LDN Video Interviews and Presentations

 

Linda Elsegood: Welcome to the LDN Radio Show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. Today I'd like to welcome our guest Pharmacist Suzanne Rosenberg from Community Compounding Pharmacy in Oregon. 

So could you tell us what made you decide to become a pharmacist? 

Suzanne Rosenberg: When I was in undergraduate school at Temple University in Philadelphia, which is my hometown, I worked at a pharmacy and I loved it. I loved working with people. I just loved everything about it and so when I graduated with my degree in psychology I applied to Northeastern University in Boston, Massachusetts and started pharmacy school two months later. I received my pharmacy degree from Northeastern. 

Linda Elsegood: Have you always stayed in the Oregon area? 

Suzanne Rosenberg: After I graduated pharmacy school I got in my car and drove to Portland, Oregon to visit some friends. I never left. That was 27 years ago. I've been practicing as a pharmacist exclusively in the Portland, Oregon area. 

Linda Elsegood: When did you buy the pharmacy? 

Suzanne Rosenberg: I moved to Portland and I worked for small independent pharmacies. I got really interested in herbal medicine. There was a company called Wild Oats that opened a large store and they had an idea where they put a pharmacy with naturopathic medicine in this grocery store with a yoga studio. They asked me to manage it. I did for six and a half years. I managed this pharmacy and turned it into a compounding pharmacy. Then another local chain recruited me and I did that for four and a half years. Then I decided that I had all these ideas of things that I wanted to do. Fifteen years ago I started Community Compounding Pharmacy in Lake Oswego, which is a suburb of Portland. It's a compounding only pharmacy. We predominantly work with integrative practitioners which I've been working with for over 23 years. I work with naturopaths, functional medicine doctors, integrative practitioners all over the West Coast. We started mainly in Portland, in the Northwest, but now we work with integrative practitioners up and down the West Coast.

Linda Elsegood: Please tell us about your pharmacy. How big is it? Do you do sterile and/or non-sterile compounding? 

Suzanne Rosenberg: We're fortunate that we only do non-sterile compounding. We're about 10,000 square feet. We have about 45 employees. We're open six days a week and we ship all over the nation, predominantly on the west coast and certain states on the east coast. Mostly on the west coast; Colorado, Arizona, Alaska, Hawaii. On the east coast: New York, Maine, Vermont, Connecticut. We are pretty much licensed mainly on the east and the west coast. We have been fortunate to have an extremely amazing staff that really supports our patients and our doctors and one of our focuses at Community Compounding is education. If you go to our website what you'll find is that we really focus a lot on education. We do that in two ways. One is we actually offer continuing education twice a year for the naturopathic community, although nurse practitioners are able to get the Continuing Education Credits as well. We actually just had one on Saturday and LDN was a big topic because it is for most ailments. One of our topics uh was PANS and PANDAS which is predominantly a childhood situation where they get inflammation. Low dose naltrexone (LDN) is a treatment for that and one of our doctors, Dr. Sarah McAllister spoke on Saturday at this conference and brought up LDN. In addition to that we also make it a priority to offer education for our patients. Patients have access to our pharmacist. We have four pharmacists on staff each day. One of the things that we really pride ourselves on is making sure that if a patient calls and has a question that their questions are answered in real time. In addition to that, every prescription, before it goes out, gets a personal phone call from one of our pharmacists to counsel them and make sure that they understand what this medication is used for, how to properly take it and just ask any questions that they may have before that prescription goes out to them. 

Linda Elsegood: Education is key. I would say pharmacists, even though they’re busy people have more time to do the research than doctors do. You are the people that educate the doctors and do the hand-holding and explaining to the doctors. They are not experts in drug interactions. That's the job of the pharmacist. We find the pharmacies that spend the time on educating their doctors help so many patients because you get a new doctor on board. How many patients does that new doctor prescribe LDN for? Then that doctor meets up with other doctor friends and they invariably end up talking about problem cases. Then LDN comes up and it's easier for the pharmacist who deals with that doctor to mention LDN because of a light bulb moment. I was talking to a colleague who talked about LDN but I don't know much about it, I don't know how to prescribe it. Without the pharmacist being so well educated themselves about LDN they wouldn't be able to convert the doctors into LDN prescribers. 

