Boost Your Immunity with Functional Medicine

With the spread of the flu, COVID-19 coronavirus, and RSV diseases in our community, I would like to remind you that there are several steps you can take to reduce your risk of illness. Additionally, there are steps you can take to boost your immunity in the event of exposure.

The following information outlines what you can do to help keep yourself and your family safe.

Step 1: Eliminate unnecessary inflammation. 

Inflammation is the term doctors give to the immune response our body generates when it is addressing an insult. This insult can take many forms including a virus, bacteria, elevated blood sugar or even toxic food. Inflammation is not just a vague concept but can be measured through blood tests looking at various chemicals and immune cells. Even low levels can be associated with chronic medical conditions like diabetes, heart disease, autoimmune conditions and even depression.

A plausible way to optimize our immunity is to eliminate as much underlying inflammation as possible. Start with these foundational measures:

• Get your diet on point. You have heard this before, but at no other time has it felt so critical to be well nourished. This means eating a nutrient dense diet that provides us the minerals, antioxidants, adequate protein and healthy fats that make the immune system function well (translation: LOTS of veggies). This also means eliminating the foods that trigger inflammation like fried foods, sugar, highly processed junk food, excess alcohol and sweetened beverages. For many people, gluten and dairy are problematic and trigger inflammation. This is a great time to complete the Whole30 that has been on your to-do list. 

• Get adequate sleep. Sleep is intimately tied to our immune health. Without sufficient sleep, our body makes fewer cytokines, a type of protein that targets infection and inflammation. Getting adequate sleep reduces our risk of infection and can improve our outcomes if we do get sick. Conversely, sleep deprivation weakness our body’s defense system and makes us more vulnerable to illness. Aim for 7-9 hours of sleep each night.

• Stay moving. Join a gym, get outside for a walk, try simple homemade weights in your basement or check out the numerous classes available online. There is great data suggesting that exercise can help the immune system find and deal with pathogens.  In the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. High intensity interval training has particularly great data but any form of movement is better than being sedentary. Aim for 150 minutes of purposeful movement per week.

• Manage your stress. Life can be stressful. How we respond can help influence our immune health. Cortisol, one of the hormones associated with stress, can suppress our immune response. This is why you may become sick after periods of stress in your past. Acknowledging our fear and frustrations is important, but embracing stress management activities like meditation, journaling, exercise, prayer and yoga can help moderate our body’s cortisol response. If these strategies are not enough, I encourage you to find a professional counselor to help you address your emotions. 

Step 2: FOLLOW THE BASICS OF GERM CONTROL.

Respiratory virus are transmitted through droplets created when you cough, sneeze or talk and possibly, when a person touches a surface or object that has a virus on it and then touches their own mouth or nose. A few basic measures can drastically reduce your risk of contracting or spreading an illness.

• Stay home when you are ill. Wait until at least 24 hours after your fever* (temperature of 100 degrees Fahrenheit or 37.8 degrees Celsius or higher) is gone. Temperature should be measured without the use of fever-reducing medicines (medicines that contains ibuprofen or acetaminophen).

  Not everyone with flu, COVID, or RSV will have a fever. Individuals with suspected or confirmed flu, who do not have a fever, should stay home from work at least 4-5 days after the onset of symptoms. Persons with the flu are most contagious during the first 3 days of their illness.

• Wear a mask when you have a cough or congestion: When in public settings or when around people outside of your household, wear a properly-fitting face covering. Wash your hands before putting on your face covering, put it over your nose and mouth and secure it under your chin, and try to fit it snugly against the sides of your face. Make sure you can still breathe easily.

• Hand washing: The most well-established way to prevent respiratory infections such as influenza and coronavirus is frequent and thorough hand washing with soap and water. Scrub your hands thoroughly with soap and water for at least 20 seconds.

• Hand sanitizer: Handwashing with soap and water is the best way to reduce germs, but if they are not available, alcohol-based hand sanitizers that contain at least 60% alcohol can help to reduce the spread of infection. Note: avoid any products containing triclosan, a known hormone-disrupting chemical.

• Covering your mouth and nose: Cover your mouth and nose with a tissue when coughing or sneezing; if your hands are not free or you don’t have a tissue, cough or sneeze into your sleeve, not your bare hands.

• Not touching your face: Avoid touching your eyes, nose, and mouth with unwashed hands, which can help provide the virus with a route of entry into the body. Since the average individual touches their face an average of 15 times per hour, remain vigilant!

