LDN Video Interviews and Presentations

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

Dr. Kathleen MacIsaac is from Florida in the United States. She first heard about LDN around 2006 while researching a different topic. It made sense biochemically, so she started using LDN in her patients, to treat fibromyalgia, chronic pain, migraine, and insomnia. She noted great response in reduction in pain and increased quality of sleep in fibromyalgia patients. More recently she is using LDN for Hashimoto’s thyroiditis; and chronic neurologic disorders including MS (multiple sclerosis), ALS (amyotrophic lateral sclerosis), and PLS (progressive lateral sclerosis). While the neurologic issues haven’t had complete resolution, the patients’ quality of life has improved, and there has been improvement in coordination, articulation, and swallowing. She has a pediatric patient on LDN for autism.

Less than 10 of her patients stopped using LDN, because they didn't notice any improvement or because they did not like a side effect, such as vivid dreams, or nausea, or some GI side effect. Those patients tended to start with milder conditions, thus less motivation to work through the side effects than ones with more debilitating conditions. There is a gap of time it takes to adapt. Most recently Dr. MacIsaac will start very low and progress upwards in dose slowly. Rather than a common titration like LDN 1.5 mg, then 3.0 mg, then 4.5 mg, she has the compounding pharmacy prepare a suspension so patients can titrate up by 0.5 mg over a longer period of time. Some patients remain on very low doses of less than a milligram, and she found it interesting that that small amount is adequate.

Linda Elsegood commented on various approaches she is aware of to lower the dropout rate for LDN, such as starting very low doses, taking LDN in the morning if there are sleep issues, and sublingual drops that are absorbed and bypass the stomach for patients with GI problems.

Dr. MacIsaac has 3 recent patients using daytime dosing of LDN for smoking and alcohol dependency issues, and it’s as if LDN doctors the brain to have less craving for nicotine or alcohol. It’s a new method of treatment for Dr. MacIsaac, and she is pursuing it further.

Linda Elsegood added that LDN is being used to treat OCD, and PMS; and Dr. Phil Boyle uses LDN in treating infertility and other gynecologic issues. Linda is aware of at least one woman whose PCOS (polycystic ovary syndrome) was improved on LDN. Linda relates that she herself had many issues with endometriosis from age 11, and a surprise added benefit when she began LDN for her MS, was her endometriosis issues cleared up. Dr. MacIsaac has found the LDN Research Trust website to be a good resource, and is learning a lot more about LDN.

Dr. MacIsaac’s practice is Healing Alternatives in Orlando Florida, and the website is http://www.healingalternativesinc.com/. The office phone is 407-682-711.

Summary from Dr. Kathleen MacIsaac, listen to the video for the show.

Keywords: LDN, low dose naltrexone, fibromyalgia, chronic pain, migraine, insomnia, Hashimoto’s, multiple sclerosis, MS, ALS, amyotrophic lateral sclerosis, PLS, progressive lateral sclerosis, autism, compounding pharmacy, alcohol, smoking, nicotine, infertility, endometriosis, OCD, PMS,  PCOS, polycystic ovary syndrome

Dr Kat Toups, LDN Radio Show 15 March 2017 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr. Kat Toups is an MD from California in the US,  a functional medicine doctor and a psychiatrist.

After graduating, being a psychiatrist I ending up working in a research centre, found trials and studies on psychiatric medications, and came to see the answer really wasn't in a pill. The kind of illnesses that my patients had could not be fixed just by giving them a medication.

They were multifactorial reasons and that the pharmaceutical route was not the answer. Maybe some of the medications did help relieve suffering for people, but they didn't solve the problem of why they were sick.

So like many people that have come to the functional medicine table, I came into it with my own illness. I had immune problems sort of on and off most of my adult life and finally crashed and burned with some serious immune illness. As a physician, I knew the limitations of what traditional medicine had to offer me.

They could give me steroids to suppress my illness, but that wouldn't cure things. And so I started learning functional medicine at that time. And I suspect a lot of your listeners are familiar with functional medicine, but the basic idea of functional medicine is that we want to understand the root cause of why someone is ill, and it usually causes are plural.

 And then as we address all of those factors and bring those things into balance, we can restore health and get people well.

I went through all the training courses with the Institute for functional medicine and subsequently became certified there.

I would say in my practice a large majority of people have immune type illnesses or infection type illnesses. Many with Chronic Fatigue and then, of course, all kinds of mood symptoms that go along with immune illness.

So some of my patients kind of have the double whammy. They have immune illnesses, and they have a brain component, either psychiatric or cognitive problems.

So I would say that I've ended up with a pretty complex set of patients and I really enjoy working with very sick people because it's so much fun to help them on that path to getting better and getting their health back.

The first thing that I look at is a timeline. So I have patients fill out quite detailed questionnaires that I can start to see what has been happening. So I start back with when your mother was pregnant, did anything happen? You know, did she have illnesses?

What happened at the delivery? Was it a vaginal birth? We know that people who are born by C-section and subsequently are not breastfed may have lower levels of healthy probiotics.

We know that the gut microbiome and our healthy probiotics are what controls our immune system in great part. So if we don't have a healthy gut microbiome, then we can predict problems with chronic illness down the road. So then I'll look at the factors all through their life. What happened in early childhood? Did you have your infections? Did you have allergies? Did you have colic?

And then I look at the stressors happening and all those various factors. What were your teenage years like? Was it pleasant or was it a time of struggle and conflict and what was happening in your family? Was somebody a drinker?

Was somebody impaired by psychiatric disorders? Did a parent die or abandoned the family? We know now that when people have a lot of those factors, we can see immune disorders developing at higher rates like 20 or 30 years later.

So the notion of PTSD Post-traumatic Stress Disorder, you don't have to be beaten or raped.

I'll ask about tick bites. I'll ask about mould exposure.

Those were, of course, things that can affect the brain and the immune system.

 And testing, of course, testing is a big part of what I do.

I also test for SIBO, Small Intestinal Bacterial Overgrowth, and people with SIBO have a lot of GI issues. They typically have a lot of bloating and a lot of gas and people can have a lot of Irritable Bowel Syndrome, either constipation or diarrhoea or both. And what happens with SIBO is we have a lot of bacteria in our colon, and that is normal, but we shouldn't have such a high level in our small intestine, but when the bacteria get out of balance they can grow into the small intestine and overtake that. And so when you eat certain foods that are fuel for those bacteria, that will just have a little party with all that food, and they give off gas and bloating, and some people can appear six or seven months pregnant with the magnitude of the bloating, with the SIBO.

And so, as a psychiatrist, it's very clear. When people have SIBO and  there's a disruption in the gut that causes leaky gut or increased permeability in your gut, that allows food particles to get through into our bloodstream and then sometimes bacterial or viral or parasite components and all those things activate our immune system. And so when that immune system gets activated, it release's these inflammatory chemicals called cytokines and they'll travel around, and they freely cross the blood-brain barrier, and they turn on the immune system in the brain.

And when there are these inflammatory cytokines turned on in our brain, it causes psychiatric symptoms. And kind of the first thing that I'll see is anxiety.

 And then it can have depression ramifications. It can have cognitive ramifications and even people who never had ADD can have ADD symptoms with trouble paying attention and being distractible and can't focus.

 SIBO is where I learned about LDN. As part of the regimen for SIBO treatment, LDN is used theoretically as a prokinetic agent. And so the thinking was that you probably have some kind of GI infection.

Your immune system turns on to fight that infection. And so the thinking with LDN is that it somehow settles down that immune reaction so that people can quit suffering from constipation or diarrhoea.

I use LDN  in a variety situations. It's been probably best studied with immune disorders and Cancer. Cancer is really kind of the ultimate failure of your immune system. So cancer is certainly one place that I have used it.

And I've used it for Hashimoto's thyroiditis, unfortunately, a condition we're seeing so much more of these days. For some people, it can help the Hashimoto's so quickly that I always warn my patients that are on thyroid medication. If they start feeling hyperthyroid, like they're on too much medication, you can feel jittery, heart racing.

Then, when you're on too much thyroid medication I advise them to let me know immediately, and I give them blood lab order to get their thyroid tests right away because what I find is for some people they can reduce their thyroid medication because of treating with the LDN. And I've had people that have completely resolved their thyroid antibodies.

I've used it for psoriasis and I started taking LDN myself because I have psoriasis and I would say within days, I stopped needing to use topical steroids on my scalp, which is where I have the worst symptoms.

I've used it with Parkinson's patients, multi-system atrophy, with a lot of Fibromyalgia's patients and Fibromyalgia is one area where people say you should watch the side effects of LDN that sometimes it might flare it up in the beginning and you might have to go start lower and go slower.

And I really haven't seen much of that. I usually let my Fibromyalgia patients know that that's been reported but I still go ahead and start with my standard dose titration.

I use it for pain conditions. We know that when you, take a dose of LDN that, it's reported that it temporarily blocks your own opiate receptors, and that causes your own brain to make opiates.

So your own brain is reported to make six times more opiates with a dose of LDN. Of course, there are feel-good hormones and that is also the component of narcotics that helps the pain. So LDN can be quite useful for pain conditions.

I spoke with one woman who told me she had been on high doses of narcotics for many years, for Regional complex sympathetic.

It's a neurologic pain disorder that can be quite disabling. And she told me that by using LDN, she was able to get off of her high doses of narcotics because it had controlled her pain.

I've seen it really help people's depression and anxiety.

I have used it with veterans with PTSD or post-traumatic stress disorder and typically we've given it at night time because that's the time when you're sleeping that your brain reportedly makes a lot of opiates but some people end up moving the medication to the daytime because of vivid dreams although they are temporary side effects. So we have the idea of giving this a couple of times during the day to see if we can get that endorphin increased during the day when these patients are really stressed and triggered by the PTSD symptoms. So they started splitting the dose and they have some very lovely results with that so I learned that I had shifted a lot of my patients who do have anxiety or PTSD symptoms to taking it in the daytime.

Lyme disease and the co-infections with Lyme are another areas that LDN is definitely put that on the first line. What I think because it happens with Lyme disease is it shuts down the immune system.

And so LDN then becomes a mechanism to help support the immune system so that it can detect and clear that infection.

I've had some discussions with one of my friends and colleagues who works with pandas, and that's the pediatric autoimmune neuro-psych disorders. Typically it's been reported in children that they'll have an infection most often strep, but it can be caused by mycoplasma.

It can be caused by other infections that trigger that child's immune response. And then the immune system starts attacking the brain and these children can develop the pretty acute onset of severe obsessive-compulsive disorder and behavioural problems. And I had recently worked up a 12-year-old for his pandas and discovered that he had an infectious source with active mycoplasma. I had started that child on Low Dose Naltrexone.

The thing about infectious diseases we have a beautiful design that is supposed to work for some kind of acute infectious diseases with a short course of antibiotics that may knock things out. The problem that we get into is with the people that have chronic infectious diseases. That is chronically triggering their immune system. And those are some of the kinds of patients that I see.

And they come in, when I take their symptom history, they have, 20 or more active symptoms that are troubling them. A traditional doctor will look at that many symptoms and say, "Oh my God, there's your neurotic, you're a psychiatric patient." I am the psychiatrist, so from my perspective, I can say you have all these symptoms. This is not in your head. It's in your body. There's something happening in your body that is triggering the symptoms. The answer for me isn't giving the psychiatric meds because those don't get them well.

I may use psychiatric medications in the short term as a bandaid.

The LDN definitely is one part of the toolkit to start helping support the immune system.

They are written about dental infections. This is a really tough area where people have a root canal because they've had an infection in a tooth and the dentist take out the roots, and they fill them up with material. What I've learned is beyond those roots stars, the infection can get into those microtubules and maybe it's a low-level infection, but it can be enough to keep turning on someone's immune system.

And some people with immune disorders just won't get well until they pull those root canal teeth, because it's triggering this chronic infection.

I took part in a Lyme disease documentary and they have so many different symptoms. And even though these people are really obviously very ill, unable to move, function, the pain, cognitively, etc and the doctor says "It's all psychological. It's in your head. "And how devastating when you feel that low to be told it's in your head and being offered antidepressants and things. I empower people and get them to believe that they can get well. And that these symptoms really are of a physiologic nature and that once we can find all the causes and support their nutrition and support their immune system, that they can get better.

My website has the information. My practices called Bay Area wellness.

So the website is www.bayareawellness.net. And my Facebook It's called Bay area wellness dash functional medicine psychiatry.

Summary of Dr. Kat Toups interview. Watch the YouTube video for full interview.

Dr Jordan Atkinson, LDN Radio Show 12 May 2017 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr Jordan Atkinson, based in Vancouver, has utilised LDN for a variety of autoimmune conditions and cancer with excellent results. As a Naturopathic doctor, his clinic does extensive testing to evaluate the patient before prescribing diet, exercise and medical solutions. 

He takes the time to know each patient's situation and then, he custom formulates a resolution. He believes in being proactive, not reactive and getting to the root of the problem before it becomes serious.

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

Dr John Kim, LDN Radio Show 07 Dec 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today we're joined by Dr John Kim. Thank you for joining us, John.

Dr John Kim: Well, thank you for the invitation, Linda,

Linda Elsegood: For those people that haven't heard you on our Vimeo channel, would you like to tell us what it is you actually do in medicine?

Dr John Kim: I'm actually in-between transition, as some people may know. For the last ten years, I've been working in Georgia where 50% of my practice is in pain management, and then the other 50% is solving complex medical puzzles; especially autoimmune conditions. I actually discovered LDN as a part of the second part of the practice, and the second part of the practice actually came about because I had wonderful techniques to help patients with chronic pain, except for patients with autoimmune disease pain. Those pains just were harder and tougher, and I had to change my paradigm and look for other tools other than what I had, and kind of open the door through LDN to treat the whole bunch of other conditions, especially autoimmune conditions with a great deal of success.

Linda Elsegood: Would you like to tell us what it is you have trained in?

Dr John Kim: So the original training in medicine began with family medicine, and I chose that because it was the most holistic of all areas. But I wanted to train more, so I actually changed my career to a speciality; to preventative medicine, and then from there I learned medical acupuncture, and then went on for a fellowship in integrative medicine with Dr Andrew Weil as a residential fellow. That kind of sums up my traditional training, but I've also done extensive basic science research in biochemistry and pharmacology.

Linda Elsegood: What would you say the outcomes have been for the patients that you have prescribed LDN for?

Dr John Kim: LDN for me hits even closer because the LDN originally was brought to me by one of my favourite patients. I'm not supposed to have favourite patient, but the patient is a favourite because she one day said, ‘Hey,I have this condition called Hashimoto's thyroiditis, and the prognosis is really depressing. I get to take medication and as Hashimoto's thyroiditis destroys more of my thyroid I get to take more and more, and you never get off it’. And she said, ‘I found something interesting called low dose naltrexone, and would you please do research?’ And I said ‘sure’ and when I did research about it, that was about ten years ago, there were fewer research articles, but even then, it really looked like the risk-benefit profile, meaning how much risk is there and how much benefit is there, was very, very limited; small, and the benefits sound so incredible. So, I prescribed the medication and what happened was that her disease went into remission, full remission, and did not require any further use of hormone treatment. Then what had happened was that within several years she got pregnant and, retained her baby, because before she was having issues with, I think miscarriage, and then she gave birth. And then after the birth, her disease returned, almost like Graves and we again used low dose naltrexone very successfully and helped the illness to go into remission as well. 

Linda Elsegood: And did she take the LDN throughout her pregnancy?

Dr John Kim: Yes. LDN through pregnancy is a very interesting topic and I had them talk to their doctor, but you know, part of the acupuncture practice I have, a small part of it is fertility. And I've noticed that LDN helps patients to get pregnant. For those I think who have issues with their ability to get pregnant it’s often coming from an autoimmune condition, and I think that LDN can reverse that.

Then I've seen LDN reverse endometriosis, and again, I think that a lot of the illnesses that we have seen have an autoimmune basis. We don't use the word autoimmune, what I like to use is the dysfunctional or stunted immune system. The immune system is no longer being intelligent, and I think the LDN corrects it.

That's why I think that LDN is such an interesting drug because LDN seems to be what we call an adaptogen, which means that it brings a system into balance. So if it's too much, it brings it down. If it's too little, it kicks it up. And I think that's how LDN works for from everything. From autoimmune diseases to HIV, to cancer.

And LDN, I think is like almost a class of its own, because it does so many nifty, therapeutic actions with some limited side effects. 

Linda Elsegood: What side effects have you noticed with your patients?

Dr John Kim: There are at least two people that I've seen that had a severely depleted state of endorphin.

They’d been ill for a long, long, long time, and their resilience is very, very limited. And for those people, I've noticed that even with one microgram of low dose naltrexone, they have a hard time taking it. And. If there was a homoeopathic pharmacy, I wondered if they could make a nanogram dosing of low dose naltrexone for these people, but these people are few and far between.

For most of the other people who have side effects, they find it easier to handle. Like some people, instead of it helping them to sleep, it has the opposite effect. So, if that's the case, it's pretty simple, they just take it at dinner time or in certain cases, I just tell them to take it with lunch or even at breakfast time.

Linda Elsegood: Well, we did have a question, which fits in quite nicely with what you're saying, and it's from Deb, and she has her own thyroid group with LDN, and she says, ‘have you seen a patient with a genuine allergic reaction, not just a side effect on  1.5 milligrams of LDN?’

