Chronic fatigue.

lurpaklegend

Hi fellow MFP followers.

I have been struggling for a long time with fatigue. It's so bad I struggle to function properly and it affects my work as well as down time. I am seeking support from my doctor but its been a lengthy process. Its physical and mental fatigue for which I'm desperate to remedy.

Blood work reveals I'm anemic but currently I don't know the cause, maybe through lack of nutrition.
I lost weight recently intentionally but this continued without me realising until those around me spoke up and said I was not looking healthy.

I was a fat kid and in my early adult years...because of this I struggle to add too many calories through fear of gaining weight again. Former Fat Boy Syndrome.

I've weighed my food for years...a habit I've maintained since my years at the gym, which I quit as I wasn't able to finish my sessions and felt I was at risk of injury.

My calories totalled around 2750 a day having meticulously entered everything I eat. I added another 500 recently but by doing so I've gained 4-5lbs in as many weeks.

I'm a 44yo male weighing 12st 4lbs. I was over 18st in my 20s.
I eat a LOT of veg everyday, I enjoy them and feel my micronutrients are pretty well catered for.
I never ate empty calories while at the gym but I stopped restricting myself after giving up lifting as I didn't feel any healthier for it so yes...I do eat more empty calories than I should but my current lack of energy was abundant even when I removed all te junk from my diet.

I've tried all sorts of diets. Gluten free, dairy free and have been tested for coeliac.

I work in food retail and am on my feet nearly all day, 8.5 hrs a day of which I'm walking at a fairly moderate pace for a majority of the time. I'd estimate 6 hrs a day 5 times a week.

My BMR is around 16500. MFP estimates I burn 2000 just by walking for those 6 hrs. That puts on daily requirement of at least 3650. Factor in I cycle roughly 3 miles 5x a week along with the rest of my daily routine...this would suggest I need 4000+ every day.
I use to consume more than that every day during my lifting days but even then I was maintaining my weight.

I'm now thinking I'm burnt out due to insufficient food intake for too long but despite my calories burnt I'm regaining lost weight rapidly on around 3250 cals a day.

Having tried conducting my own research I've read it's possible for the body to store fat despite under eating to counteract energy requirements when the body is going to need it. Starvation mode to put it simply.

Can anyone with better insight shed any light on what I've put forward. Any advice is welcomed.

I appreciate anyone having taken the time to take this all in and hope this is a suitable discussion for MFP.


Thank you.

AnnPT77

"Starvation mode" in the popular sense of that term isn't really a thing. Think about it: If that could happen in some absolute sense, people wouldn't starve to death, or they'd be overfat when they died. Sadly, many people do starve every day, and they're skeletal when it happens.

What can happen from extended or extreme under-eating is some down-regulation of certain body functions to conserve energy, so a person burns fewer calories than would be expected for their size. In addition to that, fatigue, so less daily activity, can enter the picture and reduce calorie needs further. There would still be some calorie level at which the person would lose weight, but it would possibly be an unexpectedly low number of calories; and the scale might not be a fully reliable guide because water retention effects could become unusual.

There's a good thread here on adaptive thermogenesis, which is that kind of down-regulation process:

http://community.myfitnesspal.com/en/discussion/1077746/starvation-mode-adaptive-thermogenesis-and-weight-loss/p1

Read at least the first few posts in that thread, the ones that are all by the author of the first post. I think you'll find it informative.

Sometimes people use "reverse dieting" in an attempt to counter that effect. Oversimplifying, that's gradually increasing calorie intake in small steps over quite a long period.

I understand that you're pursuing things with your doctor, and there's a lot of potential issues that would be medical. I'm sure you know that there is a health condition, Chronic Fatigue Syndrome, though that may still be somewhat ] poorly understood. Some people reportedly also experience chronic fatigue from long Covid, or consequent to some other virus. There are a lot of medical possibilities.

Since you mention anemia, have you gotten any treatment for that? I would think that once that was diagnosed, some kind of treatment would be put in place (though not all treatments work for everyone).

lurpaklegend

Firstly thank you for your reply.

I mentioned starvation mode purely based in having read articles it. Given that I'm eating over 3000cals I didn't think that would be my issue. Nor do I feel chronic fatigue syndrome the cause of how I feel. Something has to be causing it.

