Episode 39: LDN with Dr. Thomas Cowan

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Episode 39 of the Phoenix Helix Podcast: LDN with Dr. Thomas Cowan

What Is Low Dose Naltrexone?

Episode 39 of the Phoenix Helix Podcast: LDN with Dr. Thomas CowanNaltrexone is a medication that blocks opiate receptors in the brain. It is most commonly used at a high dose (50 mg) to treat heroine addiction. In the 1980’s and 90’s, researchers discovered that using it at a very low dose (1-4.5 mg) helped people with autoimmune disease without the high cost or side effects of conventional autoimmune medication.

Today, we’re going to learn more about this nontraditional autoimmune medication – how it works and how to find a doctor who prescribes it.

Our guest is Dr. Thomas Cowan, a medical doctor in San Francisco who has used Low Dose Naltrexone (LDN) for many years as part of his autoimmune patient treatment plan.


Listen to the Show

There are three ways to listen:

  1. You can subscribe to my podcast through iTunes.
  2. You can listen through Stitcher.
  3. You can also listen to the episode right here through the play bar at the bottom of this post. If you subscribe to my blog by email, you’ll got notified of future episodes.

Show Notes

  • Intro (0:00)
  • Thank You to Our Podcast Sponsor – Paleo on the Go (2:02)
  • Meet Dr. Thomas Cowan (2:41)
    • Dr. Cowan is a medical doctor in San Francisco who uses LDN with his patients with autoimmune disease.
    • He is also the author of 2 books: The Fourfold Path to Healing and The Nourishing Traditions Book of Baby and Childcare.
    • He went to medical school at Michigan State University but always knew he wanted to practice medicine in a non-conventional way. He started practicing Anthroposophical Medicine in the 80’s and 90’s. Now, he doesn’t define his practice under any specific philosophy other than working with the body’s natural wisdom in helping his patients heal.
  • An Overview of Autoimmune Disease (11:12)
    • Autoimmune disease is a condition where you have a high level of antibodies that target your own tissue and mount an inflammatory immune reaction against that tissue.
    • The immune system has two levels: (1) Cell mediated reactions that are a response to an antigen (like a virus) and usually last about 2 weeks as the body tries to eliminate that virus. (2) Humoral immune response – Antibodies which are the body’s memory for that specific virus that prevents it from being infected again.
    • Vaccines are designed to bypass and prevent cell mediated reactions by mimicking an infection, causing an antibody response without ever actually having that infection. Dr. Cowan believes the vaccine program is one of the reasons autoimmune diseases are now so common.
    • The other major cause of autoimmune disease is leaky gut, causing food antigens to leak into our bloodstream causing more antibody reactions.
    • Dr. Cowan’s autoimmune treatment plan focuses on eliminating vaccines, addressing diet, healing leaky gut, and prescribing LDN and supplements.
  • How LDN Affects Autoimmune Disease (19:11)
    • Food antigens like gluten and casein, when absorbed into our bloodstream through leaky gut, become toxic opiates that interfere with our immune response.
    • Low Dose Naltrexone replaces these toxic opiates with healthy ones instead, helping the immune system rebalance. It does this by temporarily blocking opiate receptors in the body for a few hours while you’re sleeping. During that time, the body tries to overcome the block by releasing extra opiates called endorphins.
    • Endorphins run the immune system – our immune cells, and the cells of our gut and brain, have a high number of endorphin receptors.  People with autoimmune disease often have a combination of low endorphins and high toxic opiates.
  • Why LDN Works for Some People and Not for Others (24:05)
    • Results with LDN vary – everything from having no effect at all, to mild improvements, to achieving autoimmune disease remission. Dr. Cowan has seen this range in his practice as well. It’s worth trying because if it does work, it’s an inexpensive medication ($20-60/month) with minimal side effects.
    • LDN has been mentioned on two prior podcasts as being very effective for two of my guests: Emily who has rheumatoid arthritis talked about her LDN success on Episode 33 , and Chelsey who has Crohn’s disease talked about her success on Episode 35. You can also see other video testimonials online through the LDN Research Trust.
