LDN Video Interviews and Presentations

Dr John Kim, MD - 7th November 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: I'd like to welcome back Dr John Kim, who I know many of you have listened to his radio shows in the past. He's always got exciting things to tell us. So welcome, John and thank you for joining us today. 

John Kim: Well, thank you so much. I really appreciate your effort in making Low Dose Naltrexone all front and centre in the integrative functional world.

And I think that it's even going beyond that. I'm even talking to talking to specialists within K U  in Kent, University of Kansas Medical Centre specialists, all talking about low dose naltrexone. So I think that, um, you and the listeners have done a great job putting this issue of light in the middle is the front end centre.

Linda Elsegood: Well, I have to say you're certainly one of those doctors who liked to push the envelope, think outside the box, to try to find solutions for patients who are complex, should we say? Because I mean, some people are harder to treat than others with all the different symptoms. 

John Kim: I think you said it. Oh, you've nailed it.

The word complex and my patients tend to be very complex, the integrative medicine St Paul appears to attract patients that are complex. And it's what's interesting is all part of the training that I had with Dr Andrew Weil was the theory of complexity. How do you, um, approach complex issues?  How do you solve complex medical problems? And he's always said that you want to go to the area where everything gets together like sort of a nexus of issues. So for Dr Andrew Weil it has been inflammation, which we will come back to, to LDN. And to me, it's been autoimmune or immune dysregulation that I've seen.

And it's just very interesting because this all started with one patient, one patient who came to me and said, Dr Kim, I have learned about this new idea called Low Dose Naltrexone and I have a thyroid disorder, and I would like to try it. So I told the patient that I would like you to research it. So because I am used to having complex patients, I researched it and really the potential benefit versus potential harm, I really saw more potential benefit that I didn't see much harm in them trying LDN and to make a long story short this has transformed my practice if anything, autoimmune really gets limited what I can I that acid. Oh, and put them on an anti-inflammatory diet, but a supplement, but I wasn't getting what I call reliable, repeatable results until we went to LDN.  And LDN is not 100% doesn't work 100%, but I think that it has achieved all a form on reliability or repeatability. For me.

Linda Elsegood: LDN is only one of the tools you have in your toolbox. What do you use in conjunction with LDN? 

John Kim: So for, I think that one of the things that I find most fascinating is that, in this day and age, immune dysregulation, I'm seeing a lot more allergies, food allergies, and in integrative medicine, a lot of times people say, Oh, just don't eat it.

And it's easy for the practitioners saying, but really by the time you take out all gluten, I'll take out yeast, take out the milk, it's very difficult. It's very. It can be done. But if you try to go outside, like in a restaurant or social settings, they're difficult. So one of the things that I have discovered again, through a patient, um, who was really suffering a lot because of food allergy, is there's a way to teach your body, in conjunction with Low Dose Naltrexone, to not to react to food allergies, teach it to stand down, and it's called our food allergy drops that all that they can do Amazing work. And then other tools, of course, you think of food as medicine, and I think that we understand better and better how powerful food can be. One example of this, of course, it is a vegetarian diet, an anti-inflammatory diet, and there's also ketosis that is ever more popular. Um, and of course there is Dr Terry Walls, um, modified Palio diet for autoimmune diseases and I think there are some commonalities to all these conditions.

And so we use food as medicine, one of the other tools that I love, that goes very well and hand in hand with LDN, is acupuncture and the reason I say that acupuncture are gone hand in hand is that the earlier we search with how acupuncture works have been shown demonstrated by using Naloxone, a related like a constant of naltrexone and naltrexone.

So we know that if you want to disrupt—the effects of acupuncture you can use high dose naltrexone, meaning it's possible that acupuncture is doing what LDN would be doing, and there's a paper that was written and published by a Dutch professor hypothesizes that cannabinoids, LDN, acupuncture probably share the same pathway.

And I think that that is one of the most exciting, um, ideas that, um, uh, propelled me because I started using LDN more widely than autoimmune when I read an article that LDN may have anti-inflammatory effects and since then, or how, what happened is that patients who couldn't come or could not afford acupuncture because one of the most effective tools about LDN is the cost.

