Overtraining Syndrome? No other diagnosis fits

Medical Q&A [Moderated]
1

About 5 years ago I had a lot of life stressors, which precipitated multiple systems showing signs of stress/distress.

Symptoms:

  1. extreme fatigue variability (from house bound to okay enough to run/lift without restriction)

  2. insomina (fall asleep but cannot stay asleep

  3. vision

  4. light sensitivity

  5. visual “static/snow” maybe? worse in the dark

  • digestive issues
  1. bloating/distension
  2. slowed transit
  3. GERD/Silent Reflux
  4. infrequent sharp pain (concomitant with excessive and quick evacuation, profuse sweating, lightheaded/near fainting)
  • Autonomic issues (from time-to-time; maybe histamine related)
  1. light headed
  2. tachycardia (tested negative during table tile test)
  3. Tinnitus
  • Elevated anxiety/panic episodes

Life Stressors: 1. 2016

  1. mostly okay; doing some unstructured powerlifting 5-6x a week; no cardio; at mostly healthy during the day but did eat cookies, pizza, ice cream etc. at night with maybe 20%ish bodyfat maybe more (190-195lbs)
  • 2017
  1. began training for half marathon a bit obsessively with poor running genetics (11-13 minute easy pace)
  2. began eating more fiber
  3. cut alcohol and began using marijuana
  4. by end of year - lost 25 lbs without trying
  • 2018-2023

  1. MAJOR STRESSOR: PTSD symptoms from interpersonal relationship led to death threats and police → anxiety/panic attacks/digestive issues begin pretty severely

  2. Most bloodwork/labs were unremarkable

  3. Endoscopy showed very mild irritation but nothing more

  4. A few doctors suspected SIBO

  5. treated 3 different occasions (Rifaximin, Ceftin, Nemoycin) none of them seemed to improve symptoms

  • After Covid lockdowns and contracting a viral illness (could have been Covid) developed some migraines with aura and eventually photophobia and visual static with tinnitus

Random Labs:

  1. 2018 (start of symptoms/anxiety)

  2. Test - 388 (my other labs show 450-600 range normally)

  3. SHBG - 58.1 (high)

  4. Test (available) - 125 (below normal)

  5. Test (%) - 1.4 (below normal)

  6. Hepatitis BS Antibody - positive (applies to non-numeric results - all other hep tests negative)

  7. WBC - 3.1

  8. POLYS - 40.4%

  9. EOS - 5.6%

  10. Abs Neutrophils - 1.24

  • 2019: am Cortisol (21.4 ug/dl)
  • 2020: iron serum (107 ug/dl) saturation (28%)
  • 2022: TSH 2.210
  1. Vitamin B12 727
  2. Histamine Plasma: 1.53 (high)
  3. CRP: <1
  4. Glucose: 99
  5. Cortisol: 14.3
  6. ACTH: 39.6
  • 2023
  1. apoB: 91
  2. LDL: 120 (was 84 in 2019 - could be junk food)
  3. TSH: 1.4
  4. ACTH: 18.3
  5. Lyme all negative except IGG P41 AB was positive

Current:

  1. fatigue

  2. photophobia

  3. visual snow/static

  4. digestive bloating/pain (random/erratic - but rare)

  5. Got aggressive in Training end of June-August 1 as I felt really good, relatively speaking:

  6. Squat/Bench max 7x a week

  7. Bodybuilding movements 4-5x a week

  8. HIIT running 1-2x a week

  9. Zone 2 running 1x a week

  10. woke up about 2 weeks ago feeling like garbage and stopped training

Questions:

1. Could this be RED-S/OTS?

2. If so, how can I confirm or treat this?

3. Anything from my story that stands out that I am missing as far as testing/treatment?

Thanks in advance!

2

GC,

Thanks for the post. I think there’s far more to consider here than we can get into in a forum reply, but I can try to answer your questions.

I do not think this is overtraining syndrome, as the symptoms don’t really fit and it would be unlikely to persist this long. Also, recently having great training up until 2 weeks ago doesn’t fit either. We would not recommend stopping training, but I do have concerns over your programming. There is no confirmatory test/tests for overtraining. For reference, overtraining syndrome has not been demonstrated in resistance training. Doesn’t mean it can’t happen, but it’s unlikely.

Overtraining syndrome and RED-S are not the same thing, but I can’t speak to RED-S risk without more data on bodyweight trajectory. At 190-195 lbs and 20% bodyfat, I do not suspect this to be likely.

