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Reducing COVID-19 Risk - Make a Plan Should You be Exposed or Infected (updated September 2021)

 UPDATED SEPTEMBER 2021

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
REDUCE COVID-19 RISK USING LIFESTYLE FACTORS AND NATURAL AGENTS.
MAKE A PLAN SHOULD YOU BECOME EXPOSED OR INFECTED.

In my recent blog, Reducing COVID-19 Risk - Fundamentals of Immune System Support (updated August 2021), I outlined recommendations for reducing risk of COVID-19 complications prior to viral exposure for those at average risk, focusing on prevention of illness through immune system support.  Today I am switching gears to review steps you can take to reduce complications if you become exposed to the SARS-Cov-2 virus or develop symptoms of COVID-19 illness. 

This blog takes on a very different feel in Fall 2021 than it did a year ago, as we now have three approved COVID-19 vaccines.  I remain steadfast in my support for these vaccines and feel vaccination is important not only in reducing individual risk, but also to reduce risk of serious illness in those most vulnerable. Nevertheless, breakthrough infection is possible for those vaccinated, and many are still opting not to get a vaccine, which makes having a plan should you become exposed to or infected with the SARS-Cov-2 virus of continued importance.


THE TIMELINE OF COVID-19 INFECTION
While variations exist, below is a general time-frame of COVID-19 infection, from exposure to illness.

DAY 0= EXPOSED TO SARS-Cov-2 VIRUS
We consider the day you are exposed to the virus Day Zero.

DAYS 2-3 THROUGH DAYS 10-12 = VIRAL SHEDDING
With or without symptoms, most become contagious on days 2-3, and continue to be contagious through day 12. Most are contagious before they develop symptoms.

DAY 5 = SYMPTOMS BEGIN
A vast majority will develop symptoms of COVID-19 between days 2-7 of exposure to the virus (day 5 on average). View list of possible COVID-19 symptoms HERE.

DAYS 5-12 = MILD TO MODERATE SYMPTOMS
Most who develop symptoms will have only mild to moderate symptoms during the first two weeks.

DAY 12 = RECOVERY vs HOSPITALIZATION
Moving from weeks 2 to 3 of illness is a critical time. On average, 12 days after exposure is when symptoms either begin to resolve or become significantly worse - potentially requiring hospitalization.
Keep day 12 in mind as a critical point in the course of infection, as a point where symptoms may rapidly worsen.

 

IF YOU HAVE BEEN EXPOSED TO THE SARS-Cov-2 VIRUS, BUT HAVE NO SYMPTOMS
If you have been exposed to the SARS-Cov-2 virus, or if you have been in a situation where exposure is likely, the first important step is to ISOLATE yourself from others. Remember, you can be highly contagious without any symptoms at all!  Isolation is especially important for those unvaccinated. You may also want to arrange for a COVID test, ideally 5-8 days after exposure. A COVID test in the first 4 days after exposure will have a much higher false-negative rate, meaning you may get a negative test result and still be contagious and/or develop COVID-19 illness.

If exposed, there are a number of botanicals and natural agents that may be introduced as part of your plan to reduce risk of complications. 

INCREASE DOSES OF ELDERBERRY AND MELATONIN. 
Melatonin: increase to 10-20mg at night.
Elderberry: dose varies per preparation, follow instructions on product and increase to higher range of recommended dosages.

Add or increase agents with potential to directly interrupt the ability of the virus to enter cells and replicate:
• Curcumin -increase to 1000mg twice daily
Resveratrol - increase to 100-150mg twice daily
Zinc - up to 60mg daily, ideally in the form of lozenges spread throughout the day.
• Quercetin - regular 1gram twice daily, phytosome 500mg twice daily
• EGCG - 4 cups green tea or approx 225mg EGCG daily
• Astragalus - dose varies per preparation, follow instructions on product and increase to higher range of recommended dosages.

 

IF YOU DEVELOP SYMPTOMS
If you have had known or likely exposure to the SARS-Cov-2 virus and develop symptoms of COVID-19 (with or without a positive test):
• continued isolation/quarantine is critical to reduce risk of spreading the virus to others.
• closely monitor your symptoms, designate a friend or family member to check in on you.
• consider purchasing a home blood oxygen saturation monitor to use in case of illness, especially for those unvaccinated or at elevated risk.
• treat your symptoms, and seek medical care if necessary.

Targeted natural agents may be continued during active infection. Care should be individualized for each patient, and I recommend that you work with a Functional Medicine practitioner to determine what is appropriate for you.

The Institute for Functional Medicine recommendations for the use of botanicals and natural agents with active symptoms of COVID-19.*

STOP zinc and echinacea as they are not felt to be helpful during the symptomatic phase.

If you haven’t already done so, increase melatonin to 10-20mg at night.

Add or continue curcumin, resveratrol, quercetin, and EGCG at higher dose ranges (see above).

OTHER CONSIDERATIONS
Consider adding additional anti-inflammatory agents - PEA and SPMs.
Consider adding additional anti-inflammatory agents to reduce the “cytokine storm” of inflammation responsible for many COVID-19 complications. I recommend these agents especially for my patients who already have chronic medical conditions associated with chronic inflammation and for those unvaccinated.

Palmitoylethanolamide (PEA)
PEA is a naturally occurring anti-inflammatory agent that has been shown to improve outcomes in acute respiratory disease and influenza.
I follow the recommendation of Functional Medicine specialist Dr. Kara Fitzgerald, ND:
Metagenics Hemp Advantage (with PEA) or PEA Relief: 2 caps three times per day with first symptoms. Continue for six weeks.

Specialized Pro-resolving Lipid Mediators (SPMs)
SPMs are part of the omega-3 fatty acid spectrum that has a powerful effect on reducing inflammation. SPMs help to signal the immune system to shut down the immune response and resolve inflammation (I think of them like a hose putting out a fire).
While SPMs are synthesized naturally in the body, many with chronic medical conditions that place them at higher risk for COVID-19 complications do not effectively make SPMs on their own.
Dose: During active infection, 1 gram SPM formula three times daily.  Continue at least 4 weeks.

Please note: Due to the novelty of COVID-19, minimal peer-reviewed research has been published regarding the effectiveness of dietary or lifestyle interventions for its prevention or treatment. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Consult your healthcare provider prior to use of any botanical or nutraceutical.

RESOURCES
Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery Yanuck S, Pizzorno J, Messier H, Fitzgerald K. 

The Functional Medicine Approach to COVID-19: Virus-Specific Nutraceutical and Botanical Agents 

Resistance, Resilience, and Recovery: Patient Care in a Pandemic. (IFM Continuing Education Course)



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Physicians specializing in Functional Medicine are trained and experienced in providing personalized guidance to patients in the use of nutrition, nutraceuticals, and lifestyle to prevent, reverse, and decrease the burden of complex, often chronic medical conditions.  I continue to see new and returning clients using our secure, easy video-visit format.  If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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Reducing COVID-19 Risk - Foundations of Immune System Support (updated August 2021)

 UPDATED AUGUST 2021

TAKE CONTROL OF YOUR HEALTH.
REDUCE RISK OF COVID-19 COMPLICATIONS USING LIFESTYLE FACTORS AND NATURAL AGENTS.

Like you, I was hoping we would be beyond this by now, but we are not.  Given the low rate of both worldwide and United States COVID vaccinations, the SARS-Cov-2 virus and COVID-19 infection are likely here to stay.  While those who are vaccinated are at significantly lower risk from COVID-19 complications than those unvaccinated (yes, I do recommend you get a COVID vaccine), even those vaccinated are not entirely without risk.  Immune system support is important for all.  As we move toward the Fall/Winter season - let's revisit the basics.

Foundations of Immune System Support - Using lifestyle factors and natural agents to reduce COVID-19 complications.

When it comes to reducing risk of COVID-19 complications, the best time to start is long before exposure to the SARS-Cov-2 virus.  The data on lifestyle interventions and natural agents to impact the viral life cycle is compelling, and as we enter cold, flu and COVID season there are a number of steps you can take to prime your immune system and reduce your risk of illness.

Your innate immune system is your first line of defense against any type of infection, so it’s important to have it primed and ready to recognize and attack a virus should you become exposed. The innate immune system is often described like an army. You want healthy, well-educated troops ready to respond quickly and efficiently to any situation they encounter.

LIFESTYLE FACTORS
SLEEP • DIET • STRESS • EXERCISE

Before you even think about taking vitamins or supplements, there are four key lifestyle factors that can have a powerful impact on your immune system:

SLEEP 
Studies show that people who don't get enough quality sleep are more likely to get sick after being exposed to a virus. Even one night of reduced sleep can lead to immune dysfunction, and better quality sleep is associated with less inflammation. How well are you sleeping?

• Aim for 7‐9 hours of quality sleep each night
• There are many fitness/biometric trackers that can provide sleep feedback (I use an Oura Ring).
• If you are not getting enough quality sleep, consider working with a psychologist or physician that specialize in sleep (such as Dr. Rebecca Roth in Northern Michigan). You can also consider melatonin, CBD, or other herbals.
• Check out these resources for better sleep on my website.

DIET 
Significant evidence suggests that fruit and vegetable intake can reduce the risk of chronic diseases.

  • Instead of processed foods, choose more plant‐based foods high in phytonutrients and fiber, which can help improve functioning of the immune system. Can you get close to 10 servings of vegetables and fruits per day? How many different colors of plants can you add?
  • Limit added sugar, salt and saturated fats which can all negatively impact your immune system.
  • Check out these resources on a phytonutrient-rich diet on my website


STRESS
Chronic stress can suppress your immune system and is associated with increased risk of viral infection.  Stress raises levels of Cortisol in your body, and those with higher cortisol levels have been shown to have greater mortality from COVID‐19.

  • Pay attention to your stress levels. Biometric trackers can measure heart rate variability as an objective measure of your stress.
  • Practice stress‐modifying techniques on a daily basis, including breathing, gratitude, time with family/pets, exercise and/or meditation. Check out these resources on my website to learn more about meditation.
  • If you are not able to get your stress response under control, consider working with a professional. Most therapists are now offering virtual video sessions. You can also work with your Integrative practitioner to incorporate herbal blends to help in protecting your body from the effects of stress.


EXERCISE
While a single bout of physical activity can stimulate immune function, regular exercise is most important for consistent effects.

  • Engage in moderate, regular physical activity. I encourage my patients to work up to 150 minutes weekly of cardiovascular exercise (30 minutes, 5 days per week).
  • If you are just starting an exercise program, start slow and gradually increase your activity.
  • There are MANY online exercise-at-home platforms. Some of my favorites are HASfit.com, FitOn.com and Peloton on-demand classes (meditations too).
  • Consider using a heart-rate monitor with exercise to ensure you are getting your heart rate into a safe fitness zone.

