Morning everyone!

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week we’re going to talk about a familiar topic: Low-Dose Naltrexone (LDN). I know I have talked about it before, and Robin Riddle, NP-C did an Explain This episode on the subject, but that all goes to show there’s much to learn about LDN!

 

Naltrexone 

 

For close to 60 years, Naltrexone has been used in high doses to block the effects of opiates (the highs you get from drugs like heroin, oxycontin, and morphine). We use it in this manner to get patients off of opiates and/or alcohol. 

Note: Naltrexone is different from its cousin Naloxone (Narcan). We use this drug to immediately reverse a narcotic overdose. Low-Dose Naltrexone (LDN) is completely different in use and mechanism. 

 

Low-Dose Naltrexone 

 

LDN works in different ways. It’s a great anti-inflammatory and immune modulator. How does it operate? It tricks the brain into releasing its own endorphins. Endorphins are the chemicals produced by the brain and nervous system to help you cope with pain and/or stress. In essence, LDN acts like an analgesic to diminish the perception of pain and help you relax. It’s your feel good chemicals. Like when you take a good run or bike ride and you get a “runner’s high”. That’s your brain on “opiate like” material, releasing endorphins. 

Low-Dose Naltrexone was first found to be helpful in AIDS patients. Patients with AIDS only produce about 20% of a normal person’s endorphins, the “feel good” hormones/neurotransmitters. They found early on that a 1% dose of the usual dose of Naltrexone produced an increase of 300% of that patient’s normal endorphins. In short, it made them feel a lot better! 

In functional medicine we’ve been using LDN for years and for many different conditions: 

  • Fibromyalgia
  • Crohn’s Disease 
  • Ulcerative Colitis (inflammatory diseases of the bowel)
  • Neuropathies 
  • Multiple Sclerosis (MS)
  • Arthritis (even Rheumatoid Arthritis)  
  • Anxiety/Depression 
  • Psoriasis and Eczema 
  • Lyme’s Disease 
  • Hashimoto’s Thyroiditis (most common cause of Low Thyroid) 
  • Weight loss 

LDN helps cravings. That’s how it helps with weight loss, alcohol, and opiate abuse.  

For weight loss, it decreases those “cravings” and increases growth hormone, which is essential for building lean muscle and decreasing fat. It also decreases insulin resistance which is key for weight loss. In fact, at the 2022 A4M conference in Florida it was repeatedly mentioned that anyone with Covid Long Hauler should be taking LDN. 

 

Combinations

 

Sometimes we use LDN in combination with other medications for weight loss. Contrave, an FDA approved medication for weight loss, is a combination of LDN and Wellbutrin. For weight loss, we prefer a compounded mixture of Phentermine and LDN. 

Sometimes we use hybrid dosing where we add 1mg LDN in the morning with your nighttime antidepressant. In combination, it seems to work much better than just the antidepressant alone. 

Note: A Harvard study showed doses of just 1 mg /twice a day works quicker than Prozac for depression. In recent studies, evidence has shown that antidepressants are not always effective, and we know that there can be side effects!  

 

LDN Dosing and Side Effects 

 

LDN is safe, with very few side effects. You take it at night – 1mg for the first week and then work up to 3mg. If you need more, we can dose it up to 4.5mg. In certain cases we will go up to 8 or 9mg. This is still way less than the 100mg that is used as an opiate antagonist. 

Note: The only side effect I have seen with LDN is people having more dreams than usual while taking it.

There is also micro dosing for people who need help getting off of opiates. When I say microdosing, I’m talking about 1-2 MICROgrams. By adding a microdose of LDN, those people have an easier time weaning off. 

Note: I don’t do narcotic management at Performance Medicine, so talk to your specialist about that possibility. 

There are lots of uses of Low-Dose Naltrexone (LDN) that many doctors don’t know about. We can legally use it off label to help people with stress, depression, weight loss, autoimmune diseases, and Covid Long Hauler. I can’t say enough good things about LDN!  

Hope this is helpful!

 

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