People with a prolonged very-low-calorie intake, less than1,000 calories a day, may be placing themselves at risk for disorder known asrefeeding syndrome.  Refeeding syndromeoccurs when reintroducing calories too quickly causing an imbalance in fluids andelectrolytes.  This imbalance can befatal.

Refeeding syndrome is most commonly seen is people withanorexia nervosa, chronic alcoholism, cancer, uncontrolled diabetes and peoplewho have not been eating well for several days. Dieters, even the obese, following very-low-calorie diets or fasting arealso at risk.  Tubefeeders are also atrisk for refeeding syndrome.

When people restrict caloric intake their body goes into starvationmode.  Their metabolism slows down andthey begin to use stored nutrients to supply energy.  During the first 24 hours of a very lowcalorie intake the body uses the energy it has stored in the liver andmuscles.  After three days of prolongedstarvation, the body begins to use other sources of stored energy.  The body also begins to adapt to starvation,altering the way it metabolizes nutrients. When food is reintroduced too quickly after starvation, the body cannothandle the surge in nutrients and can cause difficulty breathing, seizures,heart problems, paralysis, insulin resistance and mental instability. 

Prolonged starvation causes potassium, magnesium, thiaminand phosphorus stores to decrease.  Thesenutrients play an important role in nutrient metabolism and normal bodyfunction.  The body cannot handle theextra calories and nutrients during the refeeding process without adequatestores of these nutrients leading to physiological problems mentioned above.

Refeeding syndrome is preventable.  First it is important to recognize when youor someone you know is at risk for refeeding. Anyone with poor food and fluid intake for more than three days is atrisk, and the longer a person has had a poor intake the greater the risk.  Once risk has been determined, food andfluids need to be reintroduced slowly. Feeding too quickly, even fluids, can be dangerous.  If you are concerned about refeeding, talk toyour doctor or dietitian.

The best way to re-nourish a body after a period ofstarvation is to eat small meals frequently. People on tubefeeding should also be fed small amounts at a time withvery gradual increases.  It usually takesseveral days until the person at risk for refeeding is eating 100 percent ofcalorie needs.  It is important toclosely monitor blood levels of potassium, magnesium and phosphorus during thisperiod.