Sulodexide

Building a stone wall, and clinical updates from the field

PAST

Behind Kerrie, wall #1 to the left, wall #3, years before rebuilding it, to the right

When Kerrie and I bought our home twenty years ago, we were overwhelmed. I remember having a freakout moment when I fully grasped the enormity of the debt we had just taken on with our mortgage, and had the thought, “No wonder the government wants people to become homeowners! When you are enslaved to debt like this, you’ll be much easier to push around.” Then there was the infinite list of tasks to be accomplished before we even moved in: sanding, staining, painting, tiling, insulating, wiring. Theoretically this house was ready to move into when we bought it, but my wife built houses for a living, and we knew how hard it was to live in the middle of a construction site. We chose to stay a few months longer in our apartment and complete the home improvements on days off and evenings. In retrospect, I think that was a very wise decision.

In the first year that we lived in our house, we learned that there was some water seepage through the cinder block foundation in a few places, and undertook excavating by hand (pick and shovel) the dirt adjacent to the exterior of one wall. In the process, we discovered that the cinder block retaining wall was disintegrating, which was the impetus for building our first stone wall. It was a lot of work, but the function and beauty of this wall has rewarded us many times over for our efforts.

We divided our roles neatly. I was the cheap labor, excavating the dirt, breaking down the cinder block, and gathering the stones for building. Kerrie was the artist, architect and mason. This was a natural extension of our relationship in the kitchen. When we first moved into a small three level Trinity house in Philadelphia, there was barely room for one person in the kitchen. Harmonious meal preparation meant that there was one chef, and one sous chef or prep worker. We could switch roles, but never, ever, could there be two chefs at the same time.

A crumbling cinder block retaining wall before being rebuilt, as stone wall #2

The next wall we built was an elegant and economical solution to another problem. A different retaining wall was failing, and when we got a bid on its repair, the four digit number lead us to reconsider our options. There were still plenty of stones in the hills of our city lot, and so we set to work again. This time I had some creative license at the end of the project, because we needed some cement work to be done next to the steps. Starting with a handful of stonecrop seedlings, the plants covering this wall have transformed it into something beautiful.

The mast chef

Wall #2

The third wall we built was as much a relationship-building exercise as a way to spend time outside on a regular basis. It involved several months excavating hard clay dirt by pickaxe, shovel and bucket before we could even start laying the foundational stones. The chipmunks love its nooks and crannies, but they are awfully hard on the modest plantings which we have tried. The groundhogs and deer finished off what the chipmunks started, so that it has taken a while to find plants which are well-suited to the soil behind this wall.

Wall #3

VERY RECENT PAST

The fourth stone wall was a project which languished for at least a year. I think that one reason was how weak, tired and generally crappy I felt. From three previous experiences, I understood what it meant to excavate dirt, and carry stone in order to build a stone wall, and for the longest time, I wasn’t up to the task. I had some trepidation about whether I would ever be able to do it, because my cardiac echo had shown that I was in heart failure after the COVID shots, with an ejection fraction of 40% and four leaky valves.

Three months ago I started taking Sulodexide. It was my second attempt, as the first time around I had some low level stomach pain and heartburn, enough to make me pause after a week. This time I took it every other day for a week, then daily for a month and a half, and then went up to twice daily. There was some low-level abdominal soreness for about three weeks, which I would rate at a 1 out of 10. This has since passed. What happened over those weeks was that I began to feel stronger and stronger. In fact, I felt strong enough that Kerrie and I began to work on the fourth stone wall. In the last month of our efforts, I was climbing up a steep hillside, sometimes carrying a twenty pound, eight foot long steel pry bar to loosen large stones. I would roll them down the hill and then either leverage them into our tired little red wagon, or deadlift them with bent legs and a straight back. Then I would pull the wagon through the weeds, up a decent hill, and into the driveway, where I would unload the stones and go back for more. Each week I could feel myself getting stronger, less easily winded, and more confident.

