Maggie McKay (Host): This is the sixth in a series of podcasts on Integrative Medicine with Dr. Yoon Hang Kim, Chief Wellness Officer. Today we'll discuss LDN or low dose naltrexone. Welcome to a podcast presented by Memorial Hospital. I'm your host, Maggie McKay. Thank you so much for joining us today again, Dr. Kim, it's good to see you.

Yoon Hang Kim, MD: Great to see you again, Maggie.

Host: So can you tell us what is LDN and what is it used for?

Yoon Hang Kim, MD: LDN stands for low dose naltrexone. Naltrexone is an opioid blocker, that is used in high doses or regular doses, to help people with addiction or withdrawal symptoms or to reverse accidental overdose is also possible. Its cousin naloxone is quite in the media these days. The low dose naltrexone or LDN is completely different in that the dose we use is very, very much less.

We use, in my practice, I use it for 0.1 milligram to about 25 milligrams. And there are two big uses of LDN. One is to normalize the immune system or calm down the immune system. Two is to calm down the nervous system. And I know those are not medical words, but that's probably the best way to explain it.

So when is immune system not working? How do we know that? Well, two big things would be one is an autoimmune disease where the body's immune is attacking itself. And then the second actually is when immune system is not working properly like cancer. Because what happens there is that cancer becomes stealthy to our immune system. So if we can allow our immune system to see cancer, then immune system has a better job of being able to do what it's supposed to do.

And then the second part is the, how do you know your nervous system is not acting the way it's supposed to be? Well, you know because you get pain. And the pain you get from here is a bit different than musculoskeletal pain in that it tends to be burning, and in extreme cases, we used to call it Reflex Sympathetic Dystrophy, now we call it Complex Regional Pain Syndrome.

And what happens is that nervous system decides, whatever reason, that one limb should be on fire. So then it feels like it's on fire, it changes color, it swells up. And then what happens is that nervous system teaches the other side, the other limb, to do the same. And then later on, if it's started in the leg, it'll begin to teach it to the arms to do it.

So the LDN can be used in a variety of settings. And what I do is I mix either lifestyle, like what we discussed last time with ketosis and low dose naltrexone. And we also utilize acupuncture and low dose naltrexone to reset the nervous system.

Host: And how do you use it in your practice, like for your patients?

Yoon Hang Kim, MD: The number one thing that I do is that if there's an autoimmune condition, then low dose naltrexone is a great tool to consider to reverse autoimmune diseases. So number one reason why people have hypothyroidism would be Hashimoto's thyroiditis, which LDN can improve or in early cases possibly reverse.

And there are other conditions like MS, lupus, rheumatoid arthritis. There are numerous examples of autoimmune conditions that I use LDN and then of course for patients with cancer the most important thing that I do is listen to them and arm them with idea that people's biology has an impact, not just the pathology of cancer, and along with that, how to optimize their immune system.

So just to be clear, it's not an alternative treatment, it's an integrative approach. We would let patients go through all the things that oncologists, radiation oncologists, surgical oncologists ask them to do. And then use low dose naltrexone. And there's a doctor in New Mexico that has used this successfully on a series of people with pancreatic cancer.

Stage 4 pancreatic cancer is probably one of the most difficult conditions to treat, cure. And he published an article showing that several of his patients have outsurvived several years. And that's not the norm for pancreatic cancer stage four, because most people die within months.

Host: Do conventional medicine physicians embrace LDN when it comes to, say, cancer?

Yoon Hang Kim, MD: More and more, especially nerve pain or CNS mediated pain, there's no medication that works well. There may be Lyrica, there may be gabapentin, but it's not reliable. And LDN has less side effects. It's not insurance covered because it has to go through compounding pharmacy, but for about a dollar a day, you can get potentially very effective pain relief and also help to address the cause.

So I think that the answer is, yes, I think that it's a fantastic tool. And I'm hoping that more and more physicians find out about it, and that's why I lecture nationally to educate other healthcare providers about the helpfulness of LDN.

Host: I've heard you talk about receptors like being switches in your house. Can you talk about that?

Yoon Hang Kim, MD: So basically the receptors of opioid, for example, when the opioid receptors get turned on, then it blocks the pain. It doesn't get rid of pain. It blocks the pain signal. And naltrexone basically, if you can imagine, is blocking that switch. So you're just like when you go home, it's dark and you want to turn on the light.

Your spouse, your friend just cups their hand on the switch and won't let you turn on. And that's what naltrexone does. So in the beginning, that was how it was used. And then, a couple of researchers and physicians, Dr. Zagon and Dr. Bihari, found out that it has other uses. And then what happened is the integrated medicine LDN community found out about it.

And now, for example, in Norway, it is one of the most prescribed medicines or medications. In the U.S., the growth is phenomenal. I've written a book, not because I wanted to write a book, but they wouldn't let me publish in the beginning. They said, there's no evidence, so you can't publish. So I wrote a book and then within five years, I was invited to write an article LDN.

And so you know, the change is really, really amazing. There are more and more people taking LDN. I think there's hundreds of thousands of people in Facebook groups that talk about educate or people share their experiences of using LDN to transform their health.

Host: And you have also reminded people, though, when they watch those Facebook groups or whatever kind of platforms, that they're not doctors and to take it with a little bit of grain and salt, right?