• Keeping surfaces clean: Clean and disinfect frequently touched surfaces, especially when someone is ill. Surfaces to consider include doorknobs, phones, computer keyboards, remotes, and other surfaces that are frequently touched in rooms such as the bathroom and kitchen.

STEP 3: Supplement wisely. 

Supplements are just that… supplements. They support an otherwise healthy lifestyle. Many of us are tempted to look in the medicine cabinet for options that will boost our immunity. Unfortunately, there are no specific studies available to know how to prevent viruses with supplements or drugs. It is important to stay sensible and not go overboard when considering supplements. Below is a list of supplements that may be foundational for health and immunity.

Please note. This list is not meant to be a prescription. Before starting any supplement talk to Relish Health or your health care provider about which supplements are right for you.

Where to start:

• Multivitamin/Mineral - About 75% of the US population (ages ≥1 year) do not consume the recommended intake of fruit, and more than 80% do not consume the recommended intake of vegetables. Unfortunately, micronutrient insufficiencies are common in the US. A high-quality multivitamin may help minimize the risk of low vitamin and mineral levels.

• Vitamin D - Most cells of the immune system have vitamin D receptors which help regulate the immune response. Vitamin D deficiency is associated with increased susceptibility to infection, and 41% of adults in the U.S. are clinically deficient in Vitamin D while an even greater number have insufficient levels. Vitamin D is a fat-soluble vitamin. Most adults can safely supplement with 1000-2000 IU daily without monitoring vitamin levels with a blood test. Higher doses may be appropriate if indicated by blood tests. 

Consider adding 1 or more if appropriate:

• Zinc 30 mg once or twice daily - Zinc has been extensively studied as a treatment for the common cold and other similar respiratory viruses. There is no specific data about zinc use with COVID-19, however zinc has been demonstrated to decrease the replication of other viruses.

• Glutathione (GSH) or N-Acetyl Cysteine (NAC) - Glutathione is a potent antioxidant. It can be taken directly as a supplement. NAC helps support our body’s ability to make this antioxidant thereby indirectly increasing GSH. GSH effects the behavior of many cells of the immune system by enhancing their function. GSH may confer protection against microbial, viral and parasitic infections.

• Vitamin C - Vitamin C contributes to immune defense by supporting various immune cell functions. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. According to some studies, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. 

• Probiotic foods or supplements - A large percentage of the body’s immune system is located in our gastrointestinal tract. The billions of microbes collectively living in the gut are called the microbiome. The bacteria in our gut influence our immune system. We can foster a healthy microbiome by eating a fiber rich diet and fermented foods like sauerkraut or kimchee.

• Antiviral herbs - Herbs have long been recognized for their medicinal properties. Herbs have a long history of use and are well-studied in traditional Chinese medicine. There are promising results from herbs including Echinacea, Goldenseal, Astragalus, Andrographis, Quercetin, and Reishi. *Please talk to your doctor to identify which herbs may be best for you.

• Adaptogens - Also from traditional Chinese medicine, adaptogens are herbs that aid our bodies in reacting to or recovering from both short and long-term physical or mental stress. Some also boost immunity and overall well-being. 

Most of these supplements can be found at health food stores; or check out Dr. Leazenby’s curated list of supplements at Fullscripts for examples of high-quality, vetted products. Discuss all supplements with your medical provider before starting.

STEP 4: CONSIDER VACCINATION. 

Current influenza and COVID vaccinations can decrease the severity of illness if you should become ill. These vaccines help protect you by creating an antibody response without you having to experience potentially severe illness. Talk with Relish Health or your health care provider about whether a vaccine is appropriate for you.

VITAMIN D FOR COVID-19 PREVENTION AND TREATMENT
BOOST YOUR IMMUNE SYSTEM WITH ELDERBERRY SYRUP

References:

1. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20].  https://www.ncbi.nlm.nih.gov/books/NBK554776/

2. UpToDate Coronavirus update https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8350&source=related_link

3. How Sleep Affects your Immunity https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

4. Regular exercise benefits immunity -- even in isolation  https://www.sciencedaily.com/releases/2020/03/200331162314.htm

5. Micronutrient Inadequacies in the US Population: an Overview https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

6. Prevalence and correlates of vitamin D deficiency in US adults. https://www.ncbi.nlm.nih.gov/pubmed/21310306

7. Vitamin D https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

8. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/

9. Glutathione and infection. https://www.ncbi.nlm.nih.gov/pubmed/23089304

10. Vitamin C and Immune Function. https://www.ncbi.nlm.nih.gov/pubmed/29099763

11. The No BS Guide to Adaptogens for Hormonal Balance and Stress https://www.healthline.com/health/stress/smart-girls-guide-to-adaptogens

“An ounce of prevention is worth a pound of cure.” 

