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Alcohol consumption by Dr. Zach, ER physician

BT Montreal | posted Tuesday, Jan 8th, 2019

What is one drink?

A 341-ml (12 oz) beer or cooler with 5 per cent alcohol

A 142-ml (5oz) glass of wine (12% alcohol)

A 43-ml (1.5oz) glass of liquor (rye, gin, rum, vodka) – 40% alcohol


Recommended maximum alcohol intake:

10 drinks a week for women, with no more than 2 drinks a day most days

15 drinks a week for men, with no more than 3 drinks a day most days

Plan non-drinking days every week to avoid developing a habit.

Special occasions:

Reduce your risk of injury and harm by drinking no more than 3 drinks (for women)

or 4 drinks (for men) on any single occasion.

Plan to drink in a safe environment.


-Canada low risk drinking guidelines from canadian centre on substance abuse and addiction


Harms associated with alcohol:

When you drink alcohol, you may be putting your health and safety at risk. Your risk of harm increases with each drink that you have. And your risk of harm increases with how often you drink at amounts above the low-risk drinking guidelines, even if you do this only now and then.

Drinking alcohol may:

  • Harm your liver, pancreas, nervous system, heart, and brain.
  • Cause high blood pressure, depression, stomach problems, or sexual problems.
  • Contribute to the development of some cancers, such as cancers of the mouth, throat, esophagus, liver, colon, and breast.
  • Cause memory loss and affect your ability to think, learn, and reason.
  • Cause harm to your developing baby (fetus) if you drink during pregnancy.
  • Lead to problems at work, school, or home.
  • Increase the risk of car crashes and violent behaviour.
  • Cause you to develop an alcohol use problem.

Drinking more alcohol increases such dangers as alcoholism, high blood pressure, obesity, stroke, breast cancer, suicide and accidents.

Also, it’s not possible to predict in which people alcoholism will become a problem.

Drinking too much alcohol can raise the levels of some fats in the blood (triglycerides).

It can also lead to high blood pressure, heart failure and an increased calorie intake. (Consuming too many calories can lead to obesity and a higher risk of developing diabetes, heart attack and stroke.)

Excessive drinking and binge drinking can lead to stroke. Other serious problems include fetal alcohol syndrome, cardiomyopathy, cardiac arrhythmia and sudden cardiac death.


People who drink excessive amounts of alcohol — more than seven drinks per week for women or people older than 65 and more than 14 drinks per week for men younger than 65 — are at higher risk of death and many medical conditions.   Excessive alcohol use is the third-leading cause of preventable death in the United States, according to the U.S. National Institute on Alcohol Abuse and Alcoholism. People who drink unhealthy amounts of alcohol are more likely to have high blood pressure, heart disease, liver disease, nerve damage, infections including pneumonia and even certain cancers like breast cancer.  Drinking excessive amounts of alcohol is also associated with a number of psychiatric conditions, including depression, higher rates of suicide, anxiety, post-traumatic stress disorder, eating disorders, insomnia and other substance abuse disorders.


The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours.4 Most people who binge drink are not alcohol dependent.


Binge drinking is associated with many health problems,8–10 including the following:

  • Unintentional injuries such as car crashes, falls, burns, and alcohol poisoning.
  • Violence including homicide, suicide, intimate partner violence, and sexual assault.
  • Sexually transmitted diseases.
  • Unintended pregnancy and poor pregnancy outcomes, including miscarriage and stillbirth.
  • Fetal alcohol spectrum disorders.
  • Sudden infant death syndrome.
  • Chronic diseases such as high blood pressure, stroke, heart disease, and liver disease.
  • Cancer of the breast, mouth, throat, esophagus, liver, and colon.
  • Memory and learning problems.
  • Alcohol dependence.

Havcing said all that, most alcoholic liver disease develops in peopl ewho drink daily as opposed to binging one of 2 nights a week.


Health benefits of drinking alcohol?

Some research suggests that having 1 drink a day may help lower the risk of heart disease and diabetes in middle-aged adults. But these possible health benefits decline with each additional drink that you have. Research also shows that any amount of alcohol can increase your risk of other health problems, such as some cancers.

If you don’t drink now, don’t start drinking to lower your risk of these health problems. There are many other ways you can lower your risk, such as eating a healthy diet, exercising, staying at a healthy weight, and not smoking. Talk to your doctor about your health and the benefits and risks of drinking alcohol.


What about red wine and heart disease?

Over the past several decades, many studies have been published in science journals about how drinking alcohol may be associated with reduced mortality due to heart disease in some populations.

Some researchers have suggested that the benefit may be due to wine, especially red wine. Others are examining the potential benefits of components in red wine such as flavonoids and other antioxidants in reducing heart disease risk. Some of these components may be found in other foods such as grapes or red grape juice. The linkage reported in many of these studies may be due to other lifestyle factors rather than alcohol. Such factors may include increased physical activity, and a diet high in fruits and vegetables and lower in saturated fats No direct comparison trials have been done to determine the specific effect of wine or other alcohol on the risk of developing heart disease or stroke.

Are there potential benefits of drinking wine or other alcoholic beverages?

Research is being done to find out what the apparent benefits of drinking wine or alcohol in some populations may be due to, including the role of antioxidants, an increase in HDL (“good”) cholesterol or anti-clotting properties. Clinical trials of other antioxidants such as vitamin E have not shown any cardio-protective effect. Also, even if they were protective, antioxidants can be obtained from many fruits and vegetables, including red grape juice.

The best-known effect of alcohol is a small increase in HDL cholesterol. However, regular physical activity is another effective way to raise HDL cholesterol, and niacin can be prescribed to raise it to a greater degree. Alcohol or some substances such as resveratrol found in alcoholic beverages may prevent platelets in the blood from sticking together. That may reduce clot formation and reduce the risk of heart attack or stroke. (Aspirin may help reduce blood clotting in a similar way.) How alcohol or wine affects cardiovascular risk merits further research, but right now the American Heart Association does not recommend drinking wine or any other form of alcohol to gain these potential benefits.

The AHA does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and lowering high blood pressure, controlling your weight, getting enough physical activity and following a healthy diet.

There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures.


Drinking a glass of wine is good for the heart in the sense that the main mechanism by which alcohol protects the heart is increasing good cholesterol.  The grape skin provides flavonoids and other antioxidant substances that protect the heart and vessels from the damaging effects of free oxygen radicals produced by our body.  This is particularly true for diabetics because they have been shown to have a high production of free oxygen radicals. But we don’t have any evidence specifically related to diabetes patients.

A glass of wine can also help individuals relax.  The strongest evidence is in favor of wine, but some evidence recently showed beer and other types of alcohol may provide the same benefits related to increasing good cholesterol (HDL).

