Tuesday, May 26, 2020

Low-dose naltrexone (LDN) has been used for a wide range of conditions. There have been 177 conditions for which LDN has been reported to benefit. Most of these are case reports and case series (reports of several patients), which are anecdotal, though several randomized and double blind studies have also shown positive results. Read on and you will get an overview of how LDN works and the wide range of conditions that LDN benefits.

Unlike many drugs that work on a specific receptor for a specific mechanism, LDN works on a body-wide level on a system that has a broad range of effects. Naltrexone blocks the opioid receptors so when used at the prescription dose, which is 50 mg, it can be used for alcohol dependence and opioid dependence. When used at a low dose of 0.5-4.5 mg, naltrexone blocks a small percentage of the opioid receptors. In response to this, many endorphins are released, which provide many positive effects. We will review the benefits of LDN for pain, mood, autoimmune diseases and myriad other symptoms and conditions.

Endorphins are the body’s natural painkillers. This is because they stimulate the body’s opioid receptors, which decrease pain signals. When you take opioid painkillers you stimulate those receptors, but there are many side effects to taking these, including constipation and mental cloudiness. When you release your own endorphins by taking LDN you get the painkilling benefits of the endorphins with none of the side effects. Studies have shown that those taking morphine products can significantly reduce their doses when adding LDN to their regimen, achieving the same benefits with less morphine so less side effects. LDN has also been shown to provide relief for reflex sympathetic dystrophy and fibromyalgia and other pain conditions.

The use of LDN for autoimmune disorders is among the most intriguing potential for LDN. There are a wide variety of illnesses that have an autoimmune basis; that is, the body reacts to its own tissues, negatively affecting the function of the targeted tissue. LDN modulates the immune system with anti-inflammatory effects. Multiple sclerosis is one of the most common autoimmune diseases of the nervous system. There are several studies on LDN, with multiple sclerosis showing improved function and a decrease in medication use. Many drugs have been developed for multiple sclerosis that target the body’s immune response, but many patients have significant side effects. When taking LDN, patients are able to reduce the doses of these strong drugs, reducing their side effects.

Inflammatory bowel disease includes Crohn’s disease and ulcerative colitis. These are both autoimmune disorders. LDN has shown excellent results in double blind studies for Crohn’s disease. There are less studies for ulcerative colitis, but the autoimmune mechanism is similar to Crohn’s disease and there are many anecdotal and case series reports showing good response of ulcerative colitis to LDN. For refractory Crohn’s disease or ulcerative colitis, a trial of LDN should definitely be considered.

There are other autoimmune conditions that are improved with LDN, including rheumatologic conditions such as lupus and rheumatoid arthritis. Many dermatologic conditions have an autoimmune component such as psoriasis and alopecia areata. For these conditions there are case series and anecdotal reports of good responses to LDN.

There are LDN studies in progress for a wide range of psychological disorders, including anxiety, obsessive-compulsive disorder and post-traumatic stress disorder. The condition that has been most studied is depression. There have been several studies that have shown benefit, but more studies are needed to establish LDN’s efficacy as an antidepressant. Most of the positive reports of LDN for depression have been from patients taking LDN for their autoimmune disorders who have reported improvement of their depression. Whether this is because their autoimmune disorder is improving so their mood improves or if this is an antidepressant effect is not certain. However, it is noted that endorphins have a positive effect on mood and dopamine pathways. Runners are aware of the runner’s high. This occurs when running stimulates release of endorphins, which gives one a general feeling of well-being. This may be a basis for LDN’s positive effects on mood.

One of the best aspects of LDN is that it is very safe. Side effects are rare and minimal. The most common side effects are insomnia and vivid dreams, though some patients note tiredness when taking it. These effects occur in a small percentage of patients and usually improve after one to two weeks. A few patients have also reported stomach upset, which also improves after one to two weeks. Overall, LDN is well-tolerated with minimal side effects. This favorable side effect profile is rare for a medication with so many potential benefits. This is because LDN achieves its effects through working with the body’s neurotransmitters rather than trying to suppress inflammatory reactions.

While I have highlighted many of the conditions for which LDN has shown promise, there are multiple other conditions for which LDN has been used. LDN can help patients with thyroid disease, which often has an autoimmune component, which LDN can positively affect. Also, LDN has been shown to improve thyroid transport into cells. A retrospective study showed benefit for patients with restless leg syndrome. Naltrexone at normal dose showed promise for children with autism, with several studies showing benefit. There have been multiple reports of LDN for autism with studies in progress. LDN has been used for weight loss; while the mechanisms for weight loss have been described, there are still no studies confirming weight loss. I could list multiple other conditions but am running out of space. As a generic medication, there are no pharmaceutical financial incentives to generate large studies. Despite this, many physicians are generating studies that are proving LDN’s benefit.

A typical starting dose for LDN is 1.5mg. This dose will generate a favorable response for many conditions, and about 50% of patients will have a positive response with this dose. The success rate with LDN increases to 80-89% when the dose is tailored to the individual patient and specific condition. For example, patients with Crohn’s disease have had great results with 4.5 mg, while those with opioid dependence may benefit from very low-dose naltrexone such 0.1 mg. It is helpful to work with a physician who has experience with LDN to make the appropriate dose adjustments when needed to maximize your success with LDN. Based on its potential upside with favorable side effects profile, for anyone with these conditions it is worth a try,

By Warren Slaten, M.D.

Dr. Slaten is a wellness physician specializing in regenerative pain treatments and lifestyle counseling. He is certified in advanced bioidentical hormone replacement.