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I don't know if this qualifies as 'hacking my metabolism', but I've always had a spontaneous tendency to eat most of my food in a few hours time (between 6 and 10 p.m.).

I started with just coffee (no food) in the morning, at lunch I'm not really hungry, so I ate little, and often very late (2 p.m.).

Then around 6 p.m., I started snacking (raw carrots, yoghurt), continuing tasting food while cooking, then dinner, and then snacking again (fruits, nuts,...) while watching telly.

I tried to change that to a 'healthy diet', with 3 meals a day, especially when I was on DMF, in order to have something 'heavier' with my breakfeast dose of DMF (which was supposed to help with the GI issues I had on DMF).

Now I quit DMF, and I notice I'm going back to my old regime. I eat a kiwi in the morning, and I'm still not hungry at lunch. And I feel better when I don't have to 'forcefeed' myself in the morning or at lunch, but can just eat most of my calories in a few hours. And no, I have no trouble sleeping with all that food in my stomach - quite the contrary, if I don't eat enough in the evening, I wake up hungry at night and start eating at night.

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I also feel much, much less fatigue being in the optimal BMI range. I’d spent 10 years post having babies in the moderately overweight category and although I didn't feel big, now that my BMI is 23 it’s made a huge difference to my energy almost eliminated my fatigue. So even though I was a vegetarian, ate no sugar, no refined carbs, no alcohol or smoking and fasted daily, I just simply ate too much healthy food and so calorie restriction and weight loss has really worked on fatigue.

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Amazing read, its something I have felt for a long time (food comas) but assumed it was the same for everyone. Not particularly strictly or even consciously, I have stopped eating breakfast and have coffee with modafinil as I find this helps me with morning work/focus. I also find cutting out breads and eating for example salmon with scrambled eggs much better when not having toast. Generally I snack and avoid big meals and have cut down portions which helps loads too. Thinking back, if I have jet lag or have trouble sleeping my tactic is to have bread/cereal to induce a food coma which again has been done through trial an error rather than any research :)

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16h fast 3 meals loaded with carbs. Food coma only accured on Keto. I was more tired overall on Keto. Less energy for work out was a big thing. Only did Keto for 3months, this does not seem to be enough to get the benefits for gut bug diversity. I might give it another shot as the science is there.

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It is becoming clear that one thing that needs to be personalised is diet. Keto is not for everyone. I would suggest trying intermittent fasting instead; 5:2 or 16:8 as a starter.

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David Dawson8 min ago

On weekdays I mostly just eat one meal a day. My memory and reasoning ability just hit too badly after eating.

It’s not just sleepiness - it’s general decline of mental ability.

I once forgot the name of my own boss (of 5 years) in a meeting that prompted me to do something

I have to stop eating by 8:30 or affects my sleep too much so I really only eat between 5pm and 8:30 pm

More recently, I’ve tried eating a low sugar breakfast bar at around 3pm that’s just about tolerable.

I haven’t found any drugs so far that reduce the problem - hence just minimal daytime eating during working week.

I actually thought until recently it must be a side effect of one of the drugs i take (glatiramer acetate until recently , tegretol, duloxettine) but it seems not

I’ve had MS for 30 years, now diagnosed as SPMS and dropped Glatiramer Acetate for that reason

I’ve either had or heard about pretty much every weird MS Symptom but I’d literally never heard of the Carbohydrate Coma symptom until referenced by Dr Giovannoni

I suspect many people have the symptom and may just not make the direct link with eating

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When you feel that food coma, drink a pint of water. Make sure it's not too cold - not warm enough to be unpleasant but not freezing - room temperature if you can. If you can't handle water on its own, very weak diluted squash or equivalent. But it needs to be mostly water. This is what works for me.

I find dehydration can also cause somnolence, particularly when trying to digest food. Even for the well-hydrated PwMS, certain activities may induce somnolence including digesting lunch and driving on a long journey - this is on top of the fatigue and brain fog. We're so lucky :-(

But I find a pint of water or very weak squash, then give it 5 minutes to "work" and see how you feel (as obviously your mileage may vary, this is only what works for me).

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Less is more. Friday evening I deviated from this rule with a lovely Thai meal, and oh boy it was literally a case of aye so much I felt and was sick. Timely reminder!

Dr G I love these very practical posts that help explain lots of what ppl with Ms experience and help us understand / manage impact issues. One thing I know you mentioned before briefly on the ms blog is twitching or fasciculation as not being truly ms symptom, b it something I see so many across various platform report, i personally experience twitches, especially facial twitches very often. I would love a post on this 👍

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Eating little and often during the day avoids the problem. 3 small distinct meals, breakfast is a bowl of museli, lunch is bread and cheese with a tiny bit of chocolate and fruit at about 4. When I eat my main meal in the evening I can struggle to stay awake

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A change in the severity of 'food coma' is definitely something I have noticed. It became much worse when my MS started getting progressively worse (and MS was diagnosed). This was very relevant. Thank you.

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I have had to sleep after lunch since I can remember (otherwise I would even have difficulty finding words). That is, until I started DMF. For some reason since starting DMF last year even if I try, I can't nap in the afternoon! Any ideas Prof. G?

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Fantastic read. The year before I was diagnosed I experienced this so badly that post-lunch my speech would slur and I would be so dizzy and sleepy, I always suspected it was connected to MS. It actually improved once I was on treatment but I do now eat more regular meals and will often split lunch and dinner into two portions to eat spaced throughout the day. I find my energy stays more level that way.

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I have been diagnosed with MS since 2018, and have been following the keto diet since then, and intermittent fasting till lunch time. So my carb intake is low. I don't find that I get excessively sleepy after a meal, prob due to low intake of carbs. Its not for everyone, but it works for me.

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I have found the exact opposite. When I experience fatigue, I have learned that one thing almost guaranteed to help is to eat something. Even when I don't feel hungry, if I manage to eat something I almost always feel better soon after.

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I just had to put that into practice. I had quite a small lunch - soup and bread. Afterwards felt tired as I have all day then got a bit teary at something someone said, which is a sure sign for me of fatigue. Got worried about Covid as I've had a headache today too (on top of finding myself surrounded by maskless football fans on public transport yesterday on my way back from running a hilly trail half marathon) so took a lateral flow test. When that was clear I remembered some other things that help me, like getting outside and making a cup of tea. So I took the rubbish out (I live on an estate so have to go to the estate bins to clear my household bins), came back and made a cup of barley tea plus some tuna on protein Ryvita. It's definitely helped.

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Yes I experienced this, I cut out all refined and processed foods and most dairy and fast every day until midday or later, doing any moderate - intense exercise during the fast period. I’m a vegetarian so have not tested the impact of meat but salads and veg with very little added fats don’t seem to impact my fatigue. I totally agree with the hydration point above and good sleep hygiene - sleep just makes you want to eat fat and carbs to cope!

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I eat 3 snacks during the day - bowl of muesli for breakfast, piece of cheese with biscuits for lunch plus 4 small squares of chocolate then fruit in the afternoon. One strong coffee at lunch time. After supper in the evening can be a struggle

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