I just returned from Florida where I attended the Annual International Conference 2018 sponsored by the Institute for Functional Medicine entitled, “Solving the Puzzle of Autoimmunity: the Interplay of Gut, Genes and the Environment. “ Though the conference was not officially about psychiatric disorders, I am convinced that most of what was discussed is directly relevant and applicable to the origin and healing of most psychiatric problems.
The conference was inspiring and I came back enthusiastic to try a variety of new approaches, both on myself and my patients. Fecal Transplants and Helminth Therapy are high on my list, but fecal matter and worms are still difficult to obtain and complicated to administer. In contrast, another modality, Low Dose Naltrexone , (LDN) a conventional pharmaceutical, is readily available, safe, inexpensive and according to the lecturers, has wide applicability and efficacy.
I have been aware of the existence of Low Dose Naltrexone for some time, but never considered prescribing it to my patients or taking it myself, until I heard the lecture at the conference. Two physicians, Leonard Winestock, MD and Jill Cottel MD, who have extensive experience using it with large numbers of patients, reported that they often had excellent results in terms of achieving improvement and even remission in a wide variety of conditions. There are studies reporting its efficacy not only in classic auto immune illnesses such Ulcerative Colitis, Rheumatoid Arthritis, Multiple Sclerosis and Psoriasis, but also in diverse conditions such as Cancer, Fibromyalgia, Chronic Fatigue, Histamine Intolerance and Mast Cell Activation Disorder, Autism, Chronic Pain and Complex Regional Pain Syndrome, AIDS, PTSD and Depression.
Naltrexone, an opiate antagonist, was developed in 1963. Originally Naltrexone 50 mg three times a day was prescribed to treat opioid addiction and alcoholism. Due to receptor blockade, patients taking Naltrexone would not get high from opioids or alcohol. Unfortunately it was very poorly tolerated by patients. It resulted in dysphoria, as it not only blocked the effects of the intoxicants, but also blocked the naturally occurring endorphins in the body. Patients did not like how it made them feel and refused to take it. Endorphins are naturally occurring substances that create a feeling of well being, such as the euphoria experienced by long distance runners. They also play an important role in modulating the immune response, and in reducing pain and inflammation.
Low Dose Naltrexone is prescribed at doses between 1-4.5 mg, which at that low dose briefly blocks the opioid receptors for a few hours. Subsequently a rebound effect occurs, with increased production of endorphins, resulting in an enhanced feeling of well being, as well as a reduction in pain and inflammation. There are very few side effects. The most common one is vivid dreams, which typically resolves after a few days, but recurs when the dose is increased. Other side effects that have been reported include headaches, GI symptoms and insomnia. But side effects are typically mild and transient, if in fact, any are experienced at all.
Low Dose Naltrexone is contraindicated in patients who are taking pain medications and immune suppressive therapies. It must be obtained from a compounding pharmacy and generally costs less than one dollar a day. I obtained a 90 day supply from Johnson’s Compounding and Wellness in Waltham, MA for $49.95. Low Dose Naltrexone is available only with a prescription. A couple of days ago, I started myself and a number of my patients on 1.5 mg. I will evaluate in two weeks if the dosage should be increased. It is preferable to take the smallest possible effective dose.
Interestingly, Neil Nathan, MD, an expert who I often consult when I have patients in my practice with mold toxicity, wrote in a private communication that he never has seen Low Dose Naltrexone work in any auto immune condition. He wrote that it sometimes helps with energy and cognition. Amy Myers, MD the well known integrative physician, also wrote in a post that she has not witnessed dramatic results with her patients. It’s hard to know how to understand these discrepancies. The presenters at the conference reported impressive results in many cases, though not all. I am now taking the medication myself and prescribing it to many of my patients. The risk is low and the potential benefit high.
Not surprisingly, the efficacy of Low Dose Naltrexone is increased by eating an auto immune paleo type diet. It is particularly important to avoid gluten and casein, as they also interact with the opioid receptors. The diet should also include a wide variety of vegetables.
After my first dose, I slept restlessly and had a moderate headache the next day. The next two nights I slept better and had no headache, and had an elevated mood. I am interested in its capacity to reduce gut permeability and the permeability of the blood brain barrier. Most patients who come to see me have psychiatric symptoms which are caused by a leaky gut, a leaky brain and inflammation.