Benjamin Franklin 1736

Boost Your Immunity with Functional Medicine

Boost Your Immunity with Functional Medicine

By now we have all heard the public health pleas to stay home and wash our hands to prevent the transmission of COVID-19 and help “flatten the curve.” This public health prescription is vitally important to keeping our communities safe and our healthcare system stable. 

While social distancing is extremely important, many of us want to take additional steps to support our immunity and resilience against this extremely contagious virus. It is estimated that 80% of people will have mild disease, but it is still important to optimize our health for illness prevention and recovery.

Step 1: Eliminate unnecessary inflammation. 

Inflammation is the term doctors give to the immune response our body generates when it is addressing an insult. This insult can take many forms including a virus, bacteria, elevated blood sugar or even toxic food. Inflammation is not just a vague concept but can be measured through blood tests looking at various chemicals and immune cells. Even low levels can be associated with chronic medical conditions like diabetes, heart disease, autoimmune conditions and even depression. In the cases of severe COVID-19 viral illness, the virus seems to be capable of producing an excessive immune reaction in the host that can cause extensive tissue damage. This is sometimes termed a “Cytokine storm.” 

While there are no specific studies on COVID-19 prevention, a plausible way to optimize our immunity is to eliminate as much underlying inflammation as possible. Start with these foundational measures:

• Get your diet on point. You have heard this before, but at no other time has it felt so critical to be well nourished. This means eating a nutrient dense diet that provides us the minerals, antioxidants, adequate protein and healthy fats that make the immune system function well (translation: LOTS of veggies). This also means eliminating the foods that trigger inflammation like fried foods, sugar, highly processed junk food, excess alcohol and sweetened beverages. For many people, gluten and dairy are problematic and trigger inflammation. This is a great time to complete the Whole30 that has been on your to-do list. 

• Get adequate sleep. Since we are working from home it is very tempting to ignore our regular bedtime routine to watch the news or binge Netflix until the wee hours of the night. Sleep is intimately tied to our immune health. Without sufficient sleep, our body makes fewer cytokines, a type of protein that targets infection and inflammation. Getting adequate sleep reduces our risk of infection and can improve our outcomes if we do get sick. Conversely, sleep deprivation weakness our body’s defense system and makes us more vulnerable to illness. Aim for 7-9 hours of sleep each night.

• Stay moving. The gyms may be closed, but there are ample opportunities to keep moving. Get outside for a walk, try simple homemade weights in your basement or check out the numerous classes available online. There is great data suggesting that exercise can help the immune system find and deal with pathogens.  In the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. High intensity interval training has particularly great data but any form of movement is better than being sedentary. Aim for 150 minutes of purposeful movement per week. Check out some of these free online resources.

• Manage your stress. Life for all of us has been upheavaled in the past month. It is normal to feel stress and anxiety with change. How we respond can help influence our immune health. Cortisol, one of the hormones associated with stress, can suppress our immune response. This is why you may become sick after periods of stress in your past. Acknowledging our fear and frustrations is important, but embracing stress management activities like meditation, journaling, exercise, prayer and yoga can help moderate our body’s cortisol response. If these strategies are not enough, I encourage you to find a professional counselor to help you address your emotions. 

Step 2: Supplement wisely. 

Supplements are just that… supplements. They support an otherwise healthy lifestyle. In this age of uncertainty many of us are tempted to look in the medicine cabinet for options that will boost our immunity. Unfortunately, there are no specific studies available to know how to prevent COVID-19 with supplements or drugs. It is important to stay sensible and not go overboard when considering supplements. Below is a list of supplements that may be foundational for health and immunity.

Please note. This list is not meant to be a prescription. Before starting any supplement talk to Relish Health or your health care provider about which supplements are right for you.

Where to start:

• Multivitamin/Mineral - About 75% of the US population (ages ≥1 year) do not consume the recommended intake of fruit, and more than 80% do not consume the recommended intake of vegetables. Unfortunately, micronutrient insufficiencies are common in the US. A high-quality multivitamin may help minimize the risk of low vitamin and mineral levels.

