Category Archives: medical

“Fighting” illness

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Women are also encouraged to inspect their breasts regularly, although “Yep, still there” probably isn’t doing the trick. The health benefits to men of regularly inspecting women’s breasts is still in doubt, but statistics so far indicate that the ideal number of breasts to inspect regularly is less than 3.

No, today’s headline is not meant to worry you. Apart from a tiny head cold and burning my left hand on the wood stove, I am fine, as far as I know. Rather, I want a word with the whole “fighting” thing, which I believe is stupid and counterproductive.

I see this expression used in general, but mostly about cancer. I can see how people may think of cancer as some kind of enemy, since it is dangerous and unpredictable. But it really is no smarter than cursing the chair when you stub your toe. It may make sense at the moment, but the chair is utterly unaffected by your curses. And so is the cancer, I have every reason to believe. And then some, possibly.

Because reading is more or less automatic with me, I sometimes take in headlines of popular magazines in the shop even though I don’t buy them. And there will be a picture of someone who is probably famous in the 3-dimensional world, or at least in the 2-dimensional, and the words “Lost the battle against cancer”, which means the person is dead. What the hell people. Are you a loser because you die from cancer?  Or would these people say “Lost the fight against the lawnmower” if they got run over by their excessively heavy and pricey gardening equipment? That would actually make some sense, but usually you have the good grace to not say such a thing out loud even if you think it.

Cancer is not some guy. It is a malfunction of our own bodies. The body WILL malfunction in some way sooner or later. Even I will die one day, barring an extreme case of divine intervention. (Which seems highly unlikely, though I suppose it would be a nice surprise.) You are not a loser just because you don’t live eternally in this world.

(Incidentally, my ideal obituary would be something like this: “It pleased the Lord to take him home, but it did not please anyone else.”)

The second part of the equation is that fighting, in the sense of being mentally agitated, may actually kill you. All studies that have even looked at the matter show that meditation – the opposite of flailing around – improves the immune system, while stress weakens it. We may question the intelligent design of this, given that any normal person would probably become agitated when diagnosed with a potentially fatal illness. But I guess it does level the playing field a bit, since meditative people probably come later to the feed trough and may also be less likely to procreate. So they should have some benefits so the planet is not completely overrun by barbarians.  (In so far as it is not already.) Or perhaps the Designer just likes people meditating. In any case, it works to some extent, while fighting does not.

Vitamin D also helps regulate the immune system, making it more active when needed and less likely to attack healthy tissue. You can get it from direct sunlight, or if you live in Norway and it is winter, you can get it from cod liver oil, which is cheap and widely available. I suppose vegans will have to take an expensive trip to the tropics to soak in the sun instead, but I have only moderate qualms about cod liver oil. Verily, ye are more than many fishes! is what I think. Besides, they get their revenge in the horrible taste of the thing.

It is indeed a widespread belief that somehow forcing yourself to be optimistic will improve your odds of surviving illness, particularly cancer. However, this is as far as we know just an artifact of  the mind. A study years ago (which I failed to bookmark, it seems) actually did interview people who were newly diagnosed with cancer, about their optimism or lack thereof. A few years later, they interviewed the survivors. There was no connection at all between the initial optimism and actual survival. However, there was a very strong correlation between survival and remembering that one had been an optimist, regardless of whether this was actually true or not.

Life is actually a lot like that. Neurotypicals spend a lot of their time editing their memories to conform to consensus reality, the reality people agree on as opposed to the reality they experience in the moment.

Another fascinating but rather obvious study showed that looking at pictures of sick people actually increases the activity of the immune system. This makes perfect sense, since in the wild humans live in close-knit communities. If you see someone obviously sick, the germs are probably already all over you, or certainly will be in a few hours.

So in short: Don’t be pointlessly optimistic, take your D-vitamin, look at pictures of sick people and meditate. Oh, and don’t divorce your wife, if you’re a male. Exercise daily. Die anyway sooner or later. (But hopefully later rather than sooner.)

