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Wellness Wednesday for November 15, 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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I'm about 20-25% body fat and really need to lose some weight. I love all kinds of unhealthy food and crave them often. I just started intermittent fasting again.

Does The Motte have any tips to share for successfully making permanent diet changes? Psychological/mental advice is especially welcome.

From a more purely psychological/mental side, I would say find a higher-order goal that will help motivate you and give your denial of tasty foods purpose. If you just try to lose weight to lose weight, it will often fail in my experience.

For instance, do you want to lose weight to be a better role model for your children? To find a partner? To become healthier and live longer? To be able to engage in a hobby or other physical activity? Or maybe just to become more successful in your career and/or social life?

Instead of telling yourself 'I want to lose weight' tell yourself 'I want to achieve my higher level goal, losing weight is a step in that process.' This type of hierarchical goal setting will both make the immediate goal of losing weight seem less all encompassing, and also make it easier to remember exactly WHY you're doing it, even when the temptation is strong.

Things that have helped me:

  • get people close to you on board: tell them you're losing fat and get them to support you
  • remove liquid calories: soda, juices, sweet coffee or tea
  • replace desserts with protein bars (the ones that are tasty, obv)
  • avoid oil-based sauces
  • eat more vegetables and lean meat
  • no snacking between meals unless it's a protein shake
  • walk more and do resistance training, cardio that makes you tired makes you hungry

It's not a coincidence that @screye's advice is similar to mine. That's because that's what works.

Again, you need support from the people that live with you, they should adjust their diet to match yours:

  • if they consume liquid calories, find stuff they like and you don't
  • if they keep eating desserts, find stuff they like and you don't
  • if they keep using oil-based sauces, have them add it to their plates and, you guessed it, find stuff they like and you don't
  • if they don't like vegetables, find stuff they like and you don't find stuff they and you both like
  • if they keep snacks around, find stuff they like and you don't

If you do all this and it doesn't work, you'll have to do calorie counting. If you've fixed your diet according to the list above, your diet should be sufficiently simple that counting will be easy. Count your calories for a few days and then try to come up with a meal plan that is 500 calories smaller. Some advice:

  • it's easier to calculate the calories and macros for the whole pot and divide by the number of portions
  • the best way to avoid extra carbs is to cut down on rice/pasta/bread
  • protein:fat ratio should be at least 2:1, processed meat and most ground meant have a lot of fat

As you lose weight, your calorie target should reflect it: CalNewDiet = (CalOldMaint * WeightNew) / WeightOld - 500. When you are happy with your weight, gradually move to CalNewMaint = (CalOldMaint * WeightNew) / WeightOld.

I've heard that some people react better to refeeds than to constant caloric deficit, but I don't have experience with that. Beware of cheat meals, though. They are not an indulgence to indulge. They are a way to incorporate occasional social eating into your diet. You should still track them and don't go overboard. You have 500 calories of deficit, they are your safety buffer:

  • a Cinnabon roll is 880 calories, so if you have one, you have to find 380 calories to cut elsewhere, which is hard and will make you hungry
  • a Caramel Pecanbon MiniBon® Roll is just 460 calories, so you can have one with a black coffee once every few weeks and just know that your goal has been delayed by one day

UPD: one more weird trick I can recommend is complex food. Simple finger food that goes bag to mouth is the worst, eating food that you need to pay attention to satiates you better. Heterogenous food is better than homogenous food, since every bite feels different.

You have to make up your mind. Do you want to remain a slave to transient, small minded desires, much like a regular cigarette smoker, or do you want to increase your chances at a longer, healthier life?

It may help to read about just how destructive the worst foods are for your body (and brain). They significantly increase your chances of dying of any cause over a given year. Eating like shit daily is up there with daily heavy drinking and daily smoking in terms of risk of shortening your life. Some healthy foods, on the other hand, actively help repair the body.

Make your choice and stick to it.

For some people it will be helpful to have a "cheat day" once a week where you eat whatever you want. However I've found it's easier to go teetotal during a weight loss process. That way you don't tempt yourself to fall back into old ways.

It'll become more attractive to you to live clean and less attractive to you to eat junk, the longer you stick to it. The first few weeks will be rough. Tough it out.

I had great success with this method last year, but haven't been able to keep it up this year as work has gotten impossibly stressful. So I'll say this before even starting : "you cannot build new habits if you don't have some extra juice left in you by the end of the week."

That being said, here is what works for me (as the ADHDiest person you know)

Detailed tracking is impossible. So focus on broad rules that have an impact.

Here were my broad rules for diet:

  • No liquid calories. Especially on weekdays. (Alcohol, Lemonade, Soda, Tea, Sweet Coffee)
  • No deep fried things
  • No oil-based sauces. (Yogurt based sauces are a great substitute)
  • Smaller servings of rice & wheat

Generally speaking, if I keep this up, I just end up eating lower calorie meals without thinking about it too much. I also allows me to eat fairly delicious foods, so none of this feels like sacrifice. I love cooking, so to me this almost feels like an exciting challenge than a struggle.

Portion control is obviously important, so here were my broad rules for that:

  • No breakfast except coffee. If I must, then it it is unflavored (full fat) Greek yogurt with berries. I don't explicitly intermittently fast, but this basically facilitated the same thing.
  • No snacking outside meals. If I am craving something sweet, then it is fibrous fruits. (Plums, Pears, Pineapples, Musk Melons, etc). More importantly, never bring snacks back to the house. If I am really craving them, buy and eat them at the grocery store.
  • Promote food waste. (jk). Sometimes I am only craving the first bite of something. I am human, I break my rules. I normalized throwing away the rest of the dish after the novelty of the first bite had run out. Total gratification stays the same, calories are much lower.

