Dr Lester Lee - 13 November 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.
Linda Elsegood: Today, my guest is Dr Lester Lee, who's from California.
Thank you for joining me today. Lester.
Lester Lee: Thank you very much. Appreciate being here. Thank you.
Linda Elsegood: Can you tell us who you are, what you do, where you're from.
Lester Lee: Yes. My name is Lester Lee. I'm a physician, M.D., in Huntington Beach, Newport Beach, California.
My training in internal medicine is from the University of California, Davis, and fellowship training in sports medicine, as well as functional integrative medicine with additional training. My practice focuses on functional medicine, people who have hormone replacement deficiencies, as well as autoimmune disorders that are related to the functional integrative component of why they present to the office.
Linda Elsegood: And when did you first hear about LDN?
Lester Lee: About 15 years ago piqued my interest. My background is in pharmacy and with the pharmacy school back in '75 to '78 to PharmD program. I didn't ever practice pharmacy, but I learned about it at that time. Of course, a much more an experimental level. Because that was back, well, in the mid -- the late seventies.
My interest came with working with patients who were not getting a response from their rheumatologists for autoimmune disorders. Looking further into it and much of the -- some of the European studies, as well as here in the U.S., I think Dr Daria and another individual. I can't remember all the different researchers' names.
But I started playing in patients who had failed the injectable biologics, who have maybe rotated to different biologics with their rheumatologists because of failure to respond to medication, or they build a tolerance.
So my thought was: What the heck? These individuals are very desperate. They're in pain, they're tired, they're sick and tired, and they are -- the quality of life is just extremely poor.
So the Low Dose Naltrexone, I thought, why not? It's worth a try. And I was getting fabulous results with a limited number of patients originally a number of years ago.
The practice has a number or a fair number over the last ten years who I do place, which are appropriate candidates on the LDN. And the doses range from one-and-a-half to an, oh, even seven milligrams.
So my experience came as a result of frustrated patients spending a lot of money here in the States, especially if their insurance companies do not cover that biologic item that the rheumatologists chose or oncologist.
Then I said, you know what? This is pretty expensive. The difficulty is -- is fine. I am finding a reliable, consistent company pharmacy to make Naltrexone one-and-a-half, three, four-and-a-half, seven, what have you, milligram capsules.
And I was fortunate to find a pharmacy called Blue Coast Pharmacy right here in Orange County in Huntington Beach, as a matter of fact.
And they do an excellent job, and they mail a medication anywhere in the United States for no additional cost, and it's very fairly inexpensive, too.
Linda Elsegood: So you mentioned hormone replacement, and you mentioned oncology there. What other patients, you know, do you treat? What conditions rather, that the patients present with?
Lester Lee: The focus of my practice and reputation is hormone replacement therapy. I introduced it to Orange County back in '85, when I started practising private medicine. And a number of the patients -- again, conventional medicine is disease-oriented. My practice is proactive. A functional -- as I said, the individual has blood pressure or weight issues, diabetes.
We try to work with the causation of those rather than just giving them commercialized medicine to control the blood pressure, to control diabetes, the sugar.
Along with those maladies, of course, comes the coronary artery disease, excuse me. And the quality of life issues, the weight gain, the cognition, memory. They all send tend to diminish or decay depending on the individual as they mature.
So my patients find their way here because again, they've been frustrated with conventional medicine of treatment. Both 50/50, men and women, in terms of the patients that we see here. The practice is, of course, focused on hormone replacement optimization. Women: Estrogen, progesterone, testosterone, DHEA, pregnenolone, thyroid, adrenal support, growth hormone. Even depending on which deficiencies and presentation symptoms depend on which protocols that I would place them on men similarly, but not quite as many different hormones.
Along with that, we also find that a fair number of people who had been to their primary carers, conventional medicine were told her thyroid was normal. Well, if it wasn't adequately evaluated, completely a free T3, free T4, besides the TSH, reverse T3, an iodine level, a little more complete study of their thyroid.
We find out that they are clinically low in thyroid, and symptomatically low. We placed them on compounded thyroid, sometimes T4, T3 combination, and they get remarkable results like the lights were turned on. The cognition, the memory clears up within two or three weeks, sometimes even a shorter period of time. The weight starts coming off, the vitality comes back, the belly fat starts decreasing. Motivation is increased.
