With international travel becoming commonplace, more people need
remedies to alleviate the exhaustion and lack of mental alertness
that often cloud the first few days in a new time zone.
John Whitcomb M.D., Medical Director of Emergency Services at
St. Luke's Medical Center in Milwaukee, has coined the phrase
``chronotherapy'' and states, ``It's all in the timing. Your
biological clock is being disrupted, and the natural hormones your
body normally makes are not being made at the right time for the
new time zone you are in.
``By artificially changing the timing of your normal hormone
supply, the research project we're conducting may demonstrate a new
strategy for helping groggy international travelers ... for the few
days it takes for their natural clock to get into synch with their
new time zone.''
Whitcomb notes that the natural hormone melatonin has been
researched extensively to treat jet lag. Melatonin is produced by a
small gland in the brain called the pineal gland. Levels of
melatonin are lowest during the day, and highest at night when it
helps induce sleep. Taking additional melatonin in pill form a few
hours before retiring can help jet-lag sufferers and night-shift
workers get better sleep when they want it, even during bright
daylight.
Now Whitcomb's project aims to determine whether another
hormone, called hydrocortisone, can play an important role for
jet-lag sufferers by doing just the opposite. By taking a small
20-milligram dose on their first day, long-distance travelers may
be able to fend off the groggy, tired, confused state known as jet
lag.
NATURALLY OCCURRING HORMONES
``Because melatonin is produced by the body only at night, it is
most commonly associated with treatments for jet lag,'' says
Whitcomb. ``If you were boarding a plane in Chicago at 5 p.m., for
example, intending to fly to London, you would take melatonin
before you got on the plane.''
Whitcomb further explains that melatonin helps travelers fall
asleep, which is convenient on an eight-hour transatlantic flight.
``When you land in London, it would still be only 1 a.m. for you,
but it would be breakfast time for Londoners. That's when taking 20
milligrams of hydrocortisone may be useful to feel alert and enjoy
your first day.''
FIRST DAY
After arriving in England with her relatives, nurse Shelia
Kading suffered the usual jet lag symptoms and slipped into a deep
nap while driving through the scenic countryside.
``I felt so disappointed to miss what I had longed to see. The
foggy, disoriented feeling clouded the first day for everyone.''
Before her second trip to Europe, Shelia entered Whitcomb's
hydrocortisone study. When she arrived in England, the whole
experience went much better.
``My sister and I took melatonin before we boarded the plane,
which helped us sleep a little during the long flight. When we
landed, we each took a 20-milligram dose of hydrocortisone, and had
a really great day. By the time we went to bed that night, we were
all tired and slept well.''
HYDROCORTISONE STUDY
``Each morning your biological clock makes your body produce
hydrocortisone,'' explains Dr. Whitcomb. ``Blood levels of
hydrocortisone begin to rise as you wake up, and peak about an hour
after you get up.''
That's when a lot of people feel pretty energetic. Then as the
day passes, hydrocortisone levels drop. By bedtime they bottom out,
and tiredness takes over. At that point melatonin levels begin
rising. Sleep progresses soundly, and the refreshing slumber
reenergizes the body like nothing else.
``The idea is to take only a small dose of hydrocortisone on the
very first day when arriving in a new time zone,'' says Whitcomb,
``to help cope with the schedule adjustment. It may prove helpful
for people who occasionally have to work all night too. But
hydrocortisone should not be taken for any length of time, only
periodically and in very small doses.''
PRESCRIBED FOR MANY CONDITIONS
The adrenal glands located near the kidneys secrete cortisol.
Doctors prescribe a pill that is called hydrocortisone, which is
changed into cortisol in the body. Cortisol belongs to a group of
compounds called corticosteroids, which include estrogens and
testosterone as well.
Cortisol helps direct your body to make energy available for
immediate use, and makes your brain feel more alert.
Given for medical diseases, high doses of potent corticosteroids
produce anti-inflammatory effects. They relieve various conditions
such as arthritis, colitis, asthma, bronchitis, certain skin
rashes, and allergic or inflammatory disorders of the nose and
eyes.
Doses vary according to the individual patient and the disease.
In general, the lowest possible effective dose is used. Short
courses of corticosteroid treatment are usually well tolerated.
People who have a condition called Addison's Disease make no
natural cortisol of their own, and require daily replacement
therapy just like patients with diabetes require daily insulin.
President Kennedy had Addison's disease and was given replacement
hydrocortisone pills every day.
Potentially serious side effects can occur with long-term use of
high doses of hydrocortisone. The most serious is suppression of
the body's natural secretion of cortisol. Many people are familiar
with a very potent form of hydrocortisone called prednisone. Taken
for long periods, it can lead to easy bruising, weight gain, muscle
weakness, mood disorders and severe calcium loss from bones.
FIRST STUDY
Whitcomb's study represents the first double blind trial of
hydrocortisone for alleviating symptoms of jet lag. Neither the
doctors nor travelers know whether they are taking a placebo or the
real thing. In this way, the double blind design of the study helps
preclude bias.
So far, about 210 travelers have joined the research project.
Designed with six separate arms or groups, the study aims to sort
out various effects of hydrocortisone, melatonin and a sleeping
pill called temazepam. Travelers complete a standardized fatigue
questionnaire describing how they felt on their first day of
arrival, and send it back to Whitcomb.
TIPS FOR BEATING JET LAG
What are the usual tips for helping jet lag? According to
Whitcomb, getting sleep on the plane does help. Overnight flights
from the midwestern United States to Europe last about 8 hours, and
start in the early evening. Eating a light meal early in the
flight, and trying to sleep are good ideas.
``Some folks advocate a jet-lag diet of carbohydrates before
travel,'' says Whitcomb, ``but no good research has confirmed this.
It's important to remember however, that a heavy meal doesn't ever
help sleep in any circumstance. Despite being excited about your
vacation in France, don't watch the movie on the plane. And try not
to stay awake all night. Skip the second meal.''
Pull up the blanket and snooze for a few hours. Take a travel
pillow. Don't drink alcohol. Jet lag and a hangover make a
particularly bad combination. Drink lots of fluids to avoid getting
dehydrated.
``When you get to your destination, stay awake while the sun is
out, and bright,'' adds Whitcomb. ``Your brain needs to see the
light to switch to a new time zone. Savvy tour operators take their
tourists out to see something right away to keep them awake in the
new time zone. A sleeping pill or melatonin for a night or two will
also help you sleep when your body is reluctant to fall asleep.
