Speaker 1: Hello, this is the Itchy and Bitchy Podcast because being
itchy is bitchy and our medical system sucks. I'm doctor
Keith Nolica, a vetnary, allergist and dermatologist, and.
Speaker 2: I'm Stephen Miller, a doctor of nursing practice and a
que care nurse practitioner.
Speaker 1: Send us your questions at ask at itch not dot com.
We love you, but we're not your doctors. The information
we discuss is not direct medical advice. Please talk to
your provider who is the expert on your care. The
Itchy and BITCHI Podcast is sponsored by doc Itchy Medical
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latest veterinary medical research. Visit docchi dot com or find
us on Amazon. Don't forget to send us your questions
to ask at dot com. Welcome back. As always, we
hope you're well and safe. Are you well in safe talk?
Speaker 2: Everything's good?
Speaker 1: Yeah, excellent? Okay. This episode is actually a rebuttal for
one of our legit or bullshit segments that we did
that was based on cortisol face. And this was a
TikTok trend in some other social medias where young adults
post bubest and think that they're getting around her face
because they have abnormal cortisol levels, and they call it
cortisol face. And then there are all sorts of things
you can do for the cortisol face, and I especially
was probably overly negative about it, which I maybe tend
to do, but I'm not normally a big fan of
doctor TikTok, which is why I was negative, and really
post pubescent changes in men and women have pretty significant
body confirmation changes, and change in facial structure is pretty normal.
So going from a child face to an adult face,
some faces get skinnier, but some faces get rounder. So
I kind of poo pooed the whole idea unless you're
a sixty year old person with Cushing's disease. But then
one of the reasons we want to do this podcast
is that we're both very curious and we're a little
ocd and both of us have a little bit of insomnia.
So after that episode, I, at three o'clock in the morning,
was feeling a little bit guilty about poopooing these young
adults with cortisol face and actually thought about what I
was doing in my own clinic. And so this is
a rebuttal to that that actually, depending on what therapies
you might think about using, there could be some benefits
specifically for melatonin therapy, and so we're going to talk
about the benefits of melatonein therapy in both animals and
humans as well as focused on young adults.
Speaker 2: What do you think, Yeah, that sounds good.
Speaker 1: Okay. Do you think I was over the top last time?
Was I too harsh?
Speaker 2: No?
Speaker 1: I think well, I blame the Dorito's and the tequila.
Speaker 2: I think trying to straighten out misinterpretations of information is
what we're trying to do, and I think education is
part of that.
Speaker 1: Okay, So that's so we're good. Okay. So the gist
of it is that I was saying that it's more
likely the night before and having tequila Dorito's are some
high salt content that was causing the problem, and that
the Court is all issue was not the issue. But
it turns out that depending on what you do specifically melatonin,
you can have a lot of benefits in young adults
and adolescents. And we actually have a similar hormone imbalanced
condition and dogs that may be related to sort of
the response that we see in humans with melatonin. So
do you use melatonin in your your practice?
Speaker 2: Yes, I do, And.
Speaker 1: So your tipicly seen older adults, and so those would
be adults with like some dementia, sundowner syndrome, some cognitive disculity, anybody.
So who would you prescribe melatonin for as an actual
medical human provider? And then I'll tell you the animal side.
Speaker 2: Anyone having difficulty maintaining and getting sleep at night?
Speaker 1: And why is sleep important? We like sleep, but what's
the issue with sleep?
Speaker 2: Well, I mean sleep deprivation can lead to all kinds
of cardiovascular issues. It can lead to increases in cortisol level.
I don't know if the viewers are aware, but our
brains have a basically a master circadian pacemaker called the
suprachiasmotic nucleus, And so much like our heart has pacemaker
for pacing beats, our brain has pacemaker for sleep. And
so that leads to initiation of our autonomic nervous system
and ultimately the pineal gland, which is where melatonin's metabolized
and either released or suppressed.
Speaker 1: And so that area, the pineal gland, is interesting because
a lot of reptilian creatures we think of pineal gland.
You know, color changes based on season, based on temperature,
the Arctic fox that turns brown during the summertime and
white in the wintertime, and a lot of these are
very very complex, and we don't completely understand exactly all
of the interactions and the micro interactions that are occurring.