I’m not sure exactly what type of providers you’ve seen, so I won’t comment on the appropriateness of what’s been tested so far. The random labs presented in this format aren’t terribly clear to me. I’d be interested in knowing what your primary care physician’s plan is, as well as the consideration of a referral to a mental health professional.

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3

Thanks Dr. Feigenbaum! I’d like to clarify a few points and why I feel that training may be implicated in my chronic symptoms:

  1. From 2012-2016 I weighed around 190-195lbs and competed in powerlifting. I did almost no cardio and lifted 4-6x a week with moderate volumes and intensities. I was pretty fine health wise and had almost none of the symptoms i’ve mentioned. I did, once, have a bad relationship breakup while I was peaking for a powerlifting meet and the cumulative stress was so intolerable that I went from squatting 450 @ 180lbs to being unable to benching the bar and having to withdraw from the competition. It took me several months to recover, which is why I can’t help but to think OTS is a likely diagnosis of exclusion since it is multiple systems and seems to be related to an inability to tolerate the level or psychosocial/physiological stress I endure.
  2. Around 2017-2018 I completely stopped powerlifting and switched to half marathon training, running 5-6 days a week and dropped down to 170lbs without trying. I did try to clean up my diet a bit with a high fiber diet having never grown up eating high fiber. At the same time I had a lot of life stressors while running high volume. I began having panic attacks, digestive issues (GERD, silent reflux, quick transit bowel movements), this eventually was joined by chronic fatigue (feeling like I took Benadryl) with some achey leg muscles.
  3. 2019 Thing did not get better so I stopped lifting and running for about a year.
  4. 2020 Visual Snow/Static/Light sensitivity and some migraines with tinnitus increased (the migraines seemed linked to eating things like almonds, bananas, spinach, greek probiotic yogurt - things with either Tyramine and/or Histamine)
  5. 2021-2023 symptoms went through periods of increased or decreased intensity and generally felt better than the previous years but still no full resolution
  6. 2024 - I recently squatted/benched daily for 30+ days to a 1 RM. Some days I added bodybuilding sessions and even a 3rd session dedicated to HIIT or zone 2 running. After about 30 days i woke up with chronic fatigue again, worsening digestive symptoms (slow transit), and exercise intolerance (i’d go to the gym and feel light headed/nauseous/weak/tired). I’ve taken off the past 2 weeks and focused on adding calories and moderate walking.

OTS was the only diagnosis that made sense to me because i’ve had no bloodwork that indicated lyme, autoimmune, thryoid etc. It seems that anytime I experience life stressors my tolerance for training goes down but my neurotic personality pushes me to high volume and intensities and I seem to crash in multiple systems.

If you recommend any specific tests/labs/doctors etc. I’d really appreciate as this has been a 6 year battle and cardiologists, endocrinologist, neuropthomologist and GP have no clue.

4

I recently squatted/benched daily for 30+ days to a 1 RM. Some days I added bodybuilding sessions and even a 3rd session dedicated to HIIT or zone 2 running. After about 30 days i woke up with chronic fatigue again, worsening digestive symptoms (slow transit), and exercise intolerance (i’d go to the gym and feel light headed/nauseous/weak/tired).

Given that an extensive biomedical evaluation has been generally negative/reassuring, let’s hypothetically say that your training / programming is the culprit – or at least a major contributor, alongside your life stressors and mental health.

What would you plan to do based on this conclusion?

5

Thanks Dr Baraki. I’m planning on stopping training till insomnia and fatigue resolve enough that I can train at a more reasonable intensity and volume.

There are two things concerning me:

  1. training more than low volume seems to destroy me
  2. Even without training to excess my symptoms take forever to resolve and several (light sensitivity, visual snow/static, digestive issues) almost never fully resolve.

Are there any specialists or tests recommended ? Six years of chronic health issues is really debilitating and I have been seeing a therapist but we’ve agreed that my physical symptoms preempt my mental symptoms currently while in the past they were both in a feedback loop.

