Access ChARM Patient Portal Account

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.

  1645 Hits

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.

  1318 Hits

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.

  1047 Hits

Three Simple Steps to Prevent Summer Diet Sabotage

No matter where you live, the summer season can quickly turn into one big party! Tuesday night suddenly looks like Friday night, friends and family come out of the woodwork, and the picnics, BBQs and cocktails start becoming daily activities.

Suddenly, healthy eating becomes even more of a challenge.

Challenging, yes - but not impossible! Let me share with you the same advice I give my patients everyday - when it comes to food, don’t focus on what you shouldn’t be eating, instead focus on the foods that you need to eat at key points during the day to maintain energy, boost metabolism, and avoid over-indulging.

CONSIDER THESE THREE SIMPLE STEPS TO PREVENT SUMMER DIET SABOTAGE:

b2ap3_thumbnail_ProteinShakes.jpg1. Start your day with protein and fiber

Cereals, donuts, toast and bagels all cause a rapid rise in blood sugar (and insulin) that is followed by a blood sugar crash within hours. This can cause your energy level to plummet and can spark strong hunger and cravings. Starting your morning with protein and fiber promotes consistent energy by avoiding a blood sugar crash, boosts metabolism to promote weight loss and keep you full, often until lunchtime!

A protein shake/smoothie is an excellent way to start your summer days. Read more about reasons to start your day with a protein shake.


b2ap3_thumbnail_salad.jpg2. “Stack the Deck”
This is a concept that I frequently discuss with my patients. "Stacking the deck" simply refers to giving your body the food that it needs earlier in the day to promote stable mood and energy and reduced food cravings later in the day. If you know you have a party or event later in the evening, the last thing you want to do is starve yourself in anticipation! Not only will this increase cravings and decrease willpower, it can cause rapid mood swings. In addition, not eating during the day makes your body feel as though it is starving, which switches your metabolism to "fat-storing" mode instead of "fat-burning" mode.

3. Fill up on the good stuff first
Have you ever been to a Mexican restaurant? If you have, then you have probably gorged yourself on a basket of chips and salsa - filling yourself up before your meal even comes to the table!
Let's turn this scenario around. What if they brought out the basket of chips after you finished your meal? Would they still be as appealing? No way! Think of this as you plan your eating for your next party. Fill your plate with vegetables first. By filling up first with foods that are high in fiber and low in sugar, you will be less likely to over indulge in unhealthy choices without feeling deprived.

You can visit our online store to learn more about products we have available to help support you this summer, including my physician-formulated Balanced Vegan Protein Shake Mix, Appetite Support Formula, Starch Blocker, and Balanced Liver Support. 

b2ap3_thumbnail_CN_TheEssentialsStore.jpg

I'd love to hear your comments or questions. Feel free to message me directly at This email address is being protected from spambots. You need JavaScript enabled to view it..

Be Well!
Carin Nielsen, MD
  3433 Hits

Have you been tested for Chronic Inflammation?

b2ap3_thumbnail_fire.jpgIt is well established that chronic inflammation is a key factor in most chronic disease, yet many doctors overlook the one simple blood test that can assess your level of inflammation. Often without symptoms, chronic, low-level inflammation may be threatening your health right now without you even knowing it!



Inflammation - the Good and the Bad

Inflammation in your body has a purpose - to treat injury and illness. Without inflammation, wounds would not heal and simple infections could become deadly. The inflammation in your body that treats injury and illness comes from your immune system. Think of your immune system like your own personal army, ready for attack. If you become ill or injured, your immune system activates pathways of inflammation in your body for healing. You can see and feel this inflammation as swelling, pain, warmth and redness at an injury site or warmth from a developing fever. These symptoms are all signs that your immune system is doing it’s job! When your immune system is working properly, the inflammation is temporary, and the inflammatory pathways in your body are turned off as you heal.

b2ap3_thumbnail_injury.jpgWhile temporary, purposeful inflammation is healthy, too much inflammation in the body is not. When inflammation persists or serves no purpose, it damages the body and causes illness. In the brains of Alzheimer’s patients, inflammation destroys nerve cells. Inside arteries, smoldering inflammation damages the arterial lining and helps kick off atherosclerosis (plaque). Inside joints, inflammation eats away at cartilage causing painful arthritis.