We do think that prolactin is important in part of it,
and prolactin is one of the hormones that regulates the
seasonal effects of animals, specifically, so dogs that will go
through a heat cycle twice a year or have dramatic sheds,
or again, the arctic fox that changes color in the
summertime versus the wintertime is regulated through prolactin, which then
regulates a whole bunch of other hormones, sex hormones, estrogens, progestins, testosterone,
all of those things as well, And so it's a
very very complex system, and.
Speaker 2: There are complexities that lead to disruption in our sleep cycles.
And so our brain, specifically through our eyes respond to
sunlighter darkness, and then those the retina then responds with
either initiation of the brain spacemaker or not. And so
some things that can really inhibit or interfere with those
mechanisms would be things like alcohol intake or medications or
disturbances in sleep wake cycles as we get older, and
certainly among people with that are elderly, they can frequently
get their days and nights mixed up, and then the
wrap at night. They're sleeping during the day on and off.
And so sleepwake cycles really are important to this whole concept.
Speaker 1: And so wrapping this back around to where it comes
back to young adults and adolescents with cortisol face, which
I was overly harsh on, is that if you're having
a disruptive sleep cycle as an elderly person, we recognize
that and there are a lot of proactive measures providers
will take. But teenagers and adolescents young adults are kind
of transitioning from an almost nocturnal set up in their
circadian rhythm to a more adult daytime awake in period.
And then you add into the modern trends with gaming
at night and maybe going out and having some tequila
and partying with your friends in college, or other chemicals, chemicals,
they're being on TikTok too long at nighttime, social media,
lack of sleep, and so it turns out that in
young adults, sleep is very very important, and there's really
no other generation other than our current gen zs, so
this would be high schoolers and college students right now,
so like twenty year olds that are really affecting their
nighttime sleep behaviors. And it turns out that one of
the cute little biological tricks of this whole system is
that a huge percentage of the hormonal spikes and fluctuations
with sex hormones, bone growth, neurologic development, brain development happen
at nighttime. So sleeping for adolescents going through puberty and
young adults is incredibly important for the normal development of
their bodies and their brains and their hormones. And so
we have also an epidemic level of anxiety and depression
and all of these other sort of neurodivergent behaviors. And
one of the reasons I thought we should talk about
this is that in dogs we're recognizing this hormone imbalance.
It's sort of a premature geriatric hormone imbalance that is
melotone in sensitive. So I'm starting to call this geriatric hymns,
So that would be geriatric hormone imbalance with melotone and sensitivity,
and these are interestingly dogs that come in and they
may be like six years old or eight years old,
usually small predogs under thirty pounds, and they basically are
prematurely old looking. They just have thin skin, pot bellies,
muscle breakdown. They look older than what they really should be.
And normally we would worry about cushions disease in these dogs.
We may test them for cushions disease with an ACTH
stimulation test or a low dose TEX test or ultrasounding
the adrenal glands. How do you diagnose cushions in humans?
You do MRI of the pituitary or same hormone testing.
Speaker 2: Yeah, the hormone testing is what we do.
Speaker 1: Okay, so and these dogs may be completely normal. And
then the cheat that we've been doing in ventnory medicine
calling these atypical cushions, So they really don't have cushions,
but we kind of call them that anyway, and that's inaccurate.
So I think we need to recognize that we don't
really understand what's happening to them. But when we give
these geriatric HYMNS dog patients melatonin, about eighty percent of
them have an amazing rebound where they feel two or
three years younger. There are immune systems that were really
kind of wimping out, and they were getting UTIs and
skin infections. Your infections suddenly gets boosted. And so eighty
percent of these dogs with melatonin therapy at night just
have a miraculous rebounds in their hormone balance. And we
don't know why, but we think that we're probably regulating
prolactin and then optimizing sleep sleep cycles, which comes back
to your circadian rhythm in the brain.
Speaker 2: Yeah, And it's kind of like when you go on
a vacation for a week and you get really good
sleep for a week and you feel like a new human,
and then suddenly you get back to your routine and
you're doing all kinds of craziness at night, like sitting
up until midnight, you know, on your phone, or having
too much wine in the evening or whatever. And so
I think that sleep hygiene is something that we're not
good at teaching our children about or learning about. Sleep
hygiene becomes really relevant to this whole concept of trying
to heal the mind and body. Decreased cortisol levels allow
the bodies inherent melatonin levels to kick in, and so
I think sleep hygiene really is important, and what that
means is essentially, you know, heading to bed an hour ahead,
turning off all stimulation, sitting down in the quiet and
either meditating or reading a book or whatever, and so
sort of allowing your body to turn down in the
evening hours rather than ramping up and getting jacked up
on alcohol our you know, cell phone stimulation.