For working out, I pick a hobby I love : Soccer, climbing. But I don't enforce much other than:

  • Put dumb bells / pull bar in a highly trafficked area in the house. If you touch them, you must do 2 sets.
  • Cycle when possible

I was down to around 16-17% late last year, but I too have climbed up to 22-24% now. I have been in the midst of massive life change the last year, so I have been kind to myself. But, things are finally stabilizing. So, the target for the next 6 months is to be back to the 17% target before mid-next year.

LMK if you want suggestions for delicious low-calorie meals that still have decent amounts of protein.

What's the reasoning for no oil based sauces? Isn't is as easy to consume the same amount of fat with butter or cream based sauces?

I rarely eat oil based stuff so it doesn't really affect me but I'm curious now that both you and @orthoxerox mentioned it.

Most of my sauces are greek yogurt based. Starches also help create low calories sauces.

I hate what i call 'non satiating calories'. You could go throigh a pot full of mayo dip withour realizing that is a 1000 calories by itself. On the otherhand, the yogurt based dip is 200 calories and no one notices the difference. (Very important to use full fat yogurt.)

Since oil and butter are the same word in Russian I implicitly meant all fat-based sauces. The reasoning is liquid calories again.

LMK if you want suggestions for delicious low-calorie meals that still have decent amounts of protein.

I'm always on the lookout for more delicious low-cal meals. Have you tried gently roasted sea perch fillets with tomatoes, onions and black pepper?

This is fantastic and exactly what I was looking for.

LMK if you want suggestions for delicious low-calorie meals that still have decent amounts of protein

Yes please, I'm always looking for new ideas!

I've never needed that much due to being heavily endomorphic and turning fat into muscle easily; but when I do feel the need to loose some weight I set myself a monetary budget and eat to that.

EG, post holiday blowout I put myself on a 30$ a week food budget for a while and eat very small portions of meat and lots of beans and stuff from the garden, type of thing.

Thanks, this is a good idea.

How do you calculate body fat as a layman, I’ve never been sure how people are so certain without those high level tools like water displacement / hydrostatic weighing etc.

Skinfold measurements at a few sites get you pretty close with the right formula. May need a friend to help you take them though.

Smart scales. They are wildly inaccurate, but you don't need super high precision if you're not a bodybuilder.

You caught me, I actually don't know my precise percentage. I Googled "body fat percentage comparison" and looked at a few charts, then looked in the mirror and eyeballed it. Actually measuring to get a more precise percentage seems like a hassle and like it wouldn't actually be terribly useful information.

My experience is that those pictures are kinda dumb and bf% can have a lot of different appearances based on age, genetics, bodily condition, etc. So take it with a big grain of salt.

In any case i think screye's post is very good. Ill add that for me, its about focusing on protein. I dont elimate fats or carbs, because fats are needed and i personally get miserable on no carbs, but i only make meals that prioritize meat. This keeps me full and happy on fewer calories. I have an instant pot (which i adore and recommend) that i make meaty stews in. Ill eat this with just enough carbohydrate to make me feel good. Nice thing about this approach is you can control the carb input depending on your goals and tolerances.

How do you stop yourself from just doing stuff constantly?

I'm pretty much always doing something, every minute of the day. This has helped give me a structured and productive life but it also feels unhealthy / manic and at times I'm basically self-inflicting exhaustion.

If I don't have work I'll invent new work for myself to do, even if it's just typing up essays for here. Once I've come up with something new it soon becomes a pretty rigid part of my life. For instance, I used to workout once a day but if I had some extra time I would do a second workout just to be as productive as possible. After enough of this nowadays the second workout feels non-negotiable even though objectively it's pretty unecessary and often I don't have the time. Or if I have a spare moment I'll start cooking meals for the future. Or I used to read fiction when I was younger but now it feels irresponsible to read anything but non-fiction where I can learn something. Not that I seem to have much time to read anymore anyway, but if I'm hanging out with someone and they step out to the bathroom I'll pull out my phone and start studying something on Wikipedia or a think tank or whatever. The idea of not filling idle moments with something ostensibly productive is alien to me. If someone asks me to participate in something at work or in a social outing I will essentially always say yes regardless of whether I have bandwidth or interest and this results in me having basically no time to myself. I used to try meditation to balance it out but then I turned that into another non-negotiable chore.

The plus side of this is that I'm a productive person, I do well at work, have an active social life, and I guess also have a lot of output on an obscure forum. The downsides are...not devastating or anything, but I generally feel tired and stressed and stretched thin. It seems like an unnatural way to live, but I find the idea of not feeling productive to be almost more exhausting.

I imagine you don't actually want to do nothing but want to do something relaxing, low stress, and not explicitly productive. If that's the case, here are things that work for me:

  • Go on a slow walk in the woods with your phone on silent
  • Take a hot bath with no book or phone
  • Read some guilty pleasure fiction (I like webcomics and trashy manga)
  • Have a cup of tea and put on some relaxing instrumental music

Some of these require you to be alone with your own thoughts which is uncomfortable the first few times, but you quick get used to it.

Why fix this at all?

A majority of today's malaise is because people don't do enough things, not too much of them. And I don't necessarily even mean the number or volume of things done, but the psychological aspect of it.

If you sit on your ass and watch youtube for 2 hours, you did something, you did a lot of something. But it feels like you did nothing.

If you are achieving the feeling of doing a lot of things, then congrats.

