In the integrative health community, low dose naltrexone (LDN) has been hailed as a major breakthrough treatment for autoimmune disease and some forms of cancer. It is a safe medication, with virtually no side effects for most individuals and it is shockingly inexpensive. So, why hasn’t your doctor told you about this treatment? Like other innovative alternative treatments, many conventional doctors either do not know about LDN or they choose to ignore its existence. But despite the lack of attention that conventional medicine has bestowed on LDN, its reputation as an effective treatment for autoimmune disease is growing, to a large extent, due to patient demand. I've written about my personal experiences with LDN (see this post and this) and I've gotten a lot questions about LDN from those posts. I thought it would be a good idea to write a more general explanation of LDN for those who may be searching. At a full strength dose of 50mg, naltrexone is an opiate antagonist used in the treatment of alcohol and drug dependence. It was originally approved by the Food & Drug Administration (FDA) in 1984 for the treatment of opioid addiction (heroin/opioid narcotics), but is more commonly used today in the treatment of alcoholism. Naltrexone acts by blocking the opioid receptors in the brain to reduce cravings and inhibit the effects of the drugs or alcohol.
LDN therapy refers to the off-label use of naltrexone at low doses to treat diseases and conditions not related to substance abuse or dependency. In 1985, Bernard Bihari, MD found that when naltrexone was taken at a low dose, it enhanced patients’ immune response to HIV infection. Within the next several years, Dr. Bihari found that LDN also benefited his patients with cancer, as well as certain types of autoimmune disease. In 2007, Jill Smith, MD conducted the first published clinical trial using LDN to treat Crohn’s disease. The study had promising results with 67% of the study participants going into remission and 89% experiencing a decrease in symptoms. Since 2007, there have been a few other studies examining the efficacy of LDN in treating multiple sclerosis, fibromyalgia, Crohn’s disease, and certain types of cancer, but anecdotal reports find LDN effective in the treatment of many other diseases as well.
LDN is believed to work by briefly blocking the opioid receptors in the brain, which leads to increased endorphin production. The endorphins appear to play a central role in regulating the immune system, although the precise mechanism is still poorly understood. In contrast to the conventional medications used to treat autoimmune disease, LDN works with the immune system in an attempt to restore balance and regulation, instead of suppressing the function of the immune system. Although many more clinical trials are needed, LDN may be useful in the treatment of a wide variety of diseases that are related to immune system function.
At the low doses that are used in the treatment of autoimmune disease (typically 1.5 – 4.5mg), LDN has minimal side effects. The most frequently reported side effects are insomnia or difficulty staying asleep during the first few weeks of treatment. Some people report a transitory increase in symptoms of their disease process, but all side effects will typically resolve after a few weeks of taking LDN. There have been no clinical trials that have evaluated the long-term safety of LDN, but naltrexone itself has a long-term safety record. Toxicity studies that were conducted in the early 1980s found that naltrexone would cause reversible liver changes only at doses greater than 300mg (on average, one hundred times the dose used in LDN therapy).
With early clinical trials that show positive results in the treatment of autoimmune disease, the long safety record of the drug used at much higher doses, and minimal side effects, you would think that doctors would be jumping at the opportunity to prescribe LDN, especially since so many of the drugs used to treat autoimmune disease are toxic and have serious side effects. Unfortunately, that is not the case. Naltrexone has been on the market since 1984 and it is a cheap drug. There is not a lot of money to be made in marketing LDN for the treatment of autoimmune disease, especially since its effectiveness could displace many significantly more profitable medications. Many practicing physicians and other practitioners receive their continuing education from pharmaceutical companies and they are not likely to learn about LDN from the industry. Some physicians are simply not willing to do their own research into alternative treatments. Thus, the burden of educating practitioners about LDN often falls to the patient who is desperate to seek relief from symptoms.
If you have an autoimmune disease, proper real food nutrition and attention to other areas of your health (stress, exercise, sleep, social support, and environmental exposures) should be your top priorities. However, if you are still experiencing continued symptoms despite making changes in these areas, LDN is a wonderful adjunct therapy that may give your immune system the boost that it needs. Do not hesitate to mention the possibility of LDN therapy to your practitioner and share the research that has been done. If your practitioner does not seem open to the possibility of LDN, continuing your search until you find one that does.
Have you ever tried LDN therapy? I’d love to hear about your experiences!