Similarly, with cortisol support, if we replace the cortisol because of chronic stress, your physical, psycho-emotional, and their adrenals start becoming depleted, we give him plant-based adaptogens. Sometimes all they need to help with cortisol support during the day when it's highest, and then when they need it.
And again, the fatigue issues resolve fairly rapidly within the first two weeks, a lot of times. And of course, cortisol adequacy is needed for the optimization of thyroid support, conversion of T4 to T3, the active form of thyroid T3 with three IDI molecules. And most physicians in conventional medicine don't address that.
If you look like you're in the normal range, which is a wide range thyroid, you're normal. And cortisol, they really don't address that very much. Myself being a past '88-'92 Olympic team position for U.S. track and field, there are a fair number of athletes, intense training athletes who are clinical adrenal insufficiency and thyroid insufficient.
Remarkably, again, you place these individuals, optimize those glandular products. Well, they remarkably do well in their performance, the training, motivation, peaking at their -- their goals. So the hormone part is just part of the practice.
Heavy metal evaluations, detoxifications, neurotransmitters from the brain, salivary cortisol testing, organic acid testing So it's not just the hormones.
But when a patient comes in, male or female, of course, we addressed looking at the symptoms that helped me determine where the problem is it coming from the hormones, thyroids, the adrenals? Is it coming from some kind of toxicity, environmental, chemical, no chemical toxicity?
So the whole picture is, is it autoimmune? So that's part of it.
And synergistically, if we work with, say, the autoimmune component, let's say the LDN component, and we complement, optimize the other aspects of the thyroid, adrenals, transmitters in our brain for cognition, mood, mood swings, these individuals are remarkable. Have a turnaround, a new lease on life, the best way to describe it.
Linda Elsegood: Well, I'm surprised when you said your practice was 50/50. It would seem to be the people that I speak to, women have more issues than men with autoimmune conditions. So it's quite good that the men must be speaking up in your area and seeking health, which is a good thing.
When you start people on LDN into the protocol that you do for people that have an issue with the thyroid, do you pay particular attention? Do you find that they then have to take less of the thyroid medication?
Lester Lee: That's a very good question. No, that was one of my observations10, 12 years ago. An individual's positive thyroid antibodies, let's say their Hashimoto's, they're inflamed.
They're chronically inflamed. We're trying to modulate the inflammatory process placing them on LDN after a couple, three months. I do notice that they respond much more positively up, like, almost as like a positive modulation of the thyroid medication in terms of the dosage of their fair number.
Yes, we've been able to not completely take them off, but decrease the dosage or the frequency. If they were on, say, twice a day, they got back by with maybe once a day. And once we control the inflammatory markers and if the inflammation again, the other component of their metabolism have changed and for the better
Linda Elsegood: A few people out there listening and saying, Wow, seven milligrams of LDN? Because a lot of patients only go up to 4.5. There are doctors out there who will prescribe it as high as 12. Could you explain to us how you titrate a patient up to seven milligrams?
Lester Lee: I usually start at -- depending on the patient and diagnosis -- between one, one-and-a-half milligrams, let's say at bedtime. I'll have them on that dosage. And if there's no ill, adverse response or reactions, I bumped them to three, probably within the second or even fourth week. If there are fine, let's say, at three, control of pain, quality of sleep, insomnia resolves, they feel subjectively, they're getting better, I'll just leave them at three milligrams.
I don't tend to have a number of patients on 4.5 for my practice. It seems like three is a magic number. At 4.5, there are a fair number of people who may have some very vivid dreams, if not nightmares, if you want to call them that, and quality of sleep sometimes, of course, is going to be disrupted.
In those individuals who said, You know what, I do get a better response at four-and-a-half, but it's hard for me to sleep because I have these odd dreams.
The dosage, let's say, why don't we do this? Let's go ahead and have one-half milligrams in the morning, three milligrams at bedtime.
And I never -- because I don't have a tremendous amount of patients with those like that, but they seem to resolve that adverse. A part of the problem with, let's say, vivid dreams or accentuation of insomnia or even nausea. I believe I have added maybe just one or two patients over the last five years said, You know what, four-and-a-half milligrams, I get a little nauseated. So if I split the dosage up, it seems to be a little more receptive and agreeable to the patient.
I haven't reviewed a ton of the literature in regards to, is a higher dosage -- let's say, split the dosage, better response and all at once, at bedtime, or even daytime.
