73 - Dr William Li - Physician, Scientist & Long Covid Researcher

In episode 73 of the Long Covid Podcast I chat with the fabulous Dr William Li, who is a Physician, Scientist, president and medical director of the Angiogenesis Foundation, and bestselling author of “Eat to Beat Your Diet: Burn Fat, Heal Your Metabolism, and Live Longer”. Dr. Li is leading research into COVID-19 and Long Covid which is what brings him to the Long Covid Podcast!

We chat through some of his findings and theories, as well as what can be done to help. I learned so much from this so I hope you do too!

Photo credit: Roger Pelissier

https://drwilliamli.com
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(music - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  0:00  
Welcome to the long COVID podcast with me, Jackie Baxter. I'm really excited to bring you today's episode. Please check out the podcast website, longCOVIDpodcast.com, where there's a collection of resources, as well as a link to the Facebook support group. If you're able to please consider supporting the show is in the link in the show notes. If social media is your thing, you can follow me on Facebook @LongCOVIDpodcast or on Twitter and Instagram, both @LongCOVIDpod. I'm really keen to hear from you. If there's anyone you'd like to hear on the podcast, or if you've got any other feedback, please do get in touch through any of the social media channels or email longcovidpodcast@gmail.com. I really hope you enjoyed this episode. So here we go.

Hello, and welcome to this episode of the long COVID Podcast. I am really excited to welcome my guest tonight, Dr. William Li, who is a physician, scientist, president and Medical Director of the Angiogenesis Foundation - I hope I pronounced that correctly - and best selling author of "Eat to Beat your diet, burn fat, heal your metabolism and live longer" which will be hitting the shelves I believe in about a month. So Dr. Li is leading research into COVID and long COVID, which is what brings him here today. So a very warm welcome to the podcast.

William Li  1:43  
Thank you, Jackie. It's a pleasure to be on.

Jackie Baxter  1:45  
Amazing. Thank you so much for being here. So to start with, would you mind just introducing yourself a little and just telling us a little bit more about what it is that you do?

William Li  1:55  
Yeah, sure. Well, I'm William Li, I am a physician - internal medicine is my background, my training, which means that I take care of men and women, young and old, healthy and sick. And my goal has always been to try to keep people as healthy as possible. And even when they get sick, actually try to restore their health, with whatever tools are going to be most useful. And that's actually relevant to long COVID. I'm also a scientist, what I'm known as as the vascular biologist, which means I study blood vessels, which is actually affected in acute COVID as well as long COVID. And so I was one of the early researchers that to discover that COVID is not just a lung disease, a respiratory disease, but in fact, the Coronavirus invades your blood vessels. And so very early on, I became acutely aware and started to participate in doing the deep dive to figure out what was going on, what were the implications and now following that trail to long COVID. So that's my research world. 

And as an author of two books, my first one was called "Eat to Beat disease" was really about how the body maintains health. And although it did talk about food as medicine, with a lot of foods, the reality is the focus was What are the functions by which the body remains healthy, maintains and protects its health. And how does it get knocked off that pedestal - which is very relevant to COVID and long COVID. And my next book, which is coming out in March, is called Eat to Beat your diet. And that's a trick title. It's not a diet book. It's actually an anti diet book, that really talks about as a sequel to my first book, how do we actually improve our metabolism? How do we gain energy? How do we actually remove some of the factors that actually wear down our health. And again, you know, for people who are struggling with long COVID, being able to master your own metabolism is likely to be one of the important angles to be able to restore your normalcy. 

And so with all these things in my background, you know, I before the pandemic, I spent a lot of time in cancer research, I helped to develop more than 43 FDA approved treatments for cancer complications, diabetes and vision loss. And so when the world suddenly got hit with the pandemic in the spring of 2020, rather than sit back and wait to see what was going to happen, I literally sprang into action to see what I could discover, what I could contribute what I could learn. And man, there's been a lot, including long COVID

Jackie Baxter  4:37  
Yeah, I mean, from a sort of taking-a-step-back perspective, it must be a completely fascinating time to be a scientist and a researcher and a doctor. From a patient's perspective, it's a really terrible time, but taking the patient hat off, I can kind of see,

William Li  4:57  
well, you know, most of us who went into medicine, You know, went in because we truly wanted to contribute to people, to help people live better, longer lives and help them get through difficult spots. Think about it, before the pandemic hit, there were no COVID experts, because COVID, in fact, is a brand new human disease. You're right, in two respects, that it's an exciting time. It's an exciting time for researchers, because we're trained to tackle the unknown. So rather than, you know, just sort of be frozen with fear. Those of us who have research backgrounds like me were able to lean in to say, how do we take the modern tools, and start to grapple with this beast that suddenly emerged, you know, out of our windows? 

