LDN Video Interviews and Presentations

Viv-Hashimoto’s Thyroiditis-Scotland (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Dr Yusuf Saleeby - 19th Feb 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr. Saleeby is a 1991 graduate with a medical degree from the Medical College of Georgia in Augusta Georgia. Upon completion of post-graduate training at East Carolina University School of Medicine in Greenville, North Carolina, he had a two decade career in Emergency Medicine serving Emergency Departments in NC, SC and GA. He held leadership positions as medical director in his career. In addition, he pursued training in functional and age-management medicine since 1998. 

Currently, he practices holistic integrative and functional medicine in North & South Carolina at Carolina Holistic Medicine. From 2000 until 2006 he was appointed as co-medical director of the Emergency Department at Liberty Regional Medical Center, Hinesville, GA. In 2007 he was promoted to medical director of the Emergency Department at Marlboro Park Hospital in Bennettsville, SC until 2010.

With over 400 patients being treated in his practice currently, he has around 60 currently on Low Dose Naltrexone (LDN). In this interview Dr Yusuf Saleeby explains his interest in Chronic Lyme Disease and how LDN can help to combat the disease.

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

Michelle Resendez FNP-C - 15th Jan 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Michelle  Resendez is a certified family nurse practitioner. She combines her love for alternative and natural medicine alongside traditional medicine.

She has successfully treated patients with a diverse range of health conditions that have not responded well to conventional medical treatments.

She said" I first learned about LDN about 10 to 12 years ago, first learned about it from a naturopathic medical. The first patients I treated had thyroid conditions, Hashimoto's, Graves thyroiditis. And so I was really using it to try to the modulator assist the thyroid in functioning better. And from that point, it really expanded and opened the horizons, treating other things.

So we found that people with thyroid conditions, if they're taking thyroid medication, usually have to reduce the amount of thyroid medication.

When I start someone on Low Dose Naltrexone (LDN), easily around 0.5 to one milligram at night, and I will either reduce their thyroid medication in half, or I will just reduce, if they're on a T three medication, I'll reduce that down.

 A lot of times, their autoantibodies will start going down, and that will help the thyroid function better.

Sometimes you'll get some adverse side effects like tremors or palpitations, or just feel a little bit more excitable than her used to feel.

I have a lot of patients start noticing the effect almost immediately within a couple of days. Depends on what condition I'm treating.

A osteoarthritis type pain or structural type pain people usually notice the effects within a week of taking that.

Once they move out to one or two milligrams, they start feeling some relief.

Antibodies are a little bit more resistant, and it might take, two to three months to see antibodies go down with LDN. And that's because of the treatment approach for that is really multifactorial.

And the LDN is just an adjunct to that. And usually, we do lifestyle modifications and diet and, and other interventions to help those antibodies come down as well.

Anyone starting Low Dose Naltrexone (LDN) can experience negative side effects. The most common would be that when they get a rebound effect it at night with those endorphins kicking up, they can get some anxiety. They can get some insomnia.

Patients that we treat for viral conditions or reactivation syndromes like Chronic Fatigue Syndrome, they can actually get more severe adverse side effects such as sweating, fevers, flu like symptoms, feeling sore throat, things like that.

All of that is expected and typical. I don't like to stop treatment if they're experiencing those side effects because that's telling you that it's working. We're getting the endorphin release that we're looking for, and we're getting the immune system enhancements that we're looking for.

Those side effects are what I would consider good responses.

I haven't had anyone had any side effects that  I would consider to be adverse like hives—rashes, vomiting, anything so severe that I'd have to stop them on it.

I treat GI conditions as well. I've had probably the most success with gut issues. It's one of my top responders. Some of my earlier patients were Crohn's patients.

LDN seems to work pretty well for the exhaustion, the fatigue and the pain.

The conditions that I treat teenagers for could be anything from Attention Deficit Disorder, Depression, pain conditions, allergies, sleep issues.

Some of my kids are on the autism spectrum, so I do treat that as well.

I do have quite a few teens and young children on LDN. And I'll actually have them on liquid if they're too young to swallow a pill or won't tolerate a gummy or a sublingual lozenge.

I do have a traditional medical doctor referring to me, Neurology, Cardiology, Rheumatology. Dermatology because there's a lot of dermatologic conditions that can be treated very successfully with both topical LDN called Xeno top and then oral LDN.

The skin conditions I am treating it for it would be the Legos, Psoriasis, Rosacea, Eczema. Those are probably the top of all the skin conditions that respond really well to it. It takes normally 3 months to see results.

There's trials to find if there are some food triggers associated with that.

A lot of it is when they're having fires and because it's triggered by something and I want to find out what that trigger is.

And then the LDN just helps the body heal itself. So it's keeps them in a remission state.

When I first see a patient I typically wll do labs tests first that looks at allergies, hormones, thyroid, inflammatory markers, genetics, things like that. I try to find triggers if I can identify any and remove those before then starting on LDN. I like to see how they respond first to that.

I like to do things in stages so we can really see how impactful each thing is at each stage. So I'll take away the food triggers first if I can identify them and then add LDN onto that at some point.

Right now we've just moved into our new office. So my business partner and I have been here for three months. I'm at a two-month waiting list right now. Once we hire some more back-office staff, I'll be able to stack more appointments and that will trim down for maybe a month or two and then we'll probably get booked up again. I do keep appointments open early morning and sometimes I'll see patients after my last appointment for the day. If there's something urgent or somebody's not responding favourably to meditation or something.

I leave those time slots available for that so I can get people in if I really need.

I would say on average, patients see me every three months. That would be somebody who is stable, doing well on their regimen and not needing any further testing or imaging or interventions done.

So some patients I will see on a monthly basis if they have a lot more chronic illnesses and conditions because I like to do those steps, plan out, maybe CBO treatment, diet.

Also with hormones, thyroid continue to add things to optimize how they're doing and their quality of life.

I have some come in annually. They're probably not my patients on LDN. They're probably more. They're doing our mono treatments, pellets, injections. Yhey're doing other treatments other than just LDN.

Summary from Dr Michelle  Resendez YouTube interview. LDN Radio Show Listen to the video for the full interview.

Shivinder Deol, MD - 27th Nov 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Dr Shivinder Deol, who's an MD, certified in family medicine and anti-ageing and regenerative medicine. Dr Deol has served at Bakersfield, California community as medical director of the anti-ageing and wellness centre for over 35 years. He specializes in integrative preventative and family medicine as a primary care provider.

Thank you for joining us today, Dr Deol.

Shivinder Deol: Thank you for having me. 

Linda Elsegood: So could you give us your background? Where did you train?

Shivinder Deol: Sure. I studied in a private school in India, one of the top leading medical schools for some medical college. Graduated from there in 1975 and then I came. I did a course a year off a residency in India, and then I came and joined a University of Tennessee, Memphis and did my training in medicine, psychiatry, and family practice.

And then, I've been in practice, since 1982 in Bakersfield, California. I've taken extensive courses in regenerative medicine and anti-ageing. So my training, even though it was initially more family practice, and I'm board-certified three times and family medicine, but my interest went towards more integrative medicine and functional medicine. For the last 15, 20 years I've been doing more of that. 

Linda Elsegood: When did you know you wanted to get into medicine? Were you very young?

Shivinder Deol: No, I wanted to be an army man. My family is a strong army. But my mother wanted someone to be a doctor. So my older sister, then my brother, passed out and did not go into medicine. So my mom said:" You got to do it." And I said: "okay". I got into medicine, but I'm so glad I did because I think it was my calling and I really had an incredible journey.

You know helping people, learning and growing myself with medicine.  

Linda Elsegood: I mean, things have changed, haven't they? I mean, you must have seen it from when you first qualified. What was it? 1975 where you went to the doctors, you told the doctor what was wrong and they, I remember it well.

I got married in 76 that people had their symptoms treated. But they never actually had the root cause treated in those days, which then eliminated the need to treat the symptoms. So, you know, what is it you actually do in your practice? If a patient came to see you with complicated symptoms, why would you start?

Shivinder Deol: You know, we would just, you know, and it was a great business for physicians and all patients came in, they got better and it was just an ongoing process, drug after drug after drug, and then treating.

So no one really was treating the whole body or looking at the real cause of a disease. It was taking care of symptoms now and we'll worry about the things later. 

Linda Elsegood: Yes. So what do you do now? 

Shivinder Deol: Now my focus is changed more.  When a patient comes in, my focus is more nutritional based, first and foremost supposed thing I'm really interested in finding. So this to me, the most important thing anybody can do is improve their nutritional status because a body is constantly working and regenerating itself.

So we estimate we have close to 30 trillion cells, but out of that, almost 700 billion cells are being built every single day of life. And we have hundreds of nutrients and the food that they're eating, which is processed, and with cold storage and with cooking, microwave, we've destroyed a lot of the nutrients that the body does not get all the raw material it needs for all its needs that all the regenerative and repair needs on a daily basis.

So my focus is nutrition and then I do a lot of things with detoxification, removing chemicals, toxins, poisons, reducing inflammation in the body through Iv therapies, chelation, all kinds of different things, hyperbaric. And then we do more stuff at balancing hormones and neurotransmitters to optimize health, brain health, heart health, and overall, you know, endocrine help.

So we do a variety of things to help the body improve rather than just fixing. A sore throat, some,  my aim is if I can prevent a single heart attack, a single stroke, single cancer, we do a lot of protection for breast cancer, for instance. So, basically, if we can reduce any of these massive major diseases, it's far better than, you know, treating the simple sore throats and colds and allergies that most people will have, but they don't really affect on lifespan with these scans.

Linda Elsegood: Okay. What kind of testing do you do when you're probing the patient to find out the wrinkles? 

Shivinder Deol: Yeah. So basically, you know, the insurance companies, of course, we are all kind of stuck with insurance companies to some degree. So the standard blood work that insurance companies cover, I do that but for instance, in a standard blood test, a lot of doctors will do as a free T4 and a TSH. But the key hormone and thyroid, for instance, is there a free T3 which is the active hormone and not T4. So unless we look at three-T3   and reverse T3, you really know what the thyroid function is.

So I look at more in the functional way of looking at health and so we do a lot of hormone testing, but the best way to test hormones are either through a saliva test or a comprehensive urine analysis. And typically insurances don't cover that. We do testing for heavy metals and for chemical toxicities.

