LDN Video Interviews and Presentations

Welcome to the LDN Radio Show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. 

Dr Steve Zielinski is here today. Can you tell us who are you? What made you decide you wanted to be a pharmacist? 

I wanted to be a pharmacist because my dad was a pharmacist, and I liked it when he'd take me to work when I was a kid. I got to see him work and how he helped people. People really appreciated it. I wanted to do the same thing. 

How did you get into compounding? 

When I was in pharmacy school we were learning how to make stuff in the lab, and I was interested in making stuff. I like to cook a little bit, and compounding was just like cooking to me. That is what got me into compounding. 

Could you tell us what forms you make of LDN? 

We buy it as a bulk powder and we can make it into anything essentially. The forms of LDN we typically make are capsules, which are pretty standard. We also do a troche and we do a liquid, like an oral solution. Now we're working on transmucosal films. Those are films that you can put on the inside of your gum and it gets absorbed through the cheek. Some people complain about the troche taking a long time to dissolve and having to sit under their tongue for a long period of time. One of the things that we've started to learn to make are films that go on the inside of your gum or on the inside of your lip, almost like chew or something similar. It then gets absorbed through the skin. 

Did you learn about LDN in pharmacy school? 

I learned about naltrexone in pharmacy school. I heard it was great at 50 milligrams for treating alcohol and drug dependencies. I never learned about it at the doses that I'm using it for or the conditions that we're seeing it be beneficial for in pharmacy school. 

So how did you hear about LDN? 

Being a compounding pharmacy people would ask me, "Hey do you make low dose naltrexone?" That’s how I heard about it a lot of times. I often hear about things from other people that are wanting to learn more about it. Then it makes me learn more about it; or I get stuck in a position where I need to learn more about it because I don't know much about it, to be honest. I definitely don't claim to know everything about pharmacy, or medicine, or drugs, but when I get a question and I want to find out the answer I go and look it up. That's what I did. That's how I got started with low dose naltrexone. 

How long ago was that? 

I want to say close to five years ago. People were coming in looking for it for different conditions, and specifically pain, and I suggested this because it is low dose, not habit forming. I thought I'd give it a shot for somebody. We did and it worked. 

How many patients do you think you have on low dose naltrexone right now? 

Probably about 30 or so patients on it. 

How many doctors are sending scripts to you? 

About 10 or 11 right now. 

If you have 10 or 11 then they haven't got many patients each on LDN. What would you say is the stumbling block for them not to prescribe it more widely? 

I don't think they're aware of all the different things it can be used for. I think that's the biggest issue. I think the biggest stumbling blocks are having a good understanding of it for what they could be using it for, and then I think another stumbling block is the dosing of the medication. There's not a package insert that comes with this like there is for every other medication. You can't look this little drug up in the Physician Desk Reference and see how you prescribe low dose naltrexone. 

That's not there, but you know if you look up naltrexone, you're going to see a 50 milligrams dose and how to use it, but you're not going to see the different doses that could be used for in a different dosage forms. That's available from a compounding pharmacy. I think that's one of the hindrances that we see with this medication being prescribed. 

Did you know the LDN Research Trusts have three guides on our website. 

Those are great references that I'd love to make available to the prescribers that I work with. 

It's on the LDN Research Trust.org website under resources called LDN Guides that might be a benefit to you and your doctors. Many pharmacists that have been doing LDN for many years will have a seminar in their pharmacy and have an evening where they invite doctors to come. You give them a presentation and explain it to them.
Can you explain what conditions LDN could be used for treatment? Pick a couple and give some case studies. Tell them that you are available to answer their questions. I'm sure there are thousands of people in your area who have either chronic pain, mental health issues, autoimmune disease or cancer. The number of people you know that could be using LDN is endless. Anybody who's in your area who would like to help you expand the client database to get more doctors prescribing LDN in your area would be amazing. It would be great to see yourself grow. 

I think we end up using it as an option a lot of times when other things fail. I think that's how we get people started on it for the most part. The most interesting one has been with hair loss post COVID. I think it has been really interesting to see when people have been having their hair falling out. Whether it's from having COVID or exposed to COVID or don’t know what it is, I don't know the diagnosis but we try treating hair loss and nothing's working and then we try low dose naltrexone and it works. It has been a new one for me. 

Having COVID happen and the pandemic and everything has been a springboard for low dose naltrexone because LDN works so really well for long COVID. There are two chapters in the LDN Book Three that address long COVID, and you can hear Professor Angus Dalgleish saying that he's a cancer oncologist. He also is a virologist. He treats people with long COVID and he says that it should be a first line of treatment because patients do so well on LDN. He said some people have said it's placebo and that there's nothing to this treatment. He says that once they stop LDN all their symptoms come back. When they restart the symptoms go away. You then know it can't be placebo. It should be a first line of treatment. When people have COVID, you know they are worried about getting long COVID. They should take LDN. It really a game changer for them. There are people who have had chronic fatigue for years. Years ago they were dismissed as being imaginary or told it's depression. There is nothing wrong with you. Deal with it. Now COVID has come along and some have similar symptoms and all these people are saying who've got long COVID. Fatigue is terrible. It's absolutely awful and that's been around for a long time. People who had it were not believed. I think it is going to raise awareness that will help people with chronic fatigue syndrome. People recognize it as a condition and not just an imaginary condition. 