However, that main failure mode might be that you might be just doing inefficiently, in that case do something about that.

I was going to suggest getting married or having kids. I'm forced to sit on the couch and watch idiotic television for, often, 2 hours a night.

Idle time doing nothing is overrated. The instagram memes that urge you to "practice self-care" by sitting on your ass all day are public squeals of inferiority and copium.

The maximum amount of unproductive pleasure you should force yourself to partake in is taking time to read before bed or on the couch with your coffee. I, too, toned down my fiction in recent years, and regret having to chew through a ton of dry junk to avoid pleasure. You're allowed to dabble in fun books too. Remember, very little of that non-fiction is going to be useful. My 8-hour slog through the history of Insurance got me a fraction of a brownie point with an executive this one time. Not worth it.

if I'm hanging out with someone and they step out to the bathroom I'll pull out my phone and start studying something on Wikipedia or a think tank or whatever.

This may be the last bit of adjustment that may be worth making. Get comfortable being silent and thinking, even if someone's not in the bathroom. It can even be planning for the meal you'll cook in the future, but every human should be able to disconnect for the time it takes someone else to pee. No silver bullet besides practice.

I was going to suggest getting married or having kids. I'm forced to sit on the couch and watch idiotic television for, often, 2 hours a night.

Ironically I've thought about doing this for sort of the opposite reason - I figure if I'm going to keep myself busy anyway I might as well be doing something genuinely productive like raising kids haha.

The maximum amount of unproductive pleasure you should force yourself to partake in is taking time to read before bed or on the couch with your coffee.

This is something I actually want to start doing, at least before I go to bed, in party because I assume it might also be a healthier way to prepare for sleep than screentime.

every human should be able to disconnect for the time it takes someone else to pee

Wise words.

How do you stop yourself from just doing stuff constantly?

"Problems I wish I had" for most of the money in the world haha

In your case, I would advise committing to a specific chunk of time, say an hour or two, which you mentally label as "me time" and steadfastly refuse to do anything remotely describable as productive during it. Maybe get your wife to scold you if you lapse. Specific mental compartmentalization should work better in a highly conscientious individual, but what do I know about that? ;)

It just seems like an unnatural way to live, but I find the idea of not feeling productive to be almost more exhausting.

Being extremely intelligent and talented, running ultra-marathons or winning Nobel Prizes aren't natural either. Consider yourself immensely blessed that your particular eccentricities are highly conducive or even outright optimal for what might loosely be termed as success.

If you had tangible and debilitating results from your diligence and workaholism, such as stress, excessive fatigue or mood swings, I'd advise you to take it more seriously, but in this case my stance is more "this isn't a problem to solve, or worth solving" in the first place.

Edit:

If I don't have work I'll invent new work for myself to do, even if it's just typing up essays for here.

Not that I seem to have much time to read anymore anyway, but if I'm hanging out with someone and they step out to the bathroom I'll pull out my phone and start studying something on Wikipedia or a think tank or whatever. The idea of not filling idle moments with something ostensibly productive is alien to me.

It's funny how these particular behaviors are applicable to me, someone with ADHD, but for entirely opposite reasons. For example, I just spent a few hours studying on Ritalin, and while the drug hasn't worn off completely, here I am procrasturbating by posting on the Motte. Many (most) of my posts, good or bad, are written when writing seems like a refuge from the work I should much more sensibly be doing.

If I'm not busy doing something else or engaged in conversation, you'll be finding me on my phone, binging on Insight Porn, Wikipedia included, but this is because I hate being bored, and for the life of me can't understand people who praise it, be it for its own sake or because it serves as a generator of creative ideas (which I disagree with to a degree).

A great deal of my childhood, before I had omnipresent portable electronics, was spent day dreaming, and I would devour literature of all descriptions voraciously, to the chagrin of my teachers when they caught me reading novels under my desk. Sometimes, when I think life is shit, I remember just how awful it must have been to be so terminally bored, be it in my childhood or as the norm for most of human history.

I'd say I do experience stress and fatigue from it, but definitely not at a debilitating level

It's funny how these particular behaviors are applicable to me, someone with ADHD, but for entirely opposite reasons. For example, I just spent a few hours studying on Ritalin, and while the drug hasn't worn off completely, here I am procrasturbating by posting on the Motte. Many (most) of my posts, good or bad, are written when writing seems like a refuge from the work I should much more sensibly be doing.

Haha I think part of this is because I'm extremely generous with what I consider "productivity," as long as I'm doing something I'll categorize it like that, so that probably includes stuff other people would use to distract themselves. We both just spend more time producing content than consuming it, here at least, which does feel a little different.

In your case, I would advise committing to a specific chunk of time, say an hour or two, which you mentally label as "me time" and steadfastly refuse to do anything remotely describable as productive during it. Maybe get your wife to scold you if you lapse. Specific mental compartmentalization should work better in a highly conscientious individual, but what do I know about that? ;)

I know something like this is most likely the answer, I just have a strange habit of turning "me-time" or relaxation into another comparmentalized scheduled item. It's like on the meta level i just relate to everything I do on a very controlled, regimented level, but hey that's something I can work on too.

Anyone have unusual advice for salvaging bad skin?

I have had terrible, borderline life-destroying bad skin since high school. I've fought it for over a decade with every treatment option under the sun (including copious amounts of SPF to block out the sun), and it's still awful, albeit in a more "beat up, scarred, leathery" way now than a "covered in pimples way" it used to be.

I think I'm totally fucked and just have to accept that. But might as well ask if anyone has any unusual or hail mary methods for improving skin texture/quality, fighting acne, reducing scarring, reducing redness, etc.

