How do you feed a starving person in a way that won't kill them?

Question

AFAIK people that suffer from severe starvation (e.g., prisoners liberated from concentration camps in the end of WW2) can die if you allow them to eat "at will". There is documented evidence that eating too much after prolonged starvation can make you physically ill immediately, as well as refeeding syndrome which occurs because the body doesn't have the materials necessary to sustain digestion (And can be fatal).

If you don't have access to medical equipment, such as drips and some kind of nutrient solution, but just more common food of the type you have with you when camping or at home - how do you feed someone suffering from starvation in a safe way?

Answer 1

DISCLAIMER: This answer is only about "how to break fast" and prevent refeeding syndrome in otherwise healthy adults, not in those who suffer from chronic alcoholism, eating disorders, cancer or other conditions.

Refeeding syndrome can occur within few days of rapid feeding that follows prolonged starvation lasting for more than 5 days. Symptoms can include weakness, muscle cramps, tingling, seizures and, possibly, death.

Refeeding syndrome occurs due to glucose that quickly enters the cells and drags phosphate, potassium, magnesium and vitamin B1 with it, resulting in hypophosphatemia and, less commonly, hypokalemia, hypomagnesemia and vitamin B1 deficiency. Sodium and water retention resulting in edema can also occur.

Prevention of refeeding syndrome:

• Slow feeding in the first week:
  • after 5-10 day fasting: 20 Kcal/kg body weight/day
  • after >10 day fasting: 10 Kcal/kg body weight/day
• Taking multivitamin supplements, including vitamin B1, daily for at least 10 days
• Eating usual foods, but taking care to get enough phosphates (meat, canned fish with bones, cheese, eggs) and potassium (potatoes, bananas)
• Avoiding foods high in sugars and other quickly-absorbable carbohydrates (fruit juice, soda, sweets, white bread, pasta cookies or rice) to prevent quick blood glucose shifts
• Drinking only as much water as necessary to maintain normal skin turgor and excretion of clear or straw-yellow urine, and avoiding excessive salt intake to prevent water retention (swollen ankles)

Sources:

1. Refeeding syndrome: what it is, and how to prevent and treat it (PubMed, 2008)
2. The Importance of the Refeeding Syndrome (Hopkins Medicine, 2001)
3. Refeeding syndrome – awareness, prevention and management (PubMed, 2009)
4. Refeeding Syndrome: Recognition Is the Key to Prevention and Management (Journal of American Dietetic Association, 2008)