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When food becomes a danger • HealthNews

In severely malnourished individuals, it is essential to restore nutritional intake as soon as possible. That is why those affected are often encouraged to eat right again. However, caution is advised here: if too many nutrients are ingested in a short period of time, this can cause refeeding syndrome, with fatal consequences.

Syndrome already documented in antiquity

The syndrome was first described by the Judeo-Roman historian Flavius ​​Josephus in the 1st century AD. This documented the unexpected death of numerous Jews who escaped Roman captivity. Due to prolonged starvation, the prisoners ate a disproportionate amount of food after fleeing and subsequently died. In terms of medical history, a similar phenomenon was observed in Nazi concentration camp inmates and Japanese POWs after the end of World War II. When they resumed normal eating habits after a long period of starvation, unexpectedly severe symptoms of heart failure with neurological complications appeared. Subsequent medical research has shown a clear connection between refeeding and cardiovascular problems. Nowadays, patients with anorexia nervosa are particularly affected in the context of nutritional therapy.

Severe symptoms

Medical observations indicate that symptoms mainly occur with venous glucose infusions. However, symptoms can also develop when taking food by mouth or artificial feeding through the gut. The syndrome often occurs within the first four days of resuming a normal diet. Cardiovascular impairment, tissue fluid retention, and acute vitamin B1 deficiency are the first signs. The severity of symptoms largely depends on the length of the previous fast and the degree of malnutrition.

Fatal intake of glucose

In most cases, refeeding syndrome is due to an imbalance in mineral metabolism after chronic food deprivation. After just two days without eating, the body runs out of carbohydrate reserves and starts breaking down fat intensively. In addition, the concentration of essential minerals and vitamins is continuously reduced. If, after a long period of starvation, there is an increased supply of glucose, the pancreas immediately releases insulin to increase the production of energy in the cells. However, burning glucose requires several important vitamins and minerals, most notably vitamin B1 and phosphate. While phosphate contributes to the generation of the vital energy reserve ATP, vitamin B1 catalyzes the breakdown of glucose.

Electrolyte imbalance causes symptoms

In the course of energy generation, not only phosphates are absorbed by the cells, but also magnesium and potassium ions. The electrolyte balance is severely imbalanced in the face of previous food deprivation: while minerals continue to grow at the intercellular level, there is still a significant deficiency at the extracellular level. This imbalance causes blood vessels to leak, allowing fluid to build up in the tissues. In addition, the disproportionate amount of insulin retains water in the body, which can subsequently lead to heart and kidney complications.

therapy and prevention

To prevent the development of refeeding syndrome, it is essential to replace deficient electrolytes and vitamins before and while resuming a regular diet. At the same time, the concentration of electrolytes in the blood must be checked regularly to ensure an appropriate dosage. As part of therapy, it is advisable to continuously increase the physiological intake of food. At the beginning, a daily nutritional intake of about 15 kilocalories per kilogram is suggested. To avoid serious complications, the treatment of malnourished patients should be carried out under medical supervision. After successful therapy, it is advisable to rely on a diet rich in vitamins and minerals in order to establish a healthy metabolism. Those affected should also include foods containing proteins and carbohydrates in their diet so that malnutrition does not recur.

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