The wall is finished, soil has been spread, plants planted. The chipmunks are working over this new territory, but we are having more luck with our plant choices this time. Every day that I see that wall, I am reminded of how far I have come in my recovery, and how far I have to go, but mostly I feel hopeful for myself and the other people who are struggling with PASC and injury from the COVID shots. We’ve learned a few things.

Wall #4

PRESENT

In early June 2024 I wrote about the anticoagulant drug Sulodexide (SDX) in my Substack From Russia with love. The reference to Russia is because most of our patients have sourced it online from a Russian platform, but all SDX is manufactured in Italy. The packaging is the same, the little red gel tabs are the same, and the dosing is the same, 250LSU or 25mg. What changes is the language on the box, and the number of doses included. The Russian version has sixty gel tabs, and the Italian version has fifty.

Russian on top, Italian below

In the last two months, several patients of the Leading Edge Clinic have been implementing use of this therapy in earnest, and we are seeing a wide range of benefits with most. There have been a couple of patients who haven’t tolerated it, meaning that their symptoms got worse, or after a month of use, don’t yet notice any benefit, but most patients are reporting positive results early on in their treatment.

How do I love you Sulodexide ? Let me count the ways. SDX inhibits thrombin like Eliquis and Xarelto, and it also inhibits platelet aggregation with other platelets, decreasing stickiness to the lining of blood vessels, like Plavix/Clopidogrel. But wait, there is more. It is anti-atherosclerotic, for those in the crowd who have coronary artery disease. It is anti-fibrotic, breaking down the fibrotic changes we see in blood and tissue due to the spike protein. Perhaps most importantly, it repairs the glycocalyx, healing the endothelial cells which line the blood vessels in our body. Vessel, as it is called by manufacturer Alfa Sigma, is a great name for the drug.

What is reassuring about Sulodexide is that is has been approved by European drug agencies and has been in use since 1972. When a drug has a long history of use, there has been plenty of opportunity to explore it’s pluses and minuses. Sulodexide is available as a generic medication, which makes it cheaper than comparable drugs such as Eliquis ($100 per month for SDX compared to $700+ for Eliquis) an anticoagulant which is a factor Xa inhibitor. Eliquis has a good safety profile, and in our use of it to treat micro clotting-for more than 1000 of our patients , there have been very few complications. However, there is evidence that Sulodexide is safer than Eliquis. My colleague and national expert on amyloid fibrin microclotting has said that SDX is safer than Aspirin. I would argue that being cheaper and safer than Eliquis makes it very unlikely that we will see Sulodexide approved by the FDA anytime soon, as it would threaten the Big Pharma profits from Eliquis, Xarelto, and similar patented drugs.

Back in February of 2024, I saw noteworthy improvements in the symptoms of two vaccine injured patients who used a one month treatment of Sulodexide with 250LSU (25mg) twice daily. I diagnosed the first patient with iliac venous compression (IVC). She took Sulodexide for one month before she had stenting with my colleague Dr Brooke Spencer in Denver, CO. She was noting improvement even before the moderate sedation was wearing off, and, among my growing list of IVC patients, has experienced one of the most rapid and dramatic improvements in her vascular system, chronic back pain, energy, and cognition. The second patient took Sulodexide for one month, and while he didn’t notice any tremendous benefit while taking it, his long-term recovery has been exemplary, as he has steadily improved in his reports re: ease of breathing, absence of chest pain, increased exercise capacity, and overall well-being. This is an example of a patient who would tell you that the SDX made no difference for him, but as the person documenting his clinical trajectory over time, I would say otherwise. The results of his microclotting score are as incontrovertible as they are stunning, with a drop from 4 of 4 (worst possible) to 1 of 4 (typical for chronic disease) after one month of treatment with SDX.

I can share feedback from four of my patients who have initiated SDX therapy.