Yoon Hang Kim, MD: Yeah, well, you know, I would say that there are groups that are run very, very well with moderators who are very experienced, very ethical, and the LDN Research Trust is run very, very professionally, and they are not professionals. But you have professionals like me who will moderate, who will go and answer questions, usually not answer about specific questions but general questions. So if someone say what should I do then I don't answer that. But if they would LDN dose of 4.5 milligrams is that considered the highest dose you can use it then I tell them no I use 6, 9, 12, even 25 occasionally. And then the moderators know me, and so they'll chip in and LDN is what I call people's medicine, because this is how we're finding it, not through research, but hundreds of thousands of people are sharing the information, saying that, hey, I had this side effect, has anyone had this side effect?

And the moderators are pretty good about shutting people down if you go there and try to sell things or you're not appropriate or the information is misleading. It's not perfect, like you say, but I think that it's comparable to Encyclopedia Britannica versus Wikipedia. Even though Wikipedia is run by just people, not professionals, the accuracy is about the same. It's an excellent forum. I just would say, just know the forum that you're joining. Make sure that it's a reputable forum.

Host: Do you have a favorite one?

Yoon Hang Kim, MD: Yeah, the LDN Research Trust is excellent. And then there's another one that I use quite a bit.

Host: And to get LDN, do you need a prescription from your doctor?

Yoon Hang Kim, MD: Mmhmm. It's a compounded prescription medication, which means that, you can't usually call into your favorite pharmacy unless that is also compounded pharmacy. And fortunately, in the U.S., we have many reputable compounding pharmacies.

Host: Dr. Kim, how has LDN changed your practice and your life?

Yoon Hang Kim, MD: So, LDN for me, has changed my life because I used to have chronic pain, and the LDN really helped to control that. And, the previous episode on ketosis, actually ketosis helped me to get rid of it. So now I use LDN for anti-aging purposes as well as neuroprotective. So it can protect my nervous system.

It also helps me to go to sleep. So I take it maybe two, three times a week when I get up in the middle of night and I think it's going to be difficult for me to sleep. So it becomes a tool for me to use it at night.

Host: Are there any side effects?

Yoon Hang Kim, MD: Usual side effect is none. But, in this case, the side effect, I think it can be I've seen headaches, worsening of pain, nausea, dry heaves. So what I do is I try to use this at lowest number possible. Like, a hundred microgram or 0.1 milligram, or in some patients, even one microgram, because I have a patient yesterday who did not tolerate 10 microgram.

So if we restart it, we'll do one microgram. And I'm recommending ketosis, since that person did not tolerate LDN. I'm recommending ketosis, as a way for her to get her inflammation down. And we'll re-try it with one microgram.

Host: Is there one patient that you can think of? I'm sure there are many, but, one that comes to mind that had amazing success using LDN?

Yoon Hang Kim, MD: Yeah, so this pilot, came to me originally for acupuncture and he had post herpetic neuralgia, which you get after shingles. And the pain, in that case, it's like you had shingles every day. So the person was dying of pain and he was a pilot.

He was going to retire. He says, I'm going to put in my papers and retire. I can't stand it. And I did acupuncture, he got better. And I read in an article, if you combine LDN and acupuncture, you get even better results. Since he was driving two to three hours each way, I decided to try to save him some trip.

And then I lost him as a patient until he ran out of the prescription. Then he called me and said, Dr. Kim, it worked like magic. Can you give me more? So from there, I stopped recommending acupuncture for trigeminal neuralgia and postherpetic neuralgia. I just used LDN and the success is about 90 percent plus.

Host: That's amazing. I always think that it's not funny, but it kind of is, that when you're a doctor and someone's been coming to you and you're healed, like he was, the patient always, well, not always, but most times forgets to call and say, thank you so much. It worked. Like I was just thinking about a doctor I went to and whatever it was, was all cleared up. And I thought I never called to say, I won't be coming back because you fixed the problem. So anyway, that's so funny that you didn't find out until.

Yoon Hang Kim, MD: You know what I call that? Bathroom. Y You don't thank public bathroom for relieving yourself. That's what I tell my team. If you're in a healthcare and you don't have that humble attitude that we serve a function very much like public bathroom people are grateful for the function, but they're not grateful to the bathroom.

So I think taking ego out of that helps for us to deliver consistent and the best care. And if you look for that, I think you'll one will get burnt out, and disappointed. But if you just focus on patient experience and their outcome, then it doesn't really matter, they thank you or not because it's irrelevant.

The relevant is did they have a healing experience, number one. Number two, did they get better?

Host: Okay. Good. So I don't have to feel guilty anymore about forgetting to thank my doctor. Is there anything else you'd like to add in closing about LDN that we should know?

Yoon Hang Kim, MD: Yes. If you have an autoimmune condition or you have a condition that nervous system, overactive in terms of pain, or nerve pain or neuropathy, talk to your integrative medicine or functional medicine physician about low dose naltrexone.

Host: Thank you so much, Dr. Kim. As always, this has been so informative and educational, and we thank you for your time.

Yoon Hang Kim, MD: Thank you.

Maggie McKay (Host): To learn more, please visit MHTLC.org. Again, that's Dr. Yoon Hang Kim. If you found this podcast helpful, please share it on your social channels, and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is a podcast from Memorial Hospital.