Health & Fitness

Sleeping well is an essential strategy to optimize your health, and at the heart of it is your circadian rhythm. This is also known as your body clock. It's a natural, biological timer present in every one of your cells that helps your body recognize sleepiness and wakefulness over a period of 24 hours.

Your circadian rhythm is largely dictated by your pineal gland, located near the center of your brain, which produces melatonin, a hormone that is crucial for the regulation of your sleep cycle.

If you have had enough exposure to bright light in the daytime, your pineal gland typically starts secreting melatonin around 9 p.m.¹ As the amount of melatonin in your brain increases, sleepiness sets in as your body begins to prepare for sleep.

If you stay awake past dark, artificial light — especially that emitted by electronic devices — will inhibit your body’s melatonin production, so, ideally, you would stop using electronics at least an hour or two before bedtime to help increase melatonin production and maintain a steady circadian rhythm.

Melatonin Does More Than Control Sleep

While melatonin works as a natural sleep regulator, its biological effects don’t end there.² It’s also a potent antioxidant³ that plays an important role in cancer prevention.⁴ It’s also thought to be important for brain, cardiovascular and gastrointestinal health,⁵ and has been shown to boost your immune function in a variety of ways.

In one study,⁶ researchers suggested melatonin may even improve the treatment of bacterial diseases such as tuberculosis. In another, melatonin was identified as a potential tool against inflammation and autoimmune diseases, including Type 1 diabetes.⁷

Melatonin is also an important energy hormone. As noted in the Stanford University course paper “Melatonin and Energy Levels:”⁸

“… decreasing the melatonin in the blood stream, consistent with the body's natural response to suppress the secretion in the presence of light, causes the body to function at a higher energy level … An increase in the melatonin levels leads to a subsequent decrease in energy levels.

As such, understanding how to control and optimize the secretion and suppression of the melatonin for optimal hours of the day could help improve the treatment of sleep disorders and positively impact the energy levels of individuals.”

In short, if your sleep efficiency is impaired, meaning you’re not sleeping as deeply as you should, for as long as is ideal, then your energy level is going to be adversely affected.

Conversely, spending most of your daytime hours in poorly lit rooms, especially if you’re also exposed to excessive light after sunset, can impair your melatonin production, causing you to not sleep well.

Melatonin Protects Your Mitochondria

Importantly, the antioxidant activity of melatonin also helps protect your mitochondria, the tiny organelles inside your cells that generate most of the ATP or energy currency of your body. As noted in a 2007 paper in the Frontiers of Bioscience:⁹

“Melatonin is an ancient molecule present in unicellular organisms at the very early moment of life … The best-known actions of melatonin, currently supported by experimental and clinical data, include antioxidant and anti-inflammatory abilities, some of them involving genomic regulation of a series of enzymes.

Besides, melatonin displays anticonvulsant and antiexcitotoxic properties. Most of the beneficial consequences resulting from melatonin administration may depend on its effects on mitochondrial physiology.”

In fact, melatonin appears to be the most powerful antioxidant in this regard, as it has the ability to actually enter into your mitochondria.¹⁰ This is an ability that not all antioxidants have. According to this Frontiers of Bioscience paper,¹¹ melatonin helps “prevent mitochondrial impairment, energy failure and apoptosis in oxidatively-damaged mitochondria.”

One of the things that makes melatonin so powerful is that it doesn’t just act as an antioxidant in and of itself; it also interacts with your body’s innate antioxidant system where it recharges glutathione.¹² However, this brings us back to the importance of sleep.

Since melatonin is only released in response to darkness, and is easily and significantly inhibited by light (such as regular room lighting and electronic screens, after dark), your mitochondrial health will suffer if you do not take steps to optimize your sleep.

Aside from worsening your sleep quality and decreasing your sleep quantity, low melatonin production also increases oxidative stress, speeds up the aging process and raises your risk of degenerative diseases and chronic fatigue, thanks to its influence over your mitochondria.

