The Dr. Hedberg Show

For people with food sensitivities and chronic digestive disorders, the holiday season can be tough. Invitations to indulge in forbidden foods are everywhere—from checkout lines and television ads to office parties and family gatherings. For many, resisting temptation may be an insurmountable challenge.

Sometimes, the visceral presence or memory of how a particular savory dish or sweet treat made one feel in the past is enough to cause one to forget (or simply not care) how that food will make one feel in the present. Which is to say: lousy. Bloated, flatulent, running to the toilet, or in pain. The aftermath of a holiday feast can leave anybody feeling a little sluggish the next day, but those with a medical reason to avoid certain foods might need extra support to recover.

A “3-Day Gut Reset” incorporating a full elemental diet is probably the quickest way to restore digestive function and comfort following such dietary indiscretions. This brief, modified, protein-sparing fast is easy to implement with a product such as Elemental Select™, Moss Nutrition’s tasty, vanilla flavored meal replacement powder.

Elemental Select™ contains all the essential vitamins, minerals, and macronutrients needed for proper physiologic function, in their “elemental” predigested forms. When mixed with water, this complete, easy-to-absorb nutritional shake can be consumed throughout the day without putting any strain on the digestive organs, enabling rapid intestinal healing and repair over the brief course of a three-day period.

Both full and partial elemental diets are recognized as important management strategies for people with digestive disorders. A full elemental diet, for example, was recently shown to prevent surgical recurrence of severe inflammatory bowel disease at a dose of 1200 calories per day. Decreasing intestinal inflammation, reversing leaky gut syndrome and intestinal permeability, rebalancing the microbiome, and improving digestive health are among the clinically researched benefits of elemental diet therapies.

Typically, elemental diets are employed over a period of two to six weeks. But shorter, intensive applications can help with rapid recovery from a relapse, such as may occur when patients with compromised digestion indulge in a holiday spree. A few days of full elemental diet protocol can make a significant difference in helping these folks get back on track and quickly feel their best.

One 30-serving container of Elemental Select™ is sufficient to complete an entire 3-Day Gut Reset. The patient simply consumes ten scoops of the product per day, and nothing else. (Each scoop contains 150 calories of bioavailable nutrition; therefore, ten scoops provide 1500 calories, enough energy for most people to function normally.)

The ten daily scoops may be divided in various ways, depending entirely on individual patient preferences. The most popular method is as follows: In a blender, combine two scoops of Elemental Select™ with 8 to 10 ounces of water. Consume five times per day, at regular intervals. 

While two scoops, five times a day is ideal for most people doing a 3-Day Gut Reset, some may prefer to mix a single scoop in 8 ounces of water, and repeat ten times per day, generally on the hour.

Others may opt to divide their daily ten scoops into three or four equal servings, and replicate a “breakfast, lunch, and dinner” routine, with optional snack. (In this latter case, at least 16 ounces of water should be used to blend each “meal,” since several scoops of powder will be taken at once.) All these dosing options are absolutely fine.

Whatever schedule is chosen, it is critical to remember that Elemental Select™ is an extremely nutrient dense formula. Its nutrient density requires that Elemental Select™ must always be sipped slowly, never gulped. Using a straw may be helpful in ensuring this aim is met. If the product is consumed too quickly, stomach upset may occur. A good guideline is to allow 30 minutes for every 8 ounce serving. Using a timer may be helpful.

During the 3-Day Gut Reset, no other food or caloric substances should be consumed. Water and simple herbal teas, such as ginger, hibiscus, or peppermint tea, may be enjoyed liberally. If there is no citrus allergy, lemon juice is acceptable. Coffee should be avoided, but if caffeine withdrawal headaches are a concern, consider green tea, which is gentler on the system.

Along with all the known essential vitamins and minerals, Elemental Select™ features methylated B vitamins to optimize energy production and nervous system function.

Protein precursors are provided as free-form amino acids featuring L-carnitine, L-glutamine, and Reginator®, a proprietary blend of hypoallergenic essential aminos plus gut-friendly L-arginine. Reginator® has been shown to help increase and preserve muscle mass, even without exercise.

Two scoops of Elemental Select™ contain 3.6 grams of Reginator®, providing the muscle protein synthesis equivalent of 15-20 grams of whey or pea protein, to support lean body mass retention and optimization during the 3-Day Gut Reset.

Be sure to discuss the elemental diet and using Elemental Select with your doctor or healthcare provider.

