The Remarkable Benefits of Low-Dose Naltrexone

In this interview, we review some of the remarkable benefits of low-dose naltrexone (LDN), including the surprising benefits of microdosed LDN. The two experts featured in this interview are Linda Elsegood, a Briton who founded the LDN Research Trust1 in 2004, and Dr. Sarah Zielsdorf, who has a medical practice in the Chicago area in the U.S.

Elsegood, who was diagnosed with MS in 2000, has been involved in LDN research and public education for 16 years. LDN is a powerful, safe and effective treatment for many autoimmune diseases, yet few, including most health care professionals, know anything about it. Remarkably, LDN may even be helpful in the fight against COVID-19, as it acts to normalize your immune system.2

Elsegood recently published a book on LDN called “The LDN Book, Volume Two: The Latest Research on How Low Dose Naltrexone Could Revolutionize Treatment for PTSD, Pain, IBD, Lyme Disease, Dermatologic Conditions and More.” Each chapter is written by a medical professional with clinical knowledge of the drug’s use. Zielsdorf is one of the contributing authors. Elsegood also hosts a radio show called The LDN Radio Show.3

In the interview, she tells the story of how she discovered LDN and the dramatic benefits she has experienced from it. In summary, beneficial effects became apparent after about three weeks on the drug and, after 18 months, her condition had significantly improved.

Zielsdorf — who has an undergraduate degree in microbiology and a master’s degree in public health microbiology and emerging infectious disease — also has a personal health story that brought her to LDN. She was diagnosed with hypothyroidism (underactive thyroid) in 2003. Ten years later, she was diagnosed with Hashimoto’s, an autoimmune disorder that affects the thyroid.

“I learned about functional nutrition and triggers for autoimmunity, and started to do all of the things I needed to do to optimize my biomarkers, remove systemic inflammation, and was able to return to my [medical] training. I had been told that I could never have children and surprisingly became pregnant and had a daughter in my second year of training.

After having her, I [had a flareup]. It was then, in 2014, that a doctor put me on LDN. It changed my life … Once I graduated from residency, I started treating patients with a variety of issues with LDN. I’ve treated thousands of patients with LDN.”

Naltrexone — A Rare Gem of a Drug

Naltrexone in low or even microdoses is one of the few pharmaceutical drugs I wholeheartedly endorse. Not only is it remarkably safe, it’s also a profound adjunctive therapy for a wide variety of conditions. As explained by Zielsdorf:

“Naltrexone is one of the few things that actually enables our own bodies, our own immune systems, to be able to function better and really restore function.

After World War II, they were looking for more opioid medications. By accident, scientists figured out how to block the opioid receptor. They did the exact opposite of what they were supposed to do, which is to find morphine analogs for soldiers.

[In] the 1960s, they were able to synthesize naloxone and naltrexone … FDA approved it in the 1980s for opioid addiction at a dose of 50 to 100 milligrams, and then in the 1990s for alcohol dependence.

But it was Dr. Bernard Bihari and Dr. Ian Zagon in the 1970s that had this amazing idea that if you took a very small dose of naltrexone, compounding it in a clean way [down] to a few milligrams, if would briefly block the opioid receptor in the central nervous system — very briefly kissing that receptor and then unblocking it.

This upregulates the body’s immune system by increasing the opioid receptor’s own production of beta-endorphin and met-enkephalins. Beta-endorphins help with mood, pain, sleep and the immune system, and met-enkephalins are also known as opioid-derived growth factor, and there are receptors for these on many different tissues, including the thyroid.

We now use it for nearly all autoimmune conditions, as an adjunct for cancer, and as a treatment for chronic pain. We also use ultra-low dose [microdosed] naltrexone, which I wrote about, to help potentiate pain relief for people who are on opioids and help them to be less dependent on opioid medications.

I’ve actually been able to get patients off of fentanyl patches and get them off chronic oxycodone or Norco use where their pain specialists said, ‘You will never ever get off these pain medications.’ It’s been an incredible journey and I’m a huge advocate of it.”

Naloxone Versus Naltrexone

Naloxone (Narcan) is what is carried on ambulances and used in ERs and trauma bays as an antidote to an opioid overdose. When given at a high enough dose, naloxone or Narcan acts as a complete opioid blocker, which is why it’s used acutely when someone has taken too high a dose of an opioid.

