Starvation and Refeeding Syndrome
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Quasita
Posts: 1,530 Member
Please read and BUMP my new blog entry
http://www.myfitnesspal.com/blog/Quasita/view/starvation-and-refeeding-syndrome-a-brief-look-with-sources-223672
It has a LOT of very good resources that many people on this site need to read/see. It's good information for everyone.
Thanks, and happy MFPing!
http://www.myfitnesspal.com/blog/Quasita/view/starvation-and-refeeding-syndrome-a-brief-look-with-sources-223672
It has a LOT of very good resources that many people on this site need to read/see. It's good information for everyone.
Thanks, and happy MFPing!
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Replies
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really well written and well sourced! Nice to see somebody give a well rounded view on what an eating disorder truely is.0
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Thanks so much for writing this. You are 100% right about physical vs mental eating disorders. Those who do struggle with an eating disorder of some kind often find it very difficult to associate with labels because the causes can be so vastly different.
"Remember, our goal is to be HEALTHY not SKINNY. "
Can I get an AYYY-MEN??0 -
GREAT read, everyone should read this!0
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Thank you so much
I was worried the information would get buried with all the posts that happen, so it's good to see that some people took the time to read it. Thank you! I have been developing what I wanted to say almost immediately after my initial post about starvation. 0 -
I've read the documents that you've cited and I can't find anything in any of those articles to substantiate your statement "Basically, what this RFS is, is when a person who was previous starving (under 1200 calories) "
Each of the four articles refers to people who are "starving" though the last one includes "have severely restricted calories and/or sudden weight loss are also at risk.".
In addition to starving, the articles discuss fasting. The only site that mentions "severely restricted calories" is the only source that has something to sell you.
Just because a person eats less than 1200 calories per day, does not mean that they are starving.
Starvation is brutal. These articles discuss prisoners of war who were intentionally subjected to horrid living conditions, including being given almost nothing of nutritional value for months or perhaps years on end.
The idea that someone eating "under 1200" calories is in the same category is highly misleading.0 -
I've read the documents that you've cited and I can't find anything in any of those articles to substantiate your statement "Basically, what this RFS is, is when a person who was previous starving (under 1200 calories) "
Each of the four articles refers to people who are "starving" though the last one includes "have severely restricted calories and/or sudden weight loss are also at risk.".
In addition to starving, the articles discuss fasting. The only site that mentions "severely restricted calories" is the only source that has something to sell you.
Just because a person eats less than 1200 calories per day, does not mean that they are starving.
Starvation is brutal. These articles discuss prisoners of war who were intentionally subjected to horrid living conditions, including being given almost nothing of nutritional value for months or perhaps years on end.
The idea that someone eating "under 1200" calories is in the same category is highly misleading.
I also state that this post is one that is a followup to my previous posting, which has a cited peer reviewed discussion on what starvation is, as well as the definition of anorexia being the voluntary placing of oneself in this state by eating a substantially reduced number of calories. The articles also cite studies, which I personally have taken the time to research and read, that discuss in detail the various calorie points that are considered by nutritionist as starving.
Anorexia IS brutal. That's the point. The POWs are an exception, as well as starving people in Africa, etc etc, but there are also cited studies that discuss volunteers from an otherwise well-fed lifestyle that participated in laboratory studies that re-created these effects at the levels I am discussing.
If you would like to provide criticism, that's fine. However, if you want to do so without doing extensive digging into the sources of the sources, then you need not speak up.0 -
I.E. My point in writing the blog post is to summarize the information that I have spent hours researching and reading. Neither one of the scientific, academic papers are "selling" something unless you are referring to publishing rights and such. I just tried to provide more than one avenue, since people learn differently and not everyone wants to read through the terms.
Apparently you missed the area of the conversation in one article that discussed the groups of people that are most likely to develop malnutrition and refeeding syndrome, where it lists cancer patients, alcoholics, anorexics, people with renal failure, undiagnosed diabetes, and on and on. This is not just about the extreme cases of POWs. This can affect ANYONE that is not feeding their body properly.0 -
I do appreciate your efforts. Accurate information is always welcome.I.E. My point in writing the blog post is to summarize the information that I have spent hours researching and reading. Neither one of the scientific, academic papers are "selling" something unless you are referring to publishing rights and such. I just tried to provide more than one avenue, since people learn differently and not everyone wants to read through the terms.