• Vitamin D - Most cells of the immune system have vitamin D receptors which help regulate the immune response. Vitamin D deficiency is associated with increased susceptibility to infection, and 41% of adults in the U.S. are clinically deficient in Vitamin D while an even greater number have insufficient levels. Vitamin D is a fat-soluble vitamin. Most adults can safely supplement with 1000-2000 IU daily without monitoring vitamin levels with a blood test. Higher doses may be appropriate if indicated by blood tests. 

• Zinc - 30 mg once or twice daily - Zinc has been extensively studied as a treatment for the common cold and other similar respiratory viruses. There is no specific data about zinc use with COVID-19, however zinc has been demonstrated to decrease the replication of other viruses.

Consider adding 1 or more if appropriate:

• Glutathione (GSH) or N-Acetyl Cysteine (NAC) - Glutathione is a potent antioxidant. It can be taken directly as a supplement. NAC helps support our body’s ability to make this antioxidant thereby indirectly increasing GSH. GSH effects the behavior of many cells of the immune system by enhancing their function. GSH may confer protection against microbial, viral and parasitic infections.

• Vitamin C - Vitamin C contributes to immune defense by supporting various immune cell functions. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. According to some studies, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. 

• Probiotic foods or supplements - A large percentage of the body’s immune system is located in our gastrointestinal tract. The billions of microbes collectively living in the gut are called the microbiome. The bacteria in our gut influence our immune system. We can foster a healthy microbiome by eating a fiber rich diet and fermented foods like sauerkraut or kimchee.

• Antiviral herbs - Herbs have long been recognized for their medicinal properties. Herbs have a long history of use and are well-studied in traditional Chinese medicine. There are promising results from herbs including Echinacea, Goldenseal, Astragalus, Andrographis, Quercetin, and Reishi. *Please talk to your doctor to identify which herbs may be best for you.

• Adaptogens - Also from traditional Chinese medicine, adaptogens are herbs that aid our bodies in reacting to or recovering from both short and long-term physical or mental stress. Some also boost immunity and overall well-being. 

Most of these supplements can be found at health food stores; or check out Dr. Leazenby’s curated list of supplements at Fullscripts for examples of high-quality, vetted products. Discuss all supplements with your medical provider before starting.

A phased functional medicine supplement approach to COVID-19 provided by the Institute for Functional Medicine. May 2020. * Always consult your healthcare provider before starting supplements.

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References:

1. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20].  https://www.ncbi.nlm.nih.gov/books/NBK554776/

2. UpToDate Coronavirus update https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8350&source=related_link

3. How Sleep Affects your Immunity https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

4. Regular exercise benefits immunity -- even in isolation  https://www.sciencedaily.com/releases/2020/03/200331162314.htm

5. Micronutrient Inadequacies in the US Population: an Overview https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

6. Prevalence and correlates of vitamin D deficiency in US adults. https://www.ncbi.nlm.nih.gov/pubmed/21310306

7. Vitamin D https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

8. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/

9. Glutathione and infection. https://www.ncbi.nlm.nih.gov/pubmed/23089304

10. Vitamin C and Immune Function. https://www.ncbi.nlm.nih.gov/pubmed/29099763

11. The No BS Guide to Adaptogens for Hormonal Balance and Stress https://www.healthline.com/health/stress/smart-girls-guide-to-adaptogens

“An ounce of prevention is worth a pound of cure.” 

Benjamin Franklin 1736

Keep Calm and Moving

There have been so many changes to the world in such a short amount of time. For most of us our weekly rhythms of work, family time, exercise and stress management have been disrupted.  Given current social distancing recommendations, daily exercise might look like streaming an online yoga flow from home, taking a jog outside while responsibly keeping your distance from others, or simply doing some squats between conference calls. Regardless, getting into a groove at home is important for our physical and mental health. Maintaining a regular exercise and mindfulness routine is helpful to relieve anxiety and help build physicial and mental resiliency. Aiming for a least twenty minutes a day is a good target.

Enjoy some of these helpful links to bring some calm and movement back into your routine.

Yoga

Yoga is an ancient meditative practice that has many well documented health benefits. It is easy to do at home and can help promote a sense of calm.

• Indianapolis based “The Yoga Studio” is offering free yoga classes and meditation sessions via Instagram stories (@indyyogastudio). Their schedule is posted here.

• Yoga with Adriene on Youtube is a free on-demand resource that is great whether you are new to yoga or have years of experience.

