Dr Jackie Silkey on the LDN Radio Show 15th February 2017

Linda Elsegood: Today I'm joined by Dr Jackie Silkey, who's from just North of Salt Lake City in Utah. She's a functional medicine practitioner. Thank you for joining us, Jackie. 

Dr Jackie Silkey: Thank you for having me. 

Linda Elsegood: Could you tell us how long have you been prescribing LDN? 

Dr Jackie Silkey: I've been prescribing LDN for about five years now. I’ve treated quite a wide range. I started out using LDN for all autoimmune disorders including Hashimoto's, lupus, and now have branched out into other areas and using LDN for other applications as well. 

Linda Elsegood: And what kinds of results have you seen so far? 

Dr Jackie Silkey: I've seen very good results. I always use LDN as part of a program where I'm addressing more of the root causes of what's going on and putting a comprehensive program, both nutritional exercise, stress reduction, those type programs into place, as well as doing quite a bit of a functional medicine testing. And then I bring LDN as an anti-inflammatory as the extra treatment arm. In most of my patients, I see they are successful in implementing base therapy. 

Linda Elsegood: Have you seen any negative side effects?

Dr Jackie Silkey: Yes. When patients first, start LDN. Sometimes patients will complain of vivid dreams or difficulty sleeping—those sort of common complaints. I'll either move them to morning dosing or depending on how significant the symptoms are, I'll dial back on the dosage or just tell them to go ahead and push on through. And  I find that it improves easily within a week. 

Linda Elsegood: Have you any people that you have treated who have had marvellous results? Do you have any case studies you could quote? 

Dr Jackie Silkey: Most of my patients actually come to me to get a comprehensive program put into place, and then. I actually don't see them routinely. They go back to their primary care physician once I'm able to get them improving in the right direction. And so I don't have patients that are coming in monthly for checkups or checking in with me. So most of my patients will go back to their primary care physician once I feel like that they have plateaued on their healing with me and have put into place all of the aspects of healing that  I find to be important. 

Linda Elsegood: Well, that's good, isn't it? So if so, when a patient comes to you, you, you look at everything, that lifestyle, that diet, exercise, supplements, all this kind of thing to try to get them.to have a healthy lifestyle as well as treating the disease. Is that right? 

Dr Jackie Silkey:  Most definitely. Yeah. In fact, a lot of times I try not to even look at the disease per se. I try and look more at the patient and say, you know, why is this disease happening in the first place and see what we can do as far as reinforcing them foundationally.

And that's where I think LDN really plays a significant role,  is to reinforce people foundationally.  You know, just like we do with nutritional aspects that exercise aspects, stress reduction aspects, all of this just to reinforce not only a nice environment for healing to take place, but also to prevent relapse.

Linda Elsegood: What would you say is the best diet? We're always being asked this for people with autoimmune diseases. 

Dr Jackie Silkey: Well, it truly depends upon the person in my opinion.  I don't even like the word diet. There are so many negative connotations associated with it  I try to use nutritional plan because I really want people to think about this being a nutritional plan, one that they don't come on and off of. So diet, we always think of, I'm going to go on a diet and then I'm going to come off of the diet. And those things tend to be, you know, somewhat more extreme.

When I set up a nutritional plan, let's say for somebody with autoimmune disorders, there are some people that come to me and have read every book and have tried, you know, multiple nutritional plans have had limited success with them. I don't go back and try to recreate those. I just learned from what they've worked on and what they haven't had work in the past. Sometimes they'll do some functional medicine testing, some food sensitivity testing to dive deeper into that person's metabolism of foods and, and their sensitivities and what their blood is doing when they eat certain foods. And that way, I can kind of make a more personalized approach. 

Linda Elsegood: Are you a fan of vitamin D? 

Dr Jackie Silkey: Oh, yes. You know, we can get a lot of sunshine in the summer, but I would say the majority of patients that I test, and I do test everyone, are low. That may be an absorption issue from the GI tract. They're not absorbing it. A lot of people don't know about vitamin D,  that it's a fat-soluble vitamin and that you have to take it with fat. Otherwise, you won’t absorb it.  And there are some people that I don't think absorb their fats very well, to begin with, and so they can have absorption issues.I try and address all of those things. Testing vitamin D levels,  also taking a look at the GI tract and how well they're absorbing their vitamins. 

