50 miles...is that all?

[1morcyclist]

Question...

I've been running into issues after hitting the 50-mile mark of my longer weekend rides. Usually these rides are 65-70 miles in length but my body shuts down at about 50 miles. I feel great through out the ride ...I can keep up and feel fairly good on the hills...it's when I hit a certain time frame I have nothing left!

Is this an endurance thing? I feel like I'm in fairly good shape.. I ride 3-4 times a week, twice during the week in our local training rides. Which are 33-38 miles at 19.5/20 mph average.

Or is it my nutrition? Yesterday, I drank two bottles of water and a bottle of gatorade in four hours, ate a Snickers bar at the rest stop and ate two Clif blocks every hour. But, still limped home by myself for the last 7 miles. Interestingly, I was starved when I got home...could it be I didn't have enough calories the days before the ride?

If anyone has had this problem or any advice..I would love to hear about it?

[artifactos]

You could always try some carb loading on the days leading up to your long rides. I'm sure you're in great shape, but your body is definitely trying to tell you something. Do you try to ride at the same pace for 70 miles that you do at 35 miles? Have you tried backing down your pace a bit for the longer rides so you don't burn out more energy than you are replenishing?

[nscrbug]

Just a thought here, but...are you maybe starting out too strong and then fizzle out at the 50-mile mark because you're just gassed? That is what I've been told I do...a LOT...and it does make sense. I tend to go out a bit too strong, and then I'm always left wondering why I feel so gassed, halfway through the ride. Perhaps slow your pace down for the first half of the ride, so that you have something left in the tank for the rest of it. It doesn't seem like nutrition is your problem...based on what you took in, it seems like it would be plenty of calories to sustain you for a 4-hour ride. Personally, I couldn't handle eating 2 Clif bars every hour...they're just too dense. I can tolerate 1 Clif bar...but I cut it up into 1/3rd's and I'll have a piece every 20 miles or so...in addition to sipping on whatever is in my bottle (usually either Heed or diluted G2). I also usually carry some kind of chew (Clif Shot Bloks, Honey Stinger Chews, Powerbar Gelblasts, Luna Moons, etc.) and will take in 1-3 chews at each rest stop (we generally stop 2, maybe 3 times...depending on mileage).

ETA - Oops...sorry, I misread the OP's comment regarding Clif BLOCKS...I thought it said Clif BARS. My apologies.

[XMcShiftersonX]

Maybe it's the amount of sugar you're taking in - so you get an energy spike and then get tired when it starts to dip. I might suggest instead of Gatorade try something like a protein drink, like Perpetuem, and instead of a Snickers bar maybe a banana or a peanut butter and jelly sandwich. Or maybe have those things in addition to what you are already eating. I usually have my water bottle (which I can often refill), and a bottle with Perpetuem.

It doesn't sound like you're eating very many calories on the actual ride though. A snickers bar is what, 250 calories? And those shot blocks are nothing. On long rides I bring a banana, a clif bar, and then in between I'm downing Gu packets, which I think are around about 100 calories each. Gu is sugary, however. You're probably burning 3,000+ calories in those rides. I'm usually hungry at the tail end of a ride and then I eat a Clif Builder's bar as soon as I'm done (about 250 calories, 20 grams of protein). Then when I get home I make a smoothie, and shortly after eat a real meal. I'll probably start adding another snack of some kind here too when I'm doing 70+ miles.

-Jessica

[BleeckerSt_Girl]

Like Jessica, I too am thinking you should try a more substantial fuel too- try a hefty peanut butter & jelly sandwich (or two smaller ones) on multi-grain bread and a couple of bananas, maybe some fig newtons...dole it out to yourself during the ride, not all at once. Personally, if I used Gatorade, I'd mix it 1/2 and 1/2 with water and keep drinking all through the ride....but that's just me.
You haven't told us how old you are...? Is hot weather a factor here?

