Low Dose Naltrexone: Information for patients with inflammation & autoimmunity

Low Dose Naltrexone: Information for patients with inflammation & autoimmunity

 

 

It’s easier to call this medicine LDN, short for low dose naltrexone. Not a common prescription among many of our patients, its use in a thyroid related case is to reduce inflammation particularly in those cases with Autoimmune Thyroiditis or those whose symptoms are unresponsive to medications, natural hormones, diet and complementary therapies. Your Doctor may prescribe this medicine, in conjunction with Thyroid hormones or alone for your medical management. It has been suggested that while improvements are notable at 1 month, at about 2 months treatment is when the medication is most effective if the case is chronic[i]. Some treatment cases have reported improvements within a few days such as fibromyalgia [ii]. There is much discussion by Thyroid specialist over when and if LDN should be used with Hashimoto’s, and how effective it really is at lowering Thyroid antibodies, as a high or standard dose it is used successfully to manage addiction.

 

Naltrexone is anti-inflammatory for the central nervous system immunity cells which are called the microglial cells. (These cells are responsible for symptoms such as inflammation, fatigue, sensitivity to pain, poor sleep, poor cognitive function, mood disorders and malaise[iii]).  Treating these symptoms naturally is most effective for the majority of our patients. Where there is pain or inflammation present, and if symptoms are resistant to other methods of symptoms management is when LDN is normally considered[iv].  This effect seems to be most beneficial at low doses. At a higher dosing range it can be an antagonist for opoid receptors[v] of the body which assists pain management. Opoids are hormones in mammals; they modulate our pain and social behaviours[vi]. Low dosing will refer to microgram or nanogram dosing which is about 1/10th of traditional treatment dose, and can be prescribed alone or in conjunction with other medications.[vii]  It has never been recommended as a stand alone treatment. Causative factors of nutrition, hormones, diet lifestyle, with particular emphasis on glucose levels, stress levels and food intolerance is recommended. Neither is it is specific to toxicity symptoms (such as heavy metals), or correcting deficiency related illness. For example is you are low in iron, vitamin and Iodine you will often develop pain and inflammation. The treatment advice in this case is to correct the underlying concern. Simply taking LDN when finding out you have Thyroid antibodies will not resolve the issue alone[viii].

We also recommend eating right to manage autoimmunity, learn more here.

Another good way to treat inflammation and autoimmunity is with probiotics.

 

 

 

 

 

It is described as being “a specific and clinically beneficial impact on fibromyalgia pain. The medication is widely available, inexpensive, safe, and well-tolerated”[ix]. The analgesic and anti-inflammatory effects of LDN are not reported in higher dosing, in fact [x]. One thing both high and low doses have in common is that they can affect the proliferative cell response, just in very different ways[xi]. There is currently no formal guideline or procedure or ranges to treat to be followed when dosing LDN. There are also no health rebates or government funding for it[xii].

 

Some of the things this medication may be prescribed for include[xiii]:

 

  • Crohn’s disease: decreases pain and test markers, up to 80% improvement. Learn more about healthy digestion here.
  • Fibromyalgia: 57% of women were much improved, or very much improved, much higher than placebo. One woman in a double blind, placebo controlled study noticed her pain levels changed when they swapped her to placebo dosing. She dropped out of the study immediately, to pursue LDN dosing, which is a pity as her improvements cannot be included in the analysis of treatment success[xiv].
  • Multiple Sclerosis is another reason for prescribing, though there is not as much research to prove it’s efficacy in all cases
  • Patients with symptoms do not need to have elevated ESR in their blood test to feel better
  • Complex Regional Pain syndrome is reported to respond to treatment well (this is when the discomfort experienced by the person in question is not proportional to the injury that induced it, or excessive suffering)[xv]. As CRPS may be caused by a problem called SIBO (talk to your practitioner about the importance of your gut health) or sleep apnoea (sleep quality is crucial for optimal health) as both these other problems affect our cytokines production in increase inflammation[xvi]. As LDN may not only block cytokines but also encourage endorphins production, in cases that are resistant to natural therapies and other medications, a patient may benefit from being given this medicine.

 

Low Dose Naltrexone Information for patients with inflammation & autoimmunity

There are not currently any listed side effects and medicine contraindications with LDN and none are anticipated, but as it is early days in the use of this medicine a lack medical research in large scale studies may be the reason: So it is safer to say there is no proof either way that it does or does not interact, and it is at your Doctors discretion to recommend and prescribe per the patients case[xvii]. There is Australian research from the University of Adelaide showing LDN increases the efficacy of other pain treatments.[xviii] It is supposed to be safe for pregnancy and breastfeeding[xix].