Linda Elsegood: But I would have to say both my husband and myself, after listening to dr Tom O'Brien at the conference last year, we both stuck to the diet religiously and I have been a diabetic type two, and I was diet controlled for four years. And then I was on Metformin, and I was told a few months ago after being on a diet, say six months or so, that my sugar levels were prediabetic, and I was told that I could stop taking the Metformin.

So I'm thinking, Oh if you're going to take the medication off me, what happens if. They go upon, I don't know, and I have kidney problems. I was really panicked, and they said, don't worry, we will take your blood again. And it showed that I was at serious risk of becoming a diabetic, but I was prediabetic, and I didn't need to take the Metformin.

I've been assured enough seeing the results, and I'm not worried about it. And I'm sure if I keep my diet. As it is, but apparently once you've been diagnosed as a diabetic, they can't remove that from your records. So I'm now a diabetic in remission. So I'm, I'm really pleased about that. You know, one less drug.

Dr Jackie Silkey: I think that there's a lot of people they can say that they are diabetics and in remission as well, you know, or a diabetic, in the, making one or the other.  I think that you know, nutritional plans play a significant role as well as exercise plans and then implementing those exercise plans and then stress. Obviously, stress is going to play a significant role.

Linda Elsegood: Let’s briefly talk about exercise. Now one of the questions that we are always being asked, sick people, can appreciate the fact that they should be exercising people with, say, someone with MS who suffers from severe fatigue, where any exercise, just moving, showering is too much for them, and they spend a lot of the time in bed. What can people do too? Try an exercise when they are that fatigued. What is your suggestion? 

Dr Jackie Silkey: You're absolutely right.  I want to make sure that your listeners know that we always talk about implementing exercise programs and try not to make people feel guilty for not implementing exercise programs. But there are some people that that can actually be quite detrimental for. And, and you know, if you do an exercise program and you're recovering for two days because you did too much, then obviously, you have to build up your base before you’re ever able to really do a formal exercise program. You really have to spend quite a bit of time working with the patient and talking with the patient about what they've done in the past. What was too much for them in the past and if you can dial into what it is that their body needs. Because you take the same person with MS, and then you take the person down the street with MS, they're going to have two very different exercise tolerances, and they're going to have two very different levels of benefit from any sort of a formal exercise program. So you have to make it, in my opinion, very individualized. And that's where I find that it can be very difficult and, and can make people worse initially if physicians to a physical therapist or nurse or anyone is not listening to the person about what's been too much for them in the past and, you know, starting low and going very slow.

Linda Elsegood: So you learn to become fit enough to start to exercise basically very slowly and gradually and not to give up. Forget the idea that you're not achieving anything by baby steps. You do get there. It just takes a while, doesn't it? 

Dr Jackie Silkey: That's exactly right. And everybody has a very different starting point, and so it doesn't really matter where your starting point is, it's important that you start there and that you move forward from there.

Linda Elsegood: I think it helps to keep a diary of what you can do and try and improve on that. If you've only managed to do an extra five steps in a week, at the end of the month, you know, you may have done 20 steps or something like that. It's all just very, very slowly and gradually. And then once you become fit enough, you can then, as you were saying, do a plan. You won't fatigue yourself too much, doing 

Dr Jackie Silkey: too much 

Linda Elsegood: too soon. 

Dr Jackie Silkey: You're absolutely right. And I think that's where pedometers, you know, really play a significant role is then measuring steps and, and there's a lot of things that people can do and in their homes, just depending on where they are. Other things, you know, take more pressure off of the joints, sign up for a program that's actually done in the water, taking some, some of the pressure off of the joints themselves. So if somebody tells me that they had quite a bit of soreness and joint pain, well, there are supplements that you can take before then there's hydration that you can do before them. But there are also ways in which, if their joints are quite uncomfortable that you can do exercise in the water. Even just some gentle movements and walking within the water itself can take the pressure off of the joints enough to where you can slowly build from there. And there's actually a treadmill that's available, it's almost like it's built into a shower and certain physical therapy places will have it and where you can get in there, and you can just very slowly walk on the treadmill,  and water just to take some pressure off. Those are just some examples of different things that I'll have people do. 

