Ancient Healing Wisdom of Body Cycles Makes Drugs More Powerful, Less Toxic

There’s an old saying that timing is everything — which turns out to have important applications with regard to medical treatment and drug dosing. It’s not as simple as merely following dosing instructions that tell you to take a medication two or three times per day, with or without food, however. I’m talking about a field of study called chronotherapy, which is rooted in Traditional Chinese Medicine. Chronotherapy considers your individual biological rhythms, sleep patterns, menstrual cycles and hormonal changes, and harnesses the daily, monthly, seasonal and yearly biological clocks of human beings to optimize the power of drugs, even surgery. Modern-day doctors began to tune in to the importance of timing as they started to track trends of when symptoms of certain diseases were most likely to arise and be severe. The concept has expanded to include a variety of ailments and treatments leading to such innovations as bedtime doses of asthma medications to avert nighttime attacks… scheduling of breast cancer surgery for a specific time in a woman’s menstrual cycle… and development of insulin medications that adjust to the varying needs of patients over a 24-hour period, including while asleep.

To learn more about chronotherapy, I spoke with Michael H. Smolensky, PhD, professor of environmental physiology at the University of Texas Health Science Center at Houston. Dr. Smolensky has spent his academic career studying the importance of biological rhythms in the diagnosis and treatment of a broad spectrum of diseases, including allergy, asthma, hypertension (high blood pressure), heart disease, cancer and certain sleep disorders. He explained to me that belief in homeostasis, the theory that biological functions are more or less constant, has long dominated medicine. But research in chronobiology, the field of science dedicated to the research of biological rhythms and the biological clocks that drive them, has demonstrated that numerous rhythms and cycles are “programmed” into human functioning, some as short as a millisecond and others spanning a year. Of greatest importance to clinical medicine today is the circadian cycle — the fluctuations that take place over a 24-hour span. Dr. Smolensky told me that in the hypothalamus is a master brain clock (it’s called the suprachiasmatic nuclei) that serves to control and orchestrate the circadian rhythms and clocks present in all our cell tissues and organs.

CHRONOTHERAPY AND CHRONIC DISEASES

Here are some examples of chronotherapy principles in use today, based on the most commonly recognized predictable patterns in chronic disease symptoms:

  • Arthritis. People with osteoarthritis are advised to take their pain-relieving medications a full six hours before the time of day they commonly start to hurt — for most, this means taking meds in the morning. Rheumatoid arthritis (RA) patients, on the other hand, do better to take their medications before bedtime.
  • Asthma. Doctors now know to take very seriously asthma attacks that strike in the middle of the night — more than three-fourths of asthma attacks occur in the middle or latter stages of night-time sleep, which is when risk of death from asthma is highest.
  • Heart attack. Angina pectoris, a symptom of heart disease, is most common in the first few hours of the morning and the risk of heart attack or stroke is greatest from the early morning through noon.

CHRONOTHERAPY IN ACTION

One contemporary focus of chronotherapy is hypertension. In most healthy individuals, blood pressure is higher in the morning — but in people who have hypertension as a complication of other medical conditions (such as diabetes, renal disease, sleep apnea or advanced age), abnormally high blood pressure levels are common during sleep. Many studies have shown that doses are more effective if adjusted accordingly.

Cancer therapy is another area of application. Some highly effective chemotherapy drugs are incredibly toxic, causing side effects so severe that patients can barely tolerate them. However numerous studies of circadian rhythm cycles in cancer patients have demonstrated that side effects can be mitigated with careful timing of these potent medications. It is now possible for patients to wear a portable pump programmed to release the drugs at a certain hour. Dr. Smolensky says these devices, called “light-weight programmable-in-time ambulatory drug-delivery infusion devices,” can dramatically improve outcome. They are often used in Europe but not yet commonly available here, he said.

Contemporary chronotherapy also weighs gender differences in how and when people respond to medications. Medical researchers have seen that hypertension drugs are more effective in women when taken at night, but not so for men, and are exploring why. They are also studying the impact of the menstrual cycle on how women respond to medication, as well as in mammography, breast cancer surgery and even the likelihood of suffering sports injury.

TIME TRAVEL IN MEDICINE

Dr. Smolensky believes that incorporating biological rhythms into medical care will eventually become such an integral part of treatment that we will all someday consider it standard therapy… and the very concept of “chronotherapy” will fade away. But for now, it’s something to pay attention to and make sure you discuss with your doctor, especially with regard to prescriptive medications.

Source: Michael H. Smolensky, PhD, professor of environmental physiology, University of Texas Health Science Center at Houston, School of Public Health, Division of Environmental and Occupational Health Sciences.