So there's a really nice chemical toxicity test that looks at literally hundreds, if not thousands of different chemicals that we have been exposed to. We do food allergy testing, again, not the one that's covered by insurances, which is an immediate food has to be, but more a delayed food sensitivity test.

We look at a comprehensive digestive stool analysis. Look at gut health, gut inflammation, and see if there's an imbalance between the good and the bad bacteria in the gut. So a variety of other specialized tests that we do that can look at the body in a more natural matter. So trying to hit the cause rather than just the symptoms or repair.

Linda Elsegood: And you mentioned hyperbaric oxygen there. For people that are not familiar with hyperbaric oxygen, could you tell us what it is and how it works and what results you have seen?

Shivinder Deol: Sure. So hyperbaric oxygen is basically,  you're in a large chamber, which we are pumping in oxygen under pressure and under the, if you have some, some people remember the physics, the Boyle's law.

They've been, we put pressure, any of the gases are absorbed deeper and greater into the tissues. So when we pump in the oxygen, it goes into every joint, every fluid in the body, including the spinal CSF (cerebral spinal fluid). And so this increase oxygenation. It helps you the healing process in the body.

So if you can put oxygen into any tissues, the body starts to repair process and also discourages cancers, infections of all kinds of any chronic diseases. If we can put the oxygen, the body will start the repair process and use, any of the toxic effects off infections or, other pathologies.

So it's a great way to treat strokes or heart disease or traumatic brain disease, injuries of any kind, surgeries of any kind. So, for any surgery, if you were to get a hyperbaric treatment one before and two or three treatments after surgery, you cut down healing time in half, you cut complications in half.

So it's a very nice way to help repair the body. Also, injuries of all kinds, helps repair, very, very nice treatment, and very safe. I've been offering that for over 20 years. 

Linda Elsegood: Is it covered by insurance in the US?

Shivinder Deol: Unfortunately not. There only seven indication for which a Medicare will pay for and things like diabetic ulcer are non-healing ulcers, but you know, severe diseases they are willing to pay.  For minor issues, you know, they will not pay.

So it is typically a cash payment.

Linda : Elsegood: Is it very expensive?

It depends. So in our office, we charge to believe by the $150 to $200. There are some places, where they are in the three, $400 range. And some places, if they are using a smaller chamber, low pressure, they even offer it for like $125 a soul. But if you use a high-pressure chamber, you know, it's going to be about 150, $200, at least, if not more.

Linda Elsegood: Hmm. It's that for an hour?

Shivinder Deol: That's for an hour. But by the time you get in and out, it's going to almost be an hour and a half. So it takes about 10 minutes To get the pressure optimized in by us, then to brings the pressure down. So it's almost like an hour and a half a treatment. 

Linda Elsegood: I actually had hyperbaric oxygen when I was first diagnosed but it took me about an hour to get there and an hour to get back. It was very, very tiring because fatigue was bad. But I have claustrophobia and I was not really thinking about it, but it was quite a big tank and I think it sat about eight people. So I sat in this tank and I was thinking how am I going to feel when they close the door?

I'm really nice. And then they came out with these masks you had to put over your face. Oh, that was a testiness itself. But I, I have kind of got used to.

Shivinder Deol: We don't use a mask for this reason because it is so much closing feeling and our chamber has three different windows that you can look throughout.

So yeah, there is some claustrophobia, but it's really not that bad. 

Linda Elsegood: This small porthole but they are up high. So you couldn't actually see out. You could just see the other people who were in there with you for that.  Was quite an experience but unfortunately, it was run by a charity and it closed down many, many years ago now, which is a shame because I think they did some really good work though. So with the testing, one of the things that people quite often ask me about is Candida. Do you do Candida testing? 

Shivinder Deol: Of course, and Candida is almost like cancer. So candida basically get thin, and it's very hard to clear Candida out of the body. So yes, we do quite a bit of testing for candida because I think of candida as a very severe, but just to be insidious, it's very quiet, a low-level infection that can just, go on for years causing a lot of damage. But people not even, sometimes be aware of it, and in the long run, can lead to greater complications in losing potentially cancer.

We made it, we believe that it may be a cause of.

Linda Elsegood: Well, so many people have asked me that they do a saliva spit test in a glass of water or something and I don't know how accurate that is. But people tell me that they try these remedies to get rid of it and they can't, and they've been to doctors and they've still got it. You know, if you have a persistent Candida problem, how do you go about fixing it?

Shivinder Deol: Well,  basically that is several things. But candida loves sugar. In fact, every bad bug cancer loves sugar. So to treat any chronic infection, the first thing you have to do is cut out the sugar, cut out the carbs, and remember all carbohydrates except fiber break down to sugar, all of them. So people will cut out sugar, but they don't reduce the carbohydrates, and it's still on getting sugar in the body.

And as long as you're getting sugar, the candida is going to be almost impossible to kill. So the diet, again, comes in really important on a low carb diet. And then we may want to make the environment on hospitable for candida. So whatever the candida likes, we would cut that.

So keeping the body made more alkaline, keeping the body more oxygenated. So using oxygen and ozone therapies. And really helped clear it up candida. But Candida will generally require a prescription medicine plus several strong probiotics, Saccharomyces, and several antifungal herbal supplements to help fight the candida.

And it's a longterm treatment. It's not a quick course of treatment that'll help clear it. 

Linda Elsegood: Wow. 

Shivinder Deol: It requires a long process treatment. Yeah. 

Linda Elsegood: I didn't realize that it was so difficult to get rid of. 

Shivinder Deol: It is. 

Linda Elsegood: So how long ago was it when you first heard about LDN? 

Shivinder Deol: I think it's been, well, over ten years or even longer than that, that I've been using and that I heard about LDN.

And I think, I'm not sure if I heard it in a conference or if one of my patients came to me originally initially and asked me about it, but I think it was over ten years that I used it and the first patient that I actually use it on happened to have such a dramatic result that kind of opened my eyes.

So this lady had severe Hashimoto's thyroiditis and her tilters were in several. And so we treated her with the LDN plus a few other things, lifestyle changes, iodine, cut out gluten and so on. And her tilters started coming down dramatically, and about a year, year and a half or titers were back to completely normal.

So we had cured her now, Hashimoto's, and this was, I believe, strongly related to the use of LDN. And, so that was a very strong eyeopener for me on this, on LDN and its potential efficacy. And since that time, I've used it on a whole bunch of other patients for a whole variety of other conditions. But fortunately for me, that I had, my first patient responded so well that, it really made me a believer.

Linda Elsegood: You said that you've treated in lots of conditions with LDN. Do you have any other case studies that have been remarkable in your practice? 

Shivinder Deol: Yeah, a few others. So I have a patient with severe ms. Was very fatigued, but she's got severe tremors and she was extremely fatigued, and so I put her on LDN, and within days she could tell the improvement in energy level and the fatigue had improved very, very nicely. But unfortunately, I did not see, or she did not see any improvement in her tremors. But as far as the energy level and a mood, she comes in smiling every time. Poor thing is shaking a lot, but she's smiling. And so it improved certain parts. I had another patient who came to me from New York and stayed with me for one week.

She was on heavy pain medicine, fentanyl and morphine for 30 plus years for back pain. I got her detoxed completely within one week, and I use an IV, NAD, which is an incredible nutrient to help with the detoxification, increasing energy level and then up, put her on LDN. And this lady wrote to me about a couple, three weeks ago saying she felt so wonderful and that she has not had a single pain medicine.

In fact, she said, I don't even take Advil orTylenol but rarely for pain now. And she was really grateful that she had done so well and all for 30 years, her life was all around pain, medicine, pain medicine, and so that was a very nice response. 

Linda Elsegood: Oh, that's amazing because if you're in constant pain the whole time, it must make you feel a little bit irritable and short with people because you have to deal with that level of pain. You can't live your life normally in pain. It's not possible. Is it? 

Shivinder Deol: Right. But see, unfortunately, that reality is, what people don't realize is that acute pain and chronic pain are not the same pain.

And it's a completely different set of effects, a completely different disease, acute pain. So somebody has an acute practice, acute injury, acute surgery, that's a completely different, set of effects in the body versus somebody who's had chronic bad back pain or neck pain or whatever for 10, 20, 30 years.

 There our need for pain medicines are different. They are now just dependent on getting that  pill, of course, rather than the true pain itself. So it's become more of a withdrawal-type pain and not a lot of ease. Opioid receptors are tight, are doubted out, and so the effectiveness goes down.

But when we use something like LDN, we recharge our opioid receptors. We reactivate them. We produce a resounding amount of receptors so that we are having much better, pain relief without the need for any external medicines.  

Linda Elsegood: It always amazes me how such a small amount of naltrexone can actually be more powerful than the fentanyl and morphine.

It's hard to understand.

Shivinder Deol: It really is. But you know,  I'm a true believer of this. The body is a true miracle. And the ability of the body to repair and regenerate itself is just incredible. Our challenges that we have, that our diets are horrible. We are living in a really toxic lifestyle. And then we have all these other stresses that are influencing neuro-transmitters and our chemicals and our hormones.

The body doesn't get the opportunity to repair and regenerate itself. So when the state garbage out of the body on necessity, medicines and toxins out, we balance some of the nutrients. We helped the body produce its own good nutrients and endorphins. The repair process becomes really dramatic and the body can pretty much heal anything.

So I see a lot of miracles, but it's really not a miracle. That's what the body is designed to do is to help. He looks healthy all the time, regardless of what's going on. So we are great healers.  

Linda Elsegood: And you were going to give us another case study before I butted in.

Shivinder Deol: I did not understand. 

Linda Elsegood: You were going to tell us of another case study. Another patient. 

Shivinder Deol: Oh yeah.  A cancer patient. Basically patient comes to me with metastatic cancer. LDN is great in supporting cancer. You can literally help stop cancers from spreading.

So this patient basically the doctors told him that just go home and die and he's a relatively young guy and he doesn't want to die. You know, who does? So he came in, you know extremely tired, extremely tired, and just basically depressed, no energy and kind of giving up. But the wife is wonderful.

Wife is so supportive of him. And so we've started him on a high dose, intravenous vitamin C, 75 grams three times a week. And he started feeling a little bit better. And then I added LDN to his regimen. I've got him on a lot of different things. So put him on a keto diet, very strict Keto diet.

