LDN Video Interviews and Presentations

Sherry - 1st Jan 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today. I'm joined by Sherry who uses LDN. Thank you for joining me today, Sherry. 

Sherry [00:01:07] Thank you for inviting me. 

Linda Elsegood: [00:01:10] Could you tell our listeners what is it you take LDN for?

Sherry [00:01:16] I have the autoimmune disease, lupus. I have degenerative arthritis and fibromyalgia. These are three of the main concerns in my health, which has caused chronic pain. And it's really brought me to a place of disability, not being able to work and to enjoy life. And my health just kept deteriorating. And so a few months ago I was introduced to the alternative medication of low dose naltrexone. 

Linda Elsegood: [00:02:08] Can we just stop there for a minute? Let's find out first of all, before you found LDN, what was it like, and how long did you have all these conditions? I mean, have you had them all your life? Have they only been the last few years? Start at the beginning of your journey. 

Sherry [00:02:28] probably about 25-30 years ago I started having issues of where I would get a rash all over my body and then begin just feeling really bad and tired, and everything on my body hurt. It would happen maybe two or three times a year, or if I had gotten a virus or a urinary tract infection, I would get these symptoms. And it took several years for it to progress to where I was having these symptoms every month, every two weeks. And it took quite a while for doctors to diagnose the condition as lupus. And it is a progressive type of illness, not like it happens once and then you get better.

It just continued to get worse as I aged, and I developed more degenerative arthritis in my spine and my hands, which also inhibited me from being able to do a lot of physical activity. I was a nurse and you use your hands quite a bit. And that became very difficult to do. And then I started with the chronic muscle pain and fatigue of fibromyalgia that impacted more of my lifestyle. As time went on, I ended up taking early retirement from a job so that I could rest for a little while, and maybe reduce the stress level in my life to see if that would help. I found a job that I could do sitting down and using my computer, but still having to deal with the symptoms of chronic pain, fatigue and then flare-ups from any types of stress or viral illnesses or bacterial illnesses. So it really inhibited my life quite a bit. In 2018, I was awarded a disability determination, and that same year I couldn't do my job anymore even though it was a sit-down job. I just got to where I couldn't do full-time work. It just affected every part of my life, even my extracurricular activities within the community or with church or friends. 

I went to see a rheumatologist, and a couple of years ago and a new drug called Benlysta came out that was the first, uh, treatment for lupus; and I've been getting infusions every month and that has helped tremendously. It's cut back on the number of flare-ups I have with lupus. But degenerative arthritis and the fibromyalgia still had a great impact. And it was to the point where I could not even walk a mile. Or if I had to go to the grocery store and I had to walk around the big shopping centre, I'd make sure to hold onto the cart if I had pain in my back and my legs, and it would just make me have to sit down or, at times lie down. If I had family meals, a holiday celebration where I would do a lot of food preparation, after a short period of time, I just had to go lay down. The pain was just so tremendous in my body because of arthritis.  

Linda Elsegood: [00:07:53] can I just ask you, Sherry, how difficult was it to be diagnosed with fibromyalgia because it hasn't been recognized as a condition for that many years?

Sherry [00:08:03] That's very true. It is difficult, because as far as being recognized, and even lupus, it is the great disguise there. It was hard for them to finally put a diagnosis on me. And you find in your mind that you question whether you are going crazy or something, and what's going on with me? I know I have these feelings. So you finally find other people who are experiencing the same thing you are, and you realize you aren’t the only one that felt that way. And so yeah, it is a very difficult thing going through a disease process that is not truly recognized. 

Linda Elsegood: [00:09:28] And then you, of course, we're told about LDN. I mean, how easy was that to get a prescription and have it filled.

Sherry[00:09:38] That was another story. I had been referred to pain management because the doctor said, well, there's nothing else we can do for you. Go to pain management. And that was getting injections and getting on opioids. For some reason, it did not work on me. I guess maybe I'm just different. But the steroid injections didn't work. And as part of pain management, you also are sent to a psychiatrist to be able to find better ways to deal with chronic pain. And it was through that - that psychiatrist had dealt with other patients whose opioids and injections and all did nothing for the pain. And she said, they were put on a drug, it's off label use, but maybe this will help you. And so I started to do some research on it and talked with my pain management doctor asking if she knew about this use of naltrexone. She had never heard of it before. Then I talked with my rheumatologist and he said he had heard of it, but he's never used it for any of his patients, but he was willing to try it on me. And luckily there was the LDN Research Trust website and all the information that's for providers and patients.  He was able to be directed to that, and as he's educating himself with the use of this drug, he sent my first prescription to my pharmacy. I had no idea that it had become compounded, and my pharmacy didn't know either. So they actually made a mistake and gave me 50 milligrams of naltrexone. I'm thinking it was because I was on opioids at one point. So that was a farce. And then I finally found a pharmacy that did compounding for naltrexone, and that pharmacist was extremely helpful. He directed me to some more LDN research, information so I could educate myself and become part of the lupus support group of those who use LDN. He was an immense source of education and comfort, so I finally was able to get the medication through a compounding pharmacy in our area. 

I even talked with my primary care physician, telling her about the experience that I've been having with low dose naltrexone, and she says, this is what we need to hear. We need to hear about treatments like this, and they're not hearing it. And so anyway, my little part, I'm sharing the website information.

Linda Elsegood: [00:13:30] at what dose did you start on when you started, Sherry

Sherry [00:13:34] He started me on 4.5 milligrams right away, so I was taking that at bedtime, and immediately for the first couple of weeks, I saw no difference in the pain. I did start sleeping and dreaming, and I hadn't dreamt in quite a while, and sleeping through the night was very restorative.

It was about maybe six weeks of taking the 4.5 milligrams at bedtime that I started noticing in the day time that my pain level was decreasing. It wasn't as bad. It was tolerable. I had been where I would be from a six to eight pain score level every day, and at times more when I had to overdo things too much on my feet, or too much physical activity. I just had to go to bed and there was nothing that really helped me to take the edge off. After about six weeks, I noticed it's starting to work for pain and I was just full of joy about it. I just felt new. I felt renewed. My pain level about six weeks into LDN has gone to a three to a five every day, and that's for me, that's tolerable. That works. And I'm just overjoyed with that. And because of that, I've been able to walk for more than two miles, and hold on to a thing, or lie down, or use some other pain medication to help take the edge off. Those were the first experiences. I was just really just thrilled and told my doctors about it and they were extremely happy about it. Yeah. It set a whole new outlook on life. I don't expect that I would be 100%  a new body, a new person, but my life is definitely tolerable now in my body. 

Linda Elsegood: [00:16:49] And do you have a virus? Would you like to explain what happened when you had a virus? 

Sherry [00:16:57] Yes. It's now six days ago, I started having a respiratory virus, the cough, the congestion and all that. Usually, with lupus, those are triggers to a lupus flare-up. I didn't really know what was going to happen, but when it triggers a lupus flare-up, I get a rash over my total body and my skin becomes very painful. I have increased muscle and joint pain, fatigue, headache. It's not very nice.  It's bad enough you're not feeling well because you have a virus, then you have that on top of it. So six days ago I started with this virus then two days later I woke up and I had a lupus rash all over my body, the same type of experience that I would have prior, with the pain and fatigue, and all that went along with it. I called my rheumatologists and I reported to him what it was. Usually, he would prescribe a taper of prednisone over one to two weeks and my symptoms would be gone, the rash would be gone. And when the rash leaves, 10 days later my skin starts to peel off. The prednisone helps with the pain and the fatigue, but it usually takes about one to two weeks for me to get through an episode of a flare. 

I called my doctor as I was beginning this flare up and he didn't want to start any prednisone. He wanted to be sure that I did not have any type of infection, and afraid of it suppressing my immune system and then the virus really taking over. I agreed and I said I will call back and be reevaluated, so no prednisone next time. And then the rash and the fatigue and the pain exacerbated. And by that evening, ready to go to bed, I took in my LDN, as a backup.  We decided to give me the doses of one-milligram capsules so I could play with the dose and see if I could have a good reaction on just three milligrams of naltrexone, or if I really needed five or six milligrams of Naltrexone tab That's when I found that when I was on the three milligrams I had more disruption in sleep and more discomfort in my muscles and joints. So I went up to five milligrams and I was taking that pretty regularly and I was feeling good. And then I got the virus when I was on five milligrams of LDN. So when the flare started, that night when I went to bed, I took five milligrams of LDN. And when I woke up the next morning, my rash was almost gone. I mean, I could barely, barely notice it. I mean, it was just a shadow of it. And as the day went on the pain and the rest of the rash were totally cleared up. All the symptoms were diminishing. I still had the cold symptoms, cough and stuffy nose and all that, but the lupus flare was fading without prednisone. And that just is another surprise, to be able to do that without having prednisone. It’s just a miracle that that could happen. And every night I still continue with the five milligrams of naltrexone.

