HOW TO BREAK A FAST: Best Results & Worst Mistakes (Refeed Syndrome)

last spring I fasted for sixty hours every Sunday to Tuesday I lost 30 pounds of fat and next to no muscle during that time I spent weeks straight working on a complete guide to fasting video well weeks straight - the one week I celebrated my results with three days of raving at EDC when I finally uploaded the video the positive comments blew me away it made it all worth it there were a few questions that kept popping up though a lot of people commented asking how to break a fast wanting a more in-depth explanation it got me thinking depending whether intermittent or extended people will spend hours days or even weeks not eating typically for reasons involving fat loss improving health and longevity and stimulating at otha G but after dedicating so much time to the fast breaking the fast and the best foods optimal quantities and timing doesn't seem to get talked about as much as it probably should well I had an idea of the advice to give I decided to search the topic on YouTube to see what the big youtubers were saying and honestly what I found left me confused and frankly disappointed in the top-rated videos on breaking fasts not only is the advice suboptimal for optimizing the fat loss you've just worked so hard for some of it is biologically backwards and potentially harmful so in this video I will review and cite all the scientific literature on both optimal refeeding and fat loss by going over the research together you'll see where my recommendation comes from instead of just giving you a few foods with some vague explanation understanding of science will help you adapt the plan to what works best for you we can build the optimal refeeding plan in just three steps in order of priority first and highest priority we need to identify the potential risks and dangers of refeeding after fasting we will check the medical guidelines surrounding savory feeding and use them as the foundation of our plan if the other youtubers would just have taken a moment to understand these they could have avoided recommending things that would be healthy a normal person but totally backwards for someone breaking a fast let's make these safety guidelines common knowledge and eliminate practices that might be dangerous to health as the first step in narrowing down a repeating plan then after we tick off potential dangers we can further cut out foods that might lead to unpleasant complications digestive enzyme levels are constantly shifting and may be low after fasting understanding how these enzymatic changes happen and affect the digestion of different foods can help ensure refeeding goes not just safely but also enjoyably by the end of this section we will have further narrowed down fast-breaking recommendations cutting out foods which well they might have been within safety guidelines could have been more likely to cause digestive problems when consumed after prolonged fasting then finally we can take what's left and work within these parameters to maximize our benefits if we want to pick foods which are the least likely to undo the benefits of fasting it'll mean seeing if one food could actually be more likely to go back to stored fat versus another we'll also look into whether the altered hormones after fasting should have a bearing on what we choose to eat through this video I'll also debunk some of the recommendations I've seen in other videos cross-checking them against the published research I know I don't usually reference what other youtubers say and honestly I prefer to ignore them and just stick with the science I want to be really clear I'm not doing this to be nasty or call them out I'll be leaving their names out since I'm sure they really do have good intentions it's just after seeing these videos are getting millions of views and reading the comments from people confused by the advice I realized these ideas were now part of the fasting discussion whether I liked it or not and if these youtubers won't provide the research I will so with that let's get into it first let's look into cases where refeeding is actually dangerous and understand what causes this danger even if we aren't fasting to the dangerous extremes of truly starved people where's that line that we need to be wary of and what recommendations can we follow to stay as far away as possible from refeeding syndrome since as far back as the 1940s the medical community has known the risk of sudden refeeding when skinny and starved prisoners of war were rescued and suddenly provided with all the food they could eat instead of regaining their strength many of them suddenly got extremely sick baffling their rescuers it was so bad that some even died of heart complications a paper published in the British Medical Journal calls refeeding syndrome a well described but often forgotten condition refeeding syndrome isn't actually one specific condition is an umbrella term used to describe sudden and dangerous shifts in several fluids and electrolytes that occur after improper refeeding in individuals who have previously been eating little to no food while in mild cases people may feel no symptoms in cases of severe malnutrition people have experienced edema which is basically fluid retention in the body that causes a swollen and bloated appearance I've personally seen this happen to Fitness youtubers when they suddenly eat again after a bodybuilding show