Dr John Kim: So I think that the allergic reaction if they're talking about an anaphylactic reaction, that's probably due to the filler, not necessarily to do with LDN. As I said, the two people that I have seen a reaction, even one microgram, those people, I think probably had the reaction that they're describing, which is closer to an allergy, however, I've not seen the typical, what they call anaphylactic or IgE mediated response to naltrexone, and it's theoretically possible, but I just haven't seen it at this point.

Linda Elsegood: We have a lady called Lynn from Australia who has been using LDN for two and a half years for graves' disease in kidney neuropathy, and it’s inactive now, but she does have small, reoccurring, low-grade bladder cancer.

Her naturopath suggested that she should take a test to show nutrients, which would affect the cell line of cancer patients, so she's asking ‘would this test be worth having in regard to bladder cancer and LDN?’

Dr John Kim: I think that's a wonderful question, and it also happens to be a complex question. And the reason why I say this is that the low dose naltrexone effect on cancer, I think that is very beyond theoretical. I think that we are beginning to have case series of studies that would be the basis of one day doing a randomized control trial using LDN to use either as an augmented complementary to the conventional therapy or standalone agent. In terms of the nutrition testing, which is very popular we call this approach ’functional medicine’, within the integrative medicine spear. And in that philosophy of testing everything that you can pass on, or micronutrient testing, or even testing of the agents that are a part of the Krebs cycle, and testing those intermediate, biological functional markers to be useful.

And I think that to be honest with you, that the research just is not yet fully there. Spectracell is one company that will basically test different types of antioxidants and vitamins, and I think that it's a reasonable thing to do for cancer patients.

I would not recommend it for everybody who is in good health, but for cancer patients, if you asked me six months ago, I would say, I'm not sure, but I think that because cancer is such a debilitating and life-threatening illness because the conventional medicines alone don’t have full control over cancer.

Because even with LDN, looking at Dr Biharis’s study, that wasn't a hundred per cent. I mean, he did not get a hundred per cent either. So, I think that we have partial answers, but with cancer, we have room for improvement. I think that some types of micronutrient testing for cancer patients makes sense.

Again, that’s not recommended on a healthy person, but for cancer patients, because the stakes are so high, and because of the latest protocol by Dr Berkson, who combined alpha-lipoic acid with low dose naltrexone to help stage four cancer patients to go into remission.

So, if you look at that, then, all of a sudden what else are we missing? I mean, are there systematic studies? No. So then if there are no systematic studies, then you have to become a study of one. And how do you do that? Just like what the natural path is suggesting. I think that it is reasonable for cancer patients, but unfortunately not for everyone.

I think there's part of us that can be narcissistic and say, I want to test everything on you; genetic markers and nutrients, but I think that moderation is often a good way to go, but with cancer, I think that my answer has changed in the last year; the more I think about it, and the more I read, and the more new studies come out.

Linda Elsegood: Okay, we have a question from Christina, and she says ‘I have postpartum thyroiditis from pregnancy in 2011. My thyroid has never recovered and is very large with hypothyroidism. I do not have Hashimoto's. Should I start off at a very low dose because of my thyroid issues?’

Dr John Kim: So that's the wonderful thing about low dose naltrexone. Like I think I've shared earlier, the patient who introduced me to LDN, in the beginning, had Hashimoto's. But then she had postpartum hypothyroidism and LDN works for both, and some people would think, how can that be?

How can LDN increase the function of the thyroid and also decrease the function of the thyroid? If you look at it as LDN is an adaptogen for the immune system, meaning LDN restores the balance of the immune system, then everything makes sense. It's because the low dose naltrexone can increase the overall balance of the immune system that it can help with hyperthyroidism. It can help with hypothyroidism because the mechanism in both cases is exactly the same. Decrease the abnormalities within the immune system, and it does this it seems through glial cells binding through glial cells to There is a certain type of receptor that is responsible for releasing pro-inflammatory molecules. So, LDN binds to that site and does not allow for the release of inflammatory molecules. So, I think that the answer would be yes for somebody in that area, who is capable and is familiar with using LDN for those circumstances. And the other thing is that in such circumstances, I think aggressive testing makes sense.

So for me, if I had patients like that, I’d keep a very close eye on them, and I would test them even monthly to see what their labs are doing.

Linda Elsegood: Oh, she then goes on to say that she's actually been on LDN 1.5 milligrams and she had to take it every other day in the morning because she got very jittery.

She said she built it up to 1.5 milligrams daily and felt better. But then, after three or four weeks, her symptoms suddenly came on strong. She says, ‘does LDN bring out the disease and make you worse before you get better? Should I increase if I start to feel worse? And how long should I expect to feel worse before I start to feel better?’

Dr John Kim: I think that it's very rare. With my patients, I have seen or heard of those reactions. And I think that in one of the emails you sent me, I think that person had a similar reaction, were that there seemed to be a sudden release of catecholamines, which means molecules like epinephrine norepinephrine get released. And in such cases, you really have no choice but to go slowly, and to utilize incremental increases. I think whenever people have like a complex reaction, I will recommend them to consider having more than the standard use of LDN. I would say, you need to use more of a shotgun approach and utilize multiple assets. And I think that seems to be a good example because she's having a complex reaction; it's not a typical reaction. And so, for that, more diagnosis is needed, to see if there are any kind of issues of catecholamines being higher in her body than they should be. There's a test that they can do over 24 hours of urine collection. They can measure the overall amount of catecholamines in the body, and that indicates other problems that can be present. But if she wants to solve the issue, I think the best thing to do is branch out to other tools, and that's where I really love having more than just one tool. So, for example, I would use the LDN, I would use acupuncture because it also increases endorphins and decreases inflammation. Supplements that can also reduce inflammation, as well as immunotherapy that I talked about and those five things are what I recommend people to try before going to the conventional medications. In some cases, I see that even combining all those is not good enough, and then they have to use number six, which is conventional medications and conventional approaches. I think that it's just important that conventional medicine is not our enemy. It is neither a friend nor an enemy.

It's supposed to be our servant. We don't want it to be a master. We don't want it to be a dictator and create all kinds of problems.

Linda Elsegood: Okay. Well, we'll get ready to go into a break. If anybody out there would like to phone in and ask your questions to Dr John Kim, if you want the numbers, just go to www.ldnradio.org.

Linda Elsegood: Now we will take a call. Hello? Can you hear us?

Caller:  I can hear you, yes. Can you hear me?

Linda Elsegood: Fantastic. I can indeed. Yep.

Caller: Getting that somehow, right. Well, I refer to the guy that Dr John said had had a cancer diagnosis three years ago, bowel cancer. I haven't been using naltrexone yet, and I've had some chemotherapy, but on-base occasions I had Capecitabine to start with, and then I had Fluorouracil, and both of them threw me into A & E, so I've gone off the idea completely of conventional, well, what's it called? Chemotherapy. I'm just looking for alternatives. We've changed our diet. We’ve done all sorts of things and are feeling very positive, but just want to find out from you whether you think that I can be helped by LDN.

Dr John Kim: May I ask you what stage of cancer you were diagnosed with?

Caller: Oh, I think it was one.

Dr John Kim: So, then you are cancer-free at this time?

Caller: No. I had a CT scan a couple of weeks ago in November, and that showed that the tumours that they found, that showed up in April, have actually got bigger on my liver and in my right lung. I did have an operation to remove tumours from my left lung. So, I had the left upper lung removed and also I had about 30% of the liver removed.

Dr John Kim: So, when cancer that starts in one area goes to different areas such as liver and lung, it’s considered metastatic or stage four cancer. So the use of low dose effects for cancer that I've read about and that inspired me to use it actually are twofold. One is the original physician who made it popular or known to use LDN. Dr Bihari used low dose naltrexone for treating cancer very successfully and he had documented it. Now there's a second physician. Dr Berkson, who is in New Mexico, who is utilizing low dose naltrexone and alpha-lipoic acid, and in his case he does injections very successfully. So both parties have written about it. Dr Berkson has published his work. So, right now, all of my patients that have cancer, who come to me, pretty much, I recommend them a protocol of low dose naltrexone as well as alpha-lipoic acid, as well as other supplementation.

Now as for stage four cancer, fighting it just using low dose naltrexone generally, you know, I don't recommend it. I recommend using all the tools that you have because of the grade of the diagnosis. Using all the tools is what I recommend. Now, having said that, Dr Berkson does have documented patients who have used low dose naltrexone, and alpha-lipoic acid and the other protocols that he utilizes.

And my recommendation is to find someone near you who has utilized that protocol to success.

Caller: Wasn’t it Professor Dalgleish in the UK?  He's been fairly active I think in the LDN and cancer field. Have you come across him?

Dr John Kim: There's also Professor Liu, with whom Linda has connected me with. And you are part of the LDN research trust on Facebook, right?

Caller: No, I don’t do Facebook.

Dr Kim John: I'd like to highly recommend you to join. It's a really wonderful community to ask other people, especially in your circumstances. In general, I recommend for patients for fighting cancer for integrative medicine, low dose naltrexone, to use all the tools that make sense to them at their disposal. Because really, in my experience at least with stage four cancer, it's really difficult to make peace with stage four cancer. Cancer wants to grow, continues and there is no 99%, it has to be a hundred per cent because if you leave even 1%, it's alive.

It will double, and double. We call that tumour burden, and after the tumour has grown to a certain size, it puts a tremendous amount of burden in or way.

Linda Elsegood: The next caller now, if not, we won't have a chance to get through the queue.

Caller: Oh, sure.

Linda Elsegood: Okay. Thank you. Thank you for your call.

Caller: Thank you very much, Dr John.

Dr John Kim: Yes sir.

Linda Elsegood: Okay. I think we have another question here that may be cancer. Hello? Hello? Are you there?

Caller:  Hello? Are you talking to me?

Linda Elsegood: Yes, I am.

Caller: Okay. This is still us. No, this one wasn't cancer-related, but I can probably find one if you want.

Linda Elsegood: No, that’s fine.

Caller: This is about mast cell activation disorder, and if Dr Kim has ever prescribed or treated anyone with that condition. Has he prescribed LDN?

Dr John Kim: I have not seen one prescribed as such, but I've seen many patients who have the symptoms of this, and I think mast cell activation disorder is closer to what the physician's call IGE, mediated allergic reaction. You know, the mast cells release histamine, and some of the interesting things about that are the speed at which it can occur. It’s very rapid. In some people, you just have to scratch their skin, and you can see a welt developing very quickly.  Is your symptom like that?

Caller: This is a question and from a group member. Not me personally.

Dr John Kim: The answer is that yes, I have utilized LDN, but the utilization of LDN in such cases is an excellent question. I think LDN is a wonder drug for autoimmune diseases, but I don't think LDN, in many cases, should be utilized alone; like the previous caller wanted to use LDN for stage four cancer.

I think that of course, it can be done, if he can find a physician willing to do it, but I think that the better approach in this case and I’ve had patients with similar symptoms, is that LDN combines wonderfully with another immunotherapy, which is more common in Europe. It's called allergy drops, and what you do is you test the person for offending agents from the environment, as well as food. And mostly if IGE with food IGG can also be included. And the wonderful thing about is once you are armed with information, what things can trigger them, you can utilize allergy drops and LDN together to allow the immune system to be reeducated.

So, I'll give you an example. One patient came to me with a mast cell activation, and hers would begin with eating fruit, whatever kind of fruit, she would just not be able to breathe. And she loved fruit, but for ten years, she couldn't eat fruit. And so, I put her on LDN, and it made her symptoms a little bit better. In a year of allergy drops plus

LDN she was able to eat fruits again, and she has no reaction. So in that case, can you get that reaction just by using allergy drops? I think it's possible, but usually allergy drops alone it takes five years. Whereas in this case, within less than a year with both LDN and allergy drop, we were able to get that rapid reaction.

So, I think that LDN is a wonderful tool. Anytime the immune system is not behaving, if it’s hyperactive or sluggish, I think LDN is a wonderful tool, but I think there is this idea, a temptation almost, to view LDN as a single agent for everything. I think that everything has a tool and for some of the patients that have had severe symptoms, I'm not afraid to use LDN and Montelukast, which is also sold under the name of Singulair, and is a prescription medication, or some of them I ask to take Zyrtec and then the allergy drops. And the wonderful thing about LDN is that it seems to re-educate the immune system, so it's almost like an intelligent approach, and it compliments the allergy drop because that is also an intelligent approach.

Caller: Understood. I guess this question probably has the same answer. I’ll just ask it in a different way. Can LDN work to help histamine inflammation? So, would that basically be the same answer?

Dr John Kim: Well, I think the answer is, I think, that I would be more careful to use histamine because what we’re talking about is that what happens after the mast cells have released histamine. So, in this case, what you're looking for is rapid response. Can LDN be used to stop an anaphylactic reaction? I don't think anyone has done the study, but I don't recommend that clinically. If someone is having an acute reaction, I think the proper response would be either Benadryl shot or Benadryl liquid.

Caller: You use the word inflammation. I don't know if that's different from a reaction.

Dr John Kim: The histamine inflammation is very rapid, and I would say if you're in that rapid phase of inflammation and the answer, I think it's similar when you're having rapid phase reaction of inflammation, I think that you have to use all the tools that are required, including steroids,  in case of histamine reaction, an anti-histamine, and then use LDN long term to get gain control. And we basically create another equation, change the equation because LDN can change the basic equation, but at the time, the house is burning down. You want to use everything. LDN is a wonderful tool to redesign the infrastructure so that the immune system just only has one response, inflammation, inflammation, inflammation. LDN can change that, and it's very interesting, because people who have a reaction, in that situation, often their immune system is actually depleted, so that means they get sick easier.

I tell them that's very similar to police being told by naughty teenagers twenty-four-seven that they can't do their job. Whereas the well-rested, police force can respond to emergency calls quite adequately.

Linda Elsegood: Okay. Yes.

Caller: Thank you.

Linda Elsegood: Okay. We're back. And what I would like you to do now John, is could you answer some of the emails that were sent in, please?

Dr John Kim: Absolutely. I really love the questions from your readers or your Facebook group members. They are just so intelligent and wonderful. One of the questions that I had was from a patient who was diagnosed with pancreatic cancer.

She's taking Tramadol for pain, and clinic basically is agreeable to put her on LDN. I'm sorry her or him. But the thing is that they want the person off Tramadol and the person is asking what do you do? I've often seen this sort of question regarding Tramadol or Ultram, which is a brand name and is basically a form of synthetic opioid that's not a full-on opioid. What I mean by that is that it's got two different activities. Number one is that it does bind to the mu-opioid receptor, but it also works as a serotonin and norepinephrine uptake inhibitor.

And I think that it seems to me that this has multiple answers. So, part of the answer is that if the clinic says no, you can't take LDN and Tramadol together, I would say that the person can explore a herb which is very effective, known as corydalis. Corydalis does not use opioid receptor but has high effectiveness for controlling pain.

That is my go-to herb to control pain. The secondary herb can be something like curcumin, and especially if they can find long-acting curcumin, it can be helpful for controlling pain. Another tool that I find exceptionally well-suited that works in conjunction with low dose naltrexone is what I call neuroanatomical approach to acupuncture and is a new way of using acupuncture using scientific principles. And it works on strengthening the endorphin system and reorganizing the neurological signals that are pain prosthesis. The underlying question to this is, can you combine narcotics and LDN? And I think the answer is yes.

I formulate this from research done using what we call the microdose, dosing of LDN. So instead of using the normal dose, LDN use is 1.5 milligrams to 4.5 milligrams, but in micro-dosing, you use microgram doses. A thousand times less than one milligram would be one microgram, and that, even in my clinical use when people are using narcotic agents, my to-go game is to utilize a microdose gram dosing of LDN, and it seems to actually help patients to get pain relief longer. Then what I do is increase the dose of microgram dosing of LDN to push it up. And then what happens is similar to them not taking the medication you're just doing backwards.

By increasing the inhibitor strength, you're basically taking down the amount of narcotic that is effectively available and just two different approaches. But I think that it's more humane and I'm not convinced, because the effective dose for the naltrexone to overcome narcotics is about 5,200 milligrams anyway.

I don't think adding 1.5 milligrams or five milligrams will make a difference in the majority of people. Now I have to say, that because I know that in literature, there are people who are exquisitely sensitive, that even utilization of anaesthetic during surgery didn't work. They had to use massive amounts, and then at the end of they said, what on earth is going on with you? Why is it that I have to use massive doses on narcotics? They say ‘oh, yeah, I'm taking the LDN’. And so in that case, you know that in those people the LDN, is working so well, or probably what is happening to those people is that their affinity; the LDN attraction to the receptor, is exceptionally stronger than the general population.

But in general, I think that LDN, especially micro-dosing naltrexone or very low dose naltrexone, is safe with utilizing narcotics. I think that was a wonderful question.

Linda Elsegood: Do you have time to answer another one?

Dr John Kim: Oh, yes. Oh, there was another question of RSD or the CR, complex regional pain syndrome. That is a really heartbreaking condition.

‘My neurologist started me on 3 milligrams, then 4 milligrams and then 4.5 milligrams. I had some pain relief for six weeks, but the burning pain has returned to the same level. Do you know? Is there a reason? Is this a typical reaction? Do you agree with my doctor’s opinion that I would get more benefits after five months?’

I think that it's, it's kind of interesting because 1.5 milligrams to 4.5 is like the standard, and that's written in stone, but if you really dig in and do the research, those response studies that were performed on low dose naltrexone was sort of a convention developed over time, accepted by researchers. But I think that there are multiple ways low dose naltrexone works, and one way of course, is that it works through the immune system, and I think that the dosing of 1.5 to 4.5 often works quite well.

