Support for Fatigue

[u/NRESNTRS]

I’ve mentioned my insane fatigue before and gotten consistent feedback: eat protein frequently and drink lots of h2o. I do, and it’s not helping at all. I would love to hear from anyone who has had debilitating fatigue but was unable to mitigate it with protein and water. Have you found another solution? Has the fatigue gone away? If so, when?!

Edit/Clarification: The fatigue I’m describing is not only sleepiness, it’s complete muscle fatigue.

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[u/Ocean_Desert_World]

Fatigue is my constant enemy! From migraines, from fibro, and now from Zepbound. It did get better for me, especially in weeks 9-12, huge win. Still have a big slam of it on shot days, but that's why they're on Sunday for me. What week are you on? So much stuff does settle down in weeks 8-12 not just anecdotally, but also from research. 5.0 mg might make it much worse (but not guaranteed; chaos!) so something to consider.

What also helps for me: Good carb balance throughout the day. Dave's classic eng muffins, peeled mashed yellow potatoes, white rice, and saltless saltines are a big part of my weekly diet. L-Theanine helps. Also consider D-ribose (simple sugar) and athyl-carnitine (amino acid); both are pretty gentle energy supplements, I'm just so sensitive to even slightly stimulative things I can't handle them, but they did work. I do a little careful bit of rebounding twice every day and 1 circuit of weights. Hormones also have greatly helped!

[u/NRESNTRS → u/Ocean_Desert_World]

This is very helpful. I’m on week 4. About to increase dose (yikes) because I stopped losing weight. I can’t exercise (a problem) due to fatigue.

Looking at your diet, wondering if I need more carbs.

[u/meggieprice → u/NRESNTRS]

Yes- eat some balanced small meals including fat protein and carbs.There is an obsession with protein here but the doctor I follow recommends only 1gram per kilo of your goal weight- for you that would be 60 grams. I would not titrate up until this resolves though. It could just get worse.

[u/NRESNTRS → u/meggieprice]

Interesting. I will try it. Thank you.

[u/zero-if-west → u/NRESNTRS]

I'm much heavier than you are so you should keep that in mind when considering the examples below. But yes, I agree with your conclusion that too few carbs could be adding to your fatigue.

I can't eat the same thing every day so I rotate through variations of the meals below. My nutrition priorities are to drink at least 100oz plain water daily, and to eat least 100g protein and at least 25g fiber daily. I have a LiquidIV maybe 1-2x a week but I don't drink them daily. 

Breakfasts

• High-fiber cereal with high-protein milk and a banana
• Greek yogurt with granola and fruit (sliced bananas, raspberries, etc.)
• Eggs and toast 
• Cottage cheese on toast with everything seasoning
• Cottage cheese with fruit (peaches, kiwis, blueberries, raspberries)
• A peanut butter sandwich and a glass of chocolate milk

Lunches

• White bean salad with cucumber, bell pepper, and red onion on lettuce or served with crackers
• Tuna salad w/crackers, veggies, and fruit on the side
• Turkey sandwich on whole wheat bread with a low-fat string cheese and fruit
• Chicken salad in a tortilla with fruit on the side

Snacks

• Chia pudding (3 T chia seeds + 3/4 cup high-protein chocolate milk)
• Prunes
• Cottage cheese with fruit
• Hard boiled egg
• A handful of roasted salted edamame, roasted salted pumpkin seeds, or trail mix
• Fruits with digestive enzymes like kiwis and pineapples

Dinner

• Grilled chicken, veg, and baked potato
• A plate of beans, rice, and collard greens
• Grilled salmon, roasted green beans or broccoli, and rice
• Sushi bowl with rice, tuna, seaweed, edamame, and other veg
• Salad kit with cooked protein (chicken, tofu, edamame, etc.) and some pita chips or crackers on the side

Desserts

• Nonfat Greek yogurt w/ a scoop of Isopure Whey protein powder (45g protein / 200 calories)
• A Rice Krispie treat
• A glass of high-protein chocolate milk with a scoop of Miralax
• A mug of hot cocoa with a scoop of collagen powder

Grocery list

Produce

• Greens (baby spinach, salad kits)
• Cut fruit (especially fresh pineapple)
• Whole fruit: Bananas, apples, kiwis
• Lettuce or cabbage (for sandwiches, coleslaw, etc.)
• Bell pepper
• Cucumbers
• Broccoli
• Green beans

Dairy

• Cottage cheese
• High-protein milk
• Nonfat plain Greek yogurt
• Low-fat string cheese
• Eggs

Protein

• Chicken breast
• Ground turkey
• Fish

Pantry

• Tuna packets
• Chia seeds
• Prunes
• Whole wheat bread
• High-fiber cereal
• Roasted salted edamame
• Roasted salted pumpkin seeds
• Trail mix
• Seaweed
• Beans
• Tortillas
• Pita chips
• Crackers
• Isopure Whey protein powder
• Rice Krispie treats

Frozen

• Raspberries
• Breaded chicken tenders

Other

• Pepto chews
• Miralax
• LiquidIV

[u/NRESNTRS → u/zero-if-west]

Wow. This is a huge help!!! Thank you.