Back to a better future

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Modern, unhealthy food is making inroads in Japan as well. Not a good thing, but at least it beats the Middle Ages.

There are those who say that we live unnatural lives today, and suffer for it. Our genes are those who survived thousands of years of physical labor and a low-fat diet, so when we now have the opposite, our bodies don’t know how to react. The result is an epidemic of obesity, diabetes, hypertension, and atherosclerosis.

Hogwash, say others. The lives of our ancestors were nasty, brutish, and short. Human life expectancy is at an all-time high and still increasing, even in the mature west, with about 5 hours a day. In the developing world, progress is much faster, as people are fleeing in droves from the “healthy” life of backbreaking labor and periodic famine.

There is certainly a tendency to make the past more romantic. The people who do so tend to be on the political left, but not all liberals hold this opinion. Some liberals have actually studied history, and it is hard to think of any period of the past that was not worse than our own time in numerous ways.

That does not mean we can learn nothing from it, however. You’d think it would be the conservatives who tried to conserve the few good points of a sad time, but even these tend to yearn for a glorious past that never was: Only their imaginary good times were more recent, some time in the previous century usually. But the decades without condoms but with coat hangers were not a paradise either.

That said, there certainly are new challenges today. Childhood obesity is rampant, and unless some solution is found, it will be very hard for them to reach the age of their parents and grandparents who put on weight later in life. Every process in the body goes much faster in childhood, and this includes the harmful effects of fat in the body. We recently learned that fat has another effect apart from clogging up arteries: It acts as a pro-inflammation agent. This seems to be why autoimmune diseases are rampant in today’s high-fat population.

(Notice that fat induces inflammation when it circulates in the bloodstream. As long as it is stowed away in the fat cells, it is more or less harmless, so a person with lots of fat cells can be obese and have very little fat in the blood, and a person with few fat cells can look normal but suffer from chronic fat poisoning.)

We should certainly do our best to avoid a return to the past, with its backbreaking child labor and tooth-breaking chaff-laden diet. This does not change the fact that some physical movement each day is extremely good for your health. The question is, can we as a society do anything about this, without installing video surveillance in the homes?

Yes, we can, and we already do. In Japan, physical exercise in schools is quite a bit more frequent and more strenuous than in the US, and while children there are fatter than their parents were, they are still lagging greatly behind on the obesity wave. Here in Norway, it has become normal for schools to provide fruit for children to snack on as an alternative to bringing in chips and chocolate. As long as the child does not already have a chronic disease, the school is ideally positioned to boost public health. It is already a prison to most of the kids, after all, so a little extra torture in the form of running a few laps won’t cause an armed uprising.

For the most part, however, our lives are our own. In other words, it is up to you and me to learn from the past and the present, then use this knowledge to build a better future. This future should follow a middle way, I believe. Moderation in all things. Then again, there is a saying that “moderation is for monks”. Strangely enough, monks tend to live long and healthy lives, but the option still remains less than wildly popular.

Big pharma or small minds?

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I’m biking too… just more slowly. ^_^

In my somewhat medical entry earlier this week, I portrayed the lung specialist as an incarnation of Big Pharma.  Even as a snapshot of the moment this is not quite as nuanced as my real feelings, and in perspective even less so.

Then again, regular readers will know that I cannot even use the phrase “Big Pharma” without irony, for it is a concept typical of a very different subculture.  It goes along with a thinking that is not just mythical, but pure fantasy firmly believed to be literal truth.  It is a mainstay of progress haters, vaccine dodgers and people who think everyone can get the green light at the same time with no ill effects. And of course envious socialists, who cannot abide the thought that someone may earn money on other people’s illness.

While I eagerly support people’s right to choose shamanism and witchcraft over modern medicine, I am torn about seeing them expose their children to the same experience in applied Darwinism, and I definitely require them to wear a plague flag in public.  As for the Socialists, their intentions are as always good; it is just their realism that is faulty, as usual. Having worked for the State for 30 years, I know that it has great perseverance but very limited creativity. If you rely on the State for medical progress, you better have a long natural lifespan.