You said with chronic pain, are people using it to wean off of opioids? Are they using it once they're off the opioids? What I'm trying to say is, are you using micro-dosing LDN alongside of opioids to get patients off the opioids? 

Yes and it's really interesting to see because there's a lot of hesitation and nervousness by the prescribers to do that, because but it's such a low dose that you can wean somebody off of opioids and morphine with it. We've been successful with it and it's been pretty neat, because when you're dealing with long-term chronic pain, to use something that doesn't cause you the side effects, constipation and things like that, on top of the opioid addiction. It's pretty nice to have that in your in your toolbox as not every doctor has that, because they have that tool in their toolbox they could use, but they hesitate because of not understanding how low dose naltrexone is going to work in combination with a stronger pain medication like an opioid. It always amazes me that there are people who have had chronic pain for 20 years and they have taken the highest dose of Oxycodone, they then have another fentanyl patch put on and they end up with this cocktail of pain medication. They have to take other medications to combat the side effects that these medications have caused and their pain is still a nine to a ten every day. This time they can't come off those pain medications. They're addicted to them, although they're not working and my understanding being non-medical that these high doses of pain medications are very bad for your organs. They are damaging themselves at the same time as it's not working. 

To actually take a micro dose alongside of those medications where you don't have to reduce the dose initially everything stays the same. You're not going to go through withdrawal. You're not going to feel your security blanket has been taken away from you, but it does make the opioids you're on more effective. That means you can titrate the opioids down while titrating up the naltrexone and people come off it and I'm happy when people say for 20 years they've suffered. They've come off the opioids. They didn't go through withdrawal. People say that they feel no pain anymore but some will say I still have pain but it's a three or a four and I know it's there but it doesn't stop me from carrying on to live a normal life. I can still achieve what I want to achieve. The pain isn't stopping me and I think from the LDN point of view that is just totally mind-blowing because you think of these opioids as being like a sledgehammer. The LDN being a feather, you think how can it properly be effective but you've seen it too. I have seen it and I think it's really very interesting because people don't just come off of their opiates when they go on LDN. 

That's where they start. They start coming off of their pain medications with the hardest ones first but then the longer and longer they stay on the low dose naltrexone more things can start falling off after that as well. It's really interesting to see the same doctors that are hesitant to start the low dose naltrexone for people on chronic pain medications to be the ones that would be the one recommending that and not the next pain medication. I had a patient that was on a morphine equivalent and maybe an oxycodone or Oxycontin or something like that at the same time for chronic pain and it wasn't going away and he was on there for about two years and then something about nerve pain was mentioned and neuropathy. I had recommended using low dose naltrexone and he used it and then the doctor started titrating the doses of these medications away and it wasn't just those two it was also other things. There was Topamax for pain that wasn't needed anymore. You're not just relieving a couple of medications, it's a lot of medications. It starts with a couple and we titrated it up slowly at the same time of weaning them off of one of the pain medications. Then once he was comfortable without one of the pain medications then he learned that he could also stop a second pain medication. This was a period of maybe six to eight months and over six to eight months that he was opioid free. No morphine, no opiates. Strictly just using low dose naltrexone with other muscle relaxants as well. Then a year later or two years after that he was even able to stop some of those. It's not just stopping opiates it's stopping other medications as well. 

I know some people who had fibromyalgia or who have fibromyalgia who were taking like 14 different medications a day and some of them have got down to just taking two or three including LDN. That has to be better for your system. The less medication you're putting in your body the better. Obviously medications are important when your body isn't working correctly and you are in a lot of pain. Sometimes if the necessary evil is but I think it's a good starting point to see what alternative dosage forms and treatments can do. I think that's what I really like about it is because I kind of play and not play, but I kind of work in a pharmacy where I'm doing both nutrient depletion compounding and traditional medicine. It's not one side or the other, but how do you use them both together, and I think when you can use something that can get an effect that the doctor wasn't aware about, or wasn't completely knowledgeable about, and it works, it starts getting people interested in their own health and seeing what else is out there. I think that's the best thing about low dose naltrexone. It's one of those things that does just that because it's okay what is possible because my pain was forever and now it's gone. I had to use these opiates forever and now I don't. Once you do this and they get that X they get exposed to that then they start taking their health in their own hands. 

The favorite part of this drug is people start taking control of their own health. They can bring questions and stuff, but ultimately they take control of their health back in their own hands. Doctors if they were listening to you and work out, I think that's something we do well is we only have about 30 to 35 people. I think low dose naltrexone, but I think that's one thing we do is we run into all those stumbling blocks, those challenges. We can make the recommendation that they should do it but it's something that their doctor ultimately has to make the decision on, and so we try to equip them, to empower them to have the right information in their hands. This is where it's worked before. How can I start trying this or how can I take this step? I think that's what we do pretty well. Not with just low dose naltrexone, but all medications. If a patient has a high blood pressure and they're not sure which medication is causing it, maybe they have two or three different blood pressure medications, pharmacists are in a great position to be the advocate of saying talk to your doctor about this blood pressure medication and see all the time these medications have a risk and reward. If a medication has more risk or more downside than the actual benefit but low dose naltrexone there is a lot of good literature out there. Whether it's a case study or a larger study on multiple people or case reports or controlled trials they're out there. The data's out there. There's plenty of evidence to support using it to where it's still evidence-based medicine that we're practicing. 
 

