Medical Questions I'd Like Answered...

[deaddmwalking]

Let me rebut:



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[Iduno]

Let me rebut:



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So the list that hypothetical death cultists would be working off is:
Stop vaccination.
Commidfy antibiotics to the point they're overused, and therefore ineffective.
Reduce infrastructure money so safe water/wastewater stops being reasonably available.
Defund the Health Department/fill them with busywork instead of anything useful.

At the same time, that sounds like cartoon supervillainy, and also the real world.

[deaddmwalking]

The report from which this is pulled makes the point that there has been an increase in infectious diseases since 1980. It essentially indicts complacency - we've been so successful in eliminating these diseases that people aren't worried enough about them to continue funding the services to prevent them.

Elotar may have proven their point.

[Count Arioch the 28th]

I wish I had peace of crap.

[Iduno]

The report from which this is pulled makes the point that there has been an increase in infectious diseases since 1980. It essentially indicts complacency - we've been so successful in eliminating these diseases that people aren't worried enough about them to continue funding the services to prevent them.

Elotar may have proven their point.

Yep. And we're starting to see issues with crumbling (literally) infrastructure/safe water. And MRSA, and I've at least seen food safety issues that our Health Department is forbidden to get involved with.

I also don't see it getting better until we've got another Chicago River fire-level newsworthy even. It's the US, so it will have to happen to moderately wealthy white people; Flint won't change things. Hopefully it's just complacency.

[RobbyPants]

It essentially indicts complacency - we've been so successful in eliminating these diseases that people aren't worried enough about them to continue funding the services to prevent them.

I feel the same thing happened with unions and opposing fascism.

[DSMatticus]

So, I've had a small bump (under the skin, colorless - or at least so far under the skin that you couldn't see any color) behind my knee (not where baker's cysts are, it's off to the side near that thick, obvious tendon that runs past the knee) pretty much as long as I can remember. We're talking since I was in highschool or younger, 10-15 years.

Yesterday night, the missus pointed out a 'new' spot on my leg behind the knee. But it's not new, it's just that same bump that's always been there, except now it's brown (like a mole) and larger and she could see it. I'm already planning to call my doctor tomorrow (his clinic was closed today for Memorial day) and go in to have it checked, but in the meantime I've been doing the Dr. Google thing where I try to figure out all the things it possibly could be despite having zero medical experience. It's not going well.

I'm not really looking for a conclusive internet diagnosis or anything, because I am not an idiot, but I would really like to know what kinds of things it could be, and what kinds of things it usually turns out to be in situations like this. Because right now the only thing I can put a name to is 'melanoma,' and even if I understand melanoma is supposed to be unlikely culprit, the fact that the list of explanations I can tangibly imagine is "1. melanoma 2. ???" is kind of stressful.

[Username17]

Neurofibroma.
And of course, it could still be a popliteal cyst.
Lots of things it could be. Most of them aren't very scary if it's been there for many years.

-Username17

[Grek]

What would you make of fatigue that goes away when I elevate my legs?

[Username17]

What would you make of fatigue that goes away when I elevate my legs?

Varicose veins in your legs or congestive cardiac failure on the right side of your heart due to pulmonary hypertension.

Essentially you have blood collecting in your legs due to gravity effects because the circulatory system is unable to get the fluid moving against gravity. This causes relative anemia until your legs get elevated and the hemoglobin goes (literally) back into circulation. That can be a tubing problem with the valves being insufficient to get the one-way flow going properly, or it can be a pump problem with the heart itself being unable to pull through enough fluid to get things moving the way it's supposed to.

-Username17

[Count Arioch the 28th]

Where is there good information if you want to plan a diet? At the end of August I will have a place to myself for the first time in over a decade, so I get complete control over what I eat. I am wanting to do a diet for clean gains (I want to bulk back up, but I don't want to get fat while I'm doing so), but I literally don't know what's good information and what's bad information.

EDIT: I didn't make it 100% clear before, but I'm starting a cardio and weight training regimen. I've managed to mostly reverse my previous health issues, I want to keep up the momentum.

[deaddmwalking]

One reason that good diet advice is hard to find is because advice isn't helpful if you can't follow it.

It's possible to lose weight while eating nothing but cheeseburgers with good exercise and making sure to run a calorie deficit. It's also possible to gain weight eating nothing but salads.

Obviously, if you're trying to gain weight, you'll want to consume more calories than you expend. To build lean muscle you'll want lots of lean protein.

I think taking diet advice from someone that did what you want to do and isn't trying to make a buck by selling diet advice seems reasonable. To that end, Can you smell what the Rock is cooking?

[Count Arioch the 28th]

I saw that, and I'm not sure I'm capable of eating that much cod, let alone afford it.

[Username17]

Essentially all "diets" are elaborate games people play with themselves to eat less calories. To safely lose weight, you need to run a modest calorie deficit over a period of time. Increased exercise increases your caloric use, reduced food intake reduces your caloric reserve, and finding somewhere for those to meet can bring your weight down over time.

