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Arthritis

Arthritis is a general term used to describe inflammation and pain in one or more joints.

The 2 most common types of arthritis are Osteoarthritis and Rheumatoid arthritis.

Osteoarthritis is a common form of arthritis. Most often it is caused by general wear and tear on our joints as we age. However, Osteoarthritis can also be caused by a joint infection, or trauma to a joint. In all cases there is a loss of the smooth cartilage on the surfaces of the joints, allowing the bones to grind together with movement causing pain.

Rheumatoid Arthritis is a genetic disorder. Here, the immune system attacks the synovial membranes within the joints causing inflammation and pain. If untreated rheumatoid arthritis can be destructive, destroying both cartilage and bones within joints.

Other less common forms of arthritis are related to specific hereditary, metabolic, inflammatory, or infectious causes. For example, Gouty arthritis is caused by the build up of excessive uric acid in the blood and in the joints.

Symptoms of arthritis may include pain, stiffness, tenderness, redness, and swelling in the joint or joints, as well as difficulty moving the joint.

Osteoarthritis is diagnosed by physical examination by your doctor and X-rays. Rarely a CT or MRI is required. In other forms of arthritis specific abnormal markers can be detected in the blood. Fluid from the affected joint is sometimes extracted through a needle and analyzed to help diagnose the type of arthritis.

To avoid Osteoarthritis avoid excessive or harsh over use or injury to your joints. Also maintain an average weight; obesity adds stress to your joints. Basically, be nice to your joints.

Osteoarthritis is treated with combinations of physiotherapy and joint strengthening exercises, along with pain killers such as acetaminophen or mild non-steroidal anti-inflammatory medications. Sometime osteoarthritis is treated by injecting the affected joint with steroids and/or synthetic joint lubricating fluid. When there is severe loss of joint cartilage, surgical replacement with a prosthetic joint may be necessary.

For Rheumatoid arthritis, medications are required including non-steroidal anti-inflammatories and medications that suppress the immune system.

Creatine

Creatine is one of the most common and widely researched natural supplements on the market today. Supplementation with creatine has regularly been shown to increase muscle size and strength when added to a strength-training program. As a result, creatine has become a supplement staple for guys aiming to gain lean mass and/or enhance athletic performance.

Creatine is a natural organic compound that is produced by the body and is commonly found in foods such as fish and meat. It is stored in the muscles as phosphocreatine and serves as an energy reservoir.

Creatine monohydrate is the form that is most commonly found in dietary supplements. Although considerable research has been published on creatine supplementation, the specific synthetic procedure used to make it has not been made available.

During high intensity exercise our muscles rely on phosphocreatine and glycogen for fuel. Creatine serves to increase the levels of phosphocreatine in the muscle, allowing athletes to produce more energy during explosive lifts, sprints, and other forms of intense exercise. Phosphocreatine also maximizes performance by helping maintain optimal pH levels within the muscle. For these reasons many people use supplementation to promote greater training adaptations and to increase performance.

Although not all individuals will respond equally to creatine, it is generally accepted that supplementation will amplify the effects of resistance and strength training. A systematic review by Nissen and Sharp (2003) found that creatine supplementation over an average of 7.5 weeks increased both net lean mass by 0.36% and net strength by 1.09% per week when compared to individuals that did not supplement with creatine.

Creatine is considered generally safe for use. A few cases of creatine causing damage to the kidneys have been reported, although no large-scale studies have found a consistent pattern of toxicity in healthy humans. More research is required on the long-term effects of supplementing with creatine. Consult with your doctor first before taking any supplement.

Diabetes

Diabetes refers to a group of metabolic diseases in which there is ongoing high sugar levels in the blood.

Type 1 diabetes occurs when the pancreas does not produce insulin, the hormone required to regulate blood sugar levels. Type 2 diabetes starts when the body cannot properly use insulin, and in later stages when the pancreas fails to produce enough insulin.

Symptoms of diabetes include increased thirst, urination, and hunger; weight loss; and fatigue.

Long term complications from diabetes include narrowing and blockage of the arteries, preventing blood flow to organs and body parts. Loss of blood supply to the brain causes stroke, loss of blood to the heart muscle causes angina and heart attack, loss of blood to the kidneys causes kidney failure requiring dialysis, loss of blood to the eyes causes blindness, loss of blood flow to the penis causes impotence, loss of blood to the nerves causes decreased sensation in the hands and feet.