And, you know, the other aspect that you say, you know, frightening time for patients, I would say, for those of us who have worked in this space, it's also been, how would I describe - it's sobering, eye opening in an astounding and slightly shocking sort of way. And also, I will just confess, on a personal level - somewhat frightening, because what we're seeing is, here's a disease that we don't fully know how to treat, that didn't exist before a few years ago, and for which we don't really have tried and trued therapies at our fingertips. And that's not a good place for science to be, that's not a good place for doctors to be. 

And, you know, at least from my perspective, and I've cared for many, many patients, people with long COVID, I don't even call them patients - like people with long COVID. You know, it's kind of like diabetes, you don't want to be called a patient, you're just a regular person, but you're struggling with this, you know, difficult slippery syndrome. I've cared for a lot of people with long COVID. And, you know, I've tried to make some headway using science and you know, to some extent, have had some success. So, yeah, so I'm here to, you know, put my effort forward to help folks like you.

Jackie Baxter  7:01  
Well, I certainly appreciate it. And I'm sure everybody else does as well. So I guess, let's dive into to all of this. So I mean, you know, I think probably like every long COVID person, you know, we've all kind of done a lot of Googling and a lot of you know, Twittering, if that's even a word, and kind of trying to do our own research and sort of hack our way through this almost. And I find myself, you know, spouting medical terms that I wouldn't have even imagined before. Anyway, the most recent one that I came across, which I think is probably what led me to you, was this V E G. F. So is that maybe a good place to start? What on earth is it?

William Li  7:47  
Well, look, let me frame this for you. Because, you know, you just served up some alphabet soup, which is what we say, you know, in the research world and medical world, there's many acronyms and abbreviations, VEGF, I will tell you what each letter stands for V is vascular, which means blood vessels. Endothelial is one of the cells, that are the main cells of blood vessels. And G F stands for growth factor. And growth factor is kind of a fertilizer for growth for blood vessels. So let's talk a little bit about that. 

But before we get into VEGF, I want to frame how COVID affects blood vessels. And what we're actually learning, and as a researcher, what are we learning about long COVID and blood vessels, because it's really, really profound. 

In the beginning of the pandemic, one of the things that the medical world fully expected was - here is a virus you inhale, it causes coughing, and respiratory congestion, fever, kind of like a pneumonia, like other respiratory symptoms, except that, in addition to being a really, really serious respiratory disease, involving the lung, respiratory, there were really odd things that were also manifesting at the time. And that sounds familiar to your listeners with long COVID. That is that surprising manifestations. I'm pointing this out, because we saw it at the very beginning at the get go, let's call it March 2020, maybe even before. 

What are some of these odd things? Well, we saw people having strokes. That's not what you normally get with a respiratory disease. We saw people having COVID toe, it's a red beefy, painful toe. Also not really common, that you will see. We saw people getting blood clots all over the place, in their kidneys and their livers and their heart. I mean, just odd. That doesn't always happen - usually happen with COVID either. So this really started to draw my attention as an expert on blood vessels to ask Why we're blood vessels apparently being involved in a respiratory infection? The rest of the respiratory system is your lungs, Pulmonary system, you got two lungs, you got a bronchus, you got some airways, and then you got the mouth and nose nostrils that the viruses are inhaled through, like how would it actually get to your blood vessels? 

Well, we actually mounted a research effort to figure this out. So we this was back at the end of March 2020. Very early on. With some colleagues of mine, we actually got autopsy tissue from the first people that died of COVID. And we were able to organize a team of molecular anatomists. So think about, you know, there's a TV show in the US called CSI Crime Scene Investigation. And like, literally, that's what I did, I was working with people that could actually dive right in to the tissue of the first people to die of this unknown disease. And we went through every organ, every tissue at every level, from what you could see with your eye, way down to the microscope, all the way down to the genetic level to the DNA level. That's why I'm bringing up crime scene investigations, kind of like looking for the blood splatter on the wall, like, what's going on? 

And when you go down to that level, there's really no secrets because you can find everything. And it took us less than a week to discover why blood vessels were involved. The clotting, the strokes, the toe, the heart problems. And it turned out that we were actually saw with our own eyes, the first pictures of the Coronavirus creeping into the cells, invading the cells comprising the blood vessels, the endothelial cells, the E of the VEGF, vascular endothelial. And we actually saw pictures of these, and they were literally just, you know, it's kind of like army, like parachuters, coming out of the sky. These are the from the viruses and the viruses, and literally landing and penetrating into the ground and getting into your blood vessels system, getting into your circulation. And from there, they were spreading and damaging your circulation. 

