LDN Video Interviews and Presentations

Radio Show interviews, and Presentations from the LDN 2013, 2014, 2016, 2017, 2018 and 2019 Conferences

They are also on our    Vimeo Channel    and    YouTube Channel

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.

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.

Linda Elsegood:  This show is sponsored by Mark Drugs, who specialize in the custom compounding of medications, assuring that the client gets the proper prescriptions for their unique needs and conditions.  They work with practitioners, integrating knowledge and treatment of experts to create comprehensive health plans.

Visit MarkDrugs.com or call Roselle (630)529-3400, Deerfield (847)419-9898.


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.

Pharmacist Kim Hansen, LDN Radio Show 30 Oct 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is pharmacist Kim Hansen. She's from the Town and Country Compounding Pharmacy in New Jersey. Thank you for joining us today, Kim. 

Pharmacist Kim Hansen: Oh, it's my pleasure. Thank you for having me. 

Linda Elsegood: So when did you first decide you wanted to become a pharmacist? Was it something you'd always wanted to do?

Pharmacist Kim Hansen: Absolutely.  I was working in a small independent pharmacy, a traditional retail pharmacy when I was in high school. And on occasion the pharmacist there would say, Hey, Kim, go mix these two creams. Or Hey Kim, go mix these two liquids. I was hooked. I knew that's exactly what I wanted to do. And from that point on I headed for pharmacy school and that was my path. I knew it immediately. That's what I wanted to do.  

Linda Elsegood: So where did you study?

Pharmacist Kim Hansen: Rutgers college of pharmacy in New Jersey. 

Linda Elsegood: So you haven't moved far? 

Pharmacist Kim Hansen: I've travelled far, but I haven't moved far. 

Linda Elsegood: So once you started compounding,  what were the main medications you were doing at that time?

Pharmacist Kim Hansen: Back in the day, it was usually combining a couple of creams together. That was before we had a lot of the manufactured products that we have now. A lot of times compounds start off that way, then they end up being manufactured items later. I used to have to make a topical minoxidil solution. I used to have to make up progesterone capsules way back in the day. Suppositories for progesterone. This was 20 some years ago. So it was before I knew of LDN.  I was doing compounding before that. Mostly progesterone and topical dermatological items that were not commercially available.

Linda Elsegood: How did you hear about LDN?

Pharmacist Kim Hansen: I think it was at a compounding seminar is the first time I'd ever heard of it. It was being discussed for autoimmune issues. I started seeing prescriptions for it about seven or eight years ago. Usually, it was just capsules, usually, it was the three different dose levels that we know differently now. It started gaining traction more for me within the last three years. But I did see it back seven or eight years ago.

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

Pharmacist Kim Hansen: Right now we do capsules and oral suspensions. Most often it's the capsules that patients are happy with. We also do a cream for patients with autism, and occasionally it's added to pain gels as well.

Linda Elsegood: What is the filler of choice for people?

Pharmacist Kim Hansen: Generally speaking, patients are happy with acidophilus. I do have patients that don't want that. And then we usually use micro crystal and cellulose, but if they have a specific filler question or need, we're happy to accommodate that.

Linda Elsegood: And what strengths do you do now in the capsules? 

Pharmacist Kim Hansen: I think our lowest is a hundred microgram capsule because that patient prefers that to be in a capsule form versus the liquid form, anywhere up to 10 milligrams and anything in between. 

Linda Elsegood: And the patient population, what would you say the top conditions that LDN is treated for from your pharmacy? 

Pharmacist Kim Hansen: Hashimoto's, pain and depression. 

Linda Elsegood: So talk us through those three, Kim, the experience that you've seen from those patients. 

Pharmacist Kim Hansen: I'll start with Hashimoto's. We do notice patients are getting to a dose that is appropriate for them and are feeling better. They also require less thyroid hormone.

If someone is on thyroid hormone and start LDN, that should probably be monitored more closely than before you started the LDN, because you'll find that as the inflammation reduces, the thyroid level changes and you may need to change your dose. Usually, it's a reduction in the thyroid dose when it comes to the pain medication using it for that.

I have patients who have had their lives changed. They were in a tremendous amount of pain before, and they were put on other pain pills. Any medications usually were just adding to their pill burden, but not really giving them relief or quality of life that they were looking for. I have patients who weren't able to do any of their activities of daily life and now are doing things that they haven't done in 20 years. To me, that makes things tremendously rewarding to know we can be a part of that success story.  I should also mention when discussing pain with patients, I have patients who have become tolerant to opioids. So we also find that LDN is a way to help reduce the opioid burden and help people get off of those and still maintain their pain relief. I view those two things together like pain and sometimes patients are looking to get off the opioids for relief of their pain. So it actually does both. 

The other I  touched on was depression. I have patients who are using an increasing schedule of LDN and also weaning off usually their SSRI or antidepressant drug. And they're finding if they wean very slowly off the antidepressant and titrate upwards very slowly with the LDN, they're able to get off of the antidepressant and still maintain a non-depressed state. They're happy to be off the medication and be able to use LDN, which we know works in a different way and usually has a better overall effect than the actual medication worked for them. 

Linda Elsegood: Ultra-low-dose naltrexone helps combat the opioid crisis. Could you talk us through how, when people come to your pharmacy, whether it's been addicted to prescription drugs for many years, how LDN plays a part in getting them off the opioids, but still controlling the pain? 

Pharmacist Kim Hansen: I won't get into a specific schedule because it is so dependent on each patient. I will say that we usually start patients on the microdose or the low dose, ultra-low-dose naltrexone, usually in a suspension form, and they'll be on whatever their dose is usually for about a month. And then after they're stabilized with that, the pain management expert will slowly increase the dose of their ultra-low-dose naltrexone and also decrease their opioid dose usually by about 10%. Again I don't want to give schedules and hard limits because every patient is so different in their ability to reduce. It's very varied as far as that goes, but I have many patients who have been on rather strong doses of opioids that have been on that for years, have been able to slowly titrate up on the naltrexone and slowly wean down on the opioid and have had success and be pain-free and opioid-free. That's huge to have that happen. We had one hospice nurse  (certainly hospice nurses are very well versed in pain and pain origins and pain protocols) who herself had her own pain issue. We walked her through this process of slowly starting the ultra-low-dose naltrexone and scaling that up over time and reducing the dose of the opioid over time. Now she’s opioid-free and as pain-free. And it definitely helped her increase her quality of life and also to be able to do the things that she couldn't do before.

So that's a huge story. I mean, someone who is on opioids, to be opioid-free is huge. 

Linda Elsegood: Definitely. For people listening out there who are in a lot of pain, because I'm told nearly daily that there is somebody who is in terrible pain, but they were already on very high doses of an opioid that doesn't seem to be working, you know?  Of course, the problem with opioids is your body gets used to them, and you have to keep increasing the dose to get the effects you were having. So anybody who has chronic pain for whatever reason, or fibromyalgia or having an autoimmune disease that has a pain component to it, how would they go about.

finding a doctor who would prescribe LDN and one that would understand about the ultra-low dose, who would be able to help them transition from the opioids to the ultra-low dose?

Pharmacist Kim Hansen: Two awesome ways to find that out. One is LDN research trust. There are lists of physicians and practitioners on there that are knowledgeable in what we're talking about here. You can also ask your local compounding pharmacist because we are a treasure trove to know who is actually prescribing it in order to be able to send patients.

It works both ways. The prescriber sends the order to us as they know that we'll do a quality compounded product. I can then refer patients back to other practitioners because I know that they're knowledgeable in this and then they've attended our seminars and that we can work together with them in order to get the best outcome for the patients. So it works both ways.  

Linda Elsegood: I was quite surprised when Dr Sam was telling me how quick the process is because I thought it would be a long, slow process. But he was talking just a few weeks, which was, wow. People that had been on opioids for many years, to, find relief like that, it just amazes me that something.so small and so simple seems like tickling the pain with a feather in those ultra-low doses rather than using a really big mallet, which is the opioids, for it to work. It just is mind-blowing, isn't it? And of course, the price, LDN is not expensive, and many people have to pay for it themselves. And it's not a price out of the reach of most people. We still have people who do not have money, they're sick, they're not able to work. And if it's a choice between food or LDN, that's a problem. But we're looking at around $30 a month, depending on where you have it compounded. It's an affordable drug, isn't it? 

Pharmacist Kim Hansen: Absolutely. We try to maintain that because we do understand that patients are in pain and you don't want them to have to choose between therapy and their food or their bills or whatever that is. We want patients to get the relief that they need.

We've kept what we're doing affordable so that we can make sure that it's available to as many patients as possible. Usually, you'll find whatever pharmacy you use, if you're going to be starting a titration and working your way upwards, usually that pharmacy will put together a kit.

So you've got maybe two different doses of a capsule in there so that you can gradually increase to the dose that you are working towards. And then once you arrive at the dose that's working for you, then that pharmacy can make that dose into one pill so that it becomes more economical if that makes sense.

Linda Elsegood: Yeah. I had a lady email me this morning, I think she had Sjogren's syndrome, and she was doing really well. She'd worked up to three milligrams. It did really well. She's now on 4.5 and she's not sleeping,  not feeling as well. And I was trying to explain that with LDN it's not, the higher the dose, the better the benefit. It's what suits you best. And if at three milligrams, she felt really good, why would she need to go to 4.5? It's not working. It's making her feel ill, so she should go back to where she was in a good place. There is so much misinformation out there that people seem to think that this magic 4.5 is the goal that everybody should be on. Have you noticed that with your patients? 

Pharmacist Kim Hansen: Absolutely. I've had patients tell me the same story that you're describing here. Everybody has in their mind that more is better and that the goal is to get to a certain number because that's where the best results are.I am always cautious about making sure I explain to patients, hey, we're dispensing a kit to you. This initial kit is usually good for 49 days or seven weeks, but if at some point halfway through this kit, let one of us know that you're experiencing relief or you're not experiencing anything at all. If you are at a dose where it seems to be optimized, I don't want you to have to continue to go up because the goal isn't to make it more, the goal is to get relief, and if you're getting relief at a lower dose, then stay there because it's very easy to overshoot that and you'll lose the benefit. So, in this case, absolutely more is not better.

Linda Elsegood: Do you have any stories of people who are on a very low dose that have stuck to that's the right dose for them? 

Pharmacist Kim Hansen: Yes, a patient with diabetic neuropathy who was using the kit and they had gotten to a higher dose, and they weren't feeling so good on that. He backed off the dose he had gotten to, I think it was three milligrams. He went up to the next step, said I don't feel as good as I did on the dose before that. Then we know where you should be. And we had him go back to the dose he had come from,  he's much happier there, and he's able to function.

Whereas he was in pain and uncomfortable before. 

Linda Elsegood: What I was getting at there was, I know quite a few people that are on 1.5 or two, which I mean is low for low dose even, isn't it? People tend to think anything under three is no good, but even that is too high for some people. Not everybody gets there. As you were saying with the man with his diabetic neuropathy, you don't have to panic. Or thinking that you know you're not taking the right dose. I know some people think that it's not a therapeutic dose if it's under three, but that is a myth, isn't it? 

Pharmacist Kim Hansen: I would agree with that. Every patient is different and how they respond to it. So even if you have identical twins. A member of your trust that lectured about this, their one set of neighbours. They completely matched as people go, and the same age, same condition, same everything else. If you go down the line and, person A got results more quickly than person B. So person B was discouraged thinking that they weren't going to find the same relief that person A got.  Having to start over with patient B, and go a little bit more slowly, titration was the key for her. So whereas a lot of times you'll see dosage regimens that, every week we're going to increase by whatever the increment is. Sometimes patients will need to go even more slowly than that and maybe increasing every two weeks or maybe every month, whatever that takes. And again, not everyone is the same. So if you get to a dose rate, like, I didn't feel anything the whole way. Sometimes you can, wash it out, start over, and go more slowly and find results there. It's just so dependent on each patient and just because you haven't gotten the answer that you want and you've gone up to 4.5 sometimes the answer isn't going up a higher dose. Maybe it's starting over and going up at a slower pace.  

Linda Elsegood: Some people feel quite discouraged starting again, but by doing it very, very low and moving up very, very slowly the fallout rate isn't as high, and the success rate goes up. You know, 20% of people didn't have the relief they were looking for, but that 20% has reduced, hasn't it? We are getting a better success rate now, understanding there are people who do need to look at LDN differently. 

Pharmacist Kim Hansen: Completely agree. Back in the 80s when we were doing 1.5 and three and 4.5, that was such a rigid structure that you probably lost a lot of patients who didn't have success and or probably had side effects that they weren't pleased with. Changing our thinking with the results we have now, knowing that going more slowly and doing slower increases or lower increases is actually beneficial overall. Yes. Patients who have tried with not finding their success before; it doesn't mean you won't have success trying it in a different fashion.

Linda Elsegood: Exactly. And then there's the other school of thought where you have to take it at night. You know, it's not gonna work for you if you take it in the morning. We now know that's not true. Is that what your experience has been? 

Kim Hansen: I would say that's true.I think yes, at the beginning of the push was, Oh, you have to do it at night because your body does repair at night but you know, here's no reason why you can't do that during the day. And there are also reasons why you would want to do something twice a day and do split dosing. Some disease states and some patients do better when they're split dose.I find that is the case with using it for the antidepressant purposes, sometimes a split dose is better for that patient versus the whole dose at one time of day regardless of morning or evening. Again, individualized treatment, and you have to listen to the patient and listen to what they're saying to you so that you can work on a treatment plan together. 

Linda Elsegood: And you were saying about the topical cream for children with autism. Do you have many children with autism? 

Pharmacist Kim Hansen: We're in New Jersey, unfortunately, we have one of the highest percentages of autism in children. So yes, I do see it, not as often as I once did, but I do see it, and usually, they're not amenable to swallowing pills. So usually the parent is putting on cream at night when they go to sleep, and they don't even know what's being applied.

Even if they take a capsule and they put it into a smoothie or whatnot, kids are wise to that because they're probably on a whole bunch of stuff and they're eyeing up every meal that comes to them, making sure nothing's been hit, so they're pretty wise to it. You'll find that the cream is helpful in those cases and yes, it does work.

Linda Elsegood: And have you come across children with juvenile arthritis or pediatric Crohn’s who are taking LDN? 

