Linda Elsegood: Today I'm joined by Dr. John Kim from Georgia Integrative Medicine Clinic in the US. Thank you for joining us today.
Dr John Kim: Oh, you're welcome. It's my pleasure and honour to share this wonderful therapeutic known as low dose naltrexone.
Linda Elsegood: Thank you. So could you tell me your qualifications, please?
Dr John Kim: I am a physician originally trained in family medicine, then Chinese medicine, integrative medicine, preventive medicine, public health. I think before I went to medical school, I was doing basic science research in biochemistry, and I was a Howard Hughes Medical Research Fellow for pharmacology.
Linda Elsegood: And when did you first hear about LDN?
Dr John Kim: So this interesting part is that I have gone through two residencies, two fellowships; including an integrative medicine fellowship with Dr Andrew Weil at the University of Arizona. Those times spent in training I'd not heard of LDN. I did not learn about LDN actually until a patient of mine came to me and said, “Hey, listen, I have a thyroid issue, and I've done this research, and I just can't get a doctor to prescribe me LDN or low dose naltrexone. Would you at least do the research for me? Because you're one of the few doctors that listen to patients. And you have an open mind?” So I said, sure, let me do the research. And when I did the research, I was very surprised by the fact that this has been well-documented and utilized extensively since Dr Bihari’s use in New York, and all evidence seems to indicate very little risk and all possibilities of benefits.
So I told the patient, yeah, sure, let me go ahead and I'll prescribe the medication, and it's going to be a bit of an exploration on both parts. And amazing things began to happen. Not only her thyroid issues began to reverse and over several years not only her thyroid issues reversed, but she conceived and delivered a baby.
And so. That person made me think a lot about the possibility of what else is possible with LDN. Me being a cautious practitioner I had to go very slowly for the next about five, six years; and I would target other patients with thyroid conditions. And I began to see a pattern that I can't do with other medications. Because with all the medications in conventional medicine, we can replace thyroid hormone in different forms, but I don't have a possibility or ability to reverse illness, reverse thyroid disease. We just let it go until it goes into total failure, and you just up the dose. And in this case with LDN, I began to see patients whose doses can be halved, and other patients would basically become drug-free. And then other cases I would see the antibodies related to hypothyroidism lowered in number.
Linda Elsegood: And did any of your patient's experience negative side effects when first starting LDN?
Dr John Kim: In the beginning, none of the people really experienced any of the side effects, but as I began to use LDN more in-depth, I began to see side effects. One of the things I've run into is that typically the LDN low dose naltrexone in the literature is considered between 1.5 and 4.5. But I've noticed that in patients with what I call low endorphin reserve, where a patient has been sick for a long time, patients not feeling well for a long time, their daily activity is compromised; in those patients, I've seen that the 1.5 milligrams can have a paradoxical effect. Patients can not sleep. You tend to create insomnia. And I think that's well documented. In patients with PTSD, the LDN also can cause vivid dreams related to the PTSD; or further, create trauma. And in such cases, I began to experiment with lower doses. So I would begin using 0.5 milligrams or even lower. Now today I start even at 20 micro micrograms, and then I'll do a rapid ramp to get them to 1.5 milligrams.
Other side effects that I've seen is some nausea. I have patients that could not even tolerate one microgram of low dose naltrexone; they just feel really, really bad and in pain. So again, I think that their endorphin reserve is quite low and they’re not tolerating this dose.
Linda Elsegood: And you were talking about thyroid conditions. Have you prescribed for other autoimmune conditions now?
Dr John Kim: Yes. Oh, you know, it's thyroid Hashimoto's thyroiditis. One of the first things that I started treating when I saw the effectiveness of LDN for treating thyroid conditions - I said, Hey, if it works for Hashimoto's thyroiditis and the mechanism is through correction or modulation of our immune system, why not? Why wouldn't it be a shift in theory, work for Graves’ disease? So I began to treat patients with Graves’ disease.
Graves' disease is very interesting because the response to LDN in Graves' disease is maybe somewhat lower than with Hashimoto's thyroiditis. I have several patients who are doing very well, and they are in remission from Graves' disease with using nothing more than low dose naltrexone.
As I can understand the mechanism by which LDN works I decided that maybe we can do more. Again, the literature also helps us. So I began to treat patients with MS and we just got some amazing results, including one patient who is actually in remission from MS. She almost was not able to walk, and now she's climbing Mount Kilimanjaro and travelling all over the world and being able to enjoy a very high quality of life. And then other rheumatological conditions, such as psoriatic arthritis and many, many other conditions.
