Returning to eating after an eating disorder
Summary
When a person has been malnourished and underweight for a long time, the refeeding process cannot be done in any way. Great care must be taken to avoid complications and problems that could become serious for health.
Food restriction, repeated vomiting, compulsive exercise and laxative abuse can cause significant weight loss in the person . These behaviors end up altering the brain biochemistry and the balance of neurotransmitters. And this, in turn, can enhance depressive symptoms and obsession. The fear of gaining weight or regaining it gradually settles in the mind of the person with an eating disorder, and the weight drops dangerously. The more this functioning becomes established, the more the body is "forced" to adapt to a metabolic rate below natural needs, since a situation is occurring in which it is necessary to save energy, and what is available is redirected to cover basic functions: breathing and heartbeat. And thus, internal reserves that should be preserved are used up, such as the layer of protective fat (adipose tissue) that covers and acts as an "airbag" for many organs.
The more pronounced the weight loss, the more gradual it is to regain it. If this is not done, complications may arise, such as refeeding syndrome.
Restoring nutritional status is as important as doing therapy to work on awareness of the disorder. But when the time comes to start the refeeding process , it must be done gradually, little by little and first assessing the internal state of the body. The more pronounced the weight loss, contrary to what one might think, the more gradually it is necessary to regain it. If this is not done, there may be complications; one of them is the so-called refeeding syndrome.
Much more than a problem with food
What is refeeding syndrome?
Refeeding syndrome is basically a metabolic imbalance that occurs when the body goes from saving to being able to spend without limitations. When the person has lost many kilos compared to their previous weight and the metabolic rate is at a minimum, food, both solid and liquid, can be a sudden overload for a weakened organism that is used to so little.
When the body lacks energy, it switches from burning sugars, which is its preference, to burning fats and proteins from its reserves , eventually developing ketoacidosis and depleting the mineral salts of the cells (basically, potassium, magnesium and phosphorus). Proteins are large molecules that retain fluid in the blood (hyperosmolarity); therefore, when too strict or scarce diets lack proteins, plasma fluid moves out of the blood vessels and the lower parts of the body can swell, starting with the ankles. In severe cases, when there is chronic starvation, the abdomen also swells.
When carbohydrates (which are also large molecules) are ingested again, the body uses them preferentially and metabolism is suddenly activated: insulin is released, which causes the carbohydrates to enter the tissues and be used as a source of energy by the cells; and in the process of burning them, they must spend the scarce savings of vitamins and mineral salts that they still retained (potassium, magnesium and phosphorus), accumulating in the exchange sodium, and also the fluid that it retains. Thus, an intake of carbohydrates that suddenly reaches the body and passes into the bloodstream will cause a lot of insulin to be released suddenly (blood sugar will rise, hyperglycemia), with the risk of suffering a subsequent and apparently paradoxical hypoglycemia – which can even lead to coma – because, lacking reserves, the body temporarily loses its ability to self-regulate.
When a person has lost a lot of weight and their metabolic rate is at its lowest, food can be a sudden overload for a weakened organism that is used to so little.
So when proteins or carbohydrates suddenly arrive in previously normal quantities in the digestive tract, an electrolyte imbalance can occur that upsets the already precarious body balance. This redistribution of fluid and mineral salts in an already weakened organism can have serious consequences on many organs, especially on cardiac function (which especially needs potassium), with the risk of arrhythmias, arrest and even death.
This is what happened when Allied soldiers entered concentration camps at the end of World War II and, horrified by the conditions of the prisoners, gave them their food rations, often biscuits rich in carbohydrates; and some of the prisoners died of shock, after having had a last meal in freedom.
Cardiological repercussions of eating disorders
The clinical manifestations of refeeding syndrome are similar to other states of shock: disorientation, nausea, low blood pressure and tachycardia, with fluid retention (edema). And it can end in cardiac arrhythmia or kidney failure.
Therefore, it is very important that people with an eating disorder who are underweight or chronically malnourished are treated in an appropriate environment and by a team of specialists that includes a nutritionist. A progressive refeeding program, designed individually, must be programmed to slowly increase the calorie content and give the body time to readapt. In cases of advanced malnutrition, it is necessary to replenish mineral salts and vitamins (micronutrients) before introducing sugars. And the internal state of the body must always be assessed with analyses, both before and during the refeeding process.
Featuring
