The normal acid-base balance for blood circulating in arteries is slightly alkaline. This balance is crucial for maintaining normal physiological functions and overall health.
 
The body has several mechanisms to regulate acid-base balance:
Buffer Systems: These include bicarbonate, phosphate, and protein buffers that help neutralize excess acids or bases.
Respiratory System: Adjusting the rate and depth of breathing regulates the amount of carbon dioxide (which forms carbonic acid) in the blood.
Renal System: The kidneys help maintain acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate from urine.

Maintaining normal acid-base balance is essential for enzyme function, oxygen transport, and overall cellular activities.

Acidic Morning Saliva: ⁴ risk, cause, treatment and prevention of illness.

Oral Health and Lactate Shuttle

The normal human oral microbiome contains millions of bacteria. Oral health is maintained by balancing beneficial and harmful bacteria. Disruptions in this balance can lead to oral health issues.
 
High acid levels in the mouth decrease calcium in teeth and make it easier for cavities and tooth decay to form. Eating and drinking sugar and other carbohydrates cause harmful bacteria to produce acids. High levels of acid can fluctuate throughout the day. Untreated infections also can raise acid levels.

Lactic acid ⁵ is produced in skeletal muscles and other tissues during normal metabolism. Lactate which is not used locally can be shuttled to other sites for use elsewhere.
 
During physical exertion, lactate from skeletal muscles is used as fuel in muscles, heart, brain and liver. Any lactate not cleared accumulates in circulating blood. Eventually, lactic acid is oxidized to low levels or buffered in serum bicarbonate.

Serum lactate can appear in saliva, but the levels are generally lower compared to those in the blood. Chloride ions in saliva secreted from cells in salivary glands is gradually exchanged with bicarbonate in ductal cells. Any lactate that arrives in the oral fluid in concentrations above normal values can increase the acidity of morning saliva.

Nitrate-Nitrite-Nitric Oxide Pathway: ⁶
Nitrate-reducing bacteria in the mouth play a significant role in preventing acidic saliva solution. These bacteria convert dietary nitrates into nitrites, which can then be further reduced to nitric oxide. This process helps to neutralize acids and maintain a neutral or slightly alkaline oral microbiome.
 
Acidic saliva, especially in the morning, may indicate an imbalance in the oral microbiome, which can affect the conversion of dietary nitrates into nitric oxide. Leafy green vegetables and beet roots supply nitrates.

When oral bacteria reduce nitrates into nitrites, they produce hydroxide ions as a byproduct. The increase in hydroxide ions makes the oral microbiome more alkaline.
 
Acidic conditions hinder the growth of nitrate-reducing bacteria which reduces reduction to nitrites. Fewer nitrites causes less nitric oxide in the mouth, nose and throat.
 
When serum nitrate levels are low, the availability of nitrates for conversion into nitrites is reduced. This can upset the balance of oral bacteria, leading to a more acidic environment in the mouth, nose and throat.

Respiratory Viral Infection

Respiratory viruses ⁷ are the most frequent cause of human disease. They cause significant worldwide morbidity and mortality.
 
Rhinoviruses cause about 30% of common colds in adults. With more than 100 types of rhinovirus, it’s possible to catch a cold several times, year after year throughout life. Other respiratory viruses include influenza virus, respiratory syncytial virus, parainfluenza viruses, adenoviruses, and coronaviruses. ⁸

An important part of saliva is millions of bacteria in every drop. Good bacteria are absolutely essential for strong teeth. These bacteria grow and produce substances that have much greater effect than what’s secreted by saliva glands alone. ⁹

Acid-base balance in the mouth, nose and throat is determined by actions of good bacteria growing in acinar cells and saliva. These alkalizing bacteria are essential for good nutrition and healthy teeth.

Acidifying bacteria destroy the enamel of teeth and ulcerate soft tissue. Most dangerous of all, they produce more acid than saliva can neutralize.

Vaccination does not prevent infection. It forms antibodies that reduces illness from infection after cells have already been invaded. Same thing with antibodies formed during recovery from a previous infection.

Protection from infection prevents breakthrough of respiratory viruses after vaccination. Also prevents recurrence of illness after recovery from previous infection. Furthermore, protection from infection extends to variants of the original wild-type strain. Providing protection against any variants that appear and spread in the future.

Acidic morning saliva doesn’t indicate that cells are already infected with respiratory viruses. Rather, it signals danger from decreased protection and greater risk of becoming infected.

Respiratory viral infections disrupt nitrate-reducing bacteria in oral fluid. ¹⁰ Nitrate-reducing bacteria are crucial for converting dietary nitrate into nitrite and subsequently into nitric oxide. Further disruption can be caused by damaged immune response and lessor inflammatory response to the infection.

Maintaining a neutral to slightly alkaline pH in saliva helps support the activity of nitrate-reducing bacteria.

Cardiovascular-Kidney-Metabolic syndrome (CKM)

CKM syndrome ¹¹ is a newly named medical condition that affects heart, kidneys, brain and liver. Connections among heart disease, kidney disease, diabetes, and obesity, lead to poor health outcomes.

Obesity: Excess body fat, particularly around the waist, is a significant risk factor for CKM and acidic morning saliva.
High Blood Pressure: Hypertension is commonly associated with CKM and acidic morning saliva.
Diabetes: Both type 2 diabetes and prediabetes increase risk for CKM and acidic morning saliva.
High Cholesterol and Triglycerides: Elevated levels of these lipids in the blood contribute to CKM and acidic morning saliva.
Kidney Disease: Chronic kidney disease is a key component and risk factor for CKM and acidic morning saliva.
Metabolic Syndrome: This includes conditions like high blood sugar, high blood pressure and abnormal cholesterol levels.
 
The CKM syndrome increases the risk of development and progression of cardiovascular disease. It contributes to acidic morning saliva both for those at risk of and those with existing cardiovascular disease.

Brain Health and Cognitive Function

Neurovascular coupling: ¹²
The brain is only 2 or 3% of total body weight but requires about 20% of total energy at rest. With slightly more during physical activity. In spite of large energy requirements, it has a very limited storage of energy. Making brain tissue hugely dependent on adequate blood supply.
 
The coupling between neuronal activity and cerebral blood flow is supported by a mechanism called neurovascular coupling. This process is dependent on nitric oxide.

Sleep: ¹³
During sleep, production of saliva naturally decreases. Poor sleep has an even greater effect in reducing amount and decreasing buffer effects on oral acid production. Non-rapid eye movement (NREM) sleep plays a crucial role in cognitive performance.
Memory Consolidation: During NREM sleep, the brain consolidates new memories and skills into a more durable format. This process is essential for learning and retaining information.
Optimized Mental Pathways: NREM sleep helps optimize mental pathways for future learning.
Energy Conservation: NREM sleep helps the brain conserve energy so as to function more efficiently.
 
The result of improving NREM sleep is a positive effect on cognitive abilities.
 
Cognitive Function: ¹⁴
The proportion of cognitive function that is conscious is relatively small compared to the vast amount of subconscious processing that occurs in the brain. The majority of cognitive processing occurs outside of conscious awareness.
 
Conscious Processing: ¹⁵
Awareness: Conscious cognitive functions include activities we are aware of, such as deliberate thinking, decision-making, and problem solving.
Limited Capacity: The conscious mind can handle only a limited amount of information at any given time. 
 
Subconscious Processing:
Automatic Functions: A significant portion of cognitive functions, such as breathing, heart rate regulation, and reflexes are managed subconsciously.
Implicit Learning: Many learning processes, like language acquisition and motor skills, occur without conscious awareness.
Emotional Responses: Emotional reactions often happen unconsciously and can influence behavior and decision-making without entering conscious awareness.
 
Subconscious processes influence a wide range of cognitive functions, including perception, memory, and decision-making. It’s estimated that
95% of neurocognitive function occurs at a subconscious level.

Preventive and Protective Actions

Decreasing risk, detecting cause, preventing illness and treating disease involves a combination of choices, persistent efforts and habitual behaviors.

Physical Exercise: ¹⁶
Aim for at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise per week. Add resistance/strength exercises of 45 to 60 minutes including rest periods between sets and sessions on 2 or 3 days each week.

Healthy Diet: ¹⁷

Follow a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Include foods high in antioxidants, omega-3 fatty acids, and vitamins that support cognitive function.

Nutrition Supplements:

Sodium Bicarbonate (commonly known as baking soda).
Helps buffer lactic acid in muscles.

Creatine Nitrate ¹⁸
Creatine improves strength and muscle mass.
Nitrates enhance blood flow and endurance.

Mental Stimulation:
Engage in continuous learning and mental activities such as puzzles, reading, learning new skills, or playing musical instruments.

Adequate Sleep:

Maintain a regular sleep schedule 7-9 hours quality sleep in a  
restful sleep environment.

Stress Management:
Practice stress-reducing techniques such as meditation, yoga, or deep breathing exercises.

Social Engagement:
Stay socially active by maintaining relationships and participating in social activities.

Avoid Harmful Substances:
Avoid tobacco and limit alcohol consumption. Both can have detrimental effects on brain health.

Regular Health Check-Ups:

Monitor and manage chronic conditions such as hypertension, diabetes, and high cholesterol.

Implementing these preventive and protective actions can significantly improve health and avoid illness.

Summary

Weak Alkaline Morning Saliva protects mouth, nose and throat from infection by coronavirus, influenza virus, adenovirus and common cold viruses. Acidic saliva weakens the enzymatic protection of epithelial cells in mouth, nose and throat against infection.
 
Also, Acidic Morning Saliva may be an indication of various systemic health issues and diseases.
  

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REFERENCES

1. Kreutzberger AJB, Sanyal A, Saminathan A, Kirchhausen T. SARS-CoV-2 requires acidic pH to infect cells. Proc Natl Acad Sci 2022; 119 (38): e2209514119 https://doi.org/10.1073/pnas.2209514119

2. Chang D-K and Cheng S-F. pH-dependence of intermediate steps of membrane fusion induced by the influenza fusion peptide. Biochem J 2006; 396: 557-563 https://doi.org/10.1042/BJ20051920 Full Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1482821/

3. Panjwani A, Strauss M, Gold S, et al. Capsid Protein VP4 of Human Rhinovirus Induces Membrane Permeability by the Formation of a Size-Selective Multimeric Pore. PLoS Pathog 2014; 10(8): e1004294. https://doi.org/10.1371/journal.ppat.1004294

4. Suresh C, Veeraraghavan V, et. al. Awareness about the significance of acid–base balance of saliva in maintaining oral health. Journal of Advanced Pharmaceutical Technology & Research. 2022; 13(Suppl 1):S325-9 https://doi.org/10.4103/japtr.japtr_402_22

5. Ntovas P, Loumprinis N, et. al. The effects of physical exercise on saliva composition: a comprehensive review. Dentistry journal. 2022; 10(1):7 https://doi.org/10.3390/dj10010007

6. Rosier BT, Buetas E, Moya-Gonzalvez EM, Artacho A, Mira A. Nitrate as a potential prebiotic for the oral microbiome. Scientific reports. 2020; 10(1):12895 https://doi.org/10.1038/s41598-020-69931-x

7. Weston S, Frieman MB. Respiratory viruses. Encyclopedia of Microbiology. 2019:85 https://doi.org/10.1016/B978-0-12-801238-3.66161-5
Full Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149770/

8. Giraud-Gatineau A, Colson P, et. al. Comparison of mortality associated with respiratory viral infections between December 2019 and March 2020 with that of the previous year in Southeastern France. International Journal of Infectious Diseases. 2020; 96:154-6 https://doi.org/10.1016/j.ijid.2020.05.001

9. Corstjens PL, Abrams WR, Malamud D. Saliva and viral infections. Periodontology 2000. 2016; 70(1):93-110 https://doi.org/10.1111/prd.12112
Full Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167623/

10. Liu H, Huang Y, et. al. From nitrate to NO: potential effects of nitrate-reducing bacteria on systemic health and disease. European Journal of Medical Research. 2023; 28(1):425
https://doi.org/10.1186/s40001-023-01413-y

11. Ndumele CE, Neeland IJ, et. al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023; 148(20):1636-64
https://doi.org/10.1161/CIR.0000000000001186

