If you are not yet a meditator, you have been missing out on one of the most powerful techniques for improving health and happiness. Before COVID-19, the most consistent reason many of my patients gave for not meditating was that they didn't have the time to do it. The pandemic is a perfect time to learn how to meditate. Mantra-based meditation like TM (Transcendental Meditation) has been shown to lower blood pressure, reduce levels of stress hormones, and improve focus and clarity of thought. There are many kinds of meditation but the two that I most strongly recommend are Vipassana and TM. Below is a link to each of them to help get you started:
Astonishingly, taking the necessary precautions to get COVID-19 under control has become politicized by some people who view things like physical distancing and face-coverings as statements about their political affiliation. If you see people walking around without a face-covering, in most cases it probably will not help to call them out. In my experience, most people cannot be shamed or educated into behaving responsibly by a stranger. We should try to understand that some people do not view taking appropriate precautions as a good faith effort to do their part in protecting one another and speed up our ability to return to a fully functioning economy but rather as a signifier of political affiliation. They may not realize that what they are doing is contributing to the terrible situation we find ourselves in currently. On the other hand, demonstrating solidarity with and appreciation for those who are acting responsibly reinforces good behavior and creates a positive feeling of belonging among those of us who choose to follow the science and embrace a shared sense of responsibility to ourselves, our loved ones, and our communities. A quick word of thanks, a nod, or a point and thumbs-up to someone wearing a face-covering will be received as positive reinforcement and demonstrate to others that you identify as someone who cares. In order to get past this pandemic, we need near-universal adoption of basic measures such as physical distancing and the use of face-coverings.
Gyms are places where people breathe heavily without face-coverings and that means they are high-risk places likely to be dense with viral aerosols. Hiking, running, biking, and other outdoor forms of exercise are dramatically less risky than indoor environments where people are sharing the same air. 4 minutes/day of KPT and 30 minutes/day of outdoor exercise will help manage stress and fight against weight gain which is a real problem for many of us who have become more sedentary during the pandemic. I also recommend a set of dumbbells that can be used to do hundreds of strength and cardio-pulmonary training exercises. My favorite are the ones from Bowflex that can adjust from 5 to 52.5 lbs. with a flip of a dial. They can be used to do countless exercises including as an adjunct to enhance the KPT routine (see the video entitled KPT Advanced Workout for more details).
We now understand that COVID-19 is spread through exhaling and inhaling viral aerosols but it can also be spread by touch. An infected person not wearing a face covering can cough or sneeze emitting thousands of virus-containing droplets that fall from the air quickly to land on the ground but also on chairs, desktops, counters, and other surfaces to form what are called fomites. If someone touches a viral droplet-contaminated surface or object and then touches their eyes, nose, or mouth, they can infect themselves. Fomite transmission can also take place when an infected person touches their own nose, mouth, or eyes and then touches a door handle, phone, pen, can of food, or other items that are not for their own exclusive use. If we touch a contaminated object and then touch our face, we can get infected. The bottom line: Wash well with soapy water or use an effective hand sanitizer immediately after handling anything that isn't under your exclusive control; don't touch your face (including with gloves on); use gloves in stores and discard them before entering your car or home; and decontaminate items using wipes or sprays containing at least 70% alcohol. Here is a link to the CDC recommendations for disinfecting:
As reopening unfolded around the country it became quickly apparent that the way it was conceived in most places was based on economics and politics rather than health and safety and we are seeing the effects of that now with a large swell in the wave of infections. COVID-19 seems to be spread primarily by exhaling and inhaling viral aerosols. Those aerosols are produced when people exhale forcefully, speak, sing, or shout and can hang in the air for hours in enclosed spaces that are not well-ventilated. If an infected person in a waiting room or store aisle removes their face-covering to make a phone call, they will fill the air around them with viral aerosols that can infect those around them or the next person to enter that air space. A person breathing hard on a treadmill or spin bike will create an aerosol plume around them that can endanger others. Choir practice, religious services, bars, and restaurants are places/events where people are talking, shouting, singing, etc., typically without adequate (or any) face-coverings and these are very high-risk environments for disease spread. Don't do it. Even if you live in a place that has reopened to allow such things, I strongly recommend that you avoid them at all costs.