One thing that I really noticed is that through my practice I'm beginning to see LDN beyond just what we accept in literature. For example, I have some patients with dementia and Parkinson's disease and LDN I believe has helped to mitigate or slow down, or some cases reverse - not fully - but some effects of dementia and Parkinson's disease.
Linda Elsegood: What about cancer?
Dr John Kim: Cancer is one area that I think - I recently accepted a position with Miami Cancer Institute with the Baptist Health of South Florida, and the reason for that is that in my current private practice, I think that my experience with autoimmune diseases have been extensive and I've seen excellent results with low dose naltrexone for treating autoimmune conditions. But for cancer, to be honest, I just don't have enough patients coming to me who have cancer, and the patients that I've treated with cancer, I am not able to say that it works or doesn't work with cancer. What I have seen is studies, especially by Dr. Berkson in New Mexico, who is combining the low dose naltrexone and alpha-lipoic acid. So I began doing that as generally part of my treatment of cancer, but I'm looking forward to my new position where I will be able to see more of those patients.
Right now, I have developed a bit of reputation to help patients with autoimmune conditions. I see a lot of patients with autoimmune and different kinds of autoimmune conditions, and that has really helped me to understand the function and utility of LDN for autoimmune diseases. So what's interesting to me is all the cases where I am using LDN may be somewhat different from other people. One of the things that I've utilized LDN for is the gene for insomnia because one of the things that LDN does is to increase REM sleep, decrease sleep disruption; and also enhances people’s ability to fall asleep. And that's one of the reasons I think, unfortunately for the patients with PTSD, that doesn't work as well, because these may get them back to the conditions or memories that are very traumatic because it's very, very vivid.
The other things that I’m treating are things like tinnitus, migraine, endometriosis, and infertility. What I'm seeing is that LDN has multiple chemical functions. So one is, its modulation of proinflammatory cytokines through the clear cell in the central nervous system. And that's the primary response to invaders if you will, in our central nervous system. And as such LDN is a very valuable tool.
But in addition, it seems like LDN has other functions, such as it seems to have a very calming effect on the nerves. So LDN can be, I think, used very effectively for treating neuropathies of all different kinds. Also, as I mentioned earlier, it's almost like an adaptogen all by itself, so I often use LDN to treat patients with a mood disorder because having more endorphins seem to make patients respond better to the conventional and nonconventional treatments of depression and anxiety. Because it's kind of hard to feel depressed when you're feeling good, and endorphins give you that edge that feels good. So while you feel good, it's difficult for you to feel either anxious, or feel good and depressed at the same time.
Linda Elsegood: What do you do with patients that are already on strong opiate painkillers when they come to you?
Dr John Kim: So those patients are very interesting. About 50% of my practice is treating patients with severe pain using neuro-anatomic techniques, and I don't prescribe any narcotics at all. But we have a good track record of helping patients to get off narcotics, and in this case, we use a phenomenon of low dose naltrexone, utilizing microdose naltrexone, also known as ultra-ultra-low dose naltrexone. And in this case, we use micrograms of naltrexone. Again, as I said, the usual dose that people use of naltrexone is about 1.5 milligram to 4.5 in LDN amounts. But it's very interesting because you can take microgram doses, which is a thousand times less than milligram doses, and there are studies that demonstrate that a microdose of naltrexone results in better pain relief, and it also lessens the side effect. I have a couple of patients treated with this ultra-low dose of naltrexone, and they’re doing great. Great, great, great response. Because I have chosen not to prescribe for narcotic, they still go to their pain doctor, and the pain doctors are quite pleased because usually if you just give narcotics alone, the doses have to go up, up, up, up, up, and that's when you have overdose phenomena and people get in trouble. But in this case, what happens is that with the combination of the low dose naltrexone and the neuro-anatomic approach to pain that I developed over 20 years, we can actually reeducate their central nervous system and lower the dose of narcotic, while the patient is reporting much-improved pain. Such techniques, actually, I think to warrant a lot of research oncoming because of the obvious problem with the narcotic overdose that is going on in our country. As a matter of fact, there's medication right now that is being studied combining ultra-low-dose naltrexone and narcotic medication. It's not been approved yet, but there'll be interesting how the Oxytrex will work for patients.
Linda Elsegood: Do you keep them on the ultra-low dose, or do you increase it over time?
Dr John Kim: As their narcotics amount goes down, then I march it up because, with low dose naltrexone, I think that there is a benefit. I think the key is to start the patients depending on their narcotic history and narcotic use history and their functional assessment of the endorphin reserve status, and then trying to match that clinically. And then generally I march them up. LDN really has been an invaluable partner for me to get my patients well,
Linda Elsegood: You also mentioned alpha-lipoic acid. What do you use as a protocol? Do you have a general protocol for it?
