LDN Video Interviews and Presentations

Pharmacist John Herr, LDN Radio Show 21 Nov 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'm joined by pharmacist John Herr, and he's from New Jersey in the US. Thanks for joining me today. John. 

John Herr: Oh, you're welcome. Glad to be able to spend this time with you. 

Linda Elsegood: Good. And I didn't mention where you're from and you're from Town and Country Compounding. So first of all, tell us how you got into working as a pharmacist.

I mean, had you always been interested in pharmacy as a child? 

John Herr: Well, I've always been interested in pharmacy, and I've always been interested in like natural medicine or integrative, we now call it integrative medicine or functional medicine. But back in the day, I think we called it natural, and I was just lucky I went to a think John's University in New York City and, and I made the acquaintance of a physician who was, she was actually a pioneer in bringing natural or bioidentical progesterone into the United States. So back then, I was still in pharmacy school and, and I started to like working with patients with bioidentical progesterone.

And it just kinda changed the way that kind of, I thought as a pharmacist and I, I really consider myself like an integrative pharmacist now. So low dose naltrexone to me was just a natural progression of, you know, my knowledge and my interests.  

Linda Elsegood: so how long would you say that you've been compounding LDN now.

John Herr: Oh my God, I think it's gotta be around two, maybe around 2000 or 2002. You know, just when it was really becoming, you know, old people were starting to understand it. It's interesting. One of my patients, when I had my retail pharmacy, she ended up writing a book about it, about her husband.

It was called “Up the Creek with a Paddle”. and Mary Bradley and I, she had been in my pharmacy and her husband at the time had MS, and we were talking about, and I recommended the low dose naltrexone to her, and then she went and sought out Dr Bahari. And you know, she started, you know, they started her husband on that for his MS and that, that's where my original interest was.

And she ended up writing the book, you know, “Up the Creek with a Paddle”. And my biggest claim to fame is I’m mentioned in the book as the one who told her about researching low dose naltrexone. And then. Subsequently, after that, I became acquainted with a gentleman named Fritz Bell, who started a website, good shape because back then people were just, you know, going on the internet and they were buying the 50-milligram tablet and trying to, you know, create their own.

So, you know, Fritz had a big interest in that and, I filled prescriptions for his wife, but I also filled prescriptions for people where Fritz donated it to them because he wanted people to be able to take the medication and not have to compound their own.

So if they qualified to his standards, we would make it up and send it out, no charge. So those patients could start on the low dose naltrexone. So I go back way to the beginning. And you know, I think back then we just thought of low dose naltrexone and honestly for MS. But you know, subsequently, over the years we've just learned, you know, how vast different disease states we can treat and manage with low dose naltrexone.

Linda Elsegood: And what forms do you compound LDN in? 

John Herr: Well, the most typical is a capsule, uh, which we do an immediate release capsule. Um, we're in the process of buying a, uh, switching over to like a tablet so that we can, uh, you know, meet the need, you know, with a tablet machine. But right now we make capsules. We also make, um, we've actually done a transdermally.

I treat a lot of children on the autistic spectrum disorder. You know, we've had to do it in sublingual liquid for some of the children. Uh, we have a couple of patients on it right now, believe it or not, for a vaginal cream. We've also used it transdermally for like neuropathic pain on different areas of the body.

And I've been researching some articles recently. I'm using it as an Automic drop for chronic dry eye, but I've been talking to a couple of different integrative physicians about using it. But, uh, up to this point, we haven't have anybody try it for the ophthalmic. But I'll, I'll keep everybody appraised when we do because there is, there's a lot of interest in using it for that function as well.

Linda Elsegood: And I know that there are some dentists that are also using LDN, so that's another interesting one. And how about ultra-low-dose naltrexone? Is that used in your area that you cover? , 

John Herr: yeah, we have some patients on it. We also do a lot of pain management. We have, uh, we've managed intrathecal pumps in the home.

So I worked with a lot of doctors, pain doctors and I actually work with a doctor, a doctor speaking at the next conference in Portland. And so I work with his patients, and we have to start a lot lower on his patients because many of them are on opioids. And I've worked with some pain physicians where we've actually compounded as low as 100 microgram capsules because I think you really need a physician who is trained in pain management because they're actually weaning the patient off of the opioids as they're bringing the LDN up very gradually.

And it's a real balancing act because. You are going to detox that patient. So that's not something I would recommend for you, you know, like a general practice physician to you. Um, but we do have a lot of patients that are using it that way where they're getting off of this. And then I just, we just get tremendous feedback when they're off of the opioids, how they're then maintaining the pain with these, with, you know, LDN that we consider, you know, on that standard dose that we consider for pain.

But it is a little tricky to get them off of those. Um. Yeah. Off the opioid, while you're bringing the low dose naltrexone up to the appropriate dose. 

Linda Elsegood: I mean, I've interviewed several pain specialists, and they seem to be using 0.001 which must be like a grain of sugar of naltrexone, and they explain, sorry, 

John Herr: carry on.

Zero one micrograms, 

Linda Elsegood: Linda. Yes. Wow. Yeah, so 

John Herr: I mean, 

Linda Elsegood: exactly, but by doing that and using it alongside the opioid, it makes the opioid stronger so that they can reduce the opioid and slowly increase the by 0.001 sorts of the thing. They do like sort everyday kind of thing, until they can bring the opioid really down and the LDN can take over.

And they have it by doing it so slowly, as you can imagine. Well, slowly by my thinking, um. Or, or rather fast by my thinking. They say it's slow, but it does seem to happen quite quickly where they get them off the opioids, and they have gone, they haven't gone through withdrawal, they haven't had any side effects.

And you know, the LDN, like you were saying, can be used in place of the opioids and give pain relief. It's just amazing to me that something so small that's not harmful or toxic or even expensive can work so well. 

John Herr: Yeah, it is amazing. I mean, I think we just, as I said, when I first started working with it, we just kind of thought of it for like autoimmune.

But how we, you know, now that we know that it's working on the immune system when we know it's working on, you know, with the upregulation of endorphins and we know that it's working on the toll like receptors for inflammation. And now that we see how it affects dopamine for depression, I just think the, I mean it's just amazing to me how many opportunities there are out there for physicians to learn how they can better treat their patients for numerous, you know, disease states,  

Linda Elsegood: and of course, most people that have an autoimmune condition, one of the underlying problems is the inflammation, isn't it?

So by reducing that inflammation alone helps the person feel so much better anyway, especially with the boost of endorphins as well. 

John Herr: Oh, yeah. Actually, my wife, who's a pharmacist, is a perfect example. Like she went and had all this blood work done in her, what they call her ANA level was through the roof.

So your traditional physician would look at that and say, Oh, you must have rheumatoid arthritis. Because she was getting, wasn't really achy joints, but she was getting pain, almost like fibromyalgia pain. So we knew it was inflammation, and at the same time, her blood pressure was uncontrollable. It was, you know, we actually had her on a heart monitor, and then one of the physicians that we work with, when they did, you know, we really started working more in-depth than they did the food allergies.

We found out she was severely allergic to dairy. So, you know, started her on, you know, obviously an elimination diet, and then low dose naltrexone, which she titrated up gradually to a dose about 4.5 milligrams, but the ANA level came down, you know, uh, you know, obviously with inflammation, all the inflammation markers went down. The pain went away. And the funny thing is like we had to get her off that blood pressure medication really quick. The pressure was just dropping. So now she's just on LDN and you know, obviously supplements and you know, dietary changes, but there's no more blood pressure medication needed, and she doesn't have the pain anymore.

So it's an example of, you know, the LDN is a tool, but you still have to take into account all of the other things that are going on. But the diet, nutrition, exercise, I always try to tell people it's a package deal. You know, the LDN is one of the most important pieces, but there are other things that you can do for your health.

Linda Elsegood: Oh, definitely. Um, I used to have to take, um, Omeprazole for Acid reflux, and if I didn't take it, I was in trouble. It's that severe, but by going gluten-free I now don't have any problems at all. I don't have to take the medication. I don't have any acid reflux at all. But if I go out to eat and you know what it's like you're going through the menu and say, you know, it doesn't look as though there'd be any gluten-free in this. Could you check with the chef for me? And they'll come back and say, no, there's no gluten in it. If there is, I don't sleep that night. The acid reflux is so bad. And I have to sit up. Right. If not, I'm just going to vomit. It's terrible. So I don't always believe people when they tell me there's no gluten, cause I know if there's any gluten in it.  Yeah. So it's amazing, isn't it? How you can just eliminate other medications just by diet. My husband has problems with these. The skin on his hands. He's allergic to milk, and he'd seen so many different doctors in the past, and nobody could tell him why the palms of his hands would go like white and dry.

But when he eliminates dairy, his skin is completely normal. And that was like 30 years of trying to find out what was wrong with his skin and never had an answer. . 

John Herr: Yeah, that's what I, my thing, when I'd give talks on this, I always tell people, patients, or if I'm talking to groups of physicians, you know, whoever it might be, I, I say at least I know in the United States, I say, we say that we're in healthcare in the United States, but we really are not.

We're in sick care, you know, our, our system in this country is, I hate to say it, but it's run by big pharma. So you know where our physicians are, a lot, many of them are trained to wait until the patient presents with the disease and then give a pharmaceutical remedy for that disease, whereas an integrative medicine, or you can take like LDN, I think, you know, we're trying to get at the underlying cause and how can we correct that so that we can live healthier.

