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PaperclipPerfector  11mo ago (text post)   1861 thread views

Wellness Wednesday for May 3, 2023

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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A random yet poignant quote I once read was along the lines of- "There came a day in your life when your parents put you down and never picked you back up again."

I feel like I'm on my last "family vacation", in the sense of a vacation organized and sponsored by my parents with me and my brother along for the ride. My parents are getting old, the once plastered over cracks in the invincibility one puts up in front of one's kids are now glaringly obvious, and soon enough I'll be an independent adult living in an entirely different country two oceans away, lucky to make enough time to meet them once or twice a year.

At least it's going nicely, Thailand is a gorgeous place, and I think I've earned the right to kick back on the beach and sip a piná colada while the waves lap at my feet. Nice, but also melancholy, because I know it can't last.

Go hug your parents while you still have them. Or at least call. The thought that all this will sooner rather than later come to an end makes my heart ache.

A few years ago I made it a habit to just call my parents on any long car drive or commute. The alternative was just mindlessly listening to the radio. We mostly share parts of our day. Having young kids helps the conversation along pretty often. As a parent its hard to stop talking about your kids, but most people don't really care to hear it. However, grandparents love hearing about their grandkids.

I've been thinking about doing this, but held off because I didn't want to bother anyone. But in retrospect and given your positive experiences, I think I should try.

This Wait But Why piece hit me on that front.

Thanks, that piece always hits me in the feels. I'd call it inexplicable sadness, but I'm very clearly explicating it haha

Or this quote:

“Death is always on the way, but the fact that you don't know when it will arrive seems to take away from the finiteness of life. It's that terrible precision that we hate so much. But because we don't know, we get to think of life as an inexhaustible well. Yet everything happens a certain number of times, and a very small number, really. How many more times will you remember a certain afternoon of your childhood, some afternoon that's so deeply a part of your being that you can't even conceive of your life without it? Perhaps four or five times more. Perhaps not even. How many more times will you watch the full moon rise? Perhaps twenty. And yet it all seems limitless.”

It’s entirely about your own death, isn’t it? I get the same feeling about the 30 hugs from my parents as the 20 moon risings or the 700 pizzas left. Same one I get on my birthday or when I move out of an old apartment. It’s not about the ‘good times you had’ or the ‘people you leave behind’. That wouln’t matter if you (or, somewhat less importantly, them) had enough time.

Well, you and I can use science instead of jesus to hold onto the comforting illusion of eternal life. While I understand I can't live forever, I intend to try all the same.

I remember also reading something along the lines of, "one year, you will have your last summer. You won't realize that until a few years later". I was around 25 when I read that and realized how true it was.

Nice to see a visual representation of how short something is, vs the usual how much money Elon Musk has.

Looking for some guidance on a wide swath of symptoms I’ve been experiencing.

Warning, wall of text. TLDR at the bottom. Throwaway for privacy.

I'm a male in my early 30s. Prior to the experience I'm about to describe, I was in fairly good shape, not overweight. I ran about 12 miles (about 20 km) a week and did light weight lifting. I don't drink, I don't smoke or take any kind of illegal drugs. I take daily meds for allergies.

Two years ago, while I was on my computer playing a game, I suddenly began to experience what I could only call a "headache". It felt like an intense strain just behind my forehead / eyes. It would last only about a few seconds, then fade briefly until another would come on, maybe 15-30 seconds later. These grew in intensity and I began feeling like I was going to faint, though I never did. I unsuccessfully tried to resolve the headaches by drinking orange juice because I thought I might have had low blood sugar, even though I had eaten a fair bit a couple hours before.

I went to the hospital but decided not to go in, as it felt that the headaches were decreasing in strength. They did eventually decrease but were still happening infrequently later in the night, so I decided to go back to the hospital. There, they did blood work and performed a brain scan, both normal. I had also complained of chills and shaking, so they thought I just had a random tremor and sent me home to get a good night's rest.

I wake up the next stay, still dealing with the intermittent headache. These continue for a week, though much less intense and eventually petered out. I would, however, continue to be plagued by other strange symptoms.

In the following weeks I would start to notice that my heart rate would increase much more than normal for doing even light walking around outside for a few minutes. After it increased, it would take much more time to decrease than normal. As I mentioned above, I used to run for a few miles every few days, and when I would stop, my heart rate would rapidly return to my base of ~70.

Other miscellaneous symptoms that appeared in the few months following this initial episode:

  • Heart palpitations. These were so strong they would keep me up at night. I saw cardiologist and after an EKG, Holter monitor, and echocardiogram they could see nothing wrong.

  • Awful acid reflux. I would later be diagnosed with GERD and a hiatal hernia.

  • Feeling my pulse all throughout my upper body. Laying on my side at night I could feel it in my ribs. If I got nervous, I could feel it in the middle of my stomach, down from where the sternum is.

  • I also felt like I had trouble breathing occasionally. It wasn't the case that I was gasping for air, it just felt like my diaphragm was weak and I couldn't get a full breath in. Saw a pulmonologist and my allergist, neither could find problems with my lungs or breathing power.

  • Spasms in my diaphragm, sometimes strong enough to make me gasp. They feel like a light punch to the stomach. One time it was so strong it felt like my whole stomach had dropped.

  • I would have very little appetite occasionally. This I believe has to do with me being nervous / excited, for example, when I would play a video game. Usually, getting in a nervous / excited state would flair all my symptoms. I would get diaphragm spasms and my heart rate would rise and take a while to come down. I felt like I was in fight or flight long after stopping playing.

  • Chills

  • Twitches all over my body, including thighs, hands, even my lips

  • Occasional pains in my chest, arms and legs that feels like a brief pin prick in the sense that feels like it's localized to a small area

  • General malaise

  • Overall weakness

Some of these dissipated to varying degrees as I basically cut all activity out of my life (exciting video games / working out / hanging out with friends). I've kept this up for the past two years, taking some opportunities to indulge in some of these normal activities. I found that doing so would cause some of my symptoms to flair. I tried resuming exercise but found that I would get headaches and dizziness later in the night or a day after working out.

Fast forward to a few weeks ago, after a day of walking around in the relatively high heat for the spring, I come home, go to sit down, and have a brief spasm in my diaphragm where it feels like I can't breathe. My heart starts to race (180bpm+) and doesn't stop even after 20 minutes. I'm taken to the hospital and they diagnose me with a Potassium deficiency. I wasn't vomiting and didn't have diarrhea. I was dehydrated though and I had been sweating a bit. I had a blood test a week later and my potassium was 3.9, within the sufficient range. Prior to the initial incident 2 years ago, I had a pretty strict diet and did intermittent fasting. I think I would have been lucky to get 100% of the daily intake of potassium. I wasn't eating many fruits or vegetables or other potassium rich foods.

Although I’ve increased my potassium intake to 100% daily recommendation almost every day, I still feel malaise, weakness., still get body twitches and diaphragm spasms. I think these spasms also trigger something akin to a panic attack in me. I feel like I’m not going to be able to breathe, my heart rate increases and my hands and feet get cold.

After 2 years without answers, I’m at my wits’ end. What could be causing this? I know some of this could be caused by my hiatal hernia. I also think some of it could be cause by low potassium, though after returning to normal levels, many of these symptoms keep reoccurring. My doctor wasn’t sure about any of the symptoms I’ve mentioned here. My blood work looks fine. The cardiologist saw nothing out of the ordinary.

TLDR: Male, early 30s. Got a strange, intense headache 2 years ago. Since then, I’ve experienced a variety of symptoms including heart rate that increases quickly but returns to resting rate slowly, heart palpitations, diaphragm spasms, body twitches, malaise, and weakness. Known issues include GERD, hiatal hernia, and at least one episode of low potassium, the root cause of which is unknown. Potassium has since returned to normal and blood work looks fine. Being nervous or exerting myself flairs symptoms.

Apologies for the rambling wall of text. I really want to feel normal again. So far, my doctor and the specialists I’ve seen have not given me any actionable advice on how to do that. I'd like to thank you for reading this and would appreciate any advice the members of this forum could offer.

It sounds like an anxiety disorder. Has no one offered to treat it as such (diazepam, CBT, etc)? Almost all your symptoms can be manifestations of anxiety.