You need about 10% of your calories from fat, carbohydrates, and protein. The other seventy percent of your calories can be from any of those things because the body is pretty good at calorie substitution. So if for some reason you were able to get your total weight down with three quarters of your calories coming from refined sugars or butter fat or something, that would be totally fine. I doubt that would work, because butter and refined sugar have a high number of calories for the amount of stomach filling they produce, so it's hard to feel like you've eaten enough even after you've blown through your day's calorie limits.

When people talk about weird shit like eating snacks six times a day and never having a proper meal or eating one big meal and skipping the rest of the day or eating only things that start with the letter R or whatever, these are food games that allow the people to eat an overall acceptable number of calories by "winning the game." In essence it doesn't really matter what the game is, and these sorts of diet plans tend to fail over time because the game becomes less interesting.

-Username17

[erik]

My recommendation for diets that basically reduce caloric intake is the intermittent fasting. If you cut out a meal basically, and don't compensate with snacks/larger meals, then at least for me it was pretty easy to cut my calories and lose weight.

I did it starting in September starting at 180lbs, lost 20lbs in 2 months, held steady through November and December, then lost another 10 in January. And since January have been varying between 150-158 lbs.

I only did very modest exercise, and mostly just skip breakfast. Early on I was pretty strict about having meals only within a 6 hour window, and rarely wound up missing a meal so I basically had 1 in a 24hr period. I also did a little calorie counting early on just it get an idea of what numbers meant since I'd never considered calories before (mostly just wanted to make sure I wasn't exceeding daily recommended). Present day I'm pretty lax, and mostly just keep in mind a vague conception of whether I've eaten big meals/aggregate snacks already or not.

I heartily recommend whatever diet/routine seems like it is easiest to restrict calories and increase activity. I have a friend who has been on and off again doing keto for the last several months and he's always miserable when on it and has made almost no weight losses despite being at about double my weight. I don't get those gimmick diets if you cannot keep it up consistently.

[phlapjackage]

I only did very modest exercise...
...
I have a friend who has been on and off again doing keto for the last several months and he's always miserable when on it

I vaguely remember reading that for losing weight it's definitely calories in vs calories out, but the more important variable was calories in. I forget why this was exactly, except probably something like if you're restricting calories it's even more important that those calories are "healthy" calories, and also exercise is harder to offset the calories in. Like for example just one 100c cookie is easy to eat but to burn 100c with exercise is like a 30min walk or 15min run or whatever. Easier to just not eat the cookie.

Personal anecdote, a couple who I'm friends with started a keto diet. They were really happy with it, and were saying things like "yeah and we're never super hungry even though we skip breakfast and don't eat until the afternoon". But I noticed there was a lot of snacking (on keto-brownies and the like) that happened when we were all on vacation together...and it was a very "feeding frenzy" type of snacking. They also admitted they probably wouldn't do keto "permanently", only until they hit their target weights.

[tussock]

I find I struggle to keep weight on when I do a few months proper fitness training. I usually put out like 2000 calories an hour on the bike, so 10000+ a week in training. Just no chance to get in that much extra food to maintain weight, 4-5 days worth extra for me, doesn't fit.

Best wishes with the cardio and weights, Count. I'm just getting back into my biking this week and feeling pretty good about it, only about 20% over my best times after a shit start to the year for injuries, not bad for an old man.

Hot tip for biking, check the fucking quick-release wheels now and then, because one coming loose on a bump at any speed is gunna hurt. All better now, though.

[DrPraetor]

Essentially all "diets" are elaborate games people play with themselves to eat less calories.

-Username17

This is broadly true, with a few caveats.

Sugar is bad. Or, at least, people on a Western diet generally get too much of it. Points of contention include: how bad, how much is bad, and whether fructose (half of table sugar) is worse than glucose (the other half of table sugar, malt, starch).

Fiber is good. Or, at least, people on a Western diet generally don't get enough of it. Points of contention include why (a feeling of fullness, something-something bile acids, something-something microbiome), whether it's really fruits and vegetables which have a lot of fiber, and so on.

The research on reducing "processed food intake", is actually pretty good:
https://www.cell.com/cell-metabolism/fu ... 19)30248-7
but FWIW this mostly means eating more fiber.

Some people will eat until they get enough protein. So high-protein diets can sometimes work very well, but on a population level, low- protein diets will lead to severe over-eating in some people, which is pretty bad on average.

https://www.reddit.com/r/TheSimpsons/co ... _down_his/

[Krusk]

Im not healthy or a fitness advisor, but do have success losing weight when i care to do so. I go up/down about 60-90lbs every few years. Its 100% caloric intake. I dont exercise more during cutting times but am relatively active. Somehow diet sodas with 0 calories are also bad, dont cheat.

My target is to be back at high school 215 weight, and if i ever notice i hit 270 i cut back down. i count calories meticulously. Limit yourself to 2000 and drink water when you run out of calories until the next day. Youll drop tons the first month and then plateau, then lose a ton more and plateau again, and it will repeat. The first few days will suck and you will be super hungry.

Total time for me to cut back to target is usually 6-8 months. People ask what i did and i tell them “eat less” and they think im being coy, or dancing around a secret diet of only potatoes or some nonsense.

Highly recommend the app “lose it” for calorie tracking. By fitnow.