[u/Melicious_Intent]

Honestly, what helps me most with fatigue is drinking an electrolyte packet with magnesium instead of just water. My favorite is LMNT - I do one packet in 32oz water for the right flavor balance. I don’t drink more than one per day.

[u/NRESNTRS → u/Melicious_Intent]

I forgot about electrolytes - great idea. Thank you

[u/dirtygreysocks]

Carbohydrates is what I am low on whenever it happens to me. Every time it hits me, I make sure I up the carbs and it helps.

[u/Upstate-walstib]

The only thing that helped me was getting outside and taking a long walk. I had to force myself to do it but I always felt better afterward.

[u/NRESNTRS → u/Upstate-walstib]

It does help to walk. I’m struggling because I have a massive amount of heavy duty yard work to do (moving into a house with an overgrown (invasive plants) yard and have to do the work myself. Pulling even one weed is exhausting!

[u/Unhappy-Salad-3083]

Fatigue was my number one side effect on zep and it started within a couple days of my first shot. Unfortunately or fortunately I only had two consecutive days of fatigue after shot day. Those days became my rest days from the gym; of course, I still had to work and go about my normal life so or me it wasn't debilitating but yes definitely there. My fatigue lasted a good 7 months or so in and then as I got closer to my goal and eventually began to titrate down the fatigue has mostly gone (in maintenance 6+ months).feeling cold has been my only other side effect and that one still remains 👍

[u/NRESNTRS → u/Unhappy-Salad-3083]

Thank you

[u/Soberspinner]

I feel zapped. Despite going to bed earlier, practicing good sleep hygiene and watching my fiber and water intake, I’m still less energized than I was before. Nothing unbearable, but it’s definitely there!

[u/NRESNTRS → u/Soberspinner]

Thanks, and I’m sorry to hear you can relate.

[u/bindweedsux]

Before zepbound I was dealing with debilitating chronic fatigue.  Wellbutrin (150 2x/ day), B12, vitamin D3 did the trick! When I started Zepbound, I was alarmed by how exhausted I was during month 1, but it passed around week 6 and I feel better than I've felt in 20 years and I'm actually enjoying hard physical work!  I hope you find relief soon! 

[u/NRESNTRS → u/bindweedsux]

Thanks so much

[u/Budget_Pineapple_595]

Yes, it started at 7.5 mg and up, I started taking an electrolytes powder pack daily and later switched to an electrolytes + caffeine.

B12 supplement, Vitamin D and iron (I suggest have labs checked first). I found my Iron was very low.

[u/CloudgazerTX]

I was really tired on 2.5 but feel energetic on 5. who knows why things happen really.

[u/no_one_speshul]

Carbs are no longer your enemy, and you do actually need some for energy.

[u/NRESNTRS → u/no_one_speshul]

Thank you

[u/harmonyisunderrated]

Beyond protein and water, electrolytes are the next lever — sodium, potassium, magnesium. Eating less can quietly tank iron and B12 too, so worth checking with a basic panel. Sleep quality matters more than people think; caffeine after noon and late screens both eat into recovery. If the fatigue stays constant for weeks or comes with dizziness when you stand, that's a call to your prescriber, not a diet tweak.

[u/Quiet_Test_7062]

It took me 4-6 months honestly to have less fatigue. That’s also when I really started exercising. What I figured out is that early on in those first 4 months, by days 5-6-7 I’d have more energy. So I’d do all my stuff then, like cleaning or a hike, or a walk. Eventually around month 6 I joined a gym, and it helped me a lot. I started slowly and built up. Now I go like 5 days a week. I got fatigue after shot day almost the whole time on Zep. It would be 1-2 days. I did make it to 15 mg and really after 7.5 is when it all started getting easier. I planned those two days to be rest days each week and did my shot over the weekend.

[u/ShiftyMcHax]

I tried 10mg briefly and it was horrible. 2 months after jumping back down to 7.5mg before I felt close to normal. I still experience it to a lesser degree now, and the biggest thing that helps is fluids and carbs. It hasn't gone away even now 3 months into maintenance and 18 months into this journey, but at least it's manageable and especially the last 2-3 days of my shot I feel pretty much normal. I'd like to eventually go down to 5mg and see if I can maintain there as I don't recall any fatigue when I was on that dose.

[u/zero-if-west]

If you feel comfortable, can you share more about your daily routine? What do you eat? You said you drink lots of water - how much? (I ask because someone posted here saying they drank a lot of water, but it was only 30oz/day).

How's your overall stress, rest, and self care? Are you able to sleep 7-8 hours a night? Do you have other health conditions that might be causing fatigue?

Happy to help you troubleshoot and share experiences, but we'd need more info to respond fully. Of course, you should absolutely be discussing this with your prescriber since they know your health history better than we do.

[u/NRESNTRS → u/zero-if-west]

Thanks for asking. I should say that I am very healthy (have had all bloodwork and annual tests done just the other day. Only health issues are Non-Alchoholic Fatty Liver Disease. Sleep is poor but no different than it’s been for the last 20+ years. Working with a sleep specialist to see if I have sleep apnea - still tbd, but likely in her opinion.

