Dr John Kim on the LDN Radio Show 7th November 2018

Linda Elsegood: I'd like to welcome back Dr John Kim, who I know many of you have listened to his radio shows in the past. He's always got exciting things to tell us. So welcome, John and thank you for joining us today. 

John Kim: Well, thank you so much. I really appreciate your effort in making Low Dose Naltrexone all front and centre in the integrative functional world.

And I think that it's even going beyond that. I'm even talking to talking to specialists within K U  in Kent, University of Kansas Medical Centre specialists, all talking about low dose naltrexone. So I think that, um, you and the listeners have done a great job putting this issue of light in the middle is the front end centre.

Linda Elsegood: Well, I have to say you're certainly one of those doctors who liked to push the envelope, think outside the box, to try to find solutions for patients who are complex, should we say? Because I mean, some people are harder to treat than others with all the different symptoms. 

John Kim: I think you said it. Oh, you've nailed it.

The word complex and my patients tend to be very complex, the integrative medicine St Paul appears to attract patients that are complex. And it's what's interesting is all part of the training that I had with Dr Andrew Weil was the theory of complexity. How do you, um, approach complex issues?  How do you solve complex medical problems? And he's always said that you want to go to the area where everything gets together like sort of a nexus of issues. So for Dr Andrew Weil it has been inflammation, which we will come back to, to LDN. And to me, it's been autoimmune or immune dysregulation that I've seen.

And it's just very interesting because this all started with one patient, one patient who came to me and said, Dr Kim, I have learned about this new idea called Low Dose Naltrexone and I have a thyroid disorder, and I would like to try it. So I told the patient that I would like you to research it. So because I am used to having complex patients, I researched it and really the potential benefit versus potential harm, I really saw more potential benefit that I didn't see much harm in them trying LDN and to make a long story short this has transformed my practice if anything, autoimmune really gets limited what I can I that acid. Oh, and put them on an anti-inflammatory diet, but a supplement, but I wasn't getting what I call reliable, repeatable results until we went to LDN.  And LDN is not 100% doesn't work 100%, but I think that it has achieved all a form on reliability or repeatability. For me.

Linda Elsegood: LDN is only one of the tools you have in your toolbox. What do you use in conjunction with LDN? 

John Kim: So for, I think that one of the things that I find most fascinating is that, in this day and age, immune dysregulation, I'm seeing a lot more allergies, food allergies, and in integrative medicine, a lot of times people say, Oh, just don't eat it.

And it's easy for the practitioners saying, but really by the time you take out all gluten, I'll take out yeast, take out the milk, it's very difficult. It's very. It can be done. But if you try to go outside, like in a restaurant or social settings, they're difficult. So one of the things that I have discovered again, through a patient, um, who was really suffering a lot because of food allergy, is there's a way to teach your body, in conjunction with Low Dose Naltrexone, to not to react to food allergies, teach it to stand down, and it's called our food allergy drops that all that they can do Amazing work. And then other tools, of course, you think of food as medicine, and I think that we understand better and better how powerful food can be. One example of this, of course, it is a vegetarian diet, an anti-inflammatory diet, and there's also ketosis that is ever more popular. Um, and of course there is Dr Terry Walls, um, modified Palio diet for autoimmune diseases and I think there are some commonalities to all these conditions.

And so we use food as medicine, one of the other tools that I love, that goes very well and hand in hand with LDN, is acupuncture and the reason I say that acupuncture are gone hand in hand is that the earlier we search with how acupuncture works have been shown demonstrated by using Naloxone, a related like a constant of naltrexone and naltrexone.

So we know that if you want to disrupt—the effects of acupuncture you can use high dose naltrexone, meaning it's possible that acupuncture is doing what LDN would be doing, and there's a paper that was written and published by a Dutch professor hypothesizes that cannabinoids, LDN, acupuncture probably share the same pathway.

And I think that that is one of the most exciting, um, ideas that, um, uh, propelled me because I started using LDN more widely than autoimmune when I read an article that LDN may have anti-inflammatory effects and since then, or how, what happened is that patients who couldn't come or could not afford acupuncture because one of the most effective tools about LDN is the cost.

For less than a dollar a day you can treat the most complex conditions using LDN. So all but acupuncture when it didn't work, or it was too far out prescribed, those people offer them, which, because LDN and I've become trusting to do similar kind of things, let's use LDN in view of acupuncture, and I would see amazing results.

