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After Moving: Fatigue, Depression, Restrictive Dieting

By November 16, 2012

I recently moved to a new state. I left my friends my job and my Gym routine. Since I moved out here I have been having some physical problems; sudden weakness, achy muscles, lethargy, fatigue. It is terrible that I worry about not being able to clean or go to work and stuff like that. I worry that if I go out people are going to make do physical activities such as wash a car, pillow fight and stuff like that. In the past I have had problems with eating – nothing extreme just obsessive. 2 years ago I would try not to eat more than 20 grams of fat a day and those fat free days were good days. I would go to the gym feeling faint all the time and believed that if I ate more than 1500 cals. a day I was a failure. Somehow (and to this day I can’t figure out why) I slowly started adding fat in my diet, thus more calories. I started feeling stronger and I could work out for even longer. I actually started counting calories again to make sure I was getting enough. I would eat over 2000 a day and I would indulge religiously. I started feeling and looking stronger. I loved it, I could eat whatever I wanted and it would just fuel my body. When I moved here I started feeling really tired and weak all the time and I found myself eating excess calories to keep me from dragging myself throughout the day. I was no longer working out. I was depressed (still am) because of these physical issues (I don’t even have health insurance here). I blame the depression on the big move and my low iron levels (known to cause weakness). The last time I saw a doctor which was before I moved, she told me that my Iron levels were dropping. Due to the nature of these physical symptoms I have become very sedentary. I tell myself, “If I am going to eat and feel weak anyway, then why eat?” This has been my most restrictive time in dieting yet. If I crave something and I know my body does not need it for fuel I chew it and spit it down the toilet. I am eating about 950 cals. a day and have lost about **lbs. I am 5’2 and used to weigh ***. Now I weigh **lbs (I am 18 years of age). I have lost the muscle I had. Now I catch myself being obsessive about food like I was in the past except now I don’t restrict fats and I no longer let myself feel deprived. (Now that I really don’t need that many calories.) When I go out I think of what am I going to do when I feel weak, due to hunger. What am I going to eat? Sometimes I even take food in my purse with me. It’s crazy!!! I don’t like this, I really need to see a doctor. I know it is the anemia, that is why I am now being self destructive. I am sorry about all this drama!! But I think I need help. What do you think? – J.

Dear J.

There are many issues to be addressed in this question that do not lend themselves to a simple answer. The immediate need is for a thorough medical work-up, psychological screen and nutritional assessment.

Fatigue has many etiologies that reach far beyond consuming too few calories and low iron. In general, “Diet” means a healthy way of life and entails carefully following principles of balance, variety, moderation, adequacy and bioavailability. Though these principles may seem overwhelming to put into everyday practice, they are more beneficial and easier to follow than obsessing over calories, fat grams and weight.

A primary cause of the type of type of fatigue you’ve described is hypoglycemia (low blood sugar), which results from poor food timing, food choices, and poor food combinations. Though one could access this information from many nutritional publications, it would be beneficial to schedule a session with a registered dietitian who could simplify these principles, design a convenient food plan and provide accountability.

Iron deficiency is usually the result of malnutrition, but has several other causes, which would best be addressed by a physician. Also a physician would want to rule out a host of potential organic conditions such as chronic fatigue syndrome, asthma, insomnia, fibromyalgia, sex or other hormone imbalances, hypothyroidism, allergies, cortisol levels, adrenal malfunction etc.

The depression you’ve discussed can be a primary cause of the weakness and fatigue. This negative state of mind has evolved into a vicious downward cycle that may have begun with the life-changing event such as major move, into obsessions about food and size. These issues need to be addressed by a therapist.

Your resulting weight (less than 90% of healthy weight), malnutrition and starvation (< 1200 calories and, extreme fatigue and muscle loss), dysphoric mood (irrational thinking, low self esteem and depression) and unacceptable behaviors (chewing and spitting, avoiding work responsibilities and poor hygiene) make the recommendation of a complete workup cited in the first paragraph a priority of the highest degree. Continue to reach out to those you trust, like you have with this letter, and seek the help you need and deserve!

Kindly,

Ralph

Dear J.,

There are several different forms of anemia. It is not indicated from your submission what particular form you may have been diagnosed with. But it’s important to know that one common form of anemia is a result of folic acid deficiency in the diet. Nutrition, such as iron rich or folic acid based foods can play a role in the onset of anemia. The data also suggest that anemia is a known cause of depression.

When someone with anemia experiences the following:

  • lightheadedness
  • rapid heartbeat
  • shortness of breath, fainting
  • chest pain
  • heart failure

…the anemia is worsening and demands medical attention. It sounds as if your concern about health coverage has been a hurdle for you to seek professional feedback on what is happening to your body and mind. Although I am not familiar with your particular health insurance system, I would urge you to contact a licensed social worker at a local hospital near you and inquire about options. See “Finding Treatment” for guidance.

When someone has a physically-based depression (some physical conditions, left untreated, can bring on a kind of mood disorder and/or depression), thought clarity and self care suffer. It would be best, due to your young age, for you to have a lot of support around you. My concern is that, left without real guidance, you may not realize the seriousness of your anemia and/or disordered eating and you will deteriorate.

It is not my goal to scare you, but I must urge you to do whatever it takes to protect your life and claim your right to live and seek help. Seek professionals who understand what your mind does when it attempts to fight back against the depression with either giving up and indulging or restricting.

These extreme dieting tips or indulgences are the last hoorahs of your spirit saying: “No! There has to be more! There has to be a way I can feel and know I am alive and things are good!” Honor the fighting part of you and take care of the physical so that spirit can flourish.

Please seek immediate medical attention and let me know how you are. My thoughts, and my uplifted prayer at this very moment…are for you!

Leanne