 

BOTANICALS & NUTRACEUTICALS
There are a number of botanicals and nutraceuticals with immune-modulating effects. The choice of which and how many natural agents to incorporate into your prevention plan will be different for each person. Factors to consider include vaccination status, cost, underlying chronic medical conditions, and the degree of possible virus exposure.  Combination products, liquids, chewable and powders can lessen the burden of daily capsules.

Start with a quality Multivitamin/Multimineral, or a Comprehensive Micronutrient Test.
There are many nutrients that work together to support and enhance mucosal immunity (which lines the passageways of your nose, mouth, throat and lungs). Vitamins A, B6, B12, C, D, E, folic acid, zinc, copper and selenium all work together to support the immune system, and all are essential for the production of mucosal antibodies.  Given this, it makes sense to start with a high-quality multivitamin.  Alternatively, you can use a micronutrient test panel to see if you are meeting your needs with your current diet.

Additional nutrient foundations to prime immunity and prevent illness or complications:

  • Vitamins D, C and Zinc
  • Elderberry
  • Astragalus
  • Medicinal Mushrooms containing Beta-glucan
  • Echinacea


VITAMIN C

Vitamin C is an immune system powerhouse. This antioxidant reduces inflammation, increases the production of white blood cells, and helps to strengthen blood vessels. Vitamin C is essential in the formation of collagen, which promotes healthy skin and muscle tissue. A lack of Vitamin C makes you more prone to illness, and should you develop a respiratory illness, Vitamin C has been shown to reduce the duration and severity, and reduce complications by protecting your own tissues from damage.

Vitamin C has been used in many hospital ICUs for the treatment of COVID-19.

  • For prevention, 500-1000mg daily
  • Choose a buffered form of Vitamin C for less stomach upset

 

VITAMIN D

OPTIMIZE YOUR VITAMIN D! Vitamin D is known to activate and modulate many key aspects of the immune system involved in fighting viral and bacterial infection. Vitamin D is anti-inflammatory, and in many viruses Vitamin D has been shown to reduce the progression from exposure to illness and reduce the severity and duration of acute symptoms and complications. Evidence suggests Vitamin D supplementation may prevent upper respiratory infections.

Research has demonstrated a significant crude relationship between Vitamin D levels and both the number and mortality of COVID-19 cases. A small study in Spain of 76 patients showed that giving Vitamin D to hospitalized COVID-19 patients, otherwise given similar treatments, reduced ICU admissions from 50% to 2%.

  • For prevention, 2000-5000 IU Vitamin D3 daily with food
  • I routinely check 25,OH Vitamin D levels on my patients and aim for 50-80ng/mL

 

ZINC (acetate, citrate, picolinate, or glycinate)

Zinc has a large body of research showing its strong anti-viral properties against many viruses, and zinc supplementation has been found to reduce the duration of symptoms of the common cold.

Zinc promotes antibody and white blood cell production and reduces oxidative stress. In addition, zinc has properties that fight infection directly, and zinc lozenges may reduce the risk of developing a respiratory illness.

  • For prevention (zinc acetate, citrate, picolinate, or glycinate), 30-60mg daily in divided doses for three months, then reduce to 15-30mg daily.
  • For acute respiratory illness, begin zinc lozenges at the first sign of symptoms.


ELDERBERRY

Elderberry (Sambucus nigra) has widespread historical use as an anti-viral herb and has been used extensively in the prevention of influenza.

Elderberry is rich in vitamin C, antioxidants, and fiber. Research suggests that elderberry is most effective when used for prevention, or when taken early on in the course of a respiratory virus.

  • For prevention, consider 500mg orally, daily (of USP standard of 17% anthocyanosides).  Follow the instruction on your product.
  • Caution should be used in those with autoimmune conditions.

 

ASTRAGALUS

Astragalus membranaceus has many immune-boosting benefits with low risk of harm. Astragalus primes the innate immune system and reduces inflammation.

Astragalus has shown direct antiviral activity against SARS-Cov-2 virus by inhibiting a process necessary for viral binding.

  • Astragalus dose varies per preparation, follow instructions on product.


MEDICINAL MUSHROOMS (containing beta-glucan)
Shitake • Lion’s Mane • Reishi • Maitake

Various mushroom species have been shown to have a broad range of immune-modulating and immune-supporting mechanisms. Medicinal mushrooms also contain Beta-glucans which aid in priming the immune system and reducing inflammation. Numerous human trials have shown that beta-glucans reduce the symptoms of cold and flu and reduce upper respiratory tract infections.

  • Mushroom dose varies per preparation, follow instructions on product.
  • Dose of Beta-glucans: 250-500mg daily


ECHINACEA

Echinacea is a wildflower native to North America. Many species of Echinacea can stimulate the immune system. Echinacea preparations have been shown to reduce the frequency, severity, and duration of upper respiratory tract symptoms in several trials.

  • Echinacea dose varies per species and preparation, follow instructions on product.
  • Echinacea should be stopped if one develops symptoms of COVID-19

  

Please note: Due to the novelty of COVID-19, minimal peer-reviewed research has been published regarding the effectiveness of dietary or lifestyle interventions for its prevention or treatment. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Consult your healthcare provider prior to use of any botanical or nutraceutical.

 



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Physicians specializing in Functional Medicine are trained and experienced in providing personalized guidance to patients in the use of nutrition, nutraceuticals, and lifestyle to prevent, reverse, and decrease the burden of complex, often chronic medical conditions.  I continue to see new and returning clients using our secure, easy video-visit format.  If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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Three Steps to a Healthier Detox

Summer is here!  Sunshine, beach days and celebrations with friends and family.  Are you ready to get back out and about after the long days of COVID lockdown?  I am!  

With Summer celebrations often comes food, later nights and increased alcohol consumption - and all of this can take a toll on your health.  Taking simple steps to enhance your body's detoxification pathways can help to keep you in balance.  In the coming weeks I'll be outlining simple techniques to DETOX and RECHARGE this Summer - but first let's start with the basics.


TOXINS & DETOXIFICATION
We are exposed to toxins on a daily basis, both from our environment and through our lifestyle choices. Within each of us exists a natural and complex system of metabolic detoxification that works every day to identify and remove toxins from the body. Many factors can contribute to an accumulation of toxins in the body, including:

  • Exposure to pesticides, plastics and industrial chemicals
  • Heavy metal exposure
  • Bacterial overgrowth in the gut resulting in endotoxin exposure
  • Poor food choices
  • Overconsumption of alcohol
  • Dehydration
  • Lack of physical activity

Cultures around the world have long believed that the accumulation of toxins in the body is an underlying cause of a variety of health problems. For centuries, various cleansing and detoxification therapies have been used to minimize toxin exposure and aid the body’s ability to break down and excrete toxins.

DO YOU NEED TO “DETOX”?
Our bodies are actively detoxing on a daily basis, however sometimes they have trouble keeping up! When our natural system of metabolic detoxification becomes overburdened, toxins accumulate in the body. These toxins can cause tissue damage and may interfere with normal cellular processes. Common symptoms of toxic overload include:

  • Fatigue/low energy
  • Poor Sleep
  • Chronic constipation
  • Abdominal pain, gas and bloat
  • Increased allergy symptoms
  • Headaches
  • Itchy skin/rashes
  • Bad breath
  • Confusion or “brain fog”
  • Anxiety

If you are experiencing symptoms of toxic overload it may be time to consider a detoxification program. Such a program generally involves:

  • Reducing exposure to toxins.
  • Supporting and enhancing the body’s natural detoxification systems.
  • Encouraging the removal of toxins from the body.

While there are many approaches to detoxification and many programs available, I focus on three simple steps to ensure a safe and healthy detox.

THREE STEPS TO A HEALTHIER DETOX  

STEP ONE - FOCUS ON NUTRITION
I am generally not a fan of “juice cleanses”. Not only are such programs lacking in fiber and protein, they can also upset hormone balance by raising cortisol and disrupting blood sugar regulation.

For effective detoxification, I prefer to focus on nutrients that support the body‘s natural detoxification mechanisms and emphasize clean, organic whole foods. In particular I recommend adequate amounts of quality protein providing amino acids essential to the metabolic detoxification pathways in the liver, and a variety of colorful non-starchy vegetables which add supportive vitamins, minerals and fiber.

While non-starchy vegetables are alkaline, most toxins are acidic, so consuming these vegetables will help to push acidic toxins to be filtered out through your kidneys. Specialized proteins shakes and targeted nutraceuticals may also be utilized to support detoxification pathways.

STEP TWO - INCREASE HYDRATION
Adequate hydration is essential for a safe detoxification. Proper hydration can protect the cells and tissues in your body from the damaging effects of toxins. Water intake promotes removal of toxins from the body through your kidneys via urine, and through your intestines via stool.

During a detoxification program, I recommend higher than average water intake. To determine the amount that is right for you, take half of your weight in pounds and convert that to ounces of daily water (for example, a 140 pound woman should consume at least 70 ounces of water daily during detoxification).

STEP THREE - TREAT YOUR GUT FIRST
If you have digestive problems, it is essential to address these issues before beginning a detoxification program. This is especially important for those with chronic constipation.

Why is the gut so important in detoxification? Because you have to “take out the garbage”! The gut (along with the kidneys and your sweat glands) is the primary pathway by which toxins leave the body. I recommend support for bowel regularity with water, fiber and magnesium to help this process.

Bacterial overgrowth in the gut contributes to toxicity by exposing the body to bacterial endotoxins. For those with a history of chronic abdominal bloat, gas, and diarrhea or irregular bowel movements, identifying and treating underlying gut imbalances is an important first step in detoxification. For some, I recommend an herbal gut cleanse prior to beginning a detoxification program.

Are you ready for a personalized detoxification program? Let’s get started!

Call 231-638-5585 or This email address is being protected from spambots. You need JavaScript enabled to view it. to send me an email!



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions.  During the COVID-19 pandemic, I continue to see both new and returning clients via our easy, secure, video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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How much Fish Oil are you really taking? Read the label!

How much Fish Oil are you really taking? Read the label!

How much Fish Oil are you really taking? Read the label!

As an Integrative and Functional medicine physician, I frequently recommend omega-3 fatty acids to my patients for a variety of reasons. Omega-3 fatty acids:
  • have potent anti-inflammatory benefits
  • are important components of cell membranes
  • help to maintain heart, brain and nervous system health

Omega-3 fatty acids are backed by volumes of research indicating their value in reducing risk of conditions such as:
  • heart attack and stroke
  • autoimmune disease such as rheumatoid arthritis
  • certain forms of cancer
I most often recommend fish oil to supplement omega-3 fatty acids, because it is a rich source of the two active and essential omega-3 fatty acids known as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Other omega-3 rich supplements include cod liver oil and krill oil.
All omega-3 fatty acid supplements are not created equal!

WHAT YOU NEED TO KNOW ABOUT FISH OIL: 
  • EPA and DHA are the active omega-3 fatty acids in fish oil
  • When taking fish oil, the amount of EPA and DHA is what is most important, not total omega-3 fatty acids or total fish oil content.
  • The amount of EPA and DHA varies widely in different products.
  • Fish oil labels can be very deceiving.
  • The FDA does not regulate dietary supplements, so you need to know how to read labels!