impaired heart function including cardiac arrhythmias and even heart failure have occurred as a result of improper refeeding in the worst cases respiratory dysfunction muscular fatigue and mental confusion can also occur the more severe the malnutrition the worse the symptoms typically are and being sick or injured typically increases the risk that being said thanks to all the great research refeeding syndrome today is very preventable provided at-risk individuals refeed properly remember refeeding syndrome is caused not by eating but by incorrect eating a clinical study on subjects deemed to be at high risk found just by following a proper e feeding regime they were all successfully able to resume eating with few complications now obviously this segment isn't in tended to diagnose or treat people who might have refeeding syndrome already if you fit the risk profile for it or experience any of the symptoms you should really go see a doctor or go to the ER where they can give you the proper tests still though I'm surprised I haven't seen it mentioned in any other videos on how to break it fast I mean if we're gonna build a fast braking plan why wouldn't we make sure it adheres to the highest available safety standards to understand refeeding syndrome we need to review what happens when your body changes from a fasted state to a fed state this will only take a few minutes and I promise it's important to put it simply these two different states exist because your body has a big problem to solve during certain times of the day you'll be eating meaning your digestive system will be blasting cells with sugar and fat for energy as well as amino acids which are constantly needed to repair and replace cells across the body this wave of nutrients is more than your body can possibly make use of at that moment during other parts of the day though it may have been several hours since you've eaten now it's the opposite your digestive system is applying far too little nutrients if our bodies had to rely just on what was being digested at that exact time we'd have to be eating pretty much 24/7 just to stay alive since this obviously wasn't an option before processed food our bodies needed a system to smooth everything out ensuring that when we eat and the digestive system is providing a rush of nutrients all the excess energy and amino acids could be saved and slowly released as needed to maintain a steady supply of energy constraint while our cells can make energy from both the sugar and digesting carbohydrates and the free fatty acids and ketones from digested and stored fat only the sugars can be used for our cells fastest energy generation system called glycolysis so you'll notice when our bodies smooth out this energy supply they try and prioritize burning sugar through glycolysis for as long as possible kicking your body into this fed state storage mode is the powerful signalling hormone insulin it is released immediately after you eat and signals the body to rapidly burn fresh sugar from carbohydrates store fresh fat into fat cells for later and pack new amino acids into muscle to replace the normal breakdown between meals I'm explaining this because the shift from fasted to fed states and the actions of insulin are actually a huge part of refeeding syndrome in a moment it will all make sense remember insulin wants to ensure that if sugar is in the bloodstream and available cells take full advantage of it it triggers cells to begin taking in sugar in the form of glucose but since glycolysis also requires cells to have an ample supply of specific electrolyte minerals insulin also triggers them to begin sucking these in specifically phosphate potassium and magnesium are pulled into cells from the blood supply carbohydrates create the largest insulin spike which makes sense since they are mainly what gets burned when insulin is high proteins trigger a smaller release since the body needs to know to pack amino acids into muscle reserves and fats alone don't actually trigger an insulin response when insulin is high in addition to triggering cells to burn sugar and take in key electrolytes it also triggers the liver and muscles to take in excess blood sugar converting it into a more stable sugar called glycogen for short-term storage that way once you're done digesting and insulin levels drop a bit this stored sugar can be released into the blood by the liver and burn directly by the muscles to keep glycolysis going because sugar isn't very efficient to store our body can only keep about 24 hours worth one gram of sugar needs to be stored with three additional grams of water so to help with this higher levels of insulin trigger the kidneys to retain more water and sodium allowing less fluid and sodium to escape into the bladder so we just saw that elevated insulin can shift fluid and electrolytes now remember back to the definition of refeeding syndrome so insulin causes these shifts but what makes it especially dangerous after prolonged fasting well as you slowly go from fed to fast it the stored sugar supply begins to run out insulin naturally Falls the lock on fat cells gradually loosens as they pump free fatty acids into circulation cells begin burning fat instead not through glycolysis of course but through their less preferred and slower energy processes called the Krebs cycle and electron transport chain during this low insulin fasted State cells also stop aggressively taking