Low Dose Naltrexone for Autoimmunity
This new and little known therapy may be the next step in regulating your autoimmune condition.
For decades, autoimmune conditions have left conventional medicine dumbfounded. While there are many reasons for this, the main one is that allopathic (one disease one cure theory of medicine) simply does not work when trying to address the highly complex and intertwined path of what leads the human body to develop autoimmunity in the first place.
There is never one single cause for autoimmune conditions to develop. They develop after years of chronic inflammation and allostatic overload. Poor diet, nutrient deficiencies, Lyme disease and coinfections, toxic mold exposure, heavy metal buildup, paraben and phthalate exposure, trauma and high stress, PTSD, gut infections like H. pylori and intestinal parasites, intestinal hyperpermeability, and exposures to viruses - EBV, Cytomegalovirus, Covid-19 - are just some of the commonalities in individuals who develop autoimmune conditions. There is no way to determine how many or which one of these issues will tip the scales into the body attacking itself, or which autoimmune condition will develop, but the complexity of uncovering which issues ARE contributing and addressing them appropriately has proven to be well beyond the means of conventional medicine.
Peeling back the layers of autoimmune triggers and their causes can sometimes take years, even with the guidance of a seasoned autoimmune specialist with access to specialized training. In addition to the time this takes, there is a hefty amount of effort on the part of the client, as well as a financial investment. Due to the way our healthcare system currently operates, not everyone has access to this path of recovery. This is where Low Dose Naltrexone (LDN) comes into play.
What is Low Dose Naltrexone?
Low Dose naltrexone, in it's FDA approved dose of 50-100 mg per day, is used to help individuals suffering with alcohol or opioid dependence. In the late 1980’s, at the height of the AIDS epidemic, Dr. Bihari, a physician in NYC at the time, found that his HIV positive drug patients who were taking Naltrexone to stop using heroin had a much better immune response than those who were not, and he began researching lower doses of Naltrexone and how they affected the immune response.
Since then, many practitioners and patients alike have used LDN to manage everything from cancer to autoimmunity to chronic inflammation issues of unknown origin. LDN doesn’t always work well for every patient, but it does seem to offer an improvement in symptoms for the majority of those who try it.
Few actual studies have been done regarding the use of LDN, however in 2007 a study regarding the use of LDN for Crohns was published. This was followed shortly by a study utilizing LDN for Multiple Sclerosis, as well as one on the use of LDN for Fibromyalgia. Unfortunately, funding to study the use of LDN is hard to acquire, as it is not only no longer trademarked (and thus not profitable) to pharmaceutical manufacturers, but to be used in low doses it must be made at a compounding pharmacy.
LDN is typically used in doses of 10mg or below
There should be no long term side effects when using LDN
LDN has the potential to help with any autoimmune issue, chronic inflammation, and cancer prognosis.
There is no “best dose” of LDN, and the dose each individual patient uses should be based on their symptom relief
What Does LDN Help With and How?
LDN has been shown to be helpful with almost any autoimmune condition as well as many central nervous system disorders and cancer modulation - in this article we are focusing on autoimmunity and CNS disorders. No two patients seem to get the exact same results, and this is likely due to the many variations in what is causing an individual to have developed autoimmunity in the first place. Through the many patient consults I have performed at LDN Direct, it seems to be particularly effective for those dealing with Crohn’s, Hashimoto’s, Fibromyalgia, and Chronic Fatigue Syndrome. This is not to say it is less effective for anyone else, only that we see a high rate of efficacy regarding symptom relief for these particular diagnoses.
LDN seems to be effective for so many different issues due to the way in which it upregulates levels of endorphins. All of the diagnoses or conditions that seem to benefit from LDN have a commonality- patients experiencing them have low endorphin production. These endorphins are naturally occurring opioids, specifically OGF. LDN is an OGF receptor antagonist. It is a pure antagonist, meaning when it binds to these opioid receptors, there is no “high” obtained, it simply makes the body think it needs to produce more of these opioid endorphins. The half life of LDN is very short, and the receptors are blocked for 1-2 hours. The increased endorphins then bind to the OGF receptors once the LDN has disbursed, and from here they modulate the immune response. The other way in which LDN works is by binding to immune cells, and directly modulating the immune system by down regulating inflammatory cytokines.