And so we put LDN on, and his mood has improved a lot that he can tell, and he is now able to start to do a few things. So I don't know what the status of the cancer is. It's too early for me to do any scans on him, but I'm certainly hopeful that with his mood outlook, comparing his energy is improving that maybe we're going to get a decent result on his very widespread metastatic cancer.

...

Linda Elsegood: Well, I believe we've now come to the end of the show, so that has been amazing. When very quickly, would you like to tell patients how they can contact you if they wish to make an appointment? 

Shivinder Deol: Sure. My website is antiagingwellnesscenter.com. 

My email is support@antiagingwellness center.com and, the office phone is 661 325 7452.

Linda Elsegood: And do you have a waiting list? That's the other question.

Shivinder Deol: Do I have, what? 

Linda Elsegood: A waiting list? Do people have to wait to see you? 

Shivinder Deol: No, well we basically work people in. My philosophy always has been that we are in a service industry. We are providing a service. And  in the service industry, if you have, your electricity is gone, and you call the electrician, and he comes a month later, it doesn't work.

Or your car is broken down, you know? So if someone comes in that needs to be seen now, I'll see them the same date. I don't care. They may have to wait a little bit. We may have to work a little harder, but we take care of somebody who needs to be seen when they need to be seen. So I don't keep awaiting this for this reason.

Linda Elsegood: Oh, that's wonderful! Well, once again, thank you very much for having been our guest today, 

Shivinder Deol: Linda. Thank you very much and you take care.

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

Call 01414046545 today to speak to a LDN experts 

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

Yusuf Saleeby, MD - 20th Nov 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

I  am Dr. Yusuf Saleeby and practice in the South Eastern coastal United States in South Carolina. We have our main office near Myrtle beach and a second satellite office in Mount pleasant.

We see patients with autoimmune diseases of various types, everything from MS to Ulcerative Colitis and Crohn's disease where Low Dose Naltrexone (LDN) can be used

We are prescribing a lot of Low Dose Naltrexone (LDN). We also have relationships with several compounding pharmacies in the area, both in North and South Carolina.

If somebody comes into a compounding pharmacy seeking out LDN, but does not have a prescriber that is knowledgeable or willing to prescribe, the pharmacist will give them our names and refer them to us.

Lyme disease is a problem in every state of India, every 50 States in the US and internationall in Brazil, Argentina, China, the Netherlands, Germany.

So we are doing diagnosis with the Borrelia as well as the co-infections, like the BCO Bartonella Ehrlichia.

We know very little about good treatments. There's the variety of different protocols for for treating Lyme in the chronic phase. And it's very poorly research. It's very poorly understood, and it's all over the place.

 To protect against tick bites, if you are out in nature, after, you need to do a tick check, a full-body tick check on you. Wear brightly coloured clothing like white as opposed to a dark colour.

If you're walking in high grass pull the socks over the bottoms of your pants. Use natural repellents.

There are also some clothes that are impregnated with Permethrin. You can wear the same garment multiple times, like ten times and wash it, and it still has the active agent within the material.

When you're out in the in the woods, these little critters will crawl up from your shoes to your legs and kind of lodge in your groin area, under the armpit or axilla or back of of the neck and they can feed on you for a couple of hours or even two or three days and then fall off. And you don't realize you've been bitten.

And the heralding sign of a bullseye lesion is only present and about 30% of people who will contract a cute line.

You wouldn't know until maybe months later when you start having symptoms. And it could be a mired of symptoms. A lot of them are confused with other disorders.

A lot of people come in with Ms diagnosis,  with fibromyalgia, people with all kinds of other autoimmune diseases. And when those diseases are identified the workup stops there.

Sometimes medications that are given could be even worse than the disorder itself. But in functional medicine, we obviously go deeper to find the root cause, and sometimes we find that it is a tick-borne illness that's causing these symptoms.

Usually, at that point, it's chronic Lyme disease or late-stage Lyme, which is a totally different animal than an acute line or chew. Lyme is really easy to treat. Sixty days of Doxycycline or  a type of penicillin drug. We'll usually eradicate it, and end of a story that's it is finished. But if it sets in as chronic Lyme, it's really a different way to treat.

And it's really, really difficult to try to get it under control.

LDN does have a place in Lyme disease, and many of my patients will benefit from Low Dose Naltrexone, whether it's for the pain states associated with some of the Borrelia and Bartonella that cause fairly excruciating pain, but also as an immune enhancer because most of the people that are susceptible to the late-stage chronic Lyme disease are folks that have a  out of balance immune system. And LDN is used to put it back into balance.

I had a longstanding 20-year history of ulcerative colitis woman that came to me and within a few days of taking LDN, I get a phone call from her, and she says.

You're not going to believe this, but the bloating and gassy and my intestines and my stomach have improved like 90%.

Her belly is nice and flat. She doesn't complain of all the usual symptoms of IBD, Ulcerative Colitis.

And she's not on any of the other traditional traditionally prescribed medications for Ulcerative Colitis  Irritable Bowel Disease.

We're are seeing a lot of publications in Europe which are proponents of the use of LDN and, Inflammatory Bowel Disease.

She has sensitivity to gluten and wheat,  so if she cheats a little bit on her diet, she'll get more symptomatic. So we encourage her to be more compliant with her diet.

She's been doing that for over a decade anyway. But then with the inflammation implementation of LDN and even one milligram, her symptoms were relieved almost instantaneously.

I was just quite amazing the change in her. She almost looked  like she was four or five months pregnant when she first presented if she was that bloated.

I had a woman with Hashimoto's and  while she was on LDN, her TPO titer started to drop on a steady downward slope. And then when she ran out and was without it for three months or TPO, tighter spiked up again. And she's on a natural desiccated thyroid replacement, and she's doing quite well.

She continues taking it. I usually tell my patients. I said," well,you take it as long as you want to continue feeling well. Now if you decide at some point in the future, after two years, you don't want to feel well, well then stop taking it." And so I think they get the picture.

Or only a few patients I have to take them off  and restart at a lower dose. And sometimes they use very Low Dose Naltrexone just because of some of the symptoms. They may report a GI upset, vivid dreams that are disturbing to them. And then sometimes I switched the dosing from nighttime dosing to daytime knowing that's going to be a little less effective, but at least we're getting it in them and then making dosage adjustments.

Summary from Dr. Yusuf Saleeby LDN Radio Show. Listen to the video for the show.

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.

Dr. Michael Ruscio, DC - 14th August 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, I'd like to welcome back my guest, Dr Michael Ruscio. Thank you for joining us today, Michael. 

Dr  Michael Ruscio: Thanks for having me. 

Linda Elsegood: Now you're a speaker at the LDN 2019 conference in June in Portland, Oregon. This is a prerecorded radio show, so we've actually had the conference. Could you tell us about the presentation you're going to be giving at the conference?

Dr  Michael Ruscio: Sure I'd love to. There is a growing problem in progressive thyroid care that I'm seeing at an alarmingly increasing rate. And I think it would really benefit providers of all stripes to better understand this: essentially there are maybe two or three big misses that are occurring in thyroid care. One is over-diagnosis of hypothyroidism, or you could turn this another way - when someone isn't truly hypothyroid, but they're being offered thyroid medication as support. What often happens is the patient doesn't realize that this is being used as a temporary support. The provider doesn't make that clear delineation that they're not truly hypothyroid. Some of your levels look a little bit low, so we're going to give you this medication to try to improve your symptoms. They don't make that delineation. The patients stopped seeing that provider, but they kept taking the medication. And now, there are a fair number of patients who've been on medication for years that they don't really need to be on. And so without getting too far into details of that, that's one key component, and we can fill in some of the rationale and the facts there in a moment. But over-diagnosis of hypothyroidism in cases that are not truly hypothyroidism is becoming fairly endemic in functional medicine. 

Linda Elsegood: And where is the source of the problem coming from, because of course, clinicians are trying to help these patients?

Dr  Michael Ruscio: I don't think anyone is over-diagnosing hypothyroidism with malicious intent. I think we're all saying, well, here's the patient presenting with fatigue, depression, brain fog, constipation, dry hair, skin, nails, whatever it is. What can we do to help this patient? 

And I think what we can do to help these patients in part is better to understand the importance of gut health. There is documentation to show that various maladies in the gut can contribute to thyroid function. Autoimmunity can contribute to non-responsiveness and malabsorption of thyroid medication. And by addressing these things, we can finally see these patients respond who had otherwise been unresponsive. And sometimes it involves using no medication, or even a reduction of the thyroid medication. So that's kind of the 30,000-foot view. And I’m happy to go into more detail on any of those points. 

Linda Elsegood: It's really interesting. I've met over the last few years, many people with thyroid conditions, and they don't generally tend to reduce their medication until they're on LDN and find that it's more effective than it was before. But that was interesting you saying, and I took it to be less, was more in some cases that you don't need such a high level over time. How, how does that correlate to the gut. I know that a lot of people with thyroid conditions say that they improve greatly if they don't take gluten. What else should they be doing? Say, if you've got a patient who's got thyroid conditions, what do they need to do to try and get that gut health in the right place? 

Dr  Michael Ruscio: You make a great point, which is therapy like LDN, through its ability to positively modulate the immune system, can positively modulate the gut. And that could help with malabsorption that could be occurring because of a problem in the gut. So that's one area that is sometimes overlooked, where someone may have various digestive symptoms, and the clinician may not fully connect that. Those digestive symptoms indicate that the person is not adequately absorbing their thyroid medication. And this may account for some of the instability seen when tracking someone's thyroid levels. And there are some papers that are documenting this now, most namely in either H pylori infection or those who have ulcers, showing that the treatment of H pylori specifically can actually lead to a reduction of thyroid medication.

And of course, as you noted, there are papers published on those who have celiac disease, who when they follow a gluten-free diet, can reduce their thyroid medication. Most clinicians are probably having their patients experiment with a gluten-free diet, so that is a great recommendation. It's probably not offering the clinician anything new that they haven't heard before, but looking into something like small intestinal bacterial overgrowth or H pylori, that may offer benefit. And again, sometimes we attribute this to healing the thyroid.  This hasn’t been fully borne out by the research yet, but my thinking is when you see a change in the need for thyroid medication where someone actually needs less medication that occurs over the course of a few months, that is almost for certain not going to be due to healing the thyroid gland, but more so due to improved absorption of the thyroid medication. We see this in some of the H pylori studies where patients were able to decrease their dose of medication. And we've published on our website a handful of case studies where we've been able to reduce, in some cases as much as half someone's thyroid medication dose.

