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Low-Dose Naltrexone (LDN) as a Treatment for Autoimmune Disease


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Find out how low-dose naltrexone works, what kind of conditions it’s been studied in, and how you might find a doctor that you can work with to take it.

Revolution Health Radio podcast, Chris Kresser

What conditions is low-dose naltrexone effective for? There are actually two ways to answer this question. The first is what the scientific literature shows, and then the second is what clinical and anecdotal experience of clinicians that are working with LDN shows.

In this episode, we cover:

3:36  How LDN works
10:50  The effectiveness of LDN
17:25  Finding a doctor to work with

Steve Wright: Good morning, good afternoon, and good evening. You are listening to the Revolution Health Radio Show. I’m your host, Steve Wright, co-author at SCDlifestyle.com. This episode of the RHR podcast is brought to you by 14Four.me. This is a 14-day healthy lifestyle reset program. Chris has put together a really simple, step-by-step, hand-holding program for those of you who are still struggling with sleep issues, weight issues, gut issues — actually basically any health issues — because the 14Four.me program addresses your food, your sleep, your movement, and your stress, all foundational principles for living a long, healthy life and overcoming any sort of chronic conditions you’re still dealing with. If you’re having problems implementing these in your life, please check out 14Four.me. It might be the program for you.

With me is integrative medical practitioner, healthy skeptic, and New York Times bestselling author, Chris Kresser. Chris, how are you doing?

Chris Kresser: Pretty well. How are you, Steve?

Steve Wright: I’m catching up on some sleep, but I’m doing well.

Chris Kresser: All right. Yeah, I heard you’ve been out partying hard at Garth Brooks concerts!

Steve Wright: I can’t say I haven’t been. It’s been good to put on the Stetson, the cowboy boots, and sing some Friends in Low Places.

Chris Kresser: That’s pretty awesome. I have to remember you’re Midwest born and raised, right?

Steve Wright: Yeah, yeah, coming from the rural backwoods of Michigan. Not really that backwoods, but —

Chris Kresser: That’s great.

Steve Wright: — I got the country gene.

Chris Kresser: Good times, good times.

Steve Wright: Yes.

Chris Kresser: All right, so we have a great question this week. It was actually hard for me to believe that I had never covered it. I’ve talked about it on so many different podcasts and in blog articles and stuff, but I realized when we got this question that I had never actually covered this topic in one distinct podcast, so here we go.

Question from Larry: Hi, Chris. My name is Larry Leibowitz. I’m an integrative/functional family physician in Connecticut. I’ve become an avid listener to your podcast, and I find a lot of the material to be extremely useful and very helpful for my practice. As you can imagine, I see a lot of patients with chronic inflammatory conditions. Many of them are autoimmune in nature, and recently I’ve been considering the use of low-dose naltrexone with my patients. I’d be very interested in hearing about your experiences with the medication, some of the successes and/or failures, and in which cases you find it to be the most useful. Thanks. Take care.

Chris Kresser: All right. Yeah, like I said, it’s something we’ve talked about here and there, and it can be really useful for people with autoimmune conditions. I think a lot of folks have heard of it by now, but I want to just take the chance to give a little bit of background, explain how LDN, low-dose naltrexone, works, what kind of conditions it’s been studied in and might be effective for, and we’ll talk about some pros and cons and things to keep in mind if you take it and how you might find a doctor that you can work with to take it.

How LDN Works

As the name implies, low-dose naltrexone is a low dose of a medication called naltrexone that was originally approved back in the ’80s at a higher dose, 50 mg, for the purpose of helping opiate and heroin addicts to get off those drugs, and it works by blocking the reception of opioid hormones. So if you were on a 50 mg dose, you could take any kind of opiate drug and not get high. But the problem was that in addition to not getting high when taking these opiates, people who were taking 50 mg of naltrexone didn’t feel any pleasure at all because the opioid receptors in our brain mediate our experience of pleasure. So at the full dose, naltrexone really reduced that experience of pleasure and, therefore, wasn’t a very sustainable or effective drug.

But around that time in the mid ’80s there was a doctor in New York named Dr. Bihari who was interested in treating cancer and AIDS, which was just becoming something that people were starting to focus on more at that point, of course, and he discovered that a low dose between 3 mg and 4.5 mg of naltrexone had beneficial effects on the immune system. And since then, LDN has been used for autoimmune disease, cancer, and other conditions that involve immune dysregulation. This is important to understand if you’re going to talk to your doctor about LDN because a lot of doctors might be familiar with naltrexone that was used for this purpose and might raise their eyebrows or not be familiar with the fact that a lower dose is used for a completely different purpose. The higher dose is about blocking opioid receptors and detox and getting people off drugs, whereas the low dose is being used now for balancing and regulating the immune system, so it’s important to make that distinction.

