130 - Dr Marco Leitzke - Using Nicotine Patches for Long Covid

Episode 130 of the Long Covid Podcast is a chat with Dr Marco Leitzke who has been exploring the use of Nicotine Patches to help with Long Covid. We discuss what Nicotine is, why it can help and how this could be something incredibly useful.

Links to Dr Marco's work & social media etc: https://linktr.ee/marcoleitzke

A blog written on "Health Rising" https://www.healthrising.org/blog/2023/12/07/nicotine-patch-long-covid-chronic-fatigue-fibromyalgia/

For more information about Long Covid Breathing, their courses, workshops & other shorter sessions, please check out this link

(music - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello, and welcome to this episode of the long COVID Podcast. I am super excited today to be joined by Dr. Marko Leitzke. And we are going to be talking about the nicotine test and how this might be helpful with long COVID. And what it actually means. So a very warm welcome to the podcast today. 

Marco Leitzke  
Hello!

Jackie Baxter  
So yeah, thank you so much for joining me today. Would you be able to just say a little bit more about yourself and what it is that you do? 

Marco Leitzke  
Basically, I'm a normal consultant working in hospital dealing with intensive care and narcotics actually. And my research field is basically septicaemia which means critically ill patients. ICU wards. And yes, I came along the specialty of acute COVID infections. And we saw along the pandemic phases, terrible and horrible scenes and very critically ill patients. And that's how I came across researching for acute COVID. And by the way, I found out that very, very much similarities, acute COVID and septicaemia or sepsis.

Jackie Baxter  
So you were seeing acute COVID in your day to day?

Marco Leitzke  
like any ICU worker did.

Jackie Baxter  
Yes. So what brought you from there into the long COVID world?

Marco Leitzke  
The clinical picture is quite comparable from critically or severe cases of COVID-19, with ventilation with organ damage, with fatality in lots of cases. Yes, the time before SArs Cov two, I was researching for septicaemia, or critically ill situations and I came across nicotinic acetylcholine receptors, which is my specialty. And yes, the link was quite... was not so far to go this step.

Jackie Baxter  
So you were seeing the sort of commonalities between the two? 

Marco Leitzke  
Yes, yes. 

Jackie Baxter  
So I'm really excited to kind of talk all about what you've been doing. But before we do that, are you able to kind of talk a little bit about what is nicotine? What are these receptors that you just mentioned? What does that actually sort of mean in terms of the body?

Marco Leitzke  
I'll start with the receptors. Our autonomic nervous system, especially the vaga or recovery part, we have the sympathetic nervous and when we have a vagus fraction. And the vagus fraction is mainly operated by acetylcholine receptors and we have muscarinic receptors and nicotinic receptors. They are called that because the one fraction reacts to muscarine which is a poison of have several animals I guess. And the other fraction is called the nicotinic receptors. It's called that way because it reacts to nicotine and nicotine is a very strong agonist, substance working very strong due to this receptors. 

And especially these nicotinic receptors have a special meaning and nicotine is actually so called alkaloid that means substance which is produced by plants, actually to protect them from insects. And the problem of nicotine is that it has gotten a very bad reputation due to smoking. And I want to make clear that nicotine and smoking are two very different things. 

So if you smoke cigarettes, you inhale about 8000 poisons, which are all prone to make you very sick. And especially the substance nicotine which is the main substance of course, on every smoking, cigars, cigarettes, or pipes. The only problem of nicotine is that it makes addictive and that's the reason why so much people inhale 8000 poisons to get satisfied from the addiction. 

But the way we applicate nicotine, that means transdermal with patches, is proven to be not addictive. And for that reason I think that this Alkaloid is a very very potential medical substance which is, has been prevented from use for years and years, actually, we could have been far better developed procedures to use this substance, just because of the bad reputation we just avoid to use nicotine, which is a pity.

Jackie Baxter  
Yeah, and that is interesting because as you say, most people will associate nicotine with cigarettes and therefore, with bad health, with addiction with, you know, things that we don't really want for our health. So it's really interesting that actually, nicotine itself doesn't have to be associated with that. You said that nicotine in the way that you're using it isn't addictive. Do you know why? Why it's not addictive in that form?

