Infection Connection

For clinicians in functional medicine, these cases are all too familiar. While antibiotics, herbal medicines, biofilm disruptors, and immune support are key in managing Lyme disease, restoring quality sleep is just as essential. Without sleep, healing stalls. It is during deep sleep that glymphatic clearance occurs, immune cells regenerate, and the nervous system resets. Herbal solutions can help patients with Lyme-related insomnia achieve deep, restorative sleep. This article explores how Lyme disrupts sleep physiology and how Moss Nutrition’s new Sleep Select Herbal—a blend of saffron, valerian, American skullcap, passionflower, and Ziziphus spinosa—can help restore calm and rest. These botanicals are supported by clinical trials and tailored to address the unique neuroimmune dysregulation seen in Lyme disease. The Limits of Conventional Sleep Aids Many Lyme patients are prescribed benzodiazepines, sedative antihistamines, or off-label antidepressants for insomnia. While these may offer temporary relief, they rarely address root causes. Over time, they can disrupt sleep architecture, desensitize GABA receptors, and create dependency or withdrawal problems. By contrast, botanical nervines and adaptogens support endogenous pathways—enhancing GABA, modulating cortisol, and recalibrating circadian rhythm—without suppressing natural neurotransmission. This is the core strategy behind Sleep Select Herbal. How Lyme Disease Disrupts Sleep and Creates Nervous Tension 1. Neuroinflammation and Cytokine Overload Borrelia and its coinfections invade the central nervous system, triggering microglial activation and the release of inflammatory cytokines like IL-6, TNF-alpha, and IL-1β. These cytokines interfere with the function of sleep-promoting areas in the brain, such as the hypothalamus and suprachiasmatic nucleus. Impact: Reduced sleep drive, disrupted circadian signaling, and altered neurotransmitter synthesis. 2. Cortisol Dysregulation and HPA Axis Dysfunction Patients with chronic Lyme disease often exhibit abnormal cortisol rhythms—typically low in the morning and elevated at night. This flipped curve perpetuates insomnia, often manifesting as nighttime awakenings or difficulty falling asleep. Impact: Low melatonin, nighttime anxiety, impaired parasympathetic tone, and reduced vagal tone. 3. GABA and Serotonin Imbalance Lyme disease inflammation can disrupt the synthesis and receptor sensitivity of GABA and serotonin—the primary calming neurotransmitters. This leads to hyperarousal, panic, and light, unrefreshing sleep. Impact: Reduced GABAergic tone increases muscle tension, rumination, and sympathetic dominance. Five Botanicals to Restore Sleep in Lyme Disease Each herb in Sleep Select Herbal addresses a distinct but overlapping mechanism contributing to insomnia and nervous tension. Clinically formulated Sleep Select Herbal supports deep, restorative sleep for patients with Lyme-related insomnia and nervous tension. 1. Saffron (Crocus sativus) – The Circadian Calibrator In a 2021 double-blind, placebo-controlled study of 120 adults with poor sleep, saffron (affron®) at 14–28 mg improved sleep quality, reduced insomnia severity, and increased evening melatonin levels without next-day sedation (Lopresti et al., 2021). Mechanisms: Increases nighttime melatonin Reduces evening cortisol Improves sleep onset and continuity Patient Profile: Individuals with delayed sleep phase, high evening cortisol, or mood disturbances upon waking. 2. Valerian (Valeriana officinalis) – The GABAergic Grounder Valerian root enhances GABA signaling by inhibiting its breakdown and modulating GABA-A receptors. A clinical trial showed valerian significantly improved total sleep time, reduced latency, and enhanced sleep efficiency (Shekhar et al., 2024). Mechanisms: Binds GABA-A receptors without habituation Reduces anxiety and muscle tension

If you’re struggling with chronic fatigue syndrome (ME/CFS) or debilitating tiredness that just won’t go away, you’re not alone—and you’re not imagining things. Millions of people suffer from persistent fatigue that conventional medicine often fails to resolve. Fatigue and stress can make everyday tasks like working at a computer feel overwhelming, as seen in this image, which represents the experience of many with chronic fatigue syndrome (ME/CFS) At the Hedberg Institute, I’m always researching botanical compounds that support microcirculation, mitochondrial health, and immune regulation—all vital in restoring energy. That’s why I formulated VascuSelect, a synergistic supplement that contains three powerful plant extracts: Ginkgo biloba, grape seed extract, and mango whole fruit powder. Let’s dive into why Ginkgo biloba, in particular, stands out for those dealing with ME/CFS and how it works alongside other ingredients in VascuSelect to support your energy and vitality. An Important Study: Ginkgo Biloba for ME/CFS A recent paper published in Frontiers in Pharmacology (2022) titled “A Botanical Product Containing Cistanche and Ginkgo Extracts Potentially Improves Chronic Fatigue Syndrome Symptoms in Adults: A Randomized, Double-Blind, and Placebo-Controlled Study” sheds important light on Ginkgo’s role in combating chronic fatigue. In this gold-standard clinical trial, 101 adults with ME/CFS received a botanical supplement combining Ginkgo biloba extract (120 mg/day) and Cistanche tubulosa extract (300 mg/day) or a placebo for 60 days. The results were impressive: Significant reductions in fatigue severity Improved physical performance and VO₂ max Enhanced antioxidant status and reduced oxidative stress markers Improved sleep quality and concentration Enhanced quality of life (QOL) and sexual life (SLQ) scores Decreased blood levels of lactic acid and ammonia (both fatigue biomarkers) What’s particularly exciting is that Ginkgo biloba played a central role in this formulation. The authors noted that Ginkgo’s flavonoids and terpenoids contribute to neuroprotection, vasodilation, and mitochondrial support, all of which are key areas of dysfunction in ME/CFS patients. This study confirms that Ginkgo biloba, known for enhancing blood flow and antioxidant activity, can play a central role in reducing the burdens of ME/CFS. How Ginkgo Biloba Helps Fight Fatigue Ginkgo biloba (standardized to 24% flavonol glycosides and 6% terpenes) is one of the most studied botanical extracts for circulatory and cognitive health. But its applications go far beyond brain support—especially for those with energy-depleting illnesses like ME/CFS. Ginkgo biloba is one of the oldest and most studied medicinal plants. It’s been used for centuries in Traditional Chinese Medicine, but modern science is now validating its applications for conditions like ME/CFS, fibromyalgia, and Long COVID. 1. Improves Microcirculation Ginkgo biloba increases blood flow, especially in the small vessels of the brain and extremities. This is critical in ME/CFS, where impaired oxygen delivery to tissues can worsen fatigue. 2. Supports Mitochondrial Function Many people with ME/CFS experience dysfunctional mitochondria—the energy-producing engines of cells. Ginkgo has been shown to protect mitochondrial membranes and improve ATP production, helping the body generate more usable energy. 3. Reduces Oxidative Stress Oxidative stress is a hallmark of ME/CFS and contributes to inflammation, brain fog, and fatigue. Ginkgo’s rich flavonoid profile helps neutralize free radicals and reduce oxidative damage. In the study mentioned above, participants taking Ginkgo and Cistanche showed significant increases in antioxidant enzymes like SOD and CAT. 4. Enhances Neurotransmitter Function Ginkgo biloba modulates neurotransmitters like dopamine, serotonin, and norepinephrine—chemicals that regulate mood,