And that's where all especially with pain and neuropathy, especially Um, and then now we know the basis of it and molecular basis of it because of dr Jerry younger, uh, did, uh, published articles on fibromyalgia and using LDN with demonstrated LDN is helpful or help people with fibromyalgia. And the mechanism is fascinating because in, um, professor.

Younger is basically proposing LDN. Low dose naltrexone is functioning as an anti glial cell modulator, which there is another anti glial cell modulator but LDN is amazing because of many, many properties. It can penetrate into the brain. I think it's a quarternary. I mean, so he can, he is able to go to the CNS. Um, relatively rapidly metabolized into another compound that can stay in the body for a long time.

So really you're getting the effect of LDN in, um, and it still works as a, um, opioid antagonists, which means that you still, you're getting endorphin in peripheral as well as the central nervous system as well as in the body. It's just really amazing. Um, and then of course, um, the, the anti glial cell modulation, it just opens up all kinds of therapeutic possibilities.

Linda Elsegood: It's amazing, isn't it? Before we go on further with LDN, and I know people are going to pick up on what you said about you teaching your body too, how did you explain it? Eat foods that you are intolerant of to teach your body so you can eat those foods? How would you go about doing that? 

John Kim: So, um, there is a protocol developed in Wisconsin, and that's the poor uncle. Then I modified, what I do is that I do a generalized food allergy test. That, uh, what I call, what a wide-angle or shotgun approach where we can test a relatively large number of allergens, food, allergens at a very low cost. So that as a screening tool, once I have that tool, um, I discuss with patients, usually I give them the results and give them the ordering sheet about tests that's more specific, but more importantly, it is quantitative. Because it's truly quantitative or it's quantitative enough that it can be turned into an allergy drop. So then what you can do is you can use food allergy drops that are specifically targeting specific food at a specific dose. So you can - Well, it's similar to an allergy shot. I think it's safer because it's through the mouth. I think most of Europe is familiar with this approach. Um, and uh, the big advantage is safe because you can swish and spit and you're looking for reactions, any kind of reactions, that means that those may be too high. And then you just simply pull back to those or ask the pharmacy to, uh, formulate a the more dilute a portion.

Linda Elsegood: That's amazing. 

John Kim: and, and it goes well with LDN because a lot of patients, I ask them to do both LDN to all function as an anti-glial modulator to decrease its immune systems or tendency to overreact. And then in the meanwhile, I use the, uh, food allergy drops to lower the dose, and you can do that with environmental allergy combined LDN plus, um, plus the food, the environmental allergy drops. You just don't want to do them together. You don't want to start both of them and simultaneously because you may overwhelm the body and into, um, like a crisis. And we don't want to do that. And patients who I do this too, I prescribed, um, EpiPen to make sure that they have safety. And well, first, those, they have to take it in front of me so that I have to make sure that they are okay. They have my cell phone number. Um, and these days I think cell phone number better than the home number. So they can text me, they can email me, they can call me if they are in trouble. 

Linda Elsegood: Wow. Wow. To have a doctor who would let you text him? That's a very good service. Very good. So what else do you have to tell us? Um, that's new with LDN  John?

John Kim: So, um, the LDN part I find very interesting is that, um, I think when we first connected, the world at that time was using 1.5 milligrams as a starting dose. Now I think that most people are open to starting at 0.5 milligrams.

And even the reason I did that was I saw some, uh, category of the population of my patients who the endorphin levels were so low that at that level people had side effects. And. I've since then cut it down to 0.1 milligrams or a hundred micrograms and um, and that cut out fewer people now have a reaction, but I'm still seeing people with reaction.

So about two years ago, I started people at ten micrograms, and recently something happened with, I think the regulation that, well, I'll be, pharmacies now have to assay and prove that the amount of LDN is what it is and, or, you know, appears to some pharmacies are boarding Turley doing it, which is an excellent practice.

But as a result of it, I think the essay just doesn't work very well below a certain level. So now, um, the, some of the Compounding pharmacies, they are capable of making one microgram, but they can't guarantee it's one microgram. There's no way to assay it. So what I do now is that I, uh, I will get all the pharmacy to make a hundred microgram, all tablets, not, not a capsule, so that patients can break it in half, which becomes 50 micrograms.