However, there's another way that LDN and especially for CRPS and neuropathy that LDN can be helpful is that LDN also works as an anti-inflammatory agent for the central nervous system. What that means is that in that setting, the dosing of LDN is going to be more dose-response curve, what I call linear response.

What that means is that depending on who you are, you will need more than 4.5mg. I had patients who needed six milligrams, and who do very well on 6 milligrams or even 7.5 milligrams, and obviously, I don't start a patient on that. I titrate them. And if you look at the original dose of medicine being 5 milligrams, I think even 9 milligrams is not unreasonable for the minority of people, but I think that rather than waiting five months, what I would do is push the dose to 5 milligrams and then 6 milligrams to see or and 7 milligrams to see if that's helpful. The other part is that CRPPS is a nervous system disorder, so alpha-lipoic acid would be another tool that can be very helpful, also taking a very high dose of fish oil also can be helpful, but taking a high dose of fish oil can result in bleeding episodes or even bruising episodes. So, it would be better if you are under the care of a physician or a naturopath who is familiar with that. With alpha lipoic acid you also have to be aware that you can lower your blood sugar levels so that's another a thing you have to watch out for. 

Linda Elsegood: Something we were talking about before. How important is diet?

Dr John Kim: You know, I think that there is again a very romantic idea that you take LDN and it's like a magic bullet. It works for everything. I think that diet is important because of the way that that LDN works. You know, in my own practice, what

I do when I take in patients with autoimmune diseases, in the beginning, I just say eat well, and patients would not listen, and the minority wouldn’t.  So now I just do the full food allergy testing because that way, I can see, and show them, and then lead them to not eat these groups of food.

And second, we need to do allergy drops to normalize your response to that food because obviously it's not killing off our population, but I also would say that there's something that has changed, that our people are having autoimmune diseases. It’s like an epidemic. You know this is everywhere. Everyone is having an autoimmune condition. Why is that? I think it has to do with we're doing something different. Has our genetics changed in 50 years? I don't think so. What has changed? Our diet has changed, and our pollutant exposure has changed. So, I think that we will find more than a lot of the plastic exposures they were having, we’re going to find to be harmful to our immune system.

I think that research is just beginning on that, but diet I think, is important. Why? Because everything that happens in our body biochemically is predicated by what we eat, what we put in our body. Then if we eat anti-inflammatory food then our body will become anti-inflammatory. If we eat pro-inflammatory food then the end result is that we will be suffering from the high levels of inflammation in the body. So, I think that LDN is a wonderful tool: however, it does not give you permission to eat badly every day, smoke, and pursue an unhealthy lifestyle.

Linda Elsegood: We've just had a question come in, and it says ‘could you define allergy drops?’

Dr John Kim: So allergy drop is basically, I think that everyone has heard of allergy shots. When you have a severe allergy you give shots to people. It does work, but  I just don't like giving shots. My family members hate shots, patients hate shots.

So, what I've done, is looking for a solution that doesn't involve all shooting allergies. It makes sense to me that if it works by giving shots, it will make sense using the GI system because a big portion of our immune system is in our gut anyway. So, I've been looking for a solution to this problem for about five years. I found a solution.

I'm told that this is the more common approach in Europe to the use of allergy drops and allergy drop means that you, whatever your allergy, whether you're allergic to food or environment, you can create an antigen dose that corresponds to how much you're allergic to.

So, if you're allergic to huge levels, then you give them a minute amount of allergen, and then you systematically teach the immune system by exposure not to overreact. So, you can do that to peanuts, you can do that to wheat., you can do that to milk, you can do that for grass, fungus; the big thing that I see is yeast.

So that's the allergy drops that I talk about. I think that as I said, LDN and immunotherapy go hand in hand in my opinion, for autoimmune, and the reason is very simple; both of them are the intelligent approach to re-educating the immune system. And it seems the immune system is amazing because, that one patient I talked about that she was allergic to the fruit, what I found out was that she was allergic to grass. And grass, of course, is the cousin of fruit. So, I treated her grass allergy for about a year, and low and behold, she was able to eat fruits again, and I never went to even specific foods. I just treated grass, because that was the one thing that she was most allergic to.

So, it shows how intelligent immune system is. Of course, she was also taking LDN at the same time, which I think shortened the duration needed for her to go into remission.

Linda Elsegood: Well, I'd actually like to now talk about your LDN book that you've just managed to get published, and it's available on Amazon.

Could you tell us more about your book?

Dr John Kim: Yes, you know, it kind of began as my notes, because in the beginning, LDN was like magic. It would work. It would work. And I was almost thinking, why does it work? Why does it work? So, I started reading, and first, it was blogged on your website.

And then I just dug deeper, because of my research background I just went to the research databases and I would just read different studies, and understand better how low dose naltrexone would work. And of course, there are books already available. I think you were the editor in one of those books, but I wanted to go to the source and learn more.

And so this book is called LDN primer, and I call it primer because I feel like even after 15 years of using low dose naltrexone, I'm still a beginner. And in here I just talk about the history of LDN, and LDN as a noble anti-inflammatory agent for our central nervous system, which I don't think is utilized very often outside my clinic.

And then LDN for treating endorphin deficiency syndrome. Again, I'm looking at the conditions that LDN can treat as groups, so if you have an inflammatory condition for the central nervous system, LDN can be useful, even though it's not an autoimmune condition. LDN can be useful for people who have endorphin deficiency, and who knows if the bipolar disorder, depression, anxiety are a subset of endorphin deficiency syndrome, and I certainly treat it that way, and I have utilized LDN alongside an SSRI with great effect. And even a bipolar disorder with great effect. And then the other thing is LDN as Immuno adaptogen, and then I talk about atypical uses of LDN.

And then the last chapter I talk about clinical considerations of using LDN and share stories of my patients and my observations and ideas that I had, like dosing, you know, and how the dosing is determined. It's not scientific. It's been just supposition. I was just guessing. So then means we have the right to ask.

And what's really wonderful about your Facebook group is the interactiveness, and I see what they mean because some of the people start 0.5 and they think that's too much. I had to cut to 0.1 because.

Like in my practice, that's what I do. I look at a person and try to determine how much endorphin reserve do they have in their life.

If someone has high functionality, then I don't mind starting off 1.5 and then rapidly branch up, going up to 4.5. But if I get the sense that they are very depleted, I would start at 0.1 and then march slowly to get them to 4.5, but take my time doing it and looking for any side effects. So it's been a result of me wanting to understand LDN better and starting a blog and just continued writing.

And I kind of got caught in the web of interestingness of LDN, and I just couldn't stop writing and stop researching. And even preparing for this show, I found out there are more studies out now, and it's really a fascinating subject.

Linda Elsegood: I know a lot of people want to know how do they know how high to go if 4.5 isn't the sealing. How do they know that the dose is right for them?

Dr John Kim: Yeah. So, I think that again, understanding how LDN works is crucial. So, I call it two different dosings. One dosing is linear dosing, the other dosing is synergy dosing. So what do I mean by that? The synergy dosing; I'm referring to the LDN educating the immune system to calm down. So for most autoimmune diseases, I utilize LDN; the lowest amount of LDN required to put a patient into remission, or their symptoms into zero. So, in those cases, some patients are taking 0.5. if they're in remission. I don't want to increase it, because if their disease comes back, then I want to have a little bit of room left over to increase the dosing.

But if there are other people who have central nervous system issues, so I'll give you an example of what I mean by this. Neuropathy would be a great peripheral neuropathy. Diabetic neuropathy would be a great example. Or another example would be post-herpetic neuralgia, and LDN can do amazing things, but in those settings, we are not really counting on the LDN to reset the immune system, we’re using LDN as conventional medication, as an agent to create an anti-inflammatory effect in the central nervous system. And for that, I think that 1.5 to 4.5 dosing is a bit limited, and you have to look for ways to either make LDN work harder and then bring out the LDN synergy, and my to-go tool for that is acupuncture, especially the neuroanatomical approach to acupuncture seems to go very well with LDN. Another tool that I use routinely is alpha-lipoic acid. It seems it can enter the central nervous system with ease and works very well in synergy with LDN.

Linda Elsegood: I'm going to have to stop you there, John. We'll have to have you back on another show. And we really appreciate you being here with us today.

Dr John Kim: Thank you.

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Linda Elsegood:  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.

Dr Jill Cottel shares her LDN experience, LDN Radio Show (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Jill Cottel shares her Low Dose Naltrexone (LDN) experience on the LDN Radio Show with Linda Elsegood.

Dr Jill Cottel is a medical advisor for the LDN Research Trust and was a presenting doctor at the LDN Conference in Portland Oregon.

Now, she has developed a tele-medicine system in her practice whereby she can do medical appointments by phone in the states of Virginia and California. This added service is invaluable for patients who cannot travel for one reason or another. 

She has been a solo-practitioner with a private practice for over 20 years with a focus on holistic medicine. Dr Cottel is very knowledgeable not only of how useful Low Dose Naltrexone can be in treating autoimmune diseases, but also for treating alcoholism through alternative methods such as the Sinclair Method.

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

Dr Jill Cottel, LDN Radio Show 30 Nov 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Welcome Jill! How does it feel to be our first guest on the new LDN Radio Show?

Dr Jill Cottel: Hello, Linda. It's very exciting.

Linda Elsegood:  Thank you! Isn't amazing? I mean, you're out there in the West coast of the US and I am in England. Amazing!

Could you give us an overview of your LDN experience, please?

Dr Jill Cottel: Sure. I've been prescribing Low Dose Naltrexone since 2008 and have had a lot of success with it. It's been exciting to watch patients as they respond. I have a general internal medicine practice, so I get to see a little bit of everything. And so I've had a chance to try LDN out on a number of different clinical situations. It's kinda nice to get that, the rounded experience and try it out for different things that aren't typically used. It's been interesting.

Linda Elsegood: What would you say the main conditions that you've seen?

Dr Jill Cottel: Well, let's say in the beginning mainly I was treating autoimmune arthritis just because that was where I was seeing the main focus and a lot of the reading I was doing, and a lot of patients that I had already in my practice had different types of autoimmune arthritis.

So that was where I started. And then those patients would refer to other patients, and then I started branching out. And then kind of, it's a mixed path that I have a lot of patients with fibromyalgia or just muscle type pain and then different types of chronic pain syndromes, and then just a wide variety of other things, asthma allergies and some neurologic issues.

Linda Elsegood: One of the questions that people like to know before they start is what are the side effects likely to be. Have you noticed any side effects?

Dr Jill Cottel: Well, it's, it's really well tolerated. When you compare it with just about anything else that a doctor would prescribe.  All-day long we write prescriptions for various things, for high blood pressure, diabetes and high cholesterol.

You look at any one of those numbers of things and plot the prescribing information. It can boggle the mind about the list of things that can happen. And so when you look at Low Dose Naltrexone, very, very minimal side effects are really good profile. I would say when people report a side effect, that usually has to do with sleep.

And I would say, in my practice, that's really only maybe 10 to 20% of the people will have sleep interruptions or vivid dreams. Sometimes that will pass and sometimes not. If it is an issue, they can always move it to dose at a different time of day. And that will usually clear up the problem.

And aside from that, pretty uncommon, I've had maybe in the past couple of years, a handful of patients who've had kind of a strange headache and that usually passed within the first week. And then some patients who their stomachs are very sensitive. In the beginning, they might get a little bit of loose stool.

But again, that tends to be just in that group of patients. Even that will generally pass after the first week. So not a lot of side effects to report.

Linda Elsegood: What drugs can't you take alongside with LDN?

Dr Jill Cottel: Basically it's the narcotic medications, Oxycodone, Hydrocodone, Morphine, those sorts of pain medications. Other medications for pain like Tylenol and ibuprofen are fine.

There's really a wide variety of things that can be taken with Low Dose Naltrexone and in the way of drug interactions I haven't seen any problems except with the narcotic type medications. 

Linda Elsegood: Because I know there have been people who've asked questions about Methotrexate, Interferon drugs, steroids, and I believe all of those can be used with LDN.

Dr Jill Cottel: Right. In my practice, I've not had any issues, and I know there are a number of other clinicians using them together and haven't reported any problems. so there's some good experience there.

Linda Elsegood: What would you say has been your greatest success with LDN?

Dr Jill Cottel: I would say, probably the autoimmune arthritis patients.

They respond really dramatically and quickly. That's exciting to see when that happens. With fibromyalgia patients, every now and then you'll get someone who responds really quickly and complete response. That's exciting too. It doesn't quite happen quite as often as the other ones.

Linda Elsegood: It's amazing, isn't it? That you can get people on very, very strong painkillers where elsewhere it doesn't control the pain. They come off then, try LDN and suddenly are playing free.

It always astounds me that such a small pill can do. It's like using a sledgehammer and it doesn't work, and you tickle it with a feather and It does.

Dr Jill Cottel: Exactly. One of my first patients came off large doses of pain medication a few years back. He was on almost a 100 mg of Oxycodone or something similar and wanted to try LDN. I thought:  "Well, this is just no way that this is going to work." And he tapered off on his own. And a hundred milligrams hadn't been controlling his pain. Then he was completely pain-free on 3 mg of LDN.

It was amazing! It worked! How can 3 mg of LDN work better than 100 mg of Oxycodone? There it was. He was pain free. That's amazing!

Linda Elsegood: Always amazes me too.

Dr Jill Cottel: Think about some of these studies showing that narcotic medications can actually cause hypersensitivity to pain and possibly central pain.

Look at it that way. Maybe it makes sense that patients are going to do better off of those medications and better on LDN.

Linda Elsegood: I've also been told that if you take a cocktail of pain medications, you can then take too many and then they don't work either.

So that's interesting as well.

Dr Jill Cottel: It's hard to sort out. Often a patient with chronic pain will come in, be on a lot of different types of medicines from different classes, usually off label, l because everyone's trying to help them and it's hard for those patients.

They've got a lot of side effects. I was getting them off of those medications slowly, then LDN may start responding. You can start weaning off some of these other medications. A lot of the medications that we use for chronic pain have many side effects, so people tend to feel a lot better being able to come off of them.

Linda Elsegood: That's good. Well, we'll take a break now, and when we come back, we'll take questions.

Today's show is sponsored by the Poway integrative medicine centre who take a holistic approach to provide the highest level of health care, combining internal medicine with alternative therapies, including acupuncture and Chinese medicine.

If you're in the San Diego area, they'd love to see you or if you're in the state of California, they offer secure video conferencing appointments when clinically appropriate. 

Go to www.pimchealth.com or call 858 312 1672. On Facebook, follow Jill Cattell MDs page.

Linda Elsegood: Welcome back! Now we've taken our first caller. Can you hear us?

Blanca: Yes. Thank you so much. I am here.

Linda Elsegood: Okay. What question would you like to ask Dr. Cottel?

Blanca: Doctor thank you so much for listening to my question. Did you have any experience with Multiple Myeloma?

It's a bone marrow cancer. My husband has it, and he has been taking LDN every day for four months and we have seen these numbers stable. So I was just wondering if you have any experience with Multiple Myeloma?

Dr Jill Cottel: Not so far, but that's a great question.

I would expect, based on the positive results that other people are getting with different types of blood disorders, that LDN would be something that could be beneficial. And you said that his numbers had been stable over the past four months.

Blanca: Yes, stable., stable. He's not using any chemotherapy for now. He did chemotherapy in 2013. I heard about Low Dose Naltrexone, but actually I wasn't sure where to get it or which doctor will give it to me. So finally, back in April, we got a prescription from a doctor, and he's been taking, it six months already. He's stopped taking it for like three weeks because he developed some anaemia because and we were afraid of any interactions of any with supplements. So we stopped the Low Dose Naltrexone, and I've noticed that his numbers raise a little bit. So we went back right away to Low Dose Naltrexone, and the numbers went back to a little lower but stable. It's not a huge change, remission or something, but at least it's keeping cancer at bay.

Dr Jill Cottel: How does he feel on it? Can you tell the difference taking LDN now versus when he wasn't taking it?

Blanca: He has a sleep problem many years ago, sleep apnea and he's not having any episodes of apnea anymore, and I've noticed that he sleeps deeper. He wakes up because he has that problem from before, but it's not as acute as it was before. I think it's helping like to get more like deep sleep.

 Dr Jill Cottel: That's good. I've had some patients report they're sleeping better on it. Their quality of sleep improves.

Blanca: Exactly. I wasn't sure if he has a little bit of anaemia if it's okay to take Low Dose Naltrexone or with Tylenol, but I heard Tylenol is fine.

Dr Jill Cottel: That'd be fine.

Blanca: And so having anaemia, do you think there's a problem?

Dr Jill Cottel: No, I can't see any reason why that would be a problem with anaemia.

Blanca:  That wasn't all his concerns because he didn't, he his thinking about introducing other very, very lows that were chemotherapy capsule. So I wasn't sure if it has any interactions with chemotherapy or immunosuppressant.

 Dr Jill Cottel: I don't have any experience in patients specifically with Multiple Myeloma, but I've had other patients where I've used LDN in combination with immunosuppressants, and we haven't seen any problems.

Blanca: Okay.

Linda Elsegood: Thank you. We will get to our next call on now. Hello Sabba. What question do you have for doctor Cottel?

Sabba: I'm a pharmacy student. I just learned about LDN and how it works. I'm really interested to know more, and I just wanted to see if the doctor can explain to me the exact mechanism of action.

What's happening with this medication? And in pharmacy school, I learned that it's mostly used for alcohol dependency, but they never talked about other indications for Low Dose Naltrexone. So I just wanted to see if the doctor can explain more about the medication.

 Dr Jill Cottel: That's a great question, and I'm so glad to hear it. From the best pharmacology standpoint, this is a fascinating compound.