There are three kinds of face coverings: respirators, masks, and wraps. Respirators make a tight seal around both the nose and mouth, thus preventing unfiltered air from being inhaled and exhaled. Since tiny viral aerosols are causing the transmission of COVID-19, it is important that all of the air we breathe be filtered when we are around people outside of our household. Respirators do the best job of this and everyone should have one for when we have to be in high-risk environments (more about that in the next Pearl). Some respirators have baffles or exhalation valves that reduce exhalation resistance by allowing you to exhale unfiltered air. These are made for tradesmen who work with toxic chemicals and are reasonably efficient at protecting the wearer but, keeping in mind that about half of infected people don't know that they have COVID-19 (because they don't have symptoms), such respirators which are fine to use while spray painting but do not protect those around you from COVID-19.
Masks fit over the nose and mouth but don't make a tight seal the way that respirators so. Masks that take replaceable filters can provide significant protection but some of the inhaled and exhaled air will still make it around the mask and therefore not get filtered. A good way to evaluate the effectiveness of your mask is to take the sunglass-test: put on the mask and a pair of sunglasses and then walk up a flight (or a few flights) of stairs to get your heart rate up. If the sunglasses fog up, it means that air is flowing around your mask and this can be dangerous in high-risk environments (more about this in the next Pearl). These masks are fine for outdoor activities like hiking or brief excursions to well-ventilated stores to pick up a few items and they do offer protection against larger droplets that might hit your face if someone sneezes or coughs on you but they are not sufficient for higher-risk environments like a shared office, busy cash register, or an hour of shopping at a place like Costco.
Wraps are typically made of cloth. They can be wrapped around the face and head more than once to provide extra layers of protection. They are often more comfortable to wear than respirators or masks and can make a better seal around the nose and mouth than many masks. Wraps made of a tightly weaved cloth (like flannel) can offer better protection than most masks and have the advantage of being washable.
The Bottom Line: I recommend everyone have at least one respirator and one mask or wrap in good condition. We need to have a face-covering on at all times when we are around people who are not members of our households including close friends and relatives. At my office, we sell respirators from O2 Canada which have a higher efficiency rating and are more comfortable for long term wear than traditional N95 respirators. If you are interested in purchasing one, let us know.
Much has been written about the financial and social stressors associated with COVID-19. As the director of a primary care practice that includes family and internal medicine, and as I continue to see a small number of patients in acute pain for chiropractic care, I have come to understand that there is another, deeply unsettling and stressful aspect to the current pandemic. In the absence of a coherent, unified message from government and public health officials, many Americans simply do not know what to believe. As we find ourselves facing a frightening swell in the wave of infection across most of the country, knowing what we can and should be doing about it is important not just for the safety of our communities but also for our own mental health. Therefore, each day for the next several days, I will be posting a KPT Pearl that will attempt to make clear some aspect of COVID-19 based on my own careful reading and understanding of the scientific data that are emerging daily. I hope that doing this will help some people to reduce the stress and anxiety caused by the inconsistent, chaotic messaging, misinformation, and in some cases, disinformation coming from public officials and news sources.
Day 1: KPT COVID-19 Pearl of the Day is: Don't Share Your Air. At the most basic level, COVID-19 is spread when infected people without proper face-coverings speak, shout, chant, sing, or breathe heavily such as during exercise, producing tiny viral aerosols, and then someone sharing their their air breathes them in. This is not the only way you can catch it or spread it but viral aerosols seem to be the chief vector of transmission. Since about half of people with active COVID-19 don't show symptoms, we should be very careful not to breathe in shared air with anyone outside of our household. The best way to do that is to isolate as much as we can and when we need to be out and around others, we should keep our face-coverings on at all times. Tomorrow's post will go into some detail about face-coverings.
Supplements during Covid-19
Dear KPT people,
A lot of you have been asking about which supplements you should be taking (if any) during the COVID-19 pandemic, so I thought I would make a post about it.
First, it is important to be clear that the data supporting the use of supplements to enhance immunity is insufficient to make many strong recommendations. I personally take several supplements based on a relatively small data set in the context of my own personal philosophy of health which centers on measures to keep inflammation low and blood circulation high.
Thoughts and recommendations regarding supplements in the context of COVID-19
Several supplements have been touted as immune system boosters which might make intuitive sense during a viral pandemic. A handful of supplements even have a measure of clinical data to support such a claim. For example, in a randomized, 8-week study in 79 adults, supplementing with mushroom mycelium extract led to a 38% increase in the activity of natural killer cells (a type of white blood cell that protects against infection). (1) Similarly, elderberry extract contains compounds that inhibit some viruses' ability to penetrate into cells and has been shown to lower the intensity and shorten the duration of symptoms of certain respiratory infections. (2) That might sound good but I actually don't recommend patients take either mushroom extract and elderberry extract during COVID-19. Read on...