Linda Elsegood: I went to a class to do cross therapy, and I was in my fifties, and I turn up, and  I was the baby. They were people who were 70. It really made me smile. They were all so kind to me. And you wore a band around your, your middle. So you floated like a cork no strain on your arms and your legs, and you just bobbed. And it was difficult. It was really, really difficult. So I was saying, you know. I don't think I'm going to be able to do an hour so that I did set it all up, but that's fine. We'll just do it gradually. I could only do 20 minutes.

Dr Jackie Silkey: For some people even just going to the facility, changing into a swimsuit, getting into the water, getting out of the water and going back home, wipe them out completely. It just depends on where people start. If people are quite ill , and then you obviously cannot start with a formal exercise program. 

Linda Elsegood: I couldn't walk when I got out of the water suddenly, suddenly all the weight was on my legs, and it's like, Whoa, I can't do this. I went home, I went to bed, and I couldn't get out of bed and move without really severe problems until Thursday.  I did too much, but I didn't realize it. It just seems so easy, but my legs just, Oh, it was unbelievable. We will just go to a break, and we'll be back in just a moment. 

Today's show sponsor is Care First Speciality Pharmacy. They're leading compounders of LDN and other custom treatments servicing patients in over 18 States coast to coast. They're credited to provide you with the highest quality demanded by the industry and the expert service. You expect to learn more. Call (844) 822-7379 or visit CFS pharmacy.com. 

Back to stress, that's another thing we've never talked about so far on the radio show. What do we do when we're stressed and maybe defining stress versus depressed. I mean, when you have a chronic condition lots of things become a problem to you mentally. 

Dr Jackie Silkey: Yes. I think that you know, when we talk about, it's really important for me to teach patients when we're talking about implementing a stress-reduction plan, is that it's not at the moment necessarily to relieve stress. It's about implementing a plan. It's like a nutritional plan. It's not like you implement a nutritional plan that day, and you lose 10 pounds that same day or gain 10 pounds of muscle that same day. It takes time for you to see the fruits of your labour, but by implementing a stress-reduction plan you're putting more resilience into people's lives and into their body to be able to, to be more resilient with relapses or more resilient with a major stressor that comes along, a car accident, anything that's gonna be a big stress in somebody's life. Stress reduction versus depression, I believe you said stress versus depression, they tend to in a lot of people go hand in hand and that's where these comprehensive programs, including low dose naltrexone,  really helps. People with mental health issues and, and with depression. Now, did they have a formal diagnosis of depression?

Maybe or maybe not, but still low dose. And by reducing inflammatory factors within the brain is able to help. Most people that are dealing with a chronic illness because a chronic illness, by definition, is depressing to the body. It's stressful for the body. It's living in a body that's inflamed and living with a brain that's inflamed is very difficult.

Linda Elsegood: Let’s get to some questions and answers. 

Dr Jackie Silkey: Yeah, that sounds good. 

Linda Elsegood: We have a Marie, and she says she has a seven-year-old who was diagnosed with Crohn's four months ago, and she would like to ask, are the children taking LDN with success and when would she expect to see improvements? And what would the improvements be besides better sleep? Would it assist with pain and quality of life? She was hoping that he would have more energy and be able to go through a normal day at school. 

Dr Jackie Silkey: Well, we were talking earlier about patients that I have on  LDN and my success stories, and. You know, a lot of times I won't see them routinely, but one of the success stories that I have and that I still speak with this patient often is with a Crohn's disease patient.

So Crohn’s disease  you know, quite a bit of  inflammation within the gut. So people that are dealing with a fire brewing inside their body, whether it be in their gut or their brain or their blood or wherever. It's going to fatigue them. It's going to decrease their energy levels. Initially, it might make somebody more agitated, but initially, what initially fires somebody up and makes them hypermetabolic then to close them down later in the disease process. What I tell people what to expect is variable. I put patients on low dose naltrexone and we watch, we take a look, we dial them up.  I do tend to increase their doses slowly and watch for their most prominent symptom, for example. And the patient that I was referring to earlier, one of the hallmark symptoms she would have was diarrhoea, and so she would be having eight or nine loose bowel movements per day when she was in an active Crohn's flare, she also had some abdominal pain. 