Pharmacist Kim Hansen: I have heard of it, but not in my experience here. 

Linda Elsegood: And no children or adults with asthma allergies. 

Pharmacist Kim Hansen:  I had heard of it of course but no experience of that directly here.

Linda Elsegood:  It's amazing, isn't it? Initially, going back,15 and a half years when I started the trust, it was mainly people with MS. Then it went to Crohn's, then fibromyalgia, it was just exploding. But we didn't know too much at that point what it did for chronic pain that wasn't autoimmune. We knew it helped with cancers. We didn't know about all the mental health issues and of course, it's used in fertility clinics as well, and for women's health, for painful periods.  There's a name for that, PCOS, polycystic ovaries. Dr Phil Boyle uses it in his clinic to help women get pregnant. They take it during pregnancy, during breastfeeding, have really happy, contented babies, he says, and they have less chance of needing IV antibiotics for chest infections and things, which is apparently quite common in babies when they're firstborn. And he said, as a rule of thumb those babies are far more content when they come back for checkups,  than babies that haven't been exposed to LDN, which I think is quite interesting, isn't it? 

Pharmacist Kim Hansen: I agree completely with that. When I have a patient that's here, and I'm showing them the list of disease states or conditions that this is helpful for. And of course, their question is always, how could one thing be good for all of these? And I love that question because that means that you're thinking, okay. And you're sceptical, and that's fine, but then when you explain that a lot of these systems are all tied together and how pain and depression are linked by the same pathways as is your immune system, as are a lot of different things, inflammation, all tied together.

When you can explain and have them understand how the different systems in your body interplay, that's when the light bulb goes off because traditionally here in the United States you go to the foot doctor for your foot problem, you go to the GI doctor for your stomach problem, you go to the neurologist for the neurology problem. And really they're not all communicating.  When you look at the thread of symptoms that a patient is dealing with it's like you're missing the overall theme of inflammation or whatever that is. And LDN is helpful for that. So, therefore, it's helpful for all of those conditions. It's not because things are tied together. That's why it's helping you. I hope that made sense.

Linda Elsegood: It does. Now there are other things you can do to help inflammation as well as taking LDN. What do you suggest patients do?

Pharmacist Kim Hansen: For inflammation? Well, it's very important. I always remind patients that their diet is everything. If you look at the glycaemic index, it's scaled anywhere between zero and a hundred and sugar is at the top as being a hundred you would like to keep your dietary choices below a 50 because they are less likely to cause an insulin spike or have a glycaemic effect on your sugar. So if you keep your food items below a 50 more often than above 50 you're reducing the fire in your system. So the whole point of taking naltrexone is to reduce the fire in your body, as explained before.  Everything is connected. You can't expect the pill to do all of the work either. Reducing inflammation that you're adding to the system is also part of it.

You can't walk around eating the standard American diet of high carb and high sugar and poor nutritional value and not have inflammation if you're going to continue to feed the inflammation fire, of course, you're asking the LDN or the naltrexone to help with your symptoms.

Sometimes just reducing a lot of the inflammation that way is helpful and it certainly helps to augment what the LDN is doing. I also find that high-quality C-- products, the full spectrum ones are also helpful at reducing inflammation. Using the LDN in combination with the C--, you get the beneficial additive effects. I have patients who have needed to use that combination, and they've gotten their quality of life back.  

Linda Elsegood: it's funny what you were saying about fruits. My mother was in the hospital, and she was a type two diabetic, but her kidneys were in a very poor state, and she had to have insulin. She had quite a bit of insulin three or four times a day. When she was in the hospital, she asked for a banana. And they bought her a banana. And she said, Oh no, I, I don't like eating bananas a little green and underripe. I like them when the skin is going brown, and it's mottled and inside is all nice and squidgy. And they said, no, you can't have one like that because it's going to affect your insulin because it's very, very high in sugar when it's that ripe. That is correct. The nurse was trying to say very nicely, but it is higher in sugar, and I think my mother was thinking, a banana is a banana. The nurse was trying to say, you can have a banana but you mustn't have it when it's overripe.  Because it's too high in sugar. 

Pharmacist Kim Hansen: When I tried to talk to patients about that, of course, nobody ever wants to hear they have to make changes and give up their banana or wherever it is they're eating. Everybody likes what they eat, but when you explain it and say, Hey, these are inflammatory, what you're doing is adding to your inflammatory burden.  I'm not saying completely avoid the bananas, but if you know that you had had a banana that day cause you had to have it, maybe look at the bottom of the list to make sure that maybe we're balancing that out and making a choice that has less of a glycemic load than maybe the banana or something else. That's not to say that you should never have banana again, but maybe making choices to balance out your day versus choosing everything above 50 if you reduce the amount. Because they are both 50 and take below 50 reducing the amount of inflammation in your system, which is good for all sorts of things, Alzheimer's, heart disease, cancer risk, all of these things driven by inflammation. And why would you not want to reduce those risks? 

Linda Elsegood:  It's altering the way you look at food. Instead of being a diet which people don't stick to. It has to be a lifestyle change, doesn't it?  So it becomes a habit. You know you have good habits instead of bad habits. 

Pharmacist Kim Hansen: Agreed. If you call it a diet, people assume that is a restriction on their lifestyle. If it is health maintenance and it's on a different connotation or inflammation reduction. If you look at it that way, rather than, oh, I'm on a diet. Well, you know what? I'm trying to reduce the inflammation in my body. You'll find that you'll get fewer headaches if you get rid of sugar and carbs, which of course includes bread. There are healthier slices of bread that you can eat, more of the whole grains here.  I was amazed by this too. Everybody's under the misconception that, Oh well I, you know, I'll avoid the white bread cause I know that's not good for me and I'll just eat the wheat bread. It's no better. It really isn't any better. It's like a point or two different on this scale. What you need to do is either do it like a whole grain bread or switch to something that's grain-free, like Ezekiel bread, which has a low-glycemic index. If you're trying to make that effort, there are smarter choices that you can make.

So you don't feel like you're on a diet where you're restricted and being punished. There are ways to explain things.. You just have to be careful about continuing to pile inflammatory product after inflammatory product. It leads to all of the other health problems that I mentioned before.

We're all leading stressful lives, and probably you're not exercising as you should, and not resting as you should, and you're just adding more and more burden to your system to be able to detoxify. Helping your body do its best is certainly a better management tool all around.

Linda Elsegood: Well we've run out of time Kim, can you believe that's 30 minutes gone?

Pharmacist Kim Hansen:  I can't believe you wanted to listen to me. Wow. I'm so happy. 

Linda Elsegood:  Awesome. Thank you so much for having joined us. I really appreciate it. 

Pharmacist Kim Hansen: I'm so grateful to have been asked, and it's my pleasure. If you have any questions, certainly please give me a call and I'm happy to share anything I know. 

Linda Elsegood: Thank you.

At Town and Country Compounding Pharmacy in Ridgewood, New Jersey, owner, pharmacist, John and his team are passionate about low dose naltrexone. They have compounded LDN for over 15 years. And they're committed to compounding high-quality medications and serving as an educational resource for patients and practitioners alike. Visit https://tccompound.com/ or call (201) 447-2020 with any questions or comments you may have. Please email me at ontact@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. Judy Tsafrir, MD - Oct 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: I'd like to welcome my guest today, Dr Judy Tsafrir. Thank you for joining us today Judy. 

Judy Tsafrir: Thanks for having me, Linda. 

Linda Elsegood: I mean, you were telling me you were from Boston, um, in your practice. What's the patient population that you treat with LDN? 

Judy Tsafrir: Um, I'm a psychiatrist, a holistic psychiatrist. I see both children and adults, the more adults and kids, and people seek me out because they do not want a conventional psychiatric approach to their depression or anxiety, or whatever it is that's troubling them, which is typically just the prescription of pharmaceuticals and perhaps, um, some sort of counselling. So my approach is essentially functional medicine where I am looking for the root causes of what's going on with them and having conversations with them about their diet and their lifestyle and sleep and exercise. Um, also I trained with someone named Dr William Walsh, who is a biochemist from Chicago, and he has correlated certain laboratory studies with psychiatric symptoms, for example, elevated copper or, um, high histamine, and there are protocols of nutrients that can be prescribed instead of pharmaceuticals. A lot of patients come to see me because they are chronically ill and they're not getting help from other doctors like they're, I'm not usually the first stop so they may have many patients who have autoimmune conditions, um, which often presents psychiatrically; like there's an anxiety piece. And I've developed, um, over the past couple of years interest and awareness about mold toxicity. And so patients will come to see me because they are suffering from symptoms related to mold toxins.

And, uh. When that is addressed, that can have a big positive impact on health. 

Linda Elsegood: But isn't it amazing that you could take some supplements like iron and copper instead of a pharmaceutical drug? You know, because all drugs have potential side effects, don't they?  

Judy Tsafrir: Yes, and that, you know, the model is conventionally is to identify symptoms and suppress them. And instead of seeing the symptoms as communication that there's something wrong and looking for what it is, that could be corrected. 

Linda Elsegood: But when you said that you help people with autoimmune diseases, I mean, there were so many people, um, that I know of who have had, say, fibromyalgia or chronic fatigue, MS and before they managed to get a diagnosis so many of them are told it's in your mind, you know, that there is nothing really wrong with you and that is very depressing. 

Judy Tsafrir: and very invalidating. That's an experience that many patients have when they come to see me, that somebody, there's such relief that somebody believes them.

Linda Elsegood: And it's getting people to listen to you, isn't it? Rather than just brushing you off without investigating. 

Judy Tsafrir: Right. You know, I just came back from a conference. I actually was in a conference over the weekend in California, which was all about electric hypersensitivity and the effects of electromagnetic frequencies on our health, and this was on my radar but in a much less focused way then it will be now going forward because I would tell my patients to turn off their routers at night and tell them to not carry their cell phone in their pockets. But, um, it goes much further than that. There really needs to be a lot of avoidance and awareness about the way that electromagnetic waves are impacting our health. And I think there may be a number of patients in my practice who I've been treating for mould who may have mould or who do have mould, but maybe they would be so much better if I would also be addressing the, um, electric hypersensitivity. So this is something that has newly, like really come into focus for me,  just over the weekend.

Linda Elsegood: And what about children? You said that you treat children as well, and it's very ... 

Judy Tsafrir: yes. I mean children have an attentional problem, and they have anxiety, and uh, there can be, just the same as with adults, there can be imbalances, and I think that a lot of these kids are actually tremendously affected by the electromagnetic frequencies, like all of the screen time, that kids are doing. It's really, um, there was a child psychiatrist who spoke at the meeting who, um, kids who were so behaviorally dysregulated and suffering so much, and the families were in such a terrible state because of the child being, um, so, uh, symptomatic that with the screen, you know, with the electronic “Fast” of one month, the symptoms completely resolved. 

Linda Elsegood: Wow. But if a parent had a problem with a child, with, let's say, anxiety, I mean, how old are they normally? the youngest that you see in your practice? 

Judy Tsafrir: Oh they can be very young. They can be, you know, six years old.

They can be five years old. Just a kid who's not sleeping, who, you know, can't separate. Um, you know, I'm, I'm trained originally as a psychoanalyst and my model, previous to learning all of this functional medicine, would be to really think that there was some kind of, um, psychological dynamic going on between the parent and child, which they may also be, but there is so much to be understood in terms of what can be going on biologically In addition to all of that.  

Linda Elsegood: And would bed wetting come under that umbrella as well? 

Judy Tsafrir: Of course. I mean, that is often like a, um, an immaturity of the neurological system. And that can be developmental and can improve with time. But, um, everything that is going on, you know, can be due to, um, many different factors. Including trauma and, um, adverse experiences. But it's just, it needs to be looked at from so many different angles, including the spiritual. 

Linda Elsegood: I mean, you said that you look for the root cause, but to find the root cause for a child, obviously, you listen to the child, but their communication is going to be limited.

And of course, then you'd have to listen to the parents. How do you …?

Judy Tsafrir: And the school 

Linda Elsegood: Okay. And the school, how do you get to the root cause if you know, if there's somebody listening with a child that is having problems, what would be the process you would go through to find out what you could do to help a child?

Judy Tsafrir: The most important thing is the history and to try and get a sense from the parent, you know, what is going on, what has gone on, you know, like even going as far back as ancestrally, like, was there a lot of trauma in the parent's history? Because that can also be passed along epigenetically. Um. But then to learn about the birth and the child's development and the child's diet and the whole environment.

And when did the symptoms start? You know, was there any kind of car accident or death? I mean, our whole being is so, uh, it's such a mixture of mind, body, and spirit that it's really complicated, and you can't just typically pinpoint one thing, like you may have a car accident, but then that completely dysregulates the immune system and sets off a mass cell activation disorder.

And then they're having all kinds of very weird symptoms and maybe not tolerating foods and having strange neurological things. And, and this all may be totally exacerbated by the electromagnetic frequencies. It's just. It's very complex. So you want to try and understand as much as possible what are all the factors and try and support the person from many different directions. But it's usually not like one thing. It's like a whole confluence of different things coming together to create a kind of perfect storm. 

Linda Elsegood: So your approach would be more of a natural approach rather than, um, prescription medications? 

Judy Tsafrir: Absolutely. I mean, a lot of times people seek me out because they're on medications and they want to get off of medications.

And the typical approach for a person to get off medication, many psychiatrists are not willing to take patients off of medications, they're afraid that the patient will become destabilized and then they'll reduce the dose of medications way too quickly and then a person will have a reaction, like a withdrawal symptom; a syndrome from withdrawing from the medications and then the psychiatrist will mistakenly believe that this is as proof that “you see, you do need it for your anxiety because you are having problems”. But in fact, it's like a withdrawal syndrome and not the original problem. So. Like I, if somebody calls me and they want to simply, you know, get stimulants for their attentional problems, I tell them that I'm really not the right doctor for them.

And you know, if somebody is interested in working with me to come off of their medications, that is much more what I find interesting. And, um, I'm feeling it’s like a useful, valuable thing to do. 

Linda Elsegood: And what's your success rate with getting patients of pharmaceutical drugs? 

