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emily pickering

Clinical uses of Palmitoylethanolamide (PEA)

Joining us today is Emily Pickering, a naturopath and PhD candidate at the University of Queensland who has completed a  clinical trial with Dr Elizabeth Steels using PEA for people with type 2 diabetes, who had peripheral neuropathy.

Tune in as Emily explains the many benefits of Palmitoylethanolamide (PEA) across several conditions and why it should be a clinical consideration for practitioners.

About Emily:
Emily is a degree-qualified Naturopath and PhD candidate with the University of Queensland. Her research focuses on nutraceutical and botanical-based treatments for both prediabetes and type 2 diabetes, She is also investigating the risk factors for glucose dysregulation and developing a robust new screening tool for clinicians to use in determining the presence of glucose dysregulation at an early stage. She has worked in several clinical trials as part of her PhD, in particular investigating PEA as a treatment for reducing pain and inflammation in people with diabetic peripheral neuropathy and has an interest in understanding the interconnections between pain, mood, gut microbiome and diabetes.

Alongside her research she practices in her clinic, focusing on conditions that cause pain, hormone dysregulation and mitochondrial dysregulation, which are linked to poor mood and poor energy levels. She is passionate about educating people on the importance of managing blood glucose levels, which are often associated with, but not addressed, in chronic health problems

Connect with Emily:
Facebook
: Emily Pickering Clinical Nutritionist and Herbalist
Instagram: @emilypickeringnutritionherbs
Emailemily@evidencesciences.com.au

Transcript

Introduction

Andrew: Welcome to “Wellness by Designs.” I’m your host, Andrew Whitfield-Cook. Joining us today is Emily Pickering, a naturopath and Ph candidate, who’s going to be telling us all about why we should be using PEA or palmitoylethanolamine

Welcome to “Wellness by Designs,” Emily. How are you going?

Emily: Hi, Andrew. Thank you so much for having me, and good job at pronouncing PEA. It is a mouthful.

Andrew: I still think I stumbled over the whole thing. Yeah, it’s so much easier to say…what is it? Phenylethylamine from ice cream? So much easier. So, Emily, tell us first a little bit about your history, you’re a naturopath. What drove you to do a PhD with…this is the University of Queensland, is that right?

Emily: Yeah. Yeah. So I’m a PhD student, at the University of Queensland in the School of Pharmacy, which works very well for the field that I’m studying, which is herbal medicine and nutritional medicine and its role… My research is particularly in glucose dysregulation, type 2 diabetes. So the School of Pharmacy was a good fit for that. But, yes, I’m also a naturopath. I finished my degree in health science naturopathy in the end of 2019. And about halfway through my degree, I had a bit of a mid-degree crisis moment, I guess you could say. I was in the middle of an assignment, and I was getting just really frustrated at the time with trying to write an assignment and showing, you know, my references, trying to find like good human-use studies that showed the efficacy of, you know, the treatments that we use, so herbal medicines, and nutrients, and, like, energetic medicines.

And it was during this one particular assignment, I just got so frustrated, and I was like, “Why are there no good human studies on this?” Or like why are there so many animal studies or empirical evidence, which is really important and trying to find really, really good resources and that evidence that a lot of the medical community needs to really take us seriously and to really look at it and go, “Oh, okay. Yes,” I can see that there is promise in these treatments rather than going, “Oh, it’s as…” I have come across, a lot of people go, “Oh, it’s some hogwash.” So I got really frustrated, and I was like, “Well, I’m gonna try to do something about this.”

Like, if I can get into research and maybe support the development of more research for herbal medicines and nutraceuticals and the stuff that we are all really passionate about as naturopaths and the practice of naturopathy and the principles behind naturopathy. It’s like if I can help bring more research out and develop also good quality studies, like, you know, your double-blind studies, your placebo-controlled studies, so like the whole science community can really look at the evidence we’ve got and go, “Okay, this is good quality. I’m gonna read this. I’m gonna take it on board. I’m not just gonna disregard it.” So that’s been on the mission that I’ve been on.

And so while I was in my degree, I did a little research project with Dr Janet Schloss. And that was really great “Okay, yeah, I like doing this,” and I wrote an article for that. And then I got in contact with Dr Elizabeth Steels, who is my mentor. She’s one of my PhD supervisors. And I work with her in her clinical trials. So, yeah, I’ve done now in my PhD a clinical trial with Dr Steels using PEA for people with type 2 diabetes, who had peripheral neuropathy. And we used PEA with them to see how effective that was for that particular pain because it’s quite difficult to treat peripheral neuropathy. And there wasn’t a lot of studies so far with PEA and that specific sort of type of treatment, and particularly the form of PEA that we were using. So that’s been one of the big projects in my PhD so far.

