Low-Dose Naltrexone for Autoimmunity?
Low-dose Naltrexone (LDN) has been touted as a panacea by many with autoimmunity. Whenever I speak on the topic of autoimmunity or thyroid health, it is often one of the first things I am asked about. Do I recommend LDN? Does it really work? Which autoimmune diseases does it work for? How do you use it?
Today I’d like to help you better understand what LDN is, how it can be helpful for patients with autoimmune disease, and how I have used it with my own patients. I will also discuss how LDN can fit into The Myers Way® as part of a broader approach to reversing autoimmunity alongside The Myers Way® Autoimmune Kit. Let’s dig in!
What is Naltrexone?
Naltrexone is an opioid antagonist, meaning it blocks the opioid receptors in your brain. These receptors are meant to respond to endorphins—your body’s natural “feel good” chemicals. Opioids (including the ones used in prescription pain medications such as Percocet, Dilaudid, Lortab, Vicodin as well as drugs such as heroin) attach to these same receptors and produce a similar result. They block pain, slow breathing, and lead to a generally calming and anti-depressant effect. As an opioid blocker, Naltrexone prevents opioids from attaching to your receptors and producing this result.
Doctors began prescribing Naltrexone in the 80’s for opioid addiction because, taken at doses of 50mg to 100mg, it completely prevents patients from experiencing the high of opioid drugs. It is often used while a patient is in recovery to keep them from relapsing.1
You may have heard of Naltrexone’s sister medication, Naloxone, which was in the news at the time of Prince’s death. Naloxone could have potentially saved his life had he received it in time. The drug works by actively stripping opioids from receptors, effectively stopping an overdose from opioids in its tracks. While working as an emergency room physician in Baltimore, I routinely used this drug to save the lives of patients who had overdosed on drugs.
LDN as a Treatment for Autoimmunity
While Naltrexone is primarily for opioid addiction, a doctor in New York, Dr. Bernard Bihari, discovered that when it was taken at a much lower dose, LDM exhibited beneficial results for patients with autoimmunity, cancer, and HIV or AIDS. Hence the name Low-dose Naltrexone (LDN).2
These low doses actually increase the level of endorphins in your body. They partially block your opioid receptors when your endorphin levels are typically highest (around 3AM to 4AM). This signals your brain that your levels are low, so it ramps up the production of endorphins and increases your overall levels.3
The effects may be beneficial for autoimmune patients due to the fact that endorphins play a role in immune system modulation. Autoimmune patients typically have lower levels of endorphins than people without autoimmunity.
No one knows exactly how endorphins help modulate the immune system or why they are decreased in autoimmune patients, yet studies have shown anti-inflammatory benefits and a decrease in Crohns’, Multiple Sclerosis, and fibromyalgia symptoms in patients who were treated with LDN.4 There are also many anecdotal success stories from patients and physicians who have seen great results using Low-dose Naltrexone as an autoimmune treatment.
LDN can be used for any autoimmune disease, although it has typically been found most effective for painful conditions. Patients and physicians have seen success with LDN in almost every autoimmune disease, including:
- Rheumatoid Arthritis
- Ulcerative Colitis
- Multiple Sclerosis
- Chronic Fatigue Syndrome
How to Take Low-Dose Naltrexone
The therapeutic dose of low-dose Naltrexone for autoimmune conditions is typically somewhere between 1.5mg – 4.5mg. There are two main protocols used when starting someone on LDN—a slower, more gentle protocol starting at 1 mg, and a faster protocol starting at 1.5mg. I typically used the faster protocol in my clinic. I started patients on a dose of 1.5 mg for two weeks, increased the dose to 3 mg, and after another two weeks we increased the dose to 4.5 mg.
It is best if you take LDN at 9pm. Taking it at this time allows the medication to be most potent at 4am, right when your endorphin levels should be highest. The LDN will then partially block your opioid receptors all at one time and then release. The surge in endorphins will subsequently modulate your immune system.
LDN is not yet approved by the FDA for autoimmune diseases, so it is not commercially available. For that reason, you will need to have a compounding pharmacy fill your prescription. It is best to work with a compounding pharmacy who is familiar with making LDN to ensure that they are not compounding a slow release formula. Additionally, you do not want them to add calcium carbonate as a filler (which can slow the absorption of the medication).
