Notes on: Starvation

Material covered: 

• "Starvation is Not Painful, Experts Say"
• "What are the Symptoms of Starvation?"
• "How long can you go without food and water?"
• "What It's Like To Starve Yourself"
• Quora post
• Reddit: "ELI5: What happens when you starve to death?"
• Wikipedia: Starvation
• Wikipedia: Starvation response
• Wikipedia: Rabbit starvation
• Wikipedia: Cigarette smoking for weight loss

"Starvation is Not Painful, Experts Say"

• Opening describes a cancer patient who was unable to keep down food and was uninterested in surgery. She stopped eating and drinking, and a doctor "observed her gradual decline, providing one of the most detailed clinical accounts of starvation and dehydration." Something to keep in mind if organ donation is somehow an impossibility, I guess. 
• "Instead of feeling pain, the patient experienced the characteristic sense of euphoria that accompanies a complete lack of food and water. She was cogent for weeks, chatting with her caregivers in the nursing home and writing letters to family and friends. As her organs finally failed, she slipped painlessly into a coma and died." 
• "Medical experts say going without food and water in the last days and weeks of life is as natural as death itself." 
• "Eating and drinking during severe illness can be painful because of the demands it places on weakened organs." 
• Dr. Perry G.Fine, vice president of medical affairs at the National Hospice and Palliative Care Organization: "What my patients have told me over the last 25 years is that when they stop eating and drinking, there's nothing unpleasant about it--in fact it can be quite blissful and euphoric. It's a very smooth, graceful and elegant way to go." 
• Fine: "The word 'starve' is so emotionally loaded. People equate that with the hunger pains they feel or the thirst they feel after a long, hot day of hiking. To jump from that to a person who has an end-stage illness is a gigantic leap." 
• Dr. Ira Byock, director of palliative medicine at Dartmouth Hitchcock Medical Center: "The cessation of eating and drinking is the dominant way that mammals die. It is a very gentle way that nature has provided for animals to leave this life." 
• "In a 2003 study published in the New England Journal of Medicine, 102 hospice nurses caring for terminally ill patients who refused food and drink described their patients' final days as peaceful, with less pain and suffering than those who had elected to die through physician-assisted suicide." 
• Average rating given by nurses (1 to 9) was 8, one step below "very good death." 
• "Patients deprived of food and water will die of dehydration rather than starvation, unless they succumb to their underlying illness first. Without fluids, the body loses its ability to maintain the proper balance of potassium, sodium, calcium and other electrolytes in the bloodstream and inside cells. The kidneys react to the fluid shortage by conserving as many bodily liquids as possible. The brain, which relies on chemical signals to function properly, begins to deteriorate. So do the heart and other muscles, causing patients to feel tired and lethargic. [...] Meanwhile, the body begins mining its stores of fat and muscle to get the carbohydrates and proteins it needs to make energy." 
• Dr. Robert Sullivan, Duke University Medical Center: "If you mine too many proteins in the heart, it gets unstable. That can give rise to an irregular heartbeat, which can cause the patient to die of cardiac arrest. Or, if the muscles in the chest wall become weak, the patient can end up with pneumonia." 
• "The entire process usually takes one to two weeks. Throughout the process, the body strives to suppress the normal feelings of pain associated with deprivation. That pain of hunger is only felt by those who subsist on small amounts of food and water--victims of famine, for instance, or concentration-camp inmates." 
• "After 24 hours without any food, 'the body goes into a different mode and you're not hungry anymore,' he [Sullivan] said. 'Total starvation is not painful or uncomfortable at all. When we were hunting rabbits millions of years ago, we had to have a back-up mode because we didn't always get a rabbit. You can't go hunting if you're hungry.'" 
• "After a few days without food, chemicals known as ketones build up in the blood. These chamicals cause a mild euphoria that serves as a natural anesthetic. The weakening brain releases a surge of feel-good hormones called endorphins."
• "Doctors also have a host of treatments to ameliorate acute problems, such as sprays and swabs to moisten dry mouths and creams to moisturize flaky skin. They can also administer morphine or other powerful painkillers." 

"What are the Symptoms of Starvation?"

• "Pain in the stomach often quickly develops, then can turn into digestive and waste-related syndromes such as severe and painful constipation followed by uncontrollable diarrhea. Early symptoms of starvation include faintness, weakness, and dizziness. Thirst may also rapidly increase." 
• "Symptoms of starvation tend to become more visible of [sic] [over] time. Fat cells in the face and around the eyes tend to dissipate rapidly, giving the victim a sunken or hollowed appearance. Coordination may decrease, and simple tasks may become difficult. The body slowly becomes emaciated, though the feet and hands may swell with retained water, causing edemas. A starving person or animal may feel increased sensations of cold, as body temperature begins to drop rapidly with prolonged starvation." 
• "Blood level drops, and severe anemia or iron-deficiency begins to occur."
• "As the condition progresses toward fatality, mental symptoms become more extreme. Many victims fall into a chronic listlessness, unable to move even for basic bodily needs. Some begin to have vivid hallucinations and suffer confusion, vertigo, and vivid dreams. Some ritual starvation is undertaken to achieve these visions, but the starving person must quickly return to care and food quickly to avoid death." 
• "Victims who die of starvation-related causes usually do so by going into cardiac arrest. [...] Some victims fall into a coma for several days before this occurs." 