Naltrexone blocks the opioid receptor only briefly, and by a different mechanism. When used in low dosages as LDN, the chief benefit is actually in the rebound effect, after the opioid receptor has been briefly blocked.

Foundational Treatment Strategies for Autoimmune Diseases

With regard to autoimmune diseases, it’s important to realize there are other, equally important, foundational strategies that will benefit most patients with a dysfunctional immune system. These include optimizing your vitamin D level and omega-3 index, for example.

It’s also important to eliminate potential triggers. The reason why people have an autoimmune disease is because they’re exposed to something in the environment which serves as an antigen that their body recognizes as a foreign invader, and as a result attacks it. If you can avoid those antigens, you can often suppress and frequently eliminate symptoms without anything, because you’ve removed the stimulus.

One common autoimmune trigger is lectins, found in many otherwise healthy vegetables. Zielsdorf will typically place her autoimmune patients on a Mediterranean-style paleo diet or an oligoantigenic elimination diet to optimize detoxification, liver and kidney function, and the microbiome.

Others may be placed on a nose-to-tail carnivore diet. As noted by Zielsdorf, it’s “a way of offloading and simplifying what antigens the body is seeing.” Other helpful diets in this respect include the autoimmune paleo diet and the low-histamine or low FODMAP diet.

“I am a microbiologist and I do a ton of advanced testing, and then we start looking deeper at triggers,” she says. “I used to put everybody on LDN first, but now we know that certain patients will flair because their immune system is so suppressed due to co-infections.

We see it most with Lyme disease and with yeast overgrowth. If I suspect or I have tests confirming that a patient has one of these things, or their immune system is super suppressed … I’ll work on their microbiome before I start LDN …

I test everybody’s gut, and what I see universally is you get this hyper intense intestinal permeability in these cases … What’s so interesting is a leaky gut equals a leaky brain, and we overwhelm our immune system. I do see this. The first step is getting them off the most common triggers, and sometimes I’ll be testing for lectins too.

Universally, for all of my autoimmune patients, is that they can’t eat wheat. There are over 150 antigens in wheat that you can be sensitive to … It is also desiccated with Roundup, glyphosate, right before processing, so we get that extra toxicity. I test my patients for their environmental toxic load, and I see a lot of patients with glyphosate toxicity.

The wheat that we used to eat 10,000 years ago at the beginning of agriculture is not the wheat [we now eat]. It’s not even the same chromosome number as what our bodies ate in small amounts as hunter gatherers.”

Why You Should Avoid Monogastric Animal Meats

As mentioned by Zielsdorf, a nose-to-tail carnivore diet can be an excellent intervention in some cases, especially for those whose immune function is severely suppressed. However, you should avoid monogastric animals, meaning animals that have only one stomach.

Whereas cows have two, chickens and pigs have only one. The reason for this recommendation is because conventionally factory farmed chicken and pork will be very high in the omega-6 fat linoleic acid. This is because they are typically fed corn, which is high in this type of fat. And a high linolenic acid diet can metabolically devastate your health. So, a diet high in chicken and bacon is not doing your body any favors.

Animals with two stomachs are able to fully process omega-6-rich grains and other foods, as they are equipped with gut bacteria that can break it down into a healthier fat. Aside from cows and steer, this includes buffalo, beef and lamb.

What Can LDN Treat?

Aside from autoimmune diseases, LDN is also used in the treatment of the following conditions. Bear in mind this is not a complete list. Some of these conditions have been featured in various documentaries4 produced by the LDN Research Trust. You can find links to those documentaries in the references.

Cancer5 — Research by professor Angus George Dalgleish and his colleague Dr. Wei Lou showed LDN could bring cancer cells into remission using pulse dosing.6 LDN also works synergistically with cannabidiol (CBD), and works well for cancer, autoimmunity and pain conditions

Opioid addiction, dependence and recovery7 — Using microdoses of 0.001 milligrams (1 microgram), long-term users of opioids who have developed a tolerance to the drug are able to, over time, lower their opioid dose and avoid withdrawal symptoms as the LDN makes the opioid more effective.

For opioid dependence, the typical starting dose is 1 microgram twice a day, which will allow them to lower their opioid dose by about 60%. When the opioid is taken for pain, the LDN must be taken four to six hours apart from the opioid in order to not displace the opioid’s effects

Lyme disease and its coinfections8

Fibromyalgia

Small intestinal bacterial overgrowth (SIBO)

Restless leg syndrome

Depression

Dermatological issues

Infertility

General Dosing Guidelines

Dosing will, of course, depend on the condition being treated, but there are some general guidelines that can be helpful. Downloadable guides can be found on the LDN Research Trust site, and are available in several languages. Keep in mind that LDN is a drug, not something you can buy over the counter, and you need to work with a knowledgeable physician who can prescribe it and monitor your health.