Seconded, this screams mind-body connection/physical symptoms of anxiety.

Obviously, it could be some super rare disease no one can diagnose. Most likely though? Psychosomatic. Get a psychiatric consult ASAP.

Thirded. I have an anxiety disorder and have experienced all of these. Heck, I'm having a few right now, even though I've got this crap pretty much under control. It's also extremely likely that such a distressing physical event would spark panic attacks.

Find yourself a good SSRI!

Thank you for the reply. I am definitely naturally more neurotic than the average person. I wasn't really all that anxious when this first happened. I cant tell if it's because of certain symptoms that I have anxiety or if anxiety is most of these. It's definitely a route to consider trying to improve. I'll see if I can't find some CBT program online for anxiety. Thanks again.

Sounds like it could be chronic hyperventilation syndrome. Look up

Buteyko method and papworth method for ways to treat this. It’s strongly linked to anxiety as well.

Twitches sound kind of like benign fasciculation syndrome as well

I hadn't heard of hyperventilation syndrome. I will look into this further in addition to trying to treat my anxiety. Thank you for your reply.

No problem. One good way to test if it’s chronic hyperventilation is to get a blood o2 monitor and see if you’re above 98 percent saturation. Or you can simply hold your breath after taking a normal breath and see how long you last without feeling an urge to breath. Anything less than 20 seconds is indicative of CH iirc

I'm not a doctor. I don't even know half of what those things are.

I have personally noticed I get weird symptoms from stress. And that is immediately what I thought of when I read your list of symptoms. When I asked ChatGPT what your symptoms might mean it said:

These symptoms could be indicative of a range of potential health issues, so it's difficult to determine the exact cause without more information and a proper medical evaluation. However, some of these symptoms may be related to anxiety or stress, as stress can cause physical symptoms such as heart palpitations, acid reflux, and muscle spasms.

Is your job more stressful? Do you play intense online multiplayer games? Do you have fewer social outlets because of the pandemic? Has your lack of drinking socially isolated you? Do you have a family that is going through any kind of emergency? Did you recently have kids? Did you recently go through a breakup? Are you having enough sex?

Could be lots of things causing the stress. Might be worth considering a non-medical intervention. Think less "what is wrong with my body" and think more "ok my body is messed up, how do i make my life more enjoying to compensate for it".

Thank you for the reply. I was going through a stressful time at work and home when this initially happened. Like you suggested, I have figured out things that I enjoy to do that don't flair my symptoms. It's just difficult being unable to do some normal activities.

Synopsis: One can make huge improvements in health issues, particularly those unfairly labeled as psychological, via nutrition. Definitely increase magnesium and potassium intake, experiment with increasing calcium intake if your current intake is below 2000mg, adjust sodium intake to 3-4000mg, supplement vitamin d until greater than 50ng/ml, supplement b12 if blood level is less than 500 pg/ml. Probably start with 250mg thiamine hcl, increase slowly up to 1000-2000mg daily. 4000 words justifying this below.

Obligatory, "I'm not a doctor" opening statement. Considering that doctors have failed to aid you entirely, maybe that's for the best. I'll mention I'm the same age as you, and experience about 80% of the same symptoms, which I've had some success in addressing.

I have to disagree with the users who say these are physical manifestations of psychological issues, and that's as someone who has tried using that approach for most of my life - SSRIs, tricyclics, SNRIs, 3+ hours of meditation a day, diazepam, cannabis, massage, somatic experiencing, and more besides. I think the paradigm is backwards - psychological issues are manifestations of physical problems.

I'm going to assume you're already using an app like Cronometer to track your potassium. If not, get an account now. It's free, you can use it in your browser if you prefer, and use a disposable email if you want some privacy. When inputting your food, be sure to select from NCCDB or USDA databases. Other databases, such as CRDB, may have the specific brand you've just eaten, but they only include data for 7 or 8 nutrients. It's better to put in something generic if it has tested the full range of vitamins and minerals.

Part one: Electrolytes

Let's start with electrolytes. How is your sodium intake, and do you recall how it was when you fell ill? Most people sweat more than a litre in an hour of vigorous exercise, although it can be as high as 3 litres depending on your individual biology. The average person's sweat has 900mg of sodium per litre, or 2.25grams of salt (and again, that can be significantly higher). If you did three hours of running and two hours of lifting a week, that could easily be 11g of a salt a week you were losing just through exercise, or 1.5g a day, which could create a deficit if you were only taking the RDA of salt, or even worse if you were on a "low sodium" diet.

The RDA is supposed to be high enough that it won't cause malnutrition in 97%. That's not as high a barrier as you might imagine, as it includes all adults, and older generations are usually shorter as well as slighter. The top 3% of all men is probably more like the top 10-20% of younger men, and you'll easily be in that cohort if you're fit, active and average height. As you mentioned you were deficient in potassium, you will need to be above the RDA to start repleting those stores rather than hitting the bare minimum for day to day life.

It's a good idea to treat the RDA for minerals and most water soluble vitamins as a minimum target, not a maximum - although obviously don't apply this to macronutrients, or toxic substances like mercury or lead . In the case of sodium, the Western RDA is based on addressing blood pressure issues in a population already eating an unhealthy diet. Compare this to South Korea where they have a higher intake of salt (10 grams a day!), but much lower rates of heart disease. I suspect this is because of their higher intakes of potassium and magnesium, both of which lower blood pressure. Electrolytes all interact with each other in every conceivable combination.

How is your potassium intake now? Are you aiming for the more recent RDA of 4,700mg or the older one of 3,500mg? Certainly aim for 4,700mg at least. If you struggle to reach it, orange juice, dried fruits such as dates, figs or apricots, bananas, potatoes, red meat, oily fish, avocadoes. and even some vegetables such as broccoli are all excellent sources. Avoid spinach, and avoid supplementing potassium unless you're in dire straits. Remember you need to be above the RDA if you want to build back up the stores your body needs. Blood tests with minerals have a weird failure mode when they can pick up extreme deficiencies, but people can still be experiencing low levels of whatever mineral is in question while the tests show "low but within range." It's incredibly unlikely you can cause hyperkalemia from food intake. I've only heard of it happening to people with other issues, such as kidney function or medications that interact. There's a case here - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932298/ - of a woman who with psych issues who ate a pound of dried figs (that's 1200 calories and 3600mg of potassium) an experienced clinical hyperkalemia that was picked up by an incidental blood test. She had no other issues, was told to stop eating so much dried fruit, and her potassium levels were normal the next day - she returned three weeks later, and admitted she had done it again. As long as you don't eat a pound of dried fruit every day like a clinically certified lunatic, you will be fine.

How much magnesium do you get? Almost everyone is seriously deficient in it. The RDA says to aim for 400mg, but the RDA is too low. Dr Mildred Seelig, who was the specialist the FDA consulted to establish the RDA, initially recommended 5mg/kg of bodyweight, so 400mg for an 80kg man. However, only a few years later she increased her recommendation to 10mg/kg of bodyweight. The FDA said "that's great, or condolences for your loss, gotta admit tl;dr" and didn't make any changes. Her final view, for most of her career, was that a person needs 10mg of magnesium per kg of bodyweight when they're well, but this should be increased to 20mg/kg when recovering from illness, injury (including emotional or psychological trauma) or extreme exertion. Dr Carolyn Dean is an MD who also agrees with this. Interestingly, that's the same amount of magnesium as is given to most farm animals in their feed. Your ability to absorb magnesium decreases as your intake increases, so the jump from 5mg/kg to 20mg/kg isn't a fourfold increase within your body. A sufficiently high magnesium dose has completely removed my life long depression that otherwise had resisted all treatment, and massively reduced the anxiety that went with it.

It's difficult to get 10mg/kg from diet alone, and pretty much impossible to get 20mg/kg. This was probably different in the past. Spring water or mineral water can have magnesium contents as high as 100mg/litre, but it's almost entirely removed from tap water to avoid deposits building up and blocking the pipes. At the same time magnesium content in fruits and vegetables has fallen dramatically over the years because of a combination of agricultural methods and premature harvesting of crops, so it's almost impossible to get the same intake as the average peasant would have had 300 years ago.

