Autoimmune

Is Low Dose Naltrexone a Magic Pill? - Alternative Holistic Medicine Keller TX

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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.

Final Thoughts

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
info@stewardinglifewellness.com

 

A STEP-BY-STEP APPROACH TO HASHIMOTO'S THYROIDITIS

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)
✓ fatigue
✓ brain fog
✓ hair loss
✓ dry skin
✓ thinning of outer 3rd of eyebrows
✓ palpitations
✓ tremors

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. 

Educate Yourself

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. 

Final Thoughts

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.  

Why our culture desperately needs Functional Medicine?

 

I guess before this blog can really be written, an initial question must be asked and answered: What is Functional Medicine? Here is a quote from the Institute for Functional Medicine who is one of the leading organizations training practitioners in this model of medicine:

“Functional medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century.”

The keywords in these short two sentences are “underlying cause” and “systems-oriented approach.” It is a model built on the idea that the body is designed to function together in systems and if one system loses it integrity then a cascade of systems can suffer thereafter. This is why functional medicine practitioners like the one I train under, Dr Kalish, says that symptoms are distractions at best.  By the time a symptom surfaces it could be 2 or 3 body systems down the line from the original body system that was compromised. Hence the need for high quality and reliable lab testing. See image below for a snapshot at how complicated finding a root cause may be.

 

To summarize - functional medicine uses functional lab testing to seek out the root causes of health issues. Now we can move on to the title of the blog: Why our Culture Desperately needs Functional Medicine?

Treating symptoms is not in and of itself a bad thing. A cough is keeping you up all night compromising your immune system even further. A cough medication may be beneficial short term to help get some sleep and get your immune system back up. However other times, treating a symptom can have significant health consequences down the road. An easy example of this is the conventional approach to heartburn. Even though studies have shown that 8-9 out of 10 people who experience heartburn are actually lacking in stomach acid, we are taught to give all 10 people a medication that will further deplete their stomach acid. This may very well help the symptoms but in no way does it hardly ever treat the cause. And the majority of the time the person goes on thinking everything is ok but now they can’t properly break down proteins or absorb vital nutrients like B12, iron and minerals without adequate stomach acid.  Therefore getting to the root cause and eradicating or correcting it often leads to better function and lasting health.

Our conventional approach to headaches is similar. We’ve just been conditioned to pop a Tylenol or Advil with a headache and minimize the symptoms. This may not be a big issue is you only get a headache once a year but for those that get headaches frequently, this is covering a much deeper problem. Frequent headaches are NEVER normal even if you have a family history of migraines and you have been told you inherited them. Allergies and autoimmune diseases fall into a similar category. An imbalanced immune system can over-react to the environment or even self.  Of course again there is often a genetic component but again this is never normal and never should be just medicated to cover up the symptoms. The immune system needs support and balance. And often there needs to be deeper investigation into what may have triggered the immune system imbalance. Is there an underlying leaky gut caused by adrenal dysfunction that has led to immune compromise that needs to be healed? If so, then healing this underlying cause may very well take care of the symptoms instead of just covering them up.

Our culture is growing more busy and less rested every year. New technology. More ways to be connected. We work more and sleep less. We buy things we can’t afford and then have to work more to pay for them. Our relationships grow shallower with the delusion that we have more friends thanks to social media explosion and notifications interrupting almost every conversation.  Kids are developing sleep disturbances due to phones living in their beds with them. And if that’s not bad enough, we eat convenience fast food that has nearly zero nutritional value because we don’t have time to prepare real food. Therefore our bodies are starving for the essential nutrients they need to function properly. And then we wonder why we feel terrible, have no energy, can’t lose weight and have digestive issues. We are almost all chronically inflamed on the inside. And remember that Americans die of diseases like heart disease, cancers, strokes, diabetes that have their root in inflammation!

This is no surprise to anyone with their eyes open but still worth pondering and wondering what in the world can fix something this broken.  Do we need more medications to be developed? Maybe but is that going to really fix anything? Are we deficient in anti-depressants or TUMs? Of course not but again we’ve trained ourselves to want a quick fix but often the quick fix really doesn’t fix things well or for very long. Hence the deep seeded need for Functional Medicine in our culture. Things have to change at the root. Families have to learn the importance of communal eating - joining around the dinner table again (without twitter and facebook) and enjoying a real food nutrient dense meal. We have to re-learn how to simplify life, get good sleep and have fun. And often we need a practitioner who can help us identify these things and then test and correct the imbalances our life choices have developed over years of abuse. Sometimes these types of practitioners can be hard to find but can be found if you know where to look. The Institute for Functional Medicine has a directory of any practitioners being trained under this model. The Kalish Institute (where I am being trained) also has a directory. And sometimes old-fashioned asking around may be all you need to find someone who thinks this way.

 

A final caveat is that functional medicine does not replace the need for a strong conventional family doctor, specialists or the possible need for surgical interventions.  It just means that the conventional medical model is not based on looking for root causes, it's based on diagnosing and then treating (usually with a pharmaceutical product). Lifestyle nor nutrition is emphasized in the medical training that the majority of medical doctors or mid-level providers receive. If you have a doctor/provider who talks to you about removing gluten,sugar and processed foods from your diet, you’ve stumbled onto a rare jewel! Don’t let them go. Use functional medicine as a tool to dig deeper if you still don’t feel great despite your labs and check-ups saying you should. There is likely an underlying cause that just hasn’t been uncovered yet.