Refeeding Syndrome

Refeeding syndrome describes a series of metabolic events when re-introducing nutrition and hydration for those who are:
-significant weight loss (greater than 10%) over a short period of time, such as 2-3 months
-severely malnourished

This is referred to as the weight-gaining phase.

To reduce the threat of starvation, one must:
-eat adequate nutrition promoting normalization of BMR (Basal Metabolic Rate)
-provide body with consistent energy intake which is AT LEAST equivalent to BMR
-consume enough calories for daily activity and restoring and repairing vital tissues
-energy requirements may be as high as 3000 calories per day during this stage

Energy Intake Goal = BMR + Daily Activity + Restoration

Refeeding Syndrome was first discovered in Far East prisoners after WWII. Prisoners were found starved - had severe weight loss, low blood pressure, and heart size had become smaller. They started to eat again, yet became acutely ill. It was discovered that their insulin secretion slowed down in response to their low intake of carbohydrates. Their bodies depended on fat and protein stores to produce energy. This caused a loss in electrolytes inside the bodies cells - particularly phosphate. Blood level of phosphate looked normal but the phosphate levels were depleted inside the cells.

Signs of Refeeding Syndrome:
-patients show low phosphorus in their blood
-one starts to eat again - our bodies shift from breaking down protein and fat back to using carbohydrates again
-this causes insulin to start to secrete, which makes phosphorus to drop into our blood
-this increased insulin causes a great uptake of glucose, potassium, and magnesium into the cells
-this causes the body to start to retain fluid outside the cells, causing rapid weight gain

What happens when we stop purging behaviors?
-feel devastated because body weight almost instantly increases due to fluid retention
-this weight increase is caused by fluid shifting back to the muscles and the vascular system
this is called vascular and muscular retention
-a lot of fluid is also brought into the intestines - intestinal hyperosmolality
-these are all normal things that may last up to ten days - the body will start to readjust and the edema will subside

What happens when we start eating again?
-can have difficulty breathing (lungs atrophy due to starvation)
-gut atrophies along with the diminishing of digestive enzymes
-gastrointestinal discomfort, bloating, nausea, diarrhea

Treating Refeeding Syndrome:
-be aware of symptoms
-introduce nutrition slowly and advance slowly
-may supplement with electrolytes and vitamins
-monitor lab work for potassium, phosphorous, magnesium, sodium, and glucose
-monitor vital signs

Trusting your body (good things):
-increased body warmth
-increased hunger
-improved concentration and fewer headaches
-increased blood pressure and pulse
-less dizziness
-improved muscle strength
-restored menstrual cycle
-improved sleeping patterns
-healthier looking skin, hair, nails, and gums
-decreased fatigue