Book Review – The LDN Book edited by Linda Elsegood

Book Review – The LDN Book, edited by Linda Elsegood

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Linda Elsegood’s personal success story tells how using low-dose naltrexone (LDN) to treat her multiple sclerosis restored her quality of life and gave her hope for the future. Now she is a woman on a mission to help others learn about LDN and to promote further research into how it may be used to treat a variety of diseases. In The LDN Book: How a Little-Known Generic Drug—Low Dose Naltrexone—Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More, Elsegood has compiled chapters written by practitioners who have become experts in the use of LDN.


Pharmacist Stephen Dickson provides a comprehensive history of the opium poppy and the subsequent creation of synthetic drug compounds called opiates, which are all active at the opioid receptor sites. Opioid receptors are meant to be activated by hormones produced in the body called endorphins and enkephalins, which can relieve pain and contribute to wellbeing. However, these receptors can also be stimulated by opiates. Naltrexone was originally developed to block these receptor sites in order to assist people addicted to opiates. The developers of naltrexone reasoned that when opioid receptors were blocked, there would be no need to use or abuse opiate drugs. While a logical theory, in actual practice they had little success.

However, in low doses, naltrexone acts to temporarily block opioid receptors. The body responds by producing increased amounts of endorphins and enkephalins. The opioid receptors also increase in sensitivity and number.

Multiple Sclerosis and Lupus

Dr. Deanna Windham begins with a thorough explanation of multiple sclerosis and lupus. While she recognizes that we do not currently have drugs that treat the complexity of these diseases, LDN has been shown in a number of studies to stabilize and stop their progression. The use of LDN is a pillar in Dr. Windham’s treatment plans, though she maintains that each patient must be treated individually for their toxic load, hormone imbalances, nutrient deficiencies, and sleep issues.

Inflammatory Bowel Diseases

Dr. Jill Smith was the first to publish a study on LDN and inflammatory bowel diseases. There are opioid receptors in the gut and on immune system cells. There are a number of different types of opioid receptors and naltrexone may target different opioid receptors depending on the dose.

Dr. Smith provides case studies of remissions of inflammatory bowel diseases, Crohn’s disease and ulcerative colitis with the use of LDN, both alone and with other commonly-used drugs. LDN blocks opioid receptors for about six hours, during which the body increases its endorphin and encephalin production. After about six hours, the LDN is removed from the opioid receptors by the body and the elevated endorphins and enkephalins can act at the receptor to block cell proliferation or reverse inflammation. LDN also sensitizes and increases the number of receptors. Remission may be confirmed with radiology showing healing of the intestinal tract.

Few of Dr. Smith’s patients have experienced side effects, however, one possible side effect is sleep disturbances, which can be alleviated by changing to a morning dose or using a lower strength.


Dr. Kent Holtorf, president of the National Academy of Hypothyroidism, explores LDN treatment with thyroid disorders. He explains how LDN can be used effectively in both Grave’s Disease (hyperthyroidism) and Hashimoto’s Disease (hypothyroidism). He believes LDN can potentially improve abnormal inflammation and immune dysfunction seen with thyroid disorders, and thus, improve the reduced tissue T3 (active thyroid hormone) levels inside the cells that these conditions can cause. Normal thyroid tests cannot predict the activity of thyroid inside the cell, and so this can go unidentified and untreated.

Chronic Fatigue and Fibromyalgia

Dr. Holtorf also addresses chronic fatigue and fibromyalgia.  He writes about phases of treatment with LDN:

  1. Stabilize the patient. This stage is where pain and sleep disturbances are addressed.
  2. Enhance mitochondrial energy production with nutrients.
  3. Balance hormones as these patients typically have deficiencies.
  4. Enhance the immune system function and treat the infectious components. LDN is often part of this stage of treatment.
  5. Address issues like heavy metals, leaky gut, mold toxicity, and coagulation problems.
  6. Maintain health and balance.

An integrative approach has shown success, with treatment plans adjusted to the individual needs of each patient.

Restless Leg Syndrome

Dr. Leonard Weinstock is a gastroenterologist and internist, with a special interest in restless legs syndrome (RLS) and has identified an association between RLS and small intestine bacterial overgrowth (SIBO) and other inflammatory conditions in the gut. He used LDN to treat patients with and without antibiotics for infection. In each case he found some positive results, and has used LDN for long-term remission.


