Yusuf (JP) Saleeby, MD - LDN to help Long Covid patients; March 2022 (LDN, low dose naltrexone)
A high percentage of Covid patients continue to suffer debilitating symptoms well after the initial infection. This is because of the increased inflammation and reduced autoimmunity. Low Dose Naltrexone (LDN) bolsters and regulates our systems quite effectively. Dr. Saleeby observes many conventional doctors are finally recognizing LDN as a primary treatment for Covid long-haulers, as well as other autoimmune conditions. He cited the Ldnresearchtrust.org site as an invaluable source of information on LDN. He looks forward to Linda Elsegood’s 3rd LDN Book coming out soon.
Review by Ken Bruce
How LDN is helping Long Covid patients - Dr Yusuf (JP) Saleeby (Trascript)
Linda Elsegood: Today we're joined by Dr Yusuf Saleeby, also known as JP. Thank you for joining us today.
Dr. Saleeby: Hey Linda, it's always a pleasure.
Linda Elsegood: Now, you're going to talk to us today about Covid and Covid long-haulers, so I'll hand it over to you. Thank you.
Dr. Saleeby: Sure. So you know, two years into the pandemic we're seeing still a few cases of acute Covid infections but as of today, and this is the first of March 2022, we are not seeing too many acute cases. But what we are seeing is quite a number of long haulers or long Covid and also post Covid syndrome. It's also referred to as the syndrome of post-acute Covid infection, and the sequelae involved. And we're seeing also some issues with folks who have been vaccinated, some post-vaccine injury, but essentially what's happening is we're seeing a good bit of folks who had can't shake the initial Covid infections. And we've seen cases where a person has been infected two or even three times with different variants.
But the focus in general right now, moving forward, is a large number of folks coming in with the post-Covid infection, and some still suffering from long-haulers. There's a protocol we follow. The FLCCC has a very relevant protocol that's fairly frequently updated based on this new science coming in, and peer-reviewed articles. And that's kind of what we adhere to, with a few modifications. We're a little bit more aggressive with some of the dietary supplements that we prescribe. But essentially, low-dose naltrexone, which was offered as a second or third line agent, has now, in the recent month, been moved up to a primary intervention. So along with things like ivermectin and prednisone and omega-3 fatty acids, which is essentially what's derived from fish oil, and high doses of Vitamin D. The other agent is naltrexone, as in low-dose naltrexone. They're asking folks to begin at one milligram daily and increase to four and a half milligrams in a very short period of time. They are also stating that it's best to have people on this for two to three months to see full effect. So as with some of the other interventions, like they're recommending ivermectin, weight dose dosing, which is 0.2 milligrams per kilogram body weight, until symptoms resolve. Not necessarily for 14 days or one month, but until symptoms resolve.
And the same thing can be said for the use of low-dose naltrexone in my patient base. A lot of my patients actually are on it for a number of reasons, whether they're suffering from Lyme disease or autoimmune disease. So my patients actually have a benefit of being on LDN at the therapeutic dose, whether it's three and a half to four and a half milligrams a day. So they have the benefit of that. And then if they do get Covid, their symptoms are usually quite less. We've not really had but one or two hospitalizations. The stays are usually very short, maybe two to four days, just for high flow oxygen, and then they're discharged home. To my knowledge we've only had one or two patients ventilated during this whole pandemic. So adherence to early treatment, and the implementation of naltrexone as part of that regimen, has been very successful for us. Now our attention is focusing on folks that have long haulers still - brain fog, fatigue, loss of smell and taste, are the predominant ones; hair loss - we're seeing that as part of the syndrome. But it's mostly the fatigue. And so naltrexone is becoming a big part of our protocol for them,
Linda Elsegood: And how open-minded are other physicians to prescribing LDN.
Dr. Saleeby: As you know, it's like a certain segment of the physician population, at least in the United States, I don't know how it is worldwide, but there seems to be a better embracing of the use of low-dose naltrexone than other interventions like ivermectin and hydroxychloroquine, because those two other agents have been politicized a bit, whereas naltrexone has not. But there are certainly other interventions that are embraced by folks that are open-minded to integrative, more holistic, and what we call functional medicine, than the standard mainstream medical doctors, although the FLCCC in truth is actually established by conventional doctors who are open to using early treatment with ivermectin and hydroxychloroquine, Alinia/nitrazoxanide, along with their traditional medications like prednisone, Singulair, some antihistamines Pepcid, things like that that are used in the protocol. But what they've also introduced are things like curcumin, Nigella sativa - which is the extract of black cumin seed oil, a very potent anti-inflammatory; higher doses of Vitamin C, melatonin, probiotics, and H2 and H1 receptor blockers. H1 would be your traditional antihistamines like Benadryl or Zyrtec or Claritin, and your H2 would be things like Pepcid/famotidine.
