LDN- the miracle cure?

I stumbled upon LDN (low dose naltrexone) not too long ago and was intrigued and felt a need to find out more and more. Being in the field that I’m in, that’s actually quite a big deal. We are exposed to so many new ‘miracle cures’ from prescription medications to herbs and supplements that it becomes a problem to know when to stop.

There’s also the bias of the person ‘pushing’ the agenda. I don’t mean this in a bad way as most people ‘push’ their ideas based on their own experience, expertise, passion and interests. Just a quick look at amazon books will tell you that. I’ve come to the point where I’ve given up on deciding who the ‘master’ is.

In the hormone world, the ‘master hormone’, depending on who wrote the book, is one of these below:

  • Melatonin

  • DHEA

  • Human Growth Hormone

  • Thyroid

  • Leptin

I’m quite sure I’m forgetting a few but those spring to mind.

 The world of supplements and prescriptions is even more fun. Its a little hard to follow but I’m sure most of you know a little about Goji berries, macca, ginseng, garlic, ginger, turmeric,  Vit B12, Vit C, Vit D, Vit K, Magnesium and the list goes on.

So to bring things back to my original point- it actually takes quite a lot to get me excited these days. I’m a little jaded…

LDN first came to my attention when I was researching SIBO (small intestinal bacterial overgrowth). Because I didn’t know anything about it, I did the usual due diligence of giving it my hour’s worth. The hour turned to many hours and before I knew it, I was hooked. I didn’t have any experience in it but has many patients who I thought fitted the profile of how it could help. I even created a special LDN only consultation to see what would happen (this is quite different from my usual consults but I wanted it to be more accessible).

This is my opinion to date. I’m still in early days but already have a good number of patients on it at present. Most people have autoimmune issues. I personally prefer the sublingual route of administration as it bypasses the gut. From my experience, even those without obvious gut issues may have absorbability problems and its worth the slightly higher price point.

It is NOT a miracle cure and is not even a cure at all. What it does is to facilitate the body in mending itself by increasing our own production of feel good neurotransmitters. These don’t only make us feel good but also improve our immune system- one of the hardest things to achieve. Most people should anticipate that they will be on it for at least 3 months. Below is what you can expect (this differs based on diseases etc but is a good general guide):

  • Around 30% won’t find that it makes any difference at all

  • Of the remainder 70%, around 15% might have miraculous results

  • 30% will find a noticeable difference

  • The rest will not find much of a difference until they stop it- upon which they will then realise that there actually was a positive difference

*Please bear in mind that this is a rough estimate of my personal experience and may not correspond to other practitioners or to what you may have read. This is not a scientific accurate analysis.

My opinion on it- and I promise I will update you whenever I get more information- is this:

  • Due to the relatively low cost of it, I believe that it is worth a trial of at least 3 months

  • For those in whom it works, some need to take it for life if theirs is a lifelong autoimmune problem

  • For others, they only need to take it until their symptoms clear up and in my opinion, probably upto 3 months after. These would be the gut dysbiosis patients amongst others.

  • For mild side effects, lower the dose but do persevere

If one has realistic expectations of what can be achieved, I believe that this could prove to be a very exciting opportunity and another avenue for those who have exhausted all other avenues.

Resources:

  1. Brown, Norman, and Jaak Panksepp. “Low-Dose Naltrexone for Disease Prevention and Quality of Life.” Medical Hypotheses, vol. 72, no. 3, 2009, pp. 333–337., doi:10.1016/j.mehy.2008.06.048.

  2. Debasish Hota, Anand Srinivasan, Pinaki Dutta, Anil Bhansali, Amitava Chakrabarti, Off-Label, Low-Dose Naltrexone for Refractory Painful Diabetic Neuropathy, Pain Medicine, Volume 17, Issue 4, April 2016, Pages 790–791, https://doi.org/10.1093/pm/pnv009

  3. Jaros BA, Joanna and Peter Lio MD. "Low Dose Naltrexone in Dermatology." Journal of Drugs in Dermatology. 18.3 (2019): 235-238.

  4. Metyas, Samy K, et al. “Low Dose Naltrexone in the Treatment of Fibromyalgia.” Current Rheumatology Reviews, vol. 14, no. 2, 2018, pp. 177–180., doi:10.2174/1573397113666170321120329.

  5. Mischoulon, David, et al. “Randomized, Proof-of-Concept Trial of Low Dose Naltrexone for Patients with Breakthrough Symptoms of Major Depressive Disorder on Antidepressants.” Journal of Affective Disorders, vol. 208, 2017, pp. 6–14., doi:10.1016/j.jad.2016.08.029.

  6. Parker, Claire E et al. “Low dose naltrexone for induction of remission in Crohn's disease.” The Cochrane database of systematic reviews vol. 4,4 CD010410. 1 Apr. 2018, doi:10.1002/14651858.CD010410.pub3

  7. Patten, Denise K., et al. “The Safety and Efficacy of Low-Dose Naltrexone in the Management of Chronic Pain and Inflammation in Multiple Sclerosis, Fibromyalgia, Crohns Disease, and Other Chronic Pain Disorders.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, vol. 38, no. 3, 2018, pp. 382–389., doi:10.1002/phar.2086.

  8. Smith, Jill P., et al. “Low-Dose Naltrexone Therapy Improves Active Crohns Disease.” The American Journal of Gastroenterology, vol. 102, no. 4, 2007, pp. 820–828., doi:10.1111/j.1572-0241.2007.01045.x.

  9. William Raffaeli, Paola Indovina, Low-Dose Naltrexone to Prevent Intolerable Morphine Adverse Events: A Forgotten Remedy for a Neglected, Global Clinical Need, Pain Medicine, Volume 16, Issue 6, June 2015, Pages 1239–1242, https://doi.org/10.1111/pme.12704

  10. Younger, Jarred et al. “The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain.” Clinical rheumatology vol. 33,4 (2014): 451-9. doi:10.1007/s10067-014-2517-2

  11. Zashin, Scott. “Sjogren's Syndrome: Clinical Benefits of Low-dose Naltrexone Therapy.” Cureus vol. 11,3 e4225. 11 Mar. 2019, doi:10.7759/cureus.4225