So once we were able to start her on low dose naltrexone and then dial-up her dosing, we ended up doing something a little bit different for her. We ended up doing twice a day, smaller doses instead of once a day, larger doses. So you have to keep reassessing. But I will tell you that for some people the response is dramatic and swift. But just because somebody does not have a swift or dramatic response doesn't mean that they aren't going to have a response either later or that it be kind of this slow uptick. I would  say that, what I would tell the mother is, you're absolutely doing the right thing. See what the symptoms that are most predominant at the beginning of starting low dose naltrexone. And then always stay in contact with whoever's prescribing it so they can help guide you on the correct dosage, the correct frequency.  We were talking about stress earlier. Here's my patient who was a student and every time finals would come around, she would have a flare. And so knowing this, we knew how to put into place a stress-reduction program that really dialled up a week or two before she started studying for all of her finals. And preparing earlier for her tests. So there was less last-minute stuff. So we were able to, you know, figure out what her relapse risk factors were, and then specifically guide that around my plan. We ended up not needing the plan, but my plan was also going to think about going towards a higher dose two weeks before those stressful events, but we ended up not needing it. She was able to keep the progress that she had made for throughout the rest of the semester into final examinations by just preparing earlier and knowing what she needed to do would affect what her final result was. So, I don't know if I've given any specific timeframe. I will tell you, it varies from person to person.

 I would definitely take a look at the symptoms that your son is having and that energy, in my opinion, energy usually comes around quicker in kids. But it tends to lag behind the other symptoms, their GI symptoms. So if he's having quite a bit of abdominal pain, an improvement upon the abdominal pain might come first. Then energy might come after that. Imagine that the fire that is brewing inside the person's body is sucking them dry of energy. Well, you have to first, turn off the propane to the fire, and then you have to extinguish the fire and then with time, then that energy will then come back. There are really very few side effects. The only time that it really plays a significant role is if  I tell people about  they have to have surgery or if they accidentally fall out of the tree and break their arm and they have to go on pain medicine, any of those sorts of things where you're going to be stopping the LDN for a period of time.

Or I am trying to use no narcotic pain medications, which would be even a better choice.

So, do I feel that,  LDN is safe in children? Yes. And, even in pregnancy I have a couple of patients that are pregnant, and that stopped LDN during their pregnancy, and resumed it, after they deliver the baby while they're breastfeeding. And  I personally, don't even think that there's any reason why anybody needs to stop it during pregnancy.

But there are no studies  that have looked at LDN in pregnant women because there's, you know, there are no studies that have looked at other medications in women, but we use them. You know, and people that are addicted to opiates will use high dose naltrexone and sustained release naltrexone because the risk to the baby is much greater than the potential risk at high dose naltrexone. Low dose naltrexone is an immediate release Naltrexone compounded formula that can be used in children and young women. 

Linda Elsegood: Well I think many of the listeners will have heard of Dr Phil Boyle using it in his paternity clinics where they use LDN to get pregnant during pregnancy and during breastfeeding. He did a very good presentation for the conference last year. And it showed that babies born were of better weight, had less need for antibiotics. Apparently, some babies need, antibiotics for chest infections and the like, and they weren't contented. And I thought that has to be good  if you've got a baby that cries all the time. So in his experience, LDN has been really good, and he did a small study. I'll have to send you the link to it, which was very interesting. Very interesting indeed. Okay. We have another question here from Lucy, and it's with atopic dermatitis. I know that you do a lot of skin conditions in your practice.

