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Starvation is a severe deficiency in caloric energy intake, below the level needed to maintain an organism's life. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent
organ Organ may refer to: Biology * Organ (biology), a part of an organism Musical instruments * Organ (music), a family of keyboard musical instruments characterized by sustained tone ** Electronic organ, an electronic keyboard instrument ** Hammond ...
damage and eventually, death. The term ''inanition'' refers to the symptoms and effects of starvation. Starvation may also be used as a means of torture or execution. According to the World Health Organization (WHO), hunger is the single gravest threat to the world's public health.Malnutrition
The Starvelings
The WHO also states that malnutrition is by far the biggest contributor to
child mortality Child mortality is the mortality of children under the age of five. The child mortality rate, also under-five mortality rate, refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births. It en ...
, present in half of all cases. Undernutrition is a contributory factor in the death of 3.1 million children under five every year. Figures on actual starvation are difficult to come by, but according to the Food and Agriculture Organization, the less severe condition of undernourishment currently affects about 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 Kwashiorkor ( , ) is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates. It is thought to be caused by sufficient calorie intake, but with insufficient protein consumption (or lack of goo ...
. The exact pathogenesis of kwashiorkor is not clear, as initially it was thought to relate to diets high in carbohydrates (e.g. maize) but low in protein. While many patients have low albumin, this is thought to be a consequence of the condition. Possible causes such as aflatoxin poisoning, oxidative stress,
immune dysregulation Immune dysregulation is any proposed or confirmed breakdown or maladaptive change in molecular control of immune system processes. For example, dysregulation is a component in the pathogenesis of autoimmune diseases and some cancers. Immune system d ...
, and altered
gut microbiota Gut microbiota, gut microbiome, or gut flora, are the microorganisms, including bacteria, archaea, fungi, and viruses that live in the digestive tracts of animals. The gastrointestinal metagenome is the aggregate of all the genomes of the gut m ...
have been suggested. Treatment can help mitigate symptoms such as the pictured weight loss and
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
wasting, however prevention is of utmost importance. Without any food, humans usually die in around 2 months. There was a surprising case when someone survived 382 days. Lean people can usually survive with a loss of up to 18% of their body mass. Obese people can tolerate more, possibly over 20%. Females survive longer than males.


Signs and symptoms

The following are some of the symptoms of starvation:


Changes in behaviour or mental status

The beginning stages of starvation impact mental status and behaviours. These symptoms show up as irritable mood, fatigue, trouble concentrating, and preoccupation with food thoughts. People with those symptoms tend to be easily distracted and have no energy.


Physical signs

As starvation progresses, the physical symptoms set in. The timing of these symptoms depends on age, size, and overall health. It usually takes days to weeks, and includes weakness, fast heart rate, shallow breaths that are slowed, thirst, and constipation. There may also be diarrhea in some cases. The eyes begin to sink in and glass over. The muscles begin to become smaller and muscle wasting sets in. One prominent sign in children is a swollen belly. Skin loosens and turns pale in color, and there may be swelling of the feet and ankles.


Weakened immune system

Symptoms of starvation may also appear as a weakened immune system, slow wound healing, and poor response to infection. Rashes may develop on the skin. The body directs any nutrients available to keeping organs functioning.


Other symptoms

Other effects of starvation may include: * Anemia * Gallstones * Hypotension * Stomach disease * Cardiovascular and respiratory diseases * Irregular or absent
menstrual periods The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs a ...
in women *
Kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...
or
failure Failure is the state or condition of not meeting a desirable or intended objective (goal), objective, and may be viewed as the opposite of Success (concept), success. The criteria for failure depends on context, and may be relative to a parti ...
* Electrolyte imbalance * Emaciation * Oliguria


