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



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

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

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

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


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:

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.

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

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.

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, 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.


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

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

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

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


Vitamin C 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



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

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


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


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

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Spring Supplement Swap

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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