With incorporated pharmaceutical companies, of course, the problem is sometimes the opposite:  Things go entirely too fast.  I personally think there should be more nuance to this. When it comes to treatment for illnesses with a high mortality (including most cancers), side effects should not really be a major concern.  Is it really a problem that 5% die from the treatment if 95% die without it?  But the opposite is the case for what I would call “convenience medicine”.  It is unacceptable to have people die from low-level painkillers, for instance, or breast transplants for that matter. There should not be the same rules for these opposites.

***

In any case, do not mistake me just because of my brevity.  I don’t see doctors generally or this particular lung specialist as just greedy salespeople.  I know enough health personnel to realize that most of them are driven, deep down, by a deep urge to help others.  In general, they are better people than me, in the motivations for their work.  (Although I am working on that.) As the Russian journaler Coldheels (I think it was) wrote:  A medical student dissects many frogs not because her heart is cold but because it is warm with love.  (Sorry to mangle the quote, but it has been 10 years.  Feel free to correct me, but I know I got the spirit of it right, because I feel that way too.)

So I do not want to cast aspersion on her motivations.  But she does live and work in the middle of a milieu of “better living through chemistry”.  She went through a long checklist of diagnosis, certainly more advanced than the script of a McDonalds worker, but still very much a script.  Who has written it?  What are the assumptions you make while following it?  It never occurred to her to ask:  “You are a 51 year old man and you are not overweight, but you are not exactly muscular either.  Are you keeping in shape by exercising regularly, or are you simply not eating as much as others?”  (And I did not interrupt her to tell, although to my defense it was only minutes since I thought I would be treated for a chronic throat infection or some such.)

The point for that deviation from the script would be when there was no improvement in my lung function 15 minutes after taking a standard bronchidilating drug.  Hmm… reduced lung function but not disastrously low, no response to common drug, none of the common allergies… childhood asthma….  could it be that this guy simply has spent 45 years meticulously avoiding any strenuous activity, to the point where his lungs simply never grew to the same capacity as the average male?

While I do seem to have some degree of exercise-induced asthma, it is entirely possible that most of my reduced lung capacity as shown by the test simply comes from a life of slow motion, of walking fast but never running, biking but not too fast, always making sure to not get winded.  What does that do to a human lung?  How much is genetics and how much depends on practice?  I know my heart is beating as slowly as an athlete, but I am not an athlete. The heart speed seems to be genetic – in fact, I get the impression that my brother is even more that way than I – but that does not mean lungs follow the same pattern.

I would like to have such thoughts at least considered before committing my only body to a treatment that may be utterly pointless.  (And taxpayer money for the foreseeable future, since this is Norway  and we have socialized health care that Obama can only dream of.)

Not being able to think outside the script is obviously worse if your script is a medieval fantasy, but even a scientist is not immune.  We need to broaden our minds and see things from an ever higher perspective.  This is the path of true progress.

Fructose, corn syrup and doom

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What does carrying heavy stuff through the snow have to do with fructose? Read and find out!

Let us start this with me, as I am after all the main character here! I noticed after moving that I had lost a few pounds. Not surprising, with all the heavy lifting and little time for meals. My calorie intake is suitable for an office worker, not a mover. Now, it was only a few pounds, so I am not waking up in the night with hunger pangs as I did when I lost most of my fat reserves in 2005. And I will no doubt put these pounds back on over the next few months if nothing disastrous happens. But if I had lived in America, I would have put them back on even faster.

The reason is that I have a medical condition that makes it impossible for me to eat fat except in tiny amounts. You don’t realize how much fat there is in everyday food until it makes you spend some time in the bathroom shaking and trying to throw up. But there is another way to build fat without actually eating it. I am talking about fructose. This extra sweet sugar is naturally found in honey and many fruits, but it is not quite the essence of health you would expect from its origin.