Stages of starvation

The symptoms of starvation show up in three stages. Phase one and two can show up in anyone that skips meals, diets, and goes through fasting. Phase three is more severe, can be fatal, and results from long-term starvation. Phase one: When meals are skipped, the body begins to maintain blood sugar levels by degrading glycogen in the liver and breaking down stored fat and protein. The liver can provide glucose for the first few hours. After that, the body begins to break down fat and protein. The body uses Fatty acids as an energy source for muscles but lowers the amount of glucose sent to the brain. Another chemical that comes from fatty acids is glycerol. It can be used as glucose for energy but eventually runs out. Phase two: Phase two can last for weeks at a time. In this phase, the body mainly uses stored fat for energy. The breakdown occurs in the liver and turns fat into ketones. After fasting for one week, the brain will use these ketones and any available glucose. Using ketones lowers the need for glucose, and the body slows the breakdown of proteins. Phase three: By this point, the fat stores are gone, and the body begins to turn to stored protein for energy. This means it needs to break down muscle tissues full of protein; the muscles break down very quickly. Protein is essential for cells to work correctly, and when it runs out, the cells can no longer function. The cause of death due to starvation is usually an infection or the result of tissue breakdown. This is due to the body becoming unable to produce enough energy to fight off bacteria and viruses. The final stage of starvation includes signals like hair color loss, skin flaking, swelling in the extremities, and a bloated belly. Even though they may feel hunger, people in the final stage of starvation usually cannot eat enough food to recover.


Causes

The body expends more energy than it takes in. This imbalance can arise from one or more medical conditions or circumstantial situations, which can include: Medical reasons * Anorexia nervosa * Bulimia nervosa * Eating disorder, not otherwise specified * Celiac disease *
Coma A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...
* Major depressive disorder * Diabetes mellitus * Digestive disease *Constant vomiting Circumstantial causes *
Child A child ( : children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The legal definition of ''child'' generally refers to a minor, otherwise known as a person younger ...
,
elder An elder is someone with a degree of seniority or authority. Elder or elders may refer to: Positions Administrative * Elder (administrative title), a position of authority Cultural * North American Indigenous elder, a person who has and tr ...
, or dependant abuse *
Famine A famine is a widespread scarcity of food, caused by several factors including war, natural disasters, crop failure, Demographic trap, population imbalance, widespread poverty, an Financial crisis, economic catastrophe or government policies. Th ...
for any reason, such as political strife and war * Hunger striking *Excessive fasting *
Poverty Poverty is the state of having few material possessions or little income. Poverty can have diverse social, economic, and political causes and effects. When evaluating poverty in ...
* Torture


Biochemistry

With a typical high-carbohydrate diet, the human body relies on free blood glucose as its primary energy source. Glucose can be obtained directly from dietary sugars and by the breakdown of other carbohydrates. In the absence of dietary sugars and carbohydrates, glucose is obtained from the breakdown of stored glycogen. Glycogen is a readily-accessible storage form of glucose, stored in notable quantities in the liver and skeletal muscle. After the exhaustion of the glycogen reserve, and for the next two to three days, fatty acids become the principal metabolic fuel. At first, the brain continues to use glucose. If a non-brain tissue is using fatty acids as its metabolic fuel, the use of glucose in the same tissue is switched off. Thus, when fatty acids are being broken down for energy, all of the remaining glucose is made available for use by the brain. After two or three days of fasting, the liver begins to synthesize
ketone bodies Ketone bodies are water-soluble molecules that contain the ketone groups produced from fatty acids by the liver (ketogenesis). Ketone bodies are readily transported into tissues outside the liver, where they are converted into acetyl-CoA (acetyl- ...
from precursors obtained from fatty acid breakdown. The brain uses these ketone bodies as fuel, thus cutting its requirement for glucose. After fasting for three days, the brain gets 30% of its energy from ketone bodies. After four days, this may increase to 70% or more. Thus, the production of ketone bodies cuts the brain's glucose requirement from 80 g per day to 30 g per day, about 35% of normal, with 65% derived from ketone bodies. But of the brain's remaining 30 g requirement, 20 g per day can be produced by the liver from glycerol (itself a product of fat breakdown). This still leaves a deficit of about 10 g of glucose per day that must be supplied from another source; this other source will be the body's own proteins. After exhaustion of fat stores, the cells in the body begin to break down protein. This releases alanine and
lactate Lactate may refer to: * Lactation, the secretion of milk from the mammary glands * Lactate, the conjugate base of lactic acid Lactic acid is an organic acid. It has a molecular formula . It is white in the solid state and it is miscible with ...
produced from
pyruvate Pyruvic acid (CH3COCOOH) is the simplest of the alpha-keto acids, with a carboxylic acid and a ketone functional group. Pyruvate, the conjugate base, CH3COCOO−, is an intermediate in several metabolic pathways throughout the cell. Pyruvic aci ...
, which can be converted into glucose by the liver. Since much of human muscle mass is protein, this phenomenon is responsible for the wasting away of muscle mass seen in starvation. However, the body is able to choose which cells will break down protein and which will not. About 2–3 g of protein has to be broken down to synthesize 1 g of glucose; about 20–30 g of protein is broken down each day to make 10 g of glucose to keep the brain alive. However, this number may decrease the longer the fasting period is continued, in order to conserve protein. Starvation ensues when the fat reserves are completely exhausted and protein is the only fuel source available to the body. Thus, after periods of starvation, the loss of body protein affects the function of important organs, and death results, even if there are still fat reserves left. In a leaner person, the fat reserves are depleted faster, and the protein, sooner, therefore death occurs sooner.) Ultimately, the cause of death is in general cardiac arrhythmia or cardiac arrest, brought on by tissue degradation and
electrolyte An electrolyte is a medium containing ions that is electrically conducting through the movement of those ions, but not conducting electrons. This includes most soluble salts, acids, and bases dissolved in a polar solvent, such as water. Upon dis ...
imbalances. Conditions like
metabolic acidosis Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys ...
may also kill starving people.