Dr John Kim: Absolutely. Dr Berkson's protocol of using LDN and alpha-lipoic acid is published; anyone can look it up. I believe that he uses IV though, so I researched more talking to pharmacists, and it seems like that protocol has a side effect that people can pass out. Also, if the GI system is working, I feel like that is the first thing that we should do.
So with alpha-lipoic acid, I generally like to utilize the controlled release form or slow-release form, and that also depends on the person's ability to take alpha-lipoic acid, because if you give 600 milligrams to everybody, some people who are very sensitive to it may pass out or get hypoglycemic symptoms because alpha-lipoic acid can be a powerful agent to lower blood sugar levels in diabetic patients. It also helps with neuropathy. I know that alpha-lipoic acid and LDN are a very powerful combination to reduce inflammation in the nerves.
And that makes it interesting because most of the medications that we use do not necessarily work well in what we call a high-hydrophilic or -hydrophobic environment. A hydrophobic environment means that it's not easy for charged molecules to enter and do its job. LDN seems like it can penetrate very easily. Alpha-lipoic acid also is fat-soluble, so those two are very important. I believe that Dr Berkson’s protocol for utilizing alpha-lipoic acid may have to do with the function of keeping the blood sugar low, therefore allowing the tumour growth to be inhibited. But I think that again, a lot of studies need to be done. And that's one of the reasons I have accepted this new position in Miami for the Miami Cancer Institute. And I'm hoping that as the director of integrative medicine I will be given permission to explore the possible roles of using low dose naltrexone and other proven therapies in a system-wide manner.
Linda Elsegood: Do you use vitamin D as well?
Dr John Kim: Yes, of course, of course, I do use it. If it's low, I do supplement it. It's not a part of my protocol. Part of my protocol for cancer also includes fat-soluble vitamin C, that would be ascorbyl palmitate, because otherwise, you have to go through the vitamin C injections. I think that there are multiple responses you can get from vitamin C. So for example, high doses of vitamin C injections, that's been documented by Dr. Jeanne Drisko in the University of Kansas medical centre - I think that that research shows that the vitamin Cs can help the formation of hydrogen peroxide. And then the hydrogen peroxide goes after the tumour cells. In the dose that I'm using, I don't believe that vitamin C dose is high enough to do that. So it doesn't replace the need for IV vitamin C treatment. But again, it has to do with my current practice setting, that IV therapeutics is not very easy for me at this time. And by using the fat-soluble vitamin C, what I'm doing is overcoming the required amounts that can be taken in by the body. There are no formal studies that fat-soluble increases the amount yet, but it makes sense to me. I think that fat-soluble forms of therapy can be extremely valuable.
Oh, another example of that is S-Ethyl glutathione where the ethyl group is attached to glutathione. Multiple people have tried to play with the different formulations, but I think that the actual chemical alteration to make the molecule more hydrophobic is probably cost-effective and the best solution for some of the molecules, to encourage them to go where they need to be going to do their job.
Linda Elsegood: And you were saying that you weren't taught about LDN in medical school. Do you think that's likely to change anytime soon?
Dr John Kim: I don't think so. I think about integrative medicine and how it is now being discussed, or at least covered more in elite medical schools. So if you look at the distribution of integrative medicine in the United States alone, really it's reserved for what I call first-tier medical schools like Harvard, Vanderbilt, Duke, Yale. But it has not really penetrated a lot of the regular schools with the exception of maybe the University of Arizona, where Dr Andrew Weil started the program. Even there, I think medical students have a lot on their plate. I don't think they get enough about nutrition. I think that the medical education system is arcane. What I would like to see is breaks in mores in residence level, where after doctors graduate medical school, they get trained. That's where the doctors learn to be doctors.
What I've done with my recent book, in some sections, I've even published the patients’ lab results - not patient's identity - but their lab results, so that they can see after treatment with LDN that the TSH would start low, and then the TSH would normalize. T-3 would be high and then it would normalize and then it would also see the antibody levels all responding.
Linda Elsegood: I understand that there is a medical school in Oregon that actually teaches LDN to the medical students. So that has to be a start, probably.
Dr John Kim: It has to start somewhere. I think that for me that integrative medicine means working with patients, and that has really helped me to learn about an LDN. The nature of my practice is about 50% dealing with intractable pain. The other 50% is dealing with patients who have complex problems that they really can't get answers on. And what I found is that LDN doesn't cure everything. I think that it's dangerous to say one thing can do everything. Like, if you do LDN, you don't still need to practice good medicine.
