Long-fast refeeding effects

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Hi All,

Below are first a popular press accouny and then a medical account of the

effects

that long-term fasting with only water on human physiology after and during

refeeding.

http://news.bbc.co.uk/1/hi/entertainment/tv_and_radio/3203472.stm

.... Illusionist Blaine walked free from his Perspex box in London on

Sunday,

after completing his 44-day starvation stunt.

Crowds packed the area near London's Tower Bridge to see the 30-year-old

American

emerge at 2200 BST, clearly weakened by his apparent endurance test.

.... After his release, Blaine - who had nothing but water during his stunt - was

put

on a stretcher by paramedics and taken to a private hospital.

Blaine's box was tipped on its side to allow the illusionist to walk out.

.... A nutritional expert has warned that Blaine risks death if extreme care is

not

taken when he begins eating again.

Professor Marinof Elia, from the University of Southampton, said the illusionist

could be at risk from serious problems, including a ruptured stomach and sudden

death.

About 10,000 people packed the area to watch Blaine's exit

The magician described suffering severe heart palpitations, blurred vision and

breathing difficulties as his fast neared its end.

Blaine went straight to a clinic where a team of doctors will assess whether he

has

done lasting damage to his heart or other organs.

" He could be in hospital for a few days or more than a week, " said a spokesman.

His team has dismissed suggestions that Blaine has kept himself alive by having

dissolved nutrients such as glucose added to his water supply, saying that the

water

was pure.

It is thought that it could take as long as six months for Blaine to recover his

muscle strength and return to his normal fitness. ...

Korbonits M, Blaine D, Elia M, -Tuck J.

Refeeding Blaine -- Studies after a 44-Day Fast.

N Engl J Med. 2005 Nov 24;353(21):2306-2307. No abstract available.

PMID: 16306536

To the Editor: The opportunity to study the effects of refeeding after prolonged

fasting is rare. We recorded anthropometric, biochemical, and endocrine changes

during the refeeding period after a much-publicized 44-day fast by Blaine,

a

performance artist; we compared the findings with results obtained from a

control

group of 16 age-matched men who had a similar body-mass index (the weight in

kilograms divided by the square of the height in meters) after an overnight

fast.

Blaine ingested only water during his fast. He lost 24.5 kg (25 percent of his

original body weight), and his body-mass index dropped from 29.0 to 21.6. His

appearance and body-mass index after his fast would not by themselves have

alerted

us to the risks of refeeding. Despite cautious management, he had

hypophosphatemia

and fluid retention, important elements of the refeeding syndrome.

After hospital admission, he underwent hypocaloric refeeding for the first three

days with an oral, nutritionally complete liquid formulation and oral vitamin

and

mineral supplementation (Figure 1). His metabolic status when he arrived at the

hospital on completion of the fast showed preserved blood sugar of 5.2 mmol per

liter and normal levels of cholesterol and triglycerides, but elevated levels of

free fatty acids (1.53 mmol per liter; control-group mean [±SD], 0.50±0.27 mmol

per

liter) and a greatly elevated hydroxybutyrate level (4.92 mmol per liter;

control-group mean, 0.163±0.34 mmol per liter). The levels of vitamins B1 and B6

were depleted but were replenished immediately after admission.

Hemoconcentration

was observed on the day Blaine was admitted (day 0), and by day 10 there was

slight

edema, despite a restricted salt intake. On admission, his potassium level was

slightly low (3.3 mmol per liter), but the magnesium level was normal.

Subsequently,

the potassium concentration returned to normal with oral supplementation.

Hypophosphatemia was observed on day 1 (Figure 1), necessitating prompt

treatment

with intravenous phosphate. Grossly elevated levels of vitamin B12 (>1500 ng per

liter; normal range, 150 to 900), high levels of zinc (31.7 mmol per liter;

normal

range, 11 to 24), and slightly abnormal liver function (alanine

aminotransferase,

218 U per liter; aspartate aminotransferase, 157 U per liter) were also

observed.

High levels of insulin-like growth factor–binding protein 1 (33 ng per

milliliter;

control, 14±11 ng per milliliter), somatostatin, and cortisol, low-to-normal

levels

of insulin and very low levels of insulin-like growth factor I (65 ng per

milliliter; control, 211±53 ng per milliliter), leptin (1.7 ng per milliliter;

control, 4.6±3.6 ng per milliliter), and ghrelin (27.6 pmol per liter; control,

218±157 fmol per milliliter) were observed at the end of the fast; circulating

levels of peptide YY, agouti-related peptide, -melanocortin-stimulating hormone,

neuropeptide Y, and pro-opiomelanocortin were not substantially different from

the

levels in control subjects after an overnight fast. Blaine's sensation of

hunger,

which he did not have during the first few days, increased considerably on day

3;

this increase had been immediately preceded by an elevation in plasma levels of

orexin A and resistin, an observation of unclear relevance, given the available

data.

Al Pater, PhD; email: old542000@...

__________________________________

- PC Magazine Editors' Choice 2005

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