One of the more interesting topics I learned about this summer concerned the vast number of deaths that occurred immediately after the Allies liberated the WWII camps in Europe. It’s one of the least discussed causes of fatality. The quotes below come from a rather informative quick read; it's the first article in the references section.
Shocked at the skeletal condition of some of the prisoners they were liberating who had been subsisting on starvation diets for months or even years, Allied soldiers handed over every scrap of food they could lay their hands on. But then — many of these reports say — ‘the succour has an unexpected and horrifying effect: some of the prisoners fall instantly dead at the first bite, within minutes many others have followed.’….[1]
The liberators encountered thousands of men, women, and children who had been starved for months and did what we would naturally do as well in such circumstances. The soldiers shared their food. And many of the now-freed prisoners dropped dead. The cause of death was refeeding syndrome.
Although the liberating soldiers at Belsen quickly learned that refeeding was doing its share of harm, the mechanisms weren’t known. But they couldn’t just not feed the people. And from what’s recorded historically and what’s known today, it does indeed appear that fatal refeeding syndrome was responsible for at least some substantial portion of those 14,000 post-liberation deaths.[2]
The soldiers and Red Cross workers came to understand that food was becoming the agent of death for these people. But they couldn’t just not feed them. They were clearly starving.
What has been learned since that time (from studying anorexia patients) is that most deaths from refeeding occur within two days of first taking in sustenance. Basically, the body goes into shock due to the re-introduction of calories. And this is because of the changes the body made in response to starvation. The body instituted those changes, including to the electrolyte balance, to preserve the most important tissues for as long as possible. When starved people start eating again, those electrolytes are again thrown off-balance, but much more rapidly this time, and often with fatal results.
The most common feature of refeeding syndrome is hypophosphatemia, or a dangerous shortage of phosphates in the serum. Because refeeding syndrome occurs as a result of true starvation, there are no clinical studies. Researchers have to proceed based on observations, and those observations come from the cases of the WWII prisoners and anorexia patients today. Much about treatment is still not fully understood. I think there is a fair chance we will encounter people who have been starved in the future, and it would be good to be prepared to help them.
According to data published in the British Medical Journal, which studied over ten thousand such cases, 100 per cent of patients went into hypophosphatemia when fed intravenously with a solution that did not include phosphorus supplementation; but when it did, the incidence was reduced to just 18 per cent. So clearly, phosphate supplementation is key in refeeding. The current recommended guidelines for refeeding malnourished patients is to start with multivitamin supplements, and then proceed with feeding at 10 kcal per kilogram of body weight per day, and slowly increase it over four to seven days. This allows the patient to adjust to the re-introduction of calories and has a much higher chance of survival.[3]
In reading the above recommendations from the British Medical Journal, we see that they begin with a diet low in calories that is gradually increased over 4-7 days and that multivitamins are included. What if we don’t have multivitamins? We probably won't have handy IV solutions to administer. What are good sources of phosphorus?
Whey is an excellent source with protein and other nutrients. Nasturtium provides essential vitamins and minerals as well. Dandelion and arrowroot provide some, and popcorn is a good source as well.
References:
https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-September-16.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/
Links to related posts:
I had never heard of this until I saw a WWII movie called "The Big Red One". The US GIs liberated a camp and one of them gave a little boy an apple. The boy died after taking a few bites. This was one of the most upsetting things that I've ever seen in a film.
ReplyDeletePeople getting artificial nutrition (tube fed, IV nutrition) frequently need LOTS of replacement phosphorous in the first few days, and this is while hospitalized, just having not eaten well for weeks/months due to medical issues, etc.
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