Avoid magnesium oxide and magnesium citrate, the bioavailability is low so they will only act as laxatives. Magnesium malate, taurate, (bis)glycinate, l-threonate and chloride are all better bets. Threonate has a patent on it, so it's far too expensive unless you're quite wealthy, and people have had varied responses to malate and taurate. Glycinate works very well, but the glycine can have a paradoxical effect on some people. Most people find it makes them relax, but a minority will feel stressed and wired. Chloride is what I would recommend. It will certainly give you loose stools, but there will be no other negative side effects from it. Increase your dose slowly, to allow your body to build up tolerance. You can also apply it topically - mix approximately 2.5g magnesium chloride with 15ml water, rub it on yourself and allow it to dry. There's some debate as to how well it works, but your neck and throat area certainly absorb it well, and it should provide a sense of stress relief within a few minutes. Don't rub it on cuts, grazes, eczema, orifices, your eyes, or anywhere else common sense should hopefully discourage.

In my experience it's more effective than any antidepressant, and is an actual cure rather than simply numbing symptoms. Finally, magnesium absorption depends on acetylcholine, which in turn require choline and thiamine. I'll go into more detail on thiamine further down, but choline can be difficult to get from your diet. The only reliable way to get it is a lot of eggs. 5 eggs will get you your rda. 100g of wheat germ or 100g of beef liver will get you 80~% and 64% respectively, but you should avoid eating liver too frequently as it's very high in copper and retinol. I think in theory that high levels of copper can be balanced by high zinc, and high levels of retinol can be balanced with high vitamin e and vitamin d intake, but it's easier and safer to stick to one portion a week.

Finally it's important to think about calcium. What's your intake of that like? Are you supplementing vitamin K2? Vitamin k2 stops your body depositing calcium in soft tissue and encourages your body to bind it to the bones instead, which is great. But anecdotally, plenty of people report k2 supplementation giving them the symptoms of low calcium, which went away when they increased their calcium intake. This includes palpitations. Do you have a lot of spinach, or other foods rich in oxalates that would bind to calcium? I initially wrote oxalate off as not a serious threat until I read about a fellow who died from eating 500g of sorrel, a wild plant that has the same amount of oxalate per gram as spinach does. Your body can't absorb it, and needs to bind it to calcium to secrete it. This can often happen in the kidneys themselves, causing kidney stones. Magnesium intake helps, as oxalate binds more easily to that instead of calcium, and it passes out in your urine more easily, but it's still best to avoid large, daily portions of oxalate rich foods.

In my experience, the strength/severity/pounding nature of my palpitations was connected to calcium intake. As soon as I increased it, the ectopic beats simply felt like a beat in the wrong place, not like someone punching me from inside my own chest. It can be hard to get a high intake of calcium from regular food, so I supplement with ground eggshell powder. It's almost pure calcium carbonate, pretty bioavailable, and free as a benefit of eating eggs. I save my eggshells for a day or two, rinse and boil them, bake them for 30 minutes, and then grind them in a mortar and pestle. You can obviously get quite a lot of calcium from dairy produce, but the calories mount up. From what I've read it's ideal to keep your calcium intake slightly higher than your phosphorus intake - dairy increases both, so you can never get calcium above phosphorus. Again, avoid spinach. You will lose more calcium excreting the oxalate than you will get from the plant itself.

I can't give you any hard numbers, but I weigh 80kg and my own intake is (approximately, give or take ten percent) 1600mg magnesium, 2400mg calcium, 1800mg phosphorus, 5-6000mg potassium, and 3-4000mg sodium. This has massively reduced my stress, anxiety, depression, palpitations and fasciculations (random twitches, especially over broad areas like your whole thigh or upper arm).

Part two: Reflux and hiatal hernia.

I have only been experimenting with this a little recently. Have you tried doing the heel drops, or the associated abdominal massages? There's plenty on youtube which will be more helpful than text. Did they give you any benefit, or provide any relief?

I've seen hiatal hernias called the great pretender or the great mimicker because of the wide range of symptoms they can cause, making people worry they could have any number of serious illnesses. One that is relevant here is that it can cause immense stress to the vagus nerve. The stress can be made worse by stomach acid causing damage in the oesophagus, which won't cause any pain but will cause your body to respond like it's being injured (because it is being burnt by acid). This can make your body release adrenaline for no reason you can see, giving random bursts of panic, sudden increase in heart rate, palpitations and shortness of breath. I would guess this is why you have such bad symptoms when you are lying down, it is making the hernia aggravate the vagus nerve more and/or increasing the reflux. Is one side worse for it? I find lying on my left side immediately triggers palpitations.

My advice here is significantly more "fringe", but it might be worth experimenting with high doses of thiamine (vitamin b1). I have read several people suggesting that many digestion issues are related to it, including Elliot Overton here. I should point out, as interesting as Overton is, I don't believe he has traditional qualifications in medicine or nutrition.

I've been experimenting with this myself, initially to treat a chronic fatigue issue that has been plaguing me for a long time. I'm in the early stages so far and it's had a phenomenal impact not only on fatigue, but also on my digestion. I've been building up towards a higher dose, so I cannot confirm if it completely fixes my own reflux, but I am optimistic. I'll warn anyone reading this, though, it will trigger a "mild" form of refeeding syndrome. "Mild" in this case meaning "non fatal" compared to refeeding in anorexics, but otherwise completely crippling unless you keep your electrolyte intake very high, supplement with biotin and riboflavin, and increase thiamine in small increments. It's startlingly unpleasant. You cannot function in any way until you get your nutrition balanced so the symptoms recede.

Part three: other nutrition issues

Do you have any idea what your vitamin D levels are? It plays a big role in general health and sleep. The recommended blood levels are "the minimum amount to prevent rickets", which is better than having rickets I guess. All researchers who specialise in vitamin dD recommend a blood level of 35ng/ml, the vast majority of them recommend over 50ng/ml, and it's not uncommon to recommend 60 or even 80 as a minimum. I found this video a good starting point. It's important to make sure your vitamin d intake is daily, as well - some forms of it have a very short halflife as explained here. Monthly mega injections are not helpful. It would be ideal to get it from the sun if you can, and I suspect there are other benefits to sun exposure as well, such as helping set your circadian rhythm (you need to be exposed directly to the sun, not through glass, including spectacles). Increasing your vitamin d intake will also increase how much calcium you absorb, so in turn it's helpful to supplement vitamin K2 to help your body deal with that.

B vitamins in general are essential. As well as obtaining them from food they are naturally produced by bacteria in your gut. Which could mean that if your gut health is off, you might be significantly deficient in them even if your intake from food is ok (the fact they're produced by bacteria internally and also constantly - not as a single dose from food or a tablet - makes it difficult to know how much we need). A b complex can be very helpful, but it's difficult to find a reliable one. Many forms of vitamins (such a folate in the form of folic acid or b12 in the form of cyanocobalamin) are unhelpful at best and damaging at worst. Others, such as folate in the form methylfolate, can have a negative impact on some people (I believe due to methylation issues). If you want to experiment, it might be helpful to purchase them individually so you can tell which specific one is benefiting or harming you. From what I've read and experienced, these forms are least likely to have a negative effect:

  • b1 as thiamine hcl

  • b2 is always ok, I think.

  • b3 comes as niacin (also called nicotinic acid) and niacinamide (also called nicotinamide). Niacin in large doses can cause a "flush" reaction in large doses, which some people like for a reason I haven't been able to understand. Both should be fine.

  • b5 is pantothenic acid is easily available and fine

  • b6 is most bioavailable as p5p, from what I've read

  • b7 is biotin, I'm not aware of it being in different forms

  • b9 is less likely to cause issues as folinic acid, but methylfolate is fine if you don't have any side effects. I've been advised against the form folic acid

  • b12 is bioavailable as both methylcobalamin and adenosylcobalamin. Hydroxocobalamin is converted by your body to either form, depending on its needs. Cyanocobalamin should be avoided.

Finally, how is your sleep? A lack of restorative sleep would make these types of issues worse. I'd recommend looking at Dr Gominak's sleep protocol if you struggle with insomnia and regular suggestions like "go to bed early" or "exercise regularly" are more irritating than they are helpful. Her advice is to increase your vitamin d blood level to 60-80ng/ml, supplement with a b complex, supplement with b12 if your blood level is less than 500pg/ml, and stop the b complex after three months. It worked wonders for me, after struggling with insomnia from early childhood.