For less than a dollar a day you can treat the most complex conditions using LDN. So all but acupuncture when it didn't work, or it was too far out prescribed, those people offer them, which, because LDN and I've become trusting to do similar kind of things, let's use LDN in view of acupuncture, and I would see amazing results.

And that's where all especially with pain and neuropathy, especially Um, and then now we know the basis of it and molecular basis of it because of dr Jerry younger, uh, did, uh, published articles on fibromyalgia and using LDN with demonstrated LDN is helpful or help people with fibromyalgia. And the mechanism is fascinating because in, um, professor.

Younger is basically proposing LDN. Low dose naltrexone is functioning as an anti glial cell modulator, which there is another anti glial cell modulator but LDN is amazing because of many, many properties. It can penetrate into the brain. I think it's a quarternary. I mean, so he can, he is able to go to the CNS. Um, relatively rapidly metabolized into another compound that can stay in the body for a long time.

So really you're getting the effect of LDN in, um, and it still works as a, um, opioid antagonists, which means that you still, you're getting endorphin in peripheral as well as the central nervous system as well as in the body. It's just really amazing. Um, and then of course, um, the, the anti glial cell modulation, it just opens up all kinds of therapeutic possibilities.

Linda Elsegood: It's amazing, isn't it? Before we go on further with LDN, and I know people are going to pick up on what you said about you teaching your body too, how did you explain it? Eat foods that you are intolerant of to teach your body so you can eat those foods? How would you go about doing that? 

John Kim: So, um, there is a protocol developed in Wisconsin, and that's the poor uncle. Then I modified, what I do is that I do a generalized food allergy test. That, uh, what I call, what a wide-angle or shotgun approach where we can test a relatively large number of allergens, food, allergens at a very low cost. So that as a screening tool, once I have that tool, um, I discuss with patients, usually I give them the results and give them the ordering sheet about tests that's more specific, but more importantly, it is quantitative. Because it's truly quantitative or it's quantitative enough that it can be turned into an allergy drop. So then what you can do is you can use food allergy drops that are specifically targeting specific food at a specific dose. So you can - Well, it's similar to an allergy shot. I think it's safer because it's through the mouth. I think most of Europe is familiar with this approach. Um, and uh, the big advantage is safe because you can swish and spit and you're looking for reactions, any kind of reactions, that means that those may be too high. And then you just simply pull back to those or ask the pharmacy to, uh, formulate a the more dilute a portion.

Linda Elsegood: That's amazing. 

John Kim: and, and it goes well with LDN because a lot of patients, I ask them to do both LDN to all function as an anti-glial modulator to decrease its immune systems or tendency to overreact. And then in the meanwhile, I use the, uh, food allergy drops to lower the dose, and you can do that with environmental allergy combined LDN plus, um, plus the food, the environmental allergy drops. You just don't want to do them together. You don't want to start both of them and simultaneously because you may overwhelm the body and into, um, like a crisis. And we don't want to do that. And patients who I do this too, I prescribed, um, EpiPen to make sure that they have safety. And well, first, those, they have to take it in front of me so that I have to make sure that they are okay. They have my cell phone number. Um, and these days I think cell phone number better than the home number. So they can text me, they can email me, they can call me if they are in trouble. 

Linda Elsegood: Wow. Wow. To have a doctor who would let you text him? That's a very good service. Very good. So what else do you have to tell us? Um, that's new with LDN  John?

John Kim: So, um, the LDN part I find very interesting is that, um, I think when we first connected, the world at that time was using 1.5 milligrams as a starting dose. Now I think that most people are open to starting at 0.5 milligrams.

And even the reason I did that was I saw some, uh, category of the population of my patients who the endorphin levels were so low that at that level people had side effects. And. I've since then cut it down to 0.1 milligrams or a hundred micrograms and um, and that cut out fewer people now have a reaction, but I'm still seeing people with reaction.

So about two years ago, I started people at ten micrograms, and recently something happened with, I think the regulation that, well, I'll be, pharmacies now have to assay and prove that the amount of LDN is what it is and, or, you know, appears to some pharmacies are boarding Turley doing it, which is an excellent practice.

But as a result of it, I think the essay just doesn't work very well below a certain level. So now, um, the, some of the Compounding pharmacies, they are capable of making one microgram, but they can't guarantee it's one microgram. There's no way to assay it. So what I do now is that I, uh, I will get all the pharmacy to make a hundred microgram, all tablets, not, not a capsule, so that patients can break it in half, which becomes 50 micrograms.