At the same time, the patient is losing weight in a positive direction, meaning they were a bit overweight, and now they're at a healthier weight. They have better energy, better skin, less joint pain. 

And there's another parallel here that reinforces the same finding, which is using the liquid gel tab form of thyroid hormone known as Thyroxine. And also some research has been performed showing that in patients who have been unable to obtain stability in TSH and T4 and/or the resolution of symptoms use Thyroxine and actually are able to get many patients to a more stable TSH and T4 and improve their symptoms. And this is almost again for certain because Thyroxine being in a liquid gel tab is much more easily absorbed than some of your more traditional tablet forms. That's just a couple of ways in which the gut can directly impact the absorption of thyroid medication, which again, I don't think is being given the amount of attention that it deserves. And I can say in clinical practice. That can be the difference between success and failure in some of these cases.

And I'll just juxtapose that with - sometimes the clinician is really floundering with a patient on Levothyroxine and maybe they need to add in some T3 Cytomel, or maybe they need to switch them into a desiccated form something like Armour Thyroid or even WP Thyroid or Nature-Thyroid, or anyone of these medications that's a T4-T3 combination. 

And that's not really what the cause of the problem is. The cause of the problem is inconsistent absorption, and that is oftentimes addressed by improving the diet. As you noted, with something like gluten-free or if someone's already gluten-free, then considering some type of dysbiotic or infectious issue in the gut can then be what improves the gut health and allows the patient to more consistently absorb the medication, and then their blood levels look better and then their symptoms also look better.

Linda Elsegood: So how do people know what their gut health is? Like? How, what are the symptoms?

Dr  Michael Ruscio: That can be one of the biggest challenges because we're starting to learn that you can have - and actually, some of the older celiac research has shown this for a while - that you can have an active inflammatory issue in the gut that only manifests extra-intestinally. Meaning you have no digestive symptoms, but you may have something like atopic dermatitis or depression or fatigue or joint pain.

So one of the challenging things can be figuring out whether the gut is the root cause of this problem. Because you may have no gut symptoms, testing is oftentimes offered as a solution here, which it can be; but the testing is really imperfect, in my opinion. There are a number of things that we can test for, but there's also a number of things where the testing still hasn't been fully mapped out yet. And just as one example, we know that small intestinal fungal overgrowth does exist. Dr Satish Rao has published some research on this. But because doing a sample directly from the small intestine is impractical, then that's not something that we can really readily assess in clinical practice. So if someone could do a breath test for SIBO and a stool test for other types of bacterial and fungal dysbiosis, that's a great start. But we still might be missing something like small intestinal fungal overgrowth. 

So, in answer to your question, what can be used to help assess the health of someone's gut? Testing gives us a slice of information that can be helpful, but it doesn't give us all the information and the way I look at this is to consider taking steps to optimize your gut health kind of proactively. Even if you don't have a diagnosis of H pylori or small intestinal bacterial overgrowth, consider taking those steps to proactively improve your gut health.

If you've improved your diet, if you have a healthy lifestyle, but you're still not following optimally, well, so you're still not feeling optimal. Well, then. I think it's a good idea at that point to just, again, proactively and almost more so - empirically take steps to improve your gut health, because it can be challenging to get that definitive diagnosis on a lab test of various sorts.

Linda Elsegood: I've had people with thyroid conditions ask me questions about gut health, and they say, how do I know if I've got leaky gut? I've read that there are people that have leaky gut, and I seem to have the same kind of problems. What tests do you do for leaky gut? You mentioned that.

Dr  Michael Ruscio: Great question. And this is another area where the testing is really imperfect. We just performed a comprehensive review of the literature, literally looking at every test in humans on the markers, serum zonulin, which may be one of the better markers for assessing leaky gut. No marker really is perfect. Zonulin, that may be the best test now. Zonulin is a marker essentially of tight junction proteins in the gut and can be assessed via blood or stool, and it does correlate with various diseases like diabetes, metabolic syndrome; and in some cases, inflammatory bowel disease and IBS.

So it does seem to correlate with diseases or symptoms, but not in every case. But where the argument falls apart a little bit more, unfortunately, is when we look at what happens when we treat people, we put people on a healthy diet or on a probiotic or what have you, and this is where there are much more inconsistent findings with zonulin.

There had been a few studies showing that in people with symptoms and with high zonulin, meaning leaky gut, they then improve their diet and see a drastic improvement in their symptoms. Yet their zonulin gets either worse or stays the same. Now to be fair, there are also studies showing that zonulin can improve after using something like a probiotic, but there are also studies showing that people will see no improvement in zonulin after taking a probiotic, even though their symptoms have improved. I know this may be a little bit unpopular for me to say, uh, that zonulin may not be quite fully ready for the routine clinical application, as there are some inconsistencies with testing for leaky gut.

So this is why I say testing gives us a slice and it can be helpful, but we really cannot fully hang our hat on test results alone. Because when you look at the data behind these tests, in many cases, what you see is the tests do not perform perfectly. They're only partially informative, and so the best test, arguably, for leaky gut would be zonulin, but it certainly is not something that I think is highly reliable. So it's one slice. But we also want to take the patient's symptoms into account. And so maybe to just paint a scenario here, if someone came in with rheumatoid arthritis and they wanted to know if their gut was contributing to that rheumatoid arthritis, or even their thyroid condition, what we could do is perform some testing, and that would be maybe one-third of the data that informs how we're going to proceed. And if we find something on testing like small intestinal bacterial overgrowth or H pylori, we can treat those. However, if the testing comes up negative, one still may want you to consider a round of treatment. And this is where using things as herbal medicines and probiotics make a much more of a tenable approach, because these things I don't think, require the same rationale as using something like an antibiotic or what have you. But treat the patient for a presumed imbalance in the gut and then monitor their symptoms. If their symptoms are improving or if the dose required for the third medication becomes more stable, or even they start to appear hyperthyroid like they need less medication, then that tells you that you're on the right track.

And again, I know it's easier if I were just to proclaim one or two tests to be the best and one or two markers, and that's the easy message I think we all want. But unfortunately, when you take that easy message into clinical practice, you get really confused. And if you take my message, which is a little bit more nuanced, albeit being a little bit more complicated, I think you'll see, it really interfaces into the clinical practice more consistently and delivers better results.

Linda Elsegood: Well, I mean, unfortunately, your stomach and your bowels, you can't see, can you? It's not like psoriasis on your hands or something that you can see what's going on there. When I have spoken to doctors and asked what they think are the top four supplements that people should be taking, probiotics are always number one that people should take. What kind of a probiotic would you suggest to patients who wanted to take that to improve their gut health? 

Dr  Michael Ruscio: That's a great question, and I would certainly agree that especially for someone who's trying to improve their gut health, then a probiotic is a fairly inexpensive intervention and very safe, or even now showing some secondary health benefits. For example, one analysis has documented improvement of mood. Other research has shown a small but significant ability to improve cholesterol, blood sugar, and even blood pressure. Again, the effects there are small, and I would say not clinically significant, but at least you're getting a small movement in a healthy direction.

So I'm just trying to showcase here the neutrality, or at least small side benefit, of probiotics rather than there being some downside. We know that probiotics can improve things like H pylori and, and be synergistic with H pylori antibiotics. And in my opinion, may help to kind of re-establish a healthier balance of H pylori colonization. And they can help to eradicate things like SIBO, and intestinal fungal overgrowth. So certainly the end reduces leaky gut and there's a lot of benefits that we can attribute to probiotics. 

It's your question that’s a more challenging thing: what probiotic do I use? And this is where I think both the clinician and the consumer are confronted with just a dizzying array of options in terms of the probiotic formulas out there. One of the things I write about in my book is organizing probiotics into three different categories. And this greatly simplifies the landscape in probiotics. And when, when you read enough of the research on probiotics, and you sift through enough of these meta-analyses that summarize the high-quality clinical trials, you start to see that we can break probiotics down really into technically four categories. But one category is hard to obtain, especially in the US, so I typically focus the conversation on the three categories. 

Category one is a blend of lactobacillus and bifidobacterium strains. The exact formulas differ slightly from product to product, but then, the underlying and unifying theme is you will see the strains in the formula are predominated by various strains of lactobacillus and bifidobacterium. Your category two is just one strength, typically, which is the healthy fungus, Saccharomyces boulardii. And then your category three - you have typically anywhere from one to maybe five or six strains that are often known as soil-based or spore-forming probiotics. What I like to do with patients is have them use a moderate dose of all three of these; or in more sensitive cases, they will likely have reported some reactions to probiotics in the past.

And what you want to identify as a clinician is what category do they seem to be reacting to? Because oftentimes people are taking a category one probiotic that's the most popular and common probiotic out there. They may have tried two or three or even four different probiotics, not realizing that each one was a category one, a category one, a category one, a category one. And so they come in and say they just can't do probiotics, they react really negatively. And that's where taking a quick history and seeing if they know the names of the probiotics, quickly looking them up and determining, okay, all of these were in fact category ones. So then you can have them start with category two and category three. There are some patients by just going through that exercise of having them try a probiotic category one at a time, you can pinpoint that that is a category that you react negatively to. Now we can use the other category or categories that you do tolerate, and then you can obtain that fairly impressive benefit that can be vectored by probiotics and help the patient navigate around that reaction that had been kind of slowing their progress previously. 

Linda Elsegood: Well, the first time I wanted to buy some, I went into a whole food shop, and they had rows and rows of probiotics, and some started at 10 pounds, and some went up to 50 pounds. And I was trying to read on the bottle what was in the 10-pound one, what was in the 50, and what everything in between was. And I was just so bewildered by the end of it I asked for some help, and the young man didn't know either, really. So I just went for a middle-priced one to try it to see what it was like. But you have to do your research. It's not easy to find out. It's a minefield because there are so many things on the market and some that are similar like you're saying category one, but they're still not the same price. You know, the convenience. Sometimes if it's a really well-known brand, I think you may pay more for the name as well. 