High-Intensity Interval Training (HIIT)

HIIT is a type of aerobic exercise that involves alternating periods of regular intensity with short bursts of high intensity activity for 30 to 60 seconds duration. HIIT training is very time efficient and offers a great workout in as little as seven minutes. Check out these links to get started:

• The New York Times' Scientific 7- minute workout

• The workout app "Workout for women" offers free 4-60 minute routines that can easily be mixed and matched for variety and targeted body work. There is something for everyone in this app.

Meditation 

The benefits of meditation are numerous and supported by science. Many people start meditating to manage stress, reduce anxiety, and to cultivate peace of mind. But, there are thousands of studies documenting other less-known mindfulness meditation benefits including improved mood, lower cortisol, greater happiness and decreased inflammation.

• Headspace is a subscription-based app. During this trying time, the company is offering free access to supportive guided meditations called Weathering the storm. If you are a healthcare provider or an educator, the company is also offering free access to meditations to target your needs as well. 

Staying home in this season is our way to care for each other. Hopefully these resources help you care for yourself and find small joys in the new routine.

(This post is not sponsored. Relish Health does not receive anything in return from any link included here.)

Is it COVID-19 or a Cold?

What is known about the novel coronavirus (COVID-19) is evolving daily. There are still many unknowns about the actual number infected and the best public health measures to slow population progression. A common concern for the public is the reported similarities of COVID-19 symptoms to a seasonal cold or influenza, other viruses that are still circulating in the community. Based on symptoms alone it can be difficult to differentiate what virus is causing a patient’s symptoms. Here’s how the illnesses differ and what to do if you have symptoms.

How symptoms of COVID-19 differ from the common cold or flu

Coronaviruses are not new. They are a group of RNA viruses that cause a variety of diseases in humans and other animals. Symptoms from different coronavirus strains vary. Some cause common cold symptoms while others can cause more serious respiratory infections like SARS. The specific coronavirus making headlines today is highly infectious and new (novel) to humans meaning we have much to learn about it’s potential effect on our global community.

Many viral infections have similar symptoms, ranging from fever, mucus production, body aches and cough to shortness of breath and fatigue.

Common cold

In most cases, a cold typically comes on gradually. Symptoms typically start with a sore throat and runny nose and may be followed by coughing and sneezing. Fevers are less common. Most people recover in about 7-10 days.

Seasonal flu

Symptoms of the flu differ from colds in that they often start abruptly. Influenza can include fever (over 100.5) or chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. Some people may also have vomiting or diarrhea, though this is more common in children. Influenza (flu) can cause mild to severe illness.

COVID-19

Data from a recent study of patients in China with confirmed COVID-19 showed that the most common symptoms of this illness are a fever and cough. Shortness of breath is also a hallmark symptom that may peak on days 8-9 . The same study found that a small percentage of patients also experienced nausea or vomiting and diarrhea. 

Immunocompromised individuals are more at risk for developing a more severe version of COVID-19. They may not be able to mount a strong enough initial immune response and are at risk of significant inflammation and tissue damage triggered by the virus.

What to do if you’re sick 

Most importantly, if you get sick with fever, cough, and congestion stay at home. It is wise to reach out to a trusted health care provider for advice on differentiating between the viruses above. If you have not had the flu shot, a doctor may prescribe an anti-viral medication if the flu is suspected. If after a few days your symptoms stabilize—meaning you continue to have cough, low-grade fever, and body aches but no noticeable shortness of breath, you should continue to stay home and rest.

Reports from hospitalized cases of COVID-19 indicate that the potential for clinical deterioration appears to peak in the second week of illness (usually after day 8-9). Patients may develop shortness of breath—a major indicator of respiratory compromise.

If your symptoms worsen, particularly if you experience shortness of breath, it is imperative that you proceed to the closest emergency room. For safety, it is important to take private transportation and call ahead to let the ER know of your condition. 

How to get tested for the coronavirus?

Currently, testing for COVID-19 is being performed at state public health laboratories and The Centers for Disease Control (CDC). The CDC has broadened their guidelines for coronavirus testing so that anyone can be tested for COVID-19 if they have symptoms and a doctor’s orders.

Testing is expected to continue to become more widely available. This, however, does not mean everyone with signs of a cold should be tested for coronavirus.

The CDC is currently recommending that the following patients be tested:

1. Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

2. Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

3. Any persons including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of their symptom onset.

What if you test positive for COVID-19?

If you are sick and have been diagnosed with COVID-19 or suspected to have COVID-19 because you have been exposed to someone with COVID-19, follow the steps below to help prevent the disease from spreading to people in your home and community. Since the Seattle area faced some of the earliest cases in the United States, the Washington State Department of Health has good recommendations on their website:

• Stay home except to get medical care. You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis.

