LDN Therapy: Dr. Jeff Miskoff, LDN, and Cancer
These are the transcripts from an interview with pulmonologist Dr. Jeffrey Miskoff discussing LDN therapy. Dr. Miskoff published a case study using LDN therapy (Low Dose Naltrexone) in a patient with non small cell lung cancer (NSCLC), more specifically adenocarcinoma stage IIIa. (You can read the published case study here.)
In the case study, Dr. Miskoff shares the details of a 50 year old man who continues to thrive over five years past the grime prognosis. A diagnosis of stage IIIA non-small cell lung cancer has about a 36% five year survival rate. (R)
Denise: Dr. Miskoff can you fill me in on your background and how you began using LDN therapy (low dose naltrexone) in your practice?
Dr. Miskoff: My father was an oncologist. About eight or nine years ago, and with no risk factors, he developed pancreatic cancer. I started my research looking for complimentary and alternative treatments to help him. I recommended LDN after reading about its background and the earlier research using LDN in an IV liquid form at Penn State for pancreatic carcinoma.
My father was an astute man. He was trained in oncology at Walter Reed Medical Center in Washington D.C. At first, he was reluctant to even consider LDN (low dose naltrexone). But my stepmother convinced him to give it a trial.
He had stage-four pancreatic cancer at the time of diagnosis and was given a three to six month prognosis to survive. He made it approximately 22 months. About a month before his demise, he had stopped taking LDN. I don't know why he stopped taking it. But once he stopped, he died a month later. He was also receiving GTX (gemcitabine, taxotere, and xeloda) standard of care treatment or chemo.
That is how I got introduced to LDN. I continued reading as much as I could find on LDN therapy. Ultimately, I started using it on my own patients for a variety of ailments throughout the years.
I have other cases that I plan on publishing. Time has been a limiting factor.
This particular man, about whom the case study is written, is an interesting case because he really couldn't tolerate chemotherapy. He was a younger man (*he was 50 years old at the time of diagnosis) . He had a young child when I met him. I really felt for him.
I suggested LDN therapy to him, and he could afford approximately one dollar a day, which is all LDN costs.
And sure enough, the case tells the story how five years later, his stage III-A lung cancer is a PET scan negative at this point.
So it was really my dad and his unfortunate situation that got me interested in looking into LDN therapy.
At some point during my father's illness, my best friend and I took a trip down to the NIH (National Institute of Health). They were having a closed-door meeting that was announced on the LDN Research website. We inquired about attending and since we were both physicians, I believe, they offered us admission. We drove down to Bethesada, MD for the whole day meeting, which was fascinating to say the least.
I got more enlightened and educated on the best uses of LDN therapy for issues like MS, rheumatoid arthritis, other autoimmune disorders and carcinoma.
Denise: In your case study, you credit LDN therapy with this man's survival AND, for all practical purposes, cancer-free status. Can you explain in layman's terms how you know it's the LDN therapy that's working for this particular patient? In your paper it looks like he's also been taking a plethora of other medications alongside the LDN.
Dr. Miskoff: Well, I think he only tolerated, or did not tolerate I should say, the initial chemotherapy. He did have surgical resection of the lesion. But with a IIIA carcinoma cancer, the probability of him living five years was a low percentage, maybe 30 percent. Also, the other medications he was taking don't have any known anticancer effects that I am aware of.
On the other hand at Penn State, they had looked at the micro level of the adenocarcinoma cell.
Cancers cells have different cell types: some are adenocarcinoma, some are squamous, some are large cell, small cell, etc. Penn State had done original micro research on this cell type, looking at the cancer cell itself. And this specific type of cell, the Adenocarcinoma cell, tends to have opioid receptors on its cell membrane.
Dr. Miskoff is referring to Dr. Ian Zagon of Penn State. You can read about Dr. Zagon's work here.
At low doses, LDN hits that receptor and causes the cell to burst or self-destruct, also known as apoptosis.
I've found only a few other clinicians, maybe a few handful in the country. that are aware of these potentially anti-cancer effects.
Not many people realize that the adeno cell has opiate receptors and by hitting that receptor with the LDN at that micro-dose of 3 to 4.5 milligrams, it tends to cause apoptosis.
One question I've always had is, if the opiates given to these cancer patients, don't actually cause the cancer to multiply by stimulating the opiate receptor. I am not aware of any research examining this potential negative effect. LDN is really the opposite of a narcotic, right? It's an anti-narcotic. It's an anti-opiate. So I've always wondered if when these adenocarcinoma patients go on narcotics, do they actually drive the cells to multiply.
As you know, once people go on hospice many, if not most, are prescribed opiates. They get morphine and narcotics to make them comfortable. And they tend to pass on pretty quickly after that, most of the time it's from respiratory suppression caused by the narcotics. But I've always wondered if those that go on lower doses of narcotics drive the cancer.
The basic physiology of LDN is at least twofold: First, it causes apoptosis of the adeno cell. Secondly, when you give it at micro-doses, under five milligrams, it causes endorphins to rise. Endorphins are typically thought of as good.