Just for the hell of it, here is a list of skin treatments I currently or have formerly used:

Niacinamide

Retinoids (Accutane and Tretinoin)

Azelaic Acid

Urea repair

Vitamin C (topical and oral)

SPF (million sunscreen variants, applied every day, applied every two hours outside)

Snail Mucin Power Essence

Oral collagen supplements

Fish oil supplements

Vitamin D supplements

Daily cleansers

Hyaluronic Acid

Ferulic Acid

Toothpaste (actually a pretty good short term pimple reducer)

Glycolic Acid (exfoliator)

Korean facial masks

Slugging (putting a layer of vaseline or a similar substance on at night to trap in moisture)

Eliminating hot showers

Silk pillowcases

Claritin (to reduce general inflamation)

Rhofade (weird, controversial short-term treatment for redness that restricts blood flow to the face)

Ivermectin (fight skin mites associated with rosacea)

No sugar consumption

No dairy consumption

Black head removal tape

Botox

Dysport (similar to Botox)

Microneedling

Radiofrequency microneedling

Fraxel non-ablative laser

And I'm sure there's a whole bunch of random smaller treatments from when I was young that I forgot

I have become something of an amateur expert on this shit, feel to ask anything if you're curious.

Have you tried any corticosteroids class skin creams? I didn't see any on your list. I use them daily to keep my skin in decent shape. I found a nice strength chart here for all of the specific types. The weakest - hydrocortisone - is available OTC at pretty much any drug store. I was prescribed a class 6 on that chart for a while, but I eventually discovered that the OTC hydrocortisone worked just as well for me.

Dermatologists really don't like prescribing the stronger variants long-term, but it might be worth a try to see if it helps if the OTC stuff doesn't help much. It helps if you find a friendly one who is willing to experiment with unconventional things.

I have used OTC corticosteroids on my hands and have found it very effective. But the reputation of corticosteroids in the face is that they work in the short term at the detriment of the long term. They thin your skin, and thin skin is already the reason why facial skin tends to be so much worse than regular skin.

Have you been prescribed facial corticosteroids by a dermatologist?

Have you been prescribed facial corticosteroids by a dermatologist?

Yes I was, and I have kept using it and getting fresh prescriptions for I think like 15 years. They kept talking about "skin thinning", but nothing noticeable happened to me. They kept making me try other things, but nothing else worked (I don't remember most of the things they got me to try unfortunately). Personally, I'd rather take my chances with "skin thinning" than live with terrible itchy flaky skin on my face. I actually found that chart I linked when I was thinking about trying to order some prescription stuff from one of those sketchy overseas places that doesn't need prescriptions because I was getting seriously tired of them trying to push other things that didn't work on me. I didn't go through with that because all I could find was the ridiculously strong class 1 ones that might actually do something bad, but it did give me the idea to try the weaker OTC class 7 stuff since it's basically the same thing, just less potent. That seems to work, so I figure I both solved my problem of keeping my skin decent without dealing with annoying dermatologists and also somewhat went along with their fears by going with a weaker non-prescription version.

Obvious disclaimer, I'm not a doctor at all and haven't examined you, if you follow my example you're doing it at your own risk. I'd say try it for a week though with the OTC stuff. If it doesn't work, you're no worse off. If it works a little, consider trying to get some of the stronger versions by prescription. If it works great, then you get to decide if having something that actually works is worth possible long term risks of skin thinning. It sounds like mainstream medical advice hasn't exactly served you that well anyways.

Based on the extensive list of treatments the obvious "See a dermatologist" I suppose has already been covered? I only mention this at all because you did not. Some of what you've listed appear to be treatments for acne rosacea.

Usual medical treatments for acne vulgaris include benzoyl peroxide, azelaic acid, erythromycin, clindamycin, or dapsone. None of these are over-the-counter, at least as far as I know, depending on where you are. There is also systemic therapy, such as the use of minocycline or doxycycline. These are oral antibiotics with an anti-inflammatory effect. There is also the synthetic retinoid isotretinoin, which is highly regulated due to all sorts of possible side-effects. None of this is relevant information for the skincare hobbyist, however, unless you see a specialist, which I recommend if that route hasn't been taken--though I suspect it has. If it has, consider seeing different doctors until you attain a therapy you are content works to greater degree than what you've done tried so far.

What's up with the hot showers? Cholinergic urticaria is when you break out in hives from contact with hot water (but also an increase in body temperature and sweating), but is that what you experience? I imagine any real dermatologist would be eager to have you as a patient (This is not meant as a slight in any way).

None of this may help in the slightest, but I wish you luck.

Based on the extensive list of treatments the obvious "See a dermatologist" I suppose has already been covered?

I've been to many dermatologists, as well as two plastic surgeons, one of whom is considered one of the best laser surgeons in the world. On the whole, my experiences with them have been fairly negative. Not that their advice is bad, just that it tends to be very typical (retinoids + sunscreen + moisturizer), and they seem to lack the means or inclination to seriously deal with extremely bad cases like mine.

I don't really blame them, dermatological responses to treatments are incredibly varied on an individual basis, and there isn't really much derms can do about it at a certain point.. There are people who have dry skin and put on an OTC moisturizer for a few weeks and then they're fine. Then there are people with dry skin who will spend literally years juggling multiple moisturizers, toners, cleansers, and serums trying to find the right combo that properly protects the skin barrier without causing break outs.

Usual medical treatments for acne vulgaris include...

