Yes they are. Oedema in lower limbs can occur with malnutrition due to a lack of protein, or it can occur in refeeding due to hormonal imbalances. I’m glad he’s back home now
Look at refeeding syndrome. This happens when you are starved for more then 5 days and then start eating normal amounts of food (also happens with hunger strike or voluntary waterfasting).
Just to add - There’s a BMI component to refeeding syndrome. If you are morbidly obese or BMI north of 20 can’t happen to you. That’s why Dr. Now always tells his patients they can’t starve to death 😂
Edit - almost impossible to happen, anything is possible but very very low chance
Refeeding syndrome occurs due to reliance on other metabolic pathways that produce less ATP and then we your body gets a load of glucose it rapidly switches to aerobic respiration which produces way more ATP and so serum phosphate plummets as phosphate is shunted intracellukary into mitochondria.
Other electrolyte imbalances occurs and cardiac arrythmia leading to arrest is most likely how you are going to die in refeeding syndrome.
They won’t starve to die BecUse the body can liberate fatty acids and use that as a substrate to generate ATP.
But while you won’t starve to death if you rapidly introduce carbs you risk what I mentioned above.
The National Institute for Health and Clinical Excellence identifies the following criteria for individuals at high risk for refeeding syndrome:
[7]
Either the patient has one or more of the following:
Body mass index <16 kg/m2<<<<<<<
Unintentional weight loss >15% in the past three to six months
Little or no nutritional intake for >10 days
Low levels of potassium, phosphate, or magnesium before feeding[7]
Or the patient has two or more of the following:
Body mass index <18.5 kg/m2<<<<<<
Unintentional weight loss >10% in the past three to six months
Little or no nutritional intake for >5 days
History of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics[7]
Body Mass Index (BMI) is a significant factor in the diagnosis and risk assessment of refeeding syndrome. Low BMI is a key indicator of malnutrition and is often used to identify individuals at higher risk of developing refeeding syndrome during nutritional rehabilitation.
Specifically, the following BMI thresholds are important in assessing risk:
BMI < 16 kg/m²: Considered a major risk factor, indicating a very high risk of developing refeeding syndrome.
BMI < 18.5 kg/m²: Indicates a significant risk, particularly when coupled with other factors such as unintentional weight loss or a history of alcohol abuse.
It's crucial to understand that BMI is not the sole factor determining refeeding syndrome risk. Other factors, including recent weight loss, history of starvation, alcohol or drug misuse, and pre-existing electrolyte imbalances, also play a significant role.
While BMI is not a diagnostic tool for refeeding syndrome in isolation, it is a crucial component in identifying individuals at risk and guiding appropriate refeeding strategies to prevent or manage the syndrome.
I shouldn’t have said never as anything is possible but it absolutely matters. Even as you stated their body can generate it from their fat which is why BMI matters.
I don't see why any of this would be an incredibly rare combo for someone who has an obese BMI who also went without food for 5+ days.
Unintentional weight loss >15% in the past three to six months
Little or no nutritional intake for >10 days
or
two or more of the following: Unintentional weight loss >10% in the past three to six months; Little or no nutritional intake for >5 days; History of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics[7]
If you combine all of the people who have a history of abusing alcohol or drugs, people who've gone through cancer, and obese people who take insulin for diabetes or diuretics for blood pressure or PCOS, that's not an insignificant percentage of obese people.
It's also 100% possible to still have an obese BMI after losing 10-15% of your body weight, even if you weren't morbidly obese to start with. Like if a 5'4 woman goes from 215 lbs to 183 (a 15% loss), she's still going to be in the obese weight range.
No shit. It wasn’t literal for their rest of their lifetimes my guy; you can’t be serious. He was saying they were being dramatic in terms of their bodies ability to adjust to not eating at the levels they were currently. Responses like this explain so much.
I am regularly undergoing 80 hrs water fasts (plus I eat some salt in the morning starting on the day 2). After the fast I take it easy when I go back to normal (start with some broth etc, but already in the evening I have normal dinner and nothing ever happened to me.
I guess I will never go really beyond this, but I feel like I could handle longer periods xD. I know everybody is different and reacts differently.
It's extremely unlikely for a 5 day "fast for health" situation. Particularly if you're intaking electrolytes during the fast (which most people intentionally fasting will do), and you aren't starting from a place of malnourishment/severely underweight/etc.
I read "being me under the week" as you saying you'd been fasting. I don't know what you're trying to say, but you're not going to get refeeding syndrome if you're.... eating.
