Starvation

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Definition

Starvation is the result of a serious, or total, lack of nutrients needed for the maintenance of life.

Description

Adequate nutrition has two components—necessary nutrients and energy in the form of calories. It is possible to ingest enough energy without a well-balanced selection of individual nutrients and produce diseases that are noticeably different from those resulting from an overall insufficiency of nutrients and energy. Although all foods are a source of energy for the organism, it is possible to consume a seemingly adequate amount of food without getting the required minimum of energy (calories). For example, marasmus is the result of a diet that is deficient mainly in energy. Children who get enough calories, but not enough protein have kwashiorkor. This is typical in cultures with a limited variety of foods that eat mostly a single staple carbohydrate like maize or rice. These conditions overlap and are associated with multiple vitamin and mineral deficits, most of which have specific names and set of problems associated with them.

• Marasmus produces a very skinny child with stunted growth.
• Children with kwashiorkor have body fat, an enlarged liver, and edema—swelling from excess water in the tissues. They also have growth retardation.
• Niacin deficiency produces pellagra characterized by diarrhea, skin rashes, brain dysfunction, tongue, mouth and vaginal irritation, and trouble swallowing.
• Thiamine (Vitamin B₁) deficiency causes beriberi, which can appear as heart failure and edema, a brain and nerve disease, or both.
• Riboflavin deficiency causes a sore mouth and throat, a skin rash, and anemia.
• Lack of vitamin C (ascorbic acid)—scurvy—causes hair damage, bleeding under the skin, in muscles and joints, gum disease, poor wound healing, and in severe cases convulsions, fever, loss of blood pressure, and death.
• Vitamin B₁₂ is needed to keep the nervous system working right, and it and pyridoxine (vitamin B₆) are both necessary for blood formation.
• Vitamin A deficiency causes at first loss of night vision and eventually blindness from destruction of the cornea, a disease called keratomalacia.
• Vitamin K is necessary for blood clotting.
• Vitamin D regulates calcium balance. Without it, children get rickets and adults get osteomalacia.

— J. Ricker Polsdorfer, MD

Dictionary: star·va·tion  (stär-vā'shən)

1. The act or process of starving.
2. The condition of being starved.

The sight of the ravages of starvation in far too many parts of the modern world is all too familiar on the television screens of Western society. In our ‘developed’ countries starvation is encountered only occasionally: self-inflicted as an ultimate political statement by the hunger striker, or in the effort to lose weight, whether reasonably in the obese, or unreasonably by sufferers from eating disorders; or even more rarely in prolonged survival at sea or other circumstances of accidental isolation.

In normal circumstances, with an adequate and balanced diet, all tissues take up the required amounts of nutrients from the passing blood, in the form of simple sugars (mainly glucose), fatty acids, and amino acids. Tissues differ in the ratio of different fuels used: the brain and spinal cord, and also the red blood cells, can normally utilize only glucose. Excesses from the diet are converted to storage forms, mainly as lipid in fatty tissue and as glycogen in the liver.

Adults can survive for many weeks without food, provided they have water. For just how long depends partly on the extent of their body stores of nutrients, mainly fat. But unfortunately it is not only the fat which is broken down to simpler substances to be used for metabolic energy production and for essential repair and maintenance of the body's tissues. As soon as carbohydrate stores have run out, proteins are mobilized from muscles for the manufacture of sugars by the liver, causing progressive physical weakness.

The physiological priorities in the face of zero food intake no doubt evolved in early millenia when hunting and gathering was an unpredictable and variable source of food. The first priority is to provide the brain with glucose, which is its staple diet, and this requires a certain level of glucose in the circulating blood. The carbohydrate store in the form of liver glycogen is used first to provide this glucose but is used up in the first day or two. Then glucose has to be made from lactic acid and from amino acids derived from muscle protein, released into the blood and taken up in the liver.

But how do the various parts of the body involved ‘know’ that there is a state of starvation and ‘act’ accordingly? A fall in blood glucose directly affects the endocrine part of the pancreas to change the balance of its hormonal secretions, suppressing insulin and enhancing glucagon synthesis and release. A fall in blood glucose is sensed also in the hypothalamus in the brain, which is the co-ordinating centre for homeostatic processes — those which tend to maintain the body's status quo. This orchestrates a complex hormonal response and also switches on autonomic nervous mechanisms, which stimulate the release or synthesis of glucose in the liver; adrenaline secretion is increased from the adrenal medulla; and the anterior pituitary gland is brought into action, releasing growth hormone, and ACTH which in turn stimulates the release of cortisol from the adrenal cortex.

Glucagon promotes all the processes which tend to raise blood glucose — first its release from liver glycogen, then its synthesis from amino acids. Adrenaline, growth hormone and cortisol all promote mobilization of lipid from adipose tissue (fat stores) and the use of the resulting circulating fatty acids as metabolic fuel in preference to glucose — everywhere except the brain and the red blood cells, which do not have the necessary chemical apparatus to use them. In the liver, the predominant metabolic use of fatty acids produces the ‘ketone bodies’, acetoacetate and b-hydroxybutyrate, which circulate in the blood and can be used by other tissues for energy production. If starvation is prolonged even the brain is able to utilize these when glucose is seriously depleted. Some of the acetoacetate is converted to acetone — another ‘ketone body’ — mainly in the lungs, and this becomes noticeable on the breath. The blood becomes progressively more acidic.