For anaemia I was put on a 3 month prescription of vitamin D which did put my levels where they should be but I didn't feel any better for it.
Blood work shows I'm still showing a low blood count but the follow up blood test came back inconclusive as they tested things that weren't linked to the previous test...no result showed for blood count so I need contact my doctor to rearrange.

Sleep wise I do pretty much OK. Working days I get 7-8 hours...up to 11 hours on rest days. I don't really notice any difference no matter how long I'm in bed for, nor do I feel more energy having slept for 11 hours.

I have a clear day once a week but not too drastic. I've noticed recently that this is the only time I feel a bit better. The day after I deliberately over eat I can feel more alert at work and a little more life in my legs, more focused and less moody. This doesn't last long...within a day or 2 I slowly drop back to feeling extremely exhausted, very moody and unable to focus/concentrate on anything. This is what lead me to MFP for advice as it had me wondering if, by burning in excess of 2000 calories by walking 6 hrs a day or more at work that maybe I just need to eat more and forget about weighing myself each week.

My appetite is usually raging. I could eat all day every day...certainly more than I do now but will power and determination to maintain weight stops me from sabotaging the lost weight. Unfortunately I do have days where I want to give up and just eat purely because when I was fat and not caring about what I eat I felt far better than I do now. No energy issues and was definitely happier. Knowing that's not the sensible route I keep on track and let will power control my desire to over eat every day.
My fatigue has got worse over time...I started my weight loss journey around 17 years ago and have felt my energy issues get worse and worse soon after then.

neanderthin

I understand your tired a lot but imo you aren't actually describing chronic fatigue.

lurpaklegend

neanderthin wrote: »

I understand your tired a lot but imo you aren't actually describing chronic fatigue.

I tire quickly, can't maintain concentration or focus, low mood and my muscles feel weak all the time. It can be so bad I struggle to stand but I force myself to keep going as best I can. I've been checked for diabetes too.

My BP is fine...actually on the low side. Resting heart rate between 45-55. I'm generally in perfect health apart from the debilitating fatigue.

I use to work as many days as I wanted in a row...now I struggle with back to back days. I work 2 days in 1 day off 3 days in 1 day as a rule. I dread the 3 day stretch as I know by the end of it I'm beaten. I've never had a sick day in my life and I try to keep this record even though its been suggested I take sick time. I'm stubborn but also realise after being signed off there's nothing else to fall back on. And i know eventually I'll have to return to work and start over again.

I could go on but having googled chronic fatigue I have most of the symptoms but of course symptoms of fatigue can point to any number of ailments

lurpaklegend

I should add that the only thing I do enjoy is food. Despite feeling the way I do and reading any possible outcome whether it be anaemia CFS or any other possibility..my appetite has always remained. If anything my appetite is always Raging...I could eat all day every day given the chance which is why I set myself meal times. If I didn't I'd definitely over eat.

Another piece of information is I feel much colder than most. I wear several layers at work as well as a wooly hat whilst others walk around in t-shirts. I do have raynauds but whether this is linked to fatigue or not I don't know. Being anaemic I would imagine that's a possible cause.

neanderthin

Yeah, sorry, that hasn't changed my mind at all. I'm very familiar with chronic fatigue, been down that rabbit hole with an extended family member who was bed ridden for 2 years from chronic fatigue where someone had to feed her and needed a wheelchair to get around, and even that was fatiguing for her. She has gotten a little better but she still can't work but she can drag herself around the house. Even mild chronic fatigue is pretty devastating and the mental depression is off the charts, it's something I would not wish on my worst enemy.

MargaretYakoda

lurpaklegend wrote: »

I tire quickly, can't maintain concentration or focus, low mood and my muscles feel weak all the time. It can be so bad I struggle to stand but I force myself to keep going as best I can. I've been checked for diabetes too.

My BP is fine...actually on the low side. Resting heart rate between 45-55. I'm generally in perfect health apart from the debilitating fatigue.

Two things that come to mind:
Do you snore? Because this could be sleep apnea.
Also have you had your thyroid hormone levels checked?

Corina1143

Margaret is right. Neanderthin is right. What you're describing definitely isn't chronic fatigue.
Might be anemia, thyroid, other vitamin deficiencies.
I'd suggest testing for vitamin D, B12 and folate.

lurpaklegend

I don't snore...never have.
My thyroid has been checked.

