Writing this once so I can stop repeating it across threads. It is about fatigue, and it is deliberately narrow — everything I am not confident about is marked as such.
Mostly the deficit, and the useful part of that answer is that it is testable. Fatigue driven by a deficit tracks intake, improves within a day or two of eating properly, and worsens on the days you eat least. Fatigue that is flat regardless of intake, or that arrives on a fixed day after dosing, is behaving like a drug effect. Before assuming either, rule out the boring causes — iron, B12, thyroid, and sleep — because a fast deficit unmasks deficiencies that were previously subclinical.
The commonest reversible cause in practice is inadequate protein plus inadequate sodium, not iron. People restrict salt at the same time as calories without noticing.
Worth checking before concluding it is the drug: ferritin, B12, TSH, and total intake for three honest days. Two of those four explain most cases.
So the question, as narrowly as I can put it: whether the fatigue is a direct drug effect or simply the caloric deficit, because the answer changes what you do about it. If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
hank_denver said:Mostly the deficit, and the useful part of that answer is that it is testable.
That is right, and it stops being right at the edges. The general case is well behaved; the interesting cases in this thread are all at the boundary where the general case breaks.
hank_denver said:Mostly the deficit, and the useful part of that answer is that it is testable.
I read this differently. The confidence in this thread is running ahead of the evidence, and I would rather the uncertainty were stated than smoothed over because it is unsatisfying.
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Browse GL BiochemAnswering the narrow version, because the broad one does not have a single answer. If two explanations both fit, the useful question is which one predicts something the other does not. That is answerable; arguing about which sounds more plausible is not.
MikeFit_NJ said:That is right, and it stops being right at the edges.
Second this. I had assumed I was the exception until I read this.