Judy Tsafrir: I would say probably about 75%. It's not everybody. You know, like some people, it's really difficult, particularly, um, some of the antianxiety medicines can be really hard to get off of, but you know, like this is like, I recommend, um. Low dose naltrexone to all of my patients, essentially. And you know, I also make dietary recommendations to all of my patients, and I make recommendations about, you know, hygiene with their electronics equipment and about exercise and about sleep, um, and all of those things together make it much more possible to withdraw from medications rather than just trying to withdraw from the medication without supporting the person in any other way.  

Linda Elsegood: how long do you think it takes a patient with anxiety problems taking LDN for them to notice it's doing something for them? 

Judy Tsafrir: It's so variable. I mean, I feel like low dose naltrexone is really unpredictable in terms of if it's going to be helpful, how it's going to be helpful, for what it's going to be helpful. So for me, because it's so safe and inexpensive and potentially so effective that I really recommend it to everyone for whom it's not contraindicated, like if they're on, you know, some kind of cancer protocol and immune suppression or, but I recommend it to everyone. And, um, it really is variable in terms of the response, quite variable. 

Linda Elsegood: And what sort of dose do you start the patients on?

Judy Tsafrir:  0.5 and then I asked them to work their way up as tolerated, as fast as it is tolerated for them to 4.5 milligrams. And that's, you know, in some people, you know, they feel well at three, but when they go up to 3.5, then they don't feel as well. So then we stay at 3, it's really titrated according to how the individual feels.  

Linda Elsegood: I mean, that's the thing with LDN, isn't it? It’s unique to that person. You know, you can't say ..

Judy Tsafrir: Unique to the person

Linda Elsegood: Exactly. Cause some people to find that 2.5 works really well. They go up to three that don't feel as well. But 

Judy Tsafrir: right. 

Linda Elsegood: Sometimes they've read everything online, and they feel that if they're not on 4.5, they're doing something wrong, that they should push themselves. But that isn't the case, is it? 

Judy Tsafrir: No, that's a misunderstanding. And you know, it really is like so helpful for so many different things. And so it makes sense to me that the dose would also not be one size fits all.  

Linda Elsegood: exactly. I mean, some people try to justify a dose by saying how tall they are and how much they weigh but that ... 

Judy Tsafrir: Right, that doesn’t make any sense

Linda Elsegood:  it doesn't because, I mean, there are some men who are rugby players who can't get any further than three. And then a small lady who's very petite, like five foot tall can take 4.5 no problem. So I always think that's a, a good rule to tell people that you, you just can't pigeonhole people. It's how your body responds. With depression, and you were saying that you treat people with autoimmune diseases. Um, would you say depression for somebody with an autoimmune disease might be to do with all the symptoms and the things that they have to live with that cause the depression? 

Judy Tsafrir: Well, again, I think it's such a multifactorial situation. I mean, very often depression is either caused by or mediated through cellular inflammation. So like when a person has inflammation in their body, they have inflammation in their brain, and they feel depressed. But then when a person has, Um, chronic illness and they're living with chronic illness, and they can't find anybody who's going to help them, and, uh, they're being told it's all in their head, and it's a very hopeless and depressing situation. Another thing that I recommend to my patients that I haven't mentioned so far is dynamic neural retraining system, DNRs, which is, it's like a program of visualizations and meditations and affirmations and something that you do with your consciousness that, um, helps rewire and retrain the limbic system, which is the deep structure in the brain that is associated with trauma. And when it's activated, it can cause all kinds of physical problems and all kinds of psychiatric problems, anxiety, depression. So if a person works with this program, uh, consistently, very often they're able to really calm down their autonomic nervous system and they will be in a state of, um, not in a constant state of like sympathetic overdrive, fight or flight.

And they'll just feel much calmer and much better, but it's not also alone. It's also, you know, in combination with diet, in combination with low dose naltrexone, with this combination with other supplements that are helpful for inflammation and for rebalancing, whatever it is that is troubling the person and in psychotherapy can be very helpful as well, having a relationship with someone where you can talk through things and someone who understands and who can help you make connections and can help you see that you're responding to the present because of something that happened in the past and that's not really relevant to today. I mean.

Everything together and, and, and I recommend the spiritual practice to my patients. Uh, prayer can be very helpful. Performing rituals can be very helpful. Uh, gratitude journals can be very helpful. It's just - there are so many different things that need to be recruited together to heal a person holistically.

And before I take a person into my practice, I have quite a long conversation with them on the phone and try to assess how motivated they are to make all of these different kinds of changes because it's not like taking Prozac. 

Linda Elsegood: It’s definitely something you have to work at, isn't it?  

Judy Tsafrir: Absolutely. It's a lot of work, but you know, instead of, you know, your health being degraded, you're optimizing your health  

Linda Elsegood: it's very easy to keep things to yourself in like a family situation, not talking to family and friends, but to actually be able to talk to somebody outside of your circle.

You can say what you like. You're not going to upset anybody. They're not going to feel guilty.

Judy Tsafrir: You don't worry about burdening them. And also there's somebody who is hopefully very trained and experienced in listening to people and knowing about what are dynamics like in the family and understanding a lot about human nature and the way people feel. I mean, I also think that meditation and yoga and Tai Chi and all of these kinds of, um, mind, body, spirit practices are tremendously helpful and stabilizing and help one not totally identify with whatever, you know, upset emotion one is feeling at the moment, that there are more equanimity and more peace brought into the person's life.

Linda Elsegood: I used to do a lot of yoga and I learned at a very early age, to put myself to sleep. And it still works today. You know, the deep relaxation and your breathing and focusing.  And I can, you know, even if my mind is spinning, if I can just stop my mind and actually relax and focus, probably about two minutes and I can be asleep.

Judy Tsafrir: I say that that's just like a practice, something that you've learned and it can be taught and um, it's just so useful and so much better than taking Ambien, you know, instead of taking a pill, but, you know, maybe then you feel like very tired the next day and forgetful and, um, spaced out. 

Linda Elsegood: I was going to say, who would want to feel like that? Waking up feeling like that at the start of the day.

It doesn't sound like something we would want to do. But I can remember when I was very sick, and people would say, you know, family, and look at you, how are you? And I would say, Oh, I'm fine. Because you didn't want to say, well, actually I’m anything but fine. 

Judy Tsafrir: Right, right, right. And I mean, and also when you're feeling that way, you feel like you don't want to burden people and you know that you can't really turn to people for help. And there's some kind of shame involved in the whole thing. Like, what's wrong with you that you don't feel fine? And, um, I mean, a lot of times for, you know, that there's like, we're not, for many people, like in my, in Boston, we're not living in a war-torn area.

You know, like, it's not like there are food shortages and bombs going off, and yet people are feeling terrible, but there's nothing to point at like that. 

Linda Elsegood: Yes. Yeah, well, I can remember being rather concerned that every week I was deteriorating and it was noticeable. And I can remember lying on the sofa, my cat lying on my chest and it hurt. And, um, my mother was here, and she took him off me because it was uncomfortable for me. And I was thinking, if I keep going downhill like this, I'm going to die. You know? And it was really scary, and it was frightening. And I had nobody that I felt I could say that to, you know, “Am I going to die?” 

Judy Tsafrir: .. terrifying and lonely, so lonely, and yeah you know, like, it's not surprising that people become suicidal in that situation. They just feel so alone and so desperate. And there's no light at the end of the tunnel. 

Linda Elsegood: Yes. But luckily for me, there was LDN at the end of the tunnel. So I had, I had the light. So, 

Judy Tsafrir: that really just turned things around like really quickly? 

Linda Elsegood: uh, in three weeks.

I mean, I just very quickly, the left-hand side of my body was numb with pins and needles. I had cognitive problems. It was like English had become my second language, I couldn't recall vocabulary. Everything muddled. I slurred my speech like somebody had had a stroke. I started choking on my food, forgetting things, tripping, falling, stumbling over nothing.

I lost my leg. Strength in my left, like at double vision, lost the hearing in my left ear, had twitching muscles, restless legs and pain. Um, and I'd been told at that point by the neurologist who checked me over and sat me down and put his hands across the desk, shook my hands and said, “I'm really sorry you're secondary progressive now, and there's nothing more we can do” and he opened the door to show me out  

Judy Tsafrir: you had multiple sclerosis?  Terrible, that’s terrible, and you're sort of taught in medical school, If a person has one symptom, okay, then you try and help them. If they have ten symptoms involving ten different organ systems, then it's all in their head.

You know? Then it's, it can't be real, you know, not understanding that that is more and more and more common these days with all of the toxins in our environment and all of the electrosmog and the GMOs and the degraded food supply that this kind of chronic illness is more and more commonly seen with involving multiple organ systems.

And it doesn't fit any kind of classically recognized pattern. 

Linda Elsegood: But in three weeks, um, and I'd lost my bowel and bladder control as well, but in three weeks I started cognitively -  in my head, it was like a television set, not tuned in, and suddenly somebody was tuning it in - and I started to be able to process thoughts, being able to see properly.

The hearing had completely gone in my left ear, and that started to come back, and it was amazing. It was absolutely amazing, but it did take me 18 months to feel like, yeah, I mean, I still know I have MS and I have learned to work around things, but I can achieve things again, which was very devastating.

I can remember I had to go and see the company doctor and he said he sent a letter, and it said that I was, I'm a workaholic. And he said that I was unemployable for the foreseeable future, and that was just like a punch in the stomach. It physically hurt. Um, and I kept this letter for quite a while, and they don't come across it, and I'd read it, and I'd have the same reaction.

One day I thought, well, why am I reading this letter. If I shred it, I haven't got it anymore, and I won't be able to read it, and it won't depress me, you know? I know it was there, but I don't need to physically keep seeing it. But my whole point was to prove everybody wrong. 

Judy Tsafrir: Right. So I mean it was the only thing you did was Low Dose Naltrexone or did you also do other things in addition to that? Did you, I mean you attend to your diet? 

Linda Elsegood: Because I was in the situation that I couldn't cook for myself my diet actually got worse originally. My husband did the best he could do which was just to put something in the oven that was frozen but gradually he learned to cook. Um, because I couldn't get out of bed

I was asleep most of the time, which was a blessing because I really didn't feel well. But, um, as I improved and he improved, we started to get a better diet. But I didn't become gluten-free, dairy-free and process sugar-free for quite a while. Um, I was given three courses of intravenous steroids in an 18 month period, and the first two were only six weeks apart.

I'm a very pale person, and my face blew up and I looked like a tomato. I was so red, and so round. And I gained, um, 50 pounds in these 18 months. And then, Hey, I was type two diabetic. Um, so I was then put on the Metformin, but once, and it was very difficult to lose the weight, not being active enough and exercise was too tiring.  Still is to a point. Um, but there are certain things you can do. But once I changed my diet, I managed and I'm now classified as a diabetic in remission so I don't have to take the Metformin anymore. And I'm really pleased and I didn't realize I was told that I'd have to have Metformin for life. Nobody had actually said to me it can be reversed. I did not know that. 

Judy Tsafrir: Right. And nobody told you that, you know, if you limited your carbohydrate intake or you didn't, you know, eat gluten and dairy or sugar, that that would be beneficial to you? 

Linda Elsegood: No. Um, my mother, I, um, unfortunately, she had cancer, and it was lots of other issues, and LDN didn't work, which knocked my confidence in LDN a little bit because I really wanted it to work. But anyway, my mother knew that she was dying and all she was worried about was the trauma that it would cause me with her dying. You know, what's going to happen? I'm not going to be here to look after you. You know, she was completely selfless.

And the, she asked the doctor to look after me after she'd gone. So the doctor wanted to see me. I went to see her, and I said, you know, I was doing fine. Um, and that I really watch my diet. And I was telling her, and she said, why are you doing that? And I looked at her, and I was feeling very sad cause I just lost my mother and I looked at her and I thought “seriously, you're asking me why I have changed my diet?”. What do I say? 

Judy Tsafrir: Incredible. 

Linda Elsegood: And I just said, “because it makes me feel better”. I couldn't bare the thought of explaining to a doctor why I had changed my diet, but I was really pleased, the fact that I don't have to have the Metformin, but it was quite funny because I was given Metformin initially, and it was a, I don't know what brand it was, but it was so strong - the nausea was so bad - I couldn't, I really couldn't tolerate it. I couldn't bear to eat anything or move my head or talk to anybody. It was awful and I suffered with it for about two and a half weeks and I went back to the doctor because “I was going to die” in inverted commas if I didn't take this Metformin.

So I went back, and I said to her, well, I think I'm going to have to die because I really can't take it, it is making me feel so ill. I just can't do it. And she laughed, and she said, “Oh, there are other versions you can have” And I thought, well, I'll just come back sooner. And I didn't realize that, you know, after the first two or three days.

So then I had Glucophage, which was a slow-release Metformin, and I can tolerate that. That was fine, but apparently, it was far more expensive, so they tried to get people on the cheaper ones first. 

Judy Tsafrir: Right. But all the money, 

Linda Elsegood: thanks actually, luckily, but it's been amazing talking to you, and I realize we've run out of time.

Thank you for having been my guest today.

Judy Tsafrir, MD is a board-certified Harvard faculty member with a private practice of holistic adult and child psychiatry in the Boston area. A special area of interest is environmentally acquired illness, in particular, mold toxicity and the chronic inflammatory response syndrome. Her website is https://www.judytsafrirmd.com/.  Phone number (617) 965-3020.

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

Dr. Eduardo Patrick Beltran Monasterio - 25th Oct 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr. Eduardo Beltran was originally born in Tripoli, Libya in 1978, later he immigrated to the United States and attended Dublin Scioto High School. After graduation he was accepted at Del Valle University (School of Medicine) in Cochabamba Bolivia. Here he graduated with honors in 2006. He then went on to pursue his specialty in Internal Medicine and Dermatology at Gama Filho University in Brazil.

Throughout the years Dr Beltran has developed a significant interest in treating specific autoimmune diseases such as Psoriasis, Vitiligo, Lupus and skin cancer. He has helped thousands of patients achieve a better state of health and quality of life through Integrative Medicine in Brazil.

Dr Beltran is also an author and a clinical researcher, having treated many patients with psoriasis using Low Dose Naltrexone (LDN) and Alpha Lipoic Acid (ALA). He has published his Clinical Research on ''The Cureus Journal of Medical Science'', showing promising results with LDN.