Suzanne Rosenberg: I’m trying to convert doctors in Oregon. Oregon is kind of one of the meccas of alternative medicine. In Portland and in Oregon in general we have a lot of information. We have a really tight integrative community here and it's really neat to see. They teach each other, they're supportive of each other. It's a really neat place. I feel very fortunate that I get to practice in Portland, Oregon and in the northwest. It's a really special place. Especially as an integrative pharmacist. My entire pharmacy is an integrative pharmacy. Our model is different from some of the other compounding pharmacies in the city who I have a ton of respect for. Ours is different in the sense that a lot of the other compounding pharmacies will market to doctors who are more focused on allopathic. We do work with allopathic practitioners. We are the main compounding pharmacy for OHSU. Alll of their LDN from Oregon Health and Science University or at least most of it they have a tight relationship with us. Our model is different in the sense that we really only market and seek to educate alternative practitioners at this point. 

We are licensed all over the nation and I personally will travel. I have another woman, Holly, who also helps me. And we meet with naturopaths, functional medicine doctors, integrative practitioners, doctors who are interested in learning alternate ways of treatment. What we see as our role is to go out throughout the nation and meet with these doctors. That's really our focus. We work with doctors all over the nation. We actually will travel and we do what we call a lunch and learn. On our website you can actually go onto our website and there's a doctor portal on there. In that doctor portal you can actually request lunch and learn. We go and we sit and we meet with these doctors. We go over integrative products that we have. A lot of them have never heard of these formulas. Because we work so closely with the integrative practitioner group in the northwest we're actually creating formulas, including using LDN. We've been using a lot of LDN topically at Community Compounding. We have a formula now that we're really proud of that is a topical LDN for lichen sclerosis with some herbs in it, as well as, some hormones. We also use LDN topically when it comes to psoriasis and eczema. We use that in conjunction with a product called Ketotifen which is a mast cell stabilizer. What we do is we use LDN orally but we've also been utilizing a lot in our topical preparations. And we use a lot of integrative treatments for hair loss, skin conditions, gut, gut health and will intake different products and combine them for these new products that a lot of doctors haven't heard of because they're predominantly products that we've created with doctors in the northwest. It's really neat to go out and share these products with our doctors. All of this stuff actually is available in this doctor portal on our Community Compounding Pharmacy website; you'll find it. You will need to ask for access. My assistant will send you a code within 24 business hours. You'll have access to all of our prescription pads, all of our research articles that we have in there, and recommendations for treatments. 

I have a pamphlet about a talk that I had done in January in Hawaii for some naturopaths. It is is a little pamphlet of our top 20 formulas that our pharmacists love. Not all of them are things that we do every day but they're things that patients have come back to us and said, “Wow this really works.” Or they say, “A doctor says that formula is amazing.” Then they start telling their colleagues. That's a new thing that we just came out with a couple months ago. It was serendipitous. We didn't intentionally plan to put this together but I did it for a talk and handed it out to some doctors and they loved it. So now we have a list of the top 20 formulas that we wanted to share and we'll be adding to that regularly as things come up. A place to get a lot of information is on the doctor portal. 

Linda Elsegood: You mentioned Dr. Sarah McAllister, (you can put her name in YouTube you will see that I interviewed her many years ago. Maybe even as many as 15 years ago.) It's been a long time since I have spoken with her. She is a very nice young lady. 

Suzanne Rosenberg: She's amazing. Her talk was amazing. If anyone's interested in learning more about our talks you can go online. This one we just had recently, so in about two weeks the lecture will be available. If you're interested in learning or you know can't attend any of our webinars they are in person and they are also webinar based. You're more than welcome to visit our website. You don't need to log into the doctor portal and you can get access to these conferences. We do two conferences a year. Some of our other topics that we cover are women's health, Ehlers Danlos, mold, PANS and PANDAS. We had mitochondrial health on this last one. I would say at least 60 percent of our talks have LDN in those talks because it's so prevalent now in treating so many things. We've done a lot with the gut. We've had a lot of gut talks at these conferences. Another phenomenal naturopath in Portland, but you will see that in a lot of these treatments LDN is indicated for a lot of these patients. It is a hot topic not only in terms of autoimmune which is kind of what traditionally I would think of it being used for but now we're seeing it in so many other ways to support our immune system that is pretty much in every conference whether it's at every talk maybe sometimes women health not so much. It's a hot topic at our talks. 

Linda Elsegood: What about chronic pain and opioid addictions and people off of opioids? 

