PEA for Pee and Other Chronic Pain: Palmitoylethanolamide!
Have you heard of palmitoylethanolamide? I first heard about it a few years ago from a customer, who told me that it had helped with her interstitial cystitis enormously. She used it alongside high-potency aloe vera capsules and said they were a great combination. I’ve been researching it a lot recently and thought I’d devote this month’s blog to telling you a bit about it, as I think it’s something a lot of you might like to try.
Let’s start with its name, as it’s not the easiest word in the world to read at first glance! It helps to break it down into three chunks: palmitoyl-ethanol-amide. It is pronounced parm-it-oil-eth-a-nol-a-mide and both ‘a’ sounds are short. (Personally I think this is an incorrect way of saying it. In my opinion, because we say the word ‘amide’ with the ‘a’ as in ‘hay’, the word ought to be pronounced parm-it-oil-eth-a-nol-ay-mide. I might well continue to pronounce it this way and hope that it catches on, because I think I am in the right here!) Luckily, nobody will have to say it very often, as ‘palmitoylethanolamide’ is usually abbreviated to ‘PEA’. Please note that this has absolutely nothing to do with peas that come in pods and pea protein supplements are not the same as palmitoylethanolamide! If you’re ever buying pea protein or palmitoylethanolamide products, read the label very carefully to make sure you’re getting the kind of pea you want!
Palmitoylethanolamide is a type of fatty acid amide that can be produced by almost every cell in the human body. It is also produced in the cells of many other animals and can be found in certain foods, including egg yolks, soy lecithin and peanuts. It has tissue-protective, anti-inflammatory and pain relieving qualities and its production naturally increases in situations where tissues are damaged. However, when pain and inflammation is chronic, demand for PEA outstrips supply. In such situations, supplementation might be helpful.
Although the properties of PEA have been known for decades, it was the work of Nobel Laureate, Dr Rita Levi-Montalcini, in 1993 that sparked serious clinical research. Dr Levi-Montalcini discovered that PEA is an important modulator of mast cells. This discovery initiated significant research into palmitoylethanolamide and today, there are over 700 scientific articles about it, along with dozens of indications for its use. I wrote quite a bit about mast cells and their role in interstitial cystitis in a previous blog post, so I won’t repeat that here. The gist is that mast cells are an important immune response to tissue inflammation or damage in the short term, but if they become hyperactive or remain ‘on’ for too long, they become part of the problem, perpetuating an inflammatory cycle. By modulating mast cells, PEA might help to break this inflammatory cycle. This means PEA could play a key role in the management of interstitial cystitis.
If you’re thinking that PEA works a lot like quercetin, you are correct. Quercetin also inhibits mast cell response, as well as inhibiting histamine release and the production of COX-1 and COX-2 enzymes that cause systemic inflammation. In this sense, they are quite similar. However, PEA has some additional mechanisms of action that further enhance its anti-inflammatory properties. It directly activates PPAR-alpha receptors, which are found in the liver, heart, intestines, smooth muscle cells, and endothelial cells – including the urothelium. Activation of PPAR-alpha receptors helps to inhibit the release of pro-inflammatory enzymes and mediators, thus reducing pain. PEA also indirectly acts on the endocannabidinoid system, including CB1 and CB2 receptors. You can read more about those in this blog post, where I discussed the fact that CB1 receptors moderate perception of pain and CB2 receptors play a role in inflammation and immune response.
Not all of the modes of action of PEA are fully understood, but the fact that there are three distinct known pathways by which it acts on inflammation and pain makes it a very exciting prospect. It has been studied in a whole host of chronic pain conditions – so many that I cannot possibly elaborate on each of them. Below is a list of some of the pain conditions in which PEA has been studied. I have linked some of them to research that might interest you, although I am not doing that for all of them as it would take me forever!
- Peripheral and central neuropathy
- Multiple sclerosis
- Temporomandibular joint pain (TMJ)
- Carpal tunnel syndrome
- Prostate pain
- Unexplained bladder pain
- Interstitial cystitis
- Lichen planus and lichen sclerosus with pain and itching
- Unexplained abdominal pain
In chronic pain problems, PEA has an extremely impressive Number Needed to Treat (NNT) score of 1.5. NNT measures how many people need to be treated with a substance in order for one person to see benefit. Amitriptyline, an antidepressant often prescribed for chronic pain, has an NNT of 4.6, so as you can see, PEA performs very favourably.
PEA has also been studied in other conditions such as:
- Crohn’s disease and ulcerative colitis
- Gut inflammation and pain
- Atopic and contact dermatitis
- Psoriasis and eczema
- Chronic unexplained itching
- Chronic skin inflammation
- Neurodegenerative disorders, including Alzheimer’s, ALS and Parkinson’s disease
- Depression and anxiety
- Asthma and COPD
- Hay fever
- Stroke and spasticity
- Spinal cord injuries
As if all that isn’t enough, PEA also performs well in the prevention and treatment of colds and flu. In six clinical double-blind, placebo-controlled trials involving more than 3,000 people, PEA was shown to reduce the chance of contracting flu by 30-60%. If flu was already present, supplementation with PEA resulted in non-trivial reduction in the severity of symptoms. Duration of flu was significantly less in individuals supplementing with PEA than in control subjects.
PEA is very easily metabolised. Because it is naturally made in the body, it is also easily broken down by the body. Any cell that can make PEA also has access to an enzyme called fatty acid amide hydrolase that can break it back down into its constituent parts. These can then be reintegrated into the cell membrane. PEA is therefore extremely safe to take and no negative side effects are associated with its use. No adverse reactions with other drugs have been identified, so PEA may be taken alongside other medications and supplements. Indeed, some of the studies linked above concern PEA’s use as an adjunct therapy to pharmaceutical drugs. PEA also carries no risk of tolerance or addiction, unlike many prescribed medications, and is safe for use in the elderly and children.
If you do decide to try a palmitolyethanolamide supplement for interstitial cystitis, pelvic pain conditions, or other chronic pain, do be aware that it is not a quick fix. It can take three months for the full effects to be felt, so it will require consistency and patience. A suggested dosing protocol is to take 1200mg a day for six weeks and then reduce the dose down to 600mg a day. For a more personal dosing protocol, you could take 20mg per kilogram of body weight. In my opinion, it would be a good idea to split the daily dose into two or three smaller doses rather than taking it all at once. Individuals with liver or kidney conditions should start with a low dose of 400mg per day and increase slowly. Obviously, this should be done under the care of a qualified healthcare practitioner.
I’ve been really excited to learn more about PEA and I am extremely impressed with the wide range of conditions it has the potential to help with. I think over the next few years, it is going to become much more widely known about as more and more clinical research is carried out into it. Of course, I am especially keen to find out more about how it performs in interstitial cystitis – it would be great if some more research could be done into that. I have a sneaky feeling that PEA might be useful in persistent genital arousal disorder too!
I hope you’ve found this blog interesting. If you have, you’ll definitely want to keep an eye on the Tiny Pioneer site, as we’re hoping to have some big news to announce before the end of the year!
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