Endorphins are very psychoactive, and account for the warm feelings of falling in love, coping with stress, and bringing joy and contentment. Dr. Mark Shukhman describes the symptoms of endorphin deficiency as including:

  • Discomfort with disturbances such as changes in sound, light, temperature, or touch
  • Immune system problems such as frequent infections, allergies, and autoimmune disease
  • Crying easily, and have difficulty with painful situations
  • Craving chocolate, wine, marijuana, and alcohol

LDN helps in these conditions by increasing the levels of endorphins. Many people who have turned to opiates describe that it is the first time that they have felt normal. Although his chapter focuses on depression, psychiatrist Dr. Shukhman has also used LDN in his practice for treatment of autism, post-traumatic stress disorder, multiple personality disorder, anxiety, obsessive compulsive disorder, psychosis, and even sexual dysfunctions.


Dr. Brian Udell has a special needs pediatric practice and has found a common theme with autism to be inflammation and gut disturbances. He cites Dr. Jacquelyn McCandless’ work with children using LDN as a cream, rather than tablets, because of its bitter taste. He has seen LDN increase speech and communication, decrease aggression, and improve social development. Beta endorphin levels can be measured to confirm LDN activity.


Dr. Angus Dalgleish, an oncology practitioner in the UK, writes that, while there is very little in the published literature, LDN seems to be universally useful across all tumor types. He writes of his personal experience treating patients with metastases, achieving stability and long–term, disease-free status. He finds that LDN affects more receptor sites than just the opioid receptors. Naltrexone in large doses actually promotes tumor growth in the laboratory, so the best effects occur when it is used in low doses and used intermittently rather than continuously. Its anti-inflammatory action can be helpful in cancer. Dr. Dalgleish reports that the use of LDN also increases the production of natural killer cells. Finally, LDN can produce positive effects on mood that help in combatting the disease. He writes that failure with LDN may be linked to low vitamin D levels.


The LDN Book is just a part of Linda Elsegood’s work. Under her direction, the LDN Research Trust has an incredible number of accomplishments, including organized conferences, LDN radio, and crowdfunded documentaries. This outreach has stimulated investigation into endocrine and immune system activity that was hardly known before. This book is a window into the large body of knowledge we have gained in the last ten years.

Book Review – The LDN Book edited by Linda Elsegood2018-02-26T12:09:00-05:00

MS, Lupus, LDN, and the Hormone Connection

Multiple Sclerosis, Lupus, Low-Dose Naltrexone, and the Hormone Connection

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Nerve cells are affected by autoimmune diseases such as MS.

According to the American Autoimmune Related Diseases Association (AARDA) about 50 million Americans have an autoimmune disease and 75% of Americans with autoimmune disease are women. Multiple sclerosis (MS) and lupus are the most common of the more than 100 different autoimmune diseases.[i] Research suggests that low-dose naltrexone (LDN)—and its potential effects on hormone imbalance—may prove a positive treatment option for these diseases.

Multiple Sclerosis and Lupus

Multiple sclerosis is an autoimmune disease that affects the central nervous system. The immune system attacks the myelin sheath, the insulating layer of cells that surround and protect the nerve cells. A healthy myelin sheath allows electrical impulses to transmit quickly and efficiently along the nerve cells. When the myelin sheath is damaged, the nerve cells are left exposed and inflamed and plaques begin to form along the central nervous system. The inflammation and plaques can slow or disrupt the electrical impulses moving between the brain and the rest of the body which may cause symptoms such as numbness, weakness, tingling, dizziness, fatigue, pain, vision disturbances, difficulty walking, slurred speech and difficulties with bladder and bowel function.[ii]

Lupus is an autoimmune disease that targets the body’s tissues and organ systems including the skin, joints, cardiovascular system, brain, and kidneys. There are several types of lupus and one type may be induced by medications such as blood pressure medications, antibiotics and anticonvulsants.[iii] Because tissue damage can occur anywhere in the body, lupus can be difficult to diagnose.