Especially when compared to other anti-inflammatory medications (which may cause all manner of issues such as ulcers, poor kidney function, blood thinning or risk of blood clots) there are no reports of these side effects, or withdrawal, in any clinical studies of LDN. There were a low number of people who had some headaches and vivid dreams in some clinical studies too[xx]. It’s another reason that LDN is normally administered at 1-2 then increased to 4.5mg slowly, not the traditional Naltrexone 50mg dose[xxi]. Using a low dose approach may also improve the results for those suffering seizures, but we have not listed epilepsy or non-epileptic seizures above as a recommended use (the research is limited) [xxii].  Other medical problems practitioners and patients report have been treated with success by LDN include[xxiii], [xxiv], [xxv]:

 

  • Hashimoto’s (38% felt better, 48% had lower antibodies, 61% had better mood, 40% of people had les pain.)
  • Thyrotoxicosis
  • Lupus
  • Other autoimmune conditions
  • HIV/Aids treatments
  • Cancer of the breast, brain lung (among other cancers too)

 

Other than those we have briefly mentioned here, most of the research on LDN is done in animal studies such as its uses in the treatments of cancer, its ability to cross the blood-brain barrier to affect our central nervous system, and reverse nerve pain from chronic injury[xxvi]. Always take your LDN or other prescriptions carefully, as recommended. Symptom diaries and records of test results should also be maintained in the longer term, and physical therapies such as acupuncture may be able to increase the effectiveness of the drug too[xxvii].

 

ABOUT THE AUTHOR:

Kimberly Orbons 

Naturopath Kimberly Orbons, Adelaide, The Lucy Rose Clinic

Naturopath Kimberly Orbons, Adelaide

Adv Dip Naturopathy, Adv Dip Western Herbal Medicine

Head Naturopath Kimberly Orbons is passionate about encouraging and empowering each person to facilitate their own good health with Nutrition, Herbal Medicine and preventative lifestyle management. Using a combination of diagnostics and symptomatology to identify the different metabolic processes contributing to disease allows her to treat the root or cause of poor health, providing relief of symptoms and long term recovery.

Kimberly believes it is extremely important to build a personalized healing plan, taking all the complexities of a patient’s health and illness into consideration. Her consults have a strong focus on client care and treating each patient as an individual, and may therefore co-ordinate with other medical treatments. The goal is to establish each patient’s ability to live in the best possible state of health, naturally. Her mentors in clinical practice include Founder Lucy Herron, Dr. David Brownstein, Naturopath Angela Hywood and Dr. Sarah Wine. Since achieving her qualifications in 2007 she has extensive clinical experience, and also 3 years managing the natural health sections and seminar within pharmacy.

Kimberly works closely with our CEO Lizzy Herron, our naturopathic consultants and all The Lucy Rose clinical staff to ensure our patients are provided with the best and most up to date health services and quality health advice. She has actively contributed to our online media, patient guidelines, patient support and informational services for the past 3 years and enjoys providing excellent free to access health data to patients across Australia daily

 

Low Dose Naltrexone Information for patients with inflammation & autoimmunity

Low Dose Naltrexone Information for patients with inflammation & autoimmunity

 