[1morcyclist]

These are great suggestions! I'm going to try pb&j and fig newtons on my next long ride.

BTW...I'm 42 years old. The weather here has changed...yesterday it was around 85 degrees...with humidity that made it feel like 90 degrees by the time I rolled back in to the parking lot.

[BleeckerSt_Girl]

1mor,
heat and humidity can really take a toll. I'm 56 and I rode the other day only 20 miles but 85F and sunny, no breeze, high humidity, and some steep hills. I really got wiped out. In fact, I had to rest the next day- i think i got some mild heat stroke.
Usually I can do 30 or 50 miles and feel ok. I don't think it would have bothered me quite so much a couple years ago, but i do notice the heat effects me a little more now than it used to even though I'm in pretty good shape. I'm trying to listen to my body more these days and not push beyond where I would start feeling ill. But then, you are younger than I! ;)

50 miles at 85-90F?.... I would have been ready to throw in the towel at that point too! :cool: I think you did great!

[XMcShiftersonX]

Yeah heat definitely kicks your metabolism up, you were probably burning a lot of calories, maybe even more than 3,000 - because I would say on a long ride with mild weather you're probably burning that. Let us know how the different snacks helped... I'm curious to see if that's all you needed!

[ny biker]

I would caution you not to start eating lots of different foods on the bike that you're not used to, especially if it's hot and humid. You could wind up with stomach problems. Try new foods gradually.

Personally I can't eat anything when it's hot out. I do almost all my long rides on nothing but gatorade, water and gu. So I don't know that too much sugar/not enough protein is your problem.

I think not enough calories is the more likely culprit. Gatorade is 100 calories per 20 oz. water bottle. Clif bloks are 100 calories for three bloks, so you're only getting 66 calories from them if you're eating 2 per hour. So I would increase the total number of calories during the ride.

I like Nancy Clark's Sports Nutrition Guidebook for advice on what/how much to eat before, during and after long rides.

[TrekTheKaty]

Personally, I can't get in enough food on long rides. I carry two 24 oz bottles with Cytomax. I stop hourly to EAT (muffins, bananas, Garmin rice cakes or crackers with PB). I carry jelly bellys and gu for when I start feeling "crummy" which means I'm out of energy.

I don't know how many ounces of liquid you drank, but it may not have been enough. Is it 8-12 oz an hour? Anyone?

[OakLeaf]

I need protein any time I'm over four hours or so, and unlike running, my stomach can tolerate most anything on the bike. Tuna salad sandwiches are high on my list - just about any convenient store has them.

I think maybe your needs on the bike are related to what your diet is like the rest of the time. Most people don't seem to have an issue with getting enough protein on the bike (judging from what my companions usually eat and what's offered on organized rides). But going only by what you read in the papers, "most people" eat tons of protein every day. I only know what I eat, and that I really have to work to get 50 grams of protein a day without resorting to protein powders.

It doesn't sound like you drank enough either, but that wouldn't cause the post-ride depletion you're talking about.

I can't drink premix Gatorade or anything with HFCS when I'm exerting myself, either. That stuff just messes with my stomach and my ability to absorb real food.

[shootingstar]

For certain a ride of that length under higher temp./humidity, I need to start off with a somewhat bigger breakfast. Give myself up to 1 hr. to digest before cycling off.

I eat real food (small sandwich, fig newtons/figs, non-messy fruit, trail mix, etc.) and drink water. Natural fruit juices help me along the way. When I have a muffin, I eat parts of it along the way, if I can do it. Sometimes I'm hungry enough.

I want to have real (preferably reasonably healthy) food so that I can adapt no matter where I'm biking....'cause when we get to Europe..I have no interest running around trying to find sports-oriented food. (It's probably more expensive than I care to think.)