While the causes for MS and lupus are unknown, environmental factors may be an instigator in susceptible people. Environmental factors that may instigate MS or lupus include:

  • Nutritional deficiencies (possibly caused by poor food quality)
  • Pathogens and distortion of the gut microbiome
  • Disturbed sleep or sleep deprivation
  • Chemical exposures
  • Hormone imbalances
  • Gluten sensitivity
  • Emotional or physical stress.
  • Vitamin D deficiency (MS)
  • Smoking (MS)
  • Epstein Barr infection (MS)


Low-Dose Naltrexone

Low-dose naltrexone (LDN) has emerged as particularly effective in treating autoimmune diseases that involve impaired gastrointestinal function. Crohn’s disease, irritable bowel syndrome, and ulcerative colitis have responded, sometimes dramatically, to LDN treatment.[iv] Autoimmune disorders such as MS and lupus may also be associated with gut disturbances. Recent research on MS has found a connection with the gut microbiome, providing a reason to consider low-dose naltrexone as part of a treatment plan.[v]

Naltrexone was originally developed as a drug to block opioid receptors. These receptors are meant to be activated by hormones produced by the body called endorphins and enkephalins, which can relieve pain and contribute to wellbeing. However, these receptors can also be stimulated by opium-derived drugs called opioids. The developers of naltrexone reasoned that when opioid receptors were blocked, there would be no need to use or abuse opioid drugs. While a logical theory, in actual practice they had little success.

Low doses of naltrexone act by temporarily blocking opioid receptors. The body responds by producing increased amounts of endorphins and enkephalins. The opioid receptors also increase in sensitivity and in number.

Naltrexone is commercially available in a 380mg injection and 50mg tablets to be used as part of a treatment program for alcohol or opioid dependence. It is also added as an abuse deterrent to opioid medications and available in combination with an antidepressant for weight loss. LDN, however, is currently only available from compounding pharmacies.

The use of very small doses of naltrexone was pioneered by Dr. Bernard Bihari. He first demonstrated the effectiveness of LDN in the treatment of patients with AIDS. He established that endorphin levels were low in patients with AIDS and LDN treatment provided substantial increases in these levels. LDN treatment not only improved these patients’ quality of life, but also reduced the rate at which they died.

LDN has since been shown in studies to have multiple health benefits. LDN appears to improve the body’s response to infection with an immunomodulatory effect, resulting in patients having fewer and less frequent infections. LDN also can help the body eliminate and manage toxic exposures by improving glutathione levels, which aids in detoxification and decreases oxidative damage, making it easier to clear the body of toxins. Oxidative stress has been implicated as a triggering factor of both MS and lupus due to loss of antioxidant/oxidant balance.[iv] LDN may help to repair the linings of the gut and brain barriers that prevent absorption of foreign substances, thus healing issues caused by a damaged microbiome. Additionally, LDN may balance stress hormones and also relieve anxiety and depression by improving brain neurotransmitter function.


Dr. Deanna Windham, a contributor to The LDN Book,[iv] explored treating patients with MS and lupus with LDN. While it is not the only treatment option she uses for MS and lupus, Dr. Windham does not hesitate to use LDN because of the many benefits she has seen it provide. She cautions that full benefit may not be achieved for 12 to 18 months, so patience and commitment is essential. Dr. Windham individualizes treatment to each patient’s needs by taking a holistic approach.

  • Address diet by eliminating gluten, sugar, saturated fats, and non-foods, and add nutrient supplements
  • Help patients with detoxification of metals and solvents
  • Assist patients in smoking cessation
  • Help patients with sleep problems
  • Test hormone levels, and treat deficiencies with bioidentical hormones
The Hormone Connection

So, how are MS, lupus, and LDN connected to hormones?

High levels of estrogen relative to progesterone, or exposures to estrogen-like chemicals, may be linked to the development of autoimmune disease. In addition, high estrogen levels in men with MS correlate with more brain damage.iv However, research has shown that one specific estrogen, estriol, can have an anti-inflammatory effect in MS. Women’s International Pharmacy provided the estriol capsules used in this landmark study.[v]

Adrenal and thyroid function may also play a role in autoimmune disease. Individuals with autoimmune disease commonly experience low levels of adrenal hormones, specifically cortisol and DHEA. In fact, DHEA has reached clinical trials for FDA-approval for the treatment of lupus. Treating even subclinical thyroid deficiencies can help fatigue, brain fog, memory and sleep. Additionally, increased endorphins stimulated by LDN may even help with hormone balance.[iv]


Seeing the benefits of using LDN has directed research into studying previously unknown connections between the immune and endocrine systems. According to Dr. Windham’s experience, the key to treating MS and lupus may be using LDN in conjunction with diet, addressing other health concerns, and a healthy balance of hormones.