There's an article that was published in 2014 in clinical rheumatology, and the lead author is Jared, Younger. The title is "The use of LDN as a novel anti-inflammatory treatment for chronic pain." It outlines different pathways and receptors. Also in the LDN book, which just came out this year, the first chapter is by Dr Steven Dickson, and it goes over the pharmacology of LDN in detail. There are several different ways in which we think it works. This chemical is a mixture of both up left-handedness and right-handedness. A number of these medicines that we use are like that. The left-handed side does a number of things with different receptors that have to do with inflammation. The right-hand side has to do with the effects that it has with the opioid receptors.

Sabba: Okay. Thank you so much.

Linda Elsegood: We'll go to our next caller now, James. Hello,  what question do you have for Dr Cottel?

James: I've been taking Low Dose Naltrexone for 27 months now. I began taking it for a Non-Hodgkin's Follicular Lymphoma and I'm almost 70 years old. I feel like I'm 50 years old again. It cleared up my depression; my brain fog, my fatigue. I'm physically about twice as strong as I was.

I've always done heating, and air conditioning work and  I'm actually back doing it again now.

It cleared up the ringing in my ears that I had for years. Anyway, my question is, after taking 4.5 mg for 27 months, I was wondering if I should dosing and scheduling. In this last Research Trust documentary, they talked about different dosing protocols. And I was wondering if I should get off of it for a few days and then take it seven days a week. If I should skip a day now and then, or skip a couple of days every so often if it would help.

Dr Jill Cottel:That's a very good question. I know that Dr. Dalglish in London is looking at intermittent dosing and it seemed like when you were in the treatment phase of the disease, it was continuous, and then off, somewhere in the distant future if you were in remission, you would maybe fiddle with the schedule a little bit. But I would say that for lymphoma, I would probably continue taking it daily, but  I'm not the most experienced person for oncology with it.

James: Thank you so much for all the good work! LDN just really given me my life back and I feel great.

I really appreciate all you did.

Linda Elsegood: That's good to know. Thank you. Well, we'll go to our next caller  Harry. What question would you like to put to Dr Jill Cottel?

Harry: Well, I don't have a question. Mine is a real success story with LDN. I had Ulcerative Colitis onset 15 years ago. And for the first eight or ten years after that, I was being given everything you could think of, 5,600 mg a day of Mel Salomon Emeran?, 50 mg of Oxycodone day, which didn't solve my pain problems, which nobody could figure out. And we finally, through dr Julian Whitaker, we got some information on Low Dose Naltrexone and started reading up on it and finally found a doctor who would prescribe it. And basically with me, we went, no dairy, gluten-free, making probiotics and 4 mg of LDN a day.

And I had resulted in less than a month.

And doctors, all of them would admit that there was no way that LDN could possibly hurt me, but none of them would prescribe it.

They did want to take out my colon. They were doing colonoscopy on me literally every four to six weeks.

The last one I had here this last August, they again. The gastro doctors will say, no evidence of active disease Ulcerative Colitis. They just won't admit it's gone. Literally, at this point, I have no dietary restrictions at all. I just take my 4 mg of LDN every night, and I eat anything and everything and have zero problems.

So I would just encourage anybody who has not found a doctor where they can talk to them about these problems and can maybe get something to just quote off-label to do so. Because at the very least, if all of the doctors admit that the LDN can't hurt you, it would seem to me that it would be inventory just to at least try it for some of the more drastic things.

And they had me on all kind of stuff and none of it worked. And there are some really nasty side effects to some of those drugs they use, just like with chemo drugs. So mine is just a good story, and I realize that may not work for everybody, but it's certainly worth trying.

Dr Jill Cottel: I agree.

James: One quick aside on the pharmacology student that called a while ago. There is a video out to YouTube called "LDN, how it works." which talks very specifically about how this works. I take it with me to every doctor I go.

It's something that a normal person can understand.

We need to try and get as much information out to everybody we can about this because there are so many things that people are taking that are so terrible on their system, and then they don't work.

 That's all I had. I do appreciate the time.

Linda Elsegood: Thank you, Harry. Well, we'll go to our next caller, Theresa. Hello. Would you like to ask a question to Dr.?

Theresa: It has been wonderful. I have been taking it since May. It has helped me tremendously. Unfortunately, it hasn't 100%, maybe 80, 85% but I do understand that it doesn't correct things that have been of an old issue.

Maybe I didn't catch my problem in time, but I was able to find my doctor who wasn't familiar with the medication, but he did allow me to try it. And it's been wonderful ever since. But it hasn't corrected everything so I still look at a couple of things, and I'm looking at something called Sam-e, which is an amino acid and it does suppose to help with arthritis but my concern is with stiffness. And so I'm wondering. Will it affect that? I know it affects your brain. The Sam-e and the LDN also work in the brain and I don't know if that would be an issue with mixing those together or not.

 And there's the other issue, which is Wilson's Temperature Syndrome, which may be an issue with me.

Dr Jill Cottel: That's a good question because I often will have patients and taking Sam-me and then we'll start an antidepressant if we're treating them for depression. And then it's important to know, what herbs and supplements they're on because not everybody will bring that up. And so there are some interactions with Sam-e and different types of antidepressant drugs. We do know that Low Dose Naltrexone has some interactions with the different neurotransmitters, but it's so mild in terms of the effects with LDN that you should be fine taking it with LDN.

Actually, I do have one patient who is taking Sam-e with the LDN, and she actually did better with the combination than she did with the LDN by itself.

Theresa: That's great to know. Now my other concern is that we haven't looked into this part yet, but because my issues have been so evasive, Wilson's Temperature Syndrome, so we may be going down that road looking at certain protocols that may require some Cytomel for a small amount of time to regulate the body temperature. And this may resolve a lot of my issues. Is there any complication with using LDN and the Cytomel and maybe the Sam-e? I also use Ashwagandha.

So combining all those, I mean, I don't know what I'm doing, but I do know I feel so much better, but I don't want to pose another problem that may be worse down the road. So there would be the Cytomel and then the ashwagandha and the Sam-e.

 Dr Jill Cottel: So the Ashwagandha should not be a problem. The Cytomel I would just be very careful with that because some people will respond fairly dramatically Cytlmel just on their own when you're treating for low thyroid. And sometimes it's difficult to get the thyroid adjusted with that. So just, I would say talk to your doctor about dosing it very low and watch your thyroid numbers pretty closely.

I would say getting them checked, at least within the first six weeks of starting it. 

Theresa: He's, really unfamiliar with the LDN but my thyroid numbers are always fine, but with Wilson's temperature syndrome, the body temperature is always low.

So this is an indication of chronic infections so it can be mixed, but very, very cautiously.

Right. Well, I appreciate your time and thank you.

I heard about it about four years ago, and so lucky to have a compounding pharmacy online. Advertising it in my area, so that got the news out. So it's wonderful that the news is getting out and more people are going to be able to be a little bit less painful.

Linda Elsegood: Okay, well, we're going to have another break, and we'll be back with some more questions later. Today's show is sponsored by the Poway Integrative Medicine centre who take a holistic approach to provide the highest level of health care—combining internal medicine with alternative therapists, including acupuncture and Chinese medicine.

If you're in the San Diego area, they'd love to see you or you for in the state of California they offer secure video conferencing appointments when clinically appropriate. Go to www.pimchealth.com or call 858 312 1672

On Facebook follow Jill Cottell, MDs page.

Linda Elsegood: Welcome back and this time, which went by Cynthia. Hello, Cynthia. What question do you have for Dr. Cottel?

Dr Jill Cottel: I have PMR for the second time. I had been using LDN since July 2015, and when it came back again this July, it was significantly less pronounced than the last time. However, I'm not on steroids yet. I'm doing a low inflammatory diet, but if things get worse, is it alright if I do go into steroids? Also, there's a possibility I might be developing giant cell arthritis because I have a very painful jaw, sort of extreme tenderness on top of the head, but no headaches yet. Last time I was probable GCA, but,I had been in touch with my rheumatologists just yesterday.

Just in case they want to do a biopsy, but I really want to know where I stand beside the LDN and steroids.

Dr Jill Cottel: That's a very good question. If you were just dealing with the PMR alone, that would make it a little bit easier and it definitely, it would be fine to combine steroids with the LDN for PMR.

I've had patients do that. And you can generally get that away if you think less steroid and come down off of it more quickly. But if there's any possibility of the temporal arteritis, you have to be more careful about that because of having your vision affected. So I'd be more vigilant about that and getting your eyes checked frequently and making sure they are watching you closely.

Cynthia: Well, I'm hoping that I haven't got the GCA and I'm really hoping, but I up to what level can I take steroids because I know that with GCA they will often a GCA, sorry, start at 25 milligrams. The steroids, is that all right with LDN?

Dr Jill Cottel: It should be fine.

Cynthia: Oh great. I mean, I'm hoping not to because last time I was on steroids for three and a half years and then I was on methotrexate as well for the last year probably, and I didn't like either of them, like all the side effects combined, so I'm hoping to keep off the steroids. I just wanted to know where I was because I'm hoping to see my rheumatologist who will obviously know nothing about LDN.

Linda Elsegood: Sure. Well, good luck. with that. Bye-bye. Okay, next we have Linda. Do you have a question?

Yes, I do. I have severe Crohn's. I've had three bowel resections, and the last one I ended up with a hospital, a bug on a ventilator for two months and almost died. So it's very important that I take my LDN all the time. I've been on it for about six years, but here's my problem.

Now that they look in my colon and basically in remission I still can't control the bowel movements and diarrhoea all the time, but it's better than it used to be. I also have multiple pain issues, Fibromyalgia, myofascial pain, Stenosis and I've had to have my ureters replaced with tubes that have to be changed out every 90 days or so. I have not been able to let go of my pain medication. I worked out a plan for myself because I couldn't go off the pain medication. I don't take any pain medication after 3:00 PM in the afternoon and when I go to bed at 10 pm I take my LDN.

Do you see a problem with that?

Dr Jill Cottel: I don't.I mean if my patients are on pain medication and they're taking it so frequently that they've always got some in their blood it can be a problem. So even if their last dose, is it three, if they've already taken, a certain amount of medication that day already, it may not be completely out of their system by bedtime. But if you're on a small enough amount that you're getting enough space out from it, you should be OK. And if not you should know already because the pain would come back, and you get some withdrawal symptoms. There is the issue of course, while your chronic narcotics, the hyperalgesia of the central nervous system, pain effects from being on them.

It's risk versus benefit and with all the different pain type syndromes you're having if it's something that you aren't able to come off of you have to just do your best.

Linda: I have tried, and it just has been impossible for me. I ended up becoming homebound and in bed, and I refused to accept that, and I fight as hard as I can, so I take the minimal dose.

The earliest possible during the day and then just do the white knuckle teeth-gritting when it gets to be there in the day so that I can have my naltrexone at night. And I think it's working because my colon is still beautiful.

I so much wanted somebody to tell me if that was an acceptable way to combine them or not. So thank you very, very much. 

Mary: I have been looking at LDN for a long time, and I haven't gotten a doctor to prescribe it for me. I had to ask a couple of doctors in the UK. We live in Sweden for three and a half years, and I went to the UK for treatment with finally identical hormones and I asked the doctor there to prescribe it, but she wouldn't, she just didn't think it made any difference. But she said she didn't believe there was any research that proved that it would help. I've gone to the seminar in Las Vegas and I thought that it would help me. I currently am not taking much pain medicine. I take Arthrotec now and then. I have Fibromyalgia,  Chronic Fatigue, and the fatigue is bothering me much more than the pain now. Do you think LDN would help me?

Dr Jill Cottel: I do. Well, based on my experience. With my patients who have Fibromyalgia and Chronic Fatigue, for the Fibromyalgia, almost all of my patients have had some benefit, and a very few have not.

Almost everyone has had some. And then I've had patients where they've had dramatic improvements with the Fibromyalgia, and same thing with Chronic Fatigue. Most of my Chronic Fatigue patients are feeling much better. We do have a good couple studies looking at Fibromyalgia with Low Dose Naltrexone and you should be able to find someone to prescribe that for you.

Mary: Now we just moved about two weeks ago to Austin, Texas. Do you have, do you know of any doctors in this area that is familiar with it?

Linda Elsegood: We have a list, and there are some doctors around that area. If you would like to send me an email, contact@ldnresearchtrust.org, and we will get back to you with some of the doctors that we know of that prescribe.

Linda Elsegood: And we will quickly get to the next person. So thank you very much, Mary, for your call. Next caller is Robin. Hi there.

Robin: Hi there. My question regarding Chronic Fatigue. You just answered part of my question about Chronic Fatigue Syndrome. But I wanted to be a little bit more specific. My son, who is 18 years old, has been suffering from CFS for about two years. He seems to be improving with, nothing, I guess He's on an antiviral that doesn't seem to be helping to me, but he's just gradually getting better and specifically, do you think that it would help his, like these setbacks and crashes that he has that we're trying to really put an end to? I mean, what specifically with CFS doesn't seem to help other than just the fatigue?

Dr Jill Cottel: I would say, probably energy improves. And also a lot of times mood improves.

And so patients, sometimes the symptoms aren't as much improved, but their ability to cope with the symptoms is better. Does he have any muscle type pain at all, or is it just the fatigue?

Robin: He really doesn't have muscle pain. He has suggested that his limbs feel heavy at times. He occasionally has a headache, but not often.

It really just seems this excessive fatigue. If he doesn't get enough sleep, it's stress and emotional stress or concentrating in school, that seems to cause these setbacks the most. And then he can't basically, get off the couch for a couple of days.

Dr Jill Cottel: I would think it'd be worth trying.

Robin: I agree. Okay. I just wanted to confirm because I hear it used more with pain and Fibromyalgia, but not strictly with Chronic Fatigue syndrome though.  Thank you very much. I appreciate your help. Bye-bye.

Linda Elsegood: Sarah on Facebook wanted to know if you'd had any success with LDN for treating Epstein-Barr.

Dr Jill Cottel: I have a patient who, she had had, illness with Epstein-Barr, and she just hadn't been able to bounce back from it.

And it had been, I'm going to say at least six months, and she started taking the LDN, and I want to say within about a month she was feeling much better and then it wasn't much longer after that she kind of felt back to normal.

Linda Elsegood: Okay. And Diddy said, can LDN be taken with high doses of Manganese?

Dr Jill Cottel: I don't see any reason why not.

Linda Elsegood: Does LDN help with adrenal insufficiency?

Dr Jill Cottel: That is a good question. I don't know the answer to that. I do have patients who've come in with the diagnosis of Adrenal Fatigue, which is kind of a nebulous sort of thing, and I'm not sure anyone knows why LDN helps those patients, but it might just be the endorphins themselves helping with energy food.

Linda Elsegood: Another question. Is endorphin buildup a real thing and should people occasionally skip a dose? And if so, how often?

Dr Jill Cottel: The patients that I've had generally when they skip doses, they feel worse. And sometimes not right away. But they can usually tell the difference sometimes after four or five days off.

I think in general, probably not skipping doses. And you figure it takes a while for the endorphin levels to decline anyway. So how much difference you're making just by skipping a day or two here and there, I'm probably not making too much of a difference.

Linda Elsegood: I must admit sometimes. I'm just drifting off to sleep, and I think, I haven't taken my LDN.

Do I get up and take it and wake himself up or just miss a dose? And I sometimes miss a dose, and it doesn't make any difference. I think sleep sometimes it's better than getting up and not going back to sleep. Another question here from Kaylyn. Does LDN stop the progression of the disease?

In her case, she's got Rheumatoid Arthritis?

Dr Jill Cottel: That's a good question. I don't know that anyone knows the answer to that for sure. I think that we look at terms like remission and how people are doing clinically. So, I mean, just matter of semantics, whether you say, stopped progressing or it's in remission.

We go by how the patient is feeling clinically.

Linda Elsegood: Okay. And another one there about dosing. The benefits of splitting the dose into two over a day for CFS/ME.

Dr Jill Cottel: So again, that's a very good question. I generally discouraged my patients from doing that just because that's not the way it's classically been dosed.

And it's not the way it's been dosed in the small studies that we've had. And the mechanisms of action is to briefly block those endorphin receptors. And it has to be brief, and it has to be in and out of your system. So what the implications would be of doing that again, only 12 hours later? We don't know and Naltrexone has metabolites that stay around in the body afterword. So I would tend to discourage it. 

Linda Elsegood: okay. We've got time for one more caller.

What question would you like to ask Joe?

Joe: I would like to ask for a group member who has been trying to get an answer to this question. If Dr Jill has ever treated or know of anyone treated for a condition called a Stiff Person Syndrome, also known as a Stiff-Man Syndrome and  I'll start there, and then there's a part two.

Dr Jill Cottel: That doesn't sound familiar.

Is there anything else that goes by?

Joe:  No. Those are the only two he stated and that I know of is the stiff person or stiff-man syndrome, but is, I'm pretty sure, I believe.

Linda Elsegood: It is actually on our list of conditions that LDN can treat.

Dr Jill Cottel: Okay. I'm looking at it just in front of the computer since I'm sitting here and it says a rare neurologic disorder of unclear cause with progressive rigidity and stiffness mainly affecting the trunk muscles with spasm. So no, I don't have any personal experience.

Joe: Okay.

Linda Elsegood: I'm really going to have to stop you there.

When the hour's up, we stopped. So I'd like to thank you very, very much for taking our calls. As always, Jill, the next Wednesday we'll be joined by doctor Jim, Dr John Kim, full details are on the website.

