Refeeding Syndrome & “Normal” Eating

Refeeding syndrome is a potential complication of reintroducing food too quickly (particularly carbohydrate foods) to a patient with a low body weight who has been starved for a period of time or who has experienced rapid weight loss. This can lead to serious complications which can be fatal.
If a young person is considered to be at risk after assessment the treatment team will advise the following as a precaution:

  • Slow reintroduction of nutrition at the start of treatment, avoiding foods high in sugar and sugary drinks.
  • The introduction of milk, which is high in phosphate and supports the safe introduction of starchy carbohydrate foods (e.g. bread, rice, potato, pasta) in the diet
  • Regular blood tests
  • Regular monitoring of physical observations such as pulse, blood pressure, and temperature.

The initial goal is to prevent further weight loss and stabilise weight. As tempting as is may be to parents and carers to accelerate weight restoration, in patients at risk of refeeding syndrome this is dangerous. As worrying as it may seem, in those at very high risk of refeeding, it may be necessary to only slow the rate of weight loss, then stabilise weight before finally attempting gradual weight restoration.

Your loved one’s mental health team should have dietitian or a medical doctor who has eating disorder experience and will provide an assessment to determine if your loved one is at risk of refeeding syndrome and provide initial dietary advice.  Whilst refeeding syndrome is a rare occurrence, it is very serious. Therefore, thorough assessment is important when a person starts to eat again after a period of starvation.
The process of refeeding and trying to get back to eating “normally” is tricky and definitely not a linear, straightforward process. It is normal to make mistakes, get stuck and caught in the eating disorder. Keep working with the professionals; they are experts in eating disorders but remember you are the expert in your loved one.

You can find out more about refeeding syndrome at Great Ormond Street’s website.

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