What to Expect During Refeeding
Refeeding is a vital step in recovering from severe malnutrition and eating disorders like anorexia nervosa, bulimia nervosa and ARFID. Refeeding side effects are temporary and include IBS, feelings of fullness and food intolerances. With expert medical care, refeeding can be done safely.
Why Refeeding is Important
Refeeding is a critical intervention for patients with severe malnutrition. A serious deficit or imbalance in a person’s energy intake often causes a variety of serious medical complications. Conditions that can contribute to malnutrition are:
- Eating disorders like anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder (ARFID)
- Inflammatory bowel disease (IBD)
- Cancer
- End-stage liver disease
- Non-tuberculosis mycobacterium infection
- Chronic obstructive pulmonary disease
- Psychosis, caused by schizophrenia or other psychotic disorders
The Benefits of Refeeding
Refeeding reintroduces nutrition that provides energy and helps to normalize basic bodily functions, like cognitive processing and temperature regulation. It also supports the recovery of vital organs and is critical in medical stabilization. With refeeding, patients can expect to see improvements in:
- Vital signs
- Cognitive functioning
- Gastrointestinal function and symptoms
- Cardiac function
- Skin health
- Laboratory values
- Strength and neuromusculoskeletal function
- Energy levels
Preventing Refeeding Syndrome
Refeeding syndrome consists of a variety of medical complications that develop due to a potentially fatal shift in fluids and electrolytes that occurs in significantly malnourished patients when they are being refed.
With individualized nutrition rehabilitation, lab monitoring and clinical monitoring, refeeding syndrome is preventable.
What Happens During Refeeding
Many of the gastrointestinal complications of malnutrition can contribute to feelings of discomfort as function is restored and the body adjusts to greater food intake. Gas, bloating, diarrhea, nausea, constipation and indigestion are common during treatment. Delayed gastric emptying means that food is eliminated from the stomach very slowly, and this food retention long after eating can make patients feel full, bloated, nauseous and uncomfortable.
Water weight
In the early stages of refeeding, patients may feel as though they’re gaining weight rapidly. However, rapid weight gain early in refeeding is due to fluid shifts and water retention. This can happen for a number of reasons, including your body trying to rehydrate, but is much more prevalent in individuals with eating disorders who have a purging history.
Feelings of fullness
When patients begin the refeeding process, they may temporarily experience an uncomfortable feeling of fullness when eating due to the gastroparesis. As nutritional rehabilitation and weight restoration continue, gastric motility does normalize. Medications can help reduce the discomfort in the interim.
Irritable bowel syndrome
Irritable bowel syndrome, a type of disorder of gut brain interaction (DGBI), is common in eating disorders and malnutrition. DGBIs are characterized by gastrointestinal symptoms resulting from abnormal functioning within the GI tract and/or altered pain perception from signals sent from the GI tract to the brain. Fortunately, DGBIs tend to improve with treatment.
Temporary food intolerance
Some patients may become concerned that their GI symptoms are actually food allergies and are hesitant to reintroduce foods that have been eliminated. The majority of the time these are not actually allergies but are actually food intolerances that may also impact DGBIs. Reintroducing these food groups into the diet long-term are beneficial for recovery.
Few or no hunger cues
The sensation of hunger is a complex neurobiological mechanism that becomes dysregulated with malnutrition. The lack of hunger experienced by many individuals with malnutrition can make eating difficult, but weight restoration is ultimately necessary to turn those hunger cues back on.
Weight restoration
Weight restoration can be particularly difficult for patients with eating disorders to accept, often triggering thoughts of disordered eating. However, weight restoration is essential to normalizing all the pathology that is associated with starvation and is a required first step in your journey to recovery.
Refeeding Safely: Avoiding Complications from Malnutrition
Refeeding is a critical part of treatment for severe eating disorders and malnutrition. It restores vital body functions and supports cognitive, cardiac, and gastrointestinal recovery. While side effects like fullness or water retention are common, medical oversight helps prevent refeeding syndrome and supports a safe recovery process.
