LDN Video Interviews and Presentations

Nutrichem's LDN Book Event with Dr Adam Livingston (Low dose naltrexone) from LDN Research Trust on Vimeo.

Dr. Adam Livingston, PharmD, BSc., RPh.

Low-dose Naltrexone (LDN) Prescription Basics

Dr. Adam Livingston packs a huge amount of information into a 29 minute presentation on how Low Dose Naltrexone works to control inflammation and many autoimmune conditions. As a compounding pharmacist, he know the dangers of many of the drugs on the market. LDN does not have those dangerous side effects or addictive problems. He explains clearly how LDN works in our system and covers the benefits of combining LDN and .... You will learn much during this interesting presentation.

Review by Ken Bruce

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Adam is a compounding pharmacist that works extensively with bio-identical hormones, thyroid compounds, low-dose naltrexone, and customized pain creams. He is also a clinical pharmacist with NutriChem Biomedical Clinic.

As a clinical pharmacist focusing on medication deprescribing, Adam believes that prescription drugs can be a useful tool in a healthcare provider’s toolbox. However, for many chronic conditions, they simply aren’t that effective and can be quite unsafe and difficult to discontinue. Adam helps to guide appropriate patients away from harmful drugs such as proton pump inhibitors, benzodiazepines, opioids, and sleeping pills through NutriChem’s Deprescribing Program.
 

Dr Mark Shuhkman – Psychatric Disorders (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Pharmacist Kim Hansen, LDN Radio Show 30 Oct 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is pharmacist Kim Hansen. She's from the Town and Country Compounding Pharmacy in New Jersey. Thank you for joining us today, Kim. 

Pharmacist Kim Hansen: Oh, it's my pleasure. Thank you for having me. 

Linda Elsegood: So when did you first decide you wanted to become a pharmacist? Was it something you'd always wanted to do?

Pharmacist Kim Hansen: Absolutely.  I was working in a small independent pharmacy, a traditional retail pharmacy when I was in high school. And on occasion the pharmacist there would say, Hey, Kim, go mix these two creams. Or Hey Kim, go mix these two liquids. I was hooked. I knew that's exactly what I wanted to do. And from that point on I headed for pharmacy school and that was my path. I knew it immediately. That's what I wanted to do.  

Linda Elsegood: So where did you study?

Pharmacist Kim Hansen: Rutgers college of pharmacy in New Jersey. 

Linda Elsegood: So you haven't moved far? 

Pharmacist Kim Hansen: I've travelled far, but I haven't moved far. 

Linda Elsegood: So once you started compounding,  what were the main medications you were doing at that time?

Pharmacist Kim Hansen: Back in the day, it was usually combining a couple of creams together. That was before we had a lot of the manufactured products that we have now. A lot of times compounds start off that way, then they end up being manufactured items later. I used to have to make a topical minoxidil solution. I used to have to make up progesterone capsules way back in the day. Suppositories for progesterone. This was 20 some years ago. So it was before I knew of LDN.  I was doing compounding before that. Mostly progesterone and topical dermatological items that were not commercially available.

Linda Elsegood: How did you hear about LDN?

Pharmacist Kim Hansen: I think it was at a compounding seminar is the first time I'd ever heard of it. It was being discussed for autoimmune issues. I started seeing prescriptions for it about seven or eight years ago. Usually, it was just capsules, usually, it was the three different dose levels that we know differently now. It started gaining traction more for me within the last three years. But I did see it back seven or eight years ago.

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

Pharmacist Kim Hansen: Right now we do capsules and oral suspensions. Most often it's the capsules that patients are happy with. We also do a cream for patients with autism, and occasionally it's added to pain gels as well.

Linda Elsegood: What is the filler of choice for people?

Pharmacist Kim Hansen: Generally speaking, patients are happy with acidophilus. I do have patients that don't want that. And then we usually use micro crystal and cellulose, but if they have a specific filler question or need, we're happy to accommodate that.

Linda Elsegood: And what strengths do you do now in the capsules? 

Pharmacist Kim Hansen: I think our lowest is a hundred microgram capsule because that patient prefers that to be in a capsule form versus the liquid form, anywhere up to 10 milligrams and anything in between. 

Linda Elsegood: And the patient population, what would you say the top conditions that LDN is treated for from your pharmacy? 

Pharmacist Kim Hansen: Hashimoto's, pain and depression. 

Linda Elsegood: So talk us through those three, Kim, the experience that you've seen from those patients. 

Pharmacist Kim Hansen: I'll start with Hashimoto's. We do notice patients are getting to a dose that is appropriate for them and are feeling better. They also require less thyroid hormone.

If someone is on thyroid hormone and start LDN, that should probably be monitored more closely than before you started the LDN, because you'll find that as the inflammation reduces, the thyroid level changes and you may need to change your dose. Usually, it's a reduction in the thyroid dose when it comes to the pain medication using it for that.

I have patients who have had their lives changed. They were in a tremendous amount of pain before, and they were put on other pain pills. Any medications usually were just adding to their pill burden, but not really giving them relief or quality of life that they were looking for. I have patients who weren't able to do any of their activities of daily life and now are doing things that they haven't done in 20 years. To me, that makes things tremendously rewarding to know we can be a part of that success story.  I should also mention when discussing pain with patients, I have patients who have become tolerant to opioids. So we also find that LDN is a way to help reduce the opioid burden and help people get off of those and still maintain their pain relief. I view those two things together like pain and sometimes patients are looking to get off the opioids for relief of their pain. So it actually does both. 

