The people most exposed to the physical effects of the earthquake are the earthquake victims who are trapped under the rubble. These people face serious problems such as hunger when they stay under the rubble for a long time. In earthquake victims who resort to different methods to reduce hunger and survive, life-threatening as well as some physical symptoms may occur as a result of prolonged starvation. Experts' answer to the question of how long we can starve is that people who do not receive any medical assistance for as long as 72 hours may experience muscle tissue breakdown, vitamin and mineral deficiency and digestive system problems.
Özden Örkçü, Nutrition and Diet Specialist at NPISTANBUL Brain Hospital, evaluated the stages of hunger and the conditions caused by prolonged starvation.
Stating that hunger usually occurs due to conditions such as inadequate nutrient intake, inability to metabolize or absorb nutrients, Örkçü said, "Among the causes of hunger; In addition to diseases such as cancer, malabsorption disorders and anorexia neurosis, factors such as deprivation and prolonged fasting may also be included. However, earthquake trauma As a result, being trapped under debris and not being able to consume food for a long time can be life-threatening."
What are the Stages of Hunger?
Stating that starvation due to inadequate food intake consists of three stages, Özden Örkçü said, "The first two stages of starvation can occur even in short-term diet or fasting situations. The third stage occurs only in prolonged starvation and can lead to the end of a person's life."
Stating that blood glucose levels are maintained during the first phase of fasting through the production of glucose from proteins, glycogen and fats, Örkçü said, "First, glycogen is broken down into glucose. Only enough glycogen is stored in the liver to last for a few hours. After this time, blood sugar levels are maintained by the breakdown of fats and proteins. Fats are broken down into glycerol and fatty acids, the fatty acids can be used as an energy source, especially by the skeletal system, and reduce the use of glucose by tissues other than the brain. Glycerol can be used to make small amounts of glucose, but most glucose is made up of the amino acids of proteins. Some amino acids can be used directly for energy."
Stating that the second stage of starvation can last for several weeks and that fats are used as the main source of energy in this process, Nutrition and Diet Specialist Özden Örkçü said, "The person's liver metabolizes fatty acids into ketone bodies that can be used as an energy source. After about a week of starvation, a person's brain begins to use ketone bodies as well as glucose as energy sources. However, proteins that are not necessary for the body to survive are used first."
Stating that the third stage of starvation begins as a result of the depletion of fat reserves in the body, Örkçü said, "The body begins to use proteins as the main source of energy, and in this process, muscles, which are the largest source of protein, are rapidly depleted. As a result of this situation, proteins necessary for cellular functionality and functions are broken down and cell function becomes degenerated, that is, degraded and unable to function normally. In addition to symptoms such as weight loss, the person may experience symptoms such as distraction, confusion and increased sensitivity to disease."
Özden Örkçü stated that additional symptoms of hunger may include flaky skin, flaking, changes in hair color, large edema that causes the appearance of swelling in the lower limbs and abdominal area of the person, "During the starvation process, the ability of the human body to consume volumes of food is also reduced. Foods that are low in protein but high in calories often cannot reverse the starvation process. For the recovery and treatment of the person affected by starvation, low-volume foods fortified with minerals and vitamins can be given, which provide a large amount of protein, calories and weight. Serious complications such as dehydration can occur as a result of the starvation process and in such cases, the intervention may not be effective."
What are the diseases that may occur as a result of starvation?
Stating that the number of people who die directly and only due to starvation is very few, and that the conditions that put life functions at risk as a result of prolonged starvation are usually infectious infections and diseases, Örkçü said the following:
"Starvation damages the immune system due to excessive mineral and vitamin deficiency. Some people become weak during starvation and may die from immune-related diseases. There is a limited amount of fat, glucose, muscle mass and tissue that the body can use during starvation. Prolonged starvation can deplete these options and can be life-threatening. In the final stage of starvation, one of two different diseases, kwashiorkor and marasmus, can occur.
Marasmus is caused by an extreme lack of energy, usually from insufficient amounts of calories and protein. The person's body weight reaches dangerously low levels and infections are common. Kwashiorkor is a similar disease that affects children with protein and energy deficiency, which can result in edema and an enlarged fatty liver, causing children's abdomens to swell, giving the illusion that starving children are well nourished.
The most common cause of the condition that ends a person's life is usually a cardiac arrhythmia or heart attack caused by excessive tissue breakdown caused by autophagy or severe electrolyte imbalances. People can starve to death in as little as three weeks or as long as seventy days."
What happens if you don't eat for 3 days?
Stating that after 6 to 10 hours of fasting, the body uses most of the glucose in the bloodstream as fuel, Nutrition and Diet Specialist Özden Örkçü continued his words as follows:
"People who eat three meals a day or people who regularly eat a high-carbohydrate diet may experience hunger and low energy levels at the 10th hour. In such cases, hunger pangs subside after about 2 hours and the body adapts to the new information.
During the 12 to 16 hours of fasting, the body continues to deplete glycogen stores, while at the same time increasing its dependence on ketone bodies. As food cannot be digested by the body, the person may suffer from colds and the immune system may be weakened.
After 16 to 18 hours of starvation, the body begins autophagy, an automatic recycling process that will flush out damaged proteins, bacteria and dysfunctional cells in the body to make healthier cells.
After 24 to 32 hours of fasting, the body switches off glycogen and relies entirely on its own fat stores for energy. The brain needs glucose to work and function. Therefore, the body goes to different lengths to help muscle tissue not yet break down, usually by breaking down triglycerides from fat stores into glycerol and free fatty acids. The person's body increases human growth hormone during this process, getting most of the energy and glucose it needs to protect the muscles from body fat.
After 32 hours, significant weight loss can be seen, however, this is usually a result of fat loss as well as water loss from the consumption of carbohydrates.
Once 3 days of fasting is reached, the process of improved immunity, autophagy and reduction in inflammation continues. However, the cons start to outweigh the pros. Starving for 72 hours without any medical assistance is difficult for most people. The body can also start to break down muscle tissue, leading to vitamin and mineral deficiencies and digestive problems."
What is Refeeding Syndrome?
Stating that refeeding syndrome can occur within a few days after rapid feeding following prolonged starvation lasting more than 5 days, Örkçü said, "Symptoms may include weakness, muscle cramps, tingling, seizures and end of life. It is caused by glucose entering the cells rapidly and dragging phosphate, potassium, magnesium and vitamin B1 with it. This results in hypophosphatemia and less commonly hypokalemia, hypomagnesemia and vitamin B1 deficiency. Sodium and water retention can also occur, causing edema."
Nutrition and Diet Specialist Özden Örkçü listed the things that can be done to prevent refeeding syndrome as follows:
- Slow feeding in the first week
- After fasting for 5-10 days: 20 Kcal/kg body weight/day
- After 10 days of fasting: 10 Kcal/kg body weight/day
- Taking multivitamin supplements, including vitamin B1, daily for at least 10 days
- Eating the usual foods, but taking care to get enough phosphate (meat with bones, fish, cheese, eggs) and potassium (potatoes, bananas)
- Avoid foods high in sugar and other fast-absorbing carbohydrates (fruit juice, soda, sweets, white bread, pasta cookies or rice) to prevent rapid blood sugar changes
- Drinking water as needed to maintain normal skin turgor and clear or straw-yellow urine excretion and avoiding excessive salt intake to prevent water retention (swollen ankles)