And what kind of damage are we talking about? We're talking about - and we did this at the genetic level, we're able to literally peel open the blood vessel cell, and look at the parts of the cell, and then look at the DNA. And I can tell you that this Coronavirus, was turning off healthy DNA and turning on unhealthy, dangerous DNA. It's kind of like you know, having a burglar break into your house and go straight to your electrical system and start pulling the wires and fuses out. All right. I mean, really, it was awe-strikingly scary to see this. Because we started to realize, man, this is not your typical respiratory virus, but it gave us the first clues. That's why blood clots are going on. That's why damage to the blood vessel system are going on. That's why strokes are going on. And we published this as a lead article, you know, as a headline in the New England Journal of Medicine, which is one of the most prestigious medical journals in the world. 

And that led me and my team to get pulled straight into the center of the pandemic. I had no intention of doing this. And it was not my field, because nobody was an expert in this. But I felt like because this was a contribution that I could make that I would literally just, you know, dive into the deep end of the pool and start swimming. So I've been doing this since the beginning of the pandemic, digesting, doing research, trying to figure out everything I can. 

And during the period of long COVID starting to emerge, about summer time of 2020, so when we start first first starting to see, the survivors of the early COVID starting to complain about these really unusual problems, intense fatigue, muscle aches, lack of taste and smell and nerve tingling. You know, you name it, the difficulty breathing, the rapid heart rate, the PoTS syndrome, that I know you've covered on the show before, we started to immediately ask, wait a minute, since we know blood vessels are damaged in the acute disease, meaning right after you get infected. What was the evidence - could there be continuing damage to blood vessels that could explain long COVID? 

So one of the amazing things that we did is we actually took we contacted patients who are actually having real difficulty breathing, no energy, months later. So this is like July, August 2020. And they basically said, Dr. Li, I went to my regular doctor and I complained about my long COVID. And they did an x ray, they listen to my heart. They even do a CT scan and everything looked normal. My blood tests look normal, and I'm testing negative for COVID. And I'm really frustrated because nobody can figure out what's going on.

And I feel terrible when a doctor is unable to provide some informative answer to a patient, because when you're a patient, even bad news is a better answer than having no news. Or even worse, you know, kind of being written off as sort of just somebody who's got something going on in their head, right? Like that's gaslighting - terrible thing. So because I'm a researcher, I basically said, Well, can you give us your scans and let's go ahead and take a deep dive and look at the scans. So there is a technology that I was introduced to through the FDA that takes CT scans that might look normal, and it takes the scans and it deconstructs the CT scan,  slice by slice by slice by slice, to have 10,000 slices and it reconstructs the blood vessels. 

And there are against the backdrop of about 1000 normal healthy lungs and their circulation. We were the first to see, astoundingly, that in long COVID small blood vessels were still missing in patients who had suffered acute COVID. In other words, getting COVID at the very beginning can wipe out a lot of blood vessels in your lung, that's why you're having such problems breathing damaged blood vessels, we saw this, published it. But even in people with long COVID, their blood vessels were still damaged and hadn't recovered. In other words here was damaged it was hidden in plain sight. Because a CAT scan would not capture the blood vessels, X ray wouldn't capture, you can't hear it with a stethoscope. So a doctor would not be expected to find this, but using technology we were able to reveal part of what was going on. 

So that led us to dive deeper and deeper and deeper and when blood vessels are damaged, one of the things that they do is they release factors, proteins, when they're damaged as a way of trying to grow themselves back. Okay, one of the ways that they try to grow back, like for example, if you cut yourself, paper cut, you scrape your knee when you're ice skating or rollerblading. Once you put a bandaid on, what happens is that your local tissue because the blood vessels have been damaged, they'll release this protein as fertilizer called VEGF vascular endothelial growth factor, it tries to grow itself back. In fact, if you've ever had a scab, that fell off too early, you know, the scab on a wound. And you look at underneath that scab, The black scab comes off, it's all bubbling, red, bright red, those are lots of little tiny capillaries, little tiny blood vessels, growing back. And the growing back has VEGF - that the damaged tissue released V EGF vascular endothelial growth factor, they just get more blood vessels to grow. 

So one of the things that we believe is that as the people who have injured circulation in the lungs are desperately trying to grow back their normal circulation in their lungs, they're releasing VEGF or VEGF is what we actually call it. And that's a biomarker - we think - that might be one sign that your blood vessels are damaged, and your body is trying to repair itself. So it's not the only thing, but it may wind up becoming a very important telltale marker of what's actually going on.

Jackie Baxter  18:14  
Wow. I mean, that's kind of blew my mind just a little bit. I mean, I think one thing that we as long COVID people have struggled with, I think, and it's probably the same for doctors, actually, is that there isn't like a test you can do for long COVID. You know, there aren't really biomarkers. But actually, maybe there are, which is quite cool. But yeah, I mean, that's absolutely fascinating that this VEGF or VEGF, you said, is basically a sign that the body's trying to fix its blood vessels?