"How long can you go without food and water?"

• "Gandhi fasted for 21 days while in his 70s." 
• "Medically speaking, most doctors agree that healthy humans can go up to eight weeks without food as long as they have water."
• "Being strong and in good physical shape can help you survive longer, but so does having extra body fat." 
• "If you get to the point that your body is using up proteins, basically the body itself, then you're in bad shape." 
• "Heat means faster dehydration--cold means more energy is burned to keep the body's temperature at a cozy 98.6 degrees Fahrenheit (37 degrees Celsius)." 
• "Some symptoms you may see if you go more than a couple of days without food: 
• "Weakness
• "Confusion
• "Chronic diarrhea
• "Irritability
• "Bad decision making
• "Decreased sex drive
• "Immune deficiency"
• "In hot conditions with no water, dehydration can set in within an hour." 
• "We lose water through sweat, urine, feces and even breathing." 
• "In severe heat, an adult can lose as much as 1.5 liters of water through sweat alone." 
• "With mild dehydration, you'll experience the following: 
• "Lack of saliva
• "Decreased frequency of urine
• "Decreased output of urine
• "Deep color and strong odor in urine"
• "Moderate dehydration:
• "Even less urine
• "Dry mouth
• "Dry and sunken eyes
• "Rapid heartbeat"
• "Severe dehydration:
• "No urine
• "Lethargy and irritability
• "Vomiting and diarrhea"
• "The final stage of dehydration is shock. This is characterized by blue-gray skin that's cold to the touch. A severe drop in blood pressure produces this coolness." 
• "Assuming you're in reasonable shape and in ideal conditions--that is, not in the heat or cold and not exerting, a human can probably live for about 3 to 5 days without any water. Healthier humans can live another day or so longer." 

"What It's Like To Starve Yourself"

• "Starving yourself is a lot easier than you might think. You start out with an itch, but one that comes from the inside, a feeling that fingers can't reach. That feeling turns to pain, but not the pangs you've been promised. It's a more hollow pain, like that ringing after you hit your head on something, the moment where everything hurts but is strangely clear at the same time. After awhile, though, you just get tired. You find yourself wanting to go to sleep, even though it's only 6:00 P.M., and you wonder why you feel this way. You had a full night's sleep last night--actually, you overslept. You overslept the night before, too. In fact, you've been sleeping a lot lately. You stop to consider this fact and then you realize you can't remember the last time you ate."
• "When you've gotten over the pain, staying in this third stage--the place where you don't feel hungry, just empty and tired--becomes like a habit, the thing you use to feel death inside you. Some people smoke. You just don't eat." 
• "When you eat again, you will attack your food like a lion feasting on prey in the jungle, and friends will say that they don't know how you eat so much and stay so skinny. Your metabolism is sick. You'll smile and keep eating because right now, food is the only thing that matters." 
• "You will go through periods where you eat more and then you eat less again, replacing Vitamin supplements and diet pills with food." 
• "When you finally eat, almost anything seems possible."

"Quora Post"

• "First I became really unfocused and felt the need to sleep a lot. My joints became weired [sic]. They cracked a lot and would go out of joint occasionally. It was like my connective tissue started to disintegrate. My heart would randomly start pounding." 

"Reddit"

• "First it [the body] will use up all the glycogen (stored glucose) and adipose tissue (stored fat) to make energy. When those are gone it'll begin breaking up muscle so that it can get amino acids to make protein and glucose. After long enough, your body won't have anything left to break up for energy and your organs will begin shutting down in a last ditch effort to keep your brain and heart alive." 
• "If you don't die from an infection due to a weakened immune system or lack of some essential vitamin, you'll simply run out of energy." 
• "Typical symptoms include fatigue weakness, and painful movement due to the breakdown of your muscles, but keep in mind that if you have water the process of death from starvation can take months." 

"W: Starvation"

• "The term inanition refers to the symptoms and effects of starvation." 
• "Undernutrition is a contributory factor in the death of 3.1 million children under five every year. [...] The less severe condition of undernourishment currently affects 842 million people, or about one in eight (12.5%) people in the world population." 
• "The bloated stomach [...] represents a form of malnutrition called kwashiorkor which is caused by insufficient protein despite a sufficient calorie intake. Children are more vulnerable to kwashiorkor[,] whose advanced symptoms include weight loss and muscle wasting." 
• Medical causes of starvation:
• Anorexia nervosa
• Bulimia nervosa
• Eating disorder, not otherwise specified
• Celiac disease
• Coma
• Major depressive disorder
• Diabetes mellitus
• Digestive disease
• Constant vomiting
• "There are some clinical conditions such as recovering from surgery or burns etc., in which the person may be too fatigued or incapacitated to eat enough during their period of convalescence." 
• "One medical study estimates that in adults complete starvation leads to death within 8 to 12 weeks. There are isolated cases of individuals living up to 25 weeks without food. Starvation begins when an individual has lost about 30$ of his normal body weight. Once the loss reaches 40% death is almost inevitable." 
• "Catabolysis is the process of a body breaking down its own muscles and other tissues in order to keep vital systems such as the nervous system and heart muscle (myocardium) functioning. Vitamin deficiency is a common result of starvation, often leading to anemia, beriberi, pellagra, and scurvy. These diseases collectively can also cause diarrhea, skin rashes, edema, and heart failure." 
• "Early symptoms include impulsivity, irritability, hyperactivity, and other symptoms. Atrophy (wasting away) of the stomach weakens the perception of hunger, since the perception is controlled by the percentage of the stomach that is empty. Victims of starvation are often too weak to sense thirst, and therefore become dehydrated." 
• "All movements become painful due to muscle atrophy and dry, cracked skin that is caused by severe dehydration. With a weakened body, diseases are commonplace. Fungi, for example, often grow under the esophagus, making swallowing painful." 