[ekcjwc]

I did a 43 mile ride recently and had a similar experience. First warm day with humidity. I had my Camelbak which I sucked dry, a water bottle with G2 and was drinking my husband's Camelbak. Ate oatmeal with bananas and mil before the ride. I think where I messed up was a day or two before the ride. I did not drink a lot of water and did not eat that great. I am trying to do better a couple of days before the ride and then trying the Gu. Hang in there. You will find what works for you.

[tzvia]

For me, it's not the miles, it's the time. If I'm riding on the road, I take some Hammergel and a packet of Luna Moons, an energy/protein bar and a banana. I may not eat it all, but I do take in some gel every half hr or so, just a squirt. After about 1.5 hrs, i will stop for the bar or banana, and a couple Moons. After another 1~1.5 hours, I will stop again and have what I did not eat before, either the bar or the banana. If I am on my mountain bike ride, and am not near any store, I will take a sandwich, either a PBJ or (don't laugh) corned beef on rye or similar if the ride is more than about 2.5 hours. For shorter MTB rides, I will take the banana/bar/gel/Moon combo. I like to stop somewhere quiet on the MTB and rest for a short while and enjoy my lunch; I'm not out to hammerfest myself silly on the road or in the dirt; I want to enjoy the time and the refuel just makes me feel better.

But each person is different, what I can tolerate on the ride (corned beef) may not sit well with someone else. I've seen people take out an orange, which might sound refreshing, but if I ate it I would have instant heartburn that would last the rest of the ride.

[ny biker]

But each person is different, what I can tolerate on the ride (corned beef) may not sit well with someone else. I've seen people take out an orange, which might sound refreshing, but if I ate it I would have instant heartburn that would last the rest of the ride.

OMG corned beef!! I would be on my knees on the side of the road...:eek:

The first long ride I did was a little over 60 miles on the C&O Canal towpath (Harpers Ferry to DC, for those familiar with it). We stopped at White's Ferry for lunch and I had a turkey sandwich, which was the lightest thing on the menu. My friend had a cheesesteak. I couldn't even watch him eat it.

[shootingstar]

I would have to be desperate to have a corned beef sandwich during a ride stop. But I would and need a drink/water.

Preferred sandwiches: ham, cheese, veggie, or turkey
a small mini pizza or pizza-like bun

I could have also sushi...a couple of pieces would be the same thing. Remember there is vegetarian sushi...

I actually find bananas abit too drying during a ride, but I will have half of one with water. I prefer tangerines or orange slices or grapes/other berries.

Slices of fresh mango, would be so nice. I like to fantasize. :)

[bikerchic]

My guess is better nutrition and lots of hydration beyond sugary stuff. Protien will help you endure!

Another suggestion is better said in the Old Bull, Young Bull story:

"The old bull and the young bull were standing at the top of the hill overlooking a paddock of many gorgeous young heifers. The young bull said "Let's charge down the hill, knock over that fence and each service one of those heifers". The old bull replied "Why don't we saunter down the hill, open the gate, take a sip at the water trough and then service ALL of those heifers??"

In other words don't go all out at first it's not how fast you can be but it's can you finish the ride. Slow down and enjoy yourself!

[1morcyclist]

After reading everyone's responses to their eating habits while riding, I've come to the conclusion that I'm not taking in enough calories!

I've ridden for quite a while now...but I think it's really come to light for me this season (probably due to being a little older)! But anyway, I've got a request to get Nancy Clark's book on nutrition from the libary (which I'm looking forward to reading) and I'm going to start experimenting with eating more on these long rides.

I've done some additonal research on the number of calories and carbs needed each hour of riding so this has given me a good idea of what to take on the next long ride (this weekend). Also I've invested in some different flavors of gel and I'm going to try those too!

I hope to have a better ride this weekend...I'll let you know!

[TrekTheKaty]

Nancy Clark's book is excellent. I actually have three versions. Even her recipes are good!

