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What about Oral Progesterone for Sleep?

Last week’s video dove into the perhaps unexpected and negative effects of oral hormone supplementation on the body.  Check out that video here.  A great practitioner question came in:  what about oral progesterone used specifically for sleep?

A great question – and opportunity to challenge your learning!  Do you know why oral progesterone might help sleep?  Do you know why oral intake (vs. transdermal) might be so much more effective for countering insomnia – but only in some women?

Absolutely some women may indeed benefit tremendously from progesterone supplementation (e.g. late perimenopausal years).  Unfortunately there’s a growing trend of practitioners recommending it without even assessing hormones at all (or any other actual root cause of insomnia).   Low progesterone relative to one’s estrogen level can definitely promote poor sleep (no shortage of data showing that!  here and here and here…)  But what if hormone levels are actually adequate:  what are alternatives that might address the same pathway that progesterone boosts?

We know that optimal sleep is a critical part of the functional medicine lifestyle!  No surprise to us, a new Consumer Reports survey said that a quarter of people have trouble falling or staying asleep nightly, and more than 2/3 struggle at least once a week.  And this gap promotes depression, heart disease, lowered immunity, obesity, type 2 diabetes, and more!

Beyond the pearls for this unique situation in the video, I also want you to have a powerful toolbox for helping ALL of your patients and clients sleep better.  By far, the most important, foundational intervention I have found for optimizing sleep is what, at SAFM, we call “sleep hygiene”.  I’ve got a great handout summarizing the tenets, and I’m sharing it right here for you as a free gift.  Remember:  detailed education can create the inspiration and empowerment that finally allows a patient to make and sustain important lifestyle change.  You are also welcome to check out one of the several posts about sleep available here in our public Clinical Tips area.

I know you want the practical details!  There are other options for promoting GABA to help enable sleep.  Consider 500mg taurine (or one can use magnesium taurate and get the best of two key relaxation nutrients) taken an hour before bed.  L-theanine dosage to support sleep is typically 200-400mg (I usually recommend suntheanine, which is available in many brands).  N-acetyl-cysteine may also be quite helpful for this particular dynamic of GABA-Glutamate balance.

I hope this is helpful to you and the patients and clients you serve!

Warmly,

 

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John Castella

Hi Tracy,
NeuroScience’s Kavinace is no longer available. Is there an alternative product you recommend?
Thanks, John

SAFM Team
Reply to  John Castella

Kavinace is still available but it has been reformulated by the manufacturer to include: Melatonin, L-theanine, Resveratrol, Zinc, Selenium, Magnesium, and Astaxanthin, which seems to be a good GABA-production and sleep support. Please note that phenibut got pulled off the market by the FDA:
https://www.fda.gov/food/dietary-supplement-products-ingredients/phenibut-dietary-supplements

America Diaz

I’m a new student at SAFM and I just listened to this clinical tip. Is Phenibut back on the market and available again? My clinic had stopped carrying it about a year ago because they had been informed that the FDA had pulled it for functional medicine use. Can you share share an update on this?

SAFM Team
Reply to  America Diaz

It looks like Phenibut is still not available, this is the latest (dated 4/29/19) communication from FDA on this substance:
https://www.fda.gov/food/dietary-supplement-products-ingredients/phenibut-dietary-supplements
Please note that Kavinace from NeuroScience got reformulated and now offers a unique blend of nutrients and antioxidants to support GABA production and sleep in general.

sharon chud
sharon chud

Hello Tracy. I have put a client on Phenibut and for the first time, something worked to help her sleep. She also has a declining kidney function. She is over 60. Yes, kidney function declines with advanced age but I think hers is going down relatively fast. My question is could Phenibut worsen her kidney function? I searched and could not find any information on this. What is your opinion?

SAFM Team
Reply to  sharon chud

What I found in the literature is that overdose and acute Phenibut withdrawal can affect kidney function, which is not surprising, but safe doses and proper weaning can prevent that. Here are a couple of well-referenced articles that may be of interest to you:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952553/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535394/
Also, I would consider that your client’s kidney function is declining for a reason not related to Phenibut that is properly used. It may be worth putting the FM lens to what are the possible drivers of this situation for your client – maybe it is low-level insulin resistance, unmanifested kidney stones, toxicity or diet that’s too acidic. I recommend exploring these posts for further learning:
https://schoolafm.com/ws_clinical_know/kidney-stones-remedy-recurrence/
https://schoolafm.com/ws_clinical_know/kidney-myths-and-truths-for-practitioners/
Hope this is of help to you.

Leslie Flanigan
Leslie Flanigan

What about non-synthetic topical progesterone cream, i.e., extracted from Wild Yam?

SAFM Team

There’s no harm in trying the wild yam extract and it could be helpful. However, since it is a natural product, the amount of hormone-regulating substances can vary wildly from preparation to preparation. If you’d like to learn more about wild yam explore these write-ups:
https://www.ncbi.nlm.nih.gov/pubmed/11428178
https://www.medicalnewstoday.com/articles/322423.php

Kymberli Norman
Kymberli Norman

101 student. For intervention are the above supplements Tracy suggested recommended together? Or, trials to determine which help? Thank you!

SAFM Team

Welcome to SAFM, Kymberli! Typically, supplement recommendations depend on each unique case and those described in the post are presented as potential tools for your (soon to be quite extensive) toolbox. Some of the presented supplements can be taken together, but rarely you would recommend all at once. I encourage you to start only with those that you understand and feel comfortable using. I know that you will gain more and more confidence and understanding with time, as you are going through the various SAFM required courses and clinical deep dives. Enjoy the learning process!