“With a general pain condition, we may use 1.5 to 3 or 4.5 mg. With Hashimoto’s, we start lower and slower because patients with Hashimoto’s may actually have to reduce their thyroid hormone medication if they’re on it because they get reduction of that inflammation and they can produce more of their own thyroid hormone. So, we usually start at 0.5 mg.

For patients with mood conditions … 0.5 to 1 mg. There was an important paper that came out showing LDN is an important agent for depression, for patients who fail those meds or as an adjunct to antidepressants. PTSD patients may have to go higher. There are all sorts of strategies and you just need to find a doctor who’s well-versed in that condition.”

More Information

The LDN Research Trust’s website is an excellent resource for all things LDN. It has a variety of resources to guide patients, prescribing doctors and pharmacists alike. It also has a page where you can find LDN-literate prescribers around the world.

Of course, to learn more, be sure to pick up a copy of “The LDN Book, Volume Two: The Latest Research on How Low Dose Naltrexone Could Revolutionize Treatment for PTSD, Pain, IBD, Lyme Disease, Dermatologic Conditions and More,” and/or “The LDN Book: How a Little-Known Generic Drug ― Low Dose Naltrexone ― Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression and More,” which is the first of the two volumes.

Both books are also available on the LDN Research Trust website, along with videos featuring all of the doctors that contributed chapters to the books. You can also check out The LDN Radio Show.9 Last but not least, LDN Research Trust is a nonprofit that depends on public donations, so if you would like to contribute to the Trust’s LDN research and education efforts, please make a donation.

Addicted: America's Opioid Crisis

The featured 2019 BBC documentary, “Addicted: America’s Opioid Crisis,” explores the depth of the nation’s addiction to opioid painkillers and the role played by Purdue Pharma and other makers of the drug.

As noted in the film, opioids kill more people than any other drug on the market, and it’s the only type of drug that can condemn a person to a life of addiction after a single week of use.

According to the BBC, “1 in 8 American children live with a parent who suffers from a substance abuse disorder,” and “every 15 minutes, a baby in America is born suffering from opioid withdrawal.” Middle school-aged children interviewed also say they have easy access to drugs, should they want them.

Many now blame the drug companies that make these drugs and have falsely promoted them as safe and nonaddictive for patients of all kinds, including children.

That includes one of the former addicts followed in the film, who says he thinks the drug companies need to be held responsible for their role in creating this epidemic, and made to help pay for the solution.

Purdue Pharma Pleads Guilty and Folds

One of the most prominent drug companies involved in the creation of this opioid addiction crisis is Purdue Pharma, the maker of OxyContin. At the end of October 2020, Purdue Pharma agreed to plead guilty to three federal criminal charges relating to its role in the opioid crisis, including violating a federal anti-kickback law, conspiracy to defraud the U.S. government and violating the Food, Drug and Cosmetic Act.1,2

To settle the charges, Purdue is supposed to pay $8.3 billion in fines, forfeiture of past profits and civil liability payments,3 but because it doesn’t have the cash, the company will instead be dissolved and its assets used to erect a “public benefit company” that both makes opioids and pays for addiction treatment.

Legal Painkillers Now the Gateway Drug to Heroin

While marijuana was long known as the gateway drug to other illicit drug use, that distinction now belongs to prescription opioids. According to data4 from the National Institute on Drug Abuse, prescription opioid use is a significant risk factor for subsequent heroin use.

The incidence of heroin use is 19 times higher among those who have used opioids nonmedically than among those who have no history of opioid use, and 86% of young, urban injection drug users report using opioid pain relievers nonmedically before starting heroin. Overall, nearly 80% of heroin users now report using prescription opioids prior to heroin.

Similarly, data5 from the University of Michigan shows just under 1 in 3 people (31.8%) who misused opioids during their high school years ended up using heroin by age 35.

When it comes to children and teens, a major source of opioids are dentists, who wrote a staggering 18.1 million prescriptions for opioids in 2017.6 Opioids are frequently prescribed when extracting wisdom teeth, even though there’s no evidence to support this strategy.