I'm thrilled to announce the launch of my new podcast: Infection Connection — a show dedicated to uncovering how stealth infections and hidden pathogens are driving the rise of complex chronic illnesses. If you've followed my work at the Hedberg Institute or listened to past podcast episodes, you know I’m passionate about investigating the root causes of conditions that conventional medicine often struggles to explain. That passion has now evolved into Infection Connection — a focused exploration of the link between infections and the growing epidemic of chronic disease. What You’ll Hear on Infection Connection Each episode will take a deep dive into how infections contribute to (or trigger) some of the most challenging chronic illnesses we see today, including: Long COVID Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) Lyme Disease and coinfections Mast Cell Activation Syndrome (MCAS) Mold and Mycotoxin Illness Autoimmune Disease …and many others I’ll be drawing on the latest research, clinical experience, and the powerful tools of functional medicine to help practitioners and patients understand how to identify and address these complex drivers of disease. Who Is This Podcast For? Whether you're a health practitioner, a patient on your own healing journey, or simply someone fascinated by the science of chronic illness, Infection Connection will offer insights you won’t find anywhere else. Expect evidence-based strategies, cutting-edge perspectives, and real-world case studies that connect the dots between infection and dysfunction. Why the Change? If you’ve been subscribed to my previous podcast, you’ll automatically receive new episodes of Infection Connection — no need to re-subscribe. The updated title and direction reflect where my work has naturally evolved: a deeper focus on infectious root causes and the protocols that work. What’s Coming Up The first few episodes will cover: Ginkgo biloba and ME/CFS Herbal and supplement strategies for Long COVID The best herbs for infection-driven insomnia Stay Connected Subscribe wherever you get your podcasts, and don’t forget to leave a review if you find the content helpful — it really helps others discover the show. To subscribe on your favorite podcast platform, click here: Subscribe to Infection Connection Podcast

A new study entitled, “The Efficacy of Palmitoylethanolamide (Levagen+) on the Incidence and Symptoms of Upper Respiratory Tract Infection-A Double Blind, Randomised, Placebo-Controlled Trial” aimed to evaluate the effectiveness of a signaling lipid called Palmitoylethanolamide (PEA) in reducing the occurrence, duration, and severity of upper respiratory tract infections(URTIs). The results showed that participants who took PEA experienced fewer URTI episodes and had reduced symptoms compared to those who took a placebo, suggesting that PEA may be a safe and effective treatment option for URTIs. Palmitoylethanolamide (PEA) is a lipid compound that belongs to the N-acylethanolamine (NAE) family and has similar properties to endocannabinoids. In the context of cold and flu infections, PEA is suggested to regulate interleukins and inhibit mast cell production, thereby reducing inflammation. PEA activates NF-κB pathways through peroxisome proliferator-activated receptors (PPAR), particularly PPAR-α, and concentration-dependent mechanisms to decrease NLRP3 and inflammasome activation, ultimately leading to a decrease in the expression of cytokines and alleviation of upper respiratory tract infection symptoms. It is worth noting that the natural levels of PEA in the body and the use of PEA supplements have been found to be ineffective in producing significant clinical results due to poor absorption, resulting in low levels of PEA in the bloodstream. However, when PEA is combined with dispersion technology, such as Levagen+, the absorption of PEA is greatly improved, leading to higher concentrations in the bloodstream, which may enable a therapeutic effect. This study was conducted over a period of 12 weeks. It was a double-blind, randomized, placebo-controlled trial, where participants were divided into two groups: an active group receiving 300 mg of Levagen+ PEA twice a day and a placebo group receiving maltodextrin. The purpose of the study was to investigate the efficacy of Levagen+ PEA compared to the placebo in terms of the incidence, severity, and duration of upper respiratory tract infections (URTI). During the study, 87 participants out of the total enrolled experienced at least one URTI, resulting in a total of 103 URTI episodes. The group receiving Levagen+ PEA reported significantly fewer URTI episodes (39) compared to the placebo group (64), and a lower number of participants who fell sick at least once during the study (32 vs. 55) when compared to the placebo group. Participants in the Levagen+ PEA group reported a significantly lower severity score for scratchy throat and cough. Overall, compliance with the study was high for both groups in terms of capsule consumption. The findings of the study indicate that individuals in the Levagen+ PEA group had a significantly lower number of upper respiratory tract infection (URTI) episodes compared to the placebo group. The study suggests that Levagen+ PEA could be a viable treatment for preventing upper respiratory tract infections (URTIs) and alleviating symptoms of cold and flu. The findings indicate that Levagen+ PEA is safe and effective in reducing the frequency of URTI episodes and relieving scratchy throats and coughing in individuals with URTI symptoms. I use PEA Luteolin Select from Moss Nutrition, which contains 300 mg of Levagen+ PEA and 50 mg of the flavonoid luteolin per capsule. PEA and luteolin have been shown to work synergistically in COVID-19-related illnesses such as Long COVID. I have patients take 1 capsule twice a day with meals of PEA Luteolin Select during COVID-19, cold, and flu season for prevention and then increase to 2 capsules three times a day when they feel like they’re coming down with something. Hedberg Institute Members can download my latest upper respiratory tract infection protocols by logging in. Click here to learn more about the Hedberg Institute Membership.

A new paper entitled “Isorhamnetin protects porcine oocytes from zearalenone-induced reproductive toxicity through the PI3K/Akt signaling pathway” investigated the effects of a natural flavonoid called isorhamnetin on the damage caused by a toxin called Zearalenone (ZEA) to pig oocytes (immature egg cells). Zearalenone (ZEA) is a harmful mycotoxin found in moldy grain like corn, oats, and millet that can cause irreversible damage to the reproductive system of animals and humans. It can cause reproductive disorders by binding to estrogen receptors and has been shown to impair the development of sperm and oocytes in humans and animals. ZEA can cause oxidative stress that leads to the production of reactive oxygen species (ROS), which can be harmful and contribute to cell death. ZEA can also disrupt pregnancy, inhibit the meiosis of oocytes, and induce mitochondrial damage and stress in the maturation of oocytes. Since ZEA is heat-stable and cannot be completely eliminated from the food chain, it is important to explore potential compounds that can protect against ZEA-induced damage to oocytes. In recent years, natural substances called flavonoids, which have antioxidant properties, have gained attention for their ability to support the development of oocytes. For example, quercetin has been found to increase the proportion of porcine oocytes developing into blastocysts, while kaempferol has shown potential in reducing the negative effects of aging on the development of porcine oocytes by improving mitochondrial function and reducing oxidative stress. Isorhamnetin is a compound found in the herb ginkgo biloba and in foods like pears, onions, and peanuts. It has various pharmacological activities, such as being an antioxidant, anti-inflammatory, and antiviral. Isorhamnetin acts as an antioxidant by decreasing the production of reactive oxygen species (ROS) and increasing the expression of SOD2 protein, which helps protect against oxidative stress. This study found that isorhamnetin can protect the oocytes from ZEA-induced damage by improving their development, reducing oxidative stress, preventing mitochondrial dysfunction, and inhibiting apoptosis. This research provides a potential solution for reproductive toxicity caused by ZEA and treating female infertility. Mold Toxicity and Ginkgo Biloba Clinical Applications Ginkgo biloba is rich in isorhamnetin as well as other powerful flavonoids like quercetin, kaempferol, and luteolin which makes it the perfect herb for patients with mold toxicity. Ginkgo biloba has many benefits including anti-inflammatory, antioxidant, antiviral, anticoagulant, anti-obesity, hypolipidemic, hypotensive, anti-diabetic, anti-cancer, adaptogenic, and it protects the brain, eye, inner ear, heart, liver, cardiovascular system, reproductive system, lungs, and kidneys. Patients with mold toxicity tend to have reactivated herpes viruses like EBV, CMV, and HHV-6 and ginkgo biloba is effective against these types of viruses as explained in this article. I use VascuSelect from Moss Nutrition which contains 120 mg of standardized ginkgo biloba extract along with grape seed extract and mango extract to further support microcirculation. 120 mg of ginkgo biloba twice a day is the usual dose for this versatile herbal medicine. If you’re a practitioner who sees patients with mold toxicity and/or infertility, then VascuSelect should be considered an important part of your protocol. Click here to learn more about the Hedberg Institute Membership to take your functional medicine practice to the next level.