The other I  touched on was depression. I have patients who are using an increasing schedule of LDN and also weaning off usually their SSRI or antidepressant drug. And they're finding if they wean very slowly off the antidepressant and titrate upwards very slowly with the LDN, they're able to get off of the antidepressant and still maintain a non-depressed state. They're happy to be off the medication and be able to use LDN, which we know works in a different way and usually has a better overall effect than the actual medication worked for them. 

Linda Elsegood: Ultra-low-dose naltrexone helps combat the opioid crisis. Could you talk us through how, when people come to your pharmacy, whether it's been addicted to prescription drugs for many years, how LDN plays a part in getting them off the opioids, but still controlling the pain? 

Pharmacist Kim Hansen: I won't get into a specific schedule because it is so dependent on each patient. I will say that we usually start patients on the microdose or the low dose, ultra-low-dose naltrexone, usually in a suspension form, and they'll be on whatever their dose is usually for about a month. And then after they're stabilized with that, the pain management expert will slowly increase the dose of their ultra-low-dose naltrexone and also decrease their opioid dose usually by about 10%. Again I don't want to give schedules and hard limits because every patient is so different in their ability to reduce. It's very varied as far as that goes, but I have many patients who have been on rather strong doses of opioids that have been on that for years, have been able to slowly titrate up on the naltrexone and slowly wean down on the opioid and have had success and be pain-free and opioid-free. That's huge to have that happen. We had one hospice nurse  (certainly hospice nurses are very well versed in pain and pain origins and pain protocols) who herself had her own pain issue. We walked her through this process of slowly starting the ultra-low-dose naltrexone and scaling that up over time and reducing the dose of the opioid over time. Now she’s opioid-free and as pain-free. And it definitely helped her increase her quality of life and also to be able to do the things that she couldn't do before.

So that's a huge story. I mean, someone who is on opioids, to be opioid-free is huge. 

Linda Elsegood: Definitely. For people listening out there who are in a lot of pain, because I'm told nearly daily that there is somebody who is in terrible pain, but they were already on very high doses of an opioid that doesn't seem to be working, you know?  Of course, the problem with opioids is your body gets used to them, and you have to keep increasing the dose to get the effects you were having. So anybody who has chronic pain for whatever reason, or fibromyalgia or having an autoimmune disease that has a pain component to it, how would they go about.

finding a doctor who would prescribe LDN and one that would understand about the ultra-low dose, who would be able to help them transition from the opioids to the ultra-low dose?

Pharmacist Kim Hansen: Two awesome ways to find that out. One is LDN research trust. There are lists of physicians and practitioners on there that are knowledgeable in what we're talking about here. You can also ask your local compounding pharmacist because we are a treasure trove to know who is actually prescribing it in order to be able to send patients.

It works both ways. The prescriber sends the order to us as they know that we'll do a quality compounded product. I can then refer patients back to other practitioners because I know that they're knowledgeable in this and then they've attended our seminars and that we can work together with them in order to get the best outcome for the patients. So it works both ways.  

Linda Elsegood: I was quite surprised when Dr Sam was telling me how quick the process is because I thought it would be a long, slow process. But he was talking just a few weeks, which was, wow. People that had been on opioids for many years, to, find relief like that, it just amazes me that something.so small and so simple seems like tickling the pain with a feather in those ultra-low doses rather than using a really big mallet, which is the opioids, for it to work. It just is mind-blowing, isn't it? And of course, the price, LDN is not expensive, and many people have to pay for it themselves. And it's not a price out of the reach of most people. We still have people who do not have money, they're sick, they're not able to work. And if it's a choice between food or LDN, that's a problem. But we're looking at around $30 a month, depending on where you have it compounded. It's an affordable drug, isn't it? 

Pharmacist Kim Hansen: Absolutely. We try to maintain that because we do understand that patients are in pain and you don't want them to have to choose between therapy and their food or their bills or whatever that is. We want patients to get the relief that they need.

We've kept what we're doing affordable so that we can make sure that it's available to as many patients as possible. Usually, you'll find whatever pharmacy you use, if you're going to be starting a titration and working your way upwards, usually that pharmacy will put together a kit.

So you've got maybe two different doses of a capsule in there so that you can gradually increase to the dose that you are working towards. And then once you arrive at the dose that's working for you, then that pharmacy can make that dose into one pill so that it becomes more economical if that makes sense.

Linda Elsegood: Yeah. I had a lady email me this morning, I think she had Sjogren's syndrome, and she was doing really well. She'd worked up to three milligrams. It did really well. She's now on 4.5 and she's not sleeping,  not feeling as well. And I was trying to explain that with LDN it's not, the higher the dose, the better the benefit. It's what suits you best. And if at three milligrams, she felt really good, why would she need to go to 4.5? It's not working. It's making her feel ill, so she should go back to where she was in a good place. There is so much misinformation out there that people seem to think that this magic 4.5 is the goal that everybody should be on. Have you noticed that with your patients? 

Pharmacist Kim Hansen: Absolutely. I've had patients tell me the same story that you're describing here. Everybody has in their mind that more is better and that the goal is to get to a certain number because that's where the best results are.I am always cautious about making sure I explain to patients, hey, we're dispensing a kit to you. This initial kit is usually good for 49 days or seven weeks, but if at some point halfway through this kit, let one of us know that you're experiencing relief or you're not experiencing anything at all. If you are at a dose where it seems to be optimized, I don't want you to have to continue to go up because the goal isn't to make it more, the goal is to get relief, and if you're getting relief at a lower dose, then stay there because it's very easy to overshoot that and you'll lose the benefit. So, in this case, absolutely more is not better.

Linda Elsegood: Do you have any stories of people who are on a very low dose that have stuck to that's the right dose for them? 