And that's the gist of my response.
http://www.rd411.com/index.php
The page cited above is to a .com site. .com indicates that the site is a commercial venture. There are numerous banner ads on the front page. On that basis, I posted that they are "selling" something and they are.
The fact that that you put some effort forth does not mean that either what you wrote is accurate or that we have to accept what you wrote as being accurate.
As I stated earlier, I read through the articles at the links and could not find the 1200 calorie figure in the articles.
There's no doubt that I might have missed it so, if you would be so good as to explain what article it appeared in and indicate where it appeared, then we could clear up the misunderstanding.
What that in the NEDA article? I did not read that.Apparently you missed the area of the conversation in one article that discussed the groups of people that are most likely to develop malnutrition and refeeding syndrome, where it lists cancer patients, alcoholics, anorexics, people with renal failure, undiagnosed diabetes, and on and on. This is not just about the extreme cases of POWs. This can affect ANYONE that is not feeding their body properly.
I just scanned that article and didn't find a mention of 1200 but I didn't scan for cancer patients, etc.
"This can affect ANYONE that is not feeding their body properly."
"properly" - how is that defined?
Yes, you're making an assertion but, without an explanation, what it means to any given person can be completely different so its value is diminished.
Now, let's steer the issues away from my reading comprehension because that's not the issue.
What I take exception to, and you have failed to substantiate, is your 1200 calorie claim.
Taking it one step further, even if that is mentioned in the literature, do you actually trust a source that states that at a calorie level of X, certain things will happen to all people?
BTW, I'm 100% in agreement with the sources that I read. I've asked you to substantiate your assertion about the 1200 calorie level.0 -
Your last sentence may perhaps be a slip of the keyboard. Don't know. It doesn't help your case — you appeal to the emotions by telling us how hard you've worked on this (which is commendable!) and then you throw it in the logical dumper with your last paragraph:I've read the documents that you've cited and I can't find anything in any of those articles to substantiate your statement "Basically, what this RFS is, is when a person who was previous starving (under 1200 calories) "
Each of the four articles refers to people who are "starving" though the last one includes "have severely restricted calories and/or sudden weight loss are also at risk.".
In addition to starving, the articles discuss fasting. The only site that mentions "severely restricted calories" is the only source that has something to sell you.
Just because a person eats less than 1200 calories per day, does not mean that they are starving.
Starvation is brutal. These articles discuss prisoners of war who were intentionally subjected to horrid living conditions, including being given almost nothing of nutritional value for months or perhaps years on end.
The idea that someone eating "under 1200" calories is in the same category is highly misleading.
I also state that this post is one that is a followup to my previous posting, which has a cited peer reviewed discussion on what starvation is, as well as the definition of anorexia being the voluntary placing of oneself in this state by eating a substantially reduced number of calories. The articles also cite studies, which I personally have taken the time to research and read, that discuss in detail the various calorie points that are considered by nutritionist as starving.
Anorexia IS brutal. That's the point. The POWs are an exception, as well as starving people in Africa, etc etc, but there are also cited studies that discuss volunteers from an otherwise well-fed lifestyle that participated in laboratory studies that re-created these effects at the levels I am discussing.
If you would like to provide criticism, that's fine. However, if you want to do so without doing extensive digging into the sources of the sources, then you need not speak up.
"If you would like to provide criticism, that's fine. However, if you want to do so without doing extensive digging into the sources of the sources, then you need not speak up."
From what I understand of the last paragraph, I conclude that I have to do "extensive digging into the sources of the sources" before I can "speak up." but you also state "If you would like to provide criticism, that's fine."
That works for me. I'm providing criticism.
And the reason why I say that you're putting your case in the dumper is that I'm just some poor schlub who wandered in an asked an innocent question and you're taking me to the woodshed for it.
It seems that you've taken my comments in a manner in which they were not intended. I didn't read all of the sources of the sources - that's just too much work! Instead, I read what I thought were the sources and, based on my reading, I couldn't find the 1200 calorie figure. If it's in the sources of the sources, please cite it. If it's not there, please state that, as well.
It's great that you're into researching "this stuff". I'm interested in it, as well, and I'd love to see a medically based document that talks about the 1200 calorie figure and compares VLCD's, LCD's, and "regular" diets (whatever those are!). I think that would be a great story to tell and, unfortunately, it's not something that I've ever seen, either here or anywhere else.0 -
Like I said, the 1200 calorie intake was from my previous posting, where I discussed the recommended rehabilitation of starving individuals. In that cited source, it was discussed that the proper rehabilitation of such individuals should start at a MINIMUM of 1200 calories and the upped from there. It is a standard of nutritional rehabilitation for the malnutritioned individual.