Just glossing over "Fueling during and after exercise" says:

100-250 calories of carbs per hour after the first hour
Mix it up--use food and fluids to get a variety of fuel
Experiment to see what you can tolerate
"Keep in mind that too much sugar or food taken at once can slow down the rate at which fluids leave the stomach and become available to replace sweat losses. Be more conservative with your sugar fixes during intense exercise in hot weather, when rapid fluid replacement is perhaps more important than carb replacement........."
Weigh yourself before and after to determine if you are consuming enough fluids.

During our first century, I actually set a timer for every 45 min, so we didn't get behind on intake. I can't say we ate the right things, but we ATE! If I rolled into a stop and one bottle wasn't empty, I knew I wasn't drinking enough (stomach sloshing is bad--I used to get that running!)

Marathon books are also great sources of info. For some reason there just aren't as many books about endurance cycling! Although runners stomaches tend to me more sensitive, the info is still applicable. Try Marathon by Galloway.

[TrekTheKaty]

OMG corned beef!! I would be on my knees on the side of the road...:eek:

The first long ride I did was a little over 60 miles on the C&O Canal towpath (Harpers Ferry to DC, for those familiar with it). We stopped at White's Ferry for lunch and I had a turkey sandwich, which was the lightest thing on the menu. My friend had a cheesesteak. I couldn't even watch him eat it.

One time, we rode out for breakfast. For some reason, the bacon omelette special sounded yummy! My husband cringed when I ordered. I didn't yak, but let's say I enjoyed the omelette for the rest of the day!

That was the last time we rode out for breakfast. Now we pack a thermos of coffee and a snack--hold the bacon!

[ny biker]

One thing I learned last summer from the latest edition of Nancy Clark's book is that I wasn't getting enough sodium during rides. I started using Gu Roctane (more electrolytes than regular Gu) and I actually noticed an improvement in how I felt, especially on hot days.

[tzvia]

What's so odd about a home made corned beef sandwich on rye? I took it in my camelback on a MTB ride in the hills near Ojai CA. After climbing and climbing up from just outside town, I sat down at the highpoint, with a great view of the ocean, cows and the channel islands, and had my sandwich, a banana and some energy drink. After about 1/2 hr rest, I finished the ride (was at the half way point). As long as I take a little time to just relax after eating, I'm good to go. I had more trouble with the live beef that blocked the trail on several occasions and forced me to stop and wait. And it sure beat being really hungry after the ride and getting crap from McDonald's or Taco Bell.

[BleeckerSt_Girl]

I guess we are all different. ;) I would have no problem with a corned beef sandwich on a ride. Many times I've had bacon and eggs or lox and eggs before a 50 mile ride....i always start with a nice breakfast. and a croissant and latte. :p

[PamNY]

I can eat anything at all before and during a long ride. I don't travel very fast -- perhaps that makes a difference? It takes a ton of food to get me through a 50-mile day. And I enjoy every bit of it.:D

[1morcyclist]

It's been several weeks but I just want give an update. Last weekend, was a good example. I rode 40 miles on Saturday, very hilly route and even threw in a 22% grade short climb...I started of with a Hammer gel shot after 60 minutes and 30 minutes there after and even ate a fig bar at the rest stop. No problems on the ride...I felt great. The ride was topped of with a good size lunch that had some protein and plenty of carbs within an hour after riding.

and....

I haven't done this in a long time...but I did a hilly 60 mile group ride the following day. I used the Hammer gel again during the ride and drank Cytomax. Another great ride...without bonking!

How much you eat on a ride does make a difference! I appreciate everyone's thoughts and comments on this one. I also read Nancy Clark's book too... which was also helpful. Nancy's comments about eating within an hour after riding definitely helps with leg muscle soreness and speeds up recovery.

Thanks again!:)

[marni]

I am 64 years old and my average long distance speed is 14.5 -15 mph. On the most recent cross country ride I did (New Orleans LA to Itasca, MN along th eMIssissippi) took me through flat hot and hunid delta riding, rolling hills and wind, steep climbs with and without wind. Since I wear a body monito I can safely say that on a average day ( 75 miles) I burned between 3,000 and 4500 calories above and beyond the 1100 that is my daily burn.

that pretty much matches the average burn on the three previous cross countries. Riding around locally where it is flat and somewhat windy, I averagebetween 300 and 400 calories an hour depending on the head winds and how hard I am puess shing to maintain 15 mph or above.