in phosphate potassium and magnesium which they had been using for glycolysis if you're eating three carbohydrate containing meals a day you'll never get very deep into this ship the Switchback will be so settled that you'd barely notice as a person goes under fat longer they gradually become more fat adapted if they suddenly eat a large meal with a lot of carbs now unlike the gradual shift that got them deep into the fasted state their shift back to the high insulin fed state will be set in an immediate so where specifically do the sudden effects of insulin become too much for a long fasted person to handle and what can be done to reduce the risk to answer this let's turn to a medical paper out of the University of Virginia which outlines that the negative symptoms of refeeding syndrome stem from two preventable causes the first problem is that when the body's been underfed for a long time electrolyte levels in the blood will gradually decline electrolytes are inorganic minerals so as they are gradually lost to excretion and sweat our bodies can't simply create more we are totally dependent on our diet to provide the constant supply necessary to maintain normal levels this includes the phosphate potassium and magnesium which is sudden burst of insulin immediately triggers cells to start absorbing out of the blood as sugar burning glycolysis fires back up I explained in my video on fasting and salt just how essential electrolytes are to our survival these minerals allow our body to attract water into various spaces not to mention they enable cells to generate energy and allow nerves to send signals in a person who's already malnourished their blood levels may already be so depleted that this blood electrolyte supply is too low to handle the shift as the electrolytes are pulled into cells blood levels drop from being already low to suddenly severely low many symptoms of refeeding syndrome are actually just symptoms of severely low blood electrolytes crashing phosphate levels are actually the classical sign of repeating syndrome in one medical review they found depleted phosphate levels were present in 96% of refeeding syndrome cases when blood phosphate levels get too low it's called hypophosphatemia critical organs like the heart and lungs can then have trouble creating enough adenosine triphosphate which is their key energy molecule this can lead to serious complications and in the most extreme cases heart and respiratory failure phosphate is also necessary for the release of oxygen from red blood cells when levels crash oxygen delivery to the entire body can become impaired low magnesium levels can lead to further muscular disturbances while the sudden drop in potassium can lead to weakness paralysis and confusion thiamine a vitamin can also become depleted and result in further health complications then there's a second aspect remember insulin also stimulates the kidneys to retain sodium and water in the blood brain and all the spaces between cells this can cause edema that puffy retention of fluids often seen in those suffering from refeeding syndrome this extra fluid also raises blood pressure stressing the weakened heart further since we know different nutrients spike insulin to different levels with carbs having the biggest impact it should come as no surprise that the introductions to two separate papers on roof eating syndrome both identified the primary cause as specifically being the sudden ingestion of carbohydrates from which the mass of insulin spike would cause these potentially fatal shifts in electrolytes and fluid in 2006 the National Institute for Health Care excellence published guidelines which hospitals around the world used to determine both whether a person is at risk as well as simple guidelines so those at risk can avoid experiencing refeeding syndrome I'm going to summarize them here but keep in mind this is just for educational purposes not medical advice I won't be including everything they have to say so if you may be at risk see a doctor the first level of risk based on the guidelines is anyone having gone 5 days or more eating little to nothing that's enough to put them at some risk of refeeding syndrome in these cases doctors are advised to check their blood levels for phosphate magnesium potassium and calcium to make sure they didn't fall too low over those 5 days if low those minerals can be supplemented before and during refeeding to ward off a blood electrolyte crash in addition nutrition is limited to just 50% of the standard feeding amount for the first two days helping keep the shift more manageable this calorie restriction as well as the recommended restriction on consuming too much sodium and fluid can help reduce the likelihood of the body suddenly retaining potentially dangerous amounts of fluid so where under normal circumstances 25 to 35 calories per kilogram per day is recommended this would drop to about 12.5 to 17.5 calories per kilogram per day for those first two days also a set amount of these calories should be coming from protein so we're under normal circumstances they recommend point eight to 1.5 grams of protein per kilogram of body mass 50% of that works out to be point forward to 0.75 grams per kilogram of body weight for those first two days 200 to 300 milligrams of thiamine is also recommended daily since thiamine is a vitamin that can become critically low during prolonged underfeeding and is important to