Optimism Improves Health

[Myoak]

Optimism produces scientifically measurable improvements in immune function. Being optimistic improves health.

Optimistic Expectancies and Cell-Mediated Immunity: The Role of Positive Affect
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933956/

Quote.. “These results provide the first evidence that changes in optimistic expectancies are accompanied by changes in immunity, as well as the first evidence for a mechanism by which this effect occurs.”

“Optimistic expectancies have a number of psychosocial effects. These results add evidence that expectancies also affect immunity and, potentially, health. Importantly, this is the first evidence that expectancy change correlates with immunological change. The results also support the independence of positive and negative affect with regard to their relationships to both expectancies and immunity (Pressman & Cohen, 2005; Stone et al., 1987). Although optimistic expectancies associate with both increased positive affect and decreased negative affect, it may be as important for immunological health for people to be happy than to lack anxiety.”

[KoKo]

Optimism produces scientifically measurable improvements in immune function. Being optimistic improves health.

Optimistic Expectancies and Cell-Mediated Immunity: The Role of Positive Affect
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933956/

Quote.. “These results provide the first evidence that changes in optimistic expectancies are accompanied by changes in immunity, as well as the first evidence for a mechanism by which this effect occurs.”

“Optimistic expectancies have a number of psychosocial effects. These results add evidence that expectancies also affect immunity and, potentially, health. Importantly, this is the first evidence that expectancy change correlates with immunological change. The results also support the independence of positive and negative affect with regard to their relationships to both expectancies and immunity (Pressman & Cohen, 2005; Stone et al., 1987). Although optimistic expectancies associate with both increased positive affect and decreased negative affect, it may be as important for immunological health for people to be happy than to lack anxiety.”

Thanks for the article Myoak. Good stuff!

Take Care

[Myoak]

Want to avoid the flu? Don’t worry, Be Happy!

Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus.

https://www.ncbi.nlm.nih.gov/pubmed/17101814

OBJECTIVE:

In an earlier study, positive emotional style (PES) was associated with resistance to the common cold and a bias to underreport (relative to objective disease markers) symptom severity. This work did not control for social and cognitive factors closely associated with PES. We replicate the original study using a different virus and controls for these alternative explanations.

METHODS:

One hundred ninety-three healthy volunteers ages 21 to 55 years were assessed for a PES characterized by being happy, lively, and calm; a negative emotional style (NES) characterized by being anxious, hostile, and depressed; other cognitive and social dispositions; and self-reported health. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms.

RESULTS:

For both viruses, increased PES was associated with lower risk of developing an upper respiratory illness as defined by objective criteria (adjusted odds ratio comparing lowest with highest tertile = 2.9) and with reporting fewer symptoms than expected from concurrent objective markers of illness. These associations were independent of prechallenge virus-specific antibody, virus type, age, sex, education, race, body mass, season, and NES. They were also independent of optimism, extraversion, mastery, self-esteem, purpose, and self-reported health.

CONCLUSIONS:

We replicated the prospective association of PES and colds and PES and biased symptom reporting, extended those results to infection with an influenza virus, and "ruled out" alternative hypotheses. These results indicate that PES may play a more important role in health than previously thought.

[KoKo]

Want to avoid the flu? Don’t worry, Be Happy!

Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus.

https://www.ncbi.nlm.nih.gov/pubmed/17101814

OBJECTIVE:

In an earlier study, positive emotional style (PES) was associated with resistance to the common cold and a bias to underreport (relative to objective disease markers) symptom severity. This work did not control for social and cognitive factors closely associated with PES. We replicate the original study using a different virus and controls for these alternative explanations.

METHODS:

One hundred ninety-three healthy volunteers ages 21 to 55 years were assessed for a PES characterized by being happy, lively, and calm; a negative emotional style (NES) characterized by being anxious, hostile, and depressed; other cognitive and social dispositions; and self-reported health. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms.

