DR Sarah Ballantyne Immune Health Ebook PDF

Immune
Support
FOR COLD, FLU & COVID-19
1 IMMUNE
B Y DSUPPORT
R . S A R Aby
H Dr.
B ASarah
L L ABallantyne,
N T Y N EPhD
, PhD W W W.T H E PA L E O M O M . C O M
IMMUNE
SUPPORT
FOR COLD & FLU
BY DR. SARAH BALL ANT YNE, PhD
© Copyright 2020 the Paleo Mom LLC

No part of this publication may be reproduced, distributed, or sold in whole or in part, by any means,
with or without financial gain, without the prior written consent of the author. The information
contained in this book is for educational purposes only.
Disclaimer
Always consult your healthcare provider before making any diet or lifestyle changes. The recommen-
dations in this book are not intended to diagnose, treat, cure, or prevent any disease. By reading this
book, you agree that The Paleo Mom LLC is not responsible for your health relating to any information
presented in this book. This book contains affiliate links to products or services on external websites.
This means that The Paleo Mom LLC receives a small commission when purchases are made at these
sites without any increased cost to the buyer.
2 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

TA B L E of C O N T E N T S
ABOUT THE AUTHOR ...............................................4
SPECIAL REPORT: COVID 1....................................5
REDUCING EXPOSURE............................................7
Why Social Distancing is Needed............................8
PRIORITIES FOR IMMUNE SUPPORT..............10

Get Enough Sleep .......................................................10
Manage Stress.............................................................16
Get Moderate-Intensity Exercise................................21
NUTRIENTS FOR IMMUNE SUPPORT..............23

7 Tips to Eat More Veggies.........................................26
Top Food Sources of Essential Nutrients...................27
WHAT ABOUT SUPPLEMENTS?...........................28
WE’RE IN THIS TOGETHER....................................31

Additional Reading.....................................................33
RECOMMENDED RESOURCES...........................34
References ..................................................................36

ABOUT THE AUTHOR
Dr. Sarah Ballantyne, PhD
Award-winning public speaker, New York Times bestselling
author and world-renowned health expert, Dr. Sarah
Ballantyne, PhD (aka The Paleo Mom) believes the key to
reversing the current epidemics of chronic disease is scientific
literacy. She creates educational resources to help people
regain their health through diet and lifestyle choices informed
by the most current evidenced-based scientific research.
Dr. Sarah earned her doctorate degree in medical biophysics at
the age of 26 and spent the next four years doing research on
critical care medicine, innate immunity, gene therapy and cell
biology, earning a variety of awards for research excellence
along the way. 
Sarah’s transition from academic researcher to stay-at-home mom to award-winning and

internationally-recognized health advocate and educator was driven by her own health journey,
which included losing 120 pounds and using both diet and lifestyle to mitigate and reverse a dozen
diagnosed health conditions. Sarah’s talent for distilling scientific concepts into straight-forward
and accessible explanations form the foundation of her work and her dedication to improving
public health.
Learn more by checking out Sarah’s website, podcast and books. You can also find Dr. Sarah
on Instagram ,Facebook, Pinterest and Twitter or join her private Facebook Community here.

SPECIAL REPORT
Covid-19
As fears over covid-19 mount during the already-underway cold and flu season, I feel that it’s import-
ant to highlight the positive actions we can each take to naturally support our immune systems. Let
me emphasize right out of the gate: These are diet and lifestyle strategies that support immune health
and have been shown in scientific studies to reduce susceptibility to infection. These strategies are not
a substitute for medical care and if you suspect that you may have covid-19 (or the flu for that matter),
it’s incredibly important to call your doctor, and follow their up-to-date advise on testing, isolation and
mitigation.
The symptoms of covid-19 include fever (present in 83% to 98% of patients), cough
(present in 46% to 82% of patients), shortness of breath (present in about 31% of
patients), fatigue or muscle aches (present in 11% to 44% of patients), with less common
symptoms such as headache, loss of taste or smell, sore throat, abdominal pain and
diarrhea also reported.
Covid-19 is the name of the disease caused by the novel coronavirus, which has been named SARS-CoV-2
by the International Committee on Taxonomy of Viruses (its predecessor SARS-CoV was responsible for
the 2002 SARS outbreak).
Current estimates are that at least 80% of people in-

fected have a “mild” disease course, encompassing ev-
erything from asymptomatic to walking pneumonia
(in this case, a mild course is delineated as those who
do not require hospitalization), whereas 20% have
a moderate to severe disease course, including viral
pneumonia requiring hospitalization and respiration
support (such as supplemental oxygen or mechanical
ventilation). Analysis of data released by the Chinese
Center for Disease Control shows a case fatality rate
of 2.3%, but this may be an overestimation due to
under-counting of mild cases. As of 3-27-2020, the
mortality rate in South Korea, which has done the
most wide spread testing of any country so far (they

are testing about 10,000 people per day and even have drive-thru test facilities!), is about 1.5%. That’s
still nearly 15 times higher than the seasonal flu so far this year. Vulnerable populations include older
adults (especially over 65 years old), smokers, and people with pre-existing conditions, including diabe-
tes, high blood pressure, and cardiovascular disease.
One reason to be concerned about covid-19 is that it appears to be highly contagious.

It is spread primarily via respiratory transmission (there is some data showing other
modes of transmission such as fecal transmission are also possible) and the incubation
period averages 5 or 6 days, but may range anywhere for 1 to 14 (with one study sug-
gesting the incubation period could even be as high as 24 days).
The reproductive number (R0 [pronounced “arr not”], the expected number of secondary cases produced
by a single infected person in a susceptible population, is between 2 and 3, which means that, while
covid-19 is not a super-hot spreading virus (one that is spread by one patient to many others; for
example the R0 of measles in unvaccinated populations is about 18), it’s also clear that covid-19 won’t
be self-limiting (this pandemic won’t go away without us taking substantial action). And, there’s new
evidence that people infected with SARS-CoV-2 may be contagious for up to several days prior to show-
ing symptoms. It’s tough to extrapolate what percent of the total population could be affected if current
attempts to contain the spread of covid-19 are unsuccessful. While Harvard epidemiology professor
Marc Lipsitch has been quoted as predicting 40-70% of the global population will get it, this type of
infection rate has not yet been seen in any affected community, perhaps reflecting some success from
containment efforts. For example, the infection rate on the Diamond Princess cruise ship was about 19%
(despite quarantine protocols) and the currently reported infection rate in South Korea is about 4% (91%
of the people they’ve tested so far have tested negative, and the remaining 5% are waiting for their tests
to be processed) To compare, between 3 and 15% of Americans get the seasonal flu each year. Unfortu-
nately, it is possible that in the absence of adequate action, Professor Lipsitch’s estimates could bare out.
While the situation remains incredibly dynamic and there remain many unknowns about covid-19, there
are some actions we can all take now to both reduce our potential exposure and support our immune
systems.