various cellular processes low levels can result in neurological problems if no adverse symptoms pop up in the first two days feeding is increased to normal these guidelines are even more intensive if a patient is deemed at high basically a subject would need to meet to lesser risk criteria or one more extreme risk criteria you'll notice anyone who goes over ten days without eating is considered to be in the high-risk group in these cases feeding may be slowly increased over an entire week with more intensive monitoring involved to be safe notice also just five days of fasting is still considered high-risk if your blood electrolytes have become low in that time that's why although I only personally fast for up to four days these five-day guidelines make up the safety foundation of my reef eating plan a plan which actually begins the day I start fasting when fasting I supplement not just sodium but also I see it as the logical move to supplement phosphate potassium calcium and magnesium as well rather than waiting till it becomes depleted and potentially problematic supporting blood levels protects me when I read I actually take a pre dosed electrolyte blend which contains phosphate potassium calcium and magnesium since I get a lot of TMS from you guys asking you where I get it I put the link in the description so both during and when breaking a fast these electrolytes are a key component for me this is in line with some of the physician monitored fasting clinics I've seen which report that they administer electrolytes in anticipation of refeeding so keeping the safety guidelines in mind I keep my intake below the recommended maximum 12.5 to 17.5 calories per kilogram per day for me at 90 kilograms that means making sure I never exceed 1,500 calories while at the same time making sure I get an absolute minimum of 36 grams of protein remember this is just a safety section as we go the plan will get more and more nuanced and look beyond calories which definitely don't tell the full story additionally the guidelines recommend restricting fluid and sodium intake to further reduce the risk of insulin related fluid retention for me this is pretty easy to manage sodium has a recommended intake between 1000 and 1500 milligrams so while fasting I take two scoops of my electrolytes which total 1200 milligrams of sodium about the minimum RDA when breaking my fast though I drop my intake to just one scoop 600 milligrams this provides good support for the key electrolytes from there I just avoid high sodium foods and keep the upper limits in mind if I mean supplement is also recommended in various papers and guidelines so that can be included as well so now that we've looked at how the carbon deuced insulin spike plays a major role in refeeding syndrome you can probably imagine my dismay when I was watching what another youtuber had to say on the topic this know you can actually gain muscle and it's all about how you time your carbs see you want to have high glycemic index carbs that means carbs that are really going to spike your blood sugar really fast I'm talking maybe even something like a rice cake that's going to spike your insulin really fast see this is what I mean advice that might be perfectly valid in the fed state to promote anabolism in a refeeding context - suddenly very backwards this is absolutely the most dangerous time to be telling people you want them to spike their insulin when you can instead be recommending people take key steps to ensure health like consume electrolytes or limit their sodium before we wrap up the safety section it's also worth mentioning you should never consume alcohol to break a fast when you're fat adapted key organs are running on ketone bodies and their levels in the blood are elevated consuming alcohol at this time can easily put you into what's called alcoholic ketoacidosis a condition where the metabolism can become dysregulated it can cause nausea vomiting abdominal pain and those are just the more mild symptoms with that we can move into section 2 and practical strategies to avoid digestive discomfort starting with digestive enzymes the idea we've heard is that fasting reduces levels of important digestive enzymes this apparently sensitizes the digestive tract requiring you to select foods that are easier to digest and less likely to result in gastrointestinal distress or SIBO SIBO stands for small intestine bacterial overgrowth and plays a role in as much as 84 percent of IBS cases it's important to remember that proteins fats and carbs each have their own unique digestive enzymes and in fact there is plenty of evidence that a diet low in any of these macronutrients will result in lower levels of the enzymes used to digest that specific macronutrient according to a research paper the enzymes adapt to the diet within two to three days this adaptation is stabilized after 5 to 7 days also noting that going back to eating any macronutrient results in its digestive enzyme levels returning within a few hours in many cases most fast breaking recommendations on YouTube hinge on the idea that these reduced digestive enzymes increase your risk of IBS so in many ways it often boils down to them just giving their general dietary advice on reducing IBS nothing really specific to fast-breaking unfortunately I think this oversimplified approach tends to miss the mark remember the guidelines we covered in the safety section the recommendation of