Maggie's Farm

In The LA Times.

"Diet and exercise" are typical suggestions for the sedentary or over-eaters. However, strict nutritional plans rarely work for overweight people in the long run, and exercise has minimal effect on fat loss (but is essential for general fitness). Nutritional self-control is difficult for most people. Most, not all. 70% of Americans are overweight by some measure.

Metformin is a typical medicine for overweight, pre-diabetes, etc.  In my experience, it is not very effective and has many side effects.

In my view, semaglutide  might be the current gold standard. It's a tiny weekly injection, done easily at home. Like everything, it has some side effects but not much. It can be labeled as Wegovy or as Ozempic. You have to qualify as meaningfully overweight to get a prescription. It definitely reduces appetite, but has other beneficial physiological effects especially on the insulin system. Can it permanently re-jigger your food compulsions after months of use? It is not clear. 

Semaglutide is on-label for Type 2 diabetes, or pre-diabetes, and off-label for weight loss alone. 

If you have overweight issues, discuss it with your doctor as an option.  It could save your joints, your heart, maybe your life (for a while). I would try it, if eating were one of my hobbies.

Deliberately Divided—A Review

The world does not do a good job with people with the most serious mental illnesses. It is partly the world's fault, but it is partly because many of the seriously-ill reject the sorts of help which can be offered. Or, in many cases, can't get their act together enough to avail themselves of it.

From Michael Shellenberger, Madness for Decivilization 

Quillette's Best on Human Nature

What Light Does ‘Three Identical Strangers’ Throw on the Nature/Nurture Debate?

That is the wrong question but James Q. Wilson's 2004 essay (re-posted at City Journal for 9-11) is good.

Why is it the wrong question? Because it makes it sound as if terrorism were some sort of pathology rather than a form of war for those without large armies and weapons.  

The Truth about Autogynephilia

After having spoken with many people, over decades, about their lives and sometimes their wildest sexual fantasies, I still find the gender identity issue sort of strange. I suppose I have heard it all, but have never seen a patient who was worried about their gender expression. I have seen plenty of gay men who were afraid to come out of the closet though. That was usually prompted by wives who wondered about their husbands' lack of sex drive.

Wild fantasies are normal, at least in people lacking in the usual sorts of repression of taboos. Perhaps the political climate is making way for the overcoming of sex and gender taboos. 

From Marilyn Simon's The Language of Sex, at Quillette:

 My students, for instance, are surprised to learn that of the 154 love sonnets that Shakespeare wrote, the first 126 of them are to a young man. (The final 28, give or take, are love sonnets to the “dark lady,” who is characterized as both sexually experienced and sexually active, with desires and a will of her own. A woman adored and respected, deserving of admiration and love. So much for repressive patriarchy.) The question students invariably ask, then, is: “So… Shakespeare was bi?” To which I reply, “I think Shakespeare would have simply characterized himself as a man, a husband, and a father, though he clearly had an attraction to the beautiful young man of the sonnets, to say nothing of his many characters who demonstrate sexual flexibility in identity and desire.” “But then he’s bi!” they insist. To which I reply, “I think Shakespeare would have found our need for precise labels strange. Why do we have the need to define and to categorize human desire? Why this compulsion to attach precise labels to attraction, lust, and pleasure? If what Oscar Wilde says is true, ‘To define is to limit,’ then is it really Shakespeare and his contemporaries who are more repressed than us moderns because they didn’t self-identify as a category? Or is it us who try to contain our sexuality by itemizing every possible iteration of lust and attraction? Are we ready to assume that because we attach a label to human sexuality, we somehow understand better than Shakespeare did? Are we in a cultural position to say that Shakespeare’s insight into human nature is limited compared to the average 19-year-old student’s today?”

Where did the cultural habit of three square meals per day come from?

 It's quite recent, actually, and really a European cultural concept. More specifically, a British aristocratic concept because even today an Italian breakfast (except for the tourists) is an espresso or latte and a biscotti, and a typical French breakfast is a cafe au lait and a croissant. Typical Italian supper?  Soup and bread, or cheese and leftovers.