Welcome to the LDN Radio Show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. I have an exciting lineup of guest speakers who are LDN experts in their field. We will be discussing low dose naltrexone and its many uses in autoimmune diseases, cancers, etc. Thank you for joining us. 

Today we're joined by clinical pharmacist Sebastian Dennison from PCCA. Thank you for joining us today Sebastian. 

Thank you so much for having me. Can you tell us about your role in the PCCA and how that involves LDN? 

PCCA is a company that helps compounding pharmacists realize the needs of individual patients by providing education training, as well as, components for compounding everything from equipment to specialized bases to specific bulk active pharmaceutical ingredients AKA drugs so to speak. 

As a clinical pharmacist my role is to consult with both technicians and pharmacists when they're faced with problems that they haven't seen before. PCCA has evolved over the last 40 years of their existence as well as our role as clinical pharmacists. We're now doing a lot more external education events, working with providers and external education providers. The LDN Research Trust is a brilliant organization and because we are the ones who are pharmacists compounding LDN we're getting more and more questions on it. 

In about 2014, 2015 I was given the role of educating a lot of our members on the evolving and emerging uses of naltrexone. It grew from there obviously because as I learned more I got more and more excited about it. I realized that there was a lot more to this fancy little molecule than what we had previously known and we're still learning every day.

What would you say are the main topics that you give when you're educating pharmacists as in conditions? 

I guess I always have to go back to my own understanding of most diseases. I have to understand the underpinnings of the pathophysiology and the drivers of disease before I can understand how any drug or any sort of therapy will have a positive intervention. This goes back to something called structure activity relationships. This is the bread and butter of pharmacy. If we understand how a drug works in a set receptor or receptor families we understand how that drug will impact the disease long term. 

Understanding both the disease pathophysiology and understanding how the drugs work give us insight and so what's changed is as we understand that naltrexone has more and more receptors that it works in and more specifically at this sort of very subtle dosing in the LDN and very low dose world. We understand how it can have differential benefits in these patients and so it used to be in the the late 90s it was MS, fibromyalgia and migraine. It has since turned into so much more. The big ones that I see right now are pain, inflammation, arthritis, fibromyalgia, MS, autoimmune disorders and now we're starting to touch upon things like anti-aging uses, mental health issues, adjunct care to other disease states and you know the big ones. Cancer is becoming huge. Dermatology it's enormous. More recently some new evolving uses that I've been discussing for a couple of years and a couple that I'm really excited to be presenting in the upcoming conference.

We had a fantastic presentation last week. I believe it was from a colleague of yours, Nat Jones, on Dermatology. It was a very good presentation, and we've also had a presentation from you as well. What would you say if a patient or a pharmacist says that they've got a patient who is really skeptical about trying LDN and he's worried what effects it would have on them? People who haven't really done the homework and don't really know the ins and outs of the LDN how would you get the pharmacists to address that?

The part of my role, because it's a clinical role, and ensuring patient safety is a priority, that always goes hand in hand with pharmacy ,but in the compounding world there seems to be this lack of information because we may be new to using many molecules in new and interesting ways. That's part and parcel of what we always do, is we look at safety. We look at information that's available and we also look at side effect profiles. 

There is a saying that you get in pharmacy school, no side effect, no effect. Dosing appropriately for the patient to avoid any side effects and to avoid harm. Those are the two crucial pieces that you have to start with when counseling any patient or any person who's thinking about low dose naltrexone. The scope of health has to be made aware of the safety profile. 

There was a brilliant paper that was published in 2019. The author was Bolton He discusses the side effect profile of this all-inclusive retrospective analysis and they had almost 11,000 plus patients and they were looking at it and saying that the side effect profile is very similar to that of placebo. Which is really an interesting piece because placebo effect is very common. Headache, tinnitus, nausea, vomiting, diarrhea. We actually use that as an indication that the patient is getting too much of something. This is actually part and parcel of a dosing discussion that I'll be having in a couple of weeks with the LDN Research Trust is understanding how dosing has to be much more nuanced and much more specific. 

We do have to look at starting low, going slow, titrating to a patient response. The difficulty with low dose naltrexone is giving a patient a stable dose. It may take up to eight weeks to see a benefit fully to realize just how much the patient has changed. We know by the side effect profile very quickly whether or not we're giving them too much or things are going the wrong direction. An exacerbation of their symptoms or a worsening of their symptoms or I'm getting headaches that I didn't get or my sleep disturbances are so bad I just can't sleep at night. 

