For anyone in a physically demanding role:

• Start your medication on a stretch of days off if possible, so you can gauge your response
• Don't under-eat. Set a caloric floor (1500+ for active jobs) and hit it even when not hungry
• Frontload your calories — bigger breakfast before a shift, not a big dinner after
• Electrolyte packets (LMNT, Liquid IV, etc.) during shifts
• If fatigue is severe enough to impact patient safety or job performance, that's a conversation with your prescriber about dosing schedule or slower titration

The fatigue is almost always worst in the first 4-6 weeks and improves as your body adapts to both the drug and the new caloric baseline.

One thing that's helped me enormously: strategic caffeine timing. I have coffee at 7am and green tea at 1pm. Not more, not later. Gives me two energy bumps without wrecking my sleep. And I eat a high-protein snack (Greek yogurt, handful of almonds, string cheese) between meals to prevent energy crashes. Small things but they add up.

Okay, reality check received. I tracked everything carefully yesterday and I ate... 1,050 calories. I'm basically intermittent starving, not intermittent fasting. Going to make a conscious effort to hit 1,400 minimum starting today and get bloodwork done this week. Thank you all.