"Eating between meals"? I suspect people might feel better with 5 mini-meals - balanced snacks, really, because stuffed and lazy after supper is not an effective life plan. Stuffed and lazy after any meal is not a good plan except on Thanksgiving. Serious exercisers and athletes tend to discipline themselves to a 5 meal program to keep the nutrients flowing. They have to eat when they aren't hungry to maintain their level of fitness and power, and to keep their weight up.

A mini-meal for many can be something like a couple of slices of chicken and a handful of olives, or an apple and some cheese slices, maybe a slice of pizza or a cup of yoghurt or oatmeal with berries. Volume and details depending, of course, on total muscle mass, body frame, daily physical demands, physical goals, etc.  Body-builders need 4-5 full meals daily to put on muscle mass, while the old-fashioned three squares/day will make most adults flabby if not obese.

To understand what your body needs, look at it nude in the mirror. One look will tell you what it needs in fitness and nutrition in terms of muscular development, leanness or fatness, posture, etc. When it comes to food, we can't listen to our body too much. It's a liar because it was programmed for scarcity a long time ago, before agriculture. Humans seem to have the instinctive inclinations (eat, nap, fight, play, sex, and repeat until dark when the predators come out) of monkeys, chimps, and gorillas but we have some added higher capacities, or so the scientists claim.

A brief history of the origin of three meals/day.

Part 2 tomorrow will deal with hunger, appetite, and satiety. 

From Mate Selection for Modernity:

This mathematical model offers key insight into our unbalanced sexual marketplace. The number and weight of a woman’s mate preferences is negatively correlated with the number of eligible mates that are available to her. Thus, the distance of a prospective mate to a woman increases with each new preference she adds. Put simply, the more you demand, the less you receive.

More generally, there’s a disconnect between what women want and what is actually available to them. Whereas greater male attainment increases the number of romantic options a man has, greater female attainment reduces the number of options a woman has.

Loneliness is a sad human condition. Misanthropists, socially-phobic, and the overly-narcissistic might see it differently, but I feel that having a solid group of pals is an essential ingredient in my life. A few close friends, a bunch of lunch and couples pals, and plenty of enjoyable social friendlies. There are many things best talked about with friends instead of with spouses.

In tribal societies, everybody is, by necessity, connected but most Western people do not live that way now. Still, humans are social creatures. Humans also need support systems.

I once wrote a post about thinking about concentric social circles, from intimate confidantes to casual social aquaintances to work colleagues.  It was a good post, but I can not find it.

Scott Adams did a brief chat about how to make friends, at the 42-minute point.

Many people could use such advice. He hints that one thing to do is to join groups, and he is right about that. You also need to have something positive, pleasant, fun, or interesting to bring to the table. Having things in common helps a lot. Alas, some people are just not very likeable, and that is a handicap.

I know people who still have friends from grammar school, high school, and college.  Lifetime friends are a blessing.

These Mental Health Symptoms of Menopause Don’t Get Mentioned Enough but Affect the Majority of Women

Psychiatrists are often more alert to perimenopausal mood and cognitive changes. Whether estrogen replacement treatment is always the best solution is another question. 

The complexities of human sexuality are all out in the open nowadays. Our Greek and Roman cultural ancestors never fussed much about it. They seemed to do whatever they felt like, especially if aristocrats.

Most people just have no issues with it, but surely for some number of people sexual and/or love interests are different or variable. I have seen it many times.  It's a given that sex life and love life are important parts of life. As an MD, I remain a skeptic about the trans fad because I know that people have fantasies about everything. Fantasies are always interesting.

 Lesbians Aren’t Attracted to a Female ‘Gender Identity.’ We’re Attracted to Women

I think this is about polyamorous households rather than just multiple amorous relationships. Polygamy, basically.

It seems to work out for some Mormons and many Moslems. 

Polyamory’s Bourgeois War On Normality. Haven’t you heard? Consensual non-monogamy is totally normal and respectable.

