easy-heal

On the Gulf Coast of Florida where I live, the telltale sign of summer is not an influx of beachcombers, afternoon storms that arrive exactly at 2 p.m., or the first hurricane warning, but the appearance of hundreds of paddleboarders dotting the inlet waters.

From afar, paddleboarding looks almost spiritual — people standing on nearly invisible boards and gliding across the surface as if walking on water.

But this popular water sport offers a serious workout, just as kayaking and canoeing do. While floating along and casually dipping a paddle in the water may look effortless, much goes on beneath the surface, so to speak.

As warm weather beckons and paddle season arrives, it pays to get key muscles in shape before heading out on the water.

Tuning up muscles: Focus on core, back, arms, and shoulders

“Paddling a kayak, canoe, or paddleboard relies on muscles that we likely haven’t used much during winter,” says Kathleen Salas, a physical therapist with Spaulding Adaptive Sports Centers at Harvard-affiliated Spaulding Rehabilitation Network. “Even if you regularly weight train, the continuous and repetitive motions involved in paddling require endurance and control of specific muscles that need to be properly stretched and strengthened.”

While paddling can be a whole-body effort (even your legs contribute), three areas do the most work and thus need the most conditioning: the core, back, and arms and shoulders.

• Core. Your core comprises several muscles, but the main ones for paddling include the rectus abdominis (that famed “six-pack”) and the obliques, located on the side and front of your abdomen. The core acts as the epicenter around which every movement revolves — from twisting to bending to stabilizing your trunk to generate power.
• Back: Paddling engages most of the back muscles, but the ones that carry the most load are the latissimus dorsi muscles, also known as the lats, and the erector spinae. The lats are the large V-shaped muscles that connect your arms to your vertebral column. They help protect and stabilize your spine while providing shoulder and back strength. The erector spinae, a group of muscles that runs the length of the spine on the left and right, helps with rotation.
• Arms and shoulders: Every paddle stroke engages the muscles in your arms (biceps) and the top of your shoulder (deltoids).

Many exercises specifically target these muscles, but here are three that can work multiple paddling muscles in one move. Add them to your workouts to help you get ready for paddling season. If you haven’t done these exercises before, try the first two without weights until you can do the movement smoothly and with good form.

Three great exercises to prep for paddling

Wood chop

Muscles worked: Deltoids, obliques, rectus abdominis, erector spinae
Reps: 8–12 on each side
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with your feet about shoulder-width apart and hold a dumbbell with both hands. Hinge forward at your hips and bend your knees to sit back into a slight squat. Rotate your torso to the right and extend your arms to hold the dumbbell on the outside of your right knee.

Movement: Straighten your legs to stand up as you rotate your torso to the left and raise the weight diagonally across your body and up to the left, above your shoulder, while keeping your arms extended. In a chopping motion, slowly bring the dumbbell down and across your body toward the outside of your right knee. This is one rep. Finish all reps, then repeat on the other side. This completes one set.

Tips and techniques:

• Keep your spine neutral and your shoulders down and back
• Reach only as far as is comfortable.
• Keep your knees no farther forward than your toes when you squat.

Make it easier: Do the exercise without a dumbbell.

Make it harder: Use a heavier dumbbell.

Bent-over row

Muscles worked: Latissimus dorsi, deltoids, biceps
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with a weight in your left hand and a bench or sturdy chair on your right side. Place your right hand and knee on the bench or chair seat. Let your left arm hang directly under your left shoulder, fully extended toward the floor. Your spine should be neutral, and your shoulders and hips squared.

Movement: Squeeze your shoulder blades together, then bend your elbow to slowly lift the weight toward your ribs. Return to the starting position. Finish all reps, then repeat with the opposite arm. This completes one set.

Tips and techniques:

• Keep your shoulders squared throughout.
• Keep your elbow close to your side as you lift the weight.
• Keep your head in line with your spine.

Make it easier: Use a lighter weight.

Make it harder: Use a heavier weight.

Superman

Muscles worked: Deltoids, latissimus dorsi, erector spinae
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Lie face down on the floor with your arms extended, palms down, and legs extended.

Movement: Simultaneously lift your arms, head, chest, and legs off the floor as high as is comfortable. Hold. Return to the starting position.

Tips and techniques:

• Tighten your buttocks before lifting.
• Don’t look up.
• Keep your shoulders down, away from your ears.