Marco Leitzke  
I'll try to explain it. If you inhale from a cigarette, the substances you inhale getting through your lungs, in the so called pulmunary vessels, which means that they are within six to 10 seconds up to your brain, which releases a lot of dopamine in your vagal ventral tegmental area and the nucleus accumbens, which are two areas which are addiction related, especially to dopamine release. 

And if you apply the substance via the skin, it went through your venous system, not the pulmonary vessels, but the venous system with the rise within the blood. The concentration within blood rises very slowly, which gives the body the chance first, to, for instance, secretes so called monoamine oxidase, which are substances to reduce dopamine for instance, and which releases dopamine very, very slowly, which is not able to provoke addictiveness. That's why patches are used to prevent smoking, they are actually fighters against addiction.

Jackie Baxter  
Right? So it's to do with the slower release. Yes,

Marco Leitzke  
yes. And the other route, the route is, especially as - if you inhaled something, it is up to your brain and add to your arterial blood flow within seconds. And if you give it via transdermal pathway, it takes up to one minute. So that's the great difference. And it goes not directly to your brain, but via the liver. That means liver means always it is cannibalized. So it's a completely different kind of given. So you can compare it with intravenous injection and pastel.

Jackie Baxter  
It's fascinating and like, the dosage, for want of a better word, how does the dosage of the patch compare to smoking a couple of cigarettes for example?

Marco Leitzke  
the thing is that if you look around, you will find only extreme small minority among LC or long COVID patients, which are smokers. So, they are all nicotine naive, the patients which are suffering. So, that dosage, you cannot compare to smoking cigarettes, or you even cannot compare one long COVID patient with the other because some are very sensitive to any substance, and the others can do without problems greater dosages. 

So, my advice for now is that we should use the smallest dosages on nicotine patches which are available which is actually about seven or 7.5 milligrams per 24 hours. And these should be divided, not by cutting but by covering, this is important because the matrix which is providing the slow release of the substance and if you cut the patch, you will destroy the matrix and so you don't have the ability to control the dosage per time. 

So, I actually advise to use first line a quarter or half of the lowest dosage, that means 1.75 or 3.5 milligrams for 24 hours and is to become habituated for three up to five days and then to go up. 

So the question I am asked very often is, should I enlarge the dose if I don't feel a real improvement? And my opinion is that it's rather a question of time than a question of dosage. So you should avoid to. I know the feeling of a lot of people which are suffering for years and years and years. And any expert is helplessly looking and say I can't help you. So they want to get rid of the problem as soon as possible. 

But it's more long term rather than a sprint for that reason, I think you should avoid overdose. It's because nicotine is a very, very effective substance. And overdose, it just doesn't feel right, very comfortable. For that reason, I think it's better to use the patches at the seven milligram in brackets, up to 14 milligrams some cases for longer time, than to use it for shorter time with up to 21 milligrams, that is not advisable.

Jackie Baxter  
Yeah, I mean, that totally makes sense. I know we see that with with all sorts of things, you know, everybody is different. As a starting point,

Marco Leitzke  
I want to say you must imagine that your your body has 10 billion cells, around 10 billion cells. And this is proven any cell, each cell has such acetylcholine receptors and up to 12,000 per cell. That means 12,000 receptors per 10 billion cells means any of these receptors could be blocked. So you can imagine, if you take this substance for one day, or for what time could have been necessary to get rid of the whole problem. So try to consider rather long time for getting rid of the problem. 

But I'm quite convinced that this is the approach which will solve the problem. This is because Jean-Pierre Changeux from the Sorbonne in Paris, which is the worldwide most accepted institution - your receptor Pope, if one wants to call it like that. And he found out that there is a similarity in the RNA sequence of the spike protein, similiarities is in comparison to [unknown word] poisons which are corpratoxin, or Bucaro toxin, for instance. So these poisons are due to their affinity to the receptors, very effective poisons. And this similarity mimics blocking effects of these poisons. So that's the theory behind it. 

And because nicotine is known as a very fast, it's very high affinity to these receptors. My hypothesis was that it was possible that nicotine could compete with a virus for the binding site of the receptors. And if you hear competition, means that it's not another 01 relationship, it's more likely a question of time. But nicotine has a 30 fold higher FMT compared to acetylcholine into these receptors. So the possibility to dislodge the virus protein from the receptors is quite high. That's the reason for this theory or this hypothesis. 

And if you look around, I mean, for now, we have, I don't know how much people are using the patches, but it's worldwide. And ten thousands, really a lot of people, which basically shows how great the problem is to mankind at the moment. 