Blood results showed low vitamin D but has been remedied with tablets. This showed no sign of improvement.
My iron levels were OK...my doctor said my anemia isn't iron related although I have self medicated with B12 supplements that a family member had excess of and this also hasn't helped. I've been on them for a good couple of months. I know self medication isn't ideal but I will try anything so I can start enjoying life again.

My stress levels are OK I'm just very irritable. Financially I'm OK. I don't feel particularly worried about daily circumstances.

My leg muscles are affected mostly, hamstrings feel so weak and bending feels like such an effort. I usually pull myself up with my hands.
Grip strength is also poor quite often...I find I'm dropping things easily.

Shortness of breath is an issue which I'm aware is a symptom of anemia. I frequently need to take a deep intake of breath.

I always wake up feeling like I've not even slept no matter how long I've been in bed.

Thanks again for taking time to read my long posts and for the advice offered.

AnnPT77

@lurpaklegend, I'm getting that you routinely feel fatigued in ways that limit your quality of life. To me, it doesn't much matter whether that counts as official chronic fatigue, and I'm not a fan of comparative misery. It's almost always true in any context that someone else somewhere has it worse. So what? If we have a problem, we want to solve it . . . and it seems like that's where you are now, if I'm reading you right.

Technical diagnosis is a medical thing, and there are lots of factors that can trigger fatigue, as you've noted. I've experienced the effect of unusual conditions being more difficult and slow to be diagnosed, and it's super frustrating.

There were some good suggestions in posts above about tests to ask for, but it sounds like you've already had at least some of them.

You mention being 12st 4, which for other USA-ians like me, is 172 pounds, or about 78kg.

If you said how tall you are, I missed it. If you're average height for a male (5'10-ish, around 178 cm), that's within the normal BMI range. Unless you're quite short in stature, you're not currently significantly overweight, I would think.

I understand that you don't want to become fat again. I can relate, because I don't either.

I still think medical advice is the best plan, but I know that's been frustrating for you so far. Please keep going along that line, though: Don't give it up.

Other than that, if I were in your situation, if I could muster the commitment needed, I'd
* Resume strength training, if I could find the energy. That won't have quick results, but has potential for long term good results.
* Strive to get truly excellent nutrition, adequate protein, healthy fats, varied/colorful veggies and fruits, probiotic and prebiotic foods. Maybe consult a registered dietitian if that's an option at all.
* Take any supplements your doctor/dietitian recommend.
* Avoid alcohol, or at the very least minimize it extremely.
* Continue emphasizing sleep quality and quantity. (I think you mentioned quantity, not sure about quality.)
* Stick with that long term, steadily, at least many months before giving up. Reversing out of a low spot takes time and patience (unfortunately).

Your lifestyle already seems to include quite a bit of mild cardiovascular exercise in the form of walking, otherwise I would've put manageable cardiovascular exercise on the list.

Those are just the things people do to try to optimize general health, as I'm sure you know. They're an investment that takes time to pay off. I'm not any kind of professional or expert, no formal credentials whatsoever. I'm just an interested amateur working on her own health and fitness. Doing all the basics increases chances of improving how we feel, but of course there are no guarantees. (I get that discouragement can make a person want to give up the effort.)

The only other thing to consider is something I mentioned, and it's wildly, wildly speculative: Maybe trying the reverse dieting idea, increasing calories very slowly over quite a period of time, maybe 50-100 calories more daily for a couple of weeks or more, then another small increment if weight stays stable? I'm mostly saying that because you report feeling better (stronger, more enegetic) when you eat more. Perhaps you can routinely eat more, and stay weight stable.

At this point, personal bias, I don't think adding calories that aren't nutrient-dense is your best strategy. When a person feels sub-par, I don't think empty calories or nutrient-sparse foods are generally a good route, or any significant amount of highly processed foods, either. Those aren't general very filling, nor do they do the most to promote increased energy and health.

What's better? Meat, fish, dairy if you tolerate it, veggies, fruits, some whole grains - that kind of thing. I did a slow add back to maintenance calories when I reached goal weight, and I feel like that helped me add those calories in the form of pleasant nutritious tweaks to my eating routine, rather than some single big calorie dense treat food. (I'm weak that way. )

Just my amateur opinions throughout, though.

I'm so sorry you're going through this. I went through a long period of debilitating fatigue, also not "Chronic Fatigue Syndrome", the difference being that I knew the cause (which doesn't apply in your case) and knew about how long I'd need to tolerate it. But I understand how life-altering extreme fatigue can be.