Prevention

Starvation can be caused by factors beyond the control of the individual. The Rome Declaration on World Food Security outlines several policies aimed at increasing food securityWorld Food Summit - Rome Declaration on World Food Security
/ref> and, consequently, preventing starvation. These include: * Poverty reduction *Prevention of wars and political instability * Food aid * Agricultural sustainability *Reduction of economic inequality Supporting farmers in areas of food insecurity through such measures as free or subsidized fertilizers and seeds increases food harvest and reduces food prices.Ending Famine, Simply by Ignoring the Experts
/ref>


Treatment

Patients that suffer from starvation can be treated, but this must be done cautiously to avoid
refeeding syndrome Refeeding syndrome is a metabolic disturbance that occurs as a result of reinstitution of nutrition in people and animals who are starved, severely malnourished, or metabolically stressed because of severe illness. When too much food or liquid nut ...
. Rest and warmth must be provided and maintained. Food can be given gradually in small quantities. The quantity of food can be increased over time. Proteins may be administered intravenously to raise the level of
serum Serum may refer to: *Serum (blood), plasma from which the clotting proteins have been removed **Antiserum, blood serum with specific antibodies for passive immunity * Serous fluid, any clear bodily fluid * Truth serum, a drug that is likely to mak ...
proteins. For worse situations,
hospice Hospice care is a type of health care that focuses on the palliation of a terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by ...
care and opioid medications can be used.


Organizations

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 more macro-scale policies that will reduce famine and provide aid.


Statistics

According to estimates by the Food and Agriculture Organization, between 720 and 811 million people were affected by hunger globally in 2020. This was a decrease from estimated 925 million in 2010 and roughly 1 billion in 2009.The State of Food Insecurity in the World, 2010: Addressing Food Insecurity in Protracted Crises
/ref> In 2007, 923 million people were reported as being undernourished, an increase of 80 million since 1990–92. An estimated 820 million people did not have enough to eat in 2018, up from 811 million in the previous year, which is the third year of increase in a row. As the definitions of starving and malnourished people are different, the number of starving people is different from that of malnourished. Generally, far fewer people are starving than are malnourished. The proportion of malnourished and starving people in the world has been more or less continually decreasing for at least several centuries. This is due to an increasing supply of food and to overall gains in
economic efficiency In microeconomics, economic efficiency, depending on the context, is usually one of the following two related concepts: * Allocative or Pareto efficiency: any changes made to assist one person would harm another. * Productive efficiency: no addit ...
. In 40 years, the proportion of malnourished people in the developing world has been more than halved. The proportion of starving people has decreased even faster.


