then if they don’t work, I start going down the list. So I think I’ve said some of my favorite supplements for sleep are Theanine Serene with relora from Source Naturals. I really like that one. And phosphatidylserine I generally like whether it’s a straight phosphatidylserine or Seriphos. And then after that I would probably put Kavinace, it’s just really expensive. So that’s one of the reasons it’s a little bit lower on my list. 5-HTP is probably, yeah, fourth or fifth on my list. I haven’t seen that one help patients as much. Calm-CP could also go in there. So again you just like work your way down the list. I’ve been using CBD with patients a little bit more, cannabidiol that seems to really help people, but again, as with a lot of the HPA-D supplements when we talked about a little while ago, you kind of have to figure out some of your favorite supplements. And those are your go-to and that’s where you start with patients.
So the other thing too with patients who have chronic insomnia, by the time I’m seeing them they’re like, “Yep, I’ve tried this, that, and the other. No relief.” So depending on what patients have already tried, that might also help you figure out where to start. Doc Parsley’s Sleep Cocktail is another one that I use with some regularity. So I like the, they renamed it recently, I think. Doc Parsley’s Sleep Remedy, or something like that. But the Doc Parsley’s mix of things seems to be really helpful. So I would choose a couple and start with those whenever you have someone with sleep trouble.
And then the melatonin question. Okay so this is almost like one of the first questions that we talked about today was, well we kind of discourage long-term supplementation with glutathione. And I mentioned there’s always new research coming out that maybe we shouldn’t be supplementing with these things that we thought were like so good. Because I agree, like you mentioned, this Italian study that melatonin at 10 mg helps menopausal hot flashes. There’s also some studies that really high-dose melatonin, I don’t remember, I think it was like 20 mg, if not even more than that, is sometimes being used as an antineoplastic agent. So being used in the treatment of cancer. So there might be some situations where high-dose melatonin is good. I don’t think we have long-term safety data, though, to be able to tell patients, “Yup, it’s safe to take this supplement at a pretty high dose ongoing.” Sleep’s really, it’s one of these tricky things because we need sleep in order to be well overall. So it can become really problematic because yes, people get attached to their supplements and then don’t want to let go of them.
So is there risk to taking 10 mg of melatonin every night? I don’t know. Right now I haven’t seen the research that says there is, but would I be surprised if in five years they say, “Oh, it turns out we probably shouldn’t be supplementing with higher doses of melatonin”? It’s entirely possible. So I always have reluctance and I always try to encourage people to get down to the lowest doses and think about doing something like five nights on two nights off, or taking a week off of supplements. So I often tell people quite honestly, look I don’t know if there are any long-term adverse effects of 10 mg of melatonin or whatever supplement you’re talking about. But I’ve seen we used to think selenium was beneficial to supplement with daily. Now we recognize there are some health concerns. So I often just tell people, “Look, research is changing. It’s always evolving. There is potential risk whenever we’re supplementing with these isolated nutrients. So is there risk? Maybe.” So the reason we mention start with half a milligram is actually because some people actually seem to respond better to melatonin of one-half a milligram. I normally, I generally tell people, “Oh, go up to about 3 mg of melatonin, that’s sort of my comfort level. But again don’t know that there’s harm going higher. I just haven’t seen enough long-term safety data on that. But it may go in the opposite direction since we’re seeing these cancer studies showing favorable outcomes. So maybe these patients with the 10 mg of melatonin have an edge on us. So I’m just not sure yet.
And then you said, do I have people that backfire? I have a patient and she definitely has paradoxical reactions to almost every thing we started. What I’ve done with her is we actually used, she actually responded pretty well to CBD or cannabidiol. So I got her on the Ojai Energetics CBD. The other thing that works okay with her is we do some single herb tinctures. So I think we did a single herb tincture of California poppy. Everyone’s, like again, it’s kind of a rotation. I’ve asked her not to take these things every night. But when she needs something, we have like single herb tinctures of I think passionflower, lemon balm, something like that so she can really, really, really small doses. There are some people who just seem to have paradoxical reactions to almost everything. I see that more in tickborne illness and chronic inflammatory response syndrome.
So I don’t know. I don’t think there’s any evidence supporting that, but I’ve heard some other clinicians say as well. And then yeah, so Laura’s also asking, like there are the different options for CBD. So right now the three main CBD options I know of are Ojai Energetics, Quicksilver, and HoneyColony. So Quicksilver CBD, one huge disadvantage is that they will not ship directly to patients, unless they’ve changed that. When I last talked to them, they would only ship to a physician’s office or a practitioner’s office, and then the practitioner would have to give the supplement to the patient. They felt legally it was too risky. So they were very limited in terms of who and where they would ship to.
Ojai Energetics, I spoke with the founder Ojai Energetics and his perspective was that he actually thinks there is value to using water-soluble delivery system for cannabidiol, which is itself lipid-soluble. So this is a little bit in contrast with the Quicksilver hypothesis that the best delivery system is always going to be a liposome. The Ojai Energetics product I also liked because they’re using some of the other plant compounds. And again I think, I prefer things when they’re in more of this whole food type source and I think there’s more of the plant and I think it was, I don’t remember, it was the terpenes or the phyto-something, I can’t remember, that are in the Ojai Energetics CBD. And the Ojai Energetics CBD, I mean it’s this green, earthy sort of herbaceous tincture. Like it’s very clearly from a plant source. The CBD from Quicksilver is pretty much just like a clear fluid.
So yeah, so Brent says he tried it and it doesn’t taste good. You mean the Ojai Energetics one? I don’t think any of the CBD actually tastes particularly good, but, I mean, you just put it under your tongue and I agree, I mean, it doesn’t taste great as with a lot of our herbal supplements. But yeah, it works well. So Brent, I don’t know if you also tried the Quicksilver CBD. So I tried Quicksilver CBD, I personally didn’t notice much of like a calming effect or anything. Ojai Energetics, I feel like was a little bit more calming. I don’t know, that was my own experience. But then talking with other people, they’ve also said that CBD, they’ve had a little more success with the CBD from Ojai Energetics. So the Quicksilver product might be perfectly good. I’m not necessarily saying anything against it. It’s largely we haven’t gotten into that one as much because of the shipping restrictions. And then secondarily, it’s really just been a lot of our patients seem to be doing a little bit better with the Ojai Energetics product. I think I like the compounds that come with the Ojai Energetics, and then the HoneyColony Superior CBD, I haven’t tried yet, haven’t used that with anyone. I think that one’s even more expensive, like over a hundred dollars a bottle, or something like that. So that one’s getting even more expensive, and I’m just not sure we need to be spending that much on CBD. So that’s why I’m preferring the Ojai Energetics one for now.
So did we get everything on that one? Oh, and then yeah, in terms of when she travels or is under stress. Yeah, so again try the single herb tinctures and see what she tolerates. Depending on how bad her insomnia is. When people are traveling or under stress, if they really, really can’t sleep, I do occasionally consider prescription medications for sleep. It’s not a long-term solution, but sometimes we really need sleep. So it’s tricky, though, when patients have the paradoxical reactions.