Discoverer of Low Dose Naltrexone, Dr. Bernard Bihari

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Q: How about the autoimmune diseases?

Dr. Bihari: I can only guess, but I've seen people with autoimmune diseases who respond to it. What is clear is that the immune system’s harmony and orchestration is disturbed in autoimmune diseases. What tends to happen in a large percentage of autoimmune diseases is that the T-helper cells, which are the ones that are most vulnerable in HIV, are impaired in their function. Their numbers don’t drop substantially, but their function is impaired. They are really the master cells of the immune system. They're the ones that orchestrate the actions of the others. When they aren't functioning well, one of the functions of other immune system cells that’s very important is lost. That is, the ability the immune system has to distinguish between those chemical structures in the body that are “ME,” that belong to the self and those that are foreign to the self. It’s that ability to distinguish between self and non-self that allows the immune system to recognize bacteria as foreign, and attack them, or parasites or funguses, or cancer cells, which mutate enough so they become foreigners, as foreign almost as bacteria or funguses, and become the object of attack by immune system cells.

What happens apparently in many autoimmune diseases is that some of the immune system cells, in particular cells called macrophages and cytotoxic killer cells, lose the ability to make that distinction, usually with regard to one, or sometimes more than one, system of the body and they start attacking the body’s tissues. In multiple sclerosis, for example, the killer cells or macrophages start attacking the myelin sheath, which insulates nerve fibers. And it’s the attack of the immune system on the nerve fibers that causes the neurological impairments in multiple sclerosis. And there does appear to be significant benefit to using low dose naltrexone in treating multiple sclerosis in terms of preventing further attacks of progression.

And I assume, based on this kind of research, that it’s working by enhancing the functioning of the T-cells, thereby restoring the proper orchestration of immune function, thereby stopping the attack cells from attacking the insulation of nerve fibers. But it seems to work quite well in a range of autoimmune diseases: Lupus, rheumatoid arthritis. That’s just anecdotal. None of these things have been demonstrated in large clinical trials. But it appears anecdotally in my practice that there are good responses to the drug in diseases like asthma, which is partly autoimmune; eczema, which is entirely autoimmune; psoriasis, which is an autoimmune disease. And several less common autoimmune diseases show good response, too. Although I haven't had the opportunity to do endorphin levels on people with those diseases, I assume they're low, because it appears that restoration of normal endorphin levels causes reversal of the disease process.

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Q: Do you and your family take it?

Dr. Bihari: Yes, I’ve been taking it for several years, because my grandfather died of colon cancer. My wife takes it because of a very strong family history of breast cancer. We have a number of friends who take it because of family histories of cancer because it seems intuitively obvious to them, as it does to me, that a drug that would effectively treat cancer should also help prevent it. Proving that would be a massive effort. You'd have to follow 50,000 people for 5 to 10 years, who are in high-risk groups. One of the likely off-label uses once it’s approved will be by people who realize intuitively that it works to prevent cancer, and they’ll start taking it.

Q: And there is no reason you can think of to NOT take it?

Dr. Bihari: There’s no downside to it. Of all the people I've given it to. .. . First of all, with other physicians, if they run into what they consider side effects, they always call me because my name is so associated with it. The only side effect I've seen is a very small percentage of people find that on 3mg their sleep is poor. All they need to do is lower the dose. It simply means that that dose is too high for them because they're more sensitive to it. Generally lowering it to 2mg is enough, to 2mg or 1.5mg is enough to eliminate the sleep disturbance. That is literally the only side effect that I've seen.

I've had two women on it for fourteen years, one with multiple sclerosis, and one who had a metastatic melanoma and has been in remission, and both have stayed on it, simply to make sure their disease doesn't recur. They’ve had no side effects at all. I've been on it for ten years; my wife, for close to that. I've had a number of AIDS patients on it for as much as twelve to fourteen years, with no side effects at all. There is no downside to it.