RESULTS:

For both viruses, increased PES was associated with lower risk of developing an upper respiratory illness as defined by objective criteria (adjusted odds ratio comparing lowest with highest tertile = 2.9) and with reporting fewer symptoms than expected from concurrent objective markers of illness. These associations were independent of prechallenge virus-specific antibody, virus type, age, sex, education, race, body mass, season, and NES. They were also independent of optimism, extraversion, mastery, self-esteem, purpose, and self-reported health.

CONCLUSIONS:

We replicated the prospective association of PES and colds and PES and biased symptom reporting, extended those results to infection with an influenza virus, and "ruled out" alternative hypotheses. These results indicate that PES may play a more important role in health than previously thought.

More good stuff - fascinating! Thank you Myoak.

Take Care

[Myoak]

Optimistic People Live Longer!

Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women.

https://www.ncbi.nlm.nih.gov/pubmed/15520360

Abstract

BACKGROUND:
Major depression is known to be related to higher cardiovascular mortality. However, epidemiological data regarding dispositional optimism in relation to mortality are scanty.

OBJECTIVE:
To test whether subjects who are optimistic live longer than those who are pessimistic.

PARTICIPANTS:
Elderly subjects aged 65 to 85 years (999 men and women) completed the 30-item validated Dutch Scale of Subjective Well-being for Older Persons, with 5 subscales: health, self-respect, morale, optimism, and contacts. A total of 941 subjects (466 men and 475 women) had complete dispositional optimism data, and these subjects were divided into quartiles

CONCLUSIONS:

Our results provide support for a graded and independent protective relationship between dispositional optimism and all-cause mortality in old age. Prevention of cardiovascular mortality accounted for much of the effect.

You are so welcome KoKo!

[Myoak]

Experience less pain!

Optimism and the experience of pain: benefits of seeing the glass as half full

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935764/

Abstract

There is a strong body of literature that lends support to the health-promoting effects of an optimistic personality disposition, observed across various physical and psychological dimensions. In accordance with this evidence base, it has been suggested that optimism may positively influence the course and experience of pain… emerging experimental and clinical research links optimism to lower pain sensitivity and better adjustment to chronic pain.

This review highlights recent studies that have examined the effects of optimism on the pain experience using samples of individuals with clinically painful conditions as well as healthy samples in laboratory settings. Furthermore, factors such as catastrophizing, hope, acceptance and coping strategies, which are thought to play a role in how optimism exerts its beneficial effects on pain, are also addressed.

Introduction

“… the vast majority of empirical evidence thus far has shown that optimism reliably exerts widespread mental and physical health promoting effects [1–4]. Optimism is an individual difference factor that relates to generalized outcome expectancies… Individuals high in optimism are people who expect positive outcomes to occur in their future. As a consequence, they expect to cope effectively with everyday stress and challenge.

Conversely, individuals who are low in optimism expect negative outcomes in their future and do not expect to cope successfully [reviewed in 5, 7, 8]… previous research which has shown that a high level of optimism is linked to both enhanced physiological recovery and psychosocial adjustment to coronary artery bypass surgery, bone marrow transplant, postpartum depression, traumatic brain injury, Alzheimer’s disease, lung cancer, breast cancer, and failed in vitro fertilization [9*].

Conclusions:

“… As can be gleaned from this review of the literature, multiple studies have since examined the relationship between optimism and pain in clinical and laboratory settings, with the predominant finding being that optimism seems to benefit the pain experience and its course of treatment.”

[gargantua]

Thank you so much for these great resources.

[Myoak]

You are so welcome, Gargantua.

I recently had dinner with a life-long friend, Mike, who has cancer and was given a death sentence soon after diagnosis. That was 12 years ago! As we talked at dinner it was evident that the salient factor he attributed his longevity to was positivity. He consciously decided, he purposefully choose, to take a path of optimism and hopeful expectation for the remainder of his life no matter what his body said or what his doctors said.

Because of Mike's success I decided to look for a scientific basis in what he had done and continues doing. And, low and behold, there is peer-reviewed science behind being optimistic and positive for improving health.