• Separate yourself from other people in your home. As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.

• Call ahead before visiting your doctor. If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

• Wear a facemask. You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not be in the same room with you, or they should wear a facemask if they enter your room.

• Cover your coughs and sneezes. Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can; immediately wash your hands with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer that contains at least 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water is preferred if hands are visibly dirty.

• Avoid sharing personal household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.

• Clean your hands often. Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water is preferred if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

• Clean all “high-touch” surfaces every day. High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

• Monitor your symptoms. Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.

Discontinuing home isolation

From the Washington State Department of Health:

• If you have tested positive for COVID-19, you should remain under home isolation precautions for 7 days OR until 72 hours after fever is gone and symptoms get better, whichever is longer.

• If you have fever with cough or shortness of breath but have not been exposed to someone with COVID-19 and have not tested positive for COVID-19, you should stay home away from others until 72 hours after the fever is gone and symptoms get better.

Additional information for your household members, intimate partners, and caregivers is available here.

Dr. Leazenby has created a hand-picked list of supplements to support immunity. Review or purchase the Relish Health approved supplements through Fullscripts. Discuss all supplements with your medical provider before starting.

Boost Your Immunity with Functional Medicine

Winter is Coming Fire Cider Recipe

Immune Boosting Fire Cider

Fire cider is a spicy, immune-boosting infused vinegar that has been revered for generations as a simple and effective remedy to relieve sinus congestion, ward off colds and flus, aid digestion, and increase circulation. The hot, pungent, sour, and sweet vinegar is certainly not for the faint of heart, but once embraced, quickly wins over even the most reluctant palate. Fire cider can be sipped neat on its own, mixed with other beverages, or used in cooking. It is typically used in small doses, so a batch of the recipe below would be enough to get most families through the winter season.

Fire Cider

Author: Erica Leazenby, MD (adapted from Rosemary Gladstar’s recipe in Herbal Healing for Women)

Serves: Makes about 4 cups

Time: 30 minutes, plus 30 days 

Ingredients:

• 1 cup coarsely grated peeled horseradish (about 4 ounces)

• 1 small onion, coarsely chopped

• 8 large garlic cloves, smashed

• 1/2 cup peeled and coarsely grated or chopped ginger (about 3 ounces)

• 1 tablespoon ground turmeric

• 1 teaspoon black peppercorns

• 4 rosemary sprigs

• 1 whole clove

• 1 jalapeno pepper, halved 

• 1 lemon, quartered

• 1 orange, quartered

• 4 cups unfiltered, unpasteurized apple cider vinegar

• ¼ cup (or more) honey **NOTE: the honey is added 30 days later, AFTER the mixture is filtered.

Directions:

• Place all the ingredients (except the honey) in a large airtight glass container. Add enough vinegar to ensure that the ingredients are fully submerged in the jar. 

• Place the jar in a dark corner of your kitchen or pantry. Periodically give the jar a swirl over the course of the month. 

• After 30 days, strain the vinegar through a cheesecloth lined colander or nut milk bag. Using disposable gloves, extract as much liquid from the solids as possible. 

• Add the honey to the filtered vinegar. Mix well and add additional honey to taste.

• Transfer the liquid to a few smaller clean jars for storage. 

Suggested Uses

• Salad dressings and marinades- Use this vinegar in place of apple cider vinegar or red wine vinegar in your salad dressings or marinades for a hint of heat. This would be great in chimichurri. 

• Mocktails- Add a splash of this vinegar to a mixture of your favorite fruit juice and seltzer for an instant shrub. 

• Hot tea- Add about 1 Tablespoon of fire cider to a mug of hot water, along with a squeeze of fresh lemon juice and a little honey to sweeten… like a non-alcoholic hot toddy!

Maple Fire Vinaigrette

The sweet heat flavor of this vinaigrette partners well with hearty leafy greens like kale. Try making a salad with kale, roasted butternut squash, toasted pumpkin seeds and dried cherries.

Recipe Author: Erica Leazenby, MD

Serves: Makes about 1/3 cups

Time: 5 minutes

Ingredients:

• 1 Tablespoon maple syrup

• 1 Tablespoon apple cider vinegar

• 1 Tablespoon fire cider

• 2 Tablespoon olive oil 

• Pinch of salt

• ½ teaspoon Dijon mustard

 Directions:

• Combine all ingredients in a small glass jar with a lid. Shake well until ingredients are well combined.

• Toss with your favorite greens and serve.