[i] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[ii] J Neuroimmune Pharmacol. 2013 Jun; 8(3): 470–476. Published online 2013 Apr 2. doi:  10.1007/s11481-013-9451-y PMCID: PMC3661907 Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN) Pradeep Chopra and Mark S. Cooper
[iii] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[iv] J Neuroimmune Pharmacol. 2013 Jun; 8(3): 470–476. Published online 2013 Apr 2. doi:  10.1007/s11481-013-9451-y PMCID: PMC3661907 Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN) Pradeep Chopra and Mark S. Cooper
[v] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[vi] Fibromyalgia, autism, and opioid addiction as natural and induced disorders of the endogenous opioid hormonal system. Johnson B1, Ulberg S, Shivale S, Donaldson J, Milczarski B, Faraone SV. Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA.  https://www.ncbi.nlm.nih.gov/pubmed/25336035
[vii] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[viii] INTERVIEW WITH DR. IZABELLA WENTZ, PHARMD AND DR. MARK MANDEL, PHARMD August 4, 2017 Note: Originally published in February 2015, this article has been revised and updated for accuracy and thoroughness. https://thyroidpharmacist.com/articles/low-dose-naltrexone-and-hashimotos/
[ix] Low-Dose Naltrexone for the Treatment of Fibromyalgia Findings of a Small, Randomized, Double-Blind, Placebo-Controlled, Counterbalanced, Crossover Trial Assessing Daily Pain Levels Jarred Younger, Noorulain Noor, Rebecca McCue, and Sean Mackey , ARTHRITIS & RHEUMATISM Vol. 65, No. 2, February 2013, pp 529–538 DOI 10.1002/art.37734 © 2013, American College of Rheumatology
[x] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[xi] Low-dose naltrexone targets the opioid growth factor-opioid growth factor receptor pathway to inhibit cell proliferation: mechanistic evidence from a tissue culture model. Donahue RN1, McLaughlin PJ, Zagon IS.Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. PMID: 21807817 Exp Biol Med (Maywood). 2011 Sep;236(9):1036-50. doi: 10.1258/ebm.2011.011121. Epub 2011 Aug 1
[xii] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[xiii] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[xiv]Low-Dose Naltrexone for the Treatment of Fibromyalgia
Findings of a Small, Randomized, Double-Blind, Placebo-Controlled,
Counterbalanced, Crossover Trial Assessing Daily Pain Levels
Jarred Younger, Noorulain Noor, Rebecca McCue, and Sean Mackey , ARTHRITIS & RHEUMATISM Vol. 65, No. 2, February 2013, pp 529–538 DOI 10.1002/art.37734 © 2013, American College of Rheumatology
[xv] J Neuroimmune Pharmacol. 2013 Jun; 8(3): 470–476. Published online 2013 Apr 2. doi:  10.1007/s11481-013-9451-y PMCID: PMC3661907 Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN) Pradeep Chopra and Mark S. Cooper
[xvi] Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome: Small Intestinal Bacterial Overgrowth and Obstructive Sleep Apnea.Weinstock LB1, Myers TL, Walters AS, Schwartz OA, Younger JW, Chopra PJ, Guarino AH. PMID: 26867023 A A Case Rep. 2016 May 1;6(9):272-6.
[xvii] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[xviii] Potentiation of buprenorphine antinociception with ultra-low dose naltrexone in healthy subjects. Hay JL1, La Vincente SF, Somogyi AA, Chapleo CB, White JM. Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, Australia. PMID: 20728384  Eur J Pain. 2011 Mar;15(3):293-8. doi: 10.1016/j.ejpain.2010.07.009. Epub 2010 Aug 21.
[xix] https://stopthethyroidmadness.com/ldn/ Low Dose Naltrexone
[xx] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[xxi] The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain Jarred Younger, Luke Parkitny, and David McLain Stanford University, Stanford, CA USA Department of Anesthesia, Pain and Perioperative Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304 USA  PMCID: PMC3962576 Published online 2014 Feb 15. doi:  10.1007/s10067-014-2517-2
[xxii] Epilepsy Res. 2008 Sep;81(1):44-51. doi: 10.1016/j.eplepsyres.2008.04.010. Epub 2008 May 27. The cannabinoid anticonvulsant effect on pentylenetetrazole-induced seizure is potentiated by ultra-low dose naltrexone in mice.Bahremand A1, Shafaroodi H, Ghasemi M, Nasrabady SE, Gholizadeh S, Dehpour AR. PMID: 18502613
[xxiii] https://stopthethyroidmadness.com/ldn/ Low Dose Naltrexone
[xxiv] What diseases has it been useful for and how effective is it?  Bernard Bihari, MD, as well as other physicians and researchers, have described beneficial effects of LDN on a variety of diseases  http://www.lowdosenaltrexone.org/index.htm#What_diseases_has_it_been_useful_for
[xxv] Low Dose Naltrexone and Hashimoto’s Dr. Izabella Wentz / August 4, 2017 Note: Originally published in February 2015, this article has been revised and updated for accuracy and thoroughness. https://thyroidpharmacist.com/articles/low-dose-naltrexone-and-hashimotos/
[xxvi] J Neuroimmune Pharmacol. 2013 Jun; 8(3): 470–476. Published online 2013 Apr 2. doi:  10.1007/s11481-013-9451-y PMCID: PMC3661907 Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN) Pradeep Chopra and Mark S. Cooper
[xxvii] Enhancing acupuncture by low dose naltrexone,  http://aim.bmj.com/content/29/2/127.long Institute for Neuropathic Pain, Soest, The Netherlands  Jan M Keppel Hesselink,  David J Kopsky