The Body Eats Itself

There is nothing ennobling about death by starvation. It is neither quick nor painless. A starving person wastes away, literally consuming himself in the process. In a desperate quest for sustenance, many of the Cambodian refugees report, they were reduced to eating leaves or gnawing on the bark of trees. Neither contains remotely enough of the three major fuels that provide a body with energy: carbohydrates, proteins and fats.

Soon after food is cut off, the body switches to burning fuel reserves stored in the liver and fatty tissues. After fat is exhausted, the body accelerates the breakdown of proteins in muscles, including the heart, which saps strength. At the same time, the body attempts to husband its resources by cutting energy requirements to the minimum. Pulse rate and blood pressure fall and body temperature drops. Men become impotent; women stop menstruating, and nursing mothers fail to produce milk; children stop growing. Mental and physical lassitude set in, and individuals become obsessed with finding food. Some malnourished people develop edema, a swelling, especially in the joints and abdomen.

Though adaptive responses keep the body running for a while, even for months if some food and water are available, prolonged starvation eventually disrupts vital processes. Says Dr. Buford Nichols Jr. of Houston's Baylor College of Medicine: "You keep falling back, like a military withdrawal, but finally the body just collapses." Adds Dr. Myron Winick of New York City's Columbia University Institute of Nutrition: "Victims of starvation have to adapt. But once they do, they have a very small margin for error." Death comes in many ways. The intestinal walls become damaged; severe and constant diarrhea may develop. The loss of body fluids containing electrolytes (particularly potassium) that help control heart rhythm can lead to circulatory collapse. Lack of food weakens the body's natural defense system against infection; crowded together with inadequate sanitation and nonexistent medical care, the starving--as the refugee experience proves--become prey to typhoid, cholera, tuberculosis and malaria. The absence of essential vitamins or minerals can also bring on the so-called deficiency diseases: rickets, beriberi and pellagra. Sometimes, the hungry simply lose the will to live.

Even if they survive, children under two will be permanently scarred by prolonged starvation. Most brain growth occurs in the uterus and before the age of two; adequate nutrition after that cannot remedy an earlier deficiency. For older survivors, recovery can be complete. Doctors warn, however, that a patient must be reintroduced carefully and gradually to food. The heart and digestive system are so weak that a sudden gorging can induce shock and death. Well-meaning G.I.s at the end of World War II inadvertently killed many concentration camp inmates by giving them big meals. It may take a month or more to return to normal feeding. There is a telltale sign, says Nichols, that lets you know when victims of starvation are going to survive: they finally smile.

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