WEBVTT - Ep 190 Starvation: More than hunger 0:00:00.200 --> 0:00:03.480 Hello. My name is Jim Graham. I'd like to tell 0:00:03.480 --> 0:00:05.880 you about an experience that I had during World War 0:00:05.920 --> 0:00:09.760 Two as a guinea pig and an experiment in semi starvation. 0:00:11.280 --> 0:00:15.720 On February twelfth, nineteen forty five, we began our twenty 0:00:15.760 --> 0:00:19.959 four weeks of semi starvation. We were expected to lose 0:00:20.000 --> 0:00:22.680 about one fourth of our body weight during the next 0:00:22.760 --> 0:00:27.600 six months. The days began to drag out, each day 0:00:27.640 --> 0:00:30.840 getting longer and longer, and there seemed to be no 0:00:31.000 --> 0:00:35.279 end of starvation in sight. Six months seemed like forever. 0:00:36.560 --> 0:00:38.920 I'd look in the mirror and see that my eyes 0:00:38.960 --> 0:00:42.159 looked hollow, my cheeks were only a thin covering for 0:00:42.200 --> 0:00:45.800 the bones in my face, and my hair was getting thinner. 0:00:46.720 --> 0:00:48.960 If I tried to smile, it was just a grimace. 0:00:50.240 --> 0:00:53.000 I didn't feel like smiling in the first place, and 0:00:53.040 --> 0:00:58.280 I never laughed. My muscles were almost gone, my bones protruded, 0:00:59.000 --> 0:01:01.640 and sitting on a hard chair was uncomfortable even for 0:01:01.720 --> 0:01:05.080 a few minutes. Most of us carried around pillows to 0:01:05.120 --> 0:01:09.280 sit on. I couldn't walk up a flight of stairs 0:01:09.319 --> 0:01:12.399 without stopping to rest once or twice on the way up. 0:01:13.520 --> 0:01:17.400 I felt like an old man. And probably looked like one, 0:01:17.440 --> 0:01:21.560 since I made no effort to stand up straight. I 0:01:21.640 --> 0:01:25.880 thought about food all the time. I started collecting cookbooks, 0:01:26.000 --> 0:01:29.000 you know the kind with beautiful color pictures of delicious 0:01:29.040 --> 0:01:34.040 looking dishes. I felt cold all the time, even though 0:01:34.080 --> 0:01:37.400 it was the middle of summer. Nothing felt better than 0:01:37.440 --> 0:01:40.440 to find a nice warm spot in the sunshine and 0:01:40.560 --> 0:01:42.959 do nothing but lie there and soak up the heat 0:01:42.959 --> 0:01:49.120 of the sun. We became very irritable and intolerant. Little 0:01:49.120 --> 0:01:52.720 things seemed to annoy us. We were no longer polite 0:01:52.760 --> 0:01:56.760 with each other or with visitors. It seemed as if 0:01:56.800 --> 0:02:00.960 the veneer of civilization had been removed. Leave bear the 0:02:01.000 --> 0:02:05.360 animal underneath. We didn't enjoy having guessed because it was 0:02:05.360 --> 0:02:09.200 an effort to entertain them, and we were not usually 0:02:09.320 --> 0:02:14.079 very diplomatic about showing our feelings about it. Food occupied 0:02:14.080 --> 0:02:18.000 our thoughts all the time. At meal time, each one 0:02:18.080 --> 0:02:21.639 had his special way of dealing with the food. A 0:02:21.680 --> 0:02:24.200 couple of the fellows would eat their food quickly and 0:02:24.240 --> 0:02:26.880 then leave the cafeteria and try to forget about it. 0:02:28.080 --> 0:02:30.480 Most of the rest of us dawdled over our food. 0:02:31.440 --> 0:02:35.399 Some would mix their food altogether, others would savor each 0:02:35.480 --> 0:02:39.480 bite of each item on the plate. We'd been told 0:02:39.560 --> 0:02:44.240 before the experiment that the food might become monotonous since 0:02:44.240 --> 0:02:48.440 there were only three menus, but it was far from monotonous. 