The Pitfalls of the “Meal Cancellation Scene”… Hair Stylist Rushed to the Hospital After a Meal! The Horror of “Refeeding Syndrome”

“Everything went completely white before my eyes… I don’t remember anything after that.”

When she came to, Ms. I (38) found herself in a hospital bed. Her family told her that she had suddenly lost consciousness and been taken to the hospital by ambulance.

Right up until she collapsed, Ms. I had been sitting at the dinner table with her family. It was her first visit to her parents’ home in a long time, and she had eaten more than usual. That was all. Why did “eating” lead to her being rushed to the hospital?

It’s been a long time since the practice of skipping meals due to busyness or inconvenience began to be referred to as “meal skipping” or the “meal-skipping crowd.” “I skipped a meal again today,” “I was so busy I only had one meal today”—phrases like these sometimes become a form of self-deprecating humor or a lighthearted joke.

However, when “meal skipping” becomes a daily habit, it poses a medical risk.

If a person consistently eats very little over a long period, malnutrition can develop without them even realizing it. If malnutrition becomes severe, the perfectly ordinary act of “eating a substantial meal” for the first time in a while can actually cause significant harm to the body.

“Maybe I don’t need to eat today” becomes the norm

Ms. I works as a manager at a hair salon in a prime location in Tokyo. While working on the floor as a hairstylist, she is also responsible for salon management and staff training. It’s a position of great responsibility. Given the nature of her job, it wasn’t uncommon for her to be unable to eat at set times.

“Being a hairstylist isn’t a job where you can just say, ‘Okay, it’s lunchtime—I’m taking a break.’ If appointments come one after another, I can’t eat, and even if there’s a little downtime, there’s still plenty to do. Before I knew it, it would be evening, and there were times when I wouldn’t eat anything until closing time.”

As the cycle of “I was too busy to eat today” repeated itself, Ms. I’s mindset began to change.

“Gradually, even when I was hungry, I started thinking, ‘Oh well, it’s fine.’ It’s not that I didn’t have an appetite. I could eat if I wanted to. But I just got used to not eating.”

Skipping one meal. Then two. And before she knew it, “not eating” had become the norm. Ms. I, who was naturally slender to begin with, lost even more weight due to “canceling meals,” dropping to 170 cm tall and 45 kg. Her BMI was approximately 15.6, which falls into the “underweight” category.

Those around her noticed the change before she did.

“Regular customers started asking me, ‘Have you lost more weight?’ or ‘Are you eating properly?’ They were worried. Some people even brought me food.”

However, there were times when she was so busy that she didn’t even have time to eat the food she’d been given.

“I knew I was losing weight. But since I was able to work normally, I didn’t think I was in such a dangerous condition.”

Before I knew it, even that thin body had become “normal” to me.

Dr. Tetsuya Kubota, chairman of Kubota Clinic Matsudo Goka and an expert in nutritional therapy, is sounding the alarm.

“When people hear the term ‘malnutrition,’ they might imagine someone who can no longer eat and is bedridden. However, it is possible to be progressively malnourished even while continuing to work and go about daily life as usual. People who have been eating very little for a long time, or who have lost weight and seen their BMI drop, need to be cautious. Just because you’re ‘able to work normally’ doesn’t necessarily mean you’re okay.”

“I ate quite a bit” during a long-awaited visit home

One day, while this lifestyle continued, Mr. I returned to his parents’ home. Even his family, whom he hadn’t seen in a long time, asked him the same thing.

“Are you eating properly?”

At work, appointments or tasks would always come up just when she thought about eating. But this day was different. She had the day off. Her family was there, and a feast was laid out before her.

“I think I let my guard down because I was at my parents’ house. I ended up eating quite a bit with my family, saying, ‘This is so delicious.’”

After the meal, he was talking with his older sister.

“We talked about what we’ve been up to and family matters. Up to that point, everything was ‘normal.’”

Suddenly, everything went completely white before my eyes.

“I remember thinking, ‘Huh?’ but that’s as far as I go…”

That’s where my memory cuts off. I lost consciousness, and my family called an ambulance.

“I’d understand if I’d collapsed from malnutrition because I hadn’t been eating. But I actually ate a proper meal that day…”

Ms. I regained consciousness at the hospital. The doctor told her she had a condition she’d never heard of before: “refeeding syndrome.”

