Low Dose Naltrexone (LDN) for Lyme Disease:An Integrative Medicine Functional Medicine Perspective
- John Kim
- Jan 2
- 9 min read
Low Dose Naltrexone (LDN) for Lyme Disease:
An Integrative Medicine Perspective
Yoon Hang "John" Kim, MD, MPH
Board-Certified Integrative Medicine Physician
Direct Integrative Care
Keywords: Low Dose Naltrexone, LDN, Lyme Disease, Post-Treatment Lyme Disease Syndrome, Integrative Medicine, Functional Medicine, Chronic Inflammation, Immunomodulation
About the Author
Dr. Yoon Hang "John" Kim, residential fellowship trained in integrative medicine at University of Arizona and a recipient of the 2024 Functional Medicine for All scholarship from the Institute for Functional Medicine, brings over 20 years of experience in integrative and functional medicine to his telemedicine practice. After serving as chief wellness officer at a community hospital in Carthage, IL, where he provided care to rural and underserved populations, Dr. Kim now offers virtual integrative and functional medicine services, making personalized, evidence-based care accessible to patients regardless of location. His approach combines functional medicine lab testing with complementary therapies such as meditation, yoga, tai chi, and lifestyle interventions using food and physical activity as medicine, addressing the root causes of disease. Dr. Kim earned his medical degree from the Medical College of Wisconsin, completed a master’s in public health at San Diego State University, and trained with Dr. Andrew Weil during his residential fellowship at the University of Arizona. Certified by the American Board of Preventive Medicine, the American Board of Medical Acupuncture, and the American Board of Integrative and Holistic Medicine, he has also contributed to the field as a faculty member, consultant, and founder of the Integrative Health Studies Certificate program at the University of West Georgia. With clinical interests in autoimmune conditions, chronic pain, integrative oncology, and gastrointestinal disorders, Dr. Kim specializes in treating complex conditions such as fibromyalgia, chronic fatigue syndrome, long COVID symptoms, and toxic mold illness, and has authored two books and over 20 articles while helping establish integrative medicine practices across various institutions.
Professional Inquiries: www.yoonhangkim.com
Clinical Inquiries: www.directintegrativecare.com
Why I Started Using LDN for My Lyme Patients
If you're reading this, chances are you or someone you love is struggling with Lyme disease—and you're searching for answers beyond the conventional playbook. I get it. After two decades of practicing integrative medicine and seeing thousands of patients with complex chronic illness, I've learned that Lyme rarely plays by the rules.
Here's what frustrates me: Lyme disease is now the most common vector-borne illness in North America, yet so many patients feel abandoned by the healthcare system. They get their round of antibiotics, and when symptoms persist—the crushing fatigue, the brain fog, the joint pain that just won't quit—they're often told it's "all in their head." It's not. And that's exactly why I turned to LDN as part of my functional medicine approach.
Low Dose Naltrexone, or LDN, has become one of my go-to tools for patients dealing with the aftermath of Lyme. It's not a magic bullet—nothing is—but for the right patient, it can be a game-changer. Let me walk you through what we know, what we're still learning, and how I use it in my integrative medicine practice.
First, Let's Talk About What We're Really Dealing With
Lyme disease starts simply enough: a tick bite, often unnoticed, delivers Borrelia burgdorferi bacteria into your system. If you're lucky, you spot that classic bull's-eye rash—the erythema migrans that practically screams "Lyme!" You get treated early, and you're fine.
But here's the reality I see in my practice: many of my Lyme patients never saw a rash. Or they did see it, got antibiotics, and still ended up sick months later. Research from Johns Hopkins tells us that roughly 10-20% of properly treated Lyme patients develop what we call Post-Treatment Lyme Disease Syndrome, or PTLDS (1,2). That's a lot of people left suffering.
These folks aren't making it up. They're dealing with real, measurable inflammation. Studies show elevated cytokines like IL-6, TNF-alpha, and IL-23 in PTLDS patients (5,6). Their immune systems are stuck in overdrive, and that's where functional medicine—and LDN—can really shine.
So What Exactly is LDN?
Here's where it gets interesting. Naltrexone has been around since the 1980s as a treatment for opioid and alcohol addiction—at doses of 50-100mg. But back in 1985, a brilliant physician named Dr. Bernard Bihari discovered something unexpected: at much lower doses (we're talking 0.1-4.5mg), naltrexone does something completely different. Instead of just blocking opioid receptors, it actually helps regulate the immune system (9).
Think of it this way: when you take LDN at bedtime, it briefly blocks your opioid receptors for about 4-6 hours. Your body responds by ramping up production of endorphins—your natural feel-good, immune-regulating molecules. By morning, you've got more endorphins on board, and your immune system has gotten a gentle nudge toward balance (10).
This is exactly the kind of approach we embrace in integrative medicine: working with your body's own healing mechanisms rather than against them.
How LDN Actually Helps Lyme Patients
When I explain LDN to my Lyme patients, I focus on four key mechanisms. Understanding these helps you appreciate why this humble medication can make such a difference.
It Calms Down Overactive Immune Signaling
One of the most exciting discoveries about LDN is its ability to quiet down something called Toll-Like Receptor 4, or TLR4. This receptor is like an alarm system on your immune cells—helpful when there's a real threat, but problematic when it won't stop ringing. In chronic Lyme, that alarm often stays stuck in the "on" position, pumping out inflammatory signals. LDN helps turn down the volume (11,12).
It Addresses Brain Inflammation
If you've got "Lyme brain"—that awful fog where you can't find words or remember why you walked into a room—this one's for you. LDN modulates microglial cells, the immune cells in your brain. It helps shift them from an angry, inflammatory state to a calmer, more supportive one (13,14). Many of my patients notice improved mental clarity within weeks of starting LDN.
