In a recent Scientific American article, researchers discovered that the expression of up to 82% of our genes turn on or off at specific times of day—that is 16,400 of our 20,000 human genes (and counting).1 The science of circadian medicine may soon determine when you should take a medication or why you get sick at a certain time of day or month.
Logically, it would seem we could apply circadian wisdom to stay healthy, knowing when to take herbs and medicines to prevent disease. While the science is still in its infancy, we are fortunate to be able to foresee many circadian discoveries from the time-tested wisdom of Ayurveda. In fact, researchers are looking in old medical compendiums that date back to Roman times to help connect the dots.
Roman texts and German physicians from the 15th century, for example, pinpoint the most common occurrence of asthma attacks to between 2 a.m. and dawn.1 According to Ayurveda, 2–6 a.m. is the vata time of day, which governs the movement of air in the body. A disturbance or imbalance of vata (like asthma) is predicted to manifest most often during its time of day.
Gallbladder attacks are known to occur more commonly at night around midnight, and in 84% of cases, they occur at the same time of night each time.3 According to Ayurveda, 10 p.m–2 a.m. is the pitta time of night, where liver enzymes activate in order to detoxify the body.1 If there is an imbalance in this detox system (say a gallstone or bile sludge due to a diet of processed foods and toxic oils), a gallbladder attack may be predicted to occur more commonly at this time.
Circadian Medicine Tells Us When to Take Our Pills
Once study measuring the toxicity of acetaminophen (Tylenol) evaluated the time of the >78,000 acetaminophen overdose emergency room visits each year. The study found that a liver protein stimulates production of an antioxidant in the evening that breaks down the liver-damaging poison in acetaminophen, making it safer to take Tylenol in the evening and somewhat riskier to take in the morning. The enzyme NAC (N-acetylcysteine) is an OTC supplement that may protect the liver from acetaminophen poisoning, suggesting that NAC should always be taken with acetaminophen.4, 5
On the other hand, in the morning the liver releases another enzyme called CYP2E1, which breaks down substances in food that we may be exposed to during the day.1
Timing of drug therapy is predicted to increase effectiveness and decrease risks of medicines because of the cyclical nature of our body’s ability to process them. Currently, 56 out of the 100 most prescribed medications are known to have a circadian rhythm of effectiveness.1
Many elderly people are told to take a baby aspirin per day to protect against heart-related concerns. In a couple of studies, when the aspirin was taken in the evening, it effectively lowered blood pressure and reduced the risk of blood clots, but when it was taken in the morning, they saw no such benefit.1
In another study, an enzyme that broke down a toxic chemotherapy drug spiked by 40% if the drug was taken at midnight compared to during the daytime, thus reducing severe side effects when dosed at night.
These studies seem to suggest that during the day, the liver is involved with activity of breaking down food substances. But in the evening, the liver engages in a more complex series of enzymatic reactions to break down toxins that we may have accumulated during the day.
This shift of liver responsibilities is regulated by the light-dark cycles and evening production of melatonin from the pineal gland. Unfortunately, we slowly dial down the production of melatonin after ~50 years old, making us more susceptible to age-related health concerns.
Melatonin is misassociated as a sleep hormone supplement as its job only begins once we are asleep. However, once asleep, melatonin regulates the gut microbiome, metabolic function, self-repair, and stimulation of liver enzymes (like glutathione, SOD [superoxide dismutase], and others) to fully detox, rebuild, and prepare the body for the next day.2
Melatonin: Hack the Aging Process + Boost Detox and Repair
While melatonin has been proven to be both effective and safe, many people take much more than they need. For hacking the aging process, new science suggests that “low dose” melatonin is as or more effective than higher dosages.6
I recommend my patients take .1-1mg of liquid melatonin ~45 minutes before bed as a way to reset the circadian clock and encourage the body to continue making adequate melatonin during sleep to support health, detox, and longevity. Most of my patients find they need less and less melatonin over time to sustain benefits.
Dosing: Liquid melatonin: take 1 drop 45 minutes before bed for 3-5 nights. Then take 2 drops for 3-5 nights. Every 3-5 nights, increase by 1 drop until you experience deeper sleep and more clarity during the day. The maximum dose is 30 drops (3mg), but most see benefit between 1-10 drops. Once you reach the effective dose, slowly reduce the dose over time. Personally, I take 1 drop before bed each night.