William Li  18:55  
Right? So rather than think of it as a disease marker, like a tumor marker, right, so if you basically have, you know, a blood marker called CEA for colon cancer, like the higher the CEA the more the disease. This looks like a health marker. And it's sort of it may it may wind up being your body, sending out not a distress signal, but a signal that you can look at that says, hey, we're trying to fix ourselves, something's not well, and it's like, seeing bags of fertilizer on the driveway of a house whose garden needs to be repaired.

Jackie Baxter  19:30  
Right? Yeah. So it's a sign that there's something wrong, but it is also a sign that your body's trying to do something about it.

William Li  19:38  
Exactly, exactly. So now, you know, let me just also use this as a opportunity to say, because I'm a researcher, I am very interested in understanding fundamentals, like what is the common denominator? What is the underlying reason that we actually have any disease whether it's cancer, diabetes, heart disease, Alzheimer's, whatever. Because ultimately to find a cure, to really overcome a disease and help patients, all the big breakthroughs, okay, throughout the history of medicine has come from understanding what's going on underneath. And if you know what the target is, what the problem is, then you can send in a road crew to try to fix the potholes, rebuild the bridge, or if there's an enemy at the gate, you know, actually, where to throw the spear, you know, in order to be able to get rid of the monster. Right? So I mean, I'm giving you these analogies, because they're easy for your listeners to understand. But that's really how medical researchers come at this. 

So I've been really interested in saying what are the final common pathways, the underlying common denominators of all these 200-plus symptoms of long COVID? Because, you know, you pointed out long COVID isn't one thing, there's no one biomarker, there's not even one symptom. And so one of the struggles is really, how do you define it? You know, is it one of three, three of five, is that you have to have all 10 things? You know, doctors like to have these checkboxes to figure them out. But honestly, if you're a person who is suffering from long COVID, you don't need the boxes, you just know that you're not right. And so I'm interested in figuring out like, what could be going on that might manifest in so many different ways. 

So there's three things let me just tell you the three legs of the stool of long COVID as I see it, and again, don't let anybody fool you. There are no experts in long COVID. Anybody who's working on this is just, you know, we're all students, we're trying to figure this out. All right. We're all explorers to some extent. 

So the three legs of the stool that I see, given my background, and as a researcher, number one, micro vascular damage, blood vessels, small blood vessels damaged, okay, that helps explain a lot of things, it explains, you know, you're fatigued, you don't have good blood flow, your muscles are tired. Your brain fog. You know, by the way, we've actually seen in people with severe COVID, that the lining of the blood vessels in the brain are ripped out, like ripping the foot out of a sock, and the sock just collapses. We see this in like the thinking part, the executive portions of the brain. Pretty frightening when I tell you that right? Like when I saw the pictures that I'm like, Oh, how can that be? Like how, how bad a situation is that? 

We got to figure out how to grow - microvascular damage. Okay, we see it in the heart. We see it in the brain. We even see it in the testicles. All right. So I mean, it's everywhere. So that's number one. Oh, by the way, lack of sense of smell. No, I can't smell it the same way. Your olfactory neurons, the nerves that manage to help you interpret the apple pie smell wafting in the air, that connects a signal to your brain that knows what an apple pie is. The way that works is that has to be kept alive and functioning with blood vessels. When those blood vessels are damaged, your smell sensors don't work as well. Okay, faulty wiring, so to speak. So that's one leg of the stool. 

Second leg of the stool. And we're seeing this now, there's a low grade, autoimmune disease that COVID infection sets off in some people, it's a trigger. You don't have to have had autoimmune disease before. You might have never had autoimmune disease. Okay. But this infection, in some people, not all people, but in some people, triggers an autoimmune response, and that auto immune response seems to persist long after the Coronavirus has gone out of your body. So you test negative by PCR, but this damage is still continuing, right? 

So it's kind of like the careless cigarette smoker who's going on a hike through the woods that lights their cigarette, and when they're done halfway through, throws that burning butt into the dry and woods and then just leaves the woods right. So the Coronavirus, the smoker is gone. But the cigarette butt has been lit and now you've got a smoldering fire in the forest. All right. That's like the autoimmune disease. All right, you don't have big long, raging wildfire. But it's a smoldering that's actually going on. 

And we know this, by the way, because we actually have seen in children and adolescents who are surviving from COVID. They actually develop higher rates of type one and type two diabetes. Type one diabetes is an autoimmune disease. Increased signs of lupus-like illnesses, increased signs of arthritis, these are all autoimmune types of conditions. We're seeing this problems with thyroid we're seeing that as well. So here's an infection that once it goes away, in some people can trigger off an autoimmune disease, the second leg of the stool, alright. 