I’m sort of feeling hopeless

6

Let me quote a few things from your history here:

From 2012-2016 … lifted 4-6x a week with moderate volumes and intensities. I was pretty fine health wise and had almost none of the symptoms i’ve mentioned. I did, once, have a bad relationship breakup while I was peaking for a powerlifting meet and the cumulative stress was so intolerable that I went from squatting 450 @ 180lbs to being unable to benching the bar and having to withdraw from the competition. It took me several months to recover

From 2017-2018 … running 5-6 days a week​ … I had a lot of life stressors while running high volume. I began having panic attacks, digestive issues (GERD, silent reflux, quick transit bowel movements), this eventually was joined by chronic fatigue (feeling like I took Benadryl) with some achey leg muscles.​

  1. Got aggressive in Training end of June-August 1 as I felt really good, relatively speaking:
  1. Squat/Bench max 7x a week
  1. Bodybuilding movements 4-5x a week
  1. HIIT running 1-2x a week
  1. Zone 2 running 1x a week
  1. woke up about 2 weeks ago feeling like garbage and stopped training
  1. training more than low volume seems to destroy me
  1. Even without training to excess my symptoms take forever to resolve and several (light sensitivity, visual snow/static, digestive issues) almost never fully resolve.​

​
At what point here did you actually spend a sustained period of time training with low volume? Every description you have given here has been of a period where you were clearly training beyond your tolerance given the life stressors you’ve endured, and/or exceeded your physiologic tolerance – likely due to detraining and then jumping into unwise training approaches like daily max training every day for a month plus high intensity interval training, when you are clearly woefully underprepared for such a thing from the years of inconsistent, variable training leading up to this.

I am not able to confidently comment on your medical evaluation without an individual consultation, although I am not especially confident that there is a particular specialist who will be key to unlocking this. However, that you were capable of “feeling really good” in June & July is the most reassuring thing against a persistent, debilitating underlying medical issue needing specific treatment.

I wish it were not the case, but sometimes when people dig themselves into a deep hole, physiologically and/or psychologically, it can take way longer than they expect to dig themselves back out. The way you appear to be training is clearly not doing you any favors on that front. I would plan on strapping in for the long haul with your training, using programming with less intensity and/or volume than you’d like, for a much longer time than you’d like, and strictly respecting / obeying an autoregulation strategy that works for you. This may require enlisting some professional help with your programming just to keep yourself in check, given what seem to be tendencies to want to push too hard, too soon – perhaps as an outlet/coping mechanism in the face of stress, which I fully understand and can relate to myself.

I’m sorry you’ve dealt with these issues for a long time. It sounds like you’ve had a relatively thorough biomedical evaluation that has been mostly reassuring. Whether or not we care to attach a formal label of “overtraining syndrome” to this situation matters less than what you should do moving forward, based on your history and the information you’ve laid out here.

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7

I truly appreciate the interaction and persepctives here docs!

At what point here did you actually spend a sustained period of time training with low volume? 2008-2013, then 2015-16 I had a bit higher volume but no cardio. I will attach an example from when Dr. Mike Zourdos trained me in 2014 (intro block, volume block, and intensity block)

The way you appear to be training is clearly not doing you any favors on that front. I think this is key and maybe confirmation bias but I locked into OTS due to the descriptors fitting my symptoms really well, which spanned different systems of the body from GI to neurological etc.

Thanks! Final question(s) - would you suggest any testing or specialists considering the wide array of symptoms or is would it be better to just take off training till insomnia improves and fatigue while adding calories and then when feeling better just look to the 2014 programming that tapered me into volume? I could cut out cardio outside of walking till most of this rectifies hopefully over the next year or so.

8

It sounds like this is the period when you were feeling & performing better, which is useful information.

And you may be right, but from Dr. Feigenbaum and I’s perspective, whether or not we formally attach this diagnostic label to the situation is less important of a consideration than what you ought to do moving forward, at least with respect to your training.

As mentioned above, I’m not able to confidently comment on your medical evaluation via the forum here. Based on what you’ve described it seems like it’s been reasonably thorough and ruled out some of the more common/obvious culprits, at least. I think that you should maintain some daily physical activity, but this does not need to take the form of deliberate/aggressive “training” until your symptoms subside. If you are dealing with insomnia, I would also discuss this with your physician as this may be treatable in other ways to facilitate your recovery.

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9

Much appreciated. I will take these views at face value and track progress over the next few months form a health perspective and hopefully report good news by back the new year! Thanks :slight_smile:

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10

Chiming in from the peanut gallery. I am not a Dr or psychotherapist, but do have significant years/work in the mental health field (almost 2 decades). As one human to another, as I read through all of this, I very much get the sense of larger issues beyond training and physical recovery. If, I found myself in these circumstances or if you, OP, were my personal friend, I would be looking at/suggest finding a psychotherapist who specializes in Cognitive Behavioral Therapy as I think that approach would dovetail nicely with what appears to be disparate issues and the tools/skills learned through CBT would greatly assist in addressing the multitude of issues that have been experienced for some 8 years or so.