Refeeding syndrome describes metabolic disturbances that occur when food is

reintroduced when the body is starved, malnurished, or metabolically stressed due

to severe illness. Reintroducing food and nutrition activates hormones like
insulin, which triggers the body to produce glycogen, fat and protein in cells.
The body pulls minerals into the cells to accomplish this. When this occurs too
fast, before the body has a chance to replenish stores, refeeding syndrome can
occur.
The primary concern is the body's usage of phosphorus, potassium, calcium and
magnesium. If usage occurs too fast, too little of these minerals are left in the
blood. This is what causes the major symptoms of the refeeding syndrome, some of
which are can be fatal in extreme cicumstances.

The first mineral to consider is Phosphorus. Very low phospohrus levels in the
blood is called hypophosphatemia. "If you've ever taken a highschool biology
course, you might remember that phosphorus is used in all cells for energy, by the
creation of an Adenosine Triphosphate (ATP) molecule, which contains 3 phosphorus
molecules. So severe depletion of phosphorus may cause your entire body to �power
down�. Serum phosphate concentrations below a certain level (0.81 mmol/L) can
result muscle weakness, respiratory failure and difficulty breathing, and heart
failure.

Magnesium is involved in most enzyme systems in the body and severe depletion can
result in cramps, confusion, tremor, tetany and occasionally, seizures. lassically
the pattern known as Torsades de Point. Most magnesium (about 70%) taken orally is
not absorbed but excreted unchanged in the feces.

Potassium may also be shifted into cells, leaving dangerously low levels in the
blood, known as hypokalema. This, too can cause heart rhythm disturbances or even
cardiac arrest.

Insulin stimulates glycogen, fat and protein synthesis which requires many ions
like phosphorus, magnesium and thiamine. The stores of all these minerals have been
depleted during fasting and once refeeding begins, too much phosphorus may be taken
out of the blood by the body, leading to excessively low levels.

Therefore, it makes the most sense to start feeding slowly, with low glycemic index
foods that don't raise insulin too quickly or too severly, and foods that contain
these four minerals, including thyamine. Half size meals has worked well for me
and given my body a time to adjust.

In my own personal experience, the problems I've had with refeeding are generally
the result of over feeding, too much food, too soon. My fasts have generally been
quite short, less than 6 days, so I've not been at risk of any serious mineral
depletion. During my longest fast, I've experienced swelling minor swelling in the
legs and feet, and I chose to end that particular fast because of it. I was using
salt water during my fast, and too much salt seemed to be the cause, causing
increased water retention. Subsequent fasts were done with regular mineral water,
and I did not have the same symptoms.

Generally, I found refeeding too quickly or on the wrong foods to cause diarhea,
upset stomach or bloating. After a few tries, this is the formula that as worked
best for me:

Best refeeding foods:

Phosphorus: (before any insulin spiking foods)

- Dark leafy greens
- Swiss cheese (567mg/100g)
- Trout (269mg/100g), caution, high protein
- Egg (191mg/100g), caution, after 3 day fast, 1 egg had my stomach turning
- Herring (89mg/100g), caution, high protein
- Milk (86mg/100ml), avoid
- Avocado (52mg/100g)

Magnesium (heart considerations)

- Dark leafy greens (spinach)
- escargot (62% DV), moderate protein
- Flax (98% DV)
- spinach

Thiamine (B1): (coenzyme in carb metabolism)

- Seaweed - (1.06/100g)
- macademias - (0.64/100g) (132%DV), low carb, low starch, low protein
- Trout (.43mg/100g, 28%DV), caution, high protein
- Egg (.08mg/100g)
- Herring (.07/100g), caution, high protein

Potassium
- Lime juice
- Salmon (22%)
- Avocado (30%)
- Spinach
- Goldenberries, low GI

Calcium
- Sardines (bones)
- Chia seeds
-Cheese
- Flax (25%)
- Goldenberries

Vitamin D, B-12
- Fish

Vitamin K:
-Kale, spinach
-Fish

Recommended Meals:
- 50% calorie requirements, reintroduce foods slowly!!
- Very low GI foods
- Do not refeed with carbohydrates
- Do not refeed on milk
- Do not start with citrus or fibre

Order to reintroduce foods:

Plan for spinach first. Add in Herring/sardines, broth, small quantities (50%
max). Add in egg, above ground veggies, low carb. This is what I used in January
2020 after a 7 day fast and was very successful, no discomfort or issues.

Minerals and hydration first: (First day)

- Vegetable juice: cucumber, lime, celery (green gorilla)
- Vegetable broth: celery, garlic, onion, bell pepper, add fish or chicken bone
- spinach, egg

Thiamine: (Second day?)

- Egg, seaweed, macademias
- Trout/herring/sardine
- Avocado (1/2 fruit to maintain low carbs)

Proteins (protein can also increase insulin):

- Fish
- Kefir?

Fats (more difficult to digest, although I've experienced no problems myself,

except refeeding with fat seems to cause significant rosacea (Feb 19 2020,
refeeding with marinated cheese in olive oil with fish)):
- Egg
- avocado

Carbs last (cause fluid retention)

- Transition to carbs and fibre with egg, macademias, flax/chia/hemp
- Vegetable smoothie: kale, spinach, lettuce, sprouts

Refeeding syndrome: what it is, and how to prevent and treat it

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/

There is a tendency on the part of the faster to overeat, not alone because he is
hungry, but also because he is desirous of regaining his weight. His friends also
urge him to eat. Sinclair truly says: "A person at the end of a (long) fast is an
agitating sight to his neighbors, and their one impulse is to get a 'square meal'
into him as quickly as possible."
-Fasting Cure - Sinclair