It Rebalances Your Immune System
Chronic Lyme often throws the immune system out of whack—too much activity in some areas, not enough in others. In functional medicine terms, we see imbalances in Th1/Th2 responses and overactive Th17 pathways. LDN helps restore equilibrium, which is exactly what we're aiming for when we take an integrative medicine approach to complex illness (15).
It Boosts Your Body's Natural Painkillers
Remember that endorphin boost I mentioned? That translates to real-world pain relief for many patients. Unlike conventional pain medications that can create dependency and have significant side effects, LDN works by enhancing what your body already produces (16).
What Does the Research Actually Show?
I'll be honest with you—and this is important if you're doing your own research—we don't yet have randomized controlled trials specifically looking at LDN for Lyme disease. What we do have is compelling clinical experience and solid evidence from related conditions.
Dr. Richard Horowitz, who's treated over 12,000 Lyme patients, shared his experience at the 2012 Integrative Healthcare Symposium. In his practice, about 75% of Lyme patients experienced meaningful improvement in fatigue, muscle pain, and joint discomfort when taking LDN (17). That's a remarkable response rate for a medication with such a favorable safety profile.
We also have good data from fibromyalgia, which shares many features with chronic Lyme. A Stanford University trial found that LDN reduced pain by nearly 29% compared to 18% with placebo—and half the patients were rated as "much improved" or "very much improved" (18). A 2024 meta-analysis confirmed these findings across multiple trials (19).
For me as a functional medicine practitioner, this evidence—combined with what I see every day in my practice—makes LDN a valuable tool in managing chronic Lyme.
How I Use LDN in My Integrative Medicine Practice
Choosing the Right Patients
Not everyone with Lyme needs LDN, and it's not my first-line treatment for acute infection. Where LDN really shines is for patients who've completed appropriate antibiotic therapy but still feel lousy, folks struggling with persistent fatigue, brain fog, and widespread pain, patients with signs of immune dysregulation or autoimmune features, and those who want to reduce their reliance on conventional pain medications.
Starting Low and Going Slow
Since LDN isn't available commercially in low doses, you'll need a compounding pharmacy. I typically start patients at just 0.5-1mg at bedtime and increase by 0.5mg every week or two. Most people end up somewhere between 3-4.5mg. This gradual approach minimizes side effects and helps us find your sweet spot (21).
If you experience vivid dreams or trouble sleeping—the most common early side effects—we can switch to morning dosing. These issues usually fade within a few weeks.
The Bigger Picture: A Functional Medicine Approach
Here's something I tell every Lyme patient: LDN is a tool, not a complete solution. True healing from chronic Lyme requires addressing the whole picture. In my integrative medicine practice, that means looking at your diet (anti-inflammatory eating is crucial), supporting detoxification pathways, addressing any co-infections, optimizing sleep, managing stress, and supporting mitochondrial function.
Dr. Horowitz calls this the "16-point map" approach, and it resonates deeply with how we practice functional medicine. You can't just treat one piece of the puzzle and expect everything to fall into place (23).
A Few Important Cautions
I want to be straight with you about the limitations. We need more research—specifically, randomized trials in Lyme patients. While the evidence from clinical experience and related conditions is encouraging, it's not the same as having definitive proof.
Also, not everyone responds to LDN. In my experience, about 60-75% of patients see meaningful benefit. For the others, we need to keep exploring different approaches.
And critically: if you're currently taking opioid medications, you cannot start LDN without an appropriate washout period. LDN will precipitate withdrawal, which is dangerous and extremely unpleasant. Always work with a knowledgeable healthcare provider (22).
The Bottom Line
After twenty years of practicing integrative medicine and specializing in LDN therapy, I've seen this medication change lives for many Lyme patients. It's safe, it's affordable (typically $30-50 per month from a compounding pharmacy), and it works with your body's own healing mechanisms.
Is it right for everyone? No. Is it a standalone cure? Absolutely not. But as part of a comprehensive functional medicine approach to chronic Lyme, LDN deserves serious consideration—especially for those who've tried everything else without success.
If you're struggling with persistent Lyme symptoms and wondering whether LDN might help, I encourage you to find an integrative medicine practitioner who understands both Lyme disease and LDN therapy. You deserve a partner who will look at the whole picture and work with you toward real healing.
That's what functional medicine is all about—and that's why I love what I do.
At Direct Integrative Care, Dr. Kim is dedicated to guiding you on your path to wellness through a deeply personalized and supportive approach. We focus on integrative medicine, looking beyond symptoms to uncover the root causes of chronic conditions and develop a treatment plan tailored specifically to your unique health journey. By combining compassionate care with innovative therapies, our goal is to empower you with the knowledge and tools needed to achieve lasting health. We invite you to explore our website to learn more about how our patient-centered practice can help you find balance and vitality.
Yoon Hang Kim MD
Integrative & Functional Medicine Physician
Virtual Practice Serving IA, IL, MO, FL, GA, and TX
References
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17. 2012 Integrative Healthcare Symposium: Treating the Pain of Lyme Disease. P T. 2012;37(4):247-249.
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21. Elsegood L. The LDN Book. Chelsea Green Publishing; 2016.
22. Li Z, You Y, Griffin N, et al. Low-dose naltrexone (LDN): A promising treatment in immune-related diseases. Int Immunopharmacol. 2018;61:178-184.
23. Horowitz RI. Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease. St. Martin's Press; 2013.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Low-dose naltrexone is not FDA-approved for Lyme disease. Always consult with a qualified healthcare provider before starting any new treatment.
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