It is well-established that chronic inflammation is the root cause of many chronic diseases, including:

  • Heart disease
  • Stroke
  • Obesity
  • Many cancers
  • Arthritis
  • Alzheimer's disease
  • Diabetes

Causes of chronic inflammation:

  • b2ap3_thumbnail_Donuts.jpgStress 
  • Lack of exercise 
  • Genetic predisposition
  • Elevated blood sugars
  • Excessive calorie consumption
  • Excessive body fat (fat cells release inflammatory signals in the body)
  • Exposure to toxins (cigarettes, pesticides, heavy metals, etc.)
  • Periodontal disease
  • Infection and Imbalance in the Digestive Tract
  • Inflammatory foods 


Testing for Inflammation

Knowing your level of underlying inflammation can be a key step in making changes to reduce the development of many chronic diseases and avoid age-related health decline.

hsCRP = high-sensitivity C-reactive protein

There are several tests that can be used to assess your level of inflammation, but the one test you need to start with is the high-sensitivity C-reactive protein, or hsCRP. C-reactive protein (CRP) is a substance produced by the liver that increases in the presence of inflammation in the body. Elevated levels indicate inflammation due to infection or tissue injury. The high-sensitivity type of this test can detect chronic inflammation even at very low levels.

Do you know your hsCRP value and what it means?

hsCRP value of 2.0 or greater is considered high risk

hsCRP value 1.0-1.9 is considered borderline risk

hsCRP value kess than 1.0 is desired


If you are interested in knowing your hsCRP value, you can order a hsCRP laboratory test directly through my website without an appointment!  Follow this link to avoid insurance hassles with affordable testing and get fast results!



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. 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.


  3348 Hits

Three reasons to start your day with a Protein Shake

There are a number of reasons why starting your day with a protein shake or smoothie is a great idea.
Here are my top 3 reasons to get you thinking about what your breakfast has to offer!

1. It gives you energy and keeps you full.

b2ap3_thumbnail_tired.jpg

Sugary cereals and donuts and gluten-filled bagels cause a rapid rise in blood sugar (and insulin) that is followed by a blood sugar crash within hours. This can cause your energy level to plummet and can spark strong hunger and cravings.

Starting your morning with protein and fiber promotes consistent energy by avoiding a blood sugar crash, boosts metabolism to promote weight loss and keep you full, often until lunchtime! 


2. It's healthy and quick to make!

b2ap3_thumbnail_CLOCK.jpg
Toss your ingredients in the blender and you have a healthy, delicious breakfast in minutes.

If you are really pressed for time, use a shaker bottle to mix your shake on the go.

 

3. It's an easy way to pack more greens and super foods into your day.

blender_bottle.jpgb2ap3_thumbnail_smoothiegreen.jpgA shake or smoothie is a great way to add extra servings of the foods your body needs to stay healthy and strong! You can add handfuls of greens such as spinach or kale. Blend in 1/2 cup of dark berries for added flavor and antioxidants. A tablespoon of ground flax seed can increase fiber and improve detoxification. Use up what is left in the fridge and pack the nutrients in!

I don't just encourage my patients to start their day with a breakfast rich in protein, fiber and micronutrients - I do so myself! Most mornings I begin my day with a nutrient-packed Vegan Protein Shake. While I always start with a high-quality protein-powder base, I customize the ingredients to match my needs each day. Here are a few of my favorite tips:

  • I like to make my smoothie with 1/2 water and 1/2 unsweetened coconut or almond milk. This keeps the sugars low but allows for a creamer texture and more full flavor.
  • If I know my day will be jam-packed with patients or meetings, I make a double batch in my blender and save a second shake for mid afternoon. This allows me to maintain consistent energy during they day, and by the time I get home I can make a nice dinner without feeling like I have to raid all of my cupboards!
  • I often freeze my greens, such as organic spinach and throw 1-2 large handfuls in my blender in the morning. This prevents my greens from spoiling and adds a nice texture to my shake (my mom likes to use Watercress).
  • For patients who are often constipated, I recommend 1-2 TBSP ground chia seed for added fiber and promotion of regular bowel movements.


b2ap3_thumbnail_ProteinShakePhoto.jpgClick here for more information on my physician-approved Balanced Vegan Protein Shake mix. It's 100% vegan, 100% non-GMO, packed with fiber and micronutrients, and is a great value!

