= Starving =

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= Starving =
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Introduction
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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 damage and eventually, death. The term 'inanition'
refers to the symptoms and effects of starvation. Starvation may have
a natural cause or be man-made. Deliberately inflicting starvation
upon a population is a crime according to international criminal law
and 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. The WHO also states that
malnutrition is by far the biggest contributor to child mortality,
present in half of all cases. Undernutrition is a contributory factor
in the death of 3.1 million children under five every year. The
results also demonstrates that as global hunger levels have
stabilized, however, despite some progress in specific areas such as
stunting and exclusive breastfeeding, an alarming number of people
still face food insecurity and malnutrition. In fact, the world has
been set back 15 years, with levels of undernourishment similar to
those in 2008-2009, with between 713 and 757 million people
undernourished in 2023, and over 152 million more than in 2019 when
the mid-range was 733 million.

The bloated stomach represents a form of malnutrition called
kwashiorkor. 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,
and altered gut microbiota have been suggested. Treatment can help
mitigate symptoms such as the pictured weight loss and muscle wasting,
however prevention is of utmost importance.

Without any food, humans usually die in around 2 months. There was a
case when someone survived over a year (382 days) under medical
supervision. 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 may survive longer than males due to their higher body fat
content at the same BMI.

Changes in behaviour or mental status
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The beginning stages of starvation impact mental status and
behaviours. These symptoms show up as irritable and/or unstable mood,
fatigue, trouble concentrating, and preoccupation with food thoughts.
People with those symptoms tend to be easily distracted and have no
energy. Psychological effects are profound, including depression,
anxiety, and a decrease in cognitive functions.

Physical signs
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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. Tiredness
and dizziness also commonly occur, especially from any physical task.
The skin is often overly pale. 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
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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
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Other effects of starvation may include:
* Anemia
* Gallstones
* Hypotension
* Stomach disease
* Cardiovascular and respiratory diseases
* Irregular or absent menstrual periods in women
* Kidney disease or failure
* Electrolyte imbalance
* Emaciation
* Oliguria

Stages of starvation
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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 without significant medical
intervention.

Causes
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Medical reasons
*Anorexia nervosa
*Bulimia nervosa
*Eating disorder, not otherwise specified
*Esophageal achalasia
*Celiac disease
*Coma
*Major depressive disorder
*Diabetes mellitus
*Digestive disease
*Constant vomiting

Circumstantial causes
*Child, elder, or dependent abuse
*Famine for any reason, such as political strife and war
*Hunger striking
*Excessive fasting
*Poverty
*Torture

Biochemistry
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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 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 produced from
pyruvate, 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
imbalances. Conditions like metabolic acidosis may also kill starving
people.

Prevention
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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 security 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.

Starvation is commonly used as a method of warfare, however, it has
been outlawed and is now a crime. Notable incidents in history include
the blockade of Germany, blockade of Biafra, and the ongoing blockade
of Gaza.

Treatment
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Patients that suffer from starvation can be treated, but this must be
done cautiously to avoid refeeding syndrome. 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
proteins. For worse situations, hospice care and opioid medications
can be used.

Organizations
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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
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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. 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 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.

!Year!!1970!!1980!!1990!!2004!!2007!!2009
!Proportion of undernourished people in the less-developed world |37
% 28 % 20 % 16 % 17 % 16 %

Capital punishment
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Historically, starvation has been used as a death sentence. From the
beginning of civilization to the Middle Ages, people were immured, 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 and for her
complicity in the murder of her own husband, Drusus the Younger.

A son and daughter of Agrippina were also executed by starvation for
political reasons; Drusus Caesar, 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, 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.

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, 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 from St Columb Major was
condemned to be starved to death in a cage at Castle An Dinas 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.

See also
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* 2007-2008 world food price crisis
* Anorexia mirabilis
* Cachexia
* Global Hunger Index
* Starvation mode
* Famine scales
* Hunger strike
* List of famines
* List of people who died of starvation
* Marasmus
* Protein poisoning

Further reading
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*
[http://edition.cnn.com/2009/WORLD/europe/11/17/italy.food.summit/index.html
U.N. Chief: Hunger Kills 17,000 Kids Daily] - by CNN
*
*

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Original Article: http://en.wikipedia.org/wiki/Starving