LDN Video Interviews and Presentations

 

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/

 

LDN Webinar 18 May 2022 (LDN; low dose naltrexone)

LDN Questions Answered Live by

Pharmacist Dr Masoud Rashidi - LDN Specialist
Dr Sato-Re
Dr Mathewson

Sponsored by Innovative Compounding Pharmacy icpfolsom.com

 

 

Yusuf (JP) Saleeby, MD - LDN to help Long Covid patients; March 2022 (LDN, low dose naltrexone)

A high percentage of Covid patients continue to suffer debilitating symptoms well after the initial infection. This is because of the increased inflammation and reduced autoimmunity. Low Dose Naltrexone (LDN) bolsters and regulates our systems quite effectively. Dr. Saleeby observes many conventional doctors are finally recognizing LDN as a primary treatment for Covid long-haulers, as well as other autoimmune conditions. He cited the Ldnresearchtrust.org site as an invaluable source of information on LDN. He looks forward to Linda Elsegood’s 3rd LDN  Book coming out soon.

Review by Ken Bruce

How LDN is helping Long Covid patients - Dr Yusuf (JP) Saleeby (Trascript)

Linda Elsegood: Today we're joined by Dr Yusuf Saleeby, also known as JP. Thank you for joining us today.

Dr. Saleeby: Hey Linda, it's always a pleasure.

Linda Elsegood: Now, you're going to talk to us today about Covid and Covid long-haulers, so I'll hand it over to you. Thank you.

Dr. Saleeby: Sure. So you know, two years into the pandemic we're seeing still a few cases of acute Covid infections but as of today, and this is the first of March 2022, we are not seeing too many acute cases. But what we are seeing is quite a number of long haulers or long Covid and also post Covid syndrome. It's also referred to as the syndrome of post-acute Covid infection, and the sequelae involved. And we're seeing also some issues with folks who have been vaccinated, some post-vaccine injury, but essentially what's happening is we're seeing a good bit of folks who had can't shake the initial Covid infections. And we've seen cases where a person has been infected two or even three times with different variants.

But the focus in general right now, moving forward, is a large number of folks coming in with the post-Covid infection, and some still suffering from long-haulers. There's a protocol we follow. The FLCCC has a very relevant protocol that's fairly frequently updated based on this new science coming in, and peer-reviewed articles. And that's kind of what we adhere to, with a few modifications. We're a little bit more aggressive with some of the dietary supplements that we prescribe. But essentially, low-dose naltrexone, which was offered as a second or third line agent, has now, in the recent month, been moved up to a primary intervention. So along with things like ivermectin and prednisone and omega-3 fatty acids, which is essentially what's derived from fish oil, and high doses of Vitamin D. The other agent is naltrexone, as in low-dose naltrexone. They're asking folks to begin at one milligram daily and increase to four and a half milligrams in a very short period of time. They are also stating that it's best to have people on this for two to three months to see full effect. So as with some of the other interventions, like they're recommending ivermectin, weight dose dosing, which is 0.2 milligrams per kilogram body weight, until symptoms resolve. Not necessarily for 14 days or one month, but until symptoms resolve.

And the same thing can be said for the use of low-dose naltrexone in my patient base. A lot of my patients actually are on it for a number of reasons, whether they're suffering from Lyme disease or autoimmune disease. So my patients actually have a benefit of being on LDN at the therapeutic dose, whether it's three and a half to four and a half milligrams a day. So they have the benefit of that. And then if they do get Covid, their symptoms are usually quite less. We've not really had but one or two hospitalizations. The stays are usually very short, maybe two to four days, just for high flow oxygen, and then they're discharged home. To my knowledge we've only had one or two patients ventilated during this whole pandemic. So adherence to early treatment, and the implementation of naltrexone as part of that regimen, has been very successful for us. Now our attention is focusing on folks that have long haulers still - brain fog, fatigue, loss of smell and taste, are the predominant ones; hair loss - we're seeing that as part of the syndrome. But it's mostly the fatigue. And so naltrexone is becoming a big part of our protocol for them,

Linda Elsegood: And how open-minded are other physicians to prescribing LDN.

Dr. Saleeby: As you know, it's like a certain segment of the physician population, at least in the United States, I don't know how it is worldwide, but there seems to be a better embracing of the use of low-dose naltrexone than other interventions like ivermectin and hydroxychloroquine, because those two other agents have been politicized a bit, whereas naltrexone has not. But there are certainly other interventions that are embraced by folks that are open-minded to integrative, more holistic, and what we call functional medicine, than the standard mainstream medical doctors, although the FLCCC in truth is actually established by conventional doctors who are open to using early treatment with ivermectin and hydroxychloroquine, Alinia/nitrazoxanide, along with their traditional medications like prednisone, Singulair, some antihistamines Pepcid, things like that that are used in the protocol. But what they've also introduced are things like curcumin, Nigella sativa - which is the extract of black cumin seed oil, a very potent anti-inflammatory; higher doses of Vitamin C, melatonin, probiotics, and H2 and H1 receptor blockers. H1 would be your traditional antihistamines like Benadryl or Zyrtec or Claritin, and your H2 would be things like Pepcid/famotidine.

Some of those other agents - montelukast, which is Singulair, is also prescribed for those with MCAS - that's Mast Cell Activation Syndrome, which is part of the long haulers syndrome. It's where mast cells become destabilized and release a lot of histamine, so you have things like hives and rashes that appear, and some other complications. That's why the antihistamines and the leukotriene inhibitor Singular are used. There are some that will use anti-androgen therapies. There are some studies out of Brazil that showed that that was effective. And statins. I'm not a big fan of either of those two last agents, so I don't prescribe them in protocols for my patients. There's another SSRI (serotonin reuptake inhibitor) called fluvoxamine or brand name Luvox, which has been used, but it's not very well tolerated, so that's one that we have to be super careful with, because a lot of folks don't tolerate it. They have a lot of nausea or psychiatric kind of manifestations.

But LDN obviously is a great agent to use, because number one, it is very well tolerated; number two, it's very inexpensive. And it seems to be working very well. I mean, it was moved up from second and third tier to primary tier or primary agent to use by the FLCCC. And they're heavily research oriented. In other words, they don't make a move in that direction unless it's substantiated by large observational encounters with patients, or peer-reviewed journals.

Linda Elsegood: So, the million dollar question; put you on the hot spot here. What do you think that has done for LDN? Has it leapfrogged it forward far quicker than it would have done previously? And the second part of the question is, what do you think of everything that's been happening with using LDN for the symptoms of fatigue? What's it going to do to people with chronic fatigue syndrome?

Dr. Saleeby: Right. So yeah, I certainly think that the pandemic has elevated LDN to the top of mind for a lot of clinicians, both those that have been using it and were familiar with it to some degree in the realms of integrative and functional medicine, but also to the mainstream doctors who were unaware of LDN previous to the pandemic. Now it's front and center. I mean, it's one of four or five interventions that are considered top tier to use for people recovering from long haulers or post-Covid syndrome. So I think it did leapfrog it, I mean, in the minds of many doctors. To be put top of mind, that's a fantastic thing. That's kind of a good thing that came out of this horrible pandemic, if you will.

And the second question you had was, what about its effects on chronic fatigue. Well I've been using that in chronic fatigue and autoimmune patients and people with MSIDS (Multiple Systemic Infectious Disease Syndrome) or CIRS (Chronic Inflammatory Response Syndrome). Those are all different acronyms for almost the same essential issue. It's a syndrome that involves the immune system and inflammation, and we know that LDN and naltrexone in research is an anti-inflammatory from several different mechanisms. It helps suppress inflammation, and the post-Covid syndrome, and certainly the long haulers, is a problem mostly with inflammation. The virus is long gone. It's already out of our system. Usually 9 to 14 days after you first get infected, the virus has done its bad thing, and it's sort of kind of gone away, and what's left is the sequelae of that, which is lots of inflammation. And that's what actually hurts people. It destroys their lungs and other organs: liver, kidneys, things like that; and affects brain and cognitive issues, and things like that. So one of the interventions used is high doses of curcumin and black cumin seed oil. Those are potent anti-inflammatories. Even those that decide to use statins, they're using it for the anti-inflammatory nature of the statin, like atorvastatin. But then LDN comes in, which has a very safe and effective mechanism of lowering inflammation. I think that's why it's important.

Linda Elsegood: Well let's just hope that, as you say a good thing has come out of this. If we can get more doctors prescribing LDN and finding the benefits that patients have, hopefully they will prescribe it for more conditions. Mental health, autoimmune, cancer, pain, the list goes on. But I think it does make a big difference, the first time a doctor actually can see that LDN has done amazing things for a patient. It gives them the encouragement and the confidence to prescribe it for further patients.