First and foremost, you can reduce your exposure by
washing your hands frequently and lathering up for a full
20 seconds, making sure to get between fingers and under
nails.
A 2016 study looking at the effectiveness of

hand-washing on influenza infection showed
that proper hand-washing with soap and water
at prudent times (like before eating, after
using toilet, and after returning home from
community activities) reduced the chances
of getting the flu from 26% to 3%.
Remember that the key here is to lather vigorously,

which is far more important than what type of soap you
use. In the absence of soap and water, you may opt for a alcohol-based hand sanitizer that is at least 60%
alcohol, making sure to use enough for it to take at least 15 seconds to evaporate, again rubbing your
hands together vigorously. When washing your hands is an option, that is preferable to hand sanitizer as
it is more effective.
Also, avoid touching your eyes and mouth, especially while you’re out and about (or anytime you have
unwashed hands); and, practice “social distancing”, meaning avoiding shaking hands, fist bumps, hugging
etc. In general, try to maintain a 6-foot distance between yourself and anyone else when you’re out of
the house. Clean surfaces in your home, especially high-touch areas like door nobs, drawer pulls, light
switches, faucets, and countertops. And, clean your mobile phone daily.
It’s also important to avoid crowded areas, especially where airflow may be limited or recycled, which
is why so many events have been cancelled and various state governments are enforcing limits on how
many people can gather. If you do feel even a little under the weather, or think that you may have been
exposed, do everyone a favor by staying home and practicing self care to get better as efficiently as
possible (even if you have a mild case because this helps protect more vulnerable people). And, if you
have the ability to stay home and self-isolate, even if you’re healthy and haven’t been exposed, that is a
tremendous contribution to current efforts to limit the spread of this virus. This is definitely a time to
re-evaluate priorities and do everything we can as individuals not just to protect ourselves, but also our
communities.

WHY SOCIAL DISTANCING
IS NEEDED
Because approximately 20% of those infected require hospitalization, and 5% require advanced respira-
tory support such as ventillators, the goal is to slow (or better yet, stop) the spread of covid-19 to blunt
the peak infection rate so that our medical systems won’t be overloaded with patients requiring respira-
tory support and/or ventilators all at once (as they are in Italy, where they’re even having to make war-
time type decisions about who will receive treatment). The time that an effective coronavirus shutdown
can buy us may also allow for the development and testing of effective antiviral treatments, and for
testing capacity to ramp up sufficiently to meet current demand.
The challenge is that, in the absence of widespread testing, we have so little information
to act on. An individual doesn’t know if they have a regular ol’ cold, a bad flu, or a mild
case of covid-19, so they don’t know whether or not to quarantine themselves. Worse,
because there’s evidence that people can shed virus for up to 5 days before they show
symptoms, an individual could be spreading the novel coronavirus without even knowing
they were exposed.
There’s even evidence that infected young people especially may be asymptomatic, meaning they can
have covid-19 and be contagious but with zero symptoms. Testing capacity has yet to ramp up to the
point where people without symptoms or with only mild symptoms can qualify for testing. What this
means is that social distancing and physical isolation are the only tools we currently have as a communi-
ty to stop the spread of covid-19 and protect the vulnerable among us.
We can observe what’s happening in other countries. Italy,

for example, has been on lockdown for weeks already in
order to slow the spread of covid-19 to hopefully ease the
overwhelm of their medical system; people are asked not
to leave their homes except if absolutely necessary and the
only businesses allowed to be open are pharmacies and
grocery stores. Most European countries have followed
suit.. China mandated the largest quarantine in human
history, and is finally seeing a big drop-off in new cases.
What’s the difference between a shutdown and a lockdown?
In this context, a lockdown refers to a government mandat-
ed closing of schools, businesses, and social gatherings, in
addition to home isolation. In Italy, people who violate the
lockdown rules potentially face several months in jail and
hefty fines. In contrast, a shutdown is a recommendation, which relies on businesses and citizens to take
prudent action, perhaps with a few mandates such as how many states have already banned gatherings
over a certain threshold number of peoples (CDC guidelines are to avoid social gatherings of more than
10 people). It is my hope that if we come together in our communities to effectively shutdown for a few
weeks, we can prevent our situation from having to reach the extremes experienced in other countries.
If you have the ability to just stay home, I strongly encourage you to do so. This choice isn’t just about
protecting you and your family, but protecting those in your community who are at high-risk of a severe
or critical disease course. If you think you
can’t cloister yourself in your home for the
next weeks or months, I urge you to critical-
ly re-evaluate whether or not that’s actual-
ly true. I’m acutely aware that many people
don’t accrue sick leave, are contract or gig
economy workers that only get paid for the
hours they put in, and/or are living
paycheck-to-paycheck. Or maybe, you’ve
been labeled an essential worker, providing
a necessary service to your community. If
you’re stuck between a rock and hard place
on this one, I don’t want to add to your
anxiety or guilt. Instead, carefully read the
information in this guide and institute every
action item to protect yourself and those
around you as best you can.

This will probably come as no surprise… the most important things that you can do to support your
immune system so that it can effectively beat an infectious disease are the same things that support
your overall health: get enough sleep, manage stress, and live an active lifestyle while avoiding
overtraining. These are also the healthy lifestyle choices that are the easiest to let slide when life
gets busy.
So, a positive way to channel anxieties about covid-19 or influenza (or the next nerve-racking potential
pandemic) is as motivation to finally address lifestyle factors that might not be as dialed in as they
could be. And, any effort to implement a healthy lifestyle is likely to pay off, as we can see from
scientific studies looking at how sleep, stress and activity affect our susceptibility to colds, the flu,
and pneumonia.
GET ENOUGH SLEEP

In my popular online program, Go to Bed, I discuss all the many ways that sleep impacts our health –
and the immune system is a major mechanism behind all of them!
Just plain old “not getting enough sleep” causes inflammation. Even just three
consecutive nights of inadequate sleep can cause measurable increases in markers
of inflammation in the blood, straining our immune system so it’s less able to
respond to a pathogen.
Our immune system cycles with our circadian rhythm, along with antibody formation (the way our
bodies know to respond to super-specific invaders, like influenza or SARS-CoV-2), which predominantly
takes place during sleep. So, someone who is not getting enough sleep is also not adequately forming
antibodies. As a result, simply getting adequate sleep can protect you from infection. Studies examining
differences or changes in sleep quality have found similar differences in immune function; basically,
sleep quality and quantity is essential if we’re trying to protect ourselves from the flu season!
Some studies have specifically looked at how our regular sleep patterns impact our susceptibility to
infection. A 2015 study in 164 healthy people, looked at how sleep impacted their risk of infection and
clinical symptoms after being exposed to the common cold-causing rhinovirus (the researchers liter-
ally administered active rhinovirus up the participants noses!). After correcting for all other potential
contributors, sleep duration was the biggest predictor of whether or not the people would get a cold
(not sleep fragmentation or sleep efficiency). Sleeping less than 5 hours per night increased chances of

developing a cold by 4.5X compared to 7 or more hours of sleep!
Yikes! And getting 5 to 6 hours per night wasn’t much better;
the risk was still 4.24X higher than people who got 7 or more
hours sleep. And getting 6 to 7 hours of sleep per night still
increased risk of getting the cold by 66% compared to 7 or more
hours. Similarly, a 2012 prospective study in female nurses aged
37-57 with no pre-existing conditions showed those who rou-
tinely slept less than 5 hours per night had a 70% higher risk of
getting pneumonia over the 4-year study period than those who
routinely slept 8 hours per night.
The single best thing most of us can do to make sure we’re get-
ting enough sleep (8 hours really is a good rule of thumb) is have
a grown-up bedtime and stick to it. I suggest a bedtime that is
8.5 to 9 hours before your alarm goes off in the morning, which
allows for the normal 30ish minutes to fall asleep and normal arousals during the night. If the notion
of prioritizing sleep is totally overwhelming, my e-book Go to Bed is loaded with tips and tricks (that
include everything from tiny tweaks to lifestyle overhauls!).
Total Sleep Time Goal