A new paper published in the journal Science entitled, “Persistent complement dysregulation with signs of thromboinflammation in active Long Covid” sheds light on the causes of Long COVID. The authors begin by pointing out the current hypotheses about the causes of Long COVID, including persistent inflammation, autoimmunity, tissue damage, and viral reservoirs. In this study, researchers followed 39 healthy individuals and 113 COVID-19 patients for up to a year to identify biomarkers associated with Long COVID. At the 6-month follow-up, 40 patients still experienced Long COVID symptoms. They collected blood samples and measured over 6500 proteins to identify potential biomarkers using computational tools and experimental evaluation. In patients with Long COVID, there was an increased activation of the complement system, which is a part of the immune system that helps fight pathogens and damaged cells. This activation persists even after the acute phase of the disease. The complement system can cause damage to cell membranes, and in Long COVID patients, there is an imbalance in the formation of a complex called the terminal complement complex (TCC), also known as the membrane attack complex (MAC), which contributes to tissue damage. Long COVID patients experienced increased markers of tissue injury in their blood, along with a thromboinflammatory signature. This means that there are signs of damage to tissues and an abnormal immune response involving the activation of endothelial cells and the breakdown of red blood cells. These findings suggest that Long COVID is associated with ongoing inflammation and potential blood clotting issues. In patients with Long COVID, there are lower levels of antithrombin III, a protein that helps regulate blood clotting. This leads to increased cleavage by thrombin, which is a key factor in the formation of terminal complement complexes (TCCs). Additionally, Long COVID patients show elevated markers of platelet activation and the presence of monocyte-platelet aggregates, particularly in cases where Long COVID symptoms persist for 12 months or more. These patients also exhibit signs of antibody-mediated activation of the classical complement pathway, which is associated with increased levels of antibodies against cytomegalovirus (CMV) and Epstein-Barr virus (EBV). In this study, the researchers also used a sensitive test to measure antinuclear antibodies (ANA) in patients with Long COVID. They found that patients with Long COVID had a higher prevalence of positive ANA results compared to those without Long COVID. Positive ANA tests can indicate autoimmunity. Based on the data presented, it is suggested that Long COVID patients should undergo early cardiovascular assessment due to potential cardiovascular complications. Additionally, antiviral medications targeting SARS-CoV-2 or herpesviruses may help reduce inflammation and blood clotting in Long COVID patients. Therapies that target the terminal complement pathway could also be explored as potential treatment strategies for Long COVID and other post-infection syndromes. Long COVID Clinical Applications This paper confirms that inflammation of the blood vessels is common in Long COVID. Supporting microcirculation with herbs like ginkgo biloba, grape seed extract, and mango fruit powder can help reduce this inflammation and repair damaged blood vessels. These three herbs also are effective anti-viral agents against viruses like Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV). Ginkgo biloba has been shown to help improve the symptoms of Long COVID. I use VascuSelect from Moss Nutrition which contains standardized forms of ginkgo biloba, grape seed extract, and mango fruit powder. I also use palmitoylethanolamide (PEA) combined with luteolin to reduce inflammation and fight chronic viruses. Both of these are found in PEA Luteolin Select from Moss Nutrition.

Ginkgo biloba, known for its distinctive fan-shaped leaves, has been used in traditional medicine for centuries, particularly in Asia. Ginkgo biloba is often touted as an herb for brain health, such as improving memory and cognition. This reputation does a great disservice to the most versatile herb in the world. Ginkgo biloba can be used as a potent antiviral agent for a variety of viruses. Ginkgo biloba has some key bioactive antiviral components: Flavonoids and Terpenoids: Ginkgo leaves contain high levels of flavonoids and terpenoids, compounds known for their antioxidant properties. These substances contribute to the antiviral activity of the plant. Ginkgolides and Bilobalides: These are unique terpene trilactones found in Ginkgo biloba, which have specific antiviral activities. Ginkgo Biloba’s Mechanisms of Antiviral Action The antiviral properties of Ginkgo biloba are multi-faceted, involving multiple mechanisms: Inhibition of the fusions and synthesis of proteins in the viruses herpes simplex 1 and 2 (HSV-1 and HSV-2). Inhibition of genome replication in cytomegalovirus (HCMV) and Zika virus (ZIKV). Inhibition of viral fusion proteins in HIV, Ebola virus (EBOV), influenza A virus (IAV), and Epstein-Barr virus (EBV). Inhibition of the targeting protein and DNA of coronoviruses (SARS-CoV-2), varicella zoster virus (VZV), and measles virus. Inhibition of Viral Entry and Replication: Some studies suggest that Ginkgo biloba extracts can interfere with the ability of viruses to enter host cells or replicate. This is a key step in preventing the spread of viral infections. Immune System Modulation: Ginkgo biloba might enhance the body's immune response against viral infections. By modulating immune functions, it could help in controlling viral spread and severity. Anti-inflammatory Effects: The anti-inflammatory properties of Ginkgo biloba can be beneficial in reducing the severity of symptoms associated with viral infections. Research on Ginkgo Biloba’s Antiviral Properties Anti-MERS-CoV and Anti-HCoV-229E Properties: A study focused on the antiviral activities of Ginkgo biloba leaf extracts against Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Human Coronavirus 229E (HCoV-229E). Inhibition of Enveloped Viruses: Research published in Scientific Reports discussed how ginkgolic acid, a component of Ginkgo biloba, inhibits the fusion of enveloped viruses. The study found that ginkgolic acid had a strong inhibitory effect on Human Cytomegalovirus (HCMV) and also tested its effects on Herpes Simplex Virus-1 (HSV-1) and Zika Virus (ZIKV). Researchers also found broad spectrum inhibition by ginkgolic acid of all three classes of fusion proteins including HIV, Ebola virus (EBOV), influenza A virus (IAV) and Epstein Barr virus (EBV). In addition, inhibition was found of a non-enveloped adenovirus. The authors conclude that ginkolic acids may potentially be used to treat acute infections (e.g. Coronavirus, EBOV, ZIKV, IAV and measles), and also topically for the successful treatment of active lesions (e.g. HSV-1, HSV-2 and varicella-zoster virus (VZV)). It was observed that ginkgolic acid could inhibit the entry of these viruses into cells, thereby blocking viral replication. Another study entitled, “Ginkgolic acids inhibit SARS-CoV-2 and its variants by blocking the spike protein/ACE2 interplay” found that ginkgolic acids from ginkgo biloba inhibited the SARS-CoV-2 virus from binding to the ACE2 receptor and thus could potentially be helpful in acute COVID-19 infections. I use VascuSelect from Moss Nutrition which contains 120 mg of ginkgo biloba, 100 mg of grape seed extract, and 100 mg of mango fruit powder per capsule for acute and chronic viruses dosed 1 capsule once or twice a day with or without food. Grape seed extract and mango fruit powder have also been shown to have antiviral properties. This trio of herbs not only has antiviral prop...

