For reference: reflux · 1,000 kcal.
An unexpected observation, and I would like a differential rather than reassurance.
The conditions were within what I understood to be the acceptable range, which is why I am asking.
What would you check first, and what would you conclude from each outcome?
Start with what 1,000 kcal a day leaves you room for, because at that intake the deficit is a live competing explanation rather than a footnote. Protein is 4 kcal per gram, so 100 g costs 400 kcal — 40 per cent of the entire day's energy — and everything else has to come out of the remaining 600. A day that misses protein at 1,000 kcal has missed it by a wide margin, and reflux that tracks those days is a nutrition signal. Then separate the two by timing: a dose effect is periodic and phase-locked to the injection or to an increase, and a deficit effect is monotonic and gets worse the longer the intake stays at 1,000. Log intake, protein and reflux on the same daily row for a fortnight and the two patterns separate without any further cleverness. Nothing here is medical advice.
The honest answer is that this is usually fixable by eating more, which is unwelcome advice in this context.
A deficit beyond about a thousand kilocalories a day reliably produces fatigue, reduced training performance and reduced spontaneous movement. With appetite suppressed, deficits of that size arrive by accident rather than by plan.
| Feature | Local reaction | Sterile abscess | Cellulitis |
|---|---|---|---|
| Onset | Hours to 2 days | Days | 1–4 days, progressive |
| Warmth | Absent or minimal | Mild | Marked |
| Expansion | Static or shrinking | Slow | Expanding |
| Texture | Firm, flat or raised | Fluctuant | Diffuse, indurated |
| Systemic features | None | None | Fever, malaise possible |
| Action | Observe, rotate site | Clinical review | Same-day clinical review |
Hypothyroidism, sleep apnoea, depression and anaemia all present as fatigue and all become more likely rather than less in this population, so attribution to the compound should be a diagnosis of exclusion.
Energy deficits above roughly a thousand kilocalories a day are associated with measurable reductions in resting metabolic rate, spontaneous activity and subjective energy in controlled studies.
Weigh three days of intake honestly. That answers this most of the time.
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Browse resultsThe relevant physiology is that a large deficit reduces both available substrate and spontaneous activity, and the second is often mistaken for the first.
Three days of honest weighed intake usually settles this. Estimated intake in this situation is systematically wrong and usually wrong in the direction that hides the problem.
Carbohydrate intake specifically affects training performance and perceived energy at a given total intake, which is why very low carbohydrate approaches feel worse in the gym at matched energy.
Sleep restriction produces measurable decrements in subjective energy and in training performance independently of energy intake.
Abrupt onset points away from the deficit and towards something else.
The short version: check intake, check hydration, check iron and thyroid if it persists, and only then attribute it to the compound.
Dehydration from reduced fluid intake alongside reduced food intake produces headache, lethargy and postural dizziness, and is the cheapest thing on the list to correct.
The part that matters: iron deficiency is common, particularly in menstruating women, and low intake plus a reduced red-meat share makes it more likely. Ferritin is the test, and it is an acute-phase reactant so it needs interpreting alongside CRP.
If it persists at an adequate intake, get bloods rather than more theories.
The relevant detail is that dehydration and low sodium intake produce fatigue that is indistinguishable subjectively and much easier to fix.
Sleep quality often changes during rapid weight loss in both directions, and sleep debt produces fatigue that no amount of dietary adjustment will fix.
Ferritin as an acute-phase reactant is a recognised limitation and is why it is interpreted alongside an inflammatory marker.
Sleep is a variable here too, and no amount of eating fixes sleep debt.
Answering this needs to know the size of the deficit, since fatigue tracks it closely and predictably.
Fatigue that appeared abruptly, rather than gradually with the deficit, is a different pattern and points away from intake.
Attributing a symptom with a wide differential to the most recent change is a common and expensive error.
Check fluid and sodium before anything more exotic.
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