5 WAYS TO IMPROVE
YOUR SLEEP
1. Get bright (blue) light exposure during the day.
The light-dark cycle is the most important signal to our circadian clock. This means that one of the best
ways to set your circadian clock is be exposed to bright light (ideally sunlight) during the day, but be in
the dark at night. In fact, sunlight exposure during the day is probably the single most important thing
we can do to support the normal production of melatonin in the evening. The component of sunlight that
tells your circadian clock that it’s daytime is blue light. You have photoreceptors in your eyes and skin
that are sensitive to blue light (the receptors in your eyes are much more sensitive than those in your
skin) and convey that signal to the brain. How much time outside is enough? If it’s a sunny day, as little
as 15 minutes (without sunglasses!). If it’s cloudy, 30 minutes to an hour is better. And of course, the more
the better. So what do you do if you’re a shift worker or live in an ill-suited climate or have other barri-
ers to being outside? There’s a great biohack available for getting blue light exposure during the day: a
light therapy box. There doesn’t seem to be a difference between white light boxes and blue light boxes
in terms of supporting melatonin production, so you can pick the least expensive option–but choose one
that is bright, at least 10,000 lux. Use it for at least 15 minutes at roughly the same time every morning
or midday. Another option is to make many small changes to brighten your environment during the day:
Circadian Rhythm

use sunlight spectrumlight bulbs in your house (but you’ll want to avoid using these light bulbs in the
evening), keep curtains open during the day, make sure your computer monitor and other screens are set
to its brightest setting, drive with the windows down . . . all these things help, but they still aren’t typi-
cally as bright as a light therapy box or just being outside, even on a cloudy day.
2. Avoid bright (and blue) light in the evening.

Just as it’s important for your body to get the signal that it’s daytime during the day (or your day, if
you’re a shift worker and using a light therapy box), it’s important to tell your body it’s nighttime once
the sun goes down. This means avoiding blue light and sticking with red and yellow wavelengths of light
as well as keeping the overall light level much dimmer. You can achieve this important “darkness signal”
to your circadian clock by keeping your indoor lighting as dim as possible in the evenings with dimmer
switches, or just plain ol’ turning on fewer lights, in conjunction with investing in red or yellow light
bulbs for whatever lamps will be used in the evening. If you plan to use a computer monitor or watch TV,
there are two options. The first is to install f.lux on your computer or Android devices, or use the Night
Shift feature on Apple devices, and then set the screen brightness to the lowest setting. The second, and
probably the best biohack for supporting evening melatonin production (more technically called dim-
light melatonin production), is to wear amber-tinted glasses for the last 2 to 3 hours of your day. In fact,
several scientific studies show that wearing amber-tinted glasses in the evening improves sleep quality
and supports melatonin production. What are amber tinted glasses? Quite simple: glasses with yellow
lenses. These could be driving glasses, glaucoma glasses, or safety glasses (my personal preference is for
the larger lenses of safety glasses because they also block peripheral light and there are options that fit
well over regular glasses . . .plus they’re super cheap!). Amber-tinted glasses are also a great option for
shift workers. A more sophisticated option for getting both your bright blue light in the day and your
dim red light in the evening is programmable light bulbs where you can set the color spectrum and the
brightness for the time of day (and you can program them to automatically change at whatever time you
want! how cool is that!). It’s an investment, but then you can ditch the goofy safety glasses (although,
you’ll want to pull
3. Reduce and manage stress.

You probably recognize cortisol as being the master stress hormone. It’s also a very important circadi-
an rhythm hormone. This means if you’re under stress, not only do you have all the effects of elevated
and dysregulated cortisol to deal with, but you also disrupt your circadian rhythms. Reducing stress
means removing stressors from your life. Whether it’s saying no, asking for help, or making changes to
the structure of your life, whatever you can do to reduce stress will make a difference. Oh, and coffee
increases your body’s response to psychological stressors, so you might want to cut down on coffee or
give it up altogether. Managing stress also means increasing activities that help regulate cortisol and
make you more resilient to stressors. This might include meditating, doing yoga, going for a walk, taking
a bath, or making time for a hobby.

Just like being stressed can affect circadian rhythms, so can ignoring them. Your melatonin starts in-
creasing about 2 hours before bedtime to prepare your body for sleep. If you’re muscling through that
with a sugary snack, a scary movie, or whatever else you do to keep yourself awake at night, you are
affecting your circadian rhythms. It’s important to have a consistent bedtime and wake time. Allow-
ing fluctuations in when we go to bed, when we get up in the morning, and how long we sleep not only
negatively impacts sleep quality but also is a risk factor for obesity and diabetes. Aim for 7 to 10 hours
of sleep every night (most people need between 8 and 9). This means shifting your bedtime earlier so
you aren’t muscling through that fatigue to get a second wind (which, by the way, usually means you’re
increasing your cortisol right when it’s supposed to be at its lowest).
4. Go to bed on time! (And get enough sleep!)

Just like being stressed can affect circadian rhythms, so can ignoring them. Your melatonin starts in-
creasing about 2 hours before bedtime to prepare your body for sleep. If you’re muscling through that
with a sugary snack, a scary movie, or whatever else you do to keep yourself awake at night, you are
affecting your circadian rhythms. It’s important to have a consistent bedtime and wake time. Allow-
ing fluctuations in when we go to bed, when we get up in the morning, and how long we sleep not only
negatively impacts sleep quality but also is a risk factor for obesity and diabetes. Aim for 7 to 10 hours
of sleep every night (most people need between 8 and 9). This means shifting your bedtime earlier so
you aren’t muscling through that fatigue to get a second wind (which, by the way, usually means you’re
increasing your cortisol right when it’s supposed to be at its lowest).
5. Sleep in a cool, dark room (and keep the indoor

temperature warmer during the day).
Sleeping in a completely dark room is really important for protecting circadian rhythms. Cover up any
LED lights on phones, toothbrushes, baby monitors, or whatever other gadgets you have plugged in in
your room (masking tape works great for alarm clocks, and duct tape works great for little LED lights).
And ditch the night-lights or switch to ones with red bulbs. Blackout curtains can be one of the greatest
biohacks for getting a good night’s sleep, as can white noisegenerators (especially if there are high-
frequency/ high-pitched noises inside or outside your home, as these are very stimulating for the brain).
While you’re at it, ditch the alarm clock. Waking up to a jarring noise is very stressful. If you don’t
havethe luxury of sleeping until your body naturally wants to wake every morning (which is the best
option for protecting your circadian rhythms and overall health), a light alarm is a great investment.
The temperature of the room in which you sleep is also a cue to your circadian clock. Ideally, the indoor
temperature at night should be 65°F or lower. And the converse is also true: being warmer during the
day, typically above 75°F, supports circadian rhythms, but you can vary this range by season.