12. van Gaal S, De Lange FP, Cohen MX. The role of consciousness in cognitive control and decision making. Frontiers in human neuroscience. 2012; 6:121 https://doi.org/10.3389/fnhum.2012.00121

13. Zavecz Z, Shah VD, et. al. NREM sleep as a novel protective cognitive reserve factor in the face of Alzheimer’s disease pathology. BMC medicine. 2023; 21(1):156 https://doi.org/10.1186/s12916-023-02811-z

14. Gregory SM, Parker B, Thompson PD. Physical activity, cognitive function, and brain health: what is the role of exercise training in the prevention of dementia?. Brain sciences. 2012; 2(4):684-708
https://doi.org/10.3390/brainsci2040684

15. Perlovsky L, Ilin R. Brain. Conscious and unconscious mechanisms of cognition, emotions, and language. Brain Sci. 2012; 2(4):790-834. https://doi.org/10.3390/brainsci2040790

16. Dyakova EY, Kapilevich LV, et. al. Physical exercise associated with NO production: signaling pathways and significance in health and disease. Frontiers in cell and developmental biology. 2015; 3:19. https://doi.org/10.3389/fcell.2015.00019

17. Keller RM, Beaver L, Prater MC, Hord NG. Dietary nitrate and nitrite concentrations in food patterns and dietary supplements. Nutrition Today. 2020; 55(5):218-26 https://doi.org/10.1097/NT.0000000000000253

18. Galvan E, Walker DK, Simbo SY, Dalton R, Levers K, O’Connor A, Goodenough C, Barringer ND, Greenwood M, Rasmussen C, Smith SB. Acute and chronic safety and efficacy of dose dependent creatine nitrate supplementation and exercise performance. Journal of the International Society of Sports Nutrition. 2016; 13:1-24 https://doi.org/10.1186/s12970-016-0124-0

Nitrates are produced in almost all our cells as well as absorbed from food. As a result, more than 90% of nitrates in blood and tissue are formed in our bodies.
 
Enzymes combine organic molecules with oxygen to create nitric oxide. This formation occurs in all tissues, including skeletal muscle and brain.
 
Nitric oxide is a small but highly reactive molecule. It lasts only a few seconds before it reacts with other molecules. It diffuses rapidly across cell membranes influencing other cells in all directions.
 
The reactions influence many functions. They control:
      • blood flow,
      • nerve function,
      • metabolism,
      • muscle contraction,
      • immune response, and
      • inflammation.
 
Any nitric oxide that’s not immediately combined with other molecules transforms into nitrite. That form lasts several minutes before turning into nitrate. Both nitrite and nitrate can immediately be reduced back to nitric oxide. Which makes nitrate into a local storage source. That action makes nitric oxide available when local production is not enough.

Skeletal muscle produces nitrate and stores it during rest. During exercise, nitrate gets reduced to nitric oxide. The newly formed nitric oxide increases blood flow, energy production and force of muscle contraction. During rest, nitrate is reformed and acts as a reservoir for rapid formation of nitric oxide whenever it’s needed.
 
Concentration of nitrate in skeletal muscle is much greater than in blood plasma. As a result, nitrate transfers into blood and circulates throughout the body. That provides a source of nitric oxide wherever it’s needed anywhere in the body.

Brain uses the most energy for its size of all organs and tissue. The human brain weighs about 2% of total body weight but takes about 20% of all the energy being used at rest. Some of the energy is used to maintain cell structure and function. Most is used to generate electrical signals that pass through connections between cells.
 
Nitric oxide is a signaling molecule between cells. It activates and controls cognitive functions. Those include learning and memory mechanisms. Nitric oxide also helps regulate cerebral blood flow. In that way, it supplies oxygen and nutrients for energy.

Circulation and Storage of Nitrates

During normal function, cells produce more than enough nitric oxide. Extra nitric oxide quickly forms nitrite and nitrate. Some remains locally as a reservoir. Whenever suddenly needed, nitrate is reduced to nitrite which is reduced to nitric oxide. The rest can circulate away from where they were formed. In this way, nitrate serves as a transport and storage form of nitric oxide.

Figure 1 shows nitric oxide for cell function. Excess escapes into the systemic circulation.

Nitrates in saliva. Cells in salivary glands, like all cells, make nitric oxide. They also have a special ability to extract about 25% of the nitrates in blood plasma. Various amounts of extracted nitrate are reduced to nitrite. Some of the nitrite is swallowed into the stomach. However, some is further reduced to nitric oxide. The effect of nitric oxide in saliva is highly reactive against virus infections.

Figure 2 shows food containing nitrates coming into the mouth. After passing through to the stomach, nitrates are absorbed from the intestines. After passing into blood, nitrates circulate to all tissues and organs. Some nitrates dissolved in plasma circulate to the kidney for excretion in urine. ¹

Nitrates extracted by the salivary glands are also exposed to bacteria in the mouth. These bacteria act in addition to oral enzymes in the salivary glands. They reduce nitrates to nitrites and finally to nitric oxide. Action of bacteria
is an even greater source of nitrite and nitric oxide than natural cells of the salivary glands.

Some of the nitrates, nitrites and nitric oxide are swallowed into the stomach. From there they enter into the general circulation. This recirculation keeps nitrates flowing through salivary glands for hours after first arriving in the systemic circulation.

Figure 3 shows the effect of increasing content of nitrate in the diet for 2 weeks. Measures of nitrate and nitrite were made from serum of 46 healthy men. The peak value of nitrate appeared during the first week. During the second week, a gradual increase in bacterial action reduced levels of nitrate. During the same time, levels of nitrite increased. After 2 weeks, the nitrate supplement was discontinued. Values of nitrate and nitrite returned towards the initial levels. Note that adjustments in bacterial action kept nitrate and nitrite concentrations above their original levels.

Figure 4 shows the effects of the nitrate supplement on saliva pH. Bacterial conversion of nitrate to nitrite and nitric oxide gradually increased alkalinity of saliva. Some of the change in bacterial action was maintained even after nitrate supplements were discontinued. ²

Figure 5 shows the effect of high nitrate diet in 19 healthy men and women
for 7 days. The average concentration of nitrate in saliva and urine increased more than 400%. After discontinuing the high nitrate diet, concentrations of nitrate in saliva and nitrate in urine were measured for 14 days. Values decreased back to original levels in 14 days. ³

Note that there was a wide distribution of individual values measured among all subjects. The wide distribution represents differences in bacterial conversion of nitrate metabolism. Each subject had different combinations of bacteria. Those differences caused a wide distribution of results. Reduction of nitrate to nitrite and nitric oxide was remarkably different for each individual.

Figure 6 shows the effects of a single oral dose of supplemental nitrate. During 9 hours after ingestion, oral bacteria converted nitrate to nitrite. They also decreased salivary concentrations of lactic acid. In addition, they also increased concentrations of ammonium as well as forming nitrite. ⁴

These actions decreased acid and increased concentration of alkaline molecules. The result was increased pH of saliva. These particular results indicate a general function. The higher the pH, the greater is the rate at which bacteria are reducing nitrite and forming nitric oxide.

Acute Respiratory Viral Infection

Upper respiratory tract infections (URTI’s) occur frequently. They are the most frequent cause of short-term illness and disability in the US. Most adults suffer at least 2 or 3 URTI’s every year. Each illness episode usually lasts at least 8 to 10 days.

Immunity protects against entry of virus particles into cells. However, acid saliva allows entry into cells and replication by SARS-CoV-2 virus. Also, acid saliva allows intracellular penetration and replication by Influenza viruses. Current vaccines against SARS-CoV-2 and Influenza viruses protect against replication and transmission about 50% of the time. Current vaccines against Respiratory Syncytial Virus infection are effective most of the time.

Rhinovirus (common cold) does penetrate cells even with alkaline saliva. Also, there are no effective vaccines available for protection against Rhinovirus disease. Fortunately, nitrate levels in blood and tissue fluid effectively enhance antiviral levels of nitric oxide. It is nitric oxide that is the most effective antiviral agent. It protects epithelial cells from Rhinovirus replication and spread.

Bacteria reduce nitrate to nitrite. They also convert nitrite to nitric oxide. The actions that form nitric oxide also protect against acid levels in saliva. As a result, alkaline saliva indicates strong antiviral protection by nitric oxide against Rhinovirus infection. It also prevents URTI viruses from replicating in cells of mouth, nose and throat.

Nitric Oxide Deficiency

Maintaining optimal nitric oxide levels is essential for good health. In particular, it provides protection from respiratory viral infection. Deficiency of nitric oxide occurs when cells don’t produce enough. The result is poor function of organs and tissues all over the body.

Deficiency is commonly caused by aging, chronic medical conditions, poor diet and lack of exercise.

Natural process of aging causes metabolic dysfunction. Cellular production of nitric oxide normally is highly effective. However, with aging, essential enzymes gradually become less efficient. Particularly in acidic conditions and low oxygen concentration. As a result, cellular function no longer maintains adequate production of nitric oxide. Plasma levels of nitrite and nitrate fall.

Protection from respiratory viral infection depends on a continuing supply of nitrate to salivary glands. A decrease in plasma nitrate causes a decrease in salivary nitrite and nitric oxide. The result is decreased alkalization of saliva.

Measuring local production of nitric oxide. Measurements of forearm blood flow show the amount of nitric oxide produced locally. Brief blocking of blood flow uses up all the oxygen in the forearm. When there’s no oxygen, the nitric oxide enzymes stop producing nitric oxide. When blood starts flowing in again, any nitrate and nitrite flowing out is what flowed in. The amount of reduction indicates the amount of nitric oxide produced locally.

Decrease in local nitric oxide production in average healthy adults begins by about 30 years of age. Decrease gradually gets worse with age.

As shown in Figure 7, local production of nitric oxide is fully effective up to about 20 years of age. At about age 40, progressive decrease reduces local production by about 50%. By 60 years of age, local production is reduced by about 80%. ⁵

Poor diet and lack of exercise. Figure 7 also shows that good amounts of dietary nitrate and physical activity support circulating levels of nitrates and nitrites. Healthy levels help maintain adequate local production of nitric oxide. The combined result provides enough nitric oxide to help maintain local blood flow.

Effects of nitric oxide in the brain. Cognitive ability includes functions that we are aware of when we’re awake. These are sometimes called “executive functions.” They enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. They include memory and skilled thinking. These actions are especially performed in the prefrontal cortex of the brain.

During aging, the overall volume of the brain begins to shrink. Starting to shrink at age 40 with the rate of shrinkage increasing around 60 years of age. Structural and functional changes occurring in the prefrontal cortex have damaging effects on conscious cognitive ability.
 
Healthful lifestyle counteracts age-related changes in the prefrontal cortex. This includes increased availability of nitric oxide by diet, oral supplements and physical activity. The results we want to maintain cognitive function to filter distractions, prioritize tasks, set and achieve goals, and control impulses.

Some chronic medical conditions increase risk of Respiratory Viral Infection. They are either partially caused by Nitric Oxide Deficiency or become NO deficient as the chronic condition progresses. Once infected, they may also be resistant to nitric oxide correction of viral replication. The result may be replication and transmission to adjacent host cells.
 
Commonly encountered chronic medical conditions that enhance risk of respiratory viral infection include:
      • High Blood Pressure
      • Overweight/Obesity
      • Type 2 Diabetes Mellitus
      • Chronic Kidney Disease
      • Atherosclerotic Cardiovascular Disease
      • Metabolic Syndrome
      • Chronic Obstructive Lung Disease

Immune Response To Supplemental Nitrates

Improvements in nitric oxide function can occur quite quickly. Studies show that ingestion of nitrates increases levels of nitric oxide in air entering and leaving the lungs.

Figure 8 shows average concentrations of nitric oxide in exhaled air. Beetroot juice was used by 38 healthy men and women to increase intake of nitrates. After drinking the juice, measurements were taken for 90 minutes.

After 45 minutes, levels of nitric oxide in exhaled air were increased from 19 to 34 PPB. These data illustrate the potential for rapid response to dietary nitrate in preventing respiratory viral infections.

Figure 9 shows values from 4 of the healthy subjects. Note that levels of nitric oxide were increased for at least 3 hours. Also, note different individual levels of nitric oxide. These different levels were caused by different rates of bacterial reduction of nitrate to nitrite and nitric oxide. ⁶

Summary

Prevention of respiratory viral infection starts with preventing penetration of respiratory and immunity cells. Most respiratory viruses require acid saliva and acid mucosal fluid for attachment and penetration.
 