And every day, the lupus symptoms, the flare-ups, have diminished. I'm still working through the virus. You could probably tell, I sound probable still a little congested, but to me, it's a miracle. I  called and reported to my doctor and said, I know it's hard to believe, now I don't have the symptoms anymore and I didn't take any kind of prednisone. So that's where I am today. 

Linda Elsegood: [00:23:47] Well, What, amazing story. Truly truly is, and I'm sure those people listening who have lupus or degenerative arthritis, fibromyalgia is going to be so inspired by you, and thank you so much for sharing your story. Sherry. 

Sherry [00:24:08] Oh, I appreciate you giving me the opportunity. I hope this can help someone. I know it's so discouraging for some of these diseases, not getting the help you need.

Linda Elsegood: [00:24:21] Well, thank you for having been our guest today. 

Sherry [00:24:25] Okay. Thank you very much. 

Linda Elsegood: [00:24:29] This show is sponsored by our members who made donations. We'd like to give them a very big thank you. We have to cover the monthly costs of the radio station, software, bandwidth, phone lines, and phone calls to be able to continue with our Radio Show.

And thank you for listening.

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.

 

Dawn Ipsen, PharmD - 4th Dec 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'd like to welcome my guest pharmacist, Dr Dawn Ipsen, who is not only the owner of one compounding pharmacy but two confounding pharmacies in Washington State.  Thank you for joining me today, Dawn.

Dawn Ipsen: [00:01:35] Well, thank you Linda so much for having me. It's an absolute pleasure.

Linda Elsegood: [00:01:39] Great. So tell us, we're all interested. What made you decide you wanted to be a pharmacist?

Dawn Ipsen: [00:01:47] Oh, yes. So I knew at a, pretty early on that I wanted to be in healthcare on some aspect and pharmacy was very intriguing to me and started on that path and lucky for me, I got an opportunity to be a compounding pharmacy intern while I was in pharmacy school in a compounding pharmacy and immediately fell in love.

And so that was my path. I loved how personalized it was, how unique it was, how I was doing things that none of my classmates and colleagues was doing and so that started my journey. This was in the Seattle area. I went to the University of Washington School of pharmacy, and it was almost 20 years ago now and got my doctor and pharmacy degree there, and I've enjoyed it thoroughly.

Linda Elsegood: [00:02:43] So how did you get from pharmacy school to owning to compounding pharmacies?

Dawn Ipsen: [00:02:50] So I've always been an entrepreneur and really loved business sides of things and kind of had this long term goal that someday I was going to own a pharmacy and it definitely happened earlier in my career than I expected.

I had been working for the Kusler's family at Kusler's compounding pharmacy and had always told them: "When you're ready to do something else, keep me in mind." And got that call. Became owner of Kusler's compounding pharmacy. And  Linda, that was almost six years ago now and was just minding my own business, running my pharmacy, helping my community, doing great work.

And a couple of years into that, I received a call from another owner, the owner of Clark's compounding pharmacy in Bellevue, and he was looking for a buyer. He wanted to retire and he'd done his research and determined that he thought I would be a good fit, that I did the kind of pharmacy work that he liked to do, and I help people the way that he felt was the best way.

And so I've owned now Clark's compounding pharmacy in Bellevue, Washington for three years and even the pharmacies are only 25 miles apart. They kind of do similar, but yet different things or both, compounding, online pharmacies, Sterile. Kusler's does contract with some insurance plans, so we do help patients with that.

And Clark's is licensed in nine states, so we work with patients and not only Washington state, but Oregon, Idaho,  Arizona and Nevada. And we have Colorado and a couple of other States as well. So that's been really wonderful, great, fun and challenging. And it's just really neat that I get to use my really strong chemistry and biology background and help people really solve medication problems, for people and pets.

We helped the whole family. So that's intriguing and fun.

Linda Elsegood: [00:04:59] Wow. We never know.  It is been three years. You might get another phone call from another pharmacy.

Dawn Ipsen: [00:05:07] You never know. However, my staff might call crazy people if I do that, but no, I enjoy it, and I love the challenge and I think that it's something that, we're really successful at. We pride ourselves in the quality and in our teamwork and how we take care of patients and that we treat our patients like their family, and how we would want our family to be treated and very personalized with that care.

Linda Elsegood: [00:05:36] So with all your compounding, what forms do you compound LDN into?

Dawn Ipsen: [00:05:44]  So Low Dose Naltrexone is expanding. Actually had been working with Odell style Trek zone for roughly 10 years now, and kind of decided to become a state expert Low Dose Naltrexone about five years ago. And back then it was very primarily capsules only, and that's what we saw and actually five, 10 years ago it was even the doses were very structured at certain doses, not a lot of variability to it.   And we've learned so much, right?  Over the research and over the years. Now we're doing a much wider array of doses. Everything from ultra-low or micro-dosing for maybe patients who

are on pain therapies already and need some extra help with their immune system to even much higher doses, more frequent doses for mood situations or post-traumatic stress or depression.  And along with that, we're also helping patients who maybe there's an autism spectrum situation going on and they don't want to or aren't willing to take capsules in which we're able to make flavoured liquids and we're able to do now LDN in a transdermal.

And a transdermal is very different than just a topical. This is a cream-based that's very special and it's designed to drive the drug into the body,  but it's a great way to go when you have a patient who won't participate or can't participate in taking an oral medicine. And on top of it, we've started doing a lot of topical LDN treatment for skin conditions specifically for  psoriasis, eczema, things of that nature. So those are primarily the most dosage forms we see. So different ways to do oral, different way to do a transdermal, and then we have the topicals as well.

Linda Elsegood: [00:08:03] If I could just ask you, the topical cream or lotion, what do you call it?

Dawn Ispen: [00:08:11] It's usually a topical cream for the skin dermatology conditions.

Linda Elsegood: [00:08:17] So if you've got eczema or allergies or psoriasis and the other skin conditions like backtracked syndrome, Haley Haley's disease, applying that directly to the skin, what do you see? Does it take away the itchy, flaky redness? What do you see when people use it?

Dawn Ispen: [00:08:45] Definitely, so what we were noticing is, in psoriasis patients that were just on oral low dose naltrexone that they would typically get to effect at some point.  But it took a very, very long time. And it was, as you can imagine, hard for patients to be patient, so to speak, and wait for that. Because I mean, we all know how miserable it is to have skin that's irritated. It's red, it itches, it burns, it stings, all those things. It's very difficult to have any sort of quality of life. So we started doing both. We would help doctors with the normal oral therapies that we would be used to seeing, but then we would start making a customized cream for them, naltrexone being one of the ingredients. And we would put it in a cream base that actually had nutraceutical components to it that would help calm the skin already on its own with no drug in it. So yes, they often risked with the naltrexone and that cream base would find relief of redness and inflammation, and we'd start seeing the healing of autoimmune skin disorders much faster than if they were doing the oral alone.

On top of that, we could work more closely meeting their direct needs. So if it was causing pain, we could add an ingredient to help with that. If it was a histamine reaction, we could add another ingredient to help with that. And so it gave us a lot more flexibility to be very, very specific and customized with the treatment they needed on the skin that was bothering them.

Linda Elsegood: [00:10:31] So my question would be, Dawn. If, for example, 3 mg, the highest dose that you could tolerate orally and you're putting a topical lotion or cream on, does it matter how much naltrexone is in that cream? Does it get absorbed into the system? How does it work? Do you see what I'm saying? If three is all you can take and you've got three in the cream, does it matter?

Dawn Ispen: [00:11:03] Well, it depends. So if we are doing the topical cream base, there's a slim chance you could have some added absorption, but then we may want to go back and talk about what does it mean they couldn't tolerate more than three? Was it directly affecting their stomach and they were having nausea or cramps or something like that?

Or was it affecting sleep or why was it three their oral stealing number, right?  So when we go topical or even transdermal, a lot of times we can go higher than one would have thought than they could do orally and still avoid the side effects because they're avoiding that, what we call it in pharmacy, the first-pass effect. When a drug is swallowed it goes to the stomach and then it goes to the liver, and that's sometimes the portion of the system that's causing the side effect. And if we're avoiding that, we can get away with that. The other thing is that, given in these dermatology conditions, if we're doing Naltrexone  and it is just topical, we're not getting the systemic absorption that we would be getting in oral or transdermal delivery.