0:02:48.760 --> 0:02:53.760 It was food, and any food tasted good. To this day, 0:02:53.800 --> 0:02:56.239 I find one of the tastiest foods is a simple 0:02:56.320 --> 0:03:01.600 boiled potato. It's delicious. Any food looked good. Even the 0:03:01.639 --> 0:03:05.240 dirty crusts of bread in the street looked appetizing, and 0:03:05.280 --> 0:03:09.200 we envied the fat pigeons picking at them. Wasting food 0:03:09.320 --> 0:03:11.800 is a crime. We felt the waste of food and 0:03:11.840 --> 0:03:17.960 restaurants was intolerable. On July twenty ninth, nineteen forty five, 0:03:18.280 --> 0:03:21.280 was the day semi starvation was to end and we 0:03:21.280 --> 0:03:25.040 were to begin eating again. It was also my twenty 0:03:25.040 --> 0:03:28.440 third birthday. After the experiment was over, I was still 0:03:28.520 --> 0:03:31.959 hungry for a long time. Even when I could eat 0:03:32.000 --> 0:03:34.640 all I wanted, I would finish a meal and still 0:03:34.680 --> 0:03:40.400 feel hungry. My stomach just would not hold anymore. For months, 0:03:40.480 --> 0:03:43.600 I carried candy bars or cookies in my pocket and 0:03:43.680 --> 0:03:47.520 munched continually. In six months, I went from a low 0:03:47.560 --> 0:03:49.920 of one hundred and twenty two pounds to a high 0:03:49.920 --> 0:03:53.600 of two hundred and twenty five pounds. It took me 0:03:53.680 --> 0:03:56.440 three years to get back to normal weight and normal 0:03:56.520 --> 0:04:01.800 eating habits. In conclusion, I would like to say that 0:04:01.920 --> 0:04:05.360 I have experienced hunger and the apathy and depression that 0:04:05.400 --> 0:04:10.080 goes with it, but we lived in sanitary quarters under 0:04:10.120 --> 0:04:14.160 the constant care of doctors. Most people in areas of 0:04:14.200 --> 0:04:18.400 famine die of other diseases because of the body's inability 0:04:18.640 --> 0:04:24.279 to resist disease. Furthermore, we knew that it would all 0:04:24.279 --> 0:04:28.360 be over on a certain date. I often think how 0:04:28.400 --> 0:04:31.840 horrible it would be to be starving and never know 0:04:31.960 --> 0:04:32.839 when it would end. 0:04:33.480 --> 0:05:26.400 If ever, it's that is such a fascinating perspective, and 0:05:26.440 --> 0:05:33.880 like the fact that that video exists is kind of incredible. Yeah, yeah, yeah. 0:05:33.640 --> 0:05:37.640 It's yeah. It's especially that what he says at the end, 0:05:37.760 --> 0:05:40.160 they're like knowing that it's going to end, and how 0:05:40.240 --> 0:05:44.440 much that can change the way that you are experienced. 0:05:44.440 --> 0:05:47.360 I don't know, it's I mean, it's like and we'll 0:05:47.360 --> 0:05:49.120 get into it more later, but yeah, this is like 0:05:49.240 --> 0:05:53.440 artificial settings important nonetheless, but like, yes, this is not 0:05:53.960 --> 0:05:56.840 the type of thing that people experience under real world 0:05:56.880 --> 0:06:00.960 conditions of starvation. Yeah, so but yeah, so again that 0:06:01.240 --> 0:06:05.760 was Jim Graham who participated in the Minnesota Semi Starvation experiment. 0:06:06.160 --> 0:06:08.680 That's from a video that was recorded in nineteen ninety 0:06:08.760 --> 0:06:12.520 and it's part of Colorado State University's Digital library collections, 0:06:12.880 --> 0:06:17.080 specifically university publications, and we will post a link to 0:06:17.120 --> 0:06:19.560 the full video and the transcript as well on our 0:06:19.600 --> 0:06:22.440 website so you can watch, or listen to or read 0:06:22.480 --> 0:06:27.000 the entire thing. So, yeah, hi, I'm. 0:06:26.839 --> 0:06:30.080 Aaron Welsh and I'm Erin Almanepneke. 0:06:29.680 --> 0:06:31.719 And this is this podcast will kill You. 0:06:32.240 --> 0:06:34.760 So this week and next we're going to be talking 0:06:34.800 --> 0:06:41.000 about starvation and famine and those words, along with hunger 0:06:41.080 --> 0:06:45.080 and malnutrition, have been used a lot lately in discussions 0:06:45.120 --> 0:06:49.159 surrounding the ongoing genocide and famine happening in Gaza and 0:06:49.240 --> 0:06:50.720 the conflict raging Insudan. 0:06:51.960 --> 0:06:56.360 All of these words, you know, starvation, famine, hunger, malnutrition 0:06:56.640 --> 0:07:00.000 are associated with a lack of food and the subsequent 0:07:00.240 --> 0:07:03.400 effects of that lack of food. But each one of 0:07:03.400 --> 0:07:06.080 these words has a distinct meaning, and so what we 0:07:06.120 --> 0:07:08.760 want to do with these two episodes is to provide 0:07:08.760 --> 0:07:11.600 a bit of context for understanding, you know, what it 0:07:11.680 --> 0:07:14.120 is that we're talking about. When we talk about starvation 0:07:14.400 --> 0:07:17.080 and what it means to declare a famine. 