Are There Any Side Effects of LDN?
There are virtually no side effects of LDN. Some people report vivid dreams and/or difficulty sleeping. Those with Multiple Sclerosis sometimes report muscle spasms. I rarely received feedback with either of these sides effects. If I did, it typically occurred at the higher dose of 4.5 mg, in which case I recommend patients lower their dosage to 3mg. If you do experience difficulty falling or staying asleep you can take a melatonin supplement or my NeuroCalm Magnesium powder. I use NeuroCalm every night before bed because of magnesium’s ability to relieve occasional head tension and discomfort, and support a relaxed mood.
There are reports of LDN being so effective in patients with Hashimoto’s that it rapidly decreases antibodies and restores thyroid function, requiring a decrease in supplemental thyroid hormone. I never experienced this with my patients. However, if you have Hashimoto’s and are beginning LDN, be sure to start with the smallest dose, watch for symptoms of hyperthyroidism, and work with your doctor to monitor your thyroid labs.
LDN can interfere with any opioid medications you may be taking for pain management. You will want to take these medications away from LDN and work with your doctor, as you may need to increase the dosage of your pain medications.
When Have I Used Low-Dose Naltrexone?
I will always be honest with you. I have read the stories of people who have had amazing results with LDN and swear that it helped to reverse their autoimmunity. Personally, I tried LDN and did not notice any benefit. A large number of patients in my clinic tried LDN as well and overall did not see many astounding results. Although it was not a dramatic difference, a few patients with painful autoimmune conditions and fibromyalgia did experience good results. This does not mean that LDN does not work. Every time I write an article about autoimmunity or talk about it with The Myers Way® Community, many readers share LDN success stories, so there must be something to it!
In medicine and in life, everything is about weighing the risk with the benefit. The risk of trying LDN is very low, and the benefit is potentially very great. At worst, you’ll feel nothing at all!
If you are considering LDN, I would tell you to not simply use it as a band-aid. If you are taking LDN without also working to find and treat the underlying root cause of your condition, then you are not really doing more than the conventional approach. I think of LDN as more of an acceleration tool in a triage.
How Does Low-Dose Naltrexone Fit Into The Myers Way®?
In my clinic, I typically prescribed LDN to patients who either needed immediate symptom relief while we worked to identify their root cause or to patients who hit a plateau while addressing a root cause with a longer treatment protocol (such as mycotoxins or mold toxicity).
I always used LDN alongside the four nutritional supplements in my Autoimmune Kit. This carefully selected combination of supplements helps to maintain a healthy and balanced immune response in the face of an increasingly stressful and toxic environment. By addressing the root cause of autoimmunity, you can reverse your condition and prevent another one from developing.
As I said, this triage or acceleration approach is what I have found to be the most effective with my patients in the past. However, there is still much for physicians, patients, and researchers to learn about LDN, and my own research and protocols are constantly evolving.
That’s why I want to know about your experience with low-dose Naltrexone.
- The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Andrew Kolodny, David T Courtwright, Catherine S Hwang, Peter Kreiner, John L Eadie, Thomas W Clark, G Caleb Alexander. Annual Reviews of Public Health. 2015.
- Low-Dose Naltrexone (LDN): A Promising Treatment in Immune-Related Diseases and Cancer Therapy . Zijan Li, Yue You, Noreen Griffin, Juan Feng, Fengping Shan. NCBI. 2018.
- Understanding Endorphins and Their Importance in Pain Management. Adam S Sprouse-Blum, Greg Smith, Daniel Sugai, F Don Parsa. NCBI. 2010.
- The Use of Low-Dose Naltrexone (LDN) As A Novel Anti-Inflammatory Treatment for Chronic Pain. Jarred Younger, Luke Parkitny, David McLain. NCBI. 2014.
- Low-Dose Naltrexone for Pruritus in Systemic Sclerosis. Tracy Frech, Kristen Novak, Monica P Revelo, Maureen Murtaugh, Boaz Markewitz, Nathan Hatton, Mary Beth Scholand, Edward French, David Markewiz, Allen D Sawitzke. NCBI. 2011.
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