Without getting too geeky here, I want to tell you a little bit about how LDN works because it’s interesting, and it, of course, helps to understand how it might benefit you if you have an immune-related condition. And this is ongoing. There are new papers published about the mechanisms of LDN each year, and we’re still learning about this, but so far, there are two main mechanisms that have been identified. One is that, as I said, it regulates the immune system, and it does this primarily by promoting T regulatory cell function. The T regulatory cells, or Tregs, they keep the immune system in balance, and they turn inflammation on and off, depending on what’s needed, and they prevent the immune system from getting stuck in patients with overactive immune systems, like people with allergies or asthma or autoimmune conditions. The way this works is LDN, as I mentioned, it temporarily blockades the opioid receptors in the brain, and when the receptors are blocked, the body thinks more opioids are needed, and so it produces more, and by the time more opioids are produced, LDN is out of the system, the receptors are unblocked and receive those, and that leads to essentially a net increase in opioid production.

So if you’re wondering now, like, what does this have to do with the immune system, we now know that people with autoimmune disease often have low levels of these opioids and that white blood cells, which, of course, are what are driving the immune response, have receptors for these opioids, which, of course, suggests that they play a really important role in the immune system.

So that’s number one, this immune-regulating, balancing mechanism.

Steve Wright: Does the increase in opioids actually then cause a corresponding increase in Treg cells? Is that the point you were making there?

Chris Kresser: Yeah, exactly. And then the Treg cells are the ones that — I mean, they’ve been referred to as the police force of the immune system. I’m not sure that’s the best analogy these days, given what’s been happening, but the idea is that they balance and regulate the immune system and keep both sides in check.

Another more recently discovered mechanism is that LDN reduces inflammation in the central nervous system, and the significance of this is that inflammation in the central nervous system is thought to play a role in a number of different conditions that LDN has been shown to be effective for, like fibromyalgia and chronic pain and depression. In addition to blocking the opioid receptors, LDN blocks something called toll-like receptor 4 that’s found on white blood cells that are called microglia, and the microglia are central nervous system immune cells that produce inflammation, pain sensitivity, fatigue, sleeplessness, mood disorders, and cognitive problems. When those microglia are chronically activated, as they are fibromyalgia and other pain disorders, it results in neurotoxicity and then this whole wide cascade of symptoms that are associated with all these conditions, and LDN essentially blocks that cascade by blocking the receptors on those microglial cells. This probably explains why in some of the studies so far LDN has been shown to reduce something called erythrocyte sedimentation rate, or ESR, which is an inflammatory marker that’s elevated in conditions like fibromyalgia.

Again, to recap, there are two basic mechanisms: balancing and regulating the immune system and then reducing central nervous system inflammation. There probably are other mechanisms, but those are the ones that have been the most clearly defined so far.

Steve Wright: Chris, is there any way for people to test their opiate levels to know if they might be low and LDN would be an ideal —

Chris Kresser: Not that I’m aware of. There are some tests that can look at various kinds of immune cells and the balance between those immune cells, but they’re not widely available and they’re a little bit difficult to interpret, so it’s not something that I think is that useful for the average person or ready for primetime. I think with LDN the best way to determine if you’ll benefit from it is whether you have the conditions that it’s shown to be useful for or any other kind of immune-related condition and then just doing a therapeutic trial, but we’ll talk a little bit more about that in a second.

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The Effectiveness of LDN

OK, so what conditions is LDN effective for? There are actually two ways to answer this question. The first is what the scientific literature shows, and then the second is what clinical and anecdotal experience of clinicians that are working with LDN shows. There’s definitely research out there on LDN, but it’s still somewhat limited, and I think clinical and anecdotal experience is further ahead in terms of the breadth of conditions that LDN is being used for and the experience of how effective it can be for those conditions. The studies are also still usually relatively small sample size, not always randomized, not always double-blinded. Part of the reason for this is they’re probably not that well-funded because low-dose naltrexone is off patent, and that means that drug companies don’t stand to make a killing on selling LDN, and it’s unlikely that a whole lot of money is going to be put into it for that reason.

Having said that, the results so far of the studies on LDN have been really encouraging, and they’ve been primarily on cancer, multiple sclerosis, Crohn’s disease, fibromyalgia, and autism. It’s especially effective for Crohn’s with over a 70% remission rate and even complete mucosal healing as evidenced by colonoscopy in some cases. If you know about Crohn’s disease and how nasty it can be and how difficult to treat and how poor the success rates are of the typical treatments, that’s a pretty remarkable statistic, over 70% remission rate with mucosal healing, especially when you consider the fact that there were not documented side effects of LDN in that study compared to placebo.

So that’s what’s in the scientific literature, but anecdotally clinicians are using it for a whole wide range of conditions involving inflammation and immune dysregulation, autoimmune diseases like Hashimoto’s and Graves’, rheumatoid arthritis, lupus, psoriasis, chronic fatigue syndrome, neurodegenerative disorders like Parkinson’s and Alzheimer’s. It’s being extensively used for infertility. There’s a clinic in the United Kingdom that is basically almost entirely focused on using LDN for fertility to treat patients who are struggling with that. And the reason it’s effective for such a broad range of conditions is because of the mechanism of action. As I said, it regulates and balances the immune system and reduces inflammation, and of course, we know that inflammation and immune dysregulation are at the root of many diseases and certainly at the root of autoimmune conditions. Even though there aren’t any studies of LDN on Hashimoto’s, for example, it makes sense that it would work for Hashimoto’s if it’s working for multiple sclerosis and Crohn’s disease because the underlying mechanism of all those conditions is immune dysregulation, autoimmunity. That’s why a lot of clinicians out there feel justified and safe in using LDN for conditions that it hasn’t directly been studied on because, A, the mechanism makes sense and, B, it’s safe and well tolerated and doesn’t have any significant complications or risks or even side effects in many of these studies.

