Jonathan Collin, MD

Another Wonder Drug – Naltrexone

Most everyone reading the Townsend e-Letter are familiar with low dose naltrexone (LDN).  It has become widely known to savvy consumers who are looking for treatment support for autoimmune disease and chronic inflammatory disorders. The medical profession has largely ignored LDN, preferring to prescribe biologic modifiers for chronic illness.  This is a shame because low dose naltrexone has proven to be effective in many medical conditions with minimal risk of adverse effects. 

Naltrexone is an opiate receptor blocker.  In low doses it encourages the body to release endorphins that have a dramatic effect in reducing pain.  The practitioner/consumer group LDNresearchtrust.org serves as an educational organization for doctors and patients, offering radio show interviews, research papers, webinars, certification courses, and annual meetings.  There are now three LDN educational books available, the third book just published in 2022.  The mechanism for how LDN works is thought to involve not just endorphins but also the toll receptor system.  Given the growing medical evidence for naltrexone, it would behoove the rheumatology, gastroenterology, neurology, and pain medicine societies to seriously investigate the drug and allow presentations at their yearly meetings.

But what about naltrexone that is not low dose?  Low dose naltrexone is generally compounded in strengths of 1.5 mg to 4.5 mg; some very sensitive patients use ultra-low dose naltrexone of 0.1-0.5 mg or even lower.  The usual drug store variety naltrexone is 50 mg.  At this dose level naltrexone is a potent opioid blocker.  Anyone being prescribed morphine, hydrocodone, oxycodone, or fentanyl would have immediate withdrawal if naltrexone were to be taken.  While naltrexone was a drug designed to block the activity of an opioid, it is rarely used today as a primary treatment for opioid detoxification.  However, naltrexone is used for alcoholism or alcohol dependency with The Sinclair Program (TSP). 

John Sinclair developed the protocol as an alcohol recovery program for those individuals who struggled with abstinence.  When the alcoholic uses naltrexone while still drinking, the alcohol “buzz” fails to happen or is greatly subdued.  The program calls for taking naltrexone one hour before beginning to drink.  The usual pleasure with consumption of beer, wine, spirits is either eliminated or greatly minimized.  Naltrexone is used either once or more each day before drinking to “deprogram” the alcohol’s stimulation to drink more.  With continued use the alcoholic cuts down the number of drinks he/she has but continues to drink.  The objective is to reach a place where the individual drinks none or only the limited amount of alcohol desired.  Some individuals choose to become abstinent; others prefer to only drink a small amount.  TSP has an effectiveness rate of 78%.  Of course, there is still a need for the person to control their alcohol consumption—naltrexone cannot overcome the drinking behavior of someone who does not wish to quit or reduce their alcohol consumption.

A 40-year-old woman who works in the tech industry did have a problem with alcohol dependency.  She had been drinking heavily since her early 20s.  She would drink at work and then later at night.  On the weekends her drinking was so severe that she would become drunk or even pass out.  She did get a D.U.I.  Her alcohol consumption would be three bottles of wine or six whiskey drinks.  She reached the point where she began to crave alcohol in the morning.  She did participate in other alcohol rehabilitation programs and AA, but eventually she quit the programs and began to drink heavily again.

She elected to start on The Sinclair Program.  She was prescribed naltrexone 50 mg, which she used one hour before drinking.  After several weeks of using naltrexone, her alcohol consumption decreased to drinking 2-4 glasses of wine, a considerable reduction for her.  She continued using the naltrexone an hour before starting to drink.  It was necessary to increase her dose to 100 mg before drinking because her alcohol consumption began to increase.  As time progressed, she maintained her use of 1-2 naltrexone tablets before drinking and her alcohol consumption remained stable at 2-3 glasses of wine or 2-3 hard drinks.  Within six months she had reduced to 1-2 glasses of wine, and she was only drinking one to two days per week.  A year after starting she was able to control her alcohol consumption to drinking only on the weekends 1-2 drinks.  She continued on 2 tablets of naltrexone one hour before drinking.      

She is now three years from starting The Sinclair Method.  She only drinks on weekends, limiting her drinking to 1-3 drinks then.  She uses 100 mg of naltrexone whenever she drinks and does not use the naltrexone on those days when she does not drink.  She no longer has drunken episodes nor alcoholic misbehavior.  She is in excellent health.  The naltrexone does not cause any adverse effects.   She intends to continue using naltrexone whenever she drinks.  She is very satisfied that her alcohol dependency has been controlled and has not required abstinence.

Joel Kahn, MD, on Reversing Atherosclerosis

Joel Kahn, MD, is an integrative cardiologist, director of the Kahn Center for Cardiac Longevity in Bingham Farms, Michigan.  Dr. Kahn offers personalized care at his cardiology center with extended consultations and access to preventive screening examinations during the clinic’s Ultimate Heart Checkup.  Evaluation includes carotid intimal medial thickness ultrasound (CIMT), EndoPat (peripheral arterial tone) arterial health screening, CT heart calcium scoring, genetic testing, and nutritional counseling. Dr. Kahn’s clinic focuses on improvement and reversal of cardiovascular disease.

Nathan Pritkin popularized a plant-based low-fat diet as a dietary approach to treating coronary artery disease.  In the 1990s Dean Ornish, MD, conducted patient studies confirming the effectiveness of a plant-based low-fat diet in reversal atherosclerosis. Yet Bob Atkins, MD, was not convinced and championed a high-fat, low carbohydrate diet not only to reduce cholesterol levels and lose weight, but also to reverse heart disease.  The Atkins diet has “morphed” into the keto diet, which is proposed not just for weight loss and cardiovascular health but also as prevention for cancer and degenerative disease.  How can both these dietary approaches work?  Of course, they don’t both work. A keto diet works well for some but not others; a low-fat diet works well for some but not others.  Kahn likes many of his cardiac patients to use a Mediterranean diet high in olive oil. 

One major difference between conventional cardiology and Dr. Kahn is the latter’s employment of nutritional supplements to enhance reversal of arterial plaque.  Food and lifestyle are critical for improving cardiovascular health.  However, from Kahn’s perspective reversal of atherosclerosis also requires use of supplements to impact plaque reversal.  Of course, it is important for Kahn to have screening tools to confirm progress in treatment of atherosclerosis.

In this e-Letter we have Dr. Kahn’s article on reversal of atherosclerosis.  His December 2021 Townsend article on chelation therapy is available in the March 25, 2023 e-Letter.

 
Published May 20, 2023