And then they break that in half. It goes 25 micrograms and then once they can prove that they can tolerate it, then they can do a rapid offset increase 0.2 5.51 or basically 25 micrograms, 50 micrograms, a hundred micrograms, 200 micrograms, 500 micrograms at which that dose is where people ….

So maybe takes two months to ramp up. But I think that um, that the more complex your patients are and more they are endorphin depleted, um, that I think that is a good thing to do. So I just asked them very simple questions.

How do you sleep? Um, and people tell me its terrible than that, that makes me, uh, think that, that they're, they, they are a good candidate for a lower dose on another thing I ask is. After you get up, do you feel well-rested if the patient said, no, I, I'm sleeping a lot, but I'm not feeling very well rested is another question?

And then the third question is the resiliency question, which I made up. I said, Hey, listen if I give you a limited amount of money and I drop you off anywhere in the world, how confident do you feel you can get back and without having like psychological crises? And. Well, if people say, no, no big deal, I can get back -  just some little bit of stress, but patients, Oh my God, that would kill me. Low dose, then I would choose with a low dose. Um, but I would say if the patient were healthy, I, I don't mind starting them out at 0.1mg, I still don't want to do 0.5 because, um, I experimented with it and, um, on purpose took a higher dose and really, not everyone has a reaction, but once you have the reaction, you don't want to look at LDN. And I think it's, so, LDN can be a fantastical tool, so I don't want to, my patients would lose access to it by having a bad reaction.

Linda Elsegood: What conditions would you say, John, you are using LDN mainly for? 

John Kim: Well, you know, I think that, um, the autoimmune I think is the most popular use. Um, now, of course, we do that, but if you ask most people, most practitioners why it works, um, they will talk about endorphin, and I'm not sure that's entirely correct.

I think the side effect from a high dose of naltrexone affecting people badly is because they're triggering the complete and total depletion of endorphin by blockading the opioid receptor, especially the mu receptor. But I think that it's more likely that the autoimmune diseases are helped by the anti glial cell modulation that professor younger is talking about, and the significance of this is that now you can move beyond autoimmune, you can treat nerve disorders, if there's pain which has the basis inflammation, like fibromyalgia, in theory, is supposed to not have inflammation but stop the population of them.

I've noticed that they have high inflammatory markers, like C reactive protein, even ESR. Then I'll then LDN becomes another tool. But anything where you're suspecting that there is an immune dysregulation or over response of the immune system, especially within the central nervous system, I think that LDN becomes an invaluable tool. And I think that understanding the mechanism allows for flexible use of low dose naltrexone and I would like to invite all the listeners to come to the next 2019 LDN conference in Portland where I am honoured and privileged to share some of my observations, ideas about low dose naltrexone, um, pushing the frontiers on and the use of LDN.

Linda Elsegood: Well, I'm sure everybody would be thrilled to hear that. As I said, you always have new ideas, different theories, different ways of tackling a problem that is faced by many prescribers, with patients with complex conditions. So is there anything else that has been going on in your world of medicine? 

John Kim: Well, I think that all, as I said, I think the most, um, some of the most interesting things that I see with LDN is once you have the LDN mechanism.

So I have a patient that has resistance. Um, depression. And now within the field of psychiatry, there's thinking that some of the depression may have inflammatory components. So within a  short amount of time, less than one month, I have an elderly woman who says, Oh, I'm using it for pain purposes, but the patients are “Oh my God, I still have pain, but I, what did you do with my depression”?

So all that's, that's another tool that I think is all very, very interesting to start thinking about. It's like what other inflammatory conditions do we have? And here's where knowing the mechanism really helps the practitioners to think outside the box. Because if you can view as anything that has brain inflammation or central nervous system, peripheral nervous system, inflammatory condition, um, all of a sudden you have a tool, another extra tool, LDN, which is very affordable and very safe. And the side effects, um, none that I am aware of are life-threatening, at least none that has been reported. Um, so I think that I would urge both readers and practitioners to pay attention and the diligent in reading articles, new articles coming out.