Dr. Saleeby: Right, I think I definitely. And Linda, your website does a phenomenal job in helping me put together a PowerPoint presentation for your organization as well as for upcoming symposium I have. I've gone to your website, which is a great resource, and it lists all the different conditions that LDN is being used for, or would be useful. There’s this long list of conditions, categorized. Pulmonary, neuropsychiatric, cardiovascular. You've done a great job in enumerating all these conditions, and I think it's just a matter of time now for doctors to start embracing that, looking at the literature, looking at the peer-reviewed literature that backs up the use of this agent, a very unusual drug. It's one of my probably top five of my safe and effective drugs that I prescribe, and that's what I would grab. I tell my patients if I had to grab an agent to take with me on a deserted island, one of the top three would be naltrexone for the LDN. It's a powerful drug with a lot of uses, and it's backed up by research. That's the important thing.

Linda Elsegood: Talking about the website, we do update it monthly, so any doctor that tells us of a condition that they treated a patient for with LDN and had good results that's not on our list, we add it. We also add the latest clinical trials and peer-reviewed papers, and LDN in the news, things that have been happening. So we try and make it a one-stop, where a doctor, a researcher, a pharmacist who's looking to do a presentation, just like you were saying, that they can find the information quickly and easily. It's a never-ending job.

Dr. Saleeby: I know it is it's a great thing you offer, and I do send patients to that website in particular when we have a discussion in my office about LDN. I have some material I hand out to them, but I also direct them to the LDN Research Trust website so they can glean a lot of information. It's great resource for them.

And I understand there's a new book coming out, Linda?

Linda Elsegood: Yes, we've got the third LDN Book, which should be coming out in the fall. And we're covering different conditions. Many people have asked if it is the first book updated the third time. No, it's a series of books. So we've got Volume One and Two, now we've got Volume Three. And you put me on the spot to try and think what's in Volume Three. But it's really exciting, and you've written a chapter as well. So I think watch this space, and it will be available in a few months.

Dr. Saleeby: I mean reading Volume One and Volume Two I thought well, maybe that would be just an update, like a second edition. But it wasn't. Some novel things were discussed in Volume Two, and I'm assuming that like you say, Volume Three will be more novel stuff.

Linda Elsegood: The whole idea is to have every volume cover conditions that haven't been covered in the previous books, where we have the latest research, and we will have a section so the latest papers will be referenced at the back. I mean, we have every book, hundreds of references, and of course as time goes on, every year there are more papers coming out, which is fantastic.

The LDN Research Trust has been going over 18 years now, and initially, published papers were slow coming through. But every month there is something somewhere in the world. Somebody's done something, had something published. So it is gathering momentum

Dr. Saleeby: And Linda, I think really, with the last two years of us being in a pandemic, where a lot of focus has been on Covid 19 and what we can do for it with, let's say, off-label use of certain medications, and LDN. That's going to even push more research money towards researching LDN. I'm sure. Now that it's on the protocol,and it's like in the number one section of early interventions for long haulers, I think you'll see probably more and more papers. Actually, it should be exponential, in the number of researchers wanting to take this on and do more research, for sure.

Linda Elsegood: Fingers crossed!

Dr. Saleeby: So Linda, I've got a very interesting case that I saw in my office a few months ago, and this is actually a post-Covid vaccine injury type case. This lady, unbeknownst to her, had an underlying tick-borne infection. She actually had Lyme disease that was activated by the first dose of a Covid vaccine. I'm not going to mention which one it was, but it was a first in a series of two that she received. And within 48 hours of receiving the first dose, and then for the subsequent weekend, to two weeks thereafter, she suffered some neurological conditions that put her in a wheelchair. So this is a woman, and she was in her late 40s, and she was very ambulatory; didn't really claim any health issues. Next thing you know, within a very short period after her first vaccination, she was wheelchair-bound, couldn't walk, and had a very staggering kind of staccato that almost looked like a Parkinsonian kind of gate. It took her literally three minutes to get up out of the wheelchair and walk a few steps across the room to the doorway of my office. Now, we put her on a pretty heavy-duty protocol involving a few off-labeled drugs, but also I rapidly escalated her dose - she was never on LDN - but I placed her on low-dose naltrexone and escalated her dose pretty quickly, because I knew time is of the essence here, and I didn't want her neurological problem to progress. And during that time, it was when we discovered that she had Lyme disease as an underlying etiology, and it was just exacerbated by probably the spike proteins in the MRNA vaccine. We were able to get her rapidly up to 4.5 milligrams, which she tolerated very well. And the second time I saw her, she had transitioned from a wheelchair to a walker. On the third visit, which was a month later, she was using a cane. Now she was able to ambulate without the use of any help like a cane or even family members, but again it was extremely slow with her ambulation, and it looked kind of almost Parkinsonian in nature. Kind of like this leaning forward, kind of unsure, took her a long time to actually turn. But once she initiated the walk, she could carry on her day, and it was a little bit slow. But now I have not seen her back in about a month or two. She should have an appointment with me again soon, but I thought that was a pretty interesting case, where I think I'm pretty sure that the naltrexone had a big part to play.

Linda Elsegood: Well, thank you very much for having shared your experience with us today.

Dr. Saleeby:  Well Linda, it's always a pleasure. Have me back anytime. It's always good seeing you.

Linda Elsegood: Thank you. Any questions or comments you may have please email me, Linda, 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 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.

 

Dr Richard Nahas, LDN Radio Show 2014 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Richard Nahas is an LDN prescriber from Ottawa in Canada specialising in Brain Function and Brain Health.

Dr Nahas practices in Ottawa, Canada at the Seekers Centre. He was an ER doctor for 5 years and in 2004 was involved in dealing with the SARS outbreak. He traveled extensively to other countries to observe the varied medical systems. 

For the past 12 years he has specialized in brain function and brain health. He explains how he does functional brain assessments through QEEG tests combined with observations of other neuropathic complaints. 

He has utilized LDN for a decade, and describes the various ways brain and nerve damage affects our health. This interview touches on Chronic Regional Pain syndrome, Neuroplasticity, and pain thresholds. He explains how pain is related to sleep disorders, inflammation, mood, injuries and diseases.

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

Dr John Kim, LDN Radio Show 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'm joined by Dr. John Kim from Georgia Integrative Medicine Clinic in the US. Thank you for joining us today. 

Dr John Kim: Oh, you're welcome. It's my pleasure and honour to share this wonderful therapeutic known as low dose naltrexone. 

Linda Elsegood: Thank you. So could you tell me your qualifications, please? 

Dr John Kim: I am a physician originally trained in family medicine, then Chinese medicine, integrative medicine, preventive medicine, public health. I think before I went to medical school, I was doing basic science research in biochemistry, and I was a Howard Hughes Medical Research Fellow for pharmacology. 

Linda Elsegood: And when did you first hear about LDN? 

Dr John Kim: So this interesting part is that I have gone through two residencies, two fellowships; including an integrative medicine fellowship with Dr Andrew Weil at the University of Arizona. Those times spent in training I'd not heard of LDN. I did not learn about LDN actually until a patient of mine came to me and said, “Hey, listen, I have a thyroid issue, and I've done this research, and I just can't get a doctor to prescribe me LDN or low dose naltrexone. Would you at least do the research for me? Because you're one of the few doctors that listen to patients. And you have an open mind?” So I said, sure, let me do the research. And when I did the research, I was very surprised by the fact that this has been well-documented and utilized extensively since Dr Bihari’s use in New York, and all evidence seems to indicate very little risk and all possibilities of benefits.

So I told the patient, yeah, sure, let me go ahead and I'll prescribe the medication, and it's going to be a bit of an exploration on both parts. And amazing things began to happen. Not only her thyroid issues began to reverse and over several years not only her thyroid issues reversed, but she conceived and delivered a baby.

And so. That person made me think a lot about the possibility of what else is possible with LDN. Me being a cautious practitioner I had to go very slowly for the next about five, six years; and I would target other patients with thyroid conditions. And I began to see a pattern that I can't do with other medications. Because with all the medications in conventional medicine, we can replace thyroid hormone in different forms, but I don't have a possibility or ability to reverse illness, reverse thyroid disease. We just let it go until it goes into total failure, and you just up the dose. And in this case with LDN, I began to see patients whose doses can be halved, and other patients would basically become drug-free. And then other cases I would see the antibodies related to hypothyroidism lowered in number.

Linda Elsegood: And did any of your patient's experience negative side effects when first starting LDN?

