Access ChARM Patient Portal Account

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.

  474 Hits

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.

  838 Hits

Is your Skincare Routine ready for a BOOST?

Dreaming of Spring? 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* 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.

*minimum purchase $59, offer ends February 28, 2021



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.

  253 Hits

Three Steps to a Healthier Detox

Thinking about a “detox”? You are not alone! New Year’s resolutions often contain a theme of renewal, change and improved health, and I am commonly asked about detoxification programs this time of year.

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.

  623 Hits

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.

  1067 Hits

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.

  865 Hits

Cold, Flu and COVID Season - Ask for these 2 laboratory tests as part of your risk-reduction plan.

COLD, FLU, and COVID SEASON - Ask for these 2 laboratory tests as part of your risk-reduction plan.

Do you have a plan to reduce your risk of COVID-19 complications? In addition to measures that reduce your risk of virus exposure (hand washing, face coverings, and proper social distancing), nutrient supplementation may provide an extra measure of immune system support to reduce the risk of COVID-19 illness and complications.

How do you know what you need? In certain cases, laboratory testing can provide insight into your body’s nutrient status and help to direct supplementation needs and dosing.

WHAT IS YOUR VITAMIN D LEVEL?
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.

Evidence has shown 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%.

Exposure to sunshine is a great way to boost Vitamin D levels.  For that reason, most of my Northern Michigan patients (myself included) need to supplement in order to achieve optimal levels.

Laboratory test: Serum 25 OH Vitamin D
Optimal level: 50-80 ng/mL
Supplementation: 2000-5000 IU Vitamin D3 daily with food

CHECK YOUR GLUTATHIONE.
Glutathione is an antioxidant “powerhouse” in your body. Glutathione prevents oxidative stress and inflammation and helps boost your immune function in a number of other ways. Glutathione deficiency is associated with accelerated aging, many chronic diseases (diabetes, heart disease) and cancer.

There is mounting evidence of the role of Glutathione deficiency and COVID-19 complications. Glutathione has been shown to protect against the severe inflammatory response triggered by COVID-19 infection, and some researchers have hypothesized that Glutathione deficiency may serve as the most likely cause of serious complications and death in COVID-19 patients.

You can boost the production of glutathione in your body by eating more sulfur-rich foods. The main ones in the diet are garlic, onions and the cruciferous vegetables (broccoli, kale, collards, cabbage, cauliflower, watercress, etc).  Whey protein consumption and moderate exercise can also boost glutathione production.  Supplementation is often given in the form of N-Acetylcysteine (NAC), a glutathione precursor.  You can also supplement glutathione directly if levels are very low.

Laboratory Test: Whole Blood Glutathione level
Optimal levels: Aim for the upper quartile of your laboratory reference range.
Supplementation: N-Acetylcysteine (NAC), a glutathione precursor, 600-900mg twice daily, or Liposomal Glutathione 2-4 pumps twice daily.

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.

Subscribe to my blog!



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.

  329 Hits

Reducing COVID-19 Risk - Step Three, A Plan if You are Exposed or Infected (updated December 2020)

 UPDATED DECEMBER 2020

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
A THREE-STEP PLAN TO REDUCE COVID-19 RISK USING LIFESTYLE FACTORS AND NATURAL AGENTS.

After reviewing emerging data, and in conjunction with recommendations from the Institute for Functional Medicine, I have updated my three-step plan to reduce COVID-19 risk using nutrition, lifestyle factors, botanicals and nutraceuticals.

STEP ONE - Foundations of immune system support.
STEP TWO - Support for higher-risk conditions and situations.
STEP THREE - A plan if you are exposed or infected.

In Step One, Reducing COVID-19 Risk - Step One, Immune System Support (updated November 2020), of this series, 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. In Step Two, Reducing COVID-19 Risk - Step Two, Support for High Risk Conditions and Situations (updated November 2020), I expanded these recommendations for those with higher-risk medical conditions or situations. In this Part Three 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. 

Step Three - A plan if you are exposed or infected.

A majority of those who develop COVID-19 will recover without complications, and many infected will never develop symptoms. According to the US Centers for Disease Control and Prevention, most people with COVID-19 have mild illness and are able to recover at home without medical care.

However, as the pandemic has progressed we have learned that this is a tricky and at times unpredictable virus. While we now know those with certain medical conditions are at elevated risk for complications (see Step Two), we have also witnessed some with few or no risk factors hospitalized and even dying from COVID-19 infection. We are also seeing a growing number of COVID “long-haulers” - those who continue to have debilitating symptoms for weeks, even months, after infection.

Given this, I encourage all of you to familiarize yourself with the basics of COVID-19 infection, and outline a plan for support and care should you become exposed or infected. 


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! 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. More details on these nutraceuticals can be found in earlier steps one and two of this series.

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.
• 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.

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): 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.

  1302 Hits

Reducing COVID-19 Risk - Step Two, Support for High Risk Conditions and Situations (updated November 2020)

 UPDATED NOVEMBER 2020

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
A THREE-STEP PLAN TO REDUCE COVID-19 RISK USING LIFESTYLE FACTORS AND NATURAL AGENTS.

As I review emerging research data, and in conjunction with recommendations from the Institute for Functional Medicine, I have updated my three-step plan to reduce COVID-19 risk using nutrition, lifestyle factors, botanicals, and nutraceuticals.

STEP ONE - Foundations of immune system support
STEP TWO - Support for higher risk conditions and situations.
STEP THREE - A plan if you are exposed or infected.

Step Two - Support for high-risk conditions and situations.

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.

In Part One of this updated series, I outlined foundations of immune support that could be considered for most adults to reduce risk. Today we will review support for high-risk conditions and situations:

  • Support for those with chronic medical conditions that place them at higher risk of becoming infected and/or increase risk of COVID-19 complications.
  • Support for travel or entering other high-risk situations

 

Do you have one of these chronic medical conditions?

  • Hypertension
  • Heart disease
  • Obesity
  • Diabetes
  • Elevated insulin and/or triglycerides

If so, you are at an elevated risk of contracting COVID-19. These conditions are associated with higher circulating levels of Furin, an enzyme that makes it easier for the SARS-Cov-2 virus to infect your cells. Now is the time to make an appointment with your practitioner to outline a plan to lower blood pressures and blood sugars, optimize heart health, reduce body fat.

You can also consider adding natural inhibitors of Furin to your routine to reduce risk of infection: As you will see, many of these agents have multiple immune-modulating properties.
EGCG
ANDROGRAPHIS
GLUTATHIONE
BERBERINE

EGCG
EGCG (epigallocatechin gallate) from green tea has been shown to reduce the risk of developing acute respiratory infection. In addition to inhibiting Furin, it also reduces inflammasome activation (see below).
Dose: 4 cups green tea or approx 225mg EGCG daily

ANDROGRAPHIS
Andrographis paniculata not only Inhibits Furin, it also works to prime the innate immune system and promotes viral inactivation.
Dose: follow instructions, usually as part of a combination herbal product

GLUTATHIONE
Glutathione is an antioxidant “powerhouse” in your body. Glutathione prevents oxidative stress and inflammation and helps boost your immune function in a number of other ways. There is mounting evidence of the role of Glutathione deficiency and COVID-19 complications. Glutathione has been shown to inhibit Furin and reduce the inflammasome response (see below). Some researchers have hypothesized that Glutathione deficiency may serve as the most likely cause of serious complications and death in COVID-19 patients.

