Dr David J Zeiger, 26th Dec 2018 (LDN, low dose naltrexone)

Dr David J Zeiger, 26th Dec 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Dr David Zeiger, who is a D.O. in Integrative Medicine and a practitioner from Chicago, Illinois. He treats both chronic and acute illnesses as well as neuromuscular pain. Thank you for joining us today, David. 

Dr David Zeiger: Thank you for having me. I'm looking forward to talking to you. 

Linda Elsegood: First of all, could you tell us about you? Who is David Zeiger?

Dr David Zeiger: I have originally boarded in family medicine over 30 years ago, and I recently got boarded in integrative medicine as a speciality about two years ago. I've been practising family medicine, functional medicine and for the past 30 years as well as doing things in neuromusculoskeletal medicine, including osteopathic manipulative medicine and using techniques called prolotherapy or neural therapy to treat chronic pain syndromes. So, a variety of different therapies in my practice gives me a large toolbox to work from as I work with my patients.

Linda Elsegood: So what is the age range of the patient population which you treat? Do you do from the cradle to the grave or do you do adult medicine? 

Dr David Zeiger: It's primarily adult medicine, but I occasionally do see some adolescents, some pre-teens. I mostly see patients from about 20 to about 80. I've had a couple of 90-year-old patients in my practice, it varies. I would say more it sways more towards a female population than a male population because I do a lot of hormone therapy in my practice for menopause, premenopause, infertility, fibromyalgia, chronic fatigue, et cetera.

Linda Elsegood: Out of interest, I know you prescribe LDN, and this is why I'm interviewing you, but do you use LDN for your patients with fertility problems? 

Dr David Zeiger: I haven't been using it in that direction yet. I've got a few patients who are interested in that and once they get back to me and I will. I have found LDN to be useful for a lot of autoimmune conditions: Hashimoto’s thyroiditis, Rheumatoid arthritis and lately I've been seeing a lot more patients with what's called small intestine bacterial overgrowth and with people who have a variety of different gastrointestinal dysbiotic syndromes, leaky gut syndrome, the inflammation thereof, I found LDN to be very useful in those patients. 

Linda Elsegood: You were saying about mainly females, I think it's usually the female population that has the most autoimmune diseases as well. I think with MS, it’s three women to one man. So that is probably why as well. When you find a patient who is suitable for LDN, how do you go about treating that patient?

Dr David Zeiger: What happens is I generally spend about a good hour with a new patient to get a complete history, do a very thorough physical, literally from head to toe. There's a variety of baseline laboratories that I may use to try and find out what are some of the targets that I'm to go after, be it dysbiotic, guts, the hormonal imbalance, inflammatory markers. I will then put everything together for the patient to explain, “these are the targets that I feel are probably the most significant avenues for therapy and using various different tools, LDN being one of them, I will then broach the patient with the information. I like to refer them to the LDN network, websites and other sources of information. I think that in the States there was a company that used to sell men's clothing and the owner of the company would say, “our best customer is an educated customer.” I feel that the best patient is an educated patient. I feel that as a physician. It's my responsibility and my calling to help, educate and guide patients towards the therapies that I think that are probably the most beneficial to them and answer all the questions I possibly can.

Linda Elsegood: What dose do you start your patients off at? 

Dr David Zeiger: I usually like to start at around 0.5 milligrams and then slowly increase to around 4.5 over a period of about 14-21 days, depending on how they respond. I haven't had the use of microdose. I have a few patients that are currently in my practice where I think it’s worth considering LDN as a beginning point for their therapy.

Linda Elsegood: You said that you have patients that take it for thyroid conditions, and we have learned that some patients who are on thyroid medications have to reduce the thyroid medications because the LDN makes it work more effectively. Have you found that in your patients?

Dr David Zeiger: Most definitely. I have had a number of patients who’ve had Hashimoto's thyroiditis for 15-20 years and they have been to a variety of different practitioners, including integrative practitioners and their antibody levels have been like in the thousands and what I've often found with many of the patients with autoimmune conditions, and I'll specifically talk about how she noticed for a second, is that about 70-80% of the patients with Hashimoto's have a dysbiotic issue, or they may have parasites, they may have protozoa worms, which is what I found in one patient, and by going after these organisms and then treating the results as an inflammatory condition, using LDN as well as other nutraceutical tools, I have been able to lower the antibody levels of these patients and, to improve this as an analogy, decrease the dependence on medications for thyroid over a period of several months. I have several patients where I've actually normalized levels, they have no antibody levels anymore in their thyroid, their TSH has gone down to normal. Their stamina and energy have significantly improved and many things that were tied into that, clinical wise, have also simply improved.

Linda Elsegood: To come off medications, it’s a box with a big tick in it. To achieve that, it's really something. Have you found, in any autoimmune condition, how important do you regard gluten in the diet? 

Dr David Zeiger: Well in SIBO, Dr Mark has been doing research on SIBO for around 25 years and they have published some of the most seminal articles on this, that diet is one of the hallmarks of therapy and when we look at what the components of that are, it revolves around the antigen load from things like gluten and casein from dairy, iron from corn and those are the things that can be major autoimmune triggers in many of these patients.