Dr John Kim: In the beginning, none of the people really experienced any of the side effects, but as I began to use LDN more in-depth, I began to see side effects. One of the things I've run into is that typically the LDN low dose naltrexone in the literature is considered between 1.5 and 4.5. But I've noticed that in patients with what I call low endorphin reserve, where a patient has been sick for a long time, patients not feeling well for a long time, their daily activity is compromised; in those patients, I've seen that the 1.5 milligrams can have a paradoxical effect. Patients can not sleep. You tend to create insomnia. And I think that's well documented. In patients with PTSD, the LDN also can cause vivid dreams related to the PTSD; or further, create trauma. And in such cases, I began to experiment with lower doses. So I would begin using 0.5 milligrams or even lower. Now today I start even at 20 micro micrograms, and then I'll do a rapid ramp to get them to 1.5 milligrams. 

Other side effects that I've seen is some nausea. I have patients that could not even tolerate one microgram of low dose naltrexone; they just feel really, really bad and in pain. So again, I think that their endorphin reserve is quite low and they’re not tolerating this dose. 

Linda Elsegood: And you were talking about thyroid conditions. Have you prescribed for other autoimmune conditions now? 

Dr John Kim: Yes. Oh, you know, it's thyroid Hashimoto's thyroiditis. One of the first things that I started treating when I saw the effectiveness of LDN for treating thyroid conditions - I said, Hey, if it works for Hashimoto's thyroiditis and the mechanism is through correction or modulation of our immune system, why not? Why wouldn't it be a shift in theory, work for Graves’ disease? So I began to treat patients with Graves’ disease.

Graves' disease is very interesting because the response to LDN in Graves' disease is maybe somewhat lower than with Hashimoto's thyroiditis. I have several patients who are doing very well, and they are in remission from Graves' disease with using nothing more than low dose naltrexone.

As I can understand the mechanism by which LDN works I decided that maybe we can do more. Again, the literature also helps us. So I began to treat patients with MS and we just got some amazing results, including one patient who is actually in remission from MS. She almost was not able to walk, and now she's climbing Mount Kilimanjaro and travelling all over the world and being able to enjoy a very high quality of life. And then other rheumatological conditions, such as psoriatic arthritis and many, many other conditions. 

One thing that I really noticed is that through my practice I'm beginning to see LDN beyond just what we accept in literature. For example, I have some patients with dementia and Parkinson's disease and LDN I believe has helped to mitigate or slow down, or some cases reverse - not fully - but some effects of dementia and Parkinson's disease.

Linda Elsegood: What about cancer?

Dr John Kim: Cancer is one area that I think - I recently accepted a position with Miami Cancer Institute with the Baptist Health of South Florida, and the reason for that is that in my current private practice, I think that my experience with autoimmune diseases have been extensive and I've seen excellent results with low dose naltrexone for treating autoimmune conditions. But for cancer, to be honest, I just don't have enough patients coming to me who have cancer, and the patients that I've treated with cancer, I am not able to say that it works or doesn't work with cancer.  What I have seen is studies, especially by Dr. Berkson in New Mexico, who is combining the low dose naltrexone and alpha-lipoic acid. So I began doing that as generally part of my treatment of cancer, but I'm looking forward to my new position where I will be able to see more of those patients.

Right now, I have developed a bit of reputation to help patients with autoimmune conditions. I see a lot of patients with autoimmune and different kinds of autoimmune conditions, and that has really helped me to understand the function and utility of LDN for autoimmune diseases. So what's interesting to me is all the cases where I am using LDN may be somewhat different from other people. One of the things that I've utilized LDN for is the gene for insomnia because one of the things that LDN does is to increase REM sleep, decrease sleep disruption; and also enhances people’s ability to fall asleep. And that's one of the reasons I think, unfortunately for the patients with PTSD, that doesn't work as well, because these may get them back to the conditions or memories that are very traumatic because it's very, very vivid. 

The other things that I’m treating are things like tinnitus, migraine, endometriosis, and infertility. What I'm seeing is that LDN has multiple chemical functions. So one is, its modulation of proinflammatory cytokines through the clear cell in the central nervous system. And that's the primary response to invaders if you will, in our central nervous system. And as such LDN is a very valuable tool. 

But in addition, it seems like LDN has other functions, such as it seems to have a very calming effect on the nerves. So LDN can be, I think, used very effectively for treating neuropathies of all different kinds. Also, as I mentioned earlier, it's almost like an adaptogen all by itself, so I often use LDN to treat patients with a mood disorder because having more endorphins seem to make patients respond better to the conventional and nonconventional treatments of depression and anxiety. Because it's kind of hard to feel depressed when you're feeling good, and endorphins give you that edge that feels good. So while you feel good, it's difficult for you to feel either anxious, or feel good and depressed at the same time. 

Linda Elsegood: What do you do with patients that are already on strong opiate painkillers when they come to you? 

Dr John Kim: So those patients are very interesting. About 50% of my practice is treating patients with severe pain using neuro-anatomic techniques, and I don't prescribe any narcotics at all. But we have a good track record of helping patients to get off narcotics, and in this case, we use a phenomenon of low dose naltrexone, utilizing microdose naltrexone, also known as ultra-ultra-low dose naltrexone. And in this case, we use micrograms of naltrexone. Again, as I said, the usual dose that people use of naltrexone is about 1.5 milligram to 4.5 in LDN amounts. But it's very interesting because you can take microgram doses, which is a thousand times less than milligram doses, and there are studies that demonstrate that a microdose of naltrexone results in better pain relief, and it also lessens the side effect.  I have a couple of patients treated with this ultra-low dose of naltrexone, and they’re doing great. Great, great, great response. Because I have chosen not to prescribe for narcotic, they still go to their pain doctor, and the pain doctors are quite pleased because usually if you just give narcotics alone, the doses have to go up, up, up, up, up, and that's when you have overdose phenomena and people get in trouble. But in this case, what happens is that with the combination of the low dose naltrexone and the neuro-anatomic approach to pain that I developed over 20 years, we can actually reeducate their central nervous system and lower the dose of narcotic, while the patient is reporting much-improved pain. Such techniques, actually, I think to warrant a lot of research oncoming because of the obvious problem with the narcotic overdose that is going on in our country. As a matter of fact, there's medication right now that is being studied combining ultra-low-dose naltrexone and narcotic medication. It's not been approved yet, but there'll be interesting how the Oxytrex will work for patients. 

Linda Elsegood: Do you keep them on the ultra-low dose, or do you increase it over time? 

Dr John Kim: As their narcotics amount goes down, then I march it up because, with low dose naltrexone, I think that there is a benefit. I think the key is to start the patients depending on their narcotic history and narcotic use history and their functional assessment of the endorphin reserve status, and then trying to match that clinically. And then generally I march them up. LDN really has been an invaluable partner for me to get my patients well, 

Linda Elsegood: You also mentioned alpha-lipoic acid. What do you use as a protocol? Do you have a general protocol for it?

Dr John Kim: Absolutely. Dr Berkson's protocol of using LDN and alpha-lipoic acid is published; anyone can look it up. I believe that he uses IV though, so I researched more talking to pharmacists, and it seems like that protocol has a side effect that people can pass out. Also, if the GI system is working, I feel like that is the first thing that we should do.

So with alpha-lipoic acid, I generally like to utilize the controlled release form or slow-release form, and that also depends on the person's ability to take alpha-lipoic acid, because if you give 600 milligrams to everybody, some people who are very sensitive to it may pass out or get hypoglycemic symptoms because alpha-lipoic acid can be a powerful agent to lower blood sugar levels in diabetic patients. It also helps with neuropathy. I know that alpha-lipoic acid and LDN are a very powerful combination to reduce inflammation in the nerves. 

And that makes it interesting because most of the medications that we use do not necessarily work well in what we call a high-hydrophilic or -hydrophobic environment. A hydrophobic environment means that it's not easy for charged molecules to enter and do its job. LDN seems like it can penetrate very easily. Alpha-lipoic acid also is fat-soluble, so those two are very important. I believe that Dr Berkson’s protocol for utilizing alpha-lipoic acid may have to do with the function of keeping the blood sugar low, therefore allowing the tumour growth to be inhibited. But I think that again, a lot of studies need to be done. And that's one of the reasons I have accepted this new position in Miami for the Miami Cancer Institute. And I'm hoping that as the director of integrative medicine I will be given permission to explore the possible roles of using low dose naltrexone and other proven therapies in a system-wide manner. 

Linda Elsegood: Do you use vitamin D as well? 