Capital punishment

Historically, starvation has been used as a death sentence. From the beginning of civilization to the Middle Ages, people were
immured Immurement (from the Latin , "in" and , "wall"; literally "walling in"), also called immuration or live entombment, is a form of imprisonment, usually until death, in which a person is sealed within an enclosed space without exits. This includes i ...
, and died for want of food. In ancient Greco-Roman societies, starvation was sometimes used to dispose of guilty upper-class citizens, especially erring female members of patrician families. 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 Lucius Aelius Sejanus (c. 20 BC – 18 October AD 31), commonly known as Sejanus (), was a Roman soldier, friend and confidant of the Roman Emperor Tiberius. Of the Equites class by birth, Sejanus rose to power as prefect of the Praetorian Guar ...
and for her complicity in the murder of her own husband,
Drusus the Younger Drusus Julius Caesar (14 BC – 14 September AD 23), was the son of Emperor Tiberius, and heir to the Roman Empire following the death of his adoptive brother Germanicus in AD 19. He was born at Rome to a prominent branch of the '' gens Cla ...
. Another daughter-in-law of Tiberius, named Agrippina the Elder (a granddaughter of Augustus and the mother of
Caligula Gaius Julius Caesar Augustus Germanicus (31 August 12 – 24 January 41), better known by his nickname Caligula (), was the third Roman emperor, ruling from 37 until his assassination in 41. He was the son of the popular Roman general Germanicu ...
), also died of starvation, in 33 AD; however, it is unclear if her starvation was self-inflicted. A son and daughter of Agrippina were also executed by starvation for political reasons;
Drusus Caesar Drusus Julius Caesar (c. AD 8 – 33) was the adopted grandson and heir of the Roman emperor Tiberius, alongside his brother Nero. Born into the prominent Julio-Claudian dynasty, Drusus was the son of Tiberius' general and heir, Germanicus. Afte ...
, her second son, was put in prison in 33 AD, and starved to death by orders of Tiberius (he managed to stay alive for nine days by chewing the stuffing of his bed); Agrippina's youngest daughter, Julia Livilla, was exiled on an island in 41 by her uncle, Emperor
Claudius Tiberius Claudius Caesar Augustus Germanicus (; 1 August 10 BC – 13 October AD 54) was the fourth Roman emperor, ruling from AD 41 to 54. A member of the Julio-Claudian dynasty, Claudius was born to Nero Claudius Drusus, Drusu ...
, and her death by starvation was arranged by the empress Messalina. It is also possible that Vestal Virgins were starved when found guilty of breaking their vows of
celibacy Celibacy (from Latin ''caelibatus'') is the state of voluntarily being unmarried, sexually abstinent, or both, usually for religious reasons. It is often in association with the role of a religious official or devotee. In its narrow sense, the ...
.
Ugolino della Gherardesca Ugolino della Gherardesca (March 1289), Count of Donoratico, was an Italian nobleman, politician and naval commander. He was frequently accused of treason and features prominently in Dante's ''Divine Comedy''. Biography In the 13th century, the ...
, his sons, and other members of his family were immured in the
Muda Muda or MUDA or MuDA may refer to: People * Sultan Muda (1579–1579), nominal Sultan of Aceh * Tycho Muda (born 1988), Dutch rower * Vincent Muda (born 1988), Dutch rower Places * Muda, Estonia, a village * Mudá, Spain *Muda River, Malaysi ...
, a tower of
Pisa Pisa ( , or ) is a city and ''comune'' in Tuscany, central Italy, straddling the Arno just before it empties into the Ligurian Sea. It is the capital city of the Province of Pisa. Although Pisa is known worldwide for its leaning tower, the cit ...
, and starved to death in the thirteenth century. Dante, his contemporary, wrote about Gherardesca in his masterpiece '' The Divine Comedy''. In
Sweden Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic country located on ...
in 1317, King Birger of Sweden imprisoned his two brothers for a coup they had staged several years earlier ( Nyköping Banquet). According to legend they died of starvation a few weeks later, since their brother had thrown the prison key in the castle moat. In Cornwall in the UK in 1671,
John Trehenban John Trehenban (pronounced TREM-on) (1650–1671), of St Columb Major in Cornwall, United Kingdom, was a murderer sentenced to imprisonment in a cage on Castle An Dinas downs and starved to death. The murder of the two young girls is recorded in ...
from St Columb Major was condemned to be starved to death in a cage at
Castle An Dinas Castle an Dinas is an Iron Age hillfort at the summit of Castle Downs near St Columb Major in Cornwall, UK () and is considered one of the most important hillforts in the southwest of Britain. It dates from around the 3rd to 2nd century BCE and ...
for the murder of two girls. The Makah, a Native American tribe inhabiting the Pacific Northwest near the modern border of Canada and the United States, practiced death by starvation as a punishment for slaves.Donald, Leland (1997). Aboriginal Slavery on the Northwest Coast of North America, University of California Press, p. 23


