# Exercise and fatigue



## Radders (Jul 23, 2016)

I've been cycling the 4 miles to and from work since mid February, at the same time have lost 21lbs through reducing calories. I normally don't eat vast amounts of carbs, I think typically around the 100g a day mark. The weight loss has plateaued so I have reduced calories some more. The past two weeks I have been getting really tired legs when I meet any resistance either from hills or headwinds, and even climbing stairs.  My blood sugars are well controlled (latest hba1c 5.8% or 40). 
Does anyone have any ideas what might be causing this fatigue and what I should do about it please?


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## Matt Cycle (Jul 23, 2016)

I'll preface this by saying I'm not an expert by any means and it could be caused by a number of things but it may be a sign of glycogen depletion due to the dietary changes and increased exercise.  

This is an explanation of it from the livestrong site:

http://www.livestrong.com/article/307905-glycogen-and-weight-loss/


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## Radders (Jul 23, 2016)

Matt Cycle said:


> I'll preface this by saying I'm not an expert by any means and it could be caused by a number of things but it may be a sign of glycogen depletion due to the dietary changes and increased exercise.
> 
> This is an explanation of it from the livestrong site:
> 
> http://www.livestrong.com/article/307905-glycogen-and-weight-loss/


Thank you Matt, that seems likely. I am wondering how to combat it while still maintaining the reduced calories and carbs. I also find that I am using very little in bolus insulin at the moment and would like to continue this if possible. How do true low carbers manage, or is it because I am in the middle, not low carb but not high carb either that I am having this problem?


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## HOBIE (Jul 23, 2016)

Hydration ? Keep at it & good luck finding out what it is.


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## Radders (Jul 23, 2016)

Thanks Hobie, I did wonder about that at first but I have been hydrating myself like mad so I don't think it is that.


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## HOBIE (Jul 23, 2016)

I just thought if you where on your way to work you might not drink enough . I can remember when I did the c2c I drank for England . Was hot . Good luck sorting.


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## trophywench (Jul 23, 2016)

Err, how long since they did a Thyroid test?


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## HOBIE (Jul 23, 2016)

Radders said:


> Thanks Hobie, I did wonder about that at first but I have been hydrating myself like mad so I don't think it is that.


No problem Radders


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## Matt Cycle (Jul 23, 2016)

Radders said:


> Thank you Matt, that seems likely. I am wondering how to combat it while still maintaining the reduced calories and carbs. I also find that I am using very little in bolus insulin at the moment and would like to continue this if possible. How do true low carbers manage, or is it because I am in the middle, not low carb but not high carb either that I am having this problem?



I don't think there are any elite athletes on a low carb diet which may tell you something.  However most people aren't elite athletes yet a large proportion of the population consume enough carbs that would probably sustain Chris Froome on the TdF - thus creating problems with weight.  I think the answer lies somewhere in between.  I don't know how low carbers manage it but I do know if I'm out on my bike for 60 or 70 miles then a slice of avocado and a lump of cheese wouldn't really cut it and it has to be carbs to sustain me on the ride and replenish the lost glycogen in the following hours on return.  I wouldn't normally bolus whilst on the bike but can still need to consume lots of carbs in the form of gels, malt loaf, flapjack etc.  Protein, particularly after exercise, is crucial though to help repair muscle and avoid sore muscles and fatigue.  It's all about finding the right balance and what works for you.

Well done on what you have achieved so far and keep working at it.


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## Radders (Jul 24, 2016)

trophywench said:


> Err, how long since they did a Thyroid test?


Last week, Jenny. In January I complained about feeling weary to the consultant. This was a different kind of weary, rather than the muscle fatigue I have now. She said my levels for thyroid were on the low side of normal so suggested upping my thyroxine to 125 microgrammes and having a 3 month follow up test. By three months I had started losing weight and exercising more and I had a phone call to say I should reduce the dose back to 100, which I did. At last week's appointment the consultant (a different one ) was still concerned and asked if I was having any palpitations because my numbers are at the top limits this time, presumably due to the weight loss meaning I need less, but as I don't have any hyperthyroid symptoms he didn't suggest another adjustment.