Fructose can only be processed by the liver, whereas glucose can be used directly by every cell in the body. As a result, eating a meal rich in fructose will not cause the same sugar spikes – sudden increases in blood sugar – that is feared by diabetics and panicky relatives of diabetics. Due to the pervasive notion that blood sugar is bad, you can actually see fructose advertised as health food. The reality is a bit more gloomy. Also, in reality there is doubt about whether sugar spikes do any harm. It is the constant high blood sugar over months and years that causes damage from diabetes. Most of us don’t live long enough for the sum of our sugar spikes do do irreparable harm, especially since our body does repair itself if it is not under constant attack. But it seems fair to say that the slower processing of fructose gives a more stable blood sugar. It also seems to be widely accepted that sugar spikes cause a “rebound” which in many people cause feelings of hunger, weakness or tiredness as the blood sugar temporarily go below the usual value.

As a matter of fact, after hard work or exercise fructose will mainly be converted to glycogen, the body’s quick energy reserve, which is stored in the liver and the muscles. This is stuff you want to have lots of, but you can’t. The liver stores about enough for a day’s use, so the only way to store more of it is to burn more of it during the day, that is to say, work harder. On a regular basis.

When the liver’s store of glycogen is filled, however, things take a nasty turn. The same liver will now try to transform the sucrose into fat, or at least triglycerids, an important component of fat. As I have said occasionally, humans suck at making fat, but we excel in storing it. However, sucrose has a better chance at becoming fat than has glucose, lactose, maltose etc. It is a slow process, and a portion of the energy is lost as heat, but eventually some fat is produced. When the body attempts the same with glucose, almost all of it is burned up in the process. So sucrose is worth considering if you, like me, can only eat small quantities of fat due to some problem with absorption or processing of fatty foods. In the end, I don’t live an active enough life for lack of fat to become a problem, so my fructose box is still mostly full, but your fat problems may vary.

Actually most people’s fat problems is that they have too much fat, not too little. And fructose won’t help there. Neither will being American, since this country uses a disproportionate amount of High Fructose Corn Syrup which no other part of the world comes near.

Natural corn syrup contains mostly glucose, but Hight Fructose Corn Syrup has added large amounts of chemically refined fructose. The benefit of this is that fructose tastes sweeter than any other digestible sugar. Ordinary table sugar, which is used as a sweetener in most of the world, contains sucrose which tastes less sweet but breaks down in the body to glucose and fructose. Based on this, one would expect HFCS to be healthier than table sugar, as you can get the same sweetness by adding less. This has not happened though: Instead, Americans have gotten used to their sweets just tasting sweeter than elsewhere.

In an age where few people have manual labor (except when moving, evidently…) the conversion of fructose into fat is a risk factor for obesity. But what is perhaps just as disturbing is that it occupies the liver, which has many important tasks to do in body chemistry. Like alcohol, fructose can overtax the liver eventually and cause lasting damage, although outright death from liver failure is exceedingly rare in both cases. Rather, the liver is less effective in its daily task of neutralizing certain mildly toxic compounds, converting various foodstuffs to their optimal form for use by the body and brain, and storing energy between meals.

So all in all, I think I’ll rather live with feeling a bit hungrier for a few weeks.

“It ain’t wise to need someone”

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di090918

Why must humans fall in love?  Don’t ask me – I don’t.  But it fascinates me, perhaps in the way childhood must have fascinated Adam:  It is an essential part of life to everyone else, but I was not created that way.  (OK, it is generally accepted that Adam was not a historical person.  Then again, not everyone believes that I am who I am, either…)

I woke up to the clock radio this morning again. It played a song by Bonnie Tyler, It’s a heartache.  Personally I am more familiar with heartburn, but the lady sure put her soul into it. I happen to recognize the name because I already had a song by her in my Love Song Collection. It is called Total Eclipse of the Heart.

Yes, she seems to have a particular ability to perform songs of despair.  Perhaps she should look into a career in politics, preferably on the Left.

All this is later reflections, though. At the time, while deciding whether or not to wake up, I heard Bonnie Tyler singing “It ain’t wise to need someone” and I was like “Amen, Sister!”. Admittedly she modified it after drawing a much needed breath.  “It ain’t wise to need  someone / as much as I depended on / you.”  But my libertarian little soul wants to put a period after the someone.  One should not depend on others and not be depended on by others, is how I feel.