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

 

Brooke Hutchison, PharmD - 28th August 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Pharmacist Brooke Hutchinson is the pharmacy manager from Skip's pharmacy in Florida.

There is some changings since we start with LDN 25 years ago. We realize that not all people need to be on the 4,5mg of Low Dose Naltrexone and that's not wrong or the patient doesn't need to worry if he doesn't reach 4.5 mg. That's absolutely fine. And we've seen with a lot of patients chemical sensitivity where they're not able to tolerate the standard dose, specifically Lyme disease and Fibromyalgia's patients.

So I do in fact have patients starting off on a quarter milligram, some less. And they never achieve the three milligram. But the benefits are still there.

It truly does decrease inflammation in the body. We're seeing it used in micro dosing, Ultra Low Dose Naltrexone for pain management when patients are on opioid therapy to help them get on lower doses or actually get off of the opioid pain management and move over to the Low Dose Naltrexone.

When a patient does want to taper off of opioid based pain medication, we are using anywhere from 20 to 50 micrograms a few times a day, and it really helps patients decrease the opioid and avoid the withdrawal side effects of getting off of the opiod based pain medication. So everybody again presents a little differently, but it could be nausea, vomiting, flu like symptoms like your bones ache constipation, diarrhea.

Patients are avoiding having to go through this type of transition, trying to get off of their pain medication. And I can say it's been very beneficial.

So this process of transition from opiods to ULDN allows the brain to reset and help our body recreate our own natural endorphins to help with the pain.

I would like to say about Hashimoto's patients out there, if you have true Hashimoto's and you initiate Naltrexone. I have had patients within three days responding where they need to start backing off of their thyroid medication.

So patients present with heart palpitation, cold tolerance, irritability, anxiety. This can happen literally within the first week of initiating the Naltrexone where the patient has to start backing off of their thyroid medication.

Do not be afraid to do that. It will cause problems if the patient doesn't start backing off of their thyroid medication.

Lab values is a very helpful tool, but it's a snapshot of that day of that time. There is a fluctuation with

the TSH, FT3 but I'd say after three months of a patient going through the titration, majority of my Hashimoto's patients are completely off of their thyroid medication or there is combination.

Naltrexone takes time. When somebody has been suffering from something for such a long period of time, the healing process takes time. And that's what I always try to convey to my patients.

For my patients, for GI issues, Ulcerative colitis, Celiacs,  we also offer an oral liquid that gets absorbed through the membrane and the mouth, and it kind of avoids any kind of GI upset.

In addition to that, we also offer transdermal cream, which I use a lot in my pediatrics and adolescents, or again, patients that have sensitive GI tracks where it's applied topically to the skin and it's absorbed into the systemic circulation, bypassing the gut.

I compound anywhere from a quarter of a milligram up to nine milligrams if needed.

We have seen in different areas like autism and pandas we are using dosing twice a day. So these patients might be taking four and a half milligrams twice a day or nine milligrams twice a day.

I'm capable of compounding any milligram you could possibly think.

As LDN is a long term therapy, I usually ask my patients to be on LDN for at least six to eight months before they discontinue therapy.

Now, patients usually see change when they've gotten up to typically three milligrams,  within a few months. Healing process takes time. It doesn't prevent you from getting sick, but it does optimize immune system functioning and patients that would usually get sick five times a year, they only got sick once that year, and that's a big deal.

 We're trying to get the body to function as optimally as possible. And we're trying to decrease inflammation.  I wouldn't believe it unless I talked to so many patients all of my years of being with skips pharmacy. It was incredible.

Summary from pharmacist Dr. Brooke Hutchinson's interview. Listen to the video for the full interview.

Laurie - 7th August (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Laurie is from the United States, and uses LDN for complex regional pain syndrome (CRPS). In 2005 she suffered a stress fracture in one foot that healed slowly, during which time she was in a cast and immobilized. Toward the end of the time for the cast she started feeling burning in her foot, like fireworks going off. When the cast came off her foot was bright red, shiny, and hot to touch, and her doctor recognized her symptoms as CRPS. Drugs normally prescribed were ones she did not want to take because of side effects. She researched and found a study on CRPS at Stanford using LDN, and took information on LDN to her doctor, who researched it and was eager to prescribe it. She ramped to her current dose of LDN 4.5 mg daily, but does note short-term side effects as the dose increased, such as difficulty sleeping, or a headache.

Laurie’s pain stopped after about 3 weeks on LDN; after 4 weeks on LDN the swelling and redness were decreased, and at 2 months the color was normal and there was no swelling. Before, she couldn’t tolerate wearing anything on her foot; and now wears normal shoes and has hiked and traveled extensively, without symptoms. She did have to give up running because of arthritis and several surgeries.

Laurie relates that while the CRPS developed in the foot she broke, as common with CRPS, the other foot became involved. Similarly, one time she hurt an elbow nerve, and the CRPS symptoms jumped to her elbow.

Her first surgery was a joint replacement in her foot. Because she might have needed narcotics for post-operative pain, her doctor took her off LDN a week before surgery. In that week her CRPS flared so badly that her feet and elbow were untouchable. Post-op, when she restarted LDN, it took a month of gradual improvements before she got full effect. During that time the redness and swelling from CRPS had increased, in response to the surgery.

She learned that for subsequent surgeries, if narcotics might be needed, to stop LDN only 2 to 3 days before surgery; however the trade-off seems to be less effectiveness from the narcotics. The solution that works for her is to take Tylenol or ibuprofen before surgery; and ibuprofen normally is all she needs after surgery. In total she has had 5 or 6 surgeries, and this routine has been successful.

Laurie tried to follow an autoimmune diet, but found it pretty difficult to be true to it. She eats a lot of vegetables, and stays away from foods known as being very inflammatory – meat, dairy, sugar. She works out at a gym 5 days a week, and swims.

Laurie is so grateful for the valuable information from the LDN Research Trust (LDNRT), and became a volunteer who has contributed greatly to the Trust. Through the website she has been able to not only find information, but to connect with compounding pharmacies truly knowledgeable about LDN and options for it. She appreciates that with LDN there is hope other than some of the drugs that have difficult side effects.

Summary of Laurie’s interview, please listen to the video for the full story.

Keywords: LDN, low dose naltrexone, complex regional pain syndrome, CRPS, LDN Research Trust, LDNRT, pain, opioids, autoimmune

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.

Tom O'Bryan, DC - Gut Healing (2017 Conference) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Autoimmune diseases are the third leading cause of getting sick and dying in the industrialized world surpassed only by cancer and heart disease. Three things in the development of autoimmune diseases: having the gene for that disease, the environmental trigger that that sets it off, and the loss of intestinal barrier function. How you live your life determines whether or not you get that condition. You can arrest the development of the autoimmune disease.

Dr Tom O'Bryan: Well. Hello everyone. This is Dr Tom O'Bryan, and it's a pleasure to be with you. And this is for the Low Dose Naltrexone Conference, September 21 through the 24th of this year (2017) in Portland, Oregon. And it's with a great deal of gratitude that I am presenting there.

I'm very grateful for the work that Linda Elsegood and the entire team is doing to bring out information about low dose naltrexone to the world and how remarkable a tool it is, to use with many, many different health conditions. And in our presentations in the past in 2016 at the LDN conference, which I believe that presentation is accessible to you if you go to the LDN conference website, we talked a great deal about how LDN is a benefit with autoimmune conditions. I referenced that. And how if a person has a sensitivity to wheat, whether they know it or not, it can diminish the effectiveness of LDN. And, uh, just as a segue last year in 2016, I presented at the Fourth International Oncology Conference in Abu Dhabi and showed the studies that if a person has a sensitivity to wheat, a number of different approaches of chemotherapy will not work the way they're supposed to and is for a similar mechanism. And that is that wheat will bind down to receptor sites that LDN also binds onto and that chemotherapy can bind onto. So this whole thing about wheat is worth exploring in more detail, and you can learn more about that by reviewing the presentation from the 2016 conference.

And that's just a little of who I am. I like to start with this slide. This is a display in the museum of science in Florence, Italy. This is Galileo's finger. And Galileo bequeaths in his will that all of his inventions could be on display for all of the posterity as long as they also displayed his finger.

And I like to put that up because you're going to hear her so much marvelous information in this conference. And when I've sat as an attendee in conferences like this, I take pages and pages of notes, and I'll write down, check this for this patient, or read this article or look more into this topic.

And I have pages of notes, and then I go back home and Monday morning back to work, and I don't have time to do any of it. That there is so much good information that we get. It's hard to implement. So I came up with the principle that if there's one thing, just one thing, that I walk away from a conference, a weekend conference with that goes into my lifestyle or my practice for the rest of my career, that weekend was worthwhile.

The thousands of dollars to travel and stay in hotels and pay the registration and be out of my practice. It's worthwhile, if I can just pick up one thing, I wish I could pick up ten things, but if, if I can pick up one, then it is a value. And so that's how I feel about this presentation, that if we all understand the concept of autoimmune disease and the message that I want to give you here today, this will stay with you the rest of your life. And it will not only help you in making more informed choices in your health care but also your children, your spouse, your family.

The first part of this autoimmune disease concept is that there are four circles to consider when thinking about autoimmune diseases. Genetics, and this is not a talk about genetics today, but let me just say with genetics, if you have a gene for a particular disease, that does not mean you're going to get the disease. It means that you're vulnerable to getting that disease. So the way I say it to patients is, Mrs patient if you pull it a chain, the chain breaks at the weakest link. It's at one end, the middle, the other end. It's your heart, your brain, your liver, your kidney, wherever your weak genetic link is, that's where the chain's going to break if you pull too hard.

So the goal in life is don't pull so hard on the chain because if your weak link is your brain, that's where the disease will manifest. If you pull too hard, if the weak link in your chain is your skin, you may get psoriasis. If the weak link in your chain is your joints, you may get rheumatoid arthritis, but it's the pull on the chain that allows the gene to express itself with the vulnerability that you have.

So genetics is important, but they are not a sentence that you're doomed to get a particular condition. It's how you live your life. That determines whether or not you get that condition. Notice that the genetics in yellow there is not covering everything. That it's only the part of the genetics that merges with the infections, the toxic chemicals, the dietary components.

Those are the triggers that will pull on the chain. And then if the link breaks, the gene gets activated and here come your kidney infections. If that's your weak genetic link, or here comes your Parkinson's if that's your weak genetic link. So the goal here is to learn how to not pull on the chain so hard.

To find out what it is in your life, in your body, with your genetics, where the weak link in the chain is. So the classical paradigm of an autoimmune development, the pathogenesis of autoimmune disease involving a specific genetic trigger and exposure to genetic makeup and exposure to environmental triggers has been challenged by the addition of a third element. There are three things in the development of autoimmune diseases. You've got the gene for that particular disease, whether it's Alzheimer's or Parkinson's or rheumatoid or ms or diabetes. You've got the gene, the environmental trigger that that sets it off, the straw that breaks the camel's back, when you're pulling on that chain too hard. And there's a third element, and that is the loss of intestinal barrier function. The technical term is pathogenic intestinal permeability. The slang term is leaky gut, and we're going to talk about that in detail, so you have a clear understanding of what the scientists are talking about when they're referring to the loss of intestinal barrier function.

So in this article in autoimmune disease, in the journal, autoimmune diseases, they talked about the environmental triggers, whether it's food or something in the air or something like in your clothing. If you get dry cleaning and you're inhaling those chemicals, those minute amount of chemicals, all the time, you can't tell, but you are inhaling them.

So the trigger. Causes a breakdown in oral tolerance. That means that you no longer can tolerate this food changes your gut microbiota. The technical term is dysbiosis, which enhances gut permeability. You get this thing called pathogenic intestinal permeability or the leaky gut, which causes large macromolecules to get into the bloodstream that isn't supposed to get into the bloodstream, which your immune system reacts to, to protect you, which then can trigger autoimmunity.

And in this article, it was neuro autoimmunity. So I'm going to go through these concepts in more detail so that they're crystal clear for you. Increased intestinal permeability is, and I underlined this, is an early biological change that often preceded the onset of autoimmune diseases. The intestinal permeability comes first.

By the way, the way that I do my presentations is that this is the front page of the article I read, and in the upper right side, you see the name of the medical journal, the issue, the volume number, the date, sometimes the pages. And then in the yellow box are exact quotes from the authors, exact quotes. I haven't changed a word.

If I've added anything, it's in parentheses, but these are exact quotes. This becomes your reference library, this presentation on this topic because these are the exact quotes. Such increased permeability could be due to environmental factors such as infections and toxic molecules and allergenic foods that possibly initiate the autoimmune disease.

Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier with its intercellular tight junctions controls the balance between tolerance and immunity to non-self antigens. Non-self antigens mean, uh, environmental molecules you're exposed to, whether it's food or air or water.

It's not part of you, but it's inside of you. And when you lose tolerance to that thing and your immune system gets activated, now you have a non-self antigen. And this suggests the autoimmune process can be arrested if the interplay between genes and the environment is prevented by re-establishing intestinal barrier function.

This is the take-home point that you can arrest the development of rheumatoid psoriasis, multiple sclerosis, Parkinson's, or Alzheimer's, dermatomyositis. It doesn't matter—the autoimmune disease. Practically every autoimmune disease that we've ever looked at, we see this trilogy, which is a genetic vulnerability and the environmental trigger and intestinal permeability, and if intestinal permeability is the gateway into the development of the autoimmune disease when you take care of the intestinal permeability, you close the gates.

And when you close the gates, your immune system calms down. And I'm going to go through this in detail for you in this presentation. So if we take a look at autoimmunity, the National Institute of Health tells us the autoimmune disease coordinating committee that while many individual autoimmune diseases are rare, collectively, they are thought to affect about 8% of our population, about 24 million people. To provide a context for this, the impact of the impact on autoimmune diseases, cancer affects 9 million people. Heart disease, about 22 million people, but autoimmune disease, 24 million people. And Dr Jeffrey Bland went around the country, around the world, actually talking about autoimmune diseases, and he said, collectively, the autoimmune disease has been identified in about 24 million people in the US, but only one out of three are diagnosed.

