DR. PARAS PAREKH 1ST YEAR RESIDENT DEPARTMENT OF PHYSIOLOGY B.J.

MEDICAL COLLEGE

 Starvation

is the result of a severe or total lack of nutrients needed for the maintenance of life.

Severe reduction in vitamin, nutrient and energy intake. Most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, death.

 Fasting

is refraining from eating and drinking, for certain period of time. Can be done for a day to several weeks.

Used for thousands of years, fasting is one of the oldest therapies in medicine Many of the great doctors of ancient times and many of the oldest healing systems have recommended fasting as an integral method of healing and prevention

Fasting has also been used in nearly every religion in the world, including Hinduism, Christianity,

Buddhism, and Islam. Many of history's great

In one of the famous political acts of the last century, the Indian leader Mahatma Gandhi

fasted for 21 days to promote peace

 In

ancient times, Starvation was used as a DEATH SENTENCE.

On the basis of intake of food 1) Dry fasting. Absolute Fast, Black Fast, and Hebrew Fast. Most extreme Has spiritual roots Consists of foregoing food and water for short periods.

2) Liquid fasting.

Fasting on liquids only. Water fasting Simplest and perhaps the oldest form. Delivers the greatest level of therapeutic benefit physically and in a short period of time. Juice fasting Extremely popular. Nutritional support in a pure and natural form.

Foods Protein Polysaccharides Lipids

Aminoacids

Mono & Disaccharides

Fatty acids Glycerol

Pyruvate

Glycolysis

Acetyl CoA
Citric acid cycle

NADH

O
NH3

Electron transport & Oxidative Phosphorylation

H2O

ATP + NAD

CO2

During metabolism, first there is a hydrolysis of macromolecules to their subunits. Conversion of subunits to acetyl CoA and production of a small amount of ATP and NADH.

Oxidation of acetyl CoA to water and carbon dioxide

EFFECTS OF STARVATION ON METABOLISM

 During

starvation, the body has to depend upon its own tissue materials to get energy in absence of foods. changes can be divided into the following three stages.

Metabolic

Liver glycogen is first mobilised, Gluconeogenesis from glucogenic amino acids and later on from other substrates also. Last for not more than 2 to 3 days.

Major part of energy is derived from Fats of adipose tissue and remaining from Proteins. Last longer,usually over two weeks because adipose tissue represents the largest amount of stored food.

Fat stores are almost exhausted so energy is obtained from the breakdown of tissue protein. Cell substance will break up and cell metabolism is disrupted. This stage last for less than one week and if continued leads to death.

food Source of glucose / energy glycogen

gluconeogenesis, muscle

gluconeogenesis, other
fatty acid oxidation

Time after eating

food Source of glucose / energy glycogen

gluconeogenesis, muscle

gluconeogenesis, other
fatty acid oxidation

Time after eating

food Source of glucose / energy glycogen

gluconeogenesis, muscle

gluconeogenesis, other
fatty acid oxidation

Time after eating

food Source of glucose / energy glycogen

gluconeogenesis, muscle

gluconeogenesis, other
fatty acid oxidation

Time after eating

Muscle

Alanine / Pyruvate Glutamine

Glucos e

Brain

Glycerol

Gluconeogenesis Ketogenesis
Ketones Liver

Fat

AGL

Ureagenesis

Ketones NH3 Intestine

Urea

Kidney

Muscle

Alanine / Pyruvate Glutamine

Glucos e

Brain

Glycerol

Gluconeogenesis Ketogenesis
Ketones
Liver

Fat AGL

Ureagenesis

Ketones NH3 Intestine

Urea

Kidney

CARBOHYDRATE

EFFECTS OF STARVATION ON BASIC NUTRIENT'S METABOLISM

FATS

PROTEIN

WATER

Hypoglycaemia

Depresses Insulin secretion Increases Gluconeogenesis Insulin/glucagon ratio decrease.

Increase Glucagon activity Increase Glycogenolysis

Increase in activity of glucogenic enzymes like pyruvate carboxylase, FDPase, glucose 6-P-ase that increase both gluconeogenesis and glycogenolysis. Starvation decrease activity of enzyme G-6-PD, thus reducing HMP shunt and lipogenesis from carbohydrate.

 All

this factors try to maintain Blood sugar level as Brain and Red blood cells require continuous supply of Glucose in all condition.

II

III

IV

GLUCOSE UTILIZED (g/hora)

40

30

Exogenous Glycogen Gluconeogenesis

20

10

LEGEND
FUEL FOR BRAIN

I GLUCOSE

II GLUCOSE

III GLUCOSE

IV GLUCOSE, KETONES

V GLUCOSE, KETONES

Ruderman NB. Annu Rev Med 1975;26:248

Carbohydrate reserves are insufficient. Fats of adipose tissue is largely mobilised to the liver as FFA and oxidised for energy purposes.

