Refeeding David Blaine — Studies after a 44-Day Fast
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《新英格兰医药杂志》
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 David 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 , 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.
Figure 1. Serum Phosphate Levels in Relation to Energy Intake.
The figure shows the drop in the level of serum phosphate during the first 24 hours after hospital admission and the recovery of more normal levels after overnight intravenous supplementation with phosphate. Apart from this single intravenous intervention, all refeeding was carried out orally.
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.
Márta Korbonits, M.D., Ph.D.
Bart's and the London Queen Mary's School of Medicine and Dentistry
London E1 2AD, United Kingdom
m.korbonits@qmul.ac.uk
David Blaine
41 5th Ave.
New York, NY 10003
Marinos Elia, M.D.
Institute of Human Nutrition
Southampton SO16 6YD, United Kingdom
Jeremy Powell-Tuck, M.D.
Bart's and the London Queen Mary's School of Medicine and Dentistry
London E1 2AD, United Kingdom
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 , 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.
Figure 1. Serum Phosphate Levels in Relation to Energy Intake.
The figure shows the drop in the level of serum phosphate during the first 24 hours after hospital admission and the recovery of more normal levels after overnight intravenous supplementation with phosphate. Apart from this single intravenous intervention, all refeeding was carried out orally.
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.
Márta Korbonits, M.D., Ph.D.
Bart's and the London Queen Mary's School of Medicine and Dentistry
London E1 2AD, United Kingdom
m.korbonits@qmul.ac.uk
David Blaine
41 5th Ave.
New York, NY 10003
Marinos Elia, M.D.
Institute of Human Nutrition
Southampton SO16 6YD, United Kingdom
Jeremy Powell-Tuck, M.D.
Bart's and the London Queen Mary's School of Medicine and Dentistry
London E1 2AD, United Kingdom