It is a testament to the potentially high benefit and low risk that a conventional pharmaceutical was featured at a Functional Medicine Conference, and that for many years an organization like the Weston A Price Foundation has also been a strong proponent of its potential benefits.
My thinking is as follows: our current environment is so toxic and stressful, that we need to make use of all possible measures to strengthen our immunity, in order to maintain our health. I am really excited about the potential of Low Dose Naltrexone, and eager to see if it helps me and my patients. I will report back with my findings.
Here is a fascinating interview by Joseph Mercola, MD of Thomas Cowan, MD about Low Dose Naltrexone.
It could be something as simple as a filler. I think lactose is used sometimes. It gives me leg cramps.
I have been on LDN for about a month and a half… It took me 1 month to get to 3.5mg. LDN gives me insomnia and since I increased the dose to 3.5 mg my libido has increased dramatically. I mean it’s too much…
I am taking it for grave’s disease. I have leveled off my thyroid but my naturopath wants to lower my autoimmune grave;s indicators so I can go in remission. that is why I am taking it,
I do have a general sense of well-being and a smile on my face. I do enjoy LDN very much. I just wish it wouldn’t cause such an increase in libido.
I had never heard that before about it affecting libido. That is so interesting. For many people, that would be a welcome side effect, as people commonly feel distressed by low libido. Thank you for taking the time to write.
I also have experienced increased libido which I am very thankful for because since I’ve been on Cymbalta prior to starting the LDN, my sex drive was murdered. Like died completely. I can also reach climax more easily than I ever have before. The weird thing for me was the first 4 days I increased from 1.5 to 3mg I was like the hulk. Weird rage inside and out from nowhere. I almost took myself to the hospital because I thought I was losing my mind.
So interesting! Thank you for taking the time to write. I am sure that your experience will be of use to others, both the increased libido and rage during the dosage increase.
Dear Dr. Tsafrir,
I am following the work of Dr. Neil Nathan, MD and found you through his site. I have gotten to the root cause of my problems, mold toxicity, and have or have developed porphyria in addition to ME/CFS, Immune suppression, and Reactivated EBV. I had just been prescribed LDN when my porphyrin levels came back elevated. Can you point me in the direction of any research that indicates LDN is or is not safe for Porphyric patients? I haven’t begun yet, and my docs are having a hard time finding info, too. Thank you for your work, website, and time.
Jeanne
Hi Jeanne. Thank you for writing. I cannot say definitively, but I attended the Institute for Functional Medicine’s International Conference in Florida on AutoImmunity in early June. It was there that I listened to a lecture by two doctors who both had vast experience prescribing LDN to large numbers of patients, often with excellent and remarkable results. One was a gastro enterologist and the other an internist. The only contraindications that they mentioned was if a person was taking immunosuppressive therapy or if they were on pain medication. They never mentioned porphyria. I imagine that they would have, were it an issue. But I cannot say for sure.
I appreciate your time and response, Dr. Tsafrir. I did start LDN slowly, and it seems to be helping me with energy and to expel the mold; although I did not feel like it was in my sinuses and lungs, things are working there way out now and I am getting stronger. I am up to 2.0 mg and getting better. I am sorry that you, too had environmental illness, but I’m grateful that you can bring your experience to your practice. Happy New Year! Be well… Jeanne
It’s unfortunate to be afflicted myself, but it really is the driving force that fuels my explorations and catalyzes new learning. There was also severe illness in my family of origin, and no one understood what was wrong or how to help. It’s very meaningful to me to be able to help others since I could not help them. Thank you for writing, and I am delighted to hear that LDN has been helpful. For certain patients in my practice, it’s been extraordinarily helpful.
No automimmune disease, never sick or anything
Severe depression for 7 years despite Any and All therapy.
Wonderful Dr who commented below started me on it 3 weeks ago
Not a magic bullet, but pretty appreciably positive effect on mood, and Im a skeptic. Insane trippy dreams, which are annoying but enlightening. It feel natural, hormetic and has been a valuable help overall . 4.5mg.
This is so wonderful! Thank you for taking the time to write. Its such an important tool. I love how safe, simple and inexpensive it is.