The other part of my PhD has been looking at herbal medicines for particularly prediabetes because that’s another difficult group to work with as well because their blood sugar fluctuates so easily. We’ve been, yeah, looking at that and seeing if herbal medicine can kind of show evidence… The treatments that we’ve used in clinic, like one particular one we’ve used in clinics for so much, you know, all the naturopaths know about it, but getting good studies about it can be difficult because, yeah, their blood sugar fluctuates so much. So it’s, yeah, I’m really about creating good-quality research that we can use in clinic but is also recognized by the greater scientific community to really help naturopaths get more respect, basically.

Andrew: Yeah. But also to guide, you know, proper clinical applications to it. I totally take your point about, you know, the frustration looking at good human studies, even for innocuous fibres, for instance, mucilaginous [SP] like slippery elm, good luck trying to find a human trial. And yet it’s been around for donkey’s years. It’s almost like a given. You know, one would think, “Oh, why would you make a human trial on water?” But the problem with natural medicines as you know, is that it’s very hard to patent a slippery elm unless you patent an extract. And then, of course, it becomes company-sponsored research, which is denigrated, even though pharmaceutical is a company-sponsored research, not denigrated. So there’s this real inequity, but that’s a whole podcast. I’m hoping to do a podcast on my own channel about this inequity of how things are judged. And I hold myself guilty there as well. I used to do that myself. So let’s get on a little bit into our topic. So, firstly, PEA. Can you tell us what it is exactly and take us through how it works in mammalian biochemistry.

Emily: Yeah, no worries. So PEA is an amazing molecule. Our bodies actually make it itself. It’s an endogenous fatty acid. So our body makes it, you can get sources of it from food, but it’s only really small amounts. So our body makes it itself. It’s part of the anandamide system, which is also like the endocannabinoid system. So it works by…so, yeah, basically, our body makes natural levels of it and it has an analgesic effect. So, when we are healthy, when we are not going through lots of high levels of stress, or if we don’t have, you know, an infection or a lot of inflammation going on, our bodies naturally have good levels of it that help us, you know, with pain sensations, so, when, you know, we cut ourselves and it eventually stops hurting, or, you know, we injure ourselves and, you know, and eventually the pain goes away.

When we are under a lot of stress, or if you’ve got a chronic health condition, or, for instance, in the study that I did people with diabetes and there’s that high blood sugar levels and there’s a lot of inflammation going on, the PEA is the process…the manufacture of PEA in the body gets changed, and we actually start producing the pro-inflammatory molecules. So what that means is that you start feeling more pain, or, you know, pain medications you might end up having to…some people will take more and more pain medications because, basically, the body stopped making its natural analgesic effect. The other beauty with PEA is that it’s also an…and it has anti-inflammatory action, particularly to do with mast cell activation. It’s great for that. And also, certain inflammatory markers, like in my research, I looked at its effects on interleukin-6, which is very…there’s a lot of that activated in diabetes.

So what it also helps to do is to tone down inflammation. And as I was saying, when you’re chronically ill, when you’ve got, you know, that long-going illness, like something like diabetes or osteoarthritis and all those clinical, you know, things that we see that, you know, is gonna take a long time, there’s been a lot of build-up, there’s a lot going on under the surface, that disrupts that PEA production.

And we’ve found by, you know, with those chronic conditions, supplementing PEA has given back that analgesic effect. It’s helped to tone down some of that inflammation that PEA works on, those inflammatory markers. And, you know, people have gotten pain relief, they’ve gotten reduction in their inflammation that you can see in the clinical symptoms, but also we’ve done blood tests and it’s shown that it’s brought it down. So it’s also…other studies come out on other effects as well and exercise. It helps with lactic acid. So I usually use it before I go for a run and it stops the lactic acid burn. It’s great for that. So, yeah, that’s a whole nother area potentially for sports.

But the thing with PEA that people really need to understand, particularly whether it’s biochemistry and its mechanism of action, is that it’s actually lipophilic. It needs to go through that cellular fatty acid membrane, which is so important. If you actually put regular non-emulsified PEA into water and stir it around, a lot of the what’s called micronized will actually stay clumpy. You can see it. It’s like trying to mix B vitamins or something.

Andrew: Plaster of Paris. Yeah.