And then they break that in half. It goes 25 micrograms and then once they can prove that they can tolerate it, then they can do a rapid offset increase 0.2 5.51 or basically 25 micrograms, 50 micrograms, a hundred micrograms, 200 micrograms, 500 micrograms at which that dose is where people ….

So maybe takes two months to ramp up. But I think that um, that the more complex your patients are and more they are endorphin depleted, um, that I think that is a good thing to do. So I just asked them very simple questions.

How do you sleep? Um, and people tell me its terrible than that, that makes me, uh, think that, that they're, they, they are a good candidate for a lower dose on another thing I ask is. After you get up, do you feel well-rested if the patient said, no, I, I'm sleeping a lot, but I'm not feeling very well rested is another question?

And then the third question is the resiliency question, which I made up. I said, Hey, listen if I give you a limited amount of money and I drop you off anywhere in the world, how confident do you feel you can get back and without having like psychological crises? And. Well, if people say, no, no big deal, I can get back -  just some little bit of stress, but patients, Oh my God, that would kill me. Low dose, then I would choose with a low dose. Um, but I would say if the patient were healthy, I, I don't mind starting them out at 0.1mg, I still don't want to do 0.5 because, um, I experimented with it and, um, on purpose took a higher dose and really, not everyone has a reaction, but once you have the reaction, you don't want to look at LDN. And I think it's, so, LDN can be a fantastical tool, so I don't want to, my patients would lose access to it by having a bad reaction.

Linda Elsegood: What conditions would you say, John, you are using LDN mainly for? 

John Kim: Well, you know, I think that, um, the autoimmune I think is the most popular use. Um, now, of course, we do that, but if you ask most people, most practitioners why it works, um, they will talk about endorphin, and I'm not sure that's entirely correct.

I think the side effect from a high dose of naltrexone affecting people badly is because they're triggering the complete and total depletion of endorphin by blockading the opioid receptor, especially the mu receptor. But I think that it's more likely that the autoimmune diseases are helped by the anti glial cell modulation that professor younger is talking about, and the significance of this is that now you can move beyond autoimmune, you can treat nerve disorders, if there's pain which has the basis inflammation, like fibromyalgia, in theory, is supposed to not have inflammation but stop the population of them.

I've noticed that they have high inflammatory markers, like C reactive protein, even ESR. Then I'll then LDN becomes another tool. But anything where you're suspecting that there is an immune dysregulation or over response of the immune system, especially within the central nervous system, I think that LDN becomes an invaluable tool. And I think that understanding the mechanism allows for flexible use of low dose naltrexone and I would like to invite all the listeners to come to the next 2019 LDN conference in Portland where I am honoured and privileged to share some of my observations, ideas about low dose naltrexone, um, pushing the frontiers on and the use of LDN.

Linda Elsegood: Well, I'm sure everybody would be thrilled to hear that. As I said, you always have new ideas, different theories, different ways of tackling a problem that is faced by many prescribers, with patients with complex conditions. So is there anything else that has been going on in your world of medicine? 

John Kim: Well, I think that all, as I said, I think the most, um, some of the most interesting things that I see with LDN is once you have the LDN mechanism.

So I have a patient that has resistance. Um, depression. And now within the field of psychiatry, there's thinking that some of the depression may have inflammatory components. So within a  short amount of time, less than one month, I have an elderly woman who says, Oh, I'm using it for pain purposes, but the patients are “Oh my God, I still have pain, but I, what did you do with my depression”?

So all that's, that's another tool that I think is all very, very interesting to start thinking about. It's like what other inflammatory conditions do we have? And here's where knowing the mechanism really helps the practitioners to think outside the box. Because if you can view as anything that has brain inflammation or central nervous system, peripheral nervous system, inflammatory condition, um, all of a sudden you have a tool, another extra tool, LDN, which is very affordable and very safe. And the side effects, um, none that I am aware of are life-threatening, at least none that has been reported. Um, so I think that I would urge both readers and practitioners to pay attention and the diligent in reading articles, new articles coming out.

