LDN Video Interviews and Presentations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Linda Elsegood: What about cancer?

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

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

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

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

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

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

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

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

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

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

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

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

Linda Elsegood: Do you use vitamin D as well? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr John Kim: Thank you for the opportunity.

 

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

Yvonne - US: Fibromyalgia, Multiple Sclerosis (MS) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Yvonne from the United States takes low dose naltrexone (LDN) for multiple sclerosis and fibromyalgia. She had lifelong tremors, later developed dizziness/vertigo and frequent bladder infections, and finally eye problems.  All before age 20. She rated her quality of life as 3 to 4.

A friend of MySpace told her about LDN, and started taking it in October 2010, and feels her quality of life has gone up to 7 to 8. She no longer needs pain pills often.

She definitely recommends LDN for how it has improved her quality of life.

Listen to the video for the full story.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Linda Elsegood: How does one catch Lyme disease? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Linda Elsegood: Hypothyroid. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Yusuf Saleeby: Parathyroid hormone, PTH? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Yusuf Saleeby: Yeah. 

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

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

 

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

Pharmacist Tarek El-Ansary, LDN Radio Show 10 July 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: My guest is Tarek El-Ansary. He's the owner of Carmel Valley Pharmacy. He's also a doctor of pharmacy. Thank you for joining us today. Tarik 

Dr Tarek El-Ansary: yes, my pleasure. Thank you for having me. 

Linda Elsegood: Could you give us your background, please? 

Dr Tarek: Yes, certainly. I've been a pharmacist for almost 21 years. I graduated in 1998 from the University of Pacific School of Pharmacy with a doctorate in pharmacy. I worked in different chain pharmacies for the first eight years. And then I went on to purchase my first pharmacy, an independent pharmacy, and it was retail on need. We barely did any compounding.  I went on to buy a few more pharmacies. And we had a lot of success with that. And then about five years ago in 2013, I started Carmel Valley pharmacy and I wanted to do something different, and, start with compounding and learn all about integrative and functional medicine that goes along with compounding. And that has really opened me up to many, many more opportunities and tools in the treatment options that are available, and it's just been, it's just been an amazing ride and process.  

Linda Elsegood: wow. How would you describe your pharmacy now? 

Dr Tarek: So my pharmacy now is really just focused on customer service and patient care. We do, we're a hybrid pharmacy, which means we do both compounding, and then we also do the retail commercially available pharmaceutical products that are made by the pharmaceutical company. So we do both. And it's a walk-in. People can come in, and we do also offer delivery and mailing, and a lot of consultations. We spend a lot of time, between myself, the pharmacist and the patient, and also interacting with the doctor, getting them involved. And we really do practice the triad of medicine, which is the relationship between the doctor, the pharmacist, and the patient.  

Linda Elsegood: We are moving towards a pharmacist in the UK playing a role. Normally if you wanted any medical advice, you got it from your doctor. You didn't get it from your pharmacist, but it's still not working. How it is working in the States because you there, you just go to the pharmacy and speak to the pharmacist, but the pharmacist doesn't relay that back to the doctor.  So we don't have it working.  It's a bit dysfunctional. Really. It's not as good as what you do so 

Dr Tarek: well, It doesn't work that often unless it's a type of pharmacy like I have when other pharmacies I've been at, which just retail me, it's still, we're still really behind on that also. 

Linda Elsegood: Okay.  

Dr Tarek: Yeah. It's just the type of practice I have now is different, and so now that triad works really well. 

Linda Elsegood: And it's so good that you look into supplements and lifestyle and things that maybe the doctor wouldn't have the chance or time to go through. 

Dr Tarek: Absolutely. You know, with the seminars I attend, I've learned so much about supplements, and unfortunately, the pharmacy schools and the medical schools are just not getting into that and teaching anything about supplements even to this day.

And so with the seminars, I'm learning a lot and doing them on myself, starting them on myself and my family members, and seeing a significant difference in our own health. And so it's giving me the firsthand knowledge to recommend for my patient. And the feedback has been really good and positive, which further reinforces, you know, an ???  to be able to carry on a message to patients who need supplements and specific areas of problems that they have.

Linda Elsegood: When did you first hear about LDN? 

Dr Tarek: Uh, I think it was a seminar I attended. I go to PCCA And a A4M seminars, at least a couple of times a year just to learn the new things and keep up on my knowledge. And, probably about three or four years ago, the first time I heard it brought up at a seminar and in it was, it just sounded, it's really exciting and amazing.

At the same time, a few prescribers in my area started prescribing it and then I was able to spread the word to other prescribers that were open to doing compounds and new things that they hadn't heard about. And so we've seen it really spread since then.  

Linda Elsegood: and you're in California. So I was just thinking about the supplementation.

Do people in California need to take Vitamin D, or do they get enough sunshine? 

Dr Tarek: I would say they still need to take vitamin D. I would say just about everybody. The average level of an American, even including California is 15 and anything below 50 is considered deficient in vitamin D. Actually if you're not above 80, you're not considered optimal. And so you don't get a lot of the preventative effects of vitamin D like preventing cancer and stimulating and really helping to have a healthy immune system. And so by just being at 50, all you're doing is helping to keep your bones healthy, but you're not really helping with the immune system.

From what I've learned, it's for every thousand units you supplement per day, you bring that level up by ten, so if you're at 15 and you take 5,000 units a day, you're going to be at about 65 so you're going to be above the 50 Mark, but you're still not going to be optimal. So that kind of gives an idea of where it is, and we do see people getting tested when they are taking and it kind of, it really does follow along those lines. 

Linda Elsegood: So how long have you been compounding LDN?

Dr Tarek: We've been doing it for probably about four years now. We opened about five years ago, a little over five years ago, and we've been doing compound LDN for the last four years.

Linda Elsegood: What forms do you compound in?

Dr Tarek: Oral,  topical and transdermal. 

Linda Elsegood: Okay. So. When you say oral, is it capsules, tablets? 

Dr Tarek: Yeah, 99% of the time we have done it as a capsule. There are a few that we've done in liquid for small children that can't swallow capsules. And then also if we want systemic absorption, we can do it in transdermal effect, where we put in a light that's on base. So it gets absorbed really well into the systemic circulation. And then topically, we've used it for scars and, and, or itching type skin reactions. We've seen great effects because usually scars and itching and like psoriasis or, or rash, that's part of the immune response. And since we know LDN has a significant effect on our immune system. We’ve been seeing it having a great effect.  

Linda Elsegood: let's 

Dr Tarek: use topically. And then with transdermal always seen it used when we want to insist into the systemic circulation, especially with small children who are on the autistic spectrum. They're getting it absorbed really well and seen great effect. 

Linda Elsegood: So do you have any case studies?

Dr Tarek: Yeah. Yes, I do. I had seen them when they were presented at some seminars. I do not have them handy. I have seen case studies done specifically just as an example, I think it was the glutathione 20% mixed with LDN, 0.5% in a transdermal cream if used with autistic children on the spectrum, and a significant effect that was. That had just by applying that each night by the parents and just rubbing it between the shoulder blades and giving the child a message at nigh with the cream and the parents, the feedback has been really good. And we have about five or six small children who get on a regular basis at our pharmacy and the feedback and the parents had, they tell me that it's made a huge difference in their children's behaviour and their life.

Linda Elsegood: So how old are the children when they starting at the end? What age are they diagnosed normally with, with autism? 

Dr Tarek: It definitely ranges and we've seen as small as four or five years old. I would say probably the most common age is around 10. I think there is a level of confusion and denial on the parents' part of not understanding what is going on with the child's behaviour when they start to present with autistic behaviour around the age of four and five that I think there are a few years where they're just not understanding what's going on and to actually take them to a physician who can make a correct diagnosis.

Linda Elsegood: Yes. I knew a little boy who was autistic. A terrible shock for the parents, I must say. 

Dr Tarek: We have a nephew in our family that is dealing with it and there were a few years of just not understanding what was going on before the diagnosis was made. 

Linda Elsegood: Yeah. I just have to tell you, we, in the first documentary, we did the LDN story, we interviewed a little boy called Jacob, and he's a piano protege. He can just play Beethoven just without looking at music, and he's so talented, but he was all. I would say it was, but of course, he still is, but he doesn't show signs of it anymore. But when he was small, he wasn't responsive to his parents. He didn't want to be hugged. He didn't want to be cuddled. And as he grew older, he just used to fight them the whole time, and regularly he used to smack his mum across the face.

And one day after he'd been on LDN, she was always saying to him, you know, I love you, Jacob. I love you, Jacob. And he just didn't respond, apart from slapping her. But this particular day she said, I love you, Jacob. And he looked at her, and I think he was three or four, and he said, “I love you, mommy.”

And she called her husband, and she said, quick, quick, get the video camera. I want to ask him again, you know, say it again and see if he'll do it, and we will record it because he may never in his life. Say it again. You know, I want to catch it. And he just went from strength to strength—a totally different child. Absolutely. Amazing story.

Dr Tarek: I think there's many like that with LDN.

Linda Elsegood: Yes. Exactly. It gives you hope, but like you were saying, it's the confusion to start with, isn't it? To get that correct diagnosis. So, yeah. Is important. So with your capsules, what filler do you use? 

Dr Tarek: There are two different fillers that we use. Typically we started with avicell, which is just very clean a filler that has no side effects, no inflammatory or reactive effects on, especially specifically to patients who have sensitivities. So we never compound with anything that would contain lactose or gluten or corn starch as a filler. But now there's been a few naturopathic doctors who. They loved the idea of compounding using the filler ginger root, because of its properties, especially with the gut health and just a soothing effect it has on the gut.

So that has been one of our common fillers now with the LDN, and other meds that we compound is using ginger root as a filler. 

Linda Elsegood: Wow. Do you know, I've not heard of that before. How interesting. Sorry, ginger. Tell, make a note of that. Wow. I love ginger. 

Dr Tarek: Yeah. Yeah. It's a great idea to mix it with their LDN.

Linda Elsegood: but of course, being a capsule, you swallow it so you wouldn't notice anyway.

You would use that. It was ginger. 

Dr Tarek: Yeah. You don't get the bad taste. Yeah. 

Linda Elsegood: Oh, bad taste. I love the taste of ginger. 

Dr Tarek: Well, it can, it can have some good tastes, but I think the ginger root powder that we, you know, that we're using its a clean powder, but it does have a little bit of a bitter taste.

Linda Elsegood: does it?

Okay. So what would you say your main patient population is that use LDN? Would you know that? 

Dr Tarek: Yeah. Uh, I would say it's adults over the age of 18 mostly getting it in capsule form. The most common dosing that we see is 2.3 or 4.5 milligram where the, you know, the vast majority is definitely below 4.5 milligram due to the fact that most studies show that the modulating effects of the receptor happen below 4.5 milligrams and we just, I don't think there are enough studies out there to know what happens when we go above 4.5, and I think the consensus is there's not really a need to go above 4.5 for most uses and that we see the effect, the response we want below 4.5 without the side effects. And so that's what we mostly see and the uses, it just ranges significantly between just gut issues, any autoimmune issue, neurological issues and pain. And on and on, it just seems like they keep coming up with a medical diagnosis that they try it on and they see good effects and the side effect profile, even though it's listed as sleep disturbance or vivid dreams. In speaking to my patients, and we have a few hundred different patients getting it each month. The feedback has maybe been one or two has actually told me that they thought they had a, it affected their sleep, but then again, you know, there's a lot of things that could affect our sleep.

So it could have been a coincidence. 

Linda Elsegood: Yes. It seems to be a drug that is well tolerated. I'm must say from my fifteen years of experience of talking to doctors and pharmacists and patients. The people who mainly tend to notice side effects are people that are ultra-sensitive to drugs, and it's usually people who've got fibromyalgia or chronic fatigue syndrome. Those people seem to be so ultra-sensitive that they have to start very, very low and increase very, very slow. People get there if they're patient. But yeah, if you find it is too much for you, it's definitely an idea to have a very low dose and increase slowly. 

Dr Tarek: Yeah, and that's a great point. And the patients who do require the slow titration up, we do the 0.5-milligram capsules, and it's anywhere from every three to seven days. They start to increase from one capsule a night to the second capsule to go to one milligram, and they slowly increase as they can tolerate it, so they get their desired effect, and then we stay at that dose.

Linda Elsegood: I mean, there are some doctors who prescribe up to six milligrams, some even go higher, but there are quite a few that try six. And with the chronic fatigue, there are some doctors who actually use double dosing, night and morning. And it's reported that those patients get more of the boost of energy, which is very helpful in those cases. What about thyroid patients? Do you have many of those on LDN? 

Dr Tarek: We do, specifically when they have autoimmune, when the underlying cause of their thyroid issues is autoimmune, which I think that the large majority of them, and you know, specifically Hashimoto's. When the doctor OD is open and familiar with the uses of LDN, and they do use that on those patients, we're able to see a reduction in dose and their thyroid medication and supplementation, and we're seeing thyroid antibodies reduce just by initiating LDN. 

Linda Elsegood: That's amazing, isn't it? How that happens.

Dr Tarek: about, do you use more often in the ones that said it is helping, 

Linda Elsegood: but I mean, the people are using it for Hashimoto's, hypothyroidism, hyperthyroidism, Graves' disease, Sjogren's syndrome. I mean, they're all thyroid, aren't they? And there was a paper written on Sjogren's syndrome last week, which was interesting.

Yeah. So, yeah. And then you get people who think, how can LDN work for so many different conditions, but it's to do with the autoimmune component. We didn't realize 15 years ago how well LDN worked for pain. It doesn't have to be a condition that is all autoimmune, which causes the pain for the LDN to work. Yeah. And neuropathic pain, especially in diabetics, it works really well for phantom limb pain as well is, another quite new thing that I've learned about, but there is always something happening with LDN. I don't know whether it's common knowledge yet in California, but. pain specialists are using ultra-low-dose naltrexone alongside opioids and weaning patients off the opioids.

That's very exciting. We're actually going to be filming a documentary on LDN and pain because there are so many patients who are addicted to pain medications through no fault of their own. You know, they haven't been buying drugs on a street corner. These are prescription drugs, and it's still the same, isn't it? To try and get off those medications. You still go through the awful withdrawal symptoms, but by using ultra-low-dose naltrexone where you. I'm starting on a microdose and increase that slowly, decrease the opioid and the people that I've spoken to who it worked really well for. It's amazing. Totally amazing.

And quite quickly, because I thought you'd have to do it over a long period of time, but it doesn't seem to be as long as I would think. 

Dr Tarek: Yeah. And those ultra micro low doses, are generally very low. So it's really important for anybody who wants to try it. They really need to be careful and, and understand instead of the dosing we've been talking about thus far, which is 0.5, up to 4.5 milligrams, uh, with, with people who are on opioids, we currently, we want to go start at 0.001 milligrams, so a very ultra-low dose. And because we don't want to throw them into withdrawal and cause them more harm, we want to try to help them.

Linda Elsegood: Exactly. And it's something that you would never, ever try and do on your own. It has to be under medical supervision because you could become stuck.  Definitely. 

Dr Tarek: Yeah. 

Linda Elsegood:  What pain conditions have you your patients been using LDN for?

Dr Tarek:  I've seen it used for some fibromyalgia patients. And some neuropathic pain patients we've asked. We've also included it in our transdermal pain creams, so we are starting to add that into there and seen a lot of, a lot of great results with it. I wish we could use it with, uh—complex regional pain syndrome. The problem is those patients are generally all already on high doses of opioids, so we can't use it on them. But we have seen that it's really effective for those patients. But the patients that we have at our pharmacy, they're already on really high doses of opioids, so they just can't be on it. 

Linda Elsegood: Well, maybe they could try the ultra-low dose. 

Dr Tarek: Yeah, they could. You know, we were just starting to learn about it.

And that’s the exciting thing about LDN is we're constantly in a learning phase with this. And so we're learning more and more uses and more and more types of doses and, and, that's something that we, we want to try to communicate to those physicians that are treating those patients. And. hopefully, we can get an open ear that's open to learning more about it.

Linda Elsegood: Yes. I mean, Dr. Deepak Chopra wrote a paper long while ago now, probably 2015 on complex regional pain syndrome and LDN, not a very interesting paper, but there are more and more pain specialists looking into LDN for pain. And I have spoken to many patients who are not on just morphine or fentanyl patches, but a cocktail of medication and they say that their pain is still on a score of one to 10, 10 being worst, nine on a daily basis.

And it's awful to think that people have to suffer like that, isn't it? 

Dr Tarek: Yeah, I agree.  Yeah, I have a young lady who comes to our pharmacy regularly who has the condition and, when it's acting up, and she comes in, you can, she's just kind of , bent over and walking very slowly, and you can tell that her pain is definitely at a ten on a scale of one to 10 and even though she is currently on high doses of opioids, it's just no stopping it. The pain is at a ten and, and she can't seem to find any relief at that point. Very, very hard to see someone suffer like that.

Linda Elsegood: Unless you've witnessed it and experienced what pain can be like. You think that you know you've got a headache, you take two paracetamol, you feel okay, but there is pain out there that does seem untreatable, doesn't it? Yeah, I can remember. Yes. Dr Samyadev Datta, he's also a pain specialist, and he was telling me how he has a practice, but he also works in the hospital, and he will get a phone call in the middle of the night that there's a patient, you know, screaming out in pain, the pain levels that are a ten and he will go in, and he'll say, okay. This patient is on 14 painkillers on this cocktail. They’re on too many pain medications. It's not going to work. You've got to take them off this, this, this and this, and sorting it all out. But he's very for LDN and ultra-low-dose and there is so much more coming in this in the next year, I am sure because. The PCCA, talking about LDN, more other conferences or talking about LDN? We have an LDN conference not that far from you really, is it? California? Portland in Oregon. 

Dr Tarek: Yeah. Great.

Linda Elsegood: Hopefully, we will be able to get you there. Because meeting all these people and actually being able to put your questions to them. It's an amazing tool. Amazing tool. Well, if you would like to tell our listeners how they can contact you and what your website addresses, that would be good. 

Dr Tarek: Yes. So the name of my pharmacy is Carmel Valley Pharmacy. The website is CarmelValleyPharmacy.com. And the phone number is (858) 481-4990. And lastly, my email, and if you go to the website, you can find my email, but just to mention it, it is, CarmelValleyRX@yahoo.com and I can be reached at any of those ways and I would be happy to receive any more questions or orders for prescriptions or any needs that you have with compounding or regular prescriptions 

Linda Elsegood: Thank you.

Dr Tarek: It was my pleasure. Thank you for the invite.

Linda Elsegood: Carmel Valley Pharmacy is a family-owned independent pharmacy with a mission to provide the best pharmacy experience possible with exceptional customer service, access to knowledgeable pharmacists and cost-friendly prices. Cool. (858) 481-4990.  Call Carmell Valley pharmacy.com the friendly store for their state of the art compounding lab and waiting to help you.