Melatonin Works Synergistically With Vitamin D

In my February 2, 2020, article “The Importance of Vitamin D for Optimal Sleep,” which features my interview with neurologist and sleep coach Dr. Stasha Gominak, I review the hidden influence vitamin D has on your sleep.

A paper¹³ that will be published in the May 2020 issue of The Journal of Steroid Biochemistry and Molecular Biology — which I was able to review early, parts of which I’m sharing with you here — sheds further light on this connection. Not only does melatonin enhance vitamin D signaling, the two molecules act synergistically to optimize your mitochondrial function.

As noted in this paper,¹⁴ “The biosynthetic pathways of vitamin D and melatonin are inversely related relative to sun exposure,” meaning both are dependent on properly timed exposure to the sun.

A hypothesis presented by the researchers is that vitamin D and melatonin “play an essential role as modulators of mitochondrial function and adaptation to circadian and seasonal variations.”

Additionally, “both molecules are involved in the homeostatic functioning of the mitochondria,” the authors point out, stressing that the mitochondria are, in fact, “the final common target for melatonin and vitamin D.” Furthermore:

“A deficiency of these molecules has been associated with the pathogenesis of cardiovascular diseases, including arterial hypertension, neurodegenerative diseases, sleep disorders, kidney diseases, cancer, psychiatric disorders, bone diseases, metabolic syndrome, and diabetes, among others.

During aging, the intake and cutaneous synthesis of vitamin D, as well as the endogenous synthesis of melatonin are remarkably depleted, therefore, producing a state characterized by an increase of oxidative stress, inflammation, and mitochondrial dysfunction ...

Mitochondrial dysfunction has been related to the etiologies of many complex diseases where overactivation of the renin-angiotensin-aldosterone system (RAAS), vitamin D deficiency and the reduction of melatonin synthesis converge.

In this sense, experimental and clinical evidence indicates that inflammation, oxidative stress, as in mitochondrial dysfunction, are consistent with low levels of melatonin and vitamin D, and also represent risk factors connected with development and maintenance of prevalent acute and chronic pathologies.”

Melatonin-Vitamin D Combo Produces Strong Synergistic Effects

According to the 2020 paper in The Journal of Steroid Biochemistry and Molecular Biology,¹⁵ multiple sclerosis, cancer, neuropsychiatric disorders and high blood pressure are all examples of diseases that appear strongly linked to and affected by your vitamin D and melatonin status.

Interestingly, a 2012 study¹⁶ pointed out melatonin is “an overlooked factor in schizophrenia and in the inhibition of antipsychotic side effects.” Vitamin D deficiency has also been linked to a higher risk of schizophrenia,^17,18 especially when levels are low during development.¹⁹

When combined in treatment, melatonin and vitamin D produce strong synergistic effects against cancer. Two separate studies^20,21 have demonstrated the combination induces apoptosis and inhibits growth and division of breast cancer cells. In one of them, the combination resulted in “an almost complete cell growth arrest at 144 hours.”²²

These effects were attributed (at least in part) to enhanced release of transforming growth factor beta 1 (TGF-β1), a type of cytokine that controls cell growth, proliferation, differentiation and apoptosis. Melatonin in combination with vitamin D has also been shown to protect against apoptotic ischemia-reperfusion injury in the kidney.²³

Simple Ways to Optimize Your Melatonin and Vitamin D

The evidence suggests optimizing your melatonin production by making sure you sleep well at night may be a hidden key to maintaining mitochondrial health, which in turn is paramount for longevity and the prevention of virtually all chronic health problems.

However, while there are likely many benefits to supplementing with vitamin D and melatonin, it makes no sense to do so unless you are seeking to optimize your body’s own production.

The good news is it’s relatively simple and inexpensive to increase your melatonin and vitamin D levels. To optimize your vitamin D, I recommend getting sensible sun exposure on large portions of your body on a regular basis, ideally daily.

For further guidance, see “The Risks and Benefits of Sun Exposure.” If for whatever reason you cannot get sufficient amounts of sun exposure, consider taking a vitamin D3 supplement (along with a little extra vitamin K2 to maintain a healthy ratio between these two nutrients).

