Clearer Thinking, More Energy, Less Pain? Is Low-Dose Naltrexone Right for You?
Ella is a freshman in college and has always been an athlete, playing volleyball, softball, and track. However, this last year she has found her heart rate jumping much higher than normal and she finds that getting up from a seated position leaves her feeling lightheaded. She read an article about dysautonomia and wonders if maybe her symptoms fit but is still struggling to find answers. Until a new doctor mentions POTS and low-dose naltrexone.
Jennifer was a young mom three years ago when she got a case of mono. While it knocked her down for a bit, she recovered and was soon chasing after her rambunctious toddler. However, a recent bout of flu knocked her feet out from under her. She can no longer tolerate loud noises or bright lights. She struggles with no energy and spends most of her days and nights in bed, unable to do simple daily activities. If she does try to spend time with family or her young son, she often feels much worse. She feels as if life is moving on without her as she struggles to find treatment options. In a last-ditch effort for relief, she sees a chronic illness specialist who mentions ME/CFS and how low-dose naltrexone may help.
Carol managed to stay clear of the COVID virus for most of the pandemic but this past Thanksgiving a family gathering delivered a positive test result. Her case was mild, and she thought she was in the clear. But then this wall of fatigue and overwhelming brain fog set in, and she was at a loss. Once full of energy and able to multi-task like a pro, Carol was struggling to keep up. She saw doctor after doctor and had more tests than she could count, but still no answers and her symptoms only got worse. Until a Long COVID clinic doctor suggests low-dose naltrexone.
Naltrexone: One Medication for Multiple Conditions
Navigating the ups and downs of Long COVID, ME/CFS, or other intricate health challenges, you may have stumbled upon murmurs of a treatment known as low-dose naltrexone, or simply LDN. Think of it as an insider's tip in the chronic illness community—a relatively obscure remedy that's beginning to gain attention for its capacity to alleviate a range of stubborn symptoms that many of you know all too well. LDN isn't a cure-all—such things are scarce in our reality—but it does shine a ray of hope in places where it's sorely needed. In this blog post, we're going to explore what LDN is all about, unpack the science that supports its use, and consider how it could potentially lend a hand in your quest for improved well-being.
Naltrexone vs. Low-Dose Naltrexone (LDN): What’s the Difference?
Naltrexone is an FDA-approved medication that is routinely used to treat alcohol and opioid addiction, however, it is frequently used “off-label” at much lower doses to help with inflammation, pain, fatigue, “brain fog,” and more.
Naltrexone binds directly to the mu-opioid receptors in the body and brain, blocking opioids from activating those receptors. This "blocking" effect does a couple of helpful things: it can cut down on cravings, and if someone uses opioids while taking naltrexone, they're less likely to feel the “high,” which can help them stay on the path to recovery.
So what does a drug recovery medication have to do with Long COVID, ME/CFS, or other complex illnesses? Research shows that when used at much lower doses, this medication can provide relief to many symptoms you may experience. Low-dose naltrexone (LDN) operates differently from its higher-dose counterpart, primarily by modulating the immune system, reducing inflammation, and protecting the brain and nerves.
What Does Low-Dose Naltrexone Treat?
Low-dose naltrexone (LDN) can be used for a variety of symptoms across several conditions, although it's important to note that individual responses can vary. Here are some benefits associated with LDN:
Chronic pain improvement
Increased energy levels
Fatigue reduction
Mood stabilization
Improvement in skin conditions, such as eczema and psoriasis
Improvement of neurological symptoms, such as brain fog
Gastrointestinal (gut) symptom relief
The Science Behind Low-Dose Naltrexone
The science behind LDN is fascinating, as it involves subtle changes in the body's biochemistry that can lead to significant improvements in symptoms for some patients.
The Immunomodulatory Effects of LDN
At the heart of LDN's potential lies its ability to modulate the immune system. Originally approved at higher doses for addiction treatment, naltrexone in low doses has been found to have a paradoxical effect on the immune system. It temporarily blocks opioid receptors, which in turn leads to an increase in the production of endorphins and enkephalins (9) – the body's natural painkillers and immune modulators. This upregulation can help restore a more balanced immune response, which is often out of sync in autoimmune and chronic inflammatory conditions.
Neuroprotection and LDN
Another intriguing aspect of LDN's action is its neuroprotective potential. For conditions like Long COVID and ME/CFS, where patients often suffer from neurological symptoms such as brain fog and nerve pain, LDN's ability to protect nerve cells could be particularly beneficial. The exact mechanisms are still being studied, but it is thought that LDN may help reduce neuroinflammation and promote the health of neurons, potentially improving neurological function.
