Hi Friend
For many in the hEDS, MCAS, and ME/CFS community, the standard medical experience feels like being stuck in a "Biological Stalemate." You are told your bloodwork is "normal," yet your nervous system is in a constant state of high alert, and your pain feels like it’s being broadcast at maximum volume.
Standard care often fails because it treats symptoms in silos. At MEND Clinic, we look for the drivers: neuro-inflammation, immune dysregulation, and synaptic "stuckness."
Today, we are exploring three "frontier" treatments that are changing the landscape for complex chronic illness. These aren't just "new pills"; they are tools to fundamentally shift the state of your nervous and immune systems.
1. Low Dose Naltrexone (LDN): Calming the Brain’s "Security Guards"
LDN is the "Gold Standard" of repurposed medications in our community. While standard-dose Naltrexone (50mg+) blocks opioid receptors to treat addiction, Low Dose Naltrexone (0.5mg – 4.5mg) does something entirely different: it performs a "rebound effect" on your immune system.
The Science of Microglia: In conditions like Fibromyalgia and ME/CFS, the Microglia (the brain’s resident immune cells) become "primed." They act like angry security guards, constantly pumping out pro-inflammatory cytokines that cause brain fog, fatigue, and widespread pain. LDN acts as a Glial Cell Stabiliser, effectively turning the "dimmer switch" down on this neuro-inflammation.
The Endorphin Boost: By briefly blocking opioid receptors for a few hours at night, LDN tricks the body into producing a surge of natural endorphins and enkephalins. This helps "upregulate" your own internal pain-relief system.
The MEND Perspective: LDN is a marathon, not a sprint. We find it works best when paired with our "Calming the Alarm" neuroplasticity work. It provides the biochemical "quiet" necessary for the brain to start learning new patterns of safety.
2. GLP-1 Agonists: The New Frontier in Mast Cell Stability?
You’ve seen GLP-1s (like Mounjaro or Ozempic) in the news for weight loss, but for the chronic illness community, the real story is Systemic Anti-Inflammation.
Beyond the Gut: GLP-1 receptors aren't just in your digestive tract; they are found throughout the nervous system and on the surface of immune cells. Recent research suggests that GLP-1 agonists can significantly reduce Cytokine Storms and systemic oxidative stress.
The MCAS Connection: Emerging clinical observations suggest that GLP-1s may help stabilise mast cells. For our patients who feel like they are "allergic to the world," reducing the systemic inflammatory load can sometimes help lower the reactivity of the mast cells themselves.
Metabolic Recovery: Many with ME/CFS suffer from "metabolic gridlock," where cells cannot efficiently process energy. GLP-1s may help optimise how the mitochondria use fuel, potentially widening the "energy envelope."
The MEND Perspective: We monitor the research here closely. For a patient with hEDS/POTS and high systemic inflammation, a GLP-1 may act as a systemic "fire extinguisher," allowing other therapies to finally take hold.
3. IV Ketamine: Breaking the "Pain Loops"
If your nervous system is a computer that has "frozen," IV Ketamine is the "Hard Reset." This only for severe refractory cases.
Blocking NMDA Receptors: In chronic pain (Central Sensitisation), the brain becomes too efficient at feeling pain. The NMDA receptors in the spinal cord and brain become over-active, amplifying every sensation. Ketamine blocks these receptors, providing an immediate break in the pain signal.
Synaptogenesis (The Re-Wiring): The most exciting part of Ketamine therapy is its ability to trigger the growth of new neural connections (synapses). It increases BDNF (Brain-Derived Neurotrophic Factor), which is essentially "Miracle-Gro" for the brain.
The MEND Perspective: We view IV Ketamine as a Window of Opportunity. It provides a temporary 2–4 week period where pain is reduced and the brain is "plastic." This is the perfect time to engage in the 16-Week Nervous System Roadmap. It is not just about the infusion; it is about what you do with the "quiet" that follows. This always requires input from our in house medical psychiatry team to ensure safety and suitability
Important safety informtation
Low Dose Naltrexone (LDN)
LDN carries potential risks and is not suitable for everyone. Side effects may include vivid dreams, insomnia, headaches, nausea, and fatigue (usually temporary). LDN is contraindicated in patients taking opioid medications (including codeine, tramadol, morphine), those with acute hepatitis or liver failure, and pregnant or breastfeeding women. It may interfere with opioid-containing medications for up to 72 hours. Caution is needed in autoimmune conditions requiring immunosuppression. LDN therapy must always be prescribed and monitored by a qualified doctor who can assess your medication interactions, monitor for adverse effects, and adjust treatment accordingly. Never use LDN without proper medical supervision.
GLP-1 Receptor Agonists
GLP-1 medications carry potential risks and are not suitable for everyone. Side effects may include nausea, vomiting, diarrhoea, constipation, and reduced appetite. Serious risks include pancreatitis, gallbladder disease, kidney problems, and thyroid tumours (rare). These medications are contraindicated in patients with a history of medullary thyroid cancer, MEN2 syndrome, severe gastroparesis, or active eating disorders. Risk of hypoglycaemia increases when combined with other diabetes medications. GLP-1 therapy must always be prescribed and monitored by a qualified doctor who can assess your individual risk factors, monitor for complications, and adjust treatment accordingly. Never use GLP-1 medications without proper medical supervision.
Intravenous Ketamine
IV ketamine carries significant risks and is not suitable for everyone. Side effects may include dissociation, anxiety, increased blood pressure and heart rate, nausea, dizziness, and confusion. Serious risks include bladder toxicity (with repeated use), liver damage, cardiovascular complications, psychological distress, and potential for misuse or dependence. Ketamine is contraindicated in patients with uncontrolled hypertension, severe cardiovascular disease, active psychosis, or history of substance abuse. It may trigger psychiatric symptoms in vulnerable individuals. IV ketamine must only be administered in a controlled medical setting by qualified healthcare professionals who can monitor vital signs, manage adverse reactions, provide psychological support, and ensure proper dosing protocols. This treatment requires comprehensive screening, informed consent, and ongoing medical supervision. Never use ketamine outside of approved medical settings.
Why the "Care Team" Model is Non-Negotiable 🤝
Because our community is so biologically sensitive, these treatments cannot be "ordered online" or managed by a generalist. This is why MEND Clinic is built around a specialised team:
The Specialist Doctor: To ensure these medications don't conflict with your POTS or CCI (Craniocervical Instability) management.
The Clinical Pharmacist: To navigate compounding. Many MCAS patients react to the fillers (lactose, dyes, starches) in standard pills. Our pharmacist ensures your LDN or GLP-1 protocol is "MCAS-safe."
The Patient Advocate: To help you track your data and symptoms so we can pivot your protocol in real-time.
1-1 consults with me are still open, book here
Stay Well
Dr Ahmed
Medical Disclaimer: This newsletter is for informational and educational purposes only. It is not a substitute for professional medical advice. Low Dose Naltrexone (LDN), GLP-1 agonists, and Ketamine are prescription medications that carry significant risks and potential side effects. Always consult your physician before starting or changing any medication or treatment plan. MEND Clinic does not provide medical advice or prescriptions via email or newsletter.
