Chris Kresser: Sure. I just want to clarify: I’m not a physician. This comes from my reading of the research and also my experience with being in a clinic with other clinicians who are prescribing this regularly and also, before that, working closely with other doctors in the community, referring patients to them and kind of comanaging patients on LDN. That’s where this experience comes from.
Most practitioners that work with LDN and most of the research suggests that starting at a low dose of maybe 1.25 to 1.5 milligrams is the best option for most people. If you have a patient that is hypersensitive and they always react to stuff, even starting lower at 1 milligram might be a good idea. The way that you would titrate upwards is you generally would wait until any initial side effects have passed. The most common side effects would be sleep disturbance, but also headache, we’ve found, is another fairly typical side effect. You wait maybe three to five days after that side effect has passed or mostly resolved, and then you go up the next dose increment. You would usually increase people by 1 to 1.5 milligrams at a time, depending on how sensitive they are. So if they were at 1.5, they could go straight to 3 if they had a relatively easy time with 1.5. Or if you started them at 1 and they’re sensitive and it was really hard for them to get started, then you could just go from that to 2 milligrams. I would suggest that unless the patient is just really struggling and it’s clear that they can’t increase the dose above a certain range, then going all the way up to 4.5 milligrams and trying that for at least a period of time because most of the research we have on LDN was done at that 4.5 milligram dose. I think it’s good to at least try that, but what we’ve found is that probably only about 30 percent of patients can tolerate that amount. The remaining 60 percent or 65 percent need a dose that is lower than that. I would say, on average, it ends up being around 3 milligrams, but sometimes lower, 2.5. I haven’t seen doses below 2 be super-effective, so I would say generally 2 to 3.5 milligrams is the sweet spot. Some people need a little bit more, and some people and some studies have actually used more than 4.5. They’ve gone up to 5 or even a little bit more than 5, but there’s not a lot of research on that, and I’m having a hard time thinking of any patients we’ve had that didn’t benefit at 4.5 but benefitted significantly more at 5. That’s kind of the general range.