I personally have not taken any oral vitamin D for well over 10 years and my levels are typically over 70 ng/mL, even in the winter, but I have started taking sublingual melatonin as I am now older than 65, and believe there are benefits for such, even though I sleep in pitch dark and get bright sun exposure around 85% of the time during the day.

Optimizing your melatonin production starts with getting plenty of bright sunlight during the day, as this helps “set” your circadian clock. Then, as the evening wears on and the sun sets, you’ll want to avoid bright lighting.

Blue light from electronic screens and LED light bulbs is particularly problematic and inhibits melatonin the most. If you need lighting, opt for incandescent light bulbs, candles or salt lamps. The blue light from electronic screens can be counteracted by installing blue-blocking software such as Iris,²⁴ or wearing blue-blocking glasses.

Additionally, an interesting paper²⁵ in Nature Structural & Molecular Biology, published in 2017, highlights the usefulness of time-restricted eating to improve your sleep cycle. As noted in this paper:

“The robustness of the circadian clock deteriorates with aging. Two new studies show that aging reprograms the circadian transcriptome in a cell-type-dependent manner and that such rewiring can be reversed by caloric restriction …

Surprisingly, the expression of core clock genes and clock-controlled genes remained unchanged with aging, despite the drastic circadian reprogramming. Thus, the core clock machinery remains largely intact in old age, giving hope for the prospect of reversing aging-associated circadian reprogramming to potentially improve physiological functions.

Indeed, CR-induced robust reprogramming of the circadian transcriptome partially overlaps with the circadian transcriptome in young mice. Thus, the profound physiological impact of CR may be, in part, mediated by the reprogramming of the circadian clock …

Given that aging-associated accumulation of DNA damage in stem cells originates from exposure to mitochondrial stress and that the mitochondrial protective programs are repressed in aged adult stem cells, it is tempting to speculate that reactivating the mitochondrial protective programs may provide a means to reduce the accumulation of cellular damage and reverse aging-associated circadian reprogramming.”

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If you feel revived and energized after a hike through the woods or an afternoon in a local park, there’s likely an intrinsic reason why: Spending time in nature is good for your health. Although modern-day humans are, unfortunately, often disconnected from the natural world, spending much of their time indoors in man-made structures instead of outdoors, humans have deep connections with nature.

It’s not surprising, then, that accumulating evidence shows you can boost your health and well-being by taking time to revel in nature, and there’s even research showing just how much time you should spend in nature to reap the greatest benefits.

Two Hours a Week: The Ideal Nature ‘Dose’

A study published in Scientific Reports explored the associations between contact with nature in the last seven days and self-reported health and well-being.¹ Data from 19,806 participants were included, revealing that, compared to no nature contact, spending 120 minutes or more in nature during the previous week was associated with a greater likelihood of good health or high well-being.

In this case, more wasn’t necessarily better, as the researchers noted, “Positive associations peaked between 200 and 300 minutes per week with no further gain.”²

Also important, the benefits were achieved no matter how the time was split up, so spending 120 minutes in one occasion had the same effect as multiple shorter visits, and the benefits held true across different populations, including older adults and people with long-term health issues.

The researchers even suggested that, with further research, weekly nature guidelines could be developed similar to those given for physical activity. In fact, the study found that getting recommended levels of nature exposure weekly could result in a similar magnitude of health gains as achieving recommended levels of physical activity.³

Indeed, the health benefits of the deceptively simple act of spending time in nature are immense. As noted in Scientific Reports:

“A growing body of epidemiological evidence indicates that greater exposure to, or ‘contact with’, natural environments (such as parks, woodlands and beaches) is associated with better health and well-being, at least among populations in high income, largely urbanised, societies.

While the quantity and quality of evidence varies across outcomes, living in greener urban areas is associated with lower probabilities of cardiovascular disease, obesity, diabetes, asthma hospitalisation, mental distress, and ultimately mortality, among adults; and lower risks of obesity and myopia in children.