I think it is obvious that optimism improves interaction with social contacts... being positive leads to a happier, more satisfying life for ourselves and others. Be that as it may...

The studies listed in this thread are peer-reviewed science. They are not wishful thinking. They are reality. The reality is that optimism, being positive, improves immune function, decreases chances of getting the flu, adds years to men and women's lives, and decreases pain and more to improve health!

[KoKo]

You are so welcome, Gargantua.

I recently had dinner with a life-long friend, Mike, who has cancer and was given a death sentence soon after diagnosis. That was 12 years ago! As we talked at dinner it was evident that the salient factor he attributed his longevity to was positivity. He consciously decided, he purposefully choose, to take a path of optimism and hopeful expectation for the remainder of his life no matter what his body said or what his doctors said.

Because of Mike's success I decided to look for a scientific basis in what he had done and continues doing. And, low and behold, there is peer-reviewed science behind being optimistic and positive for improving health.

I think it is obvious that optimism improves interaction with social contacts... being positive leads to a happier, more satisfying life for ourselves and others. Be that as it may...

The studies listed in this thread are peer-reviewed science. They are not wishful thinking. They are reality. The reality is that optimism, being positive, improves immune function, decreases chances of getting the flu, adds years to men and women's lives, and decreases pain and more to improve health!

So many of us are willing to try expensive supplements, or certain diets, exercises, etc. hoping for even minor improvements to our health.

What have we got to lose by focusing our mind toward optimism, positivity, calm, etc.,?

I can't see any downside.

Take Care

[Myoak]

So many of us are willing to try expensive supplements, or certain diets, exercises, etc. hoping for even minor improvements to our health.

What have we got to lose by focusing our mind toward optimism, positivity, calm, etc.,?

I can't see any downside.

Wouldn't it be great if we could just take a pill that helps make us more happy and optimistic; which has no downside, is harmless, something that increases endorphins, something which has demonstrated benefit (not cure but benefit) in PPMS and all forms of MS?

WELL, WE CAN! It is called LDN.

KoKo, this one is for you! Yep, you...

A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis

https://pdfs.semanticscholar.org/b59...45feb9d94b.pdf

Low Dose Naltrexone for Normalizing Immune System Function

https://todayspractitioner.com/wp-co...hari_56_65.pdf

Both Dr. Maria Gironi and Dr. Bernard Bihari attributed LDN's effectiveness to increasing endorphins, which as you know make us feel good. It appears that the positive optimism which emanates from having more endorphins improves our health as well as improving our attitude and social function. Dr. J McCandless used LDN in transdermal cream for children with autism and achieved absolutely remarkable success in many.

Please Google, "Update by Dr J McCandless on transdermal LDN/more" if anyone wishes to learn more about the success of LDN cream with autistic children.

Also, There is much additional info in the LDN thread. Drs. Turel, Zagon, McLaughlin, and Smith, all at Peen State have been researching and trialing LDN for decades. They have done amazing work with very limited funding. The NMSS has turned down more than a dozen applications for LDN research that I have direct of knowledge through contact with the researchers making those applications so when the NMSS says they haven't received LDN applications (as they have told me and I saved those emails from them telling me they lacked applications to consider for funding), they are flat out wrong!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!

Yes, there is a harmless pill we can take to make ourselves happier and healthier. Its called LDN.

[marti]

Wouldn't it be great if we could just take a pill that helps make us more happy and optimistic; which has no downside, is harmless, something that increases endorphins, something which has demonstrated benefit (not cure but benefit) in PPMS and all forms of MS?

WELL, WE CAN! It is called LDN.

KoKo, this one is for you! Yep, you...

A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis

https://pdfs.semanticscholar.org/b59...45feb9d94b.pdf

Low Dose Naltrexone for Normalizing Immune System Function

https://todayspractitioner.com/wp-co...hari_56_65.pdf

Both Dr. Maria Gironi and Dr. Bernard Bihari attributed LDN's effectiveness to increasing endorphins, which as you know make us feel good. It appears that the positive optimism which emanates from having more endorphins improves our health as well as improving our attitude and social function. Dr. J McCandless used LDN in transdermal cream for children with autism and achieved absolutely remarkable success in many.

