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



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 (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 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 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 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:

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 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 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 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.

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. 

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.

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. 

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.

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