Dr  Michael Ruscio: So thank you so much for making that comment, and you're absolutely right, which is the quality of a probiotic does matter. We want to be careful not to think that more expensive automatically equates to better. And we also want to be careful that if something is drastically cheaper than others, then there may be some corner-cutting that is occurring.

So there are things that you can look for. These can be, I think, challenging for consumers, and also probably challenging for clinicians if you're not used to fact-checking these types of things. But you can look whether a company is following good manufacturing practices and is also having third party testing to ensure that their probiotic meets its label claims. And then also looking for companies that aren't using fillers. That can be irritating, especially when we're talking about people who have sensitive guts. Some probiotics, this more so happens with cheaper probiotics, they're not very potent, and they're kind of watered down with other fillers or things like prebiotics, which are significantly less expensive.

Another way around this is just finding a couple of companies that are fairly reputable and just try to use the probiotics that fall into the category system. Find those reputable companies - that's quite a bit easier than just going into a health food store and trying to figure out their 15 different probiotics. Which ones can I trust? Which ones can I not? 

Linda Elsegood: And of course, it's the same in America as it is over here. I mean, supplements aren't regulated, so you can have labels that make claims of what's inside it, but they don't have to put a percentage, so if it's not like pharmaceutical grade, where they can prove, as you were saying, what is actually in there is on the label. It is reassuring to know that you have done the best you can to try and find out what is in the probiotic or supplements of any kind, because the layperson just wouldn't know - so trying to get a good manufacturer, that's what I'm trying to say, is really the starting point, in my opinion, as a consumer. Someone that you can trust, because you can spend a fortune on the cheaper brands that, as you said before, might have fillers and all of this kind of thing. And actually not have that many ingredients that are actually going to help you. But you know, if something is a quarter of the price, it's a waste of money if it's not going to work, isn't it? So sometimes you have to pay that bit more to make sure that you've got a product that is going to do what it says it's going to do. 

Dr  Michael Ruscio: The way that I learned was with protein powders, where I was using the most expensive protein powder and I noticed it. You make your shake, and sometimes you put it in one scoop, maybe sometimes you're a little more hungry, you want a thicker shake, so you put it in maybe two or three scoops. And if I ever had more than one scoop, I would get bloated. And I later learned from one of my friends who owns his own manufacturing company, that you have to really watch out for companies putting in excipients, which are powders that help the machines run more quickly. And he explained to me that because the machines run more slowly when making his protein powder, he had to pay extra to have them not put the excipients in. So it is a legitimate thing, and especially if you have a sensitive gut, just making sure that who you're getting your product from cares about these things. And it may not be that a manufacturer is trying to do you harm, but they may be saying, well, we're trying to cater to a market that is very price sensitive. So we're gonna use excipients to cut down our costs. 

We're trying to provide these items that are most gut-friendly and maybe a little bit more expensive. But I think the customers that we're trying to appeal to understand that. A slight increase in expense, the quality would be worth that. So, yeah, it is important to find a company who is going to be attentive to these things and, and make those tough decisions of making the product more expensive when it's really in the best interest of the consumer.

Linda Elsegood: Let me ask you, what's your diet like, Michael?

Dr  Michael Ruscio: I loosely eat a paleo diet. I do eat quite a bit of dairy, and thankfully I have no problem with dairy; most meat, vegetables, fish; and I don't eat much in the way of grains. I do have some rice. I do generally avoid gluten. I do notice if I eat too much gluten, I do have a problem. Even though the healthcare consumer is told that everyone should avoid gluten, I think it is incorrect. And that's not borne out by what the best research on this topic has found. But essentially - lots of vegetables, meats, healthy fats, fish, moderate to kind of lower-carb diet. So some gluten-free grains, but not a high amount. Some kind of a moderate lower carb, paleo diet with some dairy would maybe be the best label that we could put on it. 

Linda Elsegood: Some people say that they find diets for eliminating food really restrictive. And they will ask if once they’ve started down that road of eliminating these foods, will they ever be allowed to eat them again? So you were saying that sometimes you still have gluten and you know when you've had it, so obviously you don't exclude it completely. 

Dr  Michael Ruscio: Right, and you make a great point, which is we want to be careful with diets. Not to think that an elimination diet means you eliminate forever. Most elimination diets follow the pattern of cutout foods that could be a problem for maybe a month, maybe two months. And then once you feel you've improved, then bring the foods that you can back in a kind of systematic manner, where you're bringing maybe one or two in at a time, so you can identify what foods sit well with you and if any foods are triggers.

And then it's not to say that because a food is a trigger you can never have any, but you want to be a bit more judicious with how you use it. That is really, in my opinion, a key distinction to draw because what I see happening with patients is they become so scared of food, and they may have little to no reactivity, let's say, to gluten. So they can get away with having some on some occasions. Now, if you're noticing some reactions to gluten, would I recommend making a dietary staple? Absolutely not. Right? There's also this ability to live in the world without being afraid. 

And this is where I think some of the hard-line messaging on gluten is really damaging people from a psychological perspective, because now these people are at a restaurant with their friends and should be enjoying themselves, and they're worried. They're sitting there frantically worrying internally, trying to hide it behind a smile on their face, about is there gluten in the sauce here? And now again, there are some people who are exquisitely gluten sensitive, and they have to operate like that, but I don't think that they would wish that on somebody else who at worst may feel bloated in forty-five minutes if they have some gluten. So, your level of avoidance should be required with your level of intolerance. I know that the gluten-free staunch advocates will take issue with that, but you have to weigh that against the psychological damage we do to people who don't have much of a physiological reaction but are inculcated and feared into thinking that they will have massive damage if they have gluten. And now every day in their life, they have this baseline level of fear that is damaging their health. And so when you weigh these all out, I think it's clear to see that, yes, we want to identify gluten as being a problem in those that it is and help them avoid it as best they can. But people that have little to no reactivity, they have some leeway, and we don't want to fear them into thinking that they have to eat like they have celiac disease. 

Linda Elsegood: Wonderful. Well, we've come to an end and where's the time gone? It's been amazing. Thank you so much.

Dr  Michael Ruscio: Yeah. It's been a pleasure chatting. Time always flies when you're having fun, right? 

Linda Elsegood: Well, we'll have to have you back again, so thank you very much for having been my guest today. 

Dr  Michael Ruscio: Thank you again. It's been a pleasure.

Linda Elsegood: Healthy Gut Healthy You by Dr Michael Ruscio is a long-anticipated and comprehensive guide to completely resetting and healing the gut. Arm yourself with the education tools to heal yourself from the inside out today. Visit drruscio.com for details.

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 healthy.

Thyroid Autoimmunity: Causal Relationships & Novel Therapeutics (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Links between growth hormones, sex hormones and the thyroid gland; their effects on sexuality, musculoskeletal function and immunity. Gut repair protocol. Positive effects of LDN, including in diabetes.

Let's begin with a cursory review of auto-immunity. Of course, many of us here understand all of this, but let's go through it as it specifically relates to thyroid. Thyroid autoimmunity begins with some form of environmental trigger. One good example is an antigen from food allergies, and we've been hearing a lot about that this weekend. An APC, or an antigen presenting cell, presents the antigen to a CD4 cell, and the cascade we see here is triggered. So classically, we believe Hasimoto's to be TH1 dominant. But this graphic, modified from an article published in 2002 in Nature Reviews Immunology, proposed that autoimmune hypothyroidism, or Hasimoto's thyroiditis, results from both B cell and T cell activation, which could be both TH1 or TH2 dominant. Both mechanisms are generally occurring. I think that's important. However, they do propose that for autoimmune hyperthyroidism, or Graves' disease, it’s largely B-cell and TH2 dominant.

We also have to appreciate the classic TH1 versus TH2 models being challenged. There are other discovered classes: we've got a less known TH3, there's another one called TH17 with its own chemotactic components which LDN has been proposed to influence and to modulate. The excellent thing about LDN is its ability to influence both TH1 and TH2 and TH2 dominance over other immune classes, due to overall immune modulation. This would be particularly important in Hashimoto's, as it seems to be both TH1 and TH2, and or some other immune class known or unknown. So again, immune modulation is the key to be achieved through all these multiple therapeutic vectors.

We've got four therapies here to consider, to create and reestablish immune modulation. There are others of course, as we all know, but these tend to be the most direct routes, at least for us at our clinic. So of course, LDN, as I just stated, one of the great things about LDN to wield as a therapeutic tool is this ability to sort of modulate the immune system. It's clinically forgiving, and the patient benefits. Also, the use of thyroid hormone product that contains both T4 and active T3. My particular practice focuses on comprehensive hormone replacement therapy that considers estradiol, progesterone, testosterone, cortisol, insulin, growth hormone. We know that estrogen, progesterone and cortisol tend to increase TH1, whereas testosterone, DHA, and androgens tend to influence an increase TH2. The balance of course is important. The consideration of all these hormones comprehensively will provide optimal immune modulation. And finally, the gut. We've been hearing a lot about that this weekend. We know that the gut is associated with immunity, and its dysfunctions related to opportunistic infections, food sensitivities, dysbiosis, and autoimmunity in general.

We've been tracking observational internal data on LDN and thyroid antibodies for the past about two years, the best we could in a very busy practice. Since Hashimoto's is far more common than Graves' disease, we placed our focus on Hashimoto's. We presented a total of 53 patients; they're replaced in two categories: LDN-only, and LDN with a gut repair treatment protocol. It's really important to note that the LDN-only group is also receiving comprehensive thyroid nutritional hormonal support - please don't think that it's just that. We deal with things very comprehensively in general, but what I'm trying to say is that there's a difference between the LDN-only group versus the people who were also on some kind of specific gut repair protocol that I'll explain in the next slide.

We simply calculated the average thyroid peroxidase antibodies and the average thyroglobulin antibodies, then we calculated the average values of each after a length of treatment. You can see the average there. We've got far more patients in our practice on LDN than this sample here, but we only included patients who had at least one follow-up lab to show a calculable difference in their antibodies, so we excluded some out. The LDN-only group of 39 patients with an average treatment time of about 13 months, showed a very significant antibody drop, particularly in anti-TPO, which is of course the most common autoantibody, but of course we always check both. Beginning average antibodies on gut repair patients was much higher and the change was also less significant. This is consistent with the general observation that significant gut compromise is related to autoimmunity; and as we'll see later, that compliance to gut modifications is significant.