Linda Elsegood: yes. It's, um, quite common for people to tell me that. The doctors are only treating their symptoms, but not the root cause. So of course, you then end up with all these medications and some people are taking in between 14 even 22 different medications a day, and some of those are only needed because of the cocktail of drugs that they're taking cause side effects.

But that's okay cause they'll give you another tablet which will combat the side effects from the cocktail you're taking. 

John Herr: Yeah. Well, I think Linda your example was the perfect example there. You know, that drug was originally made for somebody who had an active ulcer and then you theoretically would take it for, you know, two or three months, to allow it to heal and then change your diet and, and you know, go on. But now people just live on that drug, you know, the purple pill. It's like they have to take it forever, which you know, it affects, then you're affecting your gastric pH, your digestion. It's a slippery slope. I agree with you. 100% 

Linda Elsegood: Hmm.

And of course, I also have people telling me that it's expensive to eat healthily, and especially when you've got children, it seems. So sad, and I can understand if you only have a limited amount of money and you've got several children, they all need feeding. But - we call them crisps - you call them chips over there, and we have biscuits, you call them cookies, but you, you, you get where I'm coming from. That is cheaper than buying apples, some pears and bananas and oranges and such, which would be a healthier option. But the price difference is quite amazing, isn't it? And especially if you have. Uh, mass-produced meat from a supermarket or you're buying organic local meat or vegetables.

Uh, the price difference is quite high, isn't it.

John Herr: Oh, yeah. It's much harder to try and eat organic and healthy. You're right. And then you see the commercials where McDonald's is our friend. The dollar meal menu. Oh, please don't just don't even eat there. But do you want you to understand? Some people though, socioeconomics, they don't, they don't have that choice.

But you know, everybody can make little changes, I believe. Do you know? Uh, and then that's what we try to educate them on. And as you mentioned, I mean, just the cost of medication, like, uh, it's gotten, even when they're covered by insurance in our country, many patients can't afford their medications with their copays.

So I, whereas the low dose naltrexone, you know, I'm such a big believer in it. I, you know. Okay. I worked with Dr Dahda who, you know, explains to me that, you know, his patients are chronic pain patients. So a lot of them are, you know, disabled or they, you know, they don't have a large income. So, you know, we, you know, once we have them too, they're titrated to their dose that the dose that they're going to be on for their pain, then we dispense like a 90 day supply.

It, you know, at a cost that in most cases is lower than their copay. Uh, cause we just believe in the therapy so much that we want to, you know, help it help patients and make it available to them. 

Linda Elsegood: What about shelf life on your capsules? How long do they last? 

John Herr: Well, you know, the USP governs that in our country, so I imagine they would last longer, but where, you know, only allowed to put 180 days on, on there.

Once we, from the date that we make it now, certainly at the pharmacist, I think it would last a lot longer. But because it's compounded, you know, the USP United, which is the United States pharmacopoeia, which is basically overseen by the, you know, the FDA, the food and drug administration, and then that's up to 180.

Yeah, a day, what we call the beyond use date or expiration date. So that's what most people are getting a 90 day supply. They'll certainly going to fall within that date range.  

Linda Elsegood: I understand. And so that would be the same for the tablets as well once you start making those if that is the rules and regulations of the land. The 180 days?

John Herr: Yeah that’s correct that’s a solid dosage form and then once you go into anything that was a liquid, for example, um, now if you'd like for it to stop, I had to make it into for a young tile than a liquid format, you know, then we would be restricted, believe it or not, to a 14 day supply? You can also do testing, you know, so you can test that it's stable to extend that beyond use date. But most of the patients we see are, are using the, you know, the solid oral dosage forms, the capsules or the tablets. Yes. So it's usually not that much of a problem.  

Linda Elsegood: and what fillers do you use. 

John Herr: Well, typically, like most people, we use avicell, which is just an inert starch that people do not have any problems with.

But because we, we, you know, my pharmacy, it's, you know, we were only compounding. So we work with a lot of functional medicine and integrative practitioners. So we have a person who did have like what we call chemical sensitivities. A lot of times I don't think that they're going to be allergic to the, uh, you know, to the low dose naltrexone or it, but it could be the filler.

So sometimes what we'll do is we'll give them different filler. We might give them some avicill capsules, we might give them some acidipholis capsules, or sometimes we'll use a vitamin, you know, nutritional that we know that they can take. And then we'll have them take the, you know, capsule, you know, for about a week or so with actually, without, with no now trucks on it.

Just to make sure that they're not having any type of re, you know, reaction to the, uh, to the filler. So, you know, typically we do avicell, but you know, for specific patients, you know, if they have chemical sensitivity, we will adapt it too, you know, whatever will agree with that particular patient, especially if they practice kinesiology.

I have a couple patients and practitioners, you know, practising aetiology so they can kind of, sometimes they can tell which filters are, you know, will react to a patient even. Just from the, you know, if you understand, can aetiology, how it works in the body versus even half the taking it to see if they have a side effect.

Linda Elsegood: Okay. And what about the capsules? Are they sort of, um, a vegan free capsule? 

John Herr: Yes, we can get a, um, they're, they're a vegetable base, so now they're not a,  typically they come gelatin or, or, or vegetables. So we can, you know, we can get either, our goal is to go. At least eventually to the tablets once we, um, you don't have the tablet machine running correctly, but with the tablet you're, you know, unfortunately, you have to kind of make a couple of strengths.

It's not that you can go, oh, I can just run or, you know, or make a runoff, you know if it was a strange or an odd strength, you know, let me just make 30 or a hundred of that. What you have to do that in bigger batches, I don't think I will ever not be also making capsules. You said if you have the patients that need them, the ultra-low dose or patients who.

Everybody used to think it was 4.5 milligrams like religion, but now we know some patients do better with nine milligrams, some patients do better on three milligrams. So I envisioned that will always be, you know, compounding capsules. But we'll also, for those patients that are taking the more common dose, we'll have the availability of the, you know, tablets that we can keep up with the demand because you know, myself being, and.

in this metropolitan area of New York City, New Jersey. There are so many patients who need this, uh, need this treatment. 

Linda Elsegood: And what area do you cover? Um, before we started, you said the Manhattan area, so. Could you just explain exactly where you, you cover? 

John Herr: Oh, sure, sure. Yeah. And in the United States, uh, again, the FDA requires that you have to be licensed as a pharmacist in any state that you're going to send, you know, medication into and low dose naltrexone is considered a, you know, prescription medication in our country. So, you know, you have to be licensed in those States. So I, I've concentrated my licenses in the Northeast, so I, you know, work in areas such as, you know, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Ohio, Pennsylvania, Delaware, Maryland, you know, the, in this area of the Northeast.

But, uh, you know, previously I was president of IACT, which is the international Academy of compounding pharmacists. So I know pharmacists all over the country. And a lot of times I'll get a request for, you know, low dose naltrexone in another state. So I always know, you know, a good colleague that I can refer to that prescription to if no, if I get, I have a request and, uh, to state that I'm not licensed then.

And compounding pharmacists generally kinda like to network and share ideas with one another, which, you know, it's very collegial, which is something that, you know, really makes me enjoy the profession. So I do many instances I send prescriptions that I get to people I know in other States because I'm not licensed in that state, so we always try to make sure the patient gets their medication.

Linda Elsegood: And since you've been compounding LDN for so many years, has anybody ever reported to you any adverse effects that may be unusual? 

John Herr: I have like one patient and that she's come to like three of my seminars and her husband's a physician, but she just has a funny reaction to the naltrexone, and we've tried it.

We've tried ultra-low-dose and, and everything, but it really just upsets her, you know, upsets her stomach or her head. She just doesn't feel right on it. And I mean, she's tried it so many times because of it just, she's read so much about it, and her husband's been a practitioner. She's all one patient that's just tough to treat. But other than that, we get the typical side effects you see, which are the, uh, you know, the vivid dreams, the stomach upset, you know, maybe like a slight little headache. But typically we just work with those patients and tell them that you need to start the dose slowly and titrate up gradually.

So we've actually put together a, a, you know, like a titration kit. You know, for patients, cause many of the doctors don't realize that many doctors hear about low dose naltrexone and they just, you know, they think they can simply write a prescription for a four milligram or a 4.5 milligram. So we'll, we'll go in and educate those physicians that we have, this titration kit that we go up gradually once the patient gets to be on, you know, the dose that seems effective for he or she, well, they then compounded into that particular strength. So I think that's really helped a lot for patients to, you know, avoid the side effects and, uh, you know, get to their particular individualized dosage. 

Linda Elsegood: Well, I've been on LDN since 2003, and at that time over here anyway, we were given three milligrams for a month, and then you went on to 4.5, and that was it.

But the dropout rate was really high starting on three milligrams because we have found now that some people, you know, two milligrams is as high as they can go. So you can imagine starting on three it was a no go from the start, you know, it was far too high for them. But now, depending on what the condition is, It might be as low as 0.5 milligrams starting or 1.5 but doing it gradually and slowly. We find that not many people drop out of taking it. They seem to tolerate it really well and notice benefits quite quickly. 