Patient #1

Since starting SDX she has been feeling great, noticing much less bruising in her legs than before. When she did start it though, she noticed tingling in her legs, heaviness and some achiness, same with her chest, but has gone away. She takes this as a sign of reperfusing. Overall, she is seeing great improvements. She has been able to tolerate a two hour long car ride to the mountains with sitting up straight and no issues talking or going into a panic. She was able to see her family and friends as well.

Patient #2

A year ago he sealed the driveway. He used eight five-gallon buckets, and his wife had to spread it. This year he has poured and done all of it himself. This is a big change in terms of stamina compared to last year.  He and his wife walked to the back of their property last week and he didn’t have any issues, and he couldn’t have done a quarter of that last year.  In the last few months there were several occasions when he needed to run to do something and he could.

Patient #3

His wife says “A year and a half ago, he could barely move off the couch, and yesterday afternoon, he trimmed a big tree.  I feel like he is definitely able to do a lot more stuff. There are days when he gets foggy head, but there are days when he got less sleep, or is more stressed at work, and I would expect that some mornings he will wake up and his head will not feel right.”  

He uses his Apple watch when sleeping.  It wakes him up when his heart rate (HR) goes below 15 bpm.  Diagnosed with bad sleep apnea before COVID, then lost 35 pounds. Historically his HR has been 50 bpm when he was running in college. Since starting SDX, he isn’t getting alarms for low HR while sleeping. We could attribute improved HR to the Sulodexide.  He also doesn’t snore as badly as he did before.  He hasn’t used the CPAP machine in a long time, at least several months.  

Patient #4

He had to stop SDX for the five days leading up to a procedure, and his exercise tolerance slid backwards.  “I’m definitely not cured, I’m managing.”  With the withdrawal of therapy there was accompanying anxiety, but as soon as he went back on 250LSU daily, he started doing better again.  Scoring 99 on brain exercises. Yesterday did 193 exam questions in a day related to prep for a professional certification, scored 90% and was done in a day.

HOW DOES IT WORK?

Sulodexide has two components, or fractions. The low molecular weight of both sulodexide fractions allows for extensive oral absorption compared to unfractionated heparin. The pharmacological effects of sulodexide differ substantially from other glycosaminoglycan (GAG) drugs and are mainly characterized by a prolonged half-life and reduced effect on global coagulation and bleeding parameters. Plain English translation: with Sulodexide there is less risk of bleeding.

From a 2014 review of Sulodexide:

Sulodexide (SDX), a sulfated polysaccharide complex extracted from porcine intestinal mucosa, is a blend of two glycosaminoglycan (GAG) entities, namely a fast-moving heparin (HP) fraction and a dermatan sulfate (DS; 20%) component. The compound is unique among HP-like substances in that it is biologically active by both the parenteral and oral routes. A main feature of the agent is to undergo extensive absorption by the vascular endothelium. For this reason, in preclinical studies, SDX administered parenterally displays an antithrombotic action similar to that of HPs but associated with fewer alterations of the blood clotting mechanisms and tests, thus being much less conducive to bleeding risk than HPs. When given orally, SDX is associated with minimal changes in classic coagulation tests, but maintains a number of important effects on the structure and function of endothelial cells (EC), and the intercellular matrix. These activities include prevention or restoration of the integrity and permeability of EC, counteraction versus chemical, toxic or metabolic EC injury, regulation of EC–blood cell interactions, inhibition of microvascular inflammatory and proliferative changes, and other similar effects, thus allowing oral SDX to be considered as an endothelial-protecting agent.

We understand from our study and treatment of patients with post-acute sequelae of COVID and injury from the COVID shots, that endothelial (cells lining the blood vessels) injury occurred when the spike protein entered the blood and circulated. This happened to an exponentially greater extent from the shots, but can also occur in people who have had COVID, or who are experiencing shedding from exposure to vaccinated and boosted individuals. Therapeutics such as Sulodexide, which can counteract this endothelial injury, are showing themselves to be valuable.