There are more trials that are coming out and to be curious about LDN, and that just don't accept it as, Oh, it just, it's good for treating Hashimoto's disease. It's good for ms, and the next bet would be it's good for autoimmune diseases, but why? Why is it good for treating autoimmune diseases, once you have the idea that this is an anti glial cell modulator, then it opens up a big field, especially within regards to using it as in pain.

For inflammation, inflammation, which causes nerve pain, inflammation. That, and it's very interesting cause nerve pain is how I got started with acupuncture because, um, as you may know, the listeners may know, the tools that we have for nerve pain, um, are very limited. We can use Gabapentin. We can use another medication, in the main Lyrica.  But either you respond to it or don't respond to it. If you respond to it, you're very lucky, but if you don't respond to it, then you have to really suffer. And suffer means that a lot of people say neuropathy. How do you describe it? In the beginning, you would get the tingling, numbness, but as it progresses you, you get burning.

Not just any kind of burning, but really cold burning. And then if it advances even more. You will get like a crushing kind of pain and people can't sleep with this. And the, one of the best ways to make people dysfunctional unfunctional is taking their sleep out of the way. They can't get quality sleep, and then all of a sudden you have a big problem.

So I think that that's what all for me to LDN is doing for complex patients, is that. It's really helping me to push it out there. And then now I'm beginning to combine with treatments. So patients who are weak and they are fatigued, and because a lot of patients who have this condition to reach me takes years, sometimes decades, because they don't have, there's a lack of doctors who are willing to think and solve problems because more of us are more comfortable with protocols.

And so if you have that kind of practice all of us, and understand the mechanism, all of a sudden LDN is amazing, then you can use, if the patient is really weak, then you can target LDN to blockade the conventional way, which is the blockading of the endorphins. But it now, you know you're doing that. Then, the application can be different.

You may. You may be more, um, realize that when equilibration happens, you have to push it a little bit and, and march it out, which is a bit different than, um, the steady-state or the equilibrium that you want to bring about for glial cell. Um, modulation.

Linda Elsegood: Wow. I mean, it would be really interesting if you could just see into the future to see if in say, 20 years time where LDN would be, 

John Kim:  Yeah. I think that one of the danger is that all of us are really happy about more research, more things happening. One of the concerns I have is what happens; one of the pharmaceutical companies find a way to patent it. Cause every time I look at all ideas I had about LDN, someone's patenting it. Someone's patenting it. And as of now, I think there are, um, medications that combine, um, anti-anxiety medication and LDN at 7.5 milligrams. And they use that for weight loss. So if you were to create that combination, you can't, at least in the US because Um, intellectual property. So one, I think that the use of LDN, um, I think is at a tipping point for reaching the conventional, because I hear it from other doctors I hear from and when my fellow wants to use it, um, there is an acknowledgement, even though they say we don't like it. But if they say, yeah, there are some preliminary data, and this is very different than when I first was introduced to LDN, where the evidence was really nonclinical data, but more animal data.

So I think that it's really come a long way. I think it's accelerating. We're seeing a large number of studies coming out of ... Uh, I think in one of the Scandinavian countries, all VA has a bigger study. In, um, formally called RSD or complex regional pain syndrome. So I think we're, we're, we see some things that I think that you know, you and your listeners have done an outstanding job and it's, it's accelerating.

The only thing that I'm concerned about is public may lose access to it, the affordable access to it as, as a pharmaceutical company. And the, for those of you who do not know, um, Dr Bernard Bihari, um, was a pioneer in the field of, uh, low dose naltrexone and he, his title is called normalizing immune system function.

And that's so amazing. He didn't know about glial cells, didn't know about, but that's what he called it. And that's what I think he was right on. And. There's a concept in Chinese medicine and herbal medicine we call adaptogen. adaptogen means is to, something is too high, lowers it is too low it highers it.

So on the example of that, they like to use ginseng, but in the world of botanical medicine, I don't think I've seen as good adaptogen as LDN for normalizing immune system function. 

Linda Elsegood: I'm going to have to stop you there, John. We have run out of time, but we will definitely have you back again.

John Kim: Thank you. 

Linda Elsegood: This show is sponsored by Mark drugs who specialize in the custom compounding of medications, assuring that the client gets the proper prescriptions for their unique needs and conditions. They work with practitioners integrating knowledge and treatment of experts to create comprehensive health plans, visit https://www.markdrugs.com/ or call Roselle (630) 529-3400 or Deerfield (847) 419-9898.