Suzanne Rosenberg: We have an amazing doctor in Portland who is a naturopath. She works at the pain clinic at OHSU. She's an amazing doctor, amazing naturopath, an amazing human being. We worked very closely with her and she prescribes two things. Well, several things through us. One of the main things she prescribes through us is LDN. She does a lot of our topical pain creams as well. We also do topical pain creams for patients who are in chronic pain and the goal is to get them off of their narcotics and switch them over to LDN. I just had a patient yesterday who actually this was this was an unusual patient this was a patient who was not seeing one of these doctors, but has done her own research and is starting on a really low dose of LDN and is working with a doctor who has basically been brought in through the patient request of prescribing LDN. So here's a doctor who knew very little about LDN and here's a patient who's educating their doctor on their own. These two came together and I was counseling the patient and she was really up on her LDN. There's a lot of information out there. It was really neat to see and she was telling me, “Yeah my doctor doesn't know a lot about it so she's going to help me you know. We're gonna do this together.” That is an unusual situation but we see that too. It was a really neat conversation. 

Linda Elsegood: Regarding women's health: Dr. Phil Boyle has been using LDN in his Fertility Clinic for 20 plus years now with great success. He also uses it for endometriosis, polycystic ovaries, painful periods, heavy periods, all these things that women have to endure is found to be very very helpful. 

Suzanne Rosenberg: This is also a phone call I had yesterday with a nurse practitioner. I was on the phone all day long as are my pharmacists. They are answering questions, coming up with formulas. We had a nurse practitioner call me yesterday. Again, someone I've known for 20 years and she has a patient who has severe pelvic floor pain. What we're doing for this patient is a formula. This particular patient had actually some inflammation. They had burning pain. We were doing a suppository for her. She has mast cell and we're doing cromolyn and she had already been on diphenhydramine and ketotifen which are antihistamines. I suggested that she adds some naltrexone to it. So we'll see what happens. These are the kind of formulas we're always thinking when we're having a situation where a patient is in pain and we're trying to oh wait, and put some lidocaine in there as well, um but when a patient is in pain and we're putting things together naltrexone is always something that I'm starting to incorporate into these products because I'm finding that we're getting great results. I mean the Lichen sclerosis formula has been a huge success for us and this was a formula that we had been playing around with for years. We've been working with glycyrrhiza which is licorice root, which is a common treatment for lichen sclerosis. There was a product on the market for many years that contained licorice root. This new formula that we've created is a combination of estriol, glyceriza, aloe and naltrexone and some vitamin E. It's a steroid free cream and we have been working and trying to find something that is steroid free for lichen sclerosis and this is really the first time that we're getting feedback from our doctors and our patients, our doctors primarily because you can see it. You know they try it on one patient, they try it again and they're calling me and saying what was that formula that I called in for lichen sclerosis? I need it for this patient because it works so well. That's kind of how we get our feedback. We're really excited to have that and I'm finding that when I'm creating formulas now I'm thinking a lot more of putting naltrexone in these formulas even if they're not for other areas of the body. 

Linda Elsegood: Your patients that use it for a dermatological condition, how long do you normally find it takes before they experience any improvement? 

Suzanne Rosenberg: We are at a disadvantage because we don’t have a lot of patient follow-up. Usually pharmacists hear really amazing things or we hear things when there's an issue. We don't get to see patients all the time so it's hard for me to say but I know there's a research study that PCCA did specifically on naltrexone in their zematop product for eczema. It is something that you can Google and it has some dates and some time frames. 

What we do for our eczema and psoriasis cream is we actually add ketotifen to it as well. So it's a combination of naltrexone, ketotifen in their zematop product. Typically if patients don't get results after a month they usually stop. Most of our patients are getting results within a couple weeks. I have spoken to lots of patients with skin conditions. They seem to be the people that take the longest to respond, to notice improvement. Some of them may take six months. They stick with it and it takes that long. A lot of these patients are on LDN orally so they'll be on LDN orally for a while and then we'll start the cream. They've already had the advantage of being on LDN. 

