This page is not a treatment plan, and it does not give one. Refeeding after starvation is managed in hospital, with blood tests and heart monitoring, because the danger cannot be seen from outside. What this page can do is explain why the obvious thing, eating properly as soon as food is there, is the wrong thing, and what to do instead while you get help.
The worst food is the food on this site
In April 1945 British troops liberated the Bergen-Belsen concentration camp and did what anyone would do: they fed the survivors. The food was the army’s “compo” rations: as Somerville College, Oxford records, tinned meat, vegetables and fruit, puddings, butter, cheese and jam.
That is close to a list of what this site keeps in its cupboard. It was estimated afterwards that around 2,000 people died as a result of being given it. Progress came, the same account says, only with milk and very small quantities of food, given by mouth.
Nothing was wrong with the food. It was the right food for a soldier and the wrong food for a body that had been starving.
What refeeding syndrome is
The NHS describes it as a serious condition that can happen when someone starts eating and drinking again after five days or more without food, because of changes in the way the body turns food and drink into energy (NHS patient information). Another NHS trust explains what goes wrong: in the early stages of refeeding, blood levels of potassium, phosphate and magnesium can fall quickly, and the complications include serious heart and breathing problems (NHS patient information). The first NHS leaflet is plain that, in the worst case, a person may die.
The point that matters most is that the risk comes from eating, not from being hungry. Someone can survive the starvation and be harmed by the meal.
Who is at risk
NICE, which sets clinical guidance for the NHS in England, uses these criteria (NICE CG32, box 1). Someone is at high risk if they have one of these:
- a BMI under 16
- lost more than 15% of their body weight, without trying, in the last three to six months
- had little or no food for more than 10 days
- low potassium, phosphate or magnesium in their blood before feeding starts
or two of these:
- a BMI under 18.5
- lost more than 10% of their body weight, without trying, in the last three to six months
- had little or no food for more than 5 days
- a history of alcohol misuse, or taking certain medicines, including insulin, chemotherapy, antacids or diuretics
And NICE’s guidance goes wider than the high-risk group: anyone who has eaten little or nothing for more than five days should have food reintroduced at no more than half of what they need for the first two days, building up only if monitoring shows no problems.
Why this needs a doctor
For people at high risk, NICE recommends care from trained nutrition staff. They start feeding at a fraction of normal needs and build it up over four to seven days. They give vitamins, especially thiamin (vitamin B1), and replace potassium, phosphate and magnesium. In the most severe cases they also monitor the heart continuously.
None of that can be done safely at home. The blood levels that decide whether it is going wrong cannot be seen or felt until it has gone wrong. That is why this page will not give you a home version of the protocol. If someone has had little or no food for five days or more, get medical help: call 111, or 999 if they are very unwell.
Until help arrives
The NHS’s own advice to patients at risk comes down to two things: start with very little, and build up slowly.
- Small amounts. Do not eat a full meal, however hungry you are, and do not let anyone eat one.
- No sugary drinks and no sweets. The NHS leaflet specifically says to avoid sugary drinks, such as pop or fruit juice, and sweet and sugary foods. This is the one situation where the advice in our treats guide is reversed.
- Do not suddenly eat more than you have been told to, even when you start to feel better.
The warning signs the NHS lists are: feeling sick or being sick, swelling (usually in the legs or ankles), feeling dizzy or lightheaded, weight going up very quickly, changes in heartbeat, and weak muscles or cramp. Someone may have all of these or only some. Any of them after eating again is a reason to get help at once.
If you are the one with the food
The mistake at Belsen was generosity. If you find someone who has been without food for days, the kind instinct to give them everything you have is the dangerous one. Give a little, get help, and keep the rest for later.
This is not only about disasters
The NHS leaflets this page draws on come from mental health trusts, because refeeding is also a risk in recovery from an eating disorder. If that is why this page matters to you, the UK eating disorder charity Beat offers support, and the advice above applies just the same: help first, then very little, built up slowly.