Starvation increase the activities of the Hormone sensitive lipase, so there is increase in lipolysis in the adipose tissue.
Lipolysis release two components: Glycerol and FFA. Glycerol acts as a substrate for Gluconeogenesis and joins the carbohydrate pool.

FFA rise in the plasma from the very first day of starvation and this rise is enhanced by muscular work, probably because of increased secretion of catecholamines from adrenal medulla and sympathetic nerve ending.
As FFA level increase, ketogenesis is stimulated and ketone bodies are formed.

Vital organs like Brain and Heart can utilize ketone bodies during prolonged starvation for survival.

When fat stores are depleted and exhausted, proteins alone are available for energy purpose.

Tissue proteins are treated as food proteins , they are hydrolyzed to amino acids to a larger extent.

Released amino acids are utilized for the maintenance of the structural and functional efficiency of vital organs.

Amino acids undergo de-amination in the liver and the non-nitrogenous part helps in the maintenance of blood sugar level by gluconeogenesis.
Nitrogen excretion in urine is an index of tissue protein consumption.

During first few days, ECF is reduced due to stoppage of water intake and continued obligatory losses. On prolonged starvation,the ICF volume also fall because of cellular breakdown while ECF shows a relative expansion due to the subsequent shrinkage of cell mass that may produce oedema.

Cellular disintegration cause loss of intracellular potassium thus reducing total body potassium.
The need for drinking water is reduced after few days due to relative expansion of ECF.

Mostly observed in animals, but some direct observation have been carried out on volunteers and on professional fasting person. During the first few days, craving for foods, at meal times. Later on this craving subsides Desire for food vanishes.

Weakness gradually increases. Strong dislike to undertake any physical or mental effort. Subject falls into a state of semiconsciousness. Sleep increases and respiration becomes slower. Body weight is steadily lost. The daily loss in man during the first 10 days, is between 1 to 1.5% of the original body weight.

Adipose tissue get thinned out and finally disapper, visceral organs get displaced. Due to loss of subcutaneous fats skin hangs loose with folds. Vital organs lose the least weight wherease the less vital ones lose the most.

Breaking the fast is harder than fasting.

Avoid junk food for few days.

When breaking from water fasting, go to a juice fast for two days or eat fruits like oranges, mangos or pears. In severe condition glucose is started intravenously.

Rest the digestive system Weight loss Allow for cleansing and detoxification of the body Promote greater mental clarity

 lead

to a feeling of physical lightness, increasing energy level past to at present fasting has been a catalyst to a number of revolution.

From

 Headache Nausea

Muscle
Muscle

aches

cramps due to mineral deficits such as sodium, potassium, calcium,magnesium, and phosphorus.

Blood pressure could drop, leading to fainting spells especially when you try to sit up or stand after lying down.
Uric acid levels may rise, causing severe attacks of gout or a uric acid kidney stone. Ventricular arrhythmias, experienced usually during long water fasts.

Deprivation of water along with food follows death in approximately 7 to 10 days time whereas food starvation in 3 to 4 weeks or even longer depending on the reserve of fats in the body. Longest period of survival never exceeds 9 to 10 weeks.

CLINICAL ASPECTSPROTEIN ENERGY MALNUTRITION

The term protein energy malnutrition has been adopted by WHO in 1976. Highly prevalent in developing countries among <5 children; severe forms 1-10% & underweight 20-40%. All children with PEM have micronutrient deficiency. It is most prevalent in South Asia and sub saharan africa.

 There

are two varities of PEM 1) Marasmus 2) Kwashiorkor.

The term derived from the Greek marasmos, which means wasting. Inadequate intake of protein and calories and is characterized by emaciation. Represents the end result of starvation where both proteins and calories are deficient.

Severe wasting of muscle & s/c fats Severe growth retardation Child looks older than his age Alert but miserable Hungry Diarrhoea & Dehydration

Lack of physiological adaptation to unbalanced deficiency. Body utilized proteins and conserve S/C fat.

Marasmus represents an adaptive response to starvation, whereas kwashiorkor represents a maladaptive response to starvation.

 Oedema Psychomotor changes

Growth retardation
Muscle wasting

 Moon Hair Skin

face changes

depigmentation

Anaemia

Hypoglycemia Hypothermia Hypokalemia Hyponatremia Heart failure Dehydration & shock Infections (bacterial, viral & thrush)

Guyton and Hall Indian journal of Physiology. Harpers textbook of Biochemistry. Chatterjee-textbook of Biochemistry. Journal of Biochemistry.