Consider testing Glutathione levels and aiming for the upper quartile of your laboratory reference range.
Dose: N-Acetylcysteine (NAC), a glutathione precursor, 600-900mg twice daily, or Liposomal Glutathione 2-4 pumps twice daily.

BERBERINE
Berberine is a plant extract that is antiviral and anti-inflammatory (see below). Berberine primes the innate immune system as well as inhibiting Furin. Berberine is also used clinically to lower blood sugars and cholesterol and restore a healthy balance of gut bacteria.
Dose: 500mg 2-3 times daily

 

Chronic inflammation may put you at a higher risk of COVID-19 complications and more severe disease.
Inflammation is a primary pathway by which the body responds to viral infection. In COVID-19 infection, the “cytokine storm”, an exaggerated inflammatory response (think of this like a forest fire), is partly responsible for severe complications of COVID‐19 illness, including ARDS (acute respiratory distress syndrome).

Those with conditions associated with chronic inflammation are at higher risk for COVID-19 complications and hospitalization - including a higher risk for acute respiratory distress and exaggerated inflammation in the intestines, heart, kidneys, eyes, and brain.

Conditions associated with higher levels of chronic inflammation.

  • Hypertension
  • Diabetes
  • Chronic kidney disease
  • Obesity
  • Elevated insulin and/or triglycerides
  • Cardiovascular disease
  • Active autoimmune disease
  • Gout
  • Chronic respiratory conditions

In addition to working with their practitioner to optimize health and get better control of chronic medical conditions, those with chronic inflammation may consider adding natural inhibitors of inflammation:
EGCG • GLUTATHIONE • BERBERINE (see above)
CURCUMIN
RESVERATROL
QUERCETIN
MELATONIN

CURCUMIN
Curcumin, the primary constituent of the yellow-spice Turmeric, has powerful anti-inflammatory properties. I routinely recommend an absorption-enhanced formula of Curcumin to my patients with inflammatory conditions.
Dose: 500-1000mg twice daily of absorption-enhanced Curcumin

RESVERATROL
Resveratrol is a naturally occurring polyphenol that is found in many foods, including peanuts, grapes, blueberries, and dark chocolate. Resveratrol powerfully reduces inflammation and aids in protecting cells from inflammation-induced damage.
Dose: 100-150mg daily

QUERCETIN
Quercetin has been shown to have direct anti-viral effects against RNA viruses (like the coronavirus). Quercetin has powerful anti-oxidant and anti-inflammatory properties and can be helpful in resolving virus-induced inflammation and damage. Quercetin also stabilizes mast cells and is often used in the treatment of allergy and asthma.
Dose: regular 1gram twice daily, phytosome 500mg twice daily - use for 12 weeks

MELATONIN
Melatonin enhances several aspects of immunity and has been shown to have an inhibitory effect on the inflammatory response generated by COVID-19 infection. There is ongoing research into the use of Melatonin as a targeted therapeutic agent in COVID-19 illness.
Dose: 5-20mg

 

What about travel or other high-risk situations?
Obviously, the preferred method of prevention is to avoid high-risk situations such as travel and large-groups., however, there will certainly be times for somewhere this cannot be avoided. In addition, if you are living in close-quarters to others or work in public in an area with a high prevalence of COVID-19 injection, that can also be considered a high-risk situation.

GO BACK TO THE BASICS
Review my blog on Cold, Flu, and COVID Season - Immune-Boosting Basics and review Part One of this series. Don’t forget your Vitamin D, and consider adding immune-enhancing herbs such as Astragalus, Elderberry, and/or Echinacea. If in the high-risk categories listed above, consider additional measures to reduce Furin and inflammation. Herbal blends can also be helpful, combining several ingredients for fewer pills to take. 

ENHANCE YOUR FACE MASK
Consider using a filter in your mask, such as polypropylene or three-ply facial tissues, especially with air travel or facing long periods of time in enclosed spaces with other people. You can review my Cloth face masks - recommendations, tips, and tricks.

TRAVELING BY AIR? INCREASE YOUR ELDERBERRY!
Elderberry extracts may help to prevent the early stage of coronavirus infection, which includes COVID-19. Elderberry contains compounds that decrease the ability of viruses to infect cells.

This research paper demonstrated a significant reduction of cold duration and severity in air travelers treated with Elderberry. Travelers were initially given 600 mg/day starting 10 days before travel followed by 900 mg/day starting the day before travel and continued for 4 or 5 days post-flight. 

INCREASE YOUR MELATONIN
There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. 

  

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.

  790 Hits

Reducing COVID-19 Risk - Step One, Immune System Support (updated November 2020)

 UPDATED NOVEMBER 2020

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
A THREE-STEP PLAN TO REDUCE COVID-19 RISK USING LIFESTYLE FACTORS AND NATURAL AGENTS.

After reviewing emerging data, and in conjunction with recommendations from the Institute for Functional Medicine, I have updated my three-step plan to reduce COVID-19 risk using nutrition, lifestyle factors, botanicals and nutraceuticals.

STEP ONE - Foundations of immune system support.
STEP TWO - Support for higher risk conditions and situations.
STEP THREE - A plan if you are exposed or infected.

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

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 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. Today we are focusing on the foundations of immune system support, highlighting agents that can be used by most adults to prime the immune system and reduce risk.

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.

Nutrient foundations to prime immunity and prevent illness include:

  • 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.

  733 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.

  750 Hits

Cloth face masks - recommendations, tips, and tricks.

Cloth face masks combined with other measures, such as frequent hand-washing and social distancing, help slow the spread of COVID-19 infection.

According to the CDC, the SARS-Cov-2 virus (the virus that causes COVID-19 infection) is thought to spread most often person-to-person through respiratory droplets. These droplets are released into the air when somebody coughs or sneezes, or even just through talking. Yes, talking! Simply having a conversation with an infected person can spread the virus. Furthermore, it is now understood that those infected may spread the virus days before developing symptoms, or may have no symptoms at all yet still be able to spread the virus.

Wearing cloth face masks will be our new normal for the foreseeable future. It is important that you and your children choose appropriate masks and know how to properly handle and care for your mask.

I have spent hours researching the available data. I am also a wife and mother and I have been working to incorporate protocols for proper mask use and care in our home. In today’s blog, I am sharing a summary of my recommendations on the use of cloth face masks, as well as some tips and tricks from my own personal experience.

WHAT TYPE OF MASK?
When choosing a face mask, it is important to consider both the type of fabric and the fit of the mask to your face.

YOUR MASK SHOULD BE 2-3 LAYERS OF FABRIC.

