There is a lot of buzz in the Functional Medicine world around all of the potential benefits of Low Dose Naltrexone (LDN) for everything from Fibromyalgia to some types of cancers. Is this the magic pill we’ve all hoped for that will right all of our wrongs and heal all of our illnesses. Of course the answer is no and of course there is only One who has ultimately healed all of our wounds but LDN still offers some exciting potential benefits for many patient populations
What is LDN and how does it work?
Low Dose Naltrexone (LDN) is a simply a low dose of a medication called Naltrexone has been around for a long time. It is an opioid antagonist (or blocker) that has been used for opioid and alcohol addiction. However, it has been discovered over the past decade or so that the immune system is intricately connected with our own internal opioid system or endogenous opioid system. The normal dose of Naltrexone is 50 mg when used for its normal opioid blocking effects but when used at a very low dose of 1.5-4.5 mg just before bed, something mysterious and somewhat magical appears to occur within the body. This low dose gives temporary blockage of the opioid receptors in the body that is believed to cause an up-regulation of many of the vital elements of the immune system by upregulating the body’s endorphins.
Therefore the theory continues that many disease processes that involve a malfunctioning immune system such as autoimmune disease, neurodegenerative diseases, and cancers are partially a downstream effect of having a deficiency in endorphins. So claims have thus come this that some have seen an upregulation in numerous aspects of health and healing including helping get autoimmune diseases into remission and stimulating natural apoptotic properties within the body to fight cancers from within. Case studies continue to come out claiming benefits in many different disease processes and some clinical trials are potentially starting to confirm these reports.
Current Research and Clinical Indications for LDN
While it is important to have good research to support using a pharmaceutical or nutraceutical, I also like to see a lot of anecdotal evidence. When both are present and the risk of using the intervention is low, I am excited. So where is the current clinical research on LDN? Unfortunately it may never have any large studies done because it is a generic medication that no one can make a fortune on. Therefore no big pharmaceutical company would spend millions to do good research. But there have been a few small studies come out that showed potential benefit in pain management, Fibromyalgia, Multiple Sclerosis and Crohn’s Disease. Here are some of the studies:
LDN and for Induction of Remission in Crohn’s Disease - this is a Cochrane review of several small Randomized Controlled Trials that could be found. The author’s conclusions are skeptical but a look through the trials that were discussed is very interesting and promising as a potential addition to a full lifestyle and dietary overhaul.
LDN for Improving Quality of Life In Multiple Sclerosis Patients - shows safety of LDN for MS but no proven efficacy
Pilot Trial of LDN and Quality of Life for Multiple Sclerosis Patients- again shows safety and points to significant improvement in quality of life markers published in the Annals of Neurology. The authors conclude that more in depth studies are needed which is seconded by this author.
LDN and Complex Regional Pain Syndrome (CRPS) - two case studies revealing significant improvements in some long-standing cases! This one is cool to read and see the pictures of how severe these cases were.
LDN and Fibromyalgia and Chronic Pain - These are both good reads addressing the possible mechanisms that people with fibromyalgia and other poorly understand chronic pain syndromes are getting relief from LDN with little to no side effect profile.
Izabella Wentz, known as the Thyroid Pharmacist, has written a lot of information online and in her books regarding LDN and autoimmune thyroiditis (aka Hashimoto’s Disease). She says,
“Low Dose Naltrexone (LDN) balances the immune system by increasing the amount of T-regulatory cytokines and modulating TGF-B, leading to a reduction of Th-17, the promoter of autoimmunity. This means that it turns off the cells that cause autoimmunity!”
She also makes sure to say that LDN is not a cure but a potentially great immune modulator to prevent further damage to the thyroid while looking for the root cause.
My Clinical Experience With LDN
My experience with LDN has been primarily limited to Hashimoto’s patients. The vast majority have had a positive response on the medication and only a few out of the hundred or so said it affected their sleep and they could not get use to it. Not only did most subjectively feel better but lab parameters in the form of auto-antibodies also improved revealing a decreased autoimmune attack and therefore less destruction of the thyroid gland by the immune system.
Precautions with LDN
Common pitfalls with LDN include improper compounding, incorrect dosing, and falsely relying on LDN as a magic pill. If LDN is compounded incorrectly with the incorrect fillers or extended release instead of immediate release then the medication will likely be worthless and and a waste of money. You will want a practitioner who is LDN savvy and knows which local or mail order pharmacists know how to compound LDN correctly. See this link for some further information regarding correct compounding of LDN.
Dosing is also tricky and there are currently no guidelines that fit everyone. Typically 4.5mg before bed is a safe dose but with those taking medications that could quickly become too potent if an autoimmune disease process goes into remission, it could be dangerous. So especially with Hashimoto’s Disease, starting at 1.5-2.5 mg is a safer place to start and then slowly titrate up to 4.5mg.
Lastly, if LDN is expected to fix everything and someone expects to see tons of improvement in symptoms and labs, they are set up for failure. While supporting the immune system with LDN may be beneficial it will not fix the underlying causes of most disease processes. For example, with autoimmune diseases in general there will always be a ton of gut work to kill pathogens (if needed), remove candida overgrowth and heal intestinal permeability (leaky gut). This is all secondary to testing and supporting the HPA (hypothalamic pituitary adrenal) axis which is intricately involved with the immune system and gut health.
LDN has a lot of potential for most anything that involves a malfunctioning immune system. I’ve seen its clinical utility in autoimmune disease but clinical studies and other clinicians have seen benefits in treating cancers, neurodegenerative disorders, and other inflammatory conditions. While LDN is promising it needs to be kept in the proper perspective and place. It will never replace looking deeper for the underlying causes of immune system malfunctions and other disease processes with an in depth Functional Medicine approach to your health. If you don’t have a Functional Medicine provider, please let us help you.
As of fellow steward of God’s grace,
Jake Duncan PA-C
Functional Medicine Provider
Stewarding Life Wellness