But by understanding, looking, reviewing the literature from many years ago, bedtime seems the most common sequence to take the medication. So, of course, I follow that, too.
But during the years that transpired, a number of patients said, You know, I did pretty well on that dosage. Instead of taking five milligrams -- excuse me, three milligrams at bedtime, I took one-and-a-half twice a day, and I think I slept better.
And I still had a good response.
I'm not sure how many numbers of the other listeners have had that kind of experience either.
Linda Elsegood: Yeah, some people do do that. There are many now that prefer to take it in the morning, and they get just as good benefits, rather than taking it at night.
But the question I'm always being asked is: How do I know if the dose is right for me, and how do I know how high I can go up to? Would you like to have a go at answering that?
Lester Lee: Yes. The question comes up many times when we're starting a patient. Well, one, how do I know when I need a higher dosage, and two, well, how long should I stay on it? So again, the titration, again, my usual is about that one-and-a-half milligram, a magic number.
And once I get to about 4.5, but if I don't see much of a response after a couple of months and they'd been on that, let's say 4.5, which seems to be an average top number for most practitioners that I've spoken to. We don't seem to go higher. But in some cases where they may be on a biologic at the same time simultaneously, let's say at 4.5, I said, why don't we do this?
Well, let's go ahead and take another one-and-a-half in the morning and take your 4.5 for the next two to three weeks, four weeks, just to see if you think you feel subjective, you have a response.
And two, if you're going to be seeing your rheumatologist, your autoimmune doctor, if it could be in drawing blood, send me a copy. Let's look at the inflammatory markers. Let's see how they look compared to six months ago or three months ago.
So there isn't an exact answer. Let's say that I have four patients that, how high can it go? I don't think I've ever gone higher than seven. I'm aware of that.
There are some other practitioners who've done 10, 12. Again, I don't have that experience in those higher digits, especially in double digits. Not opposed to it.
My other thought is if I were to -- and, let's say, in a degenerative, an MS, Lou Gehrig's-type patient, and, let's say, we're already at four-and-a-half, well, I think I may do a split dosage. Let's try. I don't think there's going to be any adverse reaction, other than maybe some nightmares that you might have.
But let's go ahead and try a four-and-a-half morning, four-and-a-half at night. And you let me know if, one, if you can't tolerate it for whatever reason, and after a month, let's say if you feel there's any change -- of course, it may take three, four, or five months before they notice any kind of response, depending on the severity of their autoimmune disorder, whether it be severe Rheumatoid, Lupus, MS.
I've had a great patient who responded. I believe he was a seven-milligram dose. The split-dose was a polyarteritis nodosa.
And actually, another patient, currently, I'm trying at six milligrams, polymyositis. And he's had this diagnosis for four years now and has multiple rounds of biologic injections. And they're starting to, as he said, they're wearing off.
They're not helping me. I'll have side effects.
So three months ago, I started him at one-and-a-half. I escalated his dosage to four-and-a-half very rapidly over about maybe six to eight weeks. And currently, he's now, as of last week, six milligrams. So I'll wait for a response on how he's doing.
He's due for another round of a different biologic with his rheumatologist and urologist. But I say, Well, let's see if this works if it really does help you.
So I'm waiting for that to come, come October, to see what kind of response that we have with the new dosage.
Linda Elsegood: And people always ask as well, how long will I know if LDN is working for me? What sort of timeframe do you give your patients?
Lester Lee: I usually tell them, Well, you may notice something very rapidly, like aches and pains and insomnia within the first couple of weeks. It depends on the dosage. I normally tell them, You know, what, give it a trial. At least three months. It may take you four, but give it at least three, depending on the diagnosis, the number of years they've had that diagnosis, and the severity of the diagnosis.
I also noticed that those individuals who have short remission periods and their flares are more frequent. And not just frequent, but intense. These individuals up to six months before they had a response on the LDN.
Now, is it coincidental that they may have been going into remission anyway six months later, or was it the LDN?
I'll let them know that I -- that part, I can't answer. But either way, you're mostly symptom-free.
So is it the LDN continuum? Assuming there's no ill reaction to, let's say, the 4.5, six milligram, seven milligram.
Linda Elsegood: So what age ranges are your patients?