Pharmacist Kim Hansen: Yes, a patient with diabetic neuropathy who was using the kit and they had gotten to a higher dose, and they weren't feeling so good on that. He backed off the dose he had gotten to, I think it was three milligrams. He went up to the next step, said I don't feel as good as I did on the dose before that. Then we know where you should be. And we had him go back to the dose he had come from,  he's much happier there, and he's able to function.

Whereas he was in pain and uncomfortable before. 

Linda Elsegood: What I was getting at there was, I know quite a few people that are on 1.5 or two, which I mean is low for low dose even, isn't it? People tend to think anything under three is no good, but even that is too high for some people. Not everybody gets there. As you were saying with the man with his diabetic neuropathy, you don't have to panic. Or thinking that you know you're not taking the right dose. I know some people think that it's not a therapeutic dose if it's under three, but that is a myth, isn't it? 

Pharmacist Kim Hansen: I would agree with that. Every patient is different and how they respond to it. So even if you have identical twins. A member of your trust that lectured about this, their one set of neighbours. They completely matched as people go, and the same age, same condition, same everything else. If you go down the line and, person A got results more quickly than person B. So person B was discouraged thinking that they weren't going to find the same relief that person A got.  Having to start over with patient B, and go a little bit more slowly, titration was the key for her. So whereas a lot of times you'll see dosage regimens that, every week we're going to increase by whatever the increment is. Sometimes patients will need to go even more slowly than that and maybe increasing every two weeks or maybe every month, whatever that takes. And again, not everyone is the same. So if you get to a dose rate, like, I didn't feel anything the whole way. Sometimes you can, wash it out, start over, and go more slowly and find results there. It's just so dependent on each patient and just because you haven't gotten the answer that you want and you've gone up to 4.5 sometimes the answer isn't going up a higher dose. Maybe it's starting over and going up at a slower pace.  

Linda Elsegood: Some people feel quite discouraged starting again, but by doing it very, very low and moving up very, very slowly the fallout rate isn't as high, and the success rate goes up. You know, 20% of people didn't have the relief they were looking for, but that 20% has reduced, hasn't it? We are getting a better success rate now, understanding there are people who do need to look at LDN differently. 

Pharmacist Kim Hansen: Completely agree. Back in the 80s when we were doing 1.5 and three and 4.5, that was such a rigid structure that you probably lost a lot of patients who didn't have success and or probably had side effects that they weren't pleased with. Changing our thinking with the results we have now, knowing that going more slowly and doing slower increases or lower increases is actually beneficial overall. Yes. Patients who have tried with not finding their success before; it doesn't mean you won't have success trying it in a different fashion.

Linda Elsegood: Exactly. And then there's the other school of thought where you have to take it at night. You know, it's not gonna work for you if you take it in the morning. We now know that's not true. Is that what your experience has been? 

Kim Hansen: I would say that's true.I think yes, at the beginning of the push was, Oh, you have to do it at night because your body does repair at night but you know, here's no reason why you can't do that during the day. And there are also reasons why you would want to do something twice a day and do split dosing. Some disease states and some patients do better when they're split dose.I find that is the case with using it for the antidepressant purposes, sometimes a split dose is better for that patient versus the whole dose at one time of day regardless of morning or evening. Again, individualized treatment, and you have to listen to the patient and listen to what they're saying to you so that you can work on a treatment plan together. 

Linda Elsegood: And you were saying about the topical cream for children with autism. Do you have many children with autism? 

Pharmacist Kim Hansen: We're in New Jersey, unfortunately, we have one of the highest percentages of autism in children. So yes, I do see it, not as often as I once did, but I do see it, and usually, they're not amenable to swallowing pills. So usually the parent is putting on cream at night when they go to sleep, and they don't even know what's being applied.

Even if they take a capsule and they put it into a smoothie or whatnot, kids are wise to that because they're probably on a whole bunch of stuff and they're eyeing up every meal that comes to them, making sure nothing's been hit, so they're pretty wise to it. You'll find that the cream is helpful in those cases and yes, it does work.

Linda Elsegood: And have you come across children with juvenile arthritis or pediatric Crohn’s who are taking LDN? 

Pharmacist Kim Hansen: I have heard of it, but not in my experience here. 

Linda Elsegood: And no children or adults with asthma allergies. 

Pharmacist Kim Hansen:  I had heard of it of course but no experience of that directly here.

Linda Elsegood:  It's amazing, isn't it? Initially, going back,15 and a half years when I started the trust, it was mainly people with MS. Then it went to Crohn's, then fibromyalgia, it was just exploding. But we didn't know too much at that point what it did for chronic pain that wasn't autoimmune. We knew it helped with cancers. We didn't know about all the mental health issues and of course, it's used in fertility clinics as well, and for women's health, for painful periods.  There's a name for that, PCOS, polycystic ovaries. Dr Phil Boyle uses it in his clinic to help women get pregnant. They take it during pregnancy, during breastfeeding, have really happy, contented babies, he says, and they have less chance of needing IV antibiotics for chest infections and things, which is apparently quite common in babies when they're firstborn. And he said, as a rule of thumb those babies are far more content when they come back for checkups,  than babies that haven't been exposed to LDN, which I think is quite interesting, isn't it? 

Pharmacist Kim Hansen: I agree completely with that. When I have a patient that's here, and I'm showing them the list of disease states or conditions that this is helpful for. And of course, their question is always, how could one thing be good for all of these? And I love that question because that means that you're thinking, okay. And you're sceptical, and that's fine, but then when you explain that a lot of these systems are all tied together and how pain and depression are linked by the same pathways as is your immune system, as are a lot of different things, inflammation, all tied together.