Shinozaki M, Yokoyama T, et al. Elemental diet therapy plays a significant role in preventing surgical recurrence of Crohn’s disease in the era of biologics. Surg Today. 2021 Feb;51(2):250-257.

The endogenous compound PEA (palmitoylethanolamide) is a natural anti-inflammatory agent which works in affiliation with the endocannabinoid system to help modulate pain. PEA was first discovered in the 1950s after being isolated from the lipid fraction of egg yolk. In recent years, PEA research has largely focused on neuropathic pain states and mast cell related disorders. However, earlier research often was directed toward the ability of PEA to support upper respiratory health, a line of inquiry stemming from prior observations regarding the efficacy of egg yolk in preventing rheumatic fever.

During the 1970s, six large placebo-controlled trials were conducted to investigate PEA as a cold and flu therapy. For this research, commercial grade PEA (trade name Impulsin) was used. These early studies, which engaged close to 4,000 subjects in total, yielded remarkable results. Trials conducted during the flu season demonstrated significant efficacy in both prophylaxis and treatment, with no adverse effects reported.

In a study where adult subjects took 600 mg of PEA three times per day or an identical placebo, incidence of disease over a twelve-week period was reduced by up to 40% in the PEA group.

In another trial, subjects with cold or flu who took PEA missed significantly fewer days of work, and experienced significantly less fever, headache, and sore throat than subjects taking placebo. Follow-up studies designed to replicate these findings further showed a significant reduction in acute respiratory infections after administration of PEA. The ability of PEA to downmodulate proinflammatory cytokine activity was proposed as a primary mechanism of action.

In the decades since this early research was performed, enhanced absorption PEA enabling higher efficacy at lower doses has been developed. One such PEA formulation, Levagen+, exhibits up to 75% increased absorption compared to commercial PEA, and has been clinically researched in humans for a variety of uses, including upper respiratory health.

A recent, double-blind, placebo-controlled study gave 600 mg of Levagen+ PEA or placebo twice daily to non-vaccinated outpatients with verified mild to moderate COVID-19 infection. Serum inflammatory biomarkers were evaluated at baseline, and after four weeks of treatment. At the end of the study period, only subjects in the Levagen+ group exhibited significant reductions in inflammatory biomarkers, most notably in levels of P-selectin, a thromboinflammatory marker known to be elevated in cases of severe COVID and other conditions marked by increased inflammation and thrombosis, for example, cardiometabolic disease.

Levagen+ is the form of PEA used in Moss Nutrition PEA Luteolin Select™. The product also contains luteolin, an antioxidant bioflavonoid shown to work synergistically with, and enhance, the benefits of PEA.

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References:

Keppel Hesselink JM, de Boer T, et al. Palmitoylethanolamide: A Natural Body-Own Anti-Inflammatory Agent, Effective and Safe against Influenza and Common Cold. Int J Inflam. 2013;2013:151028.

Fessler SN, Liu L, et al. Palmitoylethanolamide Reduces Proinflammatory Markers in Unvaccinated Adults Recently Diagnosed with COVID-19: A Randomized Controlled Trial. J Nutr. 2022 Oct; 152(10): 2218–2226.

Palmitoylethanolamide (PEA) is a naturally occurring endocannabinoid-like lipid mediator naturally found in many plants. PEA is analgesic, immunomodulatory, neuroprotective, antipyretic, antiepileptic, anti-inflammatory, anticonvulsant, antibacterial and antiviral. PEA also increases endocannabinoids and it down regulates mast cell activation. 

PEA can improve immune system function without increasing inflammation. PEA also regulates fatty acid metabolism, reduces oxidation of fats, and inhibits excessive nitric oxide.

PEA may contribute to enhanced muscle recovery and improved cognition, mood and sleep. PEA may be indicated for anti-aging, immunoenhancement, brain health, allergies, and joint health.

These properties make PEA a perfect compound for managing the difficult symptoms of Long COVID.

A recent study entitled, “The Use of Palmitoylethanolamide in the Treatment of Long COVID: A Real-Life Retrospective Cohort Study” looked at the potential benefits of PEA for Long COVID symptoms. Some of the most common Long COVID symptoms include fatigue, brain fog, headache, exercise intolerance, trouble breathing, memory lapse, anosmia, dysgeusia, depression, anxiety, psychosis, nervous asthenia, PTSD, insomnia, delirium and anhedonia.

How was the study done?