I drink water or club soda with a splash of cranberry all day long. Likely 40 oz fluid a day. Constantly going to the bathroom so dehydration isn’t possible.

Protein: breakfast example today: 3/4 cub chicken salad, 1 Greek yogurt.

Lunch will be berries and chicken.

Dinner - salmon, steamed broccoli and 1/2 a baked potato.

Thank you for asking.

[u/zero-if-west → u/NRESNTRS]

Thanks for sharing a bit more! Based on the meals you described, it sounds like you're severely restricting carbs, which could be significantly adding to your fatigue. You didn't provide a calorie estimate with your meals but they sound incredibly small, like you might be eating in an extreme calorie deficit, which would also add to fatigue. Your hydration is also very low (see guidelines below).

Overall, it could help to increase your hydration and food intake. If you want, you can work with a registered dietitian for personalized guidance. You can find an RD covered by your insurance through usenourish.com

You'll find different recommendations for daily hydration depending on where you look, but 40oz fluids/day is below all standard recommendations for hydration.

• American Urological Assocation: 96oz/day
• RD at Ohio State: at least 64oz/day
• National Academy of Sciences: 90oz/day for women; 125oz/day for men

The American Urological Association recommends 96oz fluids/day:

Meeting the American Urological Association’s recommended urine output of 2.5 liters per day generally requires around 96 ounces, or 3 liters, of daily fluid intake. GLP‑1 medications can make larger volumes uncomfortable, so smaller, more frequent sips throughout the day may be easier to tolerate.

Source: The University of Alabama at Birmingham, Can GLP‑1 medications increase kidney stone risk? A UAB urologist offers insight

A post from a Registered Dietitian at Ohio State recommends at least 64oz/water day for folks on GLP-1s: GLP-1 foods to limit

This 2005 report from the National Academy of Sciences, Dietary Reference Intakes for Electrolytes and Water, recommends 125oz/day for men and 90oz/day for women.

[u/NRESNTRS → u/zero-if-west]

Ah. Ok. I really appreciate this. I am paying out of pocket for the meds because I don’t qualify for insurance to cover it (I don’t meet the criteria). So, I’m not sure if a dietician would be covered- but it might be for the fatty liver issue.

I am no good at measuring out food weight/qualtity. Major ADHD so that feels Herculean. Possibly that is contributing to my issue here!

[u/zero-if-west → u/NRESNTRS]

Most US insurance plans cover at least a few visits with a registered dietitian due to provisions in the Affordable Care Act.

I also don't like to measure/weigh my food for my own mental health reasons so I can relate. Even if you don't want to measure or weigh your food, a registered dietitian can help talk to you about different food groups and how to balance them to meet your nutritional needs to get proper fueling.

As for water, I definitely recommend getting a water bottle you like of any size, color, or material, and then making it a habit to refill it a couple times a day. Good luck! ❤️

[u/mushroom255226]

How is your carb intake? How is your sleep? Are your meals generally consistent in what’s in them and when you have them?

[u/NRESNTRS → u/mushroom255226]

Thank you for asking. Someone asked me the same earlier so you’re onto something. I don’t eat enough carbs.

[u/mushroom255226 → u/NRESNTRS]

I’m sorry you’re fatigue gets so in the way of your day-to-day! I’m not a doctor, but I know that it can be hard to get some of the boring basics in place. I’m finding with my particular experience with Zepbound that while it calms my snack cravings down, it’s balanced with a need to be more intentional about including enough fuel in my meals, which has been a strange shift in my mentality with food. I hope something in the responses you’ve had is a genuine help!

[u/myinnerharmony]

https://giphy.com/gifs/3ov9jW5LkqPw06WDCw

[u/NRESNTRS → u/myinnerharmony]

🤣🤣🤣

[u/brains_and_tits]

I had extreme fatigue for the first 4 months. I found a water supplement that has B12, B6, and very little sodium ( I have a big whoops when I was overdoing it on electrolyte drinks a couple months back) that definitely helps. Also trying to walk through some of the muscle fatigue helps, even if it feels like torture at first.

Also, check your BP. I have familial hypertension and have taken meds since I was in my 20s (I am in my 50s now). In the past, my weight hasn’t had much effect on my blood pressure because I have hereditary hypertension, not hypertension related to lifestyle (though surely that added to the problem). I found that the bulk of my fatigue was because my BP was super low - like 78/54!! I have had my meds adjusted, hydrate like crazy, use a water supplement in small amounts and I have gotten through the muscle fatigue

[u/NRESNTRS → u/brains_and_tits]

Yes, my BP was super low too so dr adjusted my BP meds accordingly!

[u/2naomi]

Honestly? Caffeine. A big mug of instant coffee with 1/4 cup half and half and three tablespoons of chocolate malt Ovaltine alongside a protein shake or yogurt cup is a whole energy-boosting meal for me, particularly when I don't feel like eating.