Slow Isn't the Same as Stuck

When someone's a few months into something and she's back in my office, sometimes she'll come right out and tell me it isn't working. Other times what she ends up saying is that she has no way of knowing one way or the other, and I've learned to treat those two as very different answers.

And I've come to think that's the more useful of the two answers, because there are real reasons she can't tell, and not one of them is that she hasn't been paying attention. Two of those reasons have to do with the question she's being asked in the first place. The third one has to do with what her body has actually been doing the whole time she's been waiting on it.

How it's going, a few months in

So when you sit down and ask yourself whether the thing you started doing is actually working, whether that's the supplement you take every morning, the food you gave up, or the walk after dinner, it feels like you're looking back over the past few months and adding up everything at once. But what's actually happening is quite a bit narrower than that. You're really answering for today, based on how you feel at that exact moment. And if today's been a rough one, the whole run behind it tends to get remembered that way too.

And that isn't a flaw in you nor is it a memory problem either. It's just how people work. How you feel right now is the easiest thing to reach for when you're trying to think back over the past few months, and it ends up coloring the rest of them. You're not making it up and you're not being careless about it. It's the only version of it you've got in front of you at the time. So a rough week in September can turn August into a rough month right along with it, without you ever once noticing that's what happened. And there's no real way to catch that while you're standing inside of it. I don't think anyone can, honestly, and that includes myself.

Which means that when a woman tells me nothing has changed, I don't want one rough day getting to decide that for the whole three months. So I try not to let either of us settle on it as the final word, because it isn't one.

The other half of it, and this is the one that seems to catch women off guard, is that a lot of them genuinely don't know what they're aiming at anymore. If you've felt off for years, you don't have a clear picture of what your good week is even supposed to look like. And you're measuring against a before that probably wasn't as good as you remember. A lot of the women I see had been tired for years by then. They just thought that was normal. So you can be doing better than you were a few months ago and still come up short, because what you're comparing yourself to wasn't as good as it looks from here. And everyone's expecting you to just know the difference. Honestly, that's a lot to expect of anyone.

And it usually comes out as questions nobody can answer. Would you be sleeping through the night by now? Would you have gone on the weekend away instead of finding a reason not to go? Would the afternoon have stopped costing you the whole evening that comes after it? Those are all fair things to be wondering about, and there isn't an honest way to answer a single one of them when you can't remember the last time any of them was true for you.

What's moving while nothing looks like it's moving

There's something about the way the body actually goes about this that I'd want you to have, because it explains more of what's going on here than anything else I could tell you.

Take your gut, since that's the one I end up walking people through the most. The cells lining it turn over somewhere around every three to five days, which is one of the quickest turnovers anywhere in your body. Brand new cells, over and over, and that's genuinely a good thing. But new cells and a lining that's back to doing its job aren't the same thing, because every one of those new cells is growing into the same conditions the old ones were living in. If whatever was irritating that lining is still going on, whether that's something you're eating, inflammation, or the balance of bacteria in there, the new cells come in under the same pressure the old ones did. So the cells themselves come back quickly, but getting those conditions to settle down is the slow part, and that can take months of eating differently.

So you could be doing every bit of it right, with the fast part of it working exactly the way it's supposed to, and still not feel all that much different yet.

Insulin resistance, if that's part of what's going on for you, hides what it's doing in a whole different way. It builds up across years, and the whole while it's building, your body is spending real effort to hold your blood sugar inside a normal looking range.

That effort does leave marks, they're just not in the place most people look. Your blood sugar is the number that gets checked, and your blood sugar is the exact thing your body has been working overtime to keep looking normal, so it often comes back looking fine. Meanwhile a few of the other numbers on that same page start to shift. Your triglycerides, which are a kind of fat that travels around in your blood, tend to creep up while your good cholesterol drifts down. And your liver enzymes, the numbers that usually go up when your liver's under some strain, can start to move too, often because fat's been building up in it, and some of that fat comes from the extra sugar. All of it's sitting right there next to the result someone called normal.

A routine lab doesn't include a fasting insulin level, and that's one I include on all of mine, because it's a very telling sign of how much work your body's been doing to keep that blood sugar looking normal. I read it alongside everything else, not on its own.

And it works the same way coming back. As things start to ease up, your body doesn't have to work as much to hold your blood sugar steady, and your triglycerides and liver enzymes can start drifting back toward where they belong, sometimes sooner than you'd expect. That part does show, if someone's looking at the right numbers. Feeling it can take longer than the numbers do, and that's the whole trouble with going by feel.

And that isn't only true of your gut or your insulin. There's an order to how the rest of it tends to improve, too. The things I usually see getting better first are sleep, energy, cravings, digestion, and how clearly someone's thinking. They're small enough that a lot of the women I work with don't count them, or don't even notice them until I ask, and that's a big part of why I ask. Hormones, inflammation and weight often follow after that, because they're responding to something that's already been getting better underneath them. So by the time any of those finally shift, whatever shifted them has been at work for months already, without asking your permission first and without telling you about it either.

Instead of the usual question

So if how you feel shifts that much from one day to the next, and it does, then me asking you how you're feeling isn't going to get either of us very far. It hands you an impossible job, which is answering for months you can only half remember. What I'd rather ask about is what you can do now that you couldn't manage a few months ago.

Because when getting better does show up, a lot of the time it doesn't show up as a feeling at all. It shows up as something you got back. Maybe you made it up the stairs without having to stop halfway, or you sat through a whole movie without falling asleep partway through it, or you cooked dinner on a Wednesday for the first time in months.

And those are all answerable. Every one of them has a yes or a no sitting behind it, and the answer doesn't move around depending on what sort of mood you happen to be in the day someone asks it of you. Whether you got up the stairs is just whether you got up the stairs. How you feel isn't like that. It's one thing on a Tuesday and something else on a Thursday, and it's different again after a bad night, so it never settles down long enough to tell you what the last few months were actually like.

Before the next appointment gets made

All of that is about the slow kind of change, the kind that's going on underneath before you're able to feel any of it. Getting worse isn't that, and I don't want the two of them getting mixed up. If you're going backwards instead of holding steady, and that includes something you could do a few months ago that you can't do now, or you've picked up a symptom you didn't have when you started, then none of that slow healing is the reason and there's nothing in here worth waiting out. Call your provider today. And if there's something you've been living with that nobody's actually looked at yet, the tiredness included, that doesn't need to wait on any of this either.

And if you go back over those same months looking for one thing you can do now that you couldn't do then, and you honestly can't find one, that doesn't settle it on its own, because a lot of those early changes are small enough to miss. But it does mean I'd want someone going through it with you, asking the questions and looking at the bloodwork too. If the two of you look and there really isn't anything, that's the difference between slow and stuck. Sometimes stuck means the real cause is somewhere nobody's checked yet, and sometimes it just means the thing you started isn't the right fit for what's going on with you, and both of those are worth finding out. A clear result last time doesn't change that. And if you did find something, but the thing that brought you in hasn't budged at all, don't let the other improvements talk you out of asking about it.

And even when things are moving, there does come a point where going back in and bringing it up is a completely fair thing to do. I can't give you an exact week for when that is, because it honestly depends on what's going on and what you're doing about it, and it doesn't look the same for everyone. But if you've been at this long enough that you can't figure out whether you've reached it, then the not knowing is its own reason to go and ask.

A second look after a clear result

Going back doesn't have to mean running the very same panel again and hoping it comes out differently this time around. If those same tests came back normal recently, and nothing's changed since, they'll usually come back normal again, and running them over and over just for the sake of it has a cost of its own. It can turn up things that were never bothering you in the first place, and I've watched people walk out of there more worried about something that got picked up by accident than they ever were about the symptom that brought them in.

What going back actually means is asking a different question this time. What else could be causing this. What hasn't been looked at yet. And if we're going to leave something off the list, how do we know.

That first question matters more than it sounds like it would, because there's so often more than one thing going on. The same tiredness can be coming from two places at once, and once one of them starts to settle down, it can look like the whole thing's been fixed, so nobody goes looking for the other one. So I don't go into it expecting to find the one answer and be finished. What I expect is to find a piece, and then take a good look at what the picture looks like with that piece in it.

And you don't have to walk in there with the answer already worked out either. When someone tells me nothing has changed, I don't take that as the end of the conversation. I take it as the first thing she's said to me. Then I'll ask her what she's been able to do lately that she couldn't before, and I keep on asking, because the useful parts are almost always the ones nobody thinks to mention. Making sense of all of it is the provider's part of this, not yours. You're not supposed to come in having already decided for yourself which pieces matter and which ones don't.

You've been carrying this on your own, and deciding whether it's working at the same time, so of course you don't know. What you do have is more to go on than you did when you started. You've got the small things nobody thought to ask about, and you've got better questions than whether it's working. Take both of them back in with you. You get a say in this, and I'd much rather you used it.

Disclaimer & A Note from a Caring Practitioner:

My goal is to translate complex wellness concepts into relatable ideas to support your journey. The explanations I provide are simplified models intended for general education and motivation, based on both clinical patterns and established wellness principles. They are not complete medical explanations, diagnoses, or personal advice.

Every person's body is unique. Your individual health needs, experiences, and underlying conditions must be evaluated by your own healthcare provider. This information is educational only and is never a substitute for professional medical consultation, diagnosis, or treatment. Always partner with your personal healthcare provider before making changes to your health regimen.