So in that sense, the amount probably doesn't quite matter, but also the amount of drug that's in that cream, they could put quite a bit on and not be getting a significant dose directly into the bloodstream. 

Linda Elsegood: [00:12:34] okay. And then would it be exactly the same as oral LDN and that if it kicks into the bloodstream, it would be the, and then go quite quickly.

Dawn Ispen: [00:12:44] Righ, so if it did go into the bloodstream or it was a transdermal delivery, what was driven in intentionally, you would expect to get the same effect as if they were on oral. You may avoid side effects of the stomach directly because again, you're not putting that drug directly in their stomach, and that can be helpful for some patients for sure.

Linda Elsegood: [00:13:09] okay. Now, patient feedback. What has been the outcomes of your patients taking LDN?

Dawn Ispen: [00:13:21] The feedback has been very, very positive. It definitely seems to be a drug that Is extremely safely tolerated with very few side effects, if any, and if there are side effects, they're typically dose-related and things that can be managed by proper titrations and proper dosing.

The benefit can be anywhere from subtle improvement to very profound improvement with a huge direct link to a much better quality of life. Even on my more subtle improved patients, they often find that their improvement was way more than they anticipated because they'll sometimes take a vacation or a holiday from LDN and realized symptoms are coming back.

They are not feeling as good,  more fatigued, on and on. And then when they restart low dose naltrexone they can then more clearly see how much benefit it was providing to them.

Linda Elsegood: [00:14:23] And what conditions would you say patients are taking LDN for? Do you know that?

Dawn Ispen: [00:14:30] Yeah. I often do know that. Of course, we have our longterm patients that have been on it for five, even five-plus years at this point that had the Fibromyalgia, Multiple Sclerosis, Crohn's disease, of course. We're seeing even more though conditions that are just in general inflammation-based and in which we're trying to control the body's autoimmune system. So Hashimoto's and Graves', Lyme disease, Rheumatoid Arthritis. We have patients that are using it, as I mentioned, for psoriasis specifically. And then, more recently in the last couple of years, we're seeing patients who do have post-traumatic stress disorder or depression that is been not responding to normal therapies and even cancer conditions that have been very helped by low dose naltrexone.

Linda Elsegood: [00:15:30] So do any of your doctors around your area prescribe LDN for infertility issues?

Dawn Ispen: [00:15:41] We don't have too many in our area that is doing naltrexone for infertility. However. there ts definitely known, it's definitely talked about. There's pretty good literature on its use  and it just might be that I'm not right next to where the infertility clinics are that are working with that.

Linda Elsegood: [00:16:09] What about mental health issues?

Dawn Ispen: [00:16:13] Yes, we definitely have doctors who are using this for mental health issues and are really trying great because they're trying to bring to light the whole topic of mental health and how important it is. And they become so much more open to other ways of thinking, other treatments, other modalities for these patients. So we're seeing things like the use of ketamine for depression. We're seeing the naltrexone being used for depression and PTSD. And I mean, I can honestly say that had patients who had been very concerned about their wellbeing and that once they work with these types of providers, down the road, their quality is just so much better and they're doing great with it.

Linda Elsegood: [00:17:02]  And of course, so many mental health issues with antidepressants, etc can make people feel a bit sluggish, drowsy whether naltrexone actually makes you feel brighter and better, and it's not addictive either.

Dawn Ispen: [00:17:24] Right. You get that endorphin release, which is so important to our wellbeing and how we feel in our motivation and our willingness and desire to interact with others in our community and those are all such important things for being part of this world.

Linda Elsegood: [00:17:45] Do you have any patient case studies you could share with us?

Dawn Ispen: [00:17:49] I'm sure. A couple of my favourites is one, she's a younger patient. Actually, she's only in her 20s, and she comes into the pharmacy and she's been coming in a long time getting naltrexone. At this point, it's usually just a quick pickup: " Hey, how are you?" And out the door, we go. And I was at the counter with her and I literally had to stop and scratch my head and I couldn't.  She looked just so great, so normal, so just young and vibrant. And I honestly couldn't remember why she even has started low dose naltrexone. And so I asked her. I was like, can you remind me why do you take the naltrexone?

What is it doing for you? And, and she's actually multiple sclerosis patients, which we actually have a lot of in Washington state because where we're located in our sunlight exposure and vitamin D levels and all that. And it has hot her completely in remission with her vitamin D and other things she's doing as well.

But she looks just so normal.  Is the only way I can describe it. And how cool is that? They here we have a twenty-something who, who is able to be a vibrant member of the community and have a well-rounded life and do what she wants to do. So she's one of my favourites because thank goodness you're staying on it to help slow any progression of the disease process that might occur later on.

And then I do have one psoriasis patient that I've ever seen psoriasis-like this before. She actually had it even on the back of her calves, which is an unusual location. And started naltrexone. Did that for about a month, just the naltrexone orally itself. And then when we added in the cream.

And when she would come back for refills, I just couldn't get over it, how fast it was healing and we marked it.  I actually took pictures of when she first picked up and then when she came in for refills and then now there's nothing left. So it's been really awesome to see somebody who had been dealing with this for most of her life, who now is doing great, well-controlled.

Her immune system is just functioning properly.

Linda Elsegood: [00:20:05] How long did that take before her skin looked normal again?

Dawn Ispen: [00:20:12] Yeah. So skin is always slow. I mean, that's with patience is a virtue. It's on any skin condition as you have to allow for the full all derm cycle, which usually is right about six weeks on average.

And so, you start in with treatment knew at the beginning or just trying to get the treatments on board and help with any symptom relief they might need. And then usually, like in this particular case, it was really about at the three-month mark that she was coming in happy that the condition was starting to reverse and go back to how the skin was supposed to be.

And then of course for full healing, it's another month or two after that. And then he'd go into maintenance mode at that point.

Linda Elsegood: [00:21:00] Well, that's amazing, isn't it? I mean, psoriasis, if you have it, and I know somebody with psoriasis, how embarrassing it is. People look at you when it's really bad. I'm not comfortable either, is it? So something that can heal and clear that up It's amazing.

Dawn Ispen: [00:21:26] Yeah, it's wonderful because it can be, like you said, not only visibly unappealing and they will often try to hide it if they can with clothing and coverage, but it hurts, it clot cracks, it bleeds, it burns, it itches.

It's just horribly uncomfortable and unrelenting, you know, it doesn't just stop. It continues.

Linda Elsegood: [00:21:50]  Do you have many children as patients?

Dawn Ispen: [00:21:53] We do. We actually work with some doctors who are very in touch with the pediatric population and that's their speciality. And they use naltrexone usually in the kids that they have some sort of a spectrum disorder where they're noncommunicative and they aren't interacting as we hoped they would be able to.

They're a great population to work with and that's where we get to become very creative and work really closely with the family itself on determining how does this child want to receive its medication and is it as simple as custom dosing and maybe they want the capsule a certain colour because it might be more appealing visually to them. Fine, perfectly great with that. Or do they need a liquid and do they want it to be flavoured a certain way or do they need a lozenge? And then for the most difficult of patients, we can do the transdermal cream delivery that I even have a couple of families that they actually apply it to the child's back, back skin area at night when the child is sleeping. So they can receive their dose that way. 

Linda Elsegood: [00:23:25] Wow. So what else do you know about LDN that you haven't shared with us?

Dawn Ispen: [00:23:35] With LDN there are lots of things can augment the therapy of LDN and getting the most out of it. And it's really looking at the patient at a whole and trying to discover what ways can we reduce inflammation load in that patient's body along with optimizing the dosage form and the regimen, the strength and the timing, it should be taken.

 I do work a lot on talking with patients about the importance, especially in Washington,  of vitamin D,  the importance of good gut health and probiotics. We're working more with patients on using full-spectrum C-- to help with pain and anxiety as well,  antioxidants and organic diet and how important all of these things are to get inflammation loads down, to get the best effect out of it.

Linda Elsegood: [00:24:32] Yes. Diet is a big one, isn't it? People do notice a big difference by changing their diet.

Dawn Ispen: [00:24:42] Diet is so huge, and you know, us living in a suburban area, gardening and farming is not simple, right? And our seasons make that challenging too, and just really encouraging our community to buy from the farmer's market get organic as much as you can, grow your food when you can yourself and just eat well, take care of your body, you're worth it. You know? It's like you are worth the extra effort in doing that.

Linda Elsegood: [00:25:14] And sugar is another big thing, isn't it? If you can't cut it out, at least cut it down.