I've used azelaic acid and dapsone, both work decently well, but always seem to loose effectiveness for me, and of course, both cause irritation for me. I've considered oral antibiotics, but I'm scared of their long-term side effects, IIRC there isn't a lot of good research on what happens when people take daily antibiotics for months and there are plenty of horror stories of people developing IBS from them.

What's up with the hot showers? Cholinergic urticaria is when you break out in hives from contact with hot water (but also an increase in body temperature and sweating), but is that what you experience?

The experience is exactly that. If I take a hot shower, I get hives on my chest. If I put my head under the water of a hot shower (which I haven't done in years), my face turns red and swells up. Even with lukewarm showers, I get some redness in my face and chest, and if I make the water a little too warm, I get hives.

You could consider using a hyper realistic silicone mask. You could try Adapaline Retinoids. See this.

hyper realistic silicone mask

Lol, reminds me of Vanilla Sky - https://youtube.com/watch?v=PZ5Eab3Na_E

It didn't mean it as a Lol, as I think I would try it in your situation. Lots and lots of people get plastic surgery which seems far more "drastic" than wearing a mask that people couldn't tell was a mask.

I didn't do it for skin problems, but a few things really helped my Rosacea:

  • High carb, low fat (less than 20g fat), low protein (less than 50g protein). Think Kempner Rice diet,
  • Supplement Stearoylethanolamide
  • Supplement Glycine.

Interesting, my current diet is 150* grams of protein per day, mostly for working out, but there is some evidence that heavy animal protein diets are better for skin due to collagen consumption. Plus heavy meat is generally better for combatting inflamation, which is linked to rosacea. What mechanism would make high protein worse for rosacea?

Collagen is good, and one reason why I supplement glycine. But most protein sources are high in branch chain amino acids, which seem to cause insulin resistance in the metabolically unhealthy. Insulin resistance increases infIamation. I am trying to reduce BCAAs to 8g a day, at least temporarily. I'm not trying to reduce other amino acids, but as a consequence my overall protein is pretty low for this experiment.

I checked Amazon and saw glycine is 10 cents per pill, but then I checked my collagen supplement and I see there's already glycine in there. But thank you for the tip.

I take about 5g a day with Bulk Supplement's Glycine Powder. It's pretty cheap stuff, but I can tell the difference in how smooth my skin gets.

I recommend checking out /r/SaturatedFat for some unorthodox health advice. They are pretty interested in eliminating inflammation, reductive stress, and insulin resistance and I think they are finally onto something.

Can you provide more information about what, exactly, is bad with regards to your skin? Is it specifically bad acne of some kind?

This. We need way more information to understand what's going on here.

including copious amounts of SPF to block out the sun

Are you 100% sure you do not have eczema, psoriasis, acne, or atopic dermatitis? If you do one of the standard treatments is phototherapy. Specifically UV phototherapy. The dose and spectrum are carefully controlled, but blocking 100% of UV may not be doing yourself any favors, given you seem to have some sort of condition. Of course UV can also damage your skin and cause skin cancer, so finding a knowledgeable dermatologist is highly recommended over blasting yourself with sun.

If you want to add another random item to your list though, some people report good results with dandruff shampoo. Like regular 2-in-1 classic head and shoulders. Just using it as body and face wash 1-2 times a week. Lather up, let dwell for 30-90 seconds, and rinse.

I have recently started to explore autoimmune issues as a causal mechanism. Reasoning: I had bad eczema on my legs as a kid, have had psoriasis in the past, and my mother has a ton of weird allergy issues (allergic to penicillin and aspirin, was on daily antihistamines for 10+ years, now goes in for monthly antihistamine shots). I went to an allergist for the first time a few weeks ago and confirmed with tests that I'm allergic to cats and tree pollen, plus based on my description to her, I'm certainly allergic to hot showers (make my whole face turn red and swell up). The doctor speculated that I was allergic to dust, but my tests were negative. Next month I'll do a skin test where they put thingys on my back for 4 days and I can't shower.

But I don't think autoimmune is the central cause. My skin looks more like it's been put through the ringer by standard acne, with underlying irritation exacerbating it.

If you want to add another random item to your list though, some people report good results with dandruff shampoo. Like regular 2-in-1 classic head and shoulders. Just using it as body and face wash 1-2 times a week. Lather up, let dwell for 30-90 seconds, and rinse.

I will look into this. I used to use Head and Shoulders daily, but due to the irritation caused by even lukewarm showering, I have cut back on my showering to once every 3ish days (I work from home, don't interact with people a lot).

What is the proposed mechanism for how it would help facial skin? Antifungal?

Looking at other Urticaria, once you get past antihistimines and phototherapy, I've seen some suggested treatments as biologic omalizumab, steroid medications, or selective serotonin reuptake inhibitors (!?).

I'm not a medical practitioner at all, but the allergy to warm water seems like something that's pretty pertinent in figuring this out. Your skin is hypersensitive and the root cause of that hypersensitivity is possibly linked to your acne.

I had stress related psoriasis once that went away after dealing with the underlying cause. Is there a possibility that the sensitivity is psychosomatic (in other words linked to stress or other mental health issues)?

I told my allergist about my hot shower response and she diagnosed me with cholinergic urticaria, but didn't say much else except recommending Claritin when I shower. On its own, it's annoying, but not a huge deal. Hell, hot water is generally considered bad for facial skin anyway, so it served as a little extra incentive to embrace cooler showers.

However, on the off chance this allergic response is connected to something bigger, I'm going to press my allergist during my next appointment. Maybe it's worth getting one of those mega antihistamine injections just to see what happens to my face. Honestly, HOPE my facial skin problems are related to my allergies, because that's so much easier to solve. Wouldn't it be amazing if the root of my problems was an allergy to some random fucking environmental thing that I can avoid or crush with antihistamines? But that's probably wishful thinking beyond the rosacea.