Dr Jackie Silkey: Atopic dermatitis. Cyclosporine is a common Western medicine drug that is used for autoimmune. So it's going to, you know, decrease somebody's immune system reaction to themselves. So the thought is, is that you know, that autoimmune disorders are really yourself, you know, attacking oneself, you know, the whole idea of that, without looking at their foundational, a lot of times what I find is foundational people with autoimmune disorders. Really, their immune system is woefully inadequate for foundational reasons instead of hyperactive, if that makes sense. So people on cyclosporine can take low dose naltrexone . Now, cyclosporine levels are normally checked for somebody who had a transplant who was trying to keep their levels at a certain parameter. And I would say initially when starting any new medication or any new supplement I tell everyone that is taking  for transplant reasons to have their levels checked after starting any new medication or any new supplement because everybody's going to react a little bit differently. So would it, would it potentially affect their levels? Possibly, but not usually. 

Linda Elsegood: Okay.

Linda Elsegood: And we have another one, about eczema on steroid treatment. This lady has been using it for 30 years, and she says, my skin is very inflamed. I have no quality of life. My dermatologist's about to put me on what  the drug we've just been talking about, and she's been off topical steroids for 18 months. And do you think LDN would help?  

Dr Jackie Silkey: As part of a comprehensive program? Absolutely. I find that part of a comprehensive program LDN plays a significant role in all of the autoimmune disorders that affect the skin, that affects the brain, that affects the GI tract.  I try not to treat a disease with a drug or a supplement. I try and treat the person who is having symptoms associated with the disease and look for what their rate-limiting stuff is. So, you know, there are some people that are not absorbing their fats well. They're not digesting. They've got some digestive enzyme insufficiency. They've got  maybe some small intestinal bacterial overgrowth symptoms. They've got a lot of  gas and indigestion, fatty stools, things like that. Well, with that person, I'm gonna think about why the eczema is just being a symptom of the problem. And by far and away, I find that things like eczema, psoriasis, all of these things tend to be more of a symptom of the problem.  Instead of me worrying about labelling people with their diseases, I say, this is a symptom of the problem and we're going to follow this symptom as we address, you know, your insufficiencies as we find them. And that's where functional medicine testing, I believe, plays a significant role. 

Linda Elsegood: And at the time you've got the body working correctly. Do you find a lot of the symptoms resolve anyway? 

Dr Jackie Silkey: Oh yes. That's exactly, that's when you know. There can be several things that you uncover that may not be directly related. Let's just take eczema. It might not be directly related to their eczema, but yet play a very significant health benefit if you can address those things as well. So, but yes, I mean, anytime I'm seeing anybody with anything from acne all the way to psoriasis. I'm definitely treating internal parameters instead of just treating, okay, is your acne better? I'm following many different things, but I think the skin makes it nice because you have an external way of evaluating how well your treatment is going. You just look at your leg, and you say, yes, the treatment seems to be doing much better. 

And people do that with depression. People do that with  getting pregnant. You were talking about infertility treatment. I mean, that's  obviously the goal and obviously the goal is to improve eczema to where it's completely asymptomatic. But. I don't  find that putting topical treatments or putting people on a cyclosporin to be that helpful in getting down to the root cause.

In fact, I think it just masks the symptoms.  I have people come in all the time that are on steroids or cyclosporin or other autoimmune medications. Humira is big here in the United States, and it just masks the symptoms, even if it controls the initial disease or the initial symptom that you're trying to control. Your body just has a way of showing that in some other area. 

Linda Elsegood: And what's the downside on using. Steroid creams longterm over the years? 

Dr Jackie Silkey: Well, first of all, it changes the quality of the skin you're using it on. And second of all, you absorbed some of the steroids through the skin. So, you know, you're interrupting the barrier protection of the skin. Are you making it less of a good barrier to disease and to infection and all the rest? Depending on  if you're just using a small amount of steroid on one area, but some patients have to put steroid creams on multiple areas of their body, and so that ends up being a  fairly large dose of steroids. Some of that is going to get delivered systemically as well as just on the skin. So the problem with steroid creams is that they can thin the skin. So we use the thickness of the skin as a measure of. Health. So think about somebody's face. Think about an older woman's face versus a younger woman's face.

Part of that ageing process is this thinning of the skin, and so it, therefore, can't withstand pressures as well. 

Linda Elsegood: We will just go to a break, and we'll be back in just a moment. Today's show sponsor is Care First speciality pharmacy a leading compounders of LDN and other custom treatments servicing patients in over 18 States coast to coast.