The patients who chose to do the gut protocol in general had the most obvious outright symptoms of gastrointestinal distress, hence motivating them to want to do the testing and follow through with the diet and the supplement commitment. So again, compliance. We can see that the decrease in thyroid antibodies in the LDN plus gut repair group was not as significant as the LDN-only group. This could be due to compliance and adherence to the gut treatment protocol, and the very small sample size of only 14 patients versus the 39.

So why did we do this? Why did we track this? What was the motivation? One, we want to make sure that we're incorporating a treatment strategy that was indeed effective at lowering antibodies. We wanted to see. Two, at least to my knowledge, there's little direct evidence and research about the use of LDN and its specific effects on thyroid antibodies, at least by what I could find If I am wrong about that, I encourage someone to let me know at the end of this presentation. Then three, because I'm a dork and I genuinely like to play this game and I like to crunch the numbers and see what we can find. We seek to add to the body of knowledge about LDN, however humble and modest this observation and methods are. It is our hope that other prescribers of LDN do the same as we have, or at least inspire the call to other researchers to provide in-depth analysis and results about LDN specific to thyroid autoimmunity.

Here's the gut repair protocol, a little bit of detail. We start off with a serum analysis of IgG reactivity to 154 different foods. It's a standard industry test. For those with high suspicion of wheat and/or gluten activity, we'll add a different test as well. And that'll include glutenin, gliadin, and what I think is very important, non-wheat, protein fractions as well. All patients in our sample had at least 11+ foods that they were reactive to. That could have been wheat, gluten, or the other foods. They were then instructed to follow a diet that of course removes these foods, and they have to do that for at least 90 days. Our gut repair protocol can, of course, go longer, but we start them off with a three-month process. During that 90-day restriction, they follow the supplement regimen designed to repair and restore gastrointestinal integrity and function. You can see the gut cocktail here. This is a simple, relatively taste neutral beverage, and includes glutamine, fructooligosaccharides, Acacia senegal, and n-acetyl-d-glucosamine, the classic herbs slippery elm in a powder form, and good old aloe vera juice. They can mix this in water, or a juice of their choice. It's consumed twice daily. We also use a professional strength, broad spectrum probiotic. We start off with a loading phase of 300 billion times 10 days, and then we go to 100 billion daily for about two months after that, and then about 30 billion as maintenance after that. Finally, we used a dual phase digestive enzyme formula that includes hydrochloric acid, pepsin, et cetera, as you can see here.

Let's do a quick couple of case reviews here. Here's a great example of a patient from our sample who was prescribed LDN and diagnosed with leaky gut, and placed on our gut protocol. He presented with a strong history of irritable bowel syndrome diagnosed when he was very young. He goes through the normal testing. He had several loose bowel movements when he first presented, including uncomplicated hemorrhoids with some occult blood. He was routinely screened by a gastrointestinal specialist. His thyroid antibodies are elevated. He also presented as hypogonadal, and he was only 28. Aside from the gut repair protocol, he was prescribed natural desiccated thyroid, and of course LDN 4.5 mg. He was really compliant for those first six months. Stools largely normalized, and his hemorrhoids improved. He got better and you can see his antibodies really got better as well, lowered drastically. Because he improved and it was part of the typical 90-day protocol, he was less compliant. A lot of times once patients get better, they start to slip a little bit, as we know, and you can see that his antibodies slipped, but he was still on the LDN, but his antibodies went back up a little bit. So this is an example of how important comprehensive care is when treating thyroid autoimmunity or any autoimmunity. The food sensitivities and gut permeability are not always fully corrected after 90 days. Sometimes we have to continue to go much longer.

Now to speak to his hypogonadism, I recently presented in London at the International Congress on Naturopathic Medicine, and my presentation was on the global decline of testosterone and sperm in men. I presented research regarding all of this and what I had found, and it was only maybe about three weeks after that presentation that another large landmark study came out of Jerusalem that did really, in fact, confirm that sperm is lowering in men. Okay. Part of that presentation was the causal relationships for lowering testosterone and sperm, and what the functional medicine practitioner can do to help. There are all kinds of reasons for this decline, but we think of diet and toxin exposure, gut compromise, and maybe even autoimmune thyroid disease. And maybe that's relevant to this example. So, in this patient, a change in diet and improvement, all of this, it actually helped with his testosterone. It's also important to mention that he and his wife were trying to get pregnant for about a year before he came to see us. And they got pregnant. So coincidence? I don't know, maybe, maybe not.

Here's another example from our sample. This was a 37-year-old female with high expression of autoimmunity, in an LDN-only group because she didn't do anything significant with her diet. She had other things going on: vitiligo, vaginal lichen sclerosis; and we discovered Hashimoto's. Interestingly, she had already known about that to some degree. They had seen serum elevated antibodies, but her conventional doctor said, well, there's nothing really you should do about that. I think we've seen some evidence here this weekend that it is important to preemptively work with someone who has that, despite what they may or may not be presenting with clinically. This patient also had low testosterone and suppressed estradiol production from oral contraceptive use. Oral contraceptives suppress ovarian function, it’s just what they do. It also can lead to gut dysbiosis, nutritional deficiencies, particularly magnesium. I gave her a low dose estradiol, optimal testosterone using subcutaneous pellets, something we focus on, and a plan to slowly wean off of her oral contraceptives. She was also placed on a nutritional regimen, of course desiccated thyroid, and of course LDN 4.5 mg. When she returned, you can see it was pretty straight forward. In a relative very short period of time, about five months, her antibodies lowered, her symptoms drastically improved. She had less headaches, which was another big concern when she first came in to see me. She's off the birth control pill, and we were able to just get her off the estrogen. She just didn't need the estradiol anymore; but she maintained the testosterone - she liked the libido from that, so we maintained that.

Why did her antibodies lower? In this case it could be several variables. It could be just getting off of the oral contraceptives, it could be the use of the natural desiccated thyroid, the normalizing of her sex hormones, all of which have immune modulating effects in and of themselves. Or, at least these could be obstacles to cure, something we say in naturopathic medicine. But of course, it could just be the LDN.

We’re here at an LDN conference. We've gathered under the basic premise that we believe LDN is worth prescribing. I certainly do, but I'm seeing changes with its use in my patients. I'm not a fan of the statement that science is settled. I think it makes us intellectually sluggish. So I think we should continue to look deeper for the sake of our patients.

A final case review, another example from our sample, technically in the LDN-only group, but who did make specific diet changes I'll explain here. This is a 56-year-old menopausal female. A large percentage of our patients would fall into this demographic. She's on desiccated thyroid, estradiol, testosterone subcutaneous pellets with oral opposing progesterone. Her initial anti-TPO was 2315. It rose up a little bit after that. At that point, she got a little more motivated to get on the LDN. We gave her that, and you can see that it started to lower.

Hashimoto's presents with these flares. You can have up and down of the antibody response anyway. But about six months later, on July 8th, 2016, we discovered mild insulin resistance and suboptimal glucose; hemoglobin A1C, insulin, homocysteine levels, all being suboptimal. At that point, I'd given her 500 mg tid of Metformin, and a proprietary palladium alpha lipoic acid mineral complex that some of you may be familiar with. Those were an injection form. I reduced her net carbs at 125. That seems to be a very reasonable and effective number, and all this of course led to getting rid of a lot of her grain-based carbohydrates as well. You can see, in a mere four months after that her anti-TPO antibodies dropped to only 74, essentially normal. This was the lowest reading she had ever had.

Was it the LDN by itself? Perhaps. I've observed that LDN very often takes several months for the full impact on thyroid antibodies to be realized, yet the idea that she avoided, or at least limited excessive carbohydrates, particularly grain-based carbohydrates, that could be part of it. Her treatment for the insulin resistance included the use of Metformin and the low carb diet. Maybe that's the reason. There is evidence that overproduction of insulin leads to B cell stimulation, possibly potentiating the TH1 pathway.

Ultimately, comprehensive strategies help the patient to realize optimal results. That should be the perspective of any functional medicine practitioner who decides to use LDN. I believe it's important to approach thyroid management in this comprehensive fashion. Tolle causam, or treat the cause. This is another tenant in naturopathic medicine that is known within the functional medicine world. I believe that the use of LDN helps us to treat that core cause, that often is autoimmunity. Another saying in naturopathic medicine is to heal the gut and the rest will follow. And this is a generalized idiom that so often is true. It's almost always an excellent place to start.

The endocrine system is one, if not the most vital system within the body. We have hormonal influences and production within the womb before we ever develop a nervous system. So dare to balance the endocrine system and you help many things with your patients, including thyroid autoimmunity. A healthy immune system is also key to managing thyroid disease. LDN proves to be one of the most effective tools in doing this, particularly when it comes to lowering an antibody response, I believe.

And finally, one of the most overlooked possibilities in thyroid hormone diagnosis and management is the clinical measurement of metabolic rates. It's something that we look at very, I believe, somewhat uniquely. And certainly of course, we look at mitochondrial function, as thyroid hormone influences mitochondrial function, second to none. If we can look at things from that perspective and correct that. even above and beyond the conventional perspective of serum analysis, then the patient realizes optimal outcomes, the patient actually gets well.

I look forward to your feedback and input on this presentation. I hope that it helps to lessen the pain of at least even one person. Thanks for your attention. Thank you.

Keywords: low dose naltrexone, LDN, thyroid, Hashimoto’s, autoimmune, antigen, TH1, TH2, Graves', immune modulation, hormone, gut, dysbiosis, thyroid peroxidase antibodies, thyroglobulin antibodies

 Presentation at the LDN 2017 Conference

Cindy - 3rd July 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda: Today, my guest is Cindy from the United States who takes LDN for MS. Thank you for joining us today, Cindy.

Cindy: You're welcome!

Linda: Could you tell me when you first noticed that there was something wrong with you? How long ago was that?