Emily: Yeah, yeah. You can see it’s a powder. So what that happens is that when it hits the intestinal lining, the microvilli, you know, they’ve got all that lipid bilayer on it. It’s not gonna absorb it easily. It doesn’t go through those water-soluble channels. So that’s been the big issue with PEA, and using PEA is that it doesn’t absorb well. Only about 30% of raw unadulterated PEA actually gets absorbed through that microvilli.

So, you know, you’ve had to do really high doses, or, you know, the early studies showed that, you know, while it helped, it didn’t really get absorbed well. So it wasn’t taken up as a big thing for a long time. But what’s been coming out more and more in recent years is changing…you know, there was micronized versions, now there’s ultra-micronized versions, and even the studies on the ultra-micronized versions, so that it’s that’s still not greatly absorbed. So what’s been found is by emulsifying it and making it more fat-soluble, it’s able to be absorbed better now. And that’s where the really interesting research and effects coming out have shown that by emulsifying it, you are really getting like that punch, showing the effects of what PEA really can do.

Andrew: It seems to me to be a very similar story to curcumin. You know, the original research, the original theory, if you like, of curcumin being an anti-inflammatory was based on Indian culture using it in their foods and always never without, always with some form of fat, whether it be ghee cream, whatever. And yet we take it into our Western thinking, and we just wanna take it with a glass of water. So that dose unit has to be in a form which will be absorbed preferably with, you know, as you say, like other foods or something like that.

But can I ask about, did the previous research that wasn’t emulsified, did they use it with food? Was that enough to change the absorption if they took it with fatty food or something like that to initiate bile acid flow, you know, pancreatic enzymes, or was that just, no, that’s the 30% that they got?

Emily: That’s a good question. I haven’t read yet a study that has shown that it was taken with food. It could be out there, I’ve just not read it. So that’s a very good question, like, in clinic because it is like a phobic… I do recommend for people, if you’re gonna use the micronized version or the ultra-micronized version, taking it with food, especially like you said, like similar to Tumeric, having it with some fatty food, that will really help with that absorption. So, yeah, that’s a really good way to get around that poor bioavailability.

Andrew: But even then you’re pushing it uphill because you’re sort of crossing your fingers hoping that you’re gonna get higher than that 30% you mentioned. So what therefore, what sort of absorption did we get with the emulsified form?

Emily: Well, the emulsified form, there was a really good study done that compared it to the regular micronized PEA, and what they found is that one arm took micronized and one arm took the emulsified PEA, and they tested their levels for eight hours. And what they found is that the emulsified PEA had a 75% greater level of absorption than the micronized PEA. So, yeah, by emulsifying it, you are really getting value for money, you are getting that efficacy, you are getting a better, you know, result and a better idea of, you know, that it’s actually going to do the full effect that it can.

Andrew: Right. So I think the race now with industry is going to be to…just like we saw with curcumin is gonna say this increase in…I hate the word bioavailable, it’s not, it’s absorption. But there’s increased absorption mechanisms through various tactics, through various vehicles of emulsification or things like that, possibly even maybe by combining it with other things. Maybe that’s the thing that we’re always missing. We want it to do its job. Food isn’t like that; Foods work in concert with each other, but anyway… So one of the issues I have is that when we look at…let’s say what we look at today, let’s say PEA. We look at PEA, what the biochemistry is, where it works, and then we go downstream. What happens to clinicians is they’re faced with a patient in pain. They have to work backwards, and they have to say, “Is this the inflammatory signals that PEA is gonna action against?” So how do we help the two connect? Like, are there any conditions where PEA absolutely just sings?

Like, you are talking about diabetes, there’s an interesting comorbid, you know, situation. You know, there’s never just diabetes. So do you find that it works across the board, or do you find that it tends to work in subsets of diabetics?

Emily: No. That’s a really good question. It’s not a miracle-cures-everything molecule. There are certain things that it works really well with. And then I’ve found like just there’s research, you know, that it’s more of a chronic sort of inflammation, mast cell activation as well. So, when you’re getting like allergies, it’s worked well with that because it works on that mast cells. It’s works, like I said, with diabetes. The peripheral neuropathy is an interleukin-6 inflammation issue. So, if you’ve got a really good way to find out what’s going on with your clients is, of course, coming back to doing pathology testing, especially when you’re looking at inflammation markers, and you wanna know what it is particularly you’ve got to address and to help guide you what treatments are gonna be best to use for that client.