Some of those other agents - montelukast, which is Singulair, is also prescribed for those with MCAS - that's Mast Cell Activation Syndrome, which is part of the long haulers syndrome. It's where mast cells become destabilized and release a lot of histamine, so you have things like hives and rashes that appear, and some other complications. That's why the antihistamines and the leukotriene inhibitor Singular are used. There are some that will use anti-androgen therapies. There are some studies out of Brazil that showed that that was effective. And statins. I'm not a big fan of either of those two last agents, so I don't prescribe them in protocols for my patients. There's another SSRI (serotonin reuptake inhibitor) called fluvoxamine or brand name Luvox, which has been used, but it's not very well tolerated, so that's one that we have to be super careful with, because a lot of folks don't tolerate it. They have a lot of nausea or psychiatric kind of manifestations.
But LDN obviously is a great agent to use, because number one, it is very well tolerated; number two, it's very inexpensive. And it seems to be working very well. I mean, it was moved up from second and third tier to primary tier or primary agent to use by the FLCCC. And they're heavily research oriented. In other words, they don't make a move in that direction unless it's substantiated by large observational encounters with patients, or peer-reviewed journals.
Linda Elsegood: So, the million dollar question; put you on the hot spot here. What do you think that has done for LDN? Has it leapfrogged it forward far quicker than it would have done previously? And the second part of the question is, what do you think of everything that's been happening with using LDN for the symptoms of fatigue? What's it going to do to people with chronic fatigue syndrome?
Dr. Saleeby: Right. So yeah, I certainly think that the pandemic has elevated LDN to the top of mind for a lot of clinicians, both those that have been using it and were familiar with it to some degree in the realms of integrative and functional medicine, but also to the mainstream doctors who were unaware of LDN previous to the pandemic. Now it's front and center. I mean, it's one of four or five interventions that are considered top tier to use for people recovering from long haulers or post-Covid syndrome. So I think it did leapfrog it, I mean, in the minds of many doctors. To be put top of mind, that's a fantastic thing. That's kind of a good thing that came out of this horrible pandemic, if you will.
And the second question you had was, what about its effects on chronic fatigue. Well I've been using that in chronic fatigue and autoimmune patients and people with MSIDS (Multiple Systemic Infectious Disease Syndrome) or CIRS (Chronic Inflammatory Response Syndrome). Those are all different acronyms for almost the same essential issue. It's a syndrome that involves the immune system and inflammation, and we know that LDN and naltrexone in research is an anti-inflammatory from several different mechanisms. It helps suppress inflammation, and the post-Covid syndrome, and certainly the long haulers, is a problem mostly with inflammation. The virus is long gone. It's already out of our system. Usually 9 to 14 days after you first get infected, the virus has done its bad thing, and it's sort of kind of gone away, and what's left is the sequelae of that, which is lots of inflammation. And that's what actually hurts people. It destroys their lungs and other organs: liver, kidneys, things like that; and affects brain and cognitive issues, and things like that. So one of the interventions used is high doses of curcumin and black cumin seed oil. Those are potent anti-inflammatories. Even those that decide to use statins, they're using it for the anti-inflammatory nature of the statin, like atorvastatin. But then LDN comes in, which has a very safe and effective mechanism of lowering inflammation. I think that's why it's important.
Linda Elsegood: Well let's just hope that, as you say a good thing has come out of this. If we can get more doctors prescribing LDN and finding the benefits that patients have, hopefully they will prescribe it for more conditions. Mental health, autoimmune, cancer, pain, the list goes on. But I think it does make a big difference, the first time a doctor actually can see that LDN has done amazing things for a patient. It gives them the encouragement and the confidence to prescribe it for further patients.
Dr. Saleeby: Right, I think I definitely. And Linda, your website does a phenomenal job in helping me put together a PowerPoint presentation for your organization as well as for upcoming symposium I have. I've gone to your website, which is a great resource, and it lists all the different conditions that LDN is being used for, or would be useful. There’s this long list of conditions, categorized. Pulmonary, neuropsychiatric, cardiovascular. You've done a great job in enumerating all these conditions, and I think it's just a matter of time now for doctors to start embracing that, looking at the literature, looking at the peer-reviewed literature that backs up the use of this agent, a very unusual drug. It's one of my probably top five of my safe and effective drugs that I prescribe, and that's what I would grab. I tell my patients if I had to grab an agent to take with me on a deserted island, one of the top three would be naltrexone for the LDN. It's a powerful drug with a lot of uses, and it's backed up by research. That's the important thing.