Dawn Ispen: [00:25:21]  Right, and look for good alternatives that are natural and if you do have to have that sweet because, you're right, it's in everything and it's hidden often it's hard to even know it's there.

Linda Elsegood: [00:25:36] It surprises me when you look at a tin food.  Dugar is in pipe beans, it's in..Just trying to think of something else. It's gone. Slipped my mind. But...

Dawn Ispen: [00:25:52] Ketchup, salad dressings.

Linda Elsegood: [00:25:55] Exactly. Sugar, sugar, sugar, sugar. It's not easy, but it's, it's similar if you're buying foods and you read the labels, gluten is in so many things.

Dawn Ispen: [00:26:13] Absolutely.

Linda Elsegood: [00:26:14] I mean, when I first started to be gluten-free, it took me ages to do my shopping because I was looking at everything and trying very hard not to get anything with gluten in it.

But it becomes easier because you know which things you can have and which things you can't have. Once you've gone through reading everything, it does become easier and you do find alternative things. I use honey as a sweetener and I use coconut sugar but it's brown colour so I can still make cakes and waffles occasionally, but there isn't a different colour but if you close your eyes you don't know, you can't see that it's a different colour. You can be creative. It's very expensive to eat organic here, and I should think it's pretty similar in the US isn't it?

Dawn Ispen: [00:27:18] It is. It definitely can be challenging to be able to do that and hard for some families to make that happen. And I always like to refer to the dirty dozen as they call it, of if you really have to pick and choose which product is most important to purchasing, organic versus maybe you could save the finances on something else.  That's at a nice way to integrate or ended up the pathway. Lucky for us in our area, at least, we do have a substantial number of farmer's markets that are all close by and available different days of the week but that can be an option for patients that are really trying to do those things, but maybe not able to get it from the grocery store all the time.

Linda Elsegood: [00:28:16] And the thing is, with organic food, it doesn't last as long as a non-organic without us being sprayed with things to keep it fresh longer.

Dawn Ispen: [00:28:28] And it sometimes doesn't look as pretty, does it either? There are more bruises and changes in how it grows and things like that.

But it's funny how our minds have that used to be the normal, right? That produce always looked like that. And then we've changed to think that that product should look perfect in every instance and that's not necessarily the case. It comes back to what you're saying with the sugar.

Linda Elsegood: [00:28:59] We have a supermarket here that sells half-price vegetables from the supplier, and they're all packaged and they're called wonky vegetables. So the carrots, parsnips, that probably got deformed but they're perfectly fine. There's nothing wrong with them. It's just as they call them wonky,  they're not perfect and I think that's great.

Linda Elsegood: [00:29:34] We've come to the end of the show so we could have carried on talking for ages. We'll have you back again another time and until then, stay well and we will speak to you again soon.

Dawn Ispen: [00:29:48] Wonderful. Thank you. Have a great day.

Linda Elsegood: [00:29:50] Thank you. Bye-bye. This show is sponsored by Kusler's compounding pharmacy and Clark's compounding pharmacy. They are more than a drug store. They are highly trained, compounding pharmacy experts, combining the art and science of preparing personalized medications to meet your specific needs, improving lives by solving medication problems for people and pets, creating solutions to medication challenges.

Visit www.kuslerspharmacy.net

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

David Borenstein, MD - 17th July 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'd like to welcome back Dr. David Bornstein from New York. Thank you for joining me today. David. Now I know you've been prescribing LDN for many, many years, but first of all, could you tell our listeners your medical background, please? 

Dr David Borenstein: Sure. Well, I initially trained in medicine at the Technion, Israel Institute of Technology in Haifa Israel.

I came back to do my internship in Staten Island hospital in New York, and I did additional training in radiation oncology and rehabilitation medicine at the State University of New York at Stony Brook. And then I opened up a private practice here in Manhattan. And I've been working here in Manhattan ever since.

Linda Elsegood: So tell us a little bit more about your practice, what you actually do there. 

Dr David Borenstein: Sure. I have an integrative medical practice and I do various different sorts of integrative approaches in functional medicine, approaches to issues such as, um, we work with a lot of patients with chronic fatigue, fibromyalgia, autoimmune diseases like MS and Crohn's, hormone replacement.

Dr David Borenstein: I work with patients who have issues with their guts. And we also do a lot of work with patients who have chronic pain. We do a lot of work with STEM cells, platelet-rich plasma, uh, and prolotherapy. We also do intravenous drips for our patients. So we offer a wide, wide variety of options for people looking. 

Linda Elsegood: I haven't had anybody explain about STEM cell treatment and possibly you could get in England, but it's not something that's been on my radar. Could you tell us a bit about the STEM cells? 

Dr David Borenstein: Sure. Basically, a STEM cell is by definition, the cell that can become any other cell in the body, so it's a very primitive early-stage cell that eventually can become lung tissue or hard tissue or bone. So what we do is we obtain, um, cells from either adipose fat tissue or we use umbilical cord, um, cells from other people, and we use it primarily to treat orthopaedic conditions. People with neck, back, shoulder, knee pain, hip pain, and we do a lot of work, uh, with that, uh, with that regard.

Um, we used to do some more work with Crohn's and autoimmune diseases, but we're primarily focusing now on orthopaedic conditions with a good amount of success and saving a lot of people from joint replacements, which is a good feeling. Wow. Yes. But you were saying. That the STEM cells can help replace all these different things.

How does the STEM cell know what you want it to do? The mechanism of action is poorly understood. We think that it either listens to a homing signal and does repair of the cell, or it actually may differentiate into that particular tissue. The mechanism, again, is poorly understood. Um, but you know, the basic science researchers are looking into that.

Dr David Borenstein: We do know from people doing STEM cell deployments for many years, that there is a good efficacy in treating orthopaedic conditions, and it's promising for treating things like cardiopulmonary diseases, neurological conditions, and um, and various other chronic medical conditions. The potential is unlimited, and this is like a very exciting field of medicine today.

Linda Elsegood: So if somebody needed a hip replacement. How would you treat that with STEM cells? 

Dr David Borenstein: Well, we would do is we initially evaluate the patient, have them come to our office, um, do a complete history, physical examination, look where the tender points are, looking at their range of motion, look at any scans, CAT scans, MRIs or x-rays.

And we will see if the patient is a candidate for having STEM cells for the hip. We generally like to use patients who are younger, uh, because. You don't, you know, the older patients, they're also candidates, but you don't want to put an artificial hip into patients who are in their thirties forties or even in their 50s because chances are because people are living into their eighties and even their nineties they're probably going to require revision of that.

And that's something you probably don't want to do. And what we would then do is we would inject. Either adipose-derived cells or umbilical cord cells into the hip joint, as well as all the attaching ligaments around the hip to make sure that the hip is nice and stable and roughly success rates depending on the age, depending on the severity of the disease, roughly in the high 70th percentile success rate, which is pretty good for, uh, having to avoid a hip replacement.

Linda Elsegood: Oh, definitely. Um, a friend of mine, his sister had problems, um, birth and she had to have a hip replaced, I think when she was. Like 15. She was very, very young. Uh, cause she couldn't run. One leg was longer than the other, and it just wore the hip. And she had another one. Uh, when she was thinking was about 35 and then another one just before she was 60.

So if she was able to have saved herself from having all these surgeries. I mean, that would just be amazing, wouldn't it? How long does it take for those STEM cells to do their work? 

Dr David Borenstein: It can take anywhere from several weeks to several months, and sometimes I have to have the patient come back. A few months later and we can boost the area where we treated with either something known as platelet-rich plasma, which are platelets we extract from, from blood, whichever, a lot of growth factors or another procedure known as prolotherapy, which is the oldest.

The oldest regenerative medicine technique will use sugar, water, dextrose, and lidocaine, and we can add some other things there. It causes localized inflammation. Okay. And it causes growth factors to come to the area and help tighten up the ligaments and, um, help improve the, um, and repair, uh, the local tissue in the joint.

So it's exciting stuff. It is, isn't it? Very, very exciting. And of course, the injection into the joint is far less traumatic for the body than having surgery to replace a hip, isn't it? You know? Not only is it less traumatic, now that's way less traumatic. It's done under local anaesthesia. So the risk goes down tremendously.

