The LDN Research Trust - Q & A Linda Elsegood

The LDN (Low Dose Naltrexone) Research Trust is at the forefront of raising awareness of the potential of low dose naltrexone as a treatment in auto-immune diseases and cancer. Not just in the UK, the LDN Research Trust has done an outstanding job on the international as well as the national stage. At the heart of this hive of activity – with multiple projects on-going at any one time – is Linda Elsegood, who founded the Trust in February 2004. Ahead of a busy schedule in organising the 2014 LDN Research conference, Linda was kind enough to answer a few questions on LDN and cancer.

Pan: There seems to have been a real rise in the level of interest in LDN and cancer, what’s driving that?

Linda: It’s been incredible really, there is so much interest coming from all areas now – not just in this country but internationally too. Social media has made a huge difference to this. People can access information much more easily than when we started more than 10 years ago. And it’s not just from patients. We get a lot more interest from doctors too. People want to know. And we’re really busy at the LDN Research Trust. We’ve got seven projects on the go at the moment, including the filming of a documentary, there’s the conference which we really want to live stream to everyone for free, to achieve this we have to raise the money. Again, social media is making the difference to this sort of thing.

Pan: In terms of this level of interest, how much is it driven directly by doctors, and how much is it doctors pushed to find out by their patients?

Opiates, Surgery and Prostate Cancer

My son, George, showed no fear when it came to the surgical treatment of his osteosarcoma. He had multiple major operations, some lasting more than 12  hours, in which his bones were moved from one place to the next, tissues cut out from one place and refashioned and repurposed elsewhere. With a tumour in his jaw, the surgeons at St George's Hospital in London worked absolute miracles. And, in the end, it wasn't the tumour in the jaw that killed him, but the metastatic spread to the pelvis and elsewhere. To this day I am astounded at the courage my son showed in facing those long, complex operations, but he had every confidence in Nick Hyde and the maxillofacial team at St Georges. And for George the thing that made it bearable was that there was something definitive about surgery - it lead to the physical removal of the tumour assuming that the margins were clear. In this he was not alone, many cancer patients would rather opt for a surgical option rather than rounds of toxic chemotherapy or being blasted with radiotherapy.

However, it is becoming increasingly clear that surgery itself could well be contributing to the metastatic spread of disease, no matter how good the surgeon or how clear the margins are. It is not the surgery itself that seems to be at issue, but the use of opiate-based pain relief (morphine, fentanyl and so on). It's a topic that I have covered a number of times on this site already:

http://www.anticancer.org.uk/2013/09/ketorolac-and-breast-cancer.html

http://www.anticancer.org.uk/2012/03/opiates-cancer-and-naltrexone.html

The culprit is the mu-Opioid Receptor (MOR) pathway that is the main target of the opiate-based pain-killers and which cause increased levels of tumour growth and metastases. We know this from epidemiological studies (looking at what happened to cancer patients after surgery based on what pain relief they had), from studies in animals and from studies in the test tube. The effect is likely due to a number of factors, including the fact that the opiates increase angiogenesis, cause immune suppression and activate a number of pro-cancer pathways.

Another epidemiological study has just been published which looks at the rate of disease progression and overall mortality in prostate cancer patients who have had a radical prostatectomy. The study, 'Association between neuraxial analgesia, cancer progression, and mortality after radical prostatectomy: a large, retrospective matched cohort study' has been published in the British Journal of Anaesthesia. The authors used a large sample of patients, matched for age, surgical year, pathological stage, Gleason scores, and presence of lymph node disease and type of anaesthesia - those treated with neuraxial anaesthesia (which has lower use of opiates) and general anaesthesia (using the 'normal' amount of opiate-based pain relief).

The results are clear and in line with the previous studies I have written about. Increased use of opiates is associated with increased risk of disease progression and higher overall mortality.

The question we need to be asking ourselves now is not whether opiates in surgery are risky for cancer patients, the evidence is there in plain sight. The question we need to be asking now is how can we ensure that clinical practice changes and changes soon? One step in the right direction is the clinical trial being run by Dr Patrice Forget in breast cancer patients:

http://www.anticancer.org.uk/2013/09/q-with-dr-patrice-forget-ketorolac-and.html

But at the same time, if I was a cancer patient about to have surgery I know that I would be wanting to speak to my surgical team and pointing them in the direction of these various results. At the very least I would be wanting to explore the use of methylnaltrexone if there is no option but opiate-based pain relief.