John Herr: Oh, I agree with you, Linda. 100% on that. And then the other thing, like I always try to caution patients on it is that don't give up on it.

Because sometimes, even though maybe they didn't get any side effects, the patient thinks they're not getting the effects from the low dose naltrexone. And it's funny, we had two women, they were, you know, they were, you know, they were girlfriend, you know, and they both had a similar condition around the same age, and they went to the same physician, both started on the titration kit and, and the one woman that she got to 3.5 mg and she was just feeling wonderful. And the other lady kept going up and she got to like 4.5 and wasn't experiencing any, um, any relief from her. Uh, you know, what she was trying to treat,  but we just told her, you know, you gotta stick with it, stick with it. And you know, she was discouraged because the girlfriend was, you know, she was not even 30, you know, it's about 30 days. And she was feeling well, and she wasn't getting any benefit that she perceived. And lo and behold, it took four months.

And then she started to get the relief. So the other thing is like, even though you know you start low on the dose and titrate, which you know, we agree 100%, you also have to make sure that the patient realizes that sometimes you need it can take six months before the low dose naltrexone really start to show differences in their body.

And I always try to caution patients, you know, depending on the disease that they're trying to treat or the condition they're talking to trying to treat, I tell them, look, this didn't happen to you overnight. You know, this whole thing was probably going on your own, in your body for a long period of time.

So, you know, you're thinking traditional medicine, like, you know, you had a toothache and somebody gave you Tylenol with Codeine, and of course, it's going to work immediately. But with this, we're trying to upregulate your body and get your body to correct what's going on. So you do have to caution patients that, you know, give it time.

I usually recommend, give it a good six months before you say it's not doing anything for you.  

Linda Elsegood: well, we noticed, um, when we did a survey that some people said they had no symptom relief, but their disease stabilized. So I mean, that's a win in my book if you've managed to stop progression, but then between 15 and 18 months there was, um, 2% of people, whatever it was, didn't find symptom relief until they'd been taking it 15 to 18 months, which is a really long time. But they had stabilized before then. Um, and only 5% of people at that time or have any side effects at all. But the number of people who have stopped LDN because it probably wasn't working, or it was too expensive, but they stopped. And those people normally come back to me in about three, four weeks and say, in actual fact, the LDN was working for me. I'd forgotten that my bladder used to play up. I'd forgotten the pain that I had, “I’d forgotten …..”. You know, it wasn't until they'd stopped that they noticed that LDN in actual fact was working for them.

John Herr: yeah. I agree with that 100%. I've, you know, I've had like another woman, we would just counselling who hang out with her. Uh, you know, general, like almost like fibromyalgia pain and everything. Had ah It's totally a had gone away while she's been on the low dose naltrexone, but then all of a sudden she started to get pain in that.

And uh, you know, she's gotten real nervous. Like, Oh no, but I held the end isn't working for me anymore. I have to have this. This is how it is. This has been a miracle for me. What's going on? But then again, you know, functional, integrative medicine, when we talked to the patient with what's going on in your life, he starts to see that, Oh, you know, now you're going through, you know, you're right at the, into perimenopause, going into menopause, you have the pain.

Oh, it's right around my menstrual cycle. Okay, what's happening there? You're probably. Your estrogen level isn't where it used to be. And we know when women, particularly that when their estrogen and the estrodile goes down, they tend to get aches and pains. Hmm. So maybe it's a matter of, you know, adjusting your estrogen at this point.

It's not that the LDN stopped working, so you always have to look at your patients, and that's why the patient always has to go back and, uh, you know, consult with there, either their compounding pharmacist who can send them back to their physician or their physician. But it's not always just the, uh, you can't always blame it on the LDN.

Other things, you know, are happening in your life are happening with your body as, as we, as we age. So it's, uh, that's why I say it's a package. 

Linda Elsegood: I was asked a question this week, and a gentleman said,

it would appear on the forums that he's been reading that LDN doesn't work as well for men as it does for women. And was this a hormonal problem? Have you noticed it doesn't work as well for men as women, it seems, 

John Herr: you know, you're right. We have more of women that, uh, that are on low dose naltrexone, but I, I don't know why, but I thought like when we were talking pain, you know, certainly the, um, I think it works for both men and women equally well, but when we have other conditions such as fibromyalgia, that it makes you wonder, is it, is it also something going on with the hormones or, I think I have a great interest now in, in like Lyme disease and low dose naltrexone. And, and we know surely that Lyme disease, you know, uh, affects the pituitary, which is signalling in the body to produce hormones. And also, if you think about chronic pain, when people are in chronic pain, they're not producing their hormones the same.

So that's where I think we have to not just think that it's just a panacea and then we can just give low dose naltrexone, but we have to measure those patients hormone levels. And adjust them accordingly. So, and I think. You know, honestly, that may be what you, what you just elucidated is that you know, women will tend to, you know, go through menopause or their hormones will change at a much earlier age than men.

So, you know, for a woman, you know, we usually say around age 50 our hormones are trying to change. Men won't happen later on in life. So maybe it's not a difference, you know, in between males and females as much as, is it also something that has to do with the relationship between the hormonal changes.

And women getting them at an earlier age than then we're associating that more women do better than men, but reality maybe. Cause it's that man still has this testosterone in his body. 

Linda Elsegood: Oh, okay. It does. It does. And we're now out of time, but I have to have you back another day. We could have carried on talking there forever.

Could you tell people how they can contact you? 

John Herr: Well, certainly, uh, you can call us at our pharmacy directly, which is a 201 447 2020, and then you can always find us on the internet. Our, uh, pharmacy is https://tccompound.com/ and from there you can even email the pharmacist a question or, you know, call us directly.

And we just love talking to patients, and that's what we do. And we, and we do hold seminars, usually monthly on low dose naltrexone, which we will post on Facebook and on our website. And, you know, make people aware that if they're, you know, in the area that they can come in and see it. 

Linda Elsegood: Wow. Amazing. Well, thank you very much for all your hard work and for promoting LDN to your patients all these years.

Um, absolutely fantastic. And for educating people, so thank you very much. 

John Herr: Oh, thank you, Linda. I love talking with you and, uh, looking forward to doing it again. 

Linda Elsegood: Thank you.

At the town, a country compounding pharmacy in Ringwood, New Jersey, owner, pharmacist, John Herr and his team are passionate about low dose naltrexone. They have compounded LDN for over 15 years. And they're committed to compounding high-quality medications and serving as an educational resource for patients and practitioners alike.

Visit https://tccompound.com/

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

Paul Battle PA-C, LDN Radio Show 22 Feb 2017 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: today. Our guest is physician assistant Paul Battle from Colorado. Paul is an experienced LDN prescriber and also has personal experience of LDN.

Paul Battle PA-C: Thank you. I really appreciate it.

Linda Elsegood: Well, I know you've been prescribing LDN for many years. How long has it been now?

Paul Battle PA-C:  Since 2008 I believe.

Linda Elsegood: Okay. I thought it was longer than that. At that time, how many different conditions do you think you've prescribed LDN for?

Paul Battle PA-C: Approximately 20 or so. Ones that I can recall right now, all varying different conditions, an autoimmune disease. It does help with cancers that have had treatment already. I can't say it's a cure for cancer, but it's a, like a supplemental treatment, especially for people who've already had cancer therapy, stage four cancers.

And then certainly the autoimmune diseases, which can include Lupus, Crohn's disease, all sort of Colitis, Complex Regional Pain Syndrome. What I generally do is look at the disease mechanism, what the aetiology of it. If it has some antibody-associated mechanism, autoimmune disease, then I consider LDN and the treatment.

Many of these people really don't have any other option. They tried multiple drugs. A lot of the drugs will have side effects and they just are looking for another answer. LDN can help with a lot of people that don't have any other options. 

Linda Elsegood: And from the patients that you've prescribed LDN for, what has been their success rate?

Paul Battle PA-C: I would say the majority of the patients get some positive response. I would say probably close to 85% of people will get some positive response. Some are very dramatic responses. For example, I had a 13-year-old girl with Crohn's disease who after just 3 months, she had already been on the biologics and was losing weight and having difficulty she had no more symptoms. All her inflammatory markers were completely normal and she's still doing well. That was probably about a year and a half ago, just a couple months ago and she's just doing remarkably well. Same with some of the complex regional pain syndrome. This is a terrible disease that plagues people, that causes severe pain due to some dysfunction or dysregulation of the immune system related to the nervous system. It's called the neural glial cells. And some people, I've had 80% relief from complex regional pain syndrome. I first started that in 2010 when this young woman who was attending college couldn't finish college. We had put a spinal cord stimulator in her neck to try and control the pain, but she still wasn't doing well.

That was my first proposal ever for CRPS and Dr Chopra wrote an article, then published an article a couple of years later after I started this young lady on it, and it worked for her. She finished college, got a career, and after a year and a half, she went off LDN without a problem and since then, I've been treating multiple people with that disease with varying success. So it really varies though, like I never can guarantee to somebody that I'm going to cure them or they're going to get 90% relief. We're just trying to improve the quality of their life.

Linda Elsegood: And how long would you say it takes on average for somebody to notice that LDN is doing something for them?

