Refeeding
Breaking my poverty-induced fasts went better after a Middle Eastern individual replied to my question on Hacker News and told me something sweet and fatty is best for breaking a long fast. Muslims eat dates for breaking their religious fasts (like Ramadan when they don't eat all day for a month).
So after that conversation, I began getting good quality chocolate cookies from the bakery.
I always had severe immediate diarrhea when breaking a fast. Like we were all three competing for the one bathroom we shared because we all reacted strongly.
Electrolytes and hydration are important, more important than food or calories per se. Though after two years of serious privation, they certainly need nutrients and calories.
You can to some degree feed people transdermally. Sea salt with a variety of micronutrients in a bath can help. Probably less than it helps me because CF leads to abnormally absorbent skin, but if you are needy enough, the body sometimes does weird things to optimize for survival.
Coconut oil is high in MCT oil medium chain triglycerides. It's one of the three types of fats.
It can be absorbed directly via skin for anyone AND is good for gut flora. You will need to rebuild their gut biome. Per research into stunting and starvation blah blah blah, merely feeding people more doesn't do enough. You need to introduce gut bugs into starving people to put weight on them.
IF coconut oil leads to headaches and nausea, they probably have metal poisoning. It helps draw metals out and headaches and nausea are side effects of dumping metals.
I'm a butter fiend. Like coconut oil, it's a good source of MCT oil and if you clarify it that removes milk solids, making it acceptable for lactose-intolerant people. Butter causes me less headaches and nausea from pulling metals out, so if they don't tolerate coconut oil well, you may wish to try butter or clarified butter as a fat source.
When I was especially sick and every little bit of lowering stress on my system mattered, I clarified organic butter or I bought ghee -- ghee is a variation on clarified butter and there are slight differences between the preparation and taste of the two things -- from the store. If you are or your patient is in poor enough condition, you may wish to do the same.
I eat cheese but I seldom drink milk. I'm not lactose intolerant but some difficulty with milk products is common with CF.
I used to throw up on fasting days. I was homeless for nearly six years, usually underfed the last week of every month and had little or nothing to eat the last day and I usually threw up that day.
Once, we were seriously underfed two days in a row late in our time on the street and I didn't start throwing up until day two and one of my sons laughed and joked "NOW it's a fasting day."
Egg whites are a near perfect protein source for humans. We use about 98 percent of the protein from egg whites and unless they have an egg allergy, people typically tolerate it well.
I fed one son homemade sugar cookies to get enough protein into him from egg whites for a time. I don't recall what prompted us to decide he needed more protein but it did solve his problem.
I mention that because my understanding is you die of starvation when you run out of muscle mass, AKA protein stores. You need to rebuild their muscle mass.
My source for that information is apparently no longer freely available as a PDF, but the link seems to redirect to a potential source probably for a fee. I posted it to Hacker News.
What I'm usually saying about that source is lack of muscle mass causes insulin resistance, not excess fat per se. So muscle plays a role in metabolizing sugar properly and in issues like diabetes and that "syndrome" that is a risk for diabetes because you are overweight.
So you need muscle to recover from starvation.
You can use the yolks for pudding. If they tolerate it, it's a source of important fats and is high in cholesterol which is critical for brain health and hormone production, so if you are treating starved people, please try to ignore its bad reputation as a thoroughly evil fat.
Fetuses, infants and small children require extra fats for brain development. If you don't have respected studies contradictimg my assumption, I would assume you need to rebuild fats in seriously underweight people.
Bone marrow is also fatty tissue, though I don't know if it's specifically high in cholesterol. But you need adequate fat stores for a functional immune system because bone marrow is where white blood cells are produced.
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