Dr John Kim: Yes, of course, of course, I do use it. If it's low, I do supplement it. It's not a part of my protocol. Part of my protocol for cancer also includes fat-soluble vitamin C, that would be ascorbyl palmitate, because otherwise, you have to go through the vitamin C injections. I think that there are multiple responses you can get from vitamin C. So for example, high doses of vitamin C injections, that's been documented by Dr. Jeanne Drisko in the University of Kansas medical centre - I think that that research shows that the vitamin Cs can help the formation of hydrogen peroxide. And then the hydrogen peroxide goes after the tumour cells. In the dose that I'm using, I don't believe that vitamin C dose is high enough to do that. So it doesn't replace the need for IV vitamin C treatment. But again, it has to do with my current practice setting, that IV therapeutics is not very easy for me at this time. And by using the fat-soluble vitamin C, what I'm doing is overcoming the required amounts that can be taken in by the body.  There are no formal studies that fat-soluble increases the amount yet, but it makes sense to me. I think that fat-soluble forms of therapy can be extremely valuable.

Oh, another example of that is S-Ethyl glutathione where the ethyl group is attached to glutathione. Multiple people have tried to play with the different formulations, but I think that the actual chemical alteration to make the molecule more hydrophobic is probably cost-effective and the best solution for some of the molecules, to encourage them to go where they need to be going to do their job. 

Linda Elsegood: And you were saying that you weren't taught about LDN in medical school. Do you think that's likely to change anytime soon? 

Dr John Kim: I don't think so. I think about integrative medicine and how it is now being discussed, or at least covered more in elite medical schools. So if you look at the distribution of integrative medicine in the United States alone, really it's reserved for what I call first-tier medical schools like Harvard, Vanderbilt, Duke, Yale. But it has not really penetrated a lot of the regular schools with the exception of maybe the University of Arizona, where Dr Andrew Weil started the program. Even there, I think medical students have a lot on their plate. I don't think they get enough about nutrition. I think that the medical education system is arcane. What I would like to see is breaks in mores in residence level, where after doctors graduate medical school, they get trained. That's where the doctors learn to be doctors.

What I've done with my recent book, in some sections, I've even published the patients’ lab results - not patient's identity - but their lab results, so that they can see after treatment with LDN that the TSH would start low, and then the TSH would normalize. T-3 would be high and then it would normalize and then it would also see the antibody levels all responding. 

Linda Elsegood: I understand that there is a medical school in Oregon that actually teaches LDN to the medical students. So that has to be a start, probably. 

Dr John Kim: It has to start somewhere. I think that for me that integrative medicine means working with patients, and that has really helped me to learn about an LDN. The nature of my practice is about 50% dealing with intractable pain. The other 50% is dealing with patients who have complex problems that they really can't get answers on. And what I found is that LDN doesn't cure everything. I think that it's dangerous to say one thing can do everything. Like, if you do LDN, you don't still need to practice good medicine. 

But LDN can be an amazing tool for autoimmune diseases especially. A lot of the tools that we have are not benign tools, or you cannot use steroids forever, you cannot use immunosuppressants forever. And I think that LDN also helps you to understand the nature of the disease. I'll give you an example. I had the longest time thinking why, how can LDN work for HIV? So when I began to read more about HIV, I found out that HIV actually is not strictly an immune deficiency condition. It's really immune derangement, meaning that the immune system is not functioning the way it's supposed to be functioning. So similarly we can postulate, we can guess we can think about cancer. Is it also possible that a cancer patient's immune system is deranged? It's not doing what it's supposed to do?

So in my practice, in the beginning, when people have an autoimmune disease, we would just use LDN. And then inevitably we would have patients for whom LDN isn't good enough. It's not doing the job by itself. So what I have done is more research, more reading, and more talking to other people, and I found out something very fascinating. What I found out is that if you have an autoimmune disease, it makes sense to check the person's autoimmune profile. And what I mean by this is not by doing conventional testing of things like C reactive protein, doing and an ANA check, or ordering an immune profile. And of course, I do that. Part of my assessment is to screen for their developing other autoimmune conditions before placing them on LDN. 

But if the patient does not respond to LDN, I think that sometimes, doing additional testing, either allergy testing to see if there’s an allergy to both respiratory allergens -  things like fungus, trees, grass, as well as food allergens. Both IgE and IgG can make sense, because again, if we're looking at autoimmune diseases as immune derangement, then you're looking for places that immune system is not functioning the normal way. I think the LDN is a powerful tool, but as I said, there are patients who don't respond to LDN alone. 

One patient had a double rheumatoid condition, and LDN alone wasn't doing it, acupuncture wasn't doing it. So what I finally did is testing on the food section, and the patients stopped eating that food; and I used immunotherapy to reteach the body to forget, to let go of the allergens that person had. And the amazing thing happened. Both of her rheumatologic diseases disappeared to the point when she went back to her rheumatologist and said, Oh, we made a mistake. We're sorry. And the patient said, Hey, you mean to say that my lab and my x-ray were all conspiring together? That's unbelievable. That's not likely. I think it's more likely the LDN plus the immunotherapy that Dr Kim asked me to do, is working together. And it's resulting in this remission. 

Linda Elsegood: You've mentioned your book. Would you like to tell us the title of the book and when it will be available? 

Dr John Kim: I'm hoping that the book will be available in December. The press release went out some days ago. The title of the book, I put it as “Understanding Low Dose Naltrexone Therapy” and then its subtitle is “A Cure For All”. I mean the illnesses of cancer, and chronic diseases.  I have to contact my old editor and see if she is available to take the job, because she edited my first book and she did such a great job, so I want to see if she can edit this book as well.

Linda Elsegood: Do you expect that you're going to be moving? Can patients still come and see you before you move, or are you fully booked? 

Dr John Kim: I think patients are still coming to see me, and my understanding is that - when I interviewed with them, they assured me that even though I'll be in the cancer centre and seeing mostly cancer patients, I will not be forbidden to see other patients. I'm really hoping that it will be the case because I feel like the autoimmune approach that I've developed can help patients, and especially patients who are not good candidates for conventional medicine in terms of long term steroid use, or the immunotherapy itself can be very harsh to some patients. So I'm hoping that I would be allowed to do that. 

And the other part is that I have this idea that some forms of cancer may involve the host, the patients. Developing all that I said about the immune derangement, that maybe their immune system is obsessing over something else, maybe food allergens; or they have an undiagnosed autoimmune condition. I've seen that once you develop cancer, you stop looking because cancer is such a deadly condition, you want to zone in on that. What I'm hoping to do is be allowed to do other observations, observe their autoimmune conditions. It can be more formal in terms of formal research, or it can be just the clinicians’ observations.  

I  remember a long time ago in London, the cholera epidemic was controlled by a Mr Snow or Dr Snow, that did not know the mechanism. He just used epidemiology to isolate the wells that were likely to be responsible for cholera. He didn't know the exact mechanism, but all he had to do is shut down those wells, the old water pumps, and then he was able to help. The field of medicine relies on collaboration and cooperation, and that's part of the reason I've accepted the position in Miami. But I think there's still room for one person to make an

observation, then through communication through books or through organizations like your organization, to reach out and ask these questions that no one else has asked. 

Linda Elsegood: Thank you. And thank you very much for your time, and sharing your experience. 

Dr John Kim: Thank you for the opportunity.

 

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.

Vera - US: Dermatomyositis, Microscopic Colitis (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Vera takes low dose naltrexone (LDN) primarily for dermatomyositis which appeared at 30 years old after her first child was born; and secondarily for microscopic colitis, which appeared after her second child was born. She rated her quality of life at 5.

Once on LDN she noted improved mood and energy, and by the third week she noted the rash started calming down, as well as her colitis. Now she rates her quality of life at a 9 or 10.

Listen to the video for the full story.

Any questions or comments you may have, please contact us at contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today.

Tracey - US: Multiple Conditions (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Tracey started to feel unwell around 1989 when she was only 26 years old. She had joint pains and swelling and was then diagnosed with fibromyalgia. She struggled on with various prescription medications until she was 40 and then she couldn’t work anymore. Other health issues had started to appear; Chronic Fatigue Syndrome, Hashimoto’s, Depression, Essential Tremors and Anxiety and she was tested for Multiple Sclerosis which came back negative. Tremors started in her hands and the medications were harsh with side effects and she finally had to finish work as she was now disabled.  

In 2015 Tracey heard about Low Dose Naltrexone (LDN) from her support groups and eventually talked her rheumatologist into prescribing it. Tracey first noticed good things happening a week after starting Low Dose Naltrexone, she felt she had more energy, she didn’t need to sleep all the time.  By week three the brain fog started lifting and she felt he could have a decent conversation again without forgetting what she was saying. She started to clean and organise the house, she no longer needed pain medication every day. 

Low dose naltrexone gave Tracey her life back after years of suffering.  

Dr Yusuf (JP) Saleeby, LDN Radio Show 08 Feb 2017 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Thank you for joining us today, Dr Saleeby. 

Dr Yusuf Saleeby: It's very good to be here, Linda. 

