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036: Using Low-Dose Naltrexone (LDN) For Chronic Skin Rash Conditions w/ Dr. Leonard Weinstock

Naltrexone was originally used to help opioid addicts in their recovery process, because it prevents people from experiencing the high of the drug. Now, Low-Dose Naltrexone (LDN) is being used in novel ways: to help with inflammation, autoimmune conditions, and chronic skin rashes.

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Today's guest, Dr. Leonard Weinstock, is Board Certified in Gastroenterology and Internal Medicine. He is an Associate Professor of Clinical Medicine and Surgery at Washington University School of Medicine and has a private practice.

Dr. Weinstock is an active lecturer and has published more than 85 articles, abstracts, editorials and book chapters. He is researching the role of small intestinal bacterial overgrowth (SIBO) and mast cell activation syndrome in a variety of syndromes.

In this episode, we talk about the use of LDN in the treatment of chronic skin conditions such as psoriasis.

Have you been prescribed LDN for a chronic skin rash? Tell us in the comments!

In this episode

  • Thoughts on addressing adult acne from a more holistic perspective
  • Why you have to look at your hormones if you've used birth control pills to control acne
  • What is LDN?
  • How can LDN help people with psoriasis, rosacea, and other skin conditions?
  • Potential side effects of LDN
  • How well does the body typically tolerate it?
  • Do you have to be on LDN for life to be symptom-free?
  • Has LDN ever been used in people with eczema or seborrheic dermatitis?

 

Quotes

“As far as tolerability of the medicine: If you go up very slowly, our ability to get people to the full anti-inflammatory dose of 4.5mg is actually quite good. So I think that the issues of insomnia and GI side effects can be diminished just by starting at 1mg and gradually increasing it every four to seven days.” [9:44]

“An autoimmune condition is rarely reversed by diet.” [11:57]

“This is a drug that is FDA-approved, but it's off-label when it's used for low doses.” [15:11]

 

Links

Find Dr. Weinstock online here

LDNresearchtrust.org

My first interview with Dr. Weinstock about the SIBO-Rosacea connection

ACNE RESOURCES

Dr. Jolene Brighten's episode

Beyond The Pill book by Dr. Brighten

Brie Wieselman's first episode

Brie Wieselman's second episode

Melissa Gallico's episode

Dr. Carrie Jones

 

“As far as tolerability of the medicine: If you go up very slowly, our ability to get people to the full anti-inflammatory dose of 4.5mg is actually quite good. So I think that the issues of insomnia and GI side effects can be diminished just by starting at 1mg and gradually increasing it every four to seven days.”

036: Using Low-Dose Naltrexone (LDN) For Chronic Skin Rash Conditions w/ Dr. Leonard Weinstock FULL TRANSCRIPT

Jennifer:                              Hi everyone and welcome back. I have a repeat guest. I'm super excited for him to join me again because we're gonna be talking about a completely different topic this time. It's a topic we have not covered yet here on The Healthy Skin Show. Welcome back to Dr. Leonard Weinstock. He's board certified in gastroenterology and internal medicine. He's an associate professor of clinical medicine and surgery at Washington University School of Medicine and has a private practice. Dr Weinstock is an active lecturer and has published more than 85 articles, abstracts, editorials and book chapters. He's researched, he is researching the role of small intestinal bacterial overgrowth and mast cell activation syndrome in a variety of syndromes. Thank you so much for joining us. Again.

Dr Weinstock:                    Thank you so much for inviting me.

Jennifer:                              Well, I'm excited today because I have not talked to anyone yet about L D N people are like, what is LDN? So why don't you fill everybody in as to what exactly that is.

Dr Weinstock:                    Okay, well, low dose naltrexone has been around for quite some time. It was approved as a high dose to prevent alcohol recidivism in patients wanting to quit drinking but in high doses. And, and so it was approved by the FDA in 1985. But around that time a researcher at Penn state was looking at the drug and using it in low doses and studying in other ways to see what it did with the body in a variety of doses. And he found out that it actually decreased inflammation when you used it at low doses. And so an investigator in clinical practice in New York started using this on his patients with HIV and with cancer and later in other conditions like arthritis and multiple sclerosis. So the doctors doing research at Penn State found that it decreased autoimmune conditions and it was did something that's unique.