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## Radders (Jul 24, 2016)

Matt Cycle said:


> I don't think there are any elite athletes on a low carb diet which may tell you something.  However most people aren't elite athletes yet a large proportion of the population consume enough carbs that would probably sustain Chris Froome on the TdF - thus creating problems with weight.  I think the answer lies somewhere in between.  I don't know how low carbers manage it but I do know if I'm out on my bike for 60 or 70 miles then a slice of avocado and a lump of cheese wouldn't really cut it and it has to be carbs to sustain me on the ride and replenish the lost glycogen in the following hours on return.  I wouldn't normally bolus whilst on the bike but can still need to consume lots of carbs in the form of gels, malt loaf, flapjack etc.  Protein, particularly after exercise, is crucial though to help repair muscle and avoid sore muscles and fatigue.  It's all about finding the right balance and what works for you.
> 
> Well done on what you have achieved so far and keep working at it.


Thanks Matt, I am only cycling 4 miles in one go so not really in your league! This is the trouble I have when looking online for any information, I am never sure whether with such a relatively small exertion, any of what's there really applies to me! It's not as if my body hasn't had time to get used to it either after 5 months.


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## Matt Cycle (Jul 24, 2016)

Radders said:


> Thanks Matt, I am only cycling 4 miles in one go so not really in your league! This is the trouble I have when looking online for any information, I am never sure whether with such a relatively small exertion, any of what's there really applies to me! It's not as if my body hasn't had time to get used to it either after 5 months.



Well, 4 mile rides are lot more than most people do.  Are you doing 8 miles a day (4 miles each way)?  If you're working 5 days a week then 40 miles a week is excellent.  Even if it's 20 then that is no mean achievement and any information would definitely apply to you as well.  Generally what I have noticed and also with people I know is the normally the body does get more used to it.  Although TdF winner Greg LeMond said 'it doesn't get any easier you just get faster'.   I note from your first post your blood sugar control and HbA1c are excellent  (I wish my HbA1c was that low ) so at a guess I feel your recent reduction in calories could be contributing to the fatigue you're feeling.  Certainly having something protein based when you arrive at work and on your return home may help.  (I think the understanding was having something protein based within 20 minutes of exercising to repair muscles).  I realise you're trying to lose weight but you don't want to feel fatigued whilst trying to do it.


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## Radders (Jul 24, 2016)

Thanks Matt, yes it's 4 miles each way, and it does sound better when you say 40 miles a week! Today we went for a longer ride to Greenwich, about 16 miles round trip I think, and I am definitely going to try replenishing with some protein. Roughly how many Grammes of protein would you recommend?


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## trophywench (Jul 24, 2016)

OK about the thyroid - but not sure what 'your lot' reckon is 'normal'?  I believe that figure is generally around 3.  However, I've been advised by my endo that I'd do better at somewhere between 1 and 2 - and my (now retired so therefore pretty experienced, one would hope and I think he is LOL) said to me the thing I quoted elsewhere 'Yes - I agree, it seems to me that people like you DO seem to do better around that level' - which was what made me laugh and ask if he meant brunette retired insurance brokers by this? - No - apparently - he meant people with diabetes, LOL

Meanwhile back at the ranch I now have low sodium levels - and apparently the only apparent symptom of it is fatigue and achy bits ..... unless your potassium shoots up at the same time at which point it becomes blooming serious - and mine hasn't.  It's usually been bang smack on the lowest end of normal - that's 130.  My highest has been 132 - so this never bothered anyone until it fell to 129 and then 128.  Harp intake of breath and various things and eventually it went back up again without changing hardly anything - except - I started to actually put a tad more salt on the two things I add it to - an egg, and chips, and they certainly don't happen every day.  Just had another test, so we'll see what happens this time.  But - we all have our U&E tested along with all the other stuff, so, how's yours?


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## Radders (Jul 24, 2016)

Hi Jenny
My thyroid function numbers this time were: free T4: 20.5 (Feb was 24.6, normal range apparently 10.3-24.5)
TSH: 0.25 (Feb was 0.11, normal range 0.4-5.5 so that's probably the one they are worried about). 
Sodium is 142 and potassium 4.4, both in the acceptable range (136-145 sodium, 3.5-5.1 potassium). Chloride looks like it's near the top of the range at 103, would that be from my salt intake?


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## trophywench (Jul 24, 2016)

Dunno about the chloride Radders, that's not something that has EVER been mentioned to me as being included in the test.!   It sounds 'salt' oriented doesn't it - sodium chlorate!  LOL

Yes your TSH is down a bit and your free T4 is up the top of normal.  There's another 'thyroid' drug you can have as well in certain circs - is it T3? - but I have to say and be honest again, that I don't actually know the subtle intricacies of the tests though I do know that in certain circumstances you can get false levels, I think of TSH measurement - when what you actually need is the added T3 (or whatever it is) on top of the Thyroxine - cos they are all out of kilter.  I think the Thyroid UK charity explains about this on their website, if you or anyone else needs more info.