Thank you. We would like to thank today's show sponsor, Dr. Jill Cottel and the Poway Integrative Medicine Centre.

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.

Linda Elsegood: Today I'm joined by Dr Jackie Silkey, who's from just North of Salt Lake City in Utah. She's a functional medicine practitioner. Thank you for joining us, Jackie. 

Dr Jackie Silkey: Thank you for having me. 

Linda Elsegood: Could you tell us how long have you been prescribing LDN? 

Dr Jackie Silkey: I've been prescribing LDN for about five years now. I’ve treated quite a wide range. I started out using LDN for all autoimmune disorders including Hashimoto's, lupus, and now have branched out into other areas and using LDN for other applications as well. 

Linda Elsegood: And what kinds of results have you seen so far? 

Dr Jackie Silkey: I've seen very good results. I always use LDN as part of a program where I'm addressing more of the root causes of what's going on and putting a comprehensive program, both nutritional exercise, stress reduction, those type programs into place, as well as doing quite a bit of a functional medicine testing. And then I bring LDN as an anti-inflammatory as the extra treatment arm. In most of my patients, I see they are successful in implementing base therapy. 

Linda Elsegood: Have you seen any negative side effects?

Dr Jackie Silkey: Yes. When patients first, start LDN. Sometimes patients will complain of vivid dreams or difficulty sleeping—those sort of common complaints. I'll either move them to morning dosing or depending on how significant the symptoms are, I'll dial back on the dosage or just tell them to go ahead and push on through. And  I find that it improves easily within a week. 

Linda Elsegood: Have you any people that you have treated who have had marvellous results? Do you have any case studies you could quote? 

Dr Jackie Silkey: Most of my patients actually come to me to get a comprehensive program put into place, and then. I actually don't see them routinely. They go back to their primary care physician once I'm able to get them improving in the right direction. And so I don't have patients that are coming in monthly for checkups or checking in with me. So most of my patients will go back to their primary care physician once I feel like that they have plateaued on their healing with me and have put into place all of the aspects of healing that  I find to be important. 

Linda Elsegood: Well, that's good, isn't it? So if so, when a patient comes to you, you, you look at everything, that lifestyle, that diet, exercise, supplements, all this kind of thing to try to get them.to have a healthy lifestyle as well as treating the disease. Is that right? 

Dr Jackie Silkey:  Most definitely. Yeah. In fact, a lot of times I try not to even look at the disease per se. I try and look more at the patient and say, you know, why is this disease happening in the first place and see what we can do as far as reinforcing them foundationally.

And that's where I think LDN really plays a significant role,  is to reinforce people foundationally.  You know, just like we do with nutritional aspects that exercise aspects, stress reduction aspects, all of this just to reinforce not only a nice environment for healing to take place, but also to prevent relapse.

Linda Elsegood: What would you say is the best diet? We're always being asked this for people with autoimmune diseases. 

Dr Jackie Silkey: Well, it truly depends upon the person in my opinion.  I don't even like the word diet. There are so many negative connotations associated with it  I try to use nutritional plan because I really want people to think about this being a nutritional plan, one that they don't come on and off of. So diet, we always think of, I'm going to go on a diet and then I'm going to come off of the diet. And those things tend to be, you know, somewhat more extreme.

When I set up a nutritional plan, let's say for somebody with autoimmune disorders, there are some people that come to me and have read every book and have tried, you know, multiple nutritional plans have had limited success with them. I don't go back and try to recreate those. I just learned from what they've worked on and what they haven't had work in the past. Sometimes they'll do some functional medicine testing, some food sensitivity testing to dive deeper into that person's metabolism of foods and, and their sensitivities and what their blood is doing when they eat certain foods. And that way, I can kind of make a more personalized approach. 

Linda Elsegood: Are you a fan of vitamin D? 

Dr Jackie Silkey: Oh, yes. You know, we can get a lot of sunshine in the summer, but I would say the majority of patients that I test, and I do test everyone, are low. That may be an absorption issue from the GI tract. They're not absorbing it. A lot of people don't know about vitamin D,  that it's a fat-soluble vitamin and that you have to take it with fat. Otherwise, you won’t absorb it.  And there are some people that I don't think absorb their fats very well, to begin with, and so they can have absorption issues. I try and address all of those things. Testing vitamin D levels,  also taking a look at the GI tract and how well they're absorbing their vitamins. 

Linda Elsegood: But I would have to say both my husband and myself, after listening to Dr Tom O'Brien at the conference last year, we both stuck to the diet religiously and I have been a diabetic type two, and I was diet controlled for four years. And then I was on Metformin, and I was told a few months ago after being on a diet, say six months or so, that my sugar levels were prediabetic, and I was told that I could stop taking the Metformin.

So I'm thinking, Oh if you're going to take the medication off me, what happens if. They go upon, I don't know, and I have kidney problems. I was really panicked, and they said, don't worry, we will take your blood again. And it showed that I was at serious risk of becoming a diabetic, but I was prediabetic, and I didn't need to take the Metformin.

I've been assured enough seeing the results, and I'm not worried about it. And I'm sure if I keep my diet. As it is, but apparently once you've been diagnosed as a diabetic, they can't remove that from your records. So I'm now a diabetic in remission. So I'm, I'm really pleased about that. You know, one less drug.

Dr Jackie Silkey: I think that there's a lot of people they can say that they are diabetics and in remission as well, you know, or a diabetic, in the, making one or the other.  I think that you know, nutritional plans play a significant role as well as exercise plans and then implementing those exercise plans and then stress. Obviously, stress is going to play a significant role.

Linda Elsegood: Let’s briefly talk about exercise. Now one of the questions that we are always being asked, sick people, can appreciate the fact that they should be exercising people with, say, someone with MS who suffers from severe fatigue, where any exercise, just moving, showering is too much for them, and they spend a lot of the time in bed. What can people do too? Try an exercise when they are that fatigued. What is your suggestion? 

Dr Jackie Silkey: You're absolutely right.  I want to make sure that your listeners know that we always talk about implementing exercise programs and try not to make people feel guilty for not implementing exercise programs. But there are some people that that can actually be quite detrimental for. And, and you know, if you do an exercise program and you're recovering for two days because you did too much, then obviously, you have to build up your base before you’re ever able to really do a formal exercise program. You really have to spend quite a bit of time working with the patient and talking with the patient about what they've done in the past. What was too much for them in the past and if you can dial into what it is that their body needs. Because you take the same person with MS, and then you take the person down the street with MS, they're going to have two very different exercise tolerances, and they're going to have two very different levels of benefit from any sort of a formal exercise program. So you have to make it, in my opinion, very individualized. And that's where I find that it can be very difficult and, and can make people worse initially if physicians to a physical therapist or nurse or anyone is not listening to the person about what's been too much for them in the past and, you know, starting low and going very slow.

Linda Elsegood: So you learn to become fit enough to start to exercise basically very slowly and gradually and not to give up. Forget the idea that you're not achieving anything by baby steps. You do get there. It just takes a while, doesn't it? 

Dr Jackie Silkey: That's exactly right. And everybody has a very different starting point, and so it doesn't really matter where your starting point is, it's important that you start there and that you move forward from there.

Linda Elsegood: I think it helps to keep a diary of what you can do and try and improve on that. If you've only managed to do an extra five steps in a week, at the end of the month, you know, you may have done 20 steps or something like that. It's all just very, very slowly and gradually. And then once you become fit enough, you can then, as you were saying, do a plan. You won't fatigue yourself too much, doing 

Dr Jackie Silkey: too much 

Linda Elsegood: too soon. 

Dr Jackie Silkey: You're absolutely right. And I think that's where pedometers, you know, really play a significant role is then measuring steps and, and there's a lot of things that people can do and in their homes, just depending on where they are. Other things, you know, take more pressure off of the joints, sign up for a program that's actually done in the water, taking some, some of the pressure off of the joints themselves. So if somebody tells me that they had quite a bit of soreness and joint pain, well, there are supplements that you can take before then there's hydration that you can do before them. But there are also ways in which, if their joints are quite uncomfortable that you can do exercise in the water. Even just some gentle movements and walking within the water itself can take the pressure off of the joints enough to where you can slowly build from there. And there's actually a treadmill that's available, it's almost like it's built into a shower and certain physical therapy places will have it and where you can get in there, and you can just very slowly walk on the treadmill,  and water just to take some pressure off. Those are just some examples of different things that I'll have people do. 

Linda Elsegood: I went to a class to do cross therapy, and I was in my fifties, and I turn up, and I was the baby. They were people who were 70. It really made me smile. They were all so kind to me. And you wore a band around your, your middle. So you floated like a cork no strain on your arms and your legs, and you just bobbed. And it was difficult. It was really, really difficult. So I was saying, you know. I don't think I'm going to be able to do an hour so that I did set it all up, but that's fine. We'll just do it gradually. I could only do 20 minutes.

Dr Jackie Silkey: For some people even just going to the facility, changing into a swimsuit, getting into the water, getting out of the water and going back home, wipe them out completely. It just depends on where people start. If people are quite ill, and then you obviously cannot start with a formal exercise program. 

Linda Elsegood: I couldn't walk when I got out of the water suddenly, suddenly all the weight was on my legs, and it's like, Whoa, I can't do this. I went home, I went to bed, and I couldn't get out of bed and move without really severe problems until Thursday.  I did too much, but I didn't realize it. It just seems so easy, but my legs just, Oh, it was unbelievable. We will just go to a break, and we'll be back in just a moment. 

Today's show sponsor is Care First Speciality Pharmacy. They're leading compounders of LDN and other custom treatments servicing patients in over 18 States coast to coast. They're credited 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 CFS pharmacy.com. 

Back to stress, that's another thing we've never talked about so far on the radio show. What do we do when we're stressed and maybe defining stress versus depressed. I mean, when you have a chronic condition lots of things become a problem to you mentally. 

Dr Jackie Silkey: Yes. I think that you know, when we talk about, it's really important for me to teach patients when we're talking about implementing a stress-reduction plan, is that it's not at the moment necessarily to relieve stress. It's about implementing a plan. It's like a nutritional plan. It's not like you implement a nutritional plan that day, and you lose 10 pounds that same day or gain 10 pounds of muscle that same day. It takes time for you to see the fruits of your labour, but by implementing a stress-reduction plan you're putting more resilience into people's lives and into their body to be able to, to be more resilient with relapses or more resilient with a major stressor that comes along, a car accident, anything that's gonna be a big stress in somebody's life. Stress reduction versus depression, I believe you said stress versus depression, they tend to in a lot of people go hand in hand and that's where these comprehensive programs, including low dose naltrexone,  really helps. People with mental health issues and, and with depression. Now, did they have a formal diagnosis of depression?

Maybe or maybe not, but still low dose. And by reducing inflammatory factors within the brain is able to help. Most people that are dealing with a chronic illness because a chronic illness, by definition, is depressing to the body. It's stressful for the body. It's living in a body that's inflamed and living with a brain that's inflamed is very difficult.

Linda Elsegood: Let’s get to some questions and answers. 

Dr Jackie Silkey: Yeah, that sounds good. 

Linda Elsegood: We have a Marie, and she says she has a seven-year-old who was diagnosed with Crohn's four months ago, and she would like to ask, are the children taking LDN with success and when would she expect to see improvements? And what would the improvements be besides better sleep? Would it assist with pain and quality of life? She was hoping that he would have more energy and be able to go through a normal day at school. 

Dr Jackie Silkey: Well, we were talking earlier about patients that I have on  LDN and my success stories, and. You know, a lot of times I won't see them routinely, but one of the success stories that I have and that I still speak with this patient often is with a Crohn's disease patient.

So Crohn’s disease  you know, quite a bit of  inflammation within the gut. So people that are dealing with a fire brewing inside their body, whether it be in their gut or their brain or their blood or wherever. It's going to fatigue them. It's going to decrease their energy levels. Initially, it might make somebody more agitated, but initially, what initially fires somebody up and makes them hypermetabolic then to close them down later in the disease process. What I tell people what to expect is variable. I put patients on low dose naltrexone and we watch, we take a look, we dial them up.  I do tend to increase their doses slowly and watch for their most prominent symptom, for example. And the patient that I was referring to earlier, one of the hallmark symptoms she would have was diarrhoea, and so she would be having eight or nine loose bowel movements per day when she was in an active Crohn's flare, she also had some abdominal pain. 

So once we were able to start her on low dose naltrexone and then dial-up her dosing, we ended up doing something a little bit different for her. We ended up doing twice a day, smaller doses instead of once a day, larger doses. So you have to keep reassessing. But I will tell you that for some people the response is dramatic and swift. But just because somebody does not have a swift or dramatic response doesn't mean that they aren't going to have a response either later or that it be kind of this slow uptick. I would  say that, what I would tell the mother is, you're absolutely doing the right thing. See what the symptoms that are most predominant at the beginning of starting low dose naltrexone. And then always stay in contact with whoever's prescribing it so they can help guide you on the correct dosage, the correct frequency.  We were talking about stress earlier. Here's my patient who was a student and every time finals would come around, she would have a flare. And so knowing this, we knew how to put into place a stress-reduction program that really dialled up a week or two before she started studying for all of her finals. And preparing earlier for her tests. So there was less last-minute stuff. So we were able to, you know, figure out what her relapse risk factors were, and then specifically guide that around my plan. We ended up not needing the plan, but my plan was also going to think about going towards a higher dose two weeks before those stressful events, but we ended up not needing it. She was able to keep the progress that she had made for throughout the rest of the semester into final examinations by just preparing earlier and knowing what she needed to do would affect what her final result was. So, I don't know if I've given any specific timeframe. I will tell you, it varies from person to person.

I would definitely take a look at the symptoms that your son is having and that energy, in my opinion, energy usually comes around quicker in kids. But it tends to lag behind the other symptoms, their GI symptoms. So if he's having quite a bit of abdominal pain, an improvement upon the abdominal pain might come first. Then energy might come after that. Imagine that the fire that is brewing inside the person's body is sucking them dry of energy. Well, you have to first, turn off the propane to the fire, and then you have to extinguish the fire and then with time, then that energy will then come back. There are really very few side effects. The only time that it really plays a significant role is if  I tell people about  they have to have surgery or if they accidentally fall out of the tree and break their arm and they have to go on pain medicine, any of those sorts of things where you're going to be stopping the LDN for a period of time.

Or I am trying to use no narcotic pain medications, which would be even a better choice.

So, do I feel that,  LDN is safe in children? Yes. And, even in pregnancy I have a couple of patients that are pregnant, and that stopped LDN during their pregnancy, and resumed it, after they deliver the baby while they're breastfeeding. And  I personally, don't even think that there's any reason why anybody needs to stop it during pregnancy.

But there are no studies  that have looked at LDN in pregnant women because there's, you know, there are no studies that have looked at other medications in women, but we use them. You know, and people that are addicted to opiates will use high dose naltrexone and sustained release naltrexone because the risk to the baby is much greater than the potential risk at high dose naltrexone. Low dose naltrexone is an immediate release Naltrexone compounded formula that can be used in children and young women. 

Linda Elsegood: Well I think many of the listeners will have heard of Dr Phil Boyle using it in his paternity clinics where they use LDN to get pregnant during pregnancy and during breastfeeding. He did a very good presentation for the conference last year. And it showed that babies born were of better weight, had less need for antibiotics. Apparently, some babies need, antibiotics for chest infections and the like, and they weren't contented. And I thought that has to be good  if you've got a baby that cries all the time. So in his experience, LDN has been really good, and he did a small study. I'll have to send you the link to it, which was very interesting. Very interesting indeed. Okay. We have another question here from Lucy, and it's with atopic dermatitis. I know that you do a lot of skin conditions in your practice.

Dr Jackie Silkey: Atopic dermatitis. Cyclosporine is a common Western medicine drug that is used for autoimmune. So it's going to, you know, decrease somebody's immune system reaction to themselves. So the thought is, is that you know, that autoimmune disorders are really yourself, you know, attacking oneself, you know, the whole idea of that, without looking at their foundational, a lot of times what I find is foundational people with autoimmune disorders. Really, their immune system is woefully inadequate for foundational reasons instead of hyperactive, if that makes sense. So people on cyclosporine can take low dose naltrexone . Now, cyclosporine levels are normally checked for somebody who had a transplant who was trying to keep their levels at a certain parameter. And I would say initially when starting any new medication or any new supplement I tell everyone that is taking  for transplant reasons to have their levels checked after starting any new medication or any new supplement because everybody's going to react a little bit differently. So would it, would it potentially affect their levels? Possibly, but not usually. 

Linda Elsegood: Okay.

Linda Elsegood: And we have another one, about eczema on steroid treatment. This lady has been using it for 30 years, and she says, my skin is very inflamed. I have no quality of life. My dermatologist's about to put me on what  the drug we've just been talking about, and she's been off topical steroids for 18 months. And do you think LDN would help?  

Dr Jackie Silkey: As part of a comprehensive program? Absolutely. I find that part of a comprehensive program LDN plays a significant role in all of the autoimmune disorders that affect the skin, that affects the brain, that affects the GI tract.  I try not to treat a disease with a drug or a supplement. I try and treat the person who is having symptoms associated with the disease and look for what their rate-limiting stuff is. So, you know, there are some people that are not absorbing their fats well. They're not digesting. They've got some digestive enzyme insufficiency. They've got  maybe some small intestinal bacterial overgrowth symptoms. They've got a lot of  gas and indigestion, fatty stools, things like that. Well, with that person, I'm gonna think about why the eczema is just being a symptom of the problem. And by far and away, I find that things like eczema, psoriasis, all of these things tend to be more of a symptom of the problem.  Instead of me worrying about labelling people with their diseases, I say, this is a symptom of the problem and we're going to follow this symptom as we address, you know, your insufficiencies as we find them. And that's where functional medicine testing, I believe, plays a significant role. 