[Count Arioch the 28th]

Well, I'm not trying to "lose weight" per se, I'm trying to shift my body composition. I'm trying to lose fat and gain muscle. And although I can't argue with the results, I don't have Dwayne Johnson's staff/ millions to do nothing but eat and work out all day.

[DSMatticus]

There really aren't any special properties to the dieting or exercise process. You eat stuff. Then you burn up a bunch of that stuff by existing. Then you burn up more of that stuff when you exercise. Then your body uses some of that stuff to build more muscle. If at the end of all that you haven't burned up all the stuff you ate, the extra stuff becomes fat. Vice versa, if you didn't eat enough stuff to do all those things, your body will make up the difference by burning fat and muscle.

If your weight is currently stable, then you are running a calorie neutral diet. If you're happy with that weight, then start exercising and slightly increase your calorie intake to maintain at calorie neutral. If you're unhappy with that weight, then start exercising and don't increase your calorie intake. You'll be exercising, so your body will grow muscle, but you'll be running a calorie deficit, so your body will burn fat and muscle. Eventually you'll lose enough fat that you're happy, at which point proceed as above.

Note that I said 'fat', not 'weight.' Because in this case you're trying to build muscle and lose fat at the same time, your nominal weight isn't a great metric of success. I'd honestly just eyeball it. Fat won't stop feeling like fat just because there's muscle underneath it, so give yourself a weekly progress squish and decide if you're happy with where you're at. If you are, you can stop running a calorie deficit. If you start putting squish back on, you've gone too far, cut back.

It's just calories in, calories out. Find your zero, figure out which direction you want to go, tip the scales in that direction.

[Whipstitch]

As has been said, calorie counting is step one. The "good" news is that if you were in bad enough shape that you had acute health problems then odds are good that you don't need to be terribly scientific about things to see satisfying improvements in the short term. Basically, bulking and cutting are just things skinny people and fitness nuts do to work around the fact that their body has opposing interests. That is, beyond a certain point your body is only going to burn up its fat reluctantly and that makes it hard to build muscle without increasing your caloric intake. If you're a standard issue chunky American though odds are good you have some runway where a combination of strength training and calorie restriction can let you improve on both fronts for a while before you'll plateau. There's no magic to it, you just need to be willing to put in the work until eventually the results start slowing down. At that point you can look to more traditional bulking and cutting cycles or else talk to a trainer if you're really unhappy with your progress.

[Orion]

As a layperson, this book offers the most convincing-sounding-to-me big-picture take on what the deal is with weight gain and weight loss. The linked review by itself is pretty informative as such things go.

https://slatestarcodex.com/2017/04/25/b ... gry-brain/

[Whipstitch]

I just wish that book didn't make the "calories in, calories out" model sound like some kind of weird fat shaming cult (although I'm aware such people exist). If anything, I'm all about calorie counting precisely because I know how super bad I am at regulating my intake when confronted with a pile of Snickers.

[Username17]

Yeah, being dismissive of "calories in, calories out" is facile glibness to sell books. At the end of the day, you can only get fatter if your calories in exceed calories out, and you can only get thinner if calories out exceeds calories in.

My next big problem with the whole "insulin model" stuff is that while insulin is obviously really important in the regulation of many diet related things (up to and including whether you go into a diabetic coma or not), humans have very little in the way of means to alter how much insulin their pancreas chooses to make for them. Going all-in on the insulin model to the exclusion of CICO might as well be going all in on astrology. Saying "You are fat because your insulin levels are high" is exactly as explanatory and helpful as saying "You are fat because Mars is in the house of Pisces."

And not to put too fine a point on it, but research in Type 2 Diabetes seems to show that shit is all wrong anyway. You aren't fat because your insulin levels are high, your insulin levels are high because you are fat. Losing weight brings blood sugar under control which in turn reduces the production of insulin by the pancreas.

The sad horrible truth about weight loss is this:

• Calories In / Calories Out is simply objectively true and no form of calories are particularly "better" or "worse" from a weight loss standpoint than any other.
• The satiation response of different people is wildly different to the same stimuli. One person can become full and stop eating by drinking water or eating celery and another person will continue to be hungry until their gall bladder detects some fat hitting the duodenum. The various diet games and food suggestions that work for one person will fail spectacularly for another.

Figure out what games you can make to make your personal body stop bothering you about eating. It won't be the same as for other people around you.

Now to put on muscle mass, you will need access to more protein. But the amount of protein you need is still a considerable minority of overall calorie intake. You're going to want like 2000 calories or more per day, and not even 800 of them have to be from protein to have positive muscle production. But basically your muscle increasing plans are irrespective of calories in, calories out and are to a first approximation entirely about exercise.

Micromanaging it can get pretty complicated. But the basics of "exercise to gain muscle, eat less to lose fat" is pretty much spot on. Don't overdo it, because there are pretty severe limits of how much you can gain/lose in a week without that being a bad thing, but the specifics of how to keep yourself doing the exercise and how to keep yourself on a lower end calorie intake are going to be pretty personal and other people's "one neat tricks" are unlikely to work for you as an individual.

-Username17