Low Dose Naltrexone, or LDN, is a relatively low-cost prescription-based treatment that has gained traction for its potential benefits in various conditions, especially those that impact the immune system such as autoimmune conditions and seasonal allergies.
Before you think this is the miracle pill you’ve been looking for, it’s important to note that LDN is not typically a “game-changer”. Patients may have symptomatic relief and see an improvement in lab results, but other treatments are still needed. In my experience, I’d estimate the response to LDN goes by the rule of thirds: ⅓ improve, ⅓ see no change at all, and ⅓ can’t tolerate the side effects. I suspect the efficacy is dependent on multiple factors, and often times we are conditioned to place power in a pill – and let other health-supporting factors (especially dietary) go by the way side.
To improve the odds that LDN will work for a patient, we want to address and optimize the following before pursuing the use of LDN:
- NUTRITION: Goal is for 90% of the diet to be made up of anti-inflammatory foods (i.e. no processed/packaged foods, especially starchy options like bread and chips, and those involving a lot of sugar), and to consume 3-9 cups of non-starchy veggies every day.
- LIFESTYLE: Daily habits support or block great health, and lifestyle choices are key. These include nutrition choices, movement/exercise, sleep, and relaxation. The most neglected of these (which also makes the greatest beneficial impact) is a daily healthy relaxation habit for stress relief, such as a leisurely walk, creating art, and gentle yoga.
- VITAMIN D LEVELS: Vitamin D plays a significant role in immune support. Target goal is a blood level between 50 and 80.
- DECREASE & TREAT SUBACUTE INFECTIONS: Best evaluated with a blood test (which identifies 10+ infections) and a stool test (to look for infections that originate in the gut). The most commonly found infections include reactivated viruses and significant gut dysbiosis.
- DECREASE & TREAT CANDIDA OVERGROWTH: I find this is best evaluated with a urine-based test called an organic acids test (OAT), which looks for breakdown metabolites of these. Some LDN experts say that candida “blocks” LDN from working, or LDN may modulate the part of the immune system that allows candida to grow.
Let’s review the FAQ’s about LDN….
What is LDN and how does it work?
Naltrexone is a drug that is typically used to reduce the effects of opioids, such as heroin and oxycodine. It is typically dosed at 50mg or above. However, in the mid-1980’s, Dr. Bernard Bihari noted that naltrexone increases endorphins, and these endorphins ultimately balance the immune system. He and his team of researchers discovered that these endorphins rise equally whether the dose was 50mg or 3mg, but stayed in circulation longer if the dose of naltrexone was lower. He recommended LDN dosing at night, because 90% of the body’s endorphins are made overnight, and taking LDN at night boosts natural endorphins by 300%. The drug stops working within a few hours, but the endorphin levels persist for up to 40 hours.
How does it work?
The body’s natural endorphins are increased with LDN, and studies show that certain cells in the immune system are increased, which help balance an over-active immune response. In autoimmune conditions, these cells may turn “off” the cells that drive autoimmunity!
The patients that may benefit from LDN include those with:
- Elevated autoimmune antibodies in blood tests (seen in systemic or organ-specific autoimmune diseases)
- Persistent autoimmune symptoms, despite being on multiple medications
- Chronic neuropathic pain or fibromyalgia
- Mood imbalances such as depression and anxiety
- MCAS (Mast Cell Activation Syndrome)
- Chronic seasonal allergies
It should be noted that although I use this to treat those with Hashimoto’s thyroiditis or Grave’s Disease, no clinical trials have been performed that look at the use of LDN in those with Hashimoto’s. It isn’t for a lack of interest, but rather a lack of potential profit by those that fund such trials. Clinical trials cost millions of dollars to perform! Although the formal research isn’t available, clinicians including myself have seen many cases where LDN successfully improved thyroid autoimmune conditions.
What are potential side effects?
Most side effects are temporary, and this is where a good practitioner comes into play. I typically start people at a low dose and increase every 1-2 weeks. If someone experiences insomnia, I will have patients take it during the day for a few weeks.
The most common side effects include vivid dreams, insomnia, nausea, and irritability. In the higher doses (e.g. 50mg), a few cases of liver toxicity have been reported, but no reports have occurred with LDN (but I still recommend periodic evaluation of liver function through testing). For those that take medications for hypothyroidism, LDN may cause someone to experience symptoms of hyperthyroidism, and doses often have to be lowered to avoid negative effects from excessive thyroid medication.
Many of these side effects can be modified by lowering the dose, changing the way it’s taken (e.g. for nausea, taking it sublingually or topically can lessen the effects), and changing the time it is taken.
How to take it.
Using this for autoimmune and immune conditions is considered off label, so it may not be covered by insurance. It has to be made via a compound pharmacy, and the doses typically start as low as 0.5mg and go up to 6 mg, but I find that 1.5-3mg works best for most patients. The cost depends on the pharmacy with which a practitioner works, and average around $0.60-$1.50 per pill.
Like I mentioned, this drug isn’t typically a game changer but it is relatively safe, and when it does work, patients often feel the difference (more energy, better mood, improved fertility, less pain) and may even have to decrease/stop medications.
Before pursuing use of this, I highly recommend optimizing diet and lifestyle as mentioned in the beginning of this post. A primary care practitioner can monitor vitamin D levels, and possibly evaluate for subacute infections. Gut evaluation through stool or urine testing is best done by an experienced functional/integrative medicine practitioner. Stool tests can cost around $400 and urine-based testing can cost around $200. Sometimes insurance companies will help out with these costs, and I find it best to pay the cash price and submit the receipt for reimbursement (many patients receive 30-60% reimbursement for these).
If you suffer from autoimmune conditions, the terrible Austin allergies, or other difficult-to-treat conditions, LDN may help. Start with the recommendations noted in this article, and you know where to find me if you need me!
Best in health,
P.S. I personally use LDN for my autoimmune conditions. I have not noticed significant changes in my symptoms, but it does keep my labs in balance and decreases my autoimmune flares. I do still experience vivid dreams, but the initial insomnia wore off after about a month. Will I have to take LDN for the rest of their life? Maybe, maybe not. Science is always evolving!