Linda Elsegood: And at the time you've got the body working correctly. Do you find a lot of the symptoms resolve anyway? 

Dr Jackie Silkey: Oh yes. That's exactly, that's when you know. There can be several things that you uncover that may not be directly related. Let's just take eczema. It might not be directly related to their eczema, but yet play a very significant health benefit if you can address those things as well. So, but yes, I mean, anytime I'm seeing anybody with anything from acne all the way to psoriasis. I'm definitely treating internal parameters instead of just treating, okay, is your acne better? I'm following many different things, but I think the skin makes it nice because you have an external way of evaluating how well your treatment is going. You just look at your leg, and you say, yes, the treatment seems to be doing much better. 

And people do that with depression. People do that with  getting pregnant. You were talking about infertility treatment. I mean, that's  obviously the goal and obviously the goal is to improve eczema to where it's completely asymptomatic. But. I don't  find that putting topical treatments or putting people on a cyclosporin to be that helpful in getting down to the root cause.

In fact, I think it just masks the symptoms.  I have people come in all the time that are on steroids or cyclosporin or other autoimmune medications. Humira is big here in the United States, and it just masks the symptoms, even if it controls the initial disease or the initial symptom that you're trying to control. Your body just has a way of showing that in some other area. 

Linda Elsegood: And what's the downside on using. Steroid creams longterm over the years? 

Dr Jackie Silkey: Well, first of all, it changes the quality of the skin you're using it on. And second of all, you absorbed some of the steroids through the skin. So, you know, you're interrupting the barrier protection of the skin. Are you making it less of a good barrier to disease and to infection and all the rest? Depending on  if you're just using a small amount of steroid on one area, but some patients have to put steroid creams on multiple areas of their body, and so that ends up being a  fairly large dose of steroids. Some of that is going to get delivered systemically as well as just on the skin. So the problem with steroid creams is that they can thin the skin. So we use the thickness of the skin as a measure of. Health. So think about somebody's face. Think about an older woman's face versus a younger woman's face.

Part of that ageing process is this thinning of the skin, and so it, therefore, can't withstand pressures as well. 

Linda Elsegood: We will just go to a break, and we'll be back in just a moment. Today's show sponsor is Care First speciality pharmacy a leading compounders of LDN and other custom treatments servicing patients in over 18 States coast to coast.

They're accredited to provide you with the highest quality demanded by the industry and the experts' service. You expect to learn more: call eight four four eight two, two seven, three, seven, nine or visit. CFS, pharmacy.com welcome back. Another thing I wanted to ask you, there's a lot of buzz going around at the moment about detoxing teas that you can have to flush out all of the builds up that you have in your bowels. Are they a good idea? 

Dr Jackie Silkey: Well, I think. When we talk about detoxification, we talk about trying to find out, first of all, what you're detoxifying from, trying to get down to kind of a root cause. If it's, you know, just general toxins that we're exposed to, then I think, you know, ramping up your own detoxification pathways is the best way to do it and pooping every day is an absolute mandatory in my clinic. Everybody that comes in, whether they're coming in for eczema or low dose naltrexone or functional medicine. One thing that I always talk to them about is how often they're having a bowel movement. To work on detoxification when you haven't worked on proper bowel function is not gonna work. You're going to do one flush of tea and they might feel better for a day or two, and then they're going to go back to their regular bowel habits. And so, sorry. No, no, no, no. So it's like anything else, doing it once might be enlightening but you want it to be something that they implement from now on. It's not a diet that they go on and off of, but something that is going to stick with them can be life-changing. 

Linda Elsegood: Out of interest. How would you make yourself go every day?

Dr Jackie Silkey: A bowel movement?  Oh, well, it depends on where I feel people are deficient in, you know, so if they're magnesium deficient, which I would tell you that the majority of us are, even our soil which we grow our vegetables are magnesium deficient. People tend to be very deficient in vegetables in general. So I try to calculate, I try and get an idea of how much, um, how much fibre people are taking in during the day, and, um, what sort of bowel, um, irritations they've had in the past. So treating somebody with irritable bowel syndrome, they've had multiple episodes of small intestinal bacterial overgrowth, and it's a very different process than treating somebody who comes in and just says, yeah, I have chronic constipation, but they don't have any abdominal pain, so you have to, you have to treat them very, very different. But somebody who's not having any abdominal pain, not having any abdominal symptoms, then I start, usually start with magnesium and ramp up their magnesium dosing and see if I can't either tests them to find out on a cellular level, what their magnesium levels are, or see what sort of improvement we get from, ramping up their magnesium, but ramping up also fibre intake, water intake.  

Linda Elsegood: So keep flushing and eating those vegetables. 

Dr Jackie Silkey: Yeah. I love magnesium too. Magnesium is great, and it's great to help people sleep better. It helps. It's helpful with nighttime leg cramps. It's helpful with bowel movements. It's helpful with slight blood pressure elevations. 

Linda Elsegood: Oh, sounds a good one to take, doesn't it? Does that come in like pill form? 

Dr Jackie Silkey: Yeah, it comes in pill form or in a granular form as well. 

Linda Elsegood: We'll certainly have to look into that.

Dr Jackie Silkey: Maybe we can start combining that with low dose naltrexone, low dose naltrexone and magnesium together. Maybe we can get one of the pharmacies to compound that for us. 

Linda Elsegood: That’s food for thought. We have a question here from Elisa. It's about allergies and fibromyalgia. She says, I stopped LDN for a few months but again,I feel tired and cannot sleep. I wanted to start again, but at this moment in time, I use melatonin. Come melatonin be taken with LDN, and I start at 1.5. 

Dr Jackie Silkey: Yes. Both of those, LDN, melatonin can be taken together. You can also take melatonin  I mean, take LDN during the day if it's affecting your sleep. You know, I think the majority of people have been using it at night because that's the original way in which it was prescribed. But I think that a lot of physicians now realize that we can use it during the day in effect, depending on what your goals are for therapy. They can sometimes be even more appropriate than night use depending on what your goals are. The first time I took it, I had a nightmare the second time I had the best dream. I mean, it was kind of more of an intense dream, but it was, you know, worthy of a book when you could have written a book about the stream and it would have been a bestseller. And the third night I was so excited to get back to that dream and nothing. So it just depends. 

Linda Elsegood: I had no vivid dreams at all, so I feel I've been roped even though only one you had one 

Dr Jackie Silkey: and I still talk about that dream, and I still try and recreate it, and I think in my spare time, may need to write a book about that.

Linda Elsegood: Melatonin is easy to get over the counter in the US, but we don't do that over here.  I don't like medication at all. And when I flew to Las Vegas for the conference, my body clock was complete upside down. It was an eight hour time difference. And the first night I woke up at three o'clock in the morning.  I had to work, I had to see people, and I was on breakfast television on one of the television stations. And I think the next morning it was like four o'clock. And then the next day, it's like half-past four. And I went into one of the local pharmacies. And the. The gentleman said, how can I help you?  I said, can you give me anything? I don't care what it is, anything.  I'm just so tired, I can't function. And he said I didn't need a drug that I could actually have melatonin and take it an hour before I went to sleep. And to try and relax.  It worked really well.

Dr Jackie Silkey: Well, with prescription medications there's this whole degree that really we should have to put medications, you know, on this grading scale. You know, one is a very benign medication, one that potentially has a much higher benefit to risk ratio all the way up to 10, where those are the riskiest drugs. And the benefit is lower than the risk. And that way it would provide patients with an idea that not all pharmaceutical medication is bad. Not all supplements are bad, but there is a whole grading system, you know, and I think it would be very helpful. I know I have a lot of people that are concerned about taking supplements on a daily basis. And I completely understand. I think as we age, melatonin is one of the hormones that really starts dropping off. There's a lot of good things that melatonin does. We have a way of measuring it. You can do a salivary measurement with people, and it's very helpful to get that sort of salivary measurement from people who are waking in the middle of the night to look at salivary cortisol and look at salivary melatonin. Who would go, drive to get their blood drawn, in the middle of the night? But by looking at salivary levels, we're able to see, you know, what, what's going on in the middle of the night. And as people age, our melatonin levels do drop off. I really feel like melatonin can be very useful in some people, and some people don't even realize. I mean, it can increase what we call the lower oesophagal sphincter in the oesophagus. So if people are having a lot of reflux at night, melatonin is helpful and in decreasing reflux at night. 

Linda Elsegood: Hmm. I used to have to take medication for reflux, but since I've changed my diet, that's another medication I've stopped.I don't need to take that anymore. So that was a really big plus.  I think people who can't sleep and then go to bed thinking, I've just taken my LDN, and I'm not going to be able to sleep tonight because I didn't sleep last night and get stressed about it. 

Dr Jackie Silkey: Oh yeah. 

Linda Elsegood: It's a cycle, isn't it, where you're thinking, I can't sleep, I can't sleep.

And that's on your mind when you lay down, and I think. Yeah. You need, I don't know what techniques you tell people when they can't get to sleep. I used to do yoga I meditate and I can, put myself to sleep ordinarily  that way without having to take anything. But just by deep breathing and relaxation and, and that kind of thing. What do you recommend? 

Dr Jackie Silkey: Yes. So I always find out what the person's tried in the past. So I'm not, you know if they haven't tried anything, then yes.  I do always start with trying to learn something that you will have with you, whether you're travelling to Las Vegas or not. You know, I mean, people can't just run out and go and get melatonin in the middle of the night, at 11 o'clock at night,  They're in a  strange environment. So I think that having any sort of programs within our own body that we have at our disposal is by far and away from the best way for us to put those plans into place. A lot of times what I'll have people do is trying to associate some of the meditation techniques that you're talking about, counting backwards, you know, starting at a hundred and counting backwards by three, and really focusing on the breath, doing a, what we call four, seven, eight breathing technique where you breathe in for four, you hold for seven, you blow out to eight, where you're really kind of tying up the mind and trying to get your mind off of, Oh, I really need some sleep tonight. I can't believe this. I didn't sleep well last night. No, it's going to happen again. That sort of cycle that sometimes our brain gets into is very detrimental, and so the more that you can kind of tie-up that aspect of the brain, those racing thoughts, those, Oh, I really should be asleep now. I've got this big radio interview tomorrow—those sort of things,  and, and tying that in with relaxation. If people feel that they, they still cannot sleep. Then, getting up, moving food, different room. You know, I'm reading a very boring book. You know, people don't even talk about trying to, trying to, you know, read a dictionary or something that you would find to be very boring, very mundane. Just again, trying to get your mind on paying attention to something else instead of what you're, what you feel like you should be doing.

And then once you start feeling a little bit fatigued, then you go right straight back, and you lay back down and you stay in that quiet space there. People that try all of the self-regulation techniques and they're still not sleeping well. And for those people that have tried all of those things, obviously we check hormones. I checked melatonin levels. I check progesterone, estrogen, and testosterone. I want to see specifically what sex hormones are doing what their thyroid hormones are doing. Then we go from there  instead of me just basing that on guesses. I like to. Individualize the treatment for the patient based on specifically what sort of issues they're having. Obviously, the treatment for high cortisol at night if somebody is going to sleep is very different than somebody who has hormones that barely work. .Those people need, you know, to consider hormone replacement, whether it be melatonin or progesterone, whatever. 

Linda Elsegood: And that leads me to another question we’re frequently asked now when I go abroad, I always take my LDN before I go to bed.

Regardless of what time zone I'm in, and some people say that they are a night shift worker, should they be taking LDN when they get up? Should they be taking it when they go to bed? Does it matter? How would you address that question? 

Dr Jackie Silkey: Well, I addressed the question of we don't really know whether it matters or not. What I tell people is that we have to get to a point to where you're a responder. So that's my initial goal is to start people on it, to get them to be a responder. Not to say, well, you know, you must be, you know, that percentage of people that don't respond and how do we get you to be a responder to LDN?

Once I know that you are responding to it, then I say, you know, now we get a chance to see if it makes a difference in you because it may not make a difference in you whether you're taking it. At the same exact time every day, or whether you're taking it right before bed, whatever time that is, whether it be one o'clock in the morning or 8:00 AM but you, you don't really know how that person until you get them to be a responder. But once they respond, then I think people will tell you that, you know?  I think this is where journaling like you were talking about, journaling can play a significant role. And there's the LDN app, as you know, which can be very, very helpful. And in and helping people out you know, the symptoms that they're having and what sort of symptom improvement that they're having. t I tell people, don't get so hung up on having to take it. Before bed that you end up missing a dose or you know, take it. When you feel like that, you're going to remember every single day to take it.  I like the idea of taking it before bed because I like to think about all of the hormones that are going through our brain and, you know, increasing growth hormone and, and trying to optimize the brain to provide healing hormones to the rest of the body. But,  I find if that is a stumbling block to somebody taking all the end, then I would much rather they be taking it at other times the day.

Then I'm not taking it at all. And for some people too, you know, you can find out that the right dose, you know? I've had some people that I've changed over to twice a day dosing if they weren't getting a good response with once a day, dosing. So it varies from person to person, just like all of medicine, you know?

Linda Elsegood: I'm going to have to stop you there. We've come to an end. I'm sure we could have gone on for another couple of hours. It's a joy and a pleasure to talk to you now for our listeners if they would like to come and see you or a consultation, how did they go about doing that? 

Dr Jackie Silkey: They can just call the office or send me a quick email and we can talk about scheduling that appointment either in person or online or something.

Linda Elsegood: We haven't yet told them how, where your office. 

Dr Jackie Silkey: Our office is just north of Salt Lake City. It's in a city called Keysville, Utah. And the office number is area code (801) 882-2200. An, the website is www Utah functional med.com. 

Linda Elsegood: And thank you very much for being with us today.

Dr Jackie Silkey: Thank you. Thank you for having me.

Linda Elsegood: Any questions or comments you may have, please email Linda, L I N Dat, LDN.org I look forward to hearing from you. Thank you for joining us today. We really appreciate your company. Until next time, stay safe.

Today's show sponsor is  Care First specialty pharmacy by leading compounders of LDN and other custom treatments servicing patients in over 18 States, coast to coast. That is why they are accredited to provide you with the highest quality to mandate by the industry and the expert service. You expect to learn more.

Call eight (448) 227-3790, visit CFS pharmacy.com.

Pharmacist Dr Ike - US, LDN Radio Show 09 June 2017 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Pharmacist Dr Ike is the CEO and founder of Enovex Total Wellness Pharmacy. He is a compassionate health care practitioner, cares about the health of every patient and tries hard to have all the information he needs to guide them to a better health.

He has been a pharmacist since 2003 and has a bachelor degree in biochemistry. He opened his own pharmacy in 2010 and a year ago he opened his Enovex pharmacy. They only do compounding, but will also do screening. They are licensed in six states.

He describes the various conditions where LDN is very effective, and applications for hormone compounding. He also talks about Ultra Low Dose Naltrexone which is very effective in enhancing action of the Fentenol patch. Less pain med is required and it lasts longer. Also the addictive nature of the Fenenol is reduced, which could be an important development in reducing opiate dependence.

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

Dr Fred Hui, LDN Radio Show (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr Fred Hui first came across Low Dose Naltrexone (LDN) around 18 years ago when one of his patients spoke of the LDN Book and the myriad of benefits LDN has to offer to autoimmune patients.

After researching it himself, Dr Hui was convinced that LDN is a safe drug and has been prescribing it for many years, gaining a great deal of experience in terms of prescribing LDN and finding his patients’ optimal doses.

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

Dr David Borenstein, LDN Radio Show 28 Dec 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today we are joined by Dr. David Bornstein.  Thank you for joining us, David. 

Dr David Borenstein: Thank you for having me. 

Linda Elsegood: For those people who haven't heard of you yet, could you tell us how you got involved in LDN? 

Dr David Borenstein: Absolutely. I'm an integrative physician. My office is in Manhattan, right here in New York; and about ten years ago, I had a patient come to me who was interested in being put on this medication known as LDN, low dose naltrexone.

Now the first thing I said was, like many people who do not know about LDN is, “Oh, we use naltrexone for drug addiction. What's this LDN?” And he said to me that he would give me literature, and I said, you know what, let me take a look at it; and on your next visit, we can talk about prescribing it.

I did some research. I made a few phone calls. And I said, okay, let me give this a try. And the patient just wanted it for general health. They didn't want it for any particular disease. So I prescribed it, and he was happy. No side effects; work beautifully. And then I had patients come in with various different abnormalities or diseases: Crohn's, MS. So I decided to try it for these patients; and lo and behold, two, three, four, five patients, they're doing okay. The patients with MS weren’t progressing, the Crohn's patients are getting better. I put a few patients who had cancer on it, and I started using it, gaining experience with it. And now it's a very big part of my practice. All thanks to that patient who came in ten years ago. 

Linda Elsegood: I can see on your website a list of conditions.  There’s thyroid, autoimmune, menopause, andropause, hormone imbalance, adrenal fatigue, chronic fatigue syndrome, fibromyalgia, chronic pain, polycystic ovary syndrome, insomnia, sleep disorders, metabolic syndrome, obesity, Crohn's disease, irritable bowel, yeast overgrowth, candida, and allergies. That is quite some list. How do you go about assessing patients to see whether they are suitable for LDN? 

Dr David Borenstein: Well, first of all, any patient who comes to see us gets a complete history and physical examination, and then we evaluate their condition.

