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What is Refeeding Syndrome & How to Avoid It


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Disordered eating and struggles with food affect millions of people across the nation. Eating disorders such as anorexia, bulimia, and others affect at least nine percent of the world’s population. In the United States, at least thirty million Americans will have an eating disorder at some point in their lifetime. Disordered eating often leads to malnutrition and other issues related to an ongoing reduction in food intake. It is important to note malnutrition or starvation can indeed occur for other reasons as well, including food insecurity which is overwhelmingly common across the nation, especially in rural and more impoverished communities.  

When someone has struggled with healthy food intake, regardless of the root cause, the process of reintroducing food is not without challenges as the body has to learn how to process and metabolize food again. This may sound odd since the body needs food to survive; however, as with many physical health conditions, how the body reacts to food when it has been starved of adequate nutrients for a period often changes. 

What is Refeeding Syndrome?

Refeeding is the process of reintroducing food after a period of malnourishment or starvation. Again, the root cause of inadequate food intake can vary, as can the duration and severity of unsafe or unhealthy eating. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. Refeeding syndrome results from the sudden shift in electrolyte levels in the body required to metabolize food. It is difficult to determine the statistical incidence of refeeding syndrome as there is no standard definition for the illness. 

However, it is essential to note that refeeding syndrome can affect anyone regardless of age, gender, or root cause of food insufficiency. For this reason, it is essential for someone who has struggled with disordered eating or malnourishment to seek appropriate therapy add a treatment center like Meadowglade to ensure the process of reintroducing food is done in a safe and supported environment. 

Refeeding syndrome typically follows a period of fasting, extreme dieting, famine, starvation, or malnourishment. Previously noted, specific conditions may increase one’s risk of developing refeeding syndrome, including alcohol use disorders, difficulty swallowing, disordered eating, or cancers of the digestive system. In addition, certain surgical procedures (such as some weight loss procedures) may also increase your risk. 

What Causes Refeeding Syndrome?

When someone is deprived of food, the way in which the body metabolizes nutrients changes. Sometimes these changes are significant and challenging to reverse. A prime example of this occurs with the body’s insulin response. Insulin is a hormone that breaks down sugars consumed when someone eats carbohydrates. When carbohydrate consumption is significantly reduced, the body slows the rate at which it produces insulin. Also, when someone is not eating sufficient carbohydrates, the body turns stored fats and proteins into energy sources. Over time, these changes in how the body processes food can deplete the storage of essential electrolytes needed to metabolize food. A specific electrolyte, phosphate, which helps your cells convert glucose into energy, is one of the most significantly affected. When food is suddenly reintroduced, there is an abrupt and sudden shift from fat metabolism back to carbohydrate metabolism. This results in a sudden increase in insulin secretion. The body looks to cells for electrolytes such as phosphate to convert the glucose to energy; however, phosphate is in short supply or nonexistent. This leads to a refeeding syndrome condition called hypophosphatemia or low phosphate, a common but dangerous symptom of refeeding syndrome. 

Other changes to the body’s ability to metabolize food also occur with malnutrition and starvation. These can include thiamine deficiencies, hypomagnesemia (low magnesium), hypokalemia (low potassium), changes to fat, glucose or protein metabolism, and abnormal sodium or fluid levels. These metabolic changes produce significant challenges when food is abruptly reintroduced, as the body does not necessarily have the means to metabolize or utilize the nutrients received. 

Refeeding Syndrome Risk Factors

Risk factors for refeeding syndrome are clearly defined. You may be at risk for developing refeeding syndrome if one or more of the following characteristics applies to your unique situation. 

  • In the last ten or more consecutive days, you have consumed little to no food or well below their calories required to sustain your body’s normal processes. 
  • Your body mass index (BMI) is under 16. 
  • A blood test has revealed low phosphate, potassium, or magnesium levels. 
  • In the last three to six months, you have lost more than 15% of your body weight due to inadequate food intake. 

You may also be at increased risk for refeeding syndrome if two or more of the following statements apply to you. 

  • If your BMI is under 18.5.
  • You have lost more than 10% of your body weight in the last three to six months. 
  • If, within the last five or more consecutive days, you have consumed little food.
  • You have a history of alcohol use disorder or use of certain medications, including insulin, diuretics, antacids, or chemotherapy drugs. 