The third leg of the stool is chronic inflammation. All right, this Chronic inflammation. Now we all know, you know, if you've read anything about health and wellness, you know, in foods - have your anti inflammatory foods, like inflammation is bad for you. Look, if you're a young person, or an old person, if you've got a little bit of inflammation, it's actually good for you. So basically, if you had surgery, and you had your appendix out, or your tonsils out or a tooth pulled, you're gonna have a little inflammation to just, you know, fight off any bacteria that's nearby, then heal up. A little inflammation is good. 

A lot of inflammation is extremely dangerous, because it basically, it's like that smoldering fire I was telling you, okay, it's actually low grade inflammation burning through your body at all times, it stresses out your metabolism, it completely throws your systems off of whack. And it sets up for all kinds of other dangerous diseases, including heart attack. I don't know if you read this, but a new study showed that rate of increased fatal heart attacks in young people under 44, is elevated by 43% in people with COVID, including Omicron, which isn't that serious. 43% increase in fatal heart attacks and people under the age of 44. Okay, moment of silence there, because that is extraordinarily sobering. That can happen with damage to the heart blood vessels that can happen with low grade inflammation. This is the kind of problem that we all need to solve. All right. 

And you know, those of us who have worked in cancer research, we're also worried about the spectre, that this smoldering inflammation could later on lead to higher rates of cancer springing up months, or possibly years, or maybe even decades later. So this is why you know, for me, as a researcher, we have to jump into this Long COVID thing to understand it. 

But if I told you that microvascular disease, autoimmunity and chronic inflammation were underlying problems, there's a little silver lining in that - we have medicines that we can work for all three of these issues. Okay, there's something we can do about all three. So this is where we are like, I've taken you right to the precipice of long COVID research. And I know you've had many, many other brilliant speakers join you on this podcast. But from my perspective, I'm, you know, my career has been in developing new treatments, and also looking at food as medicine. Once you know that, there might be three areas that you can tackle, then you can actually shift your focus away from fear and panic and sort of flailing into saying, let's focus on what we believe is going on and see if we can actually rectify it.

Jackie Baxter  27:50  
Yeah, I mean, the word flailing - that very, very aptly describes my first sort of, at least the first year, probably the first 18 months of this, I had no idea what was going on. I mean, you know, I think most other people didn't either, you know, we were sort of in fully pandemic mode. And, you know, I was gonna say no one was really that fussed. That's not quite fair. But you know, doctors were so overloaded, that it was almost like, they could only do so much. 

And then once a bit more information started to come out, and you start to hear people talking about things like autoimmune diseases, and it's like, oh, what's that? I don't know, let's ask Google, which isn't always a good idea. But then you can sort of start tackling these things a little bit. And I was gonna say start taking legs out of the stool, I'm not sure that's a good idea, either, because then your stool falls over. But you know, once you can start tackling things?

William Li  28:44  
Yeah, I mean, actually, when you see those legs in the stool, that stool's not one you want to sit on, right, so what you want to do, in fact, is you want to actually figure out how are you actually going to build health around those problems? Okay, those are weak legs of the stool, but they may be underlying causes. So, you know, like I said, the good news is that, you know, there are ways that we're looking at how to actually address and treat. And I'm just going to tell you some of the experimental ways that we're thinking about this. 

So you may not be surprised that, you know, for inflammation, we've gotten anti inflammatory diseases. So there's a number of different treatments that are used for menstrual cramps, for arthritis. You know, it's a whole range of interventions, some are inexpensive and easy to get, some of are very sophisticated and you have to infuse them into your vein. For an anti inflammation, we know how to deal with that. Okay. But but we need to do the studies to really figure out what's the right approach. 

The autoimmunity you'll that's, you know, if you talk to a rheumatologist, they'll tell you, you know, autoimmune diseases are much more easily managed today than they were a decade ago. We have some pretty powerful treatments that we can actually use to bring lupus and rheumatoid arthritis under control. But it's still not something that is easy to contend with. And some of these treatments, the powerful treatments are very expensive. And depending on where you live, I mean COVID never cared where you live, I mean, it sort of it just took you down and whatever corner it happened to find you in, kind of like a tsunami washing onto the beach and into the town. The fact of the matter is, those very sophisticated, highly effective auto immune treatments are not going to be readily available for most people. So again, I think that there's going to be an avenue of innovation and treatment to look for - who needs to get those and which ones might work better? 

By the way, one of them Baricitinib is a treatment for rheumatoid arthritis, big autoimmune disease, that's actually approved in Europe and the United States to treat acute COVID. It's lifesaving. All right, just to give you an idea of how powerful this autoimmune component actually is. But people you know, because long COVID is one of these "Yeah well you know, don't worry about it, you tested negative, you're fine, go back to work, go back to your life." And now we live in a world where, you know, I think that, you know, people call it pandemic fatigue. But honestly, I think that it's something revealing about human nature, about our humanity, that our species is just not well suited to contend with an existential threat for a long period of time. We just can't, most people can't deal with it. And so that's why everybody's just going back to work and pretending nothing's going on. 