Oral bacteria reduce nitrates to nitrite. At the same time, they produce ammonium and nitric oxide. They also reduce the effects of lactic acid. All of which prevents saliva from becoming acid. Nitric oxide also prevents replication and spread of any rhinovirus particles that do penetrate host respiratory cells.

Restoration and maintenance of cognitive function depends on nitrates circulating in blood flowing through the brain. Most of the nitrates are produced in skeletal muscle by physical activity. They also come from oral sources. These include dietary nitrates from food and nutrition supplements. Concentrated sources of nitrates are extracted from green and leafy vegetables. ⁷

Nitric oxide in the brain directs cognitive function, including memory and critical thinking. Nitric oxide also helps regulate cerebral blood flow supplying oxygen and nutrients for energy.

Effects of normal aging appear even in healthy adults. By age 40, organs and tissues start to decrease production of nitric oxide. By age 50, amounts are reduced by about 50%.

The decrease in production of nitric oxide can be avoided by physical activity. Regular exercise at moderate levels of intensity actually increases bioavailability of nitric oxide. Otherwise, what has been lost must be supplied from dietary nitrates or nutrition supplements.

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REFERENCES

1. Ma L, Hu L, Feng X, Wang S. Nitrate and Nitrite in Health and Disease. Aging and disease. 2018,9(5): 938-945 https://doi.org/10.14336/AD.2017.1207

2. Hohensinn B, Haselgrübler R, Müller U, Stadlbauer V, Lanzerstorfer P, Lirk G, Höglinger O, Weghuber J. Sustaining elevated levels of nitrite in the oral cavity through consumption of nitrate-rich beetroot juice in young healthy adults reduces salivary pH. Nitric Oxide 2016;60,10-15. https://doi.org/10.1016/j.niox.2016.08.006

3. Bondonno CP, Liu AH, Croft KD, Ward NC, Puddey IB, Woodman RJ, Hodgson JM. Short-Term Effects of a High Nitrate Diet on Nitrate Metabolism in Healthy Individuals. Nutrients 2015;7,1906-1915. https://doi.org/10.3390/nu7031906

4. Rosier BT, Buetas E, Moya-Gonzalvez EM, et al. Nitrate as a potential prebiotic for the oral microbiome. Sci Rep 2020;10,12895. https://doi.org/10.1038/s41598-020-69931-x

5. Torregrossa AC, Aranke M, Bryan NS. Nitric oxide and geriatrics: Implications in diagnostics and treatment of the elderly. J Geriatr Cardiol. 2011;8(4):230-242. https://doi.org/10.3724/SP.J.1263.2011.00230 Full Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390088/

6. Kroll JL, Werchan CA, Rosenfield D, Ritz T. Acute ingestion of beetroot juice increases exhaled nitric oxide in healthy individuals. PLoS ONE 2018;13(1): e0191030. https://doi.org/10.1371/journal.pone.0191030

7. Alharbi M, Stephan BC, Shannon OM, Siervo M. Does dietary nitrate boost the effects of caloric restriction on brain health? Potential physiological mechanisms and implications for future research. Nutrition & Metabolism. 2023;20(1):45. https://doi.org/10.1186/s12986-023-00766-9

Micro-organisms are everywhere around us and within us. Small in size, located both inside and outside natural human cells. Acquired shortly after birth, they aid digestion and metabolism, provide protection from pathogenic organisms and inhibit viral infection.

Fortunately, fewer than 1% of all the microbes people contact are potentially dangerous. Most healthy individuals with normal immunity escape dangerous microbial infection.

Most particles that are inhaled are exhaled in the same breath. But a few are trapped in the mucosal epithelial lining of mouth, nose and throat. Most that are trapped and recognized as pathogens are destroyed by protective blood and tissue cells.

Respiratory Viral Infection Requires Acid Oral Saliva ²

Salivary glands are very important. The fluid they secrete protects teeth, starts digestion and helps swallowing.

Enamel covering and protecting teeth is the hardest structure in the body. More dense even than bone. But acid softens it and lets calcium escape from the surface of teeth.

Acid damages enamel, alkali repairs it. Ideally, the more alkaline, the better. Alkaline levels in the mouth help to remineralize enamel and fight against cavity-causing bacteria.

Almost all eating and drinking brings acid into the mouth. The acid-base balance of oral fluid is measured in pH units. Increase and decrease of pH is opposite (inverse) to the power (concentration) of Hydrogen (H+) ions relative to Hydroxyl (OH-) ions in water (HOH or H2O).

Perfect balance between H+ and OH- is assigned a pH of 7.0. Thus, 6.9 is acidic and 7.1 is alkaline. Ideal blood pH is 7.4 with a normal range of 7.35 to 7.45. In general, abnormal metabolism in human cells tends to release H+ ions and lower the pH.

Most of saliva is secreted by acinar cells and then modified in the ducts. Proteins are added to fluid from serum of blood flowing through the glands. Enzymes act to produce bicarbonate in the ducts and start digestion in the oral saliva. The pH of ductal saliva is low when flow is low and increases as ductal flow of saliva increases.

Oral Microbiome ³

There are millions of bacteria on tongue and teeth and in oral mucosa and saliva. Hundreds of different kinds but with a similar core of functional types in all individuals. Differences in each individual depend on a combination of diet, lifestyle and genetic determinants. All representing a balance between competing processes for growth and function.

The microbiome provides functions that human cells have never developed. Functions related to digestion, metabolism, immunity and tissue cell maintenance. Good health ultimately depends on communication and harmony between bacteria and natural human cells. The best possible coordination results in mildly alkaline oral saliva.

The oral microbiomes of individuals in good health are much alike according to age, sex, diet and body composition. Good health has balanced actions for normal function. Secreting water, proteins, electrolytes and bicarbonate that keep the range of pH between 6.7 and 7.4, making oral saliva relatively neutral.

However, acid saliva is dangerous for risk of respiratory viral infection even when health of mouth and body is good. The task for safe saliva is to keep pH of oral fluid 7.0 or higher.

Saliva from acinar cells is very dilute and mildly acidic. Those cells secrete enzymes that transfer chloride for bicarbonate in cells along the ducts to the mouth. Bicarbonate ions increase pH of fluid reaching the mouth.

Increasing alkalinity of oral fluids favors growth of cells that produce bicarbonate and ammonium ions. Those bacteria enormously enhance alkalinity of oral saliva. The result is suppression of acid-producing bacteria functioning in oral saliva.

Nasal Irrigation and Oral Rinse ⁴

Oral and nasal saline irrigation has long been used for the treatment of upper respiratory viral infections. The procedure involves flushing the nasal cavity and rinsing the oropharyngeal region with saline solution. The treatment relieves symptoms and reduces viral load.

The combination of bicarbonate and saline solutions is more effective than sodium chloride alone.

Rapid Initiation Of Nasal Saline Irrigation ⁵

The effects of nasal irrigation have been tested treating outpatients with COVID-19. A clinical trial of high-risk patients was conducted in Georgia, USA. Patients recruited were recently positive for SARS-CoV-2 virus in nasal swabs or saliva. 79 participants were randomly assigned to twice-daily nasal irrigation.

The patients reporting twice daily irrigations with sodium bicarbonate solution were more than 8 times less likely to be hospitalized than patients not receiving nasal irrigation. ⁶

Treatment of hospitalized patients with mild or moderate COVID-19 has also been tested. In a Chinese hospital, 55 patients were divided into two groups. Both groups received regular care with the experimental group also receiving nasal irrigation and oral rinse with 5% sodium bicarbonate solution. Oral and nasopharyngeal swab samples were collected daily for assays of viral content. The negative conversion time and hospitalization time of the patients were recorded. As shown in the Figure, the average hospitalization time was 12.5 days for the control group and 7.7 days for the experimental group.

Oral Bicarbonate ⁷

Oral bicarbonate in a mouthwash greatly increases pH of oral saliva. Rinsing with 6% solution of baking soda without swallowing enhances growth and metabolism of alkali-producing bacteria. Increase in function of those bacteria favors continued production of bicarbonate even after ridding the mouthwash.

Effect of treatment with oral bicarbonate rinse at night on pH of resting saliva in the next morning has been tested. A group of 25 healthy young adult subjects from Era Medical College in India were tested before and after alkalizing oral rinse at night. The average morning resting saliva pH was 7.2 without alkalizing oral rinse the previous night. After alkalizing treatment the night before, the morning resting saliva pH was 9.4.  

Oral bicarbonate that is swallowed, increases levels of bicarbonate in serum. That reduces the effect of organic acids circulating in blood. As a result, level of organic acids in fluid secreted by acinar cells is reduced and pH of oral saliva is increased. 

Treatment With Sodium Bicarbonate

The standard dose of sodium bicarbonate for Oral Rinse and Oral Ingestion is 1 to 3 grams/day taken at night, several hours after meals and snacks.

The Oral Rinse with 1.5 grams in a 5% solution is prepared by dissolving 1/4 teaspoon of powdered sodium bicarbonate (Baking Soda) in 4 teaspoons of water. The rinse with about 1 ounce of solution is swished around in the mouth for 30 to 60 seconds and then expectorated.

The Oral Ingestion is prepared by dissolving 1/4 teaspoon of powdered sodium bicarbonate (Baking Soda) in 2 ounces of water. The solution is swallowed completely.

Tablets of sodium bicarbonate contain 325 or 650 mg. Capsules contain 500 or 1600 mg.

Summary

Sodium bicarbonate is a naturally formed substance in tissue and blood that enables acid-base balance. The bicarbonate combines with H+ and then dissociates to CO2 and water. Release and retention of CO2 in the lungs and retention and excretion of bicarbonate ion in kidneys maintains bodily functions in a tight range of pH.              

The evolution of living cells during billions of years involves close association and interactive function between animal cells and microbes. As a result, normal function of human cells depends on interaction with bacteria.

Millions of bacteria live all around us and inside us. Only a few of them are dangerous and natural functions protect us from most harmful infections.

Respiratory viral infections cause the most trouble. Our best protection from respiratory infection depends on maintaining alkaline secretions by salivary, oropharyngeal and nasal cells. Some of the protection arises from normal, healthy function. But even normal health is not completely protective. Acid secretions are particularly harmful.

Sodium bicarbonate in an oral rinse at night increases oral pH and enhances continuing bicarbonate production by oral bacteria after salivary secretion of bicarbonate by salivary cells decreases during sleep. Alkaline oral fluid protects cells of mouth, nose and throat from becoming infected by respiratory viruses.

Sodium bicarbonate swallowed at night increases the level of bicarbonate in serum circulating through cells of mouth, nose and throat all night. Maintaining alkaline pH in cells and mucosal fluid around them protects cells from infection by respiratory viruses.

Alkaline fluid protecting tissue cells from infection also enables recognition and destruction of pathogens in blood and extracellular fluid.

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When you send us results of your testing for 5-7 days, we’ll analyze risks those data indicate. We’ll call and help you maintain health and reduce risks from infection. 

[Disclaimer: It’s important to consult with your Primary Care Physician to ensure accuracy and alignment with your individual medical condition and treatment.]

______________________________________________________________________________________________________

REFERENCES

1. Wang CC, Prather KA, et al. Airborne transmission of respiratory viruses. Science, 2021;373(6558). https://doi.org/10.1042/BJ20051920

2. Kreutzberger AJ, Sanyal A, et al. SARS-CoV-2 requires acidic pH to infect cells. Proceedings of the National Academy of Sciences, 2022;119(38). https://doi.org/10.1371/journal.ppat.1004294

3. Pedersen AML, Belstrøm D. The role of natural salivary defences in maintaining a healthy oral microbiota. Journal of dentistry, 2019;80, S3-S12. https://doi.org/10.1152/physrev.00030.2019

4. Principi N, Esposito S. Nasal irrigation: an imprecisely defined medical procedure. International journal of environmental research and public health, 2017;14(5),516. https://doi.org/10.1073/pnas.2209514119

5. Baxter AL, Schwartz KR, et al. Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients. Ear, Nose & Throat Journal, 2022;01455613221123737. https://doi.org/10.1073/pnas.2209514119

6. Wang T, Zhang Y, et al. Efficacy of nasal irrigation and oral rinse with sodium bicarbonate solution on virus clearance for COVID-19 patients. Frontiers in Public Health, 2023;11,1145669. https://doi.org/10.1073/pnas.2209514119

7. Chandel S, Khan MA, et al. The effect of sodium bicarbonate oral rinse on salivary pH and oral microflora: A prospective cohort study. National journal of maxillofacial surgery, 2017;8(2),106. https://doi.org/10.1073/pnas.2209514119

• Flu: Influenza(*1)
• RV: Rhinovirus(*2)
• RSV: Respiratory Syncytial Virus(*3)

Acidic Saliva Is Bad For Your Teeth

Teeth are an important part of human development. Cutting and grinding food so it can be swallowed for digestion. Enamel of teeth is harder even than bone. Stays intact as long as it’s kept out of acid.