This is especially true if you see a biological dentist who knows what they are doing. Earlier this year I had a periapical abscess and had to have the tooth extracted. I saw one of the best dentists in Florida, Dr. Carl Litano, just south of Tampa. He used platelet rich plasma (PRP) at the extraction site and I had zero pain and no swelling without any medication. Afterward, no one could tell I had an extraction the previous day.

Children are also recklessly prescribed addictive opioids for minor surgical procedures. For example, insurance claims data from 2016 and 2017 reveal 60% of children between the ages of 1 and 18 with private insurance filled one or more opioid prescriptions after surgical tonsil removal.7,8

Meanwhile, research9 shows opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter drugs such as acetaminophen, ibuprofen and naproxen.

An Epidemic Caused by Greed

As noted in the film, this is an epidemic caused by greed within the medical system. Purdue Pharma was exceptionally skilled at marketing its product, cleverly disguising its advertisements as educational material. (The same can clearly be said about many other drug companies and their wares today.)

There can be no doubt that false advertising played a central role in the opioid epidemic,10 and for doctors, it highlights the importance of staying on top of published research rather than relying on drug company sales reps for their education.

The fraud has its roots in a short letter to the editor11,12 published in The New England Journal of Medicine in 1980. The letter — which was simply commenting on a cursory examination of patient files in a Boston hospital — stated that narcotic addiction in patients with no history of addiction was very rare.

Purdue built its marketing of OxyContin on this letter, for years falsely claiming that opioid addiction affects less than 1% of patients treated with the drugs. According to Purdue’s marketing material, featured in the film, “the most serious risk with opioids is respiratory depression.”

In reality, opioids have a very high rate of addiction and have not been proven effective for long-term use.13 A number of court cases in recent years have demonstrated how Purdue systematically misled doctors about OxyContin’s addictiveness to drive up sales.

As noted by David Powell, a senior economist at Rand, to produce the most lethal drug epidemic America has ever seen “you need a huge rise in opioid access, in a way that misuse is easy, but you also need demand to misuse the product.”14

According to the documentary, Purdue made more than $1 billion a year from its sales of OxyContin. OxyContin’s success also quickly led to other drug companies mimicking Purdue’s tactics. Other companies being called to account include Allergan, Cephalon, Endo International, Egalet Corporation, Insys Therapeutics, Johnson & Johnson, Janssen Pharmaceuticals, Mallinckrodt plc and Teva Pharmaceutical Industries.

In the final analysis, it’s clear that unconscionably deceitful marketing tactics have resulted in the death of hundreds of thousands of Americans; 46,802 Americans died from opioid overdoses in 2018 alone.15 As of June 2017, opioids became the leading cause of death among Americans under the age of 50.16

That said, the BBC also rightfully points out that we need stronger regulations and more effective checks and balances to prevent this kind of situation from happening again in the future. Merely making drug companies pay is not enough. 

Purdue Lured in, Then Abandoned Doctors

Steven May, a former Purdue sales rep, also highlights yet another scandal. The company came up with a plan to help doctors to better document their treatment of pain. Sales reps were taught how to instruct doctors to use these tools.

When those same doctors eventually got in trouble for overprescribing opioids, using Purdue’s tools, the company walked away and offered no support. Many doctors lost their medical licenses. Some ended up doing jail sentences and some committed suicide. “And they were doing exactly what [Purdue] taught us to teach them to do,” May says.

No Remorse

Adding insult to injury, when it became clear that people were dying in droves from opioid overdoses, Purdue launched an extensive damage-control operation that included the suggestion that those dying from opioids were already addicts, and that this wouldn’t happen to patients who were not already addicted to drugs. It was basically just a variation on the original lie.

According to lawsuits filed against Purdue, the company knew as early as the 1990s that OxyContin was one of the most abused drugs in the country, yet they did nothing to change their marketing and sales strategies.

That the Sacklers, the owners of Purdue, had no remorse and didn’t care about the societal effects that overprescription of their drug was having is illustrated in a 2001 email exchange between then-Purdue president Richard Sackler and an acquaintance.

In the documentary, Connecticut Attorney General William Tong reads this exchange, which begins with the unnamed acquaintance stating: “[Drug] abusers die, well that is the choice they made. I doubt a single one didn’t know the risks,” to which Sackler replied, “Abusers aren’t victims; they are the victimizers.”