That means there are about 72 million people out there with an autoimmune disease, and it's not looked for. Doctors don't look for it. Our system waits until the signs and symptoms are severe enough. With organ failure and organ can't function correctly anymore, and there's irreversible damage, and now you have symptoms, then we start to look for it.

Seventy-two million people, autoimmune diseases are the third leading cause of morbidity. That means getting sick and mortality. That means dying in the industrialized world surpassed only by cancer and heart disease. So this is what we're up against. Many times when you start looking at this world of autoimmune diseases, autoimmune diseases can affect any part of the body.

There's no part of your body that can not have an autoimmune mechanism going on. And it takes an inordinate amount of time and perseverance by the patient. Look at how many years it took on average for diagnosis of autoimmune diseases. In the last, uh, almost 20 years here now, 20, 21 years since 1996.

How many years did it take? How many doctors did the person have to see, and how many were told it's just in their head, and they're just a complainer—the years to diagnosis for different autoimmune diseases. The number of doctors seems to get a diagnosis for different autoimmune diseases. The per cent that was told, their diagnosis imagined, or that they were overly concerned that it was just in their head.

Half the people are told it's just in your head, and they've got a devastating disease that's killing off their tissue. These are not exceptions. These are the averages. Why so long and difficult is to correct, to get a correct diagnosis. Physician education was identified as a contributing factor.

The American Autoimmune and Related Diseases Association did a study of family practitioners, family doctors, and this is what they found when asked in medical school, how much training in autoimmune diseases did you receive? Look at the numbers here. 18.5% one lecture, 27.8% two lectures, 18.5% three to five lectures.

That means more than half the people. Half the doctors had some less than five lectures. Now, that's not courses. That's a lecture. This is just unacceptable. Would you agree that you received enough training to diagnose and treat autoimmune diseases? Look how many doctors feel they don't agree with that statement, that they did not get enough training.

What is the level of comfort in diagnosing autoimmune diseases? Half of the physicians interviewed were uncomfortable. Half of them because they just didn't get the training. They don't know how to identify this until it's so obvious that it's just staring you right in the face. So before I go onto this first premise, I just want to say it's not our doctor's fault that patients have to see so many doctors to get the right diagnosis.

They just weren't trained. They weren't trained in this. Now it is their fault. When they tell somebody, it's all in your head. Rather, an appropriate thing would be to say, you know, I just don't know what's going on here. I'm going to have to send you to somebody else cause I just don't know. I take issue with telling people it's in their head. Okay, let's move on.

Premise number one. Just how prevalent is the development of autoimmune diseases? Well, I'm going to introduce a new concept here about the true prevalence of autoimmunity. Autoimmune diseases are the third leading cause of getting sick and dying in the industrialized world surpassed only by cancer and heart disease.

However, if we think a little more closely about this, immune driven inflammation is key to the development of cardiovascular disease. We think the number one cause of getting sick and dying in the world is cardiovascular disease, but it is immune driven. Atherosclerosis is increasingly considered an immune system-mediated process of the vascular system.

Autoimmunity plays a major role in the development of dyslipidemia and atherosclerotic plaque formation. Atherogenesis the development of atherosclerosis has been proposed to be considered an autoimmune disease. Now, this is the World Journal of Cardiology talking to us. Thus, if the cardiovascular disease has an initiating autoimmune component, arguably what becomes the number one mechanism in the progression of getting sick and dying in the world today. If we think about it, and if cardiovascular disease is autoimmune in its initiating phases, then autoimmunity becomes the number one mechanism for getting sick and dying in the world, your immune system attacking your own tissue, and I'm going to show you why this happens, but whether it's number one or number three, it doesn't really matter. The point is it's in your practice every day. It's in your family every single day.

Premise number two, how can we identify people at risk for the development of autoimmune diseases? The National Institute of Health tells us that there are six potential mechanisms by which biomarkers can really help with identifying autoimmune diseases. They enable a diagnosis before the onset of symptoms. I'm going to explain this. They predict specific organ involvement. They predict disease flares.They identify clinically meaningful disease subsets, and they predict and monitor response to therapy and describe organ or tissue damage. So once again, if autoimmunity plays a major role in the development of dyslipidemia, atherosclerotic plaque, the next sentence in this article, what they said was the mechanisms underlying these changes include the interplay of inflammation and autoantibody formation. So the mechanisms underlying these changes include the interplay of inflammation and autoantibody formation. So we can predict organ involvement. We can enable diagnosis before the onset of symptoms. We can predict and monitor response to therapy. We can identify clinical, clinically meaningful disease subsets.

And here's what I'm going to show you how. This articles by Arbuckle and her team and came out in the New England Journal of Medicine in 2003, and she went to the Department of Veterans Affairs hospital system,and looked for people with the autoimmune disease - lupus, systemic lupus erythematosus -and she found 130 people in this one VA centre with lupus. Now, if they're in the VA system, they're veterans. If they're veterans, they were in the armed forces. If they were in the armed forces, they had their blood drawn many times over the years when they were in the armed forces when they were healthy in the Army, the Air Force, the Navy. What most people don't know is that the US government has saved all of that blood since 1978. They've got tens of millions of samples of our service people's blood.

So Dr Arbuckle went to the VA and asked for permission to look at the blood of these people currently diagnosed with lupus from when they were healthy in the Navy or in the Marines, and she received permission to do it. And what did she find? She found that antibodies are typically present many years before the diagnosis of lupus.

That the appearance of these antibodies follows a predictable course with a progressive accumulation of the antibodies, you keep producing more and more and more before the onset of lupus, before the, while those patients are still asymptomatic, they have no symptoms. So this graph from her research article shows that with the antibodies in general, they were 50% above the limit of normal six years before the patient ever had symptoms, six years, and the average was six months after the start of symptoms before they got the diagnosis of lupus in this particular study. And these are the seven different antibodies of lupus. There are seven, and you can see every single one of them. Zero is normal. So if going from left to right, the zero lines are normal and every one of those antibodies was elevated years before there ever were symptoms and referred to as the first manifestation of SLE, systemic lupus erythematosus.

Years beforehand, the antibodies were elevated, and you can see how they kept climbing up every year, going up, going up, going up until they start to plateau. After you get symptoms, you've pretty much killed off enough tissue where you're getting symptoms now. So let's just back up. Let me just tell you something here.

Why is it normal to have antibodies to your own tissue? To your thyroid or to your brain or to your muscles or to your skin. Why is it normal? Because for most patients, we have an entirely new body every seven years. Entire new body. Some cells reproduce very quickly, like the inside lining of your guts—every three to five days.

Other cells are very slow, like bone cells are very slow. So every seven years you have an entirely new body. Right? So when cells get old or damaged, they get bruised from oxidation, bad foods, radiation when you fly in it in an aeroplane. There are many reasons why our cells get damaged. When that happens, the body has to make antibodies to get rid of the old and damaged cells, to make room for new cells.

That's how we create new cells. You've got to get rid of the old ones to make room for the new ones. So there's a normal reference range of antibodies. To your thyroid, to the myelin that wraps around your nerves, to the cerebellum in your brain, to the hypothalamus, in your brain, to your skin, to your joints.

We have a normal reference range of those antibodies, but when you have elevated antibodies, like in this slide here, you see all seven antibodies to lupus are elevated years beforehand, you're killing off more cells than you're making. And if the mechanism that's causing the elevation of the antibodies - remember environmental trigger genetics and intestinal permeability - if the mechanism continues, you keep making more antibodies, more antibodies, killing off more tissue, killing off more tissue, killing off more tissue until eventually, you've killed off so much tissue now that organ can't work right now, you start getting symptoms. Then it takes years to get the right diagnosis.

As you saw in the slides from earlier, it takes years to get the right diagnosis while you're still killing off tissue. So Dr Arbuckle refers to it as the prodromal period—that period before you have symptoms when you're killing off tissue. And the entire goal here is to identify the prodromal period for people before they've killed off so many tissues the brain can't work right anymore, or the heart can't work right anymore, and they get diagnosed with cardiomyopathy, or they get diagnosed with Alzheimer's or they get diagnosed with Parkinson's. So the goal here is to understand this prodromal period, and I'm going to talk to you about the testing to identify if people are in this prodromal period killing off cells.

So Dr Arbuckle drew this graph. You have normal immunity, a normal amount of a normal immune system. You get some benign auto-immunity. You're killing off a few cells to make room for new cells. Now you get pathogenic autoimmunity where you're killing off more cells than you're making, killing off your tissue, destroying your tissue, destroying your tissue until eventually, you get the clinical illness.

Now back in 2003, Dr Arbuckle did not know about the intestinal permeability part of this. So she's got two of the three, she's got the genetics on top and the environmental factors underneath. But the third one, the gateway that caused that allows all of this to happen is intestinal permeability. So immunologists all over the world said, well, that's brilliant what Dr Arbuckle did. Let's go back to the blood banks and look and see about other diseases. And there are many, many papers now published on the world of predictive autoimmunity. So look at this graph. If you have any antibodies to lupus, any of these seven antibodies elevated - the PPV stands for positive predictive value - you have a 94 to 100% positive predictive value. You're going to get lupus within 7to 10 years. For scleroderma, if either of these antibodies is elevated, 100% you're getting scleroderma within 11 years. Rheumatoid is 52 to 97% depending on the antibodies, within 14 years, you're getting rheumatoid Sjogren's; primary antiphospholipid syndrome is 100%. Now in this one, the bottom one, beta-2 glycoprotein 1, this is the antibody that's elevated for many women with unexplained miscarriages. It's an autoimmune mechanism causing a clot, blocking the blood flow into the uterus, into the placenta, and the woman miscarries.

So every woman, of childbearing age, in my opinion, that has a family history of miscarriages, should do this test to see if they have elevated antibodies to beta-2 glycoprotein 1 because it's such a very common trigger for the loss of a pregnancy, unexplained loss of a pregnancy, especially in the second trimester, but not exclusively in the second trimester.

If you have TPO antibodies elevated, especially postpartum, it's 92% you're getting Hashimoto's within 7 to 10 years. Primary billiary cirrhosis, 95% 25 years; type one diabetes, Addison's. 70% of Crohn's disease. Look at this. If you have sacharomyces or BCA antibodies elevated, that's ASCA antibodies. ASEA it's 100% you're getting Crohn's within three years.

The science has done on this. I mean, predictive autoimmunity is where we all want to go. We all want to include. What's cooking inside of me right now? What is it that I might be able to nip in the bud before it progresses by killing off enough cells that finally I'm now I'm diagnosed with dementia or Parkinson's or schizophrenia.

So this is a test that's available that looks at 24 different tissue antibodies in one blood draw. The top four, the grey ones are to the gut. The next two are to the thyroid, the adrenals, four for the heart, the reproductive system, three for the muscles and ligaments. Then the bones, a couple for the liver and the pancreas, and the bottom six are for the brain. You do this blood test, this single blood draw.

When I did this, I had three of the ones on the bottom elevated. I had myelin, basic protein, AGL, gangliosides and cerebellar antibodies elevated. I was 45 years old. I was at the peak of my triathlon career scoring in the top 10% of the 30 to 35-year-old. So I thought I was really healthy physically, but my immune system was killing off my brain, and I never knew. All outward appearances were that I was healthy.

I'll give you another example, a 44-year-old guy comes in to see me. His father died of a massive coronary at 44; his two older brothers died in their early forties of massive coronaries. He was 28 when his last brother died, and so he went to a cardiologist who put them on a statin right away, preventively. Now he comes to me 16 years later. He's been on a statin for 16 years, but he's the picture of health, really smart guy ,and learned the potential complications of statins. So he was taking a lot of nutrition to protect himself, including coincide Akutan. His diet was squeaky clean. He never ate junk, only good food, good healthy food. His body fat was 16%/ He had an excellent job. He was an executive. Happy family life. Everything looked great to doctors every year he got his physicals,. They said you're as healthy as a horse. When he came to me and said I want to do your tests, he wanted to do this test because he had heard about it. So we did this blood draw on him.

It came back: all four antibodies to his heart were sky-high, all four of them. He said, why is that really worrisome? And I said I don't know. Let's find out. It turns out that he was allergic to wheat and to dairy. When we did the right tests for him, he was allergic to wheat and dairy. I talked about those tests in last year's presentation at the LDN conference, on testing accurately for sensitivity to wheat. So he's allergic to wheat and dairy, and we put a wheat-free dairy-free. I didn't do anything else. He was already taking a bunch of good vitamins. All of his other markers were as healthy as could be. Six months later, he comes back, and then we retest—his heart antibodies are down to normal. The autoimmune mechanism killing off his heart had stopped. It was a reaction to the environmental triggers of some of the food that he was eating. And he said you saved my life. And I said, well, I don't know. You know, the doctors that did this work, they did all the research on this. That's really what we need to be grateful for. But this test is an introductory test to identify where is the pathology in your body right now. You know, no one gets Alzheimer's in their sixties or seventies. You get Alzheimer's in your twenties and thirties. It just takes decades of killing off brain cells before the damage is so extensive that it becomes obvious, and as you kill off more brain cells, the rate of the increase goes up, so you kill off faster as you go forward, as the antibodies keep going up and up and up and up.

Premise number three, what's the trigger to the production of antibodies to yourself? And the extremely important function of the GI tract is its ability to regulate the trafficking of macromolecules between the environment and the host through a barrier mechanism. What they mean here, Mrs Patient, if you could take a doughnut and just stretch a doughnut out, and if you look down that stretched out doughnut, looked down the hole, that's your GI tract from your mouth to the other end. It's one long tube. It's 20 to 25 feet long. Winds around inside your abdomen there, but it's one big long tube. So when you swallow food, it's really not in your body yet. It's in the tube. And it's gotta be broken down to go through the walls of the doughnut into the bloodstream.

We have to digest that food, break it down. Think of proteins like a pearl necklace. Hydrochloric acid made in your stomach undoes the clasp of the pearl necklace. Now you have a string of pearls. And the digestive enzymes that we make in the pancreas, in the gallbladder or in the microbiota., these digestive enzymes act as scissors to cut the pearl necklace into smaller clumps of the pearl necklace, and it keeps snipping them, snipping them, snipping them until you snip it into each little pearl of the pearl necklace.That's digestion.