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.

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or long-haul COVID, refers to a condition where individuals experience persistent symptoms or develop new symptoms after recovering from the acute phase of COVID-19. Long COVID can affect individuals who had mild, moderate, or severe initial COVID-19 infections and can persist for weeks or months after the initial illness. The specific symptoms and their duration can vary widely between individuals, but common symptoms of long COVID include fatigue, shortness of breath, cough, joint pain, chest pain, muscle weakness, brain fog, difficulty concentrating, memory problems, sleep issues, depression, anxiety, and other neurological or psychiatric symptoms. It can also affect multiple organs in the body, such as the heart, lungs, kidneys, and brain. How does COVID-19 affect microcirculation? Microcirculation refers to the circulation of blood in the smallest blood vessels, including arterioles, capillaries, and venules. While COVID-19 primarily affects the respiratory system, there is evidence suggesting that it can have systemic effects, including impacts on the cardiovascular system and microcirculation. Here are some potential ways in which COVID-19 may affect microcirculation: Endothelial Dysfunction: COVID-19 has been associated with endothelial dysfunction, which is a condition where the cells lining blood vessels (endothelial cells) do not function properly. Endothelial dysfunction can lead to impaired regulation of blood flow and increased permeability of blood vessels. In severe cases, viral infection and the resulting immune response may damage endothelial cells, contributing to a pro-inflammatory state and a potential disruption of microcirculation. Blood Clotting and Thrombosis: COVID-19 is known to be associated with an increased risk of blood clot formation (thrombosis). The formation of blood clots can potentially affect microcirculation by blocking small blood vessels. The hypercoagulable state observed in some COVID-19 patients may contribute to microvascular thrombosis, leading to impaired blood flow in affected tissues. Inflammatory Response: The body's inflammatory response to the virus can also impact microcirculation. Inflammation can lead to the release of inflammatory mediators, causing vasodilation (widening of blood vessels) and increased permeability, which may affect blood flow in the microcirculation. Hypoxia and Tissue Damage: Severe cases of COVID-19 may lead to respiratory distress and hypoxia (low oxygen levels). Hypoxia can have detrimental effects on tissues and organs, potentially impacting microcirculation. Tissue damage and inflammation in the lungs may trigger a systemic response that affects microvascular function in other organs. Impaired Oxygen Delivery: In severe cases of COVID-19, where acute respiratory distress syndrome (ARDS) develops, oxygen exchange in the lungs becomes compromised. This can lead to inadequate oxygen delivery to tissues and affect microcirculation. What is grapeseed extract? Grapeseed extract is a dietary supplement derived from the seeds of grapes. It is rich in antioxidants, particularly compounds known as oligomeric proanthocyanidin complexes (OPCs). Additionally, grape seed extract contains flavonoids, another class of polyphenols with antioxidant properties. These antioxidants help protect the body against damage from harmful free radicals, which can play a role in various chronic diseases. Grapeseed extract is commonly used for its potential health benefits, including improved cardiovascular health, reduced inflammation, enhanced immune function, and anti-aging effects. How does grapeseed extract improve microcirculation in Long COVID? The proanthocyanidins in grape seed extract help improve blood flow and circulation. By promoting the dilation of blood vessels, the extract supports the cardiovascular system's ...

SARS-CoV-2, the virus that causes COVID-19, can severely damage the body’s circulatory vessels, which inhibits oxygen, hormones, and nutrients from getting to vital body tissues. Patients with Long COVID have been shown to have impaired microcirculation up to 18 months after infection, and possibly even longer if those vessels aren’t repaired. Damaged microcirculation can lead to many of the symptoms of Long COVID including fatigue, difficulty recovering from exercise, brain fog, sluggish brain function, muscle weakness, depressed mood, loss of smell and taste, to name a few of the most common symptoms. Mango fruit powder has been shown to improve microcirculation in a couple of excellent studies I will cover below. Mango (Mangifera indica) has the following properties: · Rich in polyphenols · Activates Sirt-1 – antioxidant, improves endothelial function, anti-inflammatory, enhances metabolism · Activates AMPK – improves muscle glucose uptake and fatty acid oxidation, hepatic fatty acid oxidation, lipid homeostasis, balances blood sugar, improves endothelial function · Improves eNOS – improves endothelial function, increases energy, antioxidant · Supports mitochondrial neogenesis The first study entitled “Effects of Mangifera indica (Careless) on Microcirculation and Glucose Metabolism in Healthy Volunteers” was a double-blind, randomized study. The name “Careless” was changed to “Careflow” for good reason because it is more descriptive of the benefits of mango fruit powder. 204 subjects were divided into three groups. One group took 100 mg a day of mango fruit powder. The second group took 300 mg of mango fruit powder. And the third group was the placebo group. Mango fruit powder was taken every day for 4 weeks. Microcirculation and endothelial function were assessed. Microcirculatory reactive hyperemia flow increased, especially in the 100 mg group. 300 mg of the mango fruit preparation reduced postprandial glucose levels compared to placebo, accompanied by significantly lower HbA1c values compared to baseline. 300 mg intake significantly improved postprandial endothelial function in individuals with decreased endothelial function after high-dose glucose intake. Both doses were well tolerated without side effects. The second study entitled “In Vitro Activation of eNOS by Mangifera indica (Careless™) and Determination of an Effective Dosage in a Randomized, Double-Blind, Human Pilot Study on Microcirculation” showed similar results on microcirculation. In this study, a dose of 100 mg or 300 mg of mango fruit powder was given to see the effects on microcirculation in a randomized, double-blind, crossover pilot study in ten healthy women. Both doses improved cutaneous blood flow, indicating improved microcirculation. Both doses were well tolerated without side effects. Both of the above studies clearly show the benefits of mango fruit powder on microcirculation which can help patients with Long COVID. Why not just eat mangos? Careflow, the mango fruit powder used in these studies, is standardized to 0.03% mangiferin which is vital for maximum effectiveness. Additionally, the mango subspecies used in Careflow is called “Kili-mooku” as opposed to the “Alfonso” mangos found in supermarkets. Mangos are cultivated in the South of India in the Tamil Nadu region as opposed to Brazil and Peru where commercial mangos come from. Kili-mooku mangos are harvested just at the right time when the beneficial plant ingredients are at their highest levels and manufactured in Germany to the highest standards. I designed VascuSelect by Moss Nutrition to contain 100 mg of Careflow standardized mango whole fruit powder along with grape seed extract and ginkgo biloba to repair and restore microcirculation. This makes VascuSelect a perfect formula for those suffering with Long COVID. I use one capsule twice a day with my patients suffering from Long COVID.