Greater quantities of neighbourhood nature are also associated with better self-reported health, and subjective well-being in adults, and improved birth outcomes, and cognitive development, in children.”⁴

Have You Heard of Nature Deficit Disorder?

The term “nature deficit disorder” was coined by journalist Richard Louv, author of “Last Child in the Woods.”⁵ This is not an actual psychological diagnosis, but rather a term used to describe a lifestyle deficit that contributes to poor psychological and physical health.

Louv suggested that humans’ alienation from nature led to “diminished use of the senses, attention difficulties and higher rates of physical and emotional illnesses.”⁶ Speaking with Yale Environment 360, Louv explained that there’s been a surge in research highlighting the ill effects of a nature deficit in recent years:

“When I wrote Last Child in the Woods in 2005, this wasn’t a hot topic. This subject was virtually ignored by the academic world. I could find 60 studies that were good studies. Now it’s approaching and about to pass 1,000 studies, and they point in one direction: Nature is not only nice to have, but it’s a have-to-have for physical health and cognitive functioning.”⁷

A 2019 study revealed, for example, that patients in a psychiatric hospital benefited immensely from gardening.⁸ Working with plants and soil stimulated reflective processes in the patients, who used the activity and the garden itself symbolically to gain insights into their illness.

Along with providing calmness and a needed change of environment from the hospital setting, gardening led to improved mood and pro-social behavior while fostering a sense of community, belonging and shared purpose.

The patients also experienced reduced isolation and felt the activity gave them a distraction from unpleasant thoughts. Gardening may be so powerful, in part due to what’s known as attention restoration theory:⁹

“Attention restoration theory suggests the ability to concentrate may be restored by exposure to natural environments.

Participating in gardening activities allowed an individual to move mentally and physically to a different place, provided an opportunity to feel connected to a larger world and allowed the participant to engage in their environment to meet their needs and interests, all of which contribute to the restorative environment.

Engagement in gardening activities has been associated with stress reduction, increased focused attention, social health, and self-efficacy.”

The flip side is also true, in that city living is linked to mood and anxiety disorders, as well as increased incidence of schizophrenia, and it could be that lack of access to green spaces is one reason why.¹⁰ On the other hand, green spaces with the highest levels of plants, butterflies and birds, otherwise known as species richness or biodiversity, may further enhance psychological health.¹¹

Another meta-analysis of 103 observational and 40 interventional studies investigating about 100 health outcomes revealed that spending more time in green spaces is associated with decreased:¹²

Salivary cortisol (a marker of stress)	Heart rate
Diastolic blood pressure	Preterm birth
Type 2 diabetes	All-cause mortality
Cardiovascular mortality

‘Park Deserts,’ Urbanization and Digital Creep

A number of factors have intertwined to make nature deficit the norm instead of the exception. You may have heard of the term “food desert,” which describes communities that have limited access to nutritious foods. “Park deserts” also exist, in which communities lack green spaces for their residents to spend time in.

With younger generations spending increasing amounts of time staring at screens, living in urban environments without access to natural spaces, the disconnectedness from nature is getting worse instead of better. In the U.K., for instance, more than 80% of the population lives in urban areas — a percentage that’s similar to that in other high-income countries.¹³

While national policies to increase access to natural spaces are limited, local level policies may exist to encourage the existence of and usage of natural spaces. That being said, “the last 20 years has seen an increasing disconnection of people from nature in many countries,” researchers wrote in Urban Ecosystems.¹⁴

Florence Williams, author of "The Nature Fix," explained that one of the symptoms of "mass generational amnesia enabled by urbanization and digital creep" is that kids in both the U.S. and the U.K. spend about half the time outdoors that their parents did a few generations ago.

