LDN for Psoriasis and Psoriatic Arthritis

Interview with Dr. Leonard Weinstock, who is an Associate Professor of Clinical Medicine and Surgery at the Washington University School of Medicine, and board certified in Gastroenterology and Internal Medicine. He is President of Specialists in Gastroenterology, and teaches at Barnes-Jewish Hospital and Missouri Baptist Medical Center. He is an investigator at the Sundance Research Center and has participated in many independent and pharmaceutical research studies. His research interests include the role of LDN in treating medical syndromes both related and unrelated to “the gut.”

I met Dr. Alexander Egeberg initially through correspondence. His research partner and my medical partner, Dr. Erik Thyssin, are actually cousins. Dr. Egeberg got interested in my work on the association between rosacea and gastrointestinal (GI) symptoms/disorders and bacterial overgrowth. We collaborated previously on research related to that. Since our new focus was on psoriasis, and he is a dermatologist, I invited him to share his viewpoint. Although I spent 20 years as an internist (only discontinuing it when I got so busy with GI patients) and have a lot of familiarity with treating skin disorders, since I’m primarily a GI doctor now, it lends credibility to the paper to have a dermatologist on board.

The question is: Where does the problem start? Is it a problem that suddenly appears on the skin? Or could the inflammatory cells be triggered by disorders in the gut? In this one individual described in the case report, clearly the two things were tied together because they always correlated with one other sequentially in time. When the GI problems flared up, his skin got worse, and vice versa. Since this patient did not have small intestinal bacterial overgrowth (SIBO), this perhaps was just the result of inflammatory cytokines deriving from inflammation in the gut “going systemic.” That’s one possibility, but we haven’t proven or disproven that one way or another.

Clearly, the patient in our case report got better each and every time he went on LDN.

Clearly, the patient in our case report got better each and every time he went on LDN. He was not the most compliant guy in terms of using medication. He did not want to do any intensive therapy. He had failed topical therapies; they were bothersome or inconvenient, or mucked up his clothing. He was ready to try something new, and also he had GI symptoms that had been going on for years…irritable bowel symptoms. So we actually thought about prescribing LDN primarily for that. We didn’t find any publications at that time about using LDN for psoriasis, but we found a video describing 16 patients that had used LDN for psoriasis and reported good response. So we decided to move forward with the LDN.

This gentleman would take LDN for a period of time, and then stop it, and eventually restart it again. Each and every time he restarted the LDN, he got better…both his GI symptoms and his skin. He really responded well to LDN. His skin responded nearly completely every time. And then, when the LDN was used for a longer period of time, the psoriasis went away. It was really a dramatic improvement.

Most of the patients were on the anti-inflammatory level of 4.5mg. There were a couple of patients among the 15 that could only get up to 2.5mg of LDN. I do find there is some variability among patients…I have some patients who can get up to 2mg or 3mg without a problem, but when they go beyond that, they have an “endorphin storm” and feel jittery or have insomnia or too vivid dreams, and have to back down in dose. For this study, however, we didn’t let the patients stay at 2mg and see if they got better after 2 months. We encouraged them to go up to 4.5mg of LDN in the beginning because it is thought that is the best anti-inflammatory level of this medicine. Some people think that 3mg is best for an autoimmune condition, but it hasn’t really been studied as well as it should be.

We encouraged them to go up to 4.5mg of LDN in the beginning because it is thought that is the best anti-inflammatory level of this medicine.

As far as what’s going on with Dead Sea therapy and endorphins, I honestly don’t know, but it’s interesting and I would like to learn more about it. What we do know is that LDN causes endorphins to surge, and that changes the T and B cells. The T cells are really important in psoriasis, so controlling the T-cells that are “running renegade” is critical. If the endorphins are increased one way or another, they will affect the T and B cells…they will affect pain receptors and reduce pain. Part of psoriasis is that it is painful.

It’s clear from our study (although it wasn’t hundreds of patients, but rather 15 patients in a preliminary observation paper) that LDN treatment worked as well as expensive topical medications that you have to put on every day- multiple times a day- that could get your clothes messy. You’re taking one safe, compounded pill each morning (sometimes in the evening as well, based on the response) and expecting a great response somewhere in the range of 60% of people. As some of my patients said, “This is a game changer.” Well, it is.

As some of my patients said, “This is a game changer.” Well, it is.

When you listen to the TV and you hear about Taltz^® and Humira^® and all the complications that go along with such drugs to improve the skin and the arthritis, you’re talking about a big potential tradeoff.

For the patients in this study, not only did their psoriasis get better, but their joint pain got better as well. Nothing works for everybody. It is unheard of to have 100% efficacy rate for any medicinal therapy. It’s rarely 50%. If you look at the inflammatory bowel disease market drugs, in which we’re talking a cost of $20,000 or $30,000 a year, those drugs work only in about 20-40% of people. But in our study, 53% of patients saw marked improvement with LDN. That’s something that you can take home and ask your doctor about.

there are physicians in your area and also telemedicine doctors who are more open-minded. Take a look on www.ldnscience.org for these important resources.

I think it’s really important to see if your physician will prescribe LDN for you. You can make them aware of a good local compounding pharmacy. You can print off some basic articles on LDN…that’s what they need to see, perhaps. But sometimes, they’re not going to give you the prescription just because they’re uncomfortable with it, even though you’re asking for an anti-narcotic (which should be an easy prescription for them to give). I’ve seen plenty of other physicians who don’t want to do that, but... there are physicians in your area and also telemedicine doctors who are more open-minded. Take a look on www.ldnscience.org for these important resources.

We at LDNscience thank you very much, Dr. Weinstock, for your contribution of time and effort to increase understanding about low dose naltrexone.