You did not go through all of the attached sources, I'm sure. You see, when an academic article is published, they cite sources for their information, including case studies, definitions, and trials. I know from your post that you have not read the 30+ cited sources. I have read those that I did not have to purchase viewing rights to, which are more than enough to support my statements.
Had you done what I suggested, and looked at previously researched items I have written, you would have seen that I recommend repeatedly that people who think they may have these issues see a physician and a nutritional counselor. My point is to educate, not to define any certain person's health condition.
As for you statements about the POWs, had you looked deeper into that, what it says is that the FIRST noticed instance of this was when they tried to feed those that had been kept from food during WWII. When those people began to get very sick and die, apparently from that eating, they did a voluntary experiment in Minnesota where men volunteered to be subjected to severely restricted diets for the sole purpose of learning how best to refeed the population of millions that had been so lacking of food. It doesn't say that it only manifests in POWs, nor does it say that that was the only instance other than the clinical trials.
The properly statement is on par with the eating disorders definitions, as well as attached documentation that discusses the intentional/unintentional instigation of malnutrition in children and adults that have unknown levels of restriction in their diets. These articles discuss how even if a person seems to be eating adequate food regarding their hunger, they can in essence still be "starving" due to lack of nutrients, and would face similar issues with RFS.
I personally suffered starvation and RFS in my early 20s, as did several of my friends on here and the eating disorders counselor that I know. You won't convince me that the instance rate of this in the common population is non-existent. The studies I provide, as well as my own experience, combat that argument over and over again.
Please, stop saying you "read" the articles if you didn't bother to read the entirety of the academic paper synopsis, and if you didn't take the time to pull up the various charts and diagrams that discuss risk factors, pre-disposition, results, and symptoms.
My point, at the end of the day, was to respond to the allthe people on MFP that are stating that they are trying to up their calories from their current sub-par level to the one that is right for them, and are seeing hurdles because they keep getting sick. If you can't respect that, then stop posting.0 -
Thank you for the article, I just recently joined this site and after logging my food for a week I saw that I was not reaching my daily caloric intake (just over 900). This site says I should have 1500 and have been working on it this week and have had severe headaches. Maybe I need to scale it back and ease into it.0
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I would caution you as to who you are saying has anorexia or bulimia solely on how many calories they eat or don't eat.
"People who have anorexia have an intense fear of gaining weight. They severely limit the amount of food they eat and can become dangerously thin." (webmd.com)
"People who have anorexia:
Weigh much less than is healthy or normal.
Are very afraid of gaining weight.
Refuse to stay at a normal weight.
Think they are overweight even when they are very thin." (www.webmd.com)
The technical criteria for Anorexia Nervosa based on the DSM-IV is very specific and a person with some but not all criteria cannot be classified as having anorexia. There are also different types...the restricting and the binge/purge type. :
"A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.
Type: Restricting Type vs. Binge-Eating/Purging Type. " (www.medicalcriteria.com)0 -
I would caution you as to who you are saying has anorexia or bulimia solely on how many calories they eat or don't eat.
"People who have anorexia have an intense fear of gaining weight. They severely limit the amount of food they eat and can become dangerously thin." (webmd.com)
"People who have anorexia:
Weigh much less than is healthy or normal.
Are very afraid of gaining weight.
Refuse to stay at a normal weight.
Think they are overweight even when they are very thin." (www.webmd.com)
The technical criteria for Anorexia Nervosa based on the DSM-IV is very specific and a person with some but not all criteria cannot be classified as having anorexia. There are also different types...the restricting and the binge/purge type. :
"A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.
Type: Restricting Type vs. Binge-Eating/Purging Type. " (www.medicalcriteria.com)
I would like to point out the fact that I post sources that discuss at length the definitions of these disorders, and that in my discussion, I state that people are suffering not mentally per se, but physically, it is the case. Most people with these highly restrictive diets don't realize that their restrictions are the same as those for ED.
Also, again, I discuss at length in my previously written article to which this is a followup, the dangers of the symptomology and encouraging certain behaviors. I guess I should have written more than "as discussed in my previous article" to imply that this was part of a series of educational pieces. But thank you.0 -
Like I said, the 1200 calorie intake was from my previous posting, where I discussed the recommended rehabilitation of starving individuals. In that cited source, it was discussed that the proper rehabilitation of such individuals should start at a MINIMUM of 1200 calories and the upped from there. It is a standard of nutritional rehabilitation for the malnutritioned individual.