Speaker 1: Yeah, cell phones are a big problem. There are a
lot of sort of self help videos and references now
that if you just remove the cell phone from the bedroom,
that way you won't wake up in the middle of
the night and feel that dopamine urge to doom scroll
for an hour, which resets your panic state in your
brain and messes up all of the hormone fluctuations. We're
going to take a brief break and then we'll be
right back and we'll talk about all of the interesting
hormones that change while we're sleeping. We're back and we
were going to talk about the various things that happen
while we sleep. So we all enjoy sleep. Sleep is
very RESTful and we feel rejuvenated. But some of the
interesting things, especially in young adults, that happen and adolescence
is growth hormone spikes in our sleep, and so growth
hormon you can imagine, does exactly that. It helps us
grow with bone length and density and muscle healing, So
if you're an athlete, that's very important, but also skin
and glands and neurons, all sorts of regenerative things the
growth hormone helps stimulate. And you know, sort of they're
all sorts of jokes about teenagers growing in the middle
of the night and you know, they wake up and
they're three inches longer and they don't know where their
feet are. But it actually is true that if your
sleep is disrupted, you have abnormal growth hormone spikes, and
that can lead to all sorts of problems. So good
night's sleep and healthy sleep habits that we were talking
about are very important. Growth hormone is one of the
things that is very important that happens in your sleep.
Do you have any comments about growth hormone.
Speaker 2: No, No, I mean, I think I totally agree with
Dell all of that.
Speaker 1: So one of the other things that's also very important
is sex hormones. So going through adolescents and developing normal
sexual characteristics for your gender at nighttime for both men
and women, testosterone, estrogen, progestins.
Speaker 2: So essentially you're speaking to gonadotropic releasing hormones.
Speaker 1: Yeah, including LH and FSH, which a lot of people
don't know about, but these are all the normal hormones
that help us develop from children, babies basically into sexually
active adults in a healthy manner, both with our physical
transformation but also our mental transformation and even gender identities.
So that's really important part of what happens in nighttime.
And again you can imagine that if you're disrupting your
sleep cycle, then that's going to be big problem. Melatonin
helps normalize the sleep cycle, so that would normalize your
growth hormone spike and your sex hormone gonatotropin fluctuations, so
you have a much more healthy transformation process.
Speaker 2: Yeah, so it definitely improves RAM regulation and sleep efficiency.
So that probably would be in the clinic setting the
number one reason for recommending someone to take.
Speaker 1: Yeah, and so young adults. So I'm a venary allergist,
and so I pay attention to human allergy treatments. And
there's actually a study that shows that if you give
melatonin to teenager with teenagers with allergies, their allergies actually improve,
which then because of the histamine release and all of
these chemicals associated with allergies flowing through their body, their
overall anxiety even ADHD can improve. So good night's sleep
and melotonin helping that can be really a good thing.
So I kind of started off poopooing the cortisol face,
but young adults taking melatonin really can be a good
thing if it helps them regulate their sleep cycle, and
then they get the normal hormone spikes with the growth hormone,
the sex hormones, LHFSAH, all of those kinds of things.
Speaker 2: Well, I also think it's important not to under estimate
the value of sleep hygiene in younger years. I think
sometimes when we're in college and we're staying up late
at night studying, or we're quote cramming for an exam
and quote sometimes we get our intrinsic melatonin levels off,
and then the downstream effects of all of that is
detrimental on the back end. And so I think again
getting back to properly weighing in on sleep hygiene, and
it may be that if you have proper sleep hygiene
and limit some chemical intake, then you may not even
need to take melatonin.
Speaker 1: Yeah, so eventually and you know, ideally we would be
wonderfully healthy and not need any kind of additives or
treatments or medications. But if again, if you're going to
treat your cortisol face, which I don't think is really
that big of a thing, but melatonin would be one
of the therapies that would probably have a lot of benefits,
so even any age group. The other in researching this
thing that I found out that I was interested in
is that while you sleep, your leptin and gleeland levels
also change, and those are two gastric hormones that affect
appetite and the feeling of fullness and kind of a
can lead to obesity if they're not maintained at a
kind of sort of healthy ratio.
