Well, maybe not all of conventional medicine.
But almost every day, in order to find material for Health Tips, I scan through the JAMA Journal of the AMA websites, Medscape, and their links, as well as a couple of nutritional and natural medicine sites. After thirty years, I know what I’m looking for and can do this pretty fast.
My eyes made a “Whoa! What’s this?” screeching halt at a staff-written article on Medscape last week (not a research paper) about Low Dose Naltrexone. The writer apparently phoned some rheumatologists and received surprising answers, namely that some had been prescribing LDN for pain control and getting excellent results without side effects. Many however had heard of it but would not prescribe until it was better studied.
The longest prescriber, a rheumatologist, had been recommending it for over thirteen years and had found it superior to the three FDA drugs (Lyrica, Cymbalta, Savella) in terms of side effects. LDN seems to work as an anti-inflammatory on nerve endings, but unfortunately (like most meds, for most conditions) it doesn’t work for everyone.
Patients themselves discover LDN by word of mouth or on chat rooms. They ask their primary care doc for an rx, are turned down, ask their rheumatologist, are turned down again, and end up at one of our offices. We’ve written hundreds of prescriptions since 2003, filled by compounding pharmacies all over the U.S.
LDN is an “orphan drug”, meaning that the patent had long expired on the original molecule, generic now for years, not owned by any one company. For this reason and unable to recoup their investment, no Big Pharma company is interested in pursuing costly clinical trials that might have proven LDN’s usefulness.
Naltrexone itself (in a 50 mg capsule and not a 4.5 mg “low dose”) was FDA approved for patients addicted to opioid medications. It worked by blocking opioid receptors in the brain. With the opioid crisis still here, full dose naltrexone is still used for this.
But an interesting phenomenon was observed among some patients taking naltrexone. Those with two chronic conditions, Crohn’s Disease and Multiple Sclerosis, reported improvement of symptoms. Many, in fact by taking naltrexone, were able to reduce their doses of conventional medications, and some could go off their meds completely.
There was one interesting sidelight: when the naltrexone was given in lower doses (as low as 1/10th or even 1/20th of the usual dose) it actually worked better. Hence: Low Dose Naltrexone which you’ll see everywhere as LDN.
During the years after I wrote the original Health Tip, the list of conditions that might be helped by LDN has, to put it bluntly, exploded. Which is why it’s mildly ironic, to me at least, that the Medscape article only mentions fibromyalgia.
If you pause and reflect on how many medical (and possibly psychiatric) conditions are associated with one word: inflammation, and how inflammation will trigger overstimulation of immunity, namely autoimmunity, you’ll also see the irony.
Now you can start listing LDN uses by the dozens.
Forward-thinking rheumatologists prescribe it (off-label, of course) for ankylosing spondylitis and rheumatoid arthritis.
Dermatologists for psoriasis.
Gastroenterologists for Crohn’s and ulcerative colitis.
Neurologists for multiple sclerosis and Alzheimer’s.
And even the so-called “Anti-Aging Centers” include LDN in their protocols.
If you’re interested in more, here’s an important link: The LDN Research Trust. One of the tabs on the landing site lists the conditions in which LDN might help, keeping in mind of course that there are no guarantees in health care.
Okay. How does LDN actually work?
As I said earlier, the regularly dosed naltrexone, the 50 mg size, simply blocks those landing sites in the brain and nervous system called ‘opioid receptors’. The most widely prescribed opioids include medications like Vicodin, Norco, Oxycontin, and morphine. Naltrexone acts as an ‘antagonist’, stopping opioid effects. Low dose naltrexone is incapable of blocking opioids so that patients using these meds don’t have to worry that using LDN will render their pain meds ineffective. LDN is also nonaddictive (not being an opioid) with minimal side effects (those ‘vivid dreams’ have been mentioned by a third of patients).
How it works for chronic pain gives us physicians some idea of how LDN works for other conditions.
First, you need to understand that you’re really taking a mixture of two forms of LDN in every capsule, a levo form, where the molecule is twisted to the left, and a dextro form, twisted to the right. These two forms are called ‘isomers’ of the molecule.
The ‘levo’ form acts to block the opioid receptors. In the process, it also raises the brain’s level of neurotransmitters, especially dopamine, one of the so-called “happy molecules” which explains it’s recent increase among psychiatrists for treatment resistant depression. Raising endorphins also reduces inflammation and in turn reduces pain and improves overall sense of well-being.
The ‘dextro’ form of LDN is more useful for autoimmune diseases, antagonizing cytokine modulated immune cells. ‘Cytokines’ is a very general term for a type of protein released by white cells that either lessens or increases inflammation. A balance of both pro- and anti-inflammatory cytokines is best.
Both fibromyalgia and severe long COVID turned out to be very similar except that for most people long COVID does eventually go away. Both are relentless storms of cytokines (muscle pain). Inflammatory cytokines damage mitochondria, the energy centers within each and every cell. The results of mitochondrial damage are “fatigue”, “muscle pain”, and “brain fog”.
If you have just about any chronic condition, it’s worth learning if LDN can be a useful adjunct to your treatment. A quick way to do this is to type the name of your condition (or symptom alone if you don’t have an ‘official’ diagnosis) into your Google bar along with either ‘low dose naltrexone’ or LDN. Just now I did this with ‘psoriasis’ and came up with several quality research articles. Get the drift?
You can ask your primary care doc or your specialist for an LDN prescription, but don’t expect glowing enthusiasm. Expect instead a lecture about “off label drugs”, “unproven”, and ending with “just take what I tell you to take”.
However, if you want to pursue a course of LDN, schedule a WholeHealth Chicago appointment.
Be well,
David Edelberg, MD