I guess what I am trying to say is that if you know you are going to ride long and strong, you need to prehydrate for a day or tow ahead of time, which for me is daily since I ride 50 miles 24 times a week and do cardio 2 x 2 hours a week. I tend to eat whole foods on a fairly regular basis. On my trainig rides I consume a breakfast of oatmeal with dried fruit ad nuts and a banana before the ride, a banana, a cup of dried fruit and nuts, and a couple of gu gels. I carry one bottle of FRS and one of plain water After ride I eat a chocolate almond recovery drink, a sandwich of whole wheat bread, meat and cheese, a large salad and a piece of fruit.

I also like Like bars which are basically dried fruit, nuts and honey and carry one or more of those as a back up on longer rides.

Keep experimenting and you will find something which keeps you going but the longer the ride ad the harder you push, the harder it becomes to not build up a nutrtion deficit for the day.

One other totally random thought... If you are bound on increasing distance, wisdom says that you shouldn't increase more than 10% a week so if you do 50 one week and 75 the next, you are pretty much going to feel it.

[Catrin]

I guess we are all different. ;) I would have no problem with a corned beef sandwich on a ride. Many times I've had bacon and eggs or lox and eggs before a 50 mile ride....i always start with a nice breakfast. and a croissant and latte. :p

It is always interesting to me reading threads of this type for it does bring home how different we all are. I typically have a large breakfast before a long hard ride or hard high intensity gym session - bacon and eggs or a frittata, something like that with something like sweet potato hash and coffee. For some odd reason I can't tolerate chicken before a longer ride if it is hot/humid - which is totally perplexing but there you are. Then again, I don't ride all that fast which probably allows my body to tolerate a wider range of food.

I concur you aren't getting enough calories, but it sounds like you are already working on that.

Marni - thanks for the recommendation on Like bars - I don't consume grain products or HCFS, but I've been looking for something that meets my needs that I can store in my Camelbak for emergencies. Stuff happens. I typically take nitrate-free beef jerky and a macadamia nut/dried cherry mix with me on the bike. I also have Salt Lick tablets with me. So far this seems to be working better than when I was still using blocks, gels and bars.

[thekarens]

@Marni, can I just say you're now my idol? :) If I can be half as fit in the next 5 - 10 years I'll be thrilled.

[marni]

karens, oh la! you flatter me. About seven years ago I had a "come to Jesus " moment that said either I was going to resign my life to a recliner and chocolate covered cherries or do something about my weight and health. Fortunately I made the right choice and started riding a bike. The rest has been based on the theory of "move it or lose it." Biking has given me my life back- literally and mentally. These days its a good day if I get out of bed without shifting the coffin lid.

[thekarens]

karens, oh la! you flatter me. About seven years ago I had a "come to Jesus " moment that said either I was going to resign my life to a recliner and chocolate covered cherries or do something about my weight and health. Fortunately I made the right choice and started riding a bike. The rest has been based on the theory of "move it or lose it." Biking has given me my life back- literally and mentally. These days its a good day if I get out of bed without shifting the coffin lid.

I had the same "Come to Jesus" moment this January. I'm 42 and when I started I was 5'3 and 200 lbs. I'm still 42 (and 5'3) but I'm down to 140 lbs. I'd still like to lose 10 more pounds. When I started I couldn't stay on the elliptical more than 5 minutes, now an hour is easy. However, the bike and fitness is still kicking my rear. I find endurance on the MTB much easier than the road bike. 20 miles at around 13/14 mph is the most I can do. I very much admire your endurance.