One of the things that I did want to share with you guys is that one of the things that we decided to do as a compounding pharmacy, especially post COVID, is our focus was really on becoming efficient. By that I mean having patients wait for their medications is no longer an option. We really wanted to make sure that efficiency was a priority of Community Compounding. One of the things that we did because we work very closely with the mast cell activation community in the northwest is we decided to start finding ways to have our turnaround time shortened. We really value our employees. They are making large batches of capsules and it is actually physically challenging. It's a lot of work. About six months ago, one of the things that we decided to do is we decided to invest in a tablet press and we are now pressing two drugs at Community Compounding. One of them being naltrexone. We are one of the few compounding pharmacies in the United States that is making low dose naltrexone tablets. Our low dose naltrexone tablets are a little different from some of the other compounding pharmacies because we work so closely with the mast cell activation community. We're very aware of allergens and food sensitivities and potential allergens for these patients. When you make a tablet you have to put a binder in there. A binder is something that holds it together and most binders are pretty inert unless you have mast cell activation or severe allergens. These patients can't tolerate many things including such things that you and I could tolerate easily. What we decided to do is we decided to not use any binders in our tablets. Our tablets only contain two ingredients. They contain a cellulose that we specifically use that is GMO free and allergen free. It's kosher. It's made from organic materials. The only other ingredient in our product is the drug. It is a GMO organic material, cellulose, called flow cell and naltrexone. If a patient is a vegan, if a patient is allergic to silicon dioxide (which is a very commonly used for most tablets), there's no issues with taking these tablets. The best part about these tablets is that they are scored. What happens with these tablets is they can be cut very easily. As you know most compounding pharmacies, including us, make naltrexone capsules which are great and we've been making them for 15 years. Of course capsules can't be accurately split. You can open one up and kind of guesstimate which we don't typically recommend as a pharmacist but it can be done. With these tablets you can use a pill cutter and we do recommend using a pill cutter because we use no binders. We press them really hard. So they're very hard. We do tell all of our patients that they will need a pill cutter. They can cut them right down the center so they know that they are getting 50 percent of that tablet. As an example, we only make three strands. We don't make a 1.5 because we make a one, a 3 and a 4.5. The one we make because we have so many patients who are super sensitive to medications, a lot of our patients will start on the 0.5 dose. It's not the most common but it's definitely common enough that it was something that we wanted to be able to offer this option. For the super sensitive patient you would use the one milligram tablet. You will have them cut that in half and start with a 0.5 and ramp up slowly to the desired 4.5 milligram dose or three milligram. Wherever they land. The three milligram tablet we made because that can be cut in half and they start with the 1.5 milligram tablet, half of that which is the 1.5. Half of the three and slowly ramp up to the 4.5 and then we do the 4.5 as the maintenance dose. What's really nice about it is that this saves patients a significant amount of money when they're using these tablets because as you know compounding pharmacies are very labor intensive. Any time that you can decrease labor in a compounding pharmacy what you're doing is you're significantly decreasing the labor dollars and then the goal is to be able to save the patient's money. The only way to do that as a compounding pharmacy is to decrease labor. What is important about it is that we have the same staff that we had here a year ago but people are working better not harder now. 

We now have an R&D team, which is a research and development team, that helps us when we have new products that we want to create and there's an issue with something, if we want to bring in a new base and we want to play with it, we have an entire team now who works on all these products. We have an IT team now. We just came up with a new IT team, where my staff in each department has their own IT specialist. The point that I'm trying to make is that as a result of the tablet machine and other ways that we've become more efficient we're actually a better compounding pharmacy. We are offering better customer service than ever. Our turnaround time is now one to two business days. I now have more time to go out and meet with doctors, educate, network and learn. The tablets are great for so many reasons. For the patients, for the pharmacy and for our ability to educate and really reach out to more people. We are really excited about these tablets and they've been a huge success for us. They've really been a great relationship builder, too. Doctors are able to use my local pharmacy for my estriol vaginal cream but also use Community Compounding for tablets and then we create these relationships. 

Now they have more pharmacies to network with if they have issues that come up with their patients. It could be that their compounding pharmacy doesn't carry a product that we carry and that happens often. Some things are expensive to carry and that creates new networks We work with other compounding pharmacies and share formulas and that has been a really nice way to network with doctors and our patients. 

Linda Elsegood: Can you tell people your website so that they can go and find out more about you. 

Suzanne Rosenberg: It is www.communitycmpd.com Or you can also type in Community Compounding Pharmacy in Oregon and you will find us. We are licensed in the whole west coast, most of the east coast. 

 

D

Today we're joined by pharmacist Dr Dawn Ipsen who's the owner of two pharmacies in Washington State, Kuslers Pharmacy and Clark Pharmacy. Could you tell us what it was that inspired you to become a pharmacist? 

I knew early on as a high schooler that I wanted to have a doctorate degree in something and was sort of a little bit torn between pharmacy and optometry and with long heartfelt discussions and soul-searching I became a pharmacist and very early on in my career not only was I trending towards being a pharmacist but I had an opportunity to intern at a compounding pharmacy and just absolutely completely fell in love. It was the art and the science and the way of being able to help individual patients in manner of which no other pharmacist in my area was able to do so, of providing very personalized therapies. I was able to really listen to patient needs and work with their doctors, to formulate the exact therapeutic tool that they needed to improve their quality of life. That is really what has driven me in my career. 