Now you've got this long tube, the inside of the tube, it's got Shea carpeting, but the surface of it is lined with cheesecloth. The cheesecloth only lets really small molecules get through. If you remember your grandmother pouring gravy into the cheesecloth, only the liquid comes through the other side and all the clumps, they stay on the outside. They can't get into the gravy pouring dish. That's the way our system is. The inside of the tube is lined with cheesecloth, so only each little pearl of the pearl necklace can get through the cheesecloth and get in the bloodstream. Then your body uses these acids that are called amino acids to make new bone cells and brain cells and heart cells. That's the raw material you make your new cells from. But it's got to be in the form of the amino acids. As you're snipping down the pearl necklace, that 33 pearl clump, that 17 pearl clump, that 19 pearl club, they're not supposed to get through into the bloodstream. They can't get through unless you have intestinal permeability.

If you get tears in the cheesecloth, then larger clumps of the pearl necklace get through the tears in the cheesecloth. They're called macromolecules. They get through the tears in the cheesecloth into the bloodstream before they're supposed to be able to get through into the bloodstream. They're supposed to go further down the digestive tract. That's one reason why your intestines are 20 to 25 feet long, because prime rib takes a whole lot longer to break down than bananas. So you've got to snip, snip, snip, snip, snip. But if you've got tears in the cheesecloth, that's intestinal permeability.

If you've got tears in the cheesecloth clumps of the prime rib, clumps of that food molecule get through before they're supposed to. They're called macromolecules, big molecules. They're not supposed to get through, but they do. And when they get through your immune system says, Whoa, what's this? This is not something I can use to make new bone cells or brain cells. I better fight this. And your immune system makes antibodies to protect you from that food.

What we see here is what's called the healthy gut. And you can see the lining of the gut here. These are the shags in the tube, in the intestines, and the shags are all lined with cheesecloth. Now, and here's what it looks like. Those big molecules can't get through into the bloodstream. They can not get through. Only the little molecules get through, and doctors notice that the absorption of the small molecules is both between the cells, paracellular, and through the cells. That's really important when we talk more about high-fat diets later on. But this is normal. This is what a healthy gut is supposed to do. Only the small molecules get through, not the big molecules. Now when you have a gut that's been damaged, and you've got the tears in the cheesecloth, if you will, now you see the big molecules get through that big green mile. You'll know don't tell this chicken out. You're going to be allergic to chicken. Oh no, not beef. You're going to be allergic to cantaloupe. Any macromolecules that get through the tears in the cheesecloth into the bloodstream, your immune system then in an effort to protect you from  the macromolecule is going to make antibodies to that molecule.

Now you become sensitive to that food - and the people who do 90 food panels, IgG panels, look at 90 different foods - and it comes back they're sensitive to 25 different foods. They say, Oh my God, that's everything I eat. What am I going to eat? Well, of course, it's everything you eat. It's because your immune system's trying to protect you.

When you heal the gut, which we'll talk about how to do when you heal the gut, you wait six months and go back and check again. Now you're sensitive to maybe three foods. This is so critically important to understand because it's these macromolecules that get into the bloodstream. Your body fights these macromolecules, the immune system trying to protect you, fights it, and then there's this whole world of molecular mimicry, the antibodies against the food start attacking your own tissue.

So a common initial autoimmune pathway and therapeutic target to the degenerative disease include the immune response to intestinal antigen presentation. That means, when these macromolecules get into your bloodstream, your immune system responds trying to protect you, which triggers intestinal inflammation from that antigen getting in, which triggers activating the tight junction proteins, which triggers antibody production to the barrier proteins, which triggers leaky or leaky gut, leaky brain, leaky bladder. Which triggers pathogenic intestinal permeability antigen and macromolecule translocation into the bloodstream and immune response to the antibody production, molecular mimicry, and other pathways that occur and the development of the autoimmune mechanism.

This is the mechanism that's responsible for so much of the autoimmune disease that we are suffering from today. Arguably, number one or two or three cause of morbidity and mortality in the industrialized world. This is the mechanism. When you understand this, and you start addressing this mechanism, you will find so many of your patients not only get dramatic results in a few months, but they're so grateful, and you extend the quality of their life and most likely the length of their life, but certainly, the quality causes you to calm down this inflammatory cascade.

The autoimmune process, once again, can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function, you can arrest the development of the autoimmune disease by healing the gut. Most critical is healing the gut. Well, what? How do you heal the gut? Well, first you have to stop throwing gasoline on the fire. You have to find out what the person is sensitive to and reacting to, and then you heal the gut. We'll talk about that in a little bit.

Premise number four, can foods trigger pathogenic intestinal permeability. This is a great study that came out of Harvard a couple of years ago using confocal endomicroscopy. They took patients, I don't remember how many patients, 36; they took 36 patients at Harvard diagnosed with irritable bowel syndrome, IBS, who were complete failures to every protocol they had tried for a year. The minimum was a year of no results. Still suffering dramatically, and this is Harvard.

So they took these people - confocal endomicroscopy is taking pictures of the inside of the gut - when, they looked at the inside of the gut, they found that the microvilli were closely attached to each other without space between. This is what it looks like. That's confocal endomicroscopy on the left, and that's a scanning electron microscope picture on the right. With confocal endomicroscopy, you get much clearer pictures of what's going on. So they exposed these 36 patients to cows milk, wheat, yeast, soy, and sterile water to see was there any reaction in the gut when they were exposed to these common antigen foods, antigenic foods. Lots of people are sensitive to these foods, so they said, well, let's, let's try it on these failure patients and see what happens. Within five minutes of exposure to food antigens, intraepithelial lymphocytes increase, epithelial leaks and gaps form between the cells and the intervillous spaces widened. This is what it looks like. It shows that the villi are close together. They injected a white dye, and I think they injected it into the femoral vein. I'm not sure. I think that's where they did so that the dye would be flowing through the blood vessels in the intestines. And then when they expose the intestines of these people to these different foods, they look to see if they got intestinal permeability. Did the dye leak out of the blood vessels out into the lumen of the intestines? So it's kind of a reverse permeability, you know? But are there gaps? And this dye is leaking out and look at B, multiple eruptions represent breaks in the wall, and they put white arrows where these eruptions are. See, the white dye is out into the lumen of the intestines, now. This all occurred within five minutes, people. Within five minutes.

Now this one is really cool. This is a five-minute video, and if you scroll over the video, you'll see the arrow comes up, and if you click on it now the videos starts, and you'll see it looks the same for a moment. But notice that the white starts showing itself more on the surface here. Remember the dye's inside. Now you can see the gaps forming. See that gap on the right side there, and it's white. Watch what happens. This is intestinal permeability as it's occurring. Look at all the white that's coming in up. The gaps between the cells that are not supposed to be there. This is how macromolecules get into the bloodstream that isn't supposed to be there.

Aren't the video's cool? To see this. This is at Harvard, within five minutes of being exposed to these foods that the clinicians thought these people might be sensitive to. After food challenge, 22 of the 36 patients showed an immediate and dramatic mucosal response to these antigens. Increased permeability is an early biological change that often precedes the onset of autoimmune disease.

Now I've shown you a video of what permeability looks like. And that foods can trigger it. There are many things that can trigger it. We'll do another session on that. I've got a full day course that I'll be doing this year at the LDN conference, going into great detail on all of this. There's just not enough time to go into all the detail now.

Premise number five the more lipopolysaccharide or weed peptides that pass through a permeable intestine, the stronger the inflammatory response. So there's a correlation between the degree of systemic inflammation and the increase in intestinal permeability. The more permeability you have, the more systemic inflammation you have; the more systemic inflammation you have, you're pulling on the chain; the more wherever the weak link is and the chain develops.

I have a gift for all of you, and the gift is I'm giving you all 43 studies that I'm using in they're all available to you. Now, 31 of those studies were free. I got them for free, so I'm giving them to you. For the others, I'm giving you the link to the abstract so that you can read the abstract. So many of these studies that you want to learn more about and read the study here they are. All you have to do is go to my website, https://thedr.com/LDN17, and all of the studies are there for you. It's my gift to you because I want you guys to really get this. You really need to know this because it's a foundational platform of healthcare. This is so common in your practice. Every day you will find six, seven out of 10 people, when you check them, they've got elevated antibodies to their own tissue. They have an autoimmune mechanism going on. Obviously, if it's the platform for most of the degenerative diseases, including atherosclerosis and cardiovascular disease, it's got to be going on in most people. So you'll have the studies here. This is what your handout will look like, the scientific references from this talk.

Premise number six. So how do you arrest pathogenic intestinal permeability? How do you arrest this process? You have to put the fire out. If, if every degenerative disease, as far as I know, every degenerative disease at the cellular level is a disease of inflammation, you have to stop the inflammation, so you have to stop throwing gasoline on the fire and then put the fire out. So how do you do that?

The first concept is a pleiotropic concept. It's a good Scrabble word. Pleiotropic it means all roads lead to Rome. You know, there are many, many ways to heal intestinal permeability and put the inflammation out in your body. There are many ways, and because certain products like glutamine, it's a great product to heal the gut. Glutamine turns on certain genes, but vitamin D turns on genes in the gut that glutamine does not. Curcumin turns on genes in the gut that vitamin D does not. And so there are many different paths to get a comprehensive treatment protocol that's going to work in the vast majority of your patients. Here's an example for curcumin. These are all the inflammatory and anti-inflammatory pathways that are impacted by taking curcumin, and I'll talk more about that in a minute. So all roads lead to Rome. A pleiotropic approach to addressing pathogenic intestinal permeability.

There are three categories to consider. First, avoid inflammatory triggers. Stop throwing gasoline on the fire. Critically important. So the question about is gluten sensitivity really limited to just celiacs or is there's this thing called non-gluten sensitivity? This is about the world of non-celiac gluten sensitivity. So in this study, this is a study that Hollon and his team at Harvard did. They took celiac patients recently diagnosed, so they had villous atrophy and lots of inflammation. They took celiac patients who were in remission at least a year on a gluten-free diet, so their microvilli had healed, and the inflammation was greatly reduced. They took people who had a problem with wheat but didn't have celiac. They refer to them as non-celiac patients with gluten sensitivity. And then they took people that didn't have a problem with wheat at all, all four groups, and they exposed them to wheat. The peptide, the clump of the pearl necklace of poorly digested wheat called gliadin, alpha-gliadin. Their conclusion: increased intestinal permeability after gliadin exposure occurs in all individuals. And one part in there, they said in all humans, so any of you that is human, every time you eat wheat, this is what happens to you irrespective of how you feel when you eat it. This is what the science tells us. Well, I don't feel bad when I wheat. It doesn't matter if you feel bad. The lucky ones are the ones that feel bad. Then if they continue to eat wheat, that's their problem to deal with. But the unlucky ones are the ones that don't feel bad when they eat wheat, because you can't feel when you tear the cheesecloth. But remember, Mrs Patient, the fastest-growing cells in the body are the inside lining of the intestines; every three to five days, you have all new lining of your gut. So you eat toast for breakfast. You tear the lining of your gut, but it heals. You eat a sandwich for lunch. You tear the lining of your gut, but it heals. You have pasta for dinner. You tear the lining of your gut, but it heals. Croutons on your salad. Tear the lining of the gut, but it heals. A cookie tears the lining of the gut. But it heals. Day in, day out, day in, day out until one day. And that can be when you're two years old, 22 years old or 92 years old. One day you cross that line. You lose oral tolerance. You don't heal anymore.  Now you get tears in the cheesecloth that don't heal. That's called pathogenic intestinal permeability. You don't feel that now the macromolecules get into the bloodstream; that now your immune system produces antibodies against those macromolecules; that now because of molecular mimicry you produce antibodies against the weak link in your chain, your thyroid, your brain, your liver, your kidney. Now you're on the autoimmune spectrum. That's how it happens.

It's so cool when you look at this science, and you realize, wow, this is so very common. This is an underlying mechanism that we can identify years in advance. And that gives you a heads up to do something different. Well, what do you do differently? Well, first stop throwing gasoline on the fire and then heal the gut. So this is the book that came out in September of last year. This is 35 years of my, professional life. But it's all about this mechanism in great, great detail. And I think everyone should read this book, not because I wrote it, but because this gives you the clear, precise, step-by-step mechanisms and what causes the primary mechanism in getting sick and dying in the world.

The immune system is attacking your own tissue. The autoimmune mechanism. Alzheimer's is autoimmune, cardiovascular diseases autoimmune, cancers are autoimmune, and all the studies are in the book with explanations on how to explain it to patients. And when you see this, you go, my God, that's profound. I make $2.10 or something on a book, so this isn't going to pay for my grandchildren's college funds. I'm not saying buy the book because of some personal benefit. I'm saying buy the book because you're really going to learn so much. Or you can take my old day course at the LDN pre-conference in September. You learn so much about this, you'll really understand it, and you can apply it in your practices.

In the book, I recommend a three-week protocol for people to give up wheat, dairy, and sugar for three weeks. And we give lots of examples of breakfast, breakfast for your kids, breakfast for the family, lunches, dinners, snacks for three weeks. And just see how you feel. Just see what happens. Cause most people can't afford or don't have access to the tests. So just do this, and you say, Oh my gosh, my headaches are gone. Oh my gosh, I'm waking up, and I've got more energy. Oh my gosh, I'm sleeping better. Oh my gosh, my child's doing better in school. They're sitting still in school. You just see a condition after condition after condition that's better after doing or during this three-week protocol. So that's a recommendation that I give to people who can't have access to the tests for one reason or another.

The second category in the pleiotropic approach to pathogenic intestinal permeability is included foods that heal intestinal permeability. The first one, of course, vegetables, and one of the benefits of the vegetables is, as you know, the microbiota work on the fibres in vegetables, insoluble fibres, to produce short-chain fatty acids like butyric acid or butyrate. Mrs Patient, the past is growing cells in the body are the inside lining of the gut. Every three to five days, you have a whole new lining to your gut. The fuel for those cells to reproduce is called butyric acid or butyrate. That is why butyric acid is so critically important. If you don't have enough butyric acid, you make your house out of straw instead of brick. And you find so many studies, just go to Google and type in butyric acid and colon cancer. And when you have low butyric acid, you're at a much higher risk of developing colon cancer because you made your house out of straw instead of brick. So you need butyric acid . How do you get butyric acid? it's the good bacteria in your gut working on the vegetable fibres that produce butyric acid.

