Low dose naltrexone (LDN) is being prescribed for autoimmune conditions by a greater number of providers.
What exactly is LDN? Naltrexone is an FDA-approved medication, although it has only been approved to help with heroin and opioid addicts by blocking opioid receptors. In the 1980’s, studies were done with lower doses of naltrexone, and realized that it can modulate the immune system. Soon thereafter it was found that LDN can benefit many people with autoimmune conditions, although it can also help with certain types of cancers, as well as some other chronic health conditions.
The question of what controls the immune system has plagued the medical community for decades. Clearly there are multiple factors that play a role. However, a growing body of research over the past two decades has pointed repeatedly to one’s own endorphin secretions (our internal opioids) as playing the central role in the beneficial orchestration of the immune system. Bone marrow progenitor cells, macrophages, natural killer cells, immature thymocytes and T cells, and B cells are all involved. The relatively recent identification of opioid-related receptors on immune cells makes it even more likely that opioids have direct effects on the immune system.
By taking LDN just before bed – ideally between the hours of 9 PM and 2 AM, there is a brief blockade of opioid receptors. When LDN is taken before bedtime, the actual blockade would occur between the hours of 2 AM and 4 AM. It is believed that this brief period of blockade, produces a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production. In general, in people with diseases that are partially or largely triggered by a deficiency of endorphins (including cancer and autoimmune diseases), or are accelerated by a deficiency of endorphins (such as HIV/AIDS), restoration of the body’s normal production of endorphins is the major therapeutic action of LDN.
Unfortunately there is not a lot of research regarding the benefits of LDN. Some studies showed that LDN might act as an anti-inflammatory agent in the central nervous system, and can help with chronic pain disorders. Other studies show that LDN can benefit those dealing with the pain associated with fibromyalgia. Other studies concluded that it can be helpful for some people with gastrointestinal disorders. A small study suggests that LDN might help some people with active Crohn’s disease.
When someone is dealing with suboptimal thyroid function or Hashimoto’s, most medical providers (including myself) will recommend thyroid hormone medication and/or supplements to enhance thyroid function. Similarly, it is common for medical providers to recommend antithyroid medication for those with overactive thyroid and Graves’ Disease. In certain cases when we struggle to obtain thyroid normalization, it makes sense to try LDN.
But why is this important? Consider a condition such as Hashimoto’s Thyroiditis, which involves the immune system damaging the thyroid gland. Thyroid medication will help replace or modulate hormone levels that are out of balance. However, taking thyroid hormone medication is not going to do anything to stop or slow down the destruction of the thyroid gland. LDN has the potential to prevent further damage of the thyroid gland from occurring. This could potentially allow patients to decrease doses of thyroid medication, achiever better control of thyroid-related symptoms, and keep other immune factors (that are usually associated with Hashimoto’s) in check. Now consider Grave’s Disease, a condition where the thyroid gland is activated and over-produces thyroid hormone. Patients with Grave’s generally use medication like Methimazole to decrease production of thyroid hormone. A lot of patients do not tolerate this medication due to side effects and changes in liver function enzymes. By modulating the immune system, using LDN, we may be able to help patients who don’t tolerate medication avoid radioactive iodine and/or thyroid surgery.
Although side effects are rare with LDN, research indicates that some patients who use LDN report vivid dreams, and occasionally, during the first week of use, patients may complain of difficulty sleeping (less than 2% of users.) Usually reducing the dose of medication will eliminate sleep disturbance.
The normal range for LDN is between 1.5 and 4.5 mg per day, taken about an hour before bedtime- NOT in the morning. There are a couple of reasons for this timing. First, since LDN blocks endorphins, doing it in the middle of the night prevents you from noticing that you feel lousy. Second, the endorphin response is greater at nighttime. I generally start with a 3 mg dose. If there is a positive effect at 3 mg, stay on that dose. If there is still no effect, I raise the dose to 4.5 mg. If there are negative effects on the 3 mg dose, I decrease the dose to 1.5 mg. That being said, the key to LDN is the low dose. So many times you may actually need to lower the dose if you don’t notice a beneficial effect.