Lester Lee: Let's see. The youngest, I believe, is probably about 23. And she is a Hashimoto's patient. And the more senior patient I have would probably be about 80, 82. And that's an MS patient.
Linda Elsegood: And in your patients of advancing years, should we say, have you come across, dementia or any memory loss problems, or Parkinson's?
Lester Lee: You mean treating with LDN, or Parkinson's?
I would say one, and that was a year ago. And have them up to 4.5 over about maybe six to eight-month period. I would say that his Parkinson's, and he feels he's not progressing, and his tremor and cognition, he feels at least subjectively. And with his neurologist is better after about eight months.
But again, it's not a significant change, but it's a positive one, and he feels he's not progressing.
Especially if a concern, not just the motor, but the cognition is major for anybody that, if I completely lose my mind, then it's not worth living at all.
So his thought is, regardless of this helping, which it should, the motor function, but if I can retard the process, not necessarily reverse it, but retard it and keep his faculties, his cognitions intact, that would be his goal.
But is there a beyond it for every set of -- if that's how we pick up like after a month.
Linda Elsegood: Oh, good. But it's the same, isn't it, with any progressive disease? If all it does is hold the progression, you know, you're winning, it's working.
I've found over the years there are many people who will say even like 18 months after being on LDN, that it hasn't actually helped with symptom relief. It's only helped to stop the progression. Which they are very happy with.
But we did a survey a long time ago now, but it was in between 15 and 18 months, and I have no idea why after having taken it so long that they started to get symptom relief after such a long period of time, where you would think if they were going to get symptom relief, they would have received it a lot sooner.
Lester Lee: Yeah, correct. And the patients who did receive any feeling of relief after six to eight months, they tend to stop on their own and follow up, let's say, on the whole, I don't see my patients but every three to six months. Especially in the hormone patients, I only see them twice a year.
Once they're dialled in and optimized it's not like I have a tremendous autoimmune, Parkinson's type practice. If they present, actually, if how they're presenting is they are coming in, they may already have diagnosed an autoimmune elsewhere. May have been on -- treated elsewhere for a number of years, but the hormone component is why they're presenting.
If they do, I'll discuss the interview. You ever heard of LDN? Google it. It's not the high dose stuff we use for opiate overdose. So Google it. Here's some information, some literature, here's a site. If you think it's appropriate, I'll get you a script. Try it out for the next two months. It's not that expensive. It's like maybe a dollar, a dollar 15 a capsule.
Blue Coast Pharmacy, again, here in Huntington Beach, California. They're very reasonably priced. They're consistent on their compounding. They may go anywhere in the United States.
So a fair number of them will say, Yeah, you know what, why not?
But again, creatures of habit, wanting immediate gratification after, say, six months, eight months, is a -- well, I don't notice anything. I said, Well, that part I can't answer when you will get a response when you feel -- whether it be subjectively or objectively.
Now, a number of times when we place a patient on, and I'm getting a fresh set of labs, let's say, they've been on six months, I don't feel much difference. Maybe.
I'm not sure we obtained lab markers, inflammatory markers. Guess what? This is how you were a year ago. They were really high. They've come down by 30, 40, 50%. So what does that mean?
Well, it means you're supposed -- you're less inflamed. So theoretically, cause and effect relationship, you should be feeling better. He said, Okay.
So interestingly, that placebo effect is a strong motivator and a strong healer. If you're looking better, I should feel better. And there are a number of patients that, Well, I guess I do feel better. All right? If it's working, it's working. But if we're showing them objective evidence that something has changed for the better.
I've had a few patients say, Well, you know what? Yeah, you're right, I think I am feeling better. I just -- I was under more stress. So maybe it was the stress, or maybe it was the loss of a job, or maybe it was this, you know, the change in a lifestyle, a change in marital status, a change in financial status, moving to a different state or a country.
Perhaps that stressor alone induced a flare, or it was just the stress of that, and they couldn't tell the difference if they're getting better, or was it just that the change in the stressor, whether it be psycho, emotional, physical.
Linda Elsegood: Have you found any of your patients who thought LDN wasn't doing anything for them and stopped and then realized LDN actually was doing something and restarted?
Lester Lee: Yes, yes, a fair number. I said a very good question. Again, back to -- I was commenting about objective evidence. Your labs are getting better. These individuals stop. Yes. They are also really, You know what, boy, within a couple of weeks, my pain came back, and therefore I couldn't sleep, or I felt swollen and puffy.