[Jiffer]

It's possible that nutrition is to blame. However, you could also have other things going on in your body that are affecting you. I'm 43 and two years ago, when I was training my hardest and riding my fastest, my period came and the next club ride I did, I started the first half strong, then limped home . . . like you. After that I really couldn't ride worth beans for about a month. Had a lot of fatigue and some dizziness. Thought it was low iron. Upped my iron intake and then started feeling better and actually did my fastest century ever (shouldn't have done it at all in retrospect). The next few months I didn't ride as much, but when 2011 hit, I got serious about training again. However, like you, when I'd do a long distance ride, I'd "bonk" at around 40 miles or so and limp home. In March I somehow managed to do a really strong half century (after giving up the notion of doing the full century). Then my period came and, once again, on the next club ride, I rode the first half strong, then limped home. And that was my last "real" ride for a very, very long time. Again, I had a lot of fatigue and when I stood, I'd get the black out sensation (though never actually passed out). I took a lot of naps and if I rode my bike at all, it was 5 miles, flat, at around 10 mph (or less).

The first thing I discovered I had was adrenal fatigue. Eventually I learned that "all" my hormones were low. My naturopathic doctor said if she didn't know I was still having periods, she'd assume I was in menopause by my test results. I also have subclinical hypothyroidism and candida. All of the things I listed are often interchangeable, meaning when you have one, you may have one or more of the others. I was also low in vitamin D, and just found out I have high levels of mercury and lead poisoning. (Mercury due at least in part to amalgam (aka:silver) fillings, which I'm getting replaced soon). Every one of the things listed can cause fatigue and mercury poisoning can potentially be the culprit of them all (along with other symptoms I have had for years . . . and the periodontitis that took all my upper teach several years ago. I've had so many dentists shake their heads trying to figure out how I got periodontitis. Well mercury poisoning can cause it). I've been doing a natural method of mercury detox for four months, even before actually being tested, cause I knew it was a likely culprit.

I have never felt 100% healthy. Since my 20's I have felt like I should have a lot more energy than I do. I think some of my issues have been underlying conditions that didn't completely rear their ugly heads until I got serious about cycling. Pushing my body as much as I did, which was completely normal exertion for a "healthy" person, pushed my body over the edge until I HAD to stop riding and figure out what was wrong.

I'm just now starting to see some progress. Some of my hormones are in the normal range now. My vitamin D is way up, but still not optimal. My TSH (thyroid test) is better (not optimal, but better than it's been). I'm feeling less fatigued and less dizzy. I've been slowly amping up my rides and exertion level.

So . . . like I said, nutrition may be your only issue. I don't know. But what you describe in your rides sounds so much like what I was experiencing and when you said you were 42, it threw up another red flag. You may want to have your hormones tested, vitamin D levels, thyroid, etc.

I don't want to start a debate with anyone (been there on this board with this topic), but I personally, avoid conventional doctors and stick with natural medicine as much as possible, but that's me. Most conventional doctors don't recognize adrenal fatigue as an actual condition because there are no drugs to cure it and the drug industry funds medical schools. Conventional doctors also often read thyroid results differently than natural ones, meaning, one doctor may think your thyroid is fine, while the other realizes it may at the least need some "help". I am also not a fan of taking drugs, so I've been on herbal tinctures to help balance hormones and other natural supplements.

Anyway, I can go on all day really, so I"ll stop right here. Feel free to PM me if you want to ask me anything. I do hope you only issue is nutrition, but wanted you to be aware of these other possibilities.

Take care!

[marni]

my top wieght was 260 at 5'4" I am currently at 150 and aiming for 140, but my focus is more on eliminating fat and eating whole food and healthy without feeling like I am constantly starving and deprived since it is a long term, daily exercise/discipline. Plus I also aim at keeping a calorie deficit on a daily basis which is why I wear a body monitor which gives me an approximation of how may calories I burn vs how many I eat. On days when I am really deficit, I know to eat a bit more the next day,and will probably feel a bit draggy. It's all a balancing act. Since my mammo came back clear a couple of weeks ago, I have stopped taking the tamoxifen and it is amazing how much more energy and enthusiasm I have and hopefully there will be less comfort eating.

