Jonathan Collin, MD

LDN, low dose naltrexone, may be the most well-known but under-appreciated drug in medicine. For one thing it is not available in the commercial pharmacy and must be compounded. Many medical professionals still confuse LDN with its higher dose drug used in addiction and alcoholism disorders. Both exert a blockade on the opiod receptor but only the high dose agent is capable of causing drug withdrawal. LDN exerts effects on the opiod receptor as well as Toll receptors, enabling an increase in endorphin production as well as modifying the expression of cytokines tamping down the inflammation present in autoimmune disease.

Over the years the research supporting LDN’s role in being an important treatment modality of numerous medical conditions has grown dramatically. Much of this research has been cited in three texts published by the LDNresearchtrust.org, the organizer of 2023’s conference in Carbondale, Pennsylvania.

Paul Anderson, NMD, lectured on the necessity to establish the optimal dose for the patient based on their own symptomatic response. It has been generally agreed that LDN dosing should be considered to be between 1-5 mg. In fact, a simple approach has been to start with 1.5 mg, then increase to 3.0 mg, and ultimately stop at 4.5 mg. However, for those individuals who are very sensitive to medication, an ultra-low dose of naltrexone has been considered using 0.1-0.5 mg. While naltrexone is generally compounded as a capsule or tablet, pharmacists now compound LDN as a liquid, sublingual, troche, and trans-dermal, the latter being employed for autoimmune dermatologic conditions.

However, as Dr. Anderson and several other speakers confirmed, some patients have inadvertently and serendipitously used much higher dosing, taking 6.0 to 12.0 mg. Anderson referred to this as “high” low dose naltrexone. For those patients who were not seeing any benefit with a lower dose of LDN, the higher dose transformed their symptoms dramatically. If nothing else, this reminds us to pay attention to our patients and what they are doing—sometimes they discover their own best cures!

Titration of LDN is not always looking for the higher dose. Anderson does recommend when using LDN in cancer care to start with a higher dose, such as 4.5-6.0 mg, and then, if the patient does not tolerate the dose to slowly reduce the dose. In other words, it may not be that the 4.5 mg dose that was initially set as a target is the best. On the other hand, Norman Marcus, MD, uses an entirely different approach for managing pain.

One of the most important applications for LDN is its use as an alternative to pain medication for management of pain. Because pain is not only an overwhelming symptom but is also highly varied, Dr. Marcus, starts with an ultra-low dose of 0.1 mg. A few patients will respond to 0.1 mg and achieve a nice reduction in their pain. Assuming that the patient experiences little response at the 0.1 mg once per day, he increases the dosing to 2x daily, then 3x daily, and finally 4x daily. While it has been standard to use LDN once daily, not infrequently a patient does better with dosing a few or more times daily. After reaching 0.1 mg 4x daily, then he will have the patient use 2 of the 0.1 mg tablets once, then twice, then three times, and finally four times daily.

Once the patient achieves a good reduction in pain, increasing the dose even higher does not improve pain reduction, the lowest dose giving the best pain reduction is the correct dose. Dr. Marcus has found some patients achieve an optimal dose at 0.1 mg and some at 3.0 mg—every patient is different.

Hormesis, the phenomenon of a drug exerting a stimulatory effect at lower doses and an inhibitory effect at higher doses is the probable explanation for why LDN dosing needs to be individualized. Dr. Anderson thinks that not only is correct dosing obligatory but also the need to “cycle” the drug. It may be better to use the LDN for a certain period of time, then to stop it. This is the thinking behind LDN use being administered once daily. LDN will have, upon use, a strong effect on endorphin production and blocking/stimulating Toll receptors; then, that effect will stop so that when it is administered 24 hours later the effect is maximal. For some individuals it may even be advantageous to stop LDN for a few days or a few weeks to achieve maximal benefit.

Ultimately the theory and evidence for LDN is never as interesting and satisfying as individual cases. Medicine has long had a jaundiced view of case reports compared to clinical trials. This may be true if it were one, two, a half dozen case studies. With LDN practitioners, case reports are not only numerous but generally spectacular and frankly unbelievable. Yet, they do occur and not just to one proponent but to many docs in widely varying disciplines.

Dr. Christine Salter, MD, DC, ND, discussed a 50-year-old woman experiencing very severe rheumatoid arthritis. As expected she had been to the rheumatologist and been through numerous arthritis treatment regimens with little success. Her disfigurement was so intense that she even faced major difficulties using the toilet—requiring special equipment, an elevated commode and more.

Dr. Salter did require the patient to modify her diet, including removal of all nightshade foods and also elimination of gluten. A program of anti-inflammatory botanicals and other nutraceuticals was recommended. LDN was started at a low dose of 1.5 mg. After some time, the rheumatic pain had reduced slightly but was not satisfactory. Salter suggested an increase in dosing using a 3.0 mg capsule. The patient did not understand the directions and used the 3.0 mg capsule 3x daily. In short order the pain had been eliminated and her flexibility improved dramatically. She continued the diet and LDN at the higher dose with Salter’s approval and has continued to experience excellent joint and musculoskeletal improvement without the need for steroids, pain medication, and other biologics.