They're accredited to provide you with the highest quality demanded by the industry and the experts' service. You expect to learn more: call eight four four eight two, two seven, three, seven, nine or visit. CFS, pharmacy.com welcome back. Another thing I wanted to ask you, there's a lot of buzz going around at the moment about detoxing teas that you can have to flush out all of the builds up that you have in your bowels. Are they a good idea? 

Dr Jackie Silkey: Well, I think. When we talk about detoxification, we talk about trying to find out, first of all, what you're detoxifying from, trying to get down to kind of a root cause. If it's, you know, just general toxins that we're exposed to, then I think, you know, ramping up your own detoxification pathways is the best way to do it and pooping every day is an absolute mandatory in my clinic. Everybody that comes in, whether they're coming in for eczema or low dose naltrexone or functional medicine. One thing that I always talk to them about is how often they're having a bowel movement. To work on detoxification when you haven't worked on proper bowel function is not gonna work. You're going to do one flush of tea and they might feel better for a day or two, and then they're going to go back to their regular bowel habits. And so, sorry. No, no, no, no. So it's like anything else, doing it once might be enlightening but you want it to be something that they implement from now on. It's not a diet that they go on and off of, but something that is going to stick with them can be life-changing. 

Linda Elsegood: Out of interest. How would you make yourself go every day?

Dr Jackie Silkey: A bowel movement?  Oh, well, it depends on where I feel people are deficient in, you know, so if they're magnesium deficient, which I would tell you that the majority of us are, even our soil which we grow our vegetables are magnesium deficient. People tend to be very deficient in vegetables in general. So I try to calculate, I try and get an idea of how much, um, how much fibre people are taking in during the day, and, um, what sort of bowel, um, irritations they've had in the past. So treating somebody with irritable bowel syndrome, they've had multiple episodes of small intestinal bacterial overgrowth, and it's a very different process than treating somebody who comes in and just says, yeah, I have chronic constipation, but they don't have any abdominal pain, so you have to, you have to treat them very, very different. But somebody who's not having any abdominal pain, not having any abdominal symptoms, then I start, usually start with magnesium and ramp up their magnesium dosing and see if I can't either tests them to find out on a cellular level, what their magnesium levels are, or see what sort of improvement we get from, ramping up their magnesium, but ramping up also fibre intake, water intake.  

Linda Elsegood: So keep flushing and eating those vegetables. 

Dr Jackie Silkey: Yeah. I love magnesium too. Magnesium is great, and it's great to help people sleep better. It helps. It's helpful with nighttime leg cramps. It's helpful with bowel movements. It's helpful with slight blood pressure elevations. 

Linda Elsegood: Oh, sounds a good one to take, doesn't it? Does that come in like PIM form? 

Dr Jackie Silkey: Yeah, it comes in pill form or in a granular form as well. 

Linda Elsegood: We'll certainly have to look into that.

Dr Jackie Silkey: Maybe we can start combining that with low dose naltrexone, low dose naltrexone and magnesium together. Maybe we can get one of the pharmacies to compound that for us. 

Linda Elsegood: That’s food for thought. We have a question here from Elisa. It's about allergies and fibromyalgia. She says, I stopped LDN for a few months but again,I feel tired and cannot sleep. I wanted to start again, but at this moment in time, I use melatonin. Come melatonin be taken with LDN, and I start at 1.5. 

Dr Jackie Silkey: Yes. Both of those, LDN, melatonin can be taken together. You can also take melatonin  I mean, take LDN during the day if it's affecting your sleep. You know, I think the majority of people have been using it at night because that's the original way in which it was prescribed. But I think that a lot of physicians now realize that we can use it during the day in effect, depending on what your goals are for therapy. They can sometimes be even more appropriate than night use depending on what your goals are. The first time I took it, I had a nightmare the second time I had the best dream. I mean, it was kind of more of an intense dream, but it was, you know, worthy of a book when you could have written a book about the stream and it would have been a bestseller. And the third night I was so excited to get back to that dream and nothing. So it just depends. 