One of the advantages of LDN as a therapy is that it’s low cost. It’s off patent, as I said, which means typically you can get it for about 40 bucks a month, 35 or 40 bucks a month from a compounding pharmacy.

The side effects are pretty minimal, in that in some of the double-blind, placebo-controlled trials, as I said, there was no difference in side effect between placebo and the treatment group, but I will say that in our experience, what we’ve seen in our clinic and other clinicians I know that work with it, there are some side effects that are fairly common, which are temporary sleep disturbance when a patient first starts taking it or vivid dreams and a mild headache, but these usually pass pretty quickly and can often be mitigated by starting with a lower dose, so if 3 mg or 4.5 mg is the ultimate dose that they end up on, starting at, like, 1 mg or 1.25 mg or something and then building up more slowly.

LDN does not have any known abuse potential. It’s not an addictive medication. One of my hesitations or criticisms of a lot of drugs is that they just primarily work by suppressing symptoms and they don’t necessarily improve the function of the body, but LDN is a little different in that respect, in that it works by improving the function, it increases the production of T regulatory cells, which then have that immune-balancing effect and, I think, makes it a little bit safer to use over the long term. Now, of course, if you can achieve results and address your autoimmune condition without using a medication, even one as safe as LDN, then that’s great, but my rubric for a treatment, you know, whether a treatment makes sense, has always been whatever is the most effective and causes the least amount of harm. In many cases, that’s not a drug, but LDN is actually one medication that I think passes that test.

One of the disadvantages of LDN is that there’s still not standardized dose, and really the patient and the prescribing physician just kind of have to figure it out through trial and error. From our experience, we’ve seen most people end up around 2.5 mg to 3 mg; 4.5 mg tends to be too much for people. I’ve seen some patients settle on as little as 1.25 mg or 1.5 mg, but anywhere in the 1 mg or 1.25 mg to 4.5 mg range could be the optimal dose for a given person.

We still need more research. I mentioned that the research we have already is somewhat limited, so we need more research.

Finding a Doctor to Work With

It’s not always easy to get a prescription. A lot of primary care doctors aren’t familiar with it. It’s not covered by insurance. It’s completely off label, but fortunately it’s pretty cheap. Even if people are paying out of pocket, it’s only about 35 or 40 bucks a month.

And although all the studies we have so far show that it’s safe, we don’t have any hard data on really long-term safety, you know, people who have been taking LDN for 10 years or something like that. Of course, that’s true for a lot of drugs, but I’m just pointing that out.

So if you’re interested in LDN, keep in mind it has to be prescribed by a physician, or in some states, a naturopath can prescribe it. You can print out some studies from PubMed. You can go into PubMed.org and search for “low-dose naltrexone,” and there are a bunch of studies that will pop out. You can print those out and take them to your doctor to discuss. There’s a website called LDNinfo.org that has kind of a clearinghouse of information on LDN that you can go to. There’s a Yahoo group about LDN that you can join and talk to folks there and try to find a practitioner in your area.

What I don’t recommend is ordering it from overseas pharmacies. You never know what you’re getting that way, and there have been a lot of studies showing that drugs that come from those pharmacies are not often what they claim to be, and that’s just flat out dangerous and not very smart. Hopefully that goes without saying, but I’m just mentioning it anyway.

And particularly with LDN, it should be obtained from a reputable compounding pharmacy that has some experience in compounding LDN. I mean, there are certain pharmacies that know which binders and fillers make the most sense with it and seem to be the best tolerated, and they just a lot more experience working with patients that are taking it, and it’s a good idea to refer your physician to one of those. Skip’s Pharmacy in Florida is the one that comes to mind that’s been doing it for the longest period of time, so you can look them up on the web. There’s also a list of recommended pharmacies on the LDNinfo.org site that you can make your doctor aware of.

Let’s see. Anything else come to mind? What have you got, Steve?

Steve Wright: I got a question. Have you seen in your patient population that, for instance, say someone settles on 3 mg, do they ever need to change that? Does the effect wear down over time, or do life circumstances sometimes mean that you could get more sensitive or less sensitive to it?

Chris Kresser: Great question. My sort of take is usually, like, let’s use any treatment, whether it’s a supplement or medication for a therapeutic purpose, to reach a therapeutic goal, and once we reach that goal, I’m always interested in seeing if we get people off of stuff, maybe once the immune system comes back into balance and the patient is symptom free. Like we’ve talked about before, the concept of tolerance. You’re an engineer, Steve. You’ve told me about it. It’s easier to maintain something within tolerance, that’s already where it should be, than it is to get it back there in the first place. A patient may want to stop taking LDN or titrate off of it after a while to just test to see if they can maintain the improvement that they’ve gained from it.