We go over the lab work. At that point, I can discuss with them if LDN would be something they would want to consider. Now, remember, when they're coming to see me, they have many different symptoms: fatigue, weight gain, hair loss, dry skin, constipation, depression, mood swings, irritable bowel. They can have a laundry list of different symptoms. So what we first need to do is just evaluate, and treat these different symptoms. And then, especially on the first visit, it's a very long visit and we have to go over many things. I generally don't bring LDN up at the first or second visit. I usually wait until a couple of visits down the road, especially to monitor their response.

I mean, I don't want to use it initially for a first-line unless there are other things we can treat.  At that point, a couple of visits later, we see how the clinical condition of the patient is improving or not improving, and then we can throw in LDN. And now remember, most of these people coming to me have no idea what low dose naltrexone is. A few do; I’d say less than 10% of my patients know exactly what I'm talking about. The other 90% have a natural inclination. And what did they tell me? I will Google it. It's the first thing:  I will Google it. I say beautiful, Google it. I give them a couple of websites, give them your website. I give him some keywords to use, and 90% of the time they come back and say, “I want this.” 

Okay, what conditions do we popularly treat with low dose naltrexone Crohn’s, any inflammatory bowel disease, irritable bowel disease, multiple sclerosis; Parkinson's is very popular; fibromyalgia, and chronic fatigue - it's a biggie now, and we have a lot of that, as well as certain types of malignancies that a lot of patients come in for, for LDN. As you can see, we can treat a wide variety of diseases. But we generally have either autoimmune disorders, or malignancies, or certain neurological disorders. Those are the most common reasons for me to put patients on LDN.  

Linda Elsegood: We have a caller here, called Christina, who would like to discuss LDN with you. Would you like to ask your question, Christina, yes? 

Patient: Hi. Thank you. Can you guys hear me? 

Linda Elsegood: We can; or I can, yes. 

Patient: Yes. So, doctor, I have a few things. I have postpartum thyroiditis, I have hypothyroidism, I have pericarditis. And I have Sjogren's syndrome. I started LDN, and I was on it for about a month, and I got very sick. I got flu-like symptoms, a burning feeling in my stomach, and all of my symptoms came back. I also have vertigo, so they think it's autoimmune, inner ear disease. So my chest pain came back, and my vertigo came back, and I went off of it because it got intolerable. I've read a lot that starting off on a very low dose and working slowly can be beneficial. My doctor doesn't want to do that because he feels that it isn't a therapeutic dose unless it's at least 1.5 mg. So I've read a lot of posts in forums, about LDN, where people have had to try three or four times before they can successfully be on LDN; and that they could have a Herxheimer reaction. And, I did the very sensitive test for Lyme, and I am negative for Lyme. So I'm wondering, is a Herxheimer reaction something that does often occur with LDN? And have you found that people have had to go on it several times before they can successfully be on it? And is a low dose, very low dose, like 0.5 mg beneficial?

Dr David Borenstein: Well, it's a very good question. The first thing I would tell you to do is before you even consider the LDN, is you seem to be having some reaction. I think you need to clear up some of the other issues that you're having. For example, you mentioned to me the Hashimoto's. I think that when I hear Hashimoto's, I hear autoimmune. The first thing I would strongly recommend, way before taking LDN, is cleaning up your gut: I can't stress the importance of gut health. You have to clean up your gut. And what do I mean by that? I mean, adding things like probiotics, digestive enzymes, gut change to improve your gut function; looking to see if you have any parasites, bacteria, any sort of viruses.

Gut health is extremely important in treating autoimmune disease. I'd also recommend some treatments possibly for candida, yeast overgrowth. Looking to see if you have leaky gut, and if you have an autoimmune disease, by definition you probably do have leaky gut, and treating the leaky gut with a gluten-free diet, cleaning it up with adding things like L-glutamine and zinc and aloe, and all these sorts of things. So I think the first approach is, before you even consider going on LDN, is cleaning up the gut. Now, that's a lot harder to do than what I just said. I mean, it takes a lot of work; and you would probably need to find some sort of practitioner to help you with this. But again, cleaning up the gut is key to success with LDN. That's number one. Now, starting LDN, even at a very low dose after that's done, I think the issue is not so much the therapeutic effect. You need to build up your LDN tolerance. So even if 0.5 mg may not be very therapeutic, I don't think that matters. I think you just need to build up the dose so you can get up to a therapeutic dose, and I agree you're probably not going to get very much benefit below 1.5 mg. Maybe not, but I think you just have to have the ability to grow tolerance. So the quick answer is clean up your gut, to start slow, work your way up, and you'll get there.

Patient: All right. Thank you, Doctor. Do you notice that you see a Herxheimer reaction, or flu-like symptoms in patients that maybe start to build up too quickly? 

Dr David Borenstein: It's very rare. You know, when I start patients off at 1.5 mg, and then I go up to 3 mg; and after that, it depends on their condition. For example, with MS I don't try to go up above 3.0 mg unless I have to, because there are issues with spasticity; and remember, we always talk about doses. We have to remember these are doses, but it's going to be different for every person. A person who is 250 pounds is going to need more than someone who's 150 pounds. So you give them the same dose, okay; when you go per kilogram, it's a very different dose. So we have to also remember that. In all the LDN pages, and on the Facebook pages and the Yahoo groups, they will talk in doses. And the problem is it's not the most accurate way of dosing, because you need to consider the weight of the patient as well. So 1.5 mg for me is going to be very different from 1.5 mg for you or another person. That's also another important point to remember when prescribing LDN. Also, some of the practitioners like to go up to 4.5 mg.  I like to keep it a little bit below that. We're finding that you're getting the opioid blockade at around 4.0 mg, and after that, it's not as effective. So recently, in the past year, year and a half, I've been keeping my maximum dose to about 4.0 mg; and I don't really go above that unless the patient has been on LDN 4.5 mg for many years. I don't want to touch it. I leave it alone. 

Patient: Okay, and thank you. I appreciate it. Could I just ask one more quick thing? I do a lot of great things for gut health, the L-glutamine and probiotics; and I stay away from gluten and dairy completely. Could you explain a little bit about how one would go about testing for parasites, bacteria and viruses? 

Dr David Borenstein: There is a test called the CDSA 2.0, from a company in North Carolina; I'm trying to remember the name of the company. I use it all the time, I can see the box. But these are special stool kits you can get, and actually, insurances will help pay for a part of the test. You collect a stool sample for three days. The test looks for parasites. It looks for your digestive enzymes. It looks to see how well you're absorbing food. It looks for bacteria and other viruses. It's a very good test. It's called a CDSA 2.0.

Patient:  Great. Thank you so much, doctor. 

Dr David Borenstein: My pleasure. Thank you. 

Patient: Bye-bye. 

Linda Elsegood: Well before we go to the break, I have another question here that's come in. It's from Susan, and she says, “When do I need to stop taking LDN prior to a minor medical procedure which requires anaesthesia?”

Dr David Borenstein: Excellent question. We know that LDN and its metabolites have a half-life of approximately 59 hours. So 60 hours; you know, technically it's two and a half days. I would at a minimum do probably a week before, and that would be a minimum I would do. Yeah, I'd say two and a half days; or at least about a week before you'd play it safe. And that would be  a good thing to do, especially if you're receiving any sort of narcotics before or after the procedure. So I just say a good solid week would be a good number. You know, you can do a little more. Wouldn't hurt, but I think to keep it safe at least a week. 

Linda Elsegood: And how long would you say to wait after you'd had narcotics before you restarted LDN 

Dr David Borenstein: Let's see, two and a half days. So I would say at least five days afterwards would be a good number. From the last point of taking a narcotic. 

Linda Elsegood: Okay. Thank you. We'll just have a quick break. If anybody would like to call in with their questions or email them, and we'll be back in a moment. 

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Okay. Welcome back. I have a question here for you, David, from a  lady in Turkey or a gentleman. They have a five-year-old son who was diagnosed with nephrotic syndrome at age three. He takes 4 mg of steroid every other day. They would like him to try LDN, but the doctor said no. And through a year, they've looked for a doctor who would prescribe LDN, without success. They say their son's on steroids, and it's very troublesome. He becomes very sick easily at home, and next year he starts school. So they would like to find a permanent solution. The question was, can LDN be prescribed for a child who takes 4 mg of steroids; and do the steroids affect the LDN.

Dr David Borenstein: Well, the second question first. Yes, it can, and that's why I like to keep the steroid dose as low as possible.  In adults, I like to keep Prednisone below 10 mg per day as a rule, and that's just an arbitrary number. I just find that it works best below 10 mg a day. Many of my patients have a lot of autoimmune immune disease and are on much higher doses. So what I do is I start them on LDN, and I have them slowly taper their Prednisone while the LDN is kicking in, in the hopes that, as the LDN dose increases and the steroid dose decreases, the LDN will start working. So far, it's worked pretty well.

Now with kids, you have to be very, very careful, especially for nephrotic syndrome. And you would need a physician to really keep on top of this. But you could, in theory, try the LDN, 80 micrograms per kilos. You do depend on the weight. He's probably gonna need a lot less than most adults would. And with a child, they tend to like to use the transdermal  - just easier to use. And you can certainly give it a try, but again, you're going to have to be under very close care of a physician when you're doing this, to make sure that everything is being watched. This is very different from a patient who's just taking it for fibromyalgia or for Crohn’s. You can have some flexibility. But with a child, you have to really keep on top of them. I definitely think it's worthwhile to try it and see if it has an effect; but remember, you have to keep on top of this, and finding a physician who's going to do that is not going to be easy. People have had a lot of trouble finding physicians prescribing LDN, just to get it for whatever disease they have. But for a child, needing constant watching, that's going to be a little bit tricky.

Linda Elsegood: Especially in Turkey where I think it's very, very difficult to get LDN prescribed anyway. 

We also had a question from Taja, and she says that she was diagnosed with rheumatoid arthritis in December 2015 and she started LDN in March. Her questions, she's got three. The first one is, do anti-inflammatory drugs have an effect on the efficacy of LDN?

Dr David Borenstein: They generally don't. The main issue when you're taking low dose naltrexone is going to be high dose steroids. Not so much the nonsteroidal anti-inflammatories, generally not. But here's the problem. When you're taking a lot of NSAIDs or nonsteroidal anti-inflammatories, it's not good for you.

It's not good for your liver, it’s certainly not good for your kidneys, and certainly not good for your stomach. So LDN would certainly be of benefit to try to help reduce your need for these anti-inflammatory medications, but they're not going to interfere with LDN. 

Linda Elsegood: And the second question is, have you seen any difference in how LDN works on patients following an anti-inflammatory diet?

Dr David Borenstein: Yes, no question, diet is key to helping patients with rheumatoid arthritis and other autoimmune diseases. Now, what do I mean by that? I mean, I always talk about LDN being a tool, not a cure of disease. It's a tool that one can use to help treat disease. Now, if you can approach disease in multiple different ways, then, of course, there's going to be a much better response. So diet is key, especially in rheumatoid arthritis. With diet, we want to make sure that the patient, especially with rheumatoid arthritis, keeps away from nightshades - tomatoes, potatoes; working on fixing the leaky gut we are treating, having a gluten-free diet. These are very key components for fixing the gut. Probiotics, digestive enzymes, stomach acid. And again, looking for parasites and bacteria in the gut. Treating the gut is extremely important in rheumatoid arthritis and other autoimmune diseases. That in combination with low dose naltrexone is a very powerful tool for treating rheumatoid arthritis and other autoimmune disorders.

Linda Elsegood: Okay. And her third question was, I take 4.5 mg of LDN. Should I change the dose if I feel my symptoms increasing? And if so, in what direction? 

Dr David Borenstein: Well, I don't know the patient's weight or their age, so I really couldn't give a super-accurate answer. That being said, you're not going up.

I mean, that's it. 4.5 mg is the max. As a matter of fact, I would probably recommend the patient lower the dose down to 4.0 mg. I wouldn't be surprised if the response improves, because if you lower the dose to 4.0 mg there may be a more effective opioid blockade. So I would probably give a trial of lowering the dose to around 4.0 mg, not 4.5 mg and see if that works a little bit better, especially if the patient is low weight. 

Linda Elsegood: Thank you. And we have a question from Jen, and she says she has MS, and she has taken LDN for three months with some improvement to her bladder.

She said she started at 1.5 mg, then increased to 3.0 mg.  Should she increase the dose or wait longer, because she's only had some improvement to the bladder? Nothing else. 

Dr David Borenstein: Okay. Well, here's the thing with MS. You have to be concerned about spasticity. Many times we have patients with MS, they have spasticity, but if spasticity is not getting worse, then you can experiment with going up at very small doses - 3.25 mg try that for a little while. Then go up to 3.5 mg, and you can go up a little bit till the spasticity increases. And that's probably the max you want to take.

So yes, that would probably be a way to go. Now, remember, although we've had patients who felt better, the goal in low dose naltrexone for MS is more to prevent exacerbations and to keep disease stable, rather than actually feel a little bit better. So if you had numerous exacerbations in the past, LDN in many cases would prevent exacerbations. If it prevents exacerbations, then LDN has done its job. Okay. So it's more for preventing the disease from coming back and halting in its tracks rather than feeling better. So three months is a little bit short. We'd have to see over a longer period of time. I don't know how many exacerbations this patient has. So the answer will be if the patient has fewer exacerbations than she did, we know the LDN is probably doing its job.

Linda Elsegood: Okay. Thank you. We have another question from Paula, and she asks if LDN is a problem with candida? She took <a medication> to help and it allowed her to get up to 4.5 mg. She stopped the <medication> several months later and some of her old autoimmune symptoms have returned. She says, “Am I getting symptoms of candida, and what would you suggest I do?” 

Dr David Borenstein: Well, the first thing I want to do is, and sometimes patients with severe candida can have problems with LDN. I think the thing you have to do is just clean out your gut and especially with candida. The same treatments that we have getting gluten and dairy-free diets, keeping away from fruits that can contribute to candida, and we all know what they are.

Anything that tastes good or isn’t good for you, it's probably good for candida. And some doctors give a course of Diflucan for a period of a month or two, that may be beneficial. It's not a cure, but it can give what I call an artillery barrage to at least lower the symptoms and then change your ability to do with the candida, with dietary changes and other supplements, cilantro, oregano, garlic, all very good for treating candida.

And just one more, which. I have a little bit of a mental block, but it also works - berberine, berberine-containing substances are very good for treating candida. Treat the candida for a month or two, even three, and then try and restarting the LDN and you'll probably get a better response.  

Linda Elsegood: and we have a question here from Alec. She says, “Could LDN help with prostate cancer and other prostate issues?” 

Dr David Borenstein: We've had patients with prostate cancer who've taken LDN. However, again, when you're treating cancer, you have to use a very combined approach. I've had patients who basically have prostate cancer, but they're not treating it because it's either low-grade cancer or its small cancer, and they don't want treatment yet, but it's certainly worth a try. And as long as your PSA doesn't go up and there are no changes in a digital examination, it's certainly something to consider. That being said, if the patient has received hormone treatments, those who are in a later stage or towards the end stage of receiving hormone treatment, we’re finding the LDN really doesn't work too well with that subset of patients. But as a rule, it's certainly worth a try, as long as you follow the rules, keep away from opioids and do the proper dosing. I think the question is, do you tell your oncologist about it? People ask me this all the time, and you know, I would, and just explain to your oncologist, or your urologist that you're on it and just give them a five-minute debriefing. Bring them some literature. But a lot of the time, urologists and oncologists are not crazy about it. But there'll be someone understanding at least in 2016, 2017. Ten to fifteen years ago, forget about it. Everyone’s mind was closed. I think we're living more open-minded today. So, again, short answer, you should always use LDN with the knowledge that your attending physician, your oncologist, your primary care doctor, whoever's treating you should probably know about LDN and that you're taking it, and just make sure that you don't only use LDN if it's something serious, a more serious disease. Because again, there are other treatment options available for more serious disease.  

Linda Elsegood: And we have a question from Leanora. She says, “What are your thoughts on LDN and a person's genetics, SNPS, and methylation pathways. Are you familiar with MTHFR, COMT, or SNP called CYP-2-D-6?” 

Dr David Borenstein: Well, here's the thing with the MTHFR and the other genetic mutations, there's no problem using LDN with that. You do have to treat the issues of those particular mutations. For example, I'm going to use MTHFR, because that's certainly by far the most common that we see. How do you treat the MTHFR? Even this is controversial, and I think this is going to change, so this is not in stone. When we have MTHFR gene mutations, you have to first evaluate to make sure homocysteine levels are normal. This other test you can use, I'm not allowed to use it in New York state, but there are better ways of checking homocysteine levels than just measuring homocysteine, but that's the tools we have, we have to use it. And making sure that you have the B-6, B-12 and methyl folate - make sure that in all your vitamins there is methyl folate - and use trimethylglycine and cleaning up the gut to detoxify.

So that's the best you can do. That being said, if you do all that and use the LDN, there shouldn't be any issues.

Linda Elsegood:. Okay. And she said, “Would know a person's genetic hiccups help determine the dose of LDN.”

Dr David Borenstein: Not really. We've been dosing LDN well before MTHFR became popular, well before. And I know Dr. Bahari when he was doing it, I, I speak with his wife from time to time also, who is in New York; and again, in the eighties and the nineties, we didn't really use MTHFR, and nothing changed. I mean, the dose is going to be basically based on the disease you have, your weight, and your tolerance. MTHFR and other genetic mutations are really not gonna make a big difference in the way we dose you. 