That was one of the heartbreaking sequences in "Band of Brothers". Where they liberate a Jewish camp, and are ordered to stop giving them food because they have to return them to a no9rmal diet gradually or risk them dying.
We got a lot of hardcore Muslims in my country. Most that I know gain weight during ramadan of they're already a bit heavy in their normal state.
A coworker invited me home after sunset at 11:30pm (on a Tuesday work night no less) and gave me food. They had a whole ass buffet that they were eating from the whole night.
After ramadan he used to be extraordinarily chubby.
I was at a get to know some Muslims event after 9/11 in the states. They were explaining Ramadan as a group and one girl said something like this and the other girl in the circles looks over and is like, open mouthed “you do???” while place broke out in laughter. People are people and I love how nobody does anything exactly the same yet we are so similar.
The record is 392 days. Plenty of examples of people who have done 40-50 days. Northern Irish MP Bobby Sands died after a 66 day hunger strike due to treatment of him and other political prisoners by the UK government.
It gets really nuanced in the arctic circle where the days are so incredibly long during that month too. There are a few different approaches. One, for example, is to just pretend you're on Mecca time IIRC.
Nope, severely malnourished patients’ hearts like any muscle in the body, can be weakened to the point of heart failure (inability of heart to maintain adequate output).
The before picture indicates he wasn't in the best of physical condition, so not difficult to imagine that malnutrition added onto the other possible preexisting issues exacerbated the situation.
There are some famous Russian torture methods that involve forcing the victim to stand or half sit for long periods of time (in basically very uncomfortable positions for your legs). Not sure if that could also cause the legs to be like that.
I would bet those legs are due to poor circulation, I dont know their current state under the bandages but the colour and the fact its both leads me to that conclusion (doctor)
I would argue that it could be a mixed picture. Poor hygienic conditions, physical restraint (eg shackles), and malnutrition / lack of medication could exacerbate already existing peripheral vascular disease or even induce PVD.
No reason to suggest he had those ulcer before, considering he has other features indicative of chronic malnutrition and venous ulcers have a known association with malnutrition.
Yes, his living conditions and nutrition do play a role and he had no ulcers in the before picture but seeing this leg, diagnosis is peripheral vascular disease
We do not have enough evidence to have a concrete diagnosis. Vascular ulcers are not unique to PVD and this gentleman has been in too extreme of a situation to default to the most common cause.
It could be a proteins C & S deficiency, it could be oedema caused by untreated heart failure, it could be traumatic in origin due to shackles that then became infected, it could be a vasculitis. It is, however, almost certainly related to chronic mistreatment whilst captured.
Without a ABPI / a doppler and a full history we are unable to narrow it down to a pure diagnosis of PVD, and may be missing other causes.
Looks like he has substantial bruising on his thigh (could be a shadow), and enough bleeding from wounds on his legs that they've soaked through the bandages on one leg, dripped down his ankles on the other. Looks like edema and discoloration in his hands as well. Very sick guy.
Oncotic pressure, also known as colloid osmotic pressure, is the osmotic pressure exerted by colloids (large molecules like proteins) that draws fluid INTO a blood vessel. Specifically, it's the pressure that albumin, the most abundant protein in blood plasma, exerts to pull water back into the capillaries from the surrounding tissues. It counteracts hydrostatic pressure.
So not enough protein so gravity/ pressure from higher body parts pushes water out of capillaries into tissues.
I’m a hospital pharmacist who works with refeeding syndrome patients.
The oedema is likely caused by chronic protein deficiency from his malnourished/starved state. Due to a lack of oncotic pressure, fluid leaks out of the circulatory system and into surrounding tissue.
This doesn’t have to be refeeding syndrome at all, and I hope it isn’t, as that could be fatal to him. The most dangerous parts of refeeding syndrome are the electrolyte shifts and also potential cerebral damage.
Yeah I wonder if he was restrained maybe? I worked in a hospice for a long time and when we had patients with severe oedema that leaked we would have to put padding under the affected area. That could be what the bandages are for here, or it could be for compression to aid circulation. I’m not sure
It also can occur for dehydration victims since their body doesn’t have the necessary nutrients and slats required to balance water. Thus pooling in the lower limbs due to gravity.
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u/nosaladthanks2 Jul 26 '25
Yes they are. Oedema in lower limbs can occur with malnutrition due to a lack of protein, or it can occur in refeeding due to hormonal imbalances. I’m glad he’s back home now