One part of using LDN for autoimmunity is knowing what dose to start at and how to titrate up to find the most optimal dose for each individual. Most patients can start at a a beginning dose of 1.5mg per day. However there are some caveats to this. If a patient is typically sensitive to medication, or if they experience chronic migraines, have MCAS, Elher’s Danlos Syndrome, or Lyme disease, it is recommended that their starting dose be 0.5mg per day. Starting at a lower dose offsets the likelihood of these patients experiencing more unpleasant side effects. Some patients need to start even lower, at 0.25mg or 0.1mg per day. There have been some rare instances where a patient had to begin at an ultra low dose (below 0.1mg per day) and slowly titrate up, but these instances are very uncommon as LDN is typically very well tolerated.
Once a patient begins LDN, it is quite common to experience some mild to moderate side effects for a few days- these will usually self regulate by day 6 if not before. They should not be severe. The most common side effects are headache, heightened anxiety, insomnia, vivid or lucid dreaming, and gastrointestinal upset. Not everyone experiences these side effects, but if they are experience at the beginning, it is likely they will be experienced again for a few days each time a patient increases their dose.
A patient will usually know when they have found their best dose if one of three things occurs:
100% symptom relief occurs. This is uncommon, but it does happen.
A symptom relief plateau occurs. If an increased dose or two does not continue to yield better symptom relief than the previous dose, there is no need to continue to increase.
Symptoms return upon further dose increases. This indicates a patient has bypassed their optimal dose and needs to titrate backwards in order to find the dose that was most helpful.
Side effects occur that were not previously experience. Sometimes if a patient increases to a dose that is too high for them, side effects will either not go away after a few days, or uncommon side effects will crop up.
Beginning at a dose higher than 1.5mg is not generally recommended, in case an individual might actually do better at 3 or even 1.5mg a day. Waiting a full two weeks is recommended between each increase in order to allow side effects to resolve and for the patient to evaluate how beneficial each incremental dose is.
Patients with severe malabsorption due to Crohn’s, Ulcerative Colitis, or IBS/IBD might do better starting with a sublingual formulation of LDN in order to bypass the gut. Sensitive patients, like those with MCAS, Lyme, and EDS, often do better with a sublingual formulation as well in order to decrease the chance of experiencing side effects.
Who Can Prescribe LDN?
Any licensed physician can prescribe LDN as an “off-label” prescription for treatments they deem appropriate for their patients. Unfortunately, many physicians have little to no knowledge of the way in which LDN can be used to help individuals with autoimmune conditions and chronic inflammatory response issues. Most are unfamiliar with how to prescribe LDN in order for their patients to get good results.
To fill a prescription for LDN, you’ll need to choose a good compounding pharmacy. A simple google search of “compounding pharmacy” followed by your zip code will pull up any in your area. The best pricing on LDN can be found at Belmar Pharmacy in Golden, CO, CareFirst Specialty Pharmacy in Cinnaminson, NJ, and Skips Pharmacy in Deerfield Bech, FL. All three of these pharmacies will ship nationwide and have very competitive pricing in addition to specializing in compounding LDN- their pharmacists are very familiar with the various ways in which LDN can be used.
If you are looking for a physician to prescribe LDN, you can click the “LDN Direct” link below. LDN Direct was founded by Dr. Sajad Zalzala in 2015, and by treating thousands of patients over the years he has been able to discover the nuances of correctly prescribing LDN. By booking a consult with LDN Direct, you are given specific instructions on how to use LDN based on your individual situation. The initial consult covers a 6 month prescription, and you can choose to renew every 6 months for as long as you need. Dr. Zalzala is licensed in all 50 states, meaning he is able to prescribe to all U.S. residents.