LDN stands for low dose naltrexone. It is an immune modulating drug that also regulates the body’s pain relief system.(1)

It is non-addictive and safe, but it can come with side effects, so we’ll get to that - as thankfully, they can be reduced or eradicated entirely.(1)

Low-dose naltrexone works in two ways: it blocks opioid receptors which forces the body to increase its levels of other natural pain relieving chemicals, like endorphins. But it also calms down immune cells in the brain called microglia. When these cells are overactive, they release inflammatory chemicals like cytokines that can drive symptoms like pain, fatigue, poor sleep, and brain fog, but are also heavily involved in endometriosis, so by dampening this response, LDN may help reduce inflammation-related symptoms in chronic inflammatory pain conditions.

It is typically used at high doses to treat opioid addiction, but at very low doses, it's being used to improve symptoms of conditions like fibromyalgia and endo.

So, why and how do I use it? So overall, when we’re talking about low dose naltrexone, the idea is that the doses are low, so typically that’s under 5mg, and it might be much lower.

SIBO

I primarily use LDN with my SIBO clients to help prevent relapse once we have them in remission. Research has shown that LDN has strong prokinetic effects(2), which means it helps to stimulate the cleaning wave, called the migrating motor complex, that clears the small intestine and keeps it free from bacteria build up, helping to prevent SIBO relapse.

We use 0.5-5 mg for this, and stick to under 2.5mg in SIBO clients prone to diarrhoea and 2.5mg-5mg in SIBO clients prone to constipation.(3) It’s taken at night, before bed, which stimulates the MMC overnight to clean the small intestine.

MCAS

I also use LDN in clients with MCAS, particularly in severe cases where we need to layer up treatments and approaches. Because LDN is an immune modulator, it may help stabilise mast cells, but also, it’s worth noting that mast cells don’t release just histamine, in fact, they release hundreds of different types of inflammatory immune chemicals, and so when you have MCAS, the symptoms you’re experiencing are very unlikely just down to histamine, so by calming the immune system overall, we can calm that inflammatory reaction.

LDN is a first line approach for MCAS for many practitioners, normally in combination with other mast cell stabilisers and anti-histamines.(4)

Fibromyalgia

I work with a lot of clients with fibromyalgia and it’s no wonder - endo patients have a 7x higher odds of having fibromyalgia.(5) LDN has been studied for fibromyalgia and a 2023 systematic review found that LDN was a safe and effective treatment for fibromyalgia symptoms, reducing pain and improving quality of life. Whilst studied doses varied, the general recommendation was 4.5mg once a day.(6)

Chronic pelvic pain

Now, of course, we can’t talk about using LDN for endo without discussing its effects on chronic pelvic pain. A 2020 systematic review of the use of LDN for chronic pain conditions looked at 8 research papers, with two of them being on chronic pelvic pain and interstitial cystitis, which is particularly relevant for our demographic because we have a 16x higher odds of also having interstitial cystitis.(5) The review found that all studies showed a reduced intensity in pain but also improved quality of life.(7)

Autoimmune conditions

Because LDN is an immune regulator, in may be supportive in autoimmune conditions. For example, it’s commonly used in patients with Hashimoto’s Thyroiditis, which endo patients have a 3x higher odds of developing(5), as it may possibly help to lower thyroid antibodies.(8) And in fact, I routinely use it with clients with Hashimoto’s Thyroiditis and have truly seen a dramatic reduction in antibodies, though research has shown no reduction in thyroid medication with LDN use.(9)

We also use LDN with SIBO because a key cause of SIBO is food poisoning, which triggers the formation of anti-vinculin antibodies, which accidentally attack the migrating motor complex nerve-cells, called Interstitial Cells of Cajal.(10) At present, we don’t have safe or effective ways of reducing these antibodies, which means our risk of SIBO relapse is high, however, it’s possible that by modulating the immune response with LDN, we could potentially lower these antibodies.

Side effects

So, as I reported earlier, LDN can come with side effects and they are typically quite common, and can include headaches, nausea and vivid dreams to name a few.

One of the best ways to reduce the risk of side effects is to titrate up (meaning build up) very, very slowly to full dose. So, for example, if you’re prescribed 4.5mg, I would spend one to two months building up to that dose, and even slower, if you need to. Additionally, if you reach a point where you’re having side effects, drop back down to the dose you didn’t have side effects with, and stay there for longer - say two weeks, or even a month if need be, and then try again to go up, this can help your body adjust to the medication. If you’re still finding that the next dose up gives you unbearable side effects, it might be that you’re better suited to a lower dose - and you’ll still reap benefits from that dose, it’ll still have positive effects, so don’t worry - not everyone needs to go to 5mg.

Now, LDN is used off-label for endometriosis and SIBO, which means it’s not yet approved as an official medication for these conditions, so whilst some doctors will prescribe it, some don’t. The good news is, you can get LDN off-label from certain pharmacies which work with the LDN Trust, which is a research charity. I’ve linked to their website in the show notes, however, if you want some help getting hold of LDN or understanding if its right for you, you can always reach out for a one-off Endo Session and I can support you with this.

Finally, you do need to give LDN time - I tend to see improvements kick in from about the three month mark, but sometimes later - especially with antibody reduction.

References:

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