Prior to receiving treatment, people with long-term eating disorders often suffer from severe malnutrition or borderline starvation. Because of the toll malnutrition takes on the body, people recovering from an eating disorder need to be very careful about the type and amount of food they consume following a period of malnourishment or starvation. Refeeding is the technical term for safely reintroducing food to a person recovering from an eating disorder.

Refeeding syndrome is a serious complication that can occur following refeeding, usually within 4 days of beginning the process. In this article, we’ll briefly describe what causes refeeding syndrome, the symptoms of refeeding syndrome, and the treatment options for refeeding syndrome.

What Causes Refeeding Syndrome?

Refeeding syndrome is characterized by irregular responses in the body’s metabolic system. These responses are brought about due to changes in the way the body reacts to carbohydrate consumption. In most cases, when a person is malnourished, their carbohydrate consumption typically drops significantly, forcing the body to utilize stored fat or protein as its main energy source. During long periods of malnourishment, the body’s ability to re-adapt to changes in metabolization can become compromised.

Broadly speaking, most incidences of refeeding syndrome are caused by sudden shifts in fluid and electrolyte levels due to the abrupt transition from malnourished fat metabolism back to carbohydrate metabolism.

The stress of this metabolic shift is further exacerbated by subsequent imbalances in key electrolytes, including:

• Abnormal sodium levels
• Deficient thiamine levels
• Low magnesium
• Low potassium

What are the Symptoms of Refeeding Syndrome?

If a person is unable to seek treatment, refeeding syndrome can lead to several dangerous complications, including heart failure, seizures, and even death.

To identify and prevent the onset of severe refeeding syndrome, keep your eyes out for these initial symptoms:

• Fatigue
• Weakness and lethargy
• Disorientation or confusion
• Trouble breathing
• High blood pressure
• Heart arrhythmia

Treating Refeeding Syndrome

Treatment for refeeding syndrome will depend on the specific complication the affected person is experiencing. To minimize the potential impact of refeeding syndrome, experts recommend keeping food reintroduction to 20 calories per kilogram of body weight. Unsurprisingly, the best way to treat refeeding syndrome is by hospitalizing high-risk individuals prior to refeeding.

Below, we’ve listed five of the most dangerous personal risk factors for refeeding syndrome:

• People suffering from anorexia nervosa
• People with a body mass index (BMI) below 16
• People who’ve eaten little or no food for 10 or more days
• People with a history of misusing alcohol, antacids, diuretics, or laxatives
• People with blood tests showing low levels of magnesium, serum phosphate, and potassium

Sources: Healthline, National Institutes of Health, Hopkins Medicine

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