    • One reason LDN may not work is if someone hasn’t changed their diet and continues to eat foods likely to turn into toxic opiates in their body (like gluten in wheat and casein in dairy).
    • In other cases, some people’s bodies might not be able to produce the extra endorphins needed.
  • Finding the Right LDN Dosage (26:31)
    • The original recommended dose was 4.5 mg before bed. Now, they know that dosage needs vary between individuals from 1-4.5 mg.
    • Dr. Cowan starts his patients with 1 or 1.5 mg for 2 weeks and then asks them to report back. If there is benefit at that level, he doesn’t raise it further. If there’s no benefit, he will double the dose to 2-3 mg. They report back in 2 weeks again.  If it’s beneficial at that level, he’ll leave it there. If there’s no effect, he’ll raise it to the maximum 4.5 mg. Note: When there’s a negative effect at any level, he doesn’t have his patients continue for two weeks, but rather call him so he can lower the dose by .5 mg immediately.
    • With LDN, more is not more effective. It’s about finding the lowest beneficial dose, and effectiveness disappears at higher levels.
    • Another option with people who have side effects at the lowest dose is to take it every other day.
    • Those people who benefit from LDN will usually receive benefit as long as they continue to take it. It’s not a temporary medication, although you can take breaks from it to test if you still need it.
    • It can sometimes take 2-3 months before noticing a benefit, although it’s also possible to feel a dramatic effect the very next day.
  • Potential Side Effects
    • Insomnia and bad dreams – although this is usually caused by going on too high a dose too quickly.
  • Compounding Pharmacies (34:15)
    • This is an off-label use of Naltrexone medication, which means there are no tablets available at this low a dose. Instead, you need to have the medicine made through a compounding pharmacy.
    • LDN needs to be combined with fillers. You want to make sure the fillers are fast-releasing and allergen-free.
    • List of compounding pharmacies experienced with making LDN.
    • If you tried LDN and it didn’t work for you, you can try again from a different pharmacy. Sometimes that makes a difference.
  • Finding an LDN-Prescribing Doctor (42:23)
    • You can ask your current doctor for a prescription, but many conventional doctors don’t believe in LDN and won’t prescribe it. If that’s the case for you, here is a list of LDN-Prescribing doctors.
    • However, Dr. Cowan recommends you find a physician who uses LDN as part of his autoimmune treatment plan and guides you in other ways as well, because LDN (independent of addressing diet, lifestyle and other factors) isn’t as effective. I have a list of Paleo Functional Practitioner Directories. Dr. Cowan himself is also accepting new patients.
  • Research Into LDN and Autoimmune Disease (46:47)
    • The LDN Book has just been published, which summarizes all of the research.
    • The LDN Research Trust is funding clinical trials.
    • Clinicaltrials.gov lists both completed trials and ones that are recruiting participants.
    • Pubmed contains published research results.
    • New research: With non-autoimmune hypothryoidism, there is a developing theory of thyroid hormone resistance – where blood levels are normal yet hypothryoid symptoms are being exhibited. LDN can help with that resistance. There is also research into using LDN for anxiety and depression. All of this is summarized in The LDN Book.
  • Helping Patients Make Medication Decisions (51:20)
    • As an MD, Dr. Cowan uses a combination of alternative and conventional medicine as needed for his patients with autoimmune disease. While the goal is to avoid or eliminate immunosuppressant medication and the symptoms they are suppressing, that can take time. He has the greatest success with people who have never been on conventional autoimmune medications at all. For those who have had autoimmune disease for many years, it will often take 1-2 years to heal the root causes and slowly taper those medications. It’s important to do that under the guidance of a doctor who specializes in reversing autoimmune disease. Trying to go off medication cold-turkey leads to autoimmune flares.
  • Outro (55:35)

