Refeeding Diet

Overview

After a period of medically induced starvation for weight loss or a period of prolonged inability to eat, such as cancer treatment, it's essential to follow a refeeding diet, a diet that re-introduces food. A refeeding diet must be done slowly and gradually to avoid refeeding syndrome, a group of potentially fatal metabolic imbalances.

Risk Factors

Certain factors can increase the risk of developing refeeding syndrome once a person starts eating after a prolonged fast. You may be at severely high risk if you've eaten very little for 15 days and if your body mass index is 14 or less. People with unintentional weight loss of more than 15 percent over three to six months and people who have little intake for five days or more and who have a BMI less than 16 may be at high risk, dietician Gina Tomlin reports on AnesthesiaUK.

Physiological Effects

When you go into starvation mode, your glucose levels drop. Energy sources switch from carbohydrate to fat and protein. Metabolism slows by as much as 20 to 25 percent, researchers from the University Hospitals Coventry and Warwickshire report in the 2009 journal "Head and Neck Oncology." When refeeding begins, glucose levels rise, which increases insulin levels. Higher insulin levels stimulate cells to absorb potassium, phosphate and magnesium. Low phosphate levels in the blood, or phosphatemia, are the cardinal sign of refeeding syndrome, the article explains.

Method

Vitamin and mineral replacement is started along with refeeding, which may be done via intravenous or tube feeding to start. To avoid fluid overload or irregular heartbeats, refeeding may be started at 50 percent of the patient's nutritional requirements in a moderate risk patient who hasn't eaten in five days or more. In severely malnourished patients, starting feeding at five calories per 2.2 lbs of weight over a 24-hour period helps to prevent complications.

Symptoms

Fluid overload causes the heart to work harder than normal, which can lead to acute heart failure. Arrhythmias can develop from electrolyte imbalances. Because digestive enzyme production may decrease during a starvation period, refeeding may trigger nausea and vomiting. Stress on the lungs can cause rapid and difficult breathing. Low phosphorus levels can lead to multiple organ failure, muscle breakdown called rhabdomyolysis, seizures, coma and death.