Hacking my inflammatory response with LDN
Microdosing an opiate antagonist to trick the body into a low inflammatory state
Last year, one of my European functional medicine docs encouraged me to try a range of novel strategies to stabilize the body from its tailspin. One of them was an increasingly popular therapy: a tiny dose of naltrexone – an opioid antagonist that works by increasing endorphins and modulating the immune system.
The therapy has broad applicability, and studies have reported benefits for folks suffering from:
ulcerative colitis, rheumatoid arthritis, multiple sclerosis and psoriasis… cancer, fibromyalgia, chronic fatigue, histamine intolerance and mast cell activation disorder, autism, chronic pain and complex regional pain syndrome (CRPS), AIDS, PTSD and depression.
How can it possibly work on all of these diseases? Because each of them is linked to chronic inflammation. Many folks also report improved mood, motivation, and productivity, which are associated with LDN-induced increases in dopamine. It seems to have a particularly positive effect on glial cells in the central nervous system.
I was not able to follow through with the therapy a year ago when I first tried it. I had too many weird symptoms and couldn’t clearly distinguish what was occurring or what was effective. But I was able to re-start the therapy a few weeks ago and I’ll maintain this dose for about 8 months to observe the greatest benefit.
How LDN works
A microdose of naltrexone keeps the body from getting locked in an inflammatory loop—that’s on top of the inflammation that naturally worsens with age (“inflammaging”).
The drug works like this: it temporarily binds to and blocks opioid receptors on cells in the body, preventing endogenous opioids from binding there (those are the opioids created within the body). The cells in the body then create more receptors, and the receptors become more sensitive. As the tiny dose of naltrexone – the blockade – leaves the body, cells are then flooded with opioids. Voila! Pain relief, coupled with a reduced inflammatory response.
During the treatment, it is important to avoid gluten and casein, which also interact with opioid receptors. Typically, practitioners encourage you to start at a dose of 0.5 mg and then work your way up every ten days to a stable dose of 4.5 mg.
Chronic inflammatory responses are increasingly common
Chronic inflammatory immune responses (“autoimmunity”) seem to be increasingly prevalent following the COVID epidemic. Long COVID and CIRS (“chronic inflammatory response syndrome”) appear to be indistinguishable.
While people may be walking around feeling mostly “fine” with a low-grade autoimmune response, it only takes an infection or accident to knock the body into a more destabilized state – seeding any number of systemic disorders, depending on the weakest link in your body’s chain.
Several functional doctors I’ve worked with have noted that many of my symptoms line up with “long COVID,” which initially had me confused about whether that infection might be an additional ingredient, on top of the injury. One fellow on an online forum describes his long COVID symptoms like this:
I just got long covid, specifically [the] neurological kind, which is tinnitus inability to sleep cognitive decline depersonalisation and speech problems like stuttering and inability to think of anything in a conversation
Instead, I now realize that these are two different catalysts for the same systemic issue. Regardless of the trigger, a CIRS response (including “long COVID”) can be triggered by any number of things, from moldy and toxic home environments to COVID vaccinations.
It’s not a silver bullet, and there are complementary ways of addressing inflammation, including exercise and supplements like curcumin, but LDN’s tolerability is high and may help to address just about any chronic inflammation. The only side effect I’ve had is a slightly drier throat, which is annoying for singing, but worth the trade-off in the long term.
On that note
I had a friend come up to me following a performance that I gave yesterday with my chamber ensemble. He said that I had a lot more life and vitality in me this time and he welcomed “the old James” back to the stage. That was a nice milestone in this process. We've got some way to go yet, but when people welcome you back to the land of the living, it's a good feeling.