There's an old breast cancer study looking at women who ran on treadmills, or ran a certain amount. The study found that these women had higher levels of endorphins, which possibly gave them a survival benefit.
Denise: You mentioned using LDN therapy for things like MS, Crohn's, Autism... it seems like research shows it can help with autoimmune diseases. What about Th2-skewed issues like allergies and asthma?
Dr. Miskoff: I take care of a lot of asthma patients and a lot of emphysema patients.
There is some suggestion on the LDN Research website of using it in emphysema. I can't recall if they have asthma listed on there, but personally I don't think, from the perspective of decreasing the cells that lead to inflammation in asthma, or partially in COPD and emphysema, that the physiology would make that much sense.
As far autoimmune issues go, like in rheumatoid arthritis or MS, you're boosting the immune system. So that kind of makes sense.
Although this is very different from how the standard medical practice in the U.S. and Europe approach rheumatoid arthritis and MS. Here and in Europe, the standard medical practice is to give an immunosuppressant or biologic to suppress the immune system. Drugs like prednisone, steroids, and expensive biologics... do work, but they have several side effects.
LDN is the exact opposite approach.
LDN builds the immune system up, so that it can fight the natural response in the body rather than just suppressing it.
As far as asthma goes, it's still being figured out. There are several proteins like interleukins, eosinophils, antibodies, and IgE involved in asthma. And I've never been able to put the connection together in my brain that LDN would work there, at least from what I've read.
So, I don't use LDN or offer it to my asthmatic and COPD patients. I am still in a standard of care practice, per se. I'd have to form a separate clinic if I really wanted to investigate that; and, I just don't have the time, unfortunately.
I'm sleep physician as well, but if my patients have another condition that I don't treat, they go to another specialist. They have specialists for rheumatoid, specialists for MS. I don't advertise myself as a specialist in those different disorders.
But if they happen to have a sleep disorder and I notice that they're suffering and not doing well with whatever their specialist is offering them, I may offer them LDN. But I have not used LDN as standard management in my asthmatic or COPD patients.
Denise: Just to double back on boosting the immune system, you mentioned interleukin-6, interleukin-12, and TNF-alpha were all decreased by LDN. Can you talk specifically about how LDN boosts in the immune system or what it modulates, if anything?
Dr. Miskoff: In asthma, right now we really only understand that interleukin-5, interleukin-4, and interleukin-13, seem to be modulating eosinophils, mast cells, and these types of things. None of those are mentioned in this case study. As far as IL-6 and TNF-alpha, I don't think anybody has a great understanding of those with LDN exactly. There is some research that that we referenced in our case study.
LDN Side Effects
Denise: What about the side effects of LDN therapy?
Dr. Miskoff: In the last decade or so of prescribing LDN, I've never seen anyone have a significant side effect, except for some vivid dreaming for about a week or two.
LDN is very well tolerated. Sometimes the fillers that the pharmacies use can cause side effects. For example, if someone is having a side effect, g.i.-related or something mild, it's probably not from the LDN. It's probably from the filler that the pharmacy used, such as lactate. Acidophilus is an alternative filler with less GI effects, per se.
Denise: Do patients stay on LDN therapy for life? Or just a limited amount of time?
Dr. Miskoff: Well, they certainly would have to come off of LDN if they end up on narcotics. If they end up on narcotics because whatever condition they have is causing enough pain that their clinician, or the patient themselves, feels they need a narcotic, then it just doesn't match with well with LDN therapy.
Narcotics and LDN are completely opposite and they will negate each other's effects. LDN will be reduced in its effect by the narcotic. And the narcotic will be reduced in its effect from the LDN, because it isn't an anti opiate.
We like to get these patients before they're on narcotics. They tend of do a lot better. It's very hard to wean people off narcotics. I don't write narcotics myself, except in hospitalized patients in the intensive care that I round in.
In fact, I can count on one hand how many narcotics I write for my patients in one year. I tend not to do that. It's the oncologists that are typically writing it, or pain management doctors.
And it's rare that anyone comes to me on narcotics. They've usually done research if they want to go on LDN and they've heard I'm writing it. I won't even talk to them about LDN if I feel they're too past the point of getting off the narcotics. My patients on LDN are handpicked patients, four or five, maybe 10, a year, potentially.
Over the ten years I've been in practice, I've built up maybe 100 patients on LDN. Most of them stay on it long term.
I have a couple of multiple sclerosis patients that have been on LDN for six or seven years.
I have a few patients with fibromyalgia. Sometimes these patients get a little improvement with LDN. But I haven't seen fantastic results with that particular condition on LDN. I've seen some reduction in symptoms.
Again, the adenocarcinomas do surprisingly well with LDN.
I have several other cases we're digging through to potentially publish as well, so that we can continue to build this database of cases to help others.
LDN and Cancer
Denise: Why did you publish this case? I'm just so curious.
Dr. Miskoff: Well, the man is still my patient. He's a wonderful person. He is a father. I've seen his children grow over the last four and a half years. And actually he had a younger child before he was diagnosed with lung cancer.