6. Get activity.
Getting some kind of activity during the day has been shown in clinical trials to support melatonin
production. There are a few exceptions, though. For example, intense activity later in the day can delay
melatonin production (basically keeping you revved up longer in the evening) unless it’s routine (say,
you always go to CrossFit in the evening and your body has adjusted).
And working out in a really bright environment in the evening can be a problem; the combination of
bright lights and activity suppresses melatonin. But, other than that, any kind of activity at any time of
day (even better if it’s outside!) will help support circadian rhythms.
7. Improve Sleep Hygiene

Sleep hygiene is just the practice of utilizing techniques and forming habits to get the best sleep possible
(Sleeping in a completely dark room is both the most important aspect of sleep hygiene and essential for
entrenching circadian rhythms).
Below is a checklist with the best changes you can make to improve your sleep hygiene and get a deeper
and more restful sleep.
SLEEP HYGIENE CHECKLIST
FF Use blackout curtains in the bedroom
FF Remove or cover up all lights in the bedroom at night (including LEDs,

alarm clocks, and night lights)
FF Switch to a light alarm clock or ditch your alarm clock altogether
FF Use a white noise generator if there is a lot of ambient noise around your house
FF Use a HEPA air filter if you have difficulty breathing at night
FF If you get hot at night, use cotton sheets and/or minimal cotton sleepwear
FF Try sleeping on your back with your knees and neck supported with soft pillows
FF Try sleeping on your side with a pillow between your knees

MANAGE STRESS
The best understood mechanism of the negative health impact
of chronic stress is how it impacts immune function.
Cortisol, the main stress hormone produced by our

adrenal glands, alters the chemical messengers of
inflammation (called cytokines) secreted by cells in
the immune system. This changes how the immune
system communicates with itself, turning on some
aspects of the immune system, while turning off
other aspects of the immune system.
There are a wealth of studies to show that high cortisol causes

inflammation. Chronic stress has been unequivocally shown to
increase susceptibility to a variety of conditions, including
autoimmune disease, cardiovascular disease, metabolic
syndrome, osteoporosis, depression, cancer and infection.
In a 1991 study, participants’ stress levels were assessed based on a questionnaire before nasal adminis-
tration of one of 5 different viruses that cause the common cold (1 strain coronavirus [not SARS-CoV-2], 3
strains of rhinovirus, and 1 strain of respiratory syncytial virus[RSV]). Rate of infection was 5.81X higher
in highest stress participants compared to lowest stress (independent of which virus they were exposed
to), and rate of developing clinical cold (meaning a symptomatic infection) was 2.16X higher. Another
yikes! An 1966 prospective study of employees who worked at a military research instillation evaluated
their stress levels six months before flu season and categorized them as either high stress or low stress.
The high stress employees were about 3X more likely to get the flu the next season compared to the
low stress employees. A more recent 2019 study looked at susceptibility to life-threatening infections
in people with stress-related disorders (including post-traumatic stress disorder [PTSD], acute stress
reaction, and adjustment disorder) compared to their full siblings without stress-related disorders and
compared to matched controls from the general population. A stress-related disorder diagnosis in-
creased risk of life-threatening infections by 47% compared to siblings and 58% compared to the general
population. PTSD specifically, increased risk of life-threatening infection by 92% compared to siblings
and 95% compared to the general population.
Mindfulness practice is a well-studied and effective strategy for managing stress (apps like Calm and
Headspace make mindfulness practice very accessible, and I recommend the book Mindsight by Dan
Siegel) and can even be helpful for stress-related disorders (as can therapies such as EMT and EMDR). Its
also helpful to reduce your stressor load if possible, including reducing commitments if possible but also

exposure to chemical stressors (like alcohol and tobacco), environmental stressors (like extreme tem-
peratures) and sensory stressors (like crowded places). Other strategies to improve resilience to stress
include: time in nature, exercise, laughing, cuddling with a pet, hugging and cuddling with a loved one,
and making time for hobbies. There’s also a link between sleep and stress: getting enough sleep helps
regulate the stress response and managing stress helps improve sleep quality. So, it’s always helpful to
work on improving sleep and stress levels at the same time.
Stress & Resilence

This last point is maybe one of the most important of this section—incorporate things (small or big) you
can do to decrease the effect that stress has on your body: changes you can make that will help you cope
with the stressors you can’t do anything about and what you can do to boost your resilience.
Resilience is the ability to adapt successfully in the face of stress and adversity.
This doesn’t mean that stressful events don’t affect you, but rather that you can handle
them without the cortisol wheels falling off your HPA axis cart.
Without resilience, an unexpected or unavoidable stressor could take a serious toll on our health.
We don’t need to be able to check off every item on this list in order to successfully navigate life’s ups
and downs. Being resilient is about more than personality traits; it’s also about developing coping strate-
gies, establishing healthful routines, and approaching life with a positive attitude.

Activities that Improve Resilience
1. HAVING FUN. Making time to have fun is probably the most powerful thing you can do to
reduce stress. So many of us get stuck in the daily grind of work, commuting, chores, looking after the
kids or our parents, cooking, cleaning, and running errands that we forget to take time for ourselves to
do something we enjoy. Sometimes we’re so busy and distracted that even when we are doing something
we love, we forget to appreciate it and puzzle (crossword, Sudoku, Rubik’s Cube, jigsaw), taking up a new
craft (like knitting lace), or learning a new language.
2. ENJOY AND CONNECT WITH NATURE. Studies show that the sights, sounds,
smells, and textures of the outdoors all have positive effects on the body and the brain. This includes
being in wilderness-type nature, such as going for a walk in the woods or sitting on the beach and watch-
ingthe waves, but also tamed nature, like sitting in a tranquil garden or looking at an amazing view of
the mountains from a balcony. Even walking in your backyard in your bare feet, or standing still a
minute to listen to the birds after dropping your child off at school, can decrease stress and impart a
feeling of peace.
If you live in the city, finding a rooftop garden or park to visit or growing a few herbs on your windowsill
can provide a connection to nature.
3. USE YOUR BRAIN. Using your brain for fun intellectual activities, whatever that might
mean for you, can help increase blood flow to the brain, which is critical for resolving inflammation
in the brain. Intellectually stimulating activities come in all flavors: reading a book that’s challenging
(because of the topic or the style of writing or maybe even the language it’s written in), learning to play
a musical instrument, solving a puzzle (crossword, Sudoku, Rubik’s Cube, jigsaw), taking up a new craft
(likeknitting lace), or learning a new language.
4. TURN OFF YOUR BRAIN. Are you thinking “This again? I thought this section was for
those of us who don’t have time to meditate!”? I really can’t emphasize enough how much daily medi-
tation practice—and I mean just 10-15 minutes per day—can improve every aspect of your health. And,
what’s even better, it can make all those things that seem beyond your control much, much easier to
manage.
5. GET ENOUGH SLEEP. Getting adequate quality sleep is probably the single most important
thing we can do for adrenal health. A growing number of studies show that poor-quality sleep or chronic
inadequate sleep causes our physiological stress responses to be exaggerated in reaction to psycholog-
ical stresses. That means that if we’re not getting enough good sleep, our adrenal glands kick into high
gear more easily in response to things like deadlines, psychotic bosses, and traffic jams. The combination
of chronic stress and poor sleep is a recipe for HPA axis dysfunction.

A recent study showed that healthy men who were restricted
to 4½ hours of sleep had a morning cortisol peak 2 hours
earlier than men who were in bed for 8½ hours. Further-
more, cortisol levels in the evening hours were 23 percent
higher in those who got 4½ hours sleep than in those who got
a full 8½ hours. Noradrenaline levels were also about 30
percent higher in the sleeprestricted men during the
early-night and early-morning hours. This adrenal activation
caused extended evening wakefulness, implying a vicious
cycle. High cortisol inhibits sleep, especially restorative deep
sleep.
But increasingly, research indicates links between sleep and stress that highlight the potential for a
vicious cycle. Poor sleep makes us less resilient to stress, and chronic stress wrecks our sleep quality.
Have you ever found yourself tossing and turning at night, worried about bills or thinking about your
to-do list?) While it may seem like this link makes it doubly hard to claw our way back to healthy
adrenals, it actually highlights the possibility of managing stress by managing sleep (and vice versa).
A few simple strategies can go a long way in terms of improving sleep quality. First and foremost is
carving out enough time for sleep; on average, we need 7 to hours’ total sleep, which typically means
being in bed for 7½ to 10 hours each night. Second, when stress is a confounding factor, it’s even more
important to make choices that entrench circadian rhythms. This means being mindful of important
zeitgebers like the light-dark cycle, meaning that we need exposure to bright (blue) light during the day,
dim (red) light in the evening, and darkness while we’re sleeping. Of course, there’s a whole lot more we
can do to improve sleep, mostly requiring only small adjustments to our choices.