Linda Elsegood: I had no vivid dreams at all, so I feel I've been roped even though only one you had one 

Dr Jackie Silkey: and I still talk about that dream, and I still try and recreate it, and I think in my spare time, may need to write a book about that.

Linda Elsegood: Melatonin is easy to get over the counter in the US, but we don't do that over here.  I don't like medication at all. And when I flew to Las Vegas for the conference, my body clock was complete upside down. It was an eight hour time difference. And the first night I woke up at three o'clock in the morning.  I had to work, I had to see people, and I was on breakfast television on one of the television stations. And I think the next morning it was like four o'clock. And then the next day, it's like half-past four. And I went into one of the local pharmacies. And the. The gentleman said, how can I help you?  I said, can you give me anything? I don't care what it is, anything.  I'm just so tired, I can't function. And he said I didn't need a drug that I could actually have melatonin and take it an hour before I went to sleep. And to try and relax.  It worked really well.

Dr Jackie Silkey: Well, with prescription medications there's this whole degree that really we should have to put medications, you know, on this grading scale. You know, one is a very benign medication, one that potentially has a much higher benefit to risk ratio all the way up to 10, where those are the riskiest drugs.And the benefit is lower than the risk. And that way it would provide patients with an idea that not all pharmaceutical medication is bad. Not all supplements are bad, but there is a whole grading system, you know, and I think it would be very helpful. I know I have a lot of people that are concerned about taking supplements on a daily basis. And I completely understand. I think as we age, melatonin is one of the hormones that really starts dropping off. There's a lot of good things that melatonin does. We have a way of measuring it. You can do a salivary measurement with people, and it's very helpful to get that sort of salivary measurement from people who are waking in the middle of the night to look at salivary cortisol and look at salivary melatonin. Who would go,drive to get their blood drawn, in the middle of the night? But by looking at salivary levels, we're able to see, you know, what, what's going on in the middle of the night. And as people age, our melatonin levels do drop off. I really feel like melatonin can be very useful in some people, and some people don't even realize.I mean, it can increase what we call the lower oesophagal sphincter in the oesophagus. So if people are having a lot of reflux at night, melatonin is helpful and in decreasing reflux at night. 

Linda Elsegood: Hmm. I used to have to take medication for reflux, but since I've changed my diet, that's another medication I've stopped.I don't need to take that anymore. So that was a really big plus.  I think people who can't sleep and then go to bed thinking, I've just taken my LDN, and I'm not going to be able to sleep tonight because I didn't sleep last night and get stressed about it. 

Dr Jackie Silkey: Oh yeah. 

Linda Elsegood: It's a cycle, isn't it, where you're thinking, I can't sleep, I can't sleep.

And that's on your mind when you lay down, and I think. Yeah. You need, I don't know what techniques you tell people when they can't get to sleep. I used to do yoga I meditate and I can, put myself to sleep ordinarily  that way without having to take anything. But just by deep breathing and relaxation and, and that kind of thing. What do you recommend? 

Dr Jackie Silkey: Yes. So I always find out what the person's tried in the past. So I'm not, you know if they haven't tried anything, then yes.  I do always start with trying to learn something that you will have with you, whether you're travelling to Las Vegas or not. You know, I mean, people can't just run out and go and get melatonin in the middle of the night, at 11 o'clock at night,  They're in a  strange environment. So I think that having any sort of programs within our own body that we have at our disposal is by far and away from the best way for us to put those plans into place. A lot of times what I'll have people do is trying to associate some of the meditation techniques that you're talking about, counting backwards, you know, starting at a hundred and counting backwards by three, and really focusing on the breath, doing a, what we call four, seven, eight breathing technique where you breathe in for four, you hold for seven, you blow out to eight, where you're really kind of tying up the mind and trying to get your mind off of, Oh, I really need some sleep tonight. I can't believe this. I didn't sleep well last night. No, it's going to happen again. That sort of cycle that sometimes our brain gets into is very detrimental, and so the more that you can kind of tie-up that aspect of the brain, those racing thoughts, those, Oh, I really should be asleep now. I've got this big radio interview tomorrow—those sort of things,  and, and tying that in with relaxation. If people feel that they, they still cannot sleep. Then, getting up, moving food, different room. You know, I'm reading a very boring book. You know, people don't even talk about trying to, trying to, you know, read a dictionary or something that you would find to be very boring, very mundane. Just again, trying to get your mind on paying attention to something else instead of what you're, what you feel like you should be doing.