Those are all signs like I'm giving too much; as a clinician and I can decrease the dose. One of the biggest problems that we see is with providers they’re thinking some is good more must be better. They do this very regressive increasing of dose and I think that's the part where we really have to focus on in the low dose naltrexone world is lower doses starting lower titrating more individually because what we're starting to see with this proliferation of use is much wider dosing parameters and we're seeing doses go all the way up to 12 to 15 milligrams in some patients and as low as 0.1 milligram and others. We don't know until we start with the patient. The last thing any of us ever want to do is see a patient come to harm or or have any negative consequence because they're already sick and they're already having problems. This is why part of my job is convincing people to start at a lower dose and titrate a little bit slower. Just to make sure that we don't go past their need point and help have the patient give us that feedback. 

That's one of the nice things about naltrexone is there is an incredibly wide safety margin. I think there's information out there where we have patients at 150 milligrams as a chronic ongoing dose for other purposes and high-dose naltrexone so to speak. Alcohol use disorders where they're taking 150 to 300 milligrams in a day. Low dose world isn't a concern of toxicity or harm. It's more not getting the right immunological modulatory response. That's the discussion and there is actually a case study where a patient ended up taking almost a whole bottle in one sitting. They were fine. They felt pretty chummy for about 24 hours but we're talking about 50 milligram tablets that I consumed, quite a few of those tablets. Our worry about harm is mitigated on the fact that we have much higher doses that are used for regular dosing naltrexone and most patients respond very favorably once we start initiating and when we see a, “Oh I don't feel right or it's getting worse,” that's usually a sign of too much. It's not going to harm you but we don't want to miss the nice response of LDN. That's the beauty of this drug. We can say to patients very comfortably, “Well the harm in trying is very minimal.” It's actually no physical harm or there's no consequence to the patient other than it may not work, as opposed to some drugs. If it doesn't work you may have some serious side effects and that we are very aware of. The discussion is very useful with other clinicians because in pharmacy, as well as, in medicine and any sort of healthcare provider is the risk has to be balanced against the benefit for the patient. When you're talking about a drug that has very minimal side effect profile especially the doses we're talking about with very small steps forward, it's a very favorable risk-benefit ratio, so to speak. Lots of benefit participation, very little risk. 

There you go in a nutshell. I mean some people, not myself, I must admit when you get medication from the doctors, not compounded, you know off the shelf, there is a leaflet inside telling you how to take it, when to take it, possible side effects, all that kind of thing. You don't get that with LDN and some people would like more information.

There is this great website you can go to, the LDN Research Trust. They have some resources there like a recent dosing guide. There is a list that we're suggesting, and I've been an advocate for this for a long time. I love the fact that the LDN Research Trust has this as an open source. There's no membership, no fees, no cost to find information. You can go and you can find patient dosing information. You go to the resources tab, highlight it and then you get a drop-down menu. You can find LDN guides - click on that and then you can find it right there. It's a PDF, you can download and print. It's actually something that we in the compounding world have been suggesting, because it's such a useful tool. It's referenced, it's got scientific references behind it, it's got information and it's got available dosing recommendations that are very different than what we saw even five years ago. 

We start at much lower doses. We titrate to patient response, that's all included in there. Unfortunately it's a 2022 reference dosing guide and I think that your team may have work too, because in 2023 we're going to see some positive changes where it's going to be reinforced by the dosing parameters that we're working with, but new references. That's going to be the tough part, is updating it. But it's brilliant. That's where I would go. And then the other one is to talk to your clinical pharmacist. If they don't have the information, find a compounding pharmacy that is already working with low dose naltrexone. 

I can walk into five pharmacies from the office that I'm sitting in currently, and I can ask them what they know about low dose naltrexone. I don't know; they'll say not a lot, because not every pharmacy has the same focus of practice, or the same education behind them. 

Our role here at PCCA is education, clinical consulting support for those people who are invested in compounding. We've seen some pharmacies here and they're like oh you just take a tablet, mix it up and throw it in some water and they’ve failed to mention that water doesn't have a preservative and if you mix it up you may not be getting a consistent dose. How much to take and you go to a clinical compounding pharmacy with that niche practice and they're worldwide by the way, we've got some members all over the world, so big shout out to all of them doing brilliant work. They're focused on this and they are advocates for the patient. They're advocates for the patient's health and so they'll give you the best up-to-date information. If not, the LDN Research Trust website, talk to a clinical compounding pharmacy that's focused on LDN.

We still have people unfortunately that think they can buy 50 milligram tablets off the internet or buy in fact LDN off the internet or make their own and it's very scary not to be recommended.

I'm going to be as diplomatic as I can. There are a lot of good people out there who are trying to do good work. There are pharmacies that are available online and you can order items from them as long as you have a valid prescription in the country to which you are sending that prescription. The difficulty with internet commerce is there's a lot of people who are great. There's someone out there who wants to buy something and I want to make some money and so they will ship you stuff that doesn't contain naltrexone. It's just got some bad tasting chemical in there that they think will change how you think. Unfortunately we see this not only in the internet commerce, but we see this in a discussion of drug supply. We don't want to see any patient take something that they think like this is going to be great and it's cheaper, and you know it's just as good quality. I can make claims on the internet all day long, and if I do that for a year, and I can sell you dirt out of the parking lot; it'll take a long time for me to be shut down. There's a lot of patients that can come to harm from that practice. 