Dear Dr Tsafir,
I commented on the Walsh program at the start of this website. I have been prescribing LDN for about 12 years for physical conditions. In 2013 Norwegian TV made a film and after that it has become very popular there. Part of it was made in my office in Dublin and now is recently in the American website http://www.lowdosenaltrexone.org.
For t he past few years I have been prescribing it for mental health conditions and it is really useful. I do not know how a physician cannot prescribe it. Apparently it is is basically an anti-inflammatory drug that has minimal side effects. I use it in almost every patient with a history of psychosis and in many cases it gets them back to a decent quality of life, I prescribe it for many with depression and it works for most of them too. I still use medication and Nutrient Power so now I have a wonderful selection of treatment options available and I enjoy medicine more than ever. Here is one case. A student was raped and she was devastated . She spent several months in a psychiatric unit. Her sister brought her to me . All the biochemistry tests were normal. She had in effect a case of post-traumatic stress disorder. I decided to put her on lowdosenaltrexone. and leave her on her two antidepressants. Almost six months later she was off the antidepressants.She was well, had a good relationship, back in college and “the past was the past” . She remains on the LDN . I have a male case of PTSD who is now in Australia . He was abused very badly. He told me that he is getting a lot of good days recently and he is optimistic about the future.LDN is not magical but it is a wonderful drug for many psychiatric conditions.
Thank you for writing. I am very grateful that you are sharing your expertise over 12 years. It’s so encouraging and confirms what I am experiencing myself in my practice. I am having remarkable results in a very short time. I am thrilled to have this new tool. It is so versatile and safe and inexpensive. Thank you again for taking the time to share.
So interesting – and what a coincidence as I just started a trial of LDN three days ago. I’m a universal reactor, I guess you could say, so my doc put my on a teensy starting dose. (0.2mg) I am experiencing insomnia, headaches, and HORRID leg cramps even on that low dose. I can tell underneath it all it is trying to lift my mood, but the tiredness from the interrupted sleep is co-opting that effect. I’m not on it for mood, I’m on it for autoimmune disorders (APS, Hashimoto’s), POTS, and MCAS, and mold toxicity. (My opinion is that I don’t have 17 trillion discrete dxs, but rather multiple expressions of an underlying, unifying dysfunction.) It’s discouraging to have such intense side effects from such a low dose. I wish I understood the mechanism of the reaction.
Not as it pertains to me, necessarily, but do you have thoughts about what mechanism might make LDN cause muscle cramping? Dr. Google has no helpful opinion. 😉
Thanks for all you do,
Syd
(Btw, I worked briefly with both Neil Nathan and Tom Cowan in the past. Both great docs!)
Thanks for writing. Wow, that is so unfortunate that you are having an adverse reaction! And at such a minuscule dose. I really don’t know why you would be having leg cramps. Maybe you could write an e-mail to Dr. Weinstock and ask him. He is a low dose naltrexone expert. He is a gastroenterologist.
Thanks you. I will. I’ll let folks know if I get info we could all use.
I was told if patients get worse on LDN that they should be tested for Lyme as it can make undiagnosed Lyme symptoms worse.
This is the exact same thing I am experiencing , I am a universal reactor aswell and 0.5 of ldn makes me feel so wired I fell like I want to jump out of my skin, severe insomnia, severe muscle cramps but I also can feel it trying to life my mood, but seems to make symptoms worse so far after about 5 days on it.
All quite thoughtful, supportive comments. I am learning a lot about alternative therapies through these posts and look forward to more. Thank you to all who’ve contributed.
I currently take 150mg lithium carbonate daily, 3.75 mg Tranxene 2/week, and 10 mg Lexapro daily. I especially want to get off both lithium and Tranxene (misdiagnosed, don’t need), but discontinuation is a huge problem for me. Two questions: is it ok to take LDN while on psychotropic medication? Do you think/know whether LDN could help with discontinuation? Many thanks for all you do. 🙏🏻
The only medications which must be avoided with ldn are medications that are opioids and also immunosuppressant medications. There should be no problem with Tranxex or Lithium. I have not seen or heard anything about its use in discontinuation problems, but I have wondered about it. I think it would be worth trying, as the risk is low and the potential benefit high. Please write again and share your experience if you decide to do so.
With pleasure!
Hi there, the great and marvelous Judy…………..
