What to Expect and Know About Refeeding
Monday, September 11, 2017
Refeeding refers to the process of increasing nutritional intake after periods of caloric restriction, which have usually resulted in weight loss. Perhaps one of the biggest fears about entering treatment for an eating disorder revolves around what to expect with refeeding. While there are undoubtedly physical and psychological challenges associated with refeeding, eating disorder specialists can help guide and support you through this process. This Medical Monday will only focus only on the physical aspects of refeeding. Common medical complications associated with refeeding include, but are not limited to, slowed digestion, the refeeding syndrome, and swelling (also called edema). The good news? All of the above can be managed and minimized under the proper guidance from eating disorder professionals and will resolve as you weight restore.
Lets start with talking about the bowels. Fullness, bloating, gas, and constipation are some of the most common physical symptoms that occur with refeeding. If this doesn’t sound fun so far, bear with me. Malnutrition leads to a slowing of the entire digestive system. Delayed emptying of food from the stomach, also known in the medical world as gastroparesis, leads to a sensation of fullness that can persist for hours after a meal. Feeling full after just one meal can make it very challenging to continue to eat throughout the day. Fear not. There are both dietary and medical therapies that can really help minimize these symptoms as much as possible. Some of these therapies include eating lower fiber foods, consuming calories as liquids rather than solids, and pills that actually work to empty the stomach faster. All of these therapies can really make the process of refeeding much more physically tolerable. Constipation can also be managed with gentle medications. Best of all. The human body is a remarkable thing and this slowed digestion will return to normal as your weight improves.
Now lets switch gears and talk a little about refeeding syndrome. This syndrome is not something that you can actually feel going on until serious medical problems develop. It can be extremely dangerous if it goes unnoticed. Refeeding syndrome occurs when a starving body starts taking in nutrition resulting in dangerous imbalances in electrolytes in the blood and can lead to multiple body system failures. Seems strange, right? Why would the body respond this way after getting the very thing it needs--food? Good question. The answer took a while to figure out, but has to do with several important electrolytes in the body, the most notable being phosphorus.
Phosphorus is your cells work horse. It is needed by all cells to make energy. A starving body that needs to repair and rebuild needs a lot of energy. When the starving body finally gets food, the food broken down into its most basic elements and shuttled into your cells to build more energy to start the healing process. This means your cells become hungry for the nutrients in food, like phosphorus, and levels in the blood stream can drop dangerously low. When undetected, this drop in phosphorus (and other electrolytes such as potassium) can lead to many dangerous medical complications, known as the refeeding syndrome, such as muscle breakdown, seizures, confusion, and heart failure.
So who is at risk for refeeding syndrome?
Most people suffering from eating disorders will be at risk especially as caloric restriction increases and your weight drops lower. Refeeding syndrome is entirely preventable with close supervision by your treatment team. This is why during treatment you might initially have blood work done daily to check for these electrolyte imbalances. You might also need to take some electrolytes by mouth or occasionally through an IV to keep your levels up. Usually, these electrolyte imbalances will resolve within a week or two.
Lastly, refeeding can sometimes result in swelling, or edema, in your legs. The exact cause of this is unknown, but it is self limiting, meaning it goes away with time. Lowering salt levels in the diet, wearing tight Ted hose stockings, and elevating your legs above the level of the heart are all ways to manage edema that develops with refeeding.
The body has remarkable capabilities to repair and restore itself. All of these complications of refeeding will resolve as the body becomes more nourished. The process of refeeding can be difficult initially, but under the proper guidance of an expert team many of the physical symptoms can be managed so you can continue to heal both mind and body and achieve sustained recovery from your eating disorder.