Paul Battle PA-C: Well, I've seen people respond in some positive fashion within 2 to 3 weeks. For example, my son, (that's how I got interested in all this) within 2 weeks with his Crohn's disease started having a positive response, getting a better colour, less pain, fewer symptoms. But I've also had people where it's taken six months.

I had a woman who was a university professor with Complex Regional Pain Syndrome who just persisted. I said," just keep on, keep on. " And she was in a wheelchair. Her symptoms were so bad. She was disabled in a wheelchair.  Then six months later, I got all these Facebook invitations to look at this video, and here she was returning to work, which was a glorious thing.

And now she just texted me last week saying she did a five kms. That's going from a person in a wheelchair totally disabled to now running five kms. That's been about a year and a half now, but she stuck it out. And I asked people to be patient. Sometimes they do not think it's doing anything. For example, in her case, she said: " I don't know if this is working.

I'm just gonna see how it goes without it." So one Friday night, she ran out of it, and that was the last time she ever skipped a dose that she said it was the worst, she described her spinal cord on fire. And I've had a number of other people saying, "well, I'm not sure if it's working."

They stop it, and then they discover it was really a mistake to stop it. So I tell people in where from a couple, three weeks to six months. 

Linda Elsegood: And from all the patients that you have prescribed LDN for, have any had negative side effects?

Paul Battle PA-C: I think some people describe a kind of tiredness or a little fatigue they may have and sometimes it depends on when they take it. For example, most people take it at night, but I have a lot of patients with these syndromes that really creates sleep deprivation anyway. I don't want to have them risk their restorative sleep. So I have them take it in the daytime and I think those people probably have a little bit more fatigued and tiredness than the people take it at night.

I met some people that just like any other medications have a little stomach distress from it, but that's pretty unusual. And you know, I'm not even sure if it's the LDN, but, the sleep deprivation, I really haven't had troubles with that too much, because I titrate them up, fairly solidly over three weeks, sometimes four week time period.

Linda Elsegood: And would you say there's any condition better than any other that you found LDN works best for?

Paul Battle PA-C: I would say the inflammatory conditions of the joints work really well. Dr Berkson,  done great the presentations on Rheumatoid Arthritis, iPad, people who were on the biologics,  that is,  the biologic agents that are what's called tissue necrosis factor inhibitors, who were doing okay on those and, they couldn't afford anymore so they want an LDN and they actually got better results. One patient of mine now was mountain climbing. He wasn't able to move his shoulders for 3 years, went on LDN, and now he's welling up that he's climbing with his kids. So I think that the joint arthritis issues, the inflammatory bowel disease, especially Crohn's. I don't find all sort of colitis as responsive as the Crohn's patients. So I'm careful to say how successful it is with Ulcerative Colitis patients, but it's certainly always a good idea to try it. The gastroenterologists recognize the Ulcerative Colitis and Crohn's that may have some different mechanisms of action.

The cancer patients, I've had several stages for cancer patients. They're living any of them with the same diagnosis. That's been good. And how much of that is the LDN? How much is it good health and a good attitude? I don't know, but I just know the other people that were treated without LDN in their particular type of cancers are no longer with us.

So I think it is a help because of the two mechanisms that LDN works. It inhibits cancer cell reproduction, and it also, according to the new research done last year by Angus, Down in Great Britain where it actually helps change the gene action with apoptosis of the cancer cells. So I think it has a dual benefit therewith, with cancer.

Linda Elsegood: We have a few questions here and we will start with the question from Randy who has Graves' and Hashimoto's. And the question is," I've heard that LDN can lower thyroid hormone and sent a person hyperthyroid, but in the information, it says it can quickly make a person hyperthyroid.

Can it really have such opposite effect."

Paul Battle PA-C: Usually it's hyper because what happens is the Hashimoto's usually has a tendency, depending on what phase of the disease you're in. Graves', usually you're hyper and that could possibly cause the problem but what it is is the Naltrexone interacts with the antibodies so if a person is Hypothyroid from Hashimoto's thyroiditis, I always tell them to reduce their thyroid supplements by half or 25% because there's been a number of people who are hyperthyroid, they're on their thyroid medication, they take the LDN and the next day they're agitated, they are like high, they're hyperthyroid because what happens is it has a tendency to neutralize the antibody action, whether it actually reduces the antibodies or how the antibodies respond to the cellular receptors with antibodies to thyroid.

We don't know, but I always warn people to cut their dose down before they take their Naltrexone. In the case of Graves' disease, I haven't heard of it causing I hypothyroidism. I guess that would be possible if it's, a lot of the inflammation is causing a hyperthyroid state, which you can't get in Grave's disease and you reduce that inflammation, you could possibly reduce the thyroid activity there.

But I haven't had that personal experience with Graves' disease. Mostly I treat the Hashimoto's thyroiditis, and that's the most common cause of hypothyroidism.

Linda Elsegood: Thank you for answering that question for Randy. We have a quite long question here, so bear with me. It's from Shantelle.

She says, "So thank you for being on the show and greetings." And she's a 54-year-old woman diagnosed with disposed systemic CIRCLE DOMA 15 years ago. The only medication she's presently taking is IVIG and Plaquenil a 0.25. She lives in the UK and is currently in the process of finding an LDN doctor.

She says she's noticed that you have experience in bioidentical hormones, and she would be very interested in your views on estrogen and testosterone. Four months ago, she changed from oral HRT to testosterone gel to having biodentical pellet implants of estrogen 50 mgs and testosterone at 100 mg.

And since she's had the pellets, she's never felt so awful in her life in terms of depression, mood and run down. And she seems to catch every bug going around compared with the four months that she was on oral.

Paul Battle PA-C: I didn't quite catch the initial diagnosis but if she's being treated with IVIG that puts it in the same class of diseases that can be treated with LDN because it's going after the same problem. That is an autoimmune disease immune dysregulation. I have a young girl who was also going to be treated with IIVIG  for an antibody associated Peripheral Neuropathy.

She had problems with antibodies to her nerve receptors so she basically did not have a lot of function in her muscles, her GI tract and they were going to give her IVIG, but it wasn't insurance approved here in the United States, at least with their insurance so I offered a LDN, and that has proven to be very good for her.

She's back in school, halftime. She was in bed or missed all of last year. So the answer to her question is: I think LDN would be a very reasonable possibility for her to approach her other disease. Do you want me to answer the question about the hormone?

Linda Elsegood: Hang on. The main question when you get to the bottom there, because the testosterone and the estrogen implant is making her feel very depressed, very down, very moody.

She feels awful. She felt quite good on the oral HRT. So she's saying to you, she wants to go on the LDN, which should she take? Should she stick with the oral or the pellets?

Paul Battle PA-C: Well, I usually use the oral just because it's easier to titrate the dose. Once she got inserted pellets with estrogen, it might've been too high of a dose, and once you put the pallet in the subcutaneous tissue, it's very difficult to adjust the dose.

So she may be running very high. I usually like to estrogen to run around 60 to 100. That's what the literature shows to be protective against osteoporosis and coronary artery disease. But if you have too much, you can certainly have psychiatric side effects just like women get what they are on the birth control pill, they can have depression.

And as far as the testosterone pellets, the same thing, once you insert those, you're kind of stuck with those for 3 or 4 months. So some people love pellets because they don't have to deal with the daily pill and adjusting things but in my experience, it's just easier to adjust. If she has trouble with estrogen, you can just reduce the pill dosage.

I work with compounding pharmacy so I can make it whatever dose I want.1 milligram, 2 milligrams. The oral therapy for estrogen has been shown to be more cardioprotective than for example, a pellet form or a cream form. So for that reason, the dosing can be easier adjusted when it's in a pill or a cream form.

Linda Elsegood: Well, that's good. I think that was the route she was hoping to go down because she felt so ill and so down. So I think you've just confirmed it for her, so thank you for that. Here's a good one. Have you prescribed LDN for migraine headaches?

Paul Battle PA-C: I have. I have several patients with migraines that I prescribed LDN mostly because the current theory on migraine headaches is not our old theory of spasm of the arteries because they've done arteriograms and found that the artery diameter doesn't really change a lot when people have migraines.

So it's really more thought to be an inflammatory process of the nerves and therefore the LDN would be appropriate to try and adjust to an inflammatory condition like that. So I do have several patients with migraines on LDN. I do other things too but it seems like that's helped them.

They were treated in traditional medications for years, probably 5 or 10 years and I seem to be getting better results with the LDN. They stay with me, so obviously I'm doing something right for them.

Linda Elsegood: And I'm talking about headaches and migraines. Have you ever known LDN to cause a migraine headache?

Paul Battle PA-C: I haven't noticed it cause a migraine, but  I have had several patients say it does cause a headache more of the dull headache, not so much the pounding vascular headache type of symptoms.

Linda Elsegood:  And we have another question. It says," Have you seen LDN improve acne breakouts?

Paul Battle PA-C:  I have not seen that. I just haven't noticed that. I use other things for acne so I haven't observed that.

Linda Elsegood: Okay. Thank you. And what it's your opinion of using Ketamine infusions in conjunction with LDN?

Paul Battle PA-C: I think they can be done. I have patients, I just had one last week.  The ketamine works in a different way. it's a dissociative anaesthetic and it works by blocking the NMDA (N-methyl-d-aspartate) receptors. That's the receptor that transmits the pain to the brain and so what it does is it blocks that and so that really doesn't have any interaction with the LDN because the LDN works on opioid receptors, endorphin receptors. I think they can be used synergistically.