In general, alcohol does not seem to have an adverse effect, unless an excessive amount is used — and it increases calories, among other things.  For example, excessive amounts of alcoholic consumption could be harmful by increasing the risk of high blood pressure, for which diabetic patients are already at high risk.


What problems does alcohol bring to the ER?

Violence, motor vehicle accidents, other injuries, heart problems, liver disease including liver failure requiring transplant.


How do I know if I have a problem?

CAGE questionnaire:

Have you ever felt you should Cut down on your drinking?

  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt bad or Guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?


Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant.

Other questions to detect a potential problem:

  • Had times when you ended up drinking more, or longer, than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Spent a lot of time drinking? Or being sick or getting over other after effects?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there


Dry January is a public health campaign urging people to abstain from alcohol for the month of January, particularly practised in the United Kingdom.

The campaign, as a formal entity, appears to be relatively recent, being described as having “sprung up in recent years” even in 2014.[1] However, the Finnish government had launched a campaign called “Sober January” in 1942 as part of its war effort.[2] The term “Dry January” was registered as a trademark by the charity Alcohol Concern in mid-2014;[3] the first ever Dry January campaign by Alcohol Concern occurred in January 2013.[4] In the leadup to the January 2015 campaign, for the first time Alcohol Concern partnered with Public Health England.[5]

In January 2014 according to Alcohol Concern, which initiated the campaign,[when?] over 17,000 Britons stopped drinking for that month.[6] While there is controversy as to the efficacy and benefits of the practice, a 2014 survey by the University of Sussex found that six months following January 2014, out of 900 surveyed participants in the custom, 72% had “kept harmful drinking episodes down” and 4% were still not drinking.[7]

Thirty-one days of sobriety might even help you cut back long-term: A 2016 study published in Health Psychology found that six months after the end of Dry January, people who had participated in the movement (even those who didn’t abstain for the entire month) reported having fewer drinks per day, drinking fewer days a week, and getting drunk less often.


Benefits of cutting out alcohol:

Weight loss

Deeper sleep

Immune system not suppressed

Better skin

The University of Sussex reported that 2015 Dry January participants in the United Kingdom also had several other benefits: 82 percent felt a sense of achievement, 79 percent saved money, 62 percent had better sleep, 62 percent had more energy and 49 percent lost weight.

Staying dry for January may also help jump-start people to give up alcohol for longer.

Although most people who participate in Dry January return to drinking, up to 8 percent stay dry six months later, according to Public Health England and the British Medical Journal.

And those who go back to drinking drink less. A 2015 study conducted in the United Kingdom and published in the journal Health Psychology found that people who participated in Dry January drank less often, had fewer drinks when they did drink and were drunk less often six months after Dry January was completed.

Dry January participants were also better able to refuse alcoholic drinks. These benefits were even seen in people who did not complete the whole month of Dry January


Should I have a Dry January?  

There is no harm in doing it (if you are dependent on alcohol then you should not stop all of a sudden; best to do it under guidance from a physician).  If you think you may have a problem, or it’s effecting your life in a negative way, then go for it. It may help you.

Safer drinking tips:


Set limits for yourself and stick to them.

Drink slowly.

Have no more than 2 drinks in any 3 hours.

For every drink of alcohol, have one non-alcoholic drink.

Eat before and while you are drinking.

Always consider your age, body weight and health problems that might suggest lower limits.

While drinking may provide health benefits for certain groups of people,

do not start to drink or increase your drinking for health benefits.

Kathleen-Approved “Systems” for Surviving the Holidays

BT Montreal | posted Tuesday, Dec 18th, 2018

Set up systems NOW that will save you from your FUTURE holiday-season self.

The holidays are a minefield for our health — we know this!

Instead of thinking “this year will be different” — without outlining the plan to make it different — only to wake up January 1st feeling unfit and energetically low, work to set up systems NOW to save you from your future less-disciplined self.

Create your strategy NOW!  Decide — in advance — which of my tips you will use!

For example, if you know that you make bad choices when you get overly hungry, never go to an event hungry. Always have food (like almonds) on you; grab a few before walking into a work event. That way you will not “have to” grab a cookie out of hunger.

Basically, ditch willpower. Change THE SYSTEM!!!!




Make it simple — the power of 3

Making healthy food choices can feel all-too confusing, and when overwhelmed it is easy to say “screw it” and fall completely off the wagon

The “simple” (but not always easy) system I follow is the “rule of 3.” I save my cognitive energy by telling myself that every meal has to have a protein, a vegetable or fruit high in vitamins and minerals (green leafy vegetables or berries), and a healthy fat. Once I eat those three things I don’t have room for any of the less-healthy stuff!


It is not just about what you eat — it is about what you DRINK!

Commit to being aware of your liquids this season. Many of us are aware of food, but fairly airy-fairy about liquids. Liquids count — they contain calories and, more important, impact our blood sugar, which effects our hormones and fat production.

Stay hydrated, watch your caffeine (and what you add to your coffee), avoid sugary liquids filled with empty calories, AND always be aware of how much alcohol you are drinking.

Before every work event, party, etc. decide in advance how much alcohol you will consume and what your plan is. Tell a friend or write it down if you need accountability. Decide … will you have a glass of water between each alcoholic drink? Or will you combine fizzy water with wine to make one glass of wine stretch into 3 drinks? Or will you sip a vodka-soda so you stay away from the carbs in beer? Or will you go wild and crazy an have weeks where you skip drinking altogether?

Carry a water bottle. Set an alarm at work to remind yourself to drink water. Too often we misunderstand dehydration as hunger. Make yourself have a set amount of water before you get your morning coffee.


Ask yourself, “How can I make this meal a little bit better??”

You don’t have to make each meal perfect, you just have to make it slightly better than originally planned.

Decide that no matter what — no matter where you are — you will attempt to make each meal even slightly better.

So, if you were going to have four servings of pasta, have three servings and some green vegetables. If you were going to have three eggs, bacon, and white bread, have two eggs, bacon, and one piece of seed-filled bread. “Eating well” exists on a continuum. Instead of labeling foods as “bad” and “good,” shoot to trend positive. Work to get to the next stage of your eating continuum.



Make your “base” healthy

Sure, indulge on your grandmother’s famous maple mashed sweet potatoes, but don’t make “indulging” your norm. When you are not at parties or events, commit to making your “base” meals as healthy as possible. If you are going to something in the evening, have a really healthy breakfast and lunch and go to the gym. Then mindfully consume only foods you enjoy at the event.

“Holiday heath perfection” is not a productive goal — it is not possible and thus simply sets you up for failure. What is possible is consistency of healthy habits during your daily life — optimizing your “base” nutrition. It is not the occasional deviations from the plan that matter — what matters are the choices you make on a daily basis, how intensely you deviate from your norms when you do deviate, AND how quickly you course correct. Deviations are not the end, they are part of the process.