In the end, of course, there can be no hope of maintaining life in the absence of food intake. Some of the defence mechanisms become counter-productive. Thus the necessary production of extra acid as a by-product of altered metabolism puts an additional load on the kidneys to deal with H⁺ excretion; the acidity also stimulates breathing, helpfully counteracting acidity by the excretion of more carbon dioxide, but imposing extra breathing work on a weakening body. Muscles waste away; oedema and accumulation of fluid in body cavities follows depletion of plasma proteins. Ultimately there is multi-organ failure from lack of fuel and loss of vital enzyme activity. Shortages of minerals and vitamins will also take their toll if starvation is not total, and hence attenuated enough for these deficiencies to take effect, but in terms of aid to starving communities, the urgent requirements are for the basic nutrients.

— Sheila Jennett

See also acid base homeostasis; blood sugar; fasting; hormones; hunger.

Total abstinence from food. Starvation for more than one day depletes the body of its glycogen stores. Glycogen is the main source of glucose, an essential fuel for the brain. In order to maintain supplies, the body uses the protein in its own cells to make glucose, resulting in muscle wasting. If starvation continues for a few weeks, the brain adapts and can use the breakdown products of fat as a fuel. Once the fat stores are used, it again resorts to using protein. If this self-destructive process continues, heart muscle is broken down and death is inevitable.

Starvation is sometimes self-inflicted by people who want to lose weight rapidly. This is generally not recommended: it can disturb the body's metabolism and some doctors believe it may lead to eating disorders such as anorexia nervosa. In addition, the muscle lost during starvation is not easily regained, leaving a person physically weaker, less active, and more susceptible to weight gain. See also fasting.

A condition resulting from the lack of essential nutrients over a long period and characterized by multiple physiologic and metabolic dysfunctions.

Long-continued deprival of food and its morbid effects. Hunger, loss of body weight and decreased muscle power and endurance occur early. Late stages include signs of milk yield drop, cessation of defecation and drinking, emaciation, loss of skin turgor without dehydration, weakness, slow heart rate and hypothermia.

• preoperative s. — see preoperative fasting.

This article is about extreme malnutrition. For other uses, see Starvation (disambiguation).

Starvation
Classification & external resources

A female child during the Nigerian-Biafran war of the late 1960s, shown suffering the effects of severe hunger and malnutrition.
ICD-10	T73.0
ICD-9	994.2
DiseasesDB	12415
MeSH	D013217

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,^[1] and as of 2001 to 2003, about 800 million people were chronically undernourished.^[2][1]

Symptoms

Individuals experiencing starvation lose substantial fat 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 -- 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.

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.^[3] 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.^[3] 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.^[3] 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".^[3] 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.^[3] 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.^[3] 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.^[4] Subjects' own estimates of the time it took for recovery ranged from two months to two years.^[4] Many subjects reported that they grossly overate and put on fat after the experiment due to the urge to eat.^[4]

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 like The Borgen Project 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

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.

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

References

1. ^ ^{a b} Kirby, Alex (2003-03-05). UN warns of future water crisis. BBC. Retrieved on 2007-09-01.
2. ^ The spectrum of malnutrition (pdf). Food and Agricultural Organization (2001-10-05). Retrieved on 2007-08-03.
3. ^ ^{a b c d e f} Brozek, Josef. "Psychology of Human Starvation and Nutritional Rehabilitation." The Scientific Monthly 70 (1950): 270-274.
4. ^ ^{a b c} Kalm LM, Semba RD (2005), They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment. Journal of Nutrition, Volume 135, Issue 6, Pages 1347-1352. Retrieved on September 13, 2007.

External links

Wikimedia Commons has media related to:

Starvation

• The Three Top Sins Of The Universe by Mark R. Elsis
• The Borgen Project
• 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

Consequences of external causes (T15-T35, T66-T98, 930-959, 990-995)
General external causes	Foreign body - Burn - Frostbite
Other external causes	Radiation poisoning - Hyperthermia - Hypothermia - Immersion foot - Chilblain - Aerosinusitis - Hypoxia - Barotrauma - Altitude sickness - Chronic mountain sickness - Decompression sickness - Asphyxia - Starvation - maltreatment (Physical abuse, Sexual abuse, Psychological abuse) - Motion sickness (Airsickness, Sea-sickness) - Electric shock - Angioedema - Hypersensitivity (Allergy)
Certain early complications of trauma	Air embolism - Fat embolism - Crush syndrome/Rhabdomyolysis - Compartment syndrome - Volkmann's contracture
Complications of surgical and medical care	Serum sickness - Malignant hyperthermia

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