Immune-boosting may make intuitive sense but it is not at all clear that increasing immunity is a good idea in COVID-19. Many people who go on to develop the severe and sometimes deadly version of this disease experience an extremely large and broad immune response that involves the release of small proteins by immune cells, known as cytokines. When cytokine production goes too high, patients experience a kind of dangerous hyper-immunity referred to as a 'cytokine storm' that can lead to severe acute respiratory distress. These are the patients who wind up in the ICU or CCU requiring help breathing. We would not want to stimulate more immunity in patients at risk for developing a hyper-immunity response.
The other severe form of COVID-19 seen in adults involves hypercoagulation (the abnormal formation of blood clots in the body). These abnormal blood clots have been implicated as the cause of strokes, heart injury, and lung injury in about 30% of patients with severe COVID-19. (3, 4, 5)
Mushroom mycelium extracts and elderberry could aggravate or increase the risk of developing these problems by stimulating the production of cytokines. Elderberry, in particular, has been shown to increase the release of interleukin-1B, a cytokine that has been identified as part of the inflammatory reaction to COVID-19.
By contrast, Boswellia (frankincense), has been shown to decrease cytokine production in patients with asthma, and so might be helpful in lowering the risk for some of the more serious effects of COVID-19, especially in those with allergies and asthma. (6)
Similarly, NAC (N-Acetylcysteine) has been shown in both in-vitro and animal studies to boost levels of glutathione. Glutathione is the body's master anti-oxidant hormone. By scavenging reactive oxygen species, glutathione lowers inflammation and reduces the production of mucous in the lungs suggesting it may be helpful in lowering the risk of chronic diseases and could be a useful adjunct in managing patients with COVID-19. (7)
Another supplement that makes sense is Vitamin D, a hormone made by the body in response to sunlight. D helps immune cells to function better while also lowering generalized inflammation. (8) Low levels of Vitamin D, most likely the result of widespread medical recommendations to limit sun exposure, is considered to be epidemic the United States (9) and studies have linked low levels of D to increased susceptibility to respiratory infections and allergic asthma. (10) By contrast, supplementation with D has been shown to significantly reduce the risk of respiratory infections. (11)
Zinc is a mineral that also plays a role in immune function. It helps to increase communication between immune cells and also aids in the reduction of inflammation. Like Vitamin D, zinc deficiency is epidemic in the U.S., and supplementation with zinc has been shown to protect against coronaviruses that cause colds. (12, 13)
It is rare that Americans experience Vitamin C deficiency, but supplementation with C has been shown to have many beneficial effects including reduction of the severity and duration of, and susceptibility to respiratory infections. (14, 15, 16) Vitamin C is another antioxidant that helps lower oxidative stress which decreases inflammation. C has even shown efficacy for the treatment of acute respiratory deficiency syndrome (ARDS) such as that seen in some severe cases of COVID-19. (17)
Various B vitamins are also essential for proper immune function and are known to be deficient in many people due to high-carbohydrate diets that are often low in vitamin and mineral-rich foods like berries, dark green vegetables, lentils, beans, eggs, and nuts. (18, 19).
Finally, there is quercetin. Quercetin is a polyphenolic compound known as a flavonoid. Flavonoids are plant pigments with special nutritional value. Data suggest that they affect cell-to-cell signaling, receptor sensitivity, and inflammatory activity. The main dietary sources of quercetin for humans are apples, berries, capers, onions, tomatoes, kale, broccoli, nuts, buckwheat and tea. (20) In several experimental models of inflammatory conditions (including infections), quercetin reduced the production of reactive oxygen species and inhibited the overexpression of different components of inflammation including cytokines, in animal studies (21, 22, 23). Quercetin has been shown to inhibit cells from being infected with influenza, Zika, and Ebola viruses by blocking the viral entry into cells and reducing viral replication. The evidence suggests that quercetin could have antiviral properties. (24, 25, 26).