Linda Elsegood: And what conditions would you use the combination to for?

Paul Battle PA-C: That would be Complex Regional Pain Syndrome. When I used to operate on people putting in spinal cord stimulators, I would put it routinely. First I would give  IV magnesium prior to surgery and that has been shown in several studies that it can reduce pain 50%. That magnesium also naturally blocks the NMDA receptor, which the ketamine does so that works with ketamine. And then I would give an infusion during surgery and then after I would give an infusion for overnight to blocked the NMDA receptors so that the surgery would not precipitate an exacerbation of the Complex Regional Pain Syndrome or what's known as RSD, or Reflex Sympathetic Dystrophy.

That's only a diagnosis that I've ever used it for and I don't know of any other diagnosis that you would use Ketamine for. Ketamine is a tricky drug. Adults can have a miserable experience whether they can have nightmares and side effects from them can be hypertension, tachycardia, hallucinations, things like that.

So with adults, you do have to be careful with it. There are low dose ketamine infusions, and there are high dose ketamine infusions. Dr Kirkpatrick at the RSD Research Centre in Tampa, Florida, does a high dose. I've been there, and I watched him do his technique there. So that's the only diagnosed I can think of.

Linda Elsegood: Well, thank you very much. We'll just go to a quick break, and we'll be back in just a moment.

To listen to individual radio shows and interviews go to www.mixcloud.com/lldnrt.

This show is sponsored by Paul Battle PA-C. He is a well-respected physician's assistant. He takes a physiological approach for your optimal health using traditional and nontraditional treatments for autoimmune diseases and bone health, using hormone replacement therapy and low dose naltrexone. He has patients throughout Colorado and other states.

Visit www.pabattle.com or call 720 773 9041.

We have a question here, Paul, which you can sympathize with. Amy has a 17 year old daughter got Crohn's disease diagnosed four months ago. She says," Are the children taking LDN with success? What can I expect to see as an improvement besides better sleep, which assist with pain and improve quality of life?

And by that, she means more energy and able to go through a normal school day. Will LDN take her pain away?

Paul Battle PA-C: You're right. That is dear to my heart because that's how I got started with my son. And for her to know, my son was diagnosed with severe Crohn's as he hits at age 10. I think it started at age 9.

He had to have a good part of his small bowel resected that time, 3 years later, he had another severe exacerbation going into hypovolemic shock and so that is a time where I started researching by myself. And that's when I read Jill Smith's article in 2007 about LDN and Crohn's and she's an excellent and respect gastroenterologist who did excellent studies on LDN and Crohn's showing a remission. So if she wants to know if it works within 8 weeks, 69% of the people in her first study, showed that they went into remission, 89% of them showed that they had a significant reduction in the Crohn's index scores.

And what are those? The index scores are more symptomatic scores on a number of stools per day. Cramping, bloody diarrhoea, fevers things like that. Those, that 89% of them had significant reduction scores, so she can't expect a very good possibility that she would have less pain because the inflammation is causing the spasm, which is causing the pain.

So reduces the inflammation. Those symptoms will improve. They also will reduce the diarrhoea if she is having diarrhoea. You can get Crohn's in any section of your GI tract from the oesophagus to the anus. My son now, he's been on LDN for 8 years. He is a weight lifter, a bodybuilder.

He's doing really well. He has a strict diet so the one thing I would tell people that you don't depend on LDN alone. It's multi-system, multiple approaches to solving the Crohn's problem and if you do these other techniques such as dietary control and supplements, probiotics, things like that, you can expect to get good control of it.

As I said, I had a 14-year old that really pretty much doesn't have symptoms anymore. Inflammatory markers are gone, so you can expect chemical markers for inflammation to be reduced when she's on the LDN and yes, they had children on certainly had my own son on it. Dr McCandless treated many thousands of people with autism with LDN, and so it's proven to be very safe with children.

Linda Elsegood: Thank you. That was an ideal question for you, wasn't it?  Robin has asked the question. She's got Multiple Sclerosis. She's had been taking LDN since 2005 and in that time, she's had no new lesions and no active ones. She's had MRIs. She says that she's no better, but she's no worse.

MS has been stable in all that time. She uses a cane away for balance away from home and uses a scooter in large stores. Now what she would like to know is, does she need to continue taking LDN for the rest of her life, or is there a period of where she can stop?

Paul Battle PA-C: That's a good question. I wouldn't because she's been stable now for almost 12 years, I would be very hesitant to stop it. There are not many people with MS that are stable for 12 years. He could have 5 or 6 years where you have this up and down cycle but that's a long time to be stable.

She has no new lesions and the cost and the risk of LDN is so low. I don't know why she would want to consider stopping it. The other thing is the benefits of LDN with your immune system in general. It upregulates many of the things that help protect you from infections. It upregulates the natural killer cells and with the new research and cancer and the old research in cancer with doctors Aegon? it may help. I can't say for sure, but there are no studies on preventing it cancer. But certainly, we've seen the action clinically and how it benefits people with cancers. I would really recommend that she stay on it for the rest of her life.

Like I said before, there are people thought: " There's no benefit here. I stop it." And they paid the price. And MS is not something you want to have an exacerbation, it can be quite devastating for some people.

Linda Elsegood: Exactly. Yes. I certainly wouldn't want to come off the LDN.

We have an interesting question from Kat and, she says that she takes baking soda in water for reflux before she goes to bed, but she also takes her LDN before bed. And will the baking soda stop the LDN from being absorbed?

Paul Battle PA-C: It might. I wouldn't really recommend that because of the baking soda itself, could inhibit the absorption of LDN.

It'd be best if you could take the LDN maybe an hour after that. By then, the baking soda should be out of her stomach and into her small intestine. So that's why we don't recommend compounding pharmacies to put calcium and other minerals in with the pills because it can disturb the absorption.

If she really needs the baking soda then she might consider doing LDN in a topical form with the oil or cream or something like that. If she has that much trouble with reflux she might have eosinophilic esophagitis, which LDN can be helpful for, since it's also an immune-based problem and that seems to be a more common diagnosis. So in the end, I wouldn't recommend her to take it at the same time.

Linda Elsegood: Just on a personal note, I used to have to take an anti-acid every night for acid reflux, which was really bad. It used to burn the back of my throat and absolutely awful. But have changed my diet and not eating gluten or dairy, the acid reflux has gone on.

I no longer have to take that medication, so I'm quite pleased.

Paul Battle PA-C: Excellent. That's the way to do it. Glutamine also was another nice thing to do. It's just an amino acid and that helps with reflux also. That's what most of the intestinal cells are dependent on for energy and also helps with restoring the intestinal cells so that's another thing she could try, but you're right, Linda, that's the best thing to do is just get away from those triggers.  Gluten and dairy are the two most common triggers for many of the diseases we're talking about. We are not used to those kinds of proteins.

Linda Elsegood: And we have a question here from Heidi and she says she's got resistant depression. "I've been on every type of antidepressant and been in counselling on and off for years, and nothing works. I currently attend CBT I am suffering from crippling anxiety, depression, and insomnia. I've read that LDN can help.

I'm very desperate for help. I wish to try what would work"

Paul Battle PA-C: That's a good question. Some of the psychiatrists on our meetings are saying it can help. I mean, it certainly, increases the endorphins or at least the endorphin function. So that in itself can help depression. I don't know if it'll help the anxiety. The cognitive behaviour therapies he's doing is helpful but newer research is showing that many people have depression. It is an inflammatory condition. For example, people who have had a heart attack, the highest risk for reinforce, and that is, another heart attack occurring is depression and it's not an accident because of inflammation from depression. Inflammation in the presence of coronary artery disease can cause the plaque to be released from the wall of the artery causing a coronary thrombosis. So I think it would be worthwhile. There are studies, and I think Sweden and Japan, are showing that people who didn't do well on the medications, did well responding with high doses of fish oil. It is also an anti-inflammatory, and I'm talking large dosages.

For example, 5 to 10 grams per day of fish oil. Because DHA, which is in the official, makes a good part of the brain weight, about 20% of the brain weight so in the studies that Purdue University with children on anyway, so that most of the kids with this kind of psychiatric diseases, 85% had low DHA.

So fish oil is another anti-inflammatory, another option for people with depression. And the other thing that's important, since I do a lot of hormone work is to make sure that the thyroid is optimized. I don't mean in the range or normal. I mean optimized at a good level, healthy level, not just in the range, like 95% of the population and that has been shown in psychiatric journals to be just as good as antidepressants for depression therapy.

Linda Elsegood: I know many people who are using LDN for depression and anxiety, and I found that it really does help. Certainly got nothing to lose by trying it.

Paul Battle PA-C: Right.  It's a great economic thing with really minimal if any side effects.

Linda Elsegood: Exactly. We have a question here from Robert who's got CFS/ME, and he said, "I was originally taking LDN at 4.5 mgs daily.

Now I'm taking it every other day based on an article which I have read recently, which is recommended, taking it every day or every other day.