So, if you’re looking at interleukin-6, which is come up in the diabetes, that works…in PEA, we’ve found in our research works very well if you’ve got that interleukin-6 high levels. It also helped in our study bring down CRP levels. So that’s just your general acute inflammation. So anyone that’s got pain or skin conditions, if you’ve got…possibly if it’s signs of leaky gut, I mean, obviously you’ve still gotta work with the gut, and you’ve still gotta apply all those naturopathic principles to treating the whole person. But there’s been more studies come out showing that it works well with eczema. So that’s inflammation-driven and it’s coming out in the skin. So, if you’ve got skin issues, it can be helpful with that. You can use it either internally or topically. It works really well mixed into creams.

Osteoarthritis is a massive area that kind of gave PEA that leg in to become more available to us as practitioners, and it also helped it become listed with the TGA. So osteoarthritis is just such a huge area that PEA can really help with. The other areas that I’ve found in clinic, and there’s other research out there, but in clinic, I’ve particularly found…I’ve got clients with endometriosis, and that’s another big inflammation-driven area. I’ve found PEA really helpful with that. I’ve had a couple of people with side effects of a mast cell stimulated infection that has…if you look into the infection that they’ve got, it’s got activated mast cell levels, and that helped bring that down.

So best advice I could give is, it’s kind of like research, either the conditions that you’ve got that you’re seeing in clinic, or the symptoms that your clients are showing and going, “Okay, is this inflammation-driven? And most of the time it is. But if I found and the research hasn’t really been showing that autoimmune conditions are suitable for PEA, it’s a different system. You know you got your innate immune system, is going haywire there. So that’s not an area that’s greatly been studied. It may help with that. I’ve not really used it in clients for autoimmune conditions because I’ve seen more like chronic illness. I see a lot of like PCOS and diabetes and that sort of more ongoing.

The other way you could use PEA is when someone’s got a lot of inflammation or a lot of acute pain. You can use PEA, as you were saying, in combination with other treatments that works really well to kind of make sure you’re covering all your bases. So you could use PEA for…it’s got that ongoing immune inflammation stimulation. And then, you know, if you’ve got someone with an autoimmune disease, you could bring in your other tools that help with that. But say, if they’re also experiencing pain, or if, you know, they’ve got a skin condition coming through, then you can use it together. It here. It works, you know, as you said, with turmeric. That’s a beautiful combination. Quercetin is really good if they’ve got, you know, allergies. There’s a few different things going on there, but allergies is really great. PEA can help bring that down. And then the quercetin helps, you know, with the immune, that histamine response as well that’s going on. Boswellia is great for, you know, other people with pain. And as I was saying, it’s getting brought into creams as well now, so you can use it topically, you can bathe in it. It’s great.

Andrew: Can I ask, when you’re making a cream, you’ve gotta be mindful obviously to make, not an aqueous cream, but a fat-soluble cream, so a more emollient-type cream. Do you tend to favour ointments over creams, or what sort of base do you use?

Emily: The ones that I’ve seen in… I’ve not made one myself, but I know people that are developing creams. And from what I know they’re doing, it’s a vitamin E based cream. So, yeah, it’s definitely needing that sort of, you know…

Andrew: Fat-soluble.

Emily: Fatty acid nutrients that are, yeah, gonna get absorbed through the skin. If you mixed it into aloe vera, I don’t think that would work well at all because it’s not getting.

Andrew: That’s so interesting because there’s so many people that aren’t satisfied with the treatments they’re receiving for eczema, for atopic dermatitis. And so they’re searching for alternatives. And I think anything that can take another edge, another degree down to help normalize their skin, you know, it can be groundbreaking for them. It can be blossoming for their self-esteem because they go through hell, these people. Same with psoriasis, actually. Any use in psoriasis?

Emily: Yeah, that’s another area that is gonna be open to more research as well. Yeah, chronic skin conditions and PEA creams are a big area that, yeah, it could be more researched. And people I know that have just used it in clinic have had great results. But, yeah, there’s some exciting projects that I can’t mention. But in time, we should be seeing stuff come out about that. I do know of one trial going on at the moment. So if someone contacts me about it I can let them know what it is. I don’t know if I can mention it here.

Andrew: No, that’s fine. No, it’s okay. We nearly got a secret outta you though, no, that’s fine. No, just for all of our listeners…

Emily: Just email me, I can tell you about it.