Added note: during the COVID-19 crisis, stress tends to be higher. This has led to many of you experiencing sudden acute episodes of back and neck pain unprovoked by activity or injury. Many of you have noted that the pain came on while watching television or sitting at the computer. Among its many effects on health, the hormones released in response to chronic stress can disturb blood sugar regulation, blood pressure, memory, decision making, and the ability to get restful, restorative sleep. In addition to a healthy diet and regimen of supplements that may help keep inflammation down but mood and energy up, I recommend two things: brief, intense cardiovascular exercise and 4 minutes of Kore Power Trainer once per day. Keeping a strong core is extra hard when we are more sedentary. KPT is the solution to that problem.
Below is the list of supplements with links in case you are interested in purchasing any of them for yourselves. I recommend that you only buy pharmaceutical grade supplements that have been tested for purity and reliability. For those of you who would like to take an all-in-one immune enhancement supplement, Metagenics has a new product that puts several of these things together in one table, called Immune Active.
Our office uses mainly two pharmaceutical-grade manufacturers: Pure Encapsulations and Metagenics. Below you will find links to our portal for each. By ordering through our portals you will receive periodic discounts sent to your email.
Pure Encapsulations products with link to purchase:
Polyphenol nutrients (for B vitamins)
Metagenics products with link to purchase: Use code DRBERKOFFWELCOME For 15% off your first purchase on everything.
Immune Active (NAC, C, Zinc, Quercetin, plus EGCG found in green tea)
GlutaClear (NAC, Vitamin C)
Inflavonoid Intensive Care (Boswellia)
D3 10,000+ K (Vitamin D plus K)
Glycogenics (Vitamin B complex)
How often should you do a core workout? How much time should you spend during core workouts? These are commonly asked questions but to answer them correctly we need to start with a little background information.
HOW MUSCLES GET STRONGER
Resistance training such as weight lifting improves musculoskeletal function by making muscles stronger. Muscles cells get stronger by thickening in response to injury. When we exercise hard enough we cause microscopic injury to muscle cells creating an inflammatory response followed by muscle healing. It is during the healing or recovery phase that muscle cells thicken and become stronger.
Soreness the day after strength training workouts (post-workout soreness) indicates that the muscles are in the inflammatory phase–in other words they are injured. Until the injury heals muscles do not become stronger. Post-workout soreness dissipates over 1-3 days as we transition to the recovery phase. It is during the recovery phase that muscles grow bigger and stronger. To build strength we need at least one day of feeling minimal to no soreness following a workout before we exercise the same muscles again.
TOO LITTLE OR TOO MUCH OF A GOOD THING...
If you do not experience any soreness the day after a workout this means that you did not cause sufficient microscopic muscle cell injury to promote an increase in muscle strength. On the other hand, severe soreness lasting more than 3 days after a workout is an indication of excessive muscle damage. Workouts that cause excessive muscle damage can lead to more serious injuries of muscle, tendon, and joint tissues (strains and sprains). Strains and sprains take you out of your sport or workout routine–sometimes for weeks or months–leading to loss in strength, and repeated injuries of this kind weaken the musculoskeletal system by forming scar tissue. Scar tissue is weaker and less elastic than normal healthy tissues. Repeated strain and sprain injuries and the scar formation, calcification, and wearing away of tissue structures makes us stiffer and more prone to injuries and chronic pain as we age.
THE RIGHT WAY TO WORK THE CORE FOR STRENGTH GAINS
So, how often should you work your core? If you are in a strength-building phase, you will want to work out sufficiently hard to feel post-workout soreness lasting ideally about 1-2 days. When soreness is 90% reduced, it is time to exercise hard again. When you begin Kore Power Trainer, you will likely be working out three times per week with at least one day in between each workout for recovery. If you are not sore the day after a KPT workout, you should repeat it the next day and consider going a bit harder. Try moving your hips closer to the edge of the mattress to make the workout more intense. When you are able to work each of the four quadrants of the core for one continuous minute on KPT with your hips at the very edge of your mattress, you have sufficient core strength to maintain good back health.
Those starting with an already strong core but wanting even more strength in order to improve athletic performance or to get that very chiseled look, can try the advanced workout which uses more difficult techniques including added resistance using hand weights. Remember that post-workout soreness indicates that you are doing sufficient work to promote an increase in muscle strength but extreme soreness lasting more than 3 days means you are overworking the muscles and potentially causing permanent tissue damage (scar formation and calcification). Adjust your workouts accordingly . If you experience excessive post-workout soreness you should back off on the amount of resistance by using smaller hand weights, moving your hips further from the edge of the mattress, etc. If you are not sore the next day, bump up the weights, move closer to the edge of the mattress etc. Regardless of your current core condition, the best and safest way to build core strength is to workout sufficiently hard to induce 1-2 days of post-workout soreness and then repeat the exercise once the soreness has dissipated by 90%.
