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(Frank) #21

Oh boy.
Refeeding syndrome.
Time to look that up.
So far since yesterday at waking, I’ve had 5 cans of sardines.
So really I’m further along.
Wednesday at 430 I had the dreaded Wendy’s.
Since then nothing but sardines.
Well, some crackers and Peanut Butter at about 10pm Wednesday…

(Bacon is a many-splendoured thing) #22

That is generally sound advice, but some people have damaged their metabolisms from restricting calories too greatly for too long, and eating to satiety doesn’t give them enough food. Kevin Hall did a study on former contestants on “The Biggest Loser,” and found that, not only had they regained all the lost weight and then some, but their metabolisms were working at something like 500 calories less than expected. It is possible to use a technique called “reverse dieting” to deal with this kind of damage, but it’s a slow process.

Now, the appetite drop in the early stages of a ketogenic diet is a very different thing from intentionally restricting caloric intake. The former is listening to your body, the latter is imposing your will on your body.

This is why the standard advice is to eat to satiety and not restrict calories. Some people—not everyone—find it difficult to get enough calories when eating only one meal a day, which is why we advise not forcing it, but waiting until it comes naturally. But in any case, all we can tell you is the science, which applies broadly; you still have to figure out what works best for your particular body.

(Doug) #23

Good point - I take Metformin normally but stop it for fasts. I don’t think it presents danger of going too low on blood sugar, but there are some medications that would. Blood pressure - probably cut down a little, if that’s possible, or stop it entirely - but I agree that a doctor should be consulted.

In my opinion, refeeding syndrome gets far more press than it deserves. The risk is almost non-existent for most people. And the length of fast matters too - 10 days or less, I wouldn’t consider it. I can’t remember all the specifics - it has to do with potassium and/or phosphorus and the electrolyte balance, a whole bunch of food right away causes one of them to be withdrawn from cells (I think). It can be very serious, even deadly, but unless somebody is predisposed toward electrolyte problems then it’s not much of a thing. There are lots of people out there doing 7, 14, 21, 30, 40 day fasts and the incidence of refeeding syndrome is exceedingly low.

I think that common sense applies too - don’t shock the body with a huge meal right away. Eat a little, then later a little more, and after a few more hours more yet. Then you’re probably good to go.

(Bacon is a many-splendoured thing) #24

Refeeding syndrome killed quite a few concentration camp survivors after World War II, until the doctors figured out what the problem was. It has to do with potassium being out of whack, but whether it’s hyperkalaemia or hypokalaemia, I don’t remember. Except that both can kill, so it pays to be careful with potassium in any case. At any rate, refeeding syndrome can be avoided, if the doctor knows what he or she is doing.

(Frank) #25

Glad to hear this.
I blew it and had 4 hard boiled eggs.
Just salted lightly


I have Dr Fung’s Complete Guide to Fasting. In that book they mention 14 days of fasting is the max they recommend because of the risk of refeeding syndrome, although they mention it is rare. Here are some excerpt from the book:

“Refeeding syndrome occurs when electrolytes, particularly phosphorus, are depleted due to malnourishment. Adults store 500 to 800 grams of phosphorus in the body. Approximately 80 percent of that is held within the skeleton, the rest in soft tissues. Most phosphorus is kept inside the tissue cells rather than in the blood, and the blood level of phosphorus is very tightly controlled. During prolonged malnutrition, blood levels of phosphorus remain normal as bone stores are used up. Once refeeding begins, the food raises insulin levels, which stimulates the synthesis of glycogen, fat, and protein. All of that requires minerals like phosphorus and magnesium. This puts an enormous demand on already-depleted phosphorus stores. Too little phosphorus is left in the blood, and that causes the body to “power down.” Muscle weakness and outright muscle breakdown have been described. It may even affect the heart muscle and the diaphragm, the muscle responsible for breathing. Magnesium can also become depleted, resulting in cramps, confusion, tremor, and, occasionally, seizures. Low potassium and magnesium can also cause heart rhythm disturbances or even outright cardiac arrest. In addition, higher insulin levels during refeeding may occasionally cause the kidneys to retain salt and water. This may show up as swelling of the feet and ankles and has been termed refeeding edema.”