And we see a lot of improvements, not straight ahead, as we see people with these strong effects. And we see people with non effects. But in the majority, a lot of people feel improvements. It's kind of undulating in some cases. But as I said, we have 10 billion cells and we have per cell a huge amount of receptors. So times the matter I think,

Jackie Baxter  
yeah, I mean, that does make sense that you know, it will take time. I mean, that's the same with everything in life, isn't it generally, but certainly with everything that people are talking about with long COVID. You know, it's kind of that slow burn of improvement, whatever it is that someone tries, whether it's nicotine or breathing which is my wheelhouse, or anything else that they try, you know, you notice that improvement a little bit, a little bit and then you get a dip, but then you know that improvement, you know? So it's it does take time. 

So you're talking about the receptors and the nicotine competing with the virus for these receptors. So this is playing into the viral persistence theory, is it? That there's virus and stuff still in the body? And that this is going to help to clear that? Is that the theory? 

Marco Leitzke  
Yes. Actually, you must, must imagine that the virus is actually nothing more but RNA or DNA stripe. Virus doesn't have any life signs, no friends or enemies. A virus is just DNA stripe. And in the way of long COVID, that's the reason why the long COVID people aren't high infectious or critically ill and often not even recognizable as acute ill persons, which makes the problem even larger. 

Because within the receptors, the virus does nothing but block the receptors. It doesn't make any chemical reaction or any biological impact, it's just blocks the receptors. The problem is that any cell of your body is regulated by these receptors. So if, for instance, the thrombocytes are regulated, the erythrocytes are the regulated, all your nerve cells are regulated by these receptors. 

Imagine a boat with a company of 10 billion sailors, it's of extreme importance that each of the sailors knows what's going on at the moment. So the effectiveness of your body is extremely, extremely dependent of the togetherness of all the cells that makes our body working. And if only a little fraction, let's say 10%, or 20%, is out of the information, out of the whole body's togetherness, your body goes in a very, very strange way wrong. 

And because any receptor can be blocked, this means the wide symptomatology of the long COVID. That's why anybody said but we have perfusion problems or we have chest problems, we have fatigue problems, we have nerval problems we have... Any specialist says could be antibodies. Yes, we have antibodies because the B lymphocytes are innovated by acetylcholine receptors, by nicotinic acetylcholine receptors, which control the production of antibodies, even auto antibodies. 

So anything in connection to long COVID could be explained by this receptor hypothesis. That's the reason why I think it's very well to go on, especially for the fact that nicotine patches are very affordable, compared to hyperbaric oxygenation to whatever - I mean, we have 75 million people suffering worldwide was half a year ago, I think it's more right now. 

How should this problem be solved with hyperbaric chambers to all the people? Or plasmapheresis, which is extremely expensive, and doesn't bring anything more than three or five days better improvement. So my opinion is, it's very worth to look, even if it's just with a penetration of 30% effectiveness, it's very worth to go that way and to try it.

Jackie Baxter  
Yeah, interesting. And, I mean, what you just said at the end, you know, when you are ill, and you've been ill for a long time, and you have all of these symptoms, and you can't do anything in your life that you want to do. And you don't really see any way of getting better, you start to look outside the box. And you know, that's when people will start thinking, well my doctor can't help me, even if you find a doctor that is, you know, empathetic, the GPs aren't mostly very good at actually finding anything that helps, because it's not their specialty. 

So people are kind of going and finding other things. And that's what I did, and that was how I recovered. But, you know, it's like if you can find something that helps a little bit, you know, if you can get 1%. If you get 10%, then maybe that means you can then find something else that will give you another 10%. So I think you know, that's why it's really worth looking at things that help a bit, because especially if they are things that already exist. 

And as you say, you know, nicotine patches are relatively affordable and available literally everywhere. Like you can walk into like a supermarket or a chemist and get one and try it out. And if it helps, great, and if it doesn't, then okay. 

So I suppose what the next question would be is, Is this safe for anybody to try? Or are there any risks or any kind of guidelines that you would suggest? 