Commit to the “love it” rule

Commit to only indulging with foods you LOVE. Don’t mindlessly eat. Go ahead and mindfully enjoy a small portion of something you love. I call this my “love it” rule. Love your mom’s apple pie? Have a small piece. Don’t mindlessly eat chips full of preservatives in front of the TV. Always be aware enough to know what you are eating so you can say no to things you don’t LOVE and then enjoy moderate portions of what you do LOVE.


BE AWARE — “awareness brings choice.” Commit to NO mindless eating

Always take a pause before you eat anything so that you know you are not simply mindlessly stuffing your face.

Sit when you eat.

Don’t mindlessly pick off of someone else’s plate.

DON’T eat as you cook — chew gum if that helps you not nosh.

Put your fork down between bites.

Consider journaling or tracking your food.  Most of us underestimate our unhealthy choices and overestimate our healthy choices.


Portions. Portions. Portions

Portions count! This season commit to being mindful of portions. Sure, have a slice of apple pie but have ONE not three.

Counting exact portions can be overwhelming and tedious, but you need a rough awareness of the amount of any one food you are eating. One cookie is not the same as five. Half a cup of pasta is not the same as four cups.

Think of a portion of healthy fat as the size of your thumb, protein as your palm, veggies as your fist, and carbs as your cupped hand.


Read menus in advance

Before your go to a restaurant, look online and decide in advance what you will eat. Chicken and vegetables? A big salad? Then when you arrive don’t even look at the menu, just order what you had previously decided on. Also, consider telling the waiter to only bring half and to have the other half packed up for tomorrow’s healthy lunch.


Always offer to bring something healthy

When I go to a party I always offer to bring a dish I want to eat — a big salad or steamed greens, etc. That way I know there will always be at least one healthy option.


Final thoughts

When you fall of your health horse—– you will; you are human — try not to let yourself “spiral” — one cookie or one drink is not the same as five cookies or five drinks. Ask yourself, “Did I enjoy the treat and have a moderate amount?” If the answer is yes, great. We all need a few treats. If the answer is no, work to understand why the fall happened — were you too hungry? dehydrated? feeling sad? — AND get right back on your health plan!


Enjoy the holidays and be merry. Don’t deprive yourself. Just be smart.

Winter health tips by Dr. Zach, ER Physician

BT Montreal | posted Thursday, Nov 22nd, 2018

Colds and Flu: Why viruses more in winter — more time indoors sharing air, viruses prefer dryer air

Cold: caused by a virus, one of several

Runny nose, cough, congestion, low grade fever, sore throat

Not caused by being cold (maybe predispose via cold vasoconstricted dry mucus membranes)


Flu: caused by influenza virus

Symptoms include fever, headache, muscle aches, extreme fatigue, sore throat, runny
nose, cough and nasal congestion. Occasionally, stomach symptoms such as nausea,
vomiting, diarrhea and abdominal pain are present.

What are complications associated with flu?
Complications caused by influenza include pneumonia and dehydration, and
worsening of chronic medical conditions such as chronic lung or heart diseases. Children
may develop sinus problems or ear infections.

How is influenza spread?
Influenza is spread from person to person by direct contact with airborne particles or large
droplets from the respiratory tract of the infected person when coughing, sneezing, or
talking. Transmission can also occur through articles recently contaminated by secretions
from the nose and throat of the infected person. Handwashing and avoiding or limiting
contact with an infected person may reduce the risk of infection.

How soon do symptoms appear?
Symptoms of influenza usually appear 1-4 days after exposure.

Virus shedding (contagiousness) begins day before symptoms appear and lasts 5-7 days.  Most infective on 2nd and 3rd days after infection. Correlated with fever. (re shedding – shouldn’t go to work)

Every year 10-25% of canadians get flu and 500-1500 die from it

Virus lives longer with low humidity and lack of sunlight.  15 min on tissues, 5 min on skin, 1-2 days on plastic or metal.  Mucus protects (up to 17 days on banknotes!)

Get the shot!  Safe for pregnant and breastfeeding women

Influenza can occur throughout the year, but seasonally peaks from December to March.

See doc if short of breath, chest pain, drowsy, neck stiff, fever in infant less than 3 months, not urinating


Tamiflu/oseltamivir:  Best if given within 48hrs.  Lessens symptoms and shortens illness 1-2 days.  Can be used as prophylaxis if exposed.

Give to ppl with chronic dz (lung dz, cancer, liver dz, kidney dz, dm, smokers, 65+)

Kids can take it but not necessary unless have health problems

Remember you can infect others, even if you take meds and feel better

Prevention with hand washing, cough into bend of elbow


Flu shot (shot is dead virus, nasal is live weakened, only for ages 2-59):  everyone 6 months and older can get. takes 2 weeks to gain immunity. Can get if chicken egg allergy unless severe — if worried, 1/10th the dose and observe 30 min before giving the rest.

Some people get soreness, or mild flulike sx.

Caregivers should get it.




From the QC government website:

In QC this year the flu vaccine is recommended and offered free of charge to people who are at higher risk of complications:

  • Children from 6 months to 17 years old who have certain chronic diseases (flushot not given before 6 months)
  • Pregnant women, in the 2nd and 3rd trimesters of their pregnancy
  • Adults who have certain chronic diseases (including pregnant women regardless the stage of pregnancy)
  • People aged 75 and over.

To reduce the risk of contamination, the flu vaccine is also offered free of charge to:

  • Family members who live in the same household of a child under 6 months of age or a person at higher risk of being hospitalized and to their caregivers
  • Health care workers

Flu vaccination is also free of charge to:

  • Healthy children from 6 to 23 months old
  • Healthy people from 60 to 74 years old (and 75 and over)

Chronic Diseases Recognized Under the Program

The flu vaccine is offered free of charge to people who have any of the chronic diseases listed below because their disease makes them more susceptible to complications from the flu.

  • Chronic cardiac or pulmonary disorders severe enough to require regular medical attention or hospital care, including the following:
    • Bronchopulmonary dysplasia
    • Cystic fibrosis
    • Chronic obstructive pulmonary disease (COPD)
    • Emphysema
    • Asthma
  • Chronic conditions such as:
    • Diabetes or other chronic metabolic disorders
    • Liver problems, including cirrhosis
    • Kidney problems
    • Blood disorders, including hemoglobinopathy
    • Cancer
    • Immunodeficiencies, including HIV infection
    • Immunosuppression caused by radiotherapy, chemotherapy and anti-rejection drugs
  • Medical conditions that may affect the ability to expel respiratory secretions and the ability to swallow, including the following:
    • Cognitive disorder
    • Spinal cord injury
    • Convulsive disorder
    • Neuromuscular disorders
    • Morbid obesity

If you are not eligible for the free vaccine, you can still get vaccinated. Since the fee may vary, contact the vaccination clinic of your choice (CLSC, medical clinic or pharmacy) to find out how much it will cost.