Dr Weinstock:                    Everybody's heard of homeopathic drugs and how using them in low doses creates a different phenomenon than high doses. Well, this is exactly the same. So it basically tricks the body. It blocks the opioid receptors on cells endorphin receptors on cells in our body for a short period of time. And during that time, the body senses it doesn't have enough endorphins. And so it creates more receptors and it gears up the internal workings of the opioids itself. And then when the naltrexone comes off in four to six hours, it releases many more endorphins, up to 14 fold more endorphins in our body normally makes, and it's in context with more receptors. But those receptors are not just on pain fibers and they're not just on the guts fibers receptors, but also on receptors on the immune cells in particular the lymphocytes and also possibly the mast cells. So what it does is it decreases activity of the T-cell, which produces all these inflammatory chemicals, cytokines, and it decreases the production of auto antibodies from the B cells. And it may reduce the activity of the mast cells.

Jennifer:                              And what's interesting is the first time that I started to learn about this particular drug was with clients who have Hashimoto's. So I was very familiar with its use with that. However you have had some experience dealing with patients who have psoriasis. And that's why I thought this was such an interesting conversation is this intersection between what you said, this drug that it can, can actually help symptoms and folks that have an autoimmune disease. So can you talk a little bit about, you know, why, where'd you get here with psoriasis and like how has that helped them?

Dr Weinstock:                    Well, as a gastroenterologist who you can ask that question too, but I've been dealing with inflammatory conditions for years and utilizing low dose naltrexone or LDN for years in a variety of inflammatory conditions and inflammatory bowel disease, inflammatory, irritable bowel other skin conditions that were tied together with celiac disease for instance. And so when I had a patient come in with an abnormal cat scan within enlarged spleen and liver and was asked to evaluate that patient and realized she also had severe severe sarcoidosis with a skin rash, I applied that treatment to the patient and the skin rash got better. Which may be in the liver and spleen got better, which made me think, well, okay, I could apply this to other skin conditions. And have had some effect in patients with rosacea, with naltrexone and dry eye with naltrexone.

Dr Weinstock:                    So we had a patient come in with severe irritable bowel syndrome and significant psoriasis and I as other investigators who are part of the panel on LDN research trust if they had experience, some said they did and it in fact 15 patients had written into that website, LDNresearchtrust.org, saying that they had good response to LDN and their naltrexone. So I felt comfortable applying that to this patient. At the same time, a friend of mine out in California [inaudible] had been applying it on her own. And then there was a lecture on giving naltrexone to patients with psoriasis at our last LDN conference. And so we basically built up a case series and found that of 15 patients, 53%, had a marked improvement with their skin where they had been failing the typical topical treatments.

Jennifer:                              Wow. That's pretty significant.

Dr Weinstock:                    Well, it's, it's hard to treat any thing 1% or more out of any drug. That's great. So especially one that generally well tolerated. Now of the 15 patients, 13 had side effects. The one who came in with the irritable bowel had headaches every time he escalated the dose, but it went away quickly. And then over the course of two years, he stayed symptom free both for his [inaudible] and his psoriasis. And if he became noncompliant, he would then flair in all three categories. And then he'd go back into remission once he restarted the drug. Yeah. And two patients had to drop out. They were non-responders in the group of 15. One had diarrhea, one had insomnia.

Jennifer:                              So if you're all listening to this, you can tell he does his research. And actually the way I found Dr Weinstock was that I read a study that he wrote. So for those of you who didn't check out the first podcast with him, I hunted him down because of some work he's done in rosacea, some amazing research. And I just love that he has this kind of brilliant researcher mind that he's also working on the front lines with patients. So it's a great intersection of valuable information. And, and of course you're very easy to talk to as well and ask questions of. So there's obviously some potential side effects in, in somebody who has one of these issues. Is low dose naltrexone something like some of these biologic drugs where you've got to stay on them for the rest of your life? Or can it be something that helps while you're working on other therapies in order to say, reduce the symptoms and reduce the inflammation and whatnot?

Dr Weinstock:                    Well, great question. For psoriasis, there are factors in your or, or and environment and yourself that can make a difference. People's symptoms get worse with smoking, stress in particular, those two things could be altered. Will that make a giant difference? It's hard to know if there's a severe case. I kind of doubted but mild case possibly. Alcohol use too. So maybe some of those patients have bacterial overgrowth and that's the source of some of the inflammation but it hasn't really been investigated at all. As far as tolerability of the medicine, if you go up very slowly, our ability to give people to get to the full anti-inflammatory dose of 4.5 milligrams is actually quite good. So I think that the issues of insomnia and GI side effects can be diminished just by starting at a milligram and gradually increasing it every four to seven days and then jump up to the 4.5 milligram.

Dr Weinstock:                    When you're doing well, some people do extremely well at night and the concept at night is that's when your bio rhythm cycle is when you have this circadian rhythm where you produce more endorphins at four in the morning anyway. And so if you take it at night, you might jump up and have more endorphins even then. But a lot of doctors are now prescribing it in the morning to reduce the risk of insomnia. And so by giving it in the morning, starting at a lower dose, we're having less side effects.