Paul Battle PA-C: We have all, traditionally been prescribing it every day because the blockade is four hours and the immunological benefits that had been described byDr Dagan and Dr Bihari himself show that the immunological benefits last for about 20 hours. For that reason, I usually do a daily dose. Now for this person, if it's benefiting him every other day, his receptors may be more sensitive, and he does not need the 4.5 mg. What he might try is take half of the tablet and take two 2.25 milligrams a day versus every other day. But then, the pharmacokinetics, that is how the drug works and how long it lasts, it would be generally recommended to be on a daily basis. Now,  you got to understand how LDN works. It is an opiate receptor blocker, and if somebody has more sensitive receptors, they may need a lower dose or not as frequent to make their immune system actually, most beneficial.

That's true. We find with cancer. We don't like to go too high on the dose. Anything above 4.5 I don't think is a good idea because then you're blocking the benefits of the opiate growth factor that Dr Zagon has described in the past. So he just may find a level that's good for him, and that's perfectly fine, but the pharmacokinetics usually indicated it should be a daily dose.

Linda Elsegood: Thank you. We'll just have one more quick break, and we'll be back in just a moment. The LDN research trust has an LDN Vimeo channel. I have interviewed over 550 LDN prescribers, researchers, pharmacists, and patients from around the world for many conditions. You can find the link from the LDN Research Trust website. If you'd like to be interviewed, sharing your experience, these email, linda@ldnrt.org

 I look forward to hearing from you.

This show is sponsored by Paul Battle PA-C. He is a well-respected physician's assistant who takes a physiological approach for your optimal health using traditional and nontraditional treatments for autoimmune diseases and bone health using hormone replacement therapy and Low Dose Naltrexone. He has patients throughout Colorado and other states.

Visit www.pabattle.com or call 720 773-9041

Welcome back. I wonder if you could tell the people listening, Paul, the benefits of attending the LDN conferences, either in person or the live stream.

Paul Battle PA-C: Well, I've my personality. I think I've been to now 4 or 5 of them and the benefits certainly I get as a practitioner, but he can also apply as a patient or interested individual, is that you hear people from all over the world and the different applications that they're using it for. When I look at myself, I'm only one practitioner in my own experience, and I certainly haven't treated everything so it gives me a great advantage to listening to other speakers from anywhere around and what they're using it for, some of which I really never thought of.  The psychiatrists are talking about how it might help depression and may help sexual function, for example.

I certainly never thought of that so I think the biggest advantage is you're seeing some of the top people around the world who've been using this for a while and all the different indications so that if you have a disease that has not been a common one that we told about LDN, like Multiple Sclerosis and Crohn's, but it's one of these more rare diseases, you then can say: " This might be an option for me." And then try to find the LDN prescriber to try it. It's such a low-risk treatment. It certainly would be worthwhile for a lot of different diseases. I think you've counted over 200 autoimmune diseases now that I think we had the experience. It is a lot of diseases to cover and it's great to hear from other people around their experiences.

Linda Elsegood: And this year we're getting case studies and some prerecorded presentations because there was so much information there that we wanted to present to everybody. It would have taken like two weeks just to sit there and watch. So you're limited to what you can do in three days, but there is going to be a lot of extra material there.

But the Q&A sessions I find amazing because not only do people in the room get to submit questions, but the people who are listening online as well, and there are some amazing questions that come up, and it's really interesting to see all these people that have been prescribing LDN for so long.

Some of the questions are very complex and answering them can be tricky. We had feedback last year from one doctor who said she thought the Q&A sessions were amazing, and she had all her questions answered. She had some questions answered that she would have asked herself if she thought of them and the whole thing was unbelievable. She said, because some of the questions that were asked, I think there are only a few where nobody on the panel knew the answer, and they just shook their heads and said, no, I don't know that one. So for her, that meant every time somebody answered a question, they didn't answer it to give an answer.

They answered it because it was a fact. So for her, that made the whole thing believable. So, that was good. But I always find that the conferences, the atmosphere is electric. You've got all these people that are so for LDN. It's just amazing, isn't it? The actual feeling in the room.

Paul Battle PA-C: Well, it is. It's a great comradery because it's still not a well-known treatment and if it doesn't have salespeople doesn't have commercials on TV.

So it's really been pretty much up to people like you, Linda, who's been one of the leaders in promoting LDN around the world and that's been my mission since it says my thumb's life is to speak at international conferences sponsored by you and sponsored by other organizations. I'm going to be speaking at the Age Medical Management conference in Florida in April about LDN and that's a whole different group of practitioners that will be hearing about LDN from myself. It's a nice, progressive movement that's helping thousands of people around the world in a very economical way. I just wish there was a way we can spread it a little bit more, but commercials are expensive, so it depends on all of us to be together.

That's where I feel a real brotherhood and sisterhood about LDN movement. We don't have a lot of help other than us volunteers or in your organization.

Linda Elsegood: And this is where the good thing is in sharing case studies and people getting together to discuss different ways of treating different conditions with LDN.

It's a good way of everybody learning. We do have another question has just come in and it's for Rheumatoid Arthritis. The question is, "How long should I take LDN to treat my Rheumatoid Arthritis?"

Paul Battle PA-C: Well, I'm not sure if he's asking how long should he take it before he notices a difference, or how long should he take it to treat it. I would stick with it at least three or four months before he would expect any dramatic results. Just give it that much time. If he does have a good result in the end, if you can get 70 or 80% improvement then he used to just stay on it the rest of his life. Rheumatoid Arthritis is not one that goes away. I would want to make sure though that it is Rheumatoid Arthritis. I had a patient in my clinic who was told by the rheumatologist she had Rheumatoid Arthritis, and so for 3 years, she's been thinking she had rheumatoid arthritis and I checked her for Lyme disease, through Armin labs, the German lab that we have come to our conferences, and she was positive for Lyme Arthritis. So the question is always make sure you have the right diagnosis also. But if he gets a good relief, Dr Bert Berkson in New Mexico has a great presentation on his patients with Rheumatoid Arthritis showing the serological markers improving dramatically on LDN. Many of the people were able to get rid of most of their rheumatoid medications of which a lot of them have side effects.

Linda Elsegood: Yes. We've had the lady Mary, who's been listening to the show, and she's talking about Complex Regional Pain Syndrome, and her daughter is 15 years old. She says: "Is it safe to take LDN at the same time as Gabapentin". Her daughter is currently on 2,700 milligrams a day, and she'd love to get her daughter off the Gabapentin but it's the only thing that takes the edge off the pain.

"Is it necessary to go gluten-free to find relief?" She said: "I know she should, and I'm gluten-free myself." But her daughter is not ready to accept. That's what she needs to do. "Are there any studies out there on the longterm effects of using LDN in adolescents?" She often searches for weeks and finding studies difficult.

What is the most normal dose for CRPS? She's 5,11 foot and weighs 140 pounds. Thank you for your help.

Paul Battle PA-C: Well, that's interesting she brings that up because I had that exact patient in my office about an hour ago. She's the CRPS patient on Gabapentin, and she's been trying to get off Gabapentine.

I believe the Gabapentin may have been helping her a little bit because Gabapentin can work with the LDN as it helps attenuate the nerve transmission. It's a class of drugs, like anti-seizure drugs, so she can certainly use them together. And is there any studies? There aren't any longterm studies on kids.

We just know that like Dr McCandless had kids on the LDN for years and there's never been any problem longterm. My son's been on it for 8 years without a problem. We have the OB-GYN doctors in Ireland who use the larger dose Naltrexone, 50 mg for infertility during pregnancy, and they have not had any problems.

So I really can't think of any other safer drug and  I've been a PA for 35 years and a lot of different medicines that I prescribed over the years. I can't think of a safer drug then Naltrexone at  3 mg, 4.5. For her at that size, I think the 4.5 milligrams would be the appropriate dose, but I would titrate it up, and regardless of the gluten-free, I think when you have any kind of immune dysregulation gluten-free is a good idea. The gluten proteins are not ones that we have been designed to digest. Dr Tom O'Bryan, who comes to our conferences, is one of the experts on gluten, said to me last year that, even a person without gluten intolerance or the Celiac disease still has inflammatory changes in their intestinal track when they do biopsies 30 minutes later.

So my recommendations would be yes to have her do gluten-free. I know my son with his Crohn's took a while, but when he finally realized, this is his body, this is this future, now he's gluten-free, dairy-free, all that. So I would highly recommend that she go on a gluten-free diet.

Linda Elsegood: Appreciate what she's saying though.

Having a 15-year-old daughter who wants to socialize and go out and be part of the crowd, and then you can't go out for a pizza because you can't eat it. It's difficult, isn't it?

Paul Battle PA-C: You have to do a gluten-free crash. A lot of pizza parts and an Italian place have gluten-free pasta, gluten-free crust. I was just had that last night, as a matter of fact so it's workable now. It's much easier now for gluten-free meals and diet, and she can always bring your own food. That's what my son's done for years, is just pack your own food and have salads and things like that.

Linda Elsegood: Well, it's not very easy in England to find anywhere that is gluten-free.

You'll find that when you come over. When I went to travel and, we were hungry, and I just wanted to grab something. I went to the supermarket, and I said to the lady because I couldn't find it," Do you have a gluten-free section?" So she said: "Yes, but it's not very popular."

We're going to stop it and we've only got what's left on the shelf. And there were like six things, and it was like, then you're going to get rid of all the small section. You do have. I thought that was quite amazing.

