BLOGS Ask the Pharmacist Ask the Pharmacist: May 2017

Q: What can you tell me about Low Dose Naltrexone (LDN) for autoimmune illness?

A: This is a hot button topic and one that you may have difficulty discussing with your physician or other health care professional. The best person I have found to explain how naltrexone works to alleviate symptoms of autoimmune illness (Hashimoto’s Thyroiditis, Lupus, Rheumatoid Arthritis, MS, etc. ) and chronic pain syndromes like Fibromyalgia is Dr. Thomas Cowan. He is a family physician and founding board member of the Weston A. Price Foundation.

Dr. Cowan happened upon LDN when a patient asked him to prescribe it. He knew nothing about it but through study and experience found that it worked for numerous conditions. Dr. Cowan discovered what doses worked best and that by itself, as a drug treatment, it is not nearly as effective as combining low dose naltrexone with lifestyle changes and additional nutritional support.

The GAPS Diet (Dr. Natasha Campbell) or the Autoimmune Paleo Diet seemed to be the most effective combination with LDN to get rid of exogenous opiates and repair the gut lining. Let’s geek out a bit to understand that statement.

Naltrexone was developed in the early 60’s when there was an increasing awareness of drug overdoses and abuse, particularly heroin. Our body naturally produces opioids (endorphins) that block pain, slow breathing and give us a natural calming effect by flooding our reward system with dopamine which gives us a feeling of pleasure. Opiates like morphine, oxycodone, methadone and heroin, are exogenous (from outside of our body) bind to those same receptors and block pain, but also cause overproduction of that euphoric feeling and addiction. At doses of 50-100mg naltrexone completely blocks the opioid receptors in the brain and no pleasurable feelings are possible.

Your diet can also be a source of opiates. Wheat and dairy contain opiates in the form of gluteomorphins (from gluten) and caseomorphins (from dairy) and they block that same receptor so your natural opiates cannot function. Now you know why the first task you are assigned when working with a functional medicine approach to your health, is to give an elimination diet a try. There is no expense to changing your diet and finding out that you feel so much better without those foods while you work on your other symptoms of chronic illness.

Dr. Bernard Bihari ( treated cancer and AIDS patients and discovered that those patients that took opiates for pain relief did not respond to treatment as well. He determined that there is a connection between the immune system and our own endorphins. If he used a low dose of naltrexone at bedtime, the opiate receptors are blocked for short period of time and then the body responds by flooding the body with endorphins and improving the immune system.

How does this explanation prove that LDN works for immune system dysfunction symptoms? Dr. Bihari’s theory that a weakened immune system allows certain cells in your body to forget how to distinguish between a foreign invader like bacteria and your own tissue. When those cells are activated as you are exposed to a bacteria or virus, they attack you instead. Its autoimmunity. LDN helps to restore your immune system and stops that cell confusion. It doesn’t work like a drug to create a response. Your body must respond to the block of the opioid receptor to stimulate your own immune system. More like a natural medicine, more homeopathically. This explains why it does not work for everyone and why the dose is not clear cut. As a bonus, LDN also reduces inflammation and slows down the digestive tract to improve healing in GI disorders. Other ways of increasing endorphin levels are aerobic exercise, acupuncture and, yay, chocolate.

The dose of LDN is important and starting low and going slow is advised. The range is 0.5mg to 4.5mg and paradoxically, lowering the dose or taking a holiday from it now and then may be beneficial. It must be compounded by a pharmacy to ensure a consistent product to be able to monitor it’s effectiveness and side effect profile. While full doses of naltrexone for drug dependence caused liver issues, none have been reported with LDN. The most common adverse symptoms are sleep disturbances (dreaming) and possible nausea or irritability. For Hashimoto’s patients, their dose of thyroid medication may need to be reduced as the autoimmunity improves which shows how important it is to work with your health care provider.

LDN is not necessarily a lifelong drug as it is possible to go into remission from an autoimmune disease. It’s one weapon in the arsenal you can use to fight the debilitating symptoms of immune dysfunction. There is a ton more information on websites devoted to people who are focusing on doing whatever it takes to return to vitality. Check out LDN science, and a new book out by Chelsea Green.

As always, work with your physician to determine if you are ready to explore low dose naltrexone. Get your team together to add LDN as you improve your food choices, sleep hygiene, mindfulness and supplements to live a strong healthy life.

To hear more about LDN come to a Stressed, Stuck and Misunderstood Lecture hosted by Bluewater Wellness for Free! See

Deidre (Dee) Kohley, Rph, works at Watkins Pharmacy, is a graduate of Ferris University and has lived all her life in Muskegon. She continues to find ways to reach women who genuinely want to get well or live an optimal life. Dee loves digging into research to find new ways to help people. She is married and has seven children and nine grandchildren who keep her busy. She loves the beach and spending time outside enjoying the seasons. You can contact her by going to her website or

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