"W: Starvation response"

• "Equivalent or closely related terms include famine response, starvation mode, famine mode, starvation resistance, starvation tolerance, adapted starvation, adaptive thermogenesis, fat adaptation, and metabolic adaptation." 
• "On average, the starvation response of the individuals after isolation [in a two-year experiment] was a 180 kcal reduction in daily total energy expenditure. 60 kcal of the starvation response was explained by a reduction in fat-free mass and fat mass. An additional 65 kcal was explained by a reduction in fidgeting, and the remaining 55 kcal was statistically insignificant." 
• "The ultimate cause of death is, in general, cardiac arrhythmia or cardiac arrest brought on by tissue degradation and electrolyte imbalance."
• "In very obese persons, it has been shown that proteins can be broken down and death from starvation occur before fat reserves are used up." 
• "The human starvation response is unique among animals in that human brains do not require the ingestion of glucose to function. During starvation, less than half the energy used by the brain comes from metabolized glucose. Because the human brain can use ketone bodies as major fuel sources, the body is not forced to break down skeletal muscles at a high rate, thereby maintaining both cognitive function and mobility for several weeks. This response is extremely important in human evolution and allowed for humans to continue to find food effectively even in the face of prolonged starvation." 

"W: Rabbit starvation"

• "Rabbit starvation, also referred to as protein poisoning or mal de caribou or fat starvation, is a rare form of acute malnutrition thought to be a complete absence of dietary fat intake coupled with ad lib protein consumption." 
• "When meat and fat are consumed in the correct ratio, such as that found in pemmican, the diet is considered nutritionally complete, and can support humans for months or more." 
• "Stressors, such as severe cold or dry environment, may intensify symptoms or decrease time to onset. Symptoms include diarrhea, headache, fatigue, low blood pressure and slow heart rate, and a vague discomfort and hunger (very similar to a food craving) that can be satisfied only by the consumption of fat." 
• "It has been observed that the human liver cannot safely metabolise much more than 221-301 g of protein per day (for an 80kg/176 pound person) and human kidneys are similarly limited in their capability to remove urea (a byproduct of protein catabolism) from the bloodstream." 

"W: Cigarette smoking for weight loss"

• Cigarette smoking for weight loss is a practice dating to early knowledge of nicotine as an appetite suppressant." 
• "Culturally, the links between smoking cigarettes and controlling weight run deep. While it is unclear how many people begin or continue smoking because of weight concerns, research reveals that white female adolescents with established weight-related anxieties are particularly prone to initiate smoking." 
• "Nicotine gum has similar effects to cigarettes in terms of appetite suppression, and there are some people who do not smoke, but use nicotine gum for the purpose of weight control or weight loss. Nicotine can also lower insulin levels in a person's bloodstream, which can reduce cravings for sugary foods. Furthermore, 'nicotine-triggered effects of adrenaline on the stomach's musculature' lead to temporary feelings of subsided hunger."
• "Other studies have shown that smokers expend more calories while engaged in activity, which echo conclusions that smokers experience heightened metabolic rates." 
• "Some studies have shown that smokers--including long term and current smokers--weigh less than nonsmokers, and gain less weight over time." 
• "While it has generally been found that white females are more apt to smoke to lose weight, one study found that smoking to lose or control weight is not limited to white females, but is prevalent across racial and gender boundaries." 
• "During the 19th century, smoking and cigarettes were commonly associated with loose morals and sexual promiscuity. A common prop in Victorian erotic pornography, cigarettes even came to be thought of as an occupational prop of prostitutes and sex workers. Even into the 20th century, women faced possible arrest if they were caught smoking in public." 
• "A new area of study examines the ways in which tobacco companies are targeting the gay community through advertising. Like early niche advertisements that appealed to female consumers, gay tobacco advertisements draw on themes of virility and body image, although it is inclear if gay men tend to smoke to control weight." 
• "Weight gain is a common experience during smoking cessation, with roughly 75% of smokers gaining weight after quitting. As nicotine is an appetite suppressant and smokers expend more energy, weight gain due to smoking cessation is generally attributed to increased caloric intake and a slowed metabolism rate."