Paul Battle PA-C: They need more education there because the Northern Europeans, as I understand it, have a little higher incidence than other population.

That is 1% of the population so I'm surprised at that. That's unfortunate.

Linda Elsegood:  We took our grandson to the cinema last week, and we were looking at menus outside to see what was gluten-free. Many places don't have menus, and we were looking at TJ TG Fridays, and we went inside and they actually have a gluten-free menu. And it was like," Wow, a whole menu of gluten-free!" You can choose it. This is it! Take it or leave it! There was actually a choice. That was very good. I had a gluten-free burger and a gluten-free bun, and it was very tasty.

I was going to say to you, Paul and anybody else out there who's listening, if there are any conferences coming up where you're a speaker, or you're attending a conference, and LDN is going to be one of the topics, let us know. We actually have on our website now an events calendar for talks and lectures so that people can read and have that as a resource available.

So you would have to give me the details, Paul, and we'll put that on there in the event calendar.

Paul Battle PA-C: We can spread the word. I love doing it. If we can help a couple of hundred people. And mostly what I really like doing is teaching the practitioners because I figured each practitioner has 1,000, 2000  patients in his practice. You've helped that many thousands of people at least be exposed to the LDN, by teaching the practitioners that, I think has a big impact on l.

Linda Elsegood: And word of mouth. Taken hold, hasn't it? People are telling friends and social media. I must admit I didn't want to join Facebook. I don't know how many years ago now. Reluctantly thinking that suggest another thing I don't have time for, but I think we have about 18300 members now.

I'm on there and I'll take this opportunity to thank all the wonderful admin people that we have who answered all the questions and help and steer people and give them advice on how to find an LDN prescribing doctor. Without them, Facebook wouldn't continue, but the number of people that pass through, who come, who go, who take the information, go to their doctors and get LDN prescribed It's a wonderful tool.

Paul Battle PA-C: It would just have to educate more people, more practitioners.  Some people may not be open to things that they're not trained in, and certainly the lack of a lot of clinical trials that do make the practitioners a little hesitant to prescribe it, but if you educate yourself, I've read a lot of it, all doctors papers and convinced that it's definitely a good thing for my patients.

I do certainly not hesitate to do that, but you do have to get educated, and that's what we're doing.

Linda Elsegood: Well, I'd like to thank you very much, Paul, for being with us today. We've just about run out of time and you've been amazing. So thank you. And I look forward to meeting you in September, but I might meet you when you come over later in the year.

Paul Battle PA-C: Yes in summer. That'd be great! Okay, Linda, I appreciate it and a really great time. I love helping out.

Linda Elsegood: Thank you very much.

Any questions or comments you may have, please Contact Us.  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.

Nancy - Australia: Relapsing Polychondritis, Sjögren's Syndrome (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Nancy from Australia takes Low Dose Naltrexone (LDN) for Relapsing Polychondritis and Sjögren's Syndrome.  Nancy had symptoms for 5 years and was diagnosed four years ago when she was 68. Nancy had just finished a year of treatment for breast cancer and suddenly got pericarditis, which is inflammation of the pericardium around the heart. Her daughter was told that her diagnosis was hopeless. 

With conflicting advice from her immunologist and her doctor, Nancy did her own research and found an article about Low Dose Naltrexone.  Nancy had to source the LDN herself as her doctors were unwilling to prescribe it but once she had it she very quickly felt improvements in her symptoms. She had more energy and less pain, the inflammation beginning to subside. Nancy’s advice to anybody with autoimmune problems is to give it a try, it’s made a big difference to Nancy’s quality of life.

Molly - France: Ankylosing Spondylitis (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Molly is English, currently living in France. Molly takes Low Dose Naltrexone for Ankylosing Spondylitis, which is one of the rustic conditions.

It's a condition that affects the spine and the sacroiliac joints that's around the hips. And also particularly for women can affect and does affect the peripheral joints of the body, like knees, elbows, shoulders, and also we get problems with our feet and the Achilles tendons. 

I started getting symptoms when I was about 15, and I'm now 74. 

When I was in my early sixties, and that was 1991, my Achilles tendon was with a bone spur on my heel. And it was horrible to walk. And I also was having problems with my eyes. And then my knees, my back and I was in total agony for three months. It would take me about three hours to actually get moving. I'm getting dressed with hell, and I had to work out how the means to get things like socks on or tights on or underwear on. And it was virtually impossible to wear bras because I couldn't get them done up. And so I stopped wearing them. 

I was on anti-inflammatories, nonsteroidal anti-inflammatory drugs for about two to three years at that point. And then that led to horrendous problems and I ended up with Inflammatory Bowel Disease.
And that was really absolutely frightful. I had very little control over gut actions which led to horrendous embarrassments or not being off and not being able to leave the house.

I heard of LDN through the Ankolysing Spondylitis Forum group called kickoff. So it's an organization made up typically solely of patients who suffer from Ankylosing Spondylitis. A member of our group posted about the Low Dose Naltrexone.

I was still living in England, so there was one doctor not too far away from me and I contacted the doctor there. 

I provided all the information, and eventually we had another telephone conversation and he provided me with my first prescription, which was a very low dose. I think something like 2.5 or 2.75 mg, initially. And I now take a dose of six milligrams that seems to suit me the best. And I really basically haven't looked back. I didn't have any side effects. I wasn't expecting to have vivid dreams. A lot of medications don't agree with me. But quite frankly, LDN has been a lifesaver for me. I can't say exactly how long it took to kick in, but it basically kept me away from really bad flares.

I would say to others to try LDN. The doctors, the Rheumatologists, very much for push the big biological drugs, which are not only horrendously expensive to provide at 1,500 to 2000 pounds a month when LDN is such cheap and cheerful medication that does work and does not have the side effects that the biological drugs produce.

I would say, "Please try the diet." And don't forget to stretch. You need to stretch and to expand the chest for deep breathing. I've got fusion in the spine and fusion in my rib cage, and I do physiotherapy every week.

Summary of Molly's interview. Please listen to the video for the full story.

Moira - England: Rheumatoid Arthritis (RA) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Moira from England takes Low Dose Naltrexone (LDN) for rheumatoid arthritis. She first started noticing a symptom of tenderness under the feet, as well as stiffness in her calves at the age of 54. By October 2009, it was carrying on into the shoulders, where she then found it difficult to get about. 

Moira found out about LDN after a treatment in January, she noticed no side effects when she first started taking it, and felt improvements in the first few days.

She also firmly believes that the Low Dose Naltrexone (LDN) is really helping her immune system. Moira has also expressed that her pain is really rather low, at a rough 60% reduction of what it was like before. and only has a flare up in one leg.

Moira encourages people to try LDN, no question about it!

Please watch the video to view the full interview. Thank you.
Any questions or comments you may have, please contact us.

Martha - US: Fibromyalgia (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Martha is from Hawaii in the United States, and takes low dose naltrexone (LDN) for fibromyalgia. Her first symptoms were a series of mysterious illnesses, stomach problems, fatigue, multiple chemical sensitivities, that in  2010 was diagnosed as fibromyalgia.

She was pretty much bedridden, felt feverish without a fever, fatigued, and in pain. Her quality of life was a 4, or 5 on a good day.

She heard about LDN in 2006 from a friend who was working with Dr Jackie McCandless, who was from the little community where she lived on the Big Island. She recently passed away but she had used it autism and then started the study in Africa using it for children with HIV.

She started LDN two years ago, and in three weeks her pain was decreased, she slept better, her depression lifted, and now she rates the quality of her life at a 10.

This is a summary of Martha’s interview. Please listen to the rest of Martha’s story by clicking on the video above.

Marie - England: Ankylosing Spondylitis (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Marie, who's originally from Germany and now from England, takes LDN for Ankylosing Spondylitis. 

I think it was when I was about 17 years old when I started experiencing symptoms. I'm now 30 years old. I had an accident. I fell on the bench on my lower back. I was too proud actually to get it looked at.  I was hurting. And from then on, I kept having problems in that area. And, because I knew that I could have Ankylosing Spondylitis anyway because my dad has got it too, I was tested when I was about 11 for the genetic defect and yes, I do have it. 

 It would take me all day to get going and straighten up in some form. And people used to look at me because I'm still teaching fitness classes and thought you shouldn't be here.
And so I could keep going. And then when it was so bad, and I had my diagnosis, I just had another inspiration. I wanted to just finally see if I can find some natural way of healing. I found it but didn't make that much difference and I came across low dose naltrexone (LDN) because I kept digging deeper.

I tried and found something natural, but doesn't have side effects because I don't do well on any medication. I was so excited when I saw LDN. I just like the idea of no side effects. 

I get my pain mainly in my lower back around L4 and L5 I'm very stiff there.

I was so excited about LDN. After having taught three classes, which usually makes me very bad for Friday, I teach four classes, and I woke up in the morning and I felt ok.  I was never ill, it was amazing!

And then on Saturday continued and ever since then after being well, I just, every day I'm thinking, "Oh my God, I should have known this before."

I had a telephone consultation with my doctor and told him I found LDN, and he said, no. Primary care trust does not support this. Then I found another prescriber.
I don't want to go on anti-TNF. I don't agree with the side effects. I don't want to give it a try. It's not even proven to work. I've done my research. I'm a very informed patient and it's my body. And I need to do what's best for my body.