Hoping you can find a solution - best wishes for that!

lurpaklegend

@AnnPT77 thank you for your compassionate reply.

@AnnPT77 thank you for the insightful reply.
You're right...and I do tell myself quite often that others are worse off than me as you said I do want to resolve my own health first and foremost so on my worst days that's all I'm concerned with.

A few follow up notes regarding your comments.

I am indeed 5' 10" meaning my BMI is within range. I am quite broad and to me I still look bigger than I'd like but even at my lowest of just under 11st I still felt this way. This is natural having been overweight for so long I guess.

I don't drink any alcohol...I never have apart from a few tasters in my teens. I hated it and am glad I never started consuming it.

I do take a multivitamin as well as a vitamin D supplement is recommended by my doctor.
I also take codeine for back pain which has come on over years of doing the job I do. Food retail does require a lot of lifting...with being on my feet 8 hrs a day it does cause a lot of back discomfort.
I have experimented periods without codeine but this showed no positive outcome.

I'm also taking mertazipine for my mood but after a medication review 2 days ago I will be stopping these in the coming weeks with the possibility or switching to a different antidepressant if my doctor feels its wise.
Although I do she signs of depression I feel it's pretty much down to the fatigue. There are other mental health issues which I won't go into now.

Something else that might be worth mentioning are my infrequent bowl movements. Usually every 3 days but if I have an IBS attack I can go a full week until I go again. I've read this could be down to a slow metabolism but as I find myself over analysing every possible aspect I wonder if this might even be because I'm burning off the calories rapidly due to the 6+ hrs walking 5 days a week. I'm probably well off the mark here.

During my medication review phone call I have requested a visit with a nutritionist who I hope could better advise just how many calories I should aim for.

MargaretYakoda

lurpaklegend wrote: »

During my medication review phone call I have requested a visit with a nutritionist who I hope could better advise just how many calories I should aim for.

Good move there. I hope the nutritionist provides you some insight.

DiscusTank5

lurpaklegend wrote: »

@AnnPT77 thank you for your compassionate reply.

@AnnPT77 thank you for the insightful reply.
You're right...and I do tell myself quite often that others are worse off than me as you said I do want to resolve my own health first and foremost so on my worst days that's all I'm concerned with.

A few follow up notes regarding your comments.

I am indeed 5' 10" meaning my BMI is within range. I am quite broad and to me I still look bigger than I'd like but even at my lowest of just under 11st I still felt this way. This is natural having been overweight for so long I guess.

I don't drink any alcohol...I never have apart from a few tasters in my teens. I hated it and am glad I never started consuming it.

I do take a multivitamin as well as a vitamin D supplement is recommended by my doctor.
I also take codeine for back pain which has come on over years of doing the job I do. Food retail does require a lot of lifting...with being on my feet 8 hrs a day it does cause a lot of back discomfort.
I have experimented periods without codeine but this showed no positive outcome.

I'm also taking mertazipine for my mood but after a medication review 2 days ago I will be stopping these in the coming weeks with the possibility or switching to a different antidepressant if my doctor feels its wise.
Although I do she signs of depression I feel it's pretty much down to the fatigue. There are other mental health issues which I won't go into now.

Something else that might be worth mentioning are my infrequent bowl movements. Usually every 3 days but if I have an IBS attack I can go a full week until I go again. I've read this could be down to a slow metabolism but as I find myself over analysing every possible aspect I wonder if this might even be because I'm burning off the calories rapidly due to the 6+ hrs walking 5 days a week. I'm probably well off the mark here.

During my medication review phone call I have requested a visit with a nutritionist who I hope could better advise just how many calories I should aim for.

I don't want to scare you, but perhaps think about a colonoscopy. I had my first one ever in Dec. and they found a mass, removed 2 days later, and my scans are clear. I'm doing 6 months of cleanup chemo now just to be safe. I had no symptoms, but some people on my colon cancer survivors FB group talk about severe fatigue. However, they aren't walking 30 hours or more a week! That alone could be the culprit.
Wishing you all the best in your health journey.

lurpaklegend

@DiscusTank5
Good shout but I've already had a colonoscopy...twice. That prep formula still gives me nightmares! Endoscopy also carried out along with an MRI of my abdomen. All came all clear.

Today was a particularly bad day despite having over indulged with a cheat day yesterday. I suffered with fatigue long before I started cheat days...I only started because I was fed up with having such a controlled healthy diet with no benefit. Coupled with having enough weight that I wasn't looking healthy...I gave myself one days break every week as it was something to look forward to ,albeit very trivial.