I’m glad to hear your enthusiastic news about LDN. I’ve been considering it for a while now but the availability of a prescriber has caused significant delay. In the meantime, also from Cowan, is my present experiment with Metformin, the diabetes med. Cowan claims it’s a wonderful brain tonic as do the nootriment community that recommends boosting its cognitive benefits by adding choline/citicholine.
I’m trying it because I was severely damaged twenty-five years ago in a short run of Prozac that catapulted me into rapid cycling…. three days in a can’t move, want to die depression then three days normal mood. A year and a half of tis torture before the fierceness abated to a tolerable cyclothymia. I refused to take anything else that was offered as antidote. And, I left Big Pharma psych meds for good.
Cowan’s spiel is , if you’re a procrastinator, you are deficient in dopamine. People who achieve what they intend to have an excellent supply of dopamine. Metformin is proven to elevate levels of dopamine as well as improving glucose delivery to muscle tissue. I’m hoping and praying this will relieve muscle weakness that’s been plaguing me for years.
We know now that the SSRIs and the SNRIs as well as amphetamine salts actually destroy serotonin and dopamine receptors, therefore, my present excitement that I may get some relief soon. I’ll let you know how my experiment turns out………..
Thanks, Judy, for making this world a far better place………….
Thank you for writing. Sorry to hear about what you have been through. Sounds rough. I am very interested in what you wrote about Metformin and will investigate. I have seen many patients suffering with discontinuation symptoms. It would be good to have another tool. All my best.
Thanks for this article.
I have been meaning to follow up on research on LDN and Lyme/mold.
Do you know if it is safe for children?
In the conference the presenters said that it was safe for children. I think that the dose may be different.
Dear Judy, I always read your blog. Thank you for your writing. I have been taking LDN now for 26 months. I started out at 1.5mg and find I feel best at 4.5 mg 6 days a week and off one day. I take it for cardiovascular health as a nutraceutical and find my hs-CRP has dropped to .3 which is very low. Inflammation and mitochondrial dysfunction are often part of the scenery of aging and I find LDN a wonderful gift. I am now 68. My daughter has been taking it for an autoimmune condition for 4 years now and has had major positive results. In my experience, the good that comes from it builds as the immune system ‘glitches’ seem to get sorted with the LDN and so over time I have felt better and better and increased my dose. I view this as my endorphins were lower for so long and as I feel better, my endorphins are better and so the 4.5 works very well. LDN is remarkable for the fact that it crosses the blood/brain barrier and supports the glial cells in the brain. As a ‘patient’ I attend the online streaming of the LDN conferences each year. This summer there is one in Glasgow. For about £40 one can attend online and listen to the latest case studies and research. Jill Cottel and Dr Weinstock are regular speakers. One can learn about the conference coming up next month and sign up via http://www.ldnresearchtrust.org.uk
Thank you for this great comment, and the different ways that you and your daughter have made use of it. I am also glad to learn about the LDN conference in the summer. I spoke with a woman today who referred to having success with LDN as a marathon rather than a sprint. It does seem that though some people do feel instantly different, that for many, the effects build over time.
I have been taking LDN for about 6 months now for problems with a rash that seems to come from multiple food intolerances. I slowly increased to 4 mg and I did have trouble sleeping each time I bumped up the dose, although I currently take melatonin P.R., so when I wake up in the night, I usually go right back to sleep. I believe that I have celiac disease, as well. Although it was not confirmed by gut biopsy, I will not go back to eating gluten to test. Most of my rash has disappeared, except for a small patch on 1 foot, so I recently bumped up to 4.5 mg to see if that will also go away. I’m also doing chelation for heavy metal overload. I feel that I still have leaky guy & am looking for other means of healing it, Restore? Butyric acid? I’ve been taking L-glutamine powder for over a year, but must need something more. An added benefit of the LDN, increased libido! I’m a 67 year old female.
I did not know that about increased libido! Thanks for writing and sharing your experience. We all learn so much from each other.