5 case reports were reported in an excellent paper on ginkgo biloba and Long COVID symptoms. Patients with Long COVID were given 80 mg of ginkgo biloba extract (EGb 761) twice a day. Patient 1 took ginkgo biloba for 11 weeks, and he had a substantial improvement in cognitive concerns, decreased perception of fatigue and an improvement in olfaction. He completely regained his sense of smell. Patient 2 took ginkgo biloba for 13 weeks and reported improvement in concentration and fatigue. Patient 3 took ginkgo biloba for 4 months and reported significant improvement in cognitive deficits. Patient 4 took ginkgo biloba for 7 weeks and reported improved concentration and fatigue. Patient 5 took ginkgo biloba for 6 weeks and reported improvement in depression, fatigue, irritability, and hyposmia. Two of these patients reported complete remission of their cognitive symptoms. None of the patients had any adverse effects. SARS-CoV-2, the virus that causes COVID-19, has been shown to damage the microcirculation blood vessels resulting in decreased blood flow to vital tissues such as the heart, kidney, muscle tissue, ear, eyes, liver, brain and nervous system. Ginkgo biloba has been shown to protect and repair large and small blood vessels, as well as a host of other body tissues. Ginkgo biloba has antioxidant properties, improves circulation, repairs and protects the brain, nervous system, eye, ear, kidney, intestine, heart, and cardiovascular system. This makes ginkgo biloba a perfect herbal medicine for Long COVID, and the results of these case reports are not surprising. How best to take ginkgo biloba? Ginkgo biloba is usually dosed 120-240 mg a day in one or two doses with or without food. It can disrupt sleep, so some people may need to take it in the morning and no later than the early afternoon. The dose used in this study was 80 mg twice a day totaling 160 mg a day. But the author’s point out that a higher dose may have yielded even better results. I normally use 120 mg twice a day with my patients. Ginkgo biloba side effects such as headache only occur in 2% of people who take it. It can take up to six weeks to notice the full effects of ginkgo biloba so give it some time to work. My formula VascuSelect from Moss Nutrition contains 120 mg of ginkgo biloba per capsule with added grape seed extract and mango fruit powder. Grape seed extract and mango also support and repair microcirculation for a synergistic effect with the ginkgo biloba. Ginkgo biloba should be standardized to 24% flavonol glycosides and 6% terpenes for maximum effectiveness. Please be sure to consult with your licensed healthcare professional before supplementing with ginkgo biloba due to potential risks of bleeding disorders. Certain medications can increase the risk of bleeding when combined with ginkgo biloba. Long COVID is having devastating consequences on society and new natural treatments are constantly emerging to help. Ginkgo biloba is now part of my evidence-based core Long COVID protocol. To learn more about grapeseed extract and Long COVID, click here to read my article. And to learn how mango fruit powder can help Long COVID, click here. Hedberg Institute Members can log in and download my latest Long COVID protocol. To learn more about the Hedberg Institute Membership, click here.

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. PEA for Cold and Flu 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. PEA and COVID-19 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. Hedberg Institute members can log in to access the COVID-19, Long COVID, cold, and flu protocols. Practitioners who are interested in learning more about the Hedberg Institute Membership click here for more details. 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. Studies on PEA and 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. PEA, Luteolin, and Long COVID Studies 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: Anti-inflammatory Anti-neurodegenerative (neuroprotective) Mast cell stabilizer Antioxidant Anticancer Antiallergy Antihypertensive Antiviral Antidiabetic 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 olfac...

A new study entitled, “Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome” has been published in the journal Clinical and Experimental Medicine which found that supplementation with Coenzyme Q10 (CoQ10) and alpha lipoic acid (ALA) may be helpful in Long COVID. COVID-19 can deplete CoQ10 levels and damage the mitochondria which are important for energy production and immune system function. CoQ10 and alpha lipoic acid can both be helpful in protecting and supporting mitochondrial function by reducing oxidative stress. CoQ10 deficiency can lead to decreased energy production resulting in fatigue and increased free radical production. Fatigue is by far the most common symptom reported in Long COVID so CoQ10 is at the top of the list of supplements to try with this condition. Alpha lipoic acid is a powerful antioxidant, and it is involved in mitochondrial energy production. ALA also has immunomodulatory properties and may actually be an anti-viral as well. The properties of both nutrients in theory make them a promising combination in the treatment of Long COVID. How was the study done? 174 patients (51% male and 49% female) aged 18-81 (mean of 51) who had COVID-19 previously and met the 2015 National Academy of Medicine diagnostic criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 52% had comorbidities including chronic lung disease (16%, 28/174), diabetes mellitus (13%,23/174), psychiatric diseases (7.5%, 13/174), and rheumatic diseases (9.8%, 17/174). 17.8% (31) of patients had been previously hospitalized for severe respiratory SARS-CoV-2 pneumonia. 82.2% had mild/moderate symptoms during the acute phase. The mean duration of Long COVID symptoms was 5.9 months. The most common symptoms were fatigue (80%), impaired concentration (68%), sleep disorders (85%) disturbed smell and/or taste (60%), memory loss (45%), dyspnea (21%) and arthromyalgias (64%). Patients were divided into two groups. The first one (116 patients) received coenzyme Q10 (ubiquinone form) and alpha lipoic acid taken every day for two months at a dose of 100 mg of CoQ10 and 100 mg of alpha lipoic acid twice a day. The control group of 58 patients did not take either supplement. The characteristics of the patients in the two groups were similar at baseline. Patients in both groups also received a variety of medications including paracetamol, codeine, NSAIDS, antidepressants (duloxetine), anticonvulsants and analgesics (pregabalin and gabapentin). They also undertook psychological and psychiatric counseling, physio-kinesiotherapy, yoga, and Pilates. What were the results? “The primary end-point was to evaluate the effectiveness of the association of coenzyme Q10 and alpha lipoic acid in reducing fatigue, expressed as a reduction in Fatigue Severity Scale (FSS), at the second month (T1), of at least 50% (complete response) from the baseline (T0) or at least 20% (partial response) from the baseline (T0). A reduction in FSS < 20% from baseline at T1 was considered as a non-response. A complete FSS response was reached most frequently in the treatment group compared to the control group. An FSS complete response was reached in 62 (53.5%) patients in the treatment group and in two (3.5%) patients in the control group. A reduction in FSS score < 20% from baseline at T1 (non-response) was observed in 11 patients in the treatment group (9.5%) and in 15 patients in the control group (25.9%) (p < 0.0001).” Author's Conclusion “Despite the short follow-up period, we demonstrated a clinical benefit, suggesting the rapid effect of this therapy. On the other hand, because of the short follow-up duration, we do not know if this clinical benefit persists over time. Our results, all based on subjective indices, were definitely in favor of the treatment group.” Dr. Hedberg’s Comments on Long COVID, CoQ10, and Alpha Lipoic Acid This study shows promising results in the use of coenzyme Q10 and...

