REFEEDING SYNDROME

It's a very common advice, that after embarking on a fast (especially a long one), water (most especially), or any drink at that (but not alcoholic) should be the first thing to take after breaking, then afterwards, light foods.

Some people have attached spirituality to it, while others have taken it as matter of generality, while not even knowing if it's right or not. Like the saying, "a lie spoken frequently often becomes the truth".

Now, let's forget about the spirituality or the generality, and go straight to the medical side and implication of this. Why should you take water or something light after a period of fasting?

This is not a matter of religion or spirituality, but it is very important that you take something light after a period of fasting in order to avoid what is known medically as REFEEDING SYNDROME.

Refeeding syndrome occurs when a person recovering from a period of starvation (fasting) is fed too rapidly i.e too fast, and this could be dangerous and sometimes fatal.

After having fasted for long hours (or days), there is a shift in fluids and electrolytes balance in the body. This shift is as a result of the body trying to maintain a fairly constant internal environment i.e adjusting to adapt to the period of starvation. This leads to an overall reduction in the rate of metabolic activities taking place in the body.

This changes in the body leads to general reduction in some nutrients and electrolytes found in the body e.g glucose, proteins, fats, vitamins, potassium, magnesium, and most especially, phosphate in the bloodstream.

WHAT HAPPENS DURING EXCESSIVE REFEEDING

During refeeding, there's increase in the level of insulin production in order to stimulate glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine.

When rapid feeding occurs after a period of starvation, the sudden increase in the insulin production causes great increased uptake (from the bloodstream) and use of phosphate, magnesium, potassium, glucose in the cells.

Insulin stimulates the absorption of potassium and glucose into the cells. Magnesium and phosphate likewise are also taken up into the cells, then water follows.

These processes result in conditions such as hypophosphatemia (reduced phosphate), hypokalemia (reduced potassium in the blood stream), reduction in serum level of magnesium, hyperglycemia (increased glucose in the bloodstream).

The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate, and may lead to widespread dysfunction of cellular processes affecting almost every physiological system. This could be more complex than you can imagine.

The overall consequences can lead to arrhythmias, cardiac arrest, respiratory disorders, impaired mental status, seizures, paralysis, insulin resistance, and ultimately, death.

The excessive introduction of carbohydrate to a diet at that point leads to lipogenesis (again as a result of insulin stimulation), which may cause fatty liver, increased carbon dioxide production.

Also, it causes a rapid decrease in renal excretion of sodium and water. If fluid repletion is then instituted to maintain a normal urine output, patients may rapidly develop fluid overload. This can lead to congestive cardiac failure, pulmonary oedema, and cardiac arrhythmia.

HOW TO PREVENT REFEEDING SYNDROME

It's very simple;

#1: First thing, resist the urge to eat. This can be difficult to do, as many people are so carried away by the intensity of their hunger and want to eat as much as the urge they're having. So just calm down, and take things slowly.

#2: Refeeding should be started at a low level of energy replacement. Milk is often the refeeding food of choice in this early period as it is naturally high in phosphate and easily tolerated by those who have been starved.

#3: Vitamin supplementation should also be started with refeeding and continued for at least 10 days.

#4: Correction of electrolyte and fluid imbalances before feeding is not necessary; it should be done alongside feeding.

#STAYHEALTHY