Aaron Hartman, MD (YouTube, Mar 14, 2025) gives a clinician-oriented overview of using nicotine as a potential therapeutic for nervous-system dysregulation (notably long COVID and POTS/dysautonomia) and some chronic pain/mast cell–related issues. He explains nicotine's actions on nicotinic acetylcholine receptors across brain, immune system, lungs and peripheral nerves (including a cholinergic anti-inflammatory pathway), notes plausible links to spike-protein–related receptor effects in COVID, and describes dosing strategies (patches, low mg doses, pulse therapy) plus risks (addiction, tolerance, withdrawal, cardiovascular and seizure risks). He emphasizes avoiding smoking/vaping, working with an experienced provider, using short courses and adjunctive anti-inflammatory/supportive therapies (omega‑3s, vitamins, clot‑dissolving enzymes) and warns about botanicals/compounds that also act at nicotinic receptors.
Chapters
Nicotine is all the rage right now. It was really interesting how one of my conferences I was at this past fall, they talked about using nicotine for long Covid symptoms as well as nicotine with pots dysautonomia and a whole host of things. I thought I had lots of time to sit and kind of process this, but unfortunately it's kind of popped up all over social media with nicotine and even some very popular social media people are being seen on camera putting their little nicotine in their mouth for like a, almost like a biohack to help their cognition a little bit. So I want to talk briefly about nicotine and its impact on our nervous system. Nicotine and the chronic health world is gaining support or gaining notoriety for use with pots dysautonomia, certain pain syndromes as well as long Covid. Because of its effect on your central nervous system, nicotine acts prominently through your parasympathetic nervous system. You have two different, you have preganglionic and postganglionic. And we're getting a little detailed here with acetylcholine. But the idea is that can work in different parts of your parasympathetic as well as your sympathetic nervous system. So nicotine is kind of tricky. It can have a calming impact. It can have an anti inflammatory impact actually through its impact on this thing called anti inflammatory cholinergic pathway, which is a big word for saying how acetylcholine can be anti inflammatory. Nicotine can activate this. It also tends to balance your sympathetic and parasympathetic nervous system activity. And so there's that. Then there's a whole idea of smoking. I'm not talking about smoking. Smoking is bad, vaping's bad. Don't do those things. I'm talking about using nicotine medicinally. And that's where there's a little bit of a hang up. Because traditional nicotine has been used for cigarettes, tobacco, which are associated with cancer. This is more for therapeutic stuff. And so again we're not talking about smoking, but as a potential therapeutic tool. Now one of the things you know, nicotine does in your body is it works in this, your sympathetic and parasympathetic nervous system. Again before certain nerves called ganglion in your parasympathetic nervous system and post these neurons post called postganglion in your sympathetic nervous system. So it can be a little weird when you can have symptoms of elevated blood pressure and salivation. You get nausea. It's almost like you get some sympathetic and some parasympathetic activation, dizziness, blood pressure fluctuations, these are all but then euphoria. The trick with nicotine is just getting enough to have the right balance in your nervous system. And at lower doses, like a milligram or two, you can actually have. You see an increased clarity of thought. It can help you think a little clearer, help wake you up a little bit. And one thing concerns us still with nicotine is addiction potential. If you take it all the time and stop it, you can have withdrawal, which is, you know, not what you're looking for. But it's interesting how in the long Covid world this is now being seen to help with some of the nervous system dysregulation we see in our long COVID patients and other chronic health issues. These receptors I'm referring to are found, I'm just looking at some notes in the brain, your immune system, lungs and nervous system. And it's interesting. The exact same receptors that nicotine works at are attacked by the spike proteins against spike proteins of COVID So that has a biologic plausibility for its utility in that. Was looking for some articles in relationship to it and there's not a whole bunch of research on that per se. But in some of my groups I'm in with other physicians, providers who are talking about using it with some benefit in some of their patients with dysautonomia. One of the big issues with nicotine is just the dose. You know, some people was one study I was looking at people trained on a 7.5 milligram nicotine patch for seven days in long COVID patients. And some of these people actually experienced complete remission. And some of the remission lasted for