HOW TO READ YOUR FISH OIL LABEL:

Look at the Serving Size.
How much of your product is considered a serving?
How much EPA and DHA is in each serving?
  • Remember, EPA and DHA are active omega-3 fatty acids, the rest of the omega-3 content is inactive.
  • Calculate how many servings you need to take to get your doctor’s recommended dose of EPA and DHA. 

Take a look at this example:

These two fish oil labels both contain 1000mg of fish oil, yet their EPA and DHA content is very different.

Product #1 contains 330mg of EPA and 250mg of DHA per serving (1 soft gel). Total EPA+DHA 580mg per serving.
b2ap3_thumbnail_MyFishOilLabel.jpg

Product #2 contains 250mg EPA+DHA per serving (1 soft gel). It does not specify amounts of each.
b2ap3_thumbnail_KirklandFishOil2.jpg

If your doctor was recommending 1000mg daily EPA+DHA, you would have to take:
  • 2 tabs of Product #1
  • 4 tabs of Product #2
Even though they both contain 1000mg of fish oil!

Take a look at this label. This product does not even specify EPA and DHA content:
b2ap3_thumbnail_WalMartFishOil2.jpg

IF A PRODUCT DOESN'T SPECIFY EPA AND DHA CONTENT, DON'T BUY IT!

——————————————

Are you getting enough omega-3 fats in your diet?  Could you benefit from more?  We can test your blood omega-3 fats through an essential fatty acid panel.  I also make individual recommendations for fish oil supplementation for patients based upon symptoms and chronic conditions.  Contact our office for more information or to book an appointment!  231-638-5585.






Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface" to find and correct underlying imbalances. I continue to see both new and returning patients from all over Michigan using my secure, easy video-visit format.  If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
  3610 Hits

Thyroid 101


b2ap3_thumbnail_Thyroid1.jpgDo you have (or suspect that you have) low thyroid function? 

Are you tired of feeling sluggish and foggy only to be told that your thyroid tests “look normal”?

You are not alone! Thyroid health is one of the most common reasons why patients seek my care - and for good reason! Optimal thyroid function is an essential component of your health and well-being. 
Your thyroid gland is part of your hormone system (also referred to as your endocrine system). The thyroid gland is shaped like a butterfly and is located inside your neck over your windpipe.
Thyroid hormones play a major role in regulating many bodily functions, including:

  • Metabolism
  • Weight
  • Energy
  • Mood
  • Temperature control
  • Bowel function
  • Cognitive function
  • Heart health
  • Skin integrity
  • Muscle development
  • Gingival health

Many conventional practitioners take a “one-size-fits-all” approach to low thyroid hormone, also called hypothyroidism. They rely on one laboratory value and prescribe one type of thyroid hormone for all patients, because that is how we are taught to approach hypothyroidism in medical school. While some patients are fine with this approach, others are not and find themselves continuing to experience symptoms without an adequate diagnosis or treatment plan.

If you have (or suspect that you have) low thyroid function, a practitioner skilled and experienced in a more comprehensive approach to hypothyroidism may help you to better understand why your thyroid hormones are low, and partner with you to create a customized treatment plan to restore energy, vitality, and well-being.


LOW VS HIGH THYROID

It is far more common to have low thyroid than high thyroid levels.
When you have a low functioning thyroid it is called hypothyroidism.
Symptoms of hypothyroidism include:
  • fatigue 
  • dry skin
  • weight gain
  • constipation
A less common condition is hyperthyroidism, when your thyroid is over-active.
Symptoms of hyperthyroidism include:
  • weight loss
  • “bulging” eyes
  • hot flashes
  • rapid or racing heart beat
UNDERSTANDING THYROID TESTING 

b2ap3_thumbnail_Thyroid2.jpgTSH = Thyroid Stimulating Hormone
TSH (Thyroid Stimulating Hormone) is made by your brain, not by your thyroid. Your brain makes TSH when it senses that your body needs more thyroid hormone. The TSH made by the brain sends a signal to the thyroid to make more thyroid hormone. 

When thyroid hormone levels in your body are low, the brain makes TSH to "turn on" your thyroid.
  • TSH high = body needs more thyroid hormone
  • TSH low = body does not need more thyroid hormone
The TSH is only test many doctors will order to evaluate thyroid function, however relying on the TSH alone does not give you a complete picture of thyroid function, and may miss a certain percentage of people with low thyroid hormone.
If you have symptoms of low thyroid and are told your TSH is "normal" - test beyond the TSH!

T4 and T3
Your thyroid makes different types of thyroid hormones. The two most important are T4 and T3.
Here’s what you need to know about T4 and T3:
  • You make much more T4 than T3
  • T4 gets converted in your tissues to T3
  • T3 is far more active than T4
Why does this matter?
If you have a normal TSH, but a low free T3, you will have all of the symptoms of low thyroid (hypothyroid) even though your doctor tells you that your thyroid is “fine”!
b2ap3_thumbnail_Thyroid3.jpg

(the lab tests shown here are taken from a patient of mine who had this issue)

BOTTOM LINE:
  • listen to your body
  • test beyond the TSH
  • know your levels of T3 hormone
My standard thyroid laboratory testing always includes:
  • TSH
  • Free T4 hormone 
  • Free T3 hormone
Additional testing often ordered include:
  • Reverse T3 (which “hides” T3 and prevents it from dong it’s work)
  • Thyroid Antibodies (to evaluate underlying autoimmune disease)
  • Levels of nutrients important to thyroid health, such as zinc and selenium

Now that you know the "Thyroid Basics", are you ready to learn more about your thyroid health?
You can This email address is being protected from spambots. You need JavaScript enabled to view it.or contact my office for more information 231-638-5585. 



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy hormone imbalance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface”  to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Book Review: "Healing Arthritis" by Susan Blum, MD, MPH

b2ap3_thumbnail_HealingArthritis.jpgIn Healing Arthritis, Dr. Susan Blum, author of the bestselling The Immune System Recovery Plan shares her science-based, drug-free treatment plan for the almost fifty million people who suffer from arthritis.

FROM THE PUBLISHER:
Arthritis is the most common cause of disability in the world—greater than both back pain and heart disease. One example, Rheumatoid Arthritis (RA), is the most common autoimmune disease, affecting 1% of the US population, and almost 68 million people worldwide. Conventional medicine tends to treat arthritis with strong, gut-damaging, immune-suppressing pain medications, temporarily relieving the symptoms of the disease without addressing its root causes. Now, in her groundbreaking new book, Dr. Susan Blum, a leading expert in functional medicine, offers a better approach to healing arthritis permanently.

MY THOUGHTS:
This book is a must-read for anyone suffering from joint pain or arthritis. While I’ve been recommending Dr. Blum’s first book The Immune System Recovery Plan to my patients for years, I find Healing Arthritis easier to read and more user-friendly for my patients to navigate. The book provides an overview of the root causes of inflammation/arthritis, focusing on:
  • inflammatory foods
  • gut health
  • the role of stress/trauma
Dr. Blum includes a straightforward two-week plan to quickly reduce pain through anti-inflammatory foods and supplements; followed by an intensive gut repair program. Once through this initial phase, her plan addresses the emotional issues that contribute to inflammation and outlines a simple, Mediterranean inspired diet to maintain a healthy gut.

I was pleased to see that the diet and supplement recommendations are given are the same available to patients in my office! This book will serve as a useful companion for patients navigating the world of Functional Medicine in treating arthritis and controlling inflammation.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including arthritis. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. When treating arthritis and autoimmune disease, my approach involves treating root causes such as toxicity, food allergy/sensitivity, stress/trauma and underlying infection. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Advanced Laboratory Spotlight: The NutrEval® Comprehensive Nutritional Testing

ADVANCED LABORATORY SPOTLIGHT:

NutraEval® COMPREHENSIVE NUTRITIONAL TESTING

A Comprehensive Test for Identifying Nutritional Deficiencies, Toxicities, Gut Imbalances, and More

by Genova Diagnostics


b2ap3_thumbnail_nutreval-fm-nutritional-test-blood-urine-small-1.pngIn my Integrative & Functional Medical practice, there is no one-size-fits-all approach to diet.  Patients come to me following a variety of diet plans - everything from vegan to keto - and I also prescribe a variety of food plans for my patients.  Regardless of the food plan of choice, I like to dig deep with data to answer the question: Is your current diet plan meeting your nutritional needs?

The NutrEval® laboratory test by Genova Diagnostics is the most commonly ordered specialty laboratory test in my practice. This test serves as an excellent starting point for evaluating nutritional status and investigating the root causes of chronic illness, as well as a useful follow-up tool to measure how well lifestyle changes and supplement regimens are working.


OVERVIEW

The NutrEval® test is an advanced nutritional analysis designed to reveal nutritional imbalances or inadequacies. NutrEval Plasma® evaluates the functional need for antioxidants, B-vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients. The test also provides insight into gut health, heavy metal toxicity, mitochondrial function and more.


YOUR REPORT INCLUDES:

Elemental Markers (both mineral nutrients and toxic metals) This section provides direct measurements of minerals and heavy metals. Mineral results can be used to identify mineral deficiencies or excess. Heavy Metal results can be a useful screening tool, if elevated levels are identified, provoked urine heavy metal testing is often recommended. Analyses measured include:
  • Copper
  • Lead
  • Magnesium
  • Mercury
  • Manganese
  • Antimony
  • Potassium
  • Arsenic
  • Selenium
  • Cadmium
  • Zinc
  • Tin

Essential and Metabolic Fatty Acids (red blood cell essential and non-essential fatty acids, including Omega-3 and Omega-6 fatty acids) The Fatty Acid Analysis is a red blood cell measurement, representing approximately 100-120 days prior to testing. When interpreting these results with patients, I am able to accurately identify what type of diet they are following, which types of oils they are cooking with, and whether or not they are supplementing with fatty acids (like Fish Oil). This section can provide valuable insight insight for diet and supplement recommendations for:
  • General Wellness
  • Inflammatory Disorders
  • Cardiovascular Risk
  • Mood and Brain Disorders

Amino Acid Analysis
(amino acids are the building blocks of protein)
The Amino Acid Analysis represents a 21-day “window” into your protein intake and amino acid balance. I use this section most often to:
  • Evaluate protein intake, digestion and absorption.
  • Evaluate amino acid balance in relationship to mood disorders.

Oxidative Stress Analysis Oxidative Stress represents the balance of antioxidants and free radical damage in the body. When describing Oxidative Stress to patients, I often describe it as “rusting” on your cells and DNA. This analysis measures markers of this “rusting”, as well as levels of Glutathione, a powerful antioxidant that plays key roles in healthy aging and detoxification (learn more here). Our levels of Glutathione are determined by both our genes and our lifestyle, so if low levels are detected, we can implement protocols for improvement.

Learn more about Glutathione HERE.