I'd love to hear your comments or questions. Feel free to message me directly at This email address is being protected from spambots. You need JavaScript enabled to view it..


Yours in Health,

Carin Nielsen, MD

  4153 Hits

Importance of LIfestyle Change is Buried under Statin Drugs in New Cholesterol-Lowering Guidelines

It has been a busy week in the medical press with opinions abound on the new guidelines published Tuesday by two of the nation’s leading heart organizations. The American Heart Association and  The American College of Cardiology.  The first new such guidelines in a decade, they serve to outline specific clinical strategies for the lowering of blood cholesterol to lower the risk of heart attack and stroke.

It is widely accepted that the new guidelines represent a dramatic shift from the current accepted "norm" of cholesterol treatment, and that adherence to these guidelines will double the number of adult Americans who are prescribed a statin medication (such as Lipitor, Crestor or Zocor) to lower cholesterol.  This is expected to increase the number of U.S. adults on statin drugs to approximately 1/3.  In addition, those taking statin drugs to lower cholesterol will no longer be monitored to reach specific target levels of LDL cholesterol, but rather simply taking a recommended dose of the medication is considered sufficient.

The new guidelines divide people needing statin treatment into two broad risk categories:
 
HIGH RISK - those with diabetes or very high levels of LDL cholesterol or those who have had a previous heart attack.  These patients are recommended to be prescribed high-dose statins regardless of other risk factors or cholesterol levels.  
 
LOW RISK -  Those not considered high risk (everyone else) should be considered for a statin if they have a calculated 10 year risk of a heart attack or stroke of at least 7.5 percent.  Doctors are advised to use a new risk calculator that factors age, sex, race, blood pressure, diabetes and total cholesterol to calculate risk.
 
So what's my take?  While the new guidelines do address lifestyle changes in the prevention and treatment of heart attach and stroke, the message is lacking, and difficult to find, buried underneath the message to focus on increased statin drug therapy.
 
Dr. Stephen Devries, an Integrative Cardiologist with the Gaples Institute for Integrative Cardiology at Northwestern University offered insightful "pros and cons" of the new guidelines in a blog post earlier this week.  To summarize:
 
Pros
 -The guidelines do a good job of clearly defining the 4 highest risk groups most likely to benefit from statins and should be helpful in addressing the current under treatment of high-risk populations - those with known vascular disease, middle age diabetics, people with exceptionally high LDL, and those with multiple risk factors. 
 
Cons
-The guidelines give a comprehensive overview of the benefits of long-term use of statins in high-risk people, but not the risks!  As I see quite commonly in my office, significant side-effects are common, especially muscle pain - experienced by up to 10% of those on statins-and more common with high doses.  In 2012, the Food and Drug Administration updated labeling on statins to include warnings about the potential for muscle weakness, confusion and memory loss, and elevated risk of developing Type 2 diabetes.
-Another concern is that recommending long term high dose statins for vascular disease regardless of cholesterol levels may reduce the incentive for patients to make lifestyle changes.  The new guidelines call for using the same high dose of statin regardless of changes in diet, exercise, or weight. Dr. Devries makes an excellent point that an accompanying guideline on Lifestyle Management to Reduce Cardiovascular Risk”  emphasizes improving cholesterol and blood pressure, rather than focusing on diet changes to impact overall risk to heart health. There’s an important difference. For example, a  Mediterranean diet in the Lyon study succeeded in reducing the risk of a serious heart problem by 72%, yet didn’t change cholesterol at all.
 
The bottom line.
According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors.  These new guidelines offer new tools to calculate risk of both heart attack and stroke, and offer specific, evidence-based drug treatment protocols for those at the highest risk.  Companion guidelines on modifying lifestyle and treatment of overweight and obesity in adults are a step in the right direction, but their message is lost behind the strong emphasis on statin drug therapy.