eating just 50% of your nutritional requirements on the first 2 days after your fast that alone will reduce the volume of food the digestive system needs to cope with in it enzyme depleted steep so just by following that guideline we are already cutting the risk of these symptoms in a popular video on YouTube on the supposed worst mistake when breaking a fast the first recommendation isn't to eat less though it's of all things to avoid vegetables the reason given is that vegetables contain fiber which the Video Creator claims will lead to SIBO and gastrointestinal distress will hold on well I can get behind choices that reduce the likelihood of GI symptoms if that's what we're trying to do here there are far more effective and proven strategies than simply avoiding all Fiverr specifically vegetables for one thing both the medical refeeding guidelines and recommendations from doctors who monitor people during fasting specifically recommend to include fiber then there's a key distinction in fiber type soluble and insoluble fibers are almost complete opposites in how they affect the body so to not even distinguish which one to avoid makes little sense if the concern is avoiding foods that are likely to result in fermentation and gas buildup I think a far better recommendation will be to have people select mainly low fodmap foods FODMAPs are fermentable oligosaccharides disaccharides monosaccharides and polyols FODMAPs are poorly absorbed and water-soluble short-chain carbohydrates that attract water into the small intestinal lumen they are also readily fermented by intestinal bacteria avoiding - map foods is a far more standard recommendation given by dietitians to those suffering from IBS than simply to avoid vegetables studies on restriction of FODMAPs from the diet have shown gi symptom improvement in up to 80 percent of IBS patients some examples of hi Vlad map foods to avoid our stone fruits beans and wheats while many green leafy vegetables proteins and resistant starches are relatively low in FODMAPs and here's the key distinction low fodmap foods that still contain fiber it's just usually the insoluble type which doesn't ferment I'm gonna include a link to a list of high and low fodmap foods so if you find yourself experiencing some short-term gastrointestinal distress after fasting you might want to stick to the low fodmap options one last thing worth noting them low fodmap diet seem to be the most effective short term since many foods high in fat maps can act as prebiotics avoiding them long term can have detrimental effects on the gut microbiome avoiding them for those few days after a fast may just be the perfect compromise what's confusing to me is that that same youtuber who prioritizes foods that are less likely to cause gas by avoiding fiber then in another video on breaking fasts his first recommendation is a sponsored post for nut butter which is the source of fiber with information like this I really don't blame the people in the comments for being so confused here's where everything will come together so let's quickly review in section 1 we determined that it's a good idea to limit our daily food intake to at most half of what we would normally consume for the first two days after a fast with a minimum range of point 4 grams to 0.75 grams of protein per kilogram of body weight if you're having trouble calculating your upper calorie limit all you need to do is multiply your weight in kilograms by 17.5 this restriction is recommended to reduce the likelihood of refeeding syndrome but also would reduce stress on the digestive system helping prevent the gastrointestinal distress we talked about in section 2 in addition vitamin and electrolyte supplementation before and during refeeding are used to support blood electrolyte levels I take a pre-mixed blend which I linked in the description alternatively you can talk to your pharmacist and see what they recommend limiting sodium and fluid intake can also help reduce excessive fluid retention in section 2 we also took it a step further and said that for the first two days it might be best to select low fodmap foods to further reduce the chances of an upset digestive system what's left now is to see if we can't optimize just a bit further first I'll narrow down food options then go through my thoughts on optimal timing lastly I'll give an example of exactly what I might eat to break a fast as a general rule of thumb you'll want to avoid heavily processed foods as they contain refined sugar which will spike insulin more intensely they're often also high in sodium which as we know contributes to fluid retention well the guidelines in section 1 stipulate a minimum protein recommendation they are pretty ambiguous when it comes to selecting carbs versus fats for your remaining energy needs the only mention of carbohydrates and the nice guidelines is here where the use of and /or seems to imply the exact balance is of little relevance to them but since fats do little to trigger insulin on their own and insulin is responsible for the shifts which potentiate refeeding syndrome shifting the ratio more in favor of fats might be the best approach so we'll have seen recommendations ranging all the way from MCT oil which is pure fat to a piece of very lean protein which contains next to no fat I think the best approach is to meet in the middle on selecting foods which are both a source of protein and also fat while being low