When did you open your first pharmacy? 

I had been a pharmacy compounding lab manager for about 10 years for the Kusler family. When they were ready to go do other things in their life I was given the opportunity to purchase Kusler's Compounding Pharmacy. It had been a pharmacy I had worked at as a staff member for 10 years and took over as the owner and I've now owned that pharmacy for almost 10 years. In January it will be 10 years. That was my first pharmacy. I was doing all my good work up at my Snohomish Pharmacy and suddenly had a random phone call on a Friday afternoon in which the Clark family was looking for a new owner for their pharmacy. They were ready to retire and go do other things as well. I've also owned Clark's Compounding Pharmacy down in Bellevue Washington for six years. I've been an owner for almost 10 years total and have had multiple locations now for about six years. We service not only the entire state of Washington but we also work within nine other states as well. Our boundaries go quite deep and it's a really great way to help all types of patients all over the nation. 

What would you say is the most popular form of LDN that you use the most? 

I would say primarily we use the most customized strengths of capsule formulations of low dose naltrexone (LDN). It gives patients really great consistency yet opportunity to get the doses titrated in appropriately where they need it to be. What's really great about how we approach our making of capsules: we use hypoallergenic fillers. We're also able to work specifically with patients who have sensitivities. We can customize what that filler might be and I think that's really what sets our pharmacies apart and why doctors and patients choose to work with us. We are experts in autoimmune and chronic inflammatory diseases and therefore we're very used to working with patients where the normal just isn't what they need and isn't what's best for them. We can customize that to be appropriate for them. Along with capsules of course, we are able to do transdermals. That's really popular in pediatrics, especially for patients with an autism spectrum disorder. We are able to make flavored liquid tinctures of it so patients are able to use various small doses to titrate up doses. We also make sublinguals. I would say capsules are pretty popular for us. 

What kind of fillers are you asked to use? 

Most of the time I will steer a patient towards microcrystalline cellulose (which is a tree-based cellulose). It is very hypoallergenic for a lot of patients. However, some patients know they have tree allergies and those patients primarily prefer rice flour. I do have a couple of patients, but very very rare, that actually do better on lactose filler. They tend to not be my autoimmune patients. They tend to be patients in the chronic pain spectrum area. We have also worked with other fillers, like tapioca flour. We can be very customized into our approach of how patients need it. I've got one patient that comes to mind that loves magnesium as their filler and that's very relaxing for their muscles. I've also seen probiotics being used. There is not one right answer to how we do things. We are that pharmacy that is able to have a conversation with a patient. We talk about what their needs are and customize it based on that approach. 

From the prescribers that you work with, do you have many consultants that you fill scripts for? 

We definitely do. That's also kind of a little side thing that I do. I've always been very passionate about teaching. I'm on faculty at University of Washington School of Pharmacy and also Bastyr University, which is one of the top naturopathic doctor schools in the nation. I teach there during summer quarter. I teach nationally to providers continuing ed-based content that is often LDN in nature, or ties into LDN. Especially with autoimmune and chronic pain and chronic inflammatory conditions. We consult a lot with doctors. I probably work with three or four hundred functional med type providers on any monthly basis, even on being able to customize therapies for their patients. We are really big in the post-COVID syndrome arena of helping patients that are really struggling and LDN. We're finding it pairing quite nicely in that condition as it's very inflammatory based. We work quite heavily within the MCAS arena for patients who have a lot of mast cell instability and need other therapies. LDN is one of the tools that is used quite frequently by those types of providers and for those specific kinds of patients. 

Do you work with any pain specialists, dermatologists, rheumatologists, gastroenterologists? 

We do. Honestly, I’m quite proud of our little Seattle area of Washington because we do have MDs that are pain specialists that are now really turning towards using LDN in their toolbox of things they have available for patients. They're getting quite savvy at it. They're doing a really great job. It is super exciting. I have some dermatologists. I consult a lot with my functional med providers that are seeing dermatology conditions like psoriasis. I have an email I need to work with a doctor on after this to help them with this patient with a psoriasis case. We are seeing it in the GI world as well for Crohn's and irritable bowel disorder. Those chronic inflammatory conditions. I would say the MD pain specialists are really turning around over here. Obviously with the opiate crisis that has occurred in our nation I think most doctors of any type of credentialing or medical training or experience are quite interested in what LDN is doing for their communities and what opportunities it affords for patients who are trying to make sure they aren’t addicted to opiates but yet have something to improve quality of life and their day-to-day living. Low dose naltrexone has been an amazing tool for that. 