The elemental diet dates back to 1932 and is one of the most utilized tools by functional medicine practitioners. It is useful for a variety of gut-related conditions and even conditions outside the gut. The elemental diet is a liquid diet that reduces inflammation in the gut, heals the gut barrier, and has an antibacterial effect.The elemental diet is done with Elemental Select powder from Moss Nutrition. A full elemental diet can be done with 100% of daily calories coming from Elemental Select or a partial elemental diet with 25-75% of calories coming from Elemental Select and the rest from whole food sources. Elemental Select is mixed with water or in a blender with ice and consumed by slowly sipping the mixture over the entire day in divided doses. Click here to learn more about the Hedberg Institute Membership. The elemental diet may be helpful for the following conditions: IBS-C and IBS-D SIBO Crohn’s disease Ulcerative colitis Diversion colitis Eosinophilic gastroenteritis and esophagitis GERD Gastritis Multiple food sensitivities Leaky Gut Constipation and diarrhea Short bowel syndrome High ileostomy output Ileal fistulas Pancreatitis Pancreatic insufficiency Pancreatic fistulas Bile-acid-induced diarrhea Refractory Celiac disease (gluten-free diet fails to resolve issues) Malabsorption Rheumatoid arthritis Eczema Psoriasis Stroke recovery Critical illness recovery COVID-19 and other viral illnesses MCAS Histamine intolerance Anemia Asthma Dermatitis herpetiformis Chronic kidney disease Cystic fibrosis HIV Cerebral palsy How does an elemental diet work? The elemental diet is purely vitamins, minerals, amino acids, medium chain triglycerides for fat, and simple carbohydrates. This means that digestion is not required so almost everything gets absorbed regardless of gut function. It is also void of any food-based compounds such as whey, pea, hemp, rice, soy, gluten, dairy, eggs, nuts etc. which makes it entirely hypoallergenic. There is virtually nothing in the elemental diet that the immune system can react to. This is a game-changer for those with food sensitivities and gut problems. There is also no fiber in the elemental diet, so it won’t exacerbate SIBO or IBS. The elemental diet also allows your digestive organs to rest. The stomach doesn’t have to pump out as much hydrochloric acid, the pancreas doesn’t have to make so many enzymes, and the gall bladder can rest as well. The elemental diet contains all the right amino acids for healing the gut barrier. For those with leaky gut syndrome or malabsorption, it can rapidly heal the gut. The elemental diet reduces pathogenic bacteria in the gut and can also improve healthy bacteria diversity. This helps reduce inflammation in the gut so the microbiome can become more balanced. This is why the elemental diet is so effective for SIBO, IBS, and IBD. How to follow an elemental diet? Elemental Select from Moss Nutrition contains 150 calories per scoop, and total daily calories should be determined by a healthcare professional. The first option is a Full Elemental Diet with 100% of daily calories consumed from Elemental Select. Sample 1,500 calorie/day protocol: 10 total scoops/day = 1,500 calories 4 scoops in the AM divided into 4 separate 8-ounce glasses of water. Mix 1 scoop with 8 ounces of water and sip slowly over a 20-60 minute period. Repeat for the next 3 scoops. Alternatively, all 4 scoops can be mixed with 32 ounces of water and sipped slowly over a 1-4 hour period. 3 scoops around lunch time. Same consumption guidelines as noted above sipped slowly over a 1-3 hour period. 3 scoops around dinner time. Same consumption guidelines as noted above sipped slowly over a 1-3 hour period. Alternatively, all 10 scoops in 10 glasses of water can be sipped slowly over the entire day without breaks.

Zinc Functions Zinc is an essential trace element required by almost every biological process in the human body including growth and development, immune function, wound healing, protein and DNA synthesis, and cell division. It is used in over 300 enzymatic reactions, serves as an anti-inflammatory and an antioxidant, and is important for sight, hearing, and taste. The system-wide ubiquity of zinc increases the clinical importance of detecting and supporting a deficiency when present. Unfortunately, it is frequently underutilized in clinical practice. Gaining a deeper understanding of the many roles zinc plays in human health, learning the appropriate methods for assessing deficiency, reviewing which conditions may benefit from supplementation with zinc, along with supplementation guidelines and recommendations will increase the clinician’s confidence in the appropriate use of zinc with patients. Zinc Select Click here to learn more about the Hedberg Institute Membership. Causes of Zinc Deficiency The most common reasons for a zinc deficiency are increased losses of zinc, increased requirements for zinc, inadequate dietary intake, or reduced bioavailability/absorption of zinc. Increased losses can come from gastrointestinal diseases, surgery, trauma, oral contraceptives, and zinc lost in ejaculate with excessive sex. The requirement for zinc increases during periods of rapid growth, pregnancy, and lactation. Common examples of inadequate dietary intake include teenagers and college students as well as individuals following plant-based diets. Diets high in fiber are also rich in phytates which inhibit absorption. Dietary factors, such as the consumption of alcohol or following a vegetarian/vegan diet, can impair zinc absorption. Decreased absorption increases the risk for deficiency. Plant-based diets and diets high in seeds, legumes, and unprocessed whole grains contain phytates that bind with zinc, inhibiting its absorption. Soaking, sprouting, and/or fermenting can reduce the phytic acid content of these foods, increasing the bioavailability of zinc. It has been shown that the process of sour leavening to make sourdough bread reduced the phytate content by ~ 25% and increased the rate of zinc absorption by 30-50%. Other dietary factors that reduce the absorption rate include coffee, calcium in dairy products, increased fiber intake from fruits and vegetables, and a high fat diet (> 100g/day) in those with fat malabsorption issues. Deficiency can also be present in those with gastrointestinal issues that impair absorption such as Celiac disease, Crohn’s disease, or bypass surgery, and in those with hypochlorhydria (commonly seen with aging). Assessment of Zinc Status Laboratory Assessment A zinc deficiency is not always easy to recognize. It can manifest as a variety of symptoms and routine laboratory testing does not provide a reliable indicator of zinc status. Low plasma stores of zinc (~0.1%) cause the standard blood test for plasma zinc concentrations to lack sensitivity and specificity, making it unreliable as a marker of deficiency. Therefore, an assessment of zinc status and a diagnosis of deficiency is largely based on clinical findings. Clinical Zinc Assessment Zinc homeostasis is primarily regulated by the amount of zinc in the diet. Clinical evaluation should include a detailed review of the patient’s dietary eating patterns to determine if a deficiency is likely. The physical examination may reveal white spots on their fingernails and/or patches of dry skin. The patient history should be reviewed for associated conditions or medications known to cause impaired zinc absorption and a therapeutic trial of zinc may be recommended in those instances. A Zinc Taste Test provides a quick and inexpensive evaluation of zinc levels that can be conducted during the office visit. This test is not completely reliable due to the dependence on individual variances in self...