Please Google, "Update by Dr J McCandless on transdermal LDN/more" if anyone wishes to learn more about the success of LDN cream with autistic children.

Also, There is much additional info in the LDN thread. Drs. Turel, Zagon, McLaughlin, and Smith, all at Peen State have been researching and trialing LDN for decades. They have done amazing work with very limited funding. The NMSS has turned down more than a dozen applications for LDN research that I have direct of knowledge through contact with the researchers making those applications so when the NMSS says they haven't received LDN applications (as they have told me and I saved those emails from them telling me they lacked applications to consider for funding), they are flat out wrong!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!

Yes, there is a harmless pill we can take to make ourselves happier and healthier. Its called LDN.

Sounds interesting. Would this help with anxiety? Sometimes I take half a Xanax when I feel myself flying off into a panic and it works well for me. No side effects. But I know doctors are not willing to offer these very much anymore.

[KoKo]

Wouldn't it be great if we could just take a pill that helps make us more happy and optimistic; which has no downside, is harmless, something that increases endorphins, something which has demonstrated benefit (not cure but benefit) in PPMS and all forms of MS?

WELL, WE CAN! It is called LDN.

KoKo, this one is for you! Yep, you...

A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis

https://pdfs.semanticscholar.org/b59...45feb9d94b.pdf

Low Dose Naltrexone for Normalizing Immune System Function

https://todayspractitioner.com/wp-co...hari_56_65.pdf

Both Dr. Maria Gironi and Dr. Bernard Bihari attributed LDN's effectiveness to increasing endorphins, which as you know make us feel good. It appears that the positive optimism which emanates from having more endorphins improves our health as well as improving our attitude and social function. Dr. J McCandless used LDN in transdermal cream for children with autism and achieved absolutely remarkable success in many.

Please Google, "Update by Dr J McCandless on transdermal LDN/more" if anyone wishes to learn more about the success of LDN cream with autistic children.

Also, There is much additional info in the LDN thread. Drs. Turel, Zagon, McLaughlin, and Smith, all at Peen State have been researching and trialing LDN for decades. They have done amazing work with very limited funding. The NMSS has turned down more than a dozen applications for LDN research that I have direct of knowledge through contact with the researchers making those applications so when the NMSS says they haven't received LDN applications (as they have told me and I saved those emails from them telling me they lacked applications to consider for funding), they are flat out wrong!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!

Yes, there is a harmless pill we can take to make ourselves happier and healthier. Its called LDN.

Thanks Myoak.

Several years ago I printed out the Italian study about LDN, and took it to my neuro appointment. He said, at that time, that he follows Cleveland Clinic suggestions, opinions, etc.

The Mellen Center had no opinions on LDN at that point, so I dropped the subject and haven't brought it up since then.

I'll have to check if opinions have changed over time.

Take Care

[Myoak]

Hi Marti,

I don't know if LDN would reduce anxiety by increasing endorphins but it may. Since it is harmless, I don't see the downside to trying it. Unfortunately, many main stream doctors avoid off-label use of meds so you likely would have to see an alternative medicine doctor or secure naltrexone off-shore for LDN. Naltrexone comes in 50 mg tablets which need to be crushed and weighed for LDN. The dose most often used in MS is 3 mg, I believe. It is not difficult to buy naltrexone from an online oversea pharmacy. I believe tens of thousands of people with MS do just that because it is so much less expensive. Small scales are readily available online, also, as are empty capsules. Of course, not everyone wants to do that themselves so an alternative medicine doctor would be a great way to give LDN a try. You may need to search for such a doctor. But thousands have successfully.

KoKo,

No, likely, the opinions of your doctors have not changed. Why? Because there has been no defining research published regarding LDN. Nor will there be because of the cost of large scale human studies.