I'm always excited to meet different LDN prescribers and nurse practitioners who are providing lots of scripts. When you get an MD or a DO that is prescribing LDN and it is completely out of their comfort zone, I always think yes, you know we've got another one on board. We're making it right. We're getting it. MDs are already working outside of the box. That is normal for them to look into LDN; it's not normal for MDs to look at LDN but as you know, I've interviewed so many people and so many MDs when they have a patient that they can't help, and fix their issues. They've tried everything and they feel as if they've failed this patient, and then they try LDN. Once they have had amazing results with the first person it's then so easy for them to look into prescribing, not only for other patients with that condition but for any autoimmune disease, chronic pain, mental health, etc. 

I mean it's really amazing and this is where people like yourself come into play. The hand-holding with doctors because a lot of them haven't got time to do the homework. They're very busy and they need somebody to tell them exactly what it is, how to prescribe it, what to look for, what to do and have somebody on hand to say, like you said, I've got a patient with psoriasis. What do I do? Can you help me? That is the way to get more doctors involved is the pharmacist doing the hand holding. 

There is a local psychiatrist in our area that works with younger adults with substance abuse disorders and teenagers that are having a lot of trouble with mental health. I had an opportunity to get him thinking about LDN and his patient population. I love when I get to reconnect with him every few months because he just raves He finally has a tool that actually does something. He felt the antidepressants and all these other things were not really fixing any of the issues or fixing the symptomatology. We still have the same abuse issues, we still have the same addiction issues and we still have the same levels of depression and suicide risk. But with LDN he's finding that he's actually causing positive change in his patient population, and that's the only thing he really changed within his practice. We're really affecting the health of our community in a very positive manner with something that's really safe and low risk and not expensive. It doesn't get any better than that. It's the best compliment I could ever have. 

It's really nice when patients take all their information to the doctor. Once you've got a doctor really hooked on prescribing LDN they can change the lives of hundreds of patients. Dr Phil Boyle uses LDN in his fertility clinic. He also uses it in women's health for things like endometriosis, polycystic ovary, painful periods, heavy periods. Right across the board he uses LDN. He gets patients coming to see him with women's health problems who also have Hashimoto's or long COVID etc. I refer to his work all the time. He gets questions a lot from local providers such as we have somebody who wants to become pregnant, or they did become pregnant and they're on LDN and they want to know what the standard of care is and can we continue, and what's the risk and benefit are. It is so great to have providers like him out there that have been doing this work for so long that we can very confidently share those case experiences and history of using the medication long term for those patients. 

There have been so many of our members who were skeptical about using LDN during pregnancy. Doctor Boyle is always very generous with his time. I will send him details and he will answer the patient and share his experience. You know we used it once up until birth rather and breastfeeding, etc. We have those people who have done two or three pregnancies using LDN who are happy to talk to other people. This is my experience with 20 years as the charity next year, which is totally amazing, but I’ve found that word of mouth and with the education it is just spreading. 

Linda, you've done an amazing job with the LDN Research Trust and I thank you for that. You have made the Research Trust, its website, resources and its books into a trusted referral point that I can use with our doctors and our patients who are wanting that next level of information beyond what I'm able to say to them. They want to go see those studies themselves. They want to go read the book themselves and I know that without a doubt I can send them to your resources for them to receive complete in-depth and correct information. Thank you Linda. You're doing amazing things and this is all because of you. 

How can people contact you? 

We have two locations in Washington State. We have Kusler's Compounding Pharmacy in Snohomish Washington and the website there is www.Kuslers.com; and then we have Clarks Compounding Pharmacy in Bellevue Washington. That website is www.clarkspharmacywa.com. The WA stands for Washington. We are happy to help patients all over and talk with doctors that need guidance and assistance in learning more. I love being an educator and I love being here to support my community. 
 

