Health & Wellness June 2021

An Integrative Approach to Immune Health

By Anne Kennard, DO, FACOG

An active member of the American College of Obstetricians and Gynecologists (ACOG) District Wellness Committee, Dr. Anne Kennard is fully immersed in the world of integrative medicine. In this article, she discusses several natural methods that can boost our immune systems and bolster our overall immune health.    

During COVID-19, doctors and patients alike have an increased interest in improving their immune health. Integrative therapies have suddenly found themselves in “prime time” as the world entered the COVID-19 pandemic.

The first defense against pathogens is the gut.  While this is not a comprehensive article on gut health, some basic principles to improve gut health should be covered in any discussion surrounding immune health. Taking a mindful pause and a few deep breaths before a meal allows the body to enter the parasympathetic “rest and digest” nervous system, increasing blood flow and gastric juice release to the stomach. Maintaining proper gut pH is a first line of defense against pathogens, through avoidance of proton pump inhibitors (PPIs) and acid-blockers, when appropriate, and introducing digestive bitters before a meal, such as eating a kale salad or dandelion greens. Eating a variety of colorful, plant-based foods provides phytonutrients and fiber for building a diverse and healthy microbiome, and incorporating spices like turmeric and ginger can decrease intestinal permeability, improving gut health. It should also be mentioned that foods themselves can have a direct antimicrobial effect, as found in garlic, rosemary, sage, and thyme. There is truly a reason to season!

Sleep must not be overlooked when considering immune system health. While most of the focus typically tends towards supplements and botanicals, nothing will replace a good nights’ sleep for prevention of illness. Putting away electronics two hours before bed, establishing a relaxing bedtime routine, and a cool, dark bedroom are key for sleep hygiene. Exposure to natural light in the morning, along with exercise, can also set the circadian rhythm up for success. Consider a guided relaxation, hypnotherapy, or yoga nidra before bed to further relax. There are some great free resources for healthcare professionals on the apps Insight Timer, Headspace, and Breethe.

There are many supplements and botanical allies for immune wellbeing. Previously considered to be for bone health only, vitamin D has emerged as a major determinant of immune health, with studies showing decreased admission and ventilation rates in COVID-19 patients who had adequate vitamin D compared to those who were deficient. Vitamin D levels should be repleted to at least 30ng/dL, with most requiring supplementation of 1,000-2,000 IU daily, and some up to 50,000 IU weekly. 

Melatonin is another natural hormone that was viewed differently during the COVID-19 pandemic, with the supplement being given to improve immunity and avoid severe disease. Generally, patients are supplemented with 2-5mg nightly, although higher doses are used in specialized circumstances. Zinc has been proven to be beneficial in reducing incidence and duration of viral infections, but must be taken as a lozenge for maximum effect.

Vitamin C has long history of use for immune health, even making its way into treatment algorithms this year for severe COVID-19 disease. In the outpatient setting, vitamin C is generally tolerated best in divided doses of 500mg three times daily. Any more than that can upset the stomach, cause some diarrhea, and is poorly absorbed. 

Andrographis herb (andrographis paniculata) is a less well-known botanical, but one with a millennia of use in Ayurveda, the traditional medicine system of India. Andrographis has been well studied, with significant improvements noted for both cold and influenza. Through the COVID-19 pandemic, the government in Thailand studied this herb, concluding that it is “a safe, effective, less costly treatment alternative and can reduce inflammation,” and recommended that patients take it for mild to moderate COVID-19 disease in the outpatient setting. Caution should be taken with diabetic patients, as the herb may lower blood sugar, and andrographis should not be used during pregnancy or in women trying to become pregnant.

Elderberry (sambucus nigra) is a phytonutrient-rich dark berry, native to North America, with a sweet, pleasant taste. It can be found commonly in syrups, gummies, lozenges, and capsules marketed for immune health. It has a long history of use for preventing and reducing cold symptoms, and is shown in studies to reduce the severity and duration of influenza. Elderberry is safe for children and during pregnancy. Making elderberry syrup can be both fun and cost effective. It is delicious on its own or atop pancakes or vanilla ice cream!

Dr. Kennard’s Elderberry Syrup
  • 4 cups water
  • 1 cup dried elderberries (Mountain Rose Herbs)
  • 2 Tbsp grated fresh ginger or 2 tsp dried ginger
  • 1 cinnamon stick
  • 1 star anise
  • 4-6 cardamom pods
  • 3 Tbsp orange zest
  • 1 cup honey
  1. Add all ingredients except honey to saucepan
  2. Bring to a boil
  3. Simmer for approximately 20-25 minutes, until the volume has reduced by half
  4. Strain out the herbs
  5. Return to the saucepan
  6. Stir in honey until dissolved

Keep refrigerated for 3 months.


To be taken at first sign of cold or flu…

  • 1 tsp three times daily for children 2-6
  • 1 Tbsp three times daily for children 7-12
  • 2 Tbsp three times daily for age 13+

Do not feed to infants less than one year of age.

  1. Kanjanasirirat P, Suksatu A, Manopwisedjaroen S, et al.High-content screening of Thai medicinal plants reveals Boesenbergia rotunda extract and its component Panduratin A as anti-SARS-CoV-2 agents. Sci Rep. 2020;10:19963. doi: 10.1038/s41598-020-77003-3.
  2. Sa-ngiamsuntorn K, Suksatu A, Pewkliang Y, et al. Anti-SARS-CoV-2 activity of Andrographis paniculata extract and its major component andrographolide in human lung epithelial cells and cytotoxicity evaluation in major organ cell representatives. doi: 1101/2020.12.08.415836.
  3. Yuvejwattana S. Thailand Clears Use of Herbal Medicine for Covid-19 Treatment. Bloomberg website. December 30, 2020. Available at:

Dr. Kennard is the Director of Integrative Medicine & Physician Wellness at Marian Regional Medical Center in Santa Maria, California and an Associate Clinical Professor at the University of Arizona, Phoenix. She lives in San Luis Obispo, California.