Where to get the flu vaccine in QC:   https://www.quebec.ca/en/health/advice-and-prevention/vaccination/flu-vaccination-program/procedure/


Heart attacks: increase in winter

5-30% increase in heart related deaths in winter, up to 50% more MI’s in winter

Cold temperature causes vasoconstriction so increased bp.  Also blood clots easier in


From the cold, shoveling

Emotional stress, weight gain, little exercise, more salt

Binge drinking is associated with atrial fibrillation, a common cardiac arrhythmia

Know the symptoms


Recommend Vitamin D (800iu/d) supplementation especially in winter, and calcium (1000mg, 1200 if >50yo)


-Bones and teeth

-Immune system

-Diabetes control

-Cardiovascular health

-Help prevent cancer — There is evidence that vitamin D may reduce the risk of some types of cancer, particularly colorectal and breast cancers.


Read more: http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/eat-well/should-i-take-a-vitamin-d-supplement/?region=on#ixzz5X1bvapy

SAD: seasonal affective disorder — decrease in sunlight

Major depressive disorder with seasonal pattern; usually worse in winter.  SAD’s prevalence in the U.S. ranges from 1.4% in Florida to 9.9% in Alaska.[

Light therapy, medications, therapy

Light therapy (10000 lux, little uv as possible (damaging to skin and eyes), 20-30min

soon after waking, eyes open but not looking directly)

Frostbite: An injury to the body caused by freezing.  It most commonly affects areas that are extremities and that are uncovered, such as the nose, ears, cheeks, fingers, and toes, especially in those with reduced blood circulation.  If recognized early, frostbite can be mild, but if left untreated it can lead to severe damage or loss of the frostbitten body part.


Signs of frostbite include a white or gray skin colour, numbness, and firmness or waxiness of the skin.  It is wise to warm or cover any area that begins to feel painful or turn red in the cold because once frostbite sets in the area may be numb and more damage may result without you feeling it.

Tips: get warm, do not walk on frostbitten toes, put the frostbitten part into warm water or warm the area with body heat.  Be careful not to burn the affected area which may well be numb.

As always, prevention is better than treatment.  Dress properly, cover your skin in the cold.



Dress like it’s cold out, not like you’re going from a heated house to a heated car to a heated work.

Abnormally low body temperature — 35C or less.  very cold temperatures, or less cold temperatures if not well dressed or wet.  very old and very young especially susceptible.

Warning signs of hypothermia include shivering, exhaustion, confusion, incoordination, memory loss, and slurred speech.  In infants you might note very low energy and bright red, cold skin.

Patients with mild hypothermia demonstrate tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and so-called “cold diuresis.”

  • Moderate hypothermia is characterized by proportionate reductions in pulse rate and cardiac output, hypoventilation, central nervous system depression, hyporeflexia, decreased renal blood flow, and loss of shivering. Paradoxical undressing may be observed. Atrial fibrillation, junctional bradycardia, and other arrhythmias can occur.
  • Severe hypothermia can lead to pulmonary edema, oliguria, areflexia, coma, hypotension, bradycardia, ventricular arrhythmias (including ventricular fibrillation), and asystole

Get warm, get help if bad. To warm place, remove wet clothing, and warm the person, such as in a warm blanket.  Warm beverages can help the person to warm up as well.

Dress warm, wear layers

Careful about falls

Shovel, salt, stay active for muscles & balance, slow down, shoes with traction, bring a phone/have a plan for falls

Dr. Zach on Sexually Transmitted Infections (STIs)

BT Montreal | posted Wednesday, Nov 7th, 2018

STI’s (sexually transmitted infections) formerly known as STD’s (sexually transmitted diseases)

more info: www.drzach.ca

Rates of sexually transmitted infections are continuing to rise across Canada

In general, all the sexually transmitted infections have been increasing in the last 20 years.

Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year in the United States, the Centers for Disease Control and Prevention announced August 28/18 at the National STD Prevention Conference in Washington.

Last year, nearly 2.3 million US cases of these sexually transmitted diseases were diagnosed, according to preliminary data.

That’s the highest number ever reported nationwide, breaking the record set in 2016 by more than 200,000 cases, according to the CDC.

The growth of dating apps is one suspected culprit.  It’s easier to find sex and easier to find anonymous sex than it was before.

More people appear to be having condomless sex, including those in the gay community, who once were at the vanguard of safe-sex campaigns in response to the HIV-AIDS epidemic.

But with HIV treatment being really so effective now that it’s essentially a chronic disease, the concern around contracting HIV has really decreased a lot and that potentially is diving the reduction in condom use.

The majority of cases are diagnosed in the under-30 age group and many of them are diagnosed at university or college sexual health clinics but there has been increasing prevalence in older adults (https://www.aarp.org/health/conditions-treatments/info-2017/std-exposure-rises-older-adults-fd.html)

With young girls and many boys in Canada being vaccinated against human papillomavirus — a major cause of cervical cancer — and changes to guidelines advising that lower-risk women be tested less often for that malignancy than previously recommended, there is likely less screening for gonorrhea and chlamydia. Such STI testing was often performed at the same time as a Pap smear.

Nationally, statistics confirm bacterial STIs are on an upward trajectory in jurisdictions across the country.

In 2015, the latest year for which national figures are available, there were almost 116,500 cases of chlamydia, the most commonly reported STI in Canada, with females accounting for two-thirds of infections, says the Public Health Agency of Canada (PHAC). Between 2010 and 2015, chlamydia rates increased by almost 17 per cent.

Gonorrhea is the second most commonly reported STI in the country. About 19,845 cases were recorded in 2015, a jump of more than 65 per cent from 2010. Males had higher rates than females, with the highest number of cases among those aged 15 to 29, PHAC says.

From 2010 to 2015, the rate of infectious syphilis in Canada increased by almost 86 per cent. In 2015, a total of 3,321 cases were reported, with nearly 94 per cent occurring among males; those aged 20 to 39 had the highest rates and men who have sex with men were among those at most risk.

While the three STIs can be successfully cured with antibiotics, untreated chlamydia and gonorrhea can lead to pelvic inflammatory disease in females, affecting fertility. Untreated, syphilis can cause damage to the brain, nerves, eyes, cardiovascular system, bones and joints. In extreme cases, it can be fatal.

There is a rare strain of gonorrhea that is resistant to standard antibiotics.  There was one case in Quebec last year.

Condom use is among the best ways to protect against infection.


