refeeding syndrome

Japanese historians just released a paper about the deaths from refeeding syndrome, after a seige of a castle in the middle ages:

After many lives were lost through starvation, castle lord Kikkawa Tsuneie (1547-1581) is believed to have committed ritual seppuku suicide to save the remaining personnel in his fortress. Hideyoshi distributed porridge to the starving survivors but more than half of them perished soon after consuming the gruel. According to Kano’s accounts, this page of history regarding the massive post-siege death toll at Tottori Castle was conventionally linked to refeeding syndrome in the medical community in Japan.

But no papers have ever been released to support the theory. Refeeding syndrome is a metabolic complication that is said to lead occasionally to heart failure, respiratory difficulties and other severe conditions associated with vitamin deficiency. It occurs when patients with chronic nutritional disorders are given nutrients abruptly,

They concluded the widespread deaths were likely due to refeeding syndrome as a result of the victims ingesting carbohydrates immediately following the end of a prolonged period of excessive hunger.

this has been reported many times in history. Wikipedia has the history of this, and cites Hippocrates for first noticing it.

Wikipedia cites articles that blame it on:

When too much food or liquid nutrition supplement is eaten during the initial four to seven days following a malnutrition event, the production of glycogen, fat and protein in cells may cause low serum concentrations of potassium, magnesium and phosphate.[2][3] Cardiac, pulmonary and neurological symptoms can be signs of refeeding syndrome. The low serum minerals, if severe enough, can be fatal.,

more here:

Refeeding syndrome is defined as medical complications that result from fluid and electrolyte shifts as a result of aggressive nutritional rehabilitation.

Actually these things are not the same.

first you have the people who come out and eat quickly and drop dead. Probably from electrolyte shift.

Then you have people who die over a few days: Probably from the body's inability to use the food given to them.

and I suspect there might be several reasons for the high mortality when you start feeding people after malnutrition or starvation.

In Africa, we screened kids at baby clinic, and referred them to our nutrition center for early refeeding (or had our village health workers work with mom on how to refeed them using food available in the villages).

But once the kid came in with kwashiorkor, although we would slowly refeed, often after a few days they would lose their body temperature and just die quietly on us.

Sigh

Physiologically, the problem was that prolonged malnutrition led to blunting of the cells that absorb nutrition, so the food just isn't absorbed. And the heart muscle is slowly replaced with fibrous tissue from months of low protein diet, meaning it might not recover quickly so the heart would be unable to meet the increase of work needed for food etc.

so it's not just electrolyte imbalance, although the electrolyte imbalance could be the cause of sudden death/

actually, I wonder if it's not from sympathetic nervous system rush.

When I had Dengue and was on IVs, I didn't eat for several days. But then our maid decided I should eat a full meal, and after eating rice and meat, I promptly vomited and my bowels releases a huge amount of BM. Almost as if my system was getting rid of everything.

Malnutrition: vegan madness and kwashiorkor

a vegan influencer living in Malaysia dies of malnutrition.

no I don't have a lot of sympathy for her. One wonders how many others she influenced have developed medical problems: being vegan is a cult. Remove organized religions (That have 2000 years experience in what is good and bad) and all sorts of crazy ideas proliferate: but the main reason I am not sympathetic is that these types are rich upper class types who are hoity toity to the rest of us (both deplorables and poor people). And quick: How many vegans work with the homeless etc. When PETA was out in Manila demonstrating, I didn't see them giving food to the poor street kids nearby. In contrast, most churches do outreach to the poor here.

Dirty little secret:

Vegan diets are lacking protein and certain vitamins. There are several reports out there about children in the affluent west suffering malnutrition and even dying because their crazy moms didn't feed them corectly

the  UKMail article shows photos of a severely undernourished lady. She was an influencer and like other cult learders this lady got lots of positive feedback on how wonderful she was, never mind that she was pushing bad advice.

Or is it a variation of anorexia nervoxa?

Ironically a lot of so called medical sites are very sympathetic to those idiots and their diet. Because too many fat people fill up the clinics. (Is it gluttony, or Plastics?)

And of course the green idiots running the world are pushing vegetarian diets so often cite their health benefits: Ignoring that yes they don't get diabetes or obesity but ignore that malnutrition makes you vulnerable to infectious disease.

In medical school, we used to call such malnourished people as having "PPP" i.e. P=ss Poor Protoplasm....

Many of these people were usually poor from the slums who couldn't afford meat and ate lots of bread but few veggies or fruit and not a lot of meat/milk/eggs due to poverty, (and the difficulty in buying food in slums aka food deserts...). Things have now improved since I was in medical school: food stamps and the WIC program have made these problems less acute.

 but I left the USA before the big homeless social epidemic hit and I suspect docs are seeing a lot more malnutrition....