Berberine is an isoquinolone alkaloid that is bitter and bright golden yellow in color. It is derived mainly from the roots, stems and rhizomes of plants such as Coptis chinensis (Chinese golden thread), Hydrastis canadensis (goldenseal), Berberis aquifolium (Oregon grape), and Berberis vulgaris (barberry). It has been used for thousands of years in traditional Chinese and Ayurvedic medicine and is generally considered safe, though it should be avoided during pregnancy and lactation. Berberine Click here to learn more about the Hedberg Institute Membership. Gastrointestinal side effects may occur due to berberine's impact on bowel motility. These include abdominal pain, distention, nausea, vomiting, and constipation. Side effects appear to be dose dependent, with increased symptoms such as low blood pressure, dyspnea, and flu-like symptoms at higher doses. Berberine is commonly used as an antibacterial, antiviral, antimicrobial, antifungal, and antihyperlipidemic agent. The many therapeutic applications of berberine are due to its antioxidant and anti-inflammatory properties, making it one of the top supplements of choice in clinical practice. It has traditionally been used for gastrointestinal related issues as well as issues involving liver dysfunction, digestive complaints, blood sugar regulation, inflammation, and infectious diseases. While berberine has exhibited a bioavailability of <1%, the metabolites of berberine have demonstrated increased absorption in the system. These metabolites contribute to the widespread impact observed from the use of berberine on liver, kidney, muscle, lung and brain. Gastrointestinal Support Chen at el (2015) conducted a randomized clinical trial that demonstrated the usefulness of using berberine in treating patients with IBS-D. Berberine (400 mg delivered twice daily) reduced the frequency of diarrhea, abdominal pain, and the urgency of defecation after 8 weeks. They concluded that berberine was well tolerated and was beneficial in treating IBS-D. They also noted that those in the berberine group showed improvements in their depression and anxiety scores and in their IBS quality of life scores. Berberine has been shown to induce structural and compositional changes in the gastrointestinal microbiota. These changes affect the metabolites dependent on the microbes such as trimethylamine N-oxide (TMAO), short chain fatty acids (SCFAs), bile acids (BAs), branched-chain amino acids (BCAAs), and aromatic amino acids (AAAs). Yao et al confirmed berberine's gut modulatory ability in their 2020 study using rats. They showed that berberine caused changes in the GI microbiota that included increased beneficial microbes in the phylum Bacteroidetes and the family Lactobacillaceae. An increase in Lactobacillaceae was also observed to be negatively associated with the risk of Type 2 Diabetes (T2D). A decrease in potentially pathogenic microbes in the phylum Proteobacteria and Verrucomicrobia was noted along with a decrease in aromatic amino acids (AAAs). The authors concluded that berberine was able to modulate the gut microbiota of the rats in the study. This led to improved glucose tolerance and the alleviation of symptoms associated with T2D, such as abnormal glucose and lipid levels. They recommended the use of berberine in the treatment of T2D in rats. Glucose and Lipid Regulation Berberine is useful in conditions associated with metabolic diseases and atherosclerosis due to its ability to decrease inflammation, improve glucose and lipid metabolism, and improve energy homeostasis, making it beneficial as a treatment option for those with T2D. The hypoglycemic effects of berberine have been shown comparable to Metformin. An important mechanism of action that occurs with the use of berberine is the activation of AMPK. Drugs such as Metformin work by stimulating this AMPK pathway. Turner et al (2008) concluded, in their study on IR mice,

Background Information—Form and Function of B12 Vitamin B12 Form Cyanocobalamin has no known biochemical function. It must be converted to become active. It gets converted for use into hydroxocobalamin, methylcobalamin, or adenosylcobalamin. These three forms are equal in bioavailability.An exception to this is for the use of adenosylcobalamin in infants with a rare inborn error of synthesis.Methylcobalamin and adenosylcobalamin are coenzyme forms of B12.Hydroxocobalamin can be converted into the above two forms. Click here to learn more about the Hedberg Institute Membership. Vitamin B12 Function Vitamin B12 is used for DNA synthesis, homocysteine metabolism, S-adenosylmethionine, red blood cell formation, nervous system and immune system function.Vitamin B 12 is necessary for folate to be metabolized properly into Methionine and Succinyl-CoA. Low levels of B12 and increased levels of folate are associated with higher concentrations of methylmalonic acid (MMA) and total plasma homocysteine (HCY). Vitamin B12 Sources The average American diet contains adequate amounts of vitamins B12, ranging from 5-15 mcg/day. Meat, poultry, fish, eggs, and dairy, constitute the primary food sources. It is not found in most non-animal food sources. Individuals consuming a plant-based diet are at an increased risk of deficiency. Non-meat food sources such as chlorella, spirulina, nori, and fermented soy contain mostly B12 analogues which have no activity in humans. Fifty-one percent of those following a macrobiotic diet were found to be deficient.Vegan Diets 0.3-0.4 mcg/dayLacto-vegetarians 1.4 mcg/day Recommended Dietary Allowances (RDA)Males >14 years: 2.4 mcg/dayFemales >14 years: 2.4 mcg/dayPregnancy: 2.6 mcgLactation: 2.8 mcg Absorption of B12 Pepsin and hydrochloric acid (HCL) are necessary for cleaving B12 from protein in stomach.Individuals with low levels are at a greater risk of deficiency due to decreased break down for absorption.B12 supplements (crystalline B12) do not require HCL or pepsin to bind to intrinsic factor (IF).B12 supplements are absorbed normally in hypochlorhydria.Intrinsic factor (IF) is made in the stomach and necessary for carrying B12 from the stomach to intestines for absorption.Individuals with genetic SNPs impairing intrinsic factor (IF) production are also at a greater risk of deficiency and must rely on B12 injections, bypassing the need for IF.IF becomes fully saturated at 2 mcg of B12.Large doses can be absorbed through passive diffusion which doesn’t require IF. This accounts for 1-2% of absorption.1000 mcg/day can overcome loss of IF due to pernicious anemia.Pernicious anemia is an autoimmune disease characterized by the destruction of parietal cells which produce IF. Possible Causes of Vitamin B12 Deficiency Pernicious anemia—Auto antibodies against parietal cells and IF Gastric disease or surgery Chronic atrophic gastritis—parietal cell death/autoimmune Use of gastric acid inhibitors (antacids, histamine receptor 2 antagonists, proton pump inhibitors) Pancreatic disease or pancreatectomy Other intestinal diseases: parasitic infections, bacterial overgrowth, ileal resection, impaired B12/IF absorption. Medications, such as cholestyramine and metformin, that impair B12 absorption or metabolism. Limited/poor food sources/choices that result in general malnutrition. Examples include vegan or vegetarian diet. Chronic alcoholism Inherited disorders involved in B12 trafficking and metabolism Miscellaneous: including HIV and nitrous oxide anesthesia Conditions that result in chronic diarrhea or malabsorption states, such as celiac disease and Crohn’s disease. Helicobacter pylori infection results in hypochlorhydria. Eradicating H Pylori can improve B12 levels. Long term psyllium supplementation (> 1 year) Genetic factors can affect absorption and transport.