Information about condoms: https://www.canada.ca/en/public-health/services/sexual-health/safer-condom-use.html

Information about gonorrhea:


Information about chlamydia:


Information about syphilis:


Information on Lymphogranuloma venereum:


Information about genital herpes:


Information about human papillomavirus:


Information about HIV-AIDS:


Hepatitis B virus (HBV) is a virus that causes inflammation of the liver. Most people do not think of hepatitis as a sexually transmitted infection; however, one of the more common modes of the spread of viral hepatitis B is through intimate sexual contact.

Hepatitis B (HBV) is 50 to 100 times easier to transmit sexually than HIV ( the virus that causes AIDS). HBV has been found in vaginal secretions, saliva, and semen. Oral sex and especially anal sex, whether it occurs in a heterosexual or homosexual context, are possible ways of transmitting the virus.

Hepatitis B is a sexually transmitted disease, but it is spread in other ways, too. This is a hardy virus that can exist on almost any surface for up to one month. You can get infected through contact with an infected person’s blood or body fluids.

Hepatitis C (HCV) is spread through contact with an infected person’s blood — which may be present because of genital sores or cuts or menstruation.HCV has been detected with greater-than-average frequency among people who have a history of sexual promiscuity — which can be defined as a history of a sexually transmitted disease, sex with a prostitute, more than five sexual partners per year, or a combination of these. A person who is in a long-term monogamous relationship with an HCV-infected person rarely contracts this virus. Only approximately 2% of sexual partners of HCV-infected people also test positive for HCV.

In Quebec HPV vaccine is offered to grade 4 students free of charge, both girls and boys.  2 doses (need 3 doses after age 18)

Halloween & Sugar, by Dr. Zach, ER Physician

BT Montreal | posted Wednesday, Oct 24th, 2018

more info: www.drzach.ca 


  1. Sugar is pleasurable and somewhat addictive.
  2. Sugar is bad for us, specifically refined sugar and especially high fructose corn syrup (glucose-fructose in Canada).
  • Better with fibre.  Juice is not our friend.
  1. Ways sugar harms us.
  2. Recommended amount of sugar intake
  3. Ways to limit sugar
  4. Ways to limit sugar this Halloween


The advice used to be cut fat for health

For years the conventional wisdom was that we should cut down on fat and cholesterol in order to lose weight and decrease our risk of heart attack and stroke. Part of the problem, it seems, is that in cutting fat people increased their consumption of sugar.  And there are better (polyunsaturated) and worse (saturated, trans) fats.

Sugar is pleasurable to consume and enhances appetite.

(debatable if addictive — Sugar activates the reward center in our brain much the same way that drugs do, and provokes similar cravings and ??withdrawal symptoms.  (Studies done in rats. Sugar is more psychologically addictive than physical)


Sugar, and especially HFCS (high fructose corn syrup), may be as unhealthy as fat and salt, and may be associated with the metabolic syndrome of obesity, diabetes, high blood pressure, and high cholesterol.

High-fructose corn syrup (called glucose-fructose in Canada) is made from corn. After it’s milled, the resulting starch is processed into a syrup. By adding enzymes, the syrup is converted into fructose. Glucose syrup is then added to the mix to make high-fructose corn syrup. The most common form of the syrup contains 45 per cent glucose and 55 per cent fructose.

Corn is abundant in North America, which helps make high-fructose corn syrup a cheaper alternative. It’s sweeter than sugar and helps extend the shelf life of processed foods. It’s also easier to blend and transport because it’s a liquid.

As a mixture, its chemical composition differs from sucrose, and some say that’s critical in its effect on the human body. Critics suggest there’s a link between the increased use of high-fructose corn syrup and a growing North American diabetes and obesity epidemic.

Sucrose comes from sugar cane and sugar beets and is our table sugar.  It consists of glucose and fructose.  Fructose is of concern because it is broken down only by the liver and can cause fatty liver.  It is broken down into components including uric acid, which may be associated with gout and increased blood pressure, and triglycerides, which are a form of bad cholesterol.  There is concern that fructose, and especially high fructose corn syrup, causes weight gain, diabetes, high blood pressure, increased cholesterol, and fatty liver.

While it is true that sugar is found naturally in many foods such as fruits, these also contain fiber, which makes us satiated, so we don’t eat as much, and which slows the absorption of sugar.

In March, 2015 the World Health Organization presented the following new guideline:  “In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake. A further reduction to below 5% of total energy intake would provide additional health benefits.”  Free sugar refers to sugar that is added to food, as opposed to the natural sugar that exists in fruits and vegetables, which are not as unhealthy.   The WHO says that limiting your sugar intake will decrease your risk of obesity, which is associated with heart attack, stroke, and certain cancers, and dental cavities.

The amount of calories that are recommended per day depend on one’s age and gender (here is a guide — http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/1_1_1-eng.php).  An average adult male should take in about 2500 calories per day, and an average woman about 2000 calories.  10% of 2000 is 200 calories, which is about 50g of sugar/day.  A single can of soda contains about 39g of free sugar, approaching the 10% recommendation for an entire day.

Added sugar is in many foods, juice is not healthy

While most people realize that there is free sugar in soft drinks, candies, cakes, and cookies, many don’t realize that there is added sugar in such foods as bread, pizza, salad dressing, yoghurt, and ketchup.  Also, even though the sugar in fruit is ok, that in fruit juice or punch is not because it is ingested without the benefit of the other components of fruit, especially the fibre. Fibre slows down the absorption of sugar and thereby decreases the unhealthy spikes in our blood glucose levels.  Moderation seems like the best policy at this time, and we should make an effort to consume less artificially sweetened foods such as soft drinks and get more of our sweetness from fruit.

Check the labels of what you are purchasing, and remember to remain physically active, which improves blood sugar levels and helps maintain a healthy weight.  Also choose brown rice bread pasta less shooting up of blood sugar.

In the U.K.and U.S., the amount of added sugar is on food labels.  In Canada the total amount of sugar is listed, which is a combination of naturally occurring and added sugar.


Fats are more filling than carbs

Fat contains 9 cals/g

Protein and carbs contains 4 cals/g

As far as wt is concerned a calorie is a calorie

But trans fat increases weight gain dm2 heart dz


1 calorie is the amount of energy or heat it takes to raise the temp of 1g of water by 1 degree celcius (=4.184 joules)

For food it’s kilocalories so

Fat is how extra energy is stored


Negative effects of too much sugar on the body (this is depressing, literally and otherwise):


  • Cavities
  • Obesity — which leads to increased risk for diabetes, heart disease, multiple cancers (endometrial, esophageal, gastric, liver, kidney, multiple myeloma, meningioma, pancreatic, colorectal, gallbladder, breast, ovarian, thyroid)
  • glucose spikes cause inflammation, associated with heart disease
  • possibly depression
  • Skin aging
  • Cell aging
  • Energy crash (after initial spike)
  • Fatty liver
  • Kidney disease
  • Gout

It may negatively effect memory and brain function

Insulin resistance — While eating sugar by itself does not cause insulin resistance, foods with sugar and fat can contribute to weight gain, thereby reducing insulin sensitivity in the body.

Worse memory — Although the brain needs glucose, too much of this energy source can be a bad thing. A 2012 study in animals by researchers at the University of California at Los Angeles indicated a positive relationship between the consumption of fructose, another form of sugar, and the aging of cells, while a 2009 study, also using an animal model, conducted by a team of scientists at the University of Montreal and Boston College, linked excess glucose consumption to memory and cognitive deficiencies.

Too much sugar can lead to obesity, insulin resistance and inflammation, all of which are risk factors for cancer and are linked to an increased risk of dying from heart disease.

A diet rich in added sugar and processed foods may increase depression risk in both men and women.

Sugary foods can increase the production of AGEs , which can accelerate skin aging and wrinkle formation.

Advanced glycation end products (AGEs) are compounds formed by reactions between sugar and protein in your body. They are suspected to play a key role in skin aging

Eating too much sugar can accelerate the shortening of telomeres, which increases cellular aging.


High-sugar foods can negatively impact your energy levels by causing a spike in blood sugar followed by a crash.


Eating too much sugar may lead to NAFLD (non-alcoholic fatty liver disease), a condition in which excessive fat builds up in the liver.

Eating too much sugar may lead to NAFLD, a condition in which excessive fat builds up in the liver.


Having consistently high blood sugar levels can cause damage to the delicate blood vessels in your kidneys. This can lead to an increased risk of kidney disease

Negatively impact dental health: Eating too much sugar can cause cavities. Bacteria in your mouth feed on sugar and release acid byproducts, which cause tooth demineralization.

Increase the risk of developing gout: Gout is an inflammatory condition characterized by pain in the joints. Added sugars raise uric acid levels in the blood, increasing the risk of developing or worsening gout.Accelerate cognitive decline: High-sugar diets can lead to impaired memory and have been linked to an increased risk of dementia.

How to reduce sugar intake in general (overall message is to keep sugar consumption in mind)

Although consuming small amounts now and then is perfectly healthy, you should try to cut back on sugar whenever possible.

Focusing on eating whole, unprocessed foods automatically decreases the amount of sugar in your diet.

Here are some tips on how to reduce your intake of added sugars:

  • Swap sodas, energy drinks, juices and sweetened teas for water or unsweetened
  • Drink your coffee black or use Stevia for a zero-calorie, natural sweetener.
  • Sweeten plain yogurt with fresh or frozen berries instead of buying flavored, sugar-loaded yogurt.
  • Consume whole fruits instead of sugar-sweetened fruit smoothies.
  • Replace candy with a homemade trail mix of fruit, nuts and a few dark chocolate chips.
  • Use olive oil and vinegar in place of sweet salad dressings like honey mustard.
  • Choose marinades, nut butters, ketchup and marinara sauce with zero added sugars.
  • Look for cereals, granolas and granola bars with under 4 grams of sugar per serving.
  • Swap your morning cereal for a bowl of rolled oats topped with nut butter and fresh berries, or an omelet made with fresh greens.
  • Instead of jelly, slice fresh bananas onto your peanut butter sandwich.
  • Use natural nut butters in place of sweet spreads like Nutella.
  • Avoid alcoholic beverages that are sweetened with soda, juice, honey, sugar or agave.
  • Shop the perimeter of the grocery store, focusing on fresh, whole ingredients.

Prepare your own meals

Exercise – it improves glucose metabolism


Advice specific to Halloween

  • Eat before you go out
  • Brush after eating the junk
  • Toss some (or give away)
  • Switch with other things
  • Make it invisible (don’t keep it visible)
  • Smaller trick or treating bags
  • Move it (your body)
  • Eating a sugary treat along with foods high in protein or fibre can result in a smaller rise in blood sugar.  So make sure kids eat a healthy meal before trick or treating.
  • If followed by a good teeth brushing, parents can also reduce their child’s risk of cavities.
  • Parents of younger children often find they can toss the majority of treats after a week or two as their children lose interest, or even forget about the stash.
  • Older children may want to weigh their treats and “sell” them back to their parents for a reasonable price per pound.
  • Other parents implement the Switch Witch. This benevolent helper can visit children as they sleep, trading the big bag of candy they have left out for her — for a small prize.
  • Whittle through the candy and get rid of some at the end of trick or treating
  • Store the candy where it’s not visible
  • Trade candy for something else
  • Smaller trick or treating bags
  • Get moving. Get some exercise by making Halloween a fun family activity. Walk instead of driving kids house to house. Set a goal of how many houses or streets you’ll visit, or compete in teams to do as many as you can. Bring a bottle of water and a flashlight, and wear comfortable shoes for walking!

Mental Health Day, by Dr. Zach Levine, ER Physician

BT Montreal | posted Wednesday, Oct 10th, 2018

More info: www.drzach.ca 


Institut national de santé publique du québec: annual prevalence of mental disorders is 20%

Fewer than 50% of people with mental disorders see a doctor for these problems

Increasing prevalence in children and adolescents.


Mental illness in Canada

  • In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness.
  • Mental illness affects people of all ages, education, income levels, and cultures.
  • Approximately 8% of adults will experience major depression at some time in their lives.
  • About 1% of Canadians will experience bipolar disorder (or “manic depression”).
  • By age 40, about 50% of the population will have or have had a mental illness.
  • Schizophrenia affects 1% of the Canadian population.
  • Anxiety disorders affect 5% of the household population, causing mild to severe impairment.
  • Suicide accounts for 24% of all deaths among 15-24 year olds and 16% among 25-44 year olds.
  • Suicide is one of the leading causes of death in both men and women from adolescence to middle age.
  • The mortality rate due to suicide among men is four times the rate among women.
  • Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.
  • Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment but also to acceptance in the community.
  • Mental illnesses can be treated effectively.