Cindy: Well, back in the 90s I was a letter carrier. I worked for the postal service delivering the mail. I noticed I started to have trouble with my balance. My leg would go numb. I would have days where my vision would change. It turned out it wasn't bad. After a couple of years of having MRIs, they were inconclusive, just not knowing the reasons, not knowing what they were. Then the year 9/11 happened and I was still working for the postal service. It was a very stressful time. From thereafter I had a flu shot because they thought I had anthrax. So I had the flu shot and 10 days later I had the biggest flare-up of anthrax that I ever had, and I didn't know I had MS yet. I noticed that I was numb from the waist down. I couldn't see, and I was in the hospital on steroids for a week. I had two months of physical therapy to recover from that. Then they diagnosed me with DNS and suggested Interferon, all those kinds of drugs. I did go on Copaxone for a while but I couldn't tolerate the side effects. So went on and off for years, and then I retired from there. I don’t do that anymore because I just couldn't do it anymore. My primary doctor showed me a book on its medical background and I read it. I went to my neurologist and asked if I could try this and she let me do it. It's been wonderful. There's a big difference in the way I feel every day. The fatigue is gone, the brain fog is gone. I feel so much better. I've had a recent MRI with no progression, no lesions which clearly confirms that this really does work and work very well.

Linda: So before you started LDN if you had to rate your quality of life on a score of 1-10, what would it have been?

Cindy: Probably about a 5 or so because what would happen is I would get up and I would be awake and able to do some things but then around 12 o'clock, 1 o'clock, I would be too tired to do anything after that.

Linda: How easy was it to get a prescription for LDN?

Cindy: Very, very simple. I went to my neurologist and she said that she'd heard of it but she said she would let me try it. So she let me try it, wanting me to stay on my previous medication as well and I decided I wasn't going to stay on and give this a try. I let him do it and I was also taking a couple of antidepressants at the time. I had been on them for years and I found I was able to wean myself off of those as well. So I'm not using those either. Then they wanted me to have another MRI. So I had that and then found that it really did work. I was afraid to almost have it because you want some confirmation. I thought it was a good MRI. There was no further progress.

Linda: What would you say your quality of life is now on a scale of 1-10?

Cindy: I would say it's very good. I mean, you can't do everything, but I think about the hours I spend being able to work all day and being able to be alert enough to get things done. I had that short window of time where I would get things done in the morning but that's not the case anymore. I can do much more than good.

 Linda: What would you say to other people with MS who are contemplating trying LDN?

Cindy: You’ve got nothing to lose. You won't regret it. You really need to try it.

Linda: In your experience, how long did it take before LDN worked for you?

Cindy: It took 2-3 months because I started out at 2 mg and then I worked my way up to 5 mg. My neurologist wants me on 5 mg. I don't know why. It's the switching what she wanted. So I went along with it. She gave it to me, and I think it's fine. I think I could probably sleep better if I take a little less, but after a while, I got over it. I started to feel really good.

Linda: Did you have any introductory side effects at all? 

Cindy: I did have to take it in the morning and now that I have a good MRI that shows that it's working, I don't worry about taking it in the morning. I just can't take it at night. It gives me too much energy.

Linda: There are people with Chronic Fatigue Syndrome who do prefer taking it in the morning for exactly that reason. They feel it gives them more energy taking it in the morning than at night because they don’t want to be wide awake in the middle of the night.

Cindy: Exactly and if It does work just as well, there's no reason to put yourself through insomnia.

Linda: What would you say to yourself in the past if you were able to go back and talk about LDN?

Cindy: I wish I knew about it. When I think about all the years I spent taking some of these drugs that actually did some damage to my liver and also had side effects… I wish I'd known about it sooner. I wish I did 20 years ago. I'm going on 18 years now. Two or three years before that, not knowing what I’ve been diagnosed with, but I think about all the years of doing other things, not knowing that there's anything else. I think it's a shame that more people don't know about it.

There are so many choices out there now where there wasn't any before, but I think this was such a good choice that if it's not tied to the mainstream. You’re competing with all these expensive medications out there that claim first and offered first. It's not worth it unless you ask for it. That's what I find to be so frustrating in the US is that you have to ask. If you didn't know to ask for it, you would never be told about it. I think that's something that needs to change.

Linda: I just think it's sad when there are people out there who will inquire about LDN, ask questions and they’ll say “I think it's really good. It's something I'd like to try people with MS”, but they don't want to give it now. They want to wait until they need to take it when things start to go wrong. I always think it's their choice. I don't say this to people, but I would rather take it before I go downhill rather than take it when you are downhill to try and improve yourself. If you can hold the progression, it's got to be a win-win, hasn't it? Rather than try and see what you can get back. What an amazing story, Cindy, and thank you very much for sharing it with us today.

Cindy: You’re welcome! I hope things change in this country where people will know that there's more than they do now.

Linda: We're working hard and we've got you as a volunteer, so that's got to be a win, win too and the best advocates are those people that take LDN. Thank you for joining us and helping us spread the word. Let's make LDN easily accessible for everybody, regardless of where you live in the world.

This show is sponsored by our members who made donations. We'd like to give them a very big thank you. We have to cover the monthly costs of the radio station software, bandwidth, phone lines, and phone calls to be able to continue with the radio show and thank you for listening.

Any questions or comments you may have, 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.

Laura Dankof, MSN, ARNP, FNP-C 26th June 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Laura Dankoff, who is a functional medicine nurse practitioner, speaker, and author. She has her own practice, which is a path to health and healing. Thank you for joining us today, 

FNP Laura Dankof: Linda, thanks for having me on. I'm looking forward to this. 

Linda Elsegood: Now, we interviewed you about three years ago, and as you well know, so much can change in a period of three years. What has been happening in your practice? 

FNP Laura Dankof: Well, I've noticed in my practice over the last three to five years, that the interest and number of people seeking out LDN as a treatment option has increased. And that's certainly been mostly due to word of mouth, but also some people have actually found me through your website as well.

Many have travelled to meet with me to determine if LDN is an option for them, as they are really frustrated with their healthcare. Sometimes they are not getting answers, or perhaps feel that there's another path that they could be exploring, and they're wondering if low dose Naltrexone is an option for them. 

Linda Elsegood: And we didn't say where your practice is did we?

FNP Laura Dankof:   That is correct. My practice is located in a little town called Westcliffe, Colorado. I used to practice in Iowa for several years in internal medicine, and so I still am licensed both in Iowa and in Colorado. And, I offer virtual and in-person appointments. 

Linda Elsegood: Oh, that's very interesting. All right, so then what would you say your patient population consists of?

FNP Laura Dankof: My patient population is a lot of people with autoimmune disease, digestive issues, hormone issues---et ceteria. Quite frankly, they're generally people who have already been through the conventional healthcare system with a traditional workup, and either has been handed a laundry list of medications or been told that there is nothing wrong with them, and there's nothing that can be done.

And they, of course, are looking for answers. They don't want to settle for that conventional diagnosis and treatment. They want to figure out, with functional medicine, what the root cause is that is preventing them from feeling well. And so, this is where we start to look at lifestyle and what's happened along their life timeline.

And in the process of that, particularly people with autoimmune conditions, such as Hashimoto’s, and other conditions such as fibromyalgia, chronic fatigue, and even severe depression, people have come to me wondering if LDN would be something that could help them.  And a lot of times I also learn from my patients, and so will look to find what research is available out there and to determine that there is no contraindication, say, for example, them being on narcotics.

Then I would tell them, it's not going to hurt us to try LDN, to see if it helps you. 

That certainly has been true with a couple of cases of severe depression that came to me.  I had never really used it in that way, and so that was one of LDNs use that kind of surprised me, that it did seem to help anecdotally, just from my experience with these patients.

 With one patient Debbie, LDN did seem to help some with her depression.  I used it in one patient with Lyme disease, a lot of cases of Hashimoto's, where we looked at and monitored their antibodies, along with other things, that can certainly contribute to Hashimoto's. You need to look at gut health, hormone balance, detoxification pathways, and a lot of other things.

So it's just not using. Low Dose Naltrexone alone. You certainly want to look at all these other things, and for people that have fibromyalgia and chronic fatigue, one of the things that I'm looking for is if they've had evidence in the past, of exposure to various viruses. That can be a possible indication of one of many contributing factors to their condition.

 For these patients, I may try anti-virials on them.  If that doesn't work, we move on to Low Dose Naltrexone, and for some, I do a phenomenal type of response to it, and I'm always amazed by this result.

Linda Elsegood: Well, it's interesting because there are so many people with autoimmune diseases that suffer from depression.

I always think if you took a healthy person who never had depression, and gave them all the symptoms and the quality of life that some of these people have, you're going to feel depressed by having to cope day after day with these symptoms. So for the people that are listening at home, who might be feeling hopeful that their depression can be helped, in several different ways, what is the first thing that you do if somebody comes to you suffering from depression? 

FNP Laura Dankof: So there are a few things that I'll do. First, I want to get an extensive history on them. Things like, does depression run in the family? What emotional or physical traumas have they had? What's their nutrition like?

Though many people do not know this, gut health is so important to our mental health. So if we don't have a healthy gut, we're not going to have a healthy brain. I may also do a few genetic tests on them looking for MTHFR, and other gene mutations and deficiencies.  The reason for this type of testing is that those mutations and deficiencies can play a role in how people process their nutrients, particularly like folate.  We need to take a really comprehensive look at things.

We also need to know what things have they previously tried that did not work.  And from that, you really need to take a thorough history from each patient and make sure you've ruled the possible contributing factors to their depression, and then decide the suitable treatment.  We need to know if they are using natural herbal remedies in combination with Low Dose Naltrexone, or in combination with their prescription medicine.

I would never just pull anybody off a prescription antidepressant if they are on one, but I may add Low Dose Naltrexone or other nutrients, and nutrients such as B12 and folate and things like that if needed to, but would cross that bridge at that time, and see if that's an opportunity to work in conjunction with those things.

I may be that they will be able to wean down to a lower dose or even off of these medications? So you basically just have to take an individualized approach in each case. 

Linda Elsegood: And how long would it take if somebody came to you that had been suffering from depression for quite a while, and we're currently not taking any medication, for you to do all the testing and begin implementing a treatment plan, such as herb's and supplements, LDN, whatever, before they could start to feel an improvement?