Naltrexone has been a generic drug for decades so there is no monetary justification for funding research. A large Phase 3 trial with 1,000 people lasting 2 years can cost $50 - $100 million dollars. The total operating revenue of the NMSS for 2017 was $195 million so there is not enough room for a single trial taking over a quarter of total revenue.

The NMSS could fund some of the LDN research applications they receive but they don't. It is inexplicable why they don't in spite of the clear and evident promise LDN has demonstrated in small trials leaving some to speculate the NMSS has doctors on its advisory board looking out for drug company interests rather than disease sufferers. Simply, it is unknown why the NMSS does not fund LDN research. The NMSS provided one grant $30k for a small LDN study many years ago but nothing since to my knowledge.

The largest LDN study was done at Penn State (not Peen State!) but the patients had to pay for the LDN out of their own pocket. I put data from that study in the LDN thread. It is extremely positive, btw, covering 215 MSers seen at Hershey Medical Center from 2005 to 2012.

KoKo, the opinions of your neurologists have not changed, IMO, because there is no new research data on which to base an evolution of opinion. Most of those who try LDN do so by their own efforts.

Understandably, LDN remains outside the purview of most neurologists. Few research dollars will ever be directed at drugs, already generic, which cannot be monetized; no mystery about that.

Therefore, those who try MS have to do it on their own. I fully realize not everyone wants to do that nor is everyone capable of doing that.

I post about it because that is how I learned about LDN and affected my life for the better. Also, there are several MSers I have assisted who are benefitting from it according to their testimony.

LDN is something we usually have to do on our own or with the assistance of an alternative medicine doctor or capable friend. Is it worth the effort? Oh yes!

Read Turel's study of the 215 with MS in the LDN thread. Oh what the heck, I'll just put it right here in my next post.

People can make up their own mind and do whatever they think is best, or choose not do anything at all. Its just something that is there and should be made aware of. Breast cancer victims may want to google, '5 things I do to not get breast cancer back by Dr. Lindsey Berkson'. Taking LDN is one of them.

I'll leave the LDN issue because there is a separate LDN thread by asking one question ... what competent doctor would not try something for a suffering patient with a high probability of being beneficial (or even a moderate probability) knowing that it is harmless?

[Myoak]

Here is the 215 person LDN study I previously referenced broken into paragraphs for readability with sections I highlighted ...

Low Dose Naltrexone for Treatment of Multiple Sclerosis


A Retrospective Chart Review of Safety and Tolerability
LETTER TO THE EDITORS—RESEARCH REPORT

Journal of Clinical Psychopharmacology • Volume 35, Number 5, October 2015 www.psychopharmacology.com 609
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

To the Editors:

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that afflicts 400,000 people in the United States and more than 4 million individuals worldwide. The most common form of MS is relapsing remitting multiple sclerosis (RRMS), characterized by alternating relapses and remissions for a period of 10 to 15 years followed by steadily progressive deterioration transitioning into secondary progressive MS.

Multiple sclerosis is characterized by neurodegeneration of the spinal cord and brain, resulting in a reduction in mobility, reduced quality of life, and increased medical expenditures. Of the Food and Drug Administration approved therapies, many such as interferon beta-1a, interferon beta-1b, glatiramer acetate, and natalizumab require daily or weekly injections, whereas some of the oral medications such as fingolimod have unproven long-term efficacy.

Nearly all of the therapies are costly and have side effects that reduce compliance. There remains an unmet medical need for safe, inexpensive therapies that delay MS progression and improve its clinical course.

A potential alternative or adjunctive therapy for MS is related to knowledge about the endogenous opioid system and its ability to modulate autoimmune diseases using animal models of MS. This novel biological pathway involves an endogenous opioid growth factor, chemically termed methionine enkephalin, and its nuclear-associated receptor, Opioid growth factor receptor.

Modulation of this pathway by exogenous administration of opioid antagonists such as naltrexone (NTX) has been shown to mediate cell replication including T lymphocytes, astrocytes, and other glia that are associated with MS inflammation and degeneration.9 The magnitude and direction of change in cell proliferation is dependent on the duration of opioid receptor blockade.