Part four: Pulling it together

Here's what I, a stranger on the internet with no qualifications in medicine, would advise.

Eat a diet of whole foods with the aim of getting 110% of the RDA at minimum. If you weigh more than 80kg, scale your targets up proportionately (eg, if you weigh 88kg, multiply the RDA value by 1.1). Make sure your vitamin a intake is in the form of retinol, rather than carotene, as carotene is converted into retinol by the body at around 8%. You can get this from either liver (I'd recommend whole, tinned cod livers - they don't taste bad and are much lower in copper than mammal liver, plus they include vitamin d - eat half a tin, approx. 55g on two consecutive days and that will get you just under a week's worth of vitamin a. Eat one tin a week, more if you have a good, educated reason to), or from a combination of eggs and butter. If you go with eggs and butter it will take a lot - around 6 eggs and 60g butter every day. Try to keep your zinc intake at 8x your copper intake at minimum, don't have more sodium than potassium, and experiment with increasing your calcium intake to see if it helps your palpitations. You will need more than the RDA of potassium to really build your body's stores back up. Blood tests can be very helpful, and also very misleading. You will not hurt yourself by eating bananas.

If you want to eat raw eggs, make sure you supplement biotin. Raw egg white contains avidin, which binds to biotin and stops you using it. Each raw egg white will bind approximately 90mcg of biotin. This means if you want to go full Gaston and have a dozen each day, you'd need to supplement more than 1000mcg of biotin just to avoid deficiency.

Avoid all the things that are sensible to avoid. Cut out sugar, syrup, alcohol, caffeine, artificial sweeteners, any recreational drugs, . Consider avoiding gluten or sticking to a FODMAP diet as best you can, which will involve cutting out pulses and many grains. In the long term you should be able to return to eating these foods, but in the short term avoiding them might improve your health by 10%, and it's a 10% that you could really benefit from right now.

Supplement magnesium, and experiment slowly increasing your intake to 20mg/kg of bodyweight, or even a little higher if you're still experiencing benefit. Initially try magnesium chloride, as it's the most reliable, but be aware that it will loosen your stools or even cause some diarrhoea. Make sure your other electrolytes are sufficiently high while doing this, or you'll feel quite unwell. Try applying magnesium topically on your neck for immediate effect, and it should give you some indication of whether or not it will be helpful for you.

If you find yourself having compulsive, negative thoughts and actions from them - things like skin picking, hair pulling, self harming, or other addictive and destructive behaviour - a supplement called inositol can be very helpful. It's a sugar, both made by your body and available from food. Experiments have used up to 18g of it without serious side effects, although I try to stay under 12g myself, and only use it when I feel I need to. It has a powerful anti anxiety effect for a certain "type" of anxious feeling, and zero addictive properties or side effects beyond mild flatulence.

Make sure you get regular vitamin D, ideally from the sun (an app called dminder is very helpful for measuring the actual amount of vitamin d you’re synthesising, particularly if you have a light sensor on your phone), and increasing b12 plus a b-complex alongside this as recommended by Dr Gominak can really help with insomnia. 4-8000iu of vitamin d is probably sufficient if you're supplementing a decent amount of magnesium, higher if not.

After establishing everything above, consider starting with a low dose of thiamine and increasing up to 1000mg-2000mg depending on your body type, size, and individual response. I would recommend thiamine hcl. More expensive forms such as TTFD might be more bioavailable but they're also more likely to cause other issues, such as mentioned here. If you start to feel truly awful on higher dose thiamine, it's not an allergy or negative response, it's refeeding syndrome. Depending on what you diet has been that day, eat 2g of salt, eat 100g of dried fruit for potassium, drink a pint of water with 2.5g of magnesium chloride dissolved in it, supplement 30mg of riboflavin (despite some much bigger supplements, your body doesn't absorb more than that at one time - feel free to supplement again later in the day though) and make sure you're already taking a biotin supplement above 1000mcg. MAKE SURE YOU HAVE THIS AVAILABLE BEFORE YOU START SUPPLEMENTING THIAMINE! You don't want to experience refeeding syndrome at 3 in the morning, or 40 miles from the nearest shop, and not have the resources to hand.

If you struggle with getting everything you need from the diet, a good starting point is 4 eggs, 40g of cheese, 150-200g potato, 1/4-1/2lb of red meat and 1/4-1/2lb of low mercury oily fish. Low mercury oil fish is unsalted anchovies, sardines, mackerel, herring, salmon or trout. Salmon and trout are usually farmed if you're in Europe, and farmed fish are exposed to antibiotics as well as being much higher in parasites. Wild salmon may have higher levels of mercury depending on the species, as do different species of mackerel, but searching the name of the specific type should give you clear results. Fill up the rest of your diet with fruit, vegetables, orange juice, potatoes, rice, cold pressed oils and butter, always aiming to hit nutritional surplus before filling up on carbs or fats. Fish/meat weights are raw values, so cooked weight will be about 15% lighter - in practice, a 90g tin of fish is the same as 1/4lb fresh. Almond oil and styrian pumpkin seed oil are both good sources of vitamin e if you're struggling to get enough. Probiotics such as kefir or kimchi could prove helpful, especially if you've had antibiotics. Homemade is vastly superior to store bought, especially as some companies make the insane move of pasteurising their product before putting it on the shelves.

ETA: While all of this should help, it will be massively limited if you are still fighting other stresses in your life. If you going through a divorce, grieving a recently departed loved on, or feuding with your local drug dealer, you will be less able to benefit from this. Similarly, if you are staying up late staring at computer screens, not getting to bed before 10pm, not getting fresh air and daylight, spending an unreasonable amount of energy arguing with strangers on the internet, or any number of other stressors that are obvious when you think about it, you'll be hindering your ability to recover. Doing the small, healthy obligations of life might only get you a 10% benefit, but again it's a 10% you need right now, and could you push you from "spiraling downwards" into "finally recovering."

Wow. First off thank you for such thorough write up. I'm thankful for my doctors but none have given me this thorough of an examination of my problems.

I don't know why but it really hadn't occurred to me to question whether the RDAs were accurate/appropriate for me.

I have started using Cronometer since the beginning of this year, which would be after I changed my diet to start eating a wider variety of foods. Inputting my old diet in which I skipped breakfast and had the same lunch everyday, I was really low on a lot of vitamins and minerals depending on my dinner.

Back when this first happened, my salt intake was probably low considering my exercise level. My diet wasn't intentionally low salt but in practice it most likely was.

For the potassium RDA, I had been using whatever RDA is in Cronometer, which was 3400mg. I'll update this manually so I start using it in the future. The easiest food for me is milk. OJ and some fruits are hard because of GERD. Since learning that I had low potassium, I began drinking a bunch of milk.

I had started taking magnesium supplements before I had tried restoring my potassium. I was worried about taking too much so I eventually stopped. I think I noticed I had soft stools and assumed I must be taking too much. But on Cronometer I am getting about 50-60% of the 400mg that is recommended there, which would be an even smaller percentage of the even higher RDA numbers you stated. After looking up low magnesium, I see it causes low potassium. You would think a doctor would have mentioned that at one point. Do you have a brand of magnesium that you recommend?

My calcium intake should be good after I started having multiple cups of milk a day. I'm not supplementing K2.

Part 2:

I initially started heel drops before I had been diagnosed with a hiatal hernia but felt like it really didn't accomplish anything. I'll look into these massages further though.

Now that you mention it, I recall it being impossible for me to sleep on my left side when my symptoms were at their worst. I could feel my pulse through my left ribs.

I'll probably hold off on high doses of thiamine and maybe try as a last resort.

Part 3:

My vitamin d levels should be good. I did discover how important vitamin d was when I was initially feeling bad. Since then, I've made it a priority to get out in the sun each day for 15-20 minutes at solar noon and as much as I can handle on the weekends (I have been using dminder for a while and love it). I live in a northern latitude so the winter is limiting for vitamin D but I get a lot in the summer.

For B vitamins, I take a multivitamin that has multiple B vitamins that has worked pretty well for me I think.

My sleep is okay. I have been getting to be too late and sometimes I wake up early and can't fall back to sleep. I average around 7 hours.