Diabetes is diagnosed through blood tests and sometimes by a urine test. Your doctor may measure the amount of sugar in your blood first thing in the morning after an overnight fast (not eating for 12 hours). High levels of sugar in your blood after not eating for 12 hours signals a problem. Your doctor may also measure something called a hemaglobin-A1C (HbA1C) in your blood. Elevated HbA1c indicates the amount of sugar in your blood has been persistently high for at least the past 2 to 3 months. Lastly, you may also have a glucose tolerance test. Here you are asked to drink a standard amount of sugar, and then blood tests are taken at specific times to determine how well your body metabolizes the sugar.

There is good evidence that obesity contributes to the development of type 2 diabetes. Therefore, maintaining a healthy body weight through proper diet and exercise is an important prevention strategy.

Both types of diabetes require a carbohydrate and calorie restricted diet and regular self monitoring of blood sugar levels.

Type 1diabetes is treated with regular administration of insulin by injections or by an insulin pump.

Type 2 diabetes is treated with various oral medications which can reduce sugar production by the liver, improve pancreatic production of insulin, or increase the body’s sensitivity to insulin. Insulin injections are sometimes also required.

Types of Diets

Determining the right diet for weight loss can be a difficult and confusing process. We are constantly bombarded with new diets, fads, and trends that promise to make pounds effortlessly melt away. In reality, the best weight loss strategy requires a combination of diet, exercise, enjoyment, and motivation. Without each of these factors, the likelihood of losing weight decreases and the chances of regaining any weight lost increases. Diets that focus on reducing the amount of refined sugars, refined starches, processed meats, sodium, and trans-fat are usually the most successful. However, there’s more to dieting than simply cutting out these foods. Most importantly, you should implement a diet and weight-loss program that works for you.

To keep weight off permanently, you should lose weight slowly. This is best done through a combination of diet and exercise. In a normal-weight adult, approximately 12 calories per pound is needed to maintain body weight. So, if you weigh 180 pounds, eating around 2200 calories per day will, depending on activity level, keep you at the same weight. If you consume fewer calories, your body will draw on your energy stores such as fat tissue to meet your requirements. There are different diets that lower your daily caloric intake; these are reviewed below. Choose one that works for you. You can also lose weight by burning more calories than you eat. Just like eating less, if you use more calories than you consume, your body will draw on your energy stores such as fat to meet the demand. Regular exercise is a great way to burn calories with activities such as swimming, walking, hiking, and even sex!

 

One approach to weight loss is selecting meals that are portion controlled to match your target caloric intake. In a normal-weight adult, approximately 12 calories per pound is needed to maintain body weight. With this in mind, if you reduce the amount you eat by 500 calories per day, this should yield a weight loss of 1 pound per week. When it comes to food, it is easy to lose track of how many calories we consume. This diet encourages the use of pre-set portions, such as breakfast bars, to help track your calories and ensure every meal you consume throughout the day matches up with your desired caloric intake.

Next, we have the Mediterranean diet. This diet is high in vegetables, fruits, legumes, grains, and monounsaturated fat. Common food sources for monounsaturated fat include olive oil, nuts, and avocados. The Mediterranean diet includes, in moderate amounts, milk, cheese, and a splash of wine. Compared to the rest of the food groups, meat products are relatively low. Research has shown that this dietary pattern reduces the risk of heart disease and helps control blood sugars.

The Dash Diet is another common low-calorie diet. It stands for Dietary Approaches to Stop Hypertension. It recommends that less than 25 percent of your caloric intake come from fat. The rest of the diet is comprised of 4 to 5 servings of fruit and vegetables, and 2 to 3 servings of low-fat dairy products per day. This diet has been proven to be effective for people with either normal or high blood pressure.

Low-fat diets are the most common strategy for weight loss. Of all the macronutrients, fat contains the highest amount of calories per gram. The energy density for fat is 9.4 calories per gram, whereas protein and carbohydrates only contain 4 calories per gram. Individuals on this diet often opt for foods that are low in fat, and typically track their fat intake instead of counting daily calories. Foods high in fat are consumed only in moderation. A meta-analysis of 32 controlled clinical studies (Hall and Guo, 2017) showed that energy expenditure and weight loss were greater when carbohydrates were used to replace foods high in fat. This is particularly why many experts and dietary guidelines recommend that no more than 30 percent of your total daily energy intake should come from fatty foods.