When you can explain and have them understand how the different systems in your body interplay, that's when the light bulb goes off because traditionally here in the United States you go to the foot doctor for your foot problem, you go to the GI doctor for your stomach problem, you go to the neurologist for the neurology problem. And really they're not all communicating.  When you look at the thread of symptoms that a patient is dealing with it's like you're missing the overall theme of inflammation or whatever that is. And LDN is helpful for that. So, therefore, it's helpful for all of those conditions. It's not because things are tied together. That's why it's helping you. I hope that made sense.

Linda Elsegood: It does. Now there are other things you can do to help inflammation as well as taking LDN. What do you suggest patients do?

Pharmacist Kim Hansen: For inflammation? Well, it's very important. I always remind patients that their diet is everything. If you look at the glycaemic index, it's scaled anywhere between zero and a hundred and sugar is at the top as being a hundred you would like to keep your dietary choices below a 50 because they are less likely to cause an insulin spike or have a glycaemic effect on your sugar. So if you keep your food items below a 50 more often than above 50 you're reducing the fire in your system. So the whole point of taking naltrexone is to reduce the fire in your body, as explained before.  Everything is connected. You can't expect the pill to do all of the work either. Reducing inflammation that you're adding to the system is also part of it.

You can't walk around eating the standard American diet of high carb and high sugar and poor nutritional value and not have inflammation if you're going to continue to feed the inflammation fire, of course, you're asking the LDN or the naltrexone to help with your symptoms.

Sometimes just reducing a lot of the inflammation that way is helpful and it certainly helps to augment what the LDN is doing. I also find that high-quality C-- products, the full spectrum ones are also helpful at reducing inflammation. Using the LDN in combination with the C--, you get the beneficial additive effects. I have patients who have needed to use that combination, and they've gotten their quality of life back.  

Linda Elsegood: it's funny what you were saying about fruits. My mother was in the hospital, and she was a type two diabetic, but her kidneys were in a very poor state, and she had to have insulin. She had quite a bit of insulin three or four times a day. When she was in the hospital, she asked for a banana. And they bought her a banana. And she said, Oh no, I, I don't like eating bananas a little green and underripe. I like them when the skin is going brown, and it's mottled and inside is all nice and squidgy. And they said, no, you can't have one like that because it's going to affect your insulin because it's very, very high in sugar when it's that ripe. That is correct. The nurse was trying to say very nicely, but it is higher in sugar, and I think my mother was thinking, a banana is a banana. The nurse was trying to say, you can have a banana but you mustn't have it when it's overripe.  Because it's too high in sugar. 

Pharmacist Kim Hansen: When I tried to talk to patients about that, of course, nobody ever wants to hear they have to make changes and give up their banana or wherever it is they're eating. Everybody likes what they eat, but when you explain it and say, Hey, these are inflammatory, what you're doing is adding to your inflammatory burden.  I'm not saying completely avoid the bananas, but if you know that you had had a banana that day cause you had to have it, maybe look at the bottom of the list to make sure that maybe we're balancing that out and making a choice that has less of a glycemic load than maybe the banana or something else. That's not to say that you should never have banana again, but maybe making choices to balance out your day versus choosing everything above 50 if you reduce the amount. Because they are both 50 and take below 50 reducing the amount of inflammation in your system, which is good for all sorts of things, Alzheimer's, heart disease, cancer risk, all of these things driven by inflammation. And why would you not want to reduce those risks? 

Linda Elsegood:  It's altering the way you look at food. Instead of being a diet which people don't stick to. It has to be a lifestyle change, doesn't it?  So it becomes a habit. You know you have good habits instead of bad habits. 

Pharmacist Kim Hansen: Agreed. If you call it a diet, people assume that is a restriction on their lifestyle. If it is health maintenance and it's on a different connotation or inflammation reduction. If you look at it that way, rather than, oh, I'm on a diet. Well, you know what? I'm trying to reduce the inflammation in my body. You'll find that you'll get fewer headaches if you get rid of sugar and carbs, which of course includes bread. There are healthier slices of bread that you can eat, more of the whole grains here.  I was amazed by this too. Everybody's under the misconception that, Oh well I, you know, I'll avoid the white bread cause I know that's not good for me and I'll just eat the wheat bread. It's no better. It really isn't any better. It's like a point or two different on this scale. What you need to do is either do it like a whole grain bread or switch to something that's grain-free, like Ezekiel bread, which has a low-glycemic index. If you're trying to make that effort, there are smarter choices that you can make.

So you don't feel like you're on a diet where you're restricted and being punished. There are ways to explain things.. You just have to be careful about continuing to pile inflammatory product after inflammatory product. It leads to all of the other health problems that I mentioned before.

We're all leading stressful lives, and probably you're not exercising as you should, and not resting as you should, and you're just adding more and more burden to your system to be able to detoxify. Helping your body do its best is certainly a better management tool all around.

Linda Elsegood: Well we've run out of time Kim, can you believe that's 30 minutes gone?

Pharmacist Kim Hansen:  I can't believe you wanted to listen to me. Wow. I'm so happy. 

Linda Elsegood:  Awesome. Thank you so much for having joined us. I really appreciate it. 

Pharmacist Kim Hansen: I'm so grateful to have been asked, and it's my pleasure. If you have any questions, certainly please give me a call and I'm happy to share anything I know. 

Linda Elsegood: Thank you.