I like your diet suggestion. I appreciate the point about holding off on carbs until I hit my nutrition markers. I thought for a while I had maybe just been eating too low of calories and that's why I didn't feel good so I started including some more carbs, but they were mostly empty nutrition.

There is so much to digest here. I'll be coming back to this post often. Thanks again for all your help.

You're very welcome, I only hope it's of some use to you. I'm glad to hear you're using Cronometer already. It's both intimidating and liberating to realise you have to take your health into your own hands.

Maybe Cronometer is using a European RDA for potassium. The American FDA increased theirs to 4700mg in 2016, partly because the average American was so much heavier than when they set the original RDA. Cronometer also set an incredibly high target for protein by default, something like 1.8g per kg of body weight. If it works for you that's great, but I think that's a target for athletes rather than the everyman. Reflux is a pain like that - I found sticking to the fodmap diet reduced the symptoms, and as you reintroduce food it helps you pinpoint which are giving you trouble. For example I've found I tolerate dried figs, apricots and dates well, but apples, pears and raisins still cause discomfort. It's worth experimenting if you're struggling to get the potassium, but obviously you know your own body best. Never try and ignore obvious pain just because someone thinks it shouldn't happen, whether that’s a medical doctor or some anonymous poster online.

I understand the worry when supplementing. I suspect if you're the kind of person who spends time on here you will be ok - the fact you're worried means that you're also researching this and you’re bright enough to do so successfully. There are certainly studies showing high dose magnesium (up to 1500mg supplemented) was effective in rapidly reversing treatment resistant depression, but I don't know enough to vouch for how strong those studies are. There are also plenty of testimonies online from people who have taken high doses for a variety of ailments, usually attached to warnings not to take it if you have kidney issues. If you're worried you can always discuss it with a doctor, but it's possible they won't be open to the idea. There are plenty of articles like this online, with doctors lamenting how little they are taught about nutrition. That's probably why no doctor you visited has mentioned it, nutritional approaches are not a major part of their tool kit despite how useful it can be. I buy magnesium from a brand called Heiltropfen, but I don't have any particular loyalty to them - they were the only company I could find selling magnesium chloride flakes that were listed as food grade. The cheaper versions marketed as bathing salts are probably fine, but I didn't feel the need to risk it at that price.

If you find the loose stools too unpleasant to deal with, Magnesium Glycinate, Taurate, Malate, and L Threonate should not have that particular side effect (although they may have others instead). The most important thing when taking high magnesium is to keep calcium/phosphorus/sodium/potassium at least as high as the RDA.

In terms of calcium, I was taking around 1500mg when the ectopic beats felt like they were pounding in my chest, but once I increased it to 2,400mg the beats only felt out of rhythm, not worryingly forceful. I think my situation is unusual, the high dose thiamine I'm currently taking means I need a higher calcium intake for now. In your situation it could be the relation between any of the electrolytes being too high or too low, but I think that is worth investigating.

I'm not so experienced with the heel drops, but it's worth looking through youtube to see the variety (and other exercises). Some people say that having your arms raised when you do them makes a huge difference, and there's probably other tricks. I hope you can find something else that helps there, though, and hey, it’s free.

Did the symptoms get worse when you were on your left side, or did they just become more noticeable? If it definitely gets worse then that indicates it could be related to the vagus nerve becoming irritated by the posture, or alternatively because it's changing the position of your heart - but this also something I've only just started reading about, so take this as an avenue to explore rather than something that is definitely the problem. Like so many other things, there are arguments for sleeping on either side. Sleeping on the right side avoids stimulating the vagus nerve but it's worse for acid reflux, so I don't see a good option there. But it might be useful information to narrow down what's affecting you.

Vitamin D can be tested privately and cheaply, if your doctor isn't willing to do it themself. The test can be ordered by post with the kit to take a tiny blood sample and return it. Your ability to synthesise vitamin d depends on a lot of nutritional factors. Bruce Hollis, the researcher I mentioned in the earlier post, says that when he started supplementing magnesium (I think it was 400mg, it definitely wasn't a huge dose) he saw his vitamin d level rise by 10ng/ml in his blood work, from something like 50 to 60 ng/ml. Sorry, it's late here and I haven't got the time to pinpoint it, but it was in one of those two videos. On the other hand, too much vitamin d can cause issues too, usually from absorbing too much calcium. I think that's mainly in people taking huge doses, or life guards who have really high sun exposure. It sounds like you've got a lot of this under control already, so I think it's unlikely to be an issue, but testing lets you know for certain instead of guessing.

And maybe I was too harsh on carbohydrates! We need them too, and there's a big difference between a healthy diet that involves decent portions of rice/potatoes/pasta, and a diet of purely hyper processed carbohydrates like pizza. It sounds like you're doing a lot better with your diet now compared to when you initially fell ill. I really hope you find some relief soon.

I am not a doctor, this is not medical advice, but it reminds me of the story here: https://www.mechanicalbasis.org/mystory

Thankfully nothing this drastic happened to me, though something like chronic fatigue syndrome might be something to look into. Thank you.

I'm going through another bout of anger over my experiences of "dating" in my 20s.

During, and post-college, the worldview I was presented with by my friends, social circle, and the women I encountered was that the explaination for all behaviors of women was "Feeling Unsafe." If something didn't go well on my date, it was because somehow I made her feel unsafe. If a woman didn't respond well to me flirting with her, it was because she was afraid I was about to assault her. The reason that a woman said "I've got to go to the bathroom, wait here, I'll be right back" was that she felt unsafe and was trying to escape in a way that wouldn't make me fly into a rage. Stood up? She Felt Unsafe. Woman I'm on a date with leaves with another man? She wanted the other man to protect her from me.

In my social circle, women's favorite topic of conversation was how much they hated men flirting with them, speaking to them, or even looking at them. Every outing to a bar was presented as a desperate struggle to Just Hang Out With Their Friends.

Then I got a little older and moved away from my college town. I had two relationships with women who actually HAD run into dangerous men, who had genuine trauma in their history. They didn't talk about Feeling Unsafe, they didn't go through life claiming constant fear of men, and they were universally confused at my low-self-esteem. One of them ran into a woman from my old social circle and was left aghast. "I didn't think all that stuff you said was real, but holy crap, is that what you were running into before you met me?"

Now, at 34 and stuck "dating" again, I just feel emotionally crippled and incapable of putting myself out there anymore; every time I do, I get flashbacks and all the old pain comes back, combined with the new pain of having loved and lost.

This resentment is common for men growing up in the West. 'Feeling unsafe' is used as justification for a whole bunch of bad behaviour from women in the dating sphere. Ghosting is probably the most obvious example. Girls don't want a confrontation so they disappear. In a social setting when asked about this they'll say things like 'I've seen guys flip out so I'm just protecting myself'. Clearly as you've figured out 'I felt unsafe' is a social 'Get Out of Jail Free' card that is played with impunity. Then you're told your a bad person if you even hint that girls would ever play it undeservedly and not for it's intended purpose.

Issues like the above led to a lot of guys on PUA/Red Pill forums going through an 'anger phase' where they detoxed from this sort of resentment towards being gaslit. Some guys got stuck there for a long, long term, but many managed to work their way through eventually.

Basically you need to accept that its common for people to act badly and impolitely in the dating sphere (largely due to the complete lack of social accountability that anonymous/atomised communities provide). It's not your fault and you did nothing to deserve that behaviour (unless you did, but I'm giving you the benefit of the doubt here).

I should be clear that guys act badly in dating too due to similar reasons to the above. There are actually dudes who physically threaten and sexually assault women and some women actually are afraid of men (although I think the last is a small proportion of the women who use it as an excuse for bad behaviour).

But dating is something you should absolutely take breaks from when you feel the need to. Particularly when using apps which are their own special type of hell.

Someone help me contextualize VO2Max scores versus the population.

So, I have a VO2Max of about 50 on a good day. Confirmed by a treadmill test in a lab but also corroborated by my fitness watches.

This translates to 90%ile for my age (42).

I find this disconcerting because I think I train really, really hard, and have been for a long time (several years). I started from some place like 30 though I haven't been measuring the progression that closely.

