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.,
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.
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