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

Pharmacist Rosella Pirulli Menta, LDN Radio Show 19 June 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'm joined by a pharmacist and naturopathic doctor, Rosella Pirulli, mentor. Thank you for joining us today. Rosella.

Rosella: Thank you for having me.

Linda Elsegood: Now you said that you got an extraordinary story to tell us:  Your journey. Would you like to explain that to us?

Rosella: Well, I went to St John's University in Queens, and that's where I got my degree in pharmacy and when I started working at a pharmacy in the Bronx of New York I wasn't very happy with just filling prescriptions and checking them and I felt that was not for me. I felt that, if I was going to have a profession and be successful, I wanted to show my children a different way to have a great life and also to be a part of a profession that helps people feeling amazingly well.

So that was my goal and so I only worked in that type of scenery for a few years and then I decided to look into other avenues. I went into homoeopathy where I did get a certificate in homoeopathy and I also looked into supplemental products because I really enjoy the supplements and teaching people how to take the correct supplements, especially if they are on certain medications that require supplements because of the problems that supplements can cause as a side effect. And the first thing I did learn was when patients were taking stands that they need to coQ10 we had a lot of patients that would complain of muscle weakness, fatigue and so I said: " You know what? I need to help patients with  drug issues and side effects." And that was the first step. And then patients would come into the store and I had a lot of patients that would complain about half flashes. And so I said, let me look into that avenue. And so, I started to dwell on how I could start a career in compounding and in that store I really couldn't do it as well but I did get my training to PTCA, and they are an FDA approved facility where I got most of my training from compounding and also in the avenue of bioidentical hormones. And then from there Rye Beach pharmacy took me on because they had a full compounding lab at the time and so they asked me if we did the store for a few years afterwards to be more in compliant, because we're now accredited by the board of PCAB and we also 700 compliance, soon to be 800 compliant by the end of the year.

But in the interim, I had to move to Florida where I worked part-time for Rye Beach pharmacy, and then I worked for a pharmacy in Florida so I had my license there as well. And I was commuting back and forth. I would come here and market to doctors because when I did graduate, I received my bachelor's in pharmacy, but I also, not knowingly, I minored in marketing, so I was I guess then I knew I was going to market, which is great because I enjoy networking.

That's like the passion for me to get doctors together, doctors and pharmacies together. It's my passion to help people get to know each other and there's always room for other avenues. So that's my enjoyment. And right now, I do have my own office where I see patients, I do phone consults as well and I also review blood work with patients. I'm really close to many of the doctors. So that's where I learned more about LDN because I went to PTCA conference and learned about LDN and how important it was for patients in different disease states.

Linda Elsegood: So, you are a supermom. You have five children.

Wow. How does it fit in with a career?

Rosella: Well, it's amazing because my kids understand that we're a team. That's it. We're a team. We work together and we all love each other so much. So my kids are so amazing with each other. They all help each other out.

So the oldest is 22. That's my daughter. My son's 20. My other daughter's 18. And I have a 15-year-old and ten years old. So we are constantly figuring things out and make it work and I think that makes them stronger and closer to the family 

Linda Elsegood: Wow, wonderful! And when did you first really get involved with LDN?

Was it at that PCCA meeting? Had you heard about LDN before then?

Rosella: I heard about it before then because we had a specific doctor that was a Lyme specialist that was working with LDN. So I asked her why was she prescribing LDN and she said it was because she had a lot of patients that were immunocompromised and fatigued, and the LDN is really helpful because it increases immune response. So I said:" That's really interesting. I'd like to learn more about it." So I did some research on it, I spoke with other doctors that were writing for it, why they were writing for it and I had one particular patient that had Crohn's disease. I asked him if he would want to try it and he's been on it ever since. So this is, at least six years that he's been on LDN. He's doing really well and will not stop it. That's for sure. I also took an autoimmune class on LDN. Not only is it great for pain. I actually had another patient that came to see me. She had a severe car accident. She had a lot of neurological issues going on and was on many other pain medications. So I helped wean her off of those pain medications and put her on LDN. Her starting dose was at 1.5 mg. We went up to 4.5 mg and then I said to her: "Let's try 5 milligrams and see if that works for you." That's when she started getting a side effect. She felt very strange. She said in mind a little weird. We went back down to 4.5 mg and she's been on 4.5 mg since about two years now. She's very happy with it. Every once in a while she has to take a Lyrica or something else.

It depends on the stressful situation in our lives, but, I mean, she's off most of her other pain meds because LDN is really working well for her.

Then I have a few other patients that I'm looking into the fertility aspect of it because I do work with a lot of fertility doctors and a lot of them don't know about LDN.

So I did more research on it to see how effective it would be. So right now I'm working with an endocrinologist who's going to start his patients on LDN and see how they do. A lot of people are fascinated by it and they want to try it. They want to help patients this way and I'm happy about that too.

Linda Elsegood: Well, there was a paper released last week by Dr Scott Zashin. He's a rheumatologist in Texas for Sjogren's Syndrome. That was quite good. The more papers and research that people do, it's going to make prescribers more confident in prescribing LDN.

Rosella: I forgot to mention I do have an ALS patient that is using it. This is amazing because he wasn't able to move his fingers and he wasn't speaking. Now it took a little bit of time. He can move his fingers, he can speak a little bit. At one point he didn't have the LDN. His doctor didn't authorize it because I think he was away and he wasn't speaking. So his sister said they need it because this was the only thing that they noticed that he needed. So I called the doctor, and I said:" Just put like PRN refills because this man is doing well with it.

Linda Elsegood: Interesting. So what I was going to say was, how long has the pharmacy been compounding LDN?

Rosella: Let's see. They've been in business for over 50 years and compounding around maybe 15 years.

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

Rosella: Capsules right now for the most part and some creams. I haven't done any sublingual yet, but I think it's worth a try for some patients.

Linda Elsegood: Sublingual is quite a useful tool when people have gut issues that obviously absorb differently and bypasses the stomach so that is hell in some patients, but maybe all your patients can tolerate the capsules quite well. What filler do you use?

Rosella: We use acidophilus. Most patients don't have any issues with that.

Linda Elsegood: Yes. Do you know roughly what patient population you normally treat or is it all autoimmune condition patients?

Rosella: It is hard to say because I'm not in the lab that much. There are a few days that I do work in the lab when they need me but basically working in my own office and I work with a lot of bioidentical patients. So my thought is to really work with thyroid issues and help patients with Hashimoto's.

From what I've read and what I've seen with other patients, LDN really helps to decrease the antibodies in Hashimoto's patients. So that'll also help them with their thyroid. That's going to be my push as well as other autoimmune diseases. And I was looking into other inflammatory diseases like endometriosis, PCOS because I feel that LDN may have a good positive result with those patients as well.

Linda Elsegood: It certainly does. I can speak from experience myself, and with endometriosis worked amazingly.

Rosella: Good to hear. Very good to hear.

Linda Elsegood: I would also like to mention when you treat thyroid patients with LDN, you have to be very careful of the levels of the dose if they're taking thyroid medication because normally they have to start reducing the dose as you increase the LDN.

That is something to look out for. This is why we always say to people who have thyroid conditions to keep in constant contact with the prescriber because you can hit some problems if you are taking too much of your thyroid medication.

Rosella: I agree with you on that. I do work with a lot of patients and I have one endocrinologist that we monitor thyroid and we compound different strengths of thyroid T3,  T4 depending on their blood levels. So we do look at that TSH really carefully and free T3. We also look at FT4, but mainly I look at the TSH and FT3. That to me is very important. I could see a difference in patients if their level changes just a bit. They can start having hair loss or weight gain and fatigue.

That's why  I do tell my patients it's so important that we monitor them, get blood levels done every few weeks to see where they are.

Linda Elsegood: The internet is an amazing tool. It helps people do their own research, but the warning is you can't take notice as gospel truth from just a person on the internet who's not a doctor, not a prescriber, but who is giving advice.

We always say the proper advice is to speak to a pharmacist or a prescriber. You people have had years of training and experience where it's all well and good listening to other people, but when you are talking about your health, you should be talking to a medical professional.

Rosella: Correct. I agree with you on that.

Linda Elsegood: Yes. I mean, it's quite scary. We had an email from a lady who had been given some kind of advice from a friend of a friend of a doctor and their advice was totally wrong. And also you should not buy LDN off the internet. It's illegal. Naltrexone is a prescription-only drug, and therefore you need a prescription to make sure all the safety standards are met.

You said that you were PCAB accredited. So just to explain to people what you have to go through to prove that your pharmacy and your compounding is spot on with the regulations.

Rosella: The regulations are intense and immense. It took us, at least about two years and we're still perfecting it to pass all of the inspection qualifications because if we're ever audited, yes.  PCAB is a credentialing organization. It takes some time for us to make sure we follow every different legality as to having our compounding lab as perfect as possible. Every aspect of it is really important. We have SLPs, and we have meetings every week to make sure that we're following our SLPs. Keeping every temperature in the lab correct, the airflow. We have to make sure that they're wearing their masks, their hats,  jackets and gloves and everything has to be precise and follow to the T. If we ever get inspected, they could definitely find us for anything that they feel that is necessary. We're trying our best to make sure we keep up with it. It's very intense. It really is. That's why we always offer our doctors to come to visit the lab or patients. We have them look through the window because they can't come into the lab and see how we are following protocol per se.