I'm surprised that despite all of the effort I put in, I'm only better than 9/10ths of the population. I'm not trying to, like, humblebrag here. I think this sucks. I'm pretty sure this doesn't mean 10% of the male population in their 40s trains harder than I do?

Is the rest of this explained by genetic variance or what? Do people who used to be on the running team in college just have that much banked up, versus someone like me who was sedentary for the first few decades of his life?

A few questions to help evaluate:

  • What is your VO2max?

  • When you say you've been training, how much do you mean you've been training and how?

  • What running times are you getting?

Regardless of the answers, quite a bit is indeed going to be a product of natural talent and cardiovascular activity during developmental stages. This is both the good and bad of picking endurance sports is that the performance is easily measured, straightforward to improve, and you'll be better than quite a few people... but also hopelessly behind quite a few people that don't even try all that hard.

Thanks for the feedback. Re: your questions: my VO2Max is 50 (was in second line of my post). I'm running 30+ miles a week. I do 70% of them at Zone 2, and run VO2 trainings (intervals) 2x per week. I pick up easy (Z1) or harder workouts (tempo/threshold) in there as well.

My best 5k ever is 23:45. I can do 1.7ish miles on a treadmill cooper.

I'm a bit overweight; about 23% body fat. I lift too, but I and am less disappointed with how that's going.

Pentathlon Attempt for the Week

I totally screwed up two separate attempts last week. First I went for it on Cleans without wrapping my right hand, because I hadn't had callous problems on Cleans so far. Hit 120, but ripped a three quarter inch long and mega thick callous off my right hand, could not finish the sets competitively so just finished out with some reps on long rest in the Jerk and Push Press.

Then later I tried doing the first three exercises at race pace, using bear komplex grips to protect my skin. That "worked" to protect my skin, but this time after hitting 120 on the clean my forearms and biceps were so pumped from the thicker grip that I had to throw in the towel.

So this morning I finally hit a full set. I taped my right hand over the torn callous right away, and was modestly conservative on rep targets, just wanted to beat my old scores. All with 28kg:

Clean 100/120

Long Cycle Clean and Strict Press 60/60

Jerk 90/120

Half Snatch 54/108

Push Press 96/120

Total Score @28kg= 1400 Points, a 210 point improvement over last time.

Pretty happy with that workout. Might have had a couple more reps in me in every exercise but the Long Cycle, but still gassing on conditioning by the end. The Half Snatch remains my weakness, but it is much improved over last time, working towards respectability. I'm mixing in a lot more interval work to try to improve my breathing and recovery: hill sprints, thai jump rope, airdyne bike repeaters, repeated sets of loaded carries, Tabata/EMOM sets of barbell Front squats. That and core work, when I can keep my core stiffer on the overhead lifts I can hit bigger reps.

I guess I need to start training the long cycle with the 36kg if I want to add points there, though I'm not confident I can actually add points by doing that. My max points attempt might be to stick with the 28kg for that exercise and get a longer break in? I'll have to experiment. But next week I want to break 1500, which I see as most likely getting the half snatch to 70 reps and then adding a couple reps to the other exercises. Gotta work on some long rep sets of snatch this week, get stronger in deep water with those.

I feel as if I am extremely unattractive due to autism and subpar physical appearance; while I have friends, dating has been almost impossible for me. While I have solid career prospects as a medical student, I believe that it is very unlikely that I will ever have an average partner. I do not think that any remotely "good" outcome is remotely realistic; at this point, it is about picking the least bad option, rather than a nonexistent and fundamentally unrealistic "good" option...at the end of the day, it has become abundantly clear to me that it is about deciding where I want the ambulances, or the lights and sirens: what institution will my partner be in and out of?

Given this: is there any set of skills that I might benefit from learning in order to be not only a good father and husband but nurse and caretaker for a partner? I know that my medical education will give me the technical skills to handle it, but medical school does not teach how to merge the roles of partner and caregiver. She might be 400 pounds and a sprained ankle away from immobility - and that is honestly one of the better things that could happen. It beats things like looking the other way at alcoholism or drug addiction. Yes, I am aware that there is "a hell of a lot of 'average' out there between prom queen and obese drug addict" but average is deeply unrealistic for me. That ain't happening any more than I'm going to discover some hidden, great athletic talent and start playing baseball for the Yankees, or compete in the Olympics.

How might I plan for things like 'my wife needs home health aides at age 45 because she can't take care of herself' or how to deal with my kids' (justifiable) disappointment at or anger at their mom because she literally ate up their college fund, or because there were a lot of experiences that they simply could not have because of their mother's size? It'd be the same way with anything else...if it was drug addiction, you've got the same problems plus or minus issues with law enforcement. If it was something like mental illness that manifested itself through terrible life choices and abuse, that'd be even worse.

In addition: how might I advertise that I am willing to go on this journey with someone: to sit by their side in the hospital because they've had a pulmonary embolism at 29. To look at wheelchairs and walkers with them in their thirties. To be their nurse and caretaker - or to work hard at medicine to earn enough to pay home health aides. How might I signal that I am not only able but willing to be that kind of caretaker?

Why do you assume that having low standards means ending up with someone with a self-destructive lifestyle or crippling health problems? You describe yourself as an ugly autistic man who is in good health and pretty much has his life together. Why don't you look for an ugly autistic woman who is in good health and pretty much has her life together?

Those are rare and usually end up with guys a hell of a lot more attractive than me. I don't blame them. It's what I'd do in their shoes. My only real choice is where I want the ambulances. How do I make that happen?

You are unreasonably certain of that being your "only choice".

Buddy, if you're a med student and on track to becoming a doctor, you really have to have fallen down the ugly tree, hit every branch and ended up with a pinecone in your ass for you to end up dating someone so decidedly below average.

Presumably you're a US med student, so you're on track to making around $250k a year unless the AIs take yer jerbs, at which point you can easily end up with hot women lining up to date you while employing herculean amounts of patience in the face of your autism.

In order of sense and sensibility:

  1. Workout. Can't cure ugly, but big muscles can distract from an unfortunate appearance.

  2. Look forward to a hot nurse or some other woman, who if not outright gold-digging, still has a vested interest in landing a decent guy, showing up in form-fitting scrubs to tease your decidedly non-autistic dick until you get the message.

  3. Visit Thailand. Fuck hot women. Adopt one and her water buffalo for the long haul.

  • I'm no slouch in the weight room: bench 225 squat 315 dead 345 weigh 160lb @ 5'6". I suppose I could try to look like a physique bodybuilder or something lol.

  • I am not sure that $250k is enough to get a Western woman to be with someone she finds disgusting on a visceral, biological level. I suppose that people vary in their disgust tolerance. Certainly my time as a medical student has really altered my feelings around disgust...I don't mind it as much, it doesn't matter as much. Some of my classmates feel differently, some feel the same way. I'd suspect that you need around a million a year to get someone to put up with that kind of disgust...I've heard that Silicon Valley was packed with fit multimillionaire virgins!

  • Sounds like that is asking to be divorced. Worse, if you are unlucky and she's quite disgusted by you. Not that there is anything at all wrong with that; I'd do the same in her shoes!

I am not sure that $250k is enough to get a Western woman to be with someone she finds disgusting on a visceral, biological level.

.. what makes you so ugly ? Being prematurely bald ?

Being too short ? Deformed, unusual face ?

Or is it all a mental problem, body dysmorphia ?

Premature baldness plus subpar facial appearance and 5’6” stature. Nothing that a medical professional would call a deformity, though I might benefit from jaw surgery.

Then you’ve got the autism to add to that. There have been studies that showed that neurotypicals (that’s normal people) judged autists as awkward based on two seconds of footage of them socially interacting, and even from snapshots of social interaction. That might not be a physical deformity, but it sure functions an awful lot like one, if people can be like “That guy’s awkward” after watching him talk to his friend across the room. For two seconds.

As such…I think a million a year sounds closer to what it would take to get someone who’s not morbidly obese, can work a full time job, not a danger to herself or others, and not addicted to hard drugs to endure that kind of disgust. I don’t blame people for that…I mean, it’d take a lot of convincing to get most people to be with someone they were viscerally disgusted by!