At Town and Country Compounding Pharmacy in Ridgewood, New Jersey, owner, pharmacist, John 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/ or call (201) 447-2020 with any questions or comments you may have. Please email me at ontact@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 John Walczyk from Johnson Compounding and Wellness (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Laurie - 7th August (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Laurie is from the United States, and uses LDN for complex regional pain syndrome (CRPS). In 2005 she suffered a stress fracture in one foot that healed slowly, during which time she was in a cast and immobilized. Toward the end of the time for the cast she started feeling burning in her foot, like fireworks going off. When the cast came off her foot was bright red, shiny, and hot to touch, and her doctor recognized her symptoms as CRPS. Drugs normally prescribed were ones she did not want to take because of side effects. She researched and found a study on CRPS at Stanford using LDN, and took information on LDN to her doctor, who researched it and was eager to prescribe it. She ramped to her current dose of LDN 4.5 mg daily, but does note short-term side effects as the dose increased, such as difficulty sleeping, or a headache.

Laurie’s pain stopped after about 3 weeks on LDN; after 4 weeks on LDN the swelling and redness were decreased, and at 2 months the color was normal and there was no swelling. Before, she couldn’t tolerate wearing anything on her foot; and now wears normal shoes and has hiked and traveled extensively, without symptoms. She did have to give up running because of arthritis and several surgeries.

Laurie relates that while the CRPS developed in the foot she broke, as common with CRPS, the other foot became involved. Similarly, one time she hurt an elbow nerve, and the CRPS symptoms jumped to her elbow.

Her first surgery was a joint replacement in her foot. Because she might have needed narcotics for post-operative pain, her doctor took her off LDN a week before surgery. In that week her CRPS flared so badly that her feet and elbow were untouchable. Post-op, when she restarted LDN, it took a month of gradual improvements before she got full effect. During that time the redness and swelling from CRPS had increased, in response to the surgery.

She learned that for subsequent surgeries, if narcotics might be needed, to stop LDN only 2 to 3 days before surgery; however the trade-off seems to be less effectiveness from the narcotics. The solution that works for her is to take Tylenol or ibuprofen before surgery; and ibuprofen normally is all she needs after surgery. In total she has had 5 or 6 surgeries, and this routine has been successful.

Laurie tried to follow an autoimmune diet, but found it pretty difficult to be true to it. She eats a lot of vegetables, and stays away from foods known as being very inflammatory – meat, dairy, sugar. She works out at a gym 5 days a week, and swims.

Laurie is so grateful for the valuable information from the LDN Research Trust (LDNRT), and became a volunteer who has contributed greatly to the Trust. Through the website she has been able to not only find information, but to connect with compounding pharmacies truly knowledgeable about LDN and options for it. She appreciates that with LDN there is hope other than some of the drugs that have difficult side effects.

Summary of Laurie’s interview, please listen to the video for the full story.

Keywords: LDN, low dose naltrexone, complex regional pain syndrome, CRPS, LDN Research Trust, LDNRT, pain, opioids, autoimmune

The Opioid Crisis and how you can help! (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Norman Marcus, MD - 10th October 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today my guest is Dr Norman Marcus, who is a pain specialist. He has a fantastic background. Thank you for joining us today, Dr Marcus.

Norman Marcus, MD: Thank you for inviting me. 

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

Norman Marcus, MD: After attending medical school, I did an internship. In the old days, it was a rotating internship where I went through the various aspects of what a doctor might do. I decided to go on to do a residency in psychiatry. And when I was doing that, I, became very interested in mind, body interaction and following my residency, I did a fellowship in psychosomatic medicine.

While I was doing my fellowship, I was asked by the department of neurology at the headache unit where I was, at Montefiore hospital (they had the first headache unit in the world). I was asked to join them. They were treating patients with headaches in the department of neurology.and at that time I was interested in biofeedback because of the whole issue of mind, body interaction. So I started to evaluate patients with headaches and treat them with medication as well as the biofeedback. And at that time I was elected president of the New York State biofeedback society.

Following a few years doing that, I was asked by the department of anesthesiology to start the first pain centre in New York City in the department of anesthesiology. And I did that with a colleague, an anesthesiologist. And we together started and then ran together the pain centre at Montefiore hospital, which I did for approximately seven years.We had a multidisciplinary program where we're teaching patients how to manage their pain using nerve blocks at times and medication and psychological interventions and relaxation training. And then from there, I was asked by the department of medicine at Lenox Hill hospital to start an inpatient pain treatment program, which I did. That ran that for about 20 years. Then while I was there,  I was asked by the princess Margaret hospital  in Windsor to start a pain centre. And I started to travel to the UK, one week a month for three years. I have an appointment in Indian NHS, and I ran the pain centre there.

And while there, we got some significant publicity and we were on the BBC, BBC two, and we were on numerous television and radio programs. And  we were able to help patients who had persistent pain. And by that time, I was starting to focus on soft tissue.I was introduced to Hans Kraus, who was President Kennedy's physician for his back and France Kraus  had a.

technique and the conceptual model on assessing soft tissue pain, muscle pain, and the president at that time was being treated by another physician, Janet Trevell, and she was injecting Kennedy five or six times a day into his muscles.

When Hans Kraus came in he stopped the injections completely and said that the problem wasn't all the muscles that needed to be injected, but rather muscles that were very deconditioned as well as maybe some muscles that needed injections.But think of all muscles that are tender as a target for injection, like dry needling or something like that, didn't make any sense. And he had a conceptual model where there were four reasons for muscle pain. Tension is the number one, then a deficiency or otherwise known as weakness and or stiffness of key postural muscles. The third was the spasm, which is involuntary contraction of the muscle that you can't straighten up and it's very painful. And the fourth was altered muscle tissue called trigger points in most jargon when we're talking about these tender spots. But actually, Dr Krause's concept was more than trigger points cause he recognized that the area of the muscle.

that was causing pain, wasn't really in the muscle in the tissue, but rather the ends of the muscle where the muscle attaches to the tendon and the tendon attached to the bone is the most tender spot. It connected to that muscle, and that one needs to be identified. Therefore, the specific muscle that's finding a spot on your body isn't sufficient because the pain isn't.

generated from that spot. It's rather generated from the ends of the muscles, so you must know which muscle you're in. So he made that distinction. And his results when he would inject the ends of a muscle were dramatic insofar as he wouldn't have to re-inject the muscle. So the standard of care now in terms of people who were doing, let's say, dry needling or trigger point injections is to repeat the injections over and over again, quite often into the same muscle whereas Dr. Krause would be able to eliminate the pain by finding the muscle specifically and then going to the ends of the muscle and doing his protocol, which involved not only injections.