Fortunately, efforts are underway to change this, including in workplaces. Williams told Yale Environment 360, “It’s needed to attract a skilled workforce. Young people are demanding high-quality outdoor experiences.”¹⁵

In fact a survey by HR advisory firm Future Workplace even found that access to natural light and outdoor views was the No. 1 most sought-after attribute of workplace environment, beating out fitness centers, on-site child care and cafeterias.¹⁶

Even schooling is increasingly taking place outdoors. Louv, who co-founded the Children & Nature Network to increase children’s time spent in nature, said outdoor schools, where the majority of learning occurs in natural spaces, have increased by 500% since 2012 in the U.S.¹⁷

Five Top Barriers to Spending Time in Nature

While in theory spending time in nature sounds good, in practice many are falling short of “recommended” amounts of nature time. A report commissioned by Velux, a window manufacturing company, revealed that 25% of Americans hardly ever go outside.^18,19

“We are increasingly turning into a generation of indoor people where the only time we get daylight and fresh air midweek is on the commute to work or school,” Peter Foldbjerg, the head of daylight energy and indoor climate at Velux, said in a statement.²⁰

In another survey of 11,817 U.S. adults and children, 25% of adults reported spending less than two hours in nature each week.²¹ The Nature of Americans report²² described a significant gap between Americans’ interest in nature and their efforts and ability to pursue that interest.

While numerous factors are contributing to an increasing disconnect between Americans and nature, the report highlighted five of the most prominent:²³

1. Physical places, or a built environment, generally discourage contact with the natural world.
2. Competing priorities for time, attention and money prevent contact with nature from becoming routine and habitual.
3. Declining direct dependence on the natural world for livelihoods and subsistence allows Americans to orient their lives to other things.
4. New technologies, especially electronic media, distract and captivate.
5. Shifting expectations about what “good” contact to nature ought to be mean adults are generally satisfied with the relatively little time they spend outdoors in nature.

How Much Time Do You Spend in Nature?

The featured study suggests it only requires 120 minutes a week to reap the benefits that nature has to offer to your physical and psychological health. Better still, you can break it up any way you want — one hour twice a week, 20 minutes six days a week, and so on. It’s a manageable quantity that should be achievable, provided you make it a weekly priority.

For some, this may mean penciling it into your schedule the way you would other important appointments. You can also combine nature with already scheduled activities. Exercising outdoors is one excellent option, but you can take this even further, taking conference calls outside, spending your lunch break in a park or even holding outdoor meetings.

You can get your children involved, too, taking 20 minutes to walk around your neighborhood after dinner or spending time together gardening. Whenever you have an opportunity to get outdoors, do it — meal times, family gatherings and washing your dog are all opportunities to be outdoors.

Making a goal to spend 120 minutes in nature each week is a good starting point that can set you on a path to increased health and well-being. As researchers noted in Scientific Reports, the benefits of such a simple act can be significant on both an individual and public health level:²⁴

“In terms of magnitude, the association between health, well-being and ≥120 mins spent in nature a week, was similar to associations between health, well-being and: (a) living in an area of low vs. high deprivation; (b) being employed in a high vs. low social grade occupation; and (c) achieving vs. not achieving recommended levels of physical activity in the last week.

Given the widely stated importance of all these factors for health and well-being, we interpret the size of the nature relationship to be meaningful in terms of potential public health implications.”

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As a parent, you can’t help but worry about the safety of your children. So it’s natural that as stories about the novel coronavirus that started in China flood the news, parents worry about whether their children could be at risk.

We are still learning about this new virus; there is much we do not know yet about how it spreads, how serious it can be, or how to treat it. The fact that so much is unknown is a big part of what makes it frightening. But there are things we do know — about this virus and other similar viruses — that can help us keep our children safe and well.

All of the advice below assumes that you and your family have not recently traveled to an area where there are known cases of coronavirus, or had some other possible exposure. If that is the case, you should call your doctor immediately for advice.

As of this writing, there are relatively few cases in the United States, and many measures are being taken to limit the spread of the virus. It’s important to stay informed and listen to the advice of public health officials in your area — and not panic if your child or someone else in your family or community gets a cough and fever. It’s far more likely to be a cold, or influenza (flu), than coronavirus.