Jennifer:                              And does someone stay on it for life? Or like I said, I was saying they could [inaudible]

Dr Weinstock:                    Good question.Here's the thing is what's the trigger for it. If it's a, a shift in your autoimmune disorder can, let's say an anti or the anti autoimmune diet. There are a number of different ones is a autoimmune paleo and there's a autoimmune diet by Myers that, you know, maybe that could do it on your, on its own, a specific carbohydrate diet. I saw a patient yesterday with ocular rosacea sorry, take that back dry eye condition due to Sjogren syndrome. And she found that LDN and the specific carbohydrate diet took care of the [inaudible] and the dry eyes in a dramatic way where other drugs had not, no. She went off of it and the symptoms back and that's the problem. You know, an autoimmune condition is rarely reversed by diet.

Dr Weinstock:                    Um but I mean, I'm saying that it can't be, it could be ameliorated, but it's pretty profound. Disorder. When it occurs and if there's nothing that can be reversed like you know gut disorder then it's hard to say, well your autoimmune diseases can get better on its own.

Jennifer:                              And I I agree with you about that. I've seen in clients and my own clinical nutrition practice that they will come in the door having thought that they could try all these different diets and that somehow that was going to fix the underlying issues and it doesn't, it might alleviate symptoms and manage symptoms slightly, but oftentimes they don't fix root causes where like as a, as a gastroenterologist, you know, you're, you know, that was how I found you is all about SIBO. I was curious about SIBO and SIBO can definitely be a root cause for some people that's hidden. I, I'm curious with a low dose naltrexone. One, one last question. I know you mentioned rosacea and you mentioned, obviously we talked about psoriasis, which is definitely an autoimmune disease. Do you know, just by chance, if there has been any other research into, and I know you said celiac the dermatitis herpetiformis is sort of like that celiac manifestation. With things like eczema, atopic dermatitis, that kind of stuff. Do you know if this has ever been used for folks with that or with like seborrhea dermatitis or anything?

Dr Weinstock:                    Yes. yes, absolutely. So you should go to the LDN research trust. It organizes the disorders that have been treated. And patients will give Vimeos and talks about their experience according to the categories of illnesses. And there's a big section on Derminological conditions that have responded. And now in terms of actual reports in the literature it's dermatitis herpetiformis.

Dr Weinstock:                    I uh it gave a report on a condition called complex regional pain syndrome where the skin change is better. And then published the sarcoidosis case where the skin and liver and the fatigue and then the hope, what we're hoping to do is get this report case report on the psoriasis published as well. But people do talk about eczema getting better. You know, it's not, nothing's a winner 100% of the time. So you have to realize that in medicine you know, a really.

Jennifer:                              Its a tool in the toolbox.

Dr Weinstock:                    Its a tool in the toolbox.

Dr Weinstock:                    And sometimes [inaudible], sometimes it doesn't.

Jennifer:                              Mm. And I'm sure people will ask me, this is a drug that a doctor has to write for. Correct. It's not a supplement. Yeah. So you've got to see a doctor, you've got to be followed by a doctor. Correct.

Dr Weinstock:                    Right. Now let me just say this is a drug that's FDA approved, but it's off label when it's used for low doses. And no, not many people are trained in that. There, there are a number and it's growing and growing and in many States where the natural paths can write for the drug, they love the drug and will prescribe it all the time. So that's, even though a lot of them don't, you know, like prescribing drugs per se, I just gave a lecture for the New Hampshire naturopaths and they have a used it with a lot of utility. And I find it to be very helpful. And then there are resources both on the LDNresearchtrust.org and also the LDNscience.org of having patients who. Are you? Hold on. Are we there?

Jennifer:                              Yep.

Dr Weinstock:                    So basically doctors who prescribe and in different States and also telemedicine so you can literally get it all over the world with a doctor. Yeah. But there are many that will do it and that are interested.

Jennifer:                              Great. Well I think that's a good resource and I would like to specify for people, especially with this case, this is something where you need to work with a doctor that is qualified to write a prescription in your state. I know natural paths are not licensed in all 50 States, so you'll have to see what's available for you and talk to your doctor. But I'm going to link up to that website, LDNresearchtrust.org in our show notes so that everybody can go and check that out. I think that sounds like a fantastic resource and I just wanna thank you so much for joining us and giving people hope because I think that, you know, everybody's journey's a little bit different. Everybody's root causes are different, but when you can find information that's not readily available, you know, this might be another tool in your toolbox that might help you get to more comfortable state and as you walk, one step in front foot in front of the other, and to get to a new, healthy normal for yourself. So thank you so much for joining us. I really appreciate it.

Dr Weinstock:                    You are welcome.


Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


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