Starvation

For other uses, see [[:extreme malnutrition]].

Starvation
Specialty	Emergency medicine

Starved Vietnamese man, who was deprived of food in a Viet Cong prison camp.

Starvation is a severe reduction in vitamin, nutrient, and energy intake, and is the most extreme form of malnutrition. In humans, prolonged starvation (in excess of 1-2 months) causes permanent organ damage and, eventually, death.

According to the Food and Agriculture Organization of the United Nations, more than 25,000 people died of starvation every day in 2003, and as of 2001 to 2003, about 800 million people were chronically undernourished.

Symptoms

Individuals experiencing starvation lose substantial fat (a.k.a. adipose) and muscle mass as the body breaks down these tissues for energy. Catabolysis is the process (medical condition) of a body breaking down muscles and other tissues in order to keep vital systems—such as the nervous system and heart muscle (myocardium) —working. Catabolysis will not begin until there are no usable sources of energy coming into the body. Vitamin deficiency is also a common result of starvation, often resulting in anemia, beriberi, pellagra, and scurvy. These diseases collectively may cause diarrhea, skin rashes, edema, and heart failure. Individuals are often irritable, fatigued, and lethargic as a result.

Physiology of starvation

During starvation or prolonged fasting state, the glycogen storage is used up and the level of insuline in the circulation is low and the level of glucagon is very high. The main mean of energy production is lipolysis. Glycerol goes to gluconeogenesis and fatty acids enter TCA cycle via acetyl CoA to produce energy. Proteolysis provides alanine which also enters gluconeogenesis. Lactate produced from pyruvate enters gluconeogenesis pathway too. Too much Acetyl CoA produces ketone bodies which you can detect in the urine exam. Brain starts to use ketone bodies as source of energy.

Psychological effects of starvation

Through several reports and studies, scientists have discovered that starvation has many psychological effects on a person, in addition to its physiological effects. The most extensive and informative study on starvation's psychological effects is called the Minnesota Starvation-Rehabilitation Experiment, which was carried out from 1944-1946. The subjects of this experiment were thirty-two healthy conscientious objectors, ages twenty to thirty-three. Subjects experienced three phases of the experiment: twelve weeks of control period, twenty four weeks of semistarvation, and then twelve weeks of rehabilitation. During the control experiments, subjects were given 3,492 calories, during the period of semistarvation, calories were decreased to 1,570, and during the period of rehabilitation, they were re-increased to normal levels. During the period of semistarvation, subjects were fed foods most likely consumed in European famine areas. The results of the starvation experiment were tested in many ways. According to Josef Brozek, author of Psychology of Human Starvation and Nutritional Rehabilitation, studies "ranged from intelligence and personality tests through ratings to purely descriptive material, provided by the experimenters' notes and diaries kept by the subjects". According to subjects of the semistarvation experiment, tiredness was the worst effect of the low calorie intake, followed by appetite, muscle soreness, irritability, apathy, sensitivity to noise, and hunger pain. Standard personality tests revealed that the starving individuals experienced a large rise in the "neurotic triad" -- hypochondriasis, depression, and hysteria. Also, the subjects of the experiment noticed a marked decrease in the drive for activity, and a remarkable decrease in sex drive. In peer evaluations, other experiment subjects noted great changes in subjects' personalities during the period of semistarvation. In interviews years later, subjects reported that they felt that they had not returned to normal by the end of the three month recovery period. Subjects' own estimates of the time it took for recovery ranged from two months to two years. Many subjects reported that they grossly overate and put on fat after the experiment due to the urge to eat.

smelly poop

Organizations Working to End Starvation

Many organizations have been highly effective at reducing starvation in different regions. Aid agencies give direct assistance to individuals, while political organizations pressure political leaders to enact policies that will reduce famine and provide aid.

Common causes of starvation

Child victim of the Holodomor.

• Anorexia nervosa
• Bulimia nervosa
• Clinical Depression
• Coma
• Crash dieting
• Diabetes mellitus (untreated)
• Digestive disease
• Famine
• Fasting
• Malnutrition
• Overpopulation
• Poverty

Capital punishment

File:Starving-livilla.jpg

The starving Livilla refusing food.
From a drawing by André Castagne

Starvation has also historically been used as a death sentence. From the beginning of civilization through to the Middle Ages people were immured, or starved to death.

In ancient Greco-Roman societies, starvation was sometimes used to dispose of guilty upper class citizens, especially erring female members of patrician families. For instance, in the year 31, Livilla, the niece and daughter-in-law of Tiberius, was discreetly starved to death by her mother for her adulterous relationship with Sejanus and for her complicity in the murder of her own husband, Drusus the Younger.

Another daughter-in-law of Tiberius, named Agrippina the Elder (a granddaughter of Augustus and the mother of Caligula) also died of starvation, in 33 (however, it is not clear if she voluntary starved herself to death or if she was forced to).

A son and a daughter of Agrippina were also executed by starvation for political reasons; Drusus Caesar, her second son, was put in prison in 33 and starved to death on the orders of Tiberius (he managed to stay alive for nine days by chewing the stuffing of his bed); Agrippina's youngest daughter, called Julia Livilla, was exiled on an island in 41 by her uncle, the emperor Claudius, and not much later, her death by starvation was arranged by the empress Messalina.

Execution by starvation was also a possible punishment for Vestal Virgins found guilty of breaking their vows.

Maximilian Kolbe, a Polish friar, offered his life to save another inmate sentenced to death in the Auschwitz concentration camp. He was starved along with another nine inmates. After two weeks of starvation he and three other inmates were still alive and executed with injections of phenol.

Ugolino della Gherardesca, his sons and other members of his family were immured in the Muda, a tower of Pisa, and starved to death in the thirteenth century. Dante, his contemporary, wrote about Gherardesca in his masterpiece The Divine Comedy.

In Sweden in 1317, the king Birger of Sweden had his two brothers locked up in the prison. They died a few weeks later because of starvation; their sentence was a punishment for a coup they staged several years earlier. This was called the Nyköping Banquet.

In Cornwall in 1671, there is a recorded case of a man by the name of John Trehenban from St Columb Major who was condemned to be starved to death in a cage at Castle An Dinas for the murder of two girls.

Treatment

Severe starving patients can be treated, but have to be treated cautiously or shock can occur. Patients should be started on small quantities of sugared water. Followed by diluted milk, and then whole milk. Only when they are able to digest these liquids can simple foods be given.

See also

• Refeeding syndrome
• Anorexia
• Anorexia nervosa
• Cachexia
• Dehydration
• Famine
• Famine response
• Famine scales
• Fasting
• Hunger
• Malnutrition
• Kwashiorkor
• Marasmus
• Muselmann
• Overpopulation
• Hunger strike
• List of famines
• List of countries by fertility rate

External links

• Starvation - Merck Manual
• FAO - Understanding food insecurity
• FAO - What the new figures on hunger mean
• The Hunger Site - Help fight hunger world wide with just a click