That’s not very realistic, of course.  Something Ryuho Okawa repeatedly points out in his later books is that we are all born with nothing.  We would not even be able to survive without receiving unconditional love to some degree at the start.  Everything we have at the present, we have because of other people.  They may not particularly have helped us out of pure ego-less love:  For instance, our teachers probably got paid for teaching us, and our employers expect us to bring in more money than we take.  But still, we would be in a bad spot without them.

You may feel alone in your car, but numerous people have worked on making it (and making the machines that make it, and mining the ore and so on).  Numerous others are involved in making sure you have gas to fill your tank, from  the geologists planning where to test drill for oil, all the way to the gas station attendant.  In a way, you are never alone in the car: The help of a thousand souls are with you, even though very few of them intended it.

In truth, we mostly live in a world of mirrors: Each of us more or less give back what we receive.  There are very few original thoughts, and most people don’t even try, and are in fact skeptical of anything not already accepted by the masses.  We neither resist the culture around us, nor make an effort to improve it.  Even though the people who eat with chopsticks and the people who eat with forks have known about each other’s habit for generations now, there is still no agreement that one of them is clearly superior.  Well, the fork seems to be making a little progress, but overall people do what they saw their parents do when they were small.  People whose parents were swearing tend to swear; people whose parents were praying tend to pray, and mostly to the same gods.

So we are connected to other people whether we know it or not. In fact, we are interwoven with them. Day by day we depend for the food we eat, the clothes we wear, the words we speak and most of the thoughts we think. And we don’t even notice. Independence, in its radical form, is impossible, even unimaginable. That is not what I think of when I say “It ain’t wise to need someone.”  What I mean is, it is not wise to depend on someone special to provide our happiness, or our meaning with life. Well, unless someone special is God, I guess, and even then it is right only in a certain sense.

But romance has become a false religion. Instead of finding our heart in another, our culture makes us hope that we can avoid finding our heart at all, and just depend on the heart of another.  That won’t work.  You can’t substitute anyone for your soul.  You cannot let anyone replace your conscience.  And you can’t go hand in hand into eternity, poetic as that might have been.

There are limits to how individual we can be, but also there are limits to how much of ourselves we can give up.  These limits vary from person to person.  Very few humans can be as individual as I am, so free to be themselves and think their own thoughts.  And yet most of those who can’t, are convinced that they are almost completely independent, relying only a little on others.  While I realize that I am a more colorful thread in a large tapestry.  I have a little wiggle room, whereas they who move not at all feel no resistance.

But then something happens, and the things we took for granted are suddenly no longer there. And we think: “It wasn’t wise to need someone that much.”  No it wasn’t, but a greater foolishness was to not realize that we needed them when they were still there.

Closing the barn door…

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Norway has ordered two shots of Mexican “swine” flu vaccine for each citizen.  The vaccine is expected to arrive in November.  The flu is expected to be endemic in Norway in September.

It is important to be seen doing something, even if “something” is  wasting the tax money.

My unusual brain

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di090324

Well, I may be human but I wouldn’t say I’m ordinary…

I was slightly surprised that binaural brainwave entrainment seemed to work on me at all, even if just a tiny little bit. After all, my brain has been unusual as long as I can remember. Most notably, typical “right brain” talents are pretty much missing: The ability to draw, to keep a rhythm, to recognize faces. They are just not there. The rest of the brain can take up the slack to some degree: I will recognize faces eventually after seeing them often, just as I will recognize any other object that I’m around for a long time. But I’m just happy if I can remember my colleagues that I see every day, while others show up after twenty or thirty years and recognize you on the street. And so on.

(Oh, and I can’t sing with other people either. (I can sing alone.) And probably not make love, although I did not try that for years and fail to improve, as with singing. Judging from song and dance, I probably would have continued to fail though, so it was just as well.)

