Refeeding syndrome and a Migraine treatment? Part 1
"Killing with kindness"
We've all heard the phrase haven't we? Have you ever considered its meaning? This post is part one of the similarities I noticed between the syndrome's treatment and a little known treatment for Migraine, leaving me to ponder my own Migraine treatment successes and failures.
The desire to generously feed someone who has been denied food for a few days or months (examples: malabsorption, illness, prolonged vomiting, anorexia and starvation) is part of being human. We instinctively want to help. Feeding is easy, and the gratification of the giver and the receiver is often profound. However.....
'Ye old farmer has known for centuries that you can't take a starved animal and throw a bunch of food to them without disastrous consequences. The process wasn't well understood however, until the second world war and physicians begin noticing that freed Japanese prisoners of war mysteriously became seriously ill or died within days.
When the body is deprived of nourishment, the metabolism within the cells begins to change. Resources are pulled from the person's/animal's own tissues in effort to survive. The depletion of carbohydrate, protein and fatty acid stores happen in that order. The metabolism mechanism for carbohydrates shrinks or disappears, and the metabolism mechanism of protein and fats becomes dominant.
In a nutritionally deprived state, electrolytes (potassium, magnesium, phosphorous - think Gatorade) which are necessary for proper Neurologic and cell firing and function, are depleted from the cell although blood test values will remain normal. Organ function is compromised which leads to reduced cardiac output, renal and immune function, etc.
The main complications of refeeding are mostly related to the electrolyte imbalance that occurs in the bloodstream when these electrolytes are pushed into the cells by the introduction of carbohydrates and sugars which haven't been present for a while. This results in lowered electrolyte and vitamin levels where they need to be for the body to work properly: surrounding the cells in the serum.
Student BMJ says "A recent meta-analysis of 18 European and North American studies, which assessed more than 10 000 inpatients, found that 31% are malnourished. " While chronic Migraineurs aren't normally inpatients, the results of their condition - diarrhea, vomiting, inadequate nutrition - may lead them to the same results.
Symptoms of refeeding syndrome will usually be seen within the first 3-4 days of the beginning of rehabilitation and may include: muscle weakness; neurologic dysfunction including Wernicke's encaphalopathy, weakness, seizures and coma; cardiac dysfunction.
*Lowered phosphorous levels can cause hemolytic anemia.
*Lowered magnesium can cause irritability, aggression and Migraine or other headache.
*Fluid overload can be a result of lowered cardiac and kidney function because increased insulin levels lead to sodium and water loss.
*Thiamin deficiency can be a problem and is an integral part of carbohydrate metabolism. Introduction of increased carbohydrates makes this situation worse. Symptoms of thiamin deficiency may include disturbance of the eyes, loss of coordination, changes in normal thought patterns and coma.
*Phosphorous depletion is often missed in these patients, but is key to the syndrome.
Those with prolonged malabsorption, under-feeding or starvation need to be closely monitored. If signs of refeeding symptoms appear, IV fluid therapy is given because the villi in the intestinal tract may be compromised and unable to absorb the needed nutrients.
Stay tuned for part two!
For more information
Magnesium for Migraine
Migraine Treatment
Vitamin Supplements
We've all heard the phrase haven't we? Have you ever considered its meaning? This post is part one of the similarities I noticed between the syndrome's treatment and a little known treatment for Migraine, leaving me to ponder my own Migraine treatment successes and failures.
The desire to generously feed someone who has been denied food for a few days or months (examples: malabsorption, illness, prolonged vomiting, anorexia and starvation) is part of being human. We instinctively want to help. Feeding is easy, and the gratification of the giver and the receiver is often profound. However.....
'Ye old farmer has known for centuries that you can't take a starved animal and throw a bunch of food to them without disastrous consequences. The process wasn't well understood however, until the second world war and physicians begin noticing that freed Japanese prisoners of war mysteriously became seriously ill or died within days.
When the body is deprived of nourishment, the metabolism within the cells begins to change. Resources are pulled from the person's/animal's own tissues in effort to survive. The depletion of carbohydrate, protein and fatty acid stores happen in that order. The metabolism mechanism for carbohydrates shrinks or disappears, and the metabolism mechanism of protein and fats becomes dominant.
In a nutritionally deprived state, electrolytes (potassium, magnesium, phosphorous - think Gatorade) which are necessary for proper Neurologic and cell firing and function, are depleted from the cell although blood test values will remain normal. Organ function is compromised which leads to reduced cardiac output, renal and immune function, etc.
The main complications of refeeding are mostly related to the electrolyte imbalance that occurs in the bloodstream when these electrolytes are pushed into the cells by the introduction of carbohydrates and sugars which haven't been present for a while. This results in lowered electrolyte and vitamin levels where they need to be for the body to work properly: surrounding the cells in the serum.
Student BMJ says "A recent meta-analysis of 18 European and North American studies, which assessed more than 10 000 inpatients, found that 31% are malnourished. " While chronic Migraineurs aren't normally inpatients, the results of their condition - diarrhea, vomiting, inadequate nutrition - may lead them to the same results.
Symptoms of refeeding syndrome will usually be seen within the first 3-4 days of the beginning of rehabilitation and may include: muscle weakness; neurologic dysfunction including Wernicke's encaphalopathy, weakness, seizures and coma; cardiac dysfunction.
*Lowered phosphorous levels can cause hemolytic anemia.
*Lowered magnesium can cause irritability, aggression and Migraine or other headache.
*Fluid overload can be a result of lowered cardiac and kidney function because increased insulin levels lead to sodium and water loss.
*Thiamin deficiency can be a problem and is an integral part of carbohydrate metabolism. Introduction of increased carbohydrates makes this situation worse. Symptoms of thiamin deficiency may include disturbance of the eyes, loss of coordination, changes in normal thought patterns and coma.
*Phosphorous depletion is often missed in these patients, but is key to the syndrome.
Those with prolonged malabsorption, under-feeding or starvation need to be closely monitored. If signs of refeeding symptoms appear, IV fluid therapy is given because the villi in the intestinal tract may be compromised and unable to absorb the needed nutrients.
Stay tuned for part two!
For more information
Magnesium for Migraine
Migraine Treatment
Vitamin Supplements
Tags: carbohydrates, electrolyte, insulin, malabsorption, migraine, refeeding, renourishing, vitamin
Comment
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Comment by Ellen S on March 29, 2009 at 1:12pm - Oops! Here is the link to the Dystonia groups discussion on Mito disorders. Really informative.
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Comment by Ellen S on March 29, 2009 at 1:11pm
- cherishdestiny, have you ever done any research about mitochondrial disorders? There is an excellent thread about it on the Dystonia page. I've not yet gotten around to blogging about mitochondrial disorders and Migraine, but Jen, our resident Neuroscientist has some information from the perspective of someone seeking a diagnosis, and there are others here like bkaren46 and others telling about their experiences and giving great links to find even more information about this often missed condition. I think you'll be really surprised to read about the connection between Migraines, gastroparesis and Mito. Maybe it's a longshot, but maybe it's something important...
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Comment by cherishdestiny on March 28, 2009 at 10:09pm - Thanks for posting this. I'll have to find a way to share it with my spouse. In addition to my migraines, I have gastroparesis that refuses to react to any medication on the market (including the domperidone that I ordered from abroad). So my stomach doesn't like to take in much food and as a result I never want to eat (much). On the other hand he's always pressuring me to eat a lot which inevitably leaves me feeling not only digestive sick but overall miserable for days. So this explains a LOT, including what the docs have been trying to explain to both of us.
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