FNP Laura Dankof:  First, I would do the evaluation and workup, and then I’d certainly look at their hormones, gut health and test for the MTHFR gene.  Then after I get results, I will create a treatment plan based on my experience in the few cases of depression that I've had, and see if they maybe want to try that.  In my experience, patients see a difference within the first month of taking it.   Now, I know in some cases, with other conditions, you need to give them a longer time, but generally speaking, when I'm seeing them back in a month, they're starting to notice a difference. Well, then they're excited about it. 

Linda Elsegood: Yeah, I bet. You know, there are people that think if you start LDN, by the end of the first week, you're going to feel better. But anything takes time, doesn't it? And you have to be patient. What dose do you normally start your patients on?

FNP Laura Dankof: I will start them on anywhere from 1.25 to 2.5 milligrams of compounded LDN.  If a patient tells me that they're very sensitive to things I will adjust the dose.   I had one person one time that was concerned about that, and we started her a little bit lower. The maximum is usually around 4.5 milligrams.  I would say that the average range is 3 milligrams of LDN.  I maybe have a few higher, a few lower, but I'd say the majority seem to have best results in the 3-milligram range.

Linda Elsegood:  Oh Okay. And what age range are your patients? 

FNP Laura Dankof: Previously to starting the path to my health and healing practice, I was working in internal medicine. So I would see people generally age 18, you know, on up to the end of life. But I would say people that were generally seeking LDN and other treatments for their autoimmune would be anywhere from age 20 to the mid-fifties.

Linda Elsegood:  Oh okay. And what about now in your new practice, will you do any consultations for children? 

FNP Laura Dankof: Yes. I am trained as a functional medicine nurse practitioner and family nurse practitioner, so I can see the whole life span. So I do see some children as well.  

Linda Elsegood: And what's your experience with LDN in children?

FNP Laura Dankof: I have not used LDN on children yet. I'd say the youngest patient that I have used LDN on was around 17, and that was prior to starting my current practice. So I have not started any children on it in my practice as of yet, not I wouldn’t consider it.

Linda Elsegood: Exactly, that's what I was going to ask. If there was anybody there with a child, close to you, would you be able to do it for them?  So that's very good. Okay. So what about pain? Have you noticed LDN has been a good source of helping with pain? 

FNP Laura Dankof: Yes, it can be.  I would probably say that my greatest experience using it for pain, would it be in helping people with fibromyalgia and their pain symptoms? But certainly, as we know, we must not use somebody on a narcotic. I've had some people come in and asked me to prescribe it, and they were on a narcotic, and I said, well, you've got to be weaned off that first before we can start that. I don't want him to have any kind of withdrawal symptoms, so you just have to be careful about that.

But otherwise, I'd say my primary experience with chronic pain symptoms, is in patients with fibromyalgia.  

Linda Elsegood: And have you seen any people with skin conditions that you've used LDN on? 

FNP Laura Dankof: No, not that I can recall right now. I think I maybe had one gal that had idiopathic urticaria, which is an itchy skin condition. And what I would say there is that a lot of times when somebody comes in with a skin condition, I'm looking at their gut microbiome, and they may have small intestinal bacteria overgrowth.  I know LDN can potentially help in that way as well to help support the immune system, so I have prescribed it for that. So yes, if we're looking at skin conditions, a lot of times those conditions can relate back to a digestive condition so then we may use LDN in that way.   

Linda Elsegood: Yes, I mean, there were a lot of people who use LDN for psoriasis, with very good results, but that isn't a quick fix either.  I've had people tell me that their skin has stayed just as flaky and patchy for six months, and then they start to have fresh skin appearing, and all the scaly bits go, which is just totally amazing. But it is very hard if you've been taking LDN for months and you haven't seen any benefits. It must be hard to continue having faith that it's going to do something for you when you've been taking it long-term.

FNP Laura Dankof: Yes, and I would say that what I generally tell people is that I recommend they stick with it for six to nine months, to see if they begin to see some benefit if they aren't somebody that responds quickly. And I would say the majority of people; they do want to stick with it because they have kind of come up empty-handed from other directions.

And this is—an avenue of hope for them, to see if this is something that will help them. 

Linda Elsegood: Hmm. And it must be very satisfying to be a nurse practitioner where people have been to so many other doctors, nurses, whoever can prescribe for them and have come up with nothing. You know, to actually be able to help these patients, you must get quite a buzz from it.

FNP Laura Dankof: It's very rewarding and humbling as well. You know, as a functional practitioner; you really care about helping people. And of course, trying to get them the answers that they deserve and that they're looking for, I don't take that mission lightly at all.

And I try to do my best to try to help them in any way that I can, and as naturally as possible, to support their bodies in a healthy way.  Certainly, LDN is just one of the tools in my toolbox to do that, and I will forever be grateful to the first person that brought LDN to my awareness, who is no longer with us.

She was a woman with stage four breast cancer, who came to me asking me if I would prescribe it. At that time, this was many years ago, I didn't know anything about it. And I thought, well, I need to look more into this. And so, had it not been for her, I might not have ever known the benefits of LDN and what it can do, and to see how many people have benefited from it, 

Linda Elsegood:  It's really so rewarding to hear that you are able to listen to one of your patients. It’s “kudos to you” for listening to your patient. You know, there are so many doctors that are so busy. I'm sure patients always recommend different things they would like to try, but doctors don't always listen and act upon what the patient says, so that's really good. 

FNP Laura Dankof: Oh, thanks. I think 90% of figuring out what's going on with the patient is listening. If there's something we don't know about, that doesn't mean it's not true and doesn't have value, and it's up to us to hear them, and for us to look into what they're saying, and see if there is merit and value in what they're bringing.  This day and age, with the internet, people are searching everywhere, so it's up to us to try to figure out and decipher what is relevant or not. 

Linda Elsegood:  Yes. So here in England, the doctors have 10 minutes per patient, and that includes getting up from the waiting room, walking into the doctor's exam room, and coming out.  So if you've got somebody who has an autoimmune disease which has a myriad of different symptoms, what can the doctor actually achieve in 10 minutes?

I mean, 10 minutes is nothing, is it?

FNP Laura Dankof: Very little. That's why quite frankly, many of us that have worked in the conventional medical setting, know that the healthcare system is broken, and you cannot begin to figure out anything and listen to a patient in that amount of time. So it's like, what are your top symptoms, and how are we going to either run a lab or give you a medication in that short amount of time and out the door?

I've never. I've never practiced that way.  I've just kind of bucked the system a little bit, I guess, and kind of flew under the radar. And now, now that I have my own practice, as many functional practitioners do, I don't take insurance because it dictates too much of that. And it allows me to spend a lot more time with patients as well.

You know, my initial visit with a patient is going to be 90 minutes. And follow-ups, depending on the situation, could be 30 to 60 minutes or more. So, that's the beauty of having your own practice and don't take insurance. And that's why a lot of functional practitioners don't, because it dictates those very things about the volume of patients you need to be seen in a day.

Linda Elsegood: Well, that's pretty good. So you really work it out and give the patient the amount of time that you feel they need. 

FNP Laura Dankof: Absolutely, because I always worry if I don't give them the time to tell their story, what am I missing, and are we going to go down the right path with their healthcare if I don't hear their journey there?  You know, like what has happened to bring them to this point that they're sitting in front of me now.  And so it is important that I hear that because there are so many clues that help put the pieces of the puzzle together. 

Linda Elsegood: And how long of a waiting list do you have? 

FNP Laura Dankof: Currently people can get into my practice pretty quickly because I just started my virtual practice in the last six months. I had been working in internal medicine, large corporate healthcare system for many years prior to that. So right now, it’s pretty easy for people to get in to see me for a consultation. 

Linda Elsegood: Well, that's really exciting, isn't it? So, the telephone consultations that you give, if they need lab work done, how do you go about doing that?

FNP Laura Dankof: If they're in Iowa or Colorado where I'm licensed, we can either run it through Lab Corp with their insurance, or I use a discounted lab called Ulta Labs. The discounted lab charges a fraction of what patients would pay running their labs through LabCorp.  So, if you have a high insurance deductible, or it's not covered, you're better off going through a discount lab. And if they are in another state other than Iowa or Colorado, we can use Alto labs where they can do some testing. They can even order it themselves.  If they need a prescription for LDN, I have to see them face to face once a year, if they're in a state other than Iowa or Colorado where I'm currently licensed.   They certainly could come to see me face to face, even if they live in a different state.  Otherwise, I would be talking to them more in a consulting role, I could not diagnose them in another state.

Linda Elsegood: Well, that's really interesting. So would you like to give us all your details? 

FNP Laura Dankof: Yes, of course. If people want more information, they can find me at wwwdotpathtohealthandhealing.com that's “path to health and healing.com” and there you'll find more information. I write a health blog there. You can kind of read my story, and why I'm so passionate about taking a functional or natural medicine approach to healthcare, along with the different kinds of conditions that I treat, and how to schedule an appointment or contact me directly. 

Linda Elsegood: You've got me intrigued. Now tell us why did you go down the path of functional medicine? 

Laura Dankof: Okay. So for many people who go into functional medicine, there was a health crisis in them or a family member, and that was certainly true in my case.  I had a daughter born with a hereditary blood disorder.

And she was very sick when she was young.  She ultimately had her spleen and gallbladder removed, and they put her on antibiotics for an extended period of time, which then led to skin conditions, eczema and so forth. So, I took her off the antibiotics, against medical advice, because of what it was doing to her.

And we healed her gut, and healed her body, through natural medicine, because the answer conventional medicine wise was to give her steroids and immunomodulating agents that would have increased her risk for cancer. And it was just going down a very deep, dark rabbit hole with her at a very young age.

And then on myself, I had thyroid and hormone-related issues when I was in graduate school and did not want to go down that pathway either. And so I started really diving deeper into functional medicine throughout that whole journey with her and with myself.  

Linda Elsegood:  Wow. I’m sure all your patients are really pleased, not that you had those obstacles, but that you chose to become a functional medicine nurse practitioner. It has been absolutely amazing speaking with you today Laura and I hope you continue with your practice and success, and we wish you all the best.

FNP Laura Dankof:  Well, thank you very much, and I've enjoyed talking to you again Linda.

Linda Elsegood: Okay, thank you. 

FNP Laura Dankof: 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 Mark drugs.com or call Roselle (630)-529-3400. Or Deerfield (847)419-9898.

Any questions or comments you may have. Please email me 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.