Metabolic Analysis (urine organic acids)
Urine organic acids are not something I learned about in Medical School. This analysis, often utilized by Naturopathic Physicians, measures metabolites in the urine that reflect processes going on in your body. This analysis provides insight into:
  • Digestion
  • Bacteria and/or Fungal Overgrowth in the Gut
  • Mitochondrial Function (cellular energy production/Krebs Cycle)
  • Neurotransmitter Balance (stress/mood)
  • Functional B-vitamin Need (not measured values in your body but rather a measurement of how your body is utilizing these vitamins)
  • Need for Detoxification Support

b2ap3_thumbnail_LabTesting.jpg


SPECIMENS:

First-morning urine and a blood draw at a participating laboratory.

COST:
  • Varies per insurance. 
  • Covered completely by many Medicare plans.
  • Commercial plans require and out-of-pocket co-pay of $200-300.
  • Not covered by Medicaid.

Note: I do not profit off of ordering this (or any other) laboratory test. Any co-pay goes directly to Genova Diagnostics.

Visit the Genova Diagnostics Website and view a Sample Report HERE.  

Ready to get started with your nutritional testing?  Contact our office at 231-638-5585 to schedule an appointment!



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like advanced laboratory testing) to find and correct underlying imbalances.
I see patients from all over Michigan using a secure, easy video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Infrared Sauna Therapy

INFRARED SAUNA THERAPY

Frequently Asked Questions


b2ap3_thumbnail_InfraredSaunta.jpgWHAT IS AN INFRARED SAUNA?
An infrared sauna uses infrared light waves to penetrate through the skin barrier, deep into the body, raising the body's core temperature.
Infrared sauna treatments, like traditional saunas, cause increased sweating and heart rate.


HOW IS AN INFRARED SAUNA DIFFERENT THAN A CONVENTIONAL SAUNA?

An infrared sauna differs from traditional saunas because the infrared light waves penetrate through the skin into the body, heating the body directly. Traditional saunas raise body temperature by heating the around you.
Infrared saunas do not heat the air around you, and produce results at lower temperatures than a traditional sauna. In fact, you can comfortably read a book or magazine during your sauna treatment!


WHAT ARE THE POTENTIAL BENEFITS OF INFRARED SAUNA?
Potential benefits of infrared sauna may include:
  • Less inflammation
  • Relief of stress
  • Relaxation of muscles
  • Reduction of chronic pain, including pain from arthritis
  • Enhanced detoxification
  • Improved heart and brain function
  • Increased calorie burning
  • Improved skin appearance
  • Lowered side effects in Diabetes
  • Reduction of coughs/colds and Influenza
  • Overall improved well-being


WHO MIGHT BENEFIT FROM INFRARED SAUNA THERAPY?

As sweating is one of the most powerful detoxification tools of the body, anyone may benefit from infrared sauna treatments.

Some studies have shown benefits of infrared sauna therapy for people with:
  • cardiovascular disease
  • diabetes
  • high blood pressure
  • congestive heart failure
  • rheumatoid arthritis
  • chronic muscle and joint pain
  • poor digestion
  • chronic depression and anger

OUR  INFRARED SAUNA THERAPY USES FAR-INFRARED LIGHT,
WHAT DOES THAT MEAN? 
All infrared sauna therapy is not the same!  There are different levels of infrared light: near, middle, and far.  These different levels represent the different sizes in infrared wavelengths and refer to the intensity of the treatment.
While near-infrared light may be helpful for wound healing and may help to warm the body. far-infrared light penetrates deeper in the body producing more sweat.  Potential benefits may include improved circulation, muscle relaxation, and enhanced detoxification.

SHOULD I BE CONCERNED ABOUT EMR (ELECTROMAGNETIC RADIATION) OR ELECTRICAL FIELDS)?

Our Finnleo® far-infrared sauna uses Pure Infra technology, which was developed to take the worry out of unnecessary exposure to EMR and EF. The electrical field in a Pure Infra is less than you’d experience from a computer screen or cell phone.

Are you ready to start infrared sauna therapy?
Give our office a call at 231-638-5585.


Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions.  Holistic therapies such as Infrared Sauna are just one way that we help patients "think outside the box". Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
  2979 Hits

Is your Skincare Routine ready for a BOOST?

Dreaming of Summer? I am! It’s that time of year when many of us are looking forward to emerging from the isolation of winter to spend time outdoors with friends and family. This is also a great time to focus on a healthy skin routine! In addition to a proper diet and adequate hydration, a routine of clean skin care products can get you ready to emerge this Spring with fresh glowing skin!

All Sanitas Skincare products are 20% off with a $99 purchase (no code required), so this is a great time to stock up, get started, or boost your routine!

NEW TO SANITAS? START WITH THE BASICS. 
CLEANSER • SERUM • MOISTURIZER

These are the every day basics that make up the foundation of your skin care routine.
CLEANSER - removes debris and preps skin for serum.
SERUM - think of serum like vitamins for your skin. Serums nourish and hydrate skin.
MOISTURIZER - hydrates skin and locks in moisture.

Note: Of these three, moisturizer is the only one I consider potentially optional.  Depending on the time of year and the hydrating-effect of the serum, moisturizer is not always needed.


FOR NORMAL AND DRY SKIN:
LEMON CREAM CLEANSER
A citrus-infused enriching everyday cleanser.
Removes surface debris without stripping or dehydrating skin. Fresh lemon scent!

VITA RICH SERUM
A hydrating, reparative serum. Contains a protective blend of Vitamins E, D, C, E, K, and essential fatty acids.  A little goes a long way!  Very hydrating, great for dry, winter skin.

ANTIOXIDANT MOISTURIZER
Highly concentrated, deeply nourishing. Contains a blend of avocado and shea butters, with vitamins and hydrating Hyaluronic Acid.


FOR NORMAL, COMBINATION, AND OILY SKIN:
ENZYMATIC FOAMING CLEANSER
A balancing formula of natural fruit acids, enzymes, and gentle foaming agents lifts surface impurities without irritating or drying.

WEIGHTLESS SERUM
Lightweight. Reduces congestion, brightens dark spots, and balances skin. Contains Zinc, Vitamin C, and Astragalus Root extract.

BALANCING MOISTURIZER
A lightweight moisturizer that tones and nourishes the skin while keeping oil under control. Matte finish.

Note: You can mix and match!  You don't have to stick with one product line.  I keep both Lemon Cream Cleanser and Enzymatic Foaming Cleanser on hand, as well as a treatment cleanser (I like Vitamin C Lactic Cleanser) to use before exfoliating.  While Weightless Serum is my go-to, I break out the Vita-Rich serum during dry winter months...

READY TO TAKE YOUR SKINCARE ROUTINE UP A NOTCH?
BOOST RESULTS WITH ALPHA-HYDROXY ACIDS
Alpha-hydroxy Acids (AHAs) exfoliate by dissolving dead skin cells, increasing cell turnover and triggering collagen regeneration.

AHAs make your skin more receptive to hydration, and even those with dry or sensitive skin can benefit from regular use of a quality AHA product, which is less likely to irritate than manual exfoliation.

CLICK HERE to learn more about AHAs.

NEW TO AHAs?
Start with a low concentration 5% glycolic acid solution 2-3 nights per week.

ALREADY USING AHAs?
Increase your concentration for improved results.
Slowly work up from a 5% to a 10%, and then a 15% GLYCOLIC ACID SOLUTION. When your current product no longer has the same “tingling” feeling, that is a sign that it’s time to increase your concentration.


A FEW CLASSIC PRODUCTS YOU DON'T WANT TO MISS. 
My absolute favorite combination - BRIGHTENING PEEL PADS and VITA C SERUM. This duo provides an instant facial and is my go-to routine before a night out or special event. After cleansing, swab face and neck with a Brightening Peel Pad. Follow with 3 drops Vita C Serum for an instant glow!

Vita C Serum is also a great reparative serum for regular use day or night, containing 30% Vitamin C with essential fatty acids for potent antioxidant protection and instant hydration to minimize the signs of aging. With Vita C Serum - a little goes a LONG WAY!  I generally use 2-3 drops at a time, not even 1/2 pump!

Boost hydration for dry winter skin with HYALURONIC CONCENTRATE. Add 1-2 pumps to your regular moisturizer for a hydrating boost that protects skin from dry winter air.  do not head to the ski hill without this!

Sanitas HAND THERAPY and LIP KITS are perfect to have on hand for last-minute gifts. Stock up while they are on sale!

All Sanitas products are cruelty free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as for general health/wellness. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

  914 Hits

Spring Supplement Swap



The changing of seasons is a great time to clean and organize your nutritional supplements and re-think your routine. The demands on your mind and body vary with the seasons, and adjusting your supplements to meet seasonal needs can help you to look and feel your best all year long!

This year the seasonal change of your supplement routine has added importance as many have spent the last year loading up on immune support to reduce the risk of COVID-19 complications.
Check out these “Spring Supplement Swaps” taking place at my house to help you get started*:

STORING THE ELDERBERRY AND STARTING ALLERGY SUPPORT
Elderberry was a staple at my house over the past year, as I worked to keep my family of four healthy during the pandemic. Now that we are all vaccinated and moving into warmer outdoor months, I check the expiration date, tighten the cap and store the bottles in a cool, dark cupboard. Elderberry is sure to be a part of our routine next winter and also for any airline travel throughout the year.

With two of us (myself included) prone to seasonal allergies, Allergy Support Formula is added to our morning routine. Unlike standard antihistamines, this patient-favorite formula has the added bonus of anti-inflammatory and immune-supportive nutrients like quercetin and proteolytic enzymes. One in the morning is generally enough, occasionally if spending a lot of time outdoors I will take a second capsule in the afternoon.

SWAPPING IMMUNE SUPPORT FOR STRESS SUPPORT
Elderberry was not the only immune support product on our shelf over the past year. Like many of you, we had a number of antiviral and immune-supporting products in the mix like extra zinc, vitamin C, and Vira-Resist immune support herbal blend.

The Vira-Resist and zinc are getting stored for the summer. In years past, I have added zinc to my summer routine to replenish minerals lost with extra sweat and infrared sauna, however having loaded up on zinc this past year we are taking a break from supplementation and focusing on getting zinc through foods like nuts, seeds, beans, and egg yolk.

Vitamin C never leaves my routine. This is an essential vitamin, meaning that your body cannot make it on its own. While it is easy to obtain vitamin C from food, supplemental vitamin C has been well-studied and found to have a number of potential health benefits, including reduction of chronic disease, immune and brain support, and even anti-aging properties! I use topical vitamin C on my face, and take supplemental vitamin C in a buffered form to reduce tummy troubles, either as a capsule or a powder in my smoothie.