  • The World Health Organization recommends a cloth mask of at least three layers of different materials.
  • I recommend at least one layer of your mask be 100% cotton, ideally the layer that sits closest to your face.

CONSIDER A FILTER IN THE MIDDLE LAYER OF YOUR MASK.

  • You can turn a two-layer mask into three layers by adding a filter. If your mask does not have a filter pocket, you can create one with a pair of scissors.
    • Consider using a polypropylene filter in your mask, especially if facing long periods of time in enclosed spaces with other people. Polypropylene holds an electrostatic charge, which may help to trap both outgoing and incoming respiratory droplets.
    • Note - polypropylene will lose its electrostatic charge when you wash it. You can recharge it by ironing it or by rubbing it with a plastic glove for around 20 seconds.
    • Tip: I ordered a large roll of “Oly-fun” polypropylene fabric online for less than $15. I was able to cut multiple filters out of the fabric and even share it with friends.
    • Three-ply facial tissues (Kleenex) can also be used as filters but should be disposed of after use.

EARLOOPS VS. TIES? 

  • This is an entirely personal preference, whatever is more comfortable for you.
  • Tip: I keep both available. My preference is to use a tied mask for longer periods of time because it seems to stay in place better. Masks with ear loops can be easier for quick trips.

YOUR MASK SHOULD FIT TIGHTLY TO YOUR FACE.

  • The edges of your mask should fit snug against your skin, avoiding gaps.
  • Your mask should cover both your nose and your mouth.
  • A light flexible wire in your mask allows for a better fit over your nose and helps your mask to stay in place.

REMOVING YOUR MASK:

  • Wash your hands before removing your mask.
  • Don’t touch the front of the mask or your face!
  • Grasp the ear loops or ties of the mask to remove.
  • Use a washable or disposable bag to store your mask.
  • Wash your hands again!
  • Trick: Attaching a Ziploc plastic bag to your child’s backpack provides easy mask storage.

HOW OFTEN SHOULD YOU WASH YOUR MASKS?

  • Ideally, masks should be washed after each use. This is especially important if wearing the mask for longer periods of time in enclosed spaces with multiple people.
  • Without washing your mask, simply not using your mask for 3 to 5 days should render the mask safe for use. You can speed up this process by placing your mask in direct sunlight.
  • Tip: having multiple masks for each family member makes this process much easier. I try to gather up masks and wash them in batches.
  • Trick: in an attempt to avoid my boys placing used masks on the kitchen counter, I created a mask station using ribbon and clothespins. This keeps our masks separate from other surfaces.

HOW TO WASH YOUR MASK.

  • You can machine washcloth masks with your other laundry, using regular detergent in a warm or hot setting. You do not need to wash your masks separately or use a sanitizing mode.
  • Alternatively, you can hand wash your mask using hot soapy water. A 20-second scrub should do the trick, just like washing your hands!
  • Masks can be dried in the dryer or laid flat to dry.
  • Tip: I occasionally wash our masks in the laundry machine, however, I prefer to hand wash and lie flat to dry. This seems to avoid excessive wear and tear on the fabric and helps to keep the mask's shape and form. When possible, I place to dry in direct sunlight.


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

I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. During the pandemic 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.

  437 Hits

Let's make a plan to reduce your risk.

 

SUPPORT YOUR IMMUNE SYSTEM & REDUCE YOUR RISK

With rising rates of COVID-19 infection and expectations for an epic influenza season, there has never been a better time to take control of your health!  Optimizing key nutrients, managing chronic medical conditions, reducing inflammation, improving sleep and controlling stress are key factors in supporting your immune system and reducing your risk. Let's make a plan for you!

 

STEP ONE 
ORDER LABORATORY TESTING

Make the most of your visit by ordering laboratory testing prior to your appointment

*Even specialty laboratory testing is covered by most Medicare plans!

 

STEP TWO
CUSTOMIZE SUPPLEMENTS

I'll customize your supplement recommendations based on your data 

  • with so many options available, how do you know which supplements are right for you?
  • there are many nutraceuticals which have been shown to reduce risk of viral infection and complications.

 

STEP THREE
MAKE A PLAN
Plan ahead to adjust diet and lifestyle to enhance immunity. Have a plan ready should you become ill.

  • schedule your appointment to review your individual risk factors and customize a plan that addresses diet, sleep, stress management and more.
  • we can also review special situations such as reducing risk with travel and protocols to have on hand should you become ill.

 

Ready to get started? Have questions? CLICK HERE!

 

**The cost of Spectracell Micronutrient Testing will be increasing after August 30th.  Please note that our office does not profit off of or uncharge on any laboratory testing. Any costs are directly to the laboratory facility.



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 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.

  572 Hits

Reduce COVID-19 risk (Step 3 of 3) Have a plan

 

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
A THREE-STEP PLAN TO REDUCE COVID-19 RISK USING NUTRITION, LIFESTYLE FACTORS, AND TARGETED NUTRACEUTICALS.


Step Three - Have a plan should you become infected.

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 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.

In conjunction with recommendations from the Institute for Functional Medicine, I have developed a three-step plan to reduce COVID-19 risk using nutrition, lifestyle factors, and targeted nutraceuticals.

  • Step One - Support your immune system.
  • Step Two - Reduce inflammation.
  • Step Three - Have a plan should you become infected.

You can refer to Step One and Step Two in my earlier blogs. These first steps are key in reducing your risk! According to experts, this virus isn’t going away anytime soon, so I strongly encourage you to use this time to take steps to boost your immune system function and reduce inflammation in your body.


Today’s blog will highlight Step Three: Should you become ill with COVID-19 infection, don’t be caught off-guard - have a plan!

Let’s start with a brief review of terminology. The term “coronavirus” actually refers to a group of viruses that get their name because of their crown-like shape seen under a microscope. Of the known coronaviruses, 9 are known to infect humans, including the common cold. This new coronavirus at the root of the current pandemic is called SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2). Those infected with the virus SARS-CoV-2 may then go on to develop COVID-19 infection (Coronavirus Disease 2019).

SARS-CoV-2 is the new coronavirus that causes COVID-19 infection. For simplicity's sake, I have been using the term COVID-19, which refers to infection with this new coronavirus.

Next, let’s acknowledge the fact that a majority of those who develop COVID-19 will recover without complications, and many infected by SARS-CoV-2 will never develop symptoms. According to the US Centers for Disease Control and Prevention, most people with COVID-19 have mild illness and are able to recover at home without medical care. Johns Hopkins University is among few institutions that have been tracking recovered cases as part of it’s reporting of comprehensive COVID-19 data and you can view real-time data on their public dashboard.


SYMPTOMS OF COVID-19 INFECTION
It’s important, again, to emphasize that some people infected with the virus have no symptoms, yet can still be contagious. That is why it is important to wear a mask in public!