Refeeding syndrome is a condition that occurs when a person who has been malnourished for an extended period begins to eat again, causing significant changes in the body’s electrolyte and fluid balance.

“When you’re unable to eat enough for an extended period, your body tries to sustain life using minimal energy. Since carbohydrates alone don’t provide enough energy, the body begins to use stored fat and protein as well.

When a meal containing carbohydrates is suddenly introduced, blood sugar levels rise and insulin is secreted. As a result, along with glucose, substances such as phosphorus, potassium, and magnesium are drawn from the bloodstream into the cells, leading to deficiencies,” explains Dr. Kubota (mentioned earlier).

Dr. Kubota goes on to explain that “phosphorus” is particularly important.

“Phosphorus is a building block of ATP (adenosine triphosphate), which cells need to produce energy. If phosphorus levels drop sharply, muscles and the heart can no longer function properly. Mild cases may involve fatigue and loss of muscle strength; in severe cases, it can lead to impaired consciousness, arrhythmias, heart failure, and respiratory failure—conditions that can be life-threatening. In other words, for people in a state of severe malnutrition, ‘eating a lot’ doesn’t necessarily mean they’ll regain their strength,”

Meals, which are supposed to give the body strength, can actually put a strain on the body when consumed too rapidly.

“Skin and bones, yet I have fatty liver.”

There was another thing that surprised me. Ms. I was told she had “fatty liver.”

“I was shocked when the doctor told me, ‘You also have fatty liver disease.’ I mean, I’m 170 cm tall and weigh 45 kg, right? I asked, ‘I’m this thin—how can I have fatty liver disease?’”

While fatty liver is often associated with obesity, overeating , or excessive drinking , “I don’t drink alcohol or sugary drinks. I hardly ever eat junk food either,” said Ms. I.

Her doctor explained that it was “fatty liver caused by malnutrition.”

“When you don’t get enough energy from your diet for an extended period, your body breaks down stored fat to use as energy. The ‘free fatty acids’ produced during this process are carried through the bloodstream to the liver.

Normally, fat that enters the liver is either used as energy or converted into triglycerides and transported out of the liver in the form of ‘VLDL (very low-density lipoprotein).’ However, when malnutrition leads to a deficiency in proteins and other nutrients, the liver’s ability to transport fat out of the liver may be impaired,” said Dr. Kubota.

For Mr. I, this was just as shocking as being rushed to the hospital.

The doctor recommended hospitalization for treatment. However, Mr. I had his job as a manager to attend to.

“I was told I should be hospitalized and follow a dietary regimen. But since I have work, I consulted with the doctor and decided to undergo treatment at home.”

When malnutrition has progressed to the point where there is a risk of refeeding syndrome, it is dangerous to suddenly increase food intake on one’s own judgment.

“For people at high risk of refeeding syndrome, rather than suddenly returning to a normal diet, we gradually increase the amount of nutrition while monitoring their physical condition. During this process, we check the levels of phosphorus, potassium, and magnesium through blood tests.

Since vitamin B1 (thiamine) is necessary for carbohydrate metabolism, we sometimes supplement thiamine for high-risk patients. “In severe cases, patients are hospitalized so we can manage their nutrition while monitoring their cardiac condition and other vital signs,” says Dr. Kubota.

It’s not as simple as “if you eat a lot, you’ll recover quickly.”

Of course, skipping a single meal does not immediately lead to refeeding syndrome. However, Dr. Kubota sounds the alarm about the “meal-skipping crowd.”

“I feel the term ‘meal-skipping crowd’ has a somewhat flippant ring to it. People who are unaware that they are chronically malnourished need to be especially careful. While ‘not eating’ is dangerous, in a body that hasn’t eaten for a long time, ‘eating’ may also require caution.

‘I’ve gotten used to not eating lately.’ If that kind of feeling has become the norm for you, I’d like you to take a moment to reassess your weight, eating habits, and nutritional status.”

To regain her health, Ms. I has reevaluated her lifestyle and is continuing treatment that involves eating regular meals under her doctor’s guidance.

While you may think, “I’m fine even if I don’t eat,” your body may be quietly slipping into malnutrition. For those for whom “skipping meals” has become a daily routine, Ms. I’s experience is by no means someone else’s problem.