Vitamin C has added benefits for those under STRESS. That includes most of us over the past year, don’t you think?! Research has shown that vitamin C helps reduce both the physical and psychological effects of stress and can also lower the output of cortisol in response to stress. Like many parents, I find this last stretch of school in the spring can be exceptionally stressful. The calendar starts to get full and there is a lot to keep track of. Add the stress from the past year, including a virtual school for my boys, and we are all feeling a little run-down! This is when I bring out my bottle of Adreset (another patient favorite), an herbal blend that supports energy and resilience under stress. For my teenage boys preparing for final exams, we occasionally use low-dose melatonin to help with a normal bedtime. Melatonin can be especially helpful when one is overstimulated from screen/computer time. For all of us, I add extra B vitamins, as research has demonstrated the benefit of B vitamins in reducing stress-related symptoms.

LOW VS HIGH DOSE VITAMIN D
Vitamin D, often referred to as “the sunshine vitamin”, is actually a steroid hormone produced from cholesterol when your skin is exposed to the sun. The health benefits of vitamin D are far-reaching and include beneficial effects for bone growth, cellular health, and immune and nervous system function.

I routinely check vitamin D levels on patients, and it is rare for me to find an optimal level in northern Michigan, therefore supplemental vitamin D at higher doses is recommended for many of my patients.

That being said, during the summer months with increased sun exposure, higher doses may not be necessary and even have the potential to be harmful. Why? You can overdose on vitamin D! Vitamin D is one of four fat-soluble vitamins (along with Vitamins A, E, and K), so levels can build up in your system and become toxic. If you are supplementing with higher-dose vitamin D it’s important to check levels about twice yearly.

I am not going to subject my boys to a blood draw this spring, I simply lower their vitamin D dose to not more than 2000 IU daily. For myself, I’m staying at 5000 IU daily because my recent labs showed vitamin D deficiency.

Recommending vitamins and nutritional supplements is not a one-size-fits-all approach. when working with patients, I take into account they are medical history, current symptoms, and use of prescription medication, as well as data from a variety of laboratory and micronutrient testing.

Curious which nutritional supplements may be best for you and your family?
Contact us to schedule an appointment!


*The supplement regimens outlined in this article are from my own personal routine. These recommendations are not intended to be used as medical advice, they simply serve as an example. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Food Sensitivities Part Two: Leaky Gut


As explained in PART ONE of this series, in medical school I was taught to evaluate symptoms in order to form a diagnosis. That diagnosis was then used to determine which medication to prescribe - such as a pill for your headache or a cream for your rash.

20 years later my approach has changed. Rather than focusing on which medication to prescribe for your symptoms, I ask the question:
WHY are you experiencing these symptoms?

I use Functional Medicine to evaluate and treat the root causes of illness.

While there are many factors that can contribute to illness, perhaps none are more important than FOOD. I see it with patients every day - the food that you eat has an immediate and significant impact on the way that you feel.

In PART ONE of this series I outlined how food sensitivities were different from food allergies and food intolerances. Today in PART TWO we dig into the WHY.
Why are you experiencing food sensitivities? The answer lies in your gut.

THE DIGESTIVE TRACT

The digestive tract (which starts at your mouth and ends where your poop comes out) is one of the primary places where the inside of your body interacts with the ‘outside’ world.

In the digestive tract, food is digested (broken down), nutrients are absorbed and various toxins and other by-products produced in the digestion process are eliminated.

Nutrients are absorbed into the body through your small intestine.

Your small intestine plays a very important role in the digestive process, letting nutrients in while simultaneously preventing bacteria, yeast, viruses, toxins, and other unwelcome substances from entering the body. This is accomplished through a special layer of cells that line your small intestine.

This layer of cells plays a very important role in your health! Between each cell is a space called a “tight junction”.

The health of these cells that line the small intestine, and the health of these tight junctions, are key to what is absorbed in the digestive tract and what is not.



WHAT IS INTESTINAL PERMEABILITY AND WHY IS IT A PROBLEM? 

Intestinal permeability is defined as how porous or “leaky” the small intestine lining is. A leaky lining occurs when the protective barrier of cells are damaged and no longer are tightly connected.

While some intestinal permeability is normal, increased and prolonged intestinal permeability (also referred to as a “leaky gut”) may reduce the absorption of essential nutrients and allow harmful substances and partially digested food to enter the bloodstream at higher levels than your body can properly manage. When this happens, the harmful substances and undigested food particles can lead to activation of the immune system and chronic inflammation.

This chronic inflammation can be experienced as a variety of symptoms throughout the body. It also increases the likelihood of developing many chronic medical conditions and even autoimmune diseases such as Celiac disease or rheumatoid arthritis.

FOOD SENSITIVITIES ARE A RESULT OF INTESTINAL PERMEABILITY, OR “LEAKY GUT”.
When the lining of the small intestine becomes porous or “leaky”, poorly digested food particles can enter the bloodstream, activate the immune system, and promote inflammation. This is the underlying factor behind most food sensitivities. Common symptoms of food sensitivities are a result of this inflammation and include:
  • Joint pain
  • Headaches
  • Weight gain
  • Rashes
  • Irritable Bowel
  • Fatigue and brain fog
  • and more
WHAT CAUSES INCREASED INTESTINAL PERMEABILITY?
There are many factors that can promote increased intestinal permeability, including:
  • Viral and bacterial infections
  • Antibiotics and other medications
  • Toxins
  • Stress
  • Inflammation
  • Poor diet
  • Food intolerances
  • Imbalances in gut bacteria
  • Poor digestion
BOTTOM LINE
Food sensitivities are the result of your immune system creating inflammation in response to food. Many symptoms throughout the body may be related to food sensitivities, and the root cause underlying most food sensitivities is increased intestinal permeability, or “leaky gut”.

Stay tuned for PART THREE of this series to learn more about how to treat symptoms of food sensitivities.

Are you suspicious that food sensitivities may be casing your symptoms? Are you ready to start your journey to feeling better by addressing the root cause of your symptoms/illness? Contact our office to schedule an appointment! 231-638-5585



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. During the COVID-19 pandemic I continue to see both new and returning patients using our secure, easy video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
  298 Hits

Food Sensitivities - Part One



WHAT'S THE DIFFERENCE BETWEEN FOOD ALLERGIES, FOOD INTOLERANCES & FOOD SENSITIVITIES?
There are a number of symptoms that my patients most often describe during our visits:

  • Fatigue
  • Headaches
  • Irritable Bowel
  • Brain Fog
  • Weight Gain
  • Joint Pain
  • Rashes
Sound familiar?

In medical school I was taught to evaluate symptoms in order to form a diagnosis. That diagnosis was then used to determine which medication to prescribe - such as a pill for your headache or a cream for your rash.

20 years later my approach has changed. Rather than focusing on which medication to prescribe for your symptoms, I ask the question:
WHY are you experiencing these symptoms?

I use Functional Medicine to evaluate and treat the root causes of illness.

While there are many factors that can contribute to illness, perhaps none are more important than FOOD. I see it with patients every day - the food that you eat has an immediate and significant impact on the way that you feel.

Could food sensitivities or intolerances be causing your symptoms?

Many of the symptoms that my patients describe, including the most common ones listed above, are often the result of food sensitivities or food intolerances. Identifying these reactions and addressing their root causes can provide lasting symptom relief.

In part one of this food sensitivity series, we answer the question:
What’s the difference between food allergies, food intolerances, and food sensitivities?

FOOD ALLERGY
Food allergy reactions are immediate, within minutes of exposure to the trigger food.

They are immune-system mediated by IgE, a fast-acting immunoglobulin specific to particular foods.

Food allergy symptoms can range from mild to life-threatening and may include swollen or itchy tongue, runny nose, skin itching, hives, wheezing/shortness of breath, closing of the airway, abdominal pain or vomiting.

Common food allergy triggers include peanuts, tree nuts and shellfish.

With true food allergies, strict avoidance of trigger foods is critical, as reactions are potentially life-threatening.

While I have seen the terms food intolerance and food sensitivity used interchangeably in some media, I separate these terms into two different types of reactions when discussing with patients.

FOOD INTOLERANCE
Food intolerances are not mediated by the immune system, but rather are a result of the body lacking an enzyme or nutrient needed to properly digest or break down a particular food or a component of the food.

Symptoms of food intolerance generally occur within an hour of eating a trigger food. Common symptoms include gas, bloating, abdominal pain or cramping, nausea, and diarrhea, but may also include flushing, inflammation and flu-like symptoms.

One of the most common food intolerances is to lactose, a component of milk products. Those with lactose intolerance lack lactase, the enzyme needed to break down lactose, and will experience abdominal bloating and diarrhea after consuming milk products. Supplemental lactase may be given for better tolerance of milk products.

Less well-known trigger ingredients I commonly see with patients include histamine, preservatives/flavorings, sulfites and acidic foods.

Food intolerances are not immune system mediated. They are a result of the body lacking a substance needed to break down a food component.

FOOD SENSITIVITY
Like food allergies, food sensitivities are mediated by the immune system. Unlike food allergies (IgE mediated), food sensitivities involve reactions that are delayed and not life-threatening (IgG or IgA).

Food sensitivities essentially represent your immune system creating inflammation in response to foods you eat. Symptoms related to food sensitivities may occur several hours up to several days after eating a trigger food.

Symptoms will vary from person to person and and can include multiple symptoms outside of the digestive tract. Common symptoms of food sensitivities include:
  • Fatigue
  • Headaches
  • Irritable Bowel
  • Brain Fog
  • Weight Gain
  • Joint Pain
  • Rashes
Other symptoms can include mood changes, changes in menstrual patterns, migraine headaches, poor sleep, acne and nasal/sinus congestion.

Food sensitivities are common to gluten/wheat, dairy products, sugar, eggs, corn, nightshade vegetables and more.

Food sensitivities are most often the result of increased intestinal permeability - the breakdown of the intestinal barrier often referred to as “leaky gut”. This breakdown of the intestinal barrier, often associated with an imbalance of bacteria, yeast and other organisms in the gut, allows foods to more easily trigger the immune system, resulting in increased inflammation and symptoms.

Food sensitivities are the result of your immune system creating inflammation in response to food. Many symptoms throughout the body may be related to food sensitivities, and the root cause underlying most food sensitivities is increased intestinal permeability, or “leaky gut”.

Learn more about the root causes of food sensitivities in part two of the series, coming soon!

Are you suspicious that food sensitivities or food intolerances may be casing your symptoms? Are you ready to start your journey to feeling better? Contact our office to schedule an appointment! 231-638-5585


Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. During the COVID-19 pandemic I continue to see both new and returning patients using our secure, easy video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

  453 Hits

Mycotoxin Illness - One Patient’s Story



As discussed in my previous blog, Mycotoxin Illness is not something I learned about in medical school and something that I was initially hesitant to explore with patients. Yet as is often the case when you have a medical practice like mine, you tend to see patients with multiple symptoms who have consulted with multiple providers and have not been given an explanation, diagnosis, or clear treatment plan.

Through years of working with such patients, I have become much more knowledgeable of and comfortable with treating conditions that are often dismissed by traditional Western Medicine. Mycotoxin Illness is one such condition.