And then once you start feeling a little bit fatigued, then you go right straight back, and you lay back down and you stay in that quiet space there. People that try all of the self-regulation techniques and they're still not sleeping well. And for those people that have tried all of those things, obviously we check hormones. I checked melatonin levels. I check progesterone, estrogen, and testosterone. I want to see specifically what sex hormones are doing what their thyroid hormones are doing. Then we go from there  instead of me just basing that on guesses. I like to. Individualize the treatment for the patient based on specifically what sort of issues they're having. Obviously, the treatment for high cortisol at night if somebody is going to sleep is very different than somebody who has hormones that barely work. .Those people need, you know, to consider hormone replacement, whether it be melatonin or progesterone, whatever. 

Linda Elsegood: And that leads me to another question we’re frequently asked now when I go abroad, I always take my LDN before I go to bed.

Regardless of what time zone I'm in, and some people say that they are a night shift worker, should they be taking LDN when they get up? Should they be taking it when they go to bed? Does it matter? How would you address that question? 

Dr Jackie Silkey: Well, I addressed the question of we don't really know whether it matters or not. What I tell people is that we have to get to a point to where you're a responder. So that's my initial goal is to start people on it, to get them to be a responder. Not to say, well, you know, you must be, you know, that percentage of people that don't respond and how do we get you to be a responder to LDN?

Once  I know that you are responding to it, then I say, you know, now we get a chance to see if it makes a difference in you because it may not make a difference in you whether you're taking it. At the same exact time every day, or whether you're taking it right before bed, whatever time that is, whether it be one o'clock in the morning or 8:00 AM but you, you don't really know how that person until you get them to be a responder. But once they respond, then I think people will tell you that, you know?  I think this is where journaling like you were talking about, journaling can play a significant role. And there's the LDN app, as you know, which can be very, very helpful. And in and helping people out you know, the symptoms that they're having and what sort of symptom improvement that they're having. t I tell people, don't get so hung up on having to take it. Before bed that you end up missing a dose or you know, take it. When you feel like that, you're going to remember every single day to take it.  I like the idea of taking it before bed because I like to think about all of the hormones that are going through our brain and, you know, increasing growth hormone and, and trying to optimize the brain to provide healing hormones to the rest of the body. But,  I find if that is a stumbling block to somebody taking all the end, then I would much rather they be taking it at other times the day.

Then I'm not taking it at all. And for some people too, you know, you can find out that the right dose, you know? I've had some people that I've changed over to twice a day dosing if they weren't getting a good response with once a day, dosing. So it varies from person to person, just like all of medicine, you know?

Linda Elsegood: I'm going to have to stop you there. We've come to an end. I'm sure we could have gone on for another couple of hours. It's a joy and a pleasure to talk to you now for our listeners if they would like to come and see you or a consultation, how did they go about doing that? 

Dr Jackie Silkey: They can just call the office or send me a quick email and we can talk about scheduling that appointment either in person or online or something.

Linda Elsegood: We haven't yet told them how, where your office. 

Dr Jackie Silkey: Our office is just north of Salt Lake City. It's in a city called Keysville, Utah. And the office number is area code (801) 882-2200. An, the website is www Utah functional med.com. 

Linda Elsegood: And thank you very much for being with us today.

Dr Jackie Silkey: Thank you. Thank you for having me.

Linda Elsegood: Any questions or comments you may have, please email Linda, L I N Dat, LDN.org I look forward to hearing from you. Thank you for joining us today. We really appreciate your company. Until next time, stay safe.

Today's show sponsor is  Care First specialty pharmacy by leading compounders of LDN and other custom treatments servicing patients in over 18 States, coast to coast. That is why they are accredited to provide you with the highest quality to mandate by the industry and the expert service. You expect to learn more.

Call eight (448) 227-3790, visit CFS pharmacy.com.