Chronic Fatigue Syndrome

“Life is full of little ironies,” he said.

This wry observation was spoken by my father during a recent phone conversation between us. He’d called me to inquire about my health and to ask how my newly released book ON PACE: Discover How to Run Every Race at Your Real Limit was doing so far. The irony he pointed out was that, despite their disparateness, the two subjects—the state of my body and the status of my book sales—shared a common theme, which was pacing itself.

When runners think of pacing, they think of the skill they use to find the right intensity in workouts and to reach the finish line in the least time possible in races. Scientists define this form of pacing as “the goal-directed distribution and management of effort across an exercise bout,” and in my book I offer this less formal definition: “the art of finding your limit.” So, what does pacing have to do with health?

Fair question. I saw no connection between effort distribution and physical well-being either, until I developed long covid, a chronic illness that affects a small percentage of COVID-19 survivors. Long covid is a type post-viral syndrome that closely resembles chronic fatigue syndrome/myalgic encephalomyelitis. Although some people do recover from CFS/ME, at least partially, there is no cure and there aren’t many treatments. Indeed, the primary treatment for CFS/ME—and now also long covid—is (you guessed it) pacing!

According to the MEpedia website, this therapeutic form of pacing “is an activity management strategy to helpME/CFS patients limit the number and severity of relapses while remaining as active as possible. First described by health psychologist Ellen Goudsmit in 1989, it gives patients the advice to: ‘do as much as you can within your limits’. Pacing recognizes research showing an abnormal metabolic and immunological response to exercise in ME/CFS and offers patients a middle ground between post-exertional malaise and the negative consequences of inactivity.”

The differences between these two forms of pacing—the one runners do and the one chronic illness sufferers do, or as I like to call them, micropacing and macropacing—are obvious. If you push too hard too early in a marathon, for example, it’s game over (with rare exceptions). Having depleted your immediate energy stores, you can’t possibly replenish them in time to salvage a good race. With CFS/ME and long covid, however, you’ve got the rest of your life to bounce back from the often devasting consequences of doing too much (days or weeks of near-total incapacitation) and try again.

The similarities between micropacing and macropacing, though, are not to be overlooked. Both skills are cultivated through experience, for which there is no workaround. Simply stated, trial-and-error is the only way to get better at either. As I often say with regard to running, “The road to pacing mastery is paved with running mistakes,” and I can tell you from bitter experience that the same is true of macropacing.

I was a very slow learner when it came to pacing longer races. I was reduced to walking in each of my first two marathons, lost more than a minute in the closing miles of my third, and didn’t really nail my marathon pacing until ten years after my debut. So, I should not be surprised that I’m also proving to be a slow learner with respect to pacing for health. The biggest mistake I made in the first 18 months with long covid was failing to respect that mental exertion is still exertion. As an athlete, I was quick to recognize the necessity of curtailing my physical activity, but instead of conserving the energy spared by this concession I redirected much of it into my work as a writer, coach, and entrepreneur. The result was that my body forced me to slow down in general by ceasing to function. In particular, the symptom that many of us covid long-haulers refer to as “brain on fire” made it impossible for me to work, regardless of will.

The other big mistake I’ve made is getting greedy during periods when I’m feeling and functioning getter. It reminds me of something my wife, who has bipolar disorder, used to do. When she was going through a rough patch, she dutifully resumed taking the medication she’d been prescribed. Months later, feeling better, she stopped taking it again, thinking she didn’t need it anymore, only to come crashing down. Similarly, when I’m doing poorly, I slow down. After taking it easy for a while, I feel somewhat better, so I start doing more—a lot more oftentimes. It’s more than I can handle, and as a result I come crashing down, just like my wife. Indeed, as I write these words, I feel like death warmed over, having ridden the wave of a recent remission in my symptoms by launching myself back into the work I love.

That’s bad pacing! But I figured out the marathon eventually, and I’m confident I’ll get better at pacing long covid too. It sucks to be unhealthy, but I must say there is a compensatory satisfaction in embracing the irony of depending now for my very well-being on a skill that I previously took such great satisfaction in developing as an athlete.

Interested in learning more about the art and science of pacing? Click here for a free sample chapter of On Pace, and here to purchase a copy.

I don’t look sick. To the contrary, I look like I could run a marathon, or so I’m told. In fact, though, the last time I tried to run I couldn’t get out of bed the next day. This isn’t a figure of speech—I could not get out of bed the next day. And it wasn’t a marathon that put me on my back. It was a single, 10-minute jog on a treadmill.

The doctors call it post-exertional malaise, and it’s common among folks with chronic fatigue syndrome, as well as for those like me who suffer from post-acute COVID-19 syndrome. So, how is it that a person who can’t jog for 10 minutes without incapacitating himself for 36 hours still manages to maintain the appearance of being fit enough to run a marathon? The answer to this question is worth sharing, I believe, because it delivers a useful general lesson about effective weight management.