In today’s blog, I am presenting the story of one patient recently diagnosed and treated for Mycotoxin Illness.

INITIAL VISIT
I first met Kathy* in August 2020. During our first visit, Kathy described symptoms that began in 2016 during a time of elevated emotional stress, life transition, and a move into a new apartment.

Her symptoms had increased over the past 4-5 years and included:

  • Chronic cough
  • A burning sensation over her chest
  • Chronic itching (head, arms, under breasts)
  • Redness of her eyes
  • Bone and joint aches, including significant pain in wrists and elbows
  • Overwhelming fatigue and brain fog
  • Night-time anxiety, often waking up feeling panicked and hot

Kathy had sought help from multiple physicians prior to our consultation including her primary care provider, two rheumatologists, an allergy specialist, and even a trip to the Mayo Clinic! Despite numerous laboratory and diagnostic tests, she was not provided with a clear diagnosis or explanation for her symptoms.

“I’ve had doctors tell me that it’s all in my head"
Kathy explained during that first visit as she described her symptoms and we discussed her past medical history. She was frustrated and visibly exhausted. Through questioning, I learned that she had been living in her current apartment for three years and had to run dehumidifiers continuously due to wet carpet.

I initiated a comprehensive laboratory workup, evaluating:

  • nutrient status
  • hormone levels
  • markers of underlying inflammation and immune system dysfunction
  • markers of underlying infection (Epstein-Barr virus, yeast, Lyme, mycoplasma)
  • urine mycotoxin testing

Mycotoxins are toxins that are released into the air from mold. Mold can grow in any wet/damp environment. In genetically susceptible individuals, mycotoxins can cause widespread inflammation, dysfunction, and tissue damage. Mycotoxins are very small and not easily detected in the blood, therefore I utilize urine mycotoxin testing when I have a strong suspicion of Mycotoxin Illness.


SECOND VISIT
Kathy and I met one month later in September 2020 to review the results of her laboratory workup, which revealed:

  • nutrient deficiencies (deficient omega-3 fats and vitamins A, D, and B12 and suboptimal glutathione and CoQ10)
  • indicators of bacteria and yeast overgrowth in the gut
  • markers of adrenal dysfunction
  • three species of elevated urine mycotoxins, including one level “off the charts” - Zearalenone

Zearalenone (ZEA) is a mycotoxin that has been shown to damage liver cells, bone marrow production, and the immune system.  Exposure to ZEA is mostly through water-damaged buildings.


I outlined a treatment plan for Kathy, which included:

  • targeted nutraceuticals to replace deficiencies (Vitamins A, D, and B12, CoQ10, and fish oil)
  • probiotics, L-glutamine, and Immunoglobulin powder for her gut
  • herbal adrenal support

We had a lengthy discussion regarding the likely role of mycotoxins in her various symptoms and the fact that her current living situation was negatively impacting her health. I encouraged her to find a way to remove herself from her apartment for a minimum two-week period to assess for change in symptoms.

A treatment protocol was outlined to address Mycotoxin Illness directly, including:

  • Intestinal binders to trap mycotoxins and prevent reabsorption
  • Supplemental Glutathione to enhance mycotoxin removal from the body
  • Adequate hydration, regular sweating, and support for regular bowel movements

 
FOUR MONTHS LATER
Kathy and I did not meet again until four months later. Rather than a two-week trial away from her apartment, Kathy had decided to immediately vacate the apartment and had moved to a new city. She had implemented all of the therapies outlined above and described her response


"It's amazing. I'm not napping all of the time anymore. I have the energy to get through the day without a nap. My bones no longer ache. My skin doesn't itch and my eyes are clear. I haven't felt this good in over four years!"

After initiating gut support, her cough had significantly improved, almost immediately. Other symptoms continued to improve and resolve. By the time we met:

  • she no longer had pain in her wrists and elbows
  • her energy had dramatically improved  
  • her memory and brain fog had significantly improved
  • her skin no longer itched
  • her eyes had cleared

I look forward to seeing how Kathy continues to improve over the coming year!

Since the onset of the COVID-19 pandemic in March 2020, many of us have been spending far more time in our homes than we had in the past. Not surprising, then, that I have seen an uptake in Mycotoxin Illness over the past year. Even Kathy noted that her symptoms had worsened with the onset of the pandemic and more time in her apartment.

This is just one patient’s story, but it is consistent with what I have been seeing in my practice over the past several years. While the response to treatment varies per individual, I have been amazed by the rapid and significant improvement in symptoms witnessed in those diagnosed and treated for Mycotoxin Illness. For those who have developed Chronic Inflammatory Response Syndrome (CIRS), testing and treatment protocols are often more complex.

You can learn more about Mycotoxin Illness in my previous blog What you need to know about Mold & Mycotoxin Illness.

Concerned that you may be experiencing symptoms related to mold exposure?  Contact our office to schedule an appointment!  231-638-5585



*This patient has read and approved this blog, however, her name has been changed to maintain privacy/patient confidentiality.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. During the COVID-19 pandemic I continue to see both new and returning patients using our secure, easy video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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What you need to know about Mold & Mycotoxin Illness

 Mycotoxin Illness is not something I learned about in medical school. In fact, even in my early years of practicing Integrative and Functional Medicine, I was reluctant to explore the concept of Mycotoxin Illness with my patients. Similar to conditions like Lyme disease (which I also now treat frequently), Mycotoxin Illness seemed “taboo” and dismissed by traditional Western Medicine.

Yet as is often the case when you have a medical practice like mine, you tend to see patients with multiple symptoms who have consulted with multiple providers and have not been given an explanation, diagnosis or clear treatment plan.

I was not looking to treat Mycotoxins…they came and found me!

WHAT ARE MYCOTOXINS?
Mold is a fungus that can grow in any wet environment. Mycotoxins are very small toxins that are released from mold into the air. Mycotoxins are considered as a type of Biotoxin - and can cause injury to and dysfunction of multiple organs and systems, including the:

  • Respiratory system
  • Immune system
  • Neurological system
  • Hematological (blood) system

Mycotoxins are tricky! They are difficult to detect in your blood. They are very small and can move into and out of your cells with ease. Mycotoxins are secreted by the liver into bile and can be reabsorbed back into the body unless “tagged: by your immune system for removal.

GENETICS PLAY A BIG ROLE IN MYCOTOXIN ILLNESS
In genetically susceptible individuals, the immune system is unable to “tag” mycotoxins for removal, and they are resorbed back into the body. This may lead to chronic stimulation of the immune system, and in some, to the development of Chronic Inflammatory Response Syndrome (CIRS) that causes injury and dysfunction throughout the body.

Certain gene variants can make you more likely to develop Mycotoxin Illness. These gene variants are associated with poor clearance of mycotoxins and increased inflammation and tissue damage.

This is why four people can be living in a water-damaged home, yet only one is significantly ill! Only those with certain gene variants are likely to be affected.

WHO IS AT RISK FOR MYCOTOXIN ILLNESS?
For those who are genetically susceptible, any mycotoxin exposure is a potential risk. Suspicion is raised for those who live or work in a building that has a history of flood or known water damage, leaks or a damp basement.

Buildings with flat roofs are more at risk. Signs of water intrusion may include a musty odor, condensation on windows, discoloration of vents or ceiling tiles and/or a need to constantly run dehumidifiers.

SYMPTOMS OF MYCOTOXIN ILLNESS
Symptoms of Mycotoxin Illness may vary from person to person. Individuals will also vary in how severe symptoms are in relation to the degree of mold to which they are exposed.

A key feature in Mycotoxin Illness if the onset of symptoms after a move or job change.

I use the following bullet-points when evaluating the possibility of Mycotoxin illness in my patients. For adults, symptoms in 8/13 bullet-points raises high suspicion.

  • Fatigue
  • Cough, increased thirst, confusion
  • Appetite swings, body temperature dysregulation, urinary frequency/urgency
  • Memory changes, problem finding words
  • Weakness, achiness, headaches, difficult new knowledge assimilation, light sensitivity
  • Concentration problems
  • Joint pain, morning stiffness, muscle cramps
  • Red eyes, blurred vision, excessive sweating or night sweats, mood swings, unusual pain (especially sharp stabbing “icepick” pain)
  • Abdominal tenderness or pain, diarrhea/loose stools
  • Unusual skin sensations, tingling, numbness
  • Eyes tearing up, disorientation, metallic taste in mouth
  • Shortness of breath, sinus congestion or nasal drainage
  • Vertigo, static electric shocks

TESTING FOR MYCOTOXINS
I test for mycotoxins in patient’s urine, most often using Great Plains Laboratory Urine Mycotoxin kit. Cyrex Labs offers mycotoxin blood antibody testing that can be very helpful, however the cost of these tests for some is prohibitive (over $500) and they are often not covered by insurance.

TREATING MYCOTOXIN ILLNESS
Treating Mycotoxin Illness begins with a first, most important step - the patient needs to be removed from the mycotoxin exposure. This is generally the most difficult part of the process. If the exposure if through a work place there may be fear of job loss. One’s home is typically one of their most important life investments, and the decision to sell or leave is often difficult. In addition, mold remediation/clean up can be expensive and does not always solve the problem 100%.

I have had this conversation with many patients over the years and it is never an easy one, however I have seen dramatic improvement and resolution of symptoms once those affected are removed from their source of exposure.

Other steps involved in treating Mycotoxin Illness include:

  • Thorough cleaning of the home or work space with consideration for air filters
  • Avoiding toxin exposure from other sources by choosing clean, non-toxic cleaning supplies, home furnishings and self-care products. This helps to reduce the overall toxic burden.
  • For some, a low-mold diet is helpful.

To promote the clearing of Mycotoxins from the body I recommend:
Intestinal Binders
Intestinal binders of various forms are taken by mouth to bind Mycotoxins in the gut, preventing reabsorption back into the body. Examples of intestinal binders include activated charcoal, chlorella, zeolite and bentonite clays, and prescription WelChol (most often prescribed to lower cholesterol).

Glutathione
Glutathione is an antioxidant “powerhouse” which aids the detoxification of Mycotoxins from the body. Glutathione levels are often reduced in those suffering from Mycotoxin Illness and Glutathione supplementation plays a key role in the treatment process.

Sweat, Hydration and Regular Bowel Movements
Sweat, urine and stool are the three primary paths Myctoxins take to leave the body. Many of my patients incorporate regular sauna use (staring with very short sessions and working up slowly) into their treatment plans. Adequate hydration is important not only to encourage the “flushing” of toxins through urine, but also to prevent tissue damage throughout the body. Intestinal binders can be constipating, so I often add extra magnesium to promote regular daily bowel movements.

For those who have developed CIRS, testing and treatment protocols are often more complex. While response to treatment varies per individual, I have been amazed by the rapid and significant improvement in symptoms witnessed in those diagnosed and treated for Mycotoxin Illness.