“It’s hard to stomach that someone would write that about people who are suffering, people who are in real distress and people who have died,” Tong says, “and that is the kind of thing that powered this company during a period and led to deceptive, fraudulent, misleading product development and marketing … [They] made money off people’s misery and I think that is what these emails show.”

Unemployment and Poverty Fuel Addiction

Many of the opioid and heroin abusers featured in “Addicted” live on the streets. Desperation and despair are evident in all. Several investigations seeking to gain insight into the causes fueling the opioid epidemic have been conducted in recent years.

Among them is a 2019 study17 in the Medical Care Research Review journal, which looked at the effects of state-level economic conditions — unemployment rates, median house prices, median household income, insurance coverage and average hours of weekly work — on drug overdose deaths between 1999 and 2014. According to the authors:18

“Drug overdose deaths significantly declined with higher house prices … by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were … only significant among males, non-Hispanic Whites, and individuals younger 45 years …

Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.”

Similarly, an investigation published in the International Journal of Drug Policy19 in 2017 connected economic recessions and unemployment with rises in illegal drug use among adults. Seventeen of the 28 studies included in the review found that the psychological distress associated with economic recessions and unemployment was a significant factor:20

“The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important.”

Another 2019 study21 published in Population Health reviewed the links between free trade and deaths from opioid use between 1999 and 2015, finding that “Job loss due to international trade is positively associated with opioid overdose mortality at the county level.” Overall, for each 1,000 people who lost their jobs due to international trade — commonly due to factory shutdowns — there was a 2.7% increase in opioid-related deaths.

Trauma Raises Addiction Risk

Abuse-related trauma is also linked to unemployment and financial stress, and that too can increase your risk of drug use and addiction. As noted in The Atlantic,22 when the coal mining industry in northeastern Pennsylvania collapsed, leaving many locals without job prospects, alcohol use increased, as did child abuse.

Many of these traumatized children, in turn, sought relief from the turmoil and ended up becoming addicted to opioids. All of this is particularly pertinent today, as many parts of the U.S. have been shut down for extended periods of time over fears of COVID-19.

Not being allowed to work, being forced to stay at home for weeks or months on end, maintaining an unnatural distance even to your loved ones and not being able to see people’s faces when out in public — all of these things can contribute to fear, anxiety and, ultimately, despair that fuels addiction. Indeed, reports23 warn that substance abuse is on the rise as a result of pandemic measures, as is domestic violence.24

Struggling With Opioid Addiction? Please Seek Help

It’s vitally important to realize that opioids are extremely addictive drugs that are not meant for long-term use for nonfatal conditions. If you’ve been on an opioid for more than two months, or if you find yourself taking a higher dosage, or taking the drug more often, you may already be addicted. Resources where you can find help include the following. You can also learn more in “How to Wean Off Opioids.”

I also urge you to listen to my interview with Dr. Sarah Zielsdorf, which is being published in tomorrow’s newsletter. In it, she explains how low-dose naltrexone (LDN), used in microdoses, can help you help combat opioid addiction and aid in your recovery.26

Using microdoses of 0.001 milligrams (1 microgram), long-term users of opioids who have developed a tolerance to the drug are able to, over time, lower their opioid dose and avoid withdrawal symptoms as the LDN makes the opioid more effective.

For opioid dependence, the typical starting dose is 1 microgram twice a day, which will allow them to lower their opioid dose by about 60%. When the opioid is taken for pain, the LDN must be taken four to six hours apart from the opioid in order to not displace the opioid’s effects.

Nondrug Pain Relief

Many types of pain can be treated entirely without drugs. Recommendations by Harvard Medical School27,28 and the British National Health Service29 include the following. You can find more detailed information about most of these techniques in “13 Mind-Body Techniques That Can Help Ease Pain and Depression.”

Gentle exercise

Physical therapy or occupational therapy

Hypnotherapy

Distracting yourself with an enjoyable activity

Maintaining a regular sleep schedule

Mind-body techniques such as controlled breathing, meditation, guided imagery and mindfulness practice that encourage relaxation. One of my personal favorites is the Emotional Freedom Techniques (EFT)

Yoga and tai chi

Practicing gratitude and positive thinking

Hot or cold packs

Biofeedback

Music therapy

Therapeutic massage

In “Billionaire Opioid Executive Stands to Make Millions More on Patent for Addiction Treatment,” I discuss several additional approaches — including helpful supplements and dietary changes — that can be used separately or in combination with the strategies listed above to control both acute and chronic pain.