Doctors may face dietary challenges with freed hostages after almost 500 days

With the hostages now in Israel's custody, one of the main concerns is preventing life-threatening complications such as salt imbalances and refeeding syndrome.

By DR. ITAY GAL JANUARY 19, 2025 21:02 Updated: JANUARY 19, 2025 21:15

Israeli forces collect released Gaza hostages Emily Damari, Romi Gonen and Doron Steinbrecher on January 19, 2025 (photo credit: IDF SPOKESPERSON'S UNIT)

With the hostages now in Israel's custody, one of the main concerns is preventing life-threatening complications such as salt imbalances and refeeding syndrome. Therefore, the nutrition protocol for the released hostages will be implemented gradually and meticulously, to ensure that deficiencies are addressed.

In the initial days, the primary focus is on the hostages' medical condition, particularly regarding the fear that they have undergone prolonged starvation. Accordingly, clinical nutrition specialists will oversee their dietary treatment, adhering to a strict and gradual protocol.

Upon arrival at an IDF base, the hostages received tea with a teaspoon of sugar, three biscuits, and applesauce. They were also given 100 mg of thiamine, a critical vitamin (B1) for metabolic processes in the body.

A deficiency in this vitamin can lead to neurological symptoms, including Wernicke-Korsakoff syndrome, a severe neurological condition characterized by confusion, eye movement disturbances, and other symptoms that can result in permanent brain damage.

In cases of refeeding, where the body resumes using energy from carbohydrates, the demand for thiamine increases. Early administration of thiamine can prevent refeeding syndrome, a life-threatening condition marked by severe metabolic imbalances.

Hearts send a special signal. (credit: africa_pink via Shutterstock)

This condition includes drops in blood levels of potassium, phosphorus, and magnesium alongside a sharp increase in thiamine demand, potentially causing cardiac and neurological complications.

Thiamine supports the proper functioning of critical systems, such as the heart, and aids cellular energy recovery after starvation.

Without proper treatment, thiamine deficiency can lead to fatigue, weakness, lactic acidosis, and impaired central nervous system function. Therefore, thiamine administration is an essential part of the treatment process for starvation victims to ensure a safe and healthy recovery.

Health Ministry guidelines:

Each hostage will undergo vital sign monitoring, including heart rate, blood pressure, and oxygen saturation, every four hours during the first 24 hours of feeding. Additionally, comprehensive blood tests will be conducted, and deficiencies will be corrected gradually based on results and BMI (calculated as weight divided by height squared).

According to the Health Ministry's plan, each hostage will be classified by their BMI. A BMI of 16 to 18.5 (the normal range is at least 20) is considered moderate risk, while a BMI below 16 indicates high risk and severe starvation.

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Based on their nutritional status, the hostages will receive multivitamin supplements once daily for at least 30 days, along with vitamin D (due to prolonged time in darkness) and vitamin B12.

Hostages at moderate to high risk will also receive fluid supplementation based on body weight and caloric nutrition to address deficiencies. Some hostages may also receive glucose infusions. Progress will be monitored, with the goal of increasing caloric intake by 33% of the target daily or every two days. The ultimate objective is to meet full nutritional needs within 5 to 10 days.

Each hostage will receive an information sheet stating:

"After a long period of limited eating, it is very important to return to regular eating gradually and moderately to prevent potentially life-threatening complications that may result from rapid exposure to food and drink following a prolonged period of significantly reduced food intake.

To help prevent nutritional and health deterioration in the near term, it is recommended to eat gradually and cautiously until you return to the amounts you were accustomed to.

The dietitian at the medical center will accompany you through the process and assist in selecting and adjusting the types and amounts of food and drink daily, based in part on the results of various medical assessments.

This support will continue even after discharge from the medical center until nutritional rehabilitation is complete. Recording the types and quantities of food and drink consumed each day can assist in providing accurate guidance."