Linda Elsegood: How long would you say it takes for your patients to notice any improvement? 

Dr David Zeiger: Generally when I start working with the patient, if I had the lab tests and I like to use what is commonly referred to in functional medicine as the 4R program where you remove, replace, reinoculate, rebalance, et cetera. As well as helping the parenchyma of the gut or the gut lining to repair itself. I find that I can usually start seeing results in patients anywhere between 6-8 weeks within a program. They start to notice things like stamina, energy, less gas, less bloating, improvement in brain fog, inflammation in joints improving. I had one fellow who had been suffering from chronic urticaria for years and we're resolving after about six weeks for the first time in years. 

Linda Elsegood: How many new patients notified you of any adverse side effects? 

Dr David Zeiger: You know, that's definitely a case by case basis. I would say the major adverse effects that I see in LDN is a couple of things. Number one, vivid dreaming. Sometimes patients will say, I've never really remembered my dreams, or now I'm remembering my dreams and these are really intense, or they're in colour. The other thing is that sometimes some of our patients suffer from a lack of sleep. Sometimes a spillover into the next day where they might feel kind of groggy. But that usually is short-lived. Gastrointestinal side effects are usually very minimal and those are usually the people where I recommend to them to have a snack at that time with a good eight ounces water, with any sort of medication to mitigate the problems. Some people may have a hypochlorhydria where they’re not able to take tablets. Aside from that, I haven't had any other major problems like headaches or some of the other symptoms some people complain about simply because I really try to warn my patients ahead of time what to expect and if they had any issues, I tell them to give me a call right away. I can usually handle any minor things and address those issues right away. 

Linda Elsegood: What would you say the average dose is? I know you said you try and get them up to 4.5, but do all your patients get up to 4.5 or do some stick at a lower dose? 

Dr David Zeiger: I've had a number of patients stick around 2-2.5 milligrams and they seem to benefit quite well at that dosage. Well, that’s exactly what we found. It's not the higher the dose, the better the benefit. It's really unique and individual per person because some people do really good on two and then they begin to take 3 milligrams and they don't feel as good. Then, by going back they, they feel fine. 

Linda Elsegood: Have you treated any cancer patients?

Dr David Zeiger: I haven't had any cancer patients in my practice at this time. There are a couple of practices out there that have been dealing a lot more with integrative approaches to cancer and so generally what happens is that I will get a patient, they will come in and say they want a sort of functional medical approach to some relative nutritional deficiencies and they may have some other issues, some musculoskeletal issues that I may treat. Then what I may say is, “if you want more of an integrative and well-balanced program…”, I'll refer them out to these other practices that specialize in integrative cancer therapy.

Linda Elsegood: If you had to pick a condition, would you say thyroid is the condition you treat the most in your practice? 

Dr David Zeiger: It’s very interesting that you mentioned that. I would say 70% of my patients have Hashimoto's thyroiditis. It's very rampant.

Linda Elsegood: That's very high. What do you do in order to lower that number of patients? 

Dr David Zeiger: I came onto the Hashimoto's scene probably around 20 years ago and I remember when I was in medical school, we were taught that this was a very rare condition but when I got into practice, I found that it was much more common and actually close to 20% of the patients that have hypothyroidism and the reasons for that were always something that I was curious about. One of the things that I started looking into were things like what are the possible autoimmune triggers. We know from the human genome project that only 12-18% of diseases are actually genetic in nature. The rest of the diseases are due to epigenetic causes. So what are those epigenetic causes? We're looking at things like different pathogen infestations, microorganisms like Blastocystis, hominins, certain protozoa. Another factor in there is stress on the immune system. Diet and nutrition, nutritional deficiencies, another, another factor. Unfortunately, over the past 60-70 years or more, the population has become more and more exposed to these kinds of pathogenic factors and I think this is what is causing a lot of the autoimmune conditions that we see today. 

Linda Elsegood: Do you think people seek you out through word of mouth that you're the man to see if you have a thyroid condition? 

Dr David Zeiger: That's what I hear. So there are people with thyroid conditions, then, of course, those with chronic fatigue syndrome. 

Linda Elsegood: How do you find people with chronic fatigue syndrome compared with the thyroid? I have found people with fibromyalgia and chronic fatigue who are ultra-sensitive to all drugs. LDN included.

Dr David Zeiger: What I've come to see is that many of these conditions have a lot of things in common. I guess the rubric that I would use since I'm also trained in homoeopathy is inflammation, which causes this inflammation, and as I mentioned a moment ago, there are many epigenetic triggers for this. So, depending upon the person's individual biochemical makeup, they will be more prone to the manifestation, all various different diseases, be it thyroid or be it adrenal or be it SIBO. What I find is that when I work with a patient, I look for those factors that will create an inflammatory condition, and then based on their family history, based on the physical findings, I can then hone that into various different subsystems or organ systems that I need to focus my attention on. Be it the thyroid, be it the adrenal, be it hormone imbalances between estrogen, progesterone, et cetera.