My good friend Terry Walls, who is a brain neurophysiologist, a professor of medicine, and she developed MS, and being a brain neurophysiologist, she knew all the cutting edge techniques of how to deal with MS and they didn't work. Within seven years, she was in a wheelchair, and her brain wasn't working very well anymore, and a friend said, wake up. What you're doing isn't working. Do something else. It's not working. And she did. She went back to the basic literature, and she found studies on animals that they had induced MS-like symptoms, and they changed their diet, and the animals got better. So she changed her diet to mimic what they did for the animals. She started feeling better. So then she went to functional medicine courses, and she learned about this, and she completely reversed her MS, and she has what she's called The Walls protocol. It's a great book on how to reverse MS. And Terry, applies these principles at the VA Medical Center in Iowa, where she's associated; and she's taking these veterans who are completely disabled. They'd lost a limb, or they've got PTSD, and they can't function in life. She's taken these bedrooms, and she's completely reversing them, getting their brains working normally again, getting rid of their chronic pains.And there are a couple of things that she's doing that I'll talk about here.

The first one, they have to eat 12 cups of vegetables a day before they eat any starches, like pasta and bread and stuff. What does that mean? It's kind of hard. There's no room for pasta after 12 cups of vegetables a day. Right? But that's how she gets them to do it. You eat 12 cups of vegetables a day, five different colours, then you can have some pasta or some toast or something.

Prebiotics, originally defined as nondigestible food ingredients, had beneficially affected the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon. That's what these vegetables are. Some of these vegetables are prebiotics. Here's a study demonstrated the apple derived pectin could modulate gut back microbiota. Here's a study that shows that apple pectin treatment attenuated the level of lipopolysaccharides and reduced intestinal permeability. So what they did here on the left, you see high-fat diets, how it changes the gut microbiota, and it causes more inflammation. And the change in the gut microbiota is to microbiota that induces weight gain. So you get more of the formicilis's family (as I understand the family of G. formicilic (Geriger)) of microbiota that hoard calories, survival, survival, hoard calories. So you store more calories, thus you gain weight. Plus you get the inflammation. Then when they did the same high fat diet, but they added pectin from apples, you see the benefits that occurred from that suppressing weight gain and healing tight junctions of intestinal permeability.

The next category here, or the next component of category two, is bone broth. And once again, Dr Walls with these vets, she has them drink one quart of bone broth a day, not a cup, a quart of bone broth the day. And how do these guys do it, because they don't have any money, they can't work because they're disabled. They can't afford to buy quarts of bone broth a day. They make their own. So these guys go out hunting. They harvest an animal, they make their own bone broth, and they're very proud to be so active in taking care of their own health in a way that they can relate to. They go hunting, they kill a deer, and they make bone broth.

Now about bone broth. Gelatin Tannet is in bone broth. It's a strong anti-inflammatory. Next fermented vegetables. And focus on diversity. Mrs Patient goes to the local natural foods store and buy five different types of fermented vegetables just to make sure they're not pasteurized because pasteurization kills bacteria. So get sauerkraut, get kimchi, get fermented beets, get kvass, get Italian flavoured fermented vegetables, curry flavoured fermented vegetables. Get five, six different types. Keep in the refrigerator. Every day, walk by, take one fork full of fermented vegetables. And somebody said, well, why can't they take more? They can take more. I'm happy, if they get a fork full, then they can take more. Do it twice a day. Why? Because every family of vegetables that ferment produces different species of probiotic bacteria, the good bacteria, and we now know it's not lactobacillus or bifidobacteria that are the commercial ones we've used for 20 years that change the gut microbiota. They help. But you really want the diversity of hundreds and hundreds of different species of good bacteria in your gut. And how do you inoculate for that? Eat fermented vegetables every day.

So you're changing the microbiota because if you have intestinal permeability, you've changed the microbiota to be more pathogenic. That contributes to more intestinal permeability. You take the nutrition and stuff to heal the gut, but if you still have dysbiotic gut flora, you're going to get more permeability. So you have to change the gut microbiota, and by doing the vegetables, doing the fermented vegetables, 12 cups a day, vegetables, bone broth and the fermented vegetables, you're going to change the microbiome.

Fermented foods and beverages were among the first processed food products consumed by humans. The ingestion of fermented foods potentially increases the numbers of microbes in the diet by up to 10,000 fold in one day. It doesn't take long to do this.Consumption of fermented foods may provide an indirect means of counteracting the hygienic, sanitized, Western diet and lifestyle. Many of these species found in fermented foods are either identical to or share physiological traits with species relevant to promoting GI tract health. You know, docs, so many of you just don't have time to talk about foods with your patients. That's understandable. Every office should bring on board a nutritionist or a registered dietician, or have one of your staff people trained, so that you can just prescribe what needs to be done, and the expert can sit down with the patient and walk them through how to change their lifestyle habits. They don't do it in a day by giving them a handout, you know it's going to take some time, and we talk about that in the full-day course, how to get the right people and how to train them, and all of that.

Next, the third category of the three categories, is nutrient supplementation. You want to do nutrient supply admin supplementation to address the inflammation, rebuild the microbiome and healing of the intestinal epithelial lining.

Vitamin D plays a role in the aetiology of autoimmunity. Vitamin D causes assembly of the adherence junctions. That's part of the control for intestinal permeability. Here is a drawing of the adherence junctions right there, and this is a drawing of two full cells, and on the outsides is the start of a third and fourth cell. Vitamin D plays a critical role in the mucosal barrier homeostasis by preserving the integrity of tight junction complexes and the healing capacity of the colonic epithelium. Vitamin D markedly enhances tight junctions by increasing junction protein expression at the kissing joints, and preserving the structural integrity of the tight junctions. Here's the visual, that's the tight junction strands. Here's the drawing of the whole thing. The upper left one is the one you saw previously. The letter B is a picture of a tight junction. Now when you see they blew up that tight junction in the lower-left corner, you see that it's looped the tight junction where food goes through, vitamins go through, its loot. Think of the Panama Canal. The gates open, the food comes down a little bit in between the cells, the gates close, the immune system checks it out. The next gate's open, the food goes down a little further. The gates close behind it, then another part of the immune system checks it out. The next gates open, the food goes down further, the gates close, the immune system checks it out. That's how we check out foods and things that we're being exposed to through the oral cavity coming down into the gut.

And then you see the drawings of these kissing joints. Now, that extracellular space, that's where the tight junctions are. That's the Panama Canal. You are going through that extracellular space. Now watch how much, and then on the right is the drawing of the kissing joint itself. And so you see the paracellular space, the extracellular space there on the right side of the drawing and the zonulin family of proteins are like shoelaces and the shoelaces, you untied the shoes, they open; you close, or you tie the shoelaces, they close the gates, open the gates, close. Now watch how much of this is controlled by vitamin D. All of those are controlled by Vitamin D. Vitamin D controls the gate opening the gate closing, the shoelaces opening the shoelaces closing, all controlled by Vitamin D.

Here are some recommended protocols that you can review. There are three main mechanisms of how probiotics contribute to human health. They shape the ecosystem by a competition for the resources and the adhesion sites. They decrease the local pH, and they produce specific antibacterial substances.

Probiotic strains can not only affect the intestinal microbiota directly, but also affect other organs by modulating the intestinal inflammation and permeability. Changes in gut microbiota modulator. Endotoxemia. By a mechanism that affects gut barrier function and increases intestinal permeability. Look at the journal diabetes metabolism that this is a critical, critical component of dealing with diabetics, is having a healthy gut and closing the intestinal permeability and rebuilding the microbiota.

Our findings that the human gut microbiome can rapidly switch between herbivores and carnivores. Functional profiles may reflect past selective pressures during human evolution. Consumption of animal foods by our ancestors were probably by little, depending on the season and forging success with readily available plant foods, offering a fallback source.

So that's why you eat meat. You change your microbiome in one day. Not saying it's bad, not saying it's good, just know it changes the microbiome. So you have to see what type of microbiome you have to determine what kind of foods you should be emphasizing more. We found that microbiota changes on the animal-based diet could be linked to altered faecal bile acid profiles and the potential for human enteric disease.

VSL Number 3 is a type of probiotic that you can use. There are some really good studies on SL Number 3, and its multi-species. You always want to go through varied species, not just take one type of probiotic, but the key is diversity.

Here are some recommendations on dosing. Fish oils exert much of their anti-inflammatory benefit by suppressing NF Kappa B, which is the major amplifier of inflammation in the body. The safety of fish oils is high, has been well established in numerous clinical studies. Drug interactions are extremely rare. A dose of up to three grams a day has been determined to be safe for general consumption.

Here are some dosing recommendations. Glutamine is the most commonly used amino acid in the gut. In a study giving 30 grams a day, every ulcerative colitis patient got better. It didn't matter how bad they were, even the really severe ones, but when they stopped the glutamine, the disease came back. And why is that? Well, it 's because the lifestyle was still throwing gasoline on the fire, and they didn't heal the gut, and they still have the microbiome of the altered lifestyle. You can't just give a pill and expect to heal the gut. We have to change the environment, the ecosystem of the gut. Glutamine is a very clinical, useful, useful tool. But it's also a substrate for lymphocytes and macrophages. So you gotta be careful, Mrs Patient. I give people, I call it the gluten sensitivity packs. There are six pills in a pack. MrsPatient, can you take one pack a day? Yes, they can. And so, okay, now if you have any reaction to the pack, you get a little bloated, you get a little cramping, anything like that, just stop that one pill. And that's the glutamine. Just keep them in a little container. Wait two weeks, take everything else to calm down the inflammation, and then you're going to be fine. Then you can take them again, because glutamine is a precursor for lymphocytes and macrophages.

Here are some recommendations. Tumeric is remarkable in its benefits. Tumeric is anti-amyloid. Orogenic. It's neuroprotective. It enhances cognition. It's a diagnostic marker. It's an antioxidant. It's an anti-inflammatory. Here are the dosings on all of these different studies. Just depending on what you're dealing with and what your target is that you know you, you can be aggressive with a tumour. It's extremely safe. And here, once again, are all the pathways. Inflammatory and anti-inflammatory pathways that are modulating to produce an anti-inflammatory effect. Here are all of the diseases that there are studies showing curcumin is of great benefit for, and how many of them are autoimmune.

Recommended protocols. Colostrum. High intestinal permeability is normal in newborns. Their guts are very permeable. That's one of the main purposes of colostrum. The first three days of mother's milk is not breast milk. It's colostrum, and one of the main purposes immediately is to turn on the genes in the gut. Say okay, baby, let's close these tight junctions now. Come on. Let's get these cells going. Close these tight junctions. Colostrum also says, all right, let's build the receptors for this good bacteria. Let's start colonizing this good bacteria that you just got washed through as you came down the birth canal. Let's start building these receptor sites. So colostrum helps to set up the environment of the gut for a healthy, well-functioning gut. It also promotes recolonization of the bowel by the friendly bacteria. It's the best remedy known for all-around gut help. Restores leaky gut to normal permeability, contains growth factors and hormones to repair damage to the lining and restore gut integrity. It's unmatched as an immune system stimulator and modulator. There are numerous note products lining the shelves of natural food stores that claim to stimulate the immune system. Only colostrum plays the entire symphony. Colostrum.

If there was only one product I was going to use, it would be this, and it would be this colostrum, produced by the author of this book, Andrew Keech. Dr Keech grew up on a dairy farm in New Zealand. He learned really early in life that you have to give these newborn calves colostrum, or they die in a week. They die. And he then learned that the humans, when they were sick, they drank the colostrum, they got better. So he decided he's going to devote his life to colostrum. So he went to Oxford and got a PhD in mechanical engineering, and I said to him, Andrew high five to you, high five Oxford PhD, way to go, man, way to go, but mechanical engineering, what is that? And he said, well, Tom, I knew I was going to make the best colostrum in the world, and no one is doing it. So I was going to have to learn how to build the equipment to do it. So he spent eight years getting a PhD in mechanical engineering to build the equipment to produce the best colostrum in the world—grass-fed antibiotic-free, hormone-free. Every batch is checked when it comes in, every batch, every time. It's the most powerful product that I know of. It's on my website. You'll see it there. My website is TheDr.com. The product is called GI Restore. It's really quite remarkable.

The two key developmental time points of the regulation of gastrointestinal tract help occur postnatally, the first few days after birth, when all the gut digestive functions are launched by first colostrum ingestion; and then the second when weaning, when the digestive system has to modify its function following a switch from mother's milk to solid food. Two critical developmental time points. The first time point is particularly relevant for all mammalian species since it's associated with a complex of dynamic changes in the gastrointestinal tract structure and function, leading to a temporary drop in gut permeability barrier. So when the guts on fire, the body's on fire. This is a protocol that will work for you. Eliminate inflammatory foods. Give prebiotics, give fermented foods, give probiotics, give Vitamin D, give glutamine, give fish oils, curcumin, colostrum; and I want to note there are many other beneficial anti-inflammatories that can be used to heal the gut, reduce inflammation. There are many. I'm not saying these are the best. These are just well referenced in the literature, and it's a safe protocol that everyone can do, and you'll get dramatic results when you do this.

So what did we talk about here in this little over an hour? Just how prevalent is the development of autoimmune disease. If the cardiovascular disease has an autoimmune component, what becomes the number one mechanism? That's how prevalent it is. Premise number two, how can we identify people at risk for the development of autoimmune disease? You do the test, and you find out. Number three, what is the trigger? in the production of antibodies to self. The addition of the third element, the loss of intestinal barrier function. Number four, can foods trigger pathogenic intestinal permeability? Yes, they can. Number five, the more LPs or wheat peptides that pass through a permeable intestine, the stronger the inflammatory response. Number six, how do we address pathogenic intestinal permeability?

Once again, we have a full day course. We'll be doing it as a pre-conference workshop in Portland in September. We guide you on all of the testing, the supplements. How do you diagnosis, how do you think about this? How do you talk to patients about it? You can find out more on the LDN Research Trust website about this. We also offer the online, you can do the course online, but I think it's better in person. You get all of my, visuals and my emphasis when it's live. For those of you that don't know, we did Betrayal, the Autoimmune Disease Solution. It aired in November and we're going to be launching it again in the very near future. I think by the time you're watching this, it will be launched again. You can find it at betrayalseries.com. I interviewed 85 of the world's leaders in autoimmunity, and the scientists, and then clinicians applying the scientist's principles, and then the patients who went through the protocols recommended by the clinicians. For example, Linda, talking about LDN, and it's really quite remarkable. And if you go to betrayalseries.com, you can find out more about that.

