Episode 146 - Research Review: The PEM Puzzle

Post-exertional malaise (PEM) is more than just feeling tired after activity — it’s a delayed and often severe worsening of symptoms that affects many people with ME/CFS and other energy-limiting conditions. In this episode, Anna unpacks what PEM is, why it happens, and what current research is beginning to reveal. Anna explains how PEM differs from everyday fatigue, explores emerging insights into energy production, inflammation, and stress responses, and discusses why “pushing through” can be harmful. She also reflects on what this research means in real life, and how it can support safer pacing, validation, and more compassionate approaches to recovery. This episode is a helpful listen if you want to better understand PEM, feel more validated in your experience, or learn how research can guide gentler, more supportive ways of managing energy. Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ Nurturing Resilience: https://annamarsh.co.uk/nurturing-resilience/ Article Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC12408823/

Oxaloacetate is a compound that plays an important role in cellular energy production and mitochondrial function. In this episode, Anna explores the emerging interest in oxaloacetate as a potential support for people with Chronic Fatigue and other energy-limiting conditions. Anna explains what oxaloacetate is, why it has gained attention in the chronic fatigue space, and how it may influence metabolism, inflammation, and energy production. She also discusses who may benefit, important considerations around dosing and sensitivity, and where oxaloacetate fits within a broader, foundations-first approach to recovery. This episode is a helpful listen if you’re curious about oxaloacetate, considering supplementation, or wanting to understand how targeted interventions can support energy when used thoughtfully and in the right context. Supplement: https://uk.iherb.com/pr/advanced-orthomolecular-research-aor-benagene-30-capsules/3308 Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ Nurturing Resilience: https://annamarsh.co.uk/nurturing-resilience/

We’ve all been there. You share some details about your chronic illness with a friend, family member or colleague and instead of empathy, you receive a prescription for yoga, meditation or a B12 injection. Although the unsolicited advice is well meaning, often it can be another load that we have to manage. Chronic illness is complex and nuanced and it is exhausting to explain the physiological complexity as well as the dramatic impact it is having on your life. This episode is here to help you waste less energy with some ideas about how you can respond in situations of unsolicited advice or when someone challenges how you are caring for your health.  Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/

Mistakes are how we learn and grow and the same is true for Chronic Fatigue Recovery. In this episode Anna shares what she wouldn’t do if she had to recover from Chronic Fatigue all over again. She shares lessons and learnings from her own experience and experience working with clients. She weaves in guidance on what she would do instead so that you can learn to build strong health foundations from the ground up.  Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/

Cycle syncing is a practice whereby you align your diet, lifestyle and energy management around your menstrual cycle. In this episode Anna answers the question: can this be helpful if you have Chronic Fatigue? Anna gives an overview of the menstrual cycle and explains how imbalances at certain points in the cycle can make us feel a certain way. She shares her own experience with cyclical fluctuations in energy and how she managed them, things that have worked clients and how to manage your cycle if you have histamine intolerance or MCAS.  Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/ Additional Resources: How to have better periods, Part 1 How to have better periods, Part 2 How to have better periods, Part 3 Perimenopause

Prompted by a question from a Nurturing Resilience Member, Anna answers the question about how long to keep going with things when you aren’t seeing progress. She talks about the importance of laying life long foundations, getting overwhelmed by healing gadgets, supplement grave yards, the importance of context, strategy and structure, testing and retesting and how giving yourself a break can be the best thing at times! Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/ Healing On A Budget Episode: https://annamarsh.co.uk/podcast/healing-on-a-budget/

***PLEASE NOTE*** Prices quote in this episode have increased since recording. Each week I get enquiries from people who are experiencing energy limiting conditions such as CFS/ME, Long Covid, Post Viral Fatigue and Mould Illness. Your health is the most important thing and you want to make sure that whoever you work with is the right fit for your needs and your budget. Which is why I wanted to create a podcast episode where I talk about how I work and the different options - to help you decide if it could be the right thing for you. In this episode I cover my qualifications, scope of practice and break down the different ways I work with clients in my business. If you have been thinking about working with a practitioner to support your health and are considering working with me, this episode is for you.  6 Month Package: https://annamarsh.co.uk/1-1/ Road Map: https://annamarsh.co.uk/fatigue-recovery-roadmap/ Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/

Prompted by a question on Instagram Anna shares 3 things that she feels stop people from recovering from Energy Limiting Conditions. She talks about how embodied safety is essential for change, some of the mistakes she made in her own journey recovering from Chronic Fatigue and insights into what can be supportive if you resonate with any of these 3 areas. Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/ Healing On A Budget Episode: https://annamarsh.co.uk/podcast/healing-on-a-budget/

One of the things that people with Chronic Fatigue struggle with the most is exercise. In this episode Anna shares her exercise journey and how she approached building her capacity from heart rate controlled walking to returning back to the gym and swimming 4km! She shares her step by step process, failures, strategies to mitigate PEM and the 3 most important considerations for anyone who wants to be able to exercise more as they recover their health.  Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/ Functional Patterns: https://www.rawmotionfitness.com/ Actively Autoimmune: https://www.activelyautoimmune.com/ Episode 89: Exercise Well with Autoimmunity: https://annamarsh.co.uk/podcast/episode-89-exercise-well-with-autoimmunity-and-zoe-mckenzie/ Episode 50: Functional Patterns For Chronic Pain: https://annamarsh.co.uk/podcast/episode-50-functional-patterns-for-chronic-pain-with-brendan-turner/

If you find yourself struggling to do things you know you should be doing to support your health, this episode of the Chronic Fatigue and Burnout Recovery Podcast is for you. Anna does a brief recap on the nervous system and explains how certain nervous system states may contribute to feeling stuck, frozen or general apathy when it comes to making diet and lifestyle changes and being consistent with them. She offers guidance on how we can better attune to the needs of our nervous system so that we can take small steps forward in the direction of health. Website: http://annamarsh.co.uk/ Instagram: https://www.instagram.com/anna_marsh_nutrition/ New Nurturing Resilience Membership: https://annamarsh.co.uk/nurturing-resilience/