Concentration camps and ghettos

Many of the prisoners in the
Nazi concentration camp From 1933 to 1945, Nazi Germany operated more than a thousand concentration camps, (officially) or (more commonly). The Nazi concentration camps are distinguished from other types of Nazi camps such as forced-labor camps, as well as concen ...
s were murdered through deliberate maltreatment, disease, starvation, and overwork, or were executed as unfit for labor. Many occupants of ghettos in eastern Europe also starved to death, most notoriously in the Warsaw Ghetto in German-occupied Poland. Prisoners were transported in inhumane conditions by rail freight cars, in which many died before reaching their destination. The prisoners were confined to the
cattle car A cattle wagon or a livestock wagon is a type of railway vehicle designed to carry livestock. Within the classification system of the International Union of Railways they fall under Class H - special covered wagons - which, in turn are part of the ...
s for days or even weeks, with little or no food or water. Many died of dehydration in the intense heat of summer or froze to death in winter. Nazi concentration camps in Europe from 1933 to 1945 deliberately underfed prisoners, who were at the same time forced to perform heavy labour. Their diet was restricted to watery vegetable soup and a little bread, with little to no dietary fats, proteins or other essential
nutrient A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excret ...
s. Such treatment led to loss of body tissues, and when prisoners became skeletal, the so-called
Muselmann Muselmann (German plural Muselmänner) was a slang term used amongst prisoners of German Nazi concentration camps during the Holocaust (World War II) to refer to those suffering from a combination of starvation (known also as "hunger disease") ...
were murdered by gas or bullets when examined by camp doctors. Starvation was also used as a punishment where victims were locked into a small cell until dead, a process which could take many days. Saint Maximilian Kolbe, a martyred Polish friar, underwent a sentence of starvation in
Auschwitz concentration camp Auschwitz concentration camp ( (); also or ) was a complex of over 40 concentration and extermination camps operated by Nazi Germany in occupied Poland (in a portion annexed into Germany in 1939) during World War II and the Holocaust. It con ...
in 1941. Ten prisoners had been condemned to death by starvation in the wake of a successful escape from the camp. Kolbe volunteered to take the place of a man with a wife and children. After two weeks of starvation, Kolbe and three other inmates remained alive; they were then executed with injections of phenol.


See also

*
2007–2008 world food price crisis World food prices increased dramatically in 2007 and the first and second quarter of 2008, creating a global crisis and causing political and economic instability and social unrest in both poor and developed nations. Although the media spo ...
* Anorexia mirabilis * Cachexia * Global Hunger Index *
Starvation mode Starvation response in animals (including humans) is a set of adaptive biochemical and physiological changes, triggered by lack of food or extreme weight loss, in which the body seeks to conserve energy by reducing the amount of calories it burns ...
*
Famine scales Famine scales are the ways in which degrees of food security are measured, from situations in which an entire population has adequate food to full-scale famine. The word "famine" has highly emotive and political connotations and there has been exte ...
* Hunger strike * List of famines *
List of people who died of starvation This is a list of notable people who died of starvation: See also *List of deaths from anorexia nervosa *Angola * Famine relief * Franklin expedition *Great Leap Forward * History of Sudan *Great Irish Famine *Little Ice Age *North Korea *Sieg ...
*
Marasmus Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the a ...
*
Protein poisoning Protein poisoning (also referred to colloquially as rabbit starvation, ''mal de caribou'', or fat starvation) is an acute form of malnutrition caused by a diet deficient in fat and carbohydrates, where almost all calories consumed come from the ...


References


Further reading

*
U.N. Chief: Hunger Kills 17,000 Kids Daily
- by '' CNN'' * * {{Authority control Causes of death Effects of external causes Execution methods Famines Hunger Malnutrition Physical torture techniques Weight loss Suicide methods