On the other hand, if somebody has a condition like Graves’ disease where there’s a real risk of going into a hyperthyroid storm and stroking out and that’s been historically an issue for them and LDN is just completely managing it without any other medication, if you’re going to weigh that against taking PTU or methimazole or pretty toxic medications that often needed for Graves’ or even more invasive, like a surgery to remove the thyroid or to radioactively ablate the thyroid gland, and you’re weighing those against just staying on LDN, of course, you have to talk to your doctor about these questions, but my take on that would be if it were me as a patient, I would rather take LDN on an ongoing basis than to face any of those outcomes. So it just depends on the person.

And the dose can fluctuate, depending, of course, on the background level of immune dysregulation. If maybe someone is gluten intolerant and they don’t know it and they’re eating gluten and they’re taking LDN and they need the full 4.5 mg dose because they kind of have their foot on the accelerator and the brake at the same time, but then they take gluten out of their diet and maybe 4.5 mg is unnecessary or even starts causing some side effects, so that’s possible.

Steve Wright: One more question.

Chris Kresser: Yeah.

Steve Wright: In previous shows and potentially in writing — I’m not sure where I remember you mentioning this — but you’ve said to commit to a timeframe for LDN because not everybody shows symptom reduction or lab test reduction at a specific point in time after starting taking it, so what are your current thoughts on that?

Chris Kresser: Yeah, it’s the same. I mean, it’s really interesting. Some people, like, the next day after they start they feel like a different person, and then other people, it can take three months for them to really feel a significant difference. We don’t really understand why that is yet. And interestingly enough, it doesn’t necessarily correspond to how sick they are or how long they’ve been sick. I’ve seen it where people have been really kind of in bad shape and they respond immediately and other people whose condition was a lot more benign or mild and they didn’t have an immediate response. I don’t know about that, but I do know that it’s common. So I would say probably give it three months before you let it go if you’re going to try it.

A couple other things to consider are that because LDN blocks the opioid receptors, some pain narcotic drugs like Percocet or morphine or tramadol, LDN can decrease their effectiveness so that typically they shouldn’t be taken together. And patients with Graves’ or Hashimoto’s that are taking thyroid meds should be careful because one thing we’ve seen happen is if someone takes LDN and their thyroid function improves, then the dose of medication they were on that was maintaining equilibrium before all of a sudden becomes too high, and that person can go into kind of like a hyperthyroid episode or start feeling heat or not sleeping well or all those typical symptoms. Your doctor should mention this to you when they prescribe it, but that’s something to be aware of and to talk about with your doctor if you’re on a thyroid medication, to be ready to reduce the dose if your thyroid function starts to improve.

A question that often comes up is, OK, are there some natural alternatives to LDN that achieve the same purpose of reducing central nervous system inflammation and promoting T regulatory cell function? Definitely, there are things that achieve both of those goals. In some cases, especially when you put them together, they can do just as good of a job as LDN, but in other cases I’ve seen LDN just be more effective even when someone’s done all these other things. But for Treg cell function, vitamin D is a powerful T regulatory cell promoter, as is glutathione, so those should definitely be in the repertoire. Maintaining adequate levels of selenium and zinc and iodine is important for immune function. Probiotics, especially bacillus species like soil-based organisms, promote Treg cell function. Butyrate, which is a short-chain fatty acid that’s produced by beneficial bacteria in the colon, improves Treg cell function, so prebiotics can actually do that indirectly. Vitamin A is important for immune balance, so cod liver oil. And then for inflammation, we have things like curcumin and boswellia — those are COX inhibitors, selective kinase response modulators, fish oil or EPA and DHA from cold-water fish, of course, and then diet obviously. Whether we’re talking about just a general, overall anti-inflammatory paleo-ish type of diet or whether you’re taking the next step and doing an autoimmune protocol type of diet, those can be important as well.

Steve Wright: Awesome. Well, it sounds like a pretty good round-out there. It seems like if people wanted to try those things, I’ve seen a lot of people try those things and not get success and then get on LDN and through LDN and some of those supplements together, like, really have a brand-new life.

Chris Kresser: Yeah, it can be pretty dramatic. And of course, I don’t want to create any false hope or unrealistic expectations for people, but for some it has definitely been life changing. I have patients who had been on those thyrotoxic drugs for 20 years or more, 25 years. One patient comes to mind who had Graves’ and had been on PTU for 20 years and was able to get off PTU completely and all other medications and just take LDN and feel better than she ever had felt during that period and maintain completely normal thyroid numbers, so it can be pretty dramatic. I have to say, though, that we have had patients who have taken it and experienced nothing at all. So it’s not a miracle, of course. No treatment is, but it helps a lot of people, and it does it pretty affordably and without causing a lot of side effects or complications or risks, and that’s a pretty good combination.

Steve Wright: Yeah, definitely. Awesome.

Chris Kresser: All right.

Steve Wright: Well, if listeners would like their question answered, make sure to go to ChrisKresser.com/PodcastQuestion to submit your questions. Chris and his team are always taking those in and trying to pull the most relevant topics that haven’t already been covered, so if you have submitted questions and you’re wondering, why, guys, haven’t we talked about my question, make sure you listen to the rest of our episodes because there’s quite a treasure trove of information that we’ve covered over, what, like, four or five years now?

