What is refeeding syndrome?

Refeeding syndrome is something which can happen in response to reintroducing food after a period of being malnourished. When we eat food, the food gets broken down in our gut and the nutrients move through the gut wall into the blood. The nutrients are then delivered to the parts of the body which need them. When someone is malnourished, the levels of certain nutrients in their blood may be too low. A doctor can measure this with a blood test. Introducing food back into the body after a period of malnourishment can actually cause the level of some nutrients in the blood to drop, because they’re used up as part of the process of getting energy from the food. If the levels of these nutrients were too low to begin with, this drop can cause levels to become dangerously low. This can have serious consequences and can even be fatal.

delicious vegetable salad and golden fork and knife on table

Refeeding syndrome can occur in anyone who’s malnourished (regardless of their body size). The longer the person has gone without adequate nutrition, the higher their risk.

Other things which can increase your risk of refeeding syndrome are:

  • Having a BMI below 18.5 – the lower your BMI is, the higher the risk is.
  • Having lost a significant amount of weight. The more weight lost, the higher the risk.
  • Having low levels of electrolytes.

Management

Depending on someone’s risk of refeeding syndrome, the safest place for them may be in hospital, where their medical team can monitor their levels of specific nutrients in their blood and watch out for signs of refeeding syndrome. If the person’s GP feels their refeeding syndrome risk can be managed in the community, their GP will need to monitor them closely.

If you’re at risk of refeeding syndrome, taking a multivitamin and supplementing with thiamine every day from when you start refeeding will help to manage your risk. Some people will also need to supplement with phosphate, which will need to be prescribed by a GP.

Adolescents (16 years and above) and adults

  • Complete multivitamin: 2 tablets per day eg. 2 x Swisse Ultivite Women’s or 2 x Blackmore’s Multivitamin for Women
  • B Complex with 300mg thiamine every day eg. 2 x Swisse Ultiboost Mega B + or 2 x Nature’s Own Ultra B 150 Forte
  • Phosphate Phebra: 500mg twice a day (if indicated)

Children

  • Children’s multivitamin: 1 tablet/gummy per day eg. Blackmores Superkids Multi Chewables
  • 100mg thiamine every day – please ask your pharmacist to suggest a suitable supplement
  • Phosphate Phebra: 500mg twice a day (if indicated)

References:

  • NSW Ministry of Health. 2018. NSW Eating Disorders Toolkit: A practice-Based Guide to the Inpatient management of Children and Adolescents with Eating Disorders.
  • WA Eating Disorders Outreach & Consultation Service (WAEDOCS). 2019. Eating Disorders: the Management of Youth and Adults – a Quick Reference Guide