Linda Elsegood: Talking about the website, we do update it monthly, so any doctor that tells us of a condition that they treated a patient for with LDN and had good results that's not on our list, we add it. We also add the latest clinical trials and peer-reviewed papers, and LDN in the news, things that have been happening. So we try and make it a one-stop, where a doctor, a researcher, a pharmacist who's looking to do a presentation, just like you were saying, that they can find the information quickly and easily. It's a never-ending job.
Dr. Saleeby: I know it is it's a great thing you offer, and I do send patients to that website in particular when we have a discussion in my office about LDN. I have some material I hand out to them, but I also direct them to the LDN Research Trust website so they can glean a lot of information. It's great resource for them.
And I understand there's a new book coming out, Linda?
Linda Elsegood: Yes, we've got the third LDN Book, which should be coming out in the fall. And we're covering different conditions. Many people have asked if it is the first book updated the third time. No, it's a series of books. So we've got Volume One and Two, now we've got Volume Three. And you put me on the spot to try and think what's in Volume Three. But it's really exciting, and you've written a chapter as well. So I think watch this space, and it will be available in a few months.
Dr. Saleeby: I mean reading Volume One and Volume Two I thought well, maybe that would be just an update, like a second edition. But it wasn't. Some novel things were discussed in Volume Two, and I'm assuming that like you say, Volume Three will be more novel stuff.
Linda Elsegood: The whole idea is to have every volume cover conditions that haven't been covered in the previous books, where we have the latest research, and we will have a section so the latest papers will be referenced at the back. I mean, we have every book, hundreds of references, and of course as time goes on, every year there are more papers coming out, which is fantastic.
The LDN Research Trust has been going over 18 years now, and initially, published papers were slow coming through. But every month there is something somewhere in the world. Somebody's done something, had something published. So it is gathering momentum
Dr. Saleeby: And Linda, I think really, with the last two years of us being in a pandemic, where a lot of focus has been on Covid 19 and what we can do for it with, let's say, off-label use of certain medications, and LDN. That's going to even push more research money towards researching LDN. I'm sure. Now that it's on the protocol,and it's like in the number one section of early interventions for long haulers, I think you'll see probably more and more papers. Actually, it should be exponential, in the number of researchers wanting to take this on and do more research, for sure.
Linda Elsegood: Fingers crossed!
Dr. Saleeby: So Linda, I've got a very interesting case that I saw in my office a few months ago, and this is actually a post-Covid vaccine injury type case. This lady, unbeknownst to her, had an underlying tick-borne infection. She actually had Lyme disease that was activated by the first dose of a Covid vaccine. I'm not going to mention which one it was, but it was a first in a series of two that she received. And within 48 hours of receiving the first dose, and then for the subsequent weekend, to two weeks thereafter, she suffered some neurological conditions that put her in a wheelchair. So this is a woman, and she was in her late 40s, and she was very ambulatory; didn't really claim any health issues. Next thing you know, within a very short period after her first vaccination, she was wheelchair-bound, couldn't walk, and had a very staggering kind of staccato that almost looked like a Parkinsonian kind of gate. It took her literally three minutes to get up out of the wheelchair and walk a few steps across the room to the doorway of my office. Now, we put her on a pretty heavy-duty protocol involving a few off-labeled drugs, but also I rapidly escalated her dose - she was never on LDN - but I placed her on low-dose naltrexone and escalated her dose pretty quickly, because I knew time is of the essence here, and I didn't want her neurological problem to progress. And during that time, it was when we discovered that she had Lyme disease as an underlying etiology, and it was just exacerbated by probably the spike proteins in the MRNA vaccine. We were able to get her rapidly up to 4.5 milligrams, which she tolerated very well. And the second time I saw her, she had transitioned from a wheelchair to a walker. On the third visit, which was a month later, she was using a cane. Now she was able to ambulate without the use of any help like a cane or even family members, but again it was extremely slow with her ambulation, and it looked kind of almost Parkinsonian in nature. Kind of like this leaning forward, kind of unsure, took her a long time to actually turn. But once she initiated the walk, she could carry on her day, and it was a little bit slow. But now I have not seen her back in about a month or two. She should have an appointment with me again soon, but I thought that was a pretty interesting case, where I think I'm pretty sure that the naltrexone had a big part to play.
Linda Elsegood: Well, thank you very much for having shared your experience with us today.
Dr. Saleeby: Well Linda, it's always a pleasure. Have me back anytime. It's always good seeing you.
Linda Elsegood: Thank you. Any questions or comments you may have please email me, Linda, at firstname.lastname@example.org. I look forward to hearing from you. Thank you for joining us today we really appreciated your company. Until next time, stay safe, and keep well.