To implement a low-carbohydrate diet you will either have to reduce the total amount of carbohydrates you eat or select foods that have a low glycemic index, such as oats, pasta, and legumes. For optimal results you should avoid high glycemic carbohydrates such as cereal, potatoes, honey, muffins, candy, juice, etc. The carbohydrates in these high glycemic foods are simple sugars that break down quickly in the body and hinder your weight loss efforts. For short-term weight loss, low carbohydrate diets are more effective than low-fat diets. However, in the long-term, low-fat diets have been proven to be better at keeping the weight off. A meta-analysis published in 2006 showed individuals who chose a low-carbohydrate diet over a low-fat diet had similar weight loss over 6 months, but were not able to maintain their weight loss and regained by 12 months.

Another short-term option is the Ketogenic diet. If you significantly restrict the amount of carbohydrates you consume, the human body will induce a metabolic condition known as physiological ketosis. When this happens, the body no longer relies on blood glucose and instead creates ketone bodies from fat to use as an energy source. The main benefit is that this increases the amount of body fat consumed for energy. However, there are side effects associated with this diet. Side effects include kidney stones, increased blood cholesterol, hypoglycemia, and lethargy. The ketogenic diet is not for everyone and is best used under the supervision of a dietician.

High protein diets tend to be more filling than other diets. In general, people will report they feel more full when they eat more protein. This can help suppress appetite and may reduce the total amount of food consumed during a meal. However, this diet is no more effective for weight loss in the long-term than other diets. One meta-analysis published in 2013 compared long-term weight loss from high protein, low protein, and low-fat diets and found no significant differences. There were also no differences in waist circumference or blood pressure. The current recommended dietary intake for protein is 0.36 grams of protein per pound of body weight. Consuming more protein, in general, provides no benefit, as our bodies are not designed to efficiently use or store excess protein.

The flu

The flu, properly called Influenza, is a viral illness that affects the airways and lungs. There are many strains of the influenza virus, and the specific strains that infect people change every year. In Canada, the influenza virus only circulates during the winter months, and is primarily transmitted by sneezing and coughing. When someone with an influenza infection in their airway coughs or sneezes, they spew influenza virus into the air, someone nearby can then breathe in the virus allowing it to infect their airway.

Influenza does not cause abdominal cramps, diarrhea, nausea or vomiting. The “stomach flu” is a misnomer.

Symptoms of an influenza infection include fever, chills, nasal congestion, sore throat, cough, muscle ache, fatigue, and headache. The symptoms of the flu are usually at their worst in the first few days, and resolve within 7-14 days. The flu can be differentiated from the common cold based on symptoms; while both can cause nasal congestion and sore throat, the common cold does not cause fever and muscle aches.

In some people, the symptoms of influenza may be mild, while in others they may be severe. The elderly and people with pre-existing lung problems are more likely to have severe symptoms from influenza. The influenza virus can also cause pneumonia, and particularly in the elderly and in people with a weakened immune system, it can be fatal.

Influenza is almost always diagnosed based on symptoms. However, your doctor may swab your nose or throat and send this to the laboratory to detect the presence of the influenza virus.

Treatment of influenza includes rest, taking acetaminophen (Tylenol) for fever or muscle ache, and staying hydrated with plenty of fluids. There is an anti-influenza medication (oseltamivir or Tamiflu) that may help, but it must be taken within the first two days of infection. It will not prevent the flu entirely, but can decrease the severity and duration of symptoms, usually by about one day. This medication is usually reserved for those who are likely to develop severe symptoms, like the elderly.

Some warning signs of severe influenza infection include chest pain when breathing, heavy cough, coughing up dark phlegm or blood, shortness of breath, and changing level of alertness. In case of severe, progressive, or prolonged symptoms, medical assessment should be sought right away.