I also strongly favor my right hand. It is not that my left hand is hanging limply by my side. It assists well enough, and I can even touch-type. But it is always the right I rely on, whether for writing or throwing darts or eating. And there are many other indicators of handedness, like what eye you use to aim with a rifle or which way you cross your arms and legs. I did a test of those in one of Desmond Morris’ books once and got a staggering 10 out of 10 right hand (left brain). This is highly unusual. Put that together with the sheer absence of typical right-brain talents, and one could be forgiven for thinking I had been dropped on my head when I was a baby.

On the other side (literally), the typical left-brain talents are highly developed, more so than in the average person. I have a very large vocabulary, for instance. Bear in mind that English is my third language (after the two Norwegian languages) and that I have never visited an English-speaking country. I did learn English in high school, but most of what I know I have picked up later by just reading. On the other hand, I struggle with the Japanese Kanji (characters that symbolize a word or concept) since these rely on visual recognition of a complex pattern, a right-brain skill.

Another anomaly occurs when I go to sleep at night. According to the textbooks, humans first drift through chaotic dreams that seem to consist of thoughts and floating images, not lifelike or intense. There are two stadiums of this, evidently, though I know not the difference between them, and then you have a period of deep dreamless sleep. After that, you go through the same two levels on your way up again, and then have a time of vivid, lifelike and intense dreams (REM sleep) before you go down again. Each cycle lasts about 90 minutes. But I start dreaming the lifelike (only more intense than my daily life) dreams within minutes (possibly moments) after I go to sleep. I have woken up after less than five minutes from these dreams when they were scary enough to wake me.

And it does not end there. My almost autistic lack of social needs, for instance. When I am off from work, I can easily go a day or two literally without seeing another human. (Not even on TV – I don’t have a TV.) During November (which I take off from work whenever possible to take part in National Novel Writing Month) I can literally go a month without talking to anyone except to say “thank you” to the lady in the supermarket when she gives me back my change. In all fairness, I get the occasional e-mail, but my impression is that this kind of life would drive most human to despair. Me, I thoroughly enjoy it. I don’t miss the sight and sound and smell of humans (or cats or dogs).

Of course, part of this is the continuing Presence that I attribute to God or Jesus or the Holy Spirit, or some combination thereof, but I cannot really prove that even to myself. It just seems to fit the description, if you know what I mean. While I’d love for this to be a purely spiritual thing, I suspect that people come with different ability to perceive such a Presence. Certainly there are many, many Christians who are more pious than me (it really doesn’t take all that much) and who don’t sense it in the same way I do. And there seems to be at least some Hindus who have very similar experience, despite worshiping at different deity. So there may be a kind of “sense organ” for this, the infamous “God organ in the brain”. I would not mind if so. After all, the fact that we have a visual cortex has never been a convincing proof that the visible world is all in our mind…

There are probably other differences as well, that I just can’t remember off the top of my head. In truth it is hard to distribute human traits among body, mind and spirit. For me no less since I grew up with my biological parents (and even two grandparents) so “nature and nurture” were often aligned. But perhaps I have given you a glimpse of some differences that may go pretty deep.

Even with that though, I would still say I am “kind of” human. Of course, the proof of belonging to the same species is being able to interbreed, and so far there has been none of that! Still, I think we are similar enough that most any human could become as happy as I am. Come as you are and become like me! Tempting, is it not?

(“Come as you are and become like us” is a fairly well known phrase in Norway, depicting churches that appear inclusive and newbie-friendly in theory but who expect everyone to think and act the same once they are members.)

Why diets don’t work

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di090307

Sometimes food just happens. This is a lot less cute when you are 50.

The twin scourges obesity and inactivity are raging through the world, maiming and killing like a berserker army. Each of them encourages the other: Feel free to try jogging with a hundred pound backpack, but be sure to have your last will and testament done first. Likewise, sitting still helps the fat just pile on, forcing you to be even less active, and so on and on.