Linda Elsegood: Wonderful. I wonder if you could tell us first of all, about yourself and how you got interested in medicine. 

Dr Yusuf Saleeby: Well, that started at a very young age, while I was living in Beirut Lebanon. I was very close to the AUB hospital. My father worked for a pharmaceutical company, so I always had an interest in medicine and science. And then I had a very pivotal moment in high school with a fantastic biology botany teacher who got me really ramped up about the sciences and about biochemistry and botany and biology.

And all through high school and undergraduate I always had my eyes on medicine. At the time I was in Atlanta, Georgia and went to premed at Georgia Tech, Georgia State University, then onto medical school in Augusta, and I did my postgraduate training up in North Carolina and then kind of settled into the Southeast, covering the Carolinas and Georgia. Mostly the first part of my career was in emergency medicine. So I had a very traditional conventional medicine career as an ER doctor. 

Linda Elsegood: Okay. So how did you get involved in therapies such as LDN? 

Dr Yusuf Saleeby: Well, in my 20 plus years in the emergency room, I saw on a daily basis, the ravages of chronic disease, a lot of which I perceived as being completely preventable. And so during my last 16 years in the emergency room, I sort of developed a curriculum to learn about what I could possibly do for patients before they reach that end-stage of chronic disease, whether it's cancer, congestive heart failure, autoimmune diseases.

It was terrible. It was depressing seeing these folks come into the emergency room. So for 16 years, I developed a curriculum where I looked at other options outside of allopathic medicine, in the integrative field and functional medicine. So I kind of built on that, with members of different organizations and going to different conferences, I kind of developed a passion for functional and integrative medicine. And that's what I've totally dedicated the latter part of my career to. I retired from emergency medicine five years ago, and I do strictly functional medicine now. 

Linda Elsegood: And how long would you say you've been prescribing LDN? 

Dr Yusuf Saleeby: Well, I've read about it peripherally, heard of it in some of the conferences I attended, but nothing until about three or four years ago, when a patient of mine who was suffering from Hashimoto's brought it to my attention and passed along a big stack of papers that she acquired doing research online.

So I've also learned from my patients. I'm never afraid to learn information from my patients. So I decided this was interesting enough for me to go after and learn more about it. A good friend of mine a couple of years ago - he's a PharmD, a pharmacist,  and does some research in North Carolina. I attended last year's conference in Orlando and came back with a wealth of information, and he was very excited. So that actually ramped up my prescribing. I dabbled in it for a couple of years, but then as about a year ago I started writing heavily for LDN and implementing it in some of the programs and protocols that I have established for my patients, especially with Lyme disease.

Linda Elsegood: And you were telling us before we came on air, where you practice from, and you're going to have a new centre soon. Would you like to tell us about that? 

Dr Yusuf Saleeby: Sure. So my first centre - I'm kind of headquartered in a little coastal town just North of Charleston, South Carolina - it’s called Murrells Inlet, and we opened up a second satellite office in the Raleigh-Durham area of North Carolina. That was about two years ago. And last year we opened a small satellite office in Charleston, South Carolina, a little area called Mt Pleasant. 

I was approached by another holistic provider and also a licensed acupuncturist and TCN specialist about a year ago about collaborating on an effort in Savannah, Georgia. So I'm happy to announce that in March of this year we'll open up another office in collaboration with another integrative healer for functional medicine practice. 

Linda Elsegood: Could you tell me what's the satellite centre? 

Dr Yusuf Saleeby: Well, we say satellite office - it's a smaller office, kind of a micro office. We don't have a large space nor do we have a large number of staff. It's actually a very personalized one-on-one, and it allows us to actually go to where the needs are. I find that with my practice I was getting referrals from all over the Carolinas because I'm one of the very few practitioners in ILADS members. So I had to kind of position myself to where a lot of patients were coming from, to make it more convenient for them. 

Linda Elsegood: Talking about Lyme disease, how many Lyme disease patients do you think you've seen in the last five years? Has the number increased? 

Dr Yusuf Saleeby: Hundreds. I think because it's been over-politicized and it's very difficult to make a diagnosis, I think there's a lot of misinformation and misunderstanding about Lyme disease. And I think a lot of people just don't get diagnosed. 

The CDC is saying within the last two years that the numbers are around 300,000 new cases in America alone. That was up from about 30,000 prior to 2013. So there's obviously some issues with their counting new cases, but ILADS estimates that there's anywhere between 800,000 to a million new cases of Lyme disease each year in America. Worldwide it’s much higher. That's pretty significant. 

So now with more recognition, there are the folks wearing green ribbons for Lyme awareness, there are people marching on Washington and Capitol Hill, and lobbyists trying to fix the wrongs that have been for so long with regards to diagnosis and treatment of Lyme disease. There's not even an ICD-10 code, which is a coding system we use to record a diagnosis for submitting claims to insurance companies. There's not even one for chronic Lyme disease. It's really quite a shame. And a lot of people have suffered for protracted periods of time. 

But with all this Lyme awareness, the floodgates have opened, and it's less politicized. The medical boards historically have gone after doctors who have practised on the fringe if you will, and taken on these patients, and have been reprimanded by medical boards. It still happens a little bit, but that's going away too. So now doctors are less fearful of losing their license and are able to treat and practice and take care of Lyme patients.

So to answer your question, hundreds and probably if it's exponential now. Three years ago, I'd get one or two patients a month. This week I've made three diagnoses of new cases of Lyme just this week. 

Linda Elsegood: Goodness. I know it's very tricky to get diagnosed. There are people that are telling us regularly. We have many, many, many members with Lyme disease, but they had such a hard time getting the diagnosis. If anyone is listening and they suspect they've got Lyme disease, how do they get a diagnosis? Who do they go to? Who do they turn to? 

Dr Yusuf Saleeby: Some resources, at least in the United States, and I know internationally, there are other resources, but in the United States, one of the premier organizations that advocates for Lyme awareness and also does some training to train doctors to be what they refer to with LLMD, which means Lyme literate medical doctors, doctors who are familiar with the caveats and the intricacies and the limitations of our testing. And can actually make a correct diagnosis. And then after that, correctly treat people, to put them in remission. I don't know that you can actually say there's a cure for Lyme disease if it's caught in the chronic stages, but you can certainly put it in remission so that people can regain a fairly normal life.

There are some that have flare-ups from time to time. So the organization that offers a lot of information and good information that's evidence-based and that's reputable, is an organization called ILADS. ILADS.org would be the website. And if you go to that website, there are the sections for some videos for patients to watch and there are videos by Dr Horowitz, a prominent doctor in the field of Lyme treatment. There's also a video by dr. Shor, who's the new incoming president of the organization. And there are some other video documentaries. Under Our Skin is a documentary that was filmed about 10 or 12 years ago. And that's a very good immersion for the average person to get a little exposure to what is involved with Lyme disease.

Linda Elsegood: How do you go about diagnosing somebody with Lyme disease? 

Dr Yusuf Saleeby: Well, it's a little tricky. There are no good direct tests for Lyme. It's difficult or impossible to culture out. So historically the Center for Disease Control has set up a one-two punch, if you will, on diagnosing. They used the Elisa test followed by a confirmatory Western Blot for a line for borrelia. However, that works great for the diagnosis and confirmation of HIV infections, but really falters when we talk about hunting down and detecting the spirochete that causes Lyme disease. The Elisa I don't even do in my practice. It is a worthless test. The Western Blot can miss up to 50 or 52% of positive cases. So we rely on other more sophisticated Western Blot technology tests that look at different bands in different species, not just one single species of borrelia. It's estimated there are about a hundred. 

And then there are other surrogate markers that we look at. Usually, if it's a chronic case of Lyme, people have immune dysfunction or a weakened immune system, and we can look at a particular type of T-cell or lymphocyte called a CD57. The CD57 test is a marker for the health and wellbeing of your T lymphocyte cells, and I use that in my practice to kind of help make the diagnosis, along with monitoring the therapy. So every three months or so we'll draw another, and hopefully, we see that number rising. The normal range is between 30 and about 300 for most reference labs. And I have seen patients coming in with numbers well under a 60. This week I had a patient with a level of 19 who was severely impaired and debilitated. So that is one tool we use. 

There is a relatively new test, that's a direct test called the Nanotrap LA - LA for line antigen. That's a direct test. In other words, it measures directly the antigens, which is independent of your body's ability to produce antibodies, which is where the Western blot falls short. So the Nanotrap LA iS a relatively new test, and it takes two large samples of urine to run. And I've had some success with ironing out a diagnosis based on this new test. 