“To help prevent problems in the post-fast refeeding period, there are two steps we recommend: 1. Do not make an extended fast a water-only fast. Drinking homemade bone broth provides phosphorus and other proteins and electrolytes, which reduces the chances of developing refeeding syndrome. And to prevent vitamin deficiency, take a daily multivitamin. 2. Do all your usual activities, especially your exercise program, during your fast. This helps to maintain your muscles and bones.”

(Bacon is a many-splendoured thing) #27

Fourteen days makes sense. But Stephen Phinney, in a couple of lectures blamed refeeding syndrome on potassium, which is where I got the idea from.

In any case, both Dr. Phinney and Dr. Fung recommend not fasting longer than three or four days without medical supervision.


From that excerpt it looks like low phosphorus, magnesium, and potassium can all cause issues. And bone broth can help. I always at least take some salt with my water during a fast, which is supposed to also help prevent potassium and magnesium depletion.

(Megan) #29

Hey Frank, this is one of the pitfalls of an extreme protocol :crazy_face:
You didn’t blow it tho, boiled eggs are a fabulous keto food.

Any health promoting way of eating needs to be sustainable for it to work. There are a lot of great keto foods awaiting you.

My standard keto advice is to eat clean (single ingredient foods and nothing highly processed, regardless of whether it’s labeled keto or not), carbs predominantly from green leafy and/or above ground vegetables, keep carbs to 20g a day initially (you can slowly increase this later if you are able to remain in ketosis eating more than 20g), make sure you get enough protein and try to get that protein in its natural form rather than from powders, don’t fear fat and especially don’t fear it while you are going through keto adaptation.

It can be hard when we have a lot of weight to lose but I also caution against under consuming calories. You don’t want your metabolism to slow down because you have signaled to your body there is a famine. My hunger signals were quite messed up when I 1st started b/c I have a very long history of overeating. It took a while for me to recognize what actual hunger is, as opposed to emotional hunger and habit hunger etc. I didn’t and don’t ignore hunger tho, and over time my appetite cues realigned to actual physical cues from my body to give it some nutrition.

Folks have differing feelings and thoughts about weighing. I weigh every 3-4 weeks and I also use a tape measure to keep track of physical changes that may or may not be reflected by the number on the scale. I do neck, upper arm, waist, hip and mid thigh measurements. Folks here also gauge their progress by how loose or tight their clothes are fitting.

Great to have you onboard here and looking forward to reading how things are going for you.

(Frank) #30

I’m about twenty higher than normal.
I could see it going higer though.
I’m nipping it at the bud before it’s 60 lbs.
Thank God the boiled eggs arent bad.
I can tell when I go to water only for a few days that it will be real tough.
At first I thought it would be easy.
Then tonight came…

(Alec) #31

Frank, you understand these are not keto, right? Put these away (top shelf or better in the bin). Don’t leave them in temptation’s way. Hope it’s going well.

(Alec) #32

Frank, if you only have about 20lbs to lose, then there really is no need to be drastic. Especially with fasting. Do a day or 2, but then get back to eating keto well. The key to this is being very low carb consistently. That is what you should be practising.


Yep, it’s hard to start (for many of us, at least. who aren’t very used to fasting. I had automatic fasting days in my childhood but deliberately doing it was different)… The first day is easy when I put my mind on it (I naturally have a small eating window and 23-26 hour happens on normal OMAD, not like I often have such days but they still regularly happen), the second isn’t so much as that is when my body realizes skipping meals. I get it it’s hard, it’s known anyway, many says the second day is the hardest (surely not for everyone though).

But just because one can do 3 days easily, 7 may be impossible (by our own will). We may get hungry at some point, I always do. When I did my tiny ones, 48 hours, it was easy until about 45 hours and got super hard… No experienced with a week but it’s very long, way longer than 3 days. It’s probably individual and depends on many things. I don’t even have the extra fat to easily sustain me for long so it’s pretty logical I run out at some point and my body starts pestering me with hunger.
Mind wise, I would worry about my metabolism after 3 days and about my muscle mass earlier :wink: So no way I go over 2-3 days. I am done if my spirit broke… I know these metabolism and muscle problems wouldn’t linger if we don’t do long term fasting/starvation but still, I don’t like them. And I think 2-3 days would give me what I want from an EF.