According to Harvard Health, common COVID-19 symptoms include:

  • fever
  • dry cough
  • fatigue
  • loss of appetite
  • loss of smell
  • body ache

More severe symptoms which often indicates pneumonia may include:

  • high fever
  • severe cough
  • shortness of breath

As new data is being collected, specific neurological and gastrointestinal symptoms have also been highlighted, which may occur with or without respiratory symptoms:

  • loss of appetite
  • nausea, vomiting
  • diarrhea
  • abdominal pain or discomfort
  • loss of smell and/or taste
  • muscle weakness
  • tingling or numbness in the hands and feet
  • dizziness
  • confusion
  • delirium
  • seizures
  • stroke

 

HOW LONG DOES IT TAKE TO DEVELOP SYMPTOMS AFTER EXPOSURE?

While the time of exposure to symptom development ranges from 2-21 days, greater than 90% of people who develop symptoms will do so within 14 days.


Now that we’ve covered the basics, let’s start making a PLAN.


KNOW YOUR OPTIONS FOR HEALTHCARE AND TESTING

WHO IS YOUR PRIMARY CARE PROVIDER (PCP)? 
You may want to check to be sure you are still considered an active patient with your PCP. I’ve had many clients report that their PCP had “dropped them” as an active patient if they had not been seen in a period of time. Become familiar with your PCP’s hours of operation and policies as they relate to COVID-19. Ask if they are willing and able to order COVID-19 testing. If you don’t currently have a PCP, establish one, or become familiar with local urgent care facilities.

A note to my patients: While I do not provide traditional Primary Care services in my office, I will be available to evaluate and prescribe COVID-19 testing when needed, and will be able to consult with patients via Tele-health during active COVID-19 infection.

WHAT TYPE OF COVID-19 TESTING IS AVAILABLE IN YOUR COMMUNITY?

This situation is rapidly evolving, so find your city or county’s health department COVID-19 website and bookmark it. Emmet and Charlevoix County residents click here

 

HAVE A PLAN FOR HOME QUARANTINE
At the first sign of COVID-19 infection, a home quarantine plan is essential to reduce the risk of others in your home and to be sure that you have the supplies you need. I encourage you to talk through this first with your spouse or partner, and then second with your children. These are not fun conversations, but they are important ones. If you are able to talk openly with your family now, it will be easier to “kick into gear” should you encounter infection.

If you live with others (when possible) designate a home quarantine bedroom and bathroom. Should you become ill, this is where you should retreat at the earliest sign of illness. While this will not be possible for everyone, this room should ideally have a window for fresh air and a private bathroom nearby. Unless you require care outside of your home, you should plan to remain in this space until deemed not contagious by your healthcare provider.


ENSURE YOUR HOME IS STOCKED WITH NEEDED SUPPLIES SHOULD YOU OR A FAMILY MEMBER BECOME ILL: 

  • adequate amounts of surface disinfectant and laundry detergent
  • extra cloth masks (these need to be washed frequently when caring for an infected person)
  • a working thermometer


CONSIDER STOCKING YOUR PANTRY WITH:

  • ingredients to make your own electrolyte drink for hydration (there are many recipe variations) online
  • bone broth - most infected do not have much of an appetite, so think about nourishing liquids to sip on
  • frozen or canned soups


I ALSO RECOMMEND YOU CONSIDER HAVING THE FOLLOWING HOME MEDICAL DEVICES AVAILABLE (ESPECIALLY FOR THOSE AT HIGH RISK):

  • home nebulizer with a prescription solution or a sterile saline solution - become familiar with how to use and clean your device
  • pulse oximeter to monitor oxygen saturations at home. There are a variety available on Amazon, or check out this new pulse oximeter APP.  You should plan to routinely monitor blood oxygen levels if experiencing shortness of breath or respiratory symptoms. Nail polish needs to be removed for accurate results. A normal blood oxygen level via pulse oximeter is 95-100%. If your oxygen level falls below 92% you should contact your healthcare provider.


A FEW NOTES:

Thermometers are in short supply and a home nebulizer and pulse oximeter can be expensive. Nebulizers and other equipment can be ordered from a local medical supply store by your PCP should you become ill. Some feel more comfortable having on hand. You can also work with a group of families together to pool resources in a COVID-19 emergency kit or plan, with supplies being shared if needed.

I encourage you to read about the use of nebulizers in COVID-19 patients by Dr. David Brownstein at the Center for Holistic Medicine. You can find his blog here


CHECK OUT THESE ADDITIONAL CDC RESOURCES: 

 

WHAT TO DO IF YOU THINK YOU HAVE COVID-19
If you think that you have COVID-19, contact your PCP via phone. Only in the case of severe symptoms or emergency should you leave your home. Evaluation and testing orders should be able to be completed vis Tele-health services. Ideally, testing is done through a drive-through center or at home.

 The CDC has a useful self-checker tool available. 

IF YOU HAVE BEEN DIAGNOSED WITH COVID-19 AND YOU FEEL YOU NEED TO BE EVALUATED AT THE HOSPITAL
If your COVID-19 symptoms become severe, and you feel you need to be evaluated at the hospital - be prepared! Most likely, you will need to enter the hospital alone and you will not be permitted to have visitors. Plan to wear your mask and bring with you:

  • a typed, accurate list of all medications and supplements - including doses and time of day you take them (having three paper copies as well as a copy on your smartphone is ideal)
  • a typed identification card that includes contact information of 1-2 family members or close friends
  • a copy of your signed and notarized Medical Power of Attorney and Living Will (if you don’t have these now is the time to create them)
  • mobile phone and tablet or laptop for communication - don’t forget chargers!
  • a bottle of Vitamin C, and any other nutritional supplements in your emergency care plan

 

NUTRACEUTICALS FOR USE DURING ACTIVE COVID-19 INFECTION
In my two previous blogs, I have outlined targeted nutraceuticals for support of the immune system and reduction of inflammasome activation. Several of these supplements have also been designated by the Medical Education Team of the Institute for Functional Medicine as appropriate for use during active COVID-19 infection. The choice of which and how many nutraceuticals to incorporate into your prevention plan will be different for each person. Consult a healthcare practitioner prior to use.

VITAMIN C

  • For prevention, 500-1000mg daily
  • During active infection, 2000-6000mg daily starting at the very first signs of illness. I recommend 1000mg per hour for up to six hours daily, reducing your dose if you develop diarrhea. Continue higher dosing for seven days.
  • Choose a buffered form of Vitamin C for less stomach upset
  • Vitamin C has been shown to both decrease viral growth and reduce symptoms.


CURCUMIN

  • During active infection, 500-1000mg twice daily
  • Curcumin has been shown to both decrease viral growth and reduce symptoms


QUERCETIN

  • During active infection, 500-1000mg twice daily
  • Quercetin has been shown to both decrease viral growth and reduce symptoms


ZINC (acetate, citrate, picolinate, or glycinate)

  • During active infection, up to 60mg daily for seven days in the form of zinc lozenges spaced throughout the day
  • Zinc has been shown to both decrease viral growth and reduce symptoms


N-ACETYLCYSTEINE (NAC)

  • During active infection, 600-900mg twice daily
  • NAC has been shown to reduce symptoms of respiratory infection, but not to decrease viral growth


GREE TEA OR EGCG

  • 4 cups daily (green tea), 225 mg daily (EGCG)
  • EGCG Has been shown to reduce symptoms of respiratory infection and decrease viral growth


RESVERATROL

  • 100-150 mg orally, 2x daily
  • Resveratrol has been shown to decrease viral growth but has not been shown to reduce symptoms


ELDERBERRY

  • 500mg orally, daily
  • Elderberry has been shown to decrease viral growth but has not been shown to reduce symptoms.