You don't have to be in a hospital. You can return to work in a relatively short period of time. I mean, if you're doing a desk job, for example, if you're getting a procedure done on a Wednesday, you can go back to work on Monday. Obviously, if you're doing, if you're working, you know, as a lineman on the, uh, for the electric company, you probably want to, you know wait a little bit longer to go back to work, but most people with desktops can go back within five or five to six days, and they don't have to be in an inpatient hospital, do any outpatient physical therapy. Now in the future, you know, two or three months, four months down the line, they may, we may need to give them some physical therapy, but it's not the inpatient type where you're stuck in a hospital or a subacute facility and you have to be there for a while.

Linda Elsegood: So it's, you know. It's nice because it allows you to go back to work in a relatively short period of time.  and when you were saying you prefer younger people, I'm just wondering if I'm in the age group. Older people.

Dr David Borenstein: Let's put it this way. Well, let's, we have a couple of ways we can, we can look at it for patients. We're using adipose-derived cells. You know, usually, I like.  If their patients are in there anywhere from the 30s too, let's say their early seventies they usually should have enough cells for doing the job.

But for patients who are in their mid to late seventies eighties even nineties I prefer sometimes to do the umbilical cord cell because I know well, they're not coming from the patient. I know they're probably going to have a high level of cells as you get older. The number of stem cells in your body are going to come down and they, they will drop.

There's no question. Someone who's, you know, 20 is going to have more STEM cell than someone who's 50, and someone who's 50 is going to have more STEM cells than someone who's 70 on, on average. So, um, usually I find that if the patient is going to be, you know, past your mid-seventies I may want to, you know, use only the umbilical cord cells because they know they have a, a good number in them.

Now, some patients will say, you know what, Dr Bornstein, I don't care. I want to use my own cells and I'll respect that and I'll use, I'll use the adipose. Fine. But you know, I have to give the patient the option. Of course. Yeah. No. 

Linda Elsegood: You have first-hand experience and knowledge about LDN? When did you first start prescribing?

Dr David Borenstein: Oh, at least 15 years ago. And the history is very interesting because I had a patient come in, and this is well before there were LDN websites, well before LDN research. Well before the information that we had, and a patient came into me and wanted LDN and I said, well, let me look into it. I was a little sceptical.

I didn't know much about it, so I did my research and said, uh, all right, let me give this a try. And I tried it on this patient. I think it was for, I believe it was either for Multiple Sclerosis or Crohn’s and, um. I got some very, very good results. So I, um, discussed LDN with a number of different compounding pharmacists, uh, one here in New York and one in, uh, one in Florida.

And I learned more about it. I did some research on it, and I started using more and more LDN in my practice. And I got some really amazing, amazing results and it just mushroomed. That has continued and we’re using it for the vast majority, everything that people are using today. I was using LDN for, you know, at least, you know, almost 15 years ago and great, great success stories, uh, multiple different, uh, conditions, and I just never looked back.

Linda Elsegood: Could you share some of those success stories with us? 

Dr David Borenstein: Oh yes. I said, for example, a number of different people with Crohn's disease, and for some reason I find the inflammatory bowel, Crohn's disease respond beautifully to LDN. I have had maybe two or three patients who really did not respond the way I wanted to, but they were very severe cases, but the vast majority of my Crohn's patients did beautifully on LDN, and this is, you know.

This is my early experience. So the vast majority of my patients were either Crohn's or MS and the MS patients also experienced quite, um, quite great results, lack of progression of the disease, some improvement in their fatigue and optic neuritis. The patients many times tried the, you know, the ABC, uh, medications, you know, and just didn't do well on them and didn't want to take them. So he did the LDN and they've never ever looked back again. So. Those are the two biggies. We also started using LDN for patients with various sorts of malignancies. I had a patient with a lung tumour, for example, and we put on LDN and it was just stable.

Didn't go anywhere. It was just sitting there, you know, and she was on it for many, many years. I lost contact with her after a while. I think she moved out of the country, but from a number of different years, she had a very stable, um, um tumour in her, in her lung, didn't, didn't do very much for it. And also we've been using it more and more since the studies came out from Stanford University on fibromyalgia.

And we've got some, you know, some positive results. I mean, I work with, in my practice, we incorporate LDN. We also use it in conjunction with other treatments. I find for fibromyalgia, it definitely takes the edge off. And, but you have to, you know, do a vast, um, uh, treatment option, um, working with their hormones, their sleep and infections.

I also find it's beneficial for Lyme disease. I do some, some work with Lyme disease, but overall, it's primarily MS, uh, autoimmune-related diseases that I use LDN for.  

Linda Elsegood: Do you ever use it for mental health issues? 

Dr David Borenstein: Yes. We've been getting more requests for that. Uh, primarily with the osteoarthritis, uh, conditions.

And I do have patients who swear up and down that it does improve their pain. Again, have patients who do not get any sort of relief. Um, I find that works better with the osteoarthritis and it does with the rheumatology conditions, but I, the number of rheumatoid patients that I have been a little bit more limited in that regard.

I also, patients have been using it for reducing alcohol cravings, which we find has been, uh, more, and we're getting more requests to do, LDN for that as well.

Linda Elsegood: Have you been asked to use full-dose naltrexone, the Sinclair method for alcoholism? No, not at all. I haven't gotten any, you know, I'm aware of it, but I haven't gotten any requests for it yet. Okay. Because they have very good success rates with that, whereby you can continue drinking and you take the tablet.

I can't remember now, it was an hour or two before you start drinking, but it takes away the craving. So where you would probably. You know, have 10 pints of beer, you might only have two. And then gradually you get, so you can take it or leave it. You don't actually need to carry on drinking. That's really interesting for people who, um, they call it now, don't they?

Alcohol use disorder and it is, uh. Yeah. A bonafide condition. You know, it's not a case of saying to people, stop. These people can't just stop. So that is an alternative for, maybe you'll have more people coming to you asking you for that. Now. It's interesting because you know, you know, one of the side effects of LDN can be projectile vomiting with alcohol consumption, although I don't see too much of it.

Dr David Borenstein: I know we've had cases of that, and it is a known, um, side effect of taking LDN. So even that alone may discourage people from, uh, from trying to take alcohol. Uh, we've had, um. Probably one, two, three, four, maybe five or six patients who've used it for addiction. Um, and they're quite happy. Um, again, most people who take LDN for the condition that they want to be treated, tend to want to continue on, on the LDN for the condition. It is very rare for people to stop it. Very rare. I find most people just want to continue it for whatever condition they have. Well, it's also the boosts the endo endorphins, which is the body's own natural feel-good fight or isn't it? So that should really give you a boost anyway, shouldn't it?

Linda Elsegood: I know people say, and I've been taking LDN 15 years or over 15 years. That it protects them. They don't catch viruses or colds or become sick in any which way. I mean, LDN works amazingly for me. I'm not complaining whatsoever, but I still get colds and flu and whatever's going around, it doesn't protect me in that way.

Um, but there are many people that say that you know, they haven't had a cold since I've been on LDN, so I don't know why I'm different, but, uh, it can happen. Well, that's amazing. You mentioned that, cause I did a consult, uh, late last week and it was for an ms patient and the patient had ms and you know, we renewed her LDN.

Dr David Borenstein: But the comment always comes up that treating for MS, but they'll say, Oh, I haven't got a cold all winter. And I get that over and over and over again. So, people, it's very rare people come to me and say, I just want it necessarily to boost the immune system. I get that. But they usually have another condition.

They usually get colds and this season, last season, the season before they've, they've never gotten colds. So it's definitely a benefit to taking LDN and we see it all the time.

Linda Elsegood: Now people can come and see you and have a consultation face to face, but you also do telemed consultations. Could you tell us about that?

Dr David Borenstein: Sure we do, uh, telemed consultations all over the United States, and we do it all over the world. So we've had patients who we've done it in the UAE, Middle East, Mexico, uh, Europe. So yes, we have patients from all over the world. We're interested in getting, uh. Getting LDN. And um, many of them come to see me here in New York because I'm right in the middle of Manhattan, and they may come to see me first and then we can do everything over the phone and we do everything over the phone initially.

So yes, we can certainly do telemedicine anywhere. There's a phone connection. 

Linda Elsegood: So how does it work? I have people say to me. Do you know what happens if I need blood tests? Do you know what happens? So if somebody came to you today and said they would like a telephone consultation and there, I don't know, in France, how would you go about, um, finding out all their medical details, etc.

Dr David Borenstein: Well, many times they'll email me all the medical reports before the initial consultation, so I'll have all of their medical records sent via email, or if they want to fax it to me, they can. But today email's much easier. And we do a complete history over the phone. We get all the information we can.

The most important thing is, one thing about LDN is it's, it's really safe as long as you're not taking narcotics. Um, and it's only, you're not mixing the LDN with certain other medications that can. Um, go against LDN. For example, we know with MS there are certain medications you're not supposed to take with LDN.