When it comes to influenza, prevention is the best strategy, and the best prevention strategy is to get the influenza vaccine every year. Admittedly the vaccine is not perfect, it takes months to produce millions of vials of vaccine, and so scientists must try and predict which strains will be circulating during the coming winter. Sometimes their predictions are good and the vaccine is a good match, sometimes it’s not so good and a strain of the influenza virus starts to circulate that was not included in the vaccine. Irrespective, there is always a partial, if not complete match, and so there is always some benefit to getting the vaccine. You do need to get the vaccine every year though, as every year different strains of influenza circulate through the population.

Other prevention strategies involve washing your hands frequently and staying home if you have influenza. If someone with influenza coughs or sneezes into their hands and then shakes hands with you, you are likely to get infected with the virus. Thus, wash your hands frequently. If you have influenza, stay home until you are better. That is good for you and will help prevent transmitting the virus to others, especially those who are more vulnerable.

Low Back Pain

Low back pain results from various causes, mostly benign, and usually resolves within 2-6 weeks.

Low back pain can result from a sudden movement, heavy lifting, or repeated lifting; particularly when people are not trained to lift properly, or have poor physical fitness.

Low back pain is most frequently caused by straining the muscles or ligaments surrounding the lower spine, or from a sprain to the small facet joints in the back of the spine. A specific cause is most often not identified. Rarer causes of low back pain include spinal disc herniation, tumour, infection, and inflammatory diseases.

People with low back pain should seek immediate medical attention if they have suffered a significant injury, if the onset of back pain is accompanied by fever, if there is blood in the urine, if there is weight loss without a change in diet, if there is a history of cancer or back surgery, if the back pain is accompanied by numbness or tingling sensation in one or both legs, or loss of urinary or bowel control.

Diagnosis of low back pain requires a physical examination by your doctor. X-ray may also be done. A CAT scan or MRI is rarely required, unless a more serious cause is suspected.

Recovery from low back pain resulting from muscle strains or sprains to the spine usually take 2-6 weeks. If the pain continues to worsen, or persist beyond the expected time frame, further medical assessment will be required.

Preventing injuries to the lower back involves maintaining physical fitness, and the use of good body mechanics in lifting (hold weight close to the body, and lift with the legs).

Although it may at first seem unexpected, long periods of bed rest is not recommended in recovery from low back pain. Bed rest results in further muscle deconditioning which will make the back pain worse and slow recovery. Maintaining close to normal activity generally results in faster healing. Therapeutic back exercises prescribed by a healthcare practitioner, such as a physiotherapist, can be helpful both in recovery and in maintaining better low back strength in the future.

Recommended doses of non-prescription pain killers, such as acetaminophen or non-steroidal anti-inflammatories ,can be helpful for pain during the acute phase of low back pain.

Powerful prescribed pain killers are usually not required, or are used for a short period only under medical supervision.

Macronutrients

Professional body builders and Olympic athletes know that success depends on proper nutrition. Their diet is carefully constructed to obtain the right combination of nutrients to fuel their performance. By eating the right amount of macronutrients people can effectively fuel their muscle growth and improve muscle recovery to maximize their workouts.

Macronutrients are nutrients that are required in large amounts. Everything we consume not only contains nutrients, but also provides us with energy in the form of calories. The three macronutrients that we rely on for energy are carbohydrates, fat, and protein.

Carbohydrates are the body’s main source of energy and can be divided into two major types solely on the basis of how easily they are digested and how much fiber they are associated with. Complex carbohydrates offer a steady supply of energy and are often found in foods that are also rich in fiber such as pasta, rice, and oats; starchy vegetables such as corn, potatoes, and squash; and legumes including beans, peas, and lentils. Simple carbohydrates refer mostly to sugars which are easily digested by the body for energy, but are usually associate with little to no fiber. Common simple carbohydrates include glucose, sucrose in the form of white or brown sugar, and fructose found in fruit and fruit juices. Some simple carbohydrates are found naturally in foods that also contain vitamins such as in fruit and milk, whereas products with added refined sugar like candy and chocolate offer little nutritional value. To avoid fatigue, opt for complex carbohydrates for fuel instead of simple carbohydrates.