MELATONIN

  • 3-20mg, taken at bedtime
  • Melatonin has been shown to decrease viral growth but has not been shown to reduce symptoms


PALMITOYLETHANOLAMIDE (PEA)

  • PEA is a naturally occurring anti-inflammatory agent that has been shown to improve outcomes in acute respiratory disease and influenza.
  • PEA modulates the endocannabinoid system
  • Functional Medicine specialist Kara Fitzgerald, ND recommends Metagenics Hemp Advantage (with PEA): 2 caps daily for prevention, increasing to 2 caps three times per day with first symptoms. Continue for six weeks


An additional consideration perking my interest:

Specialized pro-resolving Lipid Mediators (SPMs)

  • SPMs are biosynthesized from the omega-3 fatty acids. Some people cannot efficiently synthesize SPMs from omega-3 fats (think fish oil) and may benefit from taking SPMs directly
  • There are a host of studies demonstrating that SPMs rapidly resolve inflammation
  • Functional Medicine specialist Kara Fitzgerald, ND recommends Metagenics SPM Active: 2 caps daily for prevention, increasing to 2 caps 2-3 times daily during active infection

 

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, especially if taking prescription medication that could have potential interactions.



Carin Nielsen, MD Integrative MedicineI 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 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.

  821 Hits

Reduce COVID-19 risk (Step 2 of 3) Reduce Inflammation

 

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
A THREE-STEP PLAN TO REDUCE COVID-19 RISK USING NUTRITION, LIFESTYLE FACTORS, AND TARGETED NUTRACEUTICALS.


Step Two - Reduce INFLAMMATION to reduce your risk.

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 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.

In conjunction with recommendations from the Institute for Functional Medicine, I have developed a three-step plan to reduce COVID-19 risk using nutrition, lifestyle factors, and targeted nutraceuticals.

  • Step One - Support your immune system.
  • Step Two - Reduce inflammation.
  • Step Three - Have a plan should you become infected.


Today’s blog is focusing on Step Two - Reducing inflammation to reduce your risk.

The statistics are clear. Those with certain chronic medical conditions are at a higher risk for both contracting the novel coronavirus, and suffering complications from the virus. In addition to those who are immunocompromised, chronic medical conditions associated with increased risk include:

  • Hypertension
  • Diabetes
  • Chronic lung disease or moderate to severe asthma
  • Serious heart conditions
  • Severe obesity (body mass index [BMI] of 40 or higher)
  • Chronic kidney or liver disease

What do many of these chronic conditions that pose a higher risk have in common? Each is associated with increased INFLAMMATION.


KEY TERMS AND CONCEPTS RELATED TO INFLAMMATION AND COMPLICATIONS FROM COVID-19 INFECTION:

  • Cytokines are substances produced by cells of the immune system that promote inflammation. In certain patients infected with COVID-19, a cytokine storm is responsible for driving lung and tissue damage and increased risk of death.
    Think of this cytokine storm as an overwhelming, massive burst of inflammation which eventually leads to lung damage, heart damage, and multi-system organ failure.
  • Inflammasomes are a big driver of the cytokine storm. Inflammasomes are cellular complexes that detect infections and other “danger signals” in the body, and in turn, activate inflammatory cytokines.
  • When Inflammasomes detect infection (such as the COVID-19 virus), they activate cytokines which turn on inflammation. In those who become most ill with coronavirus infection, this “cytokine storm” of inflammation is responsible.

We don’t know why some people infected with the COVID-19 virus get the cytokine storm and some do not. Researchers have speculated that those with more mild illness or even asymptomatic illness may have a more robust innate immune response (see part one of this series to learn more about innate immunity and prevention), and have also suggested that those exposed to or mounting a lower viral load may have improved outcomes.

What we do know:
1. The NLRP3 inflammasome is what is activated by the COVID-19 virus.
2. Inflammasomes can also be activated by a variety of other factors, including:

  • poor diet (think high sugar and processed foods)
  • nutrient insufficiencies
  • gut infections/dysbiosis
  • increased intestinal permeability (“leaky gut”)
  • emotional stress
  • cells damaged by reactive oxygen species (ROS) due to antioxidant imbalance and
  • oxidative stress
  • damaged mitochondria
  • toxins

Given this, the goals of today’s recommendations are to:

  • Identify and reduce your personal risk of everyday inflammasome activation.
  • Identify natural inhibitors of the NLRP3 inflammasome to potentially reduce the risk of coronavirus infection and cytokine storm.

 

REDUCE INFLAMMATION AND RISK

If you have a chronic medical condition such as diabetes, hypertension, arthritis, asthma, or COPD, now is not the time to stop your medication! This is the time to be vigilant in managing your condition and doing everything you can to keep blood pressures and blood sugars under control, keep lungs clear, and reduce arthritic flares. Many primary care providers and specialists are offering tele-medicine services, so utilize your time at home to check-in and optimize your health!

DIET

  • Every time you eat or drink something, you are making the decision to either increase or decrease inflammation in your body. It’s really that simple!
  • To lower inflammation, eat real food. Avoid sugar and processed foods. Choose healthier fats and eat more plants.
  • Eating a nutrient-dense diet replenishes nutrients needed to combat inflammasome activation.
  • Eating a low glycemic-load diet lowers blood sugars and insulin, which in turn lowers inflammation.
  • Eating a diet rich in colorful fruits and vegetables provides antioxidants to reduce oxidative stress, which can trigger inflammasomes.

TOXINS
Toxic load and impaired detoxification can lead to “danger signs” in the body and activate the inflammasome response.

  • When possible, choose organic whole food. Check out the Dirty Dozen and Clean Fifteen lists by the Environmental Working Group (EWG) to help guide your choices.
  • Choose non-toxic cleaning products. The EWG also has a guide to help chooses after cleaning products.
  • Take time each day to sweat. Sweating is an effective, natural way to detoxify your body!
  • Drink at least 64oz of clean, filtered water daily to help flush toxins out of your body.
  • Avoid constipation! If stool sits in the bowel for too long, toxins and hormones can re-enter your bloodstream and cause harm. Increase fiber. Try Magnesium Glycinate 100-300mg at bedtime - this can help both sleep and bowel movements.

CLEAN UP YOUR GUT
Your gut can be a major source of inflammasome activation. Increased intestinal permeability (“leaky gut”), allows substances to get into the bloodstream that might otherwise have not, sending a “danger signal” which can activate inflammasomes. Dysbiosis (overgrowth of unwanted bacteria or yeast n the gut) can also trigger inflammasome activity.