Reducing Stressors
A stressor is a chemical or biological agent, environmental
condition, external stimulus or an event that activates the HPA
axis, causing the release of stress hormones. Stressors can be
categorized in terms as follows:
ºº prolonged periods, not getting enough sleep, extreme

Physical (e.g., injury, a vigorous workout, sitting for
environmental temperatures)
ºº
Sensory (e.g., loud noises, too-bright lights, overcrowding)
ºº
Chemical (e.g., tobacco, alcohol, drugs, allergens)
ºº
Psychological (e.g., deadlines, traffic, bills, societal andbfamily demands)
Reducing stressors is a matter of setting boundaries to protect our mental and physical well-being,
which can include:
ºº
Reevaluating our goals and priorities to make sure we aren’t taking on more commitments
than we really need to
ºº
Saying no to optional activities that would drain us more than benefit us
ºº
Asking for help from our spouse, friends, family, coworkers, or others in our social support-
network when we’re feeling overwhelmed
ºº
Limiting the presence of negative, stressful people in our lives
ºº
Making more time for sleep (which has the added benefit of increasing resilience)
ºº
Reducing physical and mental stress at work (such as by taking time to stretch and breathe
deeply throughout the day, discussing the possibility of a deadline extension or a more
flexible schedule, leaving work at work, and finding ways to get up and move)

GET MODERATE-INTENSITY
EXERCISE
Exercise is one of those moderate stressors that can be really good for our bodies. All in all, it’s import-
ant to establish an exercise routine that incorporates a variety of movements that are both aerobic
(generally, “cardio”-type exercises) and anaerobic (resistance training like weightlifting) in nature.
There are many other reasons to have movement variability, including increased metabolic benefits
and reduced risk of injury.
Apart from this, studies have demonstrated that regular exercise promotes improved
immune system function by reducing inappropriate cytokine activity, improving white
blood cell function, and regulating cortisol release (both of which are also related to
systematic inflammation – another reason why we need to tackle our health from all
of these angles!). Plus, there is added benefit to light exercise when we’re already feeling
a little sniffly: the activity may flush microbes out of the lungs and increase body
temperature to help fight the infection!
A 2006 study of overweight and obese sedentary postmenopausal women, researchers compared 45
minutes of moderate-intensity exercise 5 days per week to 45 minutes of stretching only (also 5 days per
week) over the course of a year. In the final three months of the study, the stretching only group had a
3X higher likelihood of getting a cold compared to the exercise group. But, you don’t have to work out
for 9 straight months before your immune system benefits. In a 2005 study of healthy women aged 45-
65 year, the researchers looked at how exercising for 30 minutes at a moderate intensity (60% max heart
rate) 5 times per week affected rates of upper respiratory infections over 12 weeks. Exercising resulted
in a 25% fewer episodes of upper
respiratory infections compared to the
control group. Even getting out for
a walk is beneficial. In a 1993 study
evaluating risk of common cold in
older subjects over a 12-week period,
the researchers found that the inci-
dence of the common cold was 8% in
elderly women who already exercised
at moderate intensity regularly, 21% in
previously sedentary elderly women
who walked for 40 minutes 5 times a
week during the study, and 50% in the
sedentary control subjects.
21 IMMUNE SUPPORT
362 5. Paleo Lifestyle
exercise does not appear to appreciably increase and cytotoxic T-cell numbers in the blood increase
neutrophils in the blood and may reduce both the but then rapidly return to normal. Furthermore, there
Avoiding high-intensity and strenuous workouts is important though. It’s well established that athletes
number of blood monocytes and their reactivity to is a differential effect on the helper T-cell subsets,
have a higher
inflammatory riskIn
stimuli. offact,
upper respiratory
a few infections, especially
reports indicate during
in particular Th1 periods of heavy
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benefits in those with chronic inflammatory conditions. cells (which secrete
in the hours following strenuous exercise, due to a temporary suppression of immune function. cytokines that drive antibody
By contrast, other studies show that even regular production by B cells). Specifically, acute exercise
training
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is a great killer
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startand that thisnot very active
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effect is probably exacerbated by intense training. increases the number of Th2 cells. Not surprisingly,
week (that’s a 30-minute walk 5 times per week). If you’re already a gym buff, adding in a daily walk
The effect of acute exercise on the adaptive given that Th2 cells are important modulators of B-cell
can still
immune be very
system beneficial
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1/2-hour session once per week
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or five 30-minute sessions spread
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MAKE GRADUAL CHANGES
activity each week.
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• You can absolutely mix it up with
minute inute activity and increase the intensity of
s 1 m
2 some moderate activity and some
physical activity gradually.
vigorous activity. As a general
rule, 1 minute of vigorous activity • Some physical activity is better than none.
is equivalent (in terms of health • You can gain health benefits from as little
benefits) to about 2 minutes of as 1 hour of moderately intense activity per
moderate activity. week, so that’s a great beginner’s goal.

I discuss the role of micronutrients (vitamins, minerals and phytochemicals) in immune function in the
context of chronic illness in great detail in The Paleo Approach and The Autoimmune Protocol Lecture
Series. But, let’s look at how some important micronutrients can specifically make us more resilient to
infection by supporting healthy immune function.
Vitamin A is a vital component of both the innate and adaptive immune response. This vita-
min maintains the structural integrity of mucosal cells (think the lining of your respiratory
tract and gastrointestinal tract!), so it is essential for keeping our first line
of defense physically intact. Plus, it is needed for proper function of a host
of immune cells (i.e., natural killer cells, macrophages, neutrophils, lympho-
cytes, and more!). In fact, vitamin A was identified as an immune modulating nutrient
as early as 1928! Vitamin A insufficiency is well-known to increase infection rate and
mortality, especially in school-age children. And, vitamin A supplementation has been
shown to improve antibody production in response to various vaccines. Also, many
types of infection have been shown to deplete serum vitamin A, so our nutritional need
for vitamin A may be higher during an infection (more data is needed to quantify this).
Foods rich in vitamin A include liver, other organ meats, fish and shellfish. Check out
the Organic 3 Beef Liver, available from Corganic, a whole food-based supplement
option for vitamin A.
Vitamin C might be the most well-known immune support vitamin of them all. The main
function that vitamin C holds is to act as an antioxidant within certain immune cells; this
process actually creates reactive oxygen species to kill pathogens. Since we cannot synthe-
size our own vitamin C, it is crucial that we get enough of it in our food or through supple-
mentation. However, a large meta-analys is have revealed that up to 2 grams daily vitamin
C supplementation doesn’t reduce the incidence of the common cold, the exception being people under
high physical stress including marathon runners, skiers and soldiers who do see about a 50% decrease in
cold incidence. For the general population though, vitamin C supplementation shortens cold duration by
an average of 8% in adults and 14% in children, and decreases the severity of the cold by about 5%.
The foods richest in vitamin C are citrus fruits, bell peppers, acerola cherries, and wild rose hips.

