Panacea with a Purpose?

Image from the Low Dose Naltrexone For Multiple Sclerosis blog, http://ldnformultiplesclerosis.blogspot.com

Last weekend I was lucky to attend a conference with pharmacists, physicians, naturopaths and holistic practitioners literally from around the world. Several speakers were from Europe and the UK. There was also a gastroenterologists, neurologist and several general practitioners practicing holistic medicine like myself. This was the first time I have been to an entire conference on one treatment, low dose naltrexone or LDN.  

I started using LDN several years ago or so when I came back from an integrative conference at Scripps Institute. The chronic pain specialist spoke on alternatives to narcotics for chronic pain. He mentioned things I had heard about like Tai Chi and something new, LDN. Around that time an initial study came out using it for patients with fibromyalgia who often have chronic pain and sleep that is not restorative. The first time I used it, I had an adventurous and insightful patient that noted better sleep, improved mood and decreased pain. 

The compounding pharmacist that was making the medication for this patient and I became friends over this novel therapeutic and she asked if I had ever used it for Hashimoto’s or autoimmune thyroiditis. I said I had not. The pharmacist, Wendy Medved PharmD, sent articles my way about its mechanisms and how it worked in auto-immune disease. It was from there that I learned how many applications this new option could offer my patients.  It has served many of my hypothyroid patients since. 

LDN is made from an old generic drug naltrexone. Naltrexone has long been used for its opioid antagonist effects.  If you overdosed on opiates or heroin your life would depend on this medicine or its cousin naloxone, 100 mg would be the dose. If you suffer from alcoholism, we can use it at 50 mg to help curb the urge to drink. When we start LDN we start at 0.5 to 1.5 mg and work up slowly to 4.5 mg. That is why is it compounded. And because it is compounded it adds a bit on the monthly budget ($45-60 depending on where you get it and getting to the right dose). The other problem with compounded medications is that industry isn’t motivated to study them because they can’t be “blockbuster” drugs lining their pocket books. 

I went to the conference last weekend put on by a consortium of pharmacists, doctors and others that have been looking to collect research and data on the many applications of this new treatment. I went primarily to find out: 

1. Does it work and who should use it?
2. How does it work?
3. Is it really good for everything?
4. Can you safely use it in breastfeeding, pregnancy or with children? 
5. Is there anything bad about it (side effects, etc)? 

And guess what? I learned! 

1. Yes it works, for a variety of conditions. Not everything of course. These are the things with preliminary studies: multiple sclerosis, Crohn’s disease, cancer, inflammatory conditions, fibromyalgia. From the mechanism of how it works in these diseases and from clinical experience through the collective of doctors prescribing this from the past decade it is also reasonable to try it for: any disease when the immune system is attacking itself from rheumatoid arthritis, psoriasis, ankylosing spondylitis, hypothyroidism, ulcerative colitis, type 1 diabetes, etc. It also has worked clinically for eczema, irritable bowel symptoms, anxiety, depression, Parkinson’s, Ehlers Danlos and other connective tissue diseases, and chronic fatigue syndrome. Lastly, it has been used in many cases as an additional therapy for cancer patients with and without chemotherapy and radiation. 
2. Several mechanisms for how the drug works have been postulated and studied. I will simplify them here. It decreases inflammation. It slows cellular growth and division (which is why it helps keeps cancer and the immune system in check). It acts directly on a part of the immune system that includes the B and T cells, your “fighters.” It blocks the opiate receptor, but just for a little while, so when it comes off your body has ramped up your endorphins or your natural feel good hormones. That is how it helps with mood, sleep and chronic pain. Pretty cool little molecule. 
3. It doesn’t work for everything. 
4. There was a small study of 200 people showing that it appears safe to use in pregnancy and breastfeeding. This of course should be approved by both doctor and patient if it is considered and lowest doses should be used. It has been used in kids, obviously the ones with chronic illness listed above. 
5. Like all medications there are side effects. Some people it upsets their stomach or their bowel movements. Some it gives strange dreams (and therefore is best taken during the day). Some people simply don’t like it. But overall, the risk is low, no risk known for major side effects from it. However, if you take chronic long acting narcotics it can put you right into withdrawal. That isn’t fun. Always talk with your doctor about all of your medicines and recreational activities. The other component I didn’t like to hear is that in patients that do well on it and do love it, if it is for cancer treatment, prevention, autoimmune disease or some other chronic disease, it is something you like should take forever. Getting to the right dose slowly and methodically is important. Also, making friends with your local compounding pharmacy (that makes it right and not too expensive) is key. If the problem you are taking it for can be investigated and you can find the underlying trigger and reverse it, then a year course might be all you need.  To be determined. 

I am excited to share with exploration of the wonderful world of medicine with those of you that follow these blogs and articles. Like all medications, if you don’t work with me, talk to your doctor before trying something new like this. Do your research on why it might (or might not) be good for you.

Read the book: https://ldnresearchtrust.org/ldn-book 
Check out the research: https://ldnresearchtrust.org/ldn-clinical-trials

Never stop learning.

Dr Brie