Make it easier: Lift your right arm and left leg while keeping the opposite arm and leg on the floor. Switch sides with each rep.

Make it harder: Hold in the “up” position for three to five seconds before lowering.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

If you are trying to cut back on added sugar — and you should, because excess sugar increases risks for obesity, diabetes, and heart disease — you might be tempted by products advertised as low sugar, no sugar, or sugar-free.

Many contain familiar low-calorie sugar substitutes like aspartame or sucralose instead of sugar. And as you’re reading labels, you also may run across another ingredient: sugar alcohol, which is used in products like sugar-free cookies, candies, ice cream, beverages, and chewing gums. Are any of these sweeteners a better choice nutritionally? Dr. Frank Hu, professor of nutrition and epidemiology with the Harvard T.H. Chan School of Public Health, weighs in below.

Are low-calorie or no-calorie sweeteners any healthier than natural sugar?

Also known as artificial sweeteners or sugar substitutes, the list of low-calorie and no-calorie sweeteners you may see on product nutrition labels includes acesulfame-K, saccharin, sucralose, neotame, and advantame. These have a higher sweetness intensity per gram than natural sugar.

So far research on them is mixed, although some observational studies have found that beverages containing low-calorie sweeteners are associated with a higher risk for diabetes and weight gain.

What exactly are sugar alcohols and how can you spot them?

Sugar alcohols may have the most misleading name, as they are neither sugar nor alcohol, according to Dr. Hu. “They are a type of carbohydrate derived from fruits and vegetables, although most commercial sugar alcohols are synthetically produced.”

You can usually spot many sugar alcohols on ingredient lists by “-ol” at the ends of their names. Examples include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol.

Are sugar alcohols any healthier than other sugar substitutes or natural sugar?

Here is a look at the pros and cons.

The upside of sugar alcohols

Sugar alcohols reside in the sweet spot between natural sugar and low-calorie sweeteners. They are not as overly sweet as sweeteners and don’t add too many extra calories like sugar.

“Sugar alcohols are about 40% to 80% as sweet as natural sugar, whereas artificial sweeteners like aspartame are about 200 times sweeter,” says Dr. Hu. “And they have about 25% to 75% fewer calories per gram than sugar.”

Another upside of sugar alcohols is that they break down slowly in the gut. Hence, your body only absorbs part of their overall carbohydrates. “This keeps your blood sugar and insulin levels from spiking as they do with sugar,” says Dr. Hu. “That makes them a useful sugar substitute for people with diabetes.”

The downside of sugar alcohols

The main downside to sugar alcohols is this: when taken in high amounts they can cause gastrointestinal (GI) problems, such as abdominal pain, diarrhea, or loose stools.

Because sugar alcohols are slowly digested, they have more time to feed bacteria in the gut, which can lead to fermentation and produce excess gas. Their slow digestion also can pull extra water into the colon and cause a laxative effect.

People’s tolerance for sugar alcohols depends on many factors, including body weight, health conditions, and the amount and types of sugar alcohols. “Individual differences in digestion and metabolism, gut microbiome composition, and dietary habits can also make a difference,” says Dr. Hu. “For these reasons, we recommend introducing sugar alcohols into your diet gradually and observing how your body responds.”

For people who experience GI symptoms caused by sugar alcohols, Dr. Hu says cutting back on the amount of foods and drinks made with them often can correct the problem. “Sugar alcohols are commonly found in sugar-free or low-carb products, so pay attention to food labels” he says. “Because different sugar alcohols can have different effects, it might be useful to identify specific types of sugar alcohols that cause GI side effects.”

Do sugar alcohols have health risks?

Possible long-term health risks of sugar alcohol are still being explored. A 2023 observational study found a link between using erythritol as an added sweetener and cardiovascular disease events, such as stroke and heart attack, in people with heart disease or who had risk factors like diabetes and high blood pressure. However, these findings have not been confirmed in subsequent studies.

“Sugar alcohols offer a healthier alternative to sugar because of their lower calorie content and reduced glycemic response, which is the effect food has on blood sugar levels,” says Dr. Hu. “But they also have potential drawbacks, especially for those with sensitive digestive systems, so it’s best to consume them in moderation as part of an overall healthy eating pattern.”

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Pop quiz: what is Salmonella? If you’ve ever had a run-in with this bacteria, you know it can cause a food-borne illness called salmonellosis, a form of food poisoning. But you may not know that Salmonella bacteria sicken an estimated 1.35 million people and hospitalize 26,500 every year in the United States. What’s more, it kills more total people than any other type of food poisoning.