Digestive juices in the stomach are acid but kept separate by anatomy. Saliva keeps the mouth alkaline. As long as enamel is intact, teeth stay strong.

Most food and drink brings in acid. Some from fruits and vegetables and some from digestion of sugar and starch. Bicarbonate secreted by the salivary glands buffers acid in the mouth, nose and throat. Saliva can neutralize acid and wash everything into the stomach.

SARS-CoV-2 Requires Acid To Infect Cells (*4)

Virus particles in the air coming into the mouth, nose, and throat are folded into envelopes that protect them. The envelopes have spikes that attach to receptors on epithelial cells. Just staying attached at neutral and alkaline conditions. Not fusing with cell membranes or entering into cells.

Any acid saliva conditions that persist for an hour or so cause the virus particles to fuse with cell membranes. Viruses gradually enter the cell and combine with cell molecules to begin replicating and transmitting.

Protection From Infection

Saliva is mostly water. With some proteins, electrolytes, and other chemicals like cholesterol and uric acid. There’s also cells and antibodies that provide protection against toxins and dangerous organisms.

An important part of saliva is millions of bacteria in every drop. Good bacteria are absolutely essential for strong teeth. Feeding on proteins from the salivary glands as well as sugars, fats and fiber from food that’s eaten. These bacteria grow and produce substances that have much greater effect than what’s secreted by saliva glands alone.

Acid-base balance in the mouth, nose and throat is determined by actions of good bacteria growing in acinar cells and saliva. These alkalizing bacteria are essential for good nutrition and healthy teeth. Acidifying bacteria destroy the enamel of teeth and ulcerate soft tissue. Most dangerous of all, they produce more acid than saliva can neutralize.

What’s consumed in food and drink starts the balancing. Excess amounts of sugar and starch encourage the growth of acid-producing bacteria. When sugar and starch are decreased, alkalizing bacteria increase in growth and function.

An oral rinse of baking soda in water for even a minute greatly increases alkalinity of saliva. Enough to increase growth and function of alkalizing bacteria. Even after spitting out the baking soda without swallowing. Effects of that brief rinse increase the growth of alkalizing bacteria for several hours. Enough to prevent acidifying saliva overnight. 

Nitrate Reducing Bacteria

Dietary nitrate in green leafy vegetables is converted to nitrite and secreted in saliva. The nitrite is important for cardiovascular function and muscle metabolism. The concentrations of nitrate and nitrite in saliva affect alkalinity of saliva flowing into the stomach.

Conditions That Increase Risk Of Infection

• Older age is the most common risk factor for infection and risk of serious illness. About 81% of deaths from the disease have been in people age 65 and older.
• High blood pressure, diabetes, overweight and obesity increase risk for infection and serious illness.
  
• Chronic medical diseases including lung, cardiovascular, kidney, liver and brain are common risk factors for infection.
• Less common conditions that increase risk of illness are cancer, autoimmune disease, organ transplantation and mental health conditions.

Most of the conditions that increase risk of infection cause acid saliva and increased acidity of urine. Treatment that alkalizes saliva and urine also improves medical conditions associated with increased risk of COVID-19.

Acid Saliva Indicates Danger Of Infection

Doesn’t signal that cells are already infected with SARS-CoV-2 virus. There’s still time to reduce that danger. Plus, time to reduce danger from other respiratory virus infections.

Vaccination does not prevent infection. It forms antibodies that reduces illness from infection after cells have already been invaded. Same thing with antibodies formed during recovery from a previous infection.

Protection from infection prevents breakthrough of respiratory viruses after vaccination. Also prevents recurrence of illness after recovery from previous infection. Furthermore, protection from infection extends to variants of the original wild-type strain. Including any variants that appear and spread in the future.

Let’s See If We Can Help You

We’ll send supplies for testing to the first 50 people who request our help.

When you send us results of your testing for 5-7 days, we’ll analyze risks those data indicate. We’ll call and help you maintain health and reduce risks from infection. 

[Disclaimer: It’s important to consult with your Primary Care Physician to ensure accuracy and alignment with your individual medical condition and treatment.]

REFERENCES

1. Chang D-K and Cheng S-F. pH-dependence of intermediate steps of membrane fusion induced by the influenza fusion peptide. Biochem J 2006; 396: 557-563 https://doi.org/10.1042/BJ20051920

2. Panjwani A, Strauss M, Gold S, et al. Capsid Protein VP4 of Human Rhinovirus Induces Membrane Permeability by the Formation of a Size-Selective Multimeric Pore. PLoS Pathog 2014; 10(8): e1004294. https://doi.org/10.1371/journal.ppat.1004294

3. Hu M, Bogoyevitch MA, Jans DA. Impact of respiratory syncytial virus infection on host functions: implications for antiviral strategies. Physiol Rev100; 100: 1527–1594. https://doi.org/10.1152/physrev.00030.2019

4. Kreutzberger AJB, Sanyal A, Saminathan A, Kirchhausen T. SARS-CoV-2 requires acidic pH to infect cells. Proc Natl Acad Sci 2022; 119 (38): e2209514119 https://doi.org/10.1073/pnas.2209514119

SARS-CoV-2 virus can infect cells in acid solutions where natural immunity fails to protect them.

We can measure Nitrates, Nitrites and Acid in Saliva. If Nitrates and Nitrites are too low, we can increase them with dietary supplements. If Acidity is still too great, we can further reduce it by restoring the oral acid-base buffer system.

The Saliva Nitrate Protein Defense provides protection against all current and future variants as well as the original SARS-CoV-2 virus.

Help measuring Nitrites and Acid in Saliva can be obtained from Herd Healthcare. Sign up for a Good Health Assessment at the end of this blog article.

Viruses are just a nuisance as long as they don’t get into cells of human tissues and organs. Kept out of cells in muscle, fat and nerves. Out of lungs, heart, brain, liver, pancreas and kidneys. Breathed in, swallowed or absorbed through skin or intestines into blood, lymph or tissue fluid. Stay safe from harm as long as it takes to get rid of them. Just so long as they don’t get into cells.

Normal healthy cells are strongly protected from virus entry. Blood proteins, leukocytes, T Cells and Natural Killer cells carry receptors that detect and destroy harmful invaders. There are similar defense mechanisms inside cells.

Acid-base balance in cells, tissue fluid and blood is tightly controlled. CO2 dissolved in water is a weak acid. Any change in acid-base concentration shifts more or less CO2 in and out of solution. CO2 is breathed out into the air and liquid acids and base are excreted in urine. Restoring the original acid-base balance. At slightly alkaline level with pH, potential of hydrogen, about 7.4. Neutral pH is 7.0.

Particles of SARS-CoV-2 circulate around in blood, lymph and interstitial fluid as folded proteins inside a closed envelope. To get inside cells, the virus particle must get attached. The envelope is covered with thousands of spike proteins that can attach to thousands of receptor sites. Acidity of the tissue fluid unfolds the virion envelope. Spike proteins on the virus attach to cell receptor sites and fusion begins. ¹

Protective innate antibodies inhibit fusion in proportion to acidity of tissue fluid. The viral envelope unfolds about 10% at pH 7.4 but opens completely at pH 5.5. Protective antibodies inhibit attachment completely at pH 7.4 but fail to act at pH 5.5. As a result, SARS-CoV-2 spike protein attachment to cell membranes at low pH allows up to a 3-fold increase in entry. Entry into intracellular space occurs both at the cell surface and from cytosolic vesicles. ²

Entering the host cell takes about 15 minutes. Inside the cell, the virion uses host cell functions to replicate viral molecules. Each invading virion takes over hundreds of protein actions to create about 10 infectious units. Replication cycles from entry to release of new infection units take 7 to 8 hours. The huge number of protein interactions causes many mutations which create variants among the particles released. Time from infection to symptoms is about 5 days. ³

Nitrate<->Nitrite<->Nitric Oxide-> (Oxygen Delivery)

Combinations of nitrogen and oxygen move back and forth supporting chemical oxidation and reduction. The amounts stored in these molecules determine how quickly they can be used and for how long.

Nitrates take up and release oxygen to support metabolism. Combined with sodium and potassium, they store and release energy. Amounts available control reactions for cardiovascular, neurological, renal and immunological function.

Acid-Base Balance From Metabolism

Normal cell metabolism combines proteins, fat and carbohydrates with oxygen to produce energy, CO2 and H2O. With scattered remnants of weak acids and bases. As well as electrolytes and fiber.

Sometimes metabolism gets interrupted before reactions with oxygen. Producing lactic acid as well as CO2 and energy. The result increases acidity and lowers pH. Making SARS-CoV-2 virions more able to fuse with cell membranes.

Lactic acid does not get balanced as quickly as CO2. Lactic acid is metabolized by tissues and organs all over the body. Eventually converted into energy, CO2 and H2O. In the meantime, CO2 is breathed out in the lungs. Until removing CO2 from blood increases acidity and decreases pH.

Excretion of excess acid by kidneys decreases pH of urine. Excretion of excess acid by salivary glands decreases pH of saliva.

Daily Variation Of Urine pH

Daily variations in acid-base balance of urine occur in relation to meals, physical activity and sleep. Intake of food and fluid during meals increases urine pH. ⁴

During meals, the stomach makes acid from Cl, Na, CO2 and H2O. When the acid is formed, CO2 and H2O are returned to the blood. The Cl forms acid which is secreted into the stomach. That leaves an alkaline combination of Na, CO2 and H2O which is left in the blood. The excess basic fluid in blood delivered to the kidneys is excreted in urine.

During physical activity, requirements for energy during mild exercise are matched by increased amounts of blood flow. Without any change in acid-base balance of blood. 

During sleep, decreased breathing causes a higher level of CO2 in blood leaving the lungs. As a result, the acid level in urine gradually increases during the night. A urine specimen tested in the morning is usually highly acidic. Especially a second collected specimen after fully emptying the bladder.

Daily Variation Of Saliva pH

Daily variations in acid-base balance of saliva very much follow the rate of production. During sleep, secretion of saliva is much slower than during the day. Saliva containing proteins, electrolytes and water, flows through ducts that reabsorb Cl and secrete bicarbonate. The amount of base excreted depends on rate of flow. As a result, the acidity of saliva is highest of all after several hours of sleep. ⁵

Energy for metabolism includes production of lactate. Especially with low levels of serum bicarbonate and low urine pH. Further decreasing protective effects of bicarbonate during rest.

Defense Against Viral Infection

The most obvious treatment to prevent severe illness and viral replication is initial, repeat and booster vaccination against COVID-19. Except for known diagnosed allergy to some component of a COVID-19 vaccine.

While continuing all precautions against exposure to spread of COVID-19.

Indicators of Decreased Risk of Infection and Severity of Illness:
•Morning saliva pH: at least 6.0
•Morning urine pH: at least 6.0

Conditions Increasing Risk for Infection, Vaccination Breakthrough and Severe Illness from COVID-19:
•Metabolic disease including hypertension, obesity and type 2 diabetes
•Kidney disease with metabolic acidosis and renal failure
•Lung disease with respiratory acidosis and COPD
•Autoimmune disease with chronic inflammation
•Organ transplants with medication to prevent rejection
•Cancer causing immunodeficiency

Treatment of organ dysfunction and chronic metabolic dysfunction requires correction of the underlying medical condition. As much as possible. Giving special attention to compliance with prescribed medical treatment. Including nutrition, physical activity and sleep patterns. Also, management of behavioral and psychological factors.

Services From Herd Healthcare

We will assess individual features of health to make recommendations for increasing personal safety from infection and illness.

Results of laboratory tests combined with personal information can be used to determine natural features and strength of good health protecting against infection and illness.

REFERENCES

1. Cohen FS. How Viruses Invade Cells. Biophysical Journal 2016;110(5):1028-1032.
https://doi.org/10.1016/j.bpj.2016.02.006

2. Tongqing Z, Tsybovsky Y, Olia AS, et al. Cryo-EM Structures Delineate a pH-Dependent Switch that Mediates Endosomal Positioning of SARS-CoV-2 Spike Receptor-Binding Domains. bioRxiv 2020.07.04.187989.
https://doi.org/10.1101/2020.07.04.187989

3. Bar-On YM, Flamholz A, Phillips R, Milo R (2020) Science Forum: SARS-CoV-2 (COVID-19) by the numbers eLife 9:e57309.
https://doi.org/10.7554/eLife.57309

4. Cameron M, Maalouf NM, Poindexter J, et al. The diurnal variation in urine acidification differs between normal individuals and uric acid stone formers. Kidney International 2012;81(11):1123-1130.
https://doi.org/10.1038/ki.2011.480

5. Choi J, Lyons K, Kieser J et al. Diurnal variation of intraoral pH and temperature. BDJ 2017 Open 3, 17015
https://doi.org/10.1038/bdjopen.2017.15

Not everyone exposed to COVID virus gets virus into functioning cells of lungs, heart, kidneys, muscle, fat and pancreas. Some have natural, innate full protection. Those with poor acid-base balance are poorly protected. Liable to get intracellular infection and suffer severe illness. Exercise and physical fitness restore normal acid-base balance.
 
Exercise and physical fitness also strengthen immune function. Even when immune function is weak.

Many in the US have already been infected by SARS-CoV-2. At least one-third. Of the others, probably half haven’t yet been dangerously exposed.¹

They will be. Sooner or later, everyone will be exposed. Of those not yet infected, probably half were dangerously exposed and just didn’t get infected. They were able to resist infection.

Not because they had been vaccinated against Coronavirus infection. Vaccination doesn’t prevent infection. It just prevents severe illness.

Even without symptoms of illness, people who have been infected are contagious. They expose others in close contact with them to Coronavirus infection. Any of those others who have not been vaccinated are liable to severe illness.

Not everyone exposed to SARS-CoV-2 infection gets infected. Not even when living in the same household as someone with a positive diagnosis.

Rates of transmission have been studied in 101 households in Tennessee and Wisconsin. In each household with someone newly infected, others in the household were examined and tested repeatedly for secondarily becoming infected. During 7 days of follow-up, 54% of other members became secondarily infected. 36% were symptomatic and 18% were Infected without symptoms. ²

Rates of secondary infection depended on risk factors known from other clinical studies. As shown in the figure of rates in relation to age, older household members had greater rates of secondary infection than younger members.

Other risk factors such as high blood pressure, lung disease, cardiovascular disease, diabetes, obesity, and chronic inflammatory dysfunction also increase the risk of secondary infection. Studies in other clinical trials show that about half of all people everywhere have co-morbid medical conditions that increase the likelihood of becoming infected with Coronavirus.

Apparently, many people of all ages everywhere have a natural, innate resistance to Coronavirus infection. Including all the virus variants that keep appearing. What is it that protects them?

Protection by Exercise has been studied during the COVID pandemic. Kaiser Permanente in California recorded week-by-week physical activity at outpatient health clinic visits from March 2018 to March 2020. ³

During the past 10 years, patients have been asked about their exercise. Their responses are included as vital signs in their health records. Along with body temperature, blood pressure, and pulse rate. About one-third report at least 150 minutes of moderate exercise every week. Of the others, almost one-third don’t do any exercise and the rest do less than 150 minutes.

As shown in the Figure, most of the groups with COVID infection were inconsistently active. Only 0.4% consistently exercised at least 150 minutes a week.

From January to October 2020, the clinic population of 4.7 million had about equal numbers of outpatients in each exercise group. About 2% of the total population was diagnosed with COVID-19. Those who were continuously eligible under study criteria were evaluated for risks of COVID in relation to their physical activity.

Risks of infection with COVID were much greater in those who had not been consistently active. About 3% for those who exercised less than 150 minutes a week. Less than 0.5% for those who exercised consistently at least 150 minutes a week.

Risks for severe COVID infection were much greater in those who had not been consistently active. The Figure indicates about a 20-fold increase in incidence of severe illness compared to those who had been exercising at least 150 minutes a week. Severe illness required hospitalization for 0.4% of those who had been consistently inactive. In contrast, severe illness affected only 0.02% of those who had been consistently active.

Results from other clinical studies have been similar. In addition, subjects who were older, female, belonging to minority racial or ethnic groups, were obese or had chronic health conditions were more likely to be inactive. Severity of COVID illness has always been less in subjects who consistently exercised.

Consistently, frequency and intensity of exercise are the most remarkable features discriminating between subjects at high and low risk of COVID-19 infection and severity of illness.

Energy for Action

Anything that’s alive needs energy for chemical reactions, growth, and motion. Human muscles convert chemical energy into movement with about 50% efficiency. Energy is lost in heat and CO2. Remarkably efficient considering normal body temperature is less than 100^o F. A cylinder in a car engine burns fuel at 2,800^o F. The result is about 10% fuel efficiency.

The breakdown of food releases energy. That energy is captured in smaller chemical forms and carried to places where energy is needed. Or places where it can be stored as carbohydrate or fat.

Protein Structure and Function

The chemical machines guiding action consist mostly of proteins bonded together. Called enzymes. Each enzyme acts on specific substances to break chemical bonds, rearrange them or make new bonds. More than 20,000 enzymes in a typical human cell.

The structure of proteins is more complex than a simple string of molecules. Strings are folded into 3-dimensional shapes. The folded proteins must be stable for enzymes to function correctly.

Protein folding depends on temperature and chemicals surrounding the structure. It also depends on acid-base conditions. More acidic solutions have more hydrogen positive molecules than basic solutions with more negatively charged molecules. The measure of how acidic or how basic is called pH. Which means “potential of hydrogen.” It’s a measure of how much free hydrogen carrying a positive charge is in solution.

Optimal function depends on proteins that are fully folded. Extremes of higher or lower acid-base conditions disable normal protein function.

The range of pH goes from 0 to 14. Completely acid at 0, neutral at 7 and completely alkaline at 14.

Virus Structure and Function

A virus is a core of proteins containing genetic material surrounded by a protein capsule. It can’t capture or produce energy, move or grow. It’s not alive. It can survive and multiply only by entering living cells and capturing essential materials.

Optimal function of proteins in virus particles occurs in more acidic solutions at lower pH than optimal function of proteins in host protective enzymes.

Innate Physical and Chemical Protection

Surface skin and inside membranes keep almost everything from getting inside. Cells are arranged side by side, over and under one another. Each fastened tightly to those next to it. Injury can rip them apart. Physical force, and toxic chemicals can cause injury and some places leak enough to let things inside.

Just getting inside skin and membranes is enough for poisons and toxic chemicals to cause harm. Results of those injuries have to be taken care of.

Also, getting inside is enough for infection by bacteria, fungi, parasites and worms. They start growing and spreading. They’re alive and have to be caught and killed.

Viruses that get inside into blood and tissue juice, still can’t grow and spread. Infection is not established. They need essential materials from inside cells. Floating in fluid outside cells, they can be captured and destroyed.

Cell membranes are strong and protective. Proteins join cells together. Very few chemicals just diffuse through. Proteins control movement of chemicals in and out of the cell.

Blood, tissue and most cells are slightly alkaline. Even slight change to acid has dramatic effects. Cell protection and normal cell function depend on alkaline pH. Acidic pH causes protein structure to unfold and lose normal function. ⁴

Virus infection of tissue cells depends on fusing with the cell membrane. Optimal pH for protein in a virus envelope is more acidic than protein in the host cell membrane. Alkalinity provides protection from attachment, penetration and entry of virus into cells. Once inside, the virus takes over cellular proteins that enable virus multiplication, growth and eventual destruction of the host cell.

Natural resistance to virus infection depends on maintaining a protective acid-base balance. Slightly alkaline. Host cellular protective proteins with optimal pH higher than optimal pH for invading virus particles.

Innate Immune Protection

Cells and tissue fluid contain protein receptors that recognize patterns and structures that can cause injury. Some receptors are attached to special immune cells and some are inside normal functioning cells.

These receptors bind to anything that is not natural to the tissue. Especially dangerous foreign molecular structures. They begin the process of destroying them and activating other local immune cells.

They also signal systemic activity to bring in additional protection. Some things are captured and cleared with little local effect. More damaging substances bring out full inflammatory responses.

Cellular action that creates additional inflammatory cells and substances requires energy. That energy comes from metabolism that doesn’t require oxygen. Sugar is broken down into smaller molecules releasing energy. What’s left is lactic acid. Some of the lactic acid combines with bicarbonate and some washes away in the circulation. Either way, inflammation changes the acid-base balance in tissue and blood. More acid and less bicarbonate.

Protection from COVID Infection

The virus causing COVID circulates through droplets in the air spread by coughing or sneezing. It enters through mouth, nose or eyes and spreads to the back of the throat. From there, it can reach the lungs. Also, it can be swallowed down to the stomach.

Virus particles stay on the surface until breathed out or washed away. Kept out by physical and chemical barriers of the upper airway.

Protection of Nose and Throat

Captured by cilia, virus particles are bathed in secretions. Normal acid-base balance of saliva and nasal secretions varies from pH 6 to 8. ⁵

COVID infection of nose and throat occurs when tissue fluids become acid. Acidic pH causes cell protein structure to unfold and lose normal protective function. Virus particles fuse with protein on the cell membrane, enter the cell and take over essential protein structures. Infection is completed.

Hydration affects acid-base balance of saliva and nasal secretions. Even mild dehydration reduces rates of flow and produces acid secretions. Increased rates of flow produce secretions that are less acid and more alkaline. ⁶

Drinking 6 to 8 glasses of fluid a day is commonly recommended for good health. Especially with strenuous physical activity in hot or humid weather. Even more at high altitude.

Chronic, mild dehydration is a risk factor for COVID infection of nose and throat. Especially when associated with co-morbid conditions that increase risk for severe illness from COVID. Certainly, fluid intake should be at least 6 glasses a day if pH of saliva is less than 6.0. Increasing intake of fluid could well produce secretions of saliva that are less acid and reduce risk of COVID infection. ⁷

Rates of flow also depend on general acid-base balance in circulating blood and local tissue fluid. Any acid-base shift that reduces pH in tissue fluid reduces pH of saliva and nasal secretions.

Protection of Lungs

COVID virus moves down the airway from mouth, nose and throat to the lungs. Virus particles released from cells in the nose and throat are released into the air in droplets.

Air inhaled into the lungs fills small spaces called “alveoli.” From there, CO2 moves from blood into the air that’s exhaled. Along with droplets carrying virus particles. Most droplets carried in are carried on out. But some droplets with virus join with fluid lining the air spaces.

Dissolved in tissue fluid, CO2 is a weak acid. Released into air, it leaves behind a more basic solution. Alkaline fluid with pH greater than 6.0 effectively excludes entry of virus particles.

The acid-base balance of airway lining fluid can be measured. Droplets of fluid are caught up in exhaled air. Collected and condensed, the pH has been measured. ⁸

Samples of Airway Lining Fluid were collected from 404 healthy young adults living around the University of Virginia. Individuals were excluded if they had any acute or chronic condition of any system. Median pH was 8.0. Fewer than 10% of these normal subjects had pH less than 7.4. No effect of age or sex.

Release of CO2 from fluid lining air spaces in the lungs decreases acidity and increases alkalinity. Lower levels of bicarbonate and lesser loss of CO2 increase the acidity of the fluid. Increased amounts of other acids stay in the fluid and decrease the pH.

Less than 10 percent of the total quantity of carbon dioxide carried in the blood is eliminated during passage through the lungs. Slowing the flow of air out of the air spaces decreases the amount of CO2 removed. Increased concentration of CO2 in the air slows innate action to maintain and repair cells lining the air spaces.