Um, as long as you, you're clear with that, it's usually not a problem. I remember using medication at less than one 10th the prescribed dose. So long as you're not having any, um. Taking any narcotics, you stopped in narcotics before doing procedures. You know, you're not drinking alcohol at the same time, knowing you can have projectile vomiting.

We, you know, it's a pretty safe medication and then we can prescribe it. Uh, some people, um, will. Get it from pharmacies here in the United States or, um, that's usually, or they come to New York, um, and they can get it here in New York or any other pharmacy that can be prescribed here in the United States.

So it's usually pretty straight forward. Um, our dosing, you know, we can tell them how to dose. Um, I find that certain, you know, for example, certain patients, they want. The maximal dose all the time, but they don't understand is that the maximal dose for a person weighing 250 pounds is very different from a patient weighing 125 pounds.

And, um, even Dr Bihari when he was doing it, found that many times. You would. If you give too high of a dose, you can cause too much, uh, to prolonged blockage. You want to lower the dose. So every patient, it's not so easy. You just, you know, give the maximal dose and have a nice day. You also have to, uh, take, you know, take sex and weight into account when you are prescribing and take an account.

There are side effects, you know, difficulty sleeping, vivid dreams. So all of these have to play an account. Also, a patient has neurological disorders. Certain patients over a certain dose get increased specificity. So, you know, it requires, you know, some experience in prescribing. It's not, here's the medication, have a nice day.

And every, every, uh, disease, we're going to approach it from a very different perspective. For example, in patients with inflammatory bowel disease. I find giving a full dose at the beginning is a better way of treating them as opposed to stepping up the dose. With Hashimoto's, you've got to go very, very slowly and the blood tests have to be done just to make sure the antibody levels are dropping and that they're not getting hyperthyroid.

And that's where he gets a little bit tricky. But most of the patients do their blood tests. They do them locally with their local doctors. They send it to me with theirs, when we get their LDN prescriptions and you know, everything works out well. . 

Linda Elsegood: So how do they go about having the blood tests from you? Do you send them a kit or the information to take to their own doctor? How does that work? 

Dr David Borenstein: Well, generally, generally. Uh, with most cases, yes. For what we do, we don't need blood work. The vast majority of patients either have blood work from their local doctors, or for example, if they're having Hashimoto's, someone's prescribing their blood work and prescribing their medication, and we'll just get copies of that lab work just to make sure that the antibodies are going down and not becoming hyper.

We have to warn the patients that as the antibodies come down, you're going to need a dose adjustment and they should get blood work to reduce their dosage of medications. Um, and you know, the antibody levels can drop quite dramatically. And you know, if you're, if you're having a good dosage, it can actually make you a little bit hyper.

So you have to warn the patient about that and just check the, have them check their blood levels locally. And usually, everything's fine.  and people always want to know. 

Linda Elsegood: How soon would you say in your experience that patients notice an improvement on LDN? 

Dr David Borenstein: It varies. I find that inflammatory bowel disease patients usually notice an improvement quite quickly.

I think some of the other autoimmune diseases may take a little bit of time. It all depends. Um, people react differently. We're all bio-individual. None of us are exactly the same. We're not all Toyota Corollas, so it can be anywhere from several days to several weeks, even to several months. I usually recommend that the patient be on the LDN for at least four to six months before you even think of discontinuing it because it can take that long in order to see if they're responding or not.  

Linda Elsegood: Exactly. I mean, I've had some people say to me. Um, I'm taking liquid LDN and I've nearly finished the bottle. I've been on it nearly a month. Uh, it hasn't done anything, you know, I'm thinking of stopping, you know, it's not a miracle that it's going to happen. You know, just like that. You've got to give it time, haven't you? 

Dr David Borenstein: Exactly. As you were saying. Well, several things are sort of, you got to give it time and you have to make sure that you're getting it from a place that's reputable, that you're using a good quality LDN. And I only use, you know, a number of different pharmacies that I use. Sometimes I'll change the patient from an oral to a, say, a transdermal, just to see if there's going to be any difference in the way they're, they're feeling. Remember a lot of patients with severe, for example, inflammatory bowel disease, they may not be absorbing the LDN, so doing it transdermally may be beneficial.

I find many times in kids, for example, it may be more beneficial to do a transdermally then than orally, and sometimes they have other cofactors. They have just poor absorption. You've got to say, Oh, well, why aren't you absorbing it? Maybe you have low stomach acid, so. The vast majority of the time, the patients are quite pleased.

But, um, and this would make the difference between someone who, who does LDN and someone who does LDN is knowing if there's a problem, what do you do? What's the next step? What do you have to look for? And that's the that makes all the difference in the world. 

Linda Elsegood: So if somebody would like to have a telephone consultation with you, is there a waiting list.

Dr David Borenstein: We can always accommodate patients if they, um, depending on the day, the month of the year, uh, you know, typically you're very busy, sometimes very slow if they are interested in having a telephone consultation, they can just call our office. The number is 212-262-2412 or 212-262-2413. And if they want to learn more about the practice, they can go to my website at www.davidborensteinmd.com and they can look at the website and see what we offer and if they're interested in making a telephone consultation, just call the office and we're more than happy to schedule them at the earliest possible time.

Linda Elsegood: Well, thank you very much for having been our guest today. 30 minutes went very quickly. Oh, thank you for having me.

Dr. David Bornstein is New York's leading integrative and functional medicine physician. His patients are diagnosed and treated in an integrative manner to promote recovery and continuing good health. Call 212-262-2412 for an appointment. Telemedicine appointments are available for LDN prescriptions.

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

Dr Melissa Coats, LDN Radio Show 14 Nov 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today my guest is Dr Melissa Coats from Arizona in the US. She is a naturopathic oncologist. Thank you for joining us today, Melissa. 

Melissa Coats: Thank you for having me. 

Linda Elsegood: Well, could you just give us an idea of your background, first of all, please? 

Melissa Coats: Sure. Initially growing up, I always knew I wanted to be a physician, I think, or in medicine. And when I went to school far away from home in Lynchburg, Virginia at Randolph-Macon Woman's College I focused on biology. And then after that, I didn't exactly know what part of medicine I wanted to do. So I decided to get a Masters in bioethics while I was deciding, and when I discovered bioethics, I stumbled across naturopathic medicine. Once I read the philosophy and what it was all about, I knew that was where I needed to be. Once I finished my Masters at Midwestern University, I went on to the Southwest College of Naturopathic Medicine, which was in Tempe, Arizona. And I didn't even realize it was in my native state. And so I learned all about naturopathic medicine and went on to school there, and ever since, here I am.

Linda Elsegood: Wow. And when were you first introduced to LDN? 

Melissa Coats: I believe my first introduction was through my mentor and colleague, Dr Daniel Rubin. He had co-written an article about low dose naltrexone, I think back in 2006, for its use in pancreatic cancer. And Dr Berkson who uses it a lot at his clinic, where he does a lot of hepatitis C treatment, also was very interesting to me So I learned a lot from both of them. And from then on, I've been doing more and more research and just using it in a multitude of ways with different types of things beyond cancer. But cancer is obviously one of the bigger ones that we focus on here at our clinic.  

Linda Elsegood: Could you give us an idea of your protocols for treating cancer patients, and which cancers you've actually treated with LDN?

Melissa Coats: Probably one of the bigger ones we typically put people on it for are those who have breast and colon and pancreatic cancer. Those are some that we definitely do, but we know there's some efficacy with ovarian and neuroblastoma and glioblastoma and even squamous cell carcinomas. Pretty much because of the natural killer cell and the immune stimulation that it gives.

We've found it is a very nice adjunctive thing to add on to most treatment protocols, so we utilize it quite often, usually starting with a lower dose. Depending on the sensitivity of the patient, maybe 1.5 all the way up to 4.5 milligrams, depending on what's going on and making sure that we're not conflicting with any pain medication use, of course, if the patient's had surgery or things like that.

We also, me particularly in the clinic, like to use it for other things as well. One of my very first patients actually wasn’t an oncology patient that I utilized it in - it was a person who had undiagnosed celiac disease for 25 years, and her gastrointestinal system was just a giant mess, and she was miserable. It was one of the things that I decided to introduce to a kind of calm her autoimmune issues that were going on, including her thyroid. And it really seemed to calm her gut. And she said it was like a miracle to her, and we even tested going off of it briefly to see if that was truly what was happening. And it was definitely the low dose naltrexone that was helping calm things for her. And so that was one of my first introductions to the power of it. And from then on, I've been utilizing it in many ways since  

Linda Elsegood: What are the therapies you use alongside LDN?