But LDN can be an amazing tool for autoimmune diseases especially. A lot of the tools that we have are not benign tools, or you cannot use steroids forever, you cannot use immunosuppressants forever. And I think that LDN also helps you to understand the nature of the disease. I'll give you an example. I had the longest time thinking why, how can LDN work for HIV? So when I began to read more about HIV, I found out that HIV actually is not strictly an immune deficiency condition. It's really immune derangement, meaning that the immune system is not functioning the way it's supposed to be functioning. So similarly we can postulate, we can guess we can think about cancer. Is it also possible that a cancer patient's immune system is deranged? It's not doing what it's supposed to do?
So in my practice, in the beginning, when people have an autoimmune disease, we would just use LDN. And then inevitably we would have patients for whom LDN isn't good enough. It's not doing the job by itself. So what I have done is more research, more reading, and more talking to other people, and I found out something very fascinating. What I found out is that if you have an autoimmune disease, it makes sense to check the person's autoimmune profile. And what I mean by this is not by doing conventional testing of things like C reactive protein, doing and an ANA check, or ordering an immune profile. And of course, I do that. Part of my assessment is to screen for their developing other autoimmune conditions before placing them on LDN.
But if the patient does not respond to LDN, I think that sometimes, doing additional testing, either allergy testing to see if there’s an allergy to both respiratory allergens - things like fungus, trees, grass, as well as food allergens. Both IgE and IgG can make sense, because again, if we're looking at autoimmune diseases as immune derangement, then you're looking for places that immune system is not functioning the normal way. I think the LDN is a powerful tool, but as I said, there are patients who don't respond to LDN alone.
One patient had a double rheumatoid condition, and LDN alone wasn't doing it, acupuncture wasn't doing it. So what I finally did is testing on the food section, and the patients stopped eating that food; and I used immunotherapy to reteach the body to forget, to let go of the allergens that person had. And the amazing thing happened. Both of her rheumatologic diseases disappeared to the point when she went back to her rheumatologist and said, Oh, we made a mistake. We're sorry. And the patient said, Hey, you mean to say that my lab and my x-ray were all conspiring together? That's unbelievable. That's not likely. I think it's more likely the LDN plus the immunotherapy that Dr Kim asked me to do, is working together. And it's resulting in this remission.
Linda Elsegood: You've mentioned your book. Would you like to tell us the title of the book and when it will be available?
Dr John Kim: I'm hoping that the book will be available in December. The press release went out some days ago. The title of the book, I put it as “Understanding Low Dose Naltrexone Therapy” and then its subtitle is “A Cure For All”. I mean the illnesses of cancer, and chronic diseases. I have to contact my old editor and see if she is available to take the job, because she edited my first book and she did such a great job, so I want to see if she can edit this book as well.
Linda Elsegood: Do you expect that you're going to be moving? Can patients still come and see you before you move, or are you fully booked?
Dr John Kim: I think patients are still coming to see me, and my understanding is that - when I interviewed with them, they assured me that even though I'll be in the cancer centre and seeing mostly cancer patients, I will not be forbidden to see other patients. I'm really hoping that it will be the case because I feel like the autoimmune approach that I've developed can help patients, and especially patients who are not good candidates for conventional medicine in terms of long term steroid use, or the immunotherapy itself can be very harsh to some patients. So I'm hoping that I would be allowed to do that.
And the other part is that I have this idea that some forms of cancer may involve the host, the patients. Developing all that I said about the immune derangement, that maybe their immune system is obsessing over something else, maybe food allergens; or they have an undiagnosed autoimmune condition. I've seen that once you develop cancer, you stop looking because cancer is such a deadly condition, you want to zone in on that. What I'm hoping to do is be allowed to do other observations, observe their autoimmune conditions. It can be more formal in terms of formal research, or it can be just the clinicians’ observations.
I remember a long time ago in London, the cholera epidemic was controlled by a Mr Snow or Dr Snow, that did not know the mechanism. He just used epidemiology to isolate the wells that were likely to be responsible for cholera. He didn't know the exact mechanism, but all he had to do is shut down those wells, the old water pumps, and then he was able to help. The field of medicine relies on collaboration and cooperation, and that's part of the reason I've accepted the position in Miami. But I think there's still room for one person to make an
observation, then through communication through books or through organizations like your organization, to reach out and ask these questions that no one else has asked.
Linda Elsegood: Thank you. And thank you very much for your time, and sharing your experience.
Dr John Kim: Thank you for the opportunity.
Any questions or comments you may have, please email us at Contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.