But you know, those of you who actually have been grappling with this, you know, like, once burned twice, much more cautious, right? And I think that that's really where we need to actually rally people together to look at this autoimmune component. And one of the simplest ones, just to give you an idea, by the way, this is the first long COVID podcast, and I've done other podcasts, and media shows like talking about long COVID. But I think, you know, being that this is something specifically for long COVID, I'll share with you, as a researcher some thoughts. 

Look, we have very effective treatments, simple treatments for autoimmune disease that involve steroids. Prednisone, dexamethasone, oh, dexamethasone, by the way, is an approved treatment for treating acute COVID. So should we be you know, kind of carrying a page from the playbook of acute COVID and thinking about how to use it to actually provide relief for some patients, not necessarily all patients, for whom the autoimmune symptoms are more severe? Don't know that yet, but it's worth a try. And again, you know, I think that what we in the medical community have a responsibility of doing is leaning forward so that our patients don't have to flail. 

There can be some, even if it's trial and error for a new human disease, you know, we need to trial and hope we don't make an error, but like, that's a judgment, we have to use our best judgment on behalf of the individual. Okay, so that would be an example for the autoimmune component. 

For the vascular component, blood vessels. This is my wheelhouse, I cook in this kitchen, alright, so I know a lot about it. There are treatments that can actually grow blood vessels, we use those to heal wounds in diabetes, there are treatments to get rid of extra bad blood vessels. And by the way, one of the things - odd things that acute COVID does, is as it injures your blood vessels, it triggers a repair response that's not quite normal. And so your blood vessels have at least in an acute disease have difficulty fixing themselves, they don't quite get to where they want to be. So now you have an injury, that can't quite fix itself. It's like a tree that has, you know, damage to a branch and is trying to regrow the branch. But instead of doing it properly, it grows a knob, a gnarly nub, instead of a nice branch. We see these nubs actually happening in acute COVID as well. 

So what can we do to try to normalize and repair, restore, regenerate a normal circulation? Well, there's a lot of research going on in that area. And I think a lot more will, should and will go into this area, if I have anything to do with it. But I will also tell you that I'm gonna throw something out there that might surprise your people. And I think this would - I'm not telling people to go out to do this. But I do want to give some hope and stimulate a conversation that they might bring to their doctor, you know, to explore whether or not something is reasonable. 

But it turns out that one of the things that can help repair blood vessels is a natural substance called nitric oxide. Nitric oxide is something that was used early in the pandemic to try to save people, pregnant women, from going on the ventilator. Alright, and it actually worked. So we knew - what does nitric oxide do? Nitric oxide dilates blood vessels, okay. It also causes your body to move stem cells out to regenerate blood vessels as well. It's a regenerative force so actually help you regenerate organs as well. So nitric oxide was used early in the pandemic to really test to see if we can do repair. Again, nothing yet moved into the long COVID clinic and in clinical trials, but it really needs to kind of go in this direction. And I think that there are some efforts, starting now. 

The other thing that you can do with nitric oxide, do you know, this might be interesting for people to hear about. Do you know that you can eat food that will create nitric oxide in your own body? Okay, so let me tell you, you've heard about, you know, like hot dogs, sausages, wieners. Right. And preserved meats like not being good for your health because they contain nitrites. Right? Well, it turns out that when the processed food factory pours them into your package meats, you know, that's not so good for your health. However, you can normally get nitrates in your food, healthy nitrates from the soil. 

Turns out spinach and beets are two foods that grow low to the ground. And they absorbe plenty of normal nitrates from the soil, naturally. So when you actually eat beets, or drink beet juice, or when you eat spinach, and this is the interesting part, if you take the time to chew the spinach, or, you know, like slowly sip the beet juice or to the beats. Alright, so you got to make a tasty. Anybody who wants to do this, make sure that you look up a tasty recipe, I can give you some - I like to cook so I have lots of recipes for tasty beats and tasty spinach. But when you actually take the time to chew and savor, what happens is that the microbiome, the natural, healthy bacteria that grows on your tongue, most people think of microbiome in the gut, it's on your tongue, actually interacts with the nitrates in the spinach or the beets. 

And then when you swallow it, it gets converted into a form that your body absorbs as nitric oxide. So eating beets or spinach, and this has been studied in humans generates natural nitric oxide. If you chew it and let your tongue bacteria to interact with normally, okay, little sort of like hack for yourself. And that can generate nitric oxide, good for your blood pressure, lowers your blood pressure, makes you a little bit relaxed. But it also stimulates stem cells from your bone marrow to help repair organs, you can regenerate from the inside out, repair yourself from the inside out. 

