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If my bloodwork results are OK, can I still be at risk of refeeding syndrome?

I got my doctor to send a blood work requisition form and I asked her to include sodium, potassium, magnesium, phosphate, and thiamine. She sent one with everything (except for thiamine), and also added HbA1C, creatinine, ALT, albumin, CBC, calcium, B12, and ferritin.

If all the levels are within reasonable levels a few days before ending my fast, do I still have to be careful with my refeed (other than discomfort)? I.e. can I still be at risk for refeeding syndrome?

Note that I am doing a 30-day fast.

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Answer

Yes. As far as I can recall, the issue is your intracellular levels of these electrolytes and essential minerals might be depleted (at the expense of maintaining adequate blood concentrations during fasting). So when you start eating, a rapid rise in insulin will signal cells to go into storage and growth mode, which will rapidly draw electrolytes from your blood and into tissues. This can leave you with dangerously low or unbalanced blood electrolyte levels even if they appear normal before ending the fast. Better to be safe than sorry!

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