The combination of decreased bicarbonate, increased organic acids and decreased elimination of CO2 quickly lowers the pH. Virus particles become able to fuse with cell membranes and pass into the interior. Infection is complete.

Heart Rate Response to Injury and Infection

The innate immune system includes increasing heart rate. Protein receptors that recognize danger react and send out signals for an inflammatory response. Including signals that stimulate the brain to increase heart rate. Short-term acute or long-term chronic. Complete recovery from acute injury or infection returns all systems to normal. ^{9  10}

As a result, infection by COVID virus causes an increase in resting heart rate. Before the host has any symptoms of infection. Even before virus can be detected using a nasal swab. An alert triggered by increased heart rate forms an opportunity to isolate the newly infected host from transmitting virus to others. ¹¹

Chronic Inflammation

Injury or infection anywhere that persists keeps resting heart rate higher than normal. Sympathetic nerves from the spinal cord act to increase heart rate. The vagus nerve, running through the neck and chest acts to slow the heart. ¹²

Stimulation of the vagus nerve also acts to increase secretion of saliva. Increasing not only the amount of fluid secreted but also the amount of enzymes involved in digestion. Also, the amount of immune enzymes involved in defense of salivary cells.

The defense enzymes are mostly basic proteins which increase the pH of saliva. The normal pH of saliva is about 7.0 which is neutral. At peak flow, optimum pH is close to 8.0. Much higher than optimum pH for envelope proteins of COVID viruses.  

The effect of chronic inflammation anywhere enough to increase resting heart rate is to increase acidity of saliva. Decrease in pH of saliva below 6.0 increases the risk of COVID infection in the nose and throat.

Chronic inflammation also affects acid-base transport everywhere. Local action of immune cells without oxygen increases acidity of local tissues. Local tissue acidity decreases bicarbonate and increases organic acids in circulating blood. Acid-base transport in the kidneys adjusts the pH of circulating blood by excreting acid urine. Decrease in pH of urine below 6.0 increases the risk of COVID infection in the lungs.

Exercise Training for Preventing and Controlling COVID-19 Infection

Many clinical studies have shown that moderate intensity aerobic training strengthens the immune system. It’s safe and it works! Even one 10-minute session activates neural, endocrine, cellular, and humoral defense against infection. ^{13  14  15}

Endurance training most often used is walking, running, cycling or swimming. Intensity that increases heart rate to about 70% between resting rate and maximal heart rate. Duration between 20 and 60 minutes. Frequency 3 to 5 sessions a week. That’s a total of moderate exercise for about 150 minutes in each week.

Intensity and duration for protection of most healthy people is an average heart rate between 120 and 160 bpm for at least 20 minutes. About the most that anyone can do comfortably 3 to 5 sessions a week. Able to talk but only a few words in short sentences between breaths.

So far, the best proven protective effect of regular exercise has been a lesser number of sick days. Fewer than half as many sick days in adults with exercise training over a period of 8 to 15 weeks.

The best laboratory indicator of exercise protection has been low plasma level of c-reactive protein. Levels in normal healthy adults are <3 mg/L and safest levels are <1 mg/L. CRP is produced by the liver in response to early indicators of infection and inflammation. Its level rises rapidly to a peak in about 48 hours after onset of disease. Its concentration decreases when inflammation lessens and healing begins. ¹⁶

COVID-19 infection causes average levels of 20 to 50 mg/L. Patients with severe COVID-19 requiring hospitalization had levels more than 2-fold higher than those with mild disease. Patients who died from COVID-19 had about 10-fold higher levels of CRP than the recovered patients.

High levels of CRP in healthy adults have been measured before and after moderate exercise training. A clinical study of about 200 parents and 400 adults in their families was done in USA and Europe. About 25% of them had levels of CRP greater than 3 mg/L. Those with high levels of CRP also tended to have abnormal clinical features and other abnormal laboratory values. Many similar to individuals with hypertension, obesity, diabetes and abnormal blood lipid levels. ¹⁷

An exercise training program on cycle ergometers was conducted 3 times a week for 20 weeks. Increase in heart rate during exercise started at 55% of maximum possible during the first week and increased to 75% for the average during the last week. Maximum energy capacity increased about 18%.

Reductions in CRP only occurred in individuals with levels at baseline greater than 3 mg/L. There were no consistent associations with changes in other clinical features or laboratory values.

High levels of CRP certainly indicate high risk for severe COVID-19 illness. Whether already infected or exposed to infection. Also, moderate exercise training reduces levels of CRP in patients with comorbid conditions.

Especially evident in patients with common conditions like hypertension, lung disease, diabetes and obesity. The target of exercise training always is reducing severity of comorbid conditions.

Physical fitness also affects levels of CRP and indicators of acid-base balance. Results of exercise tests were compared with blood levels measured for 2,714 healthy young adults in the US National Health and Nutrition Examination Survey (1999-2004). Lower levels of physical fitness were associated with higher levels of acid in the blood. Also, associated with higher levels of CRP. Low levels of physical fitness had chronic inflammation along with an excess of acid in tissue and blood. ^{18  19  20}

Apparently, physical activity including less than 15 to 30 minutes a day of moderate exercise causes the same risk to health and life as smoking tobacco.

Measuring Your Good Health

Good health improves natural protection from infection. Including infection by Coronovirus-2 and variants. The strength of health-supporting protection can be evaluated by physical and laboratory tests.

Vaccines that are available provide very little protection against Coronavirus infection. They do reduce the severity of illness. At least for several months. But they do not protect against illness of all variants that continue to appear. Variants that will continue to appear as long as some people are poorly protected.

Also, protection against severity reduces but does not completely protect against transmitting infection to others.

Many people have natural features and strength of good health that reduce risk from infection. As well as risk of severe illness. Many others are in great danger of infection and illness. Almost everybody can improve their health enough to decrease risk of infection and severe illness.

Results of laboratory tests combined with personal information can be used to determine natural features and strength of good health protecting against infection and illness.

We will assess individual features of health to make recommendations for increasing personal safety from infection and illness.

References

1. Adams ML, Katz DL, Grandpre J. Population-Based Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States. Emerging Infectious Diseases. 2020;26(8):1831-1833. doi:10.3201/eid2608.200679 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392427/pdf/20-0679.pdf

2. Grijalva CG, Rolfes MA, Zhu Y, et al. Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020. MMWR Morb Mortal Wkly Rep 2020;69:1631–1634. doi:10.15585/mmwr.mm6944e1
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6944e1-H.pdf

3. Sallis R, Young DR, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. British Journal of Sports Medicine 2021;55:1099-1105
 https://bjsm.bmj.com/content/bjsports/55/19/1099.full.pdf

4.  Zhou T, Tsybovsky Y, Kwong PD. A pH-dependent switch mediates conformational masking of SARS-CoV-2 spike. bioRxiv. 2020, Jul 4.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337388.1/

5. Baghizadeh Fini M. (2020). Oral saliva and COVID-19. Oral oncology, 108, 104821. doi:10.1016/j.oraloncology.2020.104821

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250788/pdf/main.pdf

6. Stookey JD, Allu PKR, et al. Hypotheses about sub-optimal hydration in the weeks before coronavirus disease (COVID-19) as a risk factor for dying from COVID-19. Med Hypotheses. 2020;144:110237. doi:10.1016/j.mehy.2020.110237

https://www.sciencedirect.com/science/article/pii/S0306987720319460

7. Farshidfar N, Hamedani S. Hyposalivation as a potential risk for SARS-CoV-2 infection: Inhibitory role of saliva. Oral Dis. 2021;27 Suppl 3:750-751. doi:10.1111/odi.13375

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267261/pdf/ODI-9999-na.pdf

8.  Paget-Brown AO, Ngamtrakulpanit L, Smith A, et al. Normative data for pH of exhaled breath condensate. Chest. 2006;129(2):426-430. doi:10.1378/chest.129.2.426

https://www.researchgate.net/publication/7297871_Normative_Data_for_pH_of_Exhaled_Breath_Condensate

9. Whelton SP, Narla V, Blaha MJ, et al. Association between resting heart rate and inflammatory biomarkers (high-sensitivity C-reactive protein, interleukin-6, and fibrinogen) (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol. 2014;113(4):644-649. doi:10.1016/j.amjcard.2013.11.009

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280910/pdf/nihms651029.pdf

10. Sajadieh A, Nielsen OW, Rasmussen V, et al. Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J. 2004;25(5):363-370. doi:10.1016/j.ehj.2003.12.003

https://academic.oup.com/eurheartj/article/25/5/363/485118

11. Hirten RP, Danieletto M, Tomalin L, et al. Use of Physiological Data From a Wearable Device to Identify SARS-CoV-2 Infection and Symptoms and Predict COVID-19 Diagnosis: Observational Study. J Med Internet Res. 2021 Feb 22;23(2):e26107. doi:10.2196/26107

https://www.jmir.org/2021/2/e26107/PDF

12. Farwell WR, Taylor EN. Serum anion gap, bicarbonate and biomarkers of inflammation in healthy individuals in a national survey. CMAJ. 2010;182(2):137-141. doi:10.1503/cmaj.090329

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817320/pdf/1820137.pdf

13. Scudiero O, Lombardo B, Brancaccio M, et al. Exercise, Immune System, Nutrition, Respiratory and Cardiovascular Diseases during COVID-19: A Complex Combination. Int J Environ Res Public Health. 2021;18(3):904. Published 2021 Jan 21. doi:10.3390/ijerph18030904

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908487/pdf/ijerph-18-00904.pdf

14. Hilde Grindvik Nielsen (May 15th 2013). Exercise and Immunity, Current Issues in Sports and Exercise Medicine, Michael Hamlin, Nick Draper and Yaso Kathiravel, IntechOpen, DOI: 10.5772/54681. Available from:

https://www.intechopen.com/chapters/44616

15. Stewart LK, Flynn MG, Campbell WW, Talbert E, et al. The influence of exercise training on inflammatory cytokines and C-reactive protein. Med Sci Sports Exerc. 2007;39(10):1714-1719. doi:10.1249/mss.0b013e31811ece1c

https://www.researchgate.net/publication/5936431_The_Influence_of_Exercise_Training_on_Inflammatory_Cytokines_and_C-Reactive_Protein

16. Martins RA, Veríssimo MT, et al. Effects of aerobic and strength-based training on metabolic health indicators in older adults. Lipids Health Dis. 2010;9:76. Published 2010 Jul 22. doi:10.1186/1476-511X-9-76

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912308/pdf/1476-511X-9-76.pdf

17. Lakka TA, Lakka HM, Rankinen T, et al. Effect of exercise training on plasma levels of C-reactive protein in healthy adults: the HERITAGE Family Study. Eur Heart J. 2005;26(19):2018-2025. doi:10.1093/eurheartj/ehi394

https://academic.oup.com/eurheartj/article/26/19/2018/532081

18. Abramowitz MK, Hostetter TH, Melamed ML. Lower serum bicarbonate and a higher anion gap are associated with lower cardiorespiratory fitness in young adults. Kidney Int. 2012;81(10):1033-1042. doi:10.1038/ki.2011.479

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340439/pdf/nihms346734.pdf

19.  Aeschbacher S, Schoen T, Dörig L, et al. Heart rate, heart rate variability and inflammatory biomarkers among young and healthy adults. Ann Med. 2017;49(1):32-41. doi:10.1080/07853890.2016.1226512

https://www.tandfonline.com/doi/pdf/10.1080/07853890.2016.1226512?needAccess=true

20. Farwell WR, Taylor EN. Serum anion gap, bicarbonate and biomarkers of inflammation in healthy individuals in a national survey. CMAJ. 2010;182(2):137-141. doi:10.1503/cmaj.090329

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817320/pdf/1820137.pdf

So far, about 10% of adults in the US have been sick from COVID-19. Another 5% had infection but no symptoms. Of those with symptoms about 20% have been hospitalized for treatment.

To learn more about programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

COVID-19 And Influenza

Illness with COVID-19 is much more serious than seasonal influenza.

Much greater impact. In 2019, there were about 10% of adults who were sick from influenza and 5% with no symptoms. But only 1% of those with symptoms were hospitalized.

Rates of infection with and without symptoms are about the same. But death rates for those with COVID-19 are more than 20 times higher.

Virus Mutation

Viruses are merely organic structures that can’t move or reproduce. They can’t generate energy. They have no functional capacity until they connect with materials in living cells.