[thekarens]

That's amazing Marni! I know how much effort and discipline it takes to keep it up. I use myfitnesspal for my calorie counting, carbs, fat, etc and an HRM for burned calories.

I could take a few lessons from you. There are days I have no desire to keep it up. I'm naturally lazy and I like junk food.

PS congrats on the test results! That's wonderful!

[goldfinch]

I don't want to start a debate with anyone (been there on this board with this topic), but I personally, avoid conventional doctors and stick with natural medicine as much as possible, but that's me. Most conventional doctors don't recognize adrenal fatigue as an actual condition because there are no drugs to cure it and the drug industry funds medical schools. Conventional doctors also often read thyroid results differently than natural ones, meaning, one doctor may think your thyroid is fine, while the other realizes it may at the least need some "help". I am also not a fan of taking drugs, so I've been on herbal tinctures to help balance hormones and other natural supplements.


Do you expect to slander the medical profession and then say you don't want a debate?

Sometimes this forum frustrates me.

[Crankin]

There are good and bad in every profession, so wholesale condemnation of a whole profession doesn't set well w/ me. I just hope no one says this about my profession.

[shootingstar]

I'm glad you're feeling better, Jiffer. I am the sort of person that avoids if possible taking aspirins, etc. I don't even get a flu shot. Maybe I will when I get older and weaker in general.

I guess on Western trained doctors vs. naturpathic doctors I wouldn't be wholesale condemning one over the other for everything. While it maybe true that the pharmaceutical giants try to win over the doctors with freebie samples,etc. there are doctors more willing to at least listen or try to keep current....

My personal feeling /biases is so much based on the following realities, Jiffer:

a) A sister who is a Western trained doctor and practices medicine for past 15 yrs. --she is not against acupuncture and sees benefits for certain conditions. (Whereas others even here in this forum, question it..) She explains known drug reactions when family members ask.

b) Another sister who is a practicing and licensed pharmacist in a teaching hospital. (They have tremendous knowledge ...in Canada university study of pharmcology is 5 yrs. prior to exam and certification.) Yes, sometimes this sister knows certain drugs more than sister a), only because a doctor has to be selective in keeping current vs. highly specialized areas/atypical diseases. The 2 do collaborate

c) A close friend who did her Master's in Pharmcokinetics, worked for major global drug firm. Left to go back to school..and is a naturopathic doctor.

NOW --who would I tend to consult first?: If it questions concerning prescribed drugs, treatments from a doctor (I have my own family doctor. My sister is 2nd opinion only.), then I would be asking both sisters. I would consider naturpathic doctor for diet (though they are not registered dieticians), preventive health care. Would I want my father to see a naturpathic doctor for his prostate cancer? No. Am I glad he's not yet on chemotherapy? Yes, it's extending his quality of life...and my doctor-sister supports his decision. (He has an oncologist.)

Yes, I know I am extraordinarily lucky to have immediate informal access to expertise. Also to have a family member is now serving to advocate for parent.

[Crankin]

There is a place for everything. I've done acupuncture, yoga, counseling, PT, and regular medication when no doctor could figure out what was wrong with me. Maybe I am jaded because I live in a place where I have access to world class medical care and there is no shortage of physicians who fully believe in complementary medicine as needed. I think you need to be a very good advocate for yourself and understand the value and risks of all treatments. Even alternative medicine (herbs, dietary supplements) have serious side effects.
My experience with symptoms very similar to Jiffers' is that it helped me to give up all expectations of speed. I could care less about stats or competing against anyone, except myself. I got back to where I was, and now I just don't care. I am fitter than I was before I got sick because I am doing other sports and I changed my diet. And, I enjoy cycling a lot more.