Are You Truly Resting?
Most of us measure our amount of rest or need for rest in hours of sleep. Although sleep is critical for recovery and repair from each day's challenges, true rest is far beyond just merely time spent in slumber. The Scripture talks often about rest outside of the context of sleep. This type of rest or "sabbath" is something most of us long for in our souls but don't really know how to experience.
Many who are driven in life and desire to help others and excel in whatever they do can easily fall into a very dangerous rut. This rut is characterized by often feeling guilty if we aren't doing something productive. In Wayne Muller's book, "Sabbath," he says, " While many of us are terribly weary, we have come to associate tremendous guilt and shame with taking time to rest. Sabbath gives us permission; it commands us to stop."
In another fantastic book called Emotionally Healthy Spirituality, Peter Scazzero describes it this way: "We listen to sermons and read books about slowing down and creating margin our lives. We read about the need to rest and recharge our batteries. Our workplaces offer seminars on increased productivity through replenishing ourselves. But we can't stop. And if we aren't busy, we feel guilty that we waste time and are not productive....It's like being addicted-- only it is not to drugs or alcohol but to tasks, to work, to doing. Any sense of rhythm in our daily, weekly, and yearly lives has been swallowed up in the blizzard of our lives."
So what? What's the danger of living without resting? I think most of us know this but don't want to face it. We miss life. We miss the beauty that's right in front of us. We live with short fuses and almost anything can cause us to get irritable, anxious, depressed, and angry. We do violence to our own lives and bodies and do violence to everyone that comes in contact with our disoriented life. We have no space in our lives for people to be human.
If this hits home with you, don't beat yourself up. We are already good at that and it only makes matters worse. Show yourself compassion. Dig into this. The 2 books mentioned above can literally save your life, restore your relationships, and return the joy back into your life, even when storms are all around. They can remind you that God sees you in your struggle and He loves you. He has given us several ropes to find our way back home. Grab hold and join me on this exciting, restful journey.
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
Hashimoto's Disease is one the most common causes of thyroid problems, particularly hypothyroid. However it is also one of the most commonly missed and mistreated causes as well. Hashimoto's is diagnosed most commonly by lab testing that reveals elevated antibodies on a lab test. It can also be diagnosed with an ultrasound or biopsy report. There is no definitive way to completely rule out Hashimoto's because it would entail biopsy of 100% of the thyroid. When Hashimoto's Disease is found it is a lock for an autoimmune process in which the immune system has triggered the thyroid as a foreign invader and is trying to destroy it. This point is critical because it is NOT inherently A THYROID PROBLEM. Let me repeat this foundation point: Hashimoto's Disease is not primarily a thyroid problem. It is an immune system malfunction.
Possible Symptoms of Hashimoto's Thyroiditis:
✓ Weight gain or weight loss (because thyroid hormone output can fluctuate early on)
✓ brain fog
✓ hair loss
✓ dry skin
✓ thinning of outer 3rd of eyebrows
Not A Thyroid Problem
Let me explain further. Conventional training has taught me and other practitioners that we treat Hashimoto's disease no different from any basic hypothyroid condition; we replace thyroid hormone. However in Hashimoto's the thyroid is really just the innocent bystander who got falsely accused of a crime he didn't commit. The immune system is the real culprit who is misguided and killing the thyroid. If that critical component is not at the core of your thinking, treatment and further investigation then you are treating as superficial as you can get. The sad reality is that most people don't even get a diagnosis for years because it is not even looked for when symptoms are present.
So What Do I Do?
If you have been diagnosed with hypothyroidism and never had your antibodies checked, the first step is get them checked and make sure you get an ultrasound. The antibodies you need to request are TPO (thyroid peroxidase) and TGB or TAA (Thyroglobulin Antibodies). If you request these from your medical provider they should be happy to run them for you. If not, look for someone who will. You are paying them. They work for you. The ultrasound is a screen to look for something really abnormal that needs further investigation like a biopsy. Thyroid cancer is relatively common and needs to be looked for or you won't find it.
