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Ask the Doctor About LDN TherapyA Possible Treatment for LeukemiaQuestion: I have just been diagnosed with pre-leukemia, bordering on full-blown leukemia. Can you point me to any alternative therapy? Answer: Leukemia is, generally speaking, an illness of the immune system, or perhaps more accurately said, a cancer of the immune system, so I thought this would be a good opportunity to introduce a therapy that I have recently become interested in. The therapy is called low-dose naltrexone (LDN), and more information, including copies of published studies, articles, interviews and even audio tapes of lectures by doctors who have used the therapy, can be found at the website www.lowdosenaltrexone.org. LDN therapy is not only a promising therapy for many debilitating illnesses, including leukemia, but it offers insight into how our immune systems function. Naltrexone was originally developed and introduced in the late 60s or early 70s. It is a drug that was created as an opiate receptor antagonist, meaning the drug blocks the opiate receptors in our bodies. A related drug, naloxone, was used as a very effective antidote for acute heroin or morphine overdose, often reversing the symptoms of overdose with these drugs in literally minutes. I can remember many times in my days of working in the emergency room that a patient with opiate toxicity was given naloxone and revived within minutes. Naltrexone, however, persists in the body for a longer period of time than does naloxone, and it was tried in patients for long-term use as a detox protocol for heroin addiction in the days before methadone. However, used in a once-per-day dose of 50 mg, it was unsuccessful in the treatment of heroin addiction. It was so effective in blocking the opiate receptors—which are the same as our endogenous endorphin receptors—that the patients felt chronically miserable and refused to take the drug. This outcome led to the discovery and elucidation of the role of endorphins in animal physiology. Endorphins are chemicals made in our bodies (in our adrenal and pituitary glands) which specifically make us feel good. They are exact copies of the exogenous (from the outside) opiates such as codeine, morphine, Vicodin, heroin, etc. A neurologist in New York City, Dr. Bernard Bihari, who at the time was treating heroin addicts with naltrexone, began to notice that many of these addicts who also had AIDS had very low levels of endogenous endorphins. He reasoned that perhaps this was what led them to use opiates in the first place. It was then discovered through literally hundreds of research papers that these opiate receptors are found all over the body, in particular on the cells produced by our immune system. Cells such as lymphocytes, natural killer cells, and so on, are full of endorphin receptors, and in fact seem to be controlled by these same endorphins. It seemed reasonable to conclude that the immune dysfunction that is characteristic of such illnesses as AIDS, cancer, auto-immune diseases (lupus, MS, Crohn's disease, etc.), chronic fatigue syndrome and possibly many other immunologically-mediated diseases shared low levels of endorphins as a unifying theme behind their immune dysfunction. In fact, one can see the body's wisdom in connecting the chemicals which produce feelings of well-being to the core functioning of our immune system regulation. Feeling low and out of sorts, then, is not merely a psychological problem, but raises alarms as to your overall health. Something needs to change, so that you can feel better. Through much experimentation, Dr. Bihari was able to show that the same naltrexone that blocks the endorphin receptors at a high dose at a much lower dose given at night blocks the receptors for only an hour or so. The body responds to this temporary block by dramatically increasing its synthesis of endorphins so the end result is often endorphin levels increased by four or five times, a restoration of immune function, and in many cases the remission of the underlying illness of the patient. Dr. Bihari was able to show this in numerous cases over many years, but it wasn't until this year that this effect could be said to be proven. In January, 2007 a study was published in the American Journal of Gastroenterology showing that over 67 percent of patients with Crohn's disease had a full remission from no other therapy than LDN. Similarly, a case study was recently published of a patient with pancreatic cancer which had metastasized to his liver, who was alive and well over four years later with no tumors detectable by X-ray. The only therapies used in his case were LDN and supplementation with alpha lipoic acid. On the LDN website you will find numerous cases of cancer patients, patients with auto-immune diseases, etc., who have had similar positive results from LDN. It is worth noting that in over 20 years of use, this medicine has shown no toxicity and no side effects except mild insomnia in the first week or so of use. It is cheap, easy to procure, and indeed its only trouble seems to be that it is non-patentable, which means there is very little money to be made from its sale. I became interested in the LDN story for several reasons. The first was a patient of mine with a prostate cancer recurrence who has had wonderful success using LDN as his main therapy. Next was this study just referred to, which was published by the most prestigious gastroenterology journal in the English-speaking world. And finally, I have been encouraged by research pointing to other modalities that have been shown to increase endogenous endorphin levels. The first of these is exercise, the second is acupuncture (which is probably why acupuncture often makes people feel good), the third is chocolate (whose high levels of phenylalanine prevent the degradation of the endorphins), and the last is Iscador, a medicine I have long used with success in my cancer patients. I can practically guarantee that good fats would be added to this list if anyone took the trouble to do the study. I say this because nothing makes people feel as good as a nutritious meal including the adequate provision of healthy fats. My guess is regular sexual activity could also be added to this list of endorphin-increasing "agents." LDN, however, clearly is the most potent endorphin stimulant that we know of, and used in conjunction with the other endorphin-friendly interventions holds much promise for those suffering from the often devastating effects of immune dysfunction. Naltrexone is a prescription medication licensed for use in 50 mg capsules for the short-term treatment of opiate overdose. There are a variety of compounding pharmacies that are currently making it available in 4.5 mg doses, which is the dose Dr. Bihari has found most effective for raising endorphin levels. The usual dose is 4.5 mg right before bed. I would be happy to discuss with any interested readers whether LDN would be right for them and, if so, to provide them with the required prescription. For those interested in more information on how to start LDN, please call my office at 415-334-1010 and schedule an appointment.
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Thomas
Cowan, MD, is a physician in private practice in San Francisco, California,
a board member of the Weston A. Price Foundation, and a regular contributor
to our "Ask the Doctor" column. His book The Fourfold Path to
Healing is now available from NewTrends Publishing,