Have you considered that physical appearance is one of the most malleable things about a person, particularly for a person with a high income? I have no specific knowledge of what about you is unattractive, but you have the following options open to you:

  1. plastic surgery if it's an unattractive face or jawline or your ears stick out or whatever

  2. weight loss drugs if you're overweight

  3. testosterone replacement therapy + personal training if you have a severe lack of muscle mass. (Girls mostly really like muscle mass.)

  4. that leg-lengthening procedure if your problem is height

  5. wigs or medical hair replacement (dunno the clinical term) if you are balding.

This is an entirely serious comment. Western society has a stigma against trying to change your appearance in these ways, but if your appearance is an impediment to you living your best life, you should change it if you have the money, which it sounds like you will.

Do these have side effects? Yeah, probably. Life is full of tradeoffs. Still, given current medical tech the OP reads a bit like a (more expensive) version of "i am worried that no woman will ever love me because all of my clothes are ugly. Should i resign myself to dying alone, or just really go hard on settling?" My dude! Just buy some new clothes!

Self-acceptance is bunk. Engineer that shit away.

that leg-lengthening procedure if your problem is height

Isn't this an extremely invasive and painful surgery where you cannot function normally with your legs for 1-2 years while recovering? I would really suggest just dating short girls instead

wigs or medical hair replacement (dunno the clinical term) if you are balding.

OP, this is much recommended. Turkey has a large industry of medical tourism for plastic surgery but especially for hair treatments so I know lots of people who did this and it can really change a balding guy for much better.

Yeah, the legs thing is probably the most invasive of the items on the list, and the one i know least about.

I simply wish to say that I approve of your flair 👌

  • plastic surgery if it's an unattractive face or jawline or your ears stick out or whatever

Will get this the minute I can afford it.

  • weight loss drugs if you're overweight

I'm 5'6 and 160.

  • testosterone replacement therapy + personal training if you have a severe lack of muscle mass. (Girls mostly really like muscle mass.)

Hmm. I'm no slouch in the weight room: bench 225, squat 315, deadlift 345.

  • that leg-lengthening procedure if your problem is height

Maybe when I'm an attending; the recovery period is long and you never fully recover your athletic potential.

  • wigs or medical hair replacement (dunno the clinical term) if you are balding.

As soon as I can afford it!

Hell yeah, dude. Remake yourself as someone hotter! Nobody can stop you! FUCK THE NATURAL ORDER.

Stop being such a baby for one.

What: accept that I will be a nurse and caretaker and start working to build a good social network to help me with that?

@Ioper put it a bit more harshly than I would have but he's correct. Even if you are such a bad catch that you have to settle for a below average woman (which probably isn't true), there's a huge expanse between "average" and "so fat she can't even hope to wipe her ass any more, either that or a meth addict". This idea that you have to consign yourself to a life of misery (either being alone or being some broken woman's caretaker) is pure bullshit.

Your biggest problem isn't being autistic or whatever, it's your mindset. Women are going to see that from a fucking mile away, my dude. Nothing chases them off faster than some guy wallowing in self pity. Stop doing this weird coping mechanism of "I'm going to be miserable no matter what, best get used to it" and start trying to be more positive. Get therapy if you have to. But whatever you do, take steps to work on ditching this toxic mindset you are in right now.

And FFS stop arguing with people trying to give you good advice in this thread. The people giving you sympathy and saying "yeah I know what you mean, it's going to be bad for people like us"? They are the ones you need to push back on and not listen to. Listening to them is just going to keep you where you are. It feels good but it's like eating junk food - it's just making you unhealthy. You are utterly wrong about what the world and your prospects are like, and if you want to be in a better place you need to stop listening to the people you're inclined to agree with and start listening to the people you've been arguing against.

there's a huge expanse between "average" and "so fat she can't even hope to wipe her ass any more, either that or a meth addict".

I think that it is unrealistic for me to be with someone that met the standards I once had:

  • Not morbidly obese

  • Not a danger to herself or others

  • Not addicted to hard drugs or alcohol

  • Able to work a full-time job, any job

  • Able to live independently and manage her own affairs.

I am working on being positive. I've realized a couple of weeks ago that these were basically my options and that it was good to be satisfied and happy with them: if my "niche" is nurse and caretaker, I need to figure out how to fill that niche rather than choosing to be celibate for life. There's plenty of guys that are happy with partners that are a lot worse than "is 500 pounds and needs a nurse and caretaker"; I've seen children that have been raised in those environments and have turned out OK...although that is a bridge that I'll cross if I ever reach it.

Why does caretaking have to be miserable? Pick the least-bad option and be happy with it, is my plan.

Quit the charade of "hard realism", you're just manufacturing reasons to wallow in unproductive self-pity.

Your doomerism is an escapist fantasy, steering you away from confronting what's genuinely achievable and taking actions in that direction. It's as delusional as thinking you'll get a hot girlfriend by simply getting a bunch of money, and even less productive.

Hmm. I mean...I am willing to work on building a social network. I've accepted that I am unlikely to ever be averagely attractive, to be honest. A good social network will help me whether I'm alone, with a partner that needs a nurse and caretaker, or with one that doesn't.

Also: gold diggers exist. I suppose that if you have a large enough pile of cash, someone's willing to hold her nose and accept prostitution on a long term contract. The problem is that most doctors do not amass sufficiently large piles of cash. I'd think around fifty million at least is necessary...

One more thing: I believe that war is one of the best ways to become more attractive, as a man. Provided that you survive in one piece, more or less. Not happier, and every veteran I know paid a very heavy price. That being said: I do intend to have myself dumped into the Alaskan wilderness in late winter, next year, with survival gear. If I survive and walk out, I suppose it might be like war minus the moral injury and risk of being maimed...although maybe the moral injury is an essential part of things.

50 million? War to make you attractive to women?

Man, you make some wild assumptions.

The first half of the first paragraph is good but then you're straight back to escapism.

If a one paragraph goal is what you can muster then focus on that. Don't engage with the doomerist escapism. Take a step back and look at your behaviour here, you're having a crisis and that is fine, but this kind of thinking is neither realistic nor productive.

Don't focus on the goal if you can't imagine it, focus on the small steps that will take you in the right direction.

  1. I suggest you come back to this after 1 year of making that sweet American medical cartel salary. That should help a bit with women not infinitely, perhaps even not much but probably more than now.

  2. From a psychological standpoint, you can just.. give up. This is the path Ive chosen. Ive not given up permanently but temporarily. Im probably of average looks but am deeply austistic in a way where I get along great with guys and terribly with girls. It feels like talking to a wall sometimes. Im making sweet bag as of late so Im hoping in the near future my bankaccount should have a strong enough gravitational field to do the job for me.

Right. That's going to get me a gold digger who's disgusted by me and only in it for the money.

Thats just being a human male my guy. You're not the only one with that fate.

Have you considered importing a wife from Southeast Asia or South America etc? Honest question - you could easily marry very well that way.

Reasonably sure that she would be disgusted by me. I don't blame her for this; in her shoes I'd get as much cash out of the awkward doctor as I could, and then either divorce him (if I was being nice, or at least average) or take out a big life insurance policy on him and get rid of him permanently (if I was really grossed out by him, or felt I could get away with it...maybe due to something like organized-crime connections.) Why sleep with someone you find disgusting on a visceral, biological level any longer than you have to? Especially when there are better options out there.

I don’t think all women place as much emphasis on looks as you think, especially in other cultures. I’ve seen some baddies with disgusting men

Second, most obese women live many years before progressive, chronic conditions slowly begin to disable them. Most do not suffer catastrophic health emergencies in their 30s. Most do not require home health aides at 45.

I'll agree...unless you're 400 pounds and gaining. I knew a woman that had a catastrophic health emergency in her late 20s; she was around 300 pounds. Another friend's mom is 450 and walking with a cane in her early fifties; she's a sprained ankle away from being bedbound.

Third, do not knowingly inflict a knife-wavingly mentally ill mother on children. That is a much worse option than a sane, stable fat woman.

Yeah, agreed. Hell, the kids being supporting members in a My 600-Lb Life episode is probably less traumatic and damaging than that kind of crazy.

And finally, there is no need to signal to a fat woman that you are willing to play nursemaid. She is not looking for a nursemaid. To offer yourself as one will make her feel profoundly unattractive, which will be a huge turn-off.