You did not go through all of the attached sources, I'm sure. You see, when an academic article is published, they cite sources for their information, including case studies, definitions, and trials. I know from your post that you have not read the 30+ cited sources. I have read those that I did not have to purchase viewing rights to, which are more than enough to support my statements.
Had you done what I suggested, and looked at previously researched items I have written, you would have seen that I recommend repeatedly that people who think they may have these issues see a physician and a nutritional counselor. My point is to educate, not to define any certain person's health condition.
As for you statements about the POWs, had you looked deeper into that, what it says is that the FIRST noticed instance of this was when they tried to feed those that had been kept from food during WWII. When those people began to get very sick and die, apparently from that eating, they did a voluntary experiment in Minnesota where men volunteered to be subjected to severely restricted diets for the sole purpose of learning how best to refeed the population of millions that had been so lacking of food. It doesn't say that it only manifests in POWs, nor does it say that that was the only instance other than the clinical trials.
The properly statement is on par with the eating disorders definitions, as well as attached documentation that discusses the intentional/unintentional instigation of malnutrition in children and adults that have unknown levels of restriction in their diets. These articles discuss how even if a person seems to be eating adequate food regarding their hunger, they can in essence still be "starving" due to lack of nutrients, and would face similar issues with RFS.
I personally suffered starvation and RFS in my early 20s, as did several of my friends on here and the eating disorders counselor that I know. You won't convince me that the instance rate of this in the common population is non-existent. The studies I provide, as well as my own experience, combat that argument over and over again.
Please, stop saying you "read" the articles if you didn't bother to read the entirety of the academic paper synopsis, and if you didn't take the time to pull up the various charts and diagrams that discuss risk factors, pre-disposition, results, and symptoms.
My point, at the end of the day, was to respond to the allthe people on MFP that are stating that they are trying to up their calories from their current sub-par level to the one that is right for them, and are seeing hurdles because they keep getting sick. If you can't respect that, then stop posting.
We agree that I haven't read all of the source material.
I've stated that and you've stated that.
While I do appreciate all that you've written, you are once again not substantiating your statement about the 1200 calorie level.
My credentials, activities, and reading habits have nothing to do with this.
My original posting read, in full:
"I've read the documents that you've cited and I can't find anything in any of those articles to substantiate your statement "Basically, what this RFS is, is when a person who was previous starving (under 1200 calories) "
Each of the four articles refers to people who are "starving" though the last one includes "have severely restricted calories and/or sudden weight loss are also at risk.".
In addition to starving, the articles discuss fasting. The only site that mentions "severely restricted calories" is the only source that has something to sell you.
Just because a person eats less than 1200 calories per day, does not mean that they are starving.
Starvation is brutal. These articles discuss prisoners of war who were intentionally subjected to horrid living conditions, including being given almost nothing of nutritional value for months or perhaps years on end.
The idea that someone eating "under 1200" calories is in the same category is highly misleading. "
I stand by my last sentence "The idea that someone eating "under 1200" calories is in the same category is highly misleading."
You seem to feel that, because I haven't read enough, I don't understand what you've written. Sorry, you gotta find smarter readers! No, the core of the issue is the wording and, you, it appears are much more interested in writing more words rather than editing your original document.
That's unfortunate because there's a good message there (one that I'm aware of) but your insistence that my lack of background knowledge is the reason I don't understand the article is simply denial. I read the article, I know all the words, and yet what you've written simply leads the reader to the wrong conclusion.
Your research was good and most of what you wrote was on the money. The only thing I'm taking issue with is one sentence.
Thanks for your contribution.0 -
It is substantiated in my previous post on my blog, which, as I said, defines 1200 calories as being the minimum one should use in feeding an individual. That post also has links that are more specifically linked to starvation. This blog post is a FOLLOWUP. Will I change the wording? No. As far as I am concerned, all I did was ask you to look at what I've already provided, yet you still haven't. That's not my issue.0
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It is substantiated in my previous post on my blog, which, as I said, defines 1200 calories as being the minimum one should use in feeding an individual. That post also has links that are more specifically linked to starvation. This blog post is a FOLLOWUP. Will I change the wording? No. As far as I am concerned, all I did was ask you to look at what I've already provided, yet you still haven't. That's not my issue.
And I'm completely fine with that!
