What you need to know about refeeding syndrome

What is refeeding syndrome?

Refeeding syndrome can occur when a person recovering from an eating disorder starts to reintroduce food. It can often be referred to as acute hormonal-metabolic disturbance in malnourished people who’s body react to re-nourishment. It is a dangerous development of low phosphorus and other electrolyte levels in the blood and fluid shifts into body tissue, this can occur when a starved person begins to consume nutrition. The insulin levels spike causing low phosphorus in the bloodstream which can cause the kidneys to retain salt and fluid. Which can break down muscles and cause weakness in the heart muscles and breathing muscles.

What is an eating disorder?

Eating disorders affect every aspect of a person’s life. It can change their thoughts and behaviours involving exercise, food and eating. There are many different eating disorders, including:

• • Anorexia nervosa

• • AFRID

• • Binge eating disorder

• • Bulimia nervosa

• • OSFED, including orthorexia nervosa and body dysmorphia

• • Purging disorder

• • UFED

• • PICA

Why is refeeding syndrome common in eating disorders?

It is commonly seen in people who are recovering from an eating disorder because their body is deficient in nutrition and energy and could be in a starved state. When the person re-introduces nutrition too quickly or the incorrect amounts it can cause the body to go into refeeding syndrome.

What are the symptoms?

We have included common symptoms of refeeding syndrome. We have included “tips” too. But, please note: refeeding syndrome is a serious and potentially fatal condition. This blog is not a substitute for medical support.

• • Fluid retention can occur when restricting carbohydrate intakes this can cause the body to become dehydrated. Therefore, when you reintroduce carbohydrates, your body will retain excess fluid which can leave you feeling bloated.

Tips to help:

1. 1. Include a quarter or half of the carbohydrate portion at each meal
   2. Aim to reduce the use of excess salt
   3. Aim to have a portion of protein at each meal. This can be beans, cheese, meat, and eggs for example

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• • Low phosphate levels occur when your body uses its carbohydrates for energy, during this time phosphate and electrolytes move into the body cells which then leads to low levels in the bloodstream. This can cause cardiac and respiratory failure.

Tips to help:

1. 1. Include foods high in phosphate like milk and yoghurt into your meals. This would be 600ml of milk or 3 induvial cartons of yoghurt

• • Low potassium can happen through excessive vomiting and laxative use or through having a restricted diet. It can lead to muscle weakness.

Tips to help:

1. 1. Including fruit and vegetables in your meals and snacks. Bananas are a good source of potassium and carbohydrates
   2. Include 600ml of milk into your meals

When to be concerned about refeeding syndrome

When you begin eating disorder recovery, it’s important to have medical appointments. Usually for the first 3 months of recovery. This way any signs of refeeding syndrome can be detected.

Worried about refeeding syndrome?

We recommend you visit your GP as soon as possible. Refeeding syndrome is a very serious side-effect of re-nourishment in eating disorder recovery. Simply let the receptionist know that are concerned about refeeding syndrome, and that you need an appointment ASAP. We (and eating disorder medical guidelines) also recommend:

• • Get your blood taken to test your electrolyte level before you start increasing your food intake. This will need to be done once a week for three weeks minimum. If your levels are low, you may need additional prescribed supplements.

• • Introduce small amounts of carbohydrates at a time and slowly increase the amounts if you’re current intake is low. We recommend reaching out to us for an appointment with our eating disorders dietitian.

• • Be honest with your doctor about what you are eating to reduce the risk of refeeding syndrome.

References:

1. Skowrońska, A., Sójta, K. and Strzelecki, D. (2019)
2. The London Centre for eating disorders and body image
3. Gaudiani, J.L. (2019) Sick enough: A guide to the medical complications of eating disorders (*)
4. Understanding eating disorders (2022) Bodywhys

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