Refeeding Syndrome and Medical Supervision in Recovery

For starters, refeeding syndrome is a rare condition, but that does not make it any less dangerous. It normally occurs in the first 24-72 hours, so if you have been eating more for a while now you are past the danger zone. But for those who are just starting out, this is important to know.

Eating enough in recovery is crucial. If you eat too little you may end up in semi-recovery, meaning, not able to fully recover. Yes, you might gain weight and seem like progressing, but not giving your body enough building material to restore itself might mean you will still continue to experience starvation symptoms. These might include bloating, water retention, uneven weight gain, constipation, slow metabolism, hormonal issues, low iron levels, no menstruation, low bone density and so on. Eating enough is a must!

But at the same time you want to be cautious about it and do it properly so you do not put yourself in unnecessary danger. That is why I always recommend consulting a doctor and having someone monitor you during recovery. If you start eating more calories all too quickly, you may put yourself at risk of developing refeeding syndrome.

You are at risk if you are severely underweight or have anorexia and/or you have decreased calories below 1000 calories a day for more than 5 days. Your body is not used to the amount of calories or food and it can be very dangerous to start eating larger portions too quickly. It is slightly less of a possibility when a patient creates equivalent deficits through excessive exercise. At relatively higher risk (keeping in mind it is a rare condition) are patients who purge. Although it is always advised that a patient increase their intake incrementally over time to avoid this serious condition.

To make sure you do not develop refeeding syndrome first increase your calories by 200 calories a day for every 2-3 days until you are up to 2000 calories a day. Once you are at 2000 calories a day it is not common to develop refeeding syndrome from that point and you can start to eat about 500 calories or more each day until you reach minimum guidelines for daily intake for your recovery (2500, 3000 or 3500 calories a day, including periods of extreme hunger – See the post about Calories for Eating Disorder Recovery).

To make sure you do not develop refeeding syndrome first increase your calories by 200 calories a day for every 2-3 days until you are up to 2000 calories a day.

People who are at especially high risk of refeeding syndrome are those who are or have: 
  • very underweight
  • severely/undernourished malnourished
  • have gone without food for more than 5 days
  • have been purging
  • have lost weight rapidly
Some of the symptoms of refeeding syndrome are:
  • weakness, dizziness, nausea
  • rapid and/or irregular heart beat
  • abdominal pain, severe constipation or diarrhoea
  • electrolyte imbalance
  • swelling, water retention
  • seizure
  • muscle weakness or contractions
  • tremor, shaking
  • paralysis
  • low blood pressure
  • paresthesia (a sensation of tingling or burning of a person’s skin)
  • shortness of breath
  • hypokalemia
  • ….and many others

Read more HERE.

I also want to mention that a person who is at risk of developing refeeding syndrome does not have to be underweight or even low weight. You can also be at a normal weight and still be at risk. For example, if you have been eating only 1000 calories or less for a week and up your calories to 3000 all of a sudden, it might still create a dangerous situation.

There is also a lot of information about how to go about increasing calories in recovery. Some even say that it is better to risk refeeding syndrome than to risk death by severe malnutrition, such as in severe anorexia cases. All in all, consult your doctor who is familiar with eating disorders, recovery and refeeding syndrome.

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