Melissa Coats: Currently, here in Arizona, we have the ability to give IV nutrients, so we use IV alpha-lipoic acid alongside the LDN. Sometimes it's vitamin C, IV. We utilize other supplements, as well, to focus on different parts of what the person needs as far as support if they're during chemotherapy or radiation or other treatments who may have anything going on.

We also utilize sometimes another natural killer cell stimulator, which is mistletoe, but we only give that in a sub Q injection versus IV here in Arizona. There's often a combination of things that we utilize with LDN to help the patient get the best for their immune system and whatever other issues they're having.

...

Melissa Coats: Sometimes, most of those patients are already on LDN, so it's definitely a good part of the mix. We definitely like to make a treatment plan very individualized to each patient, and so there's often quite a multitude of things going on at once, whether it's ... LDN, IVs, a diet plan, whatever it is. We like to bring it all together for them so that they can feel their best. 

Linda Elsegood: And you mentioned a diet plan there. Of course, with cancer, sugar. Is a no, no. What kind of a diet do you suggest patients follow? 

Melissa Coats: A lot of our suggestions as far as diet are either to focus on a very anti-inflammatory or a Mediterranean style diet. The ketogenic diet is obviously big news right now. So that is definitely utilized depending on if the patient's in a good place to do that or not. If they're in a very cachectic state or their weight is very low, we may or may not utilize that, but if they're in a place where it looks like they would benefit greatly from the anti-inflammatory effect of being on the ketogenic diet, we definitely introduce that. Definitely a big part of our consults with patients is spending a lot of time on the diet because we believe food is one of the greatest medicines you can put in your body if you're utilizing it properly.  

Linda Elsegood: And what's the age range of the patients that you treat? 

Melissa Coats: We have little tiny babies all the way up to, I think one of our patients right now that we have that I also believe is onLDN is 89. So we have quite the age range going on here in our clinic. I would say the majority of my patients range in their mid-twenties to like in the seventies and eighties. So we have quite the group. 

Linda Elsegood: And you were saying that you treated the lady with celiac disease. Have you treated any other autoimmune diseases? 

Melissa Coats: Yes. Of the ones that I've seen some benefit, a few patients who have lupus who've seen some benefit; in rheumatoid arthritis we have definitely seen some help in calming some of that; a lot of Crohn's and colitis. I definitely really see a lot of benefit with LDN when you bring in GI issues that are very inflammatory and sometimes immune-mediated. So it's definitely been helpful. I also have utilized it quite often with Hashimoto's thyroiditis to kind of calm the thyroid antibodies, and they seem to note that their thyroid works more efficiently and we see better numbers on labs when they're on the LDN, and less need for medication, which is nice.

Linda Elsegood: So the patients that you know are on LDN for thyroid, do you taper up slowly? How, what is your protocol for that? 

Melissa Coats: The patients mostly have been able to start at three milligrams, and I haven't really had to taper them per se, up or down. Sometimes we just watch the numbers and kind of see how they're feeling, and I may start them at three and just have them check-in with me about how they are feeling, whether that's too much, too little? It hasn't seemed to cause any major side effects, which is why I love using it so much because most people have a great response. 

I forgot about one case that I specifically wanted to tell you about. I have two patients that have autoimmune hepatitis that has been very difficult for them to wean off their steroids. And we have been utilizing LDN probably for the last year and their numbers as far as their liver markers, their AST and ALT have definitely decreased significantly since starting the low dose naltrexone, and I have finally been able to taper to a much lower dose of their steroids, which is wonderful because they hadn’t gotten to a low dose before without the LDN. And we found that using the LDN has made them much more successful and they're very excited about that. The thyroid becomes more efficient with the use of the LDN. They definitely need less medication, which is wonderful. So I usually check thyroid labs when I'm changing things up, every four to six weeks. And so definitely I've had many patients have to reduce their dose because of the LDN, which has been great.

Linda Elsegood: So when a patient comes to see you, let's just say a cancer patient, how would you go about putting that plan together? What is the procedure you follow?

Melissa Coats: When we meet, we initially have at least an hour consultation. We have really extensive forms that they fill out ahead of time, so that I have a really good understanding of their history, and we try to request records so we’re already in the know of what's going on so that we can spend a lot of time talking with each other about goals and where they want to begin.

While we're in consult, we actually type up a protocol so that they leave with a piece of paper that says what labs they are going to get., what treatment plans and treatment options we are interested in doing, whether that's IV or starting low dose naltrexone or some supplements. And then we make sure that there's a clear understanding if we need to check-in and get a diet diary, or what changes should be made immediately.

So they leave with that protocol in their hands so that they feel like not only did we meet and get a good understanding of what's going on, but we have a plan in action that first day, which I think is very powerful in making a patient feel empowered about taking control of their health. And we also kind of keep updating that protocol each time we meet so that if a supplement doesn't work out or we need to add something, they know exactly what's going on and can keep track, which is helpful to everybody involved.

Linda Elsegood: I was speaking to Dr Berkson, and he taught me that alpha-lipoic acid is to be taken intravenously, that it wasn't as effective in tablet form. And the other day somebody was telling me that no, the tablet form works just as well as the intravenous. So I'm now confused. Has it changed? What's your take on it? Exactly. 

Melissa Coats: My understanding is with IVs, you're bypassing the GI and you're getting full absorption; whereas orally you'd have to take a lot more, and obviously the doses are different. The IV amount we go up to is about 600 milligrams, whereas orally we're giving someone up to 1200 milligrams a day. Typically we use both, so when they're not here, they're on it orally. And then when they're in an office, they don't need to take their oral dose that day because they're getting the IV version of it  But from a strengths perspective, and I'll have to check the latest studies, I guess now that you say that, my understanding from Dr Berkson and his protocol that I've been utilizing for a number of years now, that the IV seems to be pretty vital.

Linda Elsegood: That's what he told me, so I've just wanted to check that. 

Melissa Coats: We haven't changed our protocols yet as far as I know. When I can't get numbers to move from oral dosages of things, I definitely bring in the IV protocols, and that seems to make a difference. 

Linda Elsegood: And what about vitamin C taken intravenously? Is that really effective that way? 

Melissa Coats: For absorption issues and things like that? I would say yes, because, from the standpoint of orally, most people can't handle maybe roughly above six to eight grams because it causes a lot of GI distress, even if it's buffered, whereas IV we give people up to a hundred grams, which is way past what anyone could take orally. We know that that creates a different type of stress on the cells, that it can help with reducing vascular endothelial growth factor and other inflammatory markers related to cancer.

Linda Elsegood: And if you read about vitamin C and it talks about water-soluble fat-soluble and it's flushing out of your system if you take too much, or you take too much intravenously.

Melissa Coats: It’s pretty much individualized as well. Some people can't handle certain doses. There are some patients that feel great at 40 grams, and others that can take a hundred grams and feel just as great. So it kinda depends on the person. There are tests to check also whether their plasma level of vitamin C, so that's something that we have utilized in the past.

And then based on our clinical knowledge from using it for a long time. We have kind of figured out where people tend to do well. Yes, it doesn't stay in you forever. It is leaving the body, and there's a lot that's going through the kidneys and being voided out, but for the time that it is in the body and doing what it's doing to the cells.

And if you come on a fairly regular basis, you are creating an environment that is, less available for cancer to grow. So you're creating an environment that is not what they will utilize. So that's why we use it so often. We also use alpha-lipoic acid because it's a powerful antioxidant. And then some of the other nutrients that are out there too. 

Linda Elsegood: A few years ago I had an operation, and as I came to I was in quite a bit of pain, and they gave me intravenous paracetamol, and I was thinking to myself, the pain was quite bad, and I was wondering why they are giving me paracetamol? You know, that's not gonna do any good. And it worked. I was absolutely pieced. I thought, paracetamol isn't very strong, but apparently, it's stronger if it's taken intravenously, as it goes through the metabolism by the liver. It just goes right in. I was surprised at that.

So, vitamin C, minerals, and supplements. Do you have any favourite ones? I mean, obviously, it's individually tailored to the person. But on the whole, what would you say? 

Melissa Coats: We utilize a lot in the oncology world, things that basically kinda change the terrain for cancers. So one of the things that I've utilized a lot is modified citrus pectin, which targets galectin-3, and by lowering that, you allow protection of good, healthy cells and keep other tissues healthy. So, for example, with a woman with breast cancer in one breast, you want to try and protect the other breast. So that we found that this can be helpful. And if she's going to be having surgery or a biopsy, having this on board can kind of help prevent the spread of the other rogue cells. In studies, that's what's been confirmed. So it's something that we've utilized a lot. 