in carbohydrates if you follow an omnivorous diet this would mean picking meat which isn't necessarily defined as lean for example a strip loin steak a chicken leg or a salmon Filat these three also make the low fodmap food list if you'd rather avoid me something with a similar macronutrient profile will do the same job perhaps tofu which is also on the low fodmap food list or you could try meat substitute just be sure it doesn't have too much sodium well I think the energy ratio should skew towards fats low fodmap vegetables with their insoluble fiber would also be smart to include their modest sugar contents along with the protein in the meal would help ease insulin levels up from fasting levels without the more intense impact processed sugars would have examples of these include tomatoes cucumbers and fennel timing this out obviously it's your choice but most experts tend to recommend having one single meal on the first day you break your fast with more flexibility on the second day keeping within the daily upper limit for calories shouldn't be hard for the first day for the second day keep a closer eye to make sure you don't overeat remember earlier when a youtuber suggested consuming a spoonful of salt when breaking a fast his justification for this was to lower levels of cortisol upon refeeding well there has been some research that stress hormones like cortisol and neuropeptide Y can play a role in promoting fat storage especially in the abdominal region salt is far from the most reliable way to reduce cortisol levels if you saw my video on adaptogens you'll remember cortisol levels vary greatly over the course of the day and follow a predictable daily rhythm highest in the morning lowest at the end of the day so the most obvious solution if you low cortisol when you eat isn't consuming a large amount of salt it's just to break your fast later in the day so one meal later in the day around dinner time and the next day eat when you like aiming to pick the same kinds of foods but staying below the upper limit I personally break my three to four day fasts with the following routine the day I break my fast I'll still take my electrolytes spread over the day as I've been doing the whole time but I reduce the dosage a bit to account for the electrolytes in the food I pick then at 4 p.m. I'll consume a bowl of low sodium bone broth this is both gentle will also containing amino acids prompting the release of the digestive enzyme specific to proteins in preparation for my main meal then two hours later at around 6 p.m. I'll eat about 1 cup of tomato and cucumber salad drizzled with some olive oil for some extra fat all of these are low fodmap choices along with that I'll have either a chicken lake a salmon Filat or a portion of steak I make the portion big enough to get 36 grams of protein which at my weight hits my minimum based on the guidelines I also take 200 milligrams of thiamine with my meal an idea I actually got from the reef eating guidelines we covered earlier these choices particularly the salad were influenced partly by an article published to the site of a fasting clinic which appears to have also been reviewed by a medical doctor the second day I'll stick mainly to unprocessed in low fodmap foods I'll shoot for the upper protein recommendation of 0.75 grams per kilogram of body weight and keep the energy balance more skewed towards fats while slowly adding in some more low fodmap carb sources well of course being mindful of the recommended 50% of calories rule by the third day I'm eating whatever I want if I only fasted for less than 3 days say 60 hours which is actually my usual fast length I still follow the first day but by the second day I don't really restrict myself so there you have it I hope you found this educational fasting is by far the fastest way to lose fat as well as my favorite well I only go up to 4 days at a time if you go longer that are getting your blood electrolyte levels checked and consulting with your physician I know you guys get annoyed when I keep saying this but unlike most of YouTube like to err on the side of caution what can I say I care about you guys in fact I consider you guys my friends and speaking of friends if you've made it this far and you'd like to be friends with me and keep up with my videos consider subscribing or who knows you may never see me again also feel free to follow me on my personal Instagram shoot me a DM like all my photos it's up to you some pretty cool raving pictures on there so I hope you enjoyed that and until next time d-man signing off you

Channel: Dorian Wilson

Views: 480,126

Rating: 4.896172 out of 5

Keywords: How To break A Fast, How to break a Water Fast, How to break a 3 day water fast, How to break a 7 day water fast, Best Way To Break a Fast, What to eat after fasting, Best way to break your fast, Refeeding syndrome explained, Ending a Water Fast, Intermittent fasting What to eat, Breaking a Fast Mistakes, Fast Breaking Guide, how to break a fast safely, how to break a fast properly, how to break a fast intermittent fasting

Id: h3L_118IIgE

Length: 33min 39sec (2019 seconds)

Published: Fri Apr 10 2020

Reddit Comments

[u/snuffleb1]

I thought this video answers many of the questions I have had during my fast. enjoy :)

[u/ruipmjorge]

Resume?

[u/_millenia_]

Thank you for this.

[u/surf_daze]

Super helpful and I’ll be following these guidelines when I break my fast. Thank you 😊