Spreading the Word

If you like the podcast, please leave a positive review in iTunes or Stitcher. It would mean the world to me, and also helps others find the podcast and learn about their potential for healing.

Listen to the Show

There are three ways to listen:

  1. You can subscribe to my podcast through iTunes.
  2. You can listen through Stitcher.
  3. You can also listen to the episode right here through the play bar at the bottom of this post. If you subscribe to my blog by email, you’ll got notified of future episodes.
  Have you checked out my books?   Books By Eileen Laird | Phoenix Helix

24 thoughts on “Episode 39: LDN with Dr. Thomas Cowan

  1. Pingback: Episode 39: LDN with Dr. Thomas Cowan | Paleo Digest

  2. I have RA but have modified my diet at least 95% gluten, dairy free (with the exception of coffee) and have been on LDN seven months. Flare ups are infrequent and moderate (pain scale 4). Have had several long lasting colds and am being advised to take a pneumonia vaccine (never had that nor any flu shots). I am hesitating for obvious reasons and wonder what your response would be to this decision.

    • Elaine, clearly Dr. Cowan is anti-vaccine, but that’s a decision we all need to make for ourselves in consult with our own medical teams.

  3. Thanks for this very explanatory interview on Naltrexone. I was given this a few months ago at a low dose of 1 mg. once day. But I became very anxious and was unable to sleep. My integrative medicine doctor said it had something to do with me still relying on Tramadol for pain for the RA, and said he’d wait until trying it again. The theory is that his treatment with supplements, herbs etc. is improving my symptoms and pain so that I will rely less and less on Tramadol – which is true; I take less Tramadol than I have, on most days. And when I have less Tramadol in my system, then we can try Naltrexone again. My question is why Naltrexone and Tramadol are interacting, if they are, or if perhaps my dose should be lower than 1 mg. I realize this may be a difficult question to answer. But thanks in advance, just in case. And thanks so much for all you do Eileen.

  4. Great and timely podcast for me. I have Hashimoto’s and have been on LDN for 6 months. My endo, who is a functional medicine endo (lucky me) asks if I think it works. I still have symptoms so my thought is no. This was great advice to take for tomorrow about adjusting the dose. I have never completely understood how it works but now have such a better idea.
    After a year I am still unable to decrease my antibodies through diet, lifestyle changes, etc so I would appreciate a point in any direction you may know from prior guests. I just started listening a month ago so am still working through all the old podcasts.
    Much appreciated,

    • Yes, finding the right dose with LDN is so important. And it also helps to know there are a range of responses – for some people it’s a subtle improvement, and for others it’s a dramatic one. The dose doesn’t change that – but it can make the difference in whether it works at all. As for the old podcasts, I recommend listening to my interview with Andrea Nakayama, if you haven’t already. The topic was Hashimoto’s. Wishing you wellness in every way.

  5. LDN has done wonders for me in my LYME and Bartonella treatment. I’ve had no issues other then to switch my dose to early morning because it wakes me right up.

  6. Thank you for posting this podcast. I’ve shared the link with a group of parents who have children with intractable pain. Often times LDN helps. Because it’s off label not all pediatricians know about it and this will give them more information to speak to their Dr about it. Thank you.

  7. Don’t you think metals and chemicals play a role in these diseases.
    Do you do anything to detox them. My doctor has found chemicals to be in the thyroid sometimes causing auto immune and uses detox, then Spanish Black Radish from Standard Process, then Thytrophin PMG, until no longer needed. He finds that people with cancer and neuromuscular diseases also have lot of metals and chemicals.

  8. Hi Eileen, I’m in Italy, and I just want to let your European readers know that I’ve done a course of LDN, and my doctor is listed in the LDN Prescribing Doctors Link above. I don’t have an AI disease, just an ‘issue’ with active antibodies and chronic inflammation. I don’t know if the LDN was effective for me – I was taking so many other things at the same time: Vitamins, thyroid supplements, hormones. What I can say is that my situation has improved greatly over the last three years – I’m now getting out of bed in the morning like a normal person! – and I put it all down to the Paleo Diet and Lifestyle, and our Paleo Doctor who has been great. Best wishes, A

  9. Thank you for this podcast. It was full of great information. Did I hear you say caffeine was a toxic opiate? I have changed my diet but I didn’t realize this.

    • Hi Diane. Dr. Cowan said casein, not caffeine. Casein is the protein in dairy, and many people have a similar intolerance to it that they have to gluten.

  10. I have been on the AIP diet for a month and have had no RA flare ups with only one or two episodes of slight inflammation. My doctor suggested I start taking LDN along with my Actemra infusions and Arava. Do you recommend I take LDN now that I am on AIP with no symptoms? How would I know if I would be responding to LDN or AIP diet?

    • Hi Liz. I can’t give medical advice, so I would ask your doctor that question. Ideally, you don’t want to make medication changes while doing the AIP, but your doctor might have a good reason for wanting you to take LDN sooner rather than later. Ask your doctor’s opinion about whether it would be OK to delay LDN a few months until you’re more clear about your AIP results.

  11. Thanks for this podcast, it was great to hear about this topic. I have hashimoto’s and have been on an AIP diet. I had adrenal antibodies show up for a short while before I started AIP but they are gone now. I wish you had asked the Dr Cowan if LDN was effective for adrenal autoimmunity or if it is something that would exacerbate the condition. From previous reading about it I gathered that the endorphins were produced in the adrenal glands (I could be wrong about this) and LDN for them would be like throwing gas on the fire if already have autoimmunity going on. Is this true? Thanks

  12. So glad you posted this! I have been on LDN for 1 week now. This was such a good program. I am on 1.5 mg for 30 days and will double that after the 30 days. Thank you again Eileen!

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