Much of the information in this blog was learned from Dr. Jill Carnahan through educational training with the Institute for Functional Medicine. Dr. Jill is a nationally-recognized mold illness expert and I encourage you to check out her website for more information.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including those conditions often dismissed by Western Medicine like Mold/Mycotoxin Illness and Lyme disease.  During the COVID-19 pandemic I continue to see both new and returning clients using our secure, easy video-visit format.  If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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Low Thyroid - Five Keys to Getting the Results You Are Looking For

Do you have (or suspect that you have) low thyroid function?

Are you tired of feeling sluggish and foggy only to be told that your thyroid tests “look normal”?

You are not alone! Thyroid health is one of the most common reasons why patients seek my care - and for good reason! Optimal thyroid function is an essential component of your health and well-being, as thyroid hormones play a major role in regulating many bodily functions, including

  • Metabolism
  • Weight
  • Energy
  • Mood
  • Temperature control
  • Bowel function
  • Cognitive function
  • Heart health
  • Skin integrity
  • Muscle development
  • Gingival health

Many conventional practitioners take a “one-size-fits-all” approach to low thyroid hormone, also called hypothyroidism. They rely on one laboratory value and prescribe one type of thyroid hormone for all patients, because that is how we are taught to approach hypothyroidism in medical school. While some patients are fine with this approach, others are not and find themselves continuing to experience symptoms without an adequate diagnosis or treatment plan.

If you have (or suspect that you have) low thyroid function, a practitioner skilled and experienced in a more comprehensive approach to hypothyroidism may help you to better understand why your thyroid hormones are low, and partner with you to create a customized treatment plan to restore energy, vitality, and well-being.

LOW THYROID - FIVE KEYS TO GETTING THE RESULTS YOU ARE LOOKING FOR

#1 - GET THE RIGHT TESTING AT THE RIGHT TIME
I can’t tell you how many patients I have encountered who have been told that their thyroid function is “normal“ based upon just one laboratory value - the TSH.

TSH = Thyroid Stimulating Hormone

TSH is made by your brain, not by your thyroid. Your brain makes TSH when it senses that your body needs more thyroid hormone. The TSH made by the brain sends a signal to the thyroid to make more thyroid hormone.
Patients are often confused when interpreting their TSH number because it is an “opposite” test. A high TSH value indicates low thyroid hormone in the body.

When thyroid hormone levels in your body are low, the brain makes more TSH to "turn on" your thyroid.

Getting a more accurate picture of your current thyroid health involves testing beyond the TSH and including:

  • thyroid hormone levels - Free T3, Free T4, and Reverse T3
  • Anti-thyroid antibodies

The time at which a hormone is tested will impact results. Thyroid hormones measured first thing in the morning will look different than those measured in the late afternoon. You should also have clear instructions on if and when to take your medication in relationship to your thyroid test. I generally hold thyroid medication for a first morning testing, and sometimes I have my patients take their morning medication and then test mid-afternoon for a different picture.

#2 - RECOGNIZE THE MANY FACTORS THAT CAN CONTRIBUTE TO THYROID HEALTH
If your thyroid function is not optimal, ask the question WHY? Do you have an auto-immune condition affecting your thyroid? Are there “missing ingredients” that your thyroid needs to properly function, or something interfering with your thyroid gland? There are many factors that contribute to thyroid health, including:

  • Nutrient deficiencies (such as iron, iodine, zinc and selenium)
  • Physical and emotional stress
  • Exposure to toxins (such as fluoride, pesticides, mercury)
  • Food sensitivities
  • Underlying infections and inflammation
  • Physical trauma
  • Certain medications or other medical conditions (such as celiac disease)

#3 - AIM FOR OPTIMAL HORMONE LEVELS, NOT “NORMAL RANGE” 
While “normal ranges” are provided for each laboratory test, these ranges can vary widely. To feel and look your best, the goal should be optimal hormone levels! Thyroid hormone testing is perhaps best examples of this. I can’t tell you how many patients I have met with who had been told their thyroid levels were “normal“ despite ongoing symptoms. After shifting the focus to target optimal levels, these patients are able to experience improved energy, vitality, and well-being.

#4 - GET THE PRESCRIPTION THAT IS RIGHT FOR YOU
If prescription thyroid hormone therapy is needed, there are many options available. This allows treatment plans to be individualized for each patient. In addition to the industry standard synthetic T4 hormone (Synthroid/levothyroxine), there are various forms of natural porcine thyroid available containing both T4 and T3 hormone. Experienced practitioners can prescribe precise combinations of T4 and T3 prepared by compounding pharmacies, in both immediate and sustained-release forms.

#5 - PARTNER WITH YOUR PRACTITIONER IN THE DECISION MAKING PROCESS
To optimize thyroid function, the relationship between a patient and a practitioner needs to be viewed and treated as a partnership. Optimal thyroid function is a little different for each person, and patients should feel comfortable asking questions and expressing any symptoms or concerns. When prescribing thyroid hormone, I encourage patients to listen to their body for signs and symptoms that give us insight into thyroid health, such as body temperature, mood and energy, heart palpitations and more.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including hormone imbalance and low thyroid.  During the COVID-19 pandemic, I continue to see both new and returning clients via our easy, secure, video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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HORMONE BALANCE - Four Steps to Optimize Hormone Testing

HORMONE BALANCE
Hormone Balance is one of the most common reasons patients seek my care, and for good reason! Hormones have profound effects on your mental, physical, and emotional health and well-being.

Hormones are chemical messengers made in cells throughout the body. These messengers are carried in your blood to the organs and tissues they affect. There are many types of hormones which influence nearly every bodily function.

HORMONES IMPACT:

  • Energy
  • Mood
  • Brain Function
  • Weight
  • Metabolism
  • Muscle Mass and Bone Health
  • Breast and Vaginal health
  • Menstrual cycles
  • Sleep cycles
  • Body Temperature
  • Skin Health

COULD YOU HAVE A HORMONE IMBALANCE? 
There are many symptoms and conditions associated with hormone imbalance, including:

  • Polycystic Ovarian Syndrome
  • Infertility
  • Mood Swings or Mood Disorders (depression, anxiety)
  • Poor Memory
  • Brain “Fog”
  • Poor Libido or Sexual Dysfunction
  • Poor Sleep
  • Acne and/or Aging Skin
  • Increased Appetite
  • Weight gain
  • Bone and/or Muscle Loss
  • PMS
  • Painful and/or Heavy Menstrual Periods

HORMONE TESTING
Hormone testing is an essential part of your journey toward hormone balance. Testing hormones can provide a more clear picture of your current hormone patterns and testing is invaluable to monitor hormone therapy and treatment protocols.

Testing hormones can be complicated, confusing, and at times expensive. Taking the right steps when testing hormones can ensure that you get the most useful and accurate information.


FOUR STEPS TO OPTIMIZE HORMONE TESTING


STEP ONE - FIND AN EXPERIENCED PRACTITIONER

Conventional practitioners often fall short when it comes to
hormone testing because they are not trained in how to appropriately order and interpret hormone tests (I certainly did not get this training in medical school). There are many types of hormones, and many types of tests. Working with a practitioner who is knowledgeable in how to order and interpret hormone testing is the first step in your journey toward hormone balance.


STEP TWO - CHOOSE THE RIGHT TEST
Hormones can be tested in blood, urine and saliva. When choosing the appropriate test many factors should be taken into consideration, including gender, age, and current symptoms. Many hormones are easy to test in blood, including estrogen, progesterone, testosterone, thyroid, insulin, cortisol, leptin and more. Urine testing can be used to measure hormone levels over a 24 hour period, and can also provide valuable information about hormone metabolism and bone loss. Saliva can be used to easily collect multiple samples over a day, week, or month, and is most often used to measure adrenal hormones and sex-steroid hormones such as estrogen, progesterone, and testosterone.


STEP THREE - TIMING IS EVERYTHING

For accurate and meaningful test results, the timing of hormone testing must be considered. Hormones can be tested on a specific day or time for a “snapshot” of that moment, or measured over the course of 24 hours or an entire menstrual cycle.

The time of day a hormone test is collected will impact results. For example, thyroid hormones measured first thing in the morning will look different than those measured in the late afternoon. Certain hormones, such as insulin and cortisol, are best measured in a fasting state first thing in the morning.

Finally, timing of testing in patients taking hormone therapy should be precise, and you should have clear instructions on if and when to take your medication in relationship to your hormone test. For example, thyroid medication is often held the morning of testing.


STEP FOUR - DON’T SETTLE FOR “ NORMAL RANGE”
There is no “one size fits all“ to interpreting hormone test results.
While “normal ranges” are provided for each test, these ranges can vary widely. To feel and look your best, the goal should be optimal hormone levels! One of the best examples of this is thyroid hormone. I can’t tell you how many patients I have met with who had been told their thyroid levels were “normal“ despite ongoing symptoms. After shifting the focus to optimal levels, these patients are able to experience improved energy, vitality, and well-being.

Optimal levels may vary from person to person. Each test result should be interpreted in light of the individual patient, their age and their symptoms or concerns. For example, the optimal estrogen level for a post menopausal woman on hormone therapy is often a lower level designed to provide enough hormone for bone health, not to restore the levels of a 20 year old.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy hormone balance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. During the COVID-19 pandemic I continue to see both new and returning clients using our secure, easy video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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Cold, Flu, and COVID Season - Immune-Boosting Basics

Winter is just around the corner, and this year cold and flu season has been taken to a new level - cold, flu, and COVID season.

In addition to frequent hand washing, not touching your face, and proper social distancing, nutrient supplementation may provide an extra measure this winter to boost immune system function and reduce the risk of illness.

VITAMIN D
We absorb Vitamin D through direct sunlight, which is why vitamin D deficiency is common in northern climates.

Vitamin D reduces inflammation and supports a healthy gut microbiome. Vitamin D also boosts our cells’ ability to fight off microbes, including the cells lining our mouth, throat, and lungs.

Supplementing with Vitamin D has been shown to reduce your risk of developing an acute respiratory infection, and should you become ill, Vitamin D has also been shown to reduce the severity and duration of illness, and reduce complications.

• For prevention, consider 2000-5000IU Vitamin D3 daily with food.
• I routinely check Vitamin D levels in many patients and aim for a 25, OH Vitamin D level of 60-70.

 

     


VITAMIN C
Vitamin C is an immune system powerhouse. This antioxidant reduces inflammation, increases the production of white blood cells, and helps to strengthen blood vessels. Vitamin C is essential in the formation of collagen, which promotes healthy skin and muscle tissue. A lack of Vitamin C makes you more prone to illness, and should you develop a respiratory illness, Vitamin C has been shown to reduce the duration and severity, and reduce complications by protecting your own tissues from damage.

Vitamin C has been used in many hospital ICUs for the treatment of COVID-19.

• For prevention, 500-1000mg daily
• Choose a buffered form of Vitamin C for less stomach upset

 

     


ELDERBERRY
Elderberry (Sambucus nigra) has widespread historical use as an anti-viral herb and has been used extensively in the prevention of influenza.