As a reader of your blog, I've challenged a statement that you've made and you're refusing to defend your statement. And, it's here in the record, that you're refusing to do so.
If you're interested in growing your readership, you might want to take a different approach.
I've had the good fortune to write about 15 magazine articles and I took a different approach to reader questions. (Since they occurred in the internet age, I provided links and footnotes and answered emails when people sought additional information. My undergrad thesis was before the internet so I had no link, just footnotes and biblio).
One of the results of those articles was that, in 0ver 20 years of writing software for a living, I've only ever advertised once. For the rest of all of my work, including being recruited by Apple to write software for them, I've had a steady flow of customers who seek me out and pay me for my advice and expertise.
I don't know if increasing readership is your end goal (I've heard of vanity publishing) but I'd be hard pressed to imagine that your reaction to my postings will win you any fans (I hope I'm wrong about that, though!).
Again, thanks for your work. There's a lot of good info there!0 -
I guess we look at this differently, seeing as I feel that I have defended the statement, while you don't. It's a difference of opinion. Just because you've written 15 articles for magazines, doesn't mean you trump me in my approach. It just means we differ.
I could attack back and say cite me a source that says it's healthy to eat that low that isn't from a fad diet website. I have provided ample indication as to where to find the information.
For the record, I didn't give you exactly what you want because I found your response to be rude and completely argumentative. You didn't bother to mention that there was anything worthwhile in what I had to say until later in the exchange.
I'm an internationally published author myself, and I already have an established readership. I'm not too concerned about longevity on this site, I'm not posting for popularity reasons. Maybe that's what you go for, but it's not my schtick. I post because I'm trying to help people think of things differently, and holding myself accountable to my own mistakes, to help others avoid the problems I've had to deal with because of my eating disorder.0 -
Well, of course we differ but that means nothing.I guess we look at this differently, seeing as I feel that I have defended the statement, while you don't. It's a difference of opinion. Just because you've written 15 articles for magazines, doesn't mean you trump me in my approach. It just means we differ.
I've asked you to substantiate what I see as a misleading statement.
If I understand you correctly, you feel that I should read elsewhere to understand what you're saying. That's a sign of laziness, perhaps, or someone who can't be bothered.
All in all, it's poor journalism.
If you make an assertion that's not clear, edit the document.
When you stoop to telling someone, in essence, go look it up, do you think that increases the value of what you write or do you think that it decreases it?
This implies that you have poor reasoning skills.I could attack back and say cite me a source that says it's healthy to eat that low that isn't from a fad diet website. I have provided ample indication as to where to find the information.
What I believe, think, or feel has zero bearing on your ability/desire to defend what you've written.
I haven't attacked you — I've raised a question about what you've written. Those are very, very different things.
And "attacking me [you]" would be childish and vindictive.
I took you to task on a statement that I think was misleading. You've written quite a bit but, again, have failed to respond to my simple statement.
You know, I had a bad childhood, too. Mean people are…mean. But I'm not mean.For the record, I didn't give you exactly what you want because I found your response to be rude and completely argumentative. You didn't bother to mention that there was anything worthwhile in what I had to say until later in the exchange.
I didn't insult you or call you names. My statement was very straightforward.
I've asked you repeatedly to back up your assertion and your response, in a nutshell, is "I've given you the links - go look it up."
That's a cop out, plain and simple.I'm an internationally published author myself, and I already have an established readership. I'm not too concerned about longevity on this site, I'm not posting for popularity reasons. Maybe that's what you go for, but it's not my schtick. I post because I'm trying to help people think of things differently, and holding myself accountable to my own mistakes, to help others avoid the problems I've had to deal with because of my eating disorder.
Popularity's never been my thing, frankly, and interchanges like this diminish my interest. Insofar as longevity on this site, MFP has been a good resource for me and I'll keep using the site as long as it provides value to me.
Good luck with your weight loss. Sounds like things are going an awful lot better now.0 -
Well said ATT949. I agree with what you have written.0
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The page cited above is to a .com site. .com indicates that the site is a commercial venture. There are numerous banner ads on the front page. On that basis, I posted that they are "selling" something and they are.
The gentleman is clearly new to the world of the internet. The .com extension was the only and therefore the default site address extension for years. My two sites are on a .com domain and have neither advertising, nor products/services for sale. In fact, that claim is so preposterous that I find it hard to place any credibility in the rest of your posts. I mean, you made a false claim with such conviction and certainty.0
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