Chris Kresser: Yeah, four or five years, somewhere in there. I should know, but something like that. Yeah.

Steve Wright: Awesome. And in between episodes, if you’re not following Chris on social media, this is where you can get updates on the latest articles he’s reading, different things that he’s pulled from around the web, so go to Facebook.com/ChrisKresserLAc and Twitter.com/ChrisKresser. Thanks for listening.

Chris Kresser: All right. Thanks, everyone. Talk to you next time.

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Join the conversation

  1. Hi Chris-
    I, too, am interested in what you know about LDN during pregnancy. It’s been very difficult to find reliable information about this and I am pregnant and am taking LDN currently but am not entirely reassured by either my doctor’s information or the information I have found regarding the effect this can have on the baby. Thank you in advance for any information.

  2. I had a major fall (without going into it) in 1982 & without treatment for at least 15 years pain seems to have generalized throughout my body & am now diagnosed with FM, Chronic Pain & several others. Meds I take are: Duragesic Patch 75 mcgm/hour, clonazepam .5X2 2 qhs, mirtazapine 30 mg qhs, buproprion XL 300 mg qam, & ibuprofen 400 mg q4h. My pain level has not really been helped at all but I do get brain fog, ressless leg syndrome & other probs.
    If I was to start LDN it looks like I must stop at least the Duragesic (fentanyl) patches as it looks like they would fight each other. How do I make the switch with as little ‘upset’ as possible so I may experience the positive effects as described?

    • Simple answer: you need a doctor who is LDN savvy to help you. You can’t take opioids and LDN at the same time. SOme people can take Tramadol at different times of the day. Go to the LDN Trust website and their group on Facebook for support in finding a doc and compounding pharmacy.

  3. I have Fibro. I been taking LDN for 3 weeks my pain has reduced from 7 to 3 . I could not work out or even walk for more than 20 min because my feet were in pain . Now I can walk for an hour with less pain. I have some vivid dreams and I wake up several times but I fall sleep fast and I wake up with energy my mood is much better. I feel like a I m having my life back. THE SIDE EFFECTS ARE VERY MILD like crazy dreams and headache but goes away fast. I am grateful with god to put me this doctor in my way. I feel that I am having a break.. I am so happy. my doses is 4.5 mg and I start with the same dose.

    • this is great news! May I suggest you talk to your doc about trying a slightly reduced dose? Many people on LDN can find the “sweet spot” where the sleep disturbance is reduced but still good effects overall. Good luck!

  4. Hi!

    Finally got to listen to the PodCast on LDN, uninterrupted! You mentioned that LDN is a low cost medicine. My first prescription cost me over $175! It was for 21 capsules of 1.5 mg and 30 capsules of 4.5 mg. Seems out of the range that you quoted on this PodCast!

    My second comment is that I am having some side effects from this med. I started seeing an integrative doctor in Apr. I have Hashimoto’s. She has changed my thyroid meds from Armour to WP Thyroid. I’m also taking selenium, Enlyte, a multi vitamin, Omega 3, i Throid, Vitamin D3, and probiotics. LDN is the latest that has been added to this list. I started at 1.5 mgs for 1 week, then ramped up to 3.0 mgs for 1 week, then 4.5 mgs; which is where I am right now and have been for the last 3.5 weeks. I have not had a full 8 hours of uninterrupted sleep for 3 weeks! I might be averaging about 3 hrs of sleep a night! Its taking its toll on me. I’m also having bizarre dreams and nightmares, and hot flashes, major fatigue, and mild headaches. Should I stop taking LDN? Should I reduce my dosage? Will I have to take this for the rest of my life?

    • Shelia,
      Did you shop around for pricing? I get 3 months of 3ml for $56 from Skip’s Pharmacy. I think they ship everywhere. Also wanted to mention I had the same issues with sleep in the beginning, I ended up having to take it first thing in the morning for about 3 months, then I switched back to right as I crawl into bed and no more problesm. And I wanted to mention I also have Hashi’s and barely made it to 3ml after 2 years, so be sure you aren’t going hyper and that is causing your sleep issues.

      • Hi, I get my LDN filled at Akina pharmacy in Chantilly, VA and I paid $140 for 180 4mg pills without fillers. I take one 4mg pill nightly around 9pm to support RA/PsA. It allowed me to go from being unable to lilft my arms due to excruciating pain for over 6 months to being able to lift my arms enough to put on a sweater. Gradually I regained my ability to chew, my throat stopped hurting and inner ear pain went away. This, along with an all vegetarian (raw veg/lightly cooked and NO oil at all of any sort) is bringing me back from a total invalild-like state to a functional individual. Akina is a terrific pharmacy and very responsive. They can make it into a cream, capsules or liquid. Capsules allow me to order several months at a time. Find a doctor who’ll prescribe it, have him/her call it in and since there is no issue with insurance one can fill three months at a time. I find it works best on an empty stomach, not to take it with iron pills and not eat anything afterwards.