Once connected inside living cells they multiply rapidly. With multiplication, constantly forming new protein, haphazard changes cause mutation. Most new molecules simply disappear. But some have new functional capacity with genes and traits that form new variants.

Virus Variants

Most of these variants are little different than the original forms. But some have traits that allow them to multiply and become dominant. Those that are successful grow and spread through living tissue. They frequently resist immune functions which controlled the original form of the virus.

The first variant associated with increased rate of spread appeared in the fall of 2020. Identified in the UK, it has been labelled UK Variant-B.1.1.7. Its most obvious effect is to increase the rate of transmission from person to person. Severity of illness and death rates have not been increased. So far, existing vaccines have provided effective protection from illness and death.

The first variant associated with a decreased immune response was detected in South Africa. It has been labelled South Africa Variant-B.1.351. It changes the shape of proteins attached on cell surfaces increasing its resistance to antibodies of existing vaccines.

Additional variants have been identified in Brazil and the United States. So far, all these variants have been found in most of the United States. Vaccines used in this country to prevent Coronavirus provide protection from all variants discovered so far. However, the continuing spread of viruses and the process of mutation eventually will produce variants that escape immunity from vaccines. Until about 70% the population is vaccinated or recovered from COVID-19, epidemic spread of the virus will continue.

We still don’t know how long immunity lasts after COVID-19 infection or vaccination. Also, we don’t know how frequently variants will appear that require booster injections or new vaccine formulations. It is possible that revaccination will be required every year or two.

This spread of Coronavirus will go on for a while. We have been expecting that vaccines will prevent and medications will cure COVID-19. Then everything would return to normal. But not everybody will get vaccinated, we don’t have any cures for this respiratory virus disease and variants will keep appearing.

We already know that public health measures do not provide complete protection from Coronavirus infection.

We do know that self-protection measures reduce prevalence and severity of Coronavirus infection. Good health habits prevent this respiratory virus disease and reduce its severity.

Innate And Adaptive Immunity

The immune response to COVID-19 infection has two components. It includes immediate cellular action followed by slower action of cells producing antibodies. Both components include hormonal and humoral agents.

The immediate response operates through white blood cells, dendritic cells and macrophages carrying pattern recognizing receptors. Detection of common chemicals, toxins and infectious agents elicits responses to destroy or isolate them. At the same time, the immediate response initiates local inflammation and signals systemic responses. This is the innate immune system. It continuously protects against damaging effects of injury, foreign substances and infectious agents.

The delayed response operates more slowly through white blood cells called B cells and T cells. Antibodies, proteins produced in B cells, are released into blood and attached onto invading cells and foreign substances. T cells directly kill cells that have been infected. Cell debris and foreign material are removed by macrophages.

Risk Factors For COVID-19

The risk factors for severe COVID-19 include comorbidities and physical inactivity. Comorbidities include hypertension, diabetes, obesity, cardiovascular disease and chronic lung disease. Physical inactivity includes complete lack of regular exercise.

Exercise Reduces Risk

General guidelines for physical activity include 150 minutes per week of moderate aerobic, endurance exercise and 2 or 3 sessions of resistance, strength training. Categories of endurance exercise include less than 10 minutes/week, 11 to 149 minutes/week and 150 minutes of exercise spent consistently week after week.

In the Kaiser Permanente Southern California health plan, patients are evaluated at every outpatient visit. About one-third of patients report less than 10 minutes/week and one-third report some exercise. Less than one-third exercise consistently at least 150 minutes/week.

Since January 2020, more than 100,000 patients with a diagnosis of COVID-19 were identified. Approximately 48,000 had at least three reports of exercise since March 2018. Exercise assessments revealed that 14% were inactive, 80% were inconsistently active and 6% consistently exercised at least 150 minutes/week.

Hospitalization for treatment of COVID-19 was required for more than 4,000. This was 8.7% of all who had at least 3 assessments of exercise before illness. Among those who had been consistently inactive, 10.5% were hospitalized and eventually discharged, 2.8% were hospitalized and admitted to an Intensive Care Unit. Another 2.4% died.

In comparison, 3.2% of those who had been consistently active were hospitalized and eventually discharged, 1% were hospitalized and admitted to an Intensive Care Unit and another 0.4% died.

More than 15% of those consistently inactive were severely ill or died from COVID-19 compared to less than 5% of those consistently active.

Range of Individual Responses

Severity of illness from COVID-19 infection varies considerably. From complete absence of symptoms to rapid progression of respiratory, cardiac and renal failure.

An outbreak of COVID-19 on a cruise ship had 18.5% of all people infected. Of these, 55% were asymptomatic, 39% were mild cases, 5% were severely diseased and 1% died. The majority of people liable to exposure were not infected. Most of those infected were asymptomatic or suffered only mild illness.

Genetic risk factors apparently affect risk. Genomic regions associated with coronavirus infection and illness have been identified. Also, large numbers of variable epigenetic features determine the strength of genetic risk.

Epigenetic features vary according to physical fitness, nutrition and psychological factors. All of which determine liability for infection and severity of illness.

Comorbidity Increase In Risk

Comorbidities of obesity, hypertension and diabetes more than double the risk of severe illness from COVID-19. Especially after 75 years of age. Nearly two-thirds of patients hospitalized with COVID-19 suffered from these conditions. There was obesity in 30%, hypertension in 26% and diabetes in 20%. Many had two or even three of these conditions.

Unfortunately, these conditions are common. In the U.S. about three quarters of adults are overweight or obese, about half have hypertension and nearly half have prediabetes or diabetes. All these are preventable.

Overeating And Insulin Resistance

These conditions are particularly affected by overeating. Consuming more than can be used or safely stored.

Within safe limits, between meals and overnight, sugar and fat can be stored in muscles, liver and subcutaneous fat. The amount that can be stored is limited by individual ability to increase fat storage. Some individuals can create enormous numbers of subcutaneous fat cells. Others are severely limited.

Chronic Inflammation

When all available fat cells are full, excess sugar and fat builds up in the blood. Increased levels in blood stimulate the pancreas to produce more and more insulin. Those increased levels of insulin force sugar and fat from blood into cells in skeletal muscle, liver, fat, pancreas, nerves and brain. The result is damage to cells from high levels of insulin, sugar and fat. Some damage is caused by excess fat and some is direct damage to cell structure and metabolism.

Damage to cells activates markers to recruit inflammatory immune cells. These cells repair and regenerate tissue cells. They get energy from fatty acids and produce lactic acid. The result is a shift in the acid-base balance of the region. Excess acid diffuses into the local circulation and eventually is cleared by kidneys into the urine.

Urine Excretion Of Acid

The result of many regions chronically inflamed is to increase the amount of acid in urine. Enough to shift the potential of hydrogen or pH of urine, Neutral balance of pH is 7.0. Increasing acidity of urine decreases pH. Increasing alkalinity increases pH.

The acid-base balance of tissue fluids, blood and urine is tightly controlled. Tissue fluids and arterial blood are slightly alkaline with a pH of 7.4. After 6 to 8 hours without eating, normal pH of urine is 6.5 to 7.5. The increase in acid excretion associated with chronic inflammation causes morning urine values less than 6.0.

C-Reactive Protein

Chronic inflammation also causes an increase in high-sensitivity C-Reactive Protein.

This protein is secreted by the liver in response to markers from damaged cells anywhere in the body. Stimulating formation of immune cells that repair and regenerate tissue.

Increased levels of this protein in blood indicate injury or infection. They also indicate inflammatory functions associated with atherosclerosis, hemorrhagic stroke and Alzheimer’s Disease.

Self-Protection From Coronavirus Infection

All along we have been expecting that vaccines will prevent COVID-19 and everything will return to what it used to be. Now we know that immunity to COVID-19 probably will have to be boosted every year or so. We also know that eventually COVID variants will require new versions of vaccine to continue preventing illness from Coronavirus infection.

Individual differences in protection from infection have been ignored. Differences in who gets infected, who gets ill, who has to be hospitalized and who won’t survive. Most people who get infected don’t even know it or don’t get seriously sick.

Most of those ill enough to be hospitalized have poor health habits. No regular exercise, overeating, poor sleeping and continuing psychological distress. Specific genetic traits also determine who might get infected but good health habits prevent their expression. Even the response to vaccination is hurt by poor health habits.

Good health habits prevent Coronavirus disease and reduce its severity.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

About an equal amount is paid by public funds – Medicare (20%) and Medicaid (17%). The rest of healthcare costs are paid by Donations (19%) and Out-of-pocket expenses (10%). Each year, we spend more because of poor health than we spend on the military and national security.

To learn more about programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

Healthcare for Business and Industry

Employer-sponsored healthcare began during World War II. The Stabilization Act of 1942 limited wage increases. To attract new employees, US businesses used employer-sponsored health insurance. Employees didn’t have to pay taxes on sponsored healthcare and they got coverage for themselves and their families.

Other types of benefits included Life insurance, Retirement plans and Disability insurance. Medical insurance was the most popular.

Since then, employer-sponsored healthcare has increased. Initially, only large corporations were self-insured and implemented their own insurance plans. Especially in industries where employees had a high risk of injury.

Now, increasing costs of healthcare and changes in healthcare regulations have caused small and medium-sized businesses to become self-insured. Along with opportunities and incentives to reduce healthcare costs.

Designing and implementing healthcare programs for business and industry has become an industry of “Professional Employer Organizations.”

Employee Health Benefits

Most large US employers offer a health-contingent program as part of their employees’ health benefits. These support employees in making changes to health behaviors. Including changes to reduce risk for certain chronic medical conditions and manage them more effectively.

They include health screening for risk factors as well as education and coaching for cessation of tobacco use, promotion of physical activity, stress reduction, and weight management. Some programs also include chronic disease management.

Most large employers ask for personal health information. The majority use a health risk assessment (HRA) questionnaire and some use screening by a physical examination or lab test. In addition, some large employers collect information through wearable technologies. Approximately a third of large firms offer incentives to disclose health information.

A small percent also offer incentives to reduce body weight or improve blood cholesterol levels. These health-contingent wellness programs were authorized first in 2006, and later by the Affordable Care Act.

Randomized Controlled Clinical Trials

The health, economic and employment effects of education and coaching have been studied in the US. Effects of health and wellness programs in 20 worksites were compared with health, economic and employment outcomes for 20 worksites without health-contingent programs. Each group included about 4,000 employees.

Over an 18-month period, programs offered at treatment worksites included 8 sequentially delivered sessions instructed by dietitians, each of 4 to 7 weeks in duration. Approximately 35.2% of employees in the treatment worksites completed at least 1 set of education and coaching sessions.

After 18 months, 29% of employees in the untreated groups had high cholesterol, 23% had hypertension, and 43% were obese. No statistically significant differences were detected between the employees in the untreated group worksites and treatment group worksites. Also, there were no significant differences in mean medical care spending or utilization.

Data from all worksites were examined to determine absenteeism, job tenure, and performance review scores. Here again, there were no significant differences in productivity or performance between employees in the treated and untreated worksites.

Financial Incentives

In 1996, the Health Insurance Portability and Accountability Act (HIPAA), allowed financial incentives for programs of health promotion and disease prevention. Initial limit was 20% of total healthcare coverage. In 2010, the Affordable Care Act lifted the ceiling on health-contingent program incentives to 30 percent. This limit was close to $1,800 annually for an average employee-only plan.

Employers offering health and wellness programs frequently include monetary incentives to encourage participation. Surveys show incentives are associated with higher participation rates. Especially in larger firms with comprehensive programs. They have the highest participation rates. Access to a more expensive plan elicits a participation rate of 40%. Incentives structured as penalties for not participating have an even higher participation rate of 73%.

Chronic conditions are the major cause of illness, disability, and death in the United States. A RAND Wellness Programs Study showed 87% of participants in worksite wellness programs had risk factors for costly disease. Only 13% had chronic disease requiring daily management.

Savings in healthcare costs resulted from about $30 per participating employee per month. This reduction was caused almost entirely by a 30% reduction in hospital admissions among 13% of employees who had chronic conditions. Most of the reduction in hospital admissions was the result of improved disease management.

In 2010, the Affordable Care Act allowed incentives for health outcomes up to 30% of the cost of the group health plan. However, few employers offer this type of health program. In 2019, only 7% of large employers offered health-contingent wellness programs.

