Refeeding Syndrome | Childhood Obesity News

The commonality amongst all kinds of starvation, whether unavoidably imposed or intentional, is that a person cannot simply start eating normally again. This is due to the condition called refeeding syndrome, which is characterized, if the word can even be used for such a general purpose, by “a wide range of symptoms and a lack of clear diagnostic criteria.”

Consequently, although various recommendations have been made for the management of refeeding syndrome, they “remain controversial due to a lack of objective data and quantification standards.”

Who gets refeeding syndrome? Anyone who receives increased nutrition after a prolonged experience of starvation, and this includes a lot of people because there are plenty of “populations at high risk for malnutrition.” Whatever the cause of their malnutrition, they can’t just start randomly and heedlessly eating again. Immediately following World War II, this problem was dramatically apparent among certain populations…

[…] when individuals living during the famine unexpectedly became ill following nutritional reconstitution. In 1951, Schnitker et al reported that one-fifth of Japanese prisoners starved in prison camps died suddenly after nutritional and vitamin replenishment.

The lack of food in a concentration camp or POW camp is not the only possible cause of malnutrition. Even in peacetime, ordinary citizens may be in this kind of trouble for a number of reasons. In some cases, they may experience malnutrition because of inflammatory bowel disease and other conditions that impede the absorption of nutrients.

Poorly controlled diabetes is another possible cause, as well as cancer-related conditions; inadequate post-operative recovery; undergoing dialysis because of renal failure; chronic alcoholism; extreme weight loss from a starting point of morbid obesity; or suffering from an eating disorder.

Kids with problems

That last cause is where the topic intersects with childhood obesity, because teenagers trying to be thin can kill themselves by developing refeeding syndrome with its consequent “electrolyte and metabolic disturbances that manifest in cardiopulmonary, hematologic, and neurological dysfunction.” This is just a rough outline of what can happen when nutrition is replenished carelessly: Glucose levels, rise, followed by insulin levels…

[…] which then drive phosphorus and potassium intracellularly, causing a decrease in the amount of available extracellular potassium or hypokalemia… This increase in insulin and the effects on electrolyte migration (intracellular vs. extracellular) are compounded by nutritional electrolyte deficiencies.

The many and varied effects on the body of being fed after starvation include potentially fatal conditions with exotic names like torsades de pointes and Wernicke-Korsakoff encephalopathy. Because there is so much going on, treatment requires not just a doctor or a hospital bed, but an entire interprofessional team.

A WebMD article by multiple authors also asserts that “malnutrition has serious health consequences” and provides a list of ten of them, including paralysis and cardiac arrest, and also affirms that the cure for it, “refeeding syndrome is a life-threatening complication… without swift treatment, refeeding syndrome can result in death.” According to the article,

You will need to be admitted to the hospital, and doctors will prescribe a special formula of artificial nutrients to replenish your body. This process is called refeeding. You’ll get the artificial nutrients by mouth or through a tube.‌..

During refeeding, your metabolism can start to overproduce insulin, which triggers your body to synthesize protein and produce fat. The process can monopolize the electrolytes in your body. You don’t get sufficient electrolytes to your organs and this results in organ system problems.

A Cleveland Clinic website goes into more detail, naming phosphate deficiency (hypophosphatemia) which can manifest in a number of harmful ways. Or the person might experience a magnesium deficiency, which brings its own list of problems. Or a shortage of potassium or thiamine, adding such possibilities as delirium and amnesia.

Then, there are dehydration and blood sugar maladjustments. Ominously, one risk factor that could lead to refeeding syndrome is “recent loss of more than 10% of your body weight.” This fact might need special attention in light of the recent popularity of miracle weight-loss drugs.

The Cleveland Clinic notes,

Refeeding syndrome is a complication of treatment for malnourishment. This is already a stressful condition for your body to endure. It may seem counterintuitive, but too much cure too quickly can be harmful. Refeeding is a delicate and complex process. Ideally, it should be medically supervised. During medical refeeding, your healthcare team will monitor you closely. They’ll work to prevent refeeding syndrome and will be prepared to manage it if needed.

In other words, with refeeding syndrome, the cure can literally be worse than the condition. It can be so bad that medical personnel would much prefer to avoid and prevent it, and not have to reach the point of needing to treat it.

Your responses and feedback are welcome!

Source: “Refeeding Syndrome,” NIH.gov, 11/07/22
Source: “Refeeding Syndrome,” WebMD.com, 07/19/23
Source: “Refeeding Syndrome,” ClevelandClinic.org, undated
Image by Emilio Labrador/Attribution 2.0 Generic