Dr Kat Toups, LDN Radio Show 15 March 2017 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.
Dr. Kat Toups is an MD from California in the US, a functional medicine doctor and a psychiatrist.
After graduating, being a psychiatrist I ending up working in a research centre, found trials and studies on psychiatric medications, and came to see the answer really wasn't in a pill. The kind of illnesses that my patients had could not be fixed just by giving them a medication.
They were multifactorial reasons and that the pharmaceutical route was not the answer. Maybe some of the medications did help relieve suffering for people, but they didn't solve the problem of why they were sick.
So like many people that have come to the functional medicine table, I came into it with my own illness. I had immune problems sort of on and off most of my adult life and finally crashed and burned with some serious immune illness. As a physician, I knew the limitations of what traditional medicine had to offer me.
They could give me steroids to suppress my illness, but that wouldn't cure things. And so I started learning functional medicine at that time. And I suspect a lot of your listeners are familiar with functional medicine, but the basic idea of functional medicine is that we want to understand the root cause of why someone is ill, and it usually causes are plural.
And then as we address all of those factors and bring those things into balance, we can restore health and get people well.
I went through all the training courses with the Institute for functional medicine and subsequently became certified there.
I would say in my practice a large majority of people have immune type illnesses or infection type illnesses. Many with Chronic Fatigue and then, of course, all kinds of mood symptoms that go along with immune illness.
So some of my patients kind of have the double whammy. They have immune illnesses, and they have a brain component, either psychiatric or cognitive problems.
So I would say that I've ended up with a pretty complex set of patients and I really enjoy working with very sick people because it's so much fun to help them on that path to getting better and getting their health back.
The first thing that I look at is a timeline. So I have patients fill out quite detailed questionnaires that I can start to see what has been happening. So I start back with when your mother was pregnant, did anything happen? You know, did she have illnesses?
What happened at the delivery? Was it a vaginal birth? We know that people who are born by C-section and subsequently are not breastfed may have lower levels of healthy probiotics.
We know that the gut microbiome and our healthy probiotics are what controls our immune system in great part. So if we don't have a healthy gut microbiome, then we can predict problems with chronic illness down the road. So then I'll look at the factors all through their life. What happened in early childhood? Did you have your infections? Did you have allergies? Did you have colic?
And then I look at the stressors happening and all those various factors. What were your teenage years like? Was it pleasant or was it a time of struggle and conflict and what was happening in your family? Was somebody a drinker?
Was somebody impaired by psychiatric disorders? Did a parent die or abandoned the family? We know now that when people have a lot of those factors, we can see immune disorders developing at higher rates like 20 or 30 years later.
So the notion of PTSD Post-traumatic Stress Disorder, you don't have to be beaten or raped.
I'll ask about tick bites. I'll ask about mould exposure.
Those were, of course, things that can affect the brain and the immune system.
And testing, of course, testing is a big part of what I do.
I also test for SIBO, Small Intestinal Bacterial Overgrowth, and people with SIBO have a lot of GI issues. They typically have a lot of bloating and a lot of gas and people can have a lot of Irritable Bowel Syndrome, either constipation or diarrhoea or both. And what happens with SIBO is we have a lot of bacteria in our colon, and that is normal, but we shouldn't have such a high level in our small intestine, but when the bacteria get out of balance they can grow into the small intestine and overtake that. And so when you eat certain foods that are fuel for those bacteria, that will just have a little party with all that food, and they give off gas and bloating, and some people can appear six or seven months pregnant with the magnitude of the bloating, with the SIBO.
And so, as a psychiatrist, it's very clear. When people have SIBO and there's a disruption in the gut that causes leaky gut or increased permeability in your gut, that allows food particles to get through into our bloodstream and then sometimes bacterial or viral or parasite components and all those things activate our immune system. And so when that immune system gets activated, it release's these inflammatory chemicals called cytokines and they'll travel around, and they freely cross the blood-brain barrier, and they turn on the immune system in the brain.
And when there are these inflammatory cytokines turned on in our brain, it causes psychiatric symptoms. And kind of the first thing that I'll see is anxiety.
And then it can have depression ramifications. It can have cognitive ramifications and even people who never had ADD can have ADD symptoms with trouble paying attention and being distractible and can't focus.
SIBO is where I learned about LDN. As part of the regimen for SIBO treatment, LDN is used theoretically as a prokinetic agent. And so the thinking was that you probably have some kind of GI infection.
Your immune system turns on to fight that infection. And so the thinking with LDN is that it somehow settles down that immune reaction so that people can quit suffering from constipation or diarrhoea.
I use LDN in a variety situations. It's been probably best studied with immune disorders and Cancer. Cancer is really kind of the ultimate failure of your immune system. So cancer is certainly one place that I have used it.