If your relationship with food meets any of these specific criteria or you are concerned about refeeding, you should immediately seek emergency care at a treatment center like Meadowglade. In addition to the above, other factors may put you at an increased risk for developing refeeding syndrome, including anorexia, uncontrolled diabetes, recent surgical procedures, malnourishment, ongoing use of acids or diuretics, chronic alcohol use disorders, and specific cancers. 

Symptoms of Refeeding Syndrome

Refeeding syndrome is dangerous. The symptoms of refeeding syndrome occur suddenly and can sometimes result in fatal medical complications. Some of the most common symptoms include weakness, confusion, elevated blood pressure, irregular heartbeat, in fatigue. Examples of other, more severe symptoms include respiratory failure, seizures, heart failure, coma, and death. Symptoms, regardless of severity, typically occur within four days of the beginning of the refeeding process. Although some people at risk do not develop symptoms, there is no way to know who will develop symptoms before beginning treatment. As a result, prevention is critical to ensuring your health and safety as the repeating process begins. 

Preventing & Treating Refeeding Syndrome

Preventing refeeding syndrome is essential to avoid some of the life-threatening complications that can occur during the refeeding process. Unfortunately, the underlying health conditions that increase one’s risk of developing refeeding syndrome are not always preventable; however, your treatment staff at Meadowglade can help prevent complications of refeeding syndrome by adapting your treatment program to meet your specific needs and monitoring refeeding and treatment during the early stages of your recovery. Recovery from refeeding syndrome is unique to the individual and depends on the severity of malnourishment before food was reintroduced. For some, refeeding may take up to 10 days with monitoring afterward to ensure ongoing safety. It is also important to consider other severe medical and mental health conditions that typically require simultaneous treatment in addition to the refeeding process.

Refeeding syndrome is a severe and potentially dangerous condition. Complications can occur suddenly and require immediate intervention to ensure your health and safety. Consequently, if you are at risk for refeeding syndrome, it is vital to ensure you have adequate medical supervision at a specialized facility. Research is still required to determine the best way to treat refeeding syndrome; however, treatment generally involves replacing essential electrolytes and slowing down the refeeding process to give the potty time to adjust and adapt. 

During refeeding, electrolyte levels are monitored through frequent blood tests, and IV treatments are often used to replace electrolytes slowly and steadily. However, this form of treatment may not be suitable for everyone, and your specific treatments will depend on your needs and any underlying physical health conditions you may have. Also, food and fluids are introduced at a slower rate. Sodium replacement is carefully monitored, and people who are at risk of developing heart-related complications receive vital heart monitoring to reduce the risk of potential challenges. Calorie replenishment is supervised, and the level of daily calories one consumes increases slowly over time. Generally, this is about 20 calories per kilogram of body weight or around 1000 calories per day, initially increasing gradually as the body can tolerate increased food intake. 

Depending on the root cause of malnourishment, comprehensive behavioral therapies may be part of your treatment program. If you struggle with disordered eating conditions, it is essential to treat your mental health symptoms simultaneously with your physical health symptoms. A successful recovery from refeeding syndrome without addressing any underlying mental health conditions that lead to disordered eating and malnutrition only sets you up for potential relapse and a recurrence of this potentially fatal illness. 

Refeeding syndrome occurs when someone who struggles with inadequate food intake reintroduces food too quickly after a period of starvation or malnourishment. Sudden shifts in electrolyte levels in the body lead to dangerous complications that require immediate medical intervention to ensure your health and safety. If you struggle with disordered eating or have experienced a period of malnourishment due to food insecurity or other circumstances, it is imperative to reach out for medical and mental health support and guidance as you begin the refeeding process. 

Sudden reintroduction of food in traditional quantities based on the recommended daily intake of calories can be dangerous for your body and have a sudden and detrimental impact on your physical health. Also, it is crucial to address the underlying mental health symptoms that may have led to disordered eating. At Meadowglade, our caring and compassionate treatment staff will work with you to determine the proper course of treatment to help you safely and effectively begin the refeeding process while addressing any underlying mental or physical health concerns. Co-occurring disorder treatment is essential to both your short-term and long-term recovery as well as vital relapse prevention. If you are ready to begin your path to recovery, reach out to the admissions team at Meadow glade today to learn more about how our programs can help. 


Fight for yourself, not with yourself.

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