We always suggest working with a regulated compounding pharmacy, and every pharmacy that would be available to you is regulated by your local government. It is a brick-and-mortar place that you can tangibly speak to a person, and you can ensure that you're getting a quality product, from the reason we talk about compounding, and getting it dosed individually for you. I went to school for a number of years just to learn to be a pharmacist and then I spent a number of years being trained to become a compounding pharmacist. When you're talking about 0.1 of a milligram, we're talking about smaller than a speck of sand that you can see and we're trying to dose that consistently and accurately every single time. It's a big difference than someone making at home without training and thinking like yeah I'll mix it together. We are not making cakes, we're not making omelets. We're making drugs that impact your health. We need accuracy and precision to create a clinical outcome for the health of the patient. Getting tablets off the internet from someone who's selling it to you cheap 's a little bit like buying tires that you bought that you're getting from someone that doesn't make tires. They're just trying to sell you something cheap. It's always a consequence to the patient and you hear about this over and over and over again. You hear the story of people who are unscrupulous and they're preying upon people who are in need. I would rather see a patient get a quality product because that will improve their health so significantly that all of a sudden all those other concerns evaporate. I can't speak to pricing but I can speak to when I see a quality product is used we get quality outcomes. That's the connector. That's why we work with you, because we see the quality education and the conferences and resource sharing. 

The LDN Research Trust is focused on the same outcomes you want. The best for the patient and being advocates. We want the best presentation by advocating for the best product. They go hand in hand. 

It does scare me when companies out there, or individuals that I don't know who they are, but you can actually buy LDN without a prescription, but it's a prescription-only drug ,and that should set off alarm bells that you know it's bypassing all regulations. It can be anything, and I wouldn't want to play with my health or my life. 

I would challenge anyone to really really think about this. If we say that it's a prescription item and it's only available from a registered regulated pharmacy under the guidance of a healthcare provider. Would you go and buy a heart medication off of some guy in the corner? No, you'd be thinking I'm getting this cheap and he's pretty shady and I don't know what he's up to, but you know it should work. He wouldn't take that chance with your heart. Why would you take that chance with your immune system? Why would you take that chance with anything? It's terrifying to me. I will be brutally sharp on this one. We see what's happened in the illicit drug supply with people who are changing drugs with everything from carfentanyl to dalzine to fentanyl and these are people who are a high high risk for what drugs they’re taking. What's to stop these extremely unscrupulous people who are selling things on the internet from starting to use tainted drug supply for those purposes. This is not a good group of people. They're breaking the law. 

There there's so many issues here and the intention is to become healthy. Why would we take a legal practice and start our journey there. It just it doesn't make sense to me. Yeah it's cheap, great, it's illegal. You don't know what you're getting and you're setting yourself up for a high risk, high harm potential. That's not what any of us want to see. So please there's one thing I can suggest is don't do that. 

Thank you so much for having spoken with us today Sebastian. We look forward to your conference presentation in a few weeks.

I am so excited about it. I get to come in early. I'm going to be there for the entire conference. The collection that you have put together is just amazing.

The LDN 3: To Purchase with discounts before 1st September 2022 Go to ldnresearchtrust.org/ldn-book-3 for full details

LDN Webinar Presentation 18 May 2022: Dr Masoud Rashidi - LDN, Dosing, Fillers and Compounded Options. LDN, ULDN and Pain/Opioid Issues

Sponsored by Innovative Compounding Pharmacy https://icpfolsom.com/

LDN Webinar Presentation 18 May 2022: Dr Mathewson - LDN as supportive care for Oncology and Autoimmune patients: Case Reviews

Sponsored by Innovative Compounding Pharmacy https://icpfolsom.com/

LDN Webinar Presentation 18 May 2022: Dr Sato-Re - How and why I prescribe LDN in my integrative and general practice

Sponsored by Innovative Compounding Pharmacy https://icpfolsom.com/

Pharmacist Michelle Moser, LDN Key to Success (LDN, low dose naltrexone)

Review: Michelle Moser has 35 years experience as a Pharmacist and is very experienced with the utilization of LDN (Low one Naltrexone). She volunteers her knowledge as an a LDN specialist with the LDNresearchtrust.org. Her 21 minute presentation covers how they supply a thorough service to their customers, with advice and council on dosing and related help for a variety of conditions. She explains how LDN can be used along with most other drugs, even opioids if the LDN is micro dosed and immediate release. All autoimmune conditions can benefit from LDN.

Review by Ken Bruce

Linda Elsegood: Welcome to the LDN Radio Show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. I have an exciting lineup of guest speakers who are LDN experts in their field. We will be discussing low dose naltrexone and its many uses in autoimmune diseases, cancers, etc. Thank you for joining us.

Linda Elsegood: Today I'd like to welcome back our guest pharmacist, Michelle Moser who's also one of our LDN Specialists. Thank you for joining us today, Michelle.

Michelle Moser: Oh, thank you so much for having me. It's certainly my pleasure.

Linda Elsegood: So we're all keen and eager, and as people can see, you've put “Keys To Success” up there, so take it away.