WORKING THE CORE FOR STRENGTH MAINTENANCE
If you already have sufficient core strength and are satisfied with where you are, KPT makes maintenance of core strength easy. 4 minutes of exercise 3-5 times per week is the recommended frequency of training. This means working your front abs, sides, and lower back, each for one continuous minute. If you can do this Basic Workout with your hips at the edge of the mattress without any post-workout soreness, your core is sufficiently strong for maintaining back health. If you are working through a chronic back pain problem, your doctor may recommend that you build further on this level of strength before moving to a maintenance routine. Regardless, maintenance work should be done 3-5 times per week in the absence of significant post-workout soreness.
One of the most commonly asked questions about Kore Power Trainer is, "Can KPT help me to get rid of my belly?" I can understand where the idea comes from. We only have to turn on the television late at night to see any number of products which claim to promote instant weight loss. We see someone with phenomenal looking abs rocking back and forth on a plastic seat or pushing down on some spring-loaded device and then we are told that he or she got this way by using the gimmick. Such infomercials always include testimonials with before-and-after pictures of "real people" who claim to have lost a huge amount of weight and several inches from their waistlines by rocking, squeezing, or twisting for 5 minutes a day. The images are compelling, even as our guts warn us that we are being scammed. At 54 years old, one thing has become clear to me: when something feels like a scam, it probably is.
Strength training exercises such as Kore Power Trainer help to burn a very small amount of fat. And core work alone–even with Kore Power Trainer–is not sufficient to burn away significant amounts of belly fat. Getting a super strong core is healthy. It is good for your back, improves your posture, and enhances athletic, work, and sexual performance. When abdominal fat is low, strengthening the core creates that chiseled look that many of us want. But significant amounts of abdominal fat, or adipose can only be depleted through diet or by a combination of diet and exercise. A healthy diet low in starches (carbs) and based on fresh, natural foods eaten in small portions several times per day (see The Human Diet) combined with regular cardiovascular exercise and full-body strength training, including Kore Power Trainer, is the combination that works best for getting rid of belly fat and looking and feeling your best. Unfortunately, there are no good short-cuts to significant, lasting weight loss. It requires commitment and a shift in lifestyle. Magic pills and gimmicks do not, in my experience, deliver on their promises.
BUT DOESN'T BELLY FAT TURN TO MUSCLE WHEN YOU DO AB EXERCISES?
Fat cannot be converted into muscle through exercise. Nor does muscle turn into fat when we are sedentary. Muscle and fat are separate organ tissues, like heart, lung, bone, etc. We cannot convert one kind of tissue cells into another. Lack of exercise causes muscle cells to shrink and fat cells to swell over time, giving the appearance that muscle can be 'turned into fat.' Similarly, more exercise can help build muscle size and burn some fat, giving the appearance that fat is being 'turned into muscle.' But doing ab work does not do very much to burn belly fat. I am certain that the models you see in those late night infomercials did not come to look the way that they do by rocking, twisting, or squeezing 5 minutes a day with smiles on their faces. Kore Power Trainer is not a gimmick. It is the safest, most efficient tool for gaining a strong core. But it is not a weight-loss device and if you have a layer of belly fat covering your mid-section, you will not be able to see your beautiful, strong abs until you add a healthy diet and exercise routine to your daily habits.
LOSE THE BELLY + STRENGTHEN THE CORE = BETTER HEALTH
There are good reasons to lose belly fat beyond achieving that sculpted-abs look. Belly fat (also called visceral fat, or adipose) causes the production of inflammatory hormones which promote aging and increase the risk of heart disease, diabetes, strokes, and cancers. Extra fat on the abdomen pulls the spine into extension causing compression of the joints in the lower back. It causes stress and strain on spinal discs and facet joints which lead to degenerative changes and chronic back pain. Adipose is one of the key drivers of the aging process and is implicated in virtually all forms of chronic disease. KPT in conjunction with a healthy diet and cardiovascular exercise is the ideal combination for both optimal health and spectacular, chiseled abs. Click on this highlighted link for more information on The Human Diet.
Dr. Berkoff is the inventor of Kore Power Trainer. He has been in clinical practice in La Jolla, California, since 1989.