Linda Elsegood: And what are your thoughts on people purchasing LDN off the internet?

Rosella: I just found out that they're selling a prescription item on the internet, and I'm appalled. I don't know how they're doing it. I feel the same way as you. Being that we're a credential lab and we work really hard to keep up with all the laws and the regulations, I don't know where this lab is. It's making the LDN. I have no idea. I would not recommend it at all.

Linda Elsegood: Exactly. The MHRA, which is the medicines regulatory body here in the UK quoted something like 85% of drugs that are shipped into the UK without a prescription is counterfeit. Mostly they're just fillers, they are harmless but some of them are actually lethal.

They're very dangerous. Don't play Russian roulette with your life. Get LDN from a reputable compounding pharmacy.

Rosella: I agree with you. We require to keep it as clean, pure and stable and it's really important to deal with the pharmacy credentials because you never know what you're getting out there. We work hard and we respect it.

Linda Elsegood: And not only that. You have your LDN tested so you have to prove in a 4.5 capsule that there is 4.5 of Naltrexone.

Rosella: Yes, we do.

Linda Elsegood: So if there were no checks, it could be 1 mg, 6 mg, or it could just all be fillers.

Rosella: Exactly. You're right. We do send it out for testing. We send out batches every day of different types of compounds, and then we get our results back within the right range, and we're happy we dispense it. So it's important that we do that.

It can cost up to $200 or more depending on what you're testing.

Linda Elsegood: So pain. Are you using any ultra-low-dose naltrexone yet? It's quite relatively new still. I don't know if that's something that your doctors yet know about.

Rosella: No, I don't think so.

I really haven't heard of that either. So how low is the dose then because I'd like to speak to my doctors about that.

Linda Elsegood: Well it's micro-dosing. It's probably 0.01  kind of thing. But it's really interesting. People who are on high doses of pain medication and have been for years, it's awful how it's not just America, it's all around the world how people are becoming addicted to these pain medications. I know that the whole idea is to try and get patients off the pain medications, but the withdrawals can be quite horrendous. So by using this ultra-low-dose naltrexone in micro-dosing, you can use that alongside with opioids.

They don't have to be off the opioids, but such a small dose makes the opioids far more effective. So it makes them work better, and therefore the patient is able to reduce the amount that they're taking. If you look at it as a sliding scale, you slowly increase the ultra-low dose, and we're still talking microdosing here, and then they can gradually reduce their opioids until they're on the LDN.

Most pain specialists say that they can get their patients off the opioids completely.  Some say that they just take it when they need to. They're not taking it constantly. So I think that is something that's really interesting and something new to many people but how wonderful to get these people off pain medications.  I've spoken to many people who've been on Morphine, Fentanyl, patches, and cocktails of medication and they say that they're still in pain. It doesn't work. So if we can get LDN out there and use to help these people to come off all these pain medications.

how wonderful is that? Tell us what do high doses of painkillers long term do to the body?

Rosella: They can cause a whole host of things, bone loss, blood pressure issues. It depends. I'm looking at patients that not only the opioids but if they take a NSAID what it could cause in the long run. I just believe that most of these medications,  some patients become suicidal too. Depression is another problem, weight gain. So many different things that opioids cause.  I think that if we can help patients come off of them and give them more supplementation and also LDN in a combination that'd be great.

Even Curcumin, Boswellia. There are so many amazing products out there that patients don't know about. They're just scared to come off of their opioids because of the dependency.

Linda Elsegood: Definitely. So how do patients get hold of you for a consultation?

Rosella: On the website. There is the introduction of what I do. I have a video there as well and there's also an evaluation form they can download. So on the website, there is an appointment maker there called shore, so they can make an appointment with me and it makes it really convenient for them.

Most doctors that know what I do, tell the patients to call me or go on the website or email. I have my business cards and I have that for them and that's how they get in touch with me. They used to call here. I have an assistant, her name is Tiffany, and she helps me with setting up appointments, and she's also a technician that helps to fill our scripts.

So that works out really help me.

Linda Elsegood: And do you have a waiting list, or can you see patients quite quickly?

Rosella: It depends on the month because I do marketing two days a week. So that's why it's really convenient for them to make their own schedule. It could range from a week waiting, maybe two weeks at most, then I try to fit them in. So for instance, if they can't see me within the special time frame that I have, which is usually between like eight in the morning and six,  I see them on the weekends if I can. I'll set up that schedule for patients. So I try to make it convenient, try to fit people in as quickly as possible.

Linda Elsegood: And where are you situated?

Rosella: Where am I situated? I'm in the Rye, New York. In Westchester County.

Linda Elsegood: Is it wheelchair friendly for patients too?

Rosella: Well, it is. We are a hybrid store, so downstairs is mainly where we have the retail establishment.

We have home health care and our vitamin line where we have a pharmacist that's full time working in that area. We also have the upstairs where my lab is, and where also is my office and other offices as well. If a patient needs to see me and can't walk up the stairs, there is another office downstairs that I could see them in. That works out for those patients.

Linda Elsegood: Wonderful! And could you just tell us your website?

Rosella: It's www.ryerx.com.

Linda Elsegood: Wonderful. Wow. We need to end of the show.

Rosella: Oh, great. I just wanted to clear something up. I'm not a physician. I'm a naturopath, so I cannot prescribe. I just wanted to clarify that if you don't mind.

Linda Elsegood: No, that's absolutely fine.

 Just explain what a naturopath does.

Rosella: Well, I took some courses in it, and I basically learned more about supplementation. It's a little bit different. I wanted to become a naturopathic physician, but I didn't have the time. I was basically between the kids and working full time.

I didn't go into that avenue. But it's been mainly as like learning about supplementation, helping patients with that as well as a little bit of nutrition. So I would like to go into clinical nutrition as well, but we'll see if I can cross that path when I get a chance to, once all the kids are in college, I guess, I don't know.

I'll figure it out.

Linda Elsegood: Do you test for supplementation to find out what people are low in?

Rosella: We do some blood work for sure. New York is really tough when it comes to other types of testing, so we can only do blood tests and that's how we test and we just saliva testing for the hormones. We are limited to a lot of different types of testing unless a patient lives in Connecticut or New Jersey, then we can test them with the different kits that we have.

Linda Elsegood: What about vitamins? Can you test for vitamin levels or not in New York?

Rosella: It could be tested for sure because we work with a lot of doctors that do a lot of IV therapy and they test all sorts of vitamins.

It depends on the lab that does it. But here are many labs that do testing for vitamins.

Linda Elsegood: Do you find that people in New York are deficient in vitamin D? Do you get enough sunshine there?

Rosella: I would say that everyone is deficient in vitamin D, everyone in America must be, but definitely in New York.

And then, once we rectify that, they feel better. We get them to a certain level, and they could stay on the supplementation for a good long time. Usually, I don't recommend that they come off of it, but if they have levels to go higher than  50, with the doctors ok, we'll bring down the dose a little bit.

Linda Elsegood: How would a patient feel if the vitamin D levels were low?

Rosella: Some patients tell me that they feel achy, others tell me they feel tired or depressed.

Some patients don't have any symptoms at all, so it just depends on the person. I know when I had my levels low, I would feel a little down and when it was a rainy day, I wouldn't feel myself. But now that my levels are normal it doesn't bother me.

So it's really strange how I used to feel.

Linda Elsegood: That's really interesting, isn't it? So anybody out there who would like to come and see you go online, they can find out more about you, play the video and make an appointment, come and see you and the bonuses is they can actually have a look at your compounding lab looking through the window, of course.

But that's also interesting to some people. I'm sure.

Rosella: Yes, absolutely. They love it, especially because we have a clean room as well, and it's separate from the rest of the lab, and that's where we make all the injections of HTG and b12 and they find that very interesting.

Linda Elsegood: Well, thank you very for being our guest today. We learned a lot from you.

Rosella: Thank you very much for having me and have a great day.

Linda Elsegood: Thank you.

Rosella: Thank you. Bye-bye.

Linda Elsegood: Each pharmacy has been family owned since 1946 they are a PCAB accredited compounding pharmacy growing from a corner drugstore to a wellness centre that helps patients to achieve their optimal health covering Connecticut, Florida, Illinois, Massachusetts. New Jersey, New York, Pennsylvania, and Rhode Island.

Visit www.ryerx.com, and I hope for the opportunity to earn trust.

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.

Pharmacist Masoud Rashidi, LDN Radio Show 11 Dec 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood:  I'd like to welcome my guest, Dr Masoud Rashidi.  He was from California, the owner with his wife, Dr Anna.  They own their own compounding pharmacy in Folsom.  Thanks for joining us today, Masoud. 

Masoud Rashidi:  Thank you, Linda, for having me on the show.

Linda Elsegood:  Could you tell us what made you decide to get into pharmacy?

Masoud Rashidi:   It started back in high school.  My dad knew a pharmacist, and I was able to shadow with him for a day.  It was interesting how you can help people and get to know them.  I wanted to pursue pharmacy after that.

Linda Elsegood:  Wow.  That's amazing, isn't it?  So how long have you been a pharmacist now?  Did they know about LDN?

Masoud Rashidi:  I've been a pharmacist for 15 years now, since 2004.  That's when I graduated from Western University of Health Sciences in Pomona, California.  That's where I received my doctorate degree and started working a few months thereafter.  I started working at a chain, like everybody else out of school.  They did not know about LDN.  After a few years, I started working at a chain in California.  A couple of years later, I decided to explore, because there was a need for a compounding pharmacy in town.  There was none available at the time.  So, we had rotations back to school to learn about compounding, but we still didn't know about LDN until I began compounding and started our own company in 2007.  That's where we became involved in compounding LDN.