Michelle Moser: Thank you, thank you very much. I appreciate the opportunity to share some information with everybody today that really goes over not only how patients can find their success, but how providers can also enhance patient outcomes. So here we go. The first thing I want wanted to address is that low dose naltrexone plays really well with other therapies. It's not necessarily medication that is used all by itself all the time, and that is a question that comes up from not only patients, but from providers as well, wanting to know, well, the patient is taking this this and this. Can I use LDN? And the answer almost always is yes, and the main reason is that even if we are using or prescribing opiates for patients with chronic pain, depending on how those opiates are being utilized throughout the day, LDN might still be an option. Very few times is it that LDN is not something you can start. It doesn't have very many drug interactions, so LDN is brilliant for a wide variety of indications. And as we know, as so many more autoimmune diagnoses are being found every year, I think now there's something like 100, 120 some, maybe even 140 autoimmune disorders, low dose naltrexone is a wonderful fit for most of those patients.

But we also have other dosing, such as very-low-dose, which is 50 to maybe 250 micrograms. And then we have ultra-low dosing, which stems from the oxytrial study where we were using only microgram dosing, one, two, three, four micrograms, alongside short-acting opiate medications to help reduce the need for those opiates and replace it with low dose naltrexone. Because we know that low dose naltrexone not only helps to intermittently block those pain receptors, but also helps to reduce not only inflammation and those pro-inflammatory cytokines, but we can also see that low dose naltrexone helps to modulate the immune system. And there's a wide variety of studies that have been published to emphasize exactly those parameters. So if you're needing those, either reach out to the LDN Research Trust or your local compounding pharmacist. Sometimes we have those available, as well some of the other things that we use in our compounding lab and compound on literally a daily basis, because low dose naltrexone is used for a lot of inflammation issues, autoimmune, chronic pain.

We can also use low dose naltrexone for some of those other nuanced areas such as traumatic brain injury PTSD, depression, and anxiety; and we've heard from a wide variety of wonderful practitioners during the LDN Research Trust conferences on those specific areas. But when we're able to use other medications in combination with LDN; I don't mean like in the same capsule or in the same liquid, I just mean side-by-side dosing; we can see that oxytocin, especially in a nasal spray, is incredibly helpful to help build that sense of connection, to help alleviate depression and grief, as well as go after some of those imposed pain areas. And oxytocin is one of those medications that is very easy to administer in a nasal spray, even in sublingual drops. But it is very sensitive to heat, so we have to be very careful about what dosage forms we're using. We don't use oral capsules with oxytocin. The stomach acid kind of wipes out its activity. So we need to find alternative forms for that.

But also if you're needing low dose naltrexone for dermatology issues then we can combine it with mast cell stabilizers like ketotin or either other anti-inflammatories, even tranexamic acid, to help decrease some of the redness, in that dermatology issue. And even the autoimmune dermatology products, we're very careful about the bases that we put low dose naltrexone in so that we can control exactly how deep we want that therapy to go. So not every base is going to work, because we really need to individualize that therapy for that condition.
Of course we use low dose naltrexone in a situation with ketamine, which is a non-opiate pain medication as well. And because ketamine works on different receptors than low dose naltrexone we don't see the withdrawal. We actually see the enhancement of that pain control. So there's a a lot of options here.

And lastly, I wanted to address synapsin, which is this wonderful combination of medications. It's a ginseng derivative along with an NAD that again helps to reduce the central inflammation in the brain. And when we use it in a nasal spray, of course that helps with the neural transmission directly to the brain.

As a pharmacist, when a patient is new to low dose naltrexone, or even comes to us because a provider would prefer to use our pharmacy, we emphasize that low dose naltrexone is not a cure-all drug. It actually doesn't really cure anything, but what it does do is it helps to trick the body to work on its own pathways, and much more effectively, and much more efficiently.

So when we set up the expectations, we want patients to know that this isn't like taking something like an aspirin or a Tylenol. It's going to take a little while for this medication to provide full benefit. And we also know that low dose naltrexone isn't for everybody. But when we start low with the dosing and slowly increase, that we can actually see patient outcomes in greater than 50, actually approaching 80 to 90 percent of the time, which as a pharmacist, I've been a pharmacist for over 35 years, I don't recall any other medication providing that high of patient outcome, and that high patient benefit. So we also let patients know that this is a therapy that we're going to start with a low dose, slowly increase over time, and when we find their happy dose, which may be 4.5 milligrams, might be less than that; in some situations we might actually split the dose and take some in the morning and some at night; again completely individualized therapies. We let them know that most respond in about 60 days, so you got to give it some time. And with that I try to emphasize that most of the time, by the time patients are finding low dose naltrexone either through their provider or through the suggestion of their pharmacists or other chat groups, that they have been years into their therapy without great outcomes, without great success. They've used maybe even a wide variety of providers, a wide variety of alternative therapies, and now they're going to give low dose naltrexone a shot. So don't expect everything to just magically go away in a week. That's not going to happen. And in some situations, even when we're dealing with the same disease state - so let's say we're talking about fibromyalgia patients - some respond very quickly, others do take about four to six months to respond. Even with Crohn's disease, we've heard from Dr Leonard Weinstock during the LDN Research Trust conferences, that most of his patients really respond somewhere around the four-month mark. So that is very important, so that we make sure that patients are compliant on their therapies, and that they understand that the pharmacy and the provider will be checking in with them to make sure that they're still doing well, and then if there are any questions, that come up, we can answer those right then and there rather than answering them after they've stopped their therapy.