Linda Elsegood: Okay. And she has another question, and she says” Have you seen success with LDN and endometriosis?”

Dr David Borenstein: I generally don't use LDN for endometriosis. Remember, endometriosis by definition, in most cases, is an excess of estrogen: estrogen dominance, as opposed to anything LDN would treat. So when I have endometriosis, I have to look for estrogen dominance and balancing the hormones. So I really wouldn't be using LDN for that.

There are many other things you can do to improve your hormone balance, like measuring the hormones, either through salivary testing; you can do urinary testing; in some countries, all you have is blood testing. And you have to do it on certain days of the month, balancing the hormones. And in most cases, the problem is either too much estrogen to too low progesterone or both. So balancing the estrogen, treating insulin resistance, and that's a biggie. And once you do that, that tends to be some sort of improvement in the endometriosis. So I would do that before throwing LDN at the problem. 

Linda Elsegood: Okay. And she has one more question, and it says, “LDN might not always help or improve a person's condition, but are you aware of any conditions that are known to exacerbate, or worsen, a condition or disease?

Dr David Borenstein: I have not seen that. I've only seen certain side effects from taking LDN - the vivid dreams, the difficulty sleeping, the increasing candida, and Herxheimer reaction. But I've never seen a condition get worse from the LDN. Now, of course, diseases do progress naturally, and if you don't treat them, they tend to get worse, not get better. So many times, this is the natural course of the disease. But as a rule, no, I've never—seen any detrimental effects from LDN. 

Linda Elsegood: Okay, lovely. Well, we'll just have a quick break, and we'll be back in a moment.

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Welcome back. We have some questions here from Dr Leonard Weinstock, and he says, “Have you measured pre and post LDN antithyroid antibody levels?” 

Dr David Borenstein: Well, the answer is yes, we have, because anytime I have a patient who has Hashimoto's and hypothyroidism, I always measure their antibodies. So, and as a rule, they come down, and they can come down sometimes quite quickly. And you have to be very careful with these patients because if you have them on thyroid medication and their antibodies come down, and the amount of medicine they take may be the same, but their antibodies come down. That can actually cause them to become hyperthyroid. Think of it as driving a car and all of a sudden you're driving with the accelerator halfway down and the brakes halfway down, right?

So all of a sudden you're lowering the antibody, so the brakes, you're reducing the brake and what happens - the car zooms forward. That's exactly what happens. So you have to watch it, and watch it closely. Now here are some of the problems we have in monitoring the antibodies. Many of my patients’ antibodies are through the roof and the lab that I use, which is a very common lab that most integrative doctors in the New York area use, if it's above a certain level - if the anti-TPO is above a thousand and an antithyroid globulin is above 3000, it just says greater than a thousand, greater than 3000. So if the antibodies dropped from 5,000 down to 3,500, I have no way of knowing that. All I'm seeing is that it's above 3000 or when it gets below 3000, and I can see if it's dropping or not. But as a rule, LDN is a very effective tool for treating Hashimoto's, and the antibodies can drop, and it can drop quickly, so you have to watch these antibodies very closely to make sure the patient does not become hyperthyroid. Now, if the patient's not taking any thyroid medication, then it's a very different story than if it drops, it drops, and then you have to still watch them make sure that they're not becoming hyperthyroid, but it's less of a concern because they're not taking any thyroid medication.

Linda Elsegood: Just out of interest, how often do you check the levels if they're on thyroid medication? 

Dr David Borenstein: It depends. If they're on LDN and I'm starting it, I probably would do it every four to six weeks, and I tend to be very, very conservative in the way I give the LDN. I like to start off at 1.5 mg, and then after a month go up to 3 mg and then go to 4.0 mg. However, sometimes I'll do it a little bit slower than that. Especially when I know the antibodies can drop quickly and they're on a high dose of thyroid medication. So you do it very, very slowly. Sometimes I'll just put them at 1.5 mg and have them come back in two months to see how the levels are. And then, all right, they've dropped, we're going to put you on 3.0 mg. But you know what? We're going to change your medications a little bit. Drop your medications a touch, come back in two months. But when we do it that way, you require a lot of constant monitoring. That's the best way to do it. And the safest now, thank goodness, no problems, but you know, there's a theoretical risk of hyperthyroidism, which you have to watch out for.

Linda Elsegood: Okay? And he also says, “What are your thoughts on using low dose oral methylnaltrexone for systemic inflammatory conditions without CNS pain?”

Dr David Borenstein: You know, generally I don't use it. Most of the time I use straight LDN, and I treat those other conditions other ways. As I said, I don't use the LDN only for treating pathology. I use various different ways to reduce inflammation, and there are many different ways we can reduce inflammation in outpatients. Obviously diet is very big. We know that certain foods are more inflammatory than others. High fructose corn syrup is huge. Red meats, certain nuts are huge. Dairy is huge. All inflammatory foods, so you want to change that. Use of anti-inflammatory supplements like fish oil, curcumin, Boswellia, bromelain; there are many different supplements you can take to reduce inflammation. One of the least evaluated, but very, very commonly associated with inflammation, believe it or not, is insulin. Insulin - you have to be very careful with insulin. We know that people who have hyperinsulinemia are very inflamed, and a lot of doctors aren't aware. Physicians treat blood sugar. They look at glucose. They never look at insulin. And while there is a relationship between the two, it's certainly not direct. You can have perfectly normal blood sugar and very high insulin, and that insulin can be very inflammatory. So I like to treat inflammation, look at the root cause of the inflammation, and then I add the LDN to help for any other issue that we're treating.

Again, not the primary treatment for what I do. But it's just a tool that aids in helping me treat disease. 

Linda Elsegood: And he had one more question, “Did Dr Bihari compare measurements of enkephalins with PM versus AM dosing of LDN?” 

Dr David Borenstein: I believe he may have, and it's usually about a third. As I remember, about a third less in the afternoon than in the evening. So, for example, let's say 2:00 AM in the morning is when you have the peak. It's probably three times as much at two in the morning than it is at two in the afternoon, at least three times, maybe a little bit more than that. That's why we don't recommend taking LDN in the morning. I have this question asked all the time because you don't have anywhere near the amount of endorphin peak at 2:00 PM in the afternoon than you do at 2:00 AM in the morning.

Linda Elsegood: Okay. We have another question here. Can you explain how LDN effects and regulates Th1 and Th2 rather than boosting either one?

Dr David Borenstein: Here's the thing. I've seen the charts on them, and it's probably better to explain visually. I think theTH-1 and TH-2, you know, the humoral immunity versus cellular immunity, I think a lot of this is overblown. But basically, the answer is it does affect the relationship between the two. But there's a huge chart that has all this stuff, and I probably have to do a more of a visual presentation than I can explain over the radio. It would be a very visual thing, but there are charts out there that will explain how LDN may affect the Th1 versus Th2 immunity.

Linda Elsegood: Okay. Thank you. And how does LDN affect allergy testings? 

Dr David Borenstein: Well, in theory, it really shouldn't. I have patients on LDN get allergy testing and they certainly still come up positive, so we've never seen it. I mean, it could very well be, I've never done a study, but just from anecdotal evidence, I don't see how it affects the IgE modulated immune response.  

Linda Elsegood: Another question: we're always being asked, while we're talking about testing, people say if I have to have a drug test for my work, would LDN show up? 

Dr David Borenstein: No. Remember, it's not an opioid, it's an opioid blocker. So there's going to be no problem with you going in and taking LDN and having issues at work. 

Linda Elsegood: And does LDN right serotonin levels in the brain? 

Dr David Borenstein: As far as I know, the relationship is not proven. There may be some relation to that because remember, it's working more on the opioids and met 5-enkephalin. The met 5-enkephalin somehow may have some effect on serotonin, but I haven't certainly seen that in my patients. But that would be something that research can definitely look into.  

Linda Elsegood: And we have a question from Kirsty, and she says, a week ago she started on 1.5 mg of LDN for lichen sclerosis, and she’s curious about at what point should she expect to see some relief of symptoms, and when should she increase the dose? 

Dr David Borenstein: Well I think it's still very early, but I would certainly recommend the next couple of weeks trying to go up to 3.0 mg and see how that works, and then moving up a little bit higher. And if you're not getting any results for a few months after that, it's probably less of a chance that it will work. As a rule, I think after three or four months if we’re not seeing results, either you have to clean your diet out and change what you eat, or it's probably not gonna work for what you're trying to use LDN for.

Linda Elsegood: What is the protocol that you suggest to your patients? I know you have said LDN is just one of the tools that you use and it doesn't always work for everybody, but if we were a new patient coming into you, how would you describe LDN to them if they weren't going to go off and Google it. 

Dr David Borenstein: Well, here's the thing. Usually, if I'm going to prescribe LDN, we'd have a specific reason for doing that. So maybe give me a scenario, which type of patient - one with MS, a patient with Crohn's. You tell me, and I can give you better answers. 

Linda Elsegood: Let’s say Crohn’s.

Dr David Borenstein: Perfect. Perfect. Well, most of the time, people with Crohn's maybe on Humira or other medications that would impair the immune system.

So I would explain to them it's very simple. I tell them that there's this medication that mostly integrative doctors use. It has very good success in treating Crohn's disease. It is inexpensive. A dollar a day on average. It has minimal side effects, and it works in most cases really, really well. So they say, doctor - the most common question I have for this - is, “How come my gastroenterologist didn't tell me about it?” This is the most common question I have. Why are you doing this and they're not doing it. So then I have to explain it again: most integrative doctors use this; this is compounded, not pushed by their pharmaceutical representatives. That, and explain the mechanism of action, that we know that opioids have a very important part of regulating the immune system. Then explain to them what opioid blockade is and the increase in met 5-enkephalin and how that can modulate the immune response. Now we also have to educate the patient that this is not a narcotic, because they think naltrexone, and they think drug addiction, so we have to educate them about that. 

Now, especially with Crohn's, not only do I use LDN, but I also use some of the other techniques I mentioned: treating the gut, the inflammation. But here's some good news about LDN and Crohn's. A lot of my patients don't keep to their diet. A lot of my patients don't do what I tell them. All they do is just take LDN, and that's it. And you know what? They do really well despite not having to change their diet; despite not having to do anything I tell them to do; and they respond really, really well. So that's kind of a good thing. At the same time, patients who don't respond well, we may want to have them change their diet and follow my instructions for cleaning up the gut and taking the proper supplements and diet, and then they tend to respond as well. One thing about Crohn's that works so well in our patients. A lot of the patients don't even - that's it - I want my LDN and goodbye. And it works as they come periodically to see me get their refills, and they're the happiest people in the world. 

Linda Elsegood: I have a question here that always comes up. Now, some doctors, pharmacists, think Tramadol is an opiate. Others will say it's a synthetic opioid and can be taken with LDN. Where do you stand on that? 

Dr David Borenstein: It can be taken with LDN. Don't believe anything they say. If you're in pain and you need a painkiller while taking LDN, Tramadol is what you're going to take. It works. How do I know? I've tried it on myself. You know, it's not a problem. 

Linda Elsegood: Okay. Any particular dose. 

Dr David Borenstein: You know, it’s individualized. But the point is, the question is more in general, will Tramadol have a problem working with LDN, and the answer is no. The dose is as you need it. Every pain situation is different. Certain pains, you don't really need Tramadol, you just need Tylenol or Motrin. But other pain, heavy narcotics. In that case, that's where the Tramadol comes in. That being said, in many of our patients who need high dose narcotics, you may want to just get off of LDN for a little while and hope for the best. And then when your need for narcotics goes away, restart the LDN

Linda Elsegood: So would you say with Tramadol there has to be a gap when you take LDN or can they be...

Dr David Borenstein: No, no gap at all. Just use it as needed. But sometimes Tramadol will not be enough for the pain. You may need opioids, and that's when you're going to have to go off the LDN.

Linda Elsegood: Oh, that's good. Thank you. We have people ask us about weight. We know that LDN is used in some weight loss clinics; and some people say when they start LDN, they gain weight. Do you have any experience of weight with LDN? 

Dr David Borenstein: Usually not. Usually, people don't gain weight. It's usually very well tolerated. I wouldn't use it, again, as a primary weight loss medication, although some patients have claimed that they have lost weight on it. Maybe they sleep better after a while on it, and that improves the metabolic rate. But weight loss is an entirely huge separate issue. We can have ten seminars on weight loss because it's such a complicated factor of hormones, adrenals, thyroid, lecithin, insulin. It's a huge, huge topic; and growth hormone; there are so many things that are involved in discussing weight loss, and that's just hormonally, and obviously, we have diet issues and exercise issues that we can discuss as well. But I think, for the most part, it may be a pleasant, side effect. And if you lose weight, that’s great.  

Linda Elsegood: And does LDN help with sensitivities to fragrance or chemicals.

Dr David Borenstein: Here's the thing. It's certainly worth a shot, but chemical sensitivity, and I've seen a lot of chemical sensitivity in my life; it's a very, very, very difficult thing to treat. First of all, many physicians, if not most physicians in the United States, I don't know how it is in the UK or the EU, but most physicians here don't even think that it even exists. It just doesn't exist. Okay. And I think when we're treating chemical sensitivity, we have to work on detoxification of the body. Working on building the methylating pathways, detoxing with things like charcoal or other things. Also, when I hear fragrance sensitivity, when someone has a problem with perfume, the first thing I think of is candida. Candida is the first thing I think of. Look for yeast. Many times it's a very close clinical association. Now, if you want to try LDN that's great, but I don't think that's gonna cure the issue. I think we have to look at the root cause of the problem and address it. And the LDN may be a tool in fixing, addressing that issue, but I don't think it's a cure-all, but certainly worth a shot. Again, we have a medication that's cheap, little in the way of side effects. It may have good therapeutic potential. Why not use it?  

Linda Elsegood: And another question that's always coming up, and I know you were saying about missing doses for a period of time before and after an anaesthetic. Some people say that skipping a dose is good on a regular basis. Some doctors will say once a week, some will say once a month. What is your view on that? 

Dr David Borenstein: Well for the first few years, I don't think it's necessary to skip a dose, but we're finding probably after a number of different years, and patients who've been taking LDN for many years, it certainly wouldn't hurt to skip a dose maybe once a week. First of all, it saves you a few dollars if that's a concern. But if you can skip the dose once a week. Okay, now I wouldn't do this in the initial couple of years. It's just more people that have been on it for a long period of time. Skip a dose once a week and see how you feel, and see if your clinical symptoms change. We do this, believe it or not, in Parkinson's disease, we take as a drug holiday, and it works really well when the medicine for Parkinson's disease doesn't work very well. We take a drug holiday, and it's kind of like what you're doing here. It wouldn't hurt. I don't think there's an exact protocol. I think this is very anecdotal, and every patient is different, and everyone is different. But you know, 5-6 years of LDN - try stopping it one day a week and see what happens. What's the worst-case scenario? You have to go back on it every day. That's the worst thing that's going to happen.  

Linda Elsegood: And you were saying about Parkinson's - we've got many members that are taking LDN for Parkinson's. What has been your experience with that?

Dr David Borenstein: Pretty well. Now I've been doing a lot of work with Parkinson's, and right now in my practice I've been doing a lot of work with Stem cells, and I find that Stem cells are very beneficial. And what I find is that I get the Stem cells to improve the symptoms of Parkinson's and then the LDN to keep it stable. So I've been using LDN and those patients recently with some good results too. We just keep the disease stable. So they may get a big boost in the way they function with the Stem cells, and we use the LDN to keep them that way. So I think it's a very powerful tool for treating Parkinson's and MS, and some other neurological diseases.  

Linda Elsegood: We have a question for Mary, and she says, “Have you found LDN to be beneficial for Alzheimer's?” 

Dr David Borenstein: I have not used LDN for Alzheimer's. The problem is you have a patient who may not have the best memory, and you have to be very careful with the medication. If there's a provider there with the Alzheimer's patients, you can certainly give it a try. I think there are many other things you can do for Alzheimer's patients: treating their vitamin deficiencies, B12, folic acid, lots of fish oil, making sure their thyroid is okay. And look for other deficiencies: low levels of vitamin D, look for MTHFR mutations, high levels of homocysteine. These are things that - aluminium toxicity is the thing that I would look for in treating patients with Alzheimer's. Again, if you have a physician who can work with you, this is very low risk. And very inexpensive. It's certainly worth a try. That being said, look for the other things that you need to address with patients with Alzheimer's and address those, and you'd be surprised just by giving some B12 shots, a little thyroid, and little fish oil - you may actually see some improvement.

Linda Elsegood: That's good. Well, we have time for one more quick question.

Debbie has bipolar, and she wants to know if LDN would help her. 

Dr David Borenstein: I have not treated bipolar in my practice, and I have not had any patients who would be treated with, let's say, Crohn's or MS or cancer, and also have bipolar and have any change in their symptoms. So I honestly couldn't give you an answer to that.

Linda Elsegood: Well, that's us just about over David, and thank you very, very much for taking all these questions and for your time. It's been amazing. So thank you very much. And next week we're going to be joined by Dr Mark Shukhman, who's a psychiatrist, so maybe he'll be able to answer our question on bipolar. But thank you once again, David.

Dr David Borenstein: Oh, my pleasure. Thank you.

Linda Elsegood: Belmar Pharmacy is a nationally respected compounding pharmacy. They compound low dose naltrexone, LDN; bio-identical hormones, and custom amino acids, amino blends. They're based in Colorado and ship nationwide. Their goal is better patient outcomes through quality compounding, combining effective communication between practitioner, pharmacist, and patient. Call +1 800-525-9473 or visit Belmarpharmacy.com.

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