Fats are the second major source of energy for our body. They also help keep our skin and hair healthy. Although we can convert excess protein and carbohydrates into a type of fat used to store energy, certain fatty acids can only be obtained from our diet. The three major types of fats are saturated, unsaturated and trans-fats. Saturated fats can raise bad cholesterol levels in the blood and can be found in butter, milk, cheese, ice cream and fatty meats. Conversely, unsaturated fats aid in lowering bad cholesterol and can improve our overall heart health. Vegetable oils are a great source of unsaturated fats. However, when vegetable oil hardens through a process called hydrogenation, trans-fats are formed. These trans-fats are well known for their adverse effects on the heart and blood vessels and can commonly be found in margarine, frying fats, and packaged foods. Choose foods that contain natural plant oils as a source of fat.

Proteins are the body’s bricks and mortar. Without them, our bodies would not be able to build and maintain muscle. Foods rich in protein include chicken, beef, turkey, pork, eggs, nuts, and beans. Once consumed, proteins are broken down into individual building blocks called amino acids, which are then recycled either for energy or for building muscle and other tissues. There are 20 different amino acids, 11 of which can be synthesized by the body from scratch. The remaining 9 amino acids are known as essential amino acids, as they must be obtained from food or supplements

If your goal is to gain muscle mass or to lose weight then you will have to consider the type of macronutrients and the amount of calories you consume every day. Each macronutrient serves an important function in the body. However, excessive consumption of any macronutrient can potentially be unhealthy and contribute to obesity, heart disease, and other complications. Therefore, you may want to track how many grams of protein, carbohydrates, and fat you eat each day. Calorie-wise, carbohydrates and protein both provide 4 calories per gram, while fat provides 9 calories per gram. With this information you can monitor your macronutrients with your desired caloric intake. The general recommendation for daily caloric intake suggest that 50-70 percent come from carbohydrates, 10-35 percent come from proteins, and 20-30 percent come from fats. Depending on your goal, adjust your macronutrient ratio to align with your desired caloric intake and ensure you select the best sources for carbohydrates, protein, and fat.

Portion size

Obesity is on the rise in Canada and our eating habits are partly to blame. In 2014, roughly 5.3 million adult Canadians were classified as obese. Maintaining a healthy weight means paying attention to what you eat, how much you eat, and how much you exercise.

How much you eat during a meal is often referred to as the portion size. While the amount of food served may be influenced by different cultural norms, a portion size is considered how much food a person decides to put on their plate, how much is served to a you at a restaurant, or how much is included in ready-to-eat food products. In North America, the size of our portions has been steadily increasing despite a growing awareness of the health risks associated with overeating.

In North America, we live in a culture of overconsumption. When it comes to food, we are surrounded by large portion sizes, and as consumers we are attracted to value-size pricing, that is more for less. Our constant exposure to bigger portion sizes causes us to experience “portion distortion.” That is, we begin to perceive a larger portion size as a normal amount to eat in a single sitting.

In a 2002 study published in the American Journal of Clinical Nutrition, 51 men and women were offered different portion sizes for lunch. The larger the portion the participants were served, the more they ate. Interestingly, there were no differences in reported levels of hunger and fullness after the meal regardless of the portion size or the amount of food consumed. Based on this study, it seems the amount we eat is based more on the amount of food we see than on how hungry or full we are

Pay attention to how much food you eat. Consider the number of calories you need depending on your activity level and keep your portion sizes in line with this. Don’t put more food on your plate than you need. Consider also the energy density of the foods you eat. Opt for high fiber foods such as fruits and vegetables which may allow you to eat more without consuming too many calories.

Sore Throat

Sore throat is a scratchy painful sensation in the throat, often worse when swallowing.

Many things can cause a sore throat. Most fit into three groups: viruses, bacteria, and irritants.

The most common cause of a sore throat is a viral infection, usually the common cold. Other symptoms of a cold include nasal congestion and a cough. Influenza, or the flu, can also result in sore throat, but this is usually accompanied by fever, chills, muscle aches, and fatigue. Although less common, other viral infections can cause sore throat including Epstein-Barr virus, the cause of Mononucleosis (Mono), as well as HIV.

Bacterial infections at the back of the throat can also cause pain and discomfort. Streptococcus, or Strep throat, is the most common bacterial cause of sore throat.

Additional symptoms of Strep throat include fever, enlarged and tender lymph glands in the neck, and often white patches visible at the back of the throat or on the tonsils. Gonorrhea can also infect the throat which you can get if a guy has gonorrhea in his penis and you give him a blowjob.

Lastly, allergies or irritants can cause sore throat. For those with seasonal allergies, this may occur at certain times of the year. Heartburn or acid reflux from the stomach can also irritate the throat and cause pain or discomfort.

 

Treating a sore throat involves treating both the symptoms and, when possible, the cause. Gargling with saline (1/4 teaspoon of salt in a glass of warm water) and taking acetaminophen (Tylenol) can provide temporary relief of the soreness. If the sore throat is due to a viral infection antibiotics will be of no help and symptoms will resolve on their own over about 5-10 days.

If the sore throat is accompanied by fever, enlarged lymph glands in the neck, or difficulty swallowing, you should see a doctor. He or she will likely swab the back of your throat and send this to the laboratory to try and determine if and what kind of bacteria is causing your sore throat. Sore throats due to bacterial infections are usually treated with 10 days of an antibiotic.

Resistance Training

Resistance training is an important part of an overall fitness program. The benefits are well documented and research has consistently shown that it can counter some of the effects of aging as well as increase strength, size, power, and endurance.

However, identifying what constitutes an effective training program to maximize muscular adaptations has been a topic of debate for some time. Currently, there are a lot of misconceptions regarding resistance training.

One common misconception is that muscle turns into fat when you take a break from resistance training. A lot of people associate the decrease in muscle mass with an increase in body fat, giving the impression that your muscles turn into fat. However, muscle and fat are two entirely different tissues and one is not able to convert to the other. If you decide to take a break from resistance training, it is recommended that you adjust your caloric consumption to avoid any excess fat gain. 

Another misconception is that machines are more effective than free weights. This assumption stems from the idea that machines are specifically made to deliver ideal workouts and movements.  However, multiple studies have reported no significant difference in strength gains when comparing subjects that trained with free weights and those that trained with machines (Fisher, Steele, Bruce-Low, & Smith, 2011). Both options will help you reach your goal.

It is commonly believed that lifting heavy weights is the only way to stimulate muscle growth. Many authors claim that in order to recruit the higher threshold motor units (type II fast-twitch muscle fibers), you need to train with a maximal or near maximal resistance load. However, a study conducted by Carpinelli (2008) pointed out that this principle is not quite true. The higher threshold motor units can still be recruited if you perform an exercise at a lighter resistance as long as you keep the repetition duration constant throughout the workout. As you approach temporary muscle fatigue during the repetitions, the lower threshold motor units (type I slow-twitch muscle fibers) will begin to tire and will recruit the larger motor units to complete the set.

Muscle and fat are not interchangeable. If you want to avoid excess fat gain when taking a break from the gym, adjust your food intake to match your reduced physical activity level. For those looking to activate all their muscle fibers, it is theoretically better to lift lighter weights (regardless of the resistance type) and train until momentary muscle fatigue. Recommendations to train with heavier weights in the 1-5 rep range because this results in greater strength gains lack strong supporting evidence.

Vaccinations

VaccineRecommendedDisease PreventionNumber of injectionsCost
Hepatitis AYesHepatitis A is a virus that infects and can damage your liver. 2 injections given 6 months apartVaccine is available at Public
Health clinics free for men who
have sex with men in Ontario.
Hepatitis BYesHepatitis B is a virus that infects and can damage your liver.3 injections.
- 2nd injection is given 1 month after the first
- 3rd injection is given 6 months after the first.
Vaccine is available at Public Health clinics free for men who have sex with men in Ontario
HPV
Gardasil-9
YesGaradasil-9 protects against 9 strains of the HPV virus. HPV causes genital warts and is associated with cancers of the mouth and throat, the penis, and the anus3 injections.
- 2nd injection is given 2 months after the first
- 3rd injection is given 6 months after the first.
- Free for men who have sex with men in Ontario aged 26 and under.
- For men over age 26, the cost is $540 which may be covered by some insurance plans
Annual InfluenzaYesInfluenza causes fever, muscle aches, headache and cough. 1 injection every year, usually in late fallFree in Ontario
Tetanus and diphtheriaYesTetanus, also called “lock-jaw”, causes life-threatening muscle spasms.
Diphtheria causes a severe throat infection that can make breathing difficult.
1 injection every 10 yearsFree in Ontario