And I use some mushrooms, a whole bunch of different ones. Coriolis mushroom, to help your white blood cells keep your immune system healthy. So that's a big one that we use. And then things that target vascular endothelial growth factor, which is basically kind of a signal for angiogenesis or blood vessels to grow around a tumour.

And so there are numerous things that target angiogenesis. One is a magnolia extract. There are other herbs as well that do that. So obviously vitamin C. And then there's some thought that if you stimulate things like the natural killer cell function with low dose naltrexone, that you may be inhibiting some of those other pathways in a roundabout way. So that's why it's a of things. Quercetin, resveratrol; and curcumin is a huge one, which is the active constituent found in turmeric. There's a lot. And that's why we constantly are trying to throw different curveballs at the immune system to help people fight cancer. And so that's why we utilize so many different things, because if you just use one agent, obviously the immune system and the cancer is going to figure that way around it. And so you want to make sure that we help. 

Linda Elsegood: Do probiotics play a role?

Melissa Coats: Oh, yes, definitely. The GI health and having a really good balanced flora of good bugs in the body is definitely key.

When I'm not focusing on cancer, I really do believe in the gut-brain connection. If your gut is unhealthy, so will your brain be unhealthy. And so making sure that you have good flora can definitely help people's mood and their anxiety and stress responses. It's pretty amazing. So I love probiotics and what they can do. 

Linda Elsegood: I was looking at probiotics, and you start off with what I would call a reasonably priced product. So I was reading the labels - this one has that many million and this one has got different strains in it. I was just lost. I didn't know what it was I should be behind. Which was the best? Is it a case of the more money you spend, the better the product you're getting, or should you be looking deeper than just the price you're paying? 

Melissa Coats: I think it's probably a combination of both. Hopefully, the more expensive products are good. If not, then they're just gouging you. But the main thing for us is it's good to get a variety of strains. So not just acidophilus always. You want to make sure you're getting lactobacillus and bifidobacterium, and you want multiple strains of those types of bacteria depending on what you're trying to work with, with the gut. Also, we're a big fan of billions versus millions because you don't know how much is actually lost or killed off into your absorption and what your stomach acid is doing to those bugs. Depending on how they're put into a capsule, there's always some that aren't going to make it. So the more, the merrier, hoping that you'll be colonizing the gut with some good stuff. I always tell people to rotate brands, and also research the brand and make sure that however they have them, they can prove that when they get their product on the shelf, that those bugs are still alive in there if they're supposed to be, and not been heat shocked in transit and are no longer anything other than a pill filled with nothing. So it may be that that is cost-prohibitive, but normally most of the products that are pretty good are similar in price. 

I think that there's some that are really high in the billions that are intensive protocols that you may only be doing for a week or two, that may be more costly. It just kinda depends, which is why we recommend you usually see someone who has done the research versus just buying a product at the grocery store that's just been sitting on the shelf for you have no idea how long. And so it's good to kind of find that out before you spend the money and then are disappointed.

Oh, vitamin D is another one. Yes, it also depends on the person's absorption. Sometimes I've switched patients from a capsule form to a liquid form and have them hold it under their tongue because they didn't seem to be getting anything from their capsule. And that could be a reflection of the way they absorb through their GI, or if it needs to be more sublingual in their case. And usually, the dose probably needs to be higher than they thought it needed to be. Based on our labs, if someone's our range - here for example, one of the labs we use the range is 30 to 100, and we like to see people between 60 and 80. And so that may take them taking 10,000 units a day for a while, and then they may be able to ramp back, or they may have to take more than that depending on their absorption status. But you kind of play with what seems to work for them. And yeah, there's a lot of different brands on the market. 

Linda Elsegood: What about omega-3s?

Melissa Coats: Yes. The key thing with omega-3s for me is making sure that it's a very pure product, that it's not from fish that are in a farm lot being fed dog food or something horrible like that. They need to be deep-sea coldwater fish, hopefully sustainably raised. And then the capsules themselves, when you're looking at it, you want to make sure that they're fresh. So hopefully the product has some sort of date on it that tells you that those haven't been sitting and becoming rancid.

The key is to look at the EPA and DHA content. If it's fish oil it'll typically show you EPA and DHA, and you want that to add up to over a thousand milligrams within just one or two capsules versus having to take ten capsules to get there because otherwise, you're not getting the benefit of the anti-inflammatory effect, the good healthy cholesterol effect and everything else that goes along with it.

Linda Elsegood: I was talking to a nutritionist a few years ago now. And she was saying if you had an inferior product, they usually have vitamin A in them. And the more tablets you take, the more vitamin A you're taking and you can overdose on vitamin A.

Melissa Coats: Yeah, you've really got to make sure it's a pure product. That could be bad. And that will give you a nasty headache and make you not feel good at all. But the one I believe that we carry here, as far as I know, is just really focused on the omegas aspect of it.

Linda Elsegood: Yes. And what about people who are vegans? Can you take flaxseed oil to do the same?  

Melissa Coats: You could do flax or chia seeds. Also just eating healthy oils like avocado oil, olive oil, coconut oil. You know, there's a lot of different ways to get in. Omega fatty acids that do not necessarily require a fish or krill.

Linda Elsegood: I was reading the other day an article on coconut oil where they were saying that previous research was incorrect and it wasn't as healthy as they made out. What is your stance on that?

Melissa Coats: I don't think it's the healthiest oil, but definitely, but I still see some benefit in using it, particularly the medium-chain triglycerides that come from coconut oil. Or we use MCT oil sometimes instead of just coconut oil. But if someone is just occasionally throwing a little bit of coconut oil into their smoothie, I haven't seen it detrimentally affect them and I've seen some good studies with Alzheimer's and Parkinson's research, that it helps the brain. So the MCT from coconut oil is helpful. 

I think it's also a matter of where you're getting it. If it's this big tub of coconut oil from a big box store, that may not be great versus actually getting small organic coconut oil, which might be a better option. With the ketogenic diet, they often mentioned using MCT oil does help supplement your fat content. And that's been a very pure product, and it usually doesn't have a coconut taste, but it's from coconuts. So people can use that if they don't like the coconut flavour. 

And it's nice because if you need to gain weight, it's a good way to add a hundred calories or more. Most people are not looking for that, but sometimes in the oncology world, we need to help people get more out of their meals. And because that doesn't have a taste like coconut oil, it's helpful. I don't think coconut oil is horrible, but I definitely don't recommend it to be someone's only source of fat for sure. And definitely, it is not an oil that cooks well at high heat. It will actually oxidize it and make it an unhealthy thing. So we usually recommend people use avocado oil for that. 

Linda Elsegood: Wonderful. The half an hour is up. It's gone very quickly. This was Dr Melissa coats and thank you so much. Before we go, can you tell people how they can contact you? 

Melissa Coats: Yes. You can contact us through our website at www.listenandcare.com, or you can give us a call at (480) 990-1111. And you can even have a 10-minute free consultation if you like.

Linda Elsegood: Oh wow, so we have nothing to lose and everything to gain. 

Melissa Coats: Thank you so much for having me.

Linda Elsegood: This show is sponsored by Dickson Chemist, experts in LDN and associated treatments in the UK. Dickson Chemist, the most cost-effective for LDN in all forms within the UK and Europe. They are maintaining safety standards far in excess of what is required. Why would you choose to get your LDN from anywhere else? Call 0800 027 6910 today to speak to the LDN experts.

Any questions or comments you may have, please Contact Us on our website at https://ldnresearchtrust.org/contact_us. 

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.

Lili - Denmark: Psoriasis, Psoriatic Arthritis, 11 April 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Lily from Denmark experienced the first symptoms of arthritis 20 years ago, 10 years into that she was diagnosed with psoriatic arthritis as she had developed a horrible rash mainly in her scalp. She was given methotrexate by her specialist. Methotrexate helped her in the beginning but soon stopped helping and Lili was at a loss, she had a lot of pain and very poor sleep and her life was severely affected.  

Lili did her own research online and heard about Low Dose Naltrexone from a Facebook group.  Her doctor was great and prescribed it when she requested it. The first dose helped her, she slept better and had less pain and her psoriasis, on her scalp, cleared up within a fortnight. As she increased her dose her pain also disappeared and she is now able to live a normal life.  Laura walks 8 Km a day now with her dog and sleeps through the night and consequently feels so much better.