Low dose naltrexone (LDN) is an immunomodulatory therapy used in the treatment of e.g. autoimmune diseases, neurological illnesses, cancer and HIV/AIDS. Its safety, efficacy and low price has attracted a large community of patients and doctors campaigning for more awareness and clinical trials.
BIG ON LDN 2010, the 2nd European LDN conference, was held in Glasgow, Scotland on the 24th of April 2010. Several hundred patients, doctors and other parties were present and the conference was also filmed for a TV documentary.
The first LDN conferences were held in the United States, but since 2009 they have taken place in Scotland, where LDN use and activism is blooming. The Glasgow city officials also showed keen interest in the conference.
LDN Experts and Patients Speaking
The first speaker was pharmacist Stephen Dickson, who has over 2,500 patients using LDN and counts 683 doctors prescribing it in the UK, up from about 200 in 2008. He talked about several illnesses being treated with LDN, including type I diabetes, depression and asthma.
Dr. Pat Crowley from Ireland talked about his experience prescribing LDN. He finds LDN the most useful in middle-aged women with PPMS. He also noted that there have been over 30 deaths from the MS drug Tysabri in the EU alone, and that people with MS often have elevated iron levels.
Several patients gave their testimonies about LDN: one with Crohn's disease and two with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Dr. Tom Gilhooly voiced the opinion that these are actually the two conditions where LDN is the most helpful. A double-blinded study about LDN for Crohn's will be out in May.
LDN for Fibromyalgia Study Results
One of the highlights of the conference was a video with Dr. Jarred Younger describing the yet unpublished results of his new study of LDN for fibromyalgia. He already published a pilot study in 2009, but it only had 10 patients while the new one included 30.
The results were just as impressive as in the first study: 50% improved greatly, 20% some, 10% got slightly worse and 20% saw no improvement. There were similar improvements in both fatigue and pain. LDN was much more helpful than placebo, but just as well tolerated.
Younger feels LDN works not because the increased endorphins act as painkillers, but because naltrexone reduces microglial activation, which alleviates symptoms like pain and fatigue. Another drug that does this is dextromethorphan, well-known to be helpful in fibromyalgia and other chronic illnesses.
Younger also mentioned that naltrexone has two stereoisomers, one that blocks opioid receptors and one that reduces microglial activation. This means that not only could the efficacy of LDN possibly be increased, drug companies could actually make money with it - leading to large-scale clinical trials.
LDN and Chronic Cerebrospinal Venous Insufficiency
CCSVI (chronic cerebrospinal venous insufficiency) is a recently discovered vascular condition thought to contribute to many, possibly most, cases of multiple sclerosis. Dr. Tom Gilhooly believes it may also be a factor in CFS/ME and fibromyalgia. CCSVI correlates with illness severity: the people with the most severe MS are the most likely to have it.
CCSVI can be diagnosed with Doppler scans/CT venograms (and MRI, if the former cannot be used). CCSVI is treatable by the so called "liberation procedure", opening the blockage in the vein with a stent. This is fairly safe and and complications are rare. However, Gilhooly pointed out that LDN is still relevant, as CCSVI is likely the cause of the autoimmunity seen in MS.
Low Dose Naltrexone and Drug Interactions
The traditional wisdom has been that LDN can be taken with all other drugs, except for narcotic painkillers (opioids), since it's an opioid antagonist, and immunosuppressants, since it upregulates the immune system.
Most doctors in the conference agreed with this, but Stephen Dickson believes that LDN can be combined with buprenorphine and oxycodone, but not with e.g. fentanyl or morphine. This could be because of buprenorphine and oxycodone work a bit different from most opioids.
There was also some disagreement whether LDN can be combined with interferons, steroids and other immunosuppressive drugs. Dickson voiced his opinion that LDN can be combined with interferons, while Dr. Pat Crowley and Dr. Bob Lawrence thought it could cause problems.
Dickson has also noticed LDN does not combine well with the acne drug Roaccutane nor the anaesthetic/painkiller ketamine. Ketamine binds to the mu opioid receptor, but the reason for the Roaccutane incompatibility is yet unclear.
Other Treatments for Autoimmune Diseases
Several nutritional treatments for autoimmune diseases and other immune problems were also discussed. Dickson, Gilhooly and Crowley all recommended omega-3 fatty acids and agreed about the importance of vitamin D, which can both reduce symptoms and slow the progression of MS and other illnesses.
Dickson discussed the supplement resveratrol in great length, as a treatment for autoimmune and neurodegenerative illnesses. He also recommended alpha lipoic acid, L-carnitine, beta-D-glucan, chromium and green tea. Gilhooly recommended inosine, a nutritional supplement, and a dairy-free diet.
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