Back to today..my mental fatigue was also extremely bad. During a conversation with a colleague at work I was having to repeat sentences as I was slurring my words and was hard to understand. I sound drunk but obviously wasn't.

I'm hoping to hear back from my doctor soon with an update on my medication with a switch from mertazipine to an antidepressant that actually works.

AnnPT77

lurpaklegend wrote: »

@AnnPT77 thank you for your compassionate reply.

@AnnPT77 thank you for the insightful reply.
You're right...and I do tell myself quite often that others are worse off than me as you said I do want to resolve my own health first and foremost so on my worst days that's all I'm concerned with.

A few follow up notes regarding your comments.

I am indeed 5' 10" meaning my BMI is within range. I am quite broad and to me I still look bigger than I'd like but even at my lowest of just under 11st I still felt this way. This is natural having been overweight for so long I guess.

I don't drink any alcohol...I never have apart from a few tasters in my teens. I hated it and am glad I never started consuming it.

I do take a multivitamin as well as a vitamin D supplement is recommended by my doctor.
I also take codeine for back pain which has come on over years of doing the job I do. Food retail does require a lot of lifting...with being on my feet 8 hrs a day it does cause a lot of back discomfort.
I have experimented periods without codeine but this showed no positive outcome.

I'm also taking mertazipine for my mood but after a medication review 2 days ago I will be stopping these in the coming weeks with the possibility or switching to a different antidepressant if my doctor feels its wise.
Although I do she signs of depression I feel it's pretty much down to the fatigue. There are other mental health issues which I won't go into now.

Something else that might be worth mentioning are my infrequent bowl movements. Usually every 3 days but if I have an IBS attack I can go a full week until I go again. I've read this could be down to a slow metabolism but as I find myself over analysing every possible aspect I wonder if this might even be because I'm burning off the calories rapidly due to the 6+ hrs walking 5 days a week. I'm probably well off the mark here.

During my medication review phone call I have requested a visit with a nutritionist who I hope could better advise just how many calories I should aim for.

Again, I'm so sorry you're going through all of this, and hope that answers and a solution will come soon.

For this moment, I'm going to focus in on the bolded. I'm sure you've given this lots of thought, but in terms of mundane factors, I often see people here emphasize fiber intake and water. I found that there were other things that helped me during a time some years back when I was struggling with constipation and was diagnosed with irritable bowel syndrome (IBS).

These are things I've experienced as having some possible role:

* Enough fiber (like the 25-30g minimum daily, ideally from diverse foods rather than a supplement).

* Adequate hydration, water intake of course, but also other fluids in beverages or foods. Usually, the guidance is sufficient hydration spread through the day that urine is pale yellow, like straw colored. (It may be a bright almost fluorescent-looking yellow if getting more than the essential minimum of certain water-soluble vitamins, and that can be OK, too - but it shouldn't be dark. Some meds/foods can give it a red or green tint, but I'd discuss anything other than yellow with my doctor, personally.) Dark yellow suggests under-hydration.

* Enough fat, spread through the day. A common rule of thumb it 0.35-0,45g per day per pound of bodyweight. If a person is significantly overweight (as you aren't), it might be a bit less if goal weight is much lower, to be realistic about calories.

* Exercise, perhaps especially exercise that moves the mid-section of the body.

* For some people, probiotics. I prefer probiotic foods (live-culture yogurt and kefir, unpasteurized (raw, refrigerated or home-made) kim chi and sauerkraut or other fermented pickles, live culture miso, kombucha, etc. Some people use probiotic supplements.

You may already have all of that covered, not sure. For sure, no guarantees from that, I still think your medical assessment line is the most important, but you were asking about things most people could safely try on their own.

One thing about fibers: Fermentable (prebiotic) fibers are considered beneficial for most people vs. non-fermentable fibers (like some supplements contain). However, a few people find that fermentable fibers (some of which are FODMAPs) cause digestive distress, which can include constipation but also other symptoms like bloating, gas, pain, diarrhea. That's an individual thing.

Repeating here: Please continue to talk with your doctor or other medical support. The slurring is worrisome, along with some of your other symptoms. I know it's really frustrating to have distressing symptoms like that, and not yet have an explanation, let alone a solution. Hang in there.

Sending well-wishes!