What are the best practices in the military, international aid, a medical communities regarding feeding someone who has done without food for an extended period of time? I know that great care must be taken to not give them too many calories at once, lest their bodies react horribly. But is there a formula (no pun intended)? Like so many grams of food per kilo of body weight?
Also, is there a certain foodstuff that’s used in these industries, like an energy bar or something? Or do they just go with whatever is available?
And, specific to the Thai soccer team, does anyone know what the Thai navy has been giving those lads? They’ve all written their families about what they’re going to eat when they get out - one lad wants KFC!
And yes, I know that after ten days, those boys weren’t near death from starvation, but you get my point.
Many meal replacement products exist. Often used in hospitals for patients nearing death who stop eating, etc. They have many applications, some are likely available at your local drugstore.
They are, by design, easy on the gut, but packed with nutrients, calories, vitamins etc. They likely start with something very similar.
I’m surprised that the people on the TV show “Naked & Afraid” seem to not be worried about what they eat immediately after basically starving for 21 days. Maybe the post show food regiment just is not mentioned, but some of them lose 30 pounds or more so I doubt they consume even 1000 calories during the 21 days.
There was a study back during WW2 in which volunteers deliberately fasted to the point of near starvation. (Eg grown men reduced below 120 lbs). The researchers tried different diets to see what was most effective at reconstituting them. They found there was no significant difference between diets. All that mattered was getting calories in their body.
However, there is one caveat: The volunteers in the experiment were eating daily. They were getting insufficient calories, but their diet was healthy and their metabolism was still working. If someone goes too long without eating at all, their metabolism slows to the point that the stomach basically stops functioning. These patients need to be fed smaller portions until their metabolism gets back up to speed. There have been people who forged themselves after starving and died of metabolic imbalances (aka refeeding syndrome).
The US aid agencies use a manufactured food product, its a specially soft milled grain product. Its easy for people to digest, its well hydrated to help with water that’s been lost, and vegetarian to avoid cultural taboos, its very bland according to newspeople who try it, although starving people don’t really complain.
When people are strong enough to accept other foods, a bread product and a fish and grain product are switched over. This also avoids food cultural taboos, unless there’s a fish taboo, which I assume people are now strong enough to mention. I guess there’s a chicken product, in that case.
The important thing is: soft, bland, moist, culturally sensitive. Not: tasty, highly nutritious, vitamin fortified, “hey let’s play some football now” levels of nutrition. To start with. After people are back from the brink of death, then its time to correct vitamin deficiencies, determine what foods are culturally acceptable, determine how to acquire and provide such foods, distribute such foods fairly, provide housing and cooking facilities in a culturally typical manner, etc.
I really remember during the Somalia famine, a skinny mother is hand feeding a infant, so scrawny it must have had virtually no food at all for its life so far, and the news guy, in crisp khakis in contrast to the woman’s rags, going “Edible, not palatable.”
Really guy, really. That’s the point of your news blurb. What, no steak delivery to random villages on the Indian sub-continent? No grilled pork chops to random people from sub-Saharan Africa, we’re just gonna pretend we never heard of Islamic dietary rules?
So what’s a person to do if you’re in an isolated locale and you don’t happen to have access to Dewey Finn’s ready made foods? Say a person stumbles out of the wilderness and collapses in front of my hunting cabin. I pull him in but there’s no way to get him back to town or to get help to him in my remote location. What kind of common, everyday grocery store foods would be best? I was thinking about a basic veggie beef soup diluted to one third strength with water and then run through a blender? Give him half a cup or so of this broth every hour or so and hope there are no bad effects. If it goes down well then slowly add more substantial foods.
Any other hints? How can I avoid killing this guy with too much normal food too fast?
Most people at risk for refeeding syndrome will do ok IF their calories are limited to just a bit more than they need for basic metabolic needs. So just feed them easily digested stuff in small amounts, and keep the calories well under 2400 in a day for your typical adult and you’ll probably be ok. Especially avoid any rapid increases in caloric intake, even if they say they’re really, really hungry.