LDN needs to be part of every physician’s toolbox. It works, not for everybody, but for those who do improve, LDN is “good medicine.”

Recent Lancet Study Documenting Increased Risk of Death Following Covid-19 Vaccination Is Retracted (? Censored)

On July 5 the Lancet pre-published “A Systematic Review of Autopsy Findings in Deaths After Covid-19 Vaccination.” By July 7 the study was retracted because the authors’ conclusions were (supposedly) not substantiated based on the data presented. More than 40 papers were reviewed that examined autopsies conducted on individuals who had died 1-5 weeks following their first, second, or third Covid-19 vaccination.

In the majority of cases cardiovascular causation was established in more than 50% of the autopsies, followed by thrombotic etiology as the second most common cause of death. Deaths occurred on average within 14 days of vaccination among the patients studied. The authors concluded that Covid-19 vaccination poses an increased risk of death. Because there was an increased risk of death with Covid-19 vaccination, the authors expressed concern that the entire vaccination program for Covid-19 should be reevaluated.

As Lancet has retracted the study it is necessary to go to an alternative website, such as Zenodo, to read the original complete study.¹

Food as Medicine by Sue Visser

The Townsend Letter in the past and now the Townsend e-Letter circulates primarily in the US. We are very happy to have some faithful readers (and writers) abroad. Sue Visser has made many contributions to our publication (please see her writings at townsendletter.com). Beginning in this issue she writes about the role food plays as medicine in a six-part series.

Visser lives in South Africa where she shares her nutritional information broadly. In previous writing with us she details how yam can fill in for much of what progesterone offers as a hormone. She has employed foods and herbs to treat minor and major medical conditions from autoimmune illness to cancer to cardiovascular disease. While foods lack the dramatic effect of pharmaceuticals, the tamping down of symptoms and improvement in overall health is NOT accompanied by the adverse effect of drugs. Of course, it does take time and energy to incorporate foods into our health regimens. Visser explains how food can not only be incorporated in a tasteful lifestyle but also energizes us to regain our vitality and engage in fun and purposeful activity.

In this issue she explores why our diet is fundamental to how our microbiome behaves not just in the gut but throughout our body. A probiotic pill is useful but the microbiome depends much more on the food we consume to maintain its integrity.

Watch for Sue Visser’s “Food as Medicine” each issue for the next few months!

Dietrich Klinghardt, MD, PhD – Ionic Footbaths in Combination with Cilantro Are Effective in Detoxification of Heavy Metals

Dietrich Klinghardt, MD, PhD, is renowned for his alternative approaches to managing Lyme disease and chronic illness. He is the founder of the Sophia Health Institute in Woodinville, Washington as well as the American Institute of Neural Therapy. Klinghardt is the medical director of the Institute of Neurobiology in Germany and Switzerland. He is prolific in teaching practitioners about his biologic treatments and provides training on Autonomic Response Testing (ART) used in diagnostic assessment.

In this issue Klinghardt discusses the critical role that toxins such as aluminum and glyphosate play in perpetuating chronic microbial infections, including Lyme disease. Without adequate detoxification of toxins, antibiotic treatment approaches to chronic infection will be unsatisfactory. While chelation has been a standard for the removal of toxic metals, Klinghardt asserts that the ionic foot bath in combination with cilantro will remove the metals more intensively and quickly. For the glyphosate he prefers to employ humic and fulvic acids, berries, and the sauna.

Like many of you, I did not appreciate the value of the ionic foot bath. Now I will have to give it new consideration given the success Klinghardt has experienced in treating his Lyme disease patients.

Doonesbury Takes a Swipe at the Research Supporting Nutraceuticals

When we recommend a patient use a supplement, we feel empowered when there has been research published about its efficacy and safety. Of course, it is usually not the case that the proprietary supplement in question was used during the trial or experiment. Moreover, the study usually involves mice or rats, not humans, and what are we to make of results based on rodents? Should we expect similar outcomes in people, or could the nutraceutical fail to perform as well and cause unexpected adverse effects?

Particularly awkward are claims that the research was done at an academic institution only because the investigator had been part of its faculty. It behooves us to question the evidence for a nutraceutical especially when no human trials have been conducted.

Reference

1. Nicolas Hulscher, BS, Paul E. Alexander, PhD, Richard Amerling, MD, Heather Gessling, MD, Roger Hodkinson, MD, William Makis, MD, Harvey A. Risch, MD, PhD, Mark Trozzi, MD, & Peter A. McCullough, MD, MPH. (2023). A systematic review of autopsy findings in deaths after Covid-19 vaccination. Zenodo. https://doi.org/10.5281/zenodo.8120771.

Published July 29, 2023