Linda Elsegood:  So, in your pharmacy, what forms of LDN do you offer?

Masoud Rashidi:  We provide a few different ones.  Mainly, we do capsules in many different dosages.  We also do lozenges.  We've compounded a topical, such as a transdermal application; also a liquid, both in aqueous solution or oil, depending on the situation  The kid may take the oil or not, so we go from there, depending on what flavors we can incorporate into the different formation.  We pretty much do every possible dosing that is available right now.

Linda Elsegood:  And what strength do you normally start with?  Do you do a micro-dose?

Masoud Rashidi:  Yes, we do micro-dosing; actually we've done a few of them.  Our most common one, of course, is the typical dosing, 1.5 mg, 3.0 mg, and 4.5 mg, but the last few years everything has changed.  We’re doing so many different doses every day.  We've done from 0.1 mg all the way to 9.0 mg.

With micro-dosing, we do from 1 microgram to 5, 10, depending on where are going to end up with that particular patient and their needs.  We've been doing both, like several different dosing, and we send our products to third-party testing to ensure potency and quality.

Linda Elsegood:  Having spoken to so many pharmacists, it's very difficult to say that one microgram of LDN is very difficult to know.  It's very hard to prove.  You have to find the right people to have it tested.  Lots of people, I'm sure, who take LDN are not aware of all the efforts that compounding pharmacies must go through.  Would you like to tell us a bit about that? 

Masoud Rashidi:   We received two different chemicals of Naltrexone from a couple of different wholesalers.  Then we send it for testing after compounding to determine the best one to use.  It’s not a requirement to do all this testing, but we go above and beyond to make sure we get the right dosing.  We send samples to the third-party lab to be tested to see if it is within range.  Legally, you can have 10% variation on the capsules, but in our lab, we like to keep it less than 3% to be even more accurate.  When we send it out, we tried to keep it less than 5%, especially when you get to low doses.  Ten per cent is a lot of variation when dealing with one microgram, so we try to keep that even lower than what's legally allowed to ensure higher quality.  In the past, they've rejected a chemical because it had too much water content.

Linda Elsegood:  What kinds of doctors are you dealing with?  Naturopathic doctors, pain specialists, MD’s, and other prescribers?

Masoud Rashidi:  Yes, you are right on.  One of our biggest prescribers is a nurse practitioner who specializes in women's health and sees many people with Hashimoto's and autoimmune.  We have an MD, after going to the LDN Research Trust Conference a few months ago, has become big on LDN.  We have a few naturopaths.  I go to different doctor's offices and educate them on LDN.  In California, unfortunately, a lot of naturopaths cannot prescribe; they must have oversight MD’s.  They must find a naturopath who can prescribe it because not every naturopath in California can do so.  We do have MDs, nurse practitioners, a variety of different doctors, even paediatrics.  One of our best cases was an autism patient, with a prescribing MD.  It was amazing.  Every time I think about it I get goosebumps because of what happened.  A few days later, the mom calls and says, “Oh, my kid is actually communicating with two siblings!”  It was three days later at 0.1 milligrams.  It's been about three months, and she's one of the best advocates for LDN.  She calls us all the time.  This child is talking more and more with the siblings and the parents and having eye-to-eye contact.  The mom said it was life-changing, and that's what we hear all the time.  My life has changed after LDN.  It's rewarding when you hear those words, and that's why we keep doing what we're doing.  We continue to conduct seminars for the public and for the doctors to increase awareness.  It's been very good for the patients, and our goal is to increase awareness on how great it is and how it can help in so many ways, especially with all the research articles available now.

Linda Elsegood:  What case studies do you have, feedback from patients, and their conditions?

Masoud Rashidi:  One of the biggest ones we get is RA or rheumatoid arthritis.  They get a lot of good response.  After a week or two, they can move their fingers, and they don't have much pain.  They've tried all these different drugs, and nothing works.  Now after a week or two, it's amazing sometimes.  For some patients, it takes a few months, but sometimes, within a week they call you back, and it's like, “Oh my God, what is this? This is working amazingly.” 

One amazing result was an MS (multiple sclerosis) patients.  I was brand new to compounding, six months.  We didn’t have that many employees, so we knew every patient that came in the door. He comes in with a wheelchair.  He’s tried everything.  We consulted with MS experts, and that's how we started with LDN, just speaking with them.  I kid you not, three months later, he comes in, WALKS into the pharmacy.  I'm like, whoa!  He was in tears.  He says, “I’ve been in a wheelchair for so many years.  I've tried all these drugs, and nothing has worked.  This has been amazing.”  That's when we started promoting LDN more, talking to different doctors about it.  We get to a lot of good feedback like that.  There are just too many of them to share.

Linda Elsegood:  What about patients with GI problems?  Have you had any feedback from those?

Masoud Rashidi:  Actually, we’ve seen IBS, IBD, Crohn’s disease, and things like that having really good results.  Of course, as we all know, not every drug is going to do 100% for every patient.  But we’ve had about 80% good results.  The funny part is that they’ve tried all other drugs that are commercially available, and nothing has worked.  At this point, they contact us.  After so many doctors, so many drugs, and they come in and then have good success with LDN.  Every time we do our seminars, people come in and ask, “Oh, would it work for this?”  So, we start researching.  Our latest question, Mom called us and said, “Okay, my daughter's addicted to narcotics.  They put her on Suboxone.  What can I do with LDN?  She's now more addicted to Suboxone than she was addicted to narcotics.”  We're researching that right now.  It's amazing how one drug can treat so many different conditions.

Linda Elsegood:  Definitely.  Still talking about GI, do you have any patients using it for SIBO, (small intestinal bacterial overgrowth)?

Masoud Rashidi:  I've read a lot about it.  We have a patient wanting to try it, but the doctor was not willing to prescribe it.  We referred care to this new physician.  This is our first case, and we'll find out hopefully soon.

Linda Elsegood:  What about Lyme? Is that something you've seen 

Masoud Rashidi:  Lyme…yes, we have.  So many people go undiagnosed, and then they get diagnosed, and they don’t know what to give them.  Then they're on pain meds and stuff like that.  We had a Lyme patient, we talked to her doctor and put her on LDN.  It has helped her a lot with her symptoms.  We've had quite a few patients, but she was a really severe case with multiple issues.  About two and a half months later she was off many of her medications, and she was feeling much better.  She could resume driving, not being on all these different drugs.  Previously, she was depressed.  Now she gets up, and she can do things in the morning.  We’ve had other cases with very good results as well.

Linda Elsegood:  Okay. And have you got vets around who prescribe LDN for animals?

Masoud Rashidi:  I've talked to quite a few veterinarians in town.  We’re writing a protocol on how to use LDN for pets.  One veterinarian has used it, and it helps with all the issues that humans have.  There are a lot of articles on that.  We've been starting them on the lower doses.  We do make it mostly liquid in an oil suspension so that it lasts longer.  We have had a few now.  The vets have been very happy, and the owners have been happy.  The dog had arthritic pain and could not move as much.  We gave him the LDN, the veterinarians prescribed it, and then a month or so later the dog is doing much better.  Veterinarians talk to each other.  We get more questions from different veterinarians every day and hope that we can get more awareness of LDN for pets.  It works for them.  We've seen results, few, not many, but I've read a lot of research studies on it.  I am hoping that it's going to become more popular sooner rather than later in the pet world, too.

Linda Elsegood:   Right.  It's all to do with raising awareness and making the doctors feel comfortable.  Not surprised that you have so many MD’s prescribing LDN.  Again, they are traditionally trained and many of them take some convincing to look outside the box.  You were saying ND’s in your area often can't prescribe the LDN.  What about physician assistants?  Are they allowed to prescribe?

Masoud Rashidi:  Oh yeah, they do.  We have one who's a big proponent of it because he's seen really good results.  He's a functional medicine PA.  He involved the doctor and everybody else.  It's contagious when you see good results.  They tell each other, and they start calling it in.  Yes, we have quite a few PA’s that prescribe.  Not as many as I want.  They're coming on board because we’re holding seminars in large scale now.

Linda Elsegood:  Yes, PA’s tend to have more time to listen to patients than doctors.  It's amazing what these service providers are doing.  We'd be lost without them.  

Masoud Rashidi:  You're absolutely right.  As far as they have more time to spend with the patient because doctors have a lot of other things going on at the same time. 

Linda Elsegood:  When you have a chronic disease, let's say MS or lupus, even fibromyalgia, trying to get the diagnosis isn't easy.  And then you’ve got to find somebody to help you to get the right treatment because obviously everybody is different.  It also helps to have that patient, doctor and pharmacist relationship, doesn't it?  You know, the triangle.  Presenting LDN to more doctors and letting them know that you're there to answer any questions or queries they may have I would think helps them become more confident in prescribing LDN.

Masoud Rashidi:  That's true.  Even in our patient's seminar, we had last month, we had four prescribers show up at the seminar that was for the patient.  It was very interesting.  In future seminars, we may broadcast on Facebook Live or somewhere, so more people can be reached who cannot come in.  All our seminars are free.  We do this for awareness.  We have people come in and share their stories.  Patients talk to each other, and then they start getting up and talking to the whole group.  That's amazing, too, because then they are hearing from the patient, not from us.

Linda Elsegood:  Of course, patients, as soon as they learn about LDN, they then go and find a doctor or educate their own doctor.  I think patients also play a big part in raising awareness of LDN, especially when they have good results.