months. And that was a 7.5 daily patch. But it's not a cure all because you have to worry about long term use, addiction and withdrawal. But this is a potent tool for use with our nervous system and regulating it. So how do you use nicotine? If you think about using it, which again, you should also talk with your provider first. You, you should. This is for educational purposes only. I cannot diagnose or treat anything. That's my little spiel at that. This first thing, you always need to work with a provider. Someone's experience with nicotine. Typical. Most of my experience in the past was actually with nicotine abuse with smokers and when I was in the military working in a smoking cessation clinic. But you want to work with someone who's familiar with it. So you can help guide you through it. Because it can be kind of tricky because it is a drug, but you want to use it slowly. Whether you're using pills that are slow release or a patch. I kind of like patches because you can cut them in little quarters and eights and pie quarters and it's a slow on, slow off. It's a lot less of a abuse and also less of a euphoric impact. One of the issues with the with abuse is that euphoria get people tend to like it. And that's how you get in to addiction issues. And you want, you got to notice this is not for everybody. Hypertension, heart arrhythmias, hyperthyroidism, tremors, seizures. You know, you got to be careful with nicotine. These people and especially kids with panties and pans, you need to be careful. Again, I recommend only using this in consultation with a experienced healthcare provider who's worked with these kind of patients who can kind of guide you through that. There's an issue with nicotine tolerance versus nicotine addiction. Nicotine tolerance can occur with long term usage where it just doesn't work quite as well versus addictions. When you stop, you have like this addictive behavior. And that's the reason why it's good to do it short term, have breaks and holidays, not to do it all the time. Unfortunately that's what tends to happen with things like this. You need to be super, super careful. You know, pulse therapy which is using a patch for a few days, a pill for a few days that can help prevent dependency, intolerance as well as addiction if you so choose. You're on this pathway. And another thing is like you need to have other support for nicotine use. It's really interesting how you want to, if you have issues with some of the COVID related stuff, you want to clear by up some of the extra spike proteins. And so using things like omega 3s, vitamin C, vitamin E, enzymes like nattokinase and lumbrokinase are really interesting because they've actually seen to help break down the clots associated with long Covid. And interesting enough, some of the doctors in my local community are now recommending to their patients these are on the conventional side, a couple endocrinologists actually to use enzymes for patients with elevated D dimeris which can be related to long Covid. But there's something called pro resolver mediators which are the anti inflammatory aspect of omega 3s and what they do can be super helpful to calm your brain down if you're inside to start using nicotine for any kind of inflammatory condition. And so one thing to think about. If using nicotine at all, you want to avoid other things that activate nicotine receptors. You want to avoid ginseng, lemon balm, lobelia, huperazine, a these are all things they use for doing cognitive things that act the nicotine receptor as well. And so if you combine them too, that could be kind of bad. So make sure you kind of don't do that. But a couple of final thoughts. Nicotine has been demonized largely because of its association with abuse and tobacco, which is understandable. It's not inherently bad, but it can be in the wrong situation, wrong place. It can be addictive, though it's not innately addictive, and you can develop tolerance to it. So just knowing these things can be super helpful if you decide to try to use it. A lot more research is needed, but a lot of findings are suggesting you can use it in certain chronic issues, particularly with pots, mast cell related issues, as well as some long Covid stuff. So hopefully this was helpful. One of the reasons I'm doing this is because people in my clinic have been starting to ask me about nicotine, which is kind of interesting because it's become relatively popular on social media in the last couple weeks. I want to put this out there as a resource for individuals to kind of think more scientifically about this drug, natural drug, that has that our body makes nicotine, our body makes things that work at the nicotine receptor. I guess a better way to say that and doing things appropriately is huge. You don't want to overdo things. So hopefully this is helpful. If you have additional questions, please post them here below. And when I get some time, we'll hopefully be able to answer those either here or on our podcast. Take care and we'll talk to you soon.
