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Fatigue and AnemiaFatigue and Anemia
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One order of fatigue please!
Jun 20, 2008

Hi Dr. Bob -

I am hoping you can shed a little light on my situation. For some intial background on me, I have been positive for 4 years now; and I am currently 34. The last CD4 was 595 and VL of 300 less than a month ago. The CD4 has been in the same neighborhood for the last 4 years and the viral load has always been below 1000. I am not currently nor have ever been on HIV medications.

In the past two months or so I get so tired/fatigued after eating a meal. It gets so bad that I almost fall asleep standing up.

I have read alot of information on hypoglycemia on the web and realize that testing would be required to determine this, but is there any connection between the virus and hypoglycemia? The only dietary thing that has changed in the last four years is eating a little more fast food as my partner has two kids that love it. Otherwise I try to eat very healthy foods and a fair amount of protein (I heard HIV loves to use the body's protein). I should also note that if I eat one of those monsterous salads with all of the possible toppings, I do not experience this fatigue.

I have found that mentally I do not want to eat if I have things to get done because I won't want to do them after I eat. I know that is a bad thing, but I (we) are always on the go.

So in short am I just getting older and my body is changing over time or is it possible this is HIV-related somehow? Can hypoglycemia just develop over time? Do you have any suggestions for me?

Thank you!

Response from Dr. Frascino


Postprandial fatigue (getting tired after a meal) is some ways physiologically normal. Just think of infants. What do they do after suckling mother's milk? They go to sleep. The body needs to digest the meal, so it in essence shuts down some other nonessential functions and preferentially shunts blood to the digestive tract. However, normal postprandial tiredness should not be so severe that you're falling asleep standing up. I strongly doubt this is related to clinical hypoglycemia. There is no direct correlation between HIV and hypoglycemia. Your problem, however, may well be due to what you are ingesting, particularly since you've noticed you do not experience fatigue if you eat salads.

My suggestion would be to mention this problem to your HIV specialist. A referral to an HIV-knowledgeable nutritionist may be all you need to keep your batteries charged. Certainly he could evaluate you for hypoglycemia and a host of other potential causes of HIV-related fatigue, but with the history you've provided me I think your problem can be boiled down to "we are what we eat." Your physical conditioning could also be playing a role. Make sure you are exercising regularly and not packing on extra pounds above your ideal body weight.

Dr. Bob

Temp operating range of the virus...
good combo

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