Day 5: Beyond the Hunger: Exhaustion.

My day started off pretty good, sleep seems to be pretty good at curbing my hunger for most days. I had a bit of trouble falling asleep last night (my belly was growling at me for not feeding it). But when I woke up, it didn’t seem so bad anymore. Too tired last night to try and think ahead and create some variety into my meals today, so I had the exact same thing for breakfast, lunch and dinner yesterday (except I had forgotten to pack myself an egg yesterday – boy, did I learn my lesson).

My morning was busy and honestly, I don’t think I felt the hunger as much. I little more yawning than usual, but I figured “it’s Friday”, been a long week (a slight understatement given the hunger I’ve been experiencing the last few days: despite winter being shorter in daytime hours, my days felt incredibly longer… and seconds felt like minutes). Same as previous days, I took my time before lunch to clean up my workspace, arrived 20 minutes late so I could finish my meal without and not be stuck in an awkward situation where I end up staring at everyone else eat. After lunch, I had a class to teach at the diabetes clinic, Day 3 –last of three classes for self-management of diabetes, today was about heart health. I found words slipping my mind more often than usual, mind to be a little foggier – not my most efficient day – but maybe it’s the end of the week! Didn’t put too much thought into it. In fact, I felt like I was getting the hang of this, or perhaps my body was adapting to the energy deficit I’ve been having? Getting used to the hunger gnawing at my stomach?

By 1800h, it hit me. Hunger kicked in but I was running errands on the road and shrugged it off, telling myself I’d be home soon and will take my butternut squash soup. I had roasted the squash whole, didn’t even bother throwing out the seeds – toasted them and threw it into the blender – I figured it’d add some extra protein and fat, give me a bit more satiety… threw in some tofu to add some creaminess and extra protein and desperately added in a quarter cup of oats to blend in. By the time I got home, I think I had gone beyond hunger. All I felt was weak and tired. Sentences hard to form. Words slip my mind. Forgetting where I put my wallet, but conjure enough energy to look for it even though I know I have a bill to pay and need my credit card information to do so. After I got home around 1930h, I heated my soup luke-warm and I shovelled it down. Today, I cheated. I couldn’t bare the idea of how horrible the soup had tasted yesterday… did the math in my head, after 28 cents worth of raisins I added the other day, I have nine cents left. I convinced myself it would be okay if I added some salt, pepper and curry powder, “that should well be under nine cents … right? Honestly, I didn’t really care; I’d say anything to make myself feel better for something I am not proud of. The hunger wasn’t on my side anymore, without some flavour, I wouldn’t be able to get it down. I wasn’t ravenous, but I knew if I didn’t eat, I probably would be worse off.

Exhaustion. That’s really the only term I can use to describe my state this evening. Mentally and physically. Adaptation to the energy deficit eh? Physiology is pretty incredible. I began to shut down. By 200h, I was in bed, my eyes could not stay open any longer and my whole body felt heavy. I couldn’t summon up the energy to turn off the lights, or brush my teeth before hitting the sack for good. Slept for two good hours before being woken up and getting the strength to write this entry.

I’ve never felt so tired in my life. And I’ve done a trek that required walking 15+16+16+7km from Cusco through the Salkantay pass up to Macchu Picchu. Over four days, we climbed about 1800m of vertical gain, glacier, snow, ice and rocky terrain. And honestly, 7hours of hiking on high altitudes felt like nothing compared to the way I felt today.

I can really say, whether or not one can complete this challenge is not a question of will power. It is a devastating feeling to be so helplessly fatigued. Mental processes begin to slow down, and despite my intentions to be the best that I can, only guilt and despair builds up when I continue to disappoint myself. For one week, it’s not impossible to live, but it is impossible to live well.

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Nutrient Meal TOTAL Recommended
Breakfast Lunch Dinner Per Meal Per Day
Carbohydrate (g) 55 36 58 149 30 to 60 90 to 120
Protein (g) 8 9 19 35.7 15 to 20 45 to 60
Canada’s Food Guide Servings
Vegetables/Fruit 0 2.4 0.4 4.8 7 to 8
Grains 2 0.2 2.1 4.3 6 to 7
Meat and Alternatives 1 0.3 0.5 1.8 2
Dairy and Alternatives 0.3 0 0 0.3 2
Added Fat 0 1 1.3 2.3 2 to 3

Total: 1167 kcal (60-70% estimated caloric needs).

Physical activity: 7763 steps; my gym bag followed me to work and back, runners left untouched since Day 2.

“Physical activity helps with healthy growth and development, preventing chronic diseases like cancer, Type 2 diabetes and heart disease, makes us stronger, reduces stress, prolongs independence as we get older and decreases stress” (1). All great things and seems straightforward enough when you’re eating well. Most of the times the challenge is finding time to do so. But when you’re not eating well, the barrier is not time but the lack of strength to do so. I couldn’t even get myself up to perform activities of daily living and this is only day 5. How is one supposed to “be active for at least 2.5 hours a week, focusing on moderate to vigorous aerobic activity and adding resistance activity to build muscles” on top of that when the challenge lasts over months or years? The Canadian Diabetes Association quotes that “low physical fitness is as strong a risk factor for mortality as smoking”(2). On top of that, we know that regular physical activity in conjunction with healthy eating and weight management can reduce diabetes incidence by 60% (3). Imagine the magnitude of impact of this challenge on an individual level– not just in terms of malnutrition, but functional decline in physical abilities and mental processes (reduction in thought processing, declined learning efficiency and work productivity, social exclusion, and feelings of despair, guilt, disappointment and bitterness…), and on a nation-wide healthcare level.

And as a healthcare professional, where do we begin with counseling? Currently, most of our practice revolves around empowering clients with knowledge, but when barriers as difficult as this one exists, how do we enable people to make lifestyle modifications? At most I can provide strategies to help manage finances, redirecting to more affordable food options and help with meal planning; but no matter how much preparation was done, eating well and being physically active is impossible (given me for an example, I have 4.5 years of nutrition education under my belt, and despite my meal planning I am at an average of 50% energy deficit, and how I feel? Well I’m sure that’s pretty clear). What else can we do? Put in a referral for social worker to provide further assistance in community services, and that’s about it. The root problem and major barrier to improving health status is not resolved. The current system is just not effective.

A dose of reality: today someone so humble and kind said to me “I wish I had $18 a week”, the real food allowance was $40 a month. So much respect for someone to still be so grateful, happy and open to learning when facing such a challenge that doesn’t seem to end. You’ve made some amazing modifications with your meals and it has clearly reflected in your blood sugars, so kudos for taking your health into your own hands and keep it up! And thank you for sharing a bit of your reality with me today.

  1. Public Health Agency of Canada. Benefits of physical activity. 2011.
  2. Church TS, Cheng YJ, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004; 27(1): 83-88
  3. Knowler WC, Barrett-Connor E, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403.
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