MS, Lupus, LDN, and the Hormone Connection2018-04-09T13:55:26-05:00

Low-Dose Naltrexone: Treating Pain and More

Low-Dose Naltrexone: Treating Pain, Autoimmune Disorders, Cancer, and More

By Kathy Lynch, PharmD – Women’s International Pharmacy

low-dose naltrexone image of spoonful of pillsThe late Dr. Bernard Bihari discovered and developed the therapeutic use of low-dose naltrexone (LDN) in the mid-1980s while practicing internal medicine in New York City. He was treating drug addicts with a new drug, Naltrexone, which blocked the heroin “high.” Unfortunately, 50 milligrams daily had unpleasant side effects. When his addicts started dying from AIDS, he began to search for a drug that would help them.

Dr. Bihari knew that endorphins, small neurochemicals produced by the body, had pain-relieving, anti-inflammatory properties. Dr. Bihari and his colleagues hired a lab scientist to measure patient endorphin levels. He discovered that his HIV patients had sub-normal endorphin levels. His team determined that LDN doses ranging from 1.75 to 4.5 milligrams increased endorphin levels by two to three hundred percent. By blocking the body’s endorphin receptors, LDN caused an overproduction of endorphins.

Dr. Bihari then started a small foundation to study the use of LDN in HIV patients. After one year, he discovered that the patients who took LDN had an eight percent death rate while patients taking placebo had a thirty-three percent death rate. He and his colleagues went on to treat hundreds of patients with LDN.

Endorphins have a positive effect on the immune system by increasing T-helper and natural killer cells. Not only does LDN help people with autoimmune diseases like multiple sclerosis (MS), it also seems to be beneficial as an adjunct treatment for certain types of cancer. Cancer cell surfaces have receptors for endorphins. When Dr. Bihari gave a few cancer patients LDN, their tumors shrank and they remained in remission. Dr. Bihari attributed this success to LDN’s ability to increase natural endorphin levels which in turn attach to cancer cells, causing them to die.

Today LDN is used around the world to treat pain, fibromyalgia, MS, autoimmune diseases, cancer, Crohn’s disease, autism, AIDS, and other disorders. It is particularly popular in Europe. To learn more about current LDN research go to LDN is available only from compounding pharmacies. Call and speak to a pharmacist for more information.

Low-Dose Naltrexone: Treating Pain and More2017-11-07T14:39:28-05:00

Low-Dose Naltrexone and Addiction Treatment

Low-Dose Naltrexone and Addiction Treatment

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Naltrexone has been FDA-approved for the treatment of alcoholism since 1994. Nausea and vomiting are common side effects, and headache, dizziness, fatigue, and insomnia can occur as well. Patients with acute hepatitis, liver failure, or abnormal liver function tests should not use naltrexone.

Low-dose naltrexone (LDN) has fewer side effects and contraindications than regular strength naltrexone. Dr. Paolo Mannelli found that LDN is effective in decreasing alcohol use after narcotic withdrawal treatment. It also improved the effectiveness of the narcotic treatment program itself.

In a second study, Dr. Mannelli found that the use of LDN, in conjunction with narcotic withdrawal treatment, reduced tobacco consumption while improving treatment outcomes. Dr. Mannelli concluded that further studies should explore the use of LDN in the treatment of both alcohol and alcohol-narcotic dependency, as well as in smoking cessation trials involving individuals with and without substance abuse.

  • Mannelli P, et al. Problem Drinking and Low-Dose Naltrexone-Assisted Opioid Detoxification. J. Stud. Alcohol Drugs; 2011; 72:507-513.
  • Mannelli P, et al. Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment. Nicotine Tob Res; 2013 Oct; 15(10):1705-13.
Low-Dose Naltrexone and Addiction Treatment2018-03-05T14:26:42-05:00

Low-Dose Naltrexone and Chronic Pain

Low-Dose Naltrexone and Chronic Pain

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Low-dose naltrexone (LDN) has been used to treat a variety of illnesses including cancer, certain gastrointestinal conditions, AIDS, autism, and autoimmune disorders such as multiple sclerosis. Can LDN also be helpful in treating chronic pain? A small study that investigated the effect LDN has on fibromyalgia, a chronic pain disorder, yielded promising results: LDN reduced symptoms in the entire group of ten women by more than 30%, as compared to the placebo.

How does LDN work? LDN blocks endorphin receptors for a short period of time. When the effects wear off, the body responds by producing more endorphins, the body’s natural pain-relieving and anti-inflammatory substances.

LDN may also enhance the pain-relieving effect of acupuncture. Information about these and other LDN studies can be accessed at LDN is available from Women’s International Pharmacy.

Low-Dose Naltrexone and Chronic Pain2018-04-09T13:53:42-05:00