Let me start by saying that vanity always ranked low on my list of reasons for training before I was forced to stop several months ago. My wife and I agree that I look best with a little more meat on my bones, and what meat I once had was stripped away when I became a hardcore endorphin junkie in the late 1990s. I trained hard because I enjoyed it and it made me feel good and it taught me a lot about myself and I grew as a person through the process and I derived tremendous satisfaction from chasing improvement and competing, and I didn’t particularly care how training make me look so long as it checked all of those other boxes.

Still, I am human, and all humans are vain to some degree. Hence, when I was forced to stop training and lost its many benefits, I rediscovered the reality that I actually did sort of care about my appearance. In particular, I began to worry about gaining weight. This might sound laughable to those who’ve only ever known me as a beanpole endurance athlete who can wrap the index finger and thumb of his right hand around his left wrist with an inch of overlap between the two digits. But there was a time in my life when I struggled with my weight and lacked the wherewithal to do much about it.

I hit my lifetime peak weight of 206 lbs during my sophomore year in college. All the excess poundage glommed around my middle. Even then I could have worn a woman’s wristwatch, but I carried a sloppy old beer gut bookended by stretchmark-festooned love handles, the sight of which disgusted me. I remember arriving at the Haverford College dining center one morning determined to break the dietary habits—salad avoidance, second helpings, keg party attendance—that had added 68 pounds to my former runner’s body in the span of 18 months. But upon entering the cafeteria I discovered it was omelet day, game over. The cheese-heavy three-egger I requested tasted quite scrumptious, but I didn’t enjoy it, burdened as I was by the realization that I lacked the willpower to do what was necessary to lose weight and that I would always be fat.

This pessimistic outlook on my body’s future was based in part on the assumption that I would never run again. When I did get back into running a few years later, the weight came off very easily. What’s more, my desire to improve as an athlete motivated me to make better food choices in a way that my desire to look good naked hadn’t, and I cleaned up my diet quite a bit. Still, the large volume of exercise I did routinely allowed (and in fact required) me to eat a lot, and I worried about what would happen if a major injury or other setback forced me out of training for an extended period of time. I believed that, even if I continued to choose healthy foods, I wouldn’t be able to muster the restraint necessary to reduce my intake sufficiently to avoid gaining weight.

I should have known better, and in fact I did. Both scientific and real-world evidence indicate that weight management is easier overall at lower volumes of exercise. Sure enough, when I stopped running, my appetite decreased significantly, making reduced food intake almost as easy as listening to my body. Currently I weigh 148 pounds, or 2 pounds less than I did when I stopped running.

Eating less isn’t the only reason I haven’t put on a spare tire, though. In fearing weight gain, I underestimated the power of high diet quality in managing a stable body weight. In my beer-belly days I was living on bagels and pizza (and beer), but my current diet, which features a balance of unprocessed foods, fills me up with far fewer calories. What’s more, the practice in dietary self-discipline I got from bumping up my diet quality has proven to be more transferable to regulating overall food intake than I expected. Whereas when I was still running I truly ate as much as I wanted, I now put up with a little more unsatisfied craving than before (and all the more so since I was placed on a medication that increases appetite as a side effect), and it’s not a problem.

Many years ago I created a set of integrated training and diet plans for endurance athletes seeking to improve their body composition. These short (four- to eight-week) programs were designed to help people shed a bit of excess body fat relatively quickly outside the context of race-focused training cycles, when fitness and performance are the priority and any improvement in body composition that occurs during the process is incidental. The specific methodology that made up the substance of these plans was based on a combination of mainstream science and real-world best practices. I never actually followed one of them myself for the simple reason that my weight never varied much, but ironically the formula for holding steady on the bathroom scale that I’ve defaulted to in response to my current health situation looks a lot like my old Racing Weight programs.

For example, these programs were heavy on strength training, which facilitates body composition improvement by increasing basal metabolism. Lucky for me, even in my present decrepitude I am able to tolerate a decent amount of strength training, perhaps because, unlike aerobic experience, it is discontinuous in nature. I lift weights for about 20 minutes every day, and doing so has contributed considerably to my successful weigh management. Seeing this effect has also confirmed for me that I was not doling out bad advice to my fellow athletes through my Racing Weight plans.

Inspired by this experience, I’ve created a new set of online Racing Weight plans for runners and triathletes. Six weeks in length, these plans come in four levels for each sport. You can learn more about the training component here and the dietary component here, and you can preview them here. To be clear, these are not “beach body” programs. They are practical, scientifically informed programs for performance weight management intended for use by athletes who care more about how they feel and function than about how they look. God forbid you should ever have to rely on one to merely look like you could run a marathon when in fact you can barely climb a flight of stairs!

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