Normal levels of vitamin D promote genetic expression of several immune cells, including
monocytes, macrophages, dendritic cells, and lymphocytes (this means that without vitamin D
present, the amount of these cells that are generated is much less! That leads to a sub-optimal
immune system, to say the least). There is now considerable evidence that suboptimal vitamin
D status is associated with compromised immunity and increased infection risk. A meta-analy-
sis showed that daily vitamin D supplementation (400IU to 4000IU daily, average 1600IU) decreased risk of
upper respiratory infection by 49% (bolus supplementation was not as effective and only decreased upper
respiratory infection incidence by 14%).
Optimal serum vitamin D levels are between 50 and 70 nanograms per milliliter (ng/mL). If you’re insuffi-
cient or deficient, it can be tough to get enough vitamin D3 from sun exposure and foods (fish, shellfish and
pastured meats do contain some vitamin D), so consider supplementing with vitamin D3 (5,000 IU daily is a
standard dose to address deficiency but ask your healthcare provider for a recommendation based on your
personal health history) and recheck every three months to make sure you don’t overshoot the mark.
Vitamin D levels in excess of 100 ng/mL can also cause health problems. I recommend EverlyWell for
at-home vitamin D testing.
Vitamin E is a fat-soluble vitamin (meaning that we can store it in our fat and that it is absorbed
with dietary fat) that is also responsible for maintaining proper immune function. Specifically,
alpha-tocopherol (one of the forms of vitamin E) is known to prevent oxidation or damage to
cell membranes and polyunsaturated fatty acids, which protects against systemic inflamma-
tion. A clinical trial of independently-living elderly people showed that supplementation with
200IU of vitamin E daily decreased the rate of infections by about 30%, including a 22% reduction in inci-
dence of the common cold.
Foods rich in vitamin E include avocados, olives, nuts and seeds.
Zinc, one of the dietary minerals, is also important in maintaining immune system function,
because it is needed for both development and function of immune cells. Like vitamin C, zinc
is not stored in the body, so regular consumption of foods that contain zinc is essential for an
optimal immune system. Similar to vitamin A, zinc deficiency is associated with increased
infection rate and zinc supplementation is known to improve antibody titers after vaccination.
In a 2006 clinical trial, children were given zinc (as zinc sulfate, 15mg daily increased
to 30mg at the onset of a cold) and followed for 7 months. The number of colds in
the zinc group was 30% lower than in the control group, and zinc supplementation
shortened the duration of the cold and the severity of symptoms. And, the proportion
of children with no colds during the study period was 33% in the zinc group versus
14% in the control group. In a 2007 study of elderly nursing home residents, having
normal serum zinc levels reduced the rate of pneumonia by 50% compared to low
zinc levels (normal zinc was 70 microg/dL or higher).
The foods highest in zinc are oysters and liver. Check out Organic 3 Oysterzinc™
supplements available from Corganic a whole food-based supplement option for zinc.

Other Nutrients
Other immune health nutrients include selenium, copper, manganese, iron, and B vitamins (especially
B6, B9 and B12). While deficiency is any of these can increase susceptibility to infection, supplementa-
tion has either yielded mixed and context-dependent results (worsening outcomes for some and
improving outcomes for others) or null effects in clinical trials. So, it’s important to get sufficient
levels of these micronutrients from whole food sources, and in general, supplementation is not advised.
There’s also preliminary evidence that high intake of polyphenols can help reduce infection risk,
although more data is needed.
You’ll note that nutrient supplementation (except possibly vitamin D) has a far
smaller impact on infection susceptibility than the lifestyle factors discussed above.
When it comes to nutritional strategies to support immune function, the most important
action item is to avoid nutrient deficiencies.
This is already a key principle of the Paleo Template and can be achieved by focusing on the most
nutrient dense foods available to us, eating 8+ servings per day of fresh vegetables and fruit; plus organ
meat, fish, shellfish, healthy fats, herbs, spices, and rounding out with other high-quality meats.
It’s also worth noting that studies show high consumption of vegetables and fruit are independently
beneficial for reducing upper respiratory infections, which means it’s good to eat both. My regular
readers know that I don’t support low-carb or ketogenic diets for most applications. And,
we can add infection susceptibility to the list of concerns with low-carb dietary implementation. In
athletes, increasing carbohydrate consumption (30-60 grams per hour) prior to and during strenuous
activity has been shown to decrease the infection susceptibility window post-exercise. Also in athletes,
rates of infection are lower among those who consume 3 or more servings of fruit per day compared to
those who consume less than 2.

7 Tips to Eat More Veggies
1. Eat vegetables with every meal. Yes, even breakfast.
2. Gradually increase your serving sizes of vegetables. This helps your gut
microbiota adjust to higher fiber intake, which makes it easier to digest
larger amounts of veggies.
3. Try wilted salads and lightly braised or sautéed greens like spinach. They are
heated for a very short period of time, but they decrease in volume greatly!
4. Add more vegetables to soups, stews and casseroles. Canned pumpkin or

pureed cauliflower can be used as a thickener. You can even puree greens to
add to a soup to make them “disappear”.
5. Choose smoothies over vegetable juices. Lettuce and spinach are mild flavored
so you can typically pack several servings into one smoothie.
6. Raw veggies like celery, carrots and radishes make a great portable snack.
Think of ways you can bring veggies “on the road” with you during the day.
7. Add veggies to dessert! Vegetable smoothies freeze into ice pops very well.
Also look for recipes that use vegetable powders as flour alternatives for
baking and treats!

TOP FOOD SOURCES OF
Top Food Sources
ESSENTIAL of Essential Nutrients
NUTRIENTS
ESSENTIAL AND IMPORTANT
(AND WHERE NUTRIENTS
TO GET THEM)
(AND WHERE TO GET THEM)
VITAMIN A VITAMIN C IRON
Abundant in: Fish Liver Shellfish Abundant in: Berries Citrus Dark leafy Abundant in: Dark leafy Liver Red meat
fruits greens greens
VITAMIN B1 VITAMIN D MAGNESIUM
Abundant in: Nuts & Pork Asparagus Abundant in: Fish Liver Mushrooms Abundant in: Avocados Green Fish
seeds vegetables
VITAMIN B2 VITAMIN E PHOSPHORUS
Abundant in: Organ Red Nuts & Abundant in: Avocados Leafy Fish Abundant in: Seafood Nuts & Red meat
meat meat seeds greens seeds
VITAMIN B3 VITAMIN K1 POTASSIUM
Abundant in: Organ Poultry Seafood Abundant in: Dark leafy Cruciferous Asparagus Abundant in: Leafy Root Bananas
meat greens vegetables greens vegetables
VITAMIN B5 VITAMIN K2 SELENIUM
Abundant in: Mushrooms Liver Egg yolks Abundant in: Fermented Nuts & Liver Abundant in: Fish Poultry Red meat
vegetables seeds
VITAMIN B6 CALCIUM ZINC
Abundant in: Leafy Root Red meat Abundant in: Leafy greens Nuts & seeds Fish* Abundant in: Oysters Red meat Poultry
greens vegetables *(especially canned fish with the bones)
VITAMIN B7 CHLORIDE TRACE MINERALS

Vegetables
grown in
Abundant in: Egg yolks Organ Fatty fish Abundant in: Seaweed Celery Leafy Abundant in: Unrefined Sea quality
meat greens sea salt vegetables organic soil
VITAMIN B9 CHROMIUM DHA AND EPA
Abundant in: Avocados Beets Green Abundant in: Shellfish Nuts (especially Pears Abundant in: Fish Liver Sea
vegetables Brazil nuts) vegetables
VITAMIN B12 COPPER MONOUNSATURATED