And I've used it for Hashimoto's thyroiditis, unfortunately, a condition we're seeing so much more of these days. For some people, it can help the Hashimoto's so quickly that I always warn my patients that are on thyroid medication. If they start feeling hyperthyroid, like they're on too much medication, you can feel jittery, heart racing.
Then, when you're on too much thyroid medication I advise them to let me know immediately, and I give them blood lab order to get their thyroid tests right away because what I find is for some people they can reduce their thyroid medication because of treating with the LDN. And I've had people that have completely resolved their thyroid antibodies.
I've used it for psoriasis and I started taking LDN myself because I have psoriasis and I would say within days, I stopped needing to use topical steroids on my scalp, which is where I have the worst symptoms.
I've used it with Parkinson's patients, multi-system atrophy, with a lot of Fibromyalgia's patients and Fibromyalgia is one area where people say you should watch the side effects of LDN that sometimes it might flare it up in the beginning and you might have to go start lower and go slower.
And I really haven't seen much of that. I usually let my Fibromyalgia patients know that that's been reported but I still go ahead and start with my standard dose titration.
I use it for pain conditions. We know that when you, take a dose of LDN that, it's reported that it temporarily blocks your own opiate receptors, and that causes your own brain to make opiates.
So your own brain is reported to make six times more opiates with a dose of LDN. Of course, there are feel-good hormones and that is also the component of narcotics that helps the pain. So LDN can be quite useful for pain conditions.
I spoke with one woman who told me she had been on high doses of narcotics for many years, for Regional complex sympathetic.
It's a neurologic pain disorder that can be quite disabling. And she told me that by using LDN, she was able to get off of her high doses of narcotics because it had controlled her pain.
I've seen it really help people's depression and anxiety.
I have used it with veterans with PTSD or post-traumatic stress disorder and typically we've given it at night time because that's the time when you're sleeping that your brain reportedly makes a lot of opiates but some people end up moving the medication to the daytime because of vivid dreams although they are temporary side effects. So we have the idea of giving this a couple of times during the day to see if we can get that endorphin increased during the day when these patients are really stressed and triggered by the PTSD symptoms. So they started splitting the dose and they have some very lovely results with that so I learned that I had shifted a lot of my patients who do have anxiety or PTSD symptoms to taking it in the daytime.
Lyme disease and the co-infections with Lyme are another areas that LDN is definitely put that on the first line. What I think because it happens with Lyme disease is it shuts down the immune system.
And so LDN then becomes a mechanism to help support the immune system so that it can detect and clear that infection.
I've had some discussions with one of my friends and colleagues who works with pandas, and that's the pediatric autoimmune neuro-psych disorders. Typically it's been reported in children that they'll have an infection most often strep, but it can be caused by mycoplasma.
It can be caused by other infections that trigger that child's immune response. And then the immune system starts attacking the brain and these children can develop the pretty acute onset of severe obsessive-compulsive disorder and behavioural problems. And I had recently worked up a 12-year-old for his pandas and discovered that he had an infectious source with active mycoplasma. I had started that child on Low Dose Naltrexone.
The thing about infectious diseases we have a beautiful design that is supposed to work for some kind of acute infectious diseases with a short course of antibiotics that may knock things out. The problem that we get into is with the people that have chronic infectious diseases. That is chronically triggering their immune system. And those are some of the kinds of patients that I see.
And they come in, when I take their symptom history, they have, 20 or more active symptoms that are troubling them. A traditional doctor will look at that many symptoms and say, "Oh my God, there's your neurotic, you're a psychiatric patient." I am the psychiatrist, so from my perspective, I can say you have all these symptoms. This is not in your head. It's in your body. There's something happening in your body that is triggering the symptoms. The answer for me isn't giving the psychiatric meds because those don't get them well.
I may use psychiatric medications in the short term as a bandaid.
The LDN definitely is one part of the toolkit to start helping support the immune system.
They are written about dental infections. This is a really tough area where people have a root canal because they've had an infection in a tooth and the dentist take out the roots, and they fill them up with material. What I've learned is beyond those roots stars, the infection can get into those microtubules and maybe it's a low-level infection, but it can be enough to keep turning on someone's immune system.
And some people with immune disorders just won't get well until they pull those root canal teeth, because it's triggering this chronic infection.
I took part in a Lyme disease documentary and they have so many different symptoms. And even though these people are really obviously very ill, unable to move, function, the pain, cognitively, etc and the doctor says "It's all psychological. It's in your head. "And how devastating when you feel that low to be told it's in your head and being offered antidepressants and things. I empower people and get them to believe that they can get well. And that these symptoms really are of a physiologic nature and that once we can find all the causes and support their nutrition and support their immune system, that they can get better.
My website has the information. My practices called Bay Area wellness.
So the website is www.bayareawellness.net. And my Facebook It's called Bay area wellness dash functional medicine psychiatry.
Summary of Dr. Kat Toups interview. Watch the YouTube video for full interview.