Speaker 2: Specifically, I think that points to the development of metabolic syndrome,
which is, you know, sort of cholesterol, obesity, blood pressure, BMI,
glucose metabolism, all of those things are tied into sort
of metabolic syndrome and the impact of just low melatonin
levels on that particular process, which could.
Speaker 1: Go back to my blaming the tequila and the doritos
for the cortisol face that if you're not getting enough sleep,
and then you have anxiety, and then your leptin and
gleland levels or abnormal, so you feel like you need
to eat more, and then you gain weight, and then
your face really does become moon shaped and rounder because
of all of these things that.
Speaker 2: Are well, you've got the layering on the alcohol effect
of disrupting your sleep from the tequila, right, and then
you've got your putting a high, fatty, greasy dorito into
your gut, which then derives you know, all the churning
of the gut and the mechanisms and your bodies thinking
we're up and we're going, we're ready to party. And
then you had some anxiety onto that the next day. Yeah,
and so then you're just really programming yourself for malfunction
on the back end.
Speaker 1: Okay, we're going to take another very quick break and
then we're going to come back and wrap this up
with a few thoughts. All right, we're back, and just
wrap this up very quickly. So some of the things
that actually could be beneficial for young adults taking melatonin
to regulate and get a healthy sleep cycle. And if
I had to choose my teenagers We actually have five
kids at thirty and younger. If I had to choose
them pu the cell phone away or taking melatonin, I'd
tell them to get rid of the cell phone. But
doing both maybe beneficial. So if you think you have
cortisol face melatonin may not be a horrible idea, but
always check with your provider. We're not your doctor. We
may love you, but your doctor is the expert on you.
But some of the other things maybe actual metabolic syndrome,
appetite through the gastric hormones, normal bone density and growth hormones,
muscle repair if you're into athletics, even memory atension, cognitive
functions may improve with stabilized sleep cycles that the melatonin
could help regulate. That could also help decrease possible anxiety depression.
Overall mood levels could improve. And then you know, like
I mentioned the allergic study and teenagers that the treating
the allergy and got better sleep actually helped some ADHD
symptoms and things like that.
Speaker 2: Yeah, and there are also since I'm a cardiology person,
there are cardiovascular impacts from proper melatonin physiologic conversion, and
so that includes things like nocturnal blood pressure, circadian support,
and decreases in heart rates. So there's a couple of
things there that I think on the cardiovascular side that
definitely help as well.
Speaker 1: And I mean, you may not be ready for this,
but I actually have looked up the toxic dose of
melatonin in dogs, and there is no reported toxic dose
in dogs, and so it seems to have a ceiling
effect and you could make them sick from just giving
them too much powder or pills and dogs again, I'm
speaking dogs, But so for just a teenager to get melatonin,
you know, I think there could be worse things. What
side effects in humans may be occurring with melatonin? Do
they have to be worried about toxicity?
Speaker 2: Yeah, I mean there are super therapeutic doses that actually
can cause sleep disturbance and cause disturbance in your body's
natural melatonin release. And so that's why it's important not
to keep uptight trading your dose without consultation with your provider,
because actually there is a whole theory on it's on
the fact that it's more effective if you take it
at lower doses and allow your body's intrinsic melatonin to
kick in from that low dose stimulation. So there are
all kinds of theories out there, but I think that
consultation with a sleep doctor who is an expert in
these sorts of things might be wise if you're having
severe sleep disturbance.
Speaker 1: Very good, okay. As always, one of my big pet
peeves is doctor TikTok is not a thing, so always
check with your provider. They're the expert on you. Thanks
for listening, and as always, stay well, stay safe. We'll
see you guys next time. Don't forget to send us questions.
We really like your questions, and you can visit our
sponsors at docichi dot com. Any closing comments.
Speaker 2: I would just say that I encourage people to go
to the American Academy of Sleep Physician's website and look
at some of the evidence there on sleep hygiene.
Speaker 1: All right, everyone, stay well, stay safe. Thank you for
joining us. This is the Itchy and Itchy Podcast. Don't
forget to send us your questions to ask at itchn
dot com.