I also use the Horwitz questionnaire. Dr Horowitz developed a fairly lengthy questionnaire that is a good diagnostic tool. An analogy would be the diagnosis of a headache. So you can have a normal spinal tap. You can have a normal CT or MRI, but a person still has a headache, even though there's no physical finding or test other than their subjective complaint. So in a way, a diagnosis of Lyme disease can sometimes be a kind of a subjective clinical diagnosis that confounds the testing for it. So the Horwitz questionnaire is something I use in my clinic all the time, along with some symptom scores, like the SSS-8 symptom questionnaire, and the FACIT questionnaire, which is for fatigue. So it gives me a way to quantify and put a number on their complaints. Instead of somebody saying they’re just tired or fatigued, I can put a number and then watch that number improve or not based on our therapies.

Linda Elsegood: How does one catch Lyme disease? 

Dr Yusuf Saleeby: Well, historically Lyme, of course, was named after the town in Connecticut where it was supposedly first discovered by a concerned mother who prompted the local health department to get the CDC to come up and figure out what was making all the kids in the neighbourhood sick. So it was named after the town. It was associated with a deer kick. We know now that there are other ways besides getting bitten by a deer tick that can transmit Lyme. There are researchers in Europe, the Netherlands in particular, who believe that the flea and the mosquito might also transmit Lyme.

And there are co-infections too, like the Babesia, Bartonella, Ehrlichia - there are about a dozen or so other co-infections that the tick can actually carry, so one bite from a tick can actually infect people with more than just one infectious organism. 

The other ways you can get Lyme is congenitally through the placenta. We do know, and it's been confirmed, that Lyme disease can cross the placenta and you get a newborn who can have Lyme disease because mother had it. And also we're finding out that very likely it is sexually transmitted. So you have partners who are sexually active who can actually transmit that spirochete from one to the other.

Again, there's a lot of research going on, mostly in Europe. Our research dollar is not very strong here in the United States because of the politics behind the diagnosis of chronic Lyme disease. And that's very unfortunate. So the researchers in Germany and the Netherlands have sort of taken it to the forefront of a lot of really good research.  

Linda Elsegood: Well, we will just have a quick break, and then we'll come back, and we'll discuss this further. To listen to individual radio shows and interviews, go to www.Mixcloud.com/LDNRT. Today's show sponsor is CareFirst Speciality Pharmacy. They are leading compounders of LDN and other custom treatments, servicing patients in over 18 states, coast to coast. They're widely accredited to provide you with the highest quality demanded by the industry, and the expert service you expect. To learn more, call (844) 822-7379, or visit www.cfspharmacy.pharmacy. Thank you. 

Welcome back. It's very interesting talking about Lyme disease, and I know many people will find this very interesting. You talked about it being sexually transmitted. If you think that you've caught Lyme disease from your partner, what is the first thing you should do? 

Dr Yusuf Saleeby: Well, first of all, Lyme disease infection is the chameleon of infectious diseases. In the 17th, 18th century it may have been syphilis - in other words, it had different manifestations. And then I think the baton was probably passed to HIV.

So with HIV/AIDS patients, you had a plethora of symptomatology and presentations. And I would say today that baton has again been passed to Lyme disease. So Lyme disease can affect many, many things. It can affect the skin; you have dermatological manifestations. It can affect the heart - I actually lost a patient in the ER about 15 years ago, and that's what really sparked my interest in Lyme disease. She had a bullseye lesion, and she had complete heart block and died two days after she presented to the emergency room. I always remember that case in particular. The other manifestations are neuropsychiatric, and that's a big one because a lot of people when they get infected with the Borrelia species, will instantly have that organism burrow into their neural tissue, so they present with things like MS - Multiple Sclerosis, with plaquing around their brains and spinal cord. They will present with ALS type symptoms or Parkinson like symptoms or severe depression or bipolar or even schizophrenia. And unfortunately, years can go by before the correct diagnosis is made, and these poor souls will get put on all kinds of psychotropic medications, which often don't work.

They kind of maybe mask the symptoms, or are very minimally effective until such time as they're diagnosed with Lyme; and then the appropriate therapies are rendered and then their situation improves, the plaques go away. So their MS improves and their gait comes back, or their vision comes back. They stop acting crazy. The schizophrenia seems to just melt away, and they come off of their typical poly-pharmacy where they present on multiple medications - that can go away too. Once we get their Lyme disease in remission their symptoms clear up, we can pull them off of all their antipsychotic medication and antidepressants. So when one suspects it based on a plethora of weird symptoms that haven't been diagnosed, where conventional doctors can't come up with a reason for it, it's time to get checked out.

Linda Elsegood: I know after speaking to many patients with Lyme disease, there seems to be a wide range of treatments available. What do you normally have as a protocol, or does it vary from patient to patient? 

Dr Yusuf Saleeby: Well, I believe in very personalized healthcare. So almost every one of my Lyme patients doesn't get a cookie-cutter sort of prescription. I do align myself with the ILADS protocols and some that have been developed by Dr Horowitz and others, although I also embrace some protocols developed by Dr Cowden and Dr Buner, which utilize less of high potency antibiotics, synthetics, and more into some natural anti-microbial and immune-enhancing herbals and supplements.

And that's the big thing - immune enhancement. So all the heavy lifting that the body does to fight an infection, whether it's Lyme disease or anything else, is done by our immune system, our innate and humoral immune system. 90% of it is done by a healthy immune system. The additional five or 10% can be done and accomplished by antibiotics or herbals.

So my sort of philosophy as a functional medicine doctor is to get the immune system back in its optimum health so that it can be healthy enough to fight off and suppress the Borrelia microbes. That is not necessarily the philosophy of conventional doctors who like to blast away with high doses of antibiotics for protracted periods of time, leading to other issues like dysbiosis and overgrowth in the gut microbiome and things like that.

So LDN has found its way into my practice as an adjunct therapy for many of my Lyme patients, because I know it bolsters the immune system. I don't know how many of the people listening today know what and how LDN works, but obviously this drug has been around since 1963, I believe it was created, and FDA approved since the mid-1980s. And this compound binds to certain opiate receptors, the mu kappa and delta. Receptors. But it's the mu receptors where its usefulness was first recognized in treating people with opiate addictions, and then later alcoholism. But I guess doctors were finding people returning to their clinics for refills on this higher dose of naltrexone that had some of their symptoms and signs of other chronic illnesses dissipate or disappear. And so there were some researchers like Dr Bernard Bihari who noticed this and some researchers in Europe who said, well, let's look at lower doses because what lower doses of naltrexone do is they actually can upregulate certain opioid receptors. So there's this something called opiate growth factor and opiate growth factor receptor, which when upregulated actually has a very positive effect on the immune system on what they call T helper cells - T_h1 which is your cells that actually gobble up bad bacteria and viruses. And then also has an effect on the T_h2 cells, which are the ones that produce antibodies. So I'm using LDN aggressively in my Lyme patients who show up with the CD57, which is a surrogate marker for the health of their B cells or their antibody-producing cells.

And I'm using the LDN in conjunction with other therapies, to enhance it. I'm finding on a regular basis people who come in with subtherapeutic CD57 counts are returning to my clinic, even in one to three months, with a marked improvement. And then, of course, that correlates with a marked improvement in their overall health because now their immune system is healthy. Their T_h1 and T_h2 cells are reactivated. They're healthy, they're more focused and directing the battle against these invading spirochetes, these microbes, and there's less need for the use of really high doses and protracted courses of antibiotics, 

Linda Elsegood: Having fewer antibiotics has got to be good, hasn't it? I wonder if I could just ask you to answer a few questions and then we'll come back to Lyme disease. We have a question from Kim, and she says, does LDN directly or indirectly affect dopamine levels? I know it increases endorphins. 

Dr Yusuf Saleeby: Right. So Kim, yes the LDN can enhance dopamine. It does enhance endorphins and enkephalins just because of the nature of how it works on certain receptors. I think I previously mentioned OGF are receptors on the surface of cells, and that can actually lead to enhancement of the cells to fight off cancer, especially on the lymphocytes, on the immune system cells. But LDN actually plays a pretty big role in something called PONC, which stands for pro-opiomelanocortin. That's a mouthful. It's actually a big fat protein, a precursor to ACTH, which stimulates the adrenal glands. So you get your DHEA and cortisol amongst others. And also POMC is a precursor to the endorphins and enkephalins. So when you stimulate that system with LDN it binds and has a very positive effect on the release and production of endorphins and enkephalins, and also on the HPA axis, which encompasses your adrenal glands and also some neurotransmitters in the brain and even in the gut.

Linda Elsegood: That's a really good answer. Thank you. So thank you for your question there, Kim. We have another question here from Donna. She says, “I'm a CRPS patient with autoimmune disease, mixed connective tissue disease. I've been in remission. CRPS is extremely painful, and I started at 1.5 LDN two months ago. I've been at 4.5 for a month. I was taking it at midday. Dr Bihari said to take it at night, and so far it hasn't worked. My pain management doctor thinks it's a wonder drug. Do you have any suggestions?” 