Low dosages of NTX (LDN), given once daily, block the receptor intermittently and result in inhibited cell replication. The LDN treatment of mice with experimental autoimmune encephalomyelitis (EAE), an animal model of MS, improves the course of progressive EAE. Mice immunized with myelin oligodendrocytic glycoprotein to establish EAE and treated daily with 0.1 mg/kg NTX (LDN) beginning at the time of disease induction show delayed onset of clinical disease and reduced behavioral deficits.

Pathology of the spinal cord from these mice revealed significant reductions in the number of activated astrocytes and area of demyelination. The LDN treatment of mice with established relapsing-remitting EAE revealed that endogenous opioids inhibited progression of the disease as well.

Three clinical trials of LDN in MS have been conducted and report that LDN increases the quality of life of MS patients. Cree et al concluded from a trial of 8 weeks that 4.5 mg LDN daily was a safe therapy that improved quality of life, whereas Sharafaddinzadeh et al reported safety after 17 weeks of treatment and recommended that longer trials be conducted to evaluate efficacy.

Gironi et al studied primary progressive MS patients treated with LDN for 6 months and reported increased endogenous opioid levels in the patients and improved MS. The LDN treatment of patients with other autoimmune diseases including Crohn's disease and fibromyalgia has demonstrated safety and efficacy of the therapy.

A major symptom of MS is fatigue, which is one of the many characteristics that patients seek to alleviate. Improvement in fatigue was cited in these clinical studies after LDN therapy, which suggests that there is a potential link between upregulated endogenous opioid systems and fatigue.

Gironi et al reported elevated β-endorphin levels at 1, 3, and6 months after the onset of treatment, with β-endorphin levels remaining elevated for an additional month after LDN was discontinued. A return to pretreatment levels was not reported.

To determine the safety, tolerability, and effectiveness of LDN on fatigue, a retrospective analysis of MS patients prescribed LDN (3.5 mg orally, once daily) by physicians in the Department of Neurology at The Penn State Hershey Medical Center was undertaken.

The study was approved by the Human Subjects Protection Office of the Penn State College of Medicine and Hershey Medical Center and assigned an Institutional Review Board protocol number. Prescriptions were offered to MS patients who complained of 1 or more of the following: significant fatigue, needle phobia, refusal of injection therapy for other reasons, or refractory to other modes of therapy. Because of the potential of inducing acute withdrawal symptoms, LDN was not prescribed to patients receiving daily chronic opioid medications.

All patients were given the option of receiving LDN with the understanding that medication could be stopped if they experienced side effects. Some patients already receiving disease-modifying therapy (DMT) when started on LDN continued the standard DMT along with adjunctive LDN. Evidence of major drug interactions was monitored but no interactions were reported.

The medical records of 215 MS patients, aged 18 to 65 years, seen in the MS clinic for a 7-year period (January 01, 2005 to May 31, 2012) and prescribed 3.5 mg LDN, orally, once daily, served as the study group.

The LDN was provided by a licensed compounding pharmacy and cost the patients between US $30 to $50 monthly.

Information on LDN safety, tolerance, side effects, reasons for discontinuation, and hospitalizations while taking LDN were evaluated. Study data were collected and managed using REDCap (Research Electronic Data Capture), which is a secure web application designed to support data capture for research studies, providing user friendly web-based case report forms, real time data entry validation, audit trails, and deidentified data export mechanism to common statistical packages.

Information regarding the self-reported potential effect of LDN on MS as collected by the physicians was also collated. The number of documented flares after LDN treatment was initiated was recorded, with a clinical flare defined as the appearance of new symptoms/signs or worsening of old symptoms/signs. Finally, in a retrospective manner, information regarding possible LDN effects on fatigue, quality of life, and the effect on MS was obtained from the patient's visit history and a review of symptoms.

Prescriptions for LDN were provided to 152 female (71%) and 63 male (29%) patients. The female to male ratio was 2.4:1 and more than 3 quarters of all patients had RRMS, a ratio similar to the prevalence cited in the United States. Clinically, 87% of the patients had RRMS and 10% had secondary progressive MS, with a mean disease duration of 10 years.