Andrew: Yeah. But for all of our listeners, you can’t reveal any sort of research secrets until a certain point, until the research is in because it affects the research. So what about things like using medications? So, for instance, I’m thinking about people, say, with sciatica, they’re in chronic pain, they’re screaming out from the pain. The Australian government, indeed governments around the world have now damned and dampened the access to opioids. And, you know, for instance, where people used to be chronically using opioids for migraines, not necessarily responsibly, not necessarily healthily, I admit, but the access to opioids was quite free. Now, it’s a real struggle for people to get opioids, particularly if they’re in the lower socioeconomic class because doctors are now charging above the Medicare rebate, no-fault through their own. So it’s becoming a real issue to get adequate pain relief for these people. Does or can PEA help to make opioids more effective or dampen the inflammatory signal so that the opioids can do their job.

Emily: That’s a really good area to talk about, Andrew, and that’s part of the research trial that I did. All the people that we had with peripheral neuro diabetes…sorry, peripheral neuropathy with diabetes, they, first of all, were medicated for their diabetes. So everyone was on some form of blood sugar medication, so either Metformin, there were people on insulin, there were people on combinations. So we had everyone already using medications and that was part of the trial as well to see if PEA could be used safely alongside medications. And then the other thing that with medications was going on was that pretty much everybody was using a form of pain relief. So these were all people with ongoing, longstanding, chronic nerve pain. People had numbness, stabbing pains, you know, all the really very uncomfortable, very debilitating pain.

And a lot of people were using NSAIDs. Some were using Panadol, some were using aspirin. There were people on opioids like your Lyrica, and your Endone. There was a big mix of those different pain medications. And some people found that…well, a lot of people found that it just wasn’t working for them anymore. They’d have to go on increased doses. And as you said, like, people can start using them, and then they find that they can’t taper off them. And some doctors either go, “Well, there’s nothing else that can work for your condition. We don’t have anything else.” Or some may be reluctant to reduce the dose, or people find that they reduce the dose and then the pain comes back. And so a lot of people, yeah, they feel that they get stuck taking these medications that they are either not effective for them anymore, or, you know, they all have their own, you know, side effects or, you know, risk of dependency.

So that was what we were really interested in looking at is can PEA help also people taper down these pain medications that they’re having to take? So not everybody was able to reduce their medications. There were some people with severe peripheral neuropathy that the PEA was very effective in reducing the pain in the people that were taking PEA. So there was a group taking placebo, and then there was a group taking the PEA. And the people taking the PEA had drastic, significant pain reduction from just two weeks. And over time…so the study went for eight weeks. And then over time, we sort of checked in, like, we checked in with people every two weeks, but we kept asking, you know, how’s your pain levels? Are you having to take any rescue medication?

And for this study, everyone was sort of told to stay with the regular medications that you take. You know, we don’t want you to come off your medications because some people would be in excruciating pain, and that’s not ethical. So everyone stayed on their medications. Some people occasionally required Panadol or Nurofen as emergency medications. That was fine. We just recorded it and, you know, asked how it was going. And what we found is that there were some people that didn’t need their emergency medications anymore. So some people would have to take like Nurofen or something before they went to sleep because a lot of people find that their pain is worse at night and it wakes them up during the night. So a lot of these people, their sleep was greatly effective, and some people found they could sleep a lot better, which improved their quality of health greatly. But yeah, they didn’t need to use that extra medication.

And then there were some people…like all these people were all still monitored by their doctors. So we didn’t encourage them to stop taking, you know, any medications they were on. But some people found, you know, when they had follow-up appointments with their doctor, they would say, you know, “I’m using PEA, and I’m finding the pain is really helpful.” So some people were able to work with their doctor at reducing those really strong medications. And some people were able to come off them, some people were able to take less of the amounts, some people that were using them only every now and then didn’t need them as often. So there was that really great efficacy of reducing their pain, but also helping people use less of those very strong medications. And that was great to see.

And then, you know, the safety of using PEA with these medications we found was great as well. You know, everyone stayed very stable. No one had any side effects. PEA has a really, really good safety profile. So no one had, you know, issues. There was no liver issues, there was no kidney issues, apart outside of what they came into the study with. Yeah, no one developed severe reactions. People just in terms of their medications, if they felt like…some people with PEA, because it indirectly works on that endocannabinoid system, one of the CB2 receptors, some people that may have been very sensitive to that particular system, you know, we were like, “Oh, is anyone gonna start feeling funny with PEA?” But, no, there was none of that. Other people have reported in other studies they have, but in this particular group, no one did, maybe because they were already in so much pain. But, yeah, it had a very good safety profile with other medications and helping people come off those very strong medications.