And what he used a lighter cane, just for comfort. He, it was the actual needle in the tissue that was doing the treatment. And following that, there's a three-day protocol, using neuromuscular electrical stimulation and exercises that were developed at Columbia University school of medicine in the late fifties, early sixties.

And  exercises were developed by studying 3,700 patients for four and a half years. And then he came up with an exercise program that he then administered to 300,000 people at the YMCA and studied twelve thousand of those patients in town who had an 80% success rate in diminishing or eliminating back pain.

And in patients who had had surgery for the back and had pain afterwards, that success rate was even higher. It was 82%. So those exercises then became the standard exercise at the YMCA called the Wise Ways to a healthy back. And they were given for many years until someone decided to change it. And without going into what actually happened, this essentially killed the whole awareness of these exercises, but we use them as a routine, part of the work that I'm doing. 

So when patients come in who have soft tissue pain, we diagnose one of these four mechanisms such as tension. John Sarno would be speaking about tension myositis.And now we know that there are mechanisms where if you are tense, it alters the neurons and your spinal cord  and makes them more sensitive to input sensitization. So we also test them for weakness or stiffness using the test that Hans Cross developed with his colleagues on your Weber called the Krauss Weber test. It's a very simple test, takes about two minutes  to implement. It gives you a lot of information.  They were palpating for tenderness in muscles to identify the muscle. And what happened was that I discovered  it wasn't specific enough that many people have tender spots throughout their body that don't necessarily reflect where the pain originates.

So you can have a tender point, and it may not be actually coming from there. It may be referred from another muscle, and it's almost impossible to know if you're pressing on a referral pattern or the actual pattern itself. I mean the actual muscle itself causing it, or where is this just a muscle that is receiving information from another muscle and all of this.

A complication of where the pain originates was explained to me by Sigfried Mensa. So I really began to understand what was going on on a cellular level, and on a biochemical level, through the work of professor Mincey and together, ultimately, we wrote a chapter together in a Harvard textbook. Carol Warfield is one of the editors of the textbook, and it came out a couple of years ago on the pathophysiology of muscle pain. In that period of time  I was elected president to the American Academy of Pain Medicine and served on multiple committees and became interested in how diverse the various treatments are for the pains that people complain of. 

I started the outcomes—movement in pain. To try to come up with some assessment where we could measure if a certain treatment was superior to another treatment, and that's been a work in progress for the whole pain community. It was something that I began  and we did our best to finish it, but it's still happening. And now it's a major goal and mission of NIH to come up with parameters to measure what is successful, outcomes and pain. And I've written a couple of chapters in neurosurgical textbooks on that.  Montefiore went to Lenox Hill hospital and then I left Lenox Hill hospital and went to NYU and became the director of clinical muscle pain there in the department of anesthesiology and taught students who were fellows in the Pain fellowship department of anesthesiology for ten years or so. In the last two years, I moved to Cornell where I have an appointment in neurological surgery and in anesthesiology, I'm the director of clinical muscle pain research, and I'm working together withmy colleagues and anaesthesia and neurosurgery to see how we can better define how soft tissue is an important element in patients who are coming in with a run of the mill back pain. And also those patients who are found to have a surgical indication for their back pain, but continue to have pain, despite a spot, an apparently successful surgical intervention.Why are they still in pain? And quite often it's because there's a soft tissue that was not identified as a source of pain. 

I was beginning  to tell you about the problems in identifying a specific muscle by pressing on it.  I've discovered that I could stimulate the muscles with a tiny amount of electricity, and I could much more accurately identify which muscle is the source of pain.I'm now working on a next-generation device with the Cornell school of engineering, the Meineke school of biomedical engineering, to develop an instrument where we can, have a software program that will show the clinician what are the various muscles in the body, in a region of which the patient complains of pain.

For example, if you have shoulder pain to 16 muscles that cause pain in your shoulder, how do you know which muscle is causing the pain? You don't, by pressing, you don't really know, but when we stimulate it with a tiny amount of electricity, and that particular muscle or a couple of muscles are painful, and the rest are not. Then we assume that those muscles are sensitized and are indeed the pain generator. And when we treat those muscles, generally we can eliminate the pain in the region of the body. For example, in that case, it would be the shoulder.  I had a patient who was coming to see me for knee pain, and this was about ten years ago or so, and he had 14 knee surgeries with the same orthopaedic surgeon, and every time she had  knee surgery, she continued to have pain afterwards, and she was given more.

opioid. In this case, it was oxycodone, and when finally she was receiving something like 3000 milligrams a day of oxycodone, a huge dose. 

She was coming in periodically for pain medication and she was functioning.although it was a huge dose and I wasn't entirely happy with it. But she was functioning and she had this extraordinary amount of medication and she would come in periodically, every month or so, and I'd renew the medication and then she didn't show up on one day. And I called her home, and her husband told me that she was hospitalized and said, well, what happened? Well, she had taken her medication and then she had taken an antianxiety drug, and she fell asleep in the bathtub and almost drowned and was admitted to the psychiatric unit of a hospital with supposedly a suicide attempt.