Elderberry is rich in vitamin C, antioxidants, and fiber. Research suggests that elderberry is most effective when used for prevention, or when taken early on in the course of a respiratory virus.

• For prevention, consider 500mg orally, daily (of USP standard of 17% anthocyanosides).
• Caution should be used in those with autoimmune conditions.

 

      


ZINC
Zinc has a large body of research showing its strong anti-viral properties against many viruses, and zinc supplementation has been found to reduce the duration of symptoms of the common cold.

Zinc promotes antibody and white blood cell production and reduces oxidative stress. In addition, zinc has properties that fight infection directly, and zinc lozenges may reduce the risk of developing a respiratory illness.

For prevention (zinc acetate, citrate, picolinate, or glycinate), 30-60mg daily in divided doses for three months, then reduce to 15-30mg daily.

• For acute respiratory illness, begin zinc lozenges at the first sign of symptoms.

 

     

There are a number of nutraceuticals that have demonstrated immune-boosting properties. The choice of which and how many nutraceuticals to incorporate into your prevention plan will be different for each person. Factors to consider include cost, underlying chronic medical conditions, and the degree of possible virus exposure.

Subscribe to my blog for future posts highlighting other immune-boosting nutraceuticals.

Please note: Due to the novelty of COVID-19, no peer-reviewed research has been published regarding the effectiveness of dietary or lifestyle interventions for its prevention or treatment. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Consult your healthcare provider prior to use of any nutraceutical.



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. During the COVID-19 pandemic, I continue to see patients from all over the state of Michigan using our secure, video-visit format. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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Stay Home & Eat Well with these Recipe Resources

As the COVID-19 pandemic continues to evolve, I remain committed to providing my patients and followers with useful and accurate information. I encourage you to use these resources to help in making informed decisions on how to go about your daily activities in a safe and healthy way. Please share it with friends!

 
I routinely post relevant articles and information on my Facebook page. Not a Facebook member? I have made my Facebook posts available on the homepage of my website as well.
 
Today I’m highlighting four recipe resources that are especially useful for today's Stay Home - Stay Safe environment.
 
Having a stocked pantry is as important now as it has ever been. One of my favorite go-to recipe sites Eating Bird Food has compiled a list of helpful tips to stock your healthy pantry. 
 
Another one of my favorite sites, Well Plated by Erin,  has made available a page of healthy pantry & freezer-friendly recipes.
 
Dr. Kara Fitzgerald’s nutrition staff has assembled a website full of healthy recipes. Why am I obsessed with this site? First, most of the recipes are easily modified to accommodate personal diet plans. Second, the variety of recipes has a broad range, including everything from bone broth to dessert. In addition, the recipes are designed with nutrient density in mind, seeking to optimize nutrient content for optimal immune support. For those of you science geeks (like me) interested in Functional Medicine, Dr. Kara also has an excellent podcast.
 
Ready to incorporate more plant-based options into your diet? The Physicians Committee for Responsible Medicine has the tools you need to get started in the relaunched 21-Day Vegan Kickstart online program and mobile app. The free program features hundreds of healthy recipes, meal plans, grocery lists, expert nutrition advice, cooking demonstrations, and more.
You don’t have to commit to being a strict vegan to learn from this program. We can all benefit by incorporating more plant-based principles into our diet.
  
That’s it for today. Stay home, stay safe, and stay well.
 


Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. During our Stay home - stay safe period I continue to see both new and returning clients via our secure video visit format.  If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585. 

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Non-toxic Skincare. The Why, What and How. Part Two

Non-toxic Skincare.  The Why, What and How. Part Two
Non-toxic Skincare - The Why, What and How.  
Part two:  The WHAT

This month we are highlighting healthy skin, including skincare basics, healthy skin care products, food and skin and more. This is part two of a three-part series going in-depth on the topic of toxic skincare products, including why it’s important to choose healthy skincare products, ingredients to be aware of, and resources to help you choose safe, healthy skin care products for you and your family.


PART TWO: THE WHAT

As explained in my previous blog, your skin absorbs up to 60% of what you apply to it, and serves in some cases as a direct route to your blood. Chemicals in skin care products can bioaccumulate, or store and accumulate in your body over time, potentially causing hormone disruption, inflammation, weight gain and increased cancer risk. Unfortunately, the FDA does not require proof of safety before cosmetics and other skincare products reach the market, so you need to be your own advocate to protect yourself and your family!

There are so many potentially toxic ingredients in skin care products that I had trouble choosing which ones to feature! I’ve chosen three of the most pervasive, and potentially most dangerous chemicals for today’s blog, and I provide links to articles I used in my research with more extensive information should you choose to read more!


b2ap3_thumbnail_natural-shampoo-label.jpgPARABENS

Parabens serve as preservatives in a wide variety of skincare products. Parabens are everywhere, and it’s likely that most of us have been exposed to Parabens through a number of different products throughout our lifetime. Some researchers have estimated that some 90 percent of typical grocery items contain measurable amounts of parabens. Scary!

The main concern with Parabens is that they have hormone-mimicking and estrogenic properties. This means that they can act like estrogen in the body, competing with naturally-produced estrogen and binding to estrogen receptors on cells. This can potentially create an “estrogen overload” effect in the body, which may increase the risk of hormonally-driven cancers like Breast Cancer and fuel other hormone-mediated conditions such as endometriosis.

Ingredient Keywords: methylparaben, ethylparaben, propylparaben, butylparaben, and isobutylparaben


b2ap3_thumbnail_makeup__large.jpgPHTHALATES 

Phthalates serve as plasticizers They are used to make skincare products flexible and better able to hold color and scent.

The concern with Phthalates is that they belong to a group of chemicals referred to as endocrine disrupters, which means they have the potential to disrupt your hormones. Phthalates have been shown to reduce fertility in both men and women, reduce testosterone production in men, reduce egg quality and quantity in women, and are associated with endometriosis.

How to find them? You can look for phthalates on labels, but unfortunately, you won't always find them. The FDA does not require manufacturers to list every ingredient in proprietary fragrances, so they may be hidden in the term ‘fragrance/parfum’.


b2ap3_thumbnail_Triclosan.jpgTRICLOSAN

Triclosan is added to a variety of skin care products to reduce or prevent bacterial contamination. Exposure to Triclosan is so pervasive that the U.S. Centers for Disease Control and Prevention reports that it can be found in the urine of 75 percent of all U.S. residents, as well as in plasma and breast milk.

There are a variety of concerns with Triclosan. Not only does it function as an endocrine disruptor (like phthalates), it also promotes antibiotic resistance, has been shown to be a skin irritant, and is considered to be carcinogenic, increasing the risk of certain cancers. In addition, Triclosan has been shown to have a negative environmental impact, most notably in aquatic ecosystems.

While the FDA banned the use of Triclosan in over-the-counter antiseptic soaps, gels and wipes ion 2016, it is still in widespread use in personal care products like toothpastes, shampoos, and deodorants.

Look for “Triclosan” directly on your label.

Looking for more information? Check out these resources:

Sara Gottfried, MD: Ten Toxic Ingredients That Might Be in Your Skin Care (And What to Use Instead).

MindBodyGreen: 12 Toxic Ingredients to AVOID in Cosmetics & Skin Care Products

Andrew Weil, MD: What's Wrong With Triclosan?

Scientific American: Should People be Concerned about Parabens in Beauty Products?



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and provide treatment options that go beyond the prescription pad. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Skin Care Basics - The Benefits of Alpha-hydroxy Acids (AHAs)

Skin Care Basics - The Benefits of Alpha-hydroxy Acids (AHAs)
Alpha-hydroxyl Acids (AHAs)


HOW AHAs WORK

Our skin has a natural ability to exfoliate dead skin cells and does so daily. Unfortunately, this process slows down with age, which can lead to an accumulation of dead skin cells, leaving skin appearing dull and uneven.

AHAs dissolve the upper layer of skin cells by weakening the cellular “glue” that holds dead skin cells together, encouraging exfoliation and triggering skin repair.


HOW AHAs IMPROVE YOUR SKIN.

AHAs have a number of proven skin benefits.

AHAs remove dead skin cells, revealing healthy, younger skin cells, resulting in a brighter complexion and more even skin tone. This increase in cell turnover is also effective in treating sun-damaged skin, hyperpigmentation, and melasma.

AHAs trigger collagen regeneration, thickening the outer skin layers. This works to firm and tighten skin. minimize fine lines/wrinkles, and fade blotches. (When combined with a retinol, these results can be even more dramatic, but we’ll save that for another blog...)


AHAs AND DRY OR SENSITIVE SKIN.  

Many of my clients with dry or sensitive skin get nervous when they hear the word “acid“. Have no fear! Even those with dry or sensitive skin can benefit from regular use of a quality AHA product with proper pH balance.

AHAs may actually be a better choice to exfoliate sensitive skin because they are less likely to irritate then manual exfoliation. AHAs are gently applied to the skin, no need to scrub. AHAs can also be effective for dry skin. By removing the outer layer of dead skin cells, healthy skin cells become more receptive to the skin care products you apply. Regular AHA use, combined with appropriate product, can significantly increase your skin’s moisture factor.


GETTING STARTED WITH AHAs. 
While there are a number of AHAs, the two most commonly used in skin care are Glycolic Acid and Lactic Acid. Glycolic Acid is considered to be the most powerful because it has the smallest molecular size of all AHAs. The smaller the molecule, the deeper it is able to penetrate skin layers.

When beginning an AHA regimen, it is important to “start low and go slow”.
Start low - choose a product with a lower concentration of acid to start. Over time, and under the supervision of your skin care provider, you can gradually increase the concentration of your product for added benefits.

Go slow - don’t overdo it! Start your AHA routine only 1-2 times per week, giving your skin plenty of time in between treatments to rest and repair. You can gradually work up two more frequent use. I typically recommend an every other day regimen for my patients, using AHAs twice daily on “active“ days, with “rest“ days in between.

You can add an AHA right into your regular skincare routine. Apply your AHA after cleansing, and follow with serum and/or moisturizer. Don’t forget sun protection! Use of AHAs can make your skin more susceptible to sun damage, so don’t forget your daily sunblock!

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RECOMMENDED PRODUCTS FROM OUR SANITAS SKINCARE LINE:   

Glycosolution 5% 
The perfect starting point. Removes spent skin cells and helps stimulate skin renewal. An amino acid complex, blended with glycolic acid, helps smooth the appearance of wrinkles, boost moisture retention and brighten dark spots. (also included in all Sanitas System Kits)

Brightening Peel Pads 
Instant results! These pads contain a triple acid blend to brighten, tone and reveal clear, radiant skin. Follow with 3 drops of Vita C Serum for an instant glow.

Solar Block 
A natural, non-toxic broad-spectrum sunscreen for daily use. Contains a blend of zinc oxide and antioxidants. Absorbs quickly and will not clog pores.

All Sanitas products are cruelty-free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and providing treatment options that go beyond the prescription pad. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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