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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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Guest Blog: Mindfulness

An Introduction to Mindfulness Practice

Chris Frasz, BS, MSWMindfulness, an eastern meditation practice with a history of over 2,500 years, was established as a foundation for developing a clear and focused mind, allowing one to then analyze in depth various topics for self improvement.

With the gradual introduction of this practice to the west in the 60’s, interest has gradually built, supported by a great deal of research and empirical evidence, clearly showing many mental and physical benefits. Now, the practice of mindfulness is part of our culture, being incorporated extensively throughout the United States, from hospitals to businesses, from schools to professional athletic teams. Most recently, 60 Minutes aired a segment on mindfulness, touting both its efficacy and widespread use.

Mindfulness practitioners learn to better understand and regulate their thoughts, thus taking a more active role in improving their mental well-being. With developed stability and awareness, practitioner’s benefit by viewing and relating to their mental and physical states in a more objective and healthy manner. And, as the medical world builds empirical evidence relating to the connection of one’s mental and physical well-being, the mental growth and improvement has shown significant physical benefits, including:

  • Lower blood pressure
  • Lower heart rate
  • Increase in immune system
  • Stress reduction
  • Growth of grey matter in the brain (Psychiatry Research: Neuroimaging)

Within our upcoming course, Introduction to Mindfulness for Stress Reduction, we review the mindfulness practice in detail, giving participants various ways of engaging in the practice and the rationale behind why and how the practice is effective. Guided, in-class participation, combined with discussion and presentation, enables participants to learn and grow in a supportive and safe environment. Active engagement allows participants to build their own practice and create a foundation for future growth.

Chris Frasz received his B.S. from Michigan Technological University and his Masters Degree in Social Work from the University of Michigan, Ann Arbor. He has many years of experience teaching Mindfulness Meditation at a variety of levels, drawing on his exposure to various meditation techniques from both Western and Eastern meditation teachers, including Jon Kabat-Zinn, Kyabje Gehlek Rimpoche and others. His background in engineering, business, social work, and family life give him a unique perspective in understanding and working with the various stressors related to work, family, and life in general. If you are interested in learning more about the benefits of mindfulness and our Introduction to Mindfulness to Stress Reduction courses, 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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Mindfulness – Feel less stressed by reducing your “brain chatter”.

Today we finalized and published our fall Mindfulness class schedule and I am really excited about it.

What is Mindfulness?

Here is a textbook definition:  Mindfulness is the practice of paying attention to our thoughts and feelings purposely, in order to become more present within our own lives.

Need more clarification? Here is how I explain the concept of Mindfulness to my patients:  Mindfulness is a tool to create some distance between yourself and your “brain chatter”.


There will always be stress. Often in life it seems we finish dealing with one stressor, and there is another waiting around the corner. We can't change that. What we can change is our reaction to stress. We don't have control over the presence of stress in our lives, what we do have control over is our response.

When you start to think of stress in these terms, the concept of stress itself becomes external. You can put a little distance between yourself and the stress. By doing so, the effects of stress are less likely to "take over" your mind and body.

If you feel chronically “stressed”, it is likely that you have a good amount of what I like to call “brain chatter”. As a Type-A busy working mom, I am very familiar with this concept.  “Brain chatter” is all of that stuff that is spinning around in your brain.  It is the to-do lists, the thoughts about what happened at dinner last night, about where the kids need to be picked up later, about your worries about your job, about that kitchen faucet that still needs to be fixed, and everything else.  It is all of those thoughts that are spinning around in your brain while you go about your day.

With a brain so full of chatter – it’s difficult to concentrate on anything else.  You go about your day almost on “auto pilot”. You could get yourself ready in the morning, eat breakfast, and drive to work and yet be totally unaware of your actions because you are so distracted by your “brain chatter”.  If that chatter is full of worries and negativity, it can cause you to be irritable and snap at others for no apparent reason. You react quickly, perhaps in a negative way, because you are not focused and present within moment, your brain is focusing instead on negative chatter. The chatter escalates and spreads throughout your body, causing you the physical symptoms of stress (muscle tension, headaches, and heart palpitations to name a few).


It is called Mindfulness practice for a reason. You can read about the concept all day long, but it is putting it into action that gives you results. It isn't easy! It takes time to retrain your brain to become more aware and less reactive. With patients I often use the analogy of running a marathon. You wouldn't just wake up one day and run a marathon. You would spend months, oftentimes up to a year, to train. It is similar when training your brain. When learning Mindfulness meditation, you start with a few minutes here and there, and gradually work your way up to longer meditations.


"STOP" is a quick and easy way to start incorporating Mindfulness into your daily routine as a means of reducing the effects of stress. It takes about 30 seconds. I often do this routine in between seeing patients.

S = Stop what you are doing

T = Take a deep breath.  A " belly breath", Relax your abdominal muscles and breathe deep as though you are filling your belly with air.

O = Observe. How is your body feeling? Where are your thoughts right now? If your mind is spinning with "brain chatter", acknowledge this chatter and then set it aside. Put a little bit of space in between you and your "brain chatter"

P = Proceed. Go on about your day with a mind that is slightly more clear and a body that is slightly more relaxed.

Have I sparked your interest? I’ll discuss the science and research of Mindfulness in future posts, but if you are interested in getting started this fall we will offer everything from one-night workshops to a six-week course to teach the principles and practices of Mindfulness.

Chris Frasz, MSW

Back by popular demand, we will be offering our six-week introductory course "An Introduction to Mindfulness for Stress Reduction". This course is facilitated by Chris Frasz, MSW who has facilitated several courses for us in the past and gets many rave reviews and requests for additional classes. Chris recently completed a week-long Mindfulness intensive under the direction of Jon Kabat –Zinn, the founding and executive director of the Center for Mindfulness in Medicine, Healthcare, and Society at the University of Massachusetts Medical School. Learn more about this class and Chris Frasz by clicking here,

Kelly Daunter, PsyD, LLPIn addition to the six-week introductory course, clinical psychologist Dr. Kelly Daunter will be offering three one-night Mindfulness Workshops - Mindful Eating, Mindful Parenting, and Mindfulness for Stress Reduction During the Holidays. These workshops are a great way to “get your feet wet” and see what Mindfulness Practice is all about, while applying the concept to everyday life stressors. If you’ve ever mindlessly ate a bag of potato chips, snapped at your kids and regretted it, or felt run-down by Holiday stress, one of these workshops might be for you!

Workshops will be held at Integrative Medicine | Carin Nielsen, MD in Downtown Petoskey. Space is limited and advanced registration is required. Please contact us to reserve your spot (231) 638-5585 or This email address is being protected from spambots. You need JavaScript enabled to view it.

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