Refeeding syndrome is a risk that is often associated with patients beginning a tube feeding program because they have often been receiving inadequate nutrition for a prolonged period associated with difficulties chewing or swallowing. However, anyone in a state of malnutrition -- including someone ending a prolonged fast -- is at risk of developing refeeding syndrome when they resume normal nutrition.
The introduction of large amounts of carbohydrates into a body that is moderately to severely malnourished can lead to a severe imbalance in the electrolytes potassium, phosphorus and magnesium. These electrolytes are necessary in the formation of new tissue, which is primarily what a malnourished body will use carbohydrates to do to replace the tissues that were broken down during malnutrition. The severe shift in electrolytes results in a reduction in the excretion of salt and water, precipitating a fluid overload that may result in heart and lung complications and even death.
At Risk Individuals
A Protein-Sparing Diet
Although fasting is done for a number of reasons, the effect of fasting on the risk of developing refeeding syndrome is the same. A person who has been struggling with an eating disorder such as bulimia nervosa or anorexia nervosa is not fasting for the same reasons as someone who chooses to fast for meditative reasons, but they are both malnourished. The effects of fasting can also be seen in people who have been receiving inadequate nutrition due to financial hardship. Although patients with inadequate intake as a result of mechanical eating problems with chewing or swallowing are not in a state of absolute fasting, they are also malnourished and at risk of developing refeeding syndrome when normal nutrition resumes.
- Although fasting is done for a number of reasons, the effect of fasting on the risk of developing refeeding syndrome is the same.
- Although patients with inadequate intake as a result of mechanical eating problems with chewing or swallowing are not in a state of absolute fasting, they are also malnourished and at risk of developing refeeding syndrome when normal nutrition resumes.
Your physician or dietitian can evaluate your nutritional status for malnutrition and risk of refeeding syndrome. In cases of high risk, health professionals administer conservative amounts of carbohydrates to allow the patient's body to adapt with a lower risk of developing refeeding syndrome. During this time, electrolytes are also closely monitored and appropriately supplemented to support tissue generation and fluid balance.
Signs of Refeeding
Exercise & Starvation
If you believe that you may be at risk for refeeding syndrome, consult your physician or dietitian for treatment and an appropriate diet 3. Signs of refeeding syndrome mostly pertain to excess fluid 3. Sudden weight gain from fluid retention as well as swelling, especially around the ankles and other joints, are both potentially signs of refeeding syndrome. If you experience these symptoms after resuming normal eating post-fast, consult your physician or dietitian immediately.
A Protein-Sparing Diet
Exercise & Starvation
Liquid Diets and Protein Shakes
Protein Intake After Surgery
What Can You Eat With a Feeding Tube?
What Is a Eucaloric Diet?
Differences Between Fasting and Starving
The Glucose Free Diet
A Holistic Diet for Avascular Necrosis
- "Krause's Food and Nutrition Therapy: 12th Edition"; L. Kathleen Mahan and Sylvia Escott-Stump; 2008
- "Nutrition and Diagnosis-Related Care: Sixth Edition"; Sylvia Escott-Stump; 2008
- "British Medical Journal"; Refeeding Syndrome: What It Is and How to Prevent and Treat It; Hisham M. Mehanna, et al.; June 2008
- "Nature Clinical Practice: Nephrology"; Hypophosphatemia: An Evidence-Based Approach to its Clinical Consequences and Management; Jay Amanzadeh and R.F. Reilly; January 2006
- Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. Bmj. 2008;336(7659):1495-1498. DOI:10.1136/bmj.a301
- Pulcini CD, Zettle S, Srinath A. Refeeding Syndrome. Pediatrics in Review. 2016;37(12):516-523. DOI:10.1542/pir.2015-0152
- Refeeding Syndrome. Gastrointestinal Society.
- Schnitker MA, Mattman PE, Bliss TL. A clinical study of malnutrition in Japanese prisoners of war. Ann Intern Med. 1951;35(1):69-96. doi:10.7326/0003-4819-35-1-69
- Sobotka L. Basics in Clinical Nutrition: Refeeding syndrome. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2010;5(3). DOI:10.1016/j.eclnm.2009.06.012
- Yantis, Mary Ann RN, PHD; Velander, Robyn RD, LD, CNSD How to recognize and respond to refeeding syndrome. Nursing. 2008;38(5):39-40. DOI:10.1097/01.nurse.0000317680.09538.d6
Chance Woods has been a personal trainer since 2002, specializing in fitness and nutrition. She holds a Bachelor of Science in dietetics.