So one of the interesting things that I've been looking at as a researcher in food as medicine is can we, on one hand, eat anti inflammatory foods that could be useful for suppressing some of the smoldering fire, maybe pushing back on some of the autoimmune disease? And can we actually try to look at foods that can generate nitric oxide to repair blood vessels, as a more natural way to do this, and this is one of the things that I have been working on and writing about is, you know, in the era of COVID, what are some of the tools that we can use to empower ourselves, so we don't have to wait for the doctor, we can practice some interventions on our behalf in our kitchen. And as long as they taste good, they may be good. 

Now I'll drop one last zinger at you that you might not have expected. There is a medicine by the way, that increases nitric oxide in the body. And again, I'm not giving medical advice here. I'm just telling you as a researcher, something that people should know. And it's something that you know, as a physician, I've actually looked at this a bit myself, but it turns out that Viagra actually causes your body to produce nitric oxide. Viagra actually causes your body to produce nitric oxide, which dilates blood vessels, which brings more blood flow to the penis, which then restores erectile function, and it causes stem cells to come out to repair damaged blood vessels. 

Now, low dose Viagra, like you know, to give Viagra to a diabetic, a 50 year old diabetic man, for erectile dysfunction, you have to use really high dose Viagra. But low dose Viagra is approved for babies. Babies in the ICU with lung damage, lung damage to their blood vessels. Now we're coming full circle back to long COVID and the discoveries that I mentioned to you. So interestingly, there is an avenue of research looking at whether or not Viagra, giving at lower doses, could help to repair those damaged blood vessels in the lung.

Jackie Baxter  39:30  
Wow. I mean, that's amazing, isn't it? And like you know, you've just mentioned, well you've mentioned loads of things. If it wasn't like the middle of the night here I would be off to the supermarket to buy beetroot and spinach. But so you know, you just mentioned for your three legs of your stool, three existing treatments that are already there that could be used to help people with all three of these things. And that's really good news, isn't it that they're already existing and they could just be kind of shuffled out to people to help?

William Li  40:05  
I mean, I think that there are people that are in need right now that could be empirically helped, using the thinking that I described, which is that what could be going on underneath? What do we have that's currently available that might be helpful? Can we try it under supervision of a doctor to see if it would be useful? And if it's useful, how do we manage it? How do we measure it? How long do we keep it? You know, there's a lot of questions out there. But you know, of all the things we talked about it, there's more questions than answers. But I do believe and I do agree that, you know, we're moving into a hopeful phase where, rather than just being overwhelmed by all the unknowns, all the horrible, terrible, painful, uncomfortable unknowns, that we're beginning to really think about, like how to fight back, and how to kind of take back our health, and might there be some tools. 

Now, I do think that there's plenty of room to develop new treatments for long COVID, I think we've hardly begun, actually. But we do need to begin because as a doctor, I can tell you, I want something out there, that if any of my patients who have had COVID wind up becoming people who are suffering from long COVID, I want to know that there is something that I could prescribe that could help them. And it may not be one thing, it may be a bunch of things. I want to know that. I think that our medical in a 21st century, humanity deserves to apply its medical know-how and technology to be able to develop truly effective treatments. 

I mean, if we can develop immunotherapies that can literally Dry Erase cancer from someone's body, which we're starting to see now, then we absolutely need to apply that kind of advanced thinking and an advanced technology into trying to help people with lung COVID. This is a new human disease. I wrote an article with Dr. Andy von Eschenbach, who's the former commissioner of the US FDA, in the Washington Post. This is back in September, the fall of 2020. We saw this coming a long time ago, we said there's going to be a second pandemic that come out of the first and that second pandemic is going to be long COVID. And there's going to be a lot of blood vessel damage that needs to be jumped on. And we need innovators to come in there and really start to see what we can actually do. 

So I do think that there's a lot of room for drug development, diagnostic development, better imaging, better testing. But in the meantime, you know, for people who are struggling, I think there is an opportunity to look at food, food as medicine, there's an opportunity to look at repurposing existing medicines. Oh, and by the way, this might be important for people who are listening who may have had COVID the first time and have gotten it again. Or maybe this is their first time having COVID and they're interested in, you know, trying to figure out what should I be worried about for long COVID? 

Well, it turns out a recent study just showed that, and this was a clinical trial, like an actual clinical trial, looking at people diagnosed with COVID. And by PCR, and then treated with one of three medicines. One was Metformin, which is a diabetes medicine. One was ivermectin, which is a anti parasitic drug. And a third one, I don't think it was hydroxychloroquine. But it was some - I can't remember the third medicine at the moment. But I will tell you, that one of those three, and it turns out to be Metformin, decrease the risk of developing long COVID by more than 30%. So being treated while you have acute COVID. With Metformin, at least this is what this clinical trial showed, seemed to lower the risk of developing long COVID. 