Masoud Rashidi:  Exactly.  We give them a whole binder.  We've seen that patient take those binders to their doctor and show them some of the research studies, because some doctors are still thinking of Naltrexone as a whole dose Naltrexone and they're like, “Oh, you don't need it.”  We tell them, take this to your doctor, and that has helped.  You are absolutely right.  Patients are the best advocate for this whole thing because they see results.

Linda Elsegood:  We’ve come to the end of the show.  Thank you so much for having been my guest today.  It really was a pleasure speaking with you.

Masoud Rashidi:  Thank you for having us, and it was a pleasure speaking with you.  

Linda Elsegood:  Thank you. 

This show is sponsored by Doctors Masoud and Anna Rashidi.  They graduated in 2004 from Western University with a Doctor of Pharmacy degrees. Soon after in 2007, they opened the PCAP accredited Innovative Compounding Pharmacy located at 820 Wales Drive, Suite 3, Folsom, California  95630.  To better serve the community, for more information, please call (866) 470-9197 or visit www.icpfolsom.com.  

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

Pharmacist John Herr, LDN Radio Show 21 Nov 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today I'm joined by pharmacist John Herr, and he's from New Jersey in the US. Thanks for joining me today. John. 

John Herr: Oh, you're welcome. Glad to be able to spend this time with you. 

Linda Elsegood: Good. And I didn't mention where you're from and you're from Town and Country Compounding. So first of all, tell us how you got into working as a pharmacist.

I mean, had you always been interested in pharmacy as a child? 

John Herr: Well, I've always been interested in pharmacy, and I've always been interested in like natural medicine or integrative, we now call it integrative medicine or functional medicine. But back in the day, I think we called it natural, and I was just lucky I went to a think John's University in New York City and, and I made the acquaintance of a physician who was, she was actually a pioneer in bringing natural or bioidentical progesterone into the United States. So back then, I was still in pharmacy school and, and I started to like working with patients with bioidentical progesterone.

And it just kinda changed the way that kind of, I thought as a pharmacist and I, I really consider myself like an integrative pharmacist now. So low dose naltrexone to me was just a natural progression of, you know, my knowledge and my interests.  

Linda Elsegood: so how long would you say that you've been compounding LDN now.

John Herr: Oh my God, I think it's gotta be around two, maybe around 2000 or 2002. You know, just when it was really becoming, you know, old people were starting to understand it. It's interesting. One of my patients, when I had my retail pharmacy, she ended up writing a book about it, about her husband.

It was called “Up the Creek with a Paddle”. and Mary Bradley and I, she had been in my pharmacy and her husband at the time had MS, and we were talking about, and I recommended the low dose naltrexone to her, and then she went and sought out Dr Bahari. And you know, she started, you know, they started her husband on that for his MS and that, that's where my original interest was.

And she ended up writing the book, you know, “Up the Creek with a Paddle”. And my biggest claim to fame is I’m mentioned in the book as the one who told her about researching low dose naltrexone. And then. Subsequently, after that, I became acquainted with a gentleman named Fritz Bell, who started a website, good shape because back then people were just, you know, going on the internet and they were buying the 50-milligram tablet and trying to, you know, create their own.

So, you know, Fritz had a big interest in that and, I filled prescriptions for his wife, but I also filled prescriptions for people where Fritz donated it to them because he wanted people to be able to take the medication and not have to compound their own.

So if they qualified to his standards, we would make it up and send it out, no charge. So those patients could start on the low dose naltrexone. So I go back way to the beginning. And you know, I think back then we just thought of low dose naltrexone and honestly for MS. But you know, subsequently, over the years we've just learned, you know, how vast different disease states we can treat and manage with low dose naltrexone.

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

John Herr: Well, the most typical is a capsule, uh, which we do an immediate release capsule. Um, we're in the process of buying a, uh, switching over to like a tablet so that we can, uh, you know, meet the need, you know, with a tablet machine. But right now we make capsules. We also make, um, we've actually done a transdermally.

I treat a lot of children on the autistic spectrum disorder. You know, we've had to do it in sublingual liquid for some of the children. Uh, we have a couple of patients on it right now, believe it or not, for a vaginal cream. We've also used it transdermally for like neuropathic pain on different areas of the body.

And I've been researching some articles recently. I'm using it as an Automic drop for chronic dry eye, but I've been talking to a couple of different integrative physicians about using it. But, uh, up to this point, we haven't have anybody try it for the ophthalmic. But I'll, I'll keep everybody appraised when we do because there is, there's a lot of interest in using it for that function as well.

Linda Elsegood: And I know that there are some dentists that are also using LDN, so that's another interesting one. And how about ultra-low-dose naltrexone? Is that used in your area that you cover? , 

John Herr: yeah, we have some patients on it. We also do a lot of pain management. We have, uh, we've managed intrathecal pumps in the home.

So I worked with a lot of doctors, pain doctors and I actually work with a doctor, a doctor speaking at the next conference in Portland. And so I work with his patients, and we have to start a lot lower on his patients because many of them are on opioids. And I've worked with some pain physicians where we've actually compounded as low as 100 microgram capsules because I think you really need a physician who is trained in pain management because they're actually weaning the patient off of the opioids as they're bringing the LDN up very gradually.

And it's a real balancing act because. You are going to detox that patient. So that's not something I would recommend for you, you know, like a general practice physician to you. Um, but we do have a lot of patients that are using it that way where they're getting off of this. And then I just, we just get tremendous feedback when they're off of the opioids, how they're then maintaining the pain with these, with, you know, LDN that we consider, you know, on that standard dose that we consider for pain.

But it is a little tricky to get them off of those. Um. Yeah. Off the opioid, while you're bringing the low dose naltrexone up to the appropriate dose. 

Linda Elsegood: I mean, I've interviewed several pain specialists, and they seem to be using 0.001 which must be like a grain of sugar of naltrexone, and they explain, sorry, 

John Herr: carry on.

Zero one micrograms, 

Linda Elsegood: Linda. Yes. Wow. Yeah, so 

John Herr: I mean, 

Linda Elsegood: exactly, but by doing that and using it alongside the opioid, it makes the opioid stronger so that they can reduce the opioid and slowly increase the by 0.001 sorts of the thing. They do like sort everyday kind of thing, until they can bring the opioid really down and the LDN can take over.

And they have it by doing it so slowly, as you can imagine. Well, slowly by my thinking, um. Or, or rather fast by my thinking. They say it's slow, but it does seem to happen quite quickly where they get them off the opioids, and they have gone, they haven't gone through withdrawal, they haven't had any side effects.

And you know, the LDN, like you were saying, can be used in place of the opioids and give pain relief. It's just amazing to me that something so small that's not harmful or toxic or even expensive can work so well. 

John Herr: Yeah, it is amazing. I mean, I think we just, as I said, when I first started working with it, we just kind of thought of it for like autoimmune.

But how we, you know, now that we know that it's working on the immune system when we know it's working on, you know, with the upregulation of endorphins and we know that it's working on the toll like receptors for inflammation. And now that we see how it affects dopamine for depression, I just think the, I mean it's just amazing to me how many opportunities there are out there for physicians to learn how they can better treat their patients for numerous, you know, disease states,  

Linda Elsegood: and of course, most people that have an autoimmune condition, one of the underlying problems is the inflammation, isn't it?

So by reducing that inflammation alone helps the person feel so much better anyway, especially with the boost of endorphins as well. 

John Herr: Oh, yeah. Actually, my wife, who's a pharmacist, is a perfect example. Like she went and had all this blood work done in her, what they call her ANA level was through the roof.

So your traditional physician would look at that and say, Oh, you must have rheumatoid arthritis. Because she was getting, wasn't really achy joints, but she was getting pain, almost like fibromyalgia pain. So we knew it was inflammation, and at the same time, her blood pressure was uncontrollable. It was, you know, we actually had her on a heart monitor, and then one of the physicians that we work with, when they did, you know, we really started working more in-depth than they did the food allergies.

We found out she was severely allergic to dairy. So, you know, started her on, you know, obviously an elimination diet, and then low dose naltrexone, which she titrated up gradually to a dose about 4.5 milligrams, but the ANA level came down, you know, uh, you know, obviously with inflammation, all the inflammation markers went down. The pain went away. And the funny thing is like we had to get her off that blood pressure medication really quick. The pressure was just dropping. So now she's just on LDN and you know, obviously supplements and you know, dietary changes, but there's no more blood pressure medication needed, and she doesn't have the pain anymore.

So it's an example of, you know, the LDN is a tool, but you still have to take into account all of the other things that are going on. But the diet, nutrition, exercise, I always try to tell people it's a package deal. You know, the LDN is one of the most important pieces, but there are other things that you can do for your health.

Linda Elsegood: Oh, definitely. Um, I used to have to take, um, Omeprazole for Acid reflux, and if I didn't take it, I was in trouble. It's that severe, but by going gluten-free I now don't have any problems at all. I don't have to take the medication. I don't have any acid reflux at all. But if I go out to eat and you know what it's like you're going through the menu and say, you know, it doesn't look as though there'd be any gluten-free in this. Could you check with the chef for me? And they'll come back and say, no, there's no gluten in it. If there is, I don't sleep that night. The acid reflux is so bad. And I have to sit up. Right. If not, I'm just going to vomit. It's terrible. So I don't always believe people when they tell me there's no gluten, cause I know if there's any gluten in it.  Yeah. So it's amazing, isn't it? How you can just eliminate other medications just by diet. My husband has problems with these. The skin on his hands. He's allergic to milk, and he'd seen so many different doctors in the past, and nobody could tell him why the palms of his hands would go like white and dry.

