In a world where health care providers and dietitians alike are challenging our views on diet culture, terminology, and body image, I would like to add one to the pile. The term “refeed” came about in the fitness and bodybuilding world sometime in the early 2000’s. I never thought much of it in this setting until the other day. I was at home doing a video workout (I won’t say which one) but the instructor went on and on throughout the workout about this ‘refeed day’ and how everyone was allowed a cookie! My goodness, I was so frustrated with this perspective and mindset I honestly wanted to pull my own hair out. There is so much wrong with this frame of mind and the language used to justify restriction one day and a “treat” the next.
First of all, you should never workout to “earn” food, nor should food ever be considered a “guilty pleasure” or “reward”. That being said, diet culture and having a healthy relationship with food is a whole other topic and blog post for another time. In actuality, the logic and rational for this “refeed day” was partially right; muscles are fueled by glucose and that glucose needs to be replaced. During activity, our muscles use glucose from the bloodstream initially, after about 15-20 minutes our muscle convert the glycogen stored in the muscles and liver back into glucose to maintain blood glucose and to fuel muscle activity.
Typically, for optimal performance in sport, you would want to replace this muscle glycogen after every workout to maintain that fuel source for your muscles. This allows you to maintain your endurance, speed and strength. If you choose to not replace this muscle glycogen with carbohydrates after a workout, then you have less readily available fuel and energy for your next workout. When you do hit the gym next, or go for that run, and you didn’t adequately replenish your glycogen stores, then your body will be fueled by lipids (aka fat). Now most people will read this and think YES, that’s my goal to burn the fat. The downside to this is that it is a slower metabolic system in our body, it takes much longer to convert lipids to fuel than it does carbs; therefore you will be slower, and overall performance will suffer. There are situations where burning fat is desirable for endurance sports such as ultramarathons and such, but I’m not going to go into every caveat about metabolism when I am supposed to be writing a short blog post about what refeeding actually is and why we shouldn’t call it that in the fitness world. I digress sometimes.
Okay, back to the topic in question. In this workout, the instructor goes on to explain that if you have been following the meal plan, than you are currently in a deficit of calories and this refeed day will put the glycogen back into the muscle. So sure, yes that’s mostly correct, I’m not going to divulge any more into the biochemistry as we could be here forever.
Here is the problem; in the clinical setting i.e.: hospital or inpatient program we refer to refeeding as a CRITICAL clinical event. This term is reserved for those who are extremely malnourished aka those who have been in a calorie deficit with recent weight loss and who we are about to feed again. This population is typically those living with an eating disorder, those who are extremely food insecure, some elderly, and people with severe medical conditions such as some types of cancer or irritable bowel disease. People living with these conditions are at significant risk of malnutrition. When reintroducing food to this population, specifically carbohydrates, it should be monitored by a doctor and registered dietitian; as the simple act of ‘refeeding’ can result in death.
This term ‘refeeding’ was both coined in and discovered during the second World War when both prisoners and soldiers returned home after being starved and famished and then were fed food. Electrolyte disturbances ensued, causing cardiac and neurological side effects and sometimes even death.
Today when a person comes into hospital with recent weight loss, and a history of poor food intake, they are assessed and if determined to be at risk of ‘refeeding syndrome’ then a specific protocol will be put in place. A registered dietitian will refeed the patient a specific number of calories and/or carbohydrates a day/or meal while monitoring the patient’s electrolytes: potassium, magnesium and phosphorus. The carbohydrates consumed by the patient trigger an insulin response that causes an intracellular shift of electrolytes. These electrolytes leave the extracellular fluid and shift into the cells which can cause low potassium, low magnesium or low phosphorus as well as thiamine deficiency. This shift in electrolytes, as mentioned before, can cause cardiac or neurological issues and even death.
This term ‘refeed’ is used daily by healthcare professionals when determining the health status of an individual. Doctors will ask me all the time if I think the ‘patient will refeed’ (have a critical cellular shift in electrolytes and fluid) based on my comprehensive nutrition assessment. If this is the case, then the patient’s vital signs will be monitored and daily labs will be drawn. If needed then specific electrolytes will be replaced either orally or by IV. A specific nutrition and refeeding plan will also be followed to mitigate the risks of ongoing malnutrition.
Now I ask “Why is it okay to use this term “refeed” so loosely by the health and fitness industry to describe the refueling or replenishing of muscle glycogen in a state of a mild previous calorie deficit, when health care professionals use this term very seriously to describe clinically malnourished people at risk of electrolyte disturbances?”
I request, as a dietitian that practices in both the clinical and fitness world, that we change our language. We should not use the same terminology for people living with eating disorders, chronic disease, cancer, food insecurity and other conditions related to significant malnutrition as we do for those who choose to participate in diet culture. Truth be told, preventing significant electrolyte disturbance in the body by reintroducing food into the malnourished; and having a cookie after a workout on a low calorie meal plan IS NOT THE SAME therefore we should not call it the same.
Here are some suggestions:
Refuel, Replenish, Replete, Restore…….just not REFEED!
Hearing, S. D.,(2004) Refeeding syndrome. BMJ; 328 :908 (Retrieved Dec 3, 2018)
Ivy, J.L., (2012) Muscle glycogen synthesis before and after exercise. Sports Medicine 11(1) p 6-19. (Retrieved Dec 3, 2018)
Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: what it is, and how to prevent and
treat it. BMJ (Clinical research ed.), 336(7659), 1495-8. (Retrieved Dec 3, 2018)