FATS
Abundant in: Fish Shellfish Red meat Abundant in: Mushrooms Organ meats Shellfish Abundant in: Olives & Avocados & Macadamia
olive oil avocado oil nuts
CHOLINE IODINE ALANINE
Abundant in: Egg yolks Organ Grass-fed Abundant in: Fish Shellfish Sea Abundant in: Seafood Red meat Poultry
meat dairy vegetables
ARGININE METHIONINE CoQ10
Abundant in: Red meat Seafood Nuts & Abundant in: Fish Red meat Poultry Abundant in: Fatty fish Heart Red meat
seeds
ASPARAGINE PHENYLALANINE L-CARNITINE
Abundant in: Red meat Poultry Nuts & Abundant in: Red meat Poultry Seafood Abundant in: Rad Meat Fish Poultry
seeds
ASPARTIC ACID PROLINE LYCOPENE
Abundant in: Shellfish Wild game Avocados Abundant in: Red meat Poultry Seafood Abundant in: Tomatoes Red & orange fruits
& vegetables
CYSTEINE SERINE POLYPHENOLS
78 THE AUTOIMMUNE
Abundant in: Red meat PROTOCOL
Poultry Eggs Abundant in: Red meat Poultry Seafood Abundant in: Herbs Berries Dark
27 IMMUNE SUPPORT
by Dr. Sarah Ballantyne, PhD by Dr. Sarah Ballantyne, PhD chocolate
GLUTAMINE THREONINE QUERCETIN

WHAT ABOUT SUPPLEMENTS?
I firmly believe that the above lifestyle factors and nutrient focus (from whole foods!) are by far the
most important priorities, and I hesitate to even include a section on supplements within this post.
In fact, there’s very few supplements with antiviral properties tested in humans in relevant infections
that are even worth discussing. And, please note that none of them have been tested against SARS-
CoV-2! For example, I personally take medicinal mushroom extracts and bee propolis for general
immune support; but even though they have antiviral properties proven in vitro (isolated cells) or in
animal models, their efficacy against relevant infections has not been tested in humans. Again, dialing in
sleep, stress management and activity along with avoiding nutrient deficiencies and prudent measure-
ments to prevent exposure like hand washing and social distancing are the most important action items.
Probiotics
Whether you get your probiotics from fermented
foods or take a supplement, there’s evidence to
support reduced rates of upper respiratory
infections. For example, Koreans who consume
108-180 grams daily of kimchi had a 19%
decreased risk of rhinitis (runny nose, usually
caused by the common cold) compared to those
who consumed less than 24 grams daily. And a
2011 meta-analysis of prophylactic probiotic
supplementation showed a 42% reduction in
people suffering at least one upper respiratory
infection (and a 47% reduction for 3+ upper
respiratory infections). Most of this research has
been performed with Bifidobacterium and Lactobacillus species (I recommend Organic 3 GutPro® probi-
otics available from Corganic), but there’s also research showing Bacillus coagulans can reduce
upper respiratory infection rates and Bacillus subtilis can reduce influenza (I recommend Just Thrive
probiotic which contains both Bacillus coagulans and Bacillus subtilis).
Overall, the strongest case is for supporting a healthy and diverse gut microbiome. Gut microbiome
superfoods include: vegetables of all kinds (roots and tubers, cruciferous veggies, leafy greens, parsley
family, onion family, etc.), fruit, mushrooms, nuts and seeds, extra virgin olive oil, fish, shellfish, organ
meat, grass-fed meat, and fermented foods.

Elderberry
Elderberry (Sambucus nigra) extracts have been
studied as a short-term intervention for colds, the
flu, and upper respiratory infections. Elderberry
has not been established as safe for long-term use,
nor has it been shown to prevent infections.
Instead, taking elderberry for 5 days at the first

sign of symptoms has been shown to reduce symp-
tom severity and/or decrease infection duration.
A 2004 study showed that elderberry syrup
(1 tablespoon 4 times daily for 5 days, taken at first
sign of infection) could shorten the duration of
influenza symptoms by 4 days. A 2016 study showed that elderberry extract could shorten the du-
ration of the common cold and reduce severity of symptoms. And a 2019 meta-analysis showed that
elderberry extract is effective at reducing upper respiratory infection symptoms, with additional
studies showing that the mechanism may be direct viral inhibition.
Several studies have confirmed that the anthocyanins from elderberry have antiviral, antibacterial
and anti-inflammatory properties. Plus, elderberry can enhance the immune-modulating effects of
probiotic bacteria like Lactobacillus acidophilus.
There’s mixed data on how elderberry extract may impact immune function,
specifically the production of pro-inflammatory cytokines.
Two in vitro studies (one from 2001 and one from 2019) in naive (not stimulated) human white blood
cells have shown increased production of proinflammatory cytokines, including one study show-
ing a 200-fold increase in interleukin-6 (IL-6), and a 60-fold increase in tumor necrosis factor-alpha
(TNF-α).
A contrasting 2019 in vitro study in endotoxin (LPS)-stimulated human macrophages showed a dose-
dependent decrease in pro-inflammatory cytokines, including a 60% decrease in IL-6 and a 52%
decrease in TNF-α.
There has only been one human study looking at proinflammatory cytokines in humans taking
elderberry extract. In this 2019 study, healthy postmenopausal women too 500 mg per day of
elderberry extract for 12 weeks, or a placebo. There was no statistically significant change to their
serum IL-6 nor TNF-α (if anything there was a trend downwards) nor C-reactive protein (a marker
of inflammation). There was also no significant change in biomarkers of cardiovascular disease risk,
kidney function or liver function.
There has been some concern expressed in our community that elderberry extract may contribute

to a cytokine storm, thereby increasing risk of a severe course of
covid-19. Cytokines are chemical messengers of inflammation, some
with proinflammatory properties (like the aforementioned IL-6 and
TNF-α) and some with anti-inflammatory properties. A cytokine
storm is an excessive or uncontrolled release of proinflammatory
cytokines, that may contribute to the over-activation of the immune
system that occurs in Acute Respiratory Distress Syndrome and Mul-
tiple Organ Dysfunction Syndrome (the complications causing death
from covid-19, which I just happened to research during my Ph.D.
and first postdoctoral research fellowship). Cytokine storms are
believed to occur in a subset of critically ill covid-19 patients, with
serum IL-6 being a strong predictor of survival. (These studies are
laying the groundwork to test critically ill patients and treat with
corticosteroids if their IL-6 and ferritin are elevated, even though
corticosteroids are otherwise contraindicated for viral infections in-
cluding covid-19. To my knowledge, there has yet to be a clinical trial
evaluating whether or not corticosteroids may benefit a subset of critically ill covid-19 patients).
Cytokine storms also contribute to mortality from the seasonal flu, in which elderberry does not seem
to increase the risk; however, it’s important to note that high-risk populations are never included in
these sorts of clinical trials. Over all, I think the fear that elderberry extract may cause a cytokine
storm is not supported by the literature, but its prophylactic use isn’t either.

WE’RE IN THIS TOGETHER
At this unprecedented time, I want to emphasize
that we are all in this together. Even as we physical-
ly isolate, we are engaging in a community action, to
slow the spread of this serious infectious disease, to
protect the most vulnerable among us, to keep our
healthcare system from being overwhelmed, and to
buy time for scientists to find an effective preventa-
tive and/or treatment. The truth is that at this point,
we just don’t know how long this will take, but
we’re communally committed to isolation and social
distancing for as long as it takes.
I recognize that life in isolation can be challenging.