So I said, Oh my God, I was there and it was terrible. She was finally discharged, but spent about ten days there and then called me up, made an appointment, and she came in, and I said, how are you doing? She said I'm actually doing okay. I said, well, how's your knee pain?  She said I don't have any knee pain. Really? I said, well, you know, how much medication are you taking? She says I'm not taking any medication. Wow. You were 3000 milligrams a day.  So I said, well, what happened? So she said, well, there was this doctor who was there on this staff, his name is Hugo Franco. And he came in and  gave me some medication, actually gave me some naltrexone, and that helped me get off the medication so that I was able to go down to zero in 10 days.

So I said, Oh, would she have a lot of withdrawal? She said no, I had no withdrawal. So this is impossible. I mean, it's like one of these events saying, Oh my God, how could this possibly be? So I said, I'm going to call up Hugo Franco, and I did, which subsequently we became friends, and then he explained to me that he used naltrexone in an ultra-low dose to detox patients.

So much against what you know, was on the internet, for example, or, you know, never give naltrexone when somebody was on opioids, it was great because he explained to me that it actually made the opioids stronger if you gave it in tiny, tiny doses so that with a more potent effect, you could then start to decrease it because you were getting the same effect with lower doses and you could just keep on going down, which he did.

This was amazing for me. So I said, well, perhaps, this could be useful with other patients. So I started to use it with patients where I wanted to facilitate a reduction in dosage or to get them off of opioids completely. And I was able to successfully use it in that fashion. But I still idn't quite understand how it was working until I went to a lecture by Linda Watkins and, she explained the whole phenomenon of microglia and toll-like receptor number four and how the ultra-low-dose naltrexone wasn't blocking the mule receptor. And I hope that your audience understands that.

So the mule receptor is where most of the action is when you're using an opioid and pain pathways. The major factor when you have chronic pain, microglia become very important. And the receptor that becomes stimulated on the micro clear is called like receptor number four.

And when it's stimulated, it produces cytokines. 

 And many of these cytokines are pro-inflammatory, meaning they cause inflammation, particularly interleukin one and interleukin six. So these cytokines end up giving you neuroinflammation. It's sort of making more pain, pain on top of pain.it also gives you what's called illness, behaviour or sickness behaviour where you feel you don't want to interact with other people. You feel sluggish, you want to just retreat alone, sleep a lot. And it's like a survival mechanism. So if there was true trauma or you know, some injury in your body, the microglia respond by giving you these cytokines or producing these cytokines that make you want to just rest a lot and not interact and not waste your energy using all your energy for repair.

So I started to understand that the whole issue of central sensitization, which is what happens when patients have persistent pain. The issue isn't—all the receptors. We used to think it was that it was upregulation of the receptors so that you  needed more medication, because of the new receptor.But it was very much involved with the activation of microglia and that if we could suppress the microglia, we could suppress pain and actually reduce tolerance. That's some of the tolerance was a function of activating microglia. So I started to understand it would work for patients who had  central sensitization.t I've been treating a large number of patients for the earliest endless syndrome, and the most common complaint in that population is fatigue and pain.

When you examine them using my electrical instrument, they come up with anywhere from around 50 tender or sensitized muscles test positive. When I say the relatively normal population who just comes in, let's say with that pain, the average number of muscles, it's about five, so they have ten times the number of muscles that are sensitive to a small amount of electrical stimulation.And it would appear that they have central sensitization, because they are, sensitive to all stimuli, they do have a mood disorder and quite often they have something else that fits in the whole picture, which is mast cell activation syndrome. This is like another part of the puzzle that the mast cells, which are cells in the body that respond to trauma and to infection, to any assault in the body or to a foreign body,  they sometimes become overactive.

And the whole phenomena of overactive mast cells  hasn't been recognized until quite recently. Itt turns out that patients  understand that syndrome. A large number of them have mast cell activation syndrome, which is the abundant number of mast cells. Not too many, but rather a normal number of mast cells. But the mast cells are over-producing the chemicals that they produce, and they can produce up to 200 different molecules, and you can get many different kinds of  symptoms  but commonly would be, skin sensitivity, rashes, environmental allergies, GI problems with constipation or diarrhoea.

What’s  commonly known as irritable bowel syndrome, asthmatic like problems or rapid heartbeat, a rapid heartbeat when you're getting up quickly called POTS, postural orthostatic tachycardia syndrome, or sometimes orthostatic hypertension, migraine headaches. So we see these kinds of  symptoms and the mast cells also activate the microglia. 

So in terms of my practice, you know, getting back to ultra-low-dose naltrexone, that I would say almost all the patients I see I put on two ultra-low dose naltrexone. It takes a while to titrate up because we know that the dose to 4.5 milligrams for some patients is a total overdose and they will not be able to tolerate that. And this was actually taught to me by Dr Franco, my friend. So we start at 0.1 milligrams per day, and we go up by 0.1 milligrams every other day, in divided doses.. So it's not one dose at night, but rather four times a day dosing. So it would be 0.1 then three days on the third day, it will be 0.1 twice a day. On the fifth day or sixth day, it will be 0.13 times a day. Then a couple of days after that 0.14 times a day and then start again from the 0.1 so it would be the point to 0.1 0.1 0.1 then 0.2 0.2 0.1 0.1 and going up like that until we get to the maximum of somewhere between five and six milligrams a day as a maximum dose.

So we have some patients whose total daily dose is 0.15 milligrams a day. Total daily dose, and we have other patients where the total dose is six milligrams a day. So what's the dose for ultra-low-dose naltrexone? There is no dose. It's completely idiosyncratic, meaning each patient has their dose, whatever that may be. And so. I didn't stop talking for a long time.