He came to me for a pre-operative clearance. The chest x-ray for pre-admission testing had a mass on it that was missed by the ordering primary care physician. He ordered the x-ray and nobody followed up. That physician just didn't read the report and didn't know about the mass. So when this man came to me and I saw the x-ray he had taken about a month earlier, I said, "Do you know you have a mass in your chest?"
He had no idea. Over a month had passed, at least, since he had the x-ray taken. So we moved on it quickly.
This case is very intriguing to me. It stands out in my mind. This patient is almost a cure, if you look at five years as a cure. And this particular gentleman was one of those that stood out to me as doing fantastic.
I have another case of an elderly man in his nineties. Unfortunately, he has since passed away. But he had a brain carcinoma glioblastoma, which as you know is deadly. He had it resected and I put him on LDN. He died years later with no evidence of glioblastoma on his final PET scan. He died of dementia and other neuro and aspiration complications. His son was an amazing caretaker and certainly had a lot to do with his long term survival in my opinion.
There are several other LDN cases that are also quite intriguing that I plan to get to.
We also published a case of a six-year old girl who came to me with misdiagnosed narcolepsy. I treated her with an adult strength medication off-label. Now the drug company is going for pediatric indication, not because of us, but I was doing this before the drug company ever applied for that. We've got a couple other cases that we are working on publishing that have nothing to do with LDN.
Denise: Wow, that's amazing. One final question. Why low dose? I mean, more is more is better. Isn't that the mantra?
Dr. Miskoff: No. If you go back to the Penn state work, they had figured out the 5mg dosage cutoff through the pharmacokinetics of LDN.
They found that when you get over this 4.5-5 milligrams dosage, the endorphin rise tends to not happen. And, for whatever reason, physiologically, once you get above that dose, LDN seems to lose its immune protective mechanisms, at least as far as Penn State described it originally, as I recall from my readings.
Why is there a sweet spot, if you will?
Remember that naltrexone is FDA approved, not low dose specifically. But 50 and 100-milligram dosages of naltrexone are approved for use in alcohol and heroin abuse. You need a lot of naltrexone in order to block the effects of alcohol, heroin, or opiates.
It's really not a great drug in my opinion at those doses. Patients on those doses walk around kind of like zombies. There are a lot of side effects. More is not better for sure, at least from a side effect profile and my previous experiences with other patients. Methadone seems to be more effective for heroin abuse, especially when monitored by a center with expertise.
This dosage of 4.5-5mg is a little sweet spot where you don't get the side effects and you seem to get the maximum immune boosting potential. Over five milligrams those benefits tend to trail off.
I can't take credit for the dosing of it. It comes from Penn State. Unfortunately the opioid growth factors and infusion never made it to the mainstream.
There was also research that studied LDN therapy in HIV. LDN has been found to boost CD-4 counts in HIV patients. This research was presented at an HIV conference in the late 1980's. CD-4 levels are what we track in HIV patients. But that data somehow ended up buried. And uh... you know, the joke was that it was a travesty that they presented this data to the international AIDS conference... and the data was allegedly suppressed or at least not followed through on. There was a follow-up study in Africa and I believe it did show a signal to benefit HIV patients at least in regards to the CD 4 count.
This was also the time HAART was emerging and certainly has revolutionized HIV treatment. Look at Magic Johnson for example. But, his lifestyle, support and who knows potentially complimentary regimen helped, as well. I am not his physician so I can’t speak to his care personally.
Dr. Bernard Bahari is credited with discovering LDN use clinically in AIDS patients. He may be the study that was presented at the AIDS conference which Dr. Miskoff mentions.
Dr. Burt Berskon uses LDN and IV alpha lipoic acid in his treatment of cancers. He has published several case reports on long term survivors using his protocol. "Revisiting the ALA/N (alpha-lipoic acid/low-dose naltrexone) protocol for people with metastatic and nonmetastatic pancreatic cancer: a report of 3 new cases." His clinic is Integrative Medical Center in New Mexico.
If you are exploring LDN, the LDN Research Trust is a great resource. There you can print off materials and bring them to your doctor for discussion.
My mother, who suffers from rheumatoid arthritis, is giving LDN a go. She opted to use an LDN doctor. There are several doctors online who market themselves as LDN doctors - with fees that go all the way to nearly $300/video consult session. Yikes!
We found Dr. Zalzala on the LDN Research Trust website. His charge for a video consult was a fraction of the other practitioners. You can find him here at Root Causes Clinic.
The books below introduced me to LDN in depth. I highly recommended reading one or all of them. Something that also seems to go hand in hand with LDN (for certain health challenges) is Alpha Lipoic Acid. In fact, Dr. Berkson, who wrote the seminal book on Alpha Lipoic Acid, uses LDN and Alpha Lipoic Acid in some of his protocols.
Personal stories of both LDN therapy patients and ketogenic diet.
Mary Boyle Bradley shares her and her husbands personal journey using LDN to halt the progress of MS.
An extremely detailed and science filled LDN therapy must read.
If you are exploring Alpha Lipoic Acid, I recommend that you read my post which walks you through the most effective forms and brands of Alpha Lipoic Acid.
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