    • check out my post above. Ther eis a FB group called “Got Endorphins? LDN…” and another one from the LDN Trust (UK Charity). If you go on there and talk to others you will find much cheaper options for buying LDN. One of the best is Skip’s Pharmacy in Florida which Dr Amy Nett told me about. You will also find that people with Hashi need to start VERY low and go slow, adjusting their thyroid medications as they go. They also can have Sx when they start LDN, which are not “side effects” but rather Symptoms from their disease as their body readjusts. Hang in there! There are many many people with HAshi and other autoimmune disease who call it a miracle drug.

    • Keep in mind that Armour has BOTH T-3 & T4 in it while synthetics have only T-4. If you are full of metals [who isn’t] or grew up on fluoridated water or took fluorinated drugs [go to http://www.slweb.org & click on FTRC link for a LONG list to avoid] these all block thyroid receptors including iodine uptake & deregulate enzymes that convert T-4 to T-3 . This may be your problem not the LDN.

      • I only pay 58.00 for 7mg, ask your doc to prescribe from Skips Pharmacy in Fl…there are not many compounding pharmacies that make ldn. Skips is a well known reliable source. I think you got fleeced..

      • The price of LDN seems to vary from country to country.
        I live in Toronto Canada and am still using the liquid drops which cost approx $55.00 Canadian for 60mls. This lasts me close to 3 months .I only take about .75 ml a day. and I am building at a snail’s pace to 1ml. per day.

        It seems like a ridiculous price for the medication.
        I hope you have found a better resource.

      • hi Barb. I live in spokane too. Do you have a doctor here that knows about LDN? Im willing to go to Seattle to some specialists but of course, would rather stay here. Thank you

    • Hi
      Looking at all the posts maybe the 4.5mg is too strong. inform your doctor and maybe he/she ca lower the dose

      All of the best

      • I just filled my prescrip for 3 mos LDN. (For migraines)
        I get it from Skips compounding pharmacy in Florida. It is around 35.00 per mo. for 4.5 mg. Skips is fantastic! They take the time to answer questions and will ship right away.
        Whoever sold you ldn for 175.00 seriously scammed you! There are about 8-10 reputable pharmacies in the USA that are trusted sources.
        Good luck!

  5. hi!
    i have a question- what are the negatives of taking slow release ldn? i feel crappy, moody and tired….and i just realized I am on slow release! (for 12 days) could it be blocking my endorphins for to long of time?

    • Hi Lisa,

      All data says, “no slow release,” that I have seen. Hope that helps!

      “For LDN to work, the full LDN dose must be delivered to the body in one go. Transdermal delivery methods by nature result in slow continuous delivery of a drug. This will result in continuous opiate receptor blockade – quite the opposite of the purpose of LDN which is to deliver a very short term blockade in order to create the beneficial rebound effect”
      –LDNScience.org Q&A

      From http://www.lowdosenaltrexone.org/:

      “IMPORTANT: Make sure to specify that you do NOT want LDN in a slow-release form.

      Reports have been received from patients that their pharmacies have been supplying a slow-release form of naltrexone. Pharmacies should be instructed NOT to provide LDN in an “SR” or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt “spike” in the blood stream, its therapeutic effects may be inhibited.

      Fillers. Capsules of LDN necessarily contain a substantial percentage of neutral inactive filler. Experiments by the compounding pharmacist, Dr. Skip Lenz, have demonstrated that the use of calcium carbonate as a filler will interfere with absorption of the LDN capsule. Therefore, it is suggested that calcium carbonate filler not be employed in compounding LDN capsules. He recommends either Avicel, lactose (if lactose intolerance is not a problem), or sucrose fillers as useful fast-release fillers.

      > IMPORTANT: Make sure to fill your Rx at a compounding pharmacy that has a reputation for consistent reliability in the quality of the LDN it delivers.”

      Lisa in Alaska

      • LDN should be compounded by a pharmacy given in 5 mg doses slowly until you reach 4.5 mg. My Dr. said every two weeks go up 5 mg, I ended up increasing LDN every week since I had pain come back before two weeks came around.

      • Skips in Florida is great, also near me in MA is the Amherst Pharmacy. Do not get slow release!!
        Hope this helps!

      • Hi Lisa, Have you tried the compounding pharmacy in Fairbanks? They told me they make LDN regularly and I am wondering about the quality. Thanks

    • SLOW RELEASE is NOT LDN!!!! I hope you have worked this out by now. I only just saw the post.

  6. You mentioned this drug for cancer. Im recently diagnosed SCLC and am afraid of chemo and radiation. I have seen some on a support group I am on that are taking this as palliative care, and doing well on it for years!! Can this be true for me and how would I get my doctor to prescribe it for me? thank you

  7. Hey folks, great discussion.

    My wife has MS and we have been fighting this with a Paleo and more recently Auto Immune Paleo diet for a little under five years. It was going great till a year ago when my wife’s father had a terrible accident and after two torturous weeks passed away.

    This was a very stressful and upsetting time. There are family issues as well and things had not always been great between them yet they were very much on the mend. There is lots of sadness over what could have been as I am sure there are always are in these instances.

    We have found a few problems creeping back in: fatigue, some renewals of old symptoms and a few new ones and small relapses. With all of this going on we have been considering looking at the drug options and LDN as a compliment to everything else we do seems like the best place to start.