Coronavirus Infection, Symptoms and Severe Illness

COVID-19 is a viral infection that spreads from person to person. It surely started in animals but it spreads in people. Everywhere as fast and as far as an airplane can fly. What can we do?

We hear the most instruction about using public health and social measures. Actions by individuals, communities, governments and travel that slow down spread. What else can we do? Each of us can improve our health enough to prevent getting really sick.

The best sources of information report that about 25% of people in the US already have been infected by COVID-19. About a third of those infected didn’t even know it and another third had minor symptoms. Others became so ill they had to be hospitalized and one or two percent died.

Many of those who became seriously ill were already sick with heart disease, lung disease or diabetes. But the biggest group of seriously ill were simply overweight or obese. Especially high % body fat with visceral obesity. Something that can be prevented, recognized, measured, and corrected.

All are indicators of Subcutaneous Adipopenia and Chronic Inflammation.

All are avoidable, measurable and correctable in a corporate health program.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Power of repetition is the secret to success. Test how much you can do. Keep doing it until you’re good at it. Eventually without even thinking about it. Then add a little bit more.

Make a plan where you’re going so you’ll know when you get there. Tell us your objective and when you’d like to reach it. Get started with something you know you can do. Then we’ll help you measure your progress week by week.

To learn more about programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

At the age of 50, it’s not too late to improve health. Not too late to reduce by half the risk of heart attack, stroke, cancer and dementia. To extend length of life by 10 years. In fact, it’s never too late to reduce abdominal obesity and increase strength with exercise.

Good health improves performance. Reduces heart disease, stroke, cancer and dementia. Decreases costs of living and prolongs life. We absolutely know what works for good health. Keeping weight down and strength up.

It’s more complicated to show the benefits of reducing weight and increasing exercise. Fewer than half of those who need treatment will even accept standard treatment. Fewer than 5% or those who need treatment even enter Weight Reduction and Diabetes Management programs.

When treatment is fully accepted, it works very well. About 20 years ago, in the US, 5,000 men and women, age 60 years with obesity and type 2 diabetes were treated and studied for about 10 years. Half of them were entered into a standard Diabetes Education and Self-Management Program. The other half were entered into more Intensive Programs. For the difference in treatment, each intensively treated subject received education, counselling and support that cost about $2,000 more than it cost for those in the Standard Program. Just for the first year of the study.

After the first year in the study, the group receiving Standard treatment lost about -1% body weight and the group receiving Intensive treatment lost about -9%. After 4 years, the Standard group had lost about -1% and the Intensive group lost -5%. After 8 years, the Standard group had lost about -2% and the Intensive group maintained about -5% average of weight lost.

A striking feature of both programs is the spread of effectiveness amongst all the subjects.

Even in the Standard Program, after 8 years, 12% lost more than -5% of their weight and a few subjects lost more than -10%.

In the Intensive Program, after 8 years, 35% lost more than -10% and half of those lost more than -15%.

Effectiveness losing weight reduced the incidence of heart attack, stroke and other cardiovascular disease. As a result most subjects in both groups who lost less than -10% body weight had no protection.

Note that subjects who reduced weight at least -10% for one year were 20% less likely to suffer disease, disability and death. Those who maintained more than -10% weight reduction for at least 8 years were less than half as likely to suffer heart attack, stroke or other cardiovascular disease.

The lesson from this very important clinical study is to develop individual strategies. Individuals should be helped to reach and sustain weight reduction their own best way.

Automatic brain processes control what we do every day. More than 90% of what we think, feel or do happens automatically. Without conscious thought. Non-conscious processes programmed in memory direct almost everything. Those neurocognitive programs are created by actions and functions in response to situations and events. Responses form initially to provide outcomes you want and avoid unwanted results. When responses occur over and over again, dozens or hundreds of times, they become automatic. Familiar stimuli followed by routine responses. What happened last time will likely happen next time.

What you want to do may change. Information, situations and outcomes may change. Something you learn, think, feel or imagine can change your mind. So you want to do something different.

You can change what you think, feel or do. As long as you remember. If you forget to think about the change you want, the original automatic process directs the original response. For a long time you have to think about any new response for it to happen.

Most non-conscious, automatic processes are hard to redirect. You really don’t know how strong they are. You may not even know what happened last time they functioned.

This is not like revising computer software. Just recoding. You have to change what you do and see what happens. A small change might become automatic right away. More complex changes have to be repeated many times before they become automatic. Even then, in years to come, the automatic responses may come back.

Start by stating your Ultimate Goal. Say it out loud. Write it down. Do you want to stay healthy?

Describe and study what you want and why you want it. Especially figure out good features you expect to gain.

But also review bad things you want to escape.

To reach the Ultimate Goal, there are at least 4 types of Action to include in your Action Plan.

Next, define SMART Objectives within each category of Action.

Objectives should be:
Specific: described in 2 or 3 words in relation to Ultimate Goal,
Measurable: numbers recorded at Baseline and compared each week,
Achievable: within reach using current skills, situation and time,
Relevant: contribute progress towards Ultimate Goal,
Time Defined: date, schedule and duration specified.

Start with an Action Plan For The First Week
Make your best possible estimate for improvements in health practice you are sure you can make. Even though you don’t really know what you will be able to do. Just saying you’ll do something doesn’t mean you’ll actually do it. Non-conscious automatic processes may interfere. You may have been too ambitious. Or something might come up to interfere with your plans.

Setting objectives requires balancing how difficult something is to accomplish and how often you’ll try. The ideal plan includes daily repetition at least 5 days a week. Keep testing to find what you can do 5 days a week. Then keep increasing intensity and difficulty as you go along.

The first Action Plan should include at least measuring and recording Basal Heart Rate on 5 days. Other actions might be projected for fewer days.

Review and Analyze Results at the end of each week. Exactly. More, less or the same. Figure out what really happened. It’s important to be successful. Use results from each week to make Action Plans that accurately predict what will get done next week.

Assess and State Progress that was made.
Were objectives reached? Take satisfaction!
Were objectives exceeded? More days? More effort? More accomplished? Upgrade projections!
Were objectives not met? Revise the Action Plan for next week.

Identify Issues that need special attention. What gets in the way of objectives? What can be done about it?

Review: Results, Progress, Issues

Display progress week-by-week.

Make a table or a graph of measurements showing improvements in Basal Heart Rate, Fasting Blood Sugar and Body Weight.

Show how measurements progress over time. Use color scale formatting to show relationships between measurements.

Progress in Endurance and Strength Exercise also can be displayed.

Day-by-day improvements in Endurance and Strength are hard to appreciate.

About all you notice is what makes you stiff and sore.

When the type of exercise, its intensity and duration are displayed with color formatting, you can see how all the effort gradually increases Endurance and Strength.

We all appreciate benefits of good health and we’re all concerned about hazards of poor health. Education about overweight, obesity and type 2 diabetes tells us the hazards of disease and disability. Demonstration of good daily living shows us how to improve our health.

We all have different experience from one another. Non-conscious control of what we think, feel and do happens automatically. We can change what we usually do by conscious direction. What we think about it and what we feel about it is different for all of us.

To start we need conscious, personal motivation to succeed. We test and learn what we can do to improve our health. We do that over and over again until that health practice becomes automatic.

The combination of success, satisfaction, repetition and maintenance are all powerful determinants of good health and long life.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Also, greatly increases the likelihood of infecting someone young and healthy. In fact, people with abdominal obesity or type 2 diabetes are probably the major source of COVID-19 infection in everybody else.

Let us help you improve defense against Coronavirus. You’ll be less likely to become infected and less likely to infect others.

To learn more about programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

COVID-19 is an acute viral respiratory illness that can spread from person to person. It is caused by a coronavirus similar to others that cause acute respiratory illnesses, even including the common cold. Infection can be so mild as to cause no symptoms at all or so severe as to cause serious symptoms and even to cause death.

This coronavirus called COVID-19 is enough different from all the others that there are no vaccines to prevent illness following infection. Also, there are no medications yet proven specifically effective in treating its effects.

With no prevention or treatments, this virus has spread as an epidemic throughout the world. Here in the US, the cost of treating those infected and the cost of preventing its spread between people has been enormous. It spreads rapidly and causes more serious illness than influenza.

Every year, about 12% of the population in the US gets the flu. That is they have symptoms from infection with influenza virus. Of those with symptoms, 1 or 2% have to be hospitalized and 1 in 10 of those hospitalized don’t recover. The result is 30,000 to 50,000 deaths every year from influenza.

In the first 3 months of illness with COVID-19 in the US, 1.4 million people have suffered symptoms. More than 20% of them have had to be hospitalized and more than 80,000 have died. Deaths in just three months more than twice the total deaths caused by influenza in a whole year. We still don’t know how many there will be in 12 months! Could be 3 or 4 times more!

The cost of COVID-19 in 2020 will be enormous. Both Health Care Costs and Costs to the Economy.

Medical treatment for COVID-19 will increase Health Care Costs by about 20%. Costs to the US economy for public health measures will reduce Gross Domestic Product about 20%.

Costs of Medical Treatment for COVID-19 will be about seventy times more than annual costs for medical treatment of influenza.

Portioning costs to everybody will increase Health Care Costs by $2,400. Increase caused by Influenza will be about $350.

Loss of GDP caused by COVID-19 will be about 200 times greater than loss caused by Influenza.

Loss of GDP portioned to everybody will be an annual cost of $15,000!

COVID-19 frequently is serious and potentially deadly for anyone with abdominal obesity. That’s half of the US adult population. The other half may not even have symptoms if infected or be infectious to anyone else.

Weight reduction and moderate exercise abolish risk of severe COVID-19 for individuals with abdominal obesity and greatly decrease risk of transmission to others.

No vaccine against COVID-19 will ever substitute for recovery from abdominal obesity. Vaccines against other types of coronavirus have never been successful protecting against illness. Vaccines against influenza viruses only protect about 40% of those who have been vaccinated. Also, vaccination is required every year. Only about 50% of those who could be protected actually get vaccinated each year.

The natural defense against COVID-19 involves the immune system. This includes white blood cells circulating in blood and specialized cells in organs and tissues. Immune cells recognize normal, healthy cells. They also recognize unhealthy cells. Injury or infection causes immune cells to isolate and remove unhealthy cells.

Immune cells also recognize unhealthy conditions. They collect and multiply in unhealthy tissue. Some immune cells tear down unhealthy tissue and other immune cells clean up and restore healthy conditions.

Fat in the abdomen is recognized as unhealthy. Immune cells accumulate and multiply there, especially the tear-down cells. Eventually, immune action in abdominal fat dominates the whole immunity system. Levels of immune cells, proteins and hormones all rise above normal in blood samples and other tissues. But not enough to take care of new COVID-19 infection.

Immune cells depend on normal metabolism of sugar, fat and protein just like cells in all other systems. When overloaded with sugar and fat, they become resistant to insulin. Insulin resistance and type 2 diabetes further damage immune response to infection.

Response to COVID-19 requires rapid action by immune cells. The result of abdominal obesity and type 2 diabetes is slow onset and reduced strength of immune response.

The daily news about COVID-19 often reports that severe disease and death occur mostly in elderly people. That’s not completely true. Reports from New York are different than reports from China. In a report of 5,700 patients treated in hospitals in New York City, half the patients were less than 64 years of age.

Another feature of patients with COVID-19 in New York is the severe effect of obesity. Under 60 years of age, obese patients were twice as likely to be hospitalized as those who were not obese. In hospital, those with mild obesity were twice as likely to be admitted to Intensive Care Units. Patients under 60 years of age with severe obesity were 4 times as likely to be admitted for Intensive Care.

Obesity was not the most important risk factor for patients over 60 years of age.

We don’t yet know an effective treatment for COVID-19. It’s always possible that treatment will be found that is as miraculously effective as Penicillin for Streptococcal sore throat.

We also don’t have an effective vaccine for prevention of COVID-19. It’s always possible a vaccine will be produced that is as miraculously effective as polio vaccine for acute poliomyelitis.

We do know that normal healthy % body fat and regular routine of moderate exercise greatly increase natural resistance to all viral infections.

We can prevent severe symptoms of COVID-19 in ourselves and avoid transmission of infection to others.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com