Linda Elsegood: 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.

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.

Tracy Magerus, NMD – 15th August 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr Tracy Magerus is an MD from Phoenix, Arizona. Having graduated in 2009, she has been in private practice for nearly ten years giving her a great depth of valuable experience. 

She had previously heard of Low Dose Naltrexone (LDN) during her studies in the late 2000s, but first prescribed it for one of her patients in 2012 where within weeks she noticed improvements in their overall health.

Dr Magerus currently has over 25 patients on LDN and considers it a vital tool in her naturopathic arsenal.

This is a summary of Dr Tracy Magerus’ interview. Please listen to the rest of Dr Magerus’ 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.

Dr Pamela Smith - 9th March 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr. Sahar Swidan - 2nd May 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Sahar Swidan has travelled extensively to educate while running her own Compounding Pharmacy. She has witnessed many successes with the use of Low Dose Naltrexone and ultra-LDN. 

She is a humanitarian and is writing a book on opioid-free pain medicine in an effort to educate more people on the many other optional treatments. Many experts will add chapters to make it a reliable and must-have guide.

Dr Swidan has witnessed a drastic improvement in many of patients when prescribing LDN, saying that 80-90% at least have noticed their overall health improve.

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

Bente from Denmark - 14th March 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Bente from Denmark has problems with a loose tailbone, which calls tailbone nerve pain because it's worn away the cartilage.

"In September 2013, more than more than five years ago now, during a holiday, when I came home, I went to the doctor and he said: "You just have to have patron. It can take up to about a year."

And what happened was because it was so loose, all the movement wore off the cartilage. I had periods 10 to 12 days where I couldn't even sit down for five minutes.

Couldn't get into the car to drive. Couldn't go to work. I've been off work six years.

First my doctor offered me the regular analgesic like Evil but then I ended up with Gabapentin, Lyrica Morphine until February last year.

I had CT steroid injections. They were hesitated to remove the tail bone because the sacrum has already been affected as well and then they sent me off to the pain management clinic and that's where they informed me about LDN. It is difficult to find LDN in Denmark. I only got Low Dose Naltrexone (LDN) because I got it from the pain management clinic and then my own doctor couldn't really say no.

I started at 1.5 milligrams of LDN because they gave me 4.5 tablets and then I started with a quarter of a tablet and it took me about six months to find my dosage, which is now at 3.5 milligrams.

When I first started, I felt pain relief nearly immediately only after a couple of days. I did get some nausea and a little bit of headache.

I only have the advantages now. I can tell you now I was the first person my doctor prescribed to and he has about 20 patients now with all different diagnosis on that again. He has learned and he's impressed.

I'm 95% pain free. I can drive in the car for eight hours. No problem.

I can feel my tailbone still clicking.

We have an LDN group in Denmark. When I joined in February last year, we were 800 members. Now we have 3,400. You can find different files in there You can print out and take to your doctor. And a lot of people have had success with those. That's what I do not like is people keep comparing it to the cannabis and think it's sort of a magic pill which obviously it is not. Hou have to have patience to find your right dose.

I  have more energy than before.

Some people wait 8 to 10 years before they go to a pain management clinic"

Summary of Bente's journey with Low Dose Naltrexone (LDN). Listen the full interview.

Dr Andrew David Shiller - 9th March 2018 (LDN, low dose naltrexone) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Andrew David Shiller shares his Low Dose Naltrexone (LDN) experience on the LDN Radio Show with Linda Elsegood.

Dr Andrew David Shiller is a doctor who goes the extra mile to heal his patients. After completing his “conventional” medical training, he realised it was not enough and studied holistic, functional and integrative medicine. 

He often receives new patients who were not helped by other doctors. He has great success, where others fail by covering the patient’s whole lifestyle and conditions. He has utilised Low Dose Naltrexone (LDN) for over 4 years and feels it’s an important tool for many conditions. 

Also important is diet, nutrition, exercise, detox, restful sleep, and addressing allergies. Dr Shiller states that LDN blocks pain, shifts mood, increases energy, moderates the autoimmune system and stimulates anti-inflammatory action.

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

Dr. Igor Schwartzman - 16th Feb 2018 (LDN, low dose naltrexone) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.