Secondly, educate yourself! Don't blindly assume others will do what's best for you. Everyone is different and you won't even know the right questions to ask your practitioner if you haven't done some reading. You will have to wade through some things online but you will find some good info if you look. Stop the Thyroid Madness and Facebook groups like Hashimoto's 411 are popping up often helping people get educated. One of the first areas you will want to educate yourself on is the link between the immune system and the digestive system. In other words, your diet matters significantly! With any autoimmune disease the most important place to start the healing process is through using food as medicine. Don't tune out here. Seventy to eighty percent of your immune system lines your digestive tract. If there is an unhealthy barrier system due to lack of sleep, processed foods, gluten, stress, or over-training then every time you eat you may possibly be damaging and over-working your immune system. Read about "leaky gut" or increased "intestinal permeability" and work toward an autoimmune paleo diet (AIP).
Find an Advocate
Self education is foundational but does not negate the need of finding a health care practitioner who can take you deeper. The reason why is because you will need to investigate deeper as to how to heal and balance your overly reactive immune system. If you don't, there is a risk of additional autoimmune diseases presenting in your future. Supporting gut healing, hormonal balance and inflammation in the body can not only improve your symptoms but it can also prevent future disease processes that are dependent on these broken systems. Functional Medicine's philosophy is built on finding the underlying cause rather than just treating symptoms. If you can find a Functional Medicine practitioner near you, you will gain one of the best teammates you can hire. Functional lab testing is essential to rule out digestive pathogens (i.e. bacterial infections, parasites, candida, overgrowth of opportunistic infections), hormonal imbalances (i.e. Hypothalamic Pituitary Adrenal dysfunction, estrogen dominance), or detoxification issues affecting your mitochondrial health and neurotransmitter production. These tests are typically around $500 total out of pocket but can provide a huge direction when it comes to focus on healing the body.
Medications Versus Supplements
If you catch Hashimoto's early, there is a chance you can avoid needing thyroid replacement medications. However, it is not the worst thing in the world if you do need thyroid support. There are two main options for prescription support: synthetic medications (synthroid/levothyroxine, cytomel/liothyronine) or natural dessicated medications (Armour, Nature-throid, Westhroid). Most people do better on the natural dessicated glandulars but this is when you need a practitioner who is thoughtful and will work with you until you find the right medication for you. Once a new medicine is started you will want to recheck your labs in 4-6 weeks to see how you are responding and keep your practitioner abreast on how you feel. Very few general practitioners are thoughtful in this area but I was blessed to learn under a very thoughtful DO and he taught me a lot in this area about listening to patients and being a constant learner. Thank you Dr. Simonak!
So if you have discovered Hashimoto's early and are not terribly symptomatic (weight gain, fatigue, brain fog, dry skin, hair loss...) then you should go hard after the root cause and see if you can facilitate healing with supplement protocols. This should be lab based. Blindly supplementing can at times be dangerous and make things worse. But again, do not feel bad if you need a medication. Thyroid medications are not terribly expensive and for the most part are safe to be on long term. If you are a young female looking to get pregnant it is vital that your thyroid levels are optimal and this sometimes requires frequent lab checks and tapering of medications.
While you are working with your thoughtful PCP or Functional Medicine Provider to heal the root cause of your Hashimoto's Disease, you may also want to consider looking into Low Dose Naltrexone (LDN). There are not many medications that I am excited about but this is one. The risk to benefit ratio is amazing and can help balance the immune system while the body is healing. It may not be needed long term but may prove very helpful at reducing your antibody count and need for increasing medication dosages.
Educate + Teamwork = Healing
Here is the winning equation again. Get serious about self-educating. Let me know if you want additional reading material and I can recommend several books and websites. Next start looking for your teammate/health detective who can help you look deeper. And get to work! Don't sit on the sidelines and wait for someone else to take care of you and don't even rely on a medication or supplement protocol. Your choices each day to eat a clean nutrient dense diet, think positively, go to bed early, and exercise will be the most potent prescriptions you can fulfill!
For Further reading, check out this very thorough article from Verywell.com on thyroid disorders.