And Salmonella bacteria can be sneaky — not only by triggering unusual complications, but infecting people in startling ways, says Dr. Elizabeth Hohmann, an infectious disease specialist at Massachusetts General Hospital. One patient she treated showed up with an abdominal aortic aneurysm — a dangerous bulge in the lower section of the body’s largest artery — that looked infected. Testing revealed a culprit some would find surprising: Salmonella.

“It’s just an interesting organism and it can be kind of scary,” she says.

How do people get infected by Salmonella?

Many of the foods Salmonella bacteria lurk in are raw or undercooked. Breaded raw chicken products like nuggets and chicken Kiev are one way it may reach your table. But a variety of foods have been implicated — including organic basil, cantaloupes, ground beef, nut butters, raw cookie dough, eggs, raw or unpasteurized milk, and flour.

Even small pets such as turtles and frogs, along with dog food, have contributed to Salmonella outbreaks in recent years.

You can also become infected by handling contaminated food and spreading the bacteria from your hands to your mouth. Additionally, you can spread it to others on your hands or even on your clothes without becoming sick yourself.

“It’s a bug that’s carried in stool and animal feces and is also present in the environment,” Dr. Hohmann says. “So it can set up shop in lots of different inanimate objects, soils, and machinery, especially in moist environments.”

What symptoms can Salmonella cause?

Most of the time, Salmonella infection leads to gastroenteritis, usually causing just an upset stomach, abdominal cramps, and diarrhea. These symptoms can start as soon as six hours after ingesting the bacteria. Typically, symptoms resolve on their own within two to three days.

Some people have such mild symptoms they’re barely noticeable. “The classic case might be a college student who eats a burrito from a sketchy place, gets sick for a couple of days, gets better, and doesn’t think anything of it,” says Dr. Hohmann.

Sometimes symptoms are more serious, such as severe abdominal cramping and bloody diarrhea, or unexplained high fever and marked fatigue. These symptoms require a call to your doctor.

How is salmonellosis treated?

Most people will get better on their own without any medicines. Replacing lost fluids by sipping water or electrolyte drinks to avoid dehydration will help.

Call a doctor if you have

• diarrhea and a fever higher than 102° F
• diarrhea that doesn’t improve after three days
• bloody stools
• vomiting so severe it prevents you from keeping liquids down.

Treating the infection with medicine comes with an annoying paradox, Dr. Hohmann says. If doctors decide to prescribe antibiotics, the person taking the medicine may shed the organism for longer than if they were never treated. “Then that person may have the opportunity — either through poor personal hygiene, sex, or working as a food worker — to spread it to others,” she explains. “It’s challenging.”

What complications can Salmonella lead to?

Some people get sicker with salmonellosis than others, with seemingly no rhyme or reason. But certain folks are especially vulnerable to serious infection, including:

• adults 65 and older
• pregnant women
• children under 5
• people whose immune systems are weakened by diseases (such as cancer) or treatments (such as immunosuppressing drugs).

A small percentage of those infected can have Salmonella in their blood, which can spread the infection to other parts of the body such as the urinary tract, bones, joints, or central nervous system (brain and spinal fluid).

And, like Dr. Hohmann’s patient with the abdominal aortic aneurysm, on rare occasions Salmonella can lead to unusual blood vessel complications in people who already have atherosclerosis, blockage of the arteries caused by plaque buildup.

“It’s not that common,” she says. “Many physicians are aware of it, so they take special care if Salmonella is found in a person with vascular disease.”

What steps can you take to avoid Salmonella?

While new USDA rules that take effect in 2025 may help fuel recalls of certain foods, we all can take steps to avoid the food poisoning, illness, and hospitalizations that Salmonella exposure can cause.

Dr. Hohmann and the CDC suggest these strategies:

• Using hot water and soap, wash cutting boards or plates on which you cut into raw foods — including vegetables and fruit — before using those surfaces for other purposes. If possible, use separate cutting boards for produce, meat, and fish.
• Refrigerate or freeze foods that are perishable, prepared, or left over within two hours to thwart salmonella growth.
• Always wash hands well with soap and water before preparing food and after contact with animals, using the toilet, or changing diapers.
• If you have a sick pet, take extra care handling its feces and wash your hands thoroughly afterward.