Biological — neurotransmitter imbalance — serotonin, norepinephrine

Psychological — worldview, thoughts

Social — Life events



Emotional Symptoms:

  • Constant sadness, almost every day
  • Feeling of worthlessness, of excessive or inappropriate guilt
  • Dark or suicidal thoughts
  • Loss of interest or pleasure in favourite activities

Physical Symptoms

  • Low energy
  • Aches and pains
  • Insomnia or its opposite, hypersomnia
  • Change in weight

Behavioural Symptoms

  • Change in appetite
  • Impression of restlessness
  • Difficulty making decisions or focusing


  • Therapy
  • Exercise
  • Sleep (both a result and a cause of anxiety and mood disorders)
  • Diet (studies on diet and mood are ongoing)
  • Medication

Marijuana Legalization, by Dr. Zach, ER Physician

BT Montreal | posted Wednesday, Sep 26th, 2018

For more info, visit www.drzach.ca


1. Patients present to ER because of cannabis “poisoning” (bad trip) or cannabis hyperemesis syndrome.

Cannabis poisoning (aka a “bad trip”) — anxiety, paranoia, numbness, dizziness, hallucinations, confusion, psychosis, hallucinations, slurred speech

High heart rate and BP (or orthostatic hypotension), red eyes, dry mouth

Can cause asthma exacerbation.  Rarely angina or heart attack (risk is increased)

No deaths have been reported

Peak concentration levels by route of administration:

Inhalation — 3-10 minutes (smoke vs vape, no smoke with vape)

Oral — 1-5 hours — patients with oral ingestion may take more because they won’t feel intoxicated immediately

Treatment: Largely symptomatic.  Fluids, relaxants if needed, antivomiting medications


Cannabinoid Hyperemesis Syndrome:

Most commonly reported cluster of symptoms that brings regular cannabis users to the ER is cannabinoid hyperemesis syndrome.   (even though cannabis decreases nausea in cancer patients)

It consists of intractable nausea, vomiting, and abdominal pain.

Recurrent relapsing disorder.

Vomiting may last 24-48 hours and may lead to dehydration and weight loss.

Symptoms may respond to showering in very hot water.

Treatment: supportive therapy, cannabis cessation.  IV hydration. Metoclopramide, ondasetron. Haloperidol, capsaicin cream to the abdomen chest or back.

Termination of heavy habitual cannabis use may lead to withdrawal symptoms within 48 hours — irritability, anxiety, nervousness, restlessness, sleep difficulty, seizures, and aggression.

2. Legalization results elsewhere:

In colorado ER visits spiked for 6-12 months after legalization but then leveled off.

Experience in places where pot is legalized — In Washington and Colorado:

Rising rates of pot use by minors

Increasing arrest rates of minors, especially

black and Hispanic children

Higher rates of traffic deaths from driving

while high

More marijuana-related poisonings and


A persistent black market


The public health impact of decriminalization or legalization of recreational cannabis use include:

  • Both decriminalization and legalized recreational use have been associated with increased unintentional pediatric ingestions. As an example, after legalization of recreational marijuana use in Colorado, annual calls to the regional poison control center for pediatric marijuana exposure increased 34 percent on average to 6 cases per 100,000 population, which was almost twice the rate for the rest of the United States.  Exposure to recreational marijuana accounted for about half of cases. Rates of hospital visits at a large regional children’s hospital system also increased significantly during the period of the study, although the total number of presenting patients (81) was small.
  • In regions with medical marijuana availability, diversion of drug from registered users may also encourage adolescent abuse.

3. Driving:  

In QC you’ll get a 90 day license suspension if police find any THC in your system.

Not clear how much time before it’s safe but probably at least 4 hours for inhaled and longer for edibles.

Driving stoned is not safe.  One focuses too much on one thing and is too slow to respond to sudden changes.

No clear level that is safe.

Canadian law Bill C-46 states that if you drive with 2-5 nanograms of THC per ml of blood, you’ll face a maximum fine of $1000.  More than 5 nanograms, or having a mix of booze and THC, gets a minimum $1000 fine. Repeat offenders can face up to 10 years in prison

Drivers using cannabis are two to seven times more likely to be responsible for accidents compared to drivers not using any drugs or alcohol. Furthermore, the probability of causing an accident increases with plasma levels of delta-9-tetrahydrocannabinol.

Cannabis use increases reaction time and impairs attention, concentration, short term memory, and risk assessment.  Lasts 12-24 hours


Federally approved roadside police tool is Drager DrugTest 5000 — takes a saliva sample but apparently there are false positives and negatives and there are concerns about keeping swabs at the right temperature in Canada.  Other ones are being tested.

Many police forces have not ordered the devices yet.

In the meantime police will rely on a field sobriety test, which can involve standing on one leg or tracking an object with your eye, to screen for impairment.


Testing for cannabis in the body:

Urine drug screens are less helpful in adolescents and adults for the diagnosis of acute intoxication. Although testing is usually positive several hours after acute exposure it can also be positive well after symptoms have resolved. As an example, positive results for delta-9 tetrahydrocannabinol metabolites (urine test) have been reported up to 10 days after weekly use and up to 25 days for after daily use

Saliva swab test positive for 6-12 hrs after use

Blood test shows level, positive for 36 hrs after use

Blood samples, which are legally binding, can only be taken if you fail the roadside test, and only at a police station.


4. Cannabis seems to unmask predisposition to certain mental illness, especially if used in youth


Public health agency of Canada: “One of the things that the research clearly demonstrates is that early access to cannabis can have detrimental affects for brain development and the brain develops up to age 25.”

Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders. The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between marijuana use and substance use disorders and between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability

Teenagers: Prolonged cannabis consumption below age 17 is linked to memory and attention issues later.  Alcohol is not better. Young people struggling with anxiety, depression, or learning problems are more at risk of dependency.

Mental health: people at risk of mental health issues are more likely to suffer adverse effects from cannabis use

Can one get high from second hand marijuana smoke?  No.  Exhaled smoke contains so little THC that you’d have to sit in a room with 16 joints being smoked per hour to show any signs of being high.

Plans for cannabis laws in Canada once legalized:


Controlled access

When the Cannabis Act becomes law in October 2018, adults who are 18 years or older would be able to legally:

  • possess up to 30 grams of legal dried cannabis or equivalent in non-dried form
  • share up to 30 grams of legal cannabis with other adults
  • purchase dried or fresh cannabis and cannabis oil from a provincially-licensed retailer
    • In those provinces that have not yet or choose not to put in place a regulated retail framework, individuals would be able to purchase cannabis online from a federally-licensed producer.
  • grow up to 4 cannabis plants per residence for personal use from licensed seed or seedlings
  • make cannabis products, such as food and drinks, at home provided that  organic solvents are not used

The sale of cannabis edible products and concentrates would be authorized no later than 12 months following the coming into force of the proposed legislation.

Strict Regulation

QC law:

Under the new plan, the legal age to buy, possess and consume marijuana in Quebec will be 18 — the same as the drinking age.

Other key points include:

  • No one will be allowed to grow cannabis for personal use. It will also be banned to grow it for commercial use, unless following the laws set out by the government.
  • It must be smoked in the same places as tobacco. Smoking will also be prohibited on university and CEGEP grounds.
  • There will be zero tolerance for drivers — police officers will be able to ask for a saliva sample if they suspect someone is driving while high and will be able to suspend a driver’s licence for 90 days if a sample comes back positive for ANY cannabis.

While saliva testing has yet to be federally regulated, the province says that police officers are being trained to detect signs of marijuana-impaired driving.