 I worked mainly with the rural poor and on the Res, and we had a lot of alcoholics who got most of their calories from alcohol. 

Nowadays, meth would do this, but ironically when I worked on the res, we didn't have meth and only a little cocaine: mainly marijuana and alcohol. So I know a lot about nutrition but not much about vegans or drugs.

and we had outreach to our diabetics, and WIC  that helped stop malnutriton in babies (and we stressed breast feeding). There is a reason the Public Health Service staffs these hospitals: outreach...and now the tribes are taking them over but often the staff are trained in preventive medicine and tribal customs and there is Indian preference in hiring and that helps too.

Racism is real...Yes but not race per se but ignorance or disdain for people who don't think and act like upper class white elites.

However, most of my expertise in nutrition was when I worked in Africa.

We had a lot of kwashiorkor and marasmus among babies when I worked in Africa. 

Marasmus was usually babies whose moms got pregnant too soon and the babies couldn't eat/digest adult food. But Kwashiorkor was in older toddlers who had been weaned: Meaning they now had no breast milk and the adult diet lacked protein.

We had a nutrition village to educate moms into learning to use a proper diet; Stressing chickens in cages (hybrid high egg-laying European chickens cross bred with local chickens who had resistance to local diseases) We kept them in cages because of feral dogs and also so when they laid eggs the eggs could be gathered. Part of the training was to give the egg to the kid, not the father. 

This might be seen as male privlege, but the reason the father gets the protein and food first is because if the father dies, the entire family could die, since it requires a man to plant maize etc with an oxen (women planted what we would call kitchen gardens, veggies and grain but not enough to feed everyone, but often sold for money to buy other things).

That is also the reason that the custom was that if the father died, the wife would marry his brother, to care for her and his brother's kids.

globalization pushed men and women to work in cities or overseas and send money home to keep the family going...And of course now China got rich using the same idea (bring peasants to work in factories let wifey at home with the kids to care for grandmom). 

Sigh. Both good and bad in this: but that's anothe discussion.

So how do you do outreach to traditional communities to improve health and nutrition?

Andrew Webwafa has a lot of videos up on youtube about his outreach clinics, including nutritional ones, if you want to know how this outreach is done.

Latest fad: The New Jersey diet

...............

every year there is another "magic" diet.

The problem of obesity is world wide now. Why?
well, here in the Philippines, whereas in the past kids worked in the fields they now take a tricycle to school.
And their parents now have handplows and threshers that make growing rice less work intensive.
And of course, even if you can't afford the 75 peso hamburger at McD or the 50 peso hamburger at jolibee, you can buy two for 25 pesos at the kiosk at the night market.

And women don't have 6 kids anymore (the fertility rate is down: most women have two or three kids).

And what no one wants to discuss: Estrogens in plastic and phytoestrogen in the envirtonment, and  estrogen from birth control pills.

which induces the gene for metabolic syndrome.

Of course, I am superstitious: My Austrian aunt, who is tiny because of the starvation of the WWI era, visited her home village in the 1930s and told everyone there was going to be another war.
This was when Hitler was not being taken seriously, so my mom asked her how she came to that conclusion. And she replied: because all the peasant women were getting fat, because they sensed a war was coming.

Hmm...

Breast is best

We always encouraged our moms to breast feed, and one problem was when milk formula companies peddled their products to poor women.

But as the kids got older, the parents couldn't afford formula, so watered it down and the kids ended up malnourished and often vulnerable to die from infections.

So when I read the headlines claiming Trumpieboy opposed breast feeding, I thought "WTF?"

No, not because I suspected fake news (I am used to nuances being twisted by the MSM against Trumpieboy), but because public health docs have pushed to stop this for years at the local level.

So making it a UN resolution means lots of money for UN bureaucrats to push their weight around, but not much else.

and my other question was: This issue has been around for years (we opposed this in the early 1970s) so why did it come up now, at a time when people in third world countries are a lot richer, and there are a lot more women who need to work outside the home and use formula because they can't breastfeed?

This is what I found back in the 1970s: breastfeeding was universal in rural Zimbabwe, where babies often were not weaned until 2 years old, but in urban Liberia, the patients and nurses pointed out that these women needed to work and so needed formula to feed their babies.

Nowadays, here in the Philippines, they often breast feed for up to a year, but again often supplement the child's feeding with formula.

TV ads here for formula often only are about older kids, and do insist that breast feeding is better.

what has changed in the last 40 years is that people are now richer.

Yes, there are poor people, especially in war torn countries, but as a whole, there is a lot less poverty around.

And insisting on breast feeding until one year of age means women would not be able to hold a job outside the family. Back to the good old days!