The mean (SD) duration of exposure to LDN was 817(512) days; the median period of LDN treatment was 804 days. Individuals continuing on LDN for the course of this study were on the drug for a mean (SD) of 1217 (414) days, and a median of 1254 days. Patients (n = 111) who discontinued LDN received the drug for a mean of 526 days and cited insomnia, nightmares, no change in fatigue levels, cost, and recurrence of MS flares as causes to cease taking LDN.Because LDN treatment was not rigorously monitored as for a prospective study, side effects were based on the patients “perceived” and real changes.

Seventy seven percent (n = 166) of patients taking LDN for any period of time did not report any side effects. Six percent of the patients had insomnia, whereas 5% of the patients had excessive dreams. There was no evidence of increased side effects related to other immunomodulators when combined with LDN. No abnormal laboratory results were noted.

Of the 215 patients receiving LDN, 57 patients (26%) were hospitalized during the duration of this study; 48 of these patients were hospitalized for non-MS–related events such as infections. No patient was admitted to the hospital because of side effects of LDN.

Most of the MS patients began LDN therapy because of fatigue. Nearly 60% (n = 128) of patients receiving LDN for any period of time reported a reduction in fatigue with LDN therapy. Fifty of the 215 patients commented that LDN produced no relief from fatigue and 4 patients stated that LDN increased their fatigue levels. Regarding their quality of life and the perception of LDN's effects on MS, 130 patients (60%) stated that LDN stabilized or improved their disease and 75% of the patients reported improved or stabilized quality of life. Nine patients reported that LDN reduced the quality of life, and 8% of the patients had the perception that their disease increased while on LDN but provided no details.

In conclusion, this chart review focused on 215 MS patients who were provided a prescription for oral LDN. The study reports that a significant number of patients found combination therapy of an immunomodulating agent and LDN to be tolerable and possibly beneficial. Some patients preferred to take LDN as a monotherapy. The LDN did not cause any unexpected side effects, and those reported were previously noted in the literature.

The LDN did not potentiate the side effects of the immunomodulating therapies that the patients were receiving. Any hospitalizations in this study were related to reasons other than MS, and there were no hospitalizations due to LDN.

Some limitations of this study are inherent in a retrospective chart review and include dependence on patient recollection and perception, the inability to determine specific indications for LDN, reasons for discontinuation, and proportion of patients who declined LDN because insurance did not pay for the treatment. Interactions between DMT and LDN were not elaborated, and a comparison with standard fatigue treatments such as amantadine or modafinil was not assessed.

Future studies comparing magnetic resonance imaging data before the onset of LDN therapy and periodically performed as standard of care will provide an assessment of the efficacy of daily LDN therapy. However, data from this retrospective study support future prospective double-blind investigations comparing a combination of LDN plus DMT and DMT alone.

ACKNOWLEDGMENT
The authors thank Marcus Magister, MD, Class of 2015, Penn State University College of Medicine, for the assistance in chart review, data acquisition, and data entry into REDCap.
AUTHOR DISCLOSURE
INFORMATION
Dr Zagon and Dr McLaughlin were supported in part by The Shockey Family Foundation.
None of the authors have disclosures.
Anthony P. Turel, MD Department of Neurology The Penn State University College of Medicine Hershey, PA
Keun Hee Oh, BS Ian S. Zagon, PhD Department of Neural and Behavioral Sciences The Penn State University College of Medicine Hershey, PA
Patricia J. McLaughlin, MS, DEd Department of Neural and Behavioral Sciences The Penn State University College of Medicine Hershey, PA
Pxm9@psu.edu

[REG53]

I for one believe optimism helps improve health but only with Gods help am I able to be optimistic and even then it can be hard at times.

A few years ago I ask my neuro about taking LDN and he said it would be a waste of time. I don't know if his opinion has change.


Thank you Myoak for all the infor.