Is Low-Dose Naltrexone Safe and Effective?
Clinical data suggest that LDN is generally well-tolerated, with the most common side effects being transient and mild, such as sleep disturbances and digestive discomfort. This suggests that LDN could be a safe addition to the arsenal against many chronic health conditions.
While low-dose naltrexone (LDN) has been recognized for its safety and potential efficacy in treating a variety of conditions, it's important to acknowledge that it may not be universally effective for all individuals. The response to LDN can be quite individualized, with some patients experiencing significant relief from their symptoms, while others may notice little to no improvement. This variability in response could be due to differences in individual physiology, the underlying pathology of the condition being treated, or even genetic factors that influence how a person metabolizes the drug.
The Path Forward
As we continue to navigate the uncharted waters of Long COVID, ME/CFS, and other complex conditions, LDN presents a beacon of hope. Its immune-modulating, anti-inflammatory, and neuroprotective properties make it a candidate worth considering for those battling the lingering effects of COVID-19, ME/CFS, or other complex conditions. If you're interested in exploring LDN as a treatment option, consult with your healthcare provider or visit RTHM Direct to learn how LDN can treat your specific health concerns and get you back on the path to better health.
Follow the Science
Many studies have evaluated the use of low-dose naltrexone (LDN) as a potential treatment for patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), also known as Long COVID, ME/CFS, MCAS, and dysautonomia. Studies show:
The use of LDN was associated with improvements in symptoms like fatigue, post-exertional malaise, unrefreshing sleep, and sleep patterns. The total number of symptoms also reduced.
LDN was generally well tolerated with no serious adverse effects reported.
Study results suggest LDN may provide symptom relief for those with Long COVID, ME/CFS, postural orthostatic tachycardia, and MCAS. Larger randomized controlled trials are needed to validate the use of LDN, but until then, using LDN off-label may result in symptom improvement for many. In the long-term, LDN's anti-inflammatory and immunomodulatory mechanisms could provide a new approach to managing the persistent symptoms of the conditions.
Here are just a few key studies looking at the benefits of LDN:
Bonilla, H., Tian, L., Marconi, V. C., Shafer, R., McComsey, G. A., Miglis, M., Yang, P., Bonilla, A., Eggert, L., & Geng, L. N. (2023). Low-dose naltrexone use for the management of post-acute sequelae of COVID-19. International Immunopharmacology, 124, 110966. https://doi.org/10.1016/j.intimp.2023.110966
Toljan, K., & Vrooman, B. (2018). Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization. Medical Sciences, 6(4), 82. https://doi.org/10.3390/medsci6040082
O'Kelly, B., Vidal, L., McHugh, T., Woo, J., Avramovic, G., & Lambert, J. S. (2022). Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study. Brain, Behavior, & Immunity - Health, 24, 100485. https://doi.org/10.1016/j.bbih.2022.100485
Bonilla, H., Peluso, M. J., Rodgers, K., Aberg, J. A., Patterson, T. F., Tamburro, R., Baizer, L., Goldman, J. D., Rouphael, N., Deitchman, A., Fine, J., Fontelo, P., Kim, A. Y., Shaw, G., Stratford, J., Ceger, P., Costantine, M. M., Fisher, L., Maughan, C., . . . McComsey, G. A. (2023). Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative. Frontiers in Immunology, 14. https://doi.org/10.3389/fimmu.2023.1129459
Isman, A., Nyquist, A., Strecker, B., Harinath, G., Lee, V., Zhang, X., & Zalzala, S. (2024). Low-dose naltrexone and NAD+ for the treatment of patients with persistent fatigue symptoms after COVID-19. Brain, Behavior, & Immunity - Health, 100733. https://doi.org/10.1016/j.bbih.2024.100733
Olli Polo, Pia Pesonen & Essi Tuominen (2019) Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Fatigue: Biomedicine, Health & Behavior, 7:4, 207-217, DOI: 10.1080/21641846.2019.1692770
Weinstock, L. B., Brook, J. B., Myers, T. L., & Goodman, B. (2018). Case Report: Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment. BMJ Case Reports, 2018. https://doi.org/10.1136/bcr-2017-221405
Eaton-Fitch, N., Du Preez, S., Cabanas, H. et al. Impaired TRPM3-dependent calcium influx and restoration using Naltrexone in natural killer cells of myalgic encephalomyelitis/chronic fatigue syndrome patients. J Transl Med 20, 94 (2022). https://doi.org/10.1186/s12967-022-03297-8