  • If you have chronic gut inflammation, such as IBS, bloat, irregular bowel movements, or GERD, now is the time to seek treatment! Consider working with a Functional Medicine specialist to outline a personalized treatment program.
  • Even during stay-home orders, helpful testing such as stool analysis, urine organic acids, and food sensitivity testing can be done from home without a blood draw.
  • If you have known gut dysbiosis, talk with your practitioner about adding Berberine 500mg three times daily for the next three months. Berberine has many anti-inflammatory and anti-microbial activities. It is also used to lower blood sugar and cholesterol.
  • You may also want to consider other gut-healing nutrients such as bone broth, collagen, and/or L-glutamine. I often recommend a bovine colostrum-derived immunoglobulin powder to my patients - putting an immune-boost directly into the gut. I also like combination gut-soothing powders (such as GI Revive by Designs for Health) for a variety of inflammatory gut conditions.

 

NUTRACEUTICALS TO REDUCE INFLAMMASOME ACTIVATION AND THE INFLAMMATORY RESPONSE

These featured substances were chosen by the Medical Education Committee of the Institute for Functional Medicine both because they are known to have multiple anti-inflammatory mechanisms, and also have been studied to be specifically effective in NLRP3 inflammasome inhibition. The nutraceuticals are recommended, at standard dosages, to prevent activation of the NLRP3 inflammasome, to decrease inflammation, and to potentially inhibit COVID-19 replication. The number of nutraceuticals chosen and the dosing will depend upon a variety of factors, including patient desire, pre-existing inflammation, multiple co-morbidities, higher risk, budget, etc. Consult a healthcare practitioner prior to use.

CURCUMIN

  • 500-1000mg twice daily
  • Curcumin has been shown to reduce inflammation and decrease viral activity for COVID-19.

QUERCETIN

  • For prevention, 500-1000mg daily
  • Has also been found to be effective in treating seasonal allergies and asthma
  • Found in fruits and vegetables and has a wide range of benefits, including decreasing viral growth.

OMEGA-3 FATTY ACIDS

  • 2000-2500mg EPA+DHA daily (read your label carefully)
  • Omega-3 fatty acid deficiency makes turning off an inflammatory response difficult
  • For those at higher risk, including those with underlying inflammatory conditions such as Diabetes, consider Specialized pro-resolving Lipid Mediators (SPMs). There are a host of studies on SPMs and inflammation, including inhibition of the inflammasome.

MELATONIN

  • 3-20mg, taken at bedtime
  • In addition to promoting restful sleep, melatonin has been shown to reduce inflammation.

PALMITOYLETHANOLAMIDE (PEA)

  • For prevention, 300mg twice daily
  • PEA is a naturally occurring anti-inflammatory agent that has been shown to improve outcomes in acute respiratory disease and influenza.
  • PEA modulates the endocannabinoid system

GREEN TEA OR EGCG

  • Drink 4 cups green tea daily, or take EGCG 225 mg daily
  • In addition to reducing inflammation, green tea enhances the immune system and targets one of the processes involved in COVID-19 replication.

RESVERATROL

  • 100-150 mg orally, twice daily
  • A natural compound found in red grapes has many beneficial health effects and has been shown in the lab to attack a relative of the COVID-19 virus.

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, especially if taking prescription medication that could have potential interactions.



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 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.

  1126 Hits

Reduce COVID-19 risk (Step 1 of 3) Immune System Support

 

IT'S TIME TO TAKE CONTROL OF YOUR HEALTH.
A THREE-STEP PLAN TO REDUCE COVID-19 RISK USING NUTRITION, LIFESTYLE FACTORS, AND TARGETED NUTRACEUTICALS.


Step One - Support your Immune System

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 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.

Lately, it seems we are doing a lot of waiting.

Waiting for the coronavirus pandemic to pass, waiting for social restrictions to be lifted, and for many of us, waiting and wondering if/when we will become infected with COVID-19.

It’s time to stop waiting and take control of your health.

In conjunction with recommendations from the Institute for Functional Medicine, I have developed a three-step plan to reduce COVID-19 risk using nutrition, lifestyle factors, and targeted nutraceuticals.

  • Step One - Support your immune system.
  • Step Two - Reduce inflammation.
  • Step Three - Have a plan should you become infected.


Today’s blog is focusing on Step One - Immune System Support.

Your innate immune system is your first line of defense against any type of infection, therefore it makes sense to have your innate immune response optimized, primed and ready to recognize and attack COVID-19 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 are faced with.

LIFESTYLE FACTORS
You have the control to adjust key lifestyle factors and boost your immunity.

DIET/NUTRITIOUS FOODS 
How many servings of vegetables and fruits are you eating each day? Research indicates that brightly colored vegetables and fruits boost immunity better than most supplements.

  • Aim for 10 servings of vegetables and fruits per day.
  • Try to incorporate different colors of vegetables and fruits throughout your day.
  • Include fermented vegetables or other probiotic-containing foods (work up to 1/4 cup per day).
  • Focus on real food, limiting processed foods.
  • Consider time-restricted eating, extending the window from when you stop eating at night to when you begin eating in the morning. Work up to a 12-14 hour overnight fast.


STRESS REDUCTION
Chronic stress can negatively alter immune system responses, making you more likely to get sick. Identify your personal stress reduction strategies and practice them regularly.

  • Consider meditation. Taking even a few minutes out of each day for a breath-focused meditation can work wonders on your stress response. I frequently recommend the apps “Headspace” and “Calm” to patients for guided meditations.
  • Go for a walk in the woods. Research reveals that environments can increase or reduce our stress, which in turn impacts our immune system. What you are seeing, hearing, experiencing at any moment is changing not only your mood, but how your nervous, endocrine, and immune systems are working.
  • Work with a licensed counselor or therapist. Many professionals are now offering tele-health services via video or phone.
  • If the COVID-19 pandemic has your stress levels at a peak, consider working with your Integrative/Functional Medicine practitioner on herbal options to help manage your stress response.


SLEEP
Do not underestimate the importance of sleep! Sleep has a big influence on immune function itself, and quality sleep can also reinforce your stress response.

  • Practice good sleep hygiene by maintaining consistent sleep hours. Turn off screens and ensure your room is cool, quiet, and dark.
  • Chronic sleep problems? Consider referral to a sleep specialist or a counselor certified in sleep management (remotely, of course).
  • If needed, consider melatonin, CBD, or other herbals to promote quality sleep.


EXERCISE
Are you keeping up your exercise routine? Moderate, regular physical activity helps to boost immune system function by raising levels of infection-fighting white blood cells and antibodies, increasing circulation, and decreasing stress hormones.

  • Exercise not only boosts immunity, but it also works to counteract the stress response and improve detoxification.
  • At a minimum, aim for 150 minutes of cardiovascular exercise weekly. Get your heart rate up and break a sweat!
  • Try to add-in 2-3 days of strength training weekly to build muscle mass.
  • There are MANY online exercise-at-home platforms. Some of my favorites are HASfit.com, FitOn.com and the 90-day free trial of Peloton on-demand classes (meditations too).