Opiates, cancer and naltrexone

An interesting paper in Anaesthesiology, (and yes, I know it’s not top of everyone’s reading list), looks at the influence of the mu opiod receptor (MOR) on cancer progression. While you may not have heard of the MOR, you will have heard of the drugs that target this receptor: morphine, fentanyl, heroin and other opiates. These are among the most widely used of pain-relief drugs in current medical practice. In particular these drugs are widely prescribed for cancer patients, either when undergoing surgery or when they are suffering from pain. The question of whether these drugs have an effect on cancer progression is one that is directly relevant to cancer patients here and now. While it has been known for some time that opiate drugs possibly have some indirect effects on disease progression because of the depressive effect on the immune system, the authors of this paper take things a step further and ask whether there is also a direct pro-tumour effect induced by these opiates.

The starting point for this new work is that the authors had worked with the drug methylnaltrexone (part of the same family of drugs as naltrexone), which blocks the operation of the MOR but which does not cross the blood/brain barrier. This means that while methylnaltrexone blocks the operation of opiate drugs, because it doesn’t cross into the brain it doesn’t interfere with the pain relief that opiates are used for. The clinical rationale for using methylnaltrexone is that it doesn’t stop the pain relief, but it does stop constipation and other side effects of opiates.

LDN Research Trust Newsletter

The February 2012 newsletter of the LDN Research Trust is now available here: http://www.ldnresearchtrustfiles.co.uk/docs/February%20Newsletter%202012.pdf

As well as covering all the news from the world of Low Dose Naltrexone research, there's also an article about this website and the work of the George Pantziarka TP53 Trust. It's a good read - so if you're at all interested in low dose naltrexone it's definitely worth following up.

Q&A With Dr Burt Berkson - Low Dose Naltrexone and Alpha Lipoic Acid

A couple of years ago I found an extraordinary paper in the journal Integrative Cancer Therapies which described a number of cases in which patients with advanced pancreatic cancers had responded to therapy with low dose naltrexone and alpha lipoic acid. It was a paper that positively demanded following up with a clinical trial, but although I checked up periodically no trial was forthcoming. However, the recent LDN Aware DVD included an interview with the man behind that paper, Dr Burt Berkson.

I am pleased to say that Dr Berkson agreed to answer a few questions for Anticancer.org.uk, the first part of which appears below.


PP: Background - how did the LDN/ALA protocol arise?

BB: Alpha Lipoic Acid (ALA)

While working as an internal medical resident at one of the Case Western Reserve teaching hospitals in 1977, I was told by the chief to follow two patients with severe and acute liver damage that resulted from eating hepatotoxic mushrooms. This condition is often fatal and I was told that these patients would surely die.

As a medical doctor it was necessary to follow the orders of the chief; however, as a PhD, I sought new ways of doing things. I called Dr. Fred Bartter (former chief of endocrinology) at the National Institutes of Health and asked him if he knew of anything that would help regenerate damaged organs. He answered that he was working with thioctic acid (alpha lipoic acid, ALA) as a possible treatment for diabetic complications and when given to people with diabetes, it seemed to help heal damaged livers and other organs.

Dr. Bartter sent me a case of ALA for intravenous administration. I picked it up at the Cleveland airport about seven hours after I initially called him. I rushed back to the hospital and injected the ALA into the two patients. I administered this treatment every six hours for 14 days. The patients started to recover and felt much better by the second day and were able to leave the hospital within two weeks with normal liver function. They are still alive and free of liver disease today, 34 years later.

It is interesting to note that some of the chiefs at the hospitals where I practiced medicine seemed to discourage my use of ALA. I was told that with an M.D., and a Ph.D. in cell biology/microbiology, and internal medicine training, I should concern myself with doing infectious disease research and stay out of liver disease.

Dr. Bartter, however, thought our work was very important and told me that some day we might win a Nobel Prize for our human work with ALA. He suggested that I leave Cleveland and come to work with him at NIH. But I was very discouraged by the response that I experienced from the medical community in Ohio. I left the region and moved my family to a rural community not too far from Lubbock, TX.

I became a country doctor, driving from one hospital to another each day, and even delivered babies in people’s houses on isolated ranches. When my children were high school age we moved back to a relatively large city. About fifteen years ago, I opened an integrative medical practice in Las Cruces where I use antioxidants and certain innovative prescription drugs to treat diabetes, chronic hepatitis, rheumatoid disease, lupus and other disorders with exceptionally good results. I also try to support and improve the immune system of people with cancer.