Dr Yusuf Saleeby: Well, you know, in all, honestly, there's no magic bullet. There's no panacea for everything. I've seen LDN work very, very nicely and very well for folks. And then there are some people who don't tolerate it very well. Sometimes in dosing, I am very conservative, and my protocol is to start out low and go slow. I sometimes start out with one or two milligrams and then slowly, every month titrate up, and sometimes cap at around four and a half milligrams, although I do find that sometimes a lower dose actually works better than a higher dose of. For instance, I had a patient that did marvellously at two, and then as we started to escalate the dose, we hit three, three and a half, four. She didn't do so well so we backed down to two, and she did fine.

With Hashimoto's patients, I found that starting even lower is better, at maybe a half a milligram. I've had some mixed feelings about LDNs place with Hashimoto's in that I've seen PPO titers actually climb once people have been on it. 

But I think there are other factors involved. Some of it is genomics. There is a genetic mutation or variant of a particular gene that actually enhances the ability of this drug to work on people. So what I'm going to be doing in my practice is checking people's genomic profiles for their ability to tolerate naltrexone, and also if it's an effective therapy. So sometimes we can not just do trial and error on a patient, but actually look at their genomic profile and predict whether naltrexone is going to work better for you.

I have had complaints of things like headache, insomnia, feeling wired up, some nausea, and on occasion, some Herxheimer reactions, what some would call a healing crisis. A Herxheimer reaction is when there's a big die-off of Lyme bugs, people get feverish, chills, achy, and that's called a Herxheimer reaction. So, occasionally we have some of that going on when we have folks on LDN, and it's just a matter of titrating the dose up or down or sometimes discontinuing it for a while and making sure that it's not some other factor that's getting in the way and kind of falsely blaming LDN.

Linda Elsegood: Okay. I hope that answers Donna’s question. Then we have another one which fits in nicely with what you were saying. I don't know who it is, but they said, “I've been told by my doctor today that I'm now hypothyroid. I had a blood test yesterday. The last blood test in November 2016 showed that I was borderline as other tests done earlier in 2016. I've been taking 1.5 of LDN since April and had expected my thyroid levels to improve, but the opposite seems to happen. Do you have any idea why?”

Dr Yusuf Saleeby: Well, I have one question for clarification. Are they saying they are hyper or hypo?

Linda Elsegood: Hypothyroid. 

Dr Yusuf Saleeby:  So first of all, there may be other factors. One, we have to establish that they may have an autoimmune disorder, like Hashimoto's. So along with their thyroid function tests, they would need to determine their TPL, their thyroid peroxidase titers, and the thyroglobulin antibody titers. And if it's a hyper going to hypo like Graves' disease - you can cross over from hyper to hypo - the TSI test, the thyroid-stimulating immunoglobulins - might be helpful. So we have to quantify the type of thyroid disorder that patient has and not just throw LDN discriminately at them because there may be other things in place. There could be a selenium deficiency, an iodine deficiency, there could be a conversion problem where people are not converting the T-4 thyroid hormone to the T-3 active. They may be converting to their lazy brother if you will call the reverse T three. I used the analogy of their “lazy brother “ if you will, that sits at the dining room table, eats all the food and doesn't do the dishes. It's not something you want to have a lot of around, so one has to check for that because if they're feeling worse, subjectively, that must mean that there's something going on with their thyroid that maybe the LDN is not addressing. So if it's a Graves' disease or Hashimoto's thing, you would tend to think that the LDN would have a big part to play in that. But if it's another issue, there may be other therapies. 

It could be what type of thyroid replacement therapy you're on. If we're using Armour that might be a problem. If we're using Synthroid, which is T-4 only, that patient could actually be converting too much of the T-4 to reverse T-3, instead of T3. It could be a methylation problem, so methylation pathway analysis, looking at their genomics, looking at methylation testing panels to see where they're metabolizing things. Maybe the introduction of select adaptogen herbs can help with T-4 to T-3 conversion, and blocking down things like reverse T-3. Also, deficiencies and some of the B vitamins and also vitamin D. Vitamin D deficiency can lead to a problem with conversion and reverse T-3 being escalated or high.

So just because the LDN is not working, it could be that it's possibly the wrong therapy for you. Or again there could be many issues that need to be investigated. 

Linda Elsegood: Thank you. And the next question runs into the last really. Dana sent this question in and the question says, “I was diagnosed with Hashimoto's and AE. I was taking Synthroid for seven and a half years. And the current dose was 112 micrograms In March last year, I was diagnosed with AE, and I started the IV steroid protocol, which is very effective. I didn't believe the diagnosis and didn't think steroids were the best course of treatment. I saw a functional medicine doctor who ran tests and couldn't find any other cause for my symptoms. He prescribed LDN, but I didn't start it. The main reason was that the steroids really work to stop the symptoms I was having. My husband was concerned for me to try anything else as everything read suggested that untreated AE could result in seizures, coma, or death. I went to the Mayo clinic last year. The diagnosis was confirmed, and IV steroid treatment protocol was prescribed. It was very effective and mostly eliminated all of my symptoms. She's been taking a thousand milligrams of Solu-Medrol every three weeks, reducing every four weeks. The treatment will stop in mid-June. Steroids have cut my thyroid antibodies in half. And the last time I went to see the endocrinologist, I told him I felt my thyroid was becoming overactive and suggested that my Synthroid be reduced. He said the numbers looked good and he wasn't alarmed. It was possible the symptoms I was having were side effects from steroids: heart palpitations, sweating and sleep disorders. I started reading on LDN and see that many people are able to get completely off Synthroid after starting LDN. My question is, should I wait for the steroid treatment to be over before starting LDN? I stopped taking Synthroid last week because my heart rate was getting a hundred some days, and it would skyrocket with any activity at all. Normal for me is 55. The script I have is 1.5 milligrams, and I've read that people with Hashimoto’s should start very slow, very low. Any directions you could provide would be appreciated.”

Dr Yusuf Saleeby: That was quite a question. So a couple of things to address, first of all, steroid therapy. The Solu-Medrol, which is a potent corticosteroid, is downstream treatment. In other words, it is treating the symptoms of the underlying cause of the autoimmune disease and the other issues she has, and yes, while it is effective - we do use steroids in short bursts for symptom relief - you are not really addressing the underlying cause. There's no way to ever reverse what's going on with steroid therapy. It'll basically mask symptoms. It's like a paint job on a rusted car. You're still going to have rust underneath the paint unless you do do a full rehabilitation of a car. So by just masking it over, just by slapping paint over the top, it might look shiny and bright for a while, but it still has rust underneath. 

A same analogy for upstream. You have to use a functional medicine doctor to make a diagnosis of an upstream root cause reason for your symptoms or your disorders. I don't really care what you call it. You can call it lupus. You can call it MS. You can call it ALS. You can call it Hashimoto's. Essentially from a functional medicine perspective, autoimmune diseases are the same downstream. They may just affect different body organs or systems, but the root cause can be just a handful of things that can trigger this. An infectious disease, genetics, heavy metals,  overgrowth or dysbiosis of the gut microbiome.

So some very rudimentary, very basic things can actually trigger off the cascade that winds up as an autoimmune disease of different natures, of different flavours, if you will. So the steroid therapy is basically masking your symptoms. Yeah, you're going to feel better, but it can also lead to euphoria. It can lead to bone loss. It can lead to thin skin Cushingoid like fat retention and certainly you don't want it. And there are some very detrimental side effects from long-term steroid therapy. So is my advice to my patients to try to limit the amount and length of time they're on steroids and really find the root cause and address root cause issues for your autoimmune disorders and never try to let it go so long that it really becomes a debilitating disorder. 

So hopefully that answered some questions. There was a lot to that question, but I think she would be very well served by having a functional medicine doctor to look at her, and analyze her for antecedents, mediators, and triggers, uh, through what we call the timeline and the matrix, which tools we use in functional medicine to help our patients.

Linda Elsegood: Thank you. We'll just have a quick break, and then we'll come back with some Lyme disease questions for you. Thank you. The LDN Research Trust has an LDN Vimeo channel. I have interviewed over 550 LDN prescribers, researchers, pharmacists, and patients from around the world. For many conditions, you can find the link from the LDN Research Trust website. If you'd like to be interviewed, sharing your experience, please Contact Us. I look forward to hearing from you.

Today's show sponsor is CareFirst Speciality Pharmacy. They are leading compounders of LDN and other custom treatments, servicing patients in over 18 states, coast to coast. They're widely accredited to provide you with the highest quality demanded by the industry, and the expert service you expect. To learn more, call (844) 822-7379, or visit www.cfspharmacy.pharmacy. 