33 (10 male and 23 female) patients were given 600 mg PEA twice a day for 3 months. All patients were administered the post-COVID-19 Functional Status (PCFS) scale, to assess meaningful function, before (T0) and at the end of the treatment (T1). None of the patients had any side effects from the PEA.

Study results

All the patients experienced improvement in their Long COVID symptoms as measured by the Post-COVID-19 Functional Status scale.

The combination of PEA and Luteolin has been studied extensively, with multiple published papers showing the synergistic benefits of these two compounds. PEA and luteolin have been shown to reduce neuroinflammation by modulating microglia and reducing reactive oxygen species (ROS).

Luteolin is a flavonoid, specifically a flavone, found naturally in fruits, vegetables, and herbs such as celery, parsley, lettuce, spinach, peppers, broccoli, cabbage, carrots, onions (leaves), and apples (skins). Luteolin is similar in structure to quercetin, but luteolin is more potent and is sometimes referred to as a “supercharged” quercetin.

Luteolin has the following properties:

Another study entitled, “What Is the Role of Palmitoylethanolamide Co-Ultramicronized with Luteolin on the Symptomatology Reported by Patients Suffering from Long COVID? A Retrospective Analysis Performed by a Group of General Practitioners in a Real-Life Setting” looked at the medical charts of 49 patients with Long COVID who were treated by one of nine doctors in Rome, Italy.

The patients were treated with 700 mg of PEA and 70 mg of luteolin twice a day for 90 days.

No side effects were reported during treatment, nor any drug interactions with their medications.

The authors conclude, “Supplementation with PEALUT (PEA and Luteolin) helped to improve all patient-reported symptoms, especially pain, anxiety and depression, fatigue, brain fog, anosmia and dysgeusia, leading to an overall improvement in patients’ health status.”

PEA and luteolin have been found to be effective for post-COVID loss of smell (anosmia) and memory loss.

The first study entitled, “Ultramicronized Palmitoylethanolamide and Luteolin Supplement Combined with Olfactory Training to Treat Post-COVID-19 Olfactory Impairment: A Multi-Center Double-Blinded Randomized Placebo- Controlled Clinical Trial” was done for 90 days on subjects who took 700 mg of PEA and 70 mg of luteolin once a day combined with olfactory training.

The results of this study found that those supplementing with PEA and luteolin had significant improvements and even resolution of their loss of smell compared to the placebo group who only did olfactory training.

The second study entitled, “Parosmia COVID-19 Related Treated by a Combination of Olfactory Training and Ultramicronized PEA-LUT: A Prospective Randomized Controlled Trial” was virtually identical to the first study. Subjects took 700 mg of PEA and 70 mg of luteolin along with olfactory training for 90 days, and they achieved significant results compared to the control group.

The third study entitled, “Treatment of COVID-19 olfactory dysfunction with olfactory training, palmitoylethanolamide with luteolin, or combined therapy: a blinded controlled multicenter randomized trial” set out to see if doubling the dose of PEA and luteolin to 700 mg of PEA and 70 mg of luteolin taken twice a day was superior to just once a day dosing.

The results were surprising because there was no difference between the single dose or doubling the dose. This is good news for patients because this results in a significant cost-savings.

The fourth study entitled, “Effect of Ultra-Micronized Palmitoylethanolamide and Luteolin on Olfaction and Memory in Patients with Long COVID: Results of a Longitudinal Study” used the same dose as the above studies of 700 mg of PEA and 70 mg of luteolin combined with olfactory training and found significant improvements in olfaction and improved memory/brain fog.

The one common thread among all the above studies was the importance of olfactory training along with the PEA and luteolin supplement.

PEA is not well absorbed, so it must be delivered in a specific form called Levagen+. Levagen+ PEA uses LipiSperse technology to enhance the absorption of PEA.

Most of the studies on Levagen+ PEA used 300 mg twice a day with excellent results. For more complex cases, 600 mg twice a day of Levagen+ PEA may provide better results.

The therapeutic dose of luteolin is 100-200 mg a day, since it is a potent flavonoid.

Moss Nutrition’s product PEA Luteolin Select contains 300 mg of Levagen+ PEA and 50 mg of luteolin per capsule. I use one capsule twice a day with meals for most patients, and two capsules twice a day for more complex cases.

Long COVID patients are experiencing more and more viable supplement options, and the combination of PEA and luteolin is now part of my core Long COVID protocol.

Hedberg Institute members can download my Long COVID protocol in the Practice Tools section of your membership area. Hedberg Institute members also get access to all my course material on how to treat Long COVID.