Given the grim statistics for diabetes, atherosclerosis, hypertension and the secondary diseases that follow in their footsteps, you’d think the world’s governments would be waging a War on Fat. And you would definitely think it would be one of the hottest topics of science. The world is already spending billions on diets, so why can’t scientists come right out and tell us which one is the best?

Well, you see, none of them work. Or rather, pretty much all of them work, but not in the long run. Losing weight is fairly easy, but large studies show that the pounds come back on. The scientific consensus is that significant weight loss is pretty near impossible (except in the case of chronic illness, of course). It is possible to lose a little weight – like 5% or so – and keep it off. If you get serious about losing weight, however, the body eventually gets serious too. And at some point, it stops listening to you. Basically, your free will starts fading.

This is a disturbing situation, and well worth considering. We all know from experience that we have free will. We can decide to do something unpleasant and do it, and we can decide to not do something pleasant and avoid it. In each case, we clearly see ourselves as having a choice. But the law of large numbers says something else. In the long run, it is easier to ride the horse the way it is already going. In the case of the weight loss, the body will throw at us ever more frequent and intense temptations. If that is not enough, the discomfort will intrude on our lives more and more: Hunger pangs that make it impossible to sleep, chronic fatigue that makes it hard to be active and burn calories. In extreme cases, you may find that there are blank spots in your memory and empty spots in the fridge. You have no memory of having eaten, and you certainly don’t feel like you have eaten, but you have. You may even find that food is gone from your fridge while you slept. The body will defend its fat as if it were its life. And that is no coincidence.

In the wild, too much food is not the problem. For tens of thousands of years, until just recently, hunger was the real risk. A surplus of food was temporary. If you started losing weight, no matter what your weight was at the outset, the body would interpret this as a famine coming on. It still does. And it will do what it takes to defend you from starvation, even if it means tricking or outright overruling your free will.

One clue comes from people with anorexia. It has been known for a while that patients with this mental illness have a very high mortality. But a look at the causes of death shows something less obvious: A striking number of the deaths are from suicide.

Other studies show that a lot of people – especially women – sometimes want to kill themselves but cannot. Humans are basically built with a certain level of protection. When facing death, we shrink back automatically. This is a good thing, and it is in a way unfortunate that it does not always work. As I like to say, the game is rigged: You can kill yourself when you are feeling down, but you cannot become immortal when you are feeling good. But at least it turns out there is some level of defense. But some people don’t have that level of defense. And these are the same people who are able to lose weight indefinitely. In other words, as far as the brain knows, weight loss is just another type of suicide, and it will use the whole range of defenses to avoid it.

The irony of this is of course that in our time, gaining weight above the “well rounded” level is the actual suicide. The body thinks otherwise, however.

What does help, then? First of all, it is best to not have put the weight on in the first place. But the single most reliable predictor of body fat is the body fat of people around you: Friends, family and coworkers. This works even on a national level: A Japanese moving to America will gain weight over the course of just months, while an American moving to Japan will eventually lose some. But it also works on a local level. The people around you seem to somehow calibrate you to eat slightly more or less than you normally would. (I had noticed this effect on myself long before I read about it in popular science magazines, but then again I don’t always know that I am typical enough to be a useful example.)

And physical activity seems to be more important than body mass anyway. As I said, the problem is that being obese makes it hard to exercise. But you have to start at the level where you are. Remember, if you are severely obese, you are literally in the same situation as someone who carries a heavy load, so don’t try exercise that would be suitable for a slim person. That would be like them going jogging with a heavy recliner strapped to their back or something. Simply walking will be great exercise for the obese, and in the beginning you may want to limit yourself to stretches where you can find a place to sit down and rest if you get exhausted. The single biggest jump is from complete inactivity to a little exercise. Once you get used to that, your body will gradually adapt, so you can be a tiny bit more active next week again, and so on.

But trying to simply assert your willpower and stop eating (or eat just tomatoes)? Won’t work. The body comes with failsafe against that kind of crazy behavior. It keeps tabs on you and if your diet works, it will start blocking it.

Perhaps science will have a solution one day. For now, all it has is an explanation, but we can use that to adapt at least to some extent.