There are mayny sources of pain for which opiates are the best temporary fix. For example, knee replacement.

The number of such patients who become addicted is tiny. What bothers me is the withholding of opiates for cancer patients, especially terminal patients with pain.  Since cancer is the end of the road for roughly half of people (and increasing as other causes of final ends are being better treated), withholding pain control for the terminal out of fear of addiction seems deeply wrong to me.

 Should Dying Cancer Patients Suffer From Undertreated Pain Because of 'Concerns Regarding Addiction'?

Podcast: HOW TO RAISE A LOVING AND CREATIVE 30-YEAR-OLD: FINDINGS FROM RESEARCH WITH NATHAN SZAJNBERG MD

However, they do not want to ban therapies to promote and assist genital conversion. It seems to me as if that is encouraged.

In my view, any youth who requests conversion needs to take a good look inside their head. 

Too Soon Old, Too Late Smart: Thirty True Things You Need to Know Now by Dr. Gordon Livingston

Why do people with any fat stores ever feel hungry, or eat anything at all, considering they may have 1-5 month's worth of energy stored as fat?  (We term the hunger experienced by overweight people "False Hunger," because it is.)  Except in the truly malnourished or extremely fit, low body-fat athletes, hunger is rarely a signal of an energy deficit or of any nutritional need.

Think about it. Even normal-weight (neither overweight nor underweight) people carry 8-10 weeks of energy stored in fat if they can only access it. 

You can consider appetite in the pudgy or overweight, not to mention the obese, to be a design flaw based on the hunting and gathering, and, earlier, just plain gathering condition of human existence, same as the other great apes who only become overweight in captivity. Agriculture and food abundance, along with sedentary life, exposed the design flaw for people who overnourish themselves.  Of course, physical inadequacy is another side effect.

Here are a few issues (below) - 

All female mammals have clitori and so are capable of orgasm with sufficient stimulation and arousal/excitement. I am not sure about other sorts of animals. The clitoris is a residual embryological penis with similar nerves.

Many sorts of mammals use sex recreationally. Monkeys (and apes like us), especially. A blast of oxytocin and various endorphins is a nice thing regardless of whether it is a part of bonding or just for fun. For non-humans -  and most humans now, it is not purposeful reproduction but a simple biological urge like thirst. Hence masturbation in various forms in mammals including dogs.

It's a shame that so many female humans find orgasm so elusive or difficult to reach whether in an exciting new relationship or an old one. I have spoken with many women of all ages about this. (Yes, women in their 80s like sex.) While a lucky few are able to orgasm at the touch of a penis, most not. It depends on level of attraction and arousal - the psychological component; and stimulation - the biological component. Re the latter, I sometimes recommend vibrators. Why not?

However, this is not a sex therapy post.  I am skeptical about this theory: Why do women orgasm?

A good general-interest book: Dr. Stuart Yudofsky's Fatal Flaws: Navigating Destructive Relationships with People with Disorders of Personality and Character

I have long wanted to write a brief piece on the idea of "failure to launch", a term which has been in use for almost a generation now. I will try to keep it brief, but with not entirely-formed thoughts.

My main point is that many are not equipped to launch out into the big world to become world-beaters, or even to become well-adapted to current economic-psycho-social expectations. In my view, it is remarkable that so many are equipped and willing. It is a social expectation now but not a useful one.

Humans are tribal, family- and extended-family-oriented creatures. Every human has some gifts, and many shortcomings. Luck matters in life of course, but I do believe that "we make our own luck" if we have the temperament to do so. In my career, I have seen many flawed but talented flounder on the rocks because wealth, privilege, and family enablement made it possible. 

A bit more than a century ago, and forever before that, most people worked on farms. Family farms. Life was hard before machines, but there was work for everybody in the family for generations.  Occasionally, an ambitious kid would leave for the city for work or further education. With the industrial revolution, there was work for all (including kids) off the farm, at whatever level one sought to achieve. Not pleasant work in the mills until skills were achieved, but still work, contributing to the family...