Marco Leitzke  
I've been dealing with this substance now for quite a long time, especially in relationship to long COVID. I didn't expect this huge tsunami like wave response. And what I can say, first of all, the most used misbelief to nicotine is that is vasoconstrictive, that means it reduces your perfusion. This is not right, this is wrong, it's the opposite, because nicotine enhances the interest in nitrogen oxygen concentration within the endothelial cells, which means nitrogen oxygen is responsible for vasodilatation. It's of importance. 

That means official speaking, is that nicotine is I guess, it was in 2013 that NICE which means the National Institute for Health and Care Excellence for the United Kingdom said that the transdermal use of nicotine over a time for five years without any health risks. So, this is important to know. So, this is what, I mean a major national health institution, stated by the experience of millions of people. I think this is something which could be seen as fact. 

The other things is, nicotine is often said to be cancerogenic. This is reduced to the fact that nicotine is not a cancerogene first, but it may have co-cancer-genic actions. So that means if you are exposed to cancerogenic substance, nicotine might be able to enlarge this effective carcinogenic factors. This is still not proven, but this is the way people who are scientific seems are trying to reduce something which is self proclaimed for years and years. 

I just don't want to say nicotine is just like chewing gum, no, of course not. But I think if you are in a situation, I mean, we have MECFS patients which are suffering from 20 to 35 years, and even longer and are housebound for this time. So one must consider which intervention might make me - we have considerations which are saying long term suffering from Long COVID or MECFS in terms of life quality harder than cancer. 

So we must get one step aside and think it over. Even if there was a little little proportional, a little possibility that nicotine might have some bad effects - even if - I didn't say it has, but even if it had, one must think if it was effective substance against MECFS, I would at least consider if the substance is worth to try it, especially if I know I don't use it for years right now, but for I don't know, for up to five weeks, or I saw people with up to six months. This is a question which just has to be solved within the next half or a year I don't know. 

But yes, the substance could, is even advised, not by me, but by official institutions to be usable for patients with stable angina pectoris. So this is a point, so if somebody is suffering from cardiac circulatory disease, it could be used by people for other reasons. So especially if you are a smoker and you want to cessate, or but if you are suffering as well from cardiac disease, you can use it very safely because it doesn't harm, or doesn't doesn't enlarge the problem of your heart. 

It's always advisable to go together with your practitioner, of course, not to use it by yourself to do any hazard to yourself. But this is the range, we can imagine to use the substance, especially in this special application for transdermal. 

Jackie Baxter  
Right, interesting. So, you've been working with people, and people, as you say, worldwide have been trying this out, and presumably reporting back to it. Is there any research into this? Or is it all anecdotal at the moment?

Marco Leitzke  
At the moment, all anecdotal. It has, first of all, to do with a bad reputation of nicotine, I think a lot of scientists and doctors are avoiding to jump on a train, which possibly rides the wrong direction. So this is kind of holding back development, which could be very, very useful to a lot of people in a lot of healthcare systems, especially, because it's not only healthcare systems, but economic systems. Think that a lot of skilled workers are out of work or which have to go to any rehab. 

But I am contacted by a lot of practitioners especially, or some specialists as well, which are asking me for the theory, which asked me for the hypothesis, which are using it to their patient, which are advising it to their patients. And I know about a lot of special clinics within Germany, Charite, for instance, in Berlin, or special clinic in Berchtesgaden which are using patches. 

Because the thing is, wherever you go, to what specialist ever, nobody has a good explanation for the complexity of Long COVID. Nobody. So they are actually seeking for any solution. So that's the reason why they do use patches as well. So I do all I can, and I am counting a lot of scientists here in my hometown in Leipzig, in other cities and towns as well, in Germany. 

And we are trying our best to get a randomized control trial on the way. But the hurdles are very, very high. And not only one hurdle, but 10s and 1000s. So it's a question of money of course, it's a question of ethics committees, because nicotine is not medical devices law, but medical medications law, which is quite different concerning the aspect of letting something happen and allowing you to do things. 

Yes, so we have, a lot of things are still to do. But what we see right now is that it's going to come. So I'm sure that within the next one to three years, a lot of people would have tried, and we will gain a lot of experience. And I think this this study approach is somehow attractive, because we are gaining experience. 

This is only possible with a substance which is quite secure, of course. So don't want to use any chemo therapeutic or any hard substance to be used or study that way. But this patient led science provides us a lot of experience within a very, very short time. So if you do studies by a study protocol, which is obligate, so you will always go one point to the next and the speed of experience is very, very slow. 