But when he eliminates dairy, his skin is completely normal. And that was like 30 years of trying to find out what was wrong with his skin and never had an answer. . 

John Herr: Yeah, that's what I, my thing, when I'd give talks on this, I always tell people, patients, or if I'm talking to groups of physicians, you know, whoever it might be, I, I say at least I know in the United States, I say, we say that we're in healthcare in the United States, but we really are not.

We're in sick care, you know, our, our system in this country is, I hate to say it, but it's run by big pharma. So you know where our physicians are, a lot, many of them are trained to wait until the patient presents with the disease and then give a pharmaceutical remedy for that disease, whereas an integrative medicine, or you can take like LDN, I think, you know, we're trying to get at the underlying cause and how can we correct that so that we can live healthier.

Linda Elsegood: yes. It's, um, quite common for people to tell me that. The doctors are only treating their symptoms, but not the root cause. So of course, you then end up with all these medications and some people are taking in between 14 even 22 different medications a day, and some of those are only needed because of the cocktail of drugs that they're taking cause side effects.

But that's okay cause they'll give you another tablet which will combat the side effects from the cocktail you're taking. 

John Herr: Yeah. Well, I think Linda your example was the perfect example there. You know, that drug was originally made for somebody who had an active ulcer and then you theoretically would take it for, you know, two or three months, to allow it to heal and then change your diet and, and you know, go on. But now people just live on that drug, you know, the purple pill. It's like they have to take it forever, which you know, it affects, then you're affecting your gastric pH, your digestion. It's a slippery slope. I agree with you. 100% 

Linda Elsegood: Hmm.

And of course, I also have people telling me that it's expensive to eat healthily, and especially when you've got children, it seems. So sad, and I can understand if you only have a limited amount of money and you've got several children, they all need feeding. But - we call them crisps - you call them chips over there, and we have biscuits, you call them cookies, but you, you, you get where I'm coming from. That is cheaper than buying apples, some pears and bananas and oranges and such, which would be a healthier option. But the price difference is quite amazing, isn't it? And especially if you have. Uh, mass-produced meat from a supermarket or you're buying organic local meat or vegetables.

Uh, the price difference is quite high, isn't it.

John Herr: Oh, yeah. It's much harder to try and eat organic and healthy. You're right. And then you see the commercials where McDonald's is our friend. The dollar meal menu. Oh, please don't just don't even eat there. But do you want you to understand? Some people though, socioeconomics, they don't, they don't have that choice.

But you know, everybody can make little changes, I believe. Do you know? Uh, and then that's what we try to educate them on. And as you mentioned, I mean, just the cost of medication, like, uh, it's gotten, even when they're covered by insurance in our country, many patients can't afford their medications with their copays.

So I, whereas the low dose naltrexone, you know, I'm such a big believer in it. I, you know. Okay. I worked with Dr Dahda who, you know, explains to me that, you know, his patients are chronic pain patients. So a lot of them are, you know, disabled or they, you know, they don't have a large income. So, you know, we, you know, once we have them too, they're titrated to their dose that the dose that they're going to be on for their pain, then we dispense like a 90 day supply.

It, you know, at a cost that in most cases is lower than their copay. Uh, cause we just believe in the therapy so much that we want to, you know, help it help patients and make it available to them. 

Linda Elsegood: What about shelf life on your capsules? How long do they last? 

John Herr: Well, you know, the USP governs that in our country, so I imagine they would last longer, but where, you know, only allowed to put 180 days on, on there.

Once we, from the date that we make it now, certainly at the pharmacist, I think it would last a lot longer. But because it's compounded, you know, the USP United, which is the United States pharmacopoeia, which is basically overseen by the, you know, the FDA, the food and drug administration, and then that's up to 180.

Yeah, a day, what we call the beyond use date or expiration date. So that's what most people are getting a 90 day supply. They'll certainly going to fall within that date range.  

Linda Elsegood: I understand. And so that would be the same for the tablets as well once you start making those if that is the rules and regulations of the land. The 180 days?

John Herr: Yeah that’s correct that’s a solid dosage form and then once you go into anything that was a liquid, for example, um, now if you'd like for it to stop, I had to make it into for a young tile than a liquid format, you know, then we would be restricted, believe it or not, to a 14 day supply? You can also do testing, you know, so you can test that it's stable to extend that beyond use date. But most of the patients we see are, are using the, you know, the solid oral dosage forms, the capsules or the tablets. Yes. So it's usually not that much of a problem.  

Linda Elsegood: and what fillers do you use. 

John Herr: Well, typically, like most people, we use avicell, which is just an inert starch that people do not have any problems with.

But because we, we, you know, my pharmacy, it's, you know, we were only compounding. So we work with a lot of functional medicine and integrative practitioners. So we have a person who did have like what we call chemical sensitivities. A lot of times I don't think that they're going to be allergic to the, uh, you know, to the low dose naltrexone or it, but it could be the filler.

So sometimes what we'll do is we'll give them different filler. We might give them some avicill capsules, we might give them some acidipholis capsules, or sometimes we'll use a vitamin, you know, nutritional that we know that they can take. And then we'll have them take the, you know, capsule, you know, for about a week or so with actually, without, with no now trucks on it.

Just to make sure that they're not having any type of re, you know, reaction to the, uh, to the filler. So, you know, typically we do avicell, but you know, for specific patients, you know, if they have chemical sensitivity, we will adapt it too, you know, whatever will agree with that particular patient, especially if they practice kinesiology.

I have a couple patients and practitioners, you know, practising aetiology so they can kind of, sometimes they can tell which filters are, you know, will react to a patient even. Just from the, you know, if you understand, can aetiology, how it works in the body versus even half the taking it to see if they have a side effect.

Linda Elsegood: Okay. And what about the capsules? Are they sort of, um, a vegan free capsule? 

John Herr: Yes, we can get a, um, they're, they're a vegetable base, so now they're not a,  typically they come gelatin or, or, or vegetables. So we can, you know, we can get either, our goal is to go. At least eventually to the tablets once we, um, you don't have the tablet machine running correctly, but with the tablet you're, you know, unfortunately, you have to kind of make a couple of strengths.

It's not that you can go, oh, I can just run or, you know, or make a runoff, you know if it was a strange or an odd strength, you know, let me just make 30 or a hundred of that. What you have to do that in bigger batches, I don't think I will ever not be also making capsules. You said if you have the patients that need them, the ultra-low dose or patients who.

Everybody used to think it was 4.5 milligrams like religion, but now we know some patients do better with nine milligrams, some patients do better on three milligrams. So I envisioned that will always be, you know, compounding capsules. But we'll also, for those patients that are taking the more common dose, we'll have the availability of the, you know, tablets that we can keep up with the demand because you know, myself being, and.

in this metropolitan area of New York City, New Jersey. There are so many patients who need this, uh, need this treatment. 

Linda Elsegood: And what area do you cover? Um, before we started, you said the Manhattan area, so. Could you just explain exactly where you, you cover? 

John Herr: Oh, sure, sure. Yeah. And in the United States, uh, again, the FDA requires that you have to be licensed as a pharmacist in any state that you're going to send, you know, medication into and low dose naltrexone is considered a, you know, prescription medication in our country. So, you know, you have to be licensed in those States. So I, I've concentrated my licenses in the Northeast, so I, you know, work in areas such as, you know, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Ohio, Pennsylvania, Delaware, Maryland, you know, the, in this area of the Northeast.

But, uh, you know, previously I was president of IACT, which is the international Academy of compounding pharmacists. So I know pharmacists all over the country. And a lot of times I'll get a request for, you know, low dose naltrexone in another state. So I always know, you know, a good colleague that I can refer to that prescription to if no, if I get, I have a request and, uh, to state that I'm not licensed then.

And compounding pharmacists generally kinda like to network and share ideas with one another, which, you know, it's very collegial, which is something that, you know, really makes me enjoy the profession. So I do many instances I send prescriptions that I get to people I know in other States because I'm not licensed in that state, so we always try to make sure the patient gets their medication.

Linda Elsegood: And since you've been compounding LDN for so many years, has anybody ever reported to you any adverse effects that may be unusual? 

John Herr: I have like one patient and that she's come to like three of my seminars and her husband's a physician, but she just has a funny reaction to the naltrexone, and we've tried it.

We've tried ultra-low-dose and, and everything, but it really just upsets her, you know, upsets her stomach or her head. She just doesn't feel right on it. And I mean, she's tried it so many times because of it just, she's read so much about it, and her husband's been a practitioner. She's all one patient that's just tough to treat. But other than that, we get the typical side effects you see, which are the, uh, you know, the vivid dreams, the stomach upset, you know, maybe like a slight little headache. But typically we just work with those patients and tell them that you need to start the dose slowly and titrate up gradually.

So we've actually put together a, a, you know, like a titration kit. You know, for patients, cause many of the doctors don't realize that many doctors hear about low dose naltrexone and they just, you know, they think they can simply write a prescription for a four milligram or a 4.5 milligram. So we'll, we'll go in and educate those physicians that we have, this titration kit that we go up gradually once the patient gets to be on, you know, the dose that seems effective for he or she, well, they then compounded into that particular strength. So I think that's really helped a lot for patients to, you know, avoid the side effects and, uh, you know, get to their particular individualized dosage. 

