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Explore the historical 'bucket brigade' analogy for understanding Low Dose Naltrexone (LDN) as an anti-inflammatory agent. This video by Dr. Sarah Zielsdorf, MD, MS delves into LDN's mechanism of action, its historical off-label use, and the challenges in its clinical adoption, particularly in women's health. Discover how LDN modulates the immune system and its potential benefits.
Dr. Sarah Zielsdorf, MD, MS: In the colonial period villages had villagers had to keep a bucket of water outside and whenever there was a fire they would all run to the site and pass their buckets. This shows a synergistic relationship just like in our systems in our immune systems we have cytoines which are pro and inflam anti-inflammatory pathways um which signal and there are many different intermediates. So we have to use a variety of tools to quench this fire and I think of LDN as the bucket brigade.
So naltrexone is dosed at 50 to 200 mg uh by FDA approval. It was approved in 1984 for the treatment of opiate addiction and in 1995 for alcohol abuse. Dr. Bernard Bhari was a New York neurologist and he was the physician that used initial um off label use of nrexone in doses ranging from 1 and a half milligram to three and then 4 and 1/2 milligram as an adjunct therapy for HIV AIDS in the 1980s they had the realization that endorphins are critical for an appropriate immune system response and then there's Dr. Dr. Ian Saigon and his work on MET and Kephilins or opioid derived growth factor and opioid derived growth factor receptor.
Low dose Nalrexone is a non- selective antagonist. It has strong effects on the muopioid receptor and delta opioid receptor but less antagonism of cappa opioid receptors. And these are the roles of LDN. can see improve menilins and betaendorphine synthesis, modulate microglea which are like the trash cans in the central nervous system which eat up pathogens. Modulate the immune system and support it for being better and more able to fight off infections. It's anti-inflammatory and so much more.
There are many many barriers to LDN use in women's health. Um clinicians just don't understand the mechanism of action. They just continuously are worried about um and stigmatizing what LDN is and is not. We know that LDN is used as an off label treatment for infertility. Research on this topic is evolving. There is a huge amount of fear of being blamed or scapegoed in ob gynecology um for any complication or poor outcome. It's a very highly latigenous field especially in the United States and so doctors are very unwilling to practice what is not considered the standard of care in any way.
There is fear of inducing withdrawal in babies, which is ridiculous because this is doing the exact opposite. But I've had cases where doctors are going to say that this is an opioid. It is not an opioid. It is an opioid antagonist. It is blocking that receptor and then causing the rebound effect where you're going to make more of your body's own endorphins and encaps.
There is a distrust of clinicians using lowdos nrexone as it must be some sort of snake oil. I assure you that it is not snake oil and there is difficulty in general engaging clinicians in consultation to use low-risk off label treatments to improve outcomes for specific patient populations.
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