 

Kristen Burris LAc, MSTOM - Acupuncture and Chinese Herbal Medicine(LDN; low dose naltrexone)

 

 

LDN Webinar Presentation 18 May 2022: Dr Sato-Re - How and why I prescribe LDN in my integrative and general practice

Sponsored by Innovative Compounding Pharmacy https://icpfolsom.com/

 

LDN Webinar 18 May 2022 (LDN; low dose naltrexone)

LDN Questions Answered Live by

Pharmacist Dr Masoud Rashidi - LDN Specialist
Dr Sato-Re
Dr Mathewson

Sponsored by Innovative Compounding Pharmacy icpfolsom.com

 

Joy - US: Hashimoto's Thyroiditis (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Joy is from the United States and takes LDN for Hashimoto’s thyroiditis, to boost her endorphin levels and to control her antibodies. In 2008 she had a big crash, probably from her thyroid. It would bet getter, then get worse. By 2011 she hit rock bottom – “all the fuel went out of my tank” – her thyroid was not producing enough T-3 to have any sense of wellbeing. She believes her endorphin issues started in her teenage years. In her early 20s he was treated with full-dose naltrexone for an opiate addiction, and it made her feel terrible. So, when she heard about LDN for thyroid she was concerned, but interested. She researched LDN and found it was very effective at lowering the antibodies affecting how her thyroid was working.

When she started LDN her quality of life was maybe up to 6 out of 10, because she had just started taking a natural thyroid product; before the thyroid product she was perhaps at level 2. She found naltrexone to order from India and had it shipped to her, then she mixed it with distilled water and dosed herself. When she started LDN she had “three-dimensional dreams” that were extremely vivid, but faded after about a week.  She noticed improvements in about a week as well, and had to lower her thyroid medication by about 20%. Her antibodies decreased by about 50%, but were still a bit over the acceptable range on LDN 1.5 mg. She has been on LDN 3.0 mg for a while but hasn’t been retested.

At the time of the interview Joy had been on LDN for almost 4 months, and her quality of life bounced up to an 8. If it helped her peri-menopausal hormone issues it would be a 10, but LDN doesn’t seem to be helping with that. Linda Elsegood commented that talking with Dr. Phil Boyle she learned that LDN does help with a lot of women’s problems like endometriosis, though not necessarily menopausal problems; and that LDN helped her endometriosis improve over about 18 months.

If others are unable to find a doctor to prescribe LDN. Joy recommends they do research; and gives the warning to know the signs of overmedicating with thyroid medication, as once on LDN they’ll need to lower their thyroid dose pretty quickly. Linda Elsegood advised that importing LDN from India isn’t actually legal, but realizes it may be the only way some people can get it.

Joy would love to share her information so others can talk to their doctors about LDN. Her personal physician has some autoimmune issues, and is quite excited about LDN. Linda Elsegood pointed out that the LDN Research Trust’s doctor’s information packs have been quite successful. People print it and take it to their doctors, and the success rate is very high once the doctors read the information. Word is spreading, more neurologists are using LDN for multiple sclerosis, rheumatologists are now using it as well

Summary of Joy's interview, please listen to the video for the full story.

Keywords: LDN, low dose naltrexone, Hashimoto’s, thyroiditis, thyroid, endorphins, menopause, endometriosis, multiple sclerosis

Any questions or comments you may have, please contact us.

Dr Thomas Cowan, LDN Radio Show 14 Dec 2016 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

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

Dr Thomas Cowan practices holistic medicine in San Francisco and prescribes Low Dose Naltrexone (LDN). He also has a new book called ‘Human Heart, Cosmic Heart’.

He first heard of LDN in 1992 from one of his patients with AIDS who requested it. This occurred again four years later, prompting Dr Cowan into researching LDN more thoroughly and learning about its many benefits in combating autoimmune diseases.

He says that LDN’s side effects are very uncommon and that in 95% of his autoimmune patients, he has prescribed LDN. Dr Cowan is a strong advocate of LDN.

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

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

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

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

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

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

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

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

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

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

Dr Jill Cottel, LDN Radio Show 26 July 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

The number of patients with autoimmune disease Dr. Cottel is seeing has increased, particularly thanks to her presence on the LDN Research Trust website. She also is treating more patients with alcohol use disorder (AUD) with LDN than before, with very good results.

Q: In a patient with a pain disorder, on 4.5mg LDN without good result, should he increase his dose?

A: Essentially, if you’re not getting relief on lower doses, it may work increasing the dose, but it is not well studied. Linda commented on reaching opiate blockade and the need to reduce the dose.

Q: Address where a patient with Sjogren’s has GI side effects from LDN even at ultra-low doses.

A: Have compounding pharmacy prepare LDN in water at 1mg/ml and start at a very low dose eg 0.1mg and increase by 0.1mg as tolerated, slowly. Take at bedtime. Linda commented that sublingual drops work very well also to avoid GI absorption.