Welcome back. We have a question from Chris, and he says he has Lyme disease and co-infections and does LDN work from 0.5 to 5 milligrams a day with Suboxone? He takes that at four milligrams a day. 

Dr Yusuf Saleeby: So he's on Suboxone as well as the LDN? I have very little, um, experience with the concomitant use of naltrexone and Suboxone. The mechanism of action is slightly different when we're dealing with opiate addiction. We're looking at a blockade of the mu and kappa receptors, and maybe to a lesser extent, the delta-opioid receptors. But when we talk about the use of LDN to treat Lyme disease, we don't want any interruptions or anything in the background to impede its ability to work. And it does work differently. Again, the lower dose works much more effectively on the OR receptors and what they call the toll-like receptors or TLR4s, in exacting their effect on the immune system. 

I don't have any patients in my practice that are on Suboxone. I usually wash out those kinds of drugs at the onset when I see folks. I try to take them off as many of the toxic drugs. I have very, very few patients who are taking any type of opiate, centrally acting medications. We get them off that fairly emergently so that we can open up the field of our herbals and some of our selected shortlist of good meds, if you will, to help them with their conditions. So I'm sorry, I don't really have a good answer about the interactions between Suboxone and LDN. 

Linda Elsegood: Okay. That was still a good answer. And we have a question from Kathy, who has got Lyme disease co-infections and chronic fatigue. Now she's rather concerned. She's going to go and have some allergy testing, and for food allergies as well. And she says, should she stop LDM prior to the testing? She says I ask because since taking LDN, her allergy reactions and sensitivity to food has much reduced. She's very glad about that, but she doesn't want it to affect the testing she's about to have. She wants it to be accurate. What should she do?

Dr Yusuf Saleeby: Oh, it sounds like she is looking for a big reaction for the food allergies. If she's looking to get the maximum reaction and she's found through her personal experience that while on LDN it has suppressed her allergic reaction to foods, that's probably by a mechanism of LDNs effect on the and also the T_h2 and also the T_h17, which has to do with allergy and autoimmune.

So if she stops the LDN and waits for a washout period, she could pretty much realize a stronger reaction to the food testing or the skin prick testing, if they're doing topical testing for allergies for pollen and environmental allergens. But what's the point? Is she trying to look for a bigger reaction, or is she trying to take something to help with her symptoms? So if she's trying to figure out what maybe are the offending foods or environmental allergens, yes, stop it for a bit to see if it would cause a more severe reaction. But again, she's throwing her T_h2 or T_h17, the T helper cells into chaos again. Because obviously there's something going on that's causing her to have these environmental allergens, whether it's the methylation problem, a vitamin deficiency, toxic heavy metal, an infectious organism, a smouldering infection causing her to be hyperactive. It could be her gut microbiome. She could have an obliterated crazy,  unbalanced gut microbiome that needs to be put in balance to avoid leaky gut and gastric permeability, which can lead to food allergies. So skin testing is a way to determine some of these things.

In my practice I don't do so much of the testing like IgG testing or skin testing for allergies, as I do more of an elimination diet. It's a less expensive, more comfortable way, in my opinion, to do things. And you can isolate certain foods that are problematic and eliminate them, try to eliminate them for a period of time where the antibody titers diminish, and you don't mount a response to these foods any longer. It's you sort of becoming desensitized if you will, to it. And when you are exposed to these antigens again, they don't necessarily cause the same kind of chaos or reaction. 

Linda Elsegood: One last question. Jack says that he's taking LDN and high doses of vitamin D and his question is, does LDN change the laboratory results of PTH in any way?

Dr Yusuf Saleeby: Parathyroid hormone, PTH? 

Linda Elsegood: He doesn't say what PTH stands for. 

Dr Yusuf Saleeby: Well, I'm going to assume that it's parathyroid hormone since he was talking about vitamin D and how high doses of vitamin D can certainly affect parathyroid hormone. I haven't had any issues with high doses of D affecting PTH or bone turnover markers for that matter. In my practice I check parathyroid hormone, calcium levels, and things like osteocalcin and Beta-Cross Laps, which is a CTx, a C telopeptide, which is a bone turnover marker, to assess if the thyroid therapy is appropriate. In other words, we don't want to overprescribe thyroid medicine because it can cause osteoporosis and it affects the bone turnover markers. Likewise too low thyroid can also, so you have to have the right amount. It's kind of the Goldielocks principle, where too much or too little can have detrimental effects. But I have not experienced in my practice, nor do I know anything in the literature necessarily, that LDN can affect the parathyroid hormone levels.

Linda Elsegood: That's very good, thank you. So people now know who you are, what you do, and where you operate from. How do they contact you? 

Dr Yusuf Saleeby: Well, we make it pretty easy. We have a very interactive, information-filled website. Our URL is carolinaholisticmedicine.com. So that would be one of the first, exposures. We're getting a lot of folks coming through IFM, the Institute for Functional Medicine website, ifm.org; and there's a physician finder. If they're in the area of the Carolinas or Georgia, they'll find me. ILADS also has a physician finder. So ILADS.org for anyone with Lyme disease should visit that website and they can send you to your closest Lyme doctor.

Then we have a toll free number in the United States. It's (800) 965-8482, and that again is on our website. For those calling from overseas, we do some consultation work for people outside of our region, and that number would be 843-651-9944. But the best way to get ahold of us is via our web presence, our carolinaholisticmedicine.com website.

Linda Elsegood:  That's interesting. My geography is getting better - you are on the east coast. If somebody on the west coast wanted to see you, would you do a Skype consultation, that kind of thing, if they couldn't travel to see you?

Dr Yusuf Saleeby: The laws in the United States are very different from state to state. Some have frowned upon telehealth outside of the state in which you're licensed. And we adhere to strict compliance with those laws in South Carolina and North Carolina and other states, too. Very often people come in for an initial visit, face to face with one of our providers, at our three different locations. Once that physical contact has been made, we can then comfortably meet the criteria of taking care of patients by the standard of care, at least having met them and examined them. We can do that via Skype. We use Zoom Meeting or Go To Meetings where we can screen share. So a lot of the followup is done even within our state and state of South Carolina. There are people that travel four hours to see me, and after their first encounter, we can sometimes do followups via telehealth.

There are people that come in from Buffalo, New York, from Fort Myers, Florida, that drive eight hours to come up to our office and see us. Once they make that initial contact, then we are okay. Some folks have done consultations for folks overseas, and one in particular in Brazil. We did this via telephone, and it was as a consultant only; I was not a prescribing doctor. I was only giving a second opinion on some things. The rule is at least a one-time physical encounter is required to proceed as an active patient 

Linda Elsegood: And at your practices, do you have a waiting list or can people get an appointment quite quickly with you?

Dr Yusuf Saleeby: We've built our infrastructure up pretty rapidly. I'm not the sole provider. I have a staff of highly trained - by me, and also focused on especially thyroid and now starting with Lyme - mid-level providers, a naturopathic doctor. So there's a group of us. We take a team approach. We're also bringing in health coaches to help people with remaining compliant and adherent to our programs and protocols. So to answer your question, we have positioned ourselves with keeping our infrastructure up and our staffing with very highly trained advanced providers and doctors so that there's not a huge waiting list. I know there's some practices that have a two-year waiting list and that's not us. We get people in pretty quickly. 

Linda Elsegood: Well, that's reassuring to know. Well, it's been an absolute joy to speak to you. I'm sure everybody has learned so much. I know I have, and it's really a shame that so many people are getting Lyme disease and the way it's spreading. But with more and more doctors like yourself who are helping people to find out they've got Lyme disease, and to help start treating them, surely has to be the way to go. 

Dr Yusuf Saleeby: Well, Linda, it was a pleasure speaking with you tonight, and yes, I think allied advocacy groups are making great strides and gaining ground on a lot of disinformation. And I think we see the politicization of Lyme disease kind of slowly melting away. And hopefully, the result will be more people getting this diagnosis and therapies they need, so they don't have to suffer. 

Linda Elsegood: And you've seen that starting to change already. Have you. 

Dr Yusuf Saleeby: I have, yes, I've felt it in my neck of the woods. And I know that on a national scale that's happening. There's much more awareness. It only takes a couple of celebrities to contract Lyme and write books about it to push it to the forefront of people's consciousness. 

Linda Elsegood: Indeed. And that's sad, isn't it? But a famous face really helps. Doesn't it?

Dr Yusuf Saleeby: Yeah. 

Linda Elsegood: Okay. Well, thank you very much, and we'll have to invite you back another time. 

Dr Yusuf Saleeby: My pleasure. Thank you. Bye. Bye.

 

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