And if you see long COVID Right now, you have a lot of people and they haven't got the time until we have developed a solution within the next 20 or 50 years. In that special case, I think this is very worth, this way of experience making you

Jackie Baxter  
i think like everyone's definition of safe is different. And you can do your research into something like nicotine and you can find out that it is largely safe. It may have very, very small risks in certain areas that we're not quite sure about. But you know, on the whole, it seems to be a relatively safe thing to try. 

And actually, you know, if we think about it, people are doing all sorts of other things, you know, taking lots of different supplements with no guidance, you know, completely unregulated and I suppose if you were going to compare the two, you know, that's not particularly safe either.

Marco Leitzke  
Up to 20-30 per day, anything, creatine, nattokinase, everything, I think it's crazy, it's really crazy.

Jackie Baxter  
So yeah I suppose that comes back to what you were saying about nicotine having this reputation, but when you look into it you realize maybe that it is not deserving of that reputation and maybe could be very useful?

Marco Leitzke  
I want to make one point for anybody who is about to try the nicotine patch. One must be prepared to in the first few days to feel not improvement, but getting worse and worsening. Because the set free virus particles are evoking kind of infection-like situation because virus are set free from receptor binding where they are actually trapped. 

So to break at that point means you will never know how it was  if the virus is erased by our immune system, which takes actually the immune system is prepared for it like because it has always contact to the virus, or the vaccine as well - is even an explanation for the post-vaccine syndrome because the epitope on the vaccine, which makes your immune system ready to combat the virus is the same as the spike protein. 

So the spike protein like sequence could couple as well to these receptors and could make the same issue or issues as long COVID does. So be prepared for infection like or post vaccination situation which makes you feel worse. Which is in terms of Long COVID horrible, because you are already bad and you should expect to become worse. 

But that's worth it because afterwards if your immune system recognize that there is an enemy, which has been contacted before, it is quite good able to erase this problem. I'm often asked, What about Paxlovid, or any other antiviral substance. I'm not a fan of this because because actually the immune system is able to do so. If you're reducing by antiviral or binders or whatever, you make the discoverability of Spike protein or the virus by immune system, you compromise this so that the reaction of the immune system could be lower, and not that fast as it could be. 

And on the other hand, I mean, Paxlovid is not chewing gum as well, is very, very strong substance which does not only benefit, but it does harm to the body as well. So even or some people are asking if they should take antibiotics, no, they should not take antibiotics. I think anybody must be aware that what you put into your body, anything you ingest, besides the expected effects, if it has an effect, side effects and any substance you add has some side effects, not to expect that you are doing for the good. If you are taking 20 substances. 

It shows the desperacy of the people, but it's the wrong direction, I guess. And therefore I actually say people because they need any string to hold on to feel secure. And I don't want to say put up all the substances you've taken the last few years, because it's kind of safety for them. So but actually I advise to not anything new to the usage of nicotine. Anything you used before you can do it further, except acetylcholine inhibitors, especially Mestinon, and this is quite a dangerous thing. But anything you used before you can use further, especially under the imagination, if you see any any medication. 

And in this point one can compare it with smoking, any medication. It should be clear that even smokers did use it before. So if you use nicotine with it without the 8000 toxins added, it could not be a real danger. Whatever you do,

Jackie Baxter  
yeah. Well, I'm super excited to see where this goes. I hope you do manage to get some research into this because I think that would be very interesting. 

Marco Leitzke  
I hope as well. But the main message is Um, I get not any coin for doing this. I do just not even by any producer from Nicotine patches. I think we should think twice the very bad reputation of nicotine because the possibilities of this substance. And we speak about chronic headache, we speak about depression, there are studies about this. We speak about Alzheimer's disease, we speak about chronic infections, chronic inflammatory bowel disease. 

There are so many instances which are a inferrable to a block or to compromise to systems, maybe due to viruses or maybe you just form of any Balance Disorder between two branches of the autonomic nervous system. So I think we should consider this substance for the future as a real important therapeutic substances. That's something which should be developed, I think. 

Jackie Baxter  
Yeah, it sounds like it's definitely worth exploring for sure. Well, thank you so much for joining me today. It has been really exciting diving into this and hearing all of your experience and all of the kinds of theory behind it and stuff as well. So thank you so much.

Marco Leitzke  
You're welcome. Thank you

Transcribed by https://otter.ai