Take additional steps to help more vulnerable people stay healthy:

• Don’t let young children touch high-risk animals, such as turtles, frogs, chickens, or ducks. “And if you’re taking young children to a petting zoo, they should not be petting animals unless you can disinfect their hands immediately afterward,” she says.
• Older adults and those with compromised immune systems should take extra care to wash and cook foods thoroughly.
• People who have had a transplant (such as a kidney transplant) should not keep reptiles or amphibians as pets.

“You hate to make people paranoid, so that we’re washing our lettuce leaves with soap, but it’s worth thinking about these things, particularly if you have people in your household who are susceptible — which is an increasing number of people,” Dr. Hohmann says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

When a prostate-specific antigen (PSA) blood test produces an abnormal result, the next step is usually a prostate biopsy. A biopsy can confirm or rule out a cancer diagnosis, but it also has certain drawbacks. Prostate biopsies are invasive procedures with potential side effects, and they often detect low-grade, slow-growing tumors that may not need immediate treatment — or any treatment at all.

Researchers are exploring various strategies for avoiding unnecessary biopsies. Specialized magnetic resonance imaging (MRI) scans, for instance, can be useful for predicting if a man’s tumor is likely to spread. A blood test called the Prostate Health Index (PHI) measures various forms of PSA, and can help doctors determine if a biopsy is needed.

In April, researchers at the University of Michigan published results with a test that screens for prostate cancer in urine samples. Called the MyProstateScore 2.0 (MPS2) test, it looks for 18 different genes associated with high-grade tumors. “If you’re negative on this test, it’s almost certain that you don’t have aggressive prostate cancer,” said Dr. Arul Chinnaiyan, a professor of pathology and urology at the University, in a press release.

Gathering data and further testing

To create the test, Dr. Chinnaiyan and his colleagues first turned to publicly-available databases containing over 58,000 prostate cancer-associated genes. From that initial pool, they narrowed down to 54 genes that are uniquely overexpressed in cancers classified as Grade Group 2 (GG2) or higher. The Grade Group system ranks prostate cancers from GG1 (the least dangerous) to GG5 (the most dangerous).

The team tested those 54 genes against archived urine samples from 761 men with elevated PSA who were scheduled for biopsy. This effort yielded 18 genes that consistently correlated with high-grade cancer in the biopsy specimens. These genes now make up MPS2.

Then the team validated the test by performing MPS2 testing on over 800 archived urine samples collected by a national prostate cancer research consortium. Other researchers affiliated with that consortium assessed the new urine test’s results against patient records.

Interpreting the results

Study findings showed that MPS2 correctly identified 95% of the GG2 prostate cancers and 99% of cancers that were GG3 or higher. Test accuracy was further improved by incorporating estimates of the prostate’s size (or volume, as it’s also called).

According to the team’s calculations, use of the MPS2 would have reduced unnecessary biopsies by 37%. If volume was included in the measure, then 41% of biopsies would have been avoided. By comparison, just 26% of biopsies would have been avoided with the PHI.

Dr. Chinnaiyan and his co-authors emphasize that ruling out high-grade cancer with a urine test offers some advantages over MRI. The specialized multi-parametric MRI scans needed to assess high-grade cancer in men with elevated PSA aren’t always available in community settings, for instance. Moreover, the interpretation of mpMRI results can vary from one radiologist to another. Importantly, the MPS2 can be updated over time as new prostate-cancer genes are identified.

Commentary

Dr. Boris Gershman, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, and a member of the advisory and editorial board for the Harvard Medical School Guide to Prostate Diseases, described the new study results as promising. “It does appear that the performance of the 18-gene urine test is better than PSA alone,” he says.

But Dr. Gershman adds that it will be important to consider how such a test will fit into the current two-stage approach for PSA screening, which entails prostate MRI when the PSA is abnormal. Where MRI delivers a yes/no result (meaning lesions that look suspicious for cancer are either present or not), the MPS2 provides numerical risk estimates ranging between 0% and 100%. “The challenge with clinical implementation of a continuous risk score is where to draw the line for biopsy,” Dr. Gershman says.

“This research is very encouraging, since many men in rural areas may not have access to prostate MRI machines or the added sophistication that is needed in interpreting these MRI scans,” says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “A widely available urine test may eventually help provide more precision in determining who should undergo a prostate biopsy, and may also help to assess the probability that a cancer is clinically significant and in need of treatment.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD