Episode 150: Relapse or Recalibration? Why Symptoms Can Return After Years of Stability

Creatine is often associated with the fitness industry and sports performance — but emerging research is now exploring whether it may have relevance far beyond the gym. In this episode, Anna explores the current evidence surrounding creatine supplementation in Long Covid and fatigue-related conditions, including its potential role in energy metabolism, muscle function, cognitive symptoms, nervous system health, and recovery capacity. This conversation also looks at: Why creatine is being investigated in Long Covid The link between ATP production and fatigue Potential neuroprotective and antioxidant mechanisms Brain fog and cognitive symptoms Muscle weakness, PEM, and pacing considerations Why individual responses to supplements can vary Considerations around dosage, safety, and supplement sensitivity Creatine and the menstrual cycle Importantly, this episode takes a balanced and non-dogmatic approach. While early research is promising, creatine is not presented as a “magic bullet” or standalone solution for Long Covid. As always, recovery is complex, individual, and multifactorial. This episode is intended for educational purposes only and should not replace personalised medical advice. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: https://annamarsh.co.uk/ Referenced Articles Effects of six-month creatine supplementation on patient- and clinician-reported outcomes, and tissue creatine levels in patients with post-COVID-19 fatigue syndrome Reduced tissue creatine levels in patients with long COVID-19: A cross-sectional study Creatine Supplementation in Women’s Health: A Lifespan Perspective Creatine Supplementation and Brain Health Diagnostic and Pharmacological Potency of Creatine in Post-Viral Fatigue Syndrome Role of Creatine Supplementation in Conditions Involving Mitochondrial Dysfunction: A Narrative Review

In this episode, Anna explores a side of recovery that is rarely discussed: What happens when the nervous system begins to reconnect with emotions, sensations, and internal experiences that were previously difficult to fully feel. As the body becomes safer and more regulated, many people notice unexpected shifts: emotions feeling stronger or more accessible increased sensory awareness old feelings resurfacing a changing relationship with capacity, vulnerability, and self-protection. Drawing from both personal experience and Somatic Experiencing concepts such as undercoupling and energy wells, Anna explores why these changes can emerge during recovery — and why they are often part of the nervous system recalibrating rather than “going backwards.” This episode is a gentle conversation about the emotional and physiological complexity of healing, and the process of learning how to feel safely again. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: https://annamarsh.co.uk/

In this episode, Anna breaks down a recent study exploring brain neurochemicals in Long COVID and ME/CFS — with a particular focus on glutamate and its potential role in symptoms, particularly physical capacity.  Rather than simply summarising the research, Anna walks you through what these findings may actually mean in practice. We’ll explore how glutamate fits into the wider picture of nervous system regulation, inflammation, and energy metabolism — and why these conditions can’t be understood through a single lens. Anna talks about where targeted approaches like diet, supplements, or medication may have a role, and why addressing underlying drivers is often key to more meaningful, sustainable progress. This episode is designed to help you make sense of the science — without oversimplifying it — and to offer a more integrated way of understanding your symptoms. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: https://annamarsh.co.uk/

In this episode, Anna is joined by Lexi Boreham, who shares her experience of living with and recovering from Long Covid. This conversation gently explores the reality of rebuilding a life alongside ongoing symptoms — from the early confusion of becoming unwell, to navigating setbacks, identity shifts, and the emotional impact of recovery. Together, they talk about the often-unspoken parts of the journey, including loneliness, the role of community, learning to set boundaries, and what it means to move forward when life looks very different to before. They also explore the complexities of breakups and dating during recovery — how illness can shape identity, relationships, and self-perception, and the process of learning to trust yourself and others again. This is an honest, grounded conversation about the messy middle of recovery — and the gradual, often quiet process of rebuilding a life that feels meaningful, supportive, and your own. Useful Links Find Lexi: https://www.instagram.com/_lexisophie/ Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/ Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

Some people notice that they seem to experience stimulation and stress more intensely than others. They may feel overwhelmed in busy environments, react strongly to caffeine, or find it difficult to switch off mentally after a demanding day. Sometimes people encounter the term COMT when exploring genetic testing and begin to wonder whether this might explain their nervous system sensitivity. But conversations about COMT online can quickly become confusing — and sometimes unnecessarily alarming. In this episode, Anna explores what COMT actually does in the body, how it influences the way we process certain stress-related brain chemicals, and why some nervous systems naturally experience stimulation more strongly than others. Most importantly, we discuss why COMT is not a defect, but rather a pattern of biological sensitivity that can have both challenges and strengths. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/ Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

There is a stage of recovery that many people reach where life has largely returned to normal. You may be working again. Socialising more. Exercising gently. Participating in daily life in ways that once felt impossible. And yet, your system may still experience occasional fluctuations. Energy might dip after a busy week. Sleep may become more fragile during stressful periods. Your nervous system might still feel sensitive to certain types of load. This stage can feel confusing, because you’re no longer severely ill — but things don’t always feel completely stable yet. In this episode, Anna explores what she often describes as the fine-tuning phase of recovery. At this stage the work often shifts away from major repair and toward calibrating how the body distributes load across daily life. Understanding this phase can help reduce frustration and provide a clearer framework for navigating the final stages of recovery. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/ Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

Movement can feel like a complicated topic for people living with chronic fatigue conditions. Many people have been told to exercise more. Others have experienced crashes after pushing too hard. And over time, movement itself can start to feel risky. But something interesting often emerges during recovery. Certain types of gentle, rhythmic movement can actually help the nervous system settle. In this episode, Anna explores why the body sometimes responds positively to movement — not because it improves fitness, but because it can help the nervous system process activation and return toward regulation. This episode also introduces the idea that movement can support the body in discharging and organising sympathetic activation, which can reduce internal agitation and support nervous system balance. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/ Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

One of the most frightening moments in recovery can be when symptoms suddenly return after a long period of stability. And many people immediately think: "I’m back where I started." But in many cases, what looks like a relapse is actually something quite different. Sometimes the body is simply going through a temporary recalibration. In this episode, Anna explores why symptom waves can occur even after months or years of improvement, and why these experiences often don’t mean that progress has been lost. Understanding the difference between a true relapse and a temporary recalibration can reduce a huge amount of fear and help people respond more calmly when fluctuations occur. Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/ Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

Not all post-exertional malaise (PEM) is driven by the same physiology — and understanding the difference can completely change how you approach pacing and recovery. In this episode, Anna breaks down the three most common patterns of post-exertional crashes seen in clinical practice: autonomic “hit the wall” crashes, metabolic “wired but exhausted” responses, and delayed immune-driven flares. You’ll learn why timing matters, how different symptom patterns reflect different underlying mechanisms, and why applying the wrong strategy can stall progress. This is not about avoiding movement or labelling yourself as fragile. It’s about understanding your physiology well enough to work with it. If you’ve ever felt confused by your crashes — or wondered why generic pacing advice hasn’t quite worked for you — this episode will offer clarity. Complimentary Episode: Episode 146: Research Review - The PEM puzzle Resources Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/ Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

We’re back again this week sharing a recording from one of our Nurturing Resilience Group Calls. Each month we have one call dedicated to the nervous system and one call dedicated to what I call the more “practical” elements of recovery. In this recording you will hear some of our members asking their questions and we cover topics such as protein consumption, building up physical capacity and endurance, rehabilitation for deconditioning that happens when you have been ill a long time, migraines, delayed recovery after infections, what to do when you have more energy and how to manage guilt around not “doing enough”. This is a varied conversation that covers a range of useful topics. If you want to take part yourself, you are very welcome to join the Membership and get involved.  Join Nurturing Resilience: https://annamarsh.co.uk/nurturing-resilience/ Useful Links Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page Instagram: https://www.instagram.com/anna__marsh_ Work with me: https://annamarsh.co.uk/work-together/ Website: http://annamarsh.co.uk/