I had stress related psoriasis once that went away after dealing with the underlying cause. Is there a possibility that the sensitivity is psychosomatic (in other words linked to stress or other mental health issues)?

I won't say a psychosomatic role is impossible, but I tend to be skeptical. Besides, I beat my psoriasis with cortisone (that stuff kicks ass).

I used to use Head and Shoulders daily

Wait a sec, that seems a lot for a guy who has all these skin problems. I’m sorry for the ‘have you tried turning it off and on again?’ question, but have you tried using mild/no soap?

Yep, I've tried going full caveman mode where I use nothing but a light moisturizer, and I've tried going hardcore "throw everything at my face and see what happens." I'm one of those people who is constantly caught in the see-saw between the two extremes. If I go minimalist, I get back acne; if I go maximalist, my skin gets irritated and worn out. I've never been able to maintain a good balance between the two for more than maybe a 6 month period.

Antifungal

Yes, the active ingredient, pyrithione zinc, is supposed to be anti-fungal. I think people are pretty sure it works for fungal acne, though I suspect it also helps with random dryness and itchiness. What causes dandruff after all, if not scalp dryness.

Edit: Personally, Head and Shoulders every day is too harsh for me. I also see you did mentioned acne in a different part of the thread. I think the other common remedy people try, not already on your list, is changing your pillow case every night or every other night. Some people use a fresh towel to wrap their pillow every night. If you have acne from oily skin, it's supposed to help keep your skin oils from clogging pores while you sleep. Fortunately I've never needed to try it, so no first hand experience on that one.

Always bad acne (never quite sure about type, I think bog standard), rosacea, chronically sensitive, acne scarring, lots of smaller discolorations, rough textures (especially orange peel), big pores, very dry by default.

I am currently struggling with holding myself accountable for being reliable and reliably productive. I am having trouble achieving goals that I set for myself and am passionate about (e.g. finish a draft of X project by Y date)

The part that makes this challenge to solve for me is I think it is downstream of two rare sleep disorders I have. I have a “sleep quality disorder”, which greatly reduces the restorative quality of my sleep, and I have a “sleep schedule disorder”[1], which makes it hard to predict my sleep/wake times on a daily basis.

I am currently pursuing medical treatments for both disorders, and I have had a lot of success treating the sleep quality disorder. Now, there’s roughly an 70% chance each “sleep session” that I will have a normal, restful amount of sleep. This seems to be the point of diminishing returns for treating the sleep quality disorder; more improvement will come only with much more effort.

So now I’m in a state where I follow roughly this algorithm:

  • When I wake up and try to tell if I got high quality sleep in my “sleep session”, where I generally sleep for 8 to 10 hours.
  • If I did, which happens about 70% of the time, I go about my planned activities, staying awake for roughly between 12 to 18 hours before falling asleep again.
  • If not, which happens about 20% of the time, I will generally be so exhausted as to easily fall asleep back asleep within 2 to 3 hours. I’m not really able to think clearly or be productive during this time. I will then wake up and try again.
  • About 10% of the time, I think I’m rested well enough, but after trying to be productive for a bit it becomes clear I am not, and I end up wasting a bunch of time until I fall asleep regularly again in 12 to 18 hours.

This works decently, but I have the following problems:

  1. I find it really hard to tell when I’m being unproductive for normal reasons (e.g. distraction/laziness/procrastination) versus when I’m just having a bad run of luck with my sleep.
  2. I find it hard to interface with the wider world on a calendar-day scheduled basis. I basically deliver on a “it’s done when it’s done, best effort” basis, which people who have to collaborate with me find frustrating.
  3. I struggle with building habits, because a bad run of sleep will inevitably cause me to “miss twice”, which is really fatal to habit formation. I also don’t really have reliable daily cues to hang my habits on, although with much effort I’m starting to build a “wake up” and “bed time” routine.
  4. Because my sleep + wake time is offset from the daily 24 hour cycle, I eventually end up having periods where I’m primarily awake at night, which gets me a bit depressed and saps my productivity a bit.

Currently my plan of attack is basically:

  1. Track good versus bad sleep days and timing. Use this data to better estimate work and coordinate times for things where I interface with the outside world and evaluate treatment success.
  2. Try to stick to all habits at least on good days. Intellectually, this should work, but I’ve found it really lengthens the amount of time it takes for a habit to “stick” in practice. It seems like the habit parts of my brain don’t ignore the bad sleep days.
  3. Use sleep aids to sleep again more quickly on the 10% of days I do not sleep well enough to be productive but not badly enough to fall asleep. (It’s unclear if this makes the schedule problem worse, but it does net back higher productivity by having fewer totally wasted days)
  4. Continue to iterate with light exposure therapy and melatonin to reduce variability/noise from sleep schedule disorder long term and improve mood.

If anyone has any advice or thoughts or brainstorming on how to better manage this, I’d be all ears. I think the lowest hanging fruit right now is working on concrete better ways to improve my habits/routines and make the most of the time I’m productive. I think this because I’ve sought out world-expert level medical advice for the sleep disorders, and we seem to have squeezed all the easy improvement from treatment there. So for the short term, I’m trying to find ways to make the most of what I have.

[1] The sleep schedule disorder has been medically diagnosed as non-24 circadian rhythm similar to what Eliezer Yudkowsky has. Mine seems to be more erratic and irregular than his is.