There are more trials that are coming out and to be curious about LDN, and that just don't accept it as, Oh, it just, it's good for treating Hashimoto's disease. It's good for ms, and the next bet would be it's good for autoimmune diseases, but why? Why is it good for treating autoimmune diseases, once you have the idea that this is an anti glial cell modulator, then it opens up a big field, especially within regards to using it as in pain.

For inflammation, inflammation, which causes nerve pain, inflammation. That, and it's very interesting cause nerve pain is how I got started with acupuncture because, um, as you may know, the listeners may know, the tools that we have for nerve pain, um, are very limited. We can use Gabapentin. We can use another medication, in the main Lyrica.  But either you respond to it or don't respond to it. If you respond to it, you're very lucky, but if you don't respond to it, then you have to really suffer. And suffer means that a lot of people say neuropathy. How do you describe it? In the beginning, you would get the tingling, numbness, but as it progresses you, you get burning.

Not just any kind of burning, but really cold burning. And then if it advances even more. You will get like a crushing kind of pain and people can't sleep with this. And the, one of the best ways to make people dysfunctional unfunctional is taking their sleep out of the way. They can't get quality sleep, and then all of a sudden you have a big problem.

So I think that that's what all for me to LDN is doing for complex patients, is that. It's really helping me to push it out there. And then now I'm beginning to combine with treatments. So patients who are weak and they are fatigued, and because a lot of patients who have this condition to reach me takes years, sometimes decades, because they don't have, there's a lack of doctors who are willing to think and solve problems because more of us are more comfortable with protocols.

And so if you have that kind of practice all of us, and understand the mechanism, all of a sudden LDN is amazing, then you can use, if the patient is really weak, then you can target LDN to blockade the conventional way, which is the blockading of the endorphins. But it now, you know you're doing that. Then, the application can be different.

You may. You may be more, um, realize that when equilibration happens, you have to push it a little bit and, and march it out, which is a bit different than, um, the steady-state or the equilibrium that you want to bring about for glial cell. Um, modulation.

Linda Elsegood: Wow. I mean, it would be really interesting if you could just see into the future to see if in say, 20 years time where LDN would be, 

John Kim:  Yeah. I think that one of the danger is that all of us are really happy about more research, more things happening. One of the concerns I have is what happens; one of the pharmaceutical companies find a way to patent it. Cause every time I look at all ideas I had about LDN, someone's patenting it. Someone's patenting it. And as of now, I think there are, um, medications that combine, um, anti-anxiety medication and LDN at 7.5 milligrams. And they use that for weight loss. So if you were to create that combination, you can't, at least in the US because Um, intellectual property. So one, I think that the use of LDN, um, I think is at a tipping point for reaching the conventional, because I hear it from other doctors I hear from and when my fellow wants to use it, um, there is an acknowledgement, even though they say we don't like it. But if they say, yeah, there are some preliminary data, and this is very different than when I first was introduced to LDN, where the evidence was really nonclinical data, but more animal data.

So I think that it's really come a long way. I think it's accelerating. We're seeing a large number of studies coming out of ... Uh, I think in one of the Scandinavian countries, all VA has a bigger study. In, um, formally called RSD or complex regional pain syndrome. So I think we're, we're, we see some things that I think that you know, you and your listeners have done an outstanding job and it's, it's accelerating.

The only thing that I'm concerned about is public may lose access to it, the affordable access to it as, as a pharmaceutical company. And the, for those of you who do not know, um, Dr Bernard Bihari, um, was a pioneer in the field of, uh, low dose naltrexone and he, his title is called normalizing immune system function.

And that's so amazing. He didn't know about glial cells, didn't know about, but that's what he called it. And that's what I think he was right on. And. There's a concept in Chinese medicine and herbal medicine we call adaptogen. adaptogen means is to, something is too high, lowers it is too low it highers it.

So on the example of that, they like to use ginseng, but in the world of botanical medicine, I don't think I've seen as good adaptogen as LDN for normalizing immune system function. 

Linda Elsegood: I'm going to have to stop you there, John. We have run out of time, but we will definitely have you back again.

John Kim: Thank you. 

Linda Elsegood: This show is sponsored by Mark drugs who specialize in the custom compounding of medications, assuring 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 https://www.markdrugs.com/ or call Roselle (630) 529-3400 or Deerfield (847) 419-9898.

Linda Elsegood: Any questions or comments you may have, please email me Linda@LDNRT.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.