Many factors in our modern society increase the risk of magnesium deficiency, placing a vast number of individuals at risk of suboptimal levels. An individual’s magnesium level can become depleted from issues such as medication usage, chronic diseases, poor magnesium content in crops and soil, and the increased consumption of refined and processed foods. Magtein Magnesium L-Threonate Click here to learn more about the Hedberg Institute Membership. Magnesium L-threonate offers a cost effective, safe for long term use, and well tolerated form of magnesium that provides optimum levels. It has been shown to be the only form of magnesium capable of increasing magnesium levels in the brain and cerebrospinal fluid (CSF). This ability to cross the blood brain barrier (BBB) increases its efficacy for use in many chronic disease states, especially those associated with central nervous system (CNS) dysfunction. Conditions that respond to Magnesium L-threonate Magnesium L-Threonate and PainMagnesium is useful for treating chronic pain and inflammation that occurs due to the activation of the NMDA receptor during trauma. The NMDA receptor, which is normally not activated, becomes activated during traumatic physical or emotional events. During periods of excitotoxicity, calcium shuttles through the NMDA receptor and causes increased immune system responses (release of substance P, mast cells, immune cells, oxidative stress). Magnesium works to inhibit calcium influx through the NMDA receptor thereby decreasing oxidative stress as well as decreasing inflammation by blocking substance P. Blocking the NMDA receptor also serves to inhibit cortical spreading depression (CSD). Magnesium L-Threonate and MigraineMagnesium is also useful in treating migraine due to its ability to inhibit platelet activation. Platelet activation stimulates the release of serotonin which triggers spasming of blood vessels in the central nervous system (CNS) resulting in migraine. Magnesium inhibits calcitonin gene related peptide (CGRP) mediated vasodilation, another driver of migraine. Magnesium threonate is especially useful for the treatment of migraine as it is capable of crossing the blood brain barrier (BBB) and providing Mg2+ directly to the affected area. Magnesium L-Threonate and the EarMagnesium helps protect against hearing loss from noise as well as drug ototoxicity by decreasing the oxidative stress created by these stressors. Magnesium is also protective in sudden sensorineural hearing loss due to issues such as viral infections, vascular impairment, CNS disorders, inner ear abnormalities, or immune related mechanisms. Magnesium provides protection from hearing loss due to its ability to function as a Ca2+ antagonist, vasodilator, antioxidant, and a non-competitive NMDA antagonist. Magnesium threonate, with the ability to enter the CNS, is particularly useful in working with individuals with tinnitus. Protecting and Repairing the Hippocampus: Learning, Memory, and Emotion Alzheimer’s diseaseAlzheimer’s disease (AD) is associated with a magnesium deficiency in the serum or brain.7 Yu, Guan, Gu (2015) found that magnesium L-threonate enhanced the clearance of amyloid beta, the plaquing seen in AD. They demonstrated that magnesium L-threonate was able to slow the progression of AD.Magnesium threonate treatment was even effective at preventing synapse loss and memory decline when used in mice with end-stage AD. It has also demonstrated the ability to be neuroprotective against oxidative stress and hippocampal neuronal apoptosis. Chemotherapy-induced memory/emotional deficitsMagnesium L-threonate prevented oxaliplatin(OXA)-induced behavioral and synaptic changes in a 2020 study conducted using rats. This study showed that magnesium L-threonate prevented the OXA-induced upregulation of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and nuclear factor-kappaB (NF-кB).

The combination of hydrochloric acid, lipase, and pepsin combine to create the acidic gastric juices found in the stomach. These healthy stomach acid levels serve as a first line of defense for the gastrointestinal system, preventing infectious agents from reaching the intestines. A normal gastric pH is considered to be present with pH values >3, with values below 4 capable of killing bacterial invaders within 15 minutes. Gastric juices with a pH >3 mark the beginning stages of hypochlorhydria. As the pH increases above 4, there is an increased prevalence of bacterial overgrowth. Achlorhydria is defined as a pH >7. Betaine HCL Click here to learn more about the Hedberg Institute Membership. There are two main categories of hypochlorhydria: iatrogenic and acquired. Iatrogenic hypochlorhydria is the most common, resulting from the use of medications to reduce gastric acid secretions. Proton pump inhibitors (PPIs) are one of the top ten most prescribed drugs in the world, contributing to the rise in iatrogenic hypochlorhydria. Malnutrition is the leading cause of acquired hypochlorhydria. Individuals taking PPIs generally have a pH between 5-7. Individuals with hypochlorhydria are at an increased risk for infection and disease due to a loss of this protective barrier. Research conducted by Martinsen, Fossmark, and Waldum (2019) demonstrated that individuals with hypochlorhydria were at an increased risk of a variety of infections including bacterial, fungal, and parasitic infections. One study they reviewed reported a significant decrease in Shannon’s diversity of the GI microbiome and changes in 20% of the bacterial taxa in PPI users versus non-users. The increased use of PPIs makes it necessary to review current medications, both prescribed and over the counter, at each patient encounter. Nutritional status should also be evaluated utilizing blood labs, anthropometrics, diet diaries, food allergies/sensitivities, etc. Other useful factors in screening a patient for gastric hypoacidity include assessing gender, age, stress levels/eating behaviors, geographic origin/nationality, testing of stomach acid levels, and labs to rule out concurrent diseases such as Helicobacter pylori, chronic gastritis, parietal cell autoantibodies, hypothyroidism, etc. Keep in mind that there can be discrepancies between different testing methods and cutoff values depending on the labs used. Malnutrition can be the cause of or the result of hypochlorhydria. Malnutrition that leads to a deficiency in the nutrients needed to make HCL can cause hypochlorhydria. These include chloride, sodium, potassium, zinc, and iodine. Malnutrition can also develop as a result of hypochlorhydria. Decreased gastric acidity impairs nutrient absorption resulting in possible nutrient deficiencies for most of the essential vitamins and minerals including protein, iron, calcium, magnesium, zinc, vitamins A and E, copper, and all of the B vitamins. The presence of both malnutrition and hypochlorhydria increases the risk of enteric infections. There is also an increased prevalence of food allergies in individuals with reduced gastric acidity as they lose the ability to sufficiently denature proteins. With hypochlorhydria, larger protein peptides remain which can trigger an immune system response, resulting in allergic symptoms. Therefore, screening for hypochlorhydria should be conducted in individuals that suffer from malnutrition and/or food sensitivities/allergies. There is also an increased prevalence of food allergies in individuals with reduced gastric acidity as they lose the ability to sufficiently denature proteins. With hypochlorhydria, larger protein peptides remain which can trigger an immune system response, resulting in allergic symptoms. Therefore, screening for hypochlorhydria should be conducted in individuals that suffer from malnutrition and/or food sensitivities/allergies.