My family is also troubleshooting our new reality, finding solutions to challenges as we’re faced with
them, and adapting as best we can. I can tell you that you’re not alone in feelings of anxiety, loneliness,
deprivation and general stir-craziness.
So, let’s focus on some awesome positives. By avoiding a commute, we’re gaining valuable time in our
day. With so many activities cancelled, well, that frees up time too. And while you can certainly use
that bonus time to catch up on some binge-worthy TV shows, I want to share what we’re doing to use
this extra time for life-enriching activities.
We started our shelter-in-place with a family meeting to brainstorm what we could all do with our
extra time at-home, without resorting to more screen time.
My kids actually agreed to lengthen their piano practices and even tackle an extra new piece! I’m pretty
sure I get massive parenting bonus points for talking them into that one. If your kids (or you!) play a
sport, you might be able to set up drills in your garage or yard. Or, if your kids participate in some other
after-school activity, you might be able to find a way for them to practice from home.
Other ideas that we came up with included:
ºº
Reading (I challenged both of my kids to read outside of their normal comfort zones)
ºº
Creative writing (write a novel, short story, poem, or script!)
ºº
Arts & craft projects (try something you normally would never have time for)
ºº
card and board games (I challenged my kids to learn some new games)
ºº
Meditation (we’ve been doing Headspace meditations together as a family since New Year’s, but
we’re going to choose longer meditations)
ºº
Video calls with friends and family (connection is still important)
ºº
Learn something new (how to knit, sew, cook, gardening… or research something interesting)

I also suggested my kids do a Spring Cleaning and thoroughly organize their rooms (more than just their
desk areas). Well, let’s just say that I’m happy they agreed to the extra piano practice and I’ll tackle this
one again in a week or so.
We’ve also committed to some family time activities every day, like playing board games, going for a
daily walk, playing in the backyard, meditating, or just hanging out together. Spontaneous dance parties
to goofy kids music is also on the To Do list!
If you’re looking for even more inspiration to turn all this extra time at home into quality time, why not
learn a new language (or brush up a rusty second language)? There’s plenty of great apps and podcasts to
choose from! Have a passion project that you’ve never had time for? Maybe now is a good time to tackle
it!
I also want to encourage you to use this time to dial in lifestyle factors discussed throughout this guide
that are a challenge with the hustle and bustle of everyday life.
And, as Dori so wonderfully said, just keep on swimming, swimming, swimming… We’ll all get better at
this new routine as we get into it. And this too shall pass.

ADDITIONAL READING
How Stress Undermines Health

Adrenal Fatigue: Pt 1
Why Exercise is so Important
The Benefits of Gentle Movement
Elevating Mushrooms to Food Group Status
Power of Medicinal Mushrooms
Why Bee Products are Great for the Gut Microbiome
The Importance of Nutrient Density
Adverse Reactions to Ketogenic Diets
How Ketogenic Diets Wreak Havoc on your Gut
The Fiber Manifesto–Part 1 of 5: What Is Fiber and
Why Is it Good?
The Amazing Plan world Phytochemicals
Amazing Health Benefit of Fermented Foods
Why Root Veggies are Great for the Gut-Microbiome

RECOMMENDED RESOURCES
Go to Bed
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The Autoimmune Protocol

E-B O O K
The Autoimmune Protocol e-book is your up-to-date guide to
jump-start your healing with the AIP today. With this all-in-one
e-book, you’ll hone in on the most salient information, putting
the ins and outs of the AIP at your finger tips!
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The Paleo Template

E-B O O K
The Paleo Template e-book is a comprehensive quick-start guide
and centering influence for the Paleo diet and lifestyle. Learn the
modern science behind this ancient diet and lifestyle!
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Paleo Principles
IN PRINT BOOK
Paleo Principles is the most comprehensive resource to date for
those seeking a scientifically founded nutritional approach to
optimal health. In her signature approachable yet scientifically de-
tailed style, Dr. Sarah Ballantyne, PhD, has laid a complete founda-
tion for understanding the principles of the Paleo template in order
to inform and empower your day-to-day choices. Combined with
an unprecedented collection of practical strategies, tips, and visual
guides, plus more than 200 delicious recipes and twenty meal plans
for diverse health goals, this book is a one-stop-shop for nutrition
nerd, health nut, and gourmand alike. With the perfect balance of
detailed explanations, accessible summaries of actionable information,
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and visual guides, Paleo Principles provides everything you need to
achieve your best health.
The Paleo Approach

IN PRINT BOOK
The Paleo Approach is the New York Times bestselling complete
guide to using diet and lifestyle to manage autoimmune disease and
other chronic illnesses. With over 400 pages of scientific explana-
tions of the why’s, what’s, and how’s behind diet and lifestyle rec-
ommendations to help regulate the immune system and provide the
body with the opportunity to heal. This encyclopedic resource also
contains tons of practical information including tips for transitions,
working with your doctor, medical test and treatments that might
be helpful, troubleshooting, and when and how to reintroduce
foods. This book goes into scientific detail, while keeping explana-
tions accessible and fun to read, and includes over 1200 scientific
references. This is the book for people who want to understand the
contemporary science behind how the food we eat as well as how we
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live our daily lives together impact our bodies to either promote health
or facilitate disease.

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What are some lifestyle factors discussed that can support immune function?

What are some lifestyle factors discussed that can support immune function?

What nutrients are highlighted as important for immune support?

What nutrients are highlighted as important for immune support?

Immune

© Copyright 2020 the Paleo Mom LLC

2 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

SPECIAL REPORT: COVID 1....................................5

PRIORITIES FOR IMMUNE SUPPORT..............10

Get Moderate-Intensity Exercise................................21

NUTRIENTS FOR IMMUNE SUPPORT..............23

WHAT ABOUT SUPPLEMENTS?...........................28

WE’RE IN THIS TOGETHER....................................31

3 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

Sarah’s transition from academic researcher to stay-at-home mom to award-winning and

4 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

Current estimates are that at least 80% of people in-

5 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

One reason to be concerned about covid-19 is that it appears to be highly contagious.

6 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

A 2016 study looking at the effectiveness of

Remember that the key here is to lather vigorously,

7 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

We can observe what’s happening in other countries. Italy,

9 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

GET ENOUGH SLEEP

10 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

Total Sleep Time Goal

11 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

12 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

2. Avoid bright (and blue) light in the evening.

3. Reduce and manage stress.

13 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

4. Go to bed on time! (And get enough sleep!)

5. Sleep in a cool, dark room (and keep the indoor

14 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

7. Improve Sleep Hygiene

SLEEP HYGIENE CHECKLIST

FF Use blackout curtains in the bedroom

FF Remove or cover up all lights in the bedroom at night (including LEDs,

FF Switch to a light alarm clock or ditch your alarm clock altogether

FF Use a HEPA air filter if you have difficulty breathing at night

FF Try sleeping on your side with a pillow between your knees

15 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

Cortisol, the main stress hormone produced by our

There are a wealth of studies to show that high cortisol causes

16 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

Stress & Resilence

17 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

18 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

19 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

ºº prolonged periods, not getting enough sleep, extreme

20 IMMUNE SUPPORT by Dr. Sarah Ballantyne, PhD

(2 1/2 hours) of moderately te bre

• Recent studies show that

whether you get your 150 minutes

• Engage in aerobic activity (that is, elevate

greater the health benefits,

provided that you are giving your