I'd agree here if she's still fairly mobile and able to hold down a job.

I'll agree...unless you're 400 pounds and gaining. I knew a woman that had a catastrophic health emergency in her late 20s; she was around 300 pounds. Another friend's mom is 450 and walking with a cane in her early fifties; she's a sprained ankle away from being bedbound.

I don’t think people really understand this well. People can be heavy enough that tripping and landing on your feet can be cause for amputation.

Essentially: the risks of being heavy go up exponentially with weight. You can also easily spiral and become bedbound after an amputation like that...if at 200 pounds you're just a chubby average person with a sprained ankle at 300 you are okay, maybe you break it. At 500? It's now a big deal.

is this a fetish you're acting out?

Damn, sounds like you want to court my wife.

Anyways, there's something wrong with you. Seriously. What the hell would you get out of a relationship with such a wreck?

Humility, strength, perhaps children. Why should I be celibate for life, if I can instead be in a relationship with someone that needs a nurse and caretaker - and gain whatever unique wisdom comes from sex and relationships from that experience?

I've known guys who've had it worse. Two Aspies I know had their girlfriends try to stab them. One succeeded and blocked the knife, the other very nearly died from blood loss but made a full recovery. They're in happy relationships with nice people now.

You want unique wisdom, then go and ask the people who had the experience. I mean, it seems you bought into the notion that you can generate personality traits or attractiveness or valuable experiences by going through with some zany scheme, and you also seem to be genuinely mentally ill to the point of holding ridiculous delusions as factual truths, but maybe you'll manage to consider the following: Other people have done what you consider your best path forward. Go and talk to them. Ask them about how great it is to be married to mental and biological failure. Ask them how much they get out of their lives when most of it is spent propping up that which fails to give reason to its existence beyond a hole between its legs. Maybe take a good look at them, figure out whether they're the kind that made their peace with fate and are waiting for death to release them from the shitshow they failed to extricate themselves from, or whether they're deluding themselves into thinking that what they're doing will ever get any better, or even that it's valuable. Also try to figure out how much of a burden their ward is on the people around them.

Your ideas are wrong, all wrong, and I am unreasonably angry about someone wanting to throw themselves and everyone around them into decades of misery. But it's none of my business. Go ahead, make the biggest mistake of your life. We all die eventually, and what does it matter whether you turned your life into an existential horror show. From what you wrote so far it seems your mind is beyond reason or repair, so all we can do is accept your planned self-destruction. Easy to do, since I don't know you.

You are a med student so probably mid-20s at most? Just go to some cheap bars where people get drunk and/or take drugs; do some stuff you regret in the morning. You'll figure it out. You should do it now though, as people forgive young weirdos who do dumb stuff in bars, but as you get older it becomes more creepy/sad.

Yeah. I'm 28. I hope I can be with someone that can live independently and hold a job, any job, and isn't a danger to herself or others. And isn't addicted to hard drugs. Is that too high a standard? The only concern with the drug addicts is trouble from law enforcement.

I wouldn't worry about that -- anyways I wasn't suggesting that you marry a drug addict, just that people who party and/or use drugs sometimes are a lot more open than whatever crowd you're hanging out with seems to be.

Yeah, agreed.

You sound like you have severe self-esteem issues and maybe mild anxiety. Not as a clinical diagnoses, but as character traits that hinder you in fulfilling your social potential.

Living on the spectrum comes with its share of frustrations because you will be routinely misunderstood. It seems you have at least in part overcome that, as a medical student, which is on the path to a high status/well respected job anywhere in the world. In countries with arranged marriages, you likely would have no problem at all finding a partner.

My suggestion to you would be to find some activities, true to your identity and interests, which would help you enlarge your social circle. It could be volunteering (natural since you're a medical stundent), exercise/sport related such as yoga, spiritual such as temple or church. Don't worry about finding a partner, focus just on finding people who appreciate you for who you are. Don't be creepy, but don't let fear of being perceived as a creep prevent you from talking to and meeting people.

You managed to overcome the limitations of autism for your professional life, you can do so (with work and practice) for your social life as well. You may think differently from people but that doesn't mean you cannot learn to understand them.

I am a Westerner. I don't think that it is a great idea for a woman to be with me (or anyone) simply because of a crap-ton of societal pressure - or worse, actual physical coercion. Thanks for the hope - but only morbidly obese women have been interested in me. That, and once someone that later wound up in a psych ward over threats of suicide/homicide during a drunken argument. It was, from what I heard, rather ugly; knives were waved around and cops called.

Interesting that you argue that it's about self-esteem, rather than my autism and subpar physical appearance - I'm a short, bald guy with a puny jaw. Sure. I'm no slouch in the gym and weight room, but even looking like a Greek god only goes so far. I've seen said Greek God(lets).

This additional information really confirms my initial impression. Very few men, even model level attractive, will have attractive women just fall in their lap and do all the heavy lifting. You're clearly not that attractive. But your description doesn't sound hopeless, you appear fit, no deformities/scarring that evoke an immediate reaction of pity/disgust. Women can be attracted to other things than just physical hotness: kindness, humor, cleverness, wealth, success, prestige.

Indeed, no woman will ever want you for just your physique, but does that matter? Do you want women for only their physique?

When you say short and buff, what exactly do you mean? Because I know short guys (about 165cm) that get laid and form relationships, and they don't look like Jeff Nippard, nor do their wives or girlfriends look like Jabba the Hutt. Nor are some of them particularly rich or successful.

Thanks for the hope - but only morbidly obese women have been interested in me.

It could be that only morbidly obese women have signalled interest in you - since you claim to have autism, it could be that you're not picking up on signals from normal women, or that you're failing to signal your own interest, which is something you have to do with women.

When you say short and buff, what exactly do you mean? Because I know short guys (about 165cm) that get laid and form relationships, and they don't look like Jeff Nippard, nor do their wives or girlfriends look like Jabba the Hutt. Nor are some of them particularly rich or successful.

I mean 5'4" guys that look like (and in one case, actually were) amateur physique bodybuilding competitors. Not quite Jeff Nippard tier though. They're not with women that need to use mobility scooters on a regular basis, but they're definitely with morbidly obese women.

The short guys in my medical school class are all focused on their careers; I never saw them with girlfriends. For some reason, the average-height and tall guys seem to date...

I’m in agreement with much of the thread below, with two things to add:

  1. Premature baldness is much less of an issue once you get out of the college environment. Shave your head if you don’t already.

  2. Your insecurities are not merited. If you can deal with patients/families thereof, you can surely learn to deal with the opposite sex. (Maybe disregard this if you’re set on becoming a pathologist.)

You're a med student, so you'll eventually have some money. Spend it fixing your shit. Get a personal trainer, stylist, and a shrink. You'd be amazed how quickly you're qualified for a partner who's not terrible. Brilliant supermodel? Maybe not. Average weight, socially acceptable normie? Achievable. Your dating appeal will increase monotonically for the next ten plus years as long as you're not getting fatter, and even then. In the wise words of Peter Griffin, "Men aren't fat, only fat women are fat." https://youtube.com/watch?v=nulGvzYkDoQ

You seem extremely optimistic. I've seen short guys built like Greek gods that were with morbidly obese women. A Special Forces colonel with a wife that was an abusive shitbag. Like. I just want someone that's got an excellent chance of being able to wipe their own butt at 60 and live independently. That's it. Just...don't be abusive to me or any kids we have, and be able to live independently till 60.

Eh...I know eight short guys. Four have had partners that I know of; four have not.

  • Special Forces colonel. Wound up with a pretty wife that turned out to be an abusive sack of shit.

  • Two guys that were built like Greek gods. Think physique bodybuilding competitor. Morbidly obese partners; they were decent human beings as far as I know.

  • Future neurosurgeon. Charismatic enough for a career in politics. Has an average-looking fiancee with a decent career.

I know a few short medical students and residents that can't get dates. Family med doc with average charisma and 5'4" ain't enough to get a partner that isn't morbidly obese, unless you're like top 0.1 percent charisma...and if you are that charismatic, medicine's an interesting choice.

I see absolutely nothing wrong with this; selecting some men by lot to be nurses and caretakers for women who need them - whether through bad choices or bad luck - doesn't seem like a terrible system to have going.

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