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## Matt Cycle (Jul 24, 2016)

Radders said:


> Thanks Matt, yes it's 4 miles each way, and it does sound better when you say 40 miles a week! Today we went for a longer ride to Greenwich, about 16 miles round trip I think, and I am definitely going to try replenishing with some protein. Roughly how many Grammes of protein would you recommend?



Seriously, 40 miles a week is fantastic plus any extras at weekends like the 16 miles today - even better.   In terms of protein I will sometimes have a protein shake as it's quick and easy and they contain around 25g of protein.  The only problem is they are normally fairly high in sugar - not good.  I found some at Home Bargains which were lower carb (still around 10g CHO per bottle) but only cost about 60p each.


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## Radders (Jul 25, 2016)

Thank you, I will look out for the lower carb protein shakes Matt. I was thinking of taking some yoghurt or fromage frais in to work and leaving in the fridge but a drink would be better at work. Only about 5g protein in a fromage frais though.

Jenny I have heard about the other thyroid drug but drew a complete blank when I mentioned it to the consultant!


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## grovesy (Jul 25, 2016)

Radders said:


> Thank you, I will look out for the lower carb protein shakes Matt. I was thinking of taking some yoghurt or fromage frais in to work and leaving in the fridge but a drink would be better at work. Only about 5g protein in a fromage frais though.
> 
> Jenny I have heard about the other thyroid drug but drew a complete blank when I mentioned it to the consultant!


Re Thyroid drug I met a lady who was telling me that the only one that worked for her was not available in the UK and had to get via the internet, she was the member of the Thyroid UK forum!


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## AndBreathe (Jul 25, 2016)

Personally, I believe there are growing numbers of elite athletes using low carb diets - especially endurance athletes.  A quick consultation with Dr Google returns a fair few.  Dy Tamsin Lewis low carbed her way through to becoming Women's World Ironman champion, although she retired from professional athletics when it became clear adding a new baby into the mix of extreme training, a full professional life and wider family was just a bit too much.

She also spoke at the PHCUK COnference (sorry to keep going on about this event, but it was a great day), although the rreal focus of her presentation was on mental health, where he clinical specialism lies.  She has a very interesting and inspirational personal backstory.


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## Martin Canty (Jul 25, 2016)

Matt Cycle said:


> I don't think there are any elite athletes on a low carb diet


I think that there is a growing acceptance of LCHF for endurance athletes, there are many articles (on google) relating to Ultra Runners looking at LCHF.

My friends that are Ultra Runners don't get it but they know of people within their community that do LCHF.... I guess a bit like our D community I guess!!!!

As for fatigue, remember that in the UK it has been hot over the last few weeks, hydration is a critical component of daily living, check the color of your pee.... Should be very light yellow to clear. Drinking a couple of liters of water throughout the day is a good goal, more with intense heat and/or exercise.


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## Radders (Jul 25, 2016)

Martin Canty said:


> I think that there is a growing acceptance of LCHF for endurance athletes, there are many articles (on google) relating to Ultra Runners looking at LCHF.
> 
> My friends that are Ultra Runners don't get it but they know of people within their community that do LCHF.... I guess a bit like our D community I guess!!!!
> 
> As for fatigue, remember that in the UK it has been hot over the last few weeks, hydration is a critical component of daily living, check the color of your pee.... Should be very light yellow to clear. Drinking a couple of liters of water throughout the day is a good goal, more with intense heat and/or exercise.



Thanks Martin, I did think that but I am definitely not dehydrated. I drink one and a half pints of water before leaving home (plus the milk on my breakfast) then another pint when I get there, and another during the day.


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## HOBIE (Jul 25, 2016)

Hello Radders I mentioned Hydration too because its the first thing that affects me when I am doing a bit extra. I have done the c2c on 3 occasions. One time I thought someone was putting knitting needles in my knees. The pain was daft & I had to stop. DEHYDRATION & I had drank 2 camelbacks(7lts twice) & other drinks. When dehydrated you feel slower etc. Good luck


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## Martin Canty (Jul 25, 2016)

HOBIE said:


> I had drank 2 camelbacks(7lts twice)


I hope not all at once!!!! Risk from hyponatremia (dilution & imbalance of body electrolytes....). If I'm working in extremely hot & dry environments I carry 'salt' tablets rather than "sports" drinks as they will spike my BG too much (besides, I don't like them anyway)


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## HOBIE (Jul 25, 2016)

You mentioned sports drinks not me. Water only for me when dehydrated,  T1 since 1966


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