I have autoimmune and have successfully used diy fmt. This has been most helpful after I healed my gut with diet and other gaps protocol . I did try LDN recently and I will warn folks to be careful. I’ve read many who successfully use this drug. For me it was not a good experience. Initially I became so depressed I almost felt suicidal. Since then I have read of other with similar side effects. I continued past this phase then became severely dehydrated and my eyes became very sunken. I stopped the drug for six months then gave it another go. After one dose of .5 my eyes became very sunken again even though I increased water intake and even started adding Celtic salt to my water to help absorption. No more .. this drug is just that…another drug. Again..be very careful if you decide to give it a try. Hesling the gut is key in my opinion. Healing takes a strong commitment to dietary adjustments which I findany just a rre not willing to do. We all want that magic bullet…even me. It does not exist. It took years to get.e so ill that we have symptoms that are apparent. We were sick before any symptoms surfaced. It takes a commitment and them years to heal. Remember that even the slowest movement forward is success!
Thanks for writing. Your experience is certainly not typical, but everyone is different. It was obviously very toxic for you, but for some people it’s a game changer. It is clear that LDN by itself is not a wise plan. It is optimal to combine it with an auto immune diet, meaning a whole foods diet, including animal protein, a wide variety of vegetables and gluten, casein, sugar and grain free. It’s another support in combination with many others to heal the gut.
Hi Judy –
I have been on LDN for close to 3 years. I am currently taking 4.5 mg. I was suffering with autoimmune issues that were compounded by, what my doctors have labled, a mystery illness that is still yet to be fully diagnosed.
LDN was a game changer for me! I went from bedridden (and so sick that one of my specialists wondered how I was living at all day in and day out) on most days to far more functional almost over night. While I am still not perfectly back to baseline, many of my symptoms (orthostatic tachycardia, moderate fibromyalgia, severe CFS, neuropathy, brain fog so bad that one doctor wanted to take my driver’s license away, food intolerances, a heightened fight or flight response and the list went on and on) have all significantly diminished and/or all together disappeared.
I am so grateful to see you talking about this drug!
I did see that someone above had an adverse reaction to LDN. I wonder what fillers were used in the compounding of their dosage. It would be interesting to see if this was were the sensitivity to this drug was truly lying rather then to LDN itself.
Again, thank you for educating others about this drug. My hope is that more practitioners will begin trying this drug with their patients that are suffering unnecessarily.
Thanks Jillian for sharing this useful comment, which I hope will inspire others who may be feeling hopeless, that there is something else to try. That is an excellent insight you had about questioning what the LDN was compounded with. I have heard that it can make a difference. Not in the context of an adverse effect. But some people might say that it did not do anything for them, but then when they had it compounded by a different pharmacy, the effect was not at all the same. The compounding process has an impact. Thanks again for sharing your valuable experiences.
Great you are getting the word out on LDN. I have been taking it for several years now. It has stabilized my TPO numbers. In the UK, transdermal application is used more readily than oral, and upon further investigation, I have learned that LDN can be quite hard on the liver. Though my oral formula has only cellulose as an excipient, I have just ordered it in drop form (w/olive oil) from Women’s Intl Pharmacy-a 90 day supply for $35. LDN is best administered at 9pm, so that it can take effect between 3-4am, which is when endorphin levels are at their lowest point (this was recently cited in an article by Amy Myers). I would have loved to hear those speakers at the IFN conference!
Warmly,
Susan
Thanks for writing and for sharing your experience. In the conference, the speakers said that the low doses used for modulating the immune system (1.5-4.5) is not hard on the liver.
I find it interesting that you are attempting to clean the gut that way. I found under a nutritionist in 2000 no bread,cheese,dairy,sugar, salt accept Celtic salt , no red meat , more variety of dark green vegetables raw gave more nutrients and best results. Also weekly fasting on water with lemon or Braggs Apple Cider gave the body a rest. I was instructed to drink daily green tea at least twice and 8 glasses of Distilled water or good Spring water. Later she took me off hot dogs, coldcuts, basically all processed foods, beans, millet, black rice, Quinoa found eventually can be soaked for a while will become soft with out heating.So Organic produce. Is the way to go. Most people on Meds unfortunately I see. All eat processed food , with shakes from meds and don’t speak up. I did, I won’t allow someone to experiment on me. When ignorant and they gave me lithium way way back in one week toxic no blood checkups destroyed my thyroid. Thanks to him. I am fortunate was immediately switched when notified yrs ago. Since eating mostly raw vegetables organic, fruits, seeds, nuts, all organic and fasting weekly caring not just body but spirit relaxing breathing exercises deep, and yoga daily my medicine was reduced by Dr. Is this because weight is 145 lbs now? Is it way of eating receiving B6, zinc, was deficient in yrs before they reported but didn’t have any idea it was necessary in assisting brain in mental disorders? Dr. Walsh I discovered with Nutrient therapy was aware most people with mental Disorders had nutrient deficiency. Thankfully our bodies are self healing if we assist, take responsibility to grow and clean our insides out and get stuff out hurting Toxemia kills. / EMH JoyJ!