The Quebec law would set the legal age at 18 and allow individuals to transport up to 30 grams at a time and hold 150 grams at home


A government agency, the Société québécoise du cannabis, will have exclusive legal control of recreational use, selling the product through a limited number of storefronts and online. The province will have 15 stores ready by July 1 and up to 150 in two years.


Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

7 Days of Fat-Blasting Workouts by Kathleen Trotter

BT Montreal | posted Tuesday, Sep 18th, 2018


Intervals are convenient — you can do them anywhere and on any piece of equipment or without equipment — AND they are effective. With intervals, you alternate between bouts of high- and low-intensity training. This places a high metabolic demand on the body, burns lots of calories in a short amount of time, produces a high EPOC (post-workout calorie burn), increases mitochondria growth (mitochondria help to burn fat), and helps to improve one’s fitness level. Plus, they are a fantastic workout regardless of your fitness level; you adapt the interval intensity to fit your current capacity. The intensity of your interval is dependent on your individual fitness level. For some, the “high” interval will be walking quickly. For others, it might be jogging.

Exercise will improve your mood, energy, and overall health, and change your body shape, BUT no amount of fat-blasting workouts will help you shed those extra pounds if you are eating poorly. Be aware of your nutritional choices. Consider journaling — we often overestimate our health choices and underestimate our unhealthy choices.

Always do a proper warm-up and cool-down. The warm-up should be a minimum of 5 minutes; it should promote blood flow and prime your body for motion. Typically, it entails a lower-intensity version of the workout that is to come. For example, jog to warm-up for running or do a low-impact version of high knees before an intense interval of high-impact high knees. The cool-down is 5 or more minutes of stretching, foam rolling, and light cardio that cools the body down.

All exercises can — and should — be progressed or regressed depending on your fitness level. For example, cardio options can be made low or high impact (eg, stepping your feet back into a burpee vs jumping your feet back) and strength exercises can be progressed by adding weight and/or an unstable surface such as a Bosu.

Always listen to your body. Stop if you feel faint, sick, negative pain, etc.

Progress gradually. This week of workouts is an end goal. If you have never worked out before, don’t jump right in. Maybe do 2 of the more intense workouts and on the other days go for a walk. Slowly work your way up. Progress your intensity, choice of exercise, duration, and frequency.


Monday Tabata intervals: Cardio based

Tabata is a method of interval training. One cycle of Tabata takes 4 minutes. The 4 minutes is made up of 8 sets of 20 seconds of intense work followed by 10 seconds of complete rest. After 1, 4-minute Tabata set, rest for 1 minute and move on to your next exercise. Literally any exercise can be made into an interval. Both cardio and intense strength exercises can be made into Tabata. For today’s workout, focus on cardio exercises — we will do strength tomorrow! Think mountain climbers, high knees, bum kicks, burpees, or skipping.

Sample Workout

Warm up for 5 minutes by running on the spot or dancing around your living room. Then pick a cardio exercise (such as burpees or jumping jacks). Do the exercise hard for 20 seconds. Rest for 10 seconds. Repeat for 4 minutes. That is 1 Tabata. Do 4 to 6 Tabatas. Cool down.



AMRAP stands for “as many rounds as possible.” AMRAP is an example of time-based training. With AMRAP, you aim to fit in as many cycles of a circuit as possible within a set timeframe. The faster you get through the reps of each exercise, the more times you will complete the entire circuit in the given timeframe.

For this workout include strength and cardio exercises — push-ups, squats, and jumping jacks, for example. Beginners should do 2 to 3 sets of a 6-minute round. Intermediate exercisers should aim for 3 sets of 8 minutes. If you’re advanced, 3 sets of 10 minutes. Always warm up and cool down.

Sample Workout

Within your given timeframe (6, 8, or 10 minutes) do as many rounds as you can of 10 push-ups, 10 lunges on each leg, 12 bent-over rows, and 10 jumping jacks. Record how many rounds you get through. Gradually work to increase the number of rounds you can complete in 10 minutes.


Wednesday: Extra sleep and recovery day

Both sleep and recovery are KEY for weight and fat loss!!


Thursday: Strength and cardio-based minute intervals

With minutes you don’t count reps. You do each exercise as many times as you can within that minute. Pick 4 strength exercises and 2 core exercises. After you warm up, do 1 minute of each exercise, followed by 2 minutes of core and 1 to 3 minutes of intense cardio. Aim to fit in as many good reps as possible for each strength exercise within the 1-minute timeframe. Rest for 1 minute. Beginners repeat the cycle twice. Intermediate exercisers repeat 3 times. Advanced exercisers do 4 sets.

Sample Workout

After you warm up do 1 minute of a “push” exercise such as push-ups, 1 minute of a leg exercise such as squats or lunges, 1 minute of a “pull” exercise such as pull-ups, band reverse flyes, or bent over rows, and finally 1 minute of another leg exercise such as squat pulses, squats jumps, step-ups, or bridges. Then do 2 minutes of core — think planks, V holds, side planks, etc. Finish with 3 minutes of intense cardio such as running, skipping, jumping jacks, stairs, or rowing.


Friday: De-stress with yoga and/or pilates!

Stress is the arch nemesis of fat loss — especially abdominal fat. Plus, working your core with Pilates or yoga will help you stand taller. The taller you stand, the better your midsection looks!!


Saturday: Cardio-based pyramid intervals

Pick a cardio activity — ie, anything that gets your heart rate up. Any cardio machine, running or walking outside, swimming, dancing, aerobics, etc will all work. Warm-up for 5 minutes with a moderate version of your chosen activity. Then do the following pyramid: 1 minute hard, 1 minute easy, 2 minutes hard, 2 minutes moderate, 3 minutes hard, 3 minutes moderate, 4 minutes hard, 4 minutes moderate, 5 minutes hard, 1 minute easy, and finally 5 minutes hard. Cool down for 5 to 10 minutes.


Sunday: Meal prep!

Want to lose weight? EAT BETTER! Instead of exercising on Sunday use the time to rest your body and prep your food for the week!!


More info:

What is Tabata?  https://www.flamanfitness.com/blog/stay-fit-this-summer-with-my-do-anywhere-time-efficient-yet-effective-workouts 

What is the Minute Workout? https://www.huffingtonpost.ca/kathleen-trotter/the-minute-workout_b_8296398.html

What is AMRAP?  https://www.huffingtonpost.ca/kathleen-trotter/amrap-training_b_8974816.html

What is Interval Training? (https://www.flamanfitness.com/blog/make-interval-training-your-new-best-friend).

Recovery protocols: https://www.participaction.com/en-ca/blog/lifestyle-culture/4-ways-to-recover-reduce-soreness-and-avoid-injury 

Importance of sleep and how to set up a sleep routine: https://www.theglobeandmail.com/life/health-and-fitness/health/turns-out-sleeping-can-help-you-shed-those-extra-pounds-health/article31415104/

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