In fact, influenza infects millions of people every year and kills thousands. Every year, doctors and public health officials talk about ways you can keep you and your loved ones from catching the flu. Those precautions can also help keep you safe from coronavirus, as it seems that the two illnesses spread in similar ways.

• Make sure everyone washes their hands! Using soap and water and washing for 20 seconds (about as long as it takes you to sing the alphabet song) does the trick. If you don’t have a sink handy, hand sanitizer will do — make sure you spread it well, getting it all over the hands including between the fingers. Wash before meals and snacks, after being in public places, and after being around anyone who is or might be sick.
• Encourage healthy habits, like eating a healthy diet, exercising, and getting enough sleep. This helps keep your child’s immune system strong.
• Make sure your child has received the flu vaccine. The flu is far more common — and can be very dangerous too.
• Teach children not to touch their mouths, eyes, or noses with their hands unless they have just washed them. This is easier said than done, I admit. Make a game out of it — have them itch with their knees instead. Carry tissues for wiping mouths and noses, and throw out used tissues promptly.
• Teach children to be careful about the surfaces they touch when you are out in public. Little hands seem to instinctively reach for everything around them, so you’ll need to be creative. Bring things for them to hold instead, or hold hands with them. Have them wear gloves (in cool climates in the winter you’d likely do that anyway — have extras so you can wash the worn ones when you get home). It’s not a bad idea to carry some wipes with you to wipe down seats, tables, and other such things in public areas before you use them.

Does avoiding sick people mean staying home?

In addition to the steps above:

• Stay away from sick people to the extent that this is possible. Unless there is a specific public health advisory in your area or an area you are traveling to, this does not mean holing up in your house, skipping school or daycare, and declining every birthday party invitation. Ultimately, it’s impossible to stay away from anyone who has any germs that might be spread; as is true of many viruses, it appears that people with coronavirus may be contagious before they have clear symptoms. Just be aware of symptoms of people around you, such as coughing or sneezing. Keep space between you and others in public spaces (again, to the extent possible).
• If you are hosting people at your house, you have the right (responsibility, actually) to ask people not to come if they are sick. Keep hand sanitizer by the door of your house and ask guests to use it when they arrive.
• If anyone in your family gets a fever and cough, they should stay home. Chances are it’s not coronavirus, but whatever it is, it’s likely contagious. Not only is staying home and resting the best way to get better, but also you don’t want to panic others by having your child cough in their child’s face.

Advice if your child has a fever and cough

If your child gets a fever and cough, this is what you should do:

• Call your doctor’s office for advice specific to your child and your community.
• If your doctor does not think your child needs to be checked, you can help them feel better by
  • being sure they stay hydrated. Make sure they are drinking regularly. Popsicles are a good way to get fluids in, and can soothe a sore throat.
  • using acetaminophen or ibuprofen for fever. Check with your doctor’s office about the right dose for your child.
  • using a humidifier to help with congestion.
  • limiting the use of over-the-counter cold medicines in children under the age of 6. They don’t help much (even with kids over 6), and can have side effects. In children over a year, honey can soothe a cough. Use salt water drops for stuffy noses.
  • making sure they rest. Being glued to a TV or device all day is not a good idea.

Watch for warning signs of problems, and seek medical attention if they occur:

• any trouble breathing (rapid or heavy breathing, sucking in around the neck or ribs, looking pale or bluish)
• severe cough that won’t stop
• high fever that won’t come down with acetaminophen or ibuprofen
• unusual sleepiness
• irritability or pain that you cannot soothe
• refusal to take fluids, or any signs of dehydration (dry mouth, no tears when crying, not urinating at least every six hours).

You should also check in with your doctor if your child has an unusual rash, is having a lot of vomiting or diarrhea — or if there is something else that concerns you. I have learned over the years that parents have a very good “spidey-sense” when something is wrong.

Again: try not to panic. There’s a lot of misinformation floating around. Check reliable sources for updates, follow these tips, and call your doctor if you have any questions.

Follow me on Twitter @drClaire

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