Wow this sounds very interesting I look forward to your follow up blog in a couple of weeks.
Glad you found it interesting. I will likely let the experiment run at least for 9 months before I report back. A couple of weeks will not be enough to have anything meaningful to say.
Thank you to share your discoverings. I would like to find Low Dose Naltrexone in France. To help our 23 years old daughter we have been using Gaps diet for three years and a half and now she is much better. But she is still sad and with low energy most of time. She hardly speaks. She was at psychiatric hospital three times, she was hearing voices and she was very agressive and anxious. She has stopped her medication very slowly and stopped it completely one year and a half ago. We could discover that she suffered from traumas, sexual abuse, three times. But we still hope she will get better. I would like to work with you. But I think you don’t do it by skype, do you? Anyway thank you for your work. It helps us. Véronique
I am sorry to hear about what your family has suffered. The Massachusetts Board of Registration in Medicine only permits us to see patients for the first time in the office in person, not via Skype. But if you go on the Walsh Research Institute website, or on the website of the Institute of Functional Medicine, you will likely find holistic practitioners in France.
Hi Dr. Tsafir —
Thank you for this new information. I listened to Dr. Cowan’s webcast and it took me back to what I know, have known for decades. I’m a gardener, like Dr. Cowan, and love to grow food. I had a permaculture farm Whidbey Island, Washington for 7 years until my knees gave out and my elderly husband got very sick. He died 2 years later.
After my husband’s death I moved to Santa Fe, NM. I DO NOT LIKE the desert, or high elevation (7,000 feet) and struggled unsuccessfully trying to grow food. I’m planning to return to Washington, where I still have my house and yard, where I created new, fertile soil. I am looking forward to growing my own food again. There’s no comparison. I was especially excited about the lettuces I grew. They acted like protein in my body.
I’m now listening to Leann Vogel on your website. I’m particularly interested in how childhood traumas (of which I had many) damage the immune system. I have tried countless methods my entire life (71 years) trying to resolve problems – physical, mental and psychological. I wrote a book in 1988 — ALTERNATIVES FOR EVERYONE, A guide to non-traditional health care.
So perhaps with food and LDN I could recover a more normal life. Thanks again!! I’m always happy to hear what you have to say.
Lauren
Thanks for writing. It sounds like it will be wonderful for you to return to Washington and growing your own food. Yes, Adverse Childhood Experiences have a huge life long impact on well being as an adult and can wreak havoc on the immune system.
I took it some years ago and got a very NICE experience the first dose/day and none after and I don’t think I could ever go beyond .5mg..and the recommended dose is 4mg or so. I really wanted my sister to try it as she was dealing with MS and didn’t “hear me”…she took all pharma drugs and they got her last year. She was 68….I do blame the overdosing of drugs. Many with MS do take it.
I was taking it as I was doing everything I could think of to NOT do a THR and ended up with one in 2010 and now live with 3 major complications….but no groin pain. Some do very well and then there the ones who do not.
Thanks for the comments and I urge others to try it…could work for them…
Thank you for writing. Yes, I think everyone who could possibly benefit should try it. There is no reason not to and the potential upside is profound. The recommended dose is actually whatever is effective and the lower the better. Some to fine on 1 mg or 1.5 mg and need no more than that. I am sorry to hear about your sister. So many people are really damaged by the conventional treatment for auto immune disease which involves the suppression of the immune system, the opposite of what would really be healing. Its terribly misguided.
Fascinating! I so appreciate your curiosity and generous sharing of where it takes you. Low-dose naltrexone: who’da thought?
Thank you for responding so quickly! It’s really fun for me to get immediate feedback that you find it interesting too!
Will it be a challenge to get my HCP to prescribe this?
It may be, depending upon that person’s knowledge base.