Linda Elsegood: That is absolutely amazing, and you have wrapped it up in 30 minutes. We're going to have to have you come back and talk to us again because I'm sure you  just got started in that 30 minutes. So I'd like to say thank you very much for having joined us today. I really do appreciate it. 

Norman Marcus M.D. My pleasure.

Linda Elsegood: This show is sponsored by Dixon's Chemist, who are the experts in LDN at associated treatments in the UK. Dixon's Chemist, the most cost-effective for LDN in all forms within the UK and Europe. You are maintaining safety standards in  excess of what is required. Why would you choose to get your LDN from anywhere else?

Cool. 0141404654 five today to speak to the LTN experts

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

Dr John Kim MD – 5th September 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr John Kim has great experience with LDN and shares his latest results in combining ULDN (Ultra-Low Dose Naltrexone) with acupuncture and Vitamin C.

His chemical background allows him to understand the various pathways and how his treatments are working. He explains what ULDN is and how these micro-doses of Naltrexone can help people with high sensitivity to drugs. It can also be utilized to enhance the effects of opioids while reducing the dependence, and eventually replacing them to reduce pain. 

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

George Schatz, MD – 8th August 2018(LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr. George Schatz who's an MD from Tuscan in Arizona shares his experience with Low Dose Naltrexone (LDN).

I am a medical doctor and currently a third year and chief resident of our residency program at the university of Arizona for family medicine. I was born in Pittsburgh, Pennsylvania, and I did my undergraduate training in Ohio at a small college called Hiram college.

I decided to move down to Arizona for my residency training because of the world renowned university of Arizona center for integrative medicine, which I'm looking forward to being one of the residential fellows this year to further pursue training in integrative medicine.

I first heard about LDN trought a patient who came in, who had an Ulcerative colitis or Crohn's flare. I don't remember. I don't recall which, but he had an inflammatory bowel disease flare up. And he had to be admitted to the hospital for IV fluids and for monitoring and everything. He was very sick at the time. It was very early in my training, my third year at medical school. He told me  In two weeks, he was going to meet with a doctor in New York city that was going to start in on Low Dose Naltrexone.

I didn't spend much time looking into it. I had a million other things I was trying to learn at the time.

And over the past a few years and months really I've started to hear more about LDN and so I have a few colleagues here who use LDN very commonly and so talking to some of their patients and hearing about what they were taking it for and how it was working with them. And I got extremely interested just hearing the anecdotal evidence of how people's pain is getting better, how people are off of their thyroid medications or their immunosuppressive medications for their auto immune diseases. And I got intrigued. And that's really what led me diving into the research and then using it with my patients with success.

Mostly, I use it for pain, all sorts of different pain,Fibromyalgia or Chronic Regional Pain Syndrome, formerly known as reflex sympathetic dystrophy. Also just chronic low back pain had some improvements. But also Crohn's,  thyroid issues as part of a comprehensive and anti-inflammatory or immune treatment program.

A lot of them are on opiods medications for years. I start by

slowly tapering their opiates.

So if they're on a combination of long acting and short acting, we tape it the long acting first because once that's out of the system and they can control their pain with the short acting, we can stop quicker and start the LDN shortly after.

I usually say, "If it's a Sunday night, take your last Percocet on a Sunday night and then, either Monday night, depending on how you are or Tuesday night take the first dose of LDN."

 Some people come in, especially when you start at a higher dose, they have that initial endorsement rebound and they tell you that this is the first time they felt like this in years. Of course that's what this is all about. That instant gratification as a professional helps me to continue what I'm doing, but that's not always the case. And I'd say that is almost more the exception.

Typically it takes patients anywhere from two to four to six weeks.

There's a beautiful case study that I read recently on a 35 year old guy who had low back pain. And he had tried on opiates and anti-inflammatories and then the epileptics and trigger point injections and steroid injections.

No improvement in it, of his pain. Once they got them on the 4 milligrams of Low Dose Naltrexone, two weeks later, 30% reduction in pain by six weeks, he's completely back to work. Six months after starting it, when he was totally off of it for, almost four months and he was still having just minimal pain, it was still completely, fully functional back at work. And that's something that I totally see.

Some patients mention a bit of sleep disturbance. It's really not insomnia. It's just a change in their sleep habits that can be remedied quite easily by making sure that we optimize our sleep hygiene prior to initiation of LDN and also by just making sure that we take the proper steps when we're initiating it to not really start too high, but, if we do start at what we think is an appropriate dose and has some issues, we sort of drop it down and again, that take her upwards.

 I wanted to mention has a side effect, which I find extremely interesting is if the patients tell me their issues with binge eating have decreased and it doesn't surprise me knowing the mechanism with opioid growth factor and opioid growth factor receptor and beta endorphins.  Having that endorphin surge that's the reason why people binge eat for the endorphins to quell some sort of inner pain.

And so having your opioids inside your body or beta endorphin at a higher level which can actually satisfy those cravings and you don't need to binge it's something that is fascinating to me.

And actually that reminds me a formulation of a weight loss drug that's FDA approved in the United States for and that's a combination of anti depressant and Low Dose Naltrexone. It's called Contrave.

I have an integrative medicine practice that is  growing every day. Those are the patients that come to me either requesting help in, or having heard of LDN in some specific way.

I can be found at www.georgeschatz.com,

And that's the easiest, quickest way to get in touch directly with me and my team. And I can get you a schedule for appointments starting pretty soon or booking out a couple of months, but pretty soon.

Summary of Dr. George Schatz's interview. Watch YouTube video for the full interview.