Linda Elsegood: Well, I've been on LDN since 2003, and at that time over here anyway, we were given three milligrams for a month, and then you went on to 4.5, and that was it.

But the dropout rate was really high starting on three milligrams because we have found now that some people, you know, two milligrams is as high as they can go. So you can imagine starting on three it was a no go from the start, you know, it was far too high for them. But now, depending on what the condition is, It might be as low as 0.5 milligrams starting or 1.5 but doing it gradually and slowly. We find that not many people drop out of taking it. They seem to tolerate it really well and notice benefits quite quickly. 

John Herr: Oh, I agree with you, Linda. 100% on that. And then the other thing, like I always try to caution patients on it is that don't give up on it.

Because sometimes, even though maybe they didn't get any side effects, the patient thinks they're not getting the effects from the low dose naltrexone. And it's funny, we had two women, they were, you know, they were, you know, they were girlfriend, you know, and they both had a similar condition around the same age, and they went to the same physician, both started on the titration kit and, and the one woman that she got to 3.5 mg and she was just feeling wonderful. And the other lady kept going up and she got to like 4.5 and wasn't experiencing any, um, any relief from her. Uh, you know, what she was trying to treat,  but we just told her, you know, you gotta stick with it, stick with it. And you know, she was discouraged because the girlfriend was, you know, she was not even 30, you know, it's about 30 days. And she was feeling well, and she wasn't getting any benefit that she perceived. And lo and behold, it took four months.

And then she started to get the relief. So the other thing is like, even though you know you start low on the dose and titrate, which you know, we agree 100%, you also have to make sure that the patient realizes that sometimes you need it can take six months before the low dose naltrexone really start to show differences in their body.

And I always try to caution patients, you know, depending on the disease that they're trying to treat or the condition they're talking to trying to treat, I tell them, look, this didn't happen to you overnight. You know, this whole thing was probably going on your own, in your body for a long period of time.

So, you know, you're thinking traditional medicine, like, you know, you had a toothache and somebody gave you Tylenol with Codeine, and of course, it's going to work immediately. But with this, we're trying to upregulate your body and get your body to correct what's going on. So you do have to caution patients that, you know, give it time.

I usually recommend, give it a good six months before you say it's not doing anything for you.  

Linda Elsegood: well, we noticed, um, when we did a survey that some people said they had no symptom relief, but their disease stabilized. So I mean, that's a win in my book if you've managed to stop progression, but then between 15 and 18 months there was, um, 2% of people, whatever it was, didn't find symptom relief until they'd been taking it 15 to 18 months, which is a really long time. But they had stabilized before then. Um, and only 5% of people at that time or have any side effects at all. But the number of people who have stopped LDN because it probably wasn't working, or it was too expensive, but they stopped. And those people normally come back to me in about three, four weeks and say, in actual fact, the LDN was working for me. I'd forgotten that my bladder used to play up. I'd forgotten the pain that I had, “I’d forgotten …..”. You know, it wasn't until they'd stopped that they noticed that LDN in actual fact was working for them.

John Herr: yeah. I agree with that 100%. I've, you know, I've had like another woman, we would just counselling who hang out with her. Uh, you know, general, like almost like fibromyalgia pain and everything. Had ah It's totally a had gone away while she's been on the low dose naltrexone, but then all of a sudden she started to get pain in that.

And uh, you know, she's gotten real nervous. Like, Oh no, but I held the end isn't working for me anymore. I have to have this. This is how it is. This has been a miracle for me. What's going on? But then again, you know, functional, integrative medicine, when we talked to the patient with what's going on in your life, he starts to see that, Oh, you know, now you're going through, you know, you're right at the, into perimenopause, going into menopause, you have the pain.

Oh, it's right around my menstrual cycle. Okay, what's happening there? You're probably. Your estrogen level isn't where it used to be. And we know when women, particularly that when their estrogen and the estrodile goes down, they tend to get aches and pains. Hmm. So maybe it's a matter of, you know, adjusting your estrogen at this point.

It's not that the LDN stopped working, so you always have to look at your patients, and that's why the patient always has to go back and, uh, you know, consult with there, either their compounding pharmacist who can send them back to their physician or their physician. But it's not always just the, uh, you can't always blame it on the LDN.

Other things, you know, are happening in your life are happening with your body as, as we, as we age. So it's, uh, that's why I say it's a package. 

Linda Elsegood: I was asked a question this week, and a gentleman said,

it would appear on the forums that he's been reading that LDN doesn't work as well for men as it does for women. And was this a hormonal problem? Have you noticed it doesn't work as well for men as women, it seems, 

John Herr: you know, you're right. We have more of women that, uh, that are on low dose naltrexone, but I, I don't know why, but I thought like when we were talking pain, you know, certainly the, um, I think it works for both men and women equally well, but when we have other conditions such as fibromyalgia, that it makes you wonder, is it, is it also something going on with the hormones or, I think I have a great interest now in, in like Lyme disease and low dose naltrexone. And, and we know surely that Lyme disease, you know, uh, affects the pituitary, which is signalling in the body to produce hormones. And also, if you think about chronic pain, when people are in chronic pain, they're not producing their hormones the same.

So that's where I think we have to not just think that it's just a panacea and then we can just give low dose naltrexone, but we have to measure those patients hormone levels. And adjust them accordingly. So, and I think. You know, honestly, that may be what you, what you just elucidated is that you know, women will tend to, you know, go through menopause or their hormones will change at a much earlier age than men.

So, you know, for a woman, you know, we usually say around age 50 our hormones are trying to change. Men won't happen later on in life. So maybe it's not a difference, you know, in between males and females as much as, is it also something that has to do with the relationship between the hormonal changes.

And women getting them at an earlier age than then we're associating that more women do better than men, but reality maybe. Cause it's that man still has this testosterone in his body. 

Linda Elsegood: Oh, okay. It does. It does. And we're now out of time, but I have to have you back another day. We could have carried on talking there forever.

Could you tell people how they can contact you? 

John Herr: Well, certainly, uh, you can call us at our pharmacy directly, which is a 201 447 2020, and then you can always find us on the internet. Our, uh, pharmacy is https://tccompound.com/ and from there you can even email the pharmacist a question or, you know, call us directly.

And we just love talking to patients, and that's what we do. And we, and we do hold seminars, usually monthly on low dose naltrexone, which we will post on Facebook and on our website. And, you know, make people aware that if they're, you know, in the area that they can come in and see it. 

Linda Elsegood: Wow. Amazing. Well, thank you very much for all your hard work and for promoting LDN to your patients all these years.

Um, absolutely fantastic. And for educating people, so thank you very much. 

John Herr: Oh, thank you, Linda. I love talking with you and, uh, looking forward to doing it again. 

Linda Elsegood: Thank you.

At the town, a country compounding pharmacy in Ringwood, New Jersey, owner, pharmacist, John Herr and his team are passionate about low dose naltrexone. They have compounded LDN for over 15 years. And they're committed to compounding high-quality medications and serving as an educational resource for patients and practitioners alike.

Visit https://tccompound.com/

any questions or comments you may have. Please email me contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciate your company. Until next time, stay safe and keep well.

Martha - US: Fibromyalgia (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Martha is from Hawaii in the United States, and takes low dose naltrexone (LDN) for fibromyalgia. Her first symptoms were a series of mysterious illnesses, stomach problems, fatigue, multiple chemical sensitivities, that in  2010 was diagnosed as fibromyalgia.

She was pretty much bedridden, felt feverish without a fever, fatigued, and in pain. Her quality of life was a 4, or 5 on a good day.

She heard about LDN in 2006 from a friend who was working with Dr Jackie McCandless, who was from the little community where she lived on the Big Island. She recently passed away but she had used it autism and then started the study in Africa using it for children with HIV.

She started LDN two years ago, and in three weeks her pain was decreased, she slept better, her depression lifted, and now she rates the quality of her life at a 10.

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

Kat - US: Fibromyalgia, Interstitial Cystitis, RA, Pain (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Kat from the United States shares her story of how low dose naltrexone (LDN) has helped her with fibromyalgia and other chronic pain conditions, including interstitial cystitis, arthritis, and a displaced SI joint.

Kat first developed fibromyalgia, arthritis, and interstitial cystitis in the years following an automobile accident in February of 2004. Her symptoms include extreme fatigue, constant headaches, different odd pains that would come at random, as well as bladder and gastrointestinal problems. She learned about Low Dose Naltrexone (LDN) while searching for treatments for her fibromyalgia. She brought the information packet about LDN to her doctors, who prescribed it for her as it seemed like it was unlikely to do any harm, and it could help her condition.

When she began taking LDN, any side effects were very very slight compared to the reactions she had to other medications her doctors had prescribed. She had a little stomach disturbance and some strange dreams, but those side effects were very short-lived. 

LDN has given Kat decent sleep, a lot more energy now that she’s off narcotics, and she has a clearer mind. Her pain is very much reduced and much more manageable than before. She knows that the LDN provides significant relief because about a month ago, she forgot to put the LDN in her pill organizer, and within three days without LDN, she felt terrible. And not only is the LDN helping with her various pains, but she’s also been sick much less often.

Kat started at 1.5 mg per night, and gradually increased her dosage to 4.5 mg each night. However, she has found that her best dosage is 4.5 mg morning and evening. Kat notes that while she felt a difference on LDN fairly quickly, some people take longer, even months to feel better, so it’s best to be patient when you start taking Low Dose Naltrexone (LDN).

This has been a summary of Kat’s interview. For the whole story, please listen to our recording at the link provided above.