And I'm sorry, I just researched everything very thoroughly. And weighed out the pros and cons and tried to find reasons for why something should be working. And that's how I came to try LDN. 

My quality of life before LDN was a 2 out of 10. I couldn't concentrate anymore. I couldn't get any work done. I'm a freelance fitness instructor, a freelance designer, and I run a webshop so I can work around my problems, but I still couldn't get a lot done. And I was severely ill.

Now I'm bouncing and looked like an average person. You can't tell that I've got something wrong unless I have to demonstrate my spine flexion. Now my quality of life is a 9. I still know there's a problem there because then when I exercise too much, it goes a little bit. 

I would say to others to try it, go for it because you've got nothing to lose. It doesn't have any side effects. Many people report excellent results.  And if it doesn't work at least, you give it a try. I've persuaded my father too, to give it a try. Two weeks last night on LDN for him. It's not worked as well for him instantly as it did for me, which was quite sad. But I think that is because he doesn't incorporate a clean diet, which was very relevant to Ankylosing Spondylitis since the guts are very involved in this as well. 

Please watch the video for the full story.

Margaret - US: Cushing's, Hashimoto's, PCOS, Arthritis, Depression (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: I'd like to introduce Margaret from the United States who takes LDN. Thank you for joining me, Margaret.

Margaret: Hi,

Linda Elsegood: thank you. Could you tell us when you first started to get sick, how old were you?

Margaret: Well, after the birth of my first child when I was 20, um, I started to have a lot of hormonal problems and symptoms.

And after several years and several doctors, um, my first diagnosis was with the polycystic ovarian syndrome. And, um, I suffered through, uh, many years of trying to find someone to treat me in a way that didn't have a lot of side effects. And I eventually went on Metformin, and that was very helpful. And I kind of had a period of good health for several years, and then when I was about 35 I started to have a lot of new symptoms that were similar but different and more intense.

And after probably four years of that, I finally was diagnosed with having Cushing's disease and having an ACTH secreting pituitary tumour. And I had pituitary surgery, two years ago, in May of 2013. And they found the tumour, they got it out, and I went into remission. And the recovery from that is quite brutal.

You have to slowly wean off of steroids. You have to take them as replacement because your pituitary doesn't work right for a while. And the withdrawal from steroids has been like into heroin withdrawal. So it's very intense. It's very painful. You have a lot of joint pain, muscle pain, um, a lot of psychological symptoms, depression, um, anxiety because not having enough cortisol is almost as anxious.

It is provoking as not as having too much. And so it's, you know, a good year of weaning. And then what happens is because you had high cortisol for so long, a lot of autoimmune things pop up that were being suppressed by the cortisol. And that's kind of where I'm at at this point, where now I have really high Hashimoto's titers and.

You know, I'd have to replace a lot of hormones and I'm still in the recovery process from Cushing's. But, you know, in the meantime, ten other autoimmune things get you.

Linda Elsegood: So, before you, um, started on LDN, could you describe what a typical day for you felt like?

Margaret: Well, I started on LDN when I was about sixteen months postop from pituitary surgery. So I would say that I had very little quality of life. I was still in the place where I was in a lot of pain. I didn't work full time. I was only working part-time and only from home at that point. I could barely do the grocery store by myself and come back home. I still have people taking my kids to school for me and all. It was basically helping me just to survive.

So I would say probably on a scale of one to 10, it was about a three.

Linda Elsegood: Oh, wow. That's not good. Not a good life.

Margaret: I mean, it was better than when I had Cushing's where my life was a zero. Yeah. Before they took the tumour out, I was home-bound and could not work. Didn't think straight. Had severe panic disorder. And anxiety all the time. And how did slept in probably two years by the time I had surgery. Yeah. So it's a really intense disease.

Linda Elsegood: It certainly sounds like it. So how did you hear about LDN?

Margaret: My endocrinologist, who, he is a Cushing specialist. That's what he specializes in. He actually recommends it to a lot of his postop patients because most of us have these underlying autoimmune problems and he gives it out quite frequently, especially if you kind of linger in your recovery.

I mean, some people just snap right back. That wasn't me. Maybe cause I was older, not sure, but he recommended it. And my primary care doctor prescribed it for me. I ended up making my own with a 50 millilitre, uh, 50 millilitres and 50-milligram pills because my insurance doesn't cover compounding.

And that was the most economical way for me to do it. And so my primary care doctors, he's in on it too, and he actually prescribed it for me. And, um, you know, does all the followup for it for me.

Linda Elsegood: When you started, did you notice any side effects at all?

Margaret: Well, I started at 0.5.mg, cause I was doing liquid, it was really easy to change my dose based on whatever I was noticing.

So the very first thing that I noticed was that I started dreaming, like a lot, and they weren't bad dreams. They were actually amazing, wonderful dreams. But when you have Cushing's and you don't sleep for a long time, you don't dream anymore cause you never get to REM sleep. And I'd had several sleep studies. You know when I was sick but didn't know what was wrong with me.

And I never got up. I never had any REM at all. So I will say that the very first thing that happened was it gave me background sleep and I started dreaming on a regular basis. And each increase in dose I would have several days of. Just fantastical dreams, which is a good thing for me. So it's a side effect, but a good one to me.

IThey were never bad dreams or nightmares or anything like that.  I did notice that on each dose increase that I would have a little bit of bowel motility, very short-lived. And when you have hormone issues. That's not unusual. You know, there's a lot of stuff going on in my body, so I don't know if I can particularly attribute it to LDN, but I think so. and it just was, you know, getting used to it. So at this point, I'm, my endo wants me to work up to four, but I'm very slowly working my way up. Right now, I'm on four, and that has been a process of about a year of getting up that high. And I stayed at three for a long time. But my Hashi titers were still very high, and so he wanted me to go up a little higher and see if we could get it to work.

Linda Elsegood: So, what is a typical day like for you now?

Margaret: Well, I attribute some of it to LDN. Some of it is just simply time. And my pituitary is recovering, but I now work full time. I am completely in control of my own life. I still have some chronic pain. It's much better. I do think that the LDN helped with the pain a lot.

It is now where I can take two Motrin a day and be pretty okay. I also use acupuncture extensively, which is, you know, it's not about LDN, but that is a huge part of my recovery as well. And I would say, you know, my life is an eight, and I work full time, probably 60 hours a week. I take my own kids to school.

I have a child in college now. And I take him to school and I grocery shop, clothing shop. I do everything now. And so it's a huge improvement from before I had surgery for my pituitary tumour. And I think LDN is probably half that. I, I won't be stopping it anytime soon.

Linda Elsegood: What would you say to other people who are thinking of trying LDN?

Margaret: You know, I think it's such, it's such a longstanding drug that's been around for so long and they know what the side effects are and it's really easy. So low risk, why not try it? And I think that's how I presented it to my primary care. I said, you know, cause he had other people on it.

And so he had heard of it. He was aware of the drug, and it's such a low dose. He just had no problem letting me try it, even if he didn't really believe in it necessarily. So I would approach it in that way. But I mean, the risks are very low and if it doesn't help, then just quit if it does and amazing.

Yeah. That's what I would say. Try it,

Linda Elsegood: You have such an amazing story and so inspirational for other people. Thank you very much. You're sharing it with us.

Margaret: Oh, you're welcome.

Any questions or comments you may have, please Contact Us.  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.

Louise - US: Rheumatoid Arthritis (RA) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Louise from the United States uses Low Dose Naltrexone (LDN) for Rheumatoid Arthritis. She had numerous issues for many decades, but was never tested for rheumatoid arthritis, and nobody thought to do that. 30 years ago, Louise had carpal tunnel syndrome in both hands and. Today, her rheumatologist tells her that if she had been tested for it, she thinks that she would have shown positive for rheumatoid arthritis. Two years ago, Louise had a flare, five joints were in pain, feeling really bad, and the pain kept increasing.

Louise was tested for the antibody, which was four times the normal high, and also for rheumatoid factor. 

A naturopath prescribed her with Low Dose Naltrexone (LDN) after seeing wonders with other diseases. Now her flares have disappeared. 

Fortunately for Louise, LDN is inexpensive in the United States. Although Louise recommends people research into LDN, she has noticed far fewer side effects. But also recommends people to try one thing at a time, opposed to herself.

Please watch the video to view the full interview. 

Any questions or comments you may have, please contact us.

Dr Bob Lawrence, LDN Radio Show (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Bob Lawrence shares his Low Dose Naltrexone (LDN) experience on the LDN Radio Show with Linda Elsegood.

Dr Bob Lawrence from Wales was shocked when he first came across Low Dose Naltrexone (LDN), puzzled as to why such a simple treatment could be so effective at treating such devastating diseases.

He has found LDN to be very successful in his patients, some of whom have noticed improvements in their health within a matter of days.

He first prescribed LDN in 2000 and within weeks he had many of his patients on the drug. In this interview he explains LDN’s benefits and his shock as to why mainstream medicine is yet to adopt LDN as an integral component of treatment programs.

This is a summary of Dr Bob Lawrence’s interview. Please listen to the rest of Dr Lawrence’s interview  by clicking on the video above.