Our doctor tells us how many times a day we should take a pill, but they don't usually tell us the exact time at which it needs to be taken. The future of medicine could be influenced by the idea that a pill can be popped at the right time. It is possible to know the time of day when certain diseases are at their worst, thanks to increasing studies.
59 asthmatics were split into three groups. For four weeks, the first group used steroids. The second used the same inhalers at the same time as the first. The optimal dose for the third group was four times a day at 7am, noon, 7pm and 10pm.
The results came in after a month. The 8am group had the least improvement, while the 5.30pm group had the same effectiveness. Taking a drug once was just as effective as taking it four times if you took it at the right time.
Professor David Ray of the University of Oxford uses his own inhaler when he thinks it will be most effective. As co-director of the Sir Jules Thorn Sleep and Circadian Neuroscience Institute, the professor has conducted his own research into body clock and respiratory disease. The effectiveness of drugs can be improved by matching them with our rhythms.
People who had their flu jabs in the morning were more likely to get sick than those who had them in the afternoon. The patients who received their vaccine between 9am and 11am had higher levels of anti-flu antibodies than the patients who were jabbed between 3pm and 5pm.
Our internal clock regulates our biological activity along with external signals such as light and temperature. It's not just because your mum told you to that you sleep at night, it's also because light stimulates melatonin production and makes you sleepy. Our body temperature can vary by as much as half a degree throughout the day, and we are usually the hottest in the morning just in time for the News at Six. Mouse livers grow almost 50% in size during the day before they shrink at night.
Many chronobiologists believe that we should use this information to improve healthcare. There is a long and short history to the field of melatonin. Sir John Floyer, an English physician, noticed in 1698 that he had asthma attacks after sleeping and that he had to fit by the time he got to work the next day.
The Denver asthma report for one, as well as research undertaken in Canada between 1976 and 1991, found that children given chemotherapy for their leukaemia in the evening had better disease-free survival rates than those treated in the morning Doctors prescribe certain drugs for high cholesterol to be taken at night in order to correspond with the time when your body produces the most cholesterol.
There is still a lot to be cautious of. The field is still evolving according to Robert Dallmann, a professor at the University of Warwick. He says there was a feeling that this was too complicated. Floyer didn't know why his asthma worsened at night. Before it was a black box, notice was only taken once the field started to get to the mechanisms underlying lots of this.
Three American geneticists won the prize for discovering the mechanisms that control our biological clock. The scientists isolated a gene that controls the biological rhythms of fruit flies and found that the gene degrades during the day and accumulates at night. Ray believes that the nominators could see that the science hadn't been translated into the clinic. There is a lot of early-phase work showing what huge potential there is here.
There are pitfalls of potential. If scientists discovered that the flu vaccine works better in the morning over a decade ago, then why aren't people getting it at 9am? The health service could only give half as many jabs in a week. It can be difficult to get people to attend their immunisation appointments, and limiting them to a narrow window could mean that pregnant women with morning sickness miss their appointment, which is much worse than simply being jabbed in the afternoon. Ray says that health systems are under financial pressure. It is similar to a supertanker trying to change course.
Providers don't want to jump the gun before enough evidence has been gathered. In a study of healthcare workers in China, it was found that the Covid-19 vaccine was more effective in the morning. The study found that Covid vaccinations had better efficacy in the afternoon. The vaccinations in both studies were different, but a number of other factors make it difficult to analyze the results.
Funding is the issue. There are marketing and safety issues when it comes to producing drugs that should be taken during the day. There are risks if someone takes it early or late. Patients with long-term conditions don't adhere to their medication Even without new medicine, the field of chronopharmacology can be revolutionary.
It is not unusual for a drug to work in mice and not in humans. According to a study published in 2020, preventive stroke strategies that worked in rodents but failed in humans may have worked because rats are nocturnal. Rats are tested during the day when they are inactive and humans are tested during the day when they are awake.
A lot of promising drugs may have been tested in humans at the wrong time of day. The volunteers were recruited and subjected to a trial. Drugs that were written off as too toxic could be safe if the time of day a drug is administered. Many trials should have clock logic in order to save money and lives.
If you need to take a drug at 8am for it to be effective, you can't because you don't like the morning. One drug can change the timing of another problem. It's not just about matching medicines with your rhythms, it's also about creating medicine that affects the rest of the body.
When he was working in Psychiatry, Vasudevan became interested in the rhythms of the day. He says that when something goes wrong in the brain, it leads to sleep problems. Theorised, "If you can correct the sleep and melatonin, you can fix the mood."
The Oxford Centre for Innovation has a company called CircadianTherapeutics. He and his colleagues are trying to find drugs to treat diseases. The team is working with blind veterans who have disrupted sleep cycles. They are constantly jet-legged. The idea is to have a drug that mimics the effects of light on the brain so that they can take it once a day.
Drugs are being developed to help people with disorders of the brain. Some people with Alzheimer's and Parkinson's are distressed and confused in the late afternoon. There are drugs that could help with these symptoms.
We shouldn't just manipulate our body clock for the sake of it, as Vasudevan warns that taking one newly discovered drug to affect the timing of another could "introduce extra risk". There are still possibilities. If the ideal time for you to take a drug is between 1am and 4am, most people are not going to wake up to take it. At some point in the future, taking a single drug to change your timing could help another drug.
Drugs aren't the only way to live a good life. They are exactly what they say they are. In October 2021, a study from Harvard Medical School found that eating earlier affects the speed at which you burn calories and store fat. Women who exercised in the morning burned more abdominal fat and reduced their blood pressure than women who exercised in the evening, but the later exercisers had better muscular performance, according to a study.
Some of us are morning people and some of us are evening people, so it is important to remember that our internal biology does not always match up. Ray believes that in the future we will likely see personalized chronopharmacology based on the clock phase of the person rather than just going off the time on the wall.
He used his research to find out what works best for him. He says that he uses some of the current knowledge on time-restricted eating and that he chooses his painkillers differently at certain times of the day.
It is important to remember that the time of day that a medicine is taken doesn't matter. It doesn't matter what time of day you give the drug, if the disease doesn't change by the time of day The time of day it is taken doesn't matter if the drug has a long half-life or not.
Scientists warn about being too enthusiastic. Sancar believes that cancer researchers have overstated positive findings from small studies in the past. chronopharmacology is emerging and exciting. It's important to be careful about selling it too much. If you cry wolf it can lead to unhappiness. People are becoming more aware of the field at that point in time.
Patients are over the moon when Ray says that they would like to hear their views about timing and the time of day.
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