 

NUTRACEUTICALS
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. Consult a healthcare practitioner prior to use.


VITAMIN C

  • For prevention, 500-1000mg daily
  • Choose a buffered form of Vitamin C for less stomach upset
  • Vitamin C contributes to immune defense by supporting various cellular functions of the immune system. Vitamin C has been used in hospital ICUs to treat COVID-19

 

VITAMIN D

  • For prevention, 2000-5000IU Vitamin D3 daily with food
  • Enhances immune system function, reduces viral growth, and can reduce upper respiratory infections.

 

ZINC (acetate, citrate, picolinate, or glycinate)

  • For prevention, 20-40mg daily for three months
  • A large body of research shows that zinc has strong anti-viral properties against many viruses.


QUERCETIN

  • For prevention, 500-1000mg daily
  • Has also been found to be effective in treating seasonal allergies and asthma
  • Found in fruits and vegetables and has a wide range of benefits, including decreasing viral growth.


N-ACETYLCYSTEINE (NAC)

  • For prevention, 500-600mg daily
  • Promotes the production of glutathione, a potent antioxidant that supports immune function. It also reduces the severity of the flu


ELDERBERRY

  • 500mg orally, daily
  • Packed with vitamin C, dietary fiber, and antioxidants. It has been used extensively in the prevention of influenza.


GREEN TEA or EGCG

  • 4 cups daily (green tea)225 mg orally, daily (EGCG)
  • In addition to reducing inflammation, green tea enhances the immune system and targets one of the processes involved in COVID-19 replication.


RESVERATROL  

  • 100-150 mg orally, 2x daily
  • A natural compound found in red grapes has many beneficial health effects and has been shown in the lab to attack a relative of the COVID-19 virus.

 

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, especially if taking prescription medication that could have potential interactions.



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.

  1258 Hits

The coronavirus is HIGHLY CONTAGIOUS - tips to protect yourself and the ones you love.

 

The coronavirus is HIGHLY CONTAGIOUS.
TIPS TO PROTECT YOURSELF AND OTHERS.


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.

Today’s blog is about how HIGHLY CONTAGIOUS the coronavirus is, with tips on how to protect yourself and others.

By now, most of you should understand the vital importance of social distancing to “flatten the curve” of the coronavirus pandemic, and reduce the burden on our healthcare systems. This importance has been reinforced by government mandates such as the “Stay Home, Stay Safe” mandate in Michigan, and we are now living in a new reality of social distancing and social isolation that is likely to be measured in months rather than weeks.

Our daily lives have changed dramatically, and in order to protect yourself and your family, I am encouraging you to go beyond social distancing and use an abundance of caution and vigilance in your daily activities to reduce your risk of contracting or transmitting the coronavirus.

The coronavirus can be spread silently, without symptoms.
Asymptomatic transmission of the coronavirus is real, and there is growing data showing that a significant number of cases are a result of asymptomatic exposure.
Even today, as I finish this blog, there is suggestion that simply talking, not coughing/sneezing, can be a source of spreading this virus.

What this means:

  • you could become infected with the virus from somebody who does not have any symptoms
  • you could potentially be a source of infecting others if you contract the virus but do not have symptoms

 

For the time being, reduce the amount of time you spend in public places.
This (obviously) excludes those with essential jobs such as healthcare workers. The rest of us need to stay home. If possible, stock up on 14 days worth of groceries at a time. This requires planning ahead!

  • Keep track of food and essential toiletries available in your home, and levels of cleaning supplies.
  • Plan menus ahead of time to anticipate grocery needs.
  • If you take medications or nutritional supplements on a regular basis, stock up with a three month supply.

 

When in a public place, conduct yourself in a manner that assumes that anyone you come in contact with is infected with the coronavirus.
You can also take that one step further and assume that you are infected and capable of transmitting the virus to others.

  • Stay a minimum of 6 feet away from other people.
  • Only touch what you need to touch.“You touch it, you buy it.”
  • Wash hands frequently, and use hand sanitizer as a back-up.
  • Stop touching your face!
  • Consider covering your nose and mouth with a cotton mask or scarf when in public (the CDC is currently considering a statement about this)

 

Be vigilant about SURFACES.
In a study published March 24, 2020, NIH scientists found that the virus that causes COVID-19, can be detected:

  • In the air for up to three hours
  • On cardboard for up to 24 hours
  • On plastic and stainless steel surfaces for up to three days

Another study, published on the CDC’s website found that traces of COVID-19 genetic blueprint were found on surfaces throughout the Diamond Princess cruise ship as long as 17 days after passengers and crew had disembarked from the voyage. My take on this? When you are in public - assume all surfaces are contaminated with coronavirus and take appropriate precautions.

Disinfect EVERYTHING that enters your home.

PACKAGES
Packages delivered to your home have likely been handled by several people, and we know that the coronavirus can live on cardboard up to 24 hours and plastic up to three days, so you need to have a plan:

  • move mail and packages into your garage and if able, let them sit for several days before opening
  • be vigilant about disinfecting your doorknobs and washing hands immediately after transferring packages and mail
  • leave envelopes and cardboard for recycling outside of the home, only transfer into the home what you need
  • wipe all items being brought into the home with a disinfectant
  • for more information, check out this article

 

GROCERIES
Similar to packages assume all grocery surfaces are contaminated with the coronavirus and develop a plan for disinfecting. Here is the plan we’ve implemented at our house:

  • only one family member does the grocery shopping (my husband)
  • we leave any grocery items that do not need to be placed in the refrigerator or freezer in the garage to wait, usually 5-6 days.
  • items heading to the refrigerator or freezer are thoroughly disinfected first (I use a diluted bleach solution)
  • produce is washed for 20+ seconds with soap and water
  • Check out this video by my former teacher and colleague Dr. Jeff VanWingen. 

Here is one last link with answers to frequently asked questions.

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. 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.

  730 Hits

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. 

  636 Hits

Integrative Therapies & Nutritional Supplements - Expert Recommendations during COVID-19 Crisis

Amidst the chaos of the emerging COVID-19 crisis, it is more important than ever to have access to well-sourced,  evidence-based information when making decisions regarding your health and wellbeing.

Over the past week, I have been receiving many questions regarding the use of Integrative therapies and nutritional supplements to support the immune system. To answer such questions, I turned to my own trusted sources in an attempt to provide the most accurate information possible.

Thankfully, the team at the Andrew Weil Center for Integrative Medicine at the University of Arizona has developed a set of strategies to be considered for immune system support. These strategies are designed to reduce the severity or the duration of a viral infection, and include measures to reduce risk, as well as supplements to avoid should you become ill.  The recommendations are based upon available evidence, however, it is important to note that Integrative measures have not been validated in human trials of COVID-19.