    My one concern with LDN was that this was it – once you start you have to walk this path for life. With no drugs so far and not even steroids we were not keen to do this but I feel we need a little extra help for a while.

    One thing that I found very interesting was that this does not have to be a forever thing and that if we can use LDN to get this under control then we can try and dial it down and even possibly get off the LDN.

    I will certainly feedback on our progress.


    • My sister (51) has ms, she has been on ldn for at least 5 or 6 yrs, it has saved her from ALL symptoms including debilitating migraines. From what I understand it is considered by many doctors including my own, to be a miracle drug with no side effects. It helps modulate the immune system to work better!
      Hope that helps

  8. Back in April, Renee posted these links. I have joined the LDN one and most of the questions people have posted to Chris here can be put to the group there. There is a wealth of experience there from people who have been on LDN for long and short periods of time and with many different conditions.

    https://www.facebook.com/groups/GotEndorphins/ Great group of folks to support and learn about LDN from personal stories and experiences.

    https://www.facebook.com/groups/LDN4Hashi/ For Hashi folks who want to learn or help support others on LDN

  9. Hey, so in the Podcast Chris said that LDN has been shown to help Crohn’s and many other autoimmune disease. I have UC and was wondering if its been found that help that? I was diagnosed almost two years ago, after a year no medication had worked for me so i stopped taking all the meds. Started SCD went into complete Remission after 4 months that lasted for 4 months and now ive been in a flare for the past month and a half. Seems to just be getting worse and still stick strictly to the SCD. Im considering the LDN after listening to the podcast. I also live in CT and would be looking for a doctor in the state thats familiar with LDN. Thanks for your support

    • HI Tim,
      scroll down and you will find a link to a Facebok group of people using LDN. Every day someone posts ” I have this condition do others have experience with it and LDN?” It’s quite a good resource and since there really aren’t actual protocols, old timers can offer good advice on dosage and increasing etc. My personal opinion is give it a try. If you are already working with SCD and clearly interested in more than the standard medications can offer, many people report great benefit, sometimes immediately and sometimes over time. Good luck!

  10. Just to add myself to the anecdotes:-)

    I have SLE (lupus) and it was very serious @21yo (1987) (and then Immuran, immune-suppressive nearly killed me). I got kidney involvement at 25 (1 year of cyclophosphamide) and this was a few years into a diet/supplement regime that was quite close to what is now called AIP Paleo. I believe that my diet and lifestyle focus over the years has kept me relatively well for someone with severe lupus. I was on Prednisone for 13 years but have had no drugs for my lupus (not even Plaquenil) since 2000…

    That is, until I started LDN about 18 months ago when I had a lupus flare affecting my kidneys. I declined the immune suppression this time (Mycophenalate and prednisone) and started on 3mg of LDN, took a homeopathic (that I do believe helped) and spent 10 weeks in Tasmania focusing on self care. My kidney disease reversed. I went off the LND for a few months and then had a joint flare early 2015. I’m back on it and have gone up to 4.5mg. Just about to retreat my kidneys and Anti DNA binding antibody to see how I’m going.

    I say to anyone with autoimmune disease: give LDN a try and experiment with different doses. Some people on here have even spoken about experimenting with a daytime dose. I am imagining I will stay on some dose of it for the foreseeable future, maybe forever. I think we have nothing to lose (except all those heavy duty medications) and so much to gain. Grateful for this community to keep up the conversation.

    It’s especially heartening to read the stories of the people with MS and RA with LDN. Thankyou!

    • PS Chris says “I would say probably give it three months before you let it go if you’re going to try it.”

  11. I am a research subject that Nova Southeastern University’s Neuro immunology department. I have 4 antibodies present as well as Hashimoto’s, Sjogren’s syndrome, CFS, Fibromyalgia. LDN has been miraculous for me. I am still on 1.5 because I get the rattles with any more. At my team’s request, I also went on 23andme.com and livewello.com to decode my raw genome data. I do have SNP rs1799971 in OPRM1 AG. A complete non-processed, organic plant strong diet coupled with the LDN has been life changing. Still, it’s a constant work in progress. One thing of note. I have not experienced any change in my thyroid condition. have not had to lower my dose…but haven’t had to raise it either.
    Thank you so much for taking interest and sharing this incredible information.

    • Hi Karen: I have Hashcimoto’s Thyroiditis with extremely elevated antibodies. I provided my GP with information about LDN use for this condition. She denied prescribing this for me. Can you or anyone else in the conversation, herein, recommend or direct me to reputable compounding pharmacy in US or in Europe where I can purchase this without a prescription? Or, to a well known. reputable doctor in US who I can work with who will prescribe LDN for me. In help will be appreciated.
      Thank you, Paula Thompson

      • there re no pharmacies in the US that can supply LDN without a prescription. But you can ask a local reputable compounding pharmacy for doctors who prescribe. We do not recommned overseas/internet sources. Take a look at the LDN Trust website and Facebook group and also a Facebook group called Got Endorphins LDN… there are many many people there who will help you. PS HAshimoto is a condition where you want to start low (.5mg and build up slowly. They often have exacerbations and Sx come up and also have to monitor thier thyroid meds carefully as they can quite quickly need less.