I recently stumbled on this LessWrong post about self-love that piqued my interest: https://www.lesswrong.com/posts/BfTW9jmDzujYkhjAb/you-are-probably-underestimating-how-good-self-love-can-be

... I, like a lot of my peers, especially software folks, experience a lot of internal self-criticism and self-loathing. I would absolutely love to change this, but finding the right playbook for fundamentally changing your relationship with yourself is challenging, to put it lightly. I'm trying to figure out what an effective "30-days of self-love" would look like to go and change the direction of the ship.

Practices like metta or any of the other brahmaviharas are no panacea at all, as a lot of the western meditative footguns fundamentally block successful performance, particularly:

  • Focusing on the intention of well-wishing over the feeling is quite difficult, intention is subtle compared to feeling. It's very easy to accidentally go and do mantra meditation on the phrases, or get overly focused on feeling or body sensation.
  • It's quite easy to go and over effort metta compared to something like anapanasati. The effort, at least in my case, is difficult to actually debug since it feels like a fundamental belief issue ("you have to try for things that are worthwhile").
  • Metta (and meditation broadly) can be extremely reinforcing of old patterns and of self-centeredness generally. I've seen several friends, independently into meditation [as seemingly everyone is nowadays], come back in these really self-centered states.

... that's not even mentioning the problems with certain courses (like Finder's course) and orgs (Dhamma Sukha, the TWIM camp, loves making false, and frankly delusional claims about their method).

I've tried therapy a couple times, but the expense is killer, and I have a lot of trouble with the whole "you need to do this for years or months to see any small tangible benefit" paradigm. In fact, a lot of the therapists I've seen seem like they're much more interested in keeping therapy going versus helping me and potentially losing my business. I've tried ACT/CBT/REBTs therapies, IFS, somatic therapy, and in our therapy-as-a-universal positive society tend to try again every several years, but I always get the ick from the experience every single time and eventually fizzle out. Last time I tried IFS, I did it for 9 months but couldn't say that any behavior was any different.

I honestly wonder whether, as an adult, it's possible for me to go and change something as fundamental as my relationship with myself, but if it is, I'd really love to go and try. I think others are much better at doing something without seeing the tangible benefits, I just can't go and do something every day without seeing some kind of improvement over weeks and months.

My initial thought was to try IFS techniques to get a deeper understanding of your inner critics/exiles so that you can help repurpose them. However, I see you have already tried IFS.

Since you are not satisfied with the results of your sober techniques, I would gently point you toward considering psilocybin in a low to medium dose. It may open your mind to new ways of approaching your relationship to yourself. It can make new ways of thinking about yourself feel salient and "real" causing you to feel like you can actually change them when sober. After a single experience you may gain a deeper appreciation and insight into the sober practices that you have already tried. Specifically, you may feel more in touch with different "parts" of yourself and this will lead to increased success with IFS.

People sometimes say psilocybin (or other psychedelics) feel like years of therapy after a single dose.

In the lesswrong link they talk about MDMA and that seems like it could work too.

What’s the relation between “software folks” and self-loathing here?

I suppose it's interesting because as someone who holds a lot of feelings of self-hatred, I'm totally aware that I could drop them like a hot potato and engage in self-love instead. It's just so unconvincing. Fundamentally I don't believe and I don't think I could make myself believe that I deserve love. And frankly, I'm not any more low-functioning under these conditions than I was a few years ago when I didn't feel this way.

It feels a little bit to me like Christianity. Of course it would be very nice to just reach out with my mind and reciprocate the boundless, deep, unconditional love that God has for me. I just don't believe it, I don't believe Jesus rose from the dead, or that gay sex is wrong.

More broadly, I don't think people need to have a 'relationship with themselves'. The whole thing sounds hideous. Is it not better to not have a relationship with yourself at all? I feel happiest when I'm at work, focusing on some task external to myself. I think of such times as when I'm being myself, rather than talking or fighting myself. And though maybe some level of introspection is a necessary part of existence, it's in service to actually inhabiting yourself.

This is a lot of words and all quite complicated. In my experience it is a "simple" habit modification.

You have an established habit of negative self talk that has become second nature.

I'm running late for the dentist. Why am I so useless at everything?

The first step is to just become more aware of this reflex.

I'm running late for the dentist. Why am I so useless at everything? Oh, there's the negative self-talk reflex.

Once you are aware of it, you can practice reframing or rephrasing, and talk to yourself like you would a friend.

I'm running late for the dentist. Why am I so useless at everything? Oh that's negative self talk. Actually it's no big deal. People are sometimes late for things and I was busy with work.

And then you can stop yourself as you have the negative response

I'm running late for the dentist. Why am I so -- actually it's not a big deal. I'm good.

And then you just jump to the healthy response

I'm running late for the dentist. It's no big deal. Can't wait to get dinner afterwards.

Each step is building a habit, and like any habit requires a bit of effort and mindfulness to start with, but gets easier with time. It shouldn't take years, probably closer to a week or two for each stage. I probably isn't Nick Cammarata MDMA-fuelled self love, but is a good way of getting you out of these automatic negative thought patterns.

It's not really obvious to me that the latter is healthier than the former. Responding to all things with serene indifference seems like a pretty shitty and even self-centred way to proceed through life. I guess it's just part and parcel of the way that people tend to pathologize negative thoughts and negativity as being 'unhealthy'.

Plus, I personally find as a negative self-talker that acknowledging my negative self-talk reflexes just makes it worse. Now instead of thinking about whatever bad event set me off, I'm thinking about how stupid and irrational and unhealthy and undisciplined I am for engaging in negative self-talk.