While I am not opposed to statin therapy in high-risk populations, I will not allow the message of lifestyle modification to be lost with my clients.  My approach involves digging deeper with specialized testing to evaluate risk, "thinking outside the box" to treat all risk factors, and treating each client with a personalized approach.  If you want to learn more about your risk, or how these guidelines affect you or someone you love, consider an Integrative Medicine consultation.  www.CarinNielsenMD.com.
 
  3720 Hits

There goes our daylight - Do you know your Vitamin D level?

Last week I had a follow-up visit with a male patient in his early 40s who had come to see me for muscle aches and decreased muscle stamina with exercise. He was having soreness on a daily basis, particularly in his upper thighs.  Laboratory workup had revealed significant Vitamin D deficiency. He reported at his follow up visit that after only 3-5 days of high-dose Vitamin D supplementation, his muscle symptoms were noticeably improved.

He was surprised to hear that I see this quite frequently, both Vitamin D deficiency and other patients with similar symptoms of muscle aches that improve when Vitamin D intake is increased. My medical practice is in Northern Michigan, and Vitamin D deficiency is quite common. I have been checking Vitamin D levels routinely on my patients for many years, and I rarely find an "optimal" level, let alone a level that isn’t deficient!

b2ap3_thumbnail_sunshine.jpg

Why is your Vitamin D level important?

Did you know that Vitamin D is actually a fat-soluble hormone?  Your body produces Vitamin D in your skin when exposed to sunshine or ultraviolet light. Knowing that, it’s not surprising that north of the 45th parallel Vitamin D deficiency is quite common!

Vitamin D is necessary to absorb calcium, it helps to regulate the levels of calcium and phosphorus in the body, and together with these minerals works to maintain bone strength and integrity. The benefits of Vitamin D intake on bone health and reduction of osteoporosis is well documented by randomized controlled trials and evidence has also linked Vitamin D intake to reduced falls in the elderly.

A growing body of research suggests that Vitamin D intake may be linked to reduced risk of cancer (specifically breast, prostate and colon cancer), depression, autoimmune disease, and heart disease, although further studies are needed to verify these results.  Vitamin D deficiency has been linked to chronic muscle aches and pains, and (as described above) I have observed numerous patients with chronic diffuse muscle pain (especially in the thighs and forearms) get relief when restoring their Vitamin D levels to normal.

Do you know your Vitamin D level?

When testing your Vitamin D level, it is important to order the correct test. There are two tests for Vitamin D – 1,25(OH) Vitamin D or 25(OH) Vitamin D. 25(OH) Vitamin D is the best test as it is the best marker of overall Vitamin D status. 

A level below 30 ng/dl is considered deficient. In my practice we first look to raise levels above 30 into the “normal range”, and then look to get levels in the “optimal range” (those of you who are clients of mine know that this is a frequent topic of conversation, what is normal for one person may not be normal for another, and therefore when interpreting test results we strive for the optimal level for best health). Opinions vary as to “optimal” Vitamin D levels.  I strive to get levels to at least 48 ng/dl, as a comprehensive review of evidence from various studies found this level to be optimal for cancer prevention.

How do you raise your Vitamin D levels?

There are two types of Vitamin D: Vitamin D3 (cholecalciferol – which is the type of Vitamin D synthesized in your skin when exposed to sunlight), and Vitamin D2 (ergocalciferol – found in Vitamin D fortified foods and synthesized by plants).

Vitamin D3 is better utilized by the body than D2, and is the preferred source for supplementing. Vitamin D3 is found in eggs, organ meats, animal fat, cod liver oil, and fish.  It is also available in both liquid and capsule supplements.  If you are considering supplementing with Vitamin D speak with your physician about what dose is most appropriate for you.

Can I get too much Vitamin D?

Yes!  While Vitamin D toxicity is rare, it can happen if you over-supplement. Unlike many water-soluble vitamins, Vitamin D is fat-soluble and excess intake will store in your fatty tissues. Excess Vitamin D intake has also been linked to kidney stone formation.

For more information, or if you are interested in having your Vitamin D levels tested, contact our office at 231-638-5585 or This email address is being protected from spambots. You need JavaScript enabled to view it..

 

 

 

 

  3231 Hits