    • Karen- You wrote, “. At my team’s request, I also went on 23andme.com and livewello.com to decode my raw genome data. I do have SNP rs1799971 in OPRM1 AG.”

      Could you talk more about that SNP and how it relates to LDN?


      • Karen, I had the same question. I have OPRM1 genotype AA and Phenotype -/-. I’m trying to figure out if it is likely to work for me. I’ve read on 23 and me that Naltrexone would be unlikely to work for me in terms of opiod detox. But does that me the same would be true for LDN? The goals are different. Thanks.

  12. My physician started me on 4.5 mg of LDN back in November of 2014. At the time my TPO antibodies were 436 iu/ml and my THY Ab was 6043. Blood work done this week shows my TPO @ 131.8 and my THY Ab at 141. I can’t believe how much it has come down. Unfortunately, I’m not feeling any better but I am so encouraged by the results and know that I am working with a great MD who is on the right track! After reading this article, I am prepared to give up the gluten to see if I feel better. I have been reluctant to do so thus far.

  13. Hi Chris! I have Scleroderma with recently diagnosed heart/lung involvement and a recent trial of Methotrexate was not tolerated due to its affect on my liver. I also have esophageal and gut dysmotility and SIBO. I’ve been eating Paleo AIP for 2 years.

    This was a great article with good information and it gives me new hope! Are you able to provide any links to recent scholarly articles referencing LDN use in various autoimmune diseases? I plan to address this as a possible treatment with my Rheumatologist and a recent pertinent article would help. Thank you so much!

  14. Chris, can you post the links to the research on LDN and specific diseases, especially Crohn’s? I’m also curious if LDN would be helpful for folks tapering off of steroids from treating autoimmune diseases.

  15. I have Auto Immune Hepatitis. I have been on prednisone therapy since being diagnosed in 1999. Is this a condition which could be helped by using this therapy? I am under the care of a liver specialists at Duke. I need something that I can tolerate other than prednisone or in combination with. The long term use of prednisone is taking a tole. I developed diabetes not long after starting the prednisone therapy. It did save my life but I need a change.


    • Hi Ruth, I have SLE (lupus) which has been lufe threatening in the past. I have been on LDN for about 18 months. I’m pretty sure it helped me reverse kidney lupus. I went off it for a few months, had a joint flare and am now back on. I have taken 3mg and 4.5. I believe that since there are no side effects except sleep disturbance or intense dreams (and a pleasant side effect of mood improvement) there is no reason not to try it. I was on prednisone for 13 years and also a year of cyclophosphamide.

      • Hello, My Mom has been on prednisone for 12 years for Lupus. She wants to try the LDN but is afraid to stop prednisone. Where can I find info on taking both or the transition? I’m successfully taking LDN for Brain Cancer.

  16. Hey. Great show, as always. Just an aside… the opening theme song sucks. It’s too much like elevator music. I liked the old sleuthing theme you all had. Bring it back! 🙂

  17. Hi Chris,

    Could you please be more specific about LDN working on “opioid hormones”? Which ones? enkephalins? endorphins? dynorphins? all three?

    If it’s mainly working on the endorphin pathways, would d-phenylalanine (which boosts endorphin production) be contraindicated?

  18. I have tried LDN with no results after a month without side effects, but then reintroduced it and it seemed to work immediately w/ insomnia and dry eye side effects. I had so much more energy and I was completely pain free. The most interesting thing is that it gradually stopped working a week after starting it. I started at 1.75mg and doubled it after the 1st week, but did not seem to improve anything. I have sense tried to reintroduce it again, but haven’t been able to achieve the same benefiting affects.

  19. I tried LDN for my hypo-hashi. It was a daunting experience. I woke up several times a night for two months and could not take the interrupted sleep anymore. I got to 3.0 mg but had to stop to get back my sleep. Did anyone else have this experience?

    • The original doc suggests a dose between 1.75-4.5 mg. Did you try reducing to a dose that didn’t bother you?

    • Yes! I had that experience and have Hashimoto’s along with other A I disorders. I started to take it at 12:00 noon and no problems at all. I only need 1.5 because I get the rattles if I take any more. It does cause some activity in the brain so taking it at night could cause insomnia. I have been on it for over a year and it has been a miracle. Good luck!

  20. LDN sounds exactly what I need. I have Hashimotos and Graves eye disease. I am currently on Levothyroxine 88mg and would like to transition to Natural Dessicated Thyroid. I have heard that NDT can raise the antibodies but if taken with LDN they can be lowered or kept in check. Any thoughts on this? Where in the heck can I find a Doctor that can help me with this..I’m in a small rural North Carolina town….

    • Donna, i don’t know how far you are from GA…but there’s a doctor here in Lawrenceville who has me on NatureThroid and is also working with other patients on low dose Naltrexone…
      Jeanine at [email protected] if you want more info..

      • Jeanine, I would like more info and as soon as I hsve a moment I’ll email you, Thanks…

    • I was on Naturethroid for hypothyroidism and Hashi. After about a year, I ended up with Graves and hyperthyroidism. Started LDN after about 6 months which appears to be working. I blame the dessicated pig thyroid for my Graves antibodies. Wish I only did LDN in the first place.