Andrew Weil Center for Integrative Medicine recommendations

REDUCING YOUR RISK:

  • Adequate sleep: Shorter sleep duration increases the risk of infectious illness. Adequate sleep also ensures the secretion of melatonin, a molecule that may play a role in reducing coronavirus virulence (see Melatonin below).
  • Stress management: Psychological stress disrupts immune regulation. Various mindfulness techniques such as meditation, breathing exercises, and guided imagery reduce stress. Zinc: Coronaviruses appear to be susceptible to the viral inhibitory actions of zinc. Zinc may prevent coronavirus entry into cells and appears to reduce coronavirus virulence. The typical daily dosing of zinc is 15mg – 30mg daily with lozenges potentially providing direct protective effects in the upper respiratory tract.
  • Vegetables and Fruits: Vegetables and fruits provide a repository of flavonoids that are considered a cornerstone of an anti-inflammatory diet. At least 5–7 servings of vegetables and 2– 3 servings of fruits are recommended daily. Some of these foods and/or dietary supplements include tomatoes, apples, onions, oranges, nuts, parsley, celery, berries, licorice, and Chinese skullcap.
  • Vitamin C: Clinical trials have found that vitamin C shortens the frequency, duration, and severity of the common cold and the incidence of pneumonia. The typical daily dosing of vitamin C ranges from 500mg to 3000mg daily with even higher doses utilized during times of acute infection.
  • Melatonin: Melatonin has been shown to be anti-inflammatory. It also reduces oxidative lung injury and inflammatory cell recruitment during viral infections.
  • Curcumin: Curcumin, a key component of turmeric, has anti-inflammatory actions and antiviral effects against a variety of similar viruses.

 

IF YOU HAVE SYMPTOMS OF INFECTION OR HAVE BEEN DIAGNOSED WITH CORONAVIRUS:
To Avoid: In the absence of human clinical data, caution is warranted with the following immune-activating agents due to their possible stimulation of inflammatory response:

  • Sambucus nigra (Elderberry)
  • Polysaccharide extracts from medicinal mushrooms
  • Echinacea angustifolia and E. purpurea
  • Larch arabinogalactan
  • Vitamin D

 

LIKELY SAFE
There are other commonly used natural immune-stimulating and antiviral agents, several of which may work to restore immune balance [homeostasis]. These are, therefore, likely safe to use both prior to, and during COVID-19 virus infection. Whether these agents mitigate the symptoms or severity of COVID-19 is unknown and, therefore, the benefit of these agents during COVID-19 infection is unknown.

Recommendations include:

  • Allium sativum (garlic)
  • Quercetin
  • Astragalus
  • Zinc
  • Vitamin A
  • Vitamin C
  • Full mycelium mushroom extracts
  • Mentha piperita (peppermint)
  • Andrographis paniculata

 

ADDITIONAL INFORMATION
Regardless of how you may choose to incorporate the above recommendations, please continue to be vigilant:

  • Regular hand washing (minimum 20 seconds of scrubbing with soap and water)
  • Social distancing (6 feet, ideally staying home when possible)
  • Stop non-essential travel

If you are considering nutritional supplementation, I have provided additional information and resources on dosing, potential drug interactions, and most common side effects:

ZINC

  • Zinc plays a vital role in helping our immune system fight off bacteria and viruses.
  • Dosing: (as stated above) 15-30mg daily (you may already be taking this amount in your daily multivitamin/multimineral). Do not exceed 40mg daily. Long-term supplementation with high-dose zinc is not recommended.
  • While zinc supplementation is generally recognized as safe for most adults, potential interactions may occur with certain antibiotics. For more information CLICK HERE.

VITAMIN C

  • Dosing: As listed above, Vitamin C dosing ranges from 500-3000mg.
  • The most common side effects are diarrhea and gastrointestinal upset, which are more common at higher doses.
  • For more information about Vitamin C, CLICK HERE.

TURMERIC/CURCUMIN

  • Turmeric is a very powerful natural anti-inflammatory agent and also has beneficial antioxidant properties. The responsible constituents are curcuminoids, of which curcumin is most prominent.
  • Dosing:  While many patients take 300-500mg of turmeric/curcumin daily for general health, I often recommend increasing this to three times daily (approximately 1500mg in divided doses) for immune support.
  • You should avoid supplementation with turmeric/curcumin if you have a history of gallstones, are receiving chemotherapy, or are on blood thinners (like warfarin).
  • Supplementation can slow the elimination of some prescription drugs, including phenytoin (Dilantin), propranolol (Inderal), and theophylline. CLICK HERE for more information.

QUERCETIN

  • While Quercetin is most commonly known for it's anti-histamine and anti-allergy properties, it is also a potent anti-viral.
  • Dosing: 500mg 2-3 times daily.  Quercetin is generally well-tolerated with few side effects.
  • Quercetin is available in many foods, to learn more CLICK HERE.

VITAMIN A 

  • Dosing: Vitamin A is a fat-soluble vitamin.  This means that levels of Vitamin A can build up in your body, rather than being excreted in your urine like most other water-soluble vitamins.
  • For appropriate patients, I generally recommend 3000-5000 IU of Vitamin A (which you may be getting in your multivitamin/multimineral). 
  • Do not exceed doses of 10000 IU daily.
  • Possible side effects of Vitamin A supplementation include nausea and vomiting, headache, blurred vision, muscular weakness, elevated liver function tests, liver toxicity
  • Those who regularly consume alcohol or are taking Coumadin/warfarin or a retinoid-based medication should avoid supplementing with Vitamin A. 
  • For more information CLICK HERE.

VITAMIN D

  • The immune-supporting properties of Vitamin D are well established. There have been a number of studies looking at vitamin D levels and rates of influenza, upper respiratory infections, as well as other infections. All have reported an association of lower vitamin D levels and increased rates of infection.
  • CLICK HERE for additional information
  • Like Vitamin A, Vitamin D is a fat-soluble vitamin, which increases its potential for toxicity.  I generally recommend that my patients maintain a serum level of 25, OH Vitamin D3 at 60-70 ng/ml. 
  • Supplementation of 2000 IU Vitamin D3 daily is generally recognized as safe.  Many of my patients are taking 5000 IU Vitamin D3 daily, with regular monitoring of blood levels.

ASTRAGALUS

  • Dosing: Astragalus root can be found in many different forms. Supplements are available as capsules and liquid extracts. The root may also be ground into a powder, which can be brewed into teas. Follow dosage directions on product labels.
  • Potential interactions: Those who are immunodeficient, have hormone-sensitive cancer, are on anticoagulants, diuretic or antihypertensive medications should use caution or avoid use. 
  • CLICK HERE for additional information.
     

SOURCES:
Andrew Weil Center for Integrative Medicine, University of Arizona
Memorial Sloan Kettering Cancer Center
National Center for Complementary and Integrative Health
Linus Pauling Institute, Oregon State University

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. If choosing to incorporate nutritional supplements, this decision should be discussed with and approved by your healthcare provider.  IF YOU ARE PREGNANT OR BREASTFEEDING YOU SHOULD AVOID ALL NUTRITIONAL SUPPLEMENTATION UNLESS UNDER THE RECOMMENDATION AND SUPERVISION OF YOUR HEALTHCARE PROVIDER.



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. We are continuing to see new and returning clients during the COVID-19 crisis using our easy, secure video format.

  2453 Hits