Linda Elsegood: With regards to the neuromuscular pain that you treat, and as you were just saying there, how inflammation plays a big part in these conditions, what techniques do you use to treat neuromuscular pain? 

Dr David Zeiger: Well, I'm an osteopathic physician. So I have been trained in medicine so using osteopathic manipulative therapies, I use that modality. I was also trained in medical acupuncture. I use that from time to time. If there are other certain other kinds of, say ligamentous instabilities, I will use a technique called prolotherapy, which is an injection technique to regenerate the ligaments. The interesting thing is that we talk about autoimmune conditions, one of the things that we find with SIBO patients or some of these other conditions is that you may have a variant of a syndrome, which is genetically inherited weakness of the ligaments. It can also be related to certain inflammatory factors in the body that can be triggered by various different things I've just mentioned. So looking at all these different kinds of moving parts, you try to get a picture of what is the most impactful on the patients and health then focus on those things that you can start to build a foundation of health for them.

Linda Elsegood: You were saying that you are an osteopathic physician, and I have seen a chiropractor. What is the difference between the two? 

Dr David Zeiger: That's, that's a very good question. Chiropractic actually evolved from osteopathic medicine. Andrew Taylor Still, who was the founder of osteopathic medicine in the 1800s hundreds, developed osteopathic techniques. A fellow by the name of Palmer was a student of Still. He was also at that time was a hypnotist and he went off and founded a chiropractic practice. So the evolution of the two professions sort of had a certain amount of parallelism between the two of them. The difference between chiropractic and osteopathy is that osteopathic medicine is basically maintained, all of official allopathic medicine. As a matter of fact, osteopathic medicine was the first medical professional to incorporate x-rays. As an osteopath, I have an unlimited license to practice medicine and surgery, whereas a chiropractor has a limited license to practice, basically manual medicine. They cannot give injections. They cannot deliver babies. They cannot do ICU medicine. Although some chiropractors now are trying to become what they call internal chiropractors, internal medicine chiropractors. It's more of functional medicine, but they cannot prescribe hypertensive and I happen to take medication. They can't prescribe antibiotics, those kinds of things that I, as an osteopathic physician and surgeon can. 

Linda Elsegood: I have MS and before I was diagnosed different things kept going numb and I saw a chiropractor, but he had this way of running his fingers down my spine and would say, does it hurt here? He would press really hard with his thumbs. But then he would also get a hold of your neck and twist it to the side until it cracked. I didn't like that. That put me off osteopathic medicine. 

Dr David Zeiger: The palpatory techniques are highly developed. Being able to feel for joint mobility, tissue texture changes, is this inflamed? Is this boggy? Is this hard? I can tell you that when we are assessing a patient. Structurally, those are the skills that we use with our hands because we're talking in that way. Also we use our visual perception of like, how a person walks, how they stand, how they sit and then listen to the patient. Are they talking? So we're basically incorporating all of these other skills of palpation percussion, auscultation, which is hearing. As any other doctor does, any other physician does. Then we understand the biomechanics of the body. So when we look at how the shoulder moves or the hip moves, and then getting into finer detail within the cranium. Osteopathy, which has been around for 80 years or more, it's where we can actually palpate the very subtle motions of the movement of the cranial bones. These things don't fuse until death or certain disease states. Cranial osteopaths are able to determine how well they are functioning, how the different bones are functioning in relationship to one another. If you were to look inside the head and you look in the brain and you see the brain sitting on top of what they call the tentorium, which is like these membranes, all the nerves. I come off the brain and go through the membrane, which is all the ligaments, and then go down through like little holes in the skull down into these cranial nerves that go into the eyes and the nose or down to the neck, and if there is head trauma, surgical trauma, inflammation or infection, then these membranes can then become twisted, inflamed, boggy and cause basically a restriction of flow and thereby affect the end-organ tissue. So train cranial osteopaths to look at this when they're treating, children with cerebral palsy or children with autism, or people who have had PTSD or people who have had chronic headaches, migraine headaches, et cetera. 

Linda Elsegood: We've come to the end of the show, but for people who are in Chicago or the Chicago area in Illinois, how do they get a hold of you? Where do they go? 

Dr David Zeiger: You could call my office at 312-255-9444 and the name of the practice is Healthworks Integrative Medical Clinic. 

Linda Elsegood: Do you have a website for that?

Dr David Zeiger: Healthworksimc.com

Linda Elsegood: Do you have a waiting list?

Dr David Zeiger: I do but if somebody calls me up and they say “I really need to see you”, I will get them in somehow. 

Linda Elsegood: Thank you very much for being such an amazing guest today. I do appreciate it. 

Dr David Zeiger: Well, thank you for the opportunity to talk to you and thank you for your time. 

Linda Elsegood: This show is sponsored by Mark Drugs who specialize in the custom compounding of medications, ensuring that the client gets the proper prescriptions for their unique needs and conditions. They work with practitioners integrating knowledge and treatment of experts. To create comprehensive health plans, visit markdrugs.com or call Roselle at (630) 529-3400 or (847) 419-9898.

Any questions or comments you may have. Please email me at Contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.