So take care of yourselves. Hope you have a wonderful time in Portland. Make sure to tell those important to you how much you love them.

And this is the last slide, a very good book to read about genetics The last paragraph in this book, throughout your life, the most profound influences on your health, vitality, and function are not the doctors you visit or the drugs or the surgery, the therapies you've done. The most profound influences are the cumulative effects of the decisions you make about your diet and lifestyle on the expression of your genes.

And with that, I would say thank you very much for your kind attention.

Linda Elsegood: Thank you for listening to this presentation. All past conference presentations can be found on our website, www.ldnresearchtrust.org.

 

Thyroid Autoimmunity: Causal Relationships & Novel Therapeutics (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Links between growth hormones, sex hormones and the thyroid gland; their effects on sexuality, musculoskeletal function and immunity. Gut repair protocol. Positive effects of LDN, including in diabetes.

Let's begin with a cursory review of auto-immunity. Of course, many of us here understand all of this, but let's go through it as it specifically relates to thyroid. Thyroid autoimmunity begins with some form of environmental trigger. One good example is an antigen from food allergies, and we've been hearing a lot about that this weekend. An APC, or an antigen presenting cell, presents the antigen to a CD4 cell, and the cascade we see here is triggered. So classically, we believe Hasimoto's to be TH1 dominant. But this graphic, modified from an article published in 2002 in Nature Reviews Immunology, proposed that autoimmune hypothyroidism, or Hasimoto's thyroiditis, results from both B cell and T cell activation, which could be both TH1 or TH2 dominant. Both mechanisms are generally occurring. I think that's important. However, they do propose that for autoimmune hyperthyroidism, or Graves' disease, it’s largely B-cell and TH2 dominant.

We also have to appreciate the classic TH1 versus TH2 models being challenged. There are other discovered classes: we've got a less known TH3, there's another one called TH17 with its own chemotactic components which LDN has been proposed to influence and to modulate. The excellent thing about LDN is its ability to influence both TH1 and TH2 and TH2 dominance over other immune classes, due to overall immune modulation. This would be particularly important in Hashimoto's, as it seems to be both TH1 and TH2, and or some other immune class known or unknown. So again, immune modulation is the key to be achieved through all these multiple therapeutic vectors.

We've got four therapies here to consider, to create and reestablish immune modulation. There are others of course, as we all know, but these tend to be the most direct routes, at least for us at our clinic. So of course, LDN, as I just stated, one of the great things about LDN to wield as a therapeutic tool is this ability to sort of modulate the immune system. It's clinically forgiving, and the patient benefits. Also, the use of thyroid hormone product that contains both T4 and active T3. My particular practice focuses on comprehensive hormone replacement therapy that considers estradiol, progesterone, testosterone, cortisol, insulin, growth hormone. We know that estrogen, progesterone and cortisol tend to increase TH1, whereas testosterone, DHA, and androgens tend to influence an increase TH2. The balance of course is important. The consideration of all these hormones comprehensively will provide optimal immune modulation. And finally, the gut. We've been hearing a lot about that this weekend. We know that the gut is associated with immunity, and its dysfunctions related to opportunistic infections, food sensitivities, dysbiosis, and autoimmunity in general.

We've been tracking observational internal data on LDN and thyroid antibodies for the past about two years, the best we could in a very busy practice. Since Hashimoto's is far more common than Graves' disease, we placed our focus on Hashimoto's. We presented a total of 53 patients; they're replaced in two categories: LDN-only, and LDN with a gut repair treatment protocol. It's really important to note that the LDN-only group is also receiving comprehensive thyroid nutritional hormonal support - please don't think that it's just that. We deal with things very comprehensively in general, but what I'm trying to say is that there's a difference between the LDN-only group versus the people who were also on some kind of specific gut repair protocol that I'll explain in the next slide.

We simply calculated the average thyroid peroxidase antibodies and the average thyroglobulin antibodies, then we calculated the average values of each after a length of treatment. You can see the average there. We've got far more patients in our practice on LDN than this sample here, but we only included patients who had at least one follow-up lab to show a calculable difference in their antibodies, so we excluded some out. The LDN-only group of 39 patients with an average treatment time of about 13 months, showed a very significant antibody drop, particularly in anti-TPO, which is of course the most common autoantibody, but of course we always check both. Beginning average antibodies on gut repair patients was much higher and the change was also less significant. This is consistent with the general observation that significant gut compromise is related to autoimmunity; and as we'll see later, that compliance to gut modifications is significant.

The patients who chose to do the gut protocol in general had the most obvious outright symptoms of gastrointestinal distress, hence motivating them to want to do the testing and follow through with the diet and the supplement commitment. So again, compliance. We can see that the decrease in thyroid antibodies in the LDN plus gut repair group was not as significant as the LDN-only group. This could be due to compliance and adherence to the gut treatment protocol, and the very small sample size of only 14 patients versus the 39.

So why did we do this? Why did we track this? What was the motivation? One, we want to make sure that we're incorporating a treatment strategy that was indeed effective at lowering antibodies. We wanted to see. Two, at least to my knowledge, there's little direct evidence and research about the use of LDN and its specific effects on thyroid antibodies, at least by what I could find If I am wrong about that, I encourage someone to let me know at the end of this presentation. Then three, because I'm a dork and I genuinely like to play this game and I like to crunch the numbers and see what we can find. We seek to add to the body of knowledge about LDN, however humble and modest this observation and methods are. It is our hope that other prescribers of LDN do the same as we have, or at least inspire the call to other researchers to provide in-depth analysis and results about LDN specific to thyroid autoimmunity.

Here's the gut repair protocol, a little bit of detail. We start off with a serum analysis of IgG reactivity to 154 different foods. It's a standard industry test. For those with high suspicion of wheat and/or gluten activity, we'll add a different test as well. And that'll include glutenin, gliadin, and what I think is very important, non-wheat, protein fractions as well. All patients in our sample had at least 11+ foods that they were reactive to. That could have been wheat, gluten, or the other foods. They were then instructed to follow a diet that of course removes these foods, and they have to do that for at least 90 days. Our gut repair protocol can, of course, go longer, but we start them off with a three-month process. During that 90-day restriction, they follow the supplement regimen designed to repair and restore gastrointestinal integrity and function. You can see the gut cocktail here. This is a simple, relatively taste neutral beverage, and includes glutamine, fructooligosaccharides, Acacia senegal, and n-acetyl-d-glucosamine, the classic herbs slippery elm in a powder form, and good old aloe vera juice. They can mix this in water, or a juice of their choice. It's consumed twice daily. We also use a professional strength, broad spectrum probiotic. We start off with a loading phase of 300 billion times 10 days, and then we go to 100 billion daily for about two months after that, and then about 30 billion as maintenance after that. Finally, we used a dual phase digestive enzyme formula that includes hydrochloric acid, pepsin, et cetera, as you can see here.

Let's do a quick couple of case reviews here. Here's a great example of a patient from our sample who was prescribed LDN and diagnosed with leaky gut, and placed on our gut protocol. He presented with a strong history of irritable bowel syndrome diagnosed when he was very young. He goes through the normal testing. He had several loose bowel movements when he first presented, including uncomplicated hemorrhoids with some occult blood. He was routinely screened by a gastrointestinal specialist. His thyroid antibodies are elevated. He also presented as hypogonadal, and he was only 28. Aside from the gut repair protocol, he was prescribed natural desiccated thyroid, and of course LDN 4.5 mg. He was really compliant for those first six months. Stools largely normalized, and his hemorrhoids improved. He got better and you can see his antibodies really got better as well, lowered drastically. Because he improved and it was part of the typical 90-day protocol, he was less compliant. A lot of times once patients get better, they start to slip a little bit, as we know, and you can see that his antibodies slipped, but he was still on the LDN, but his antibodies went back up a little bit. So this is an example of how important comprehensive care is when treating thyroid autoimmunity or any autoimmunity. The food sensitivities and gut permeability are not always fully corrected after 90 days. Sometimes we have to continue to go much longer.

Now to speak to his hypogonadism, I recently presented in London at the International Congress on Naturopathic Medicine, and my presentation was on the global decline of testosterone and sperm in men. I presented research regarding all of this and what I had found, and it was only maybe about three weeks after that presentation that another large landmark study came out of Jerusalem that did really, in fact, confirm that sperm is lowering in men. Okay. Part of that presentation was the causal relationships for lowering testosterone and sperm, and what the functional medicine practitioner can do to help. There are all kinds of reasons for this decline, but we think of diet and toxin exposure, gut compromise, and maybe even autoimmune thyroid disease. And maybe that's relevant to this example. So, in this patient, a change in diet and improvement, all of this, it actually helped with his testosterone. It's also important to mention that he and his wife were trying to get pregnant for about a year before he came to see us. And they got pregnant. So coincidence? I don't know, maybe, maybe not.

Here's another example from our sample. This was a 37-year-old female with high expression of autoimmunity, in an LDN-only group because she didn't do anything significant with her diet. She had other things going on: vitiligo, vaginal lichen sclerosis; and we discovered Hashimoto's. Interestingly, she had already known about that to some degree. They had seen serum elevated antibodies, but her conventional doctor said, well, there's nothing really you should do about that. I think we've seen some evidence here this weekend that it is important to preemptively work with someone who has that, despite what they may or may not be presenting with clinically. This patient also had low testosterone and suppressed estradiol production from oral contraceptive use. Oral contraceptives suppress ovarian function, it’s just what they do. It also can lead to gut dysbiosis, nutritional deficiencies, particularly magnesium. I gave her a low dose estradiol, optimal testosterone using subcutaneous pellets, something we focus on, and a plan to slowly wean off of her oral contraceptives. She was also placed on a nutritional regimen, of course desiccated thyroid, and of course LDN 4.5 mg. When she returned, you can see it was pretty straight forward. In a relative very short period of time, about five months, her antibodies lowered, her symptoms drastically improved. She had less headaches, which was another big concern when she first came in to see me. She's off the birth control pill, and we were able to just get her off the estrogen. She just didn't need the estradiol anymore; but she maintained the testosterone - she liked the libido from that, so we maintained that.

Why did her antibodies lower? In this case it could be several variables. It could be just getting off of the oral contraceptives, it could be the use of the natural desiccated thyroid, the normalizing of her sex hormones, all of which have immune modulating effects in and of themselves. Or, at least these could be obstacles to cure, something we say in naturopathic medicine. But of course, it could just be the LDN.

We’re here at an LDN conference. We've gathered under the basic premise that we believe LDN is worth prescribing. I certainly do, but I'm seeing changes with its use in my patients. I'm not a fan of the statement that science is settled. I think it makes us intellectually sluggish. So I think we should continue to look deeper for the sake of our patients.

A final case review, another example from our sample, technically in the LDN-only group, but who did make specific diet changes I'll explain here. This is a 56-year-old menopausal female. A large percentage of our patients would fall into this demographic. She's on desiccated thyroid, estradiol, testosterone subcutaneous pellets with oral opposing progesterone. Her initial anti-TPO was 2315. It rose up a little bit after that. At that point, she got a little more motivated to get on the LDN. We gave her that, and you can see that it started to lower.

Hashimoto's presents with these flares. You can have up and down of the antibody response anyway. But about six months later, on July 8th, 2016, we discovered mild insulin resistance and suboptimal glucose; hemoglobin A1C, insulin, homocysteine levels, all being suboptimal. At that point, I'd given her 500 mg tid of Metformin, and a proprietary palladium alpha lipoic acid mineral complex that some of you may be familiar with. Those were an injection form. I reduced her net carbs at 125. That seems to be a very reasonable and effective number, and all this of course led to getting rid of a lot of her grain-based carbohydrates as well. You can see, in a mere four months after that her anti-TPO antibodies dropped to only 74, essentially normal. This was the lowest reading she had ever had.

Was it the LDN by itself? Perhaps. I've observed that LDN very often takes several months for the full impact on thyroid antibodies to be realized, yet the idea that she avoided, or at least limited excessive carbohydrates, particularly grain-based carbohydrates, that could be part of it. Her treatment for the insulin resistance included the use of Metformin and the low carb diet. Maybe that's the reason. There is evidence that overproduction of insulin leads to B cell stimulation, possibly potentiating the TH1 pathway.

Ultimately, comprehensive strategies help the patient to realize optimal results. That should be the perspective of any functional medicine practitioner who decides to use LDN. I believe it's important to approach thyroid management in this comprehensive fashion. Tolle causam, or treat the cause. This is another tenant in naturopathic medicine that is known within the functional medicine world. I believe that the use of LDN helps us to treat that core cause, that often is autoimmunity. Another saying in naturopathic medicine is to heal the gut and the rest will follow. And this is a generalized idiom that so often is true. It's almost always an excellent place to start.

The endocrine system is one, if not the most vital system within the body. We have hormonal influences and production within the womb before we ever develop a nervous system. So dare to balance the endocrine system and you help many things with your patients, including thyroid autoimmunity. A healthy immune system is also key to managing thyroid disease. LDN proves to be one of the most effective tools in doing this, particularly when it comes to lowering an antibody response, I believe.

And finally, one of the most overlooked possibilities in thyroid hormone diagnosis and management is the clinical measurement of metabolic rates. It's something that we look at very, I believe, somewhat uniquely. And certainly of course, we look at mitochondrial function, as thyroid hormone influences mitochondrial function, second to none. If we can look at things from that perspective and correct that. even above and beyond the conventional perspective of serum analysis, then the patient realizes optimal outcomes, the patient actually gets well.

I look forward to your feedback and input on this presentation. I hope that it helps to lessen the pain of at least even one person. Thanks for your attention. Thank you.

Keywords: low dose naltrexone, LDN, thyroid, Hashimoto’s, autoimmune, antigen, TH1, TH2, Graves', immune modulation, hormone, gut, dysbiosis, thyroid peroxidase antibodies, thyroglobulin antibodies

 Presentation at the LDN 2017 Conference