No, no and it’s fine as long as you get your nutrients most of the time… A low-cal day here and there is fine but undereating something all the time isn’t.
Some people MUST eat without hunger or else they starve themselves… Hunger and satiation isn’t always reliable for everyone.

IDK why you are so hungry all the time, do you eat enough? Not now, you clearly don’t eat enough if you just eat some sardines (I still can’t imagine why you eat like this instead of some normal keto) but usually? And of course, carbs can interfere. Eat keto food, enough of it and you shouldn’t be hungry like crazy all the time, not even before fat adaptation… In some cases you need to figure out which items work not well for your satiation… I easily could eat 1 kg meat feeling I was starving afterwards… Chicken alone can’t satiate me. I need a lot of protein too so lots of fat with little protein doesn’t help either.

(Frank) #34

Thats what I last ate before starting to fast…
It’s tougher than I thought it would be.

(Frank) #35

I’d never make 7 days…
I think I’m hungry all the time because I am approaching Type 2.
My younger brother has it, my dad had it.
This is precautionary.
I’ll need a little luck.
They say the cravings leave when you hit ketosis.
I’ll see what happens.
Way tougher than I thought.
And like Alec said, I am putting the chips in the car out of harms way.

(Frank) #36

The chips I have are going either in the car or garbage.
Real tough now.

(Doug) #37

Frank, it’s a process, and it often takes time. Cravings leaving when you hit ketosis - maybe, but there is a huge psychological part of this for most of us, as well as physical stuff. When somebody eats very low-carbohydrate for a long time, the cravings often get lower or go away, but not always. It’s important to be patient, and know that you are doing something very good for yourself.

Eating a lot of carbohydrates = high insulin, especially over the long term. “High insulin” and being resistant to the effects of insulin is really what Type 2 diabetes and pre-diabetes are. This cuts down or prevents access to our stored fat, so if we fast or eat less, then we can’t make up the difference from our fat. So, hunger and cravings result on a physical level. Your cells need more energy, and the body has a hormonal response to this which makes you hungry. It gets better over time - eating very-carb lowers your insulin and lets you better use your stored fat.

Type 2 diabetes - runs in my family. My grandmother - my dad’s mom, was one of 6 or 7 kids, who as adults were all ‘big,’ all diabetic. I used to think that diabetes was a one-way street, that it meant first taking oral medications, then injecting insulin, then increasing the insulin dosages and more pills besides. But that does not have to be. For most of us, the thing that caused the problems in the first place is too much carbohydrate in our diet, and changing that is the key. Eating very low-carb has reversed diabetes for many people.

I don’t know if diabetes can truly be “cured,” but after starting to eat ketogenically (even if far from perfectly), I’ve never gotten an A1C test in the diabetic range again. It certainly can be reversed or put in remission, and the person can avoid the bad effects of diabetes. It’s not like completely turning back the clock to when we were 20, or 10, or 5, before were were diabetic or pre-diabetic, but it’s 100% better than not doing anything.

Yes, it can be “real tough.” It does get better though, and you have plenty of time. :+1:

(Frank) #38

It was all good until I had the hip replacement and retired.
It’s been all downhill from there.
Thanks for the advice.
I won’t give up.
I don’t drink, smoke or do drugs.
But since the hip I’ve been battling hunger.


Not to crap on your parade, but going from normal eating, to only sardines, to nothing and then not having a plan isn’t going to end well.

Assuming you’ve decided to eat keto and that’s why your here, now (realistically last week) would be a good time to learn the ins and outs and plan accordingly. Not hard to do, but going in blind with no real plan will result in failure.

Also know that doing it this way aside from the fast part being very difficult as you’re not going to be burning bodyfat efficiently yet will result in lots of water loss, muscle glycogen loss and the false appearance that you’ve lost a ton, but that will be almost all water and very little fat in that time frame, When you eat your weight is going to jump up a lot, be ready for that.


It’s not THAT simple. Though if you do it not super indulgently, you probably have better chances.
You wanted 7 days on sardines and a 7 day EF so I suppose you don’t cling to sweets and whatnot. Very good but I still don’t understand why you go for such an extreme style right away… Keep your carbs very low and no sweeteners if you like, that may be great against cravings but being too strict (I can’t possibly know what is too strict for you but something sustainable sounds better to me)… It may backfire. Or not, who knows? But 14 days on very low-cal… Tricky.