Hmmm... this is the real "Handmaiden's tale".

The Federalist has the backstory and indeed it is "fake news".

“The Trump Administration believes it’s a public health priority that women and their families have all the information to decide how to appropriately deliver nutrition to their children, whether it is via breastfeeding or other methods,” an HHS spokesman said. The agency pointed out that the United States has a long history of supporting breastfeeding and breastfeeding programs, and is the largest bilateral donor of foreign assistance programs in this area. Exclusive breastfeeding rates have doubled across 20 of countries where these programs have focused between 1990 and 2014, they say. The U.S. also supports complementary feeding programs and accurate description of the same as a matter of long-standing policy. The original resolution would have made that policy goal difficult, officials said.

Viking stuff

Archeology.org:

Did the high incidence of alpha 1 antitrypsin help the Vikings survive the fact that they carried a lot of parasites?


This can cause emphesema and liver disease.

 Last year, Danish scientists studying the remains of a Viking privy found that the ancient Norse and their domestic animals were infested with a variety of intestinal parasites. These parasites release enzymes called proteases that cause disease. The immune system also creates proteases that can cause inflammation and damage, but the body has natural defenses against those, including a molecule called alpha-1-antitrypsin (A1AT).

Because they were more or less constantly infected, Vikings evolved to produce “deviant” forms of A1AT that were specifically useful against worm-related proteases instead of the body’s own.

In the absence of normal A1AT, the immune system’s own proteases are free to damage tissue, including in the lungs and liver. At the time, the benefits of this genetic mutation outweighed the risks. Not so today.

-------------------
 Science has an article about the lost Viking settlement in Greenland.

The story goes that they were farmers, but when the Little Ice Age came, they kept farming and slowly starved to death because they were just too rigid to learn to hunt seals etc from the local Inuit.

But now some question that since the prescence of seal bones in the garbage heaps suggest they did hunt a lot.


For later reading.

Arsenic in ground water

I was checking the Pirate bay for downloads (Outlander S02E12 actually... I haven't seen it available on local TV yet but it will probably arrive in Asia next year since we tend to be a year or two behind... except for stuff like the walking dead, which is advertised as "same day as the USA"...) . Illegal? Sort of: they passed a law but it is on hold if I remember correctly.

well, anyway, while on that site I found someone had posted quite a few books on Arsenic and water today.

These textbooks are illegal, of course, but on the other hand they are probably useful for those working in rural areas who don't have oodles of money to spend on such stuff.

No, I didn't download them: Too technical. But one of the books was about South America's arsenic problem.

South America? I was aware of the mass poisoning of Bengladesh from deep wells dug so people could have safe water (and not die of dysentary etc) but I wasn't aware of the problem in South America.

Well, anyway, the WHO has a report here on Peru with an introduction that summarizes the problem

An estimated 200 million people worldwide are exposed to arsenic concentrations in drinking water that exceed the recommended limit of 10 µg/l1 as set out in the guidelines of the World Health Organization (WHO).2 The majority of this exposed population lives in southern Asian countries such as Bangladesh, Cambodia, India, Nepal and Viet Nam. In addition, elevated levels of arsenic have been found in several countries in Latin America, such as Argentina, Bolivia, Chile and Mexico. Recent estimates suggest that at least 4.5 million people in Latin America are exposed to arsenic levels higher than 50 µg/l – the Bangladeshi threshold.

some of this is from mining run off, but a lot is from natural groundwater contamination.

We grow brown rice, and there is a problem with that because the bran concentrates arsenic if the irrigation water is contaminated. more HERE

But so far, this is not a problem here in the Philippines

Psst: It's the food, guys

StrategyPage has an article on China's military, that includes this:

February 24, 2014:  The Chinese military has noticed that current recruit are larger than those of two decades ago. On average the current recruits are 20mm (.8 inch) taller and 50mm (two inches) larger at the waist. Designers of military equipment have been ordered to adjust the design of vehicles and other equipment to reflect this. This sort of thing is not unique to China....
 

This growth is one of the side effects of affluence. Prosperity does many things, one of the more obvious effects is to make children and grandchildren of those who started the economic boom obviously larger. More food, especially more meat, makes children grow larger. This was first observed during the 1980s in Japan where many family photos, which included three generations, revealed dramatic differences in the height of each generation. Those who grew up before World War II were noticeably smaller than those born in the 1950s when the food supply was more regular and more abundant than before the war. The kids born in the 1970s were, as adolescents, larger than their parents and towered over their grandparents. Now it’s happening to China, which experienced food shortages throughout the 20^th century. This did not begin to improve until the late 1970s. Now many affluent Chinese have to worry about obesity.