One thing we've also learned over the years with low dose naltrexone is that often less is more. So increasing the dose frequency beyond twice a day is not necessarily very helpful, and certainly going above maybe even six milligrams isn't usually as effective as lower doses, especially when we're dealing with autoimmune conditions. Now if we're dealing with weight loss, then we then we move into a little bit different realm. But again that therapy is taken once or twice a day, so again it's about treating that individual and making sure that that individual is heard, is listened to, and is able to express their goals so that we can effectively meet those.

And I wanted to throw this in there too, that we had a gal who slowly increased her dose, and when she was at 3 milligrams she felt great. She got up to 3.5, she wasn't feeling as good, and she went up to 4 and she still wasn't feeling very good. So we bumped her back down to 3 and then we slowly increased with 0.1 milligram dosing, which is itty-bitty, but sometimes even that 0.1 milligram makes all the difference in the world. And her happy dose was 3.1 milligrams. So it was great, and that's where she stayed, and she's been at that dose now for a couple of years. We also let patients know that yes, the pharmacy will check in with you periodically, usually around week 3 or 4, but don't wait for us. If something comes up, please get a hold of us, please let us know how we can help you, because we'd much rather answer those questions sooner than later, or have them stop therapy altogether, and really have to start all back at square one. So when we're slowly increasing these doses, we try to make it as easy as possible for the patient to understand. So whether we're dealing with capsules or liquids, we've built these great handouts so that patients understand how to slowly increase their dose without taking literally a handful of capsules at a time. That isn't necessarily the best way to go about it, because then they have to wash it down with a lot of water, and if dosing is at bedtime, that could very much disrupt their sleep because they've got to get up in the middle of the night to use the restroom. So we provide these handouts, and we color code them, because we provide two different strengths in two different colored bottles, and we emphasize that as we are reading from left to right rather than using the columns top to bottom. Then we're going to be able to use a little bit of out of one bottle or the other bottle concurrently as we slowly increase that dose. But we also have liquids that we use, and this liquid starter kit includes a lot more color, mainly because we slowly associate the color with the gradation, and this is actually a twice a day dosing starter kit that we use with a liquid base, because liquids are a lot easier to manipulate and find those doses that are going to be specific to them. Not everybody uses doses that are the same in the morning or at night. Sometimes one end is higher than the other.

Also, using an oil suspension is going to give a longer dating for the patient. Their bottle is going to last longer than 30 days, and that's also very pleasing to the patient, because they're very cost conscious, as they should be, because the majority of the time these medications are out of pocket expenditures. We offer an almond oil base, an olive oil base, or an MCT oil base which is derived from coconut oil. We can splash it with a natural flavor like tangerine, lemon, mint, cinnamon; and then in some situations we might actually add a little natural sweetener like a Stevia. W at this pharmacy really steer away from artificial sweeteners because we find that sometimes that actually increases inflammation, and we're also really careful about the oils that we are using. These are not cosmetic or traditional food-grade, these are bases that are backed by the United States Pharmacopoeia with a national monograph behind those.

We also are really careful about the fillers that we put in our capsules, and we work again with that individual to ensure that we're using a filler that is going to best meet their needs. All of the capsules are immediately released. We do not use any extended-release product, because that does slow down the absorption. A lot of times there's absorption issues to begin with, and certainly if we do extend the release of the naltrexone, we are actually bypassing and negating the science behind how naltrexone actually works at that receptor site. Most of the time we're using a microcrystalline cellulose, but we do have other fillers as well, so again we let them know we try to make this as easy as possible. But if it is at all confusing when the patient goes over their medication, we ask that they call the pharmacy. Let's go over those questions right away to make sure that they are getting the best information for the greatest success possible

So with our patient follow-up programs, we identify those individuals who have recently received their medications, and we kind of look at where they're at in their in their dosing schedule. We give them a call or we send them a text, “Hey we'd like to check in with you. We want to make sure everything is going well”. And we also realize that not all patients are available 9 to 5 when the pharmacy is open. Sometimes we need to schedule conversations outside of business hours, and so we make sure that that is available to a patient so that all of their needs are being met. We check in with them at least once during their first month, but we always reiterate to the patient if something comes up, get a hold of us, and this is how. We have an email option, we have a texting option, and we have a phone call option as well.

We also let them know that as dosing adjustments are being made. sometimes side effects might crop up. and so we let them know exactly what those are. Sometimes it is vivid dreams, but often when we have vivid dreams we know LDN is working, because it's helping us get into that REM sleep cycle. But if those vivid dreams become disturbing or change our sleep patterns, then we want to move the dosing schedule. We also let them know that if there's a little bit of a headache, how to alleviate that, and how long that those side effects might persist, and when they should expect those to go away. And if they're having issues with perhaps constipation, we explain that as well, because sometimes even these very small side effects can allow a patient or cause a patient to back off of their therapy and abruptly stop.

Answering the questions as they come up again are keys to success. This is how we allow our patients to communicate so that we are acknowledging what is going on with them, and they feel heard and understood. Anytime that we can alleviate side effects only allows for a better health program and for greater success, and this is when really their prescriber or their provider becomes the hero in all of this, because they suggested a therapy that is finally working for them, maybe even after years or decades of them searching for a really good way to feel better, perhaps even feel normal.