(Not OP) It's not serene indifference as much as understanding the nature of your limits, and the role externalities play in your existence.

Self-Love and Self-Hatred are two sides of the same coin. They are self-obsession. Thinking your farts are roses or you're utterly worthless are both unhealthy paradigms. You can't have an accurate view of yourself, much less the world, if you can't balance it out a bit.

Most people need more self-hatred IME, but it's not a vast majority or anything.

Oh, it's very selfish, no question. And it's probably not very healthy, but as I said elsewhere, I'm not religious - that applies to modern health-worship as well as Christianity.

Indifference isn't always a "healthy" response, but it can be. Every situation is different and there are many good and bad ways to think about each one.

Now instead of thinking about whatever bad event set me off, I'm thinking about how stupid and irrational and unhealthy and undisciplined I am for engaging in negative self-talk.

I was going to mention this but didn't want to make things too complicated. You are allowed to have the negative self talk, but then you have to practice the rephrasing even if you don't feel it. Would you talk to your friend like that? How would you think about things if it was your friend and not you? And actually think it "out loud".

On negativity - I argue negativity is unhealthy. I know what you mean, it's no good thinking everything is great when it's not, but you can still maintain good vibes while acknowledging and fixing mistakes.

I don't really get the question. I'm not my own friend. For a start, I can't leave or abandon myself. I have to be nice to my friends, and besides, I picked them so I like them. I didn't pick myself.

At the same time, this means I can't really trust my friends to be honest about me. When they say I look good, that's just them being good friends. I actually know I look small, fat and weak. Whereas if a stranger online tells me that I'm weak, lazy and pathetic, that's probably because it's true.

Okay, you didn't pick yourself, but you're going to spend the rest of your life with yourself, so you might as well treat yourself right and be your own cheerleader. It is not being "honest" to be hyper-critical and beat yourself up all the time. It is not useful. It is a self-reinforcing bad habit. It is a cognitive distortion. It is a trapped prior. But there are other ways of being that are just as honest but far more energizing.

Is being my own uncritical cheerleader actually the right thing to do? I mean, ultimately if I wanted unconditional love, I have friends and family who care about me. And yet, despite their love, I am kind of a fuckup and a loser and not very happy with my life of no money, no bf, and hating my body. Clearly, love isn't all you need - at some point I needed discipline or criticism. And though that's my fault for rejecting or shying away from those things earlier in my life, but if people around me won't provide that or can't be trusted to do so or if I'm too brittle to accept criticism from others, I have to provide that for myself.

Whereas if a stranger online tells me that I'm weak, lazy and pathetic, that's probably because it's true.

I agree with most of what you wrote above this, though I'm ignorant of if it is actually true if you look small, fat, or weak. But I'm not sure how you land on the conclusion that a stranger online telling you these things is an indication that these things are true. Strangers online are not known for their honesty, nor are they known for their great judgment. I think it's quite possible that they're telling you this because it's true, but I'm skeptical that it's probable. If a stranger online told you you were strong, conscientious, and great, would you also presume that it's probably because it's true?

No. They're just being nice. But there's no reason for someone to make a false criticism of me. But also I find the criticism of others fits better with my own negative self talk.

Reframing negative thoughts means detaching from the part of your self that generates these negatives thoughts. You won't end up "responding to all things with serene indifference" because what you are detaching from is your inner thoughts and not the outside world.

Nor is it about pathologizing negative thoughts. In fact, the primary thing that changes is that you start dealing with them head on:

  • Step 0: avoid activities in life because they cause you negative emotions (e.g. I won't go to the party because nobody wants to hang out with me) and instead numb yourself using drugs, alcohol, video games, social media etc. Since you didn't accomplice anything you now start to form this habit of generating negative thoughts that explain your behavior (e.g. nobody wants to be friends with me)
  • Step 1: become aware of this cognitive trap and try to instead suppress your negative thoughts (e.g. I will go to the party even knowing that this will make me anxious and panicky and I will try my best)
  • Step 2: cognitively reframe and realize that your negative thoughts are an ingrained habit that isn't useful for you and try to change it (e.g. I will go to the party because I am good enough that there will be some people to talk to and hang out with)

You'll still experience emotions and thoughts about things in the world. But now you will be in a better position to respond to them in the way that you want.

Watch this video: Why it's Actually Valuable to be Detached

I don't think this really rings true. Yes, relentless negative thoughts are unpleasant to deal with. But they don't cause me to avoid activities. I still regularly go the gym or go to work even if it feels terrible or if it's a tremendous effort.

As weak and counterintuitive as this sounds, I've found physical changes are the key for me. In particular, lots of exercise, exposure to sunlight, getting enough sleep. And when I say exercise I mean in particular weight training but also sweat-inducing cardio. I don't think about it too much but exercise tends to take me out of my own head, which for me is very much what is needed and is counter to the therapy idea where you reflect, dwell upon, or otherwise parse yourself to death. I believe in self-awareness, but I know too many self-absorbed people who constantly go on about wellness but are themselves nothing like I want to be.

Seconded, vigorous exercise is a far more effective antidepressant for me than any of the actual antidepressants I've been prescribed.

Feeling Good by David Burns can help with this and related things. The trick is to become more aware of your own self-criticism and identify when it is valid vs inaccurate.

For me, self love / recovery from bad self talk began with identifying whose voice those words reminded me of, and in what circumstances. The fourth step of the Twelve Steps is a valid therapeutic method for this; there are many variations on the worksheets, and the iOS/Android fourth step app (99¢ for maintenance/development) is a great interactive tool.