When the British Army took control of Bergen Belsen in April 1945, they found 50,000 survivors, all emaciated.
I read elsewhere, in an account from one of the army doctors, that they had to order soldiers not to give them food from their rations as it was killing them.
When the 16 survivors emerged from the Andes in 1972 after their plane crashed and they had to eat the bodies of their friends after their food ran out, one of them ate a daisy after his helicopter landed, and the two young men (Nando Parrado and Roberto Canessa) who initially walked out were offered bread and cheese, and were tearing chunks of them off and swallowed them whole. AFAIK, these did stay down.
After they were taken to the hospital, they were initially given things like Jello and beef broth, until the doctors heard how they had kept themselves alive for the previous two months.
Fifteen are still alive; the oldest one died in 2015 at the age of 79. I recommend reading this link to the end; he had a very interesting life even excepting this.
If you ask for refugee diet (RFML) on some airlines, you get a small amount of white rice.
White rice is not a nutritionally complete meal: it’s not a cure for malnutrition. It’s what you give people who are healthy but haven’t eaten for a while.
What about congee? I first heard of this when I read Joan Didion’s wonderful (and very sad) book, “The Year of Magical Thinking”; for a while after her husband’s sudden death, it was the only thing that tasted good, and she was able to get plain congee - just rice, chicken broth, and spices - from a Chinese take-out place around the corner.
Anderson Cooper did a piece on PlumpyNut a few years ago for “60 Minutes”. He was reporting from Africa (don’t remember where, but it was in a desert) and he asked a nurse or dietitian about peanut allergy. She replied that she’d never seen a case of it there, because food allergies seem to be a First World disease. I also remember women carrying 5 or 6 of these plastic containers, that looked like butter tubs, on their heads, and a little boy who couldn’t have been two years old walking around holding one on his head.
People in a starvation mode, regardless of why, also need their electrolytes (sodium, calcium, potassium, magnesium, chloride) monitored and adjusted accordingly in addition to keeping them hydrated. If they can’t find a vein, they may insert an IV needle into a fatty area like the buttocks, abdomen, or under the breasts, or even into the tibia in extreme cases. :eek: The latter is most commonly used in babies; I never saw it ordered, and I read that one of the American Ebola patients had to have this done due to severe third spacing, and said it was every bit as painful as it sounds.
Bread & water.
And somewhat limited quantities – smaller meals every few hours. Bread is non-dense enough that even if they stuff themself with it, that’s still not too bad.
After a day or so, start adding some protein to the diet: bread sandwiches with cheese or meat; and meat broth with some vegetables, like your beef veggie idea, or the traditional chicken noodle soup. Yhat should do for a few days, until you can get medical help.
The process of turning food into a usable form of energy in digestion uses significant amounts of electrolytes (potassium, phosphorus, calcium, sodium, and magnesium.) Someone who has been without food for a significant time is probably already quite low on these. A large calorie ingestion could easily cause an extreme imbalance. Electrolytes are also crucial in muscle operation. The heart being mostly muscle could be effected, causing an episode, possibly a fatal one.
So, you want to reintroduce calories slowly, as has been mentioned above, making sure to include electrolyte dense foods such as fruits (bananas are great), nuts (including peanuts - yes I know it’s not really a nut), green leafy veggies, and dairy. Maybe a nice trail mix and some yogurt!
Be wary (at least at first) of off the shelf sports drinks and meal replacement drinks like Ensure as these are notoriously high in sugar.
What are the different stages of starvation? For boys going 9 days without food, they are not at death level starvation but they are certainly past initial-hungry first few days. (They might have been nibbling small food supplies that they took with them into the cave, too, I hear, which prevented their digestive systems from going to sleep?)
Therapeutic foods, such as Plumpy’nut, are also very rich in vitamins and minerals. They basically contain everything needed to digest the fat and protein and access the calories. Self contained, as it were. There is no worry about additional depletion of minerals.
Also, the WHO recommends that acute malnutrition be attacked in phases, and as such, most therapeutic foods come in varying calorie “sizes.”