So, you know, I guess I was -- so a number of times, I would just tell a patient, If you can't really tell if you're getting better, go ahead and stop it for a week. See if you feel any different.
And a fair number of patients have said, Yeah, you know what, I'm not sure if it's in my mind, but I guess I was a lot better, so I'm going to go back on it.
I said, Okay, that's a very good observation, and a very good question -- observation, because how do we know it's helping? Sometimes takes off it.
Linda Elsegood: Exactly. But I think it's good in your practice that you are not only looking for root causes, but to try and prevent conditions happening in the first place, which is thought to be a really good idea.
And how soon can a patient get to see you? Do you have a waiting list?
Lester Lee: Actually, I do not. I have myself, two other full-time practitioners. So we can normally accommodate you in less than a week. And, in fact, most cases within 48 hours. We take our time. We spend anywhere from 30 minutes to an hour with a patient on initial consultations because a fair number may have a very complicated history.
And especially if our concern is your flare, your autoimmune precipitated, initiated by toxic exposure, heavy metal exposure, chemical, no chemical.
Oh, just had a lady last two weeks ago. Her silicone breast implants -- two years ago, she was perfectly fine. Received the silicone implants and was diagnosed autoimmune.
And she just recently, three weeks ago, had them removed and the surgeon said that, Gee, you're really inflamed, your tissues are inflamed.
We do urine testing for plastics, benzenes, a panel of chemical, non-chemical exposure. And she was positive for eight items and chemicals having to do with plastics.
So her diagnosis, her autoimmune was triggered by chemical exposure, from all things, silicone implants.
Linda Elsegood: No, it's funny you should say that. In the last year, I've had must be three people who've told me the similar thing, that they will absolutely find it or they had breast implants, and that triggered an autoimmune condition.
Lester Lee: Right?
Linda Elsegood: Do we always know what it is we're putting in our bodies? No. No, we don't.
Lester Lee: And how do we know that we're going to be reactive? Yes. It's like the foods, the healthy foods we eat, whether it be kale, cruciferous vegetables, ginger, healthy fish and salmon.
And when Dr Sigler, I believe she spoke with you on your show a few months back. They eat very healthily. They only eat egg yolks. He can eat egg white because it's healthy. It's the gold standard for protein.
We do a food hypersensitivity panel on them. 50, 60 items. 50, 60 things come up, and highly reactive columns. And, you know, I eat every one of those, and they're all healthy.
From kale to broccoli, to sauerkraut to bananas. And guess what? Eliminate all 50 of these items in your diet. See how you feel the next two weeks. Amazingly again, cognition, better skin quality. It's a key. Lights turn on again. They feel so much better.
Again, can these be triggers just from food? Not gluten, not Celiac, but, say, just certain foods. I am creating a reaction, inflammation trigger autoimmune component.
So we're looking at the root causes, again, of finding where is the trigger coming from? The trigger for weight gain, because you're chronic, inflamed, you're chronically inflamed, it's hard to lose weight if you're estrogen dominant. And it's hard to lose weight.
So we put them on my end. All three would put them on to lower the estrogen. And they feel better. They lose weight more readily. Their breasts aren't swollen. They're not soppy. They're not retaining as much water. The cycles aren't as heavy. Their neurosis isn't bad.
So again, we're looking not just hormone replacement therapy. But if I come across, and my doctors come across, there are other components of why you're inflamed that can relate to your autoimmune, your MTFHR, DNA mutation gene is positive, two copies, things like that.
We bring into the picture. And the whole global picture, again, is, you're inflamed. Let's find out the reason why. And you have an autoimmune. It's genetics. But you're the only person that has it in your family. So let's see if there was some kind of a trigger that caused it.
So that's how my practice works. They didn't come here because of autoimmune. We may discover autoimmune. We may be hoping to find a resolution, a mitigating factor that would cause the autoimmune.
And then LDN is one of the components that we may work with, helping with the symptoms of the autoimmune.
Linda Elsegood: Well, we've now run out of time.
It was very interesting talking to you. You've got so much to say.
Lester Lee: Interesting for running on going to be half an hour. They didn't mean to squeeze in that much information, short period of time.
Linda Elsegood: Well, we'll have to have you back another time. And thank you for having been our guest today.
Lester Lee: Thank you very much.
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