Of course, so does vaccination. And we think boosting will also be very important as well. But the fact that we can actually start to think about a medication, again, Metformin, it's been around forever. It's a safe, inexpensive pill that has very few side effects, that's used to treat adult onset diabetes, you know, could that be a new medicine that for newly diagnosed COVID patients, a doctor should prescribe that in order to be able to lower their chances of developing long COVID? All unanswered questions, but really, really promising. And as a doctor who has been involved with long COVID patients, I think optimistic. And exciting for doctors, because we're starting to think maybe we're gonna have some tools.

Jackie Baxter  44:40  
Yeah, I mean, that is amazing, isn't it? I mean, the idea that you could actually stop long COVID in its tracks before it gets started. I mean, that's obviously amazing. I mean, certainly something that concerns me is that you know, maybe I will get better. No, I will get better. But what happens if I got COVID again? You know, could I end up with Long COVID Mark Two? And like, that's such a horrifying thought, you know, let alone anyone who, you know hasn't had long COVID to start with. So that's really great news. But I feel like you've given me so much hope actually tonight, which is amazing.

William Li  45:17  
I'm glad I came across that way. Because really, I think that's what my own perspective is that as medical research, you know, will science will pave the way to solutions for health that that we don't have yet. But they're coming a little too slowly from my tastes, and I think for most people, but they are coming. And so you know, focus on where the progress is, rather than where the progress is not. That's one of the things that you know, in medicine, each doctor is hopeful. And when you think about, like how many really difficult, horrible diseases, there are, the way that we actually sort of stay hopeful and stay encouraging, and really try to do the best for our patients, is always, to be able to look at where the sun rises, you know, because tomorrow is going to be the new day. And I think that that's kind of what it's going to be like for long COVID. 

You know, finally, I think that, you know, one of the things that people should understand is that as we try to live with COVID, because it has no sign of going away, I was just writing about this earlier today. You know, there is a important aspect of self efficacy, you know, like we can take care of ourselves, we must take care of ourselves. And in the same way that, you know, the idea of vaccination and masking has become controversial and politicized and polarizing. You know, look, if you don't want to get pregnant, and you don't want to get an STD, wear a condom, you know, it's not 100%. But it's actually a much better protection than not wearing one and I'm keeping that example, kind of a stark example, because it's so simple, that everyone would accept it. And that's why I'm actually bringing it up, not for the shock value, but for the simplicity value. 

And that's where we are with these basic treatments, you know, try not to get swept into the polarizing conversations. You know, it's fairly simple. I mean, the disease is very complicated. What happens in your body is very, very complicated. With all those complexities that people are trying to figure out, like, let's not add anymore, and take it upon yourself to just sort of navigate the path so we can actually be as safe as possible. 

Jackie Baxter  47:27  
Yeah. 

William Li  47:28  
Anybody else who wants to especially wants to be interested in the not so medical technology, pharmaceutical side, one of the things that I do if they want to learn more about food as medicine is that I actually do a lot of work. And I've put up a ton of information on my website - you can follow me on social, I'm always talking about foods that can actually amplify your health. And you can find my handles @DrWilliamLi . And you know, I do master classes, I do all kinds of free things that really just try to get the information out there. 

I started this, by the way at the very beginning of the pandemic, because I felt like the one thing that we need to be able to do is get reliable, trustworthy, scientific information out in ways that people can do something about. And certainly, diet and lifestyle is something that, you know, perhaps we've taken for granted for too long. But now, certainly, I think everyone's attention has been raised to the importance of health. And this is whether you are struggling with long COVID, whether you are actually recovering from acute COVID or whether you don't have COVID. You know, these are things that we can all do for ourselves.

Jackie Baxter  48:39  
Yeah, definitely. And I will make sure I drop those links into the show notes. So if anyone's sort of frantically scrambling for a pen right now, I'll pop it in the show notes. 

Well, thank you so much for joining me tonight. It's been absolutely fascinating. I feel like I've learned so much that my head is about to explode. So I hope everybody listening will have done as well. So thank you so much, and thank you for everything that you're doing to help. 

William Li  49:06  
Thank you. 

Jackie Baxter  49:07  
Thank you so much to all of my guests, and to you for listening. I hope you've enjoyed it, or at least found it useful. The long COVID podcast is entirely self produced and self funded. I'm doing all of this myself. If you're able to, please go to buymeacoffee.com/longCOVIDpod to help me cover the costs of hosting the podcast. Please look out for the next episode of the long COVID podcast. It's available on all the usual podcast hosting things and do get in touch, I'd love to hear from you.

Transcribed by https://otter.ai