Q: In a patient with MS on LDN 3.0mg developed double vision, is higher dose LDN advised? What about Vitamin K2 for MS, will it re-wrap the nerves? Can Mediterranean diet decrease inflammation?

A: Always have double vision checked to be sure of cause. If from MS, increasing LDN to 4.5mg may help. As for Vitamin K2, some studies suggest K2 may inhibit inflammation of anti-microglial cells, and perhaps the body could heal itself. Yes, that diet decreases inflammation; diet is very important in treating autoimmune disease.

Q: Patient with Hashimoto’s starting LDN, what side effects should be looked for.

A: Typically, LDN is well tolerated. Perhaps headaches or vivid dreams early on, and patients with GI problems may have diarrhea.

Q: Can LDN help fibromyalgia and cancer prevention?

A: Yes for fibromyalgia, but not everyone goes into full remission. Probably yes for cancer prevention; there are animal studies to support that, as well as that LDN is used in treatment of cancer.

Q: Patient on prednisolone for polymyalgia and can’t get off steroids. Will LDN help?

A: Yes, recommend adding LDN then tapering steroids. There are complications from chronic steroid use.

Q: Can LDN and thyroid medications be taken at the same time?

A: Thyroid medications are to be taken alone, at least 1 hour from other medications.

Q: Is LDN for real?

A: Yes! There are lots of sources for information from prescribers, patients, and through small studies.

Q: Use LDN in post-polio syndrome?

A: In her one patient with post-polio syndrome, LDN has helped with the pain, but in post-polio syndrome there are many sources for pain, and as LDN is so well tolerated, she recommends its use.

Q: How do you know LDN is working (patient with Hashimoto’s)? Can gluten ever be re-introduced?

A: Clinical response is the indicator of success in Hashimoto’s. Dr. Tom O’Bryan has a series on this. Once you have antibodies to gluten, they will increase when exposed to gluten, and can interfere with how LDN works.

< Note: the LDN App was retired >

Q: Will LDN help with pernicious anemia and rheumatoid arthritis (RA) and how do I get it?

A: Get information from the LDN Research Trust website to take to your doctor. LDN is an immune modulator and calms RA. Pernicious anemia is an autoimmune disorder, traditionally treated with B12 injections so use of LDN and pernicious anemia would be interesting to study.

Q: Can you take LDN and Chantix, a medication used for smoking cessation? Are there studies on LDN and vitiligo?

A: LDN may help with smoking cessation and Chantix. Linda has heard of patient using LDN for vitiligo with great success.

Q: Can going on/off LDN be a problem?

A: For those on LDN for a long time, it’s not likely to cause a problem, but you may notice a return of symptoms.

Q: In Type I diabetes and alopecia universalis

A: Dr. Cottel has seen few cases but has not seen great success with LDN. Linda noted she has spoken with patients who had great success with LDN for alopecia; but LDN is not a miracle drug nor does it work in all people.

Q: Is it ok to take LDN for fibromyalgia with thyroid medication?

A: They can be taken together, but be sure to take them at least an hour apart.

Q: Hashimoto’s and Sjogren’s who is pregnant. Is LDN safe during pregnancy?

A: Dr. Phil Boyle covered this at the last conference: no problems taking LDN during pregnancy

Q: Can LDN be used in Crohn’s disease the same way as the immunosuppressants used?

A: LDN is effective in some patients with Crohn’s disease and might allow tapering off other immunosuppressants.

Q: Can LDN be used in patients with glioblastoma?

A: Many prescribers use LDN in treating cancer as part of a complete treatment program.

Q: If LDN helps with pain in a neuropathic pain condition, does it mean the condition is autoimmune?

A: No. You can get pain relief from the endorphin effect of LDN.

This is a summary. Please listen to the full interview.

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

Dr Jackie Silkey: Thank you for having me. 

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

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

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

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

Linda Elsegood: Have you seen any negative side effects?

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

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

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

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

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

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

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

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

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

Linda Elsegood: Are you a fan of vitamin D? 

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

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

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

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

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

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

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

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

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

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

Dr Jackie Silkey: too much 

Linda Elsegood: too soon. 

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

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

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

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

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

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

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

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

Dr Jackie Silkey: Yeah, that sounds good. 

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

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

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

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

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

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

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

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

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

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

Linda Elsegood: Okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Linda Elsegood: So keep flushing and eating those vegetables. 

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

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

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

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

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

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

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

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

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

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

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

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

Dr Jackie Silkey: Oh yeah. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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