Andrew: Gotcha. And what about relevant dosages? Like, you know, you say it doesn’t work in some people. Like, for instance, you are talking about gabapentin previously, and that’s a drug well known for titration. You know, if 75 doesn’t work, then they take 150, 300, blah, blah, blah. Did you have to titrate the dose in any of these patients, or were you restricted in the research for just using that standard dose that you chose? Can you tell us a little bit more about relevant dosing?

Emily: Yeah. Well, in the trial, there was just one dose of PEA, and everyone stayed on the same amount for the whole trial, which was 700 milligrams of the emulsified PEA. But what I do in clinic, because I can, you know, treat people individually, in clinic, I definitely titrate. So, if I’ve got someone…especially, usually, when I start seeing a client or they start on PEA, they’ll start at a higher dose. Especially if there is that high level of chronic pain, you wanna bring that pain down, you know, as safely, but as quickly as you can. So doing a high dose of PEA, like I usually do 600 milligrams of the emulsified PEA, breaking that into 300 milligrams twice a day because you do need to spread it out during the day, by doing that for…depending on the client, but usually, I’ll probably say, you know, “Take the high dose for at least a month.” That way, we’re really bringing down that inflammation, we’re bringing down the pain.

And then after a month, I’ll check back in with the client, or like after the bottle runs out, which is, you know, depending on what I’m using is usually about a month. I’ll check back in with the client and go, “How are you going? Have you found your pains reduced?” And then I’ll check through with like the other symptoms that are going on and the other processes. But if I find that people are getting that relief, or once people get that relief, especially from pain and then they start to stabilize, then I go, “Okay, well, what really happens there is that once you bring down that inflammation, the body then can…” I was saying how the body makes PEA itself. And when there’s really high inflammation, that system gets broken.

When you bring down that inflammation by doing high-dose acute PEA supplementation, you can stop that inflammation spike. You can stop that really high inflammation production. The body can start to sort of settle down and that connection back to making your own PEA can restart. So, eventually, the body can start making its own PEA, and then, you know, knowing how long that’s gonna take is going to vary for each client, depending on how much is going on. And, you know, you’ve still gotta look at other issues. You know, you gotta look at their diet, you gotta look at their stress levels. So you’ve still really gotta bring it into that holistic practice.

But once you’ve brought down that inflammation and, you know, they’ve got their stress levels under control, or, you know, whatever it is that’s going on in their life, I often go, “Okay, let’s try to peel back the PEA, let’s maybe do like…” You know, if they’re 150-milligram capsules, I go, “Let’s try one capsule less a day and see how you go with that. And then, you know, if their pain spikes back up, it’s like, “Okay, well, you’re not ready yet.” So we, like, wait another month and go, “Okay, let’s try it again.” Or if people, you know, after a month, their pain levels come back down, everything else is settling down, I go, “Okay, let’s the dose back. Let’s reduce by just one capsule at a time.” If they’re okay with that, then maybe two weeks we might try, or give it another month, and I go, “Okay, let’s see if we can reduce it back again.”

And some clients I’ve found can, you know, after a couple of months of like starting with the high dose and then slowly bringing it back down, you know, if they’re fixed off their diet and, you know, they’re managing their stress, they can come off PEA because their body’s been able to kickstart that natural PEA production again. Other people and other conditions, if they’ve not fixed their diet, or they’ve got other stuff going on, they might need to keep using it. It might need to stay being a high dose, it might need to stay being a low dose. So you really just gotta use your clinical insights, your clinical intuition, and just keep checking in with your client and going, you know, “How are you going? You know, what’s been going on?” And basically, if they look like they’re still struggling, I don’t recommend lowering the dose until you’ve worked on, you know, what else is going on with the client?

Andrew: Yeah. Yeah. That’s right. Amanda, there’s so much more to learn. Thank you so much for sharing your research, which I think is so important, but also how we can use PEA to sort of weave through, I guess, a support network, if you like, for patients in pain, but also, other inflammatory diseases. We didn’t even touch on things to do with the mast cell activation syndrome. Like, for instance, mold, you know, ADHD, autism spectrum disorder, things like that. But I thank you so much for sharing as what we could today on “Wellness by Designs.” I hope to get you back on again soon.

Emily: Thanks, Andrew. I could talk about this forever.

Andrew: I look forward to it. It sounds great. And thank you, everyone, for joining us today. You can find all the other interviews, and, of course, the show notes on this interview on the Designs for Health website, I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”