Sulodexide has been studied extensively in relation to venous ulcers, chronic venous disease, and diabetic neuropathy. There was one study of Sulodexide use in PASC patients with chest pain, which had positive statistical and clinical significance. One application which intrigues me, and which I will be exploring with patients, is its potential use in treating tinnitus, because that has been one of the hardest nuts to crack in PASC and vaccine injury. Sulodexide studies showed that when used in conjunction with melatonin, or as monotherapy, it was a viable treatment option for patients suffering from central or sensorineural tinnitus. If you are ready to be truly blown away by the potential benefits and safety of SDX, check out this 2020 study Comparative Efficacy and Safety of Sulodexide and Other Extended Anticoagulation Treatments for Prevention of Recurrent Venous Thromboembolism: A Bayesian Network Meta-analysis.

HOW TO GET IT?

Did you ever see the movie The Dallas Buyers Club with Matthew McConaughey? In 1985 Dallas, electrician and hustler Ron Woodroof works around the system to help AIDS patients get the medication they need after he is diagnosed with the disease. This was the time of Fauci 101. Here we are, nearly forty years later, and it’s Fauci 201. Where there is a will, there is a way. In one case, a dedicated father obtained SDX for his vaccine injured son by taking a redeye flight to Mexico, visiting a farmacia with a relative, purchasing SDX, and flying back to the East Coast. Some good Samaritans on vacation in Italy have visited Italian pharmacies where they paid $50 per box and brought SDX back with them in their suitcase, which they then shared with others in need. If YOU happen to travel to Italy, with a prescription from an American physician, you will typically be able to get SDX. Most of the SDX our patients are using has been ordered online. The prices vary quite a bit, with Mexican sellers charging $600 per box, Malaysian sellers $10 per box (but they want an Rx and your passport number, which makes me uneasy). They have had the most consistent results with the Russian vendors, charging a reasonable price of between $100-200 per box. We have reached out to the Italian drug manufacturer Alfa Sigma to discuss getting the SDX for a clinical trial in the United States, and then applying to the FDA for permission to import the drug and provide it to our patients, but have not received a reply from the company. If you have an Alfa Sigma connection, please email me via Substack.

Sulodexide is being used to treat serious vascular conditions with multi-organ compromise in post-acute sequelae of COVID (PASC) and injury from the COVID shots, which is a clinical arena without clear standards of care, clinical guidance, or agreement about how to treat. There is no comparable Rx drug on the market which effectively breaks down fibrotic structures and repairs the endothelium WHILST inhibiting thrombin and platelet aggregation. Due to its approval in Europe in 1972, there are more than 400 academic articles re: the use of SDX, with a very clear body of evidence demonstrating its safety and effectiveness both in clinical trials and real world use. SDX is demonstrably safer than any of the other options on the market such as Eliquis, Xarelto, and Plavix.

I expect that this brief exposition on Sulodexide will raise more questions among readers. Please remember that this is not individual health care advice for you. If Sulodexide sounds promising to you, please do more research on your own, as there are more than 400 scientific references to be found, and discuss it with your healthcare provider. I suggest starting with PubMed, the free online search engine available through the NIH. As with purchasing other medicine, such as IVM, from outside the United States, there are inherent risks which the regulatory structure of FDA approval is meant to protect us from (but which can also impede our access to safe, repurposed drugs). Personally, I obtained Sulodexide from abroad for a cost of ~$80 for a one month supply, and when I shared images of the package, medication blister packs and package insert with a Russian-reading pharmacist, he validated that I had the genuine article. Buyer beware, as I can’t speak for the ethics and quality control of the person on the other end of such transactions, and you would be purchasing the drug at your own risk. No, I won’t share the websites patients have used successfully, because that increases the likelihood that they will be shut down. But, as I said, where there is a will, there is a way.