When we enhance compliance, of course we see better outcomes. When a patient is heard, when they are allowed the time to explain what's going on with them, they take ownership of their own care, and in our experience at our pharmacy, we find that when a patient takes ownership over their care, they're more likely to then be fully engaged and follow other processes or programs that may be in place by the provider. Often that leads to less phone calls to the provider office, less insignificant or issues that could be dealt with over a simple phone call, maybe even less visits to the emergency room mental health, which is always a concern, and especially in the last couple of years with stress and anxiety and depression, we see that even using low dose naltrexone can be beneficial in helping some of those areas where patients may not have been using low dose naltrexone as a primary concern, but they realize that oh my gosh, these other symptoms have disappeared too. And that's always a great benefit. We see increased patient compliance, and always better patient outcomes.

But truly, because low dose naltrexone is such a low-risk, low-side-effect, it's a low dose and honestly, it's a very low cost medication. That safety margin is much better than most commercially available prescription medications. The minimal drug interactions make it a prime candidate for the use of low dose naltrexone in the majority of health concerns and diagnoses, and quite honestly, we have over 30 years of research behind low dose naltrexone. So if you're looking for great science in using a medication that is beneficial for many many people not just in the short term but over decades. This is where we really say, “Why not try low dose naltrexone. It's a fabulous way to really get after some of those chronic issues that maybe will enhance a lifestyle, and be able to allow somebody to cross things off of their bucket list.

So here we are. I want to thank Linda for the opportunity to chat with everyone today and certainly, if there's any questions that I can help with, please let me know. This is my personal email, and these are questions, and my cell, as well as my store phone number. So I'm happy to help. Thanks so much Linda.

Linda Elsegood: Thank you! Any questions or comments you may have, please email me, Linda, at linda@ldnrt.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.

Terry Wingo - LDN Specialist, LDN Radio Show 20 April 2021 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Terry Wingo graduated from Auburn University in 1975 with a bachelor of science in Pharmacy. He has fellowships with the American College of Apothecaries and the American College of Veterinary Pharmacists.

After working in independent community pharmacy settings for ten years, he and his family moved to Madison, Alabama, to become part of Madison Drugs. In 1997, frustrated with the limits of patient benefit in the disease management model, he joined PCCA. In 2000 converted the Pharmacy to a compounding and wellness only practice and has never looked back. Since then, he has added a pharmacist partner, moved the Pharmacy in 2011 from the original 2,000 sf to 6,000 sf in a new development, expanded compounding services, and added other patient-based wellness services such as massage therapy and yoga classes and assisted lymphatic therapy. For many years he has offered classes on wellness topics for patients, nurses, and prescribers. Terry spends his workdays in scheduled wellness consults and believes his purpose is to advocate for patients and serve as a resource for prescribers.
 

Angie Fielden - LDN Specialist, LDN Radio Show (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Angie Fielden is a highly motivated director of marketing for Solutions Pharmacy with 22 years of pharmacy experience. She works alongside Solutions Pharmacy’s team of knowledgeable pharmacists, which currently serve over 20 states. She specializes in marketing, public relations, external business relationships, sales, brand management, Social media marketing, hormone replacement therapy and is an LDN specialist. She is responsible for educating providers on the compounded medications Solutions Pharmacy produces. Angie is a powerful force in the medical industry and uses her positive attitude and tireless energy to encourage others to work hard and never become complacent, which is a personal motto she lives by. Angie’s desire is to help millions of patients achieve a better quality of life. In 2000, Angie formed a society of providers that learned how to prescribe, problem-solve and maintain physiological hormone levels using Bio-Identical Replacement Therapy (BHRT). The providers were located in 5 different countries, but most of them were from the US. This was a growing field during this time and helped to expand Solutions Pharmacy. In 2003 Solutions Pharmacy was mentioned in the back of Suzanne Somer’s books as one of the few compounding pharmacies specializing in compounded BHRT. American Medical Review noted solutions Pharmacy as “A leading expert in bio-identical hormone replacement therapy.” From 2003 to current Angie attends medical conferences regularly to expand her knowledge base about medical issues and compounded medications to help patients achieve a better quality of life. In August 2013, Solutions Pharmacy opened a new location in Ooltewah, TN, a state-of-the-art compounding pharmacy operating as a 503A pharmacy. Angie is inspired daily by God. She loves spending time with her husband Jim, Ryker, their Doberman and the rest of their family.

Pharmacist Masoud Rashidi, LDN Radio Show 24 May 2021 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Pharmacist Masoud Rashidi learned about LDN (Low Dose Naltrexone) at one of Linda Elsegood’s LDN Conferences. He has become very knowledgeable in compounding this remarkable drug. He councils doctors on it’s many applications for their patients. He is experienced in LDN and Ultra LDN, which is used to help patients get off the dangerous opioids they take for chronic pain. He recommends a slow increase in micro grams of LDN while reducing and eventually stopping the opioids. LDN increases our naturally produced opioids and relieves the pain. This was a very informative interview.