0:07:17.440 --> 0:07:21.680 Yeah, so we're starting out this week discussing starvation, the 0:07:21.680 --> 0:07:26.000 physiological and psychological impacts, and a little bit about its history. 0:07:26.040 --> 0:07:29.680 And you'll hear more about that Minnesota semi starvation experiment. 0:07:29.560 --> 0:07:33.240 Yes you will. And then next week we'll turn to famine. 0:07:33.280 --> 0:07:37.040 We'll go through the definition or definitions of famine, what 0:07:37.240 --> 0:07:41.840 causes famine, and how famines have changed throughout history, before 0:07:41.880 --> 0:07:44.200 we outline some of what's happening with the famine in 0:07:44.280 --> 0:07:47.880 Gaza and other food in security crises in other areas 0:07:47.920 --> 0:07:48.520 of the world. 0:07:48.960 --> 0:07:52.840 Yeah, we have a lot to cover these two episodes, 0:07:53.400 --> 0:07:55.560 so we decided to do things a little differently and 0:07:55.720 --> 0:07:59.320 just start right into it. Yes, Yeah, we're going to 0:07:59.320 --> 0:08:19.760 take a quick break and then get started. My goal 0:08:20.040 --> 0:08:23.360 for this first part of today's episode is to walk 0:08:23.520 --> 0:08:27.720 us through what is happening in our bodies, what happens 0:08:27.720 --> 0:08:31.160 inside of our bodies when we are deprived of food. 0:08:32.000 --> 0:08:34.440 So I'm going to start with what's happening on like 0:08:34.520 --> 0:08:38.439 a fairly minute scale, like how does the inner machinery 0:08:38.480 --> 0:08:41.000 of our body keep ticking if we don't provide it 0:08:41.080 --> 0:08:46.040 with any source of energy, and that process can happen 0:08:46.160 --> 0:08:48.680 for any reason. Right. It could be because you lack 0:08:48.720 --> 0:08:51.560 access to food. It could also be because of prolonged illness. 0:08:51.720 --> 0:08:54.800 It could be a restrictive food intake disorder, It could 0:08:54.840 --> 0:08:56.720 be any number of things. But I'm going to go 0:08:56.760 --> 0:09:00.679 through the mechanism of what's going on. But then we're 0:09:00.720 --> 0:09:02.720 going to take a step back a little bit outside 0:09:02.760 --> 0:09:05.080 of our bodies and talk about some of the bigger 0:09:05.120 --> 0:09:10.800 picture consequences of prolonged starvation, especially in the context in 0:09:10.840 --> 0:09:14.280 which we most commonly see starvation today around the globe, 0:09:14.360 --> 0:09:16.920 which is lack of access to food. 0:09:17.120 --> 0:09:19.440 Right, right, right, so population level. 0:09:19.240 --> 0:09:23.200 Effects exactly exactly, Yeah, well, individual and population level, but 0:09:23.320 --> 0:09:32.360 like right, so it's a lot, it's all depressing. As animals, 0:09:32.960 --> 0:09:36.760 we use the food that we eat to create energy, 0:09:36.960 --> 0:09:41.080 and that is the process that we call metabolism. And 0:09:41.280 --> 0:09:43.760 we don't have to get deep into biochemistry. Don't worry, 0:09:43.920 --> 0:09:49.120 because I simply cannot. But there are three main macronutrients 0:09:49.120 --> 0:09:51.720 that are most important, at least for my discussion today, 0:09:51.760 --> 0:09:56.640 and that is carbohydrates or glucose, fats, and protein, and 0:09:56.760 --> 0:09:59.120 these are the majority of what makes up our foods. 0:09:59.200 --> 0:10:01.800 Of course, there's a lot lo of micronutrients. We've covered 0:10:01.840 --> 0:10:04.199 several of them on this podcast. They are essential to 0:10:04.280 --> 0:10:07.640 keep us functioning, but the big three are what we're 0:10:07.640 --> 0:10:10.640 going to focus on today. We have to break down 0:10:11.040 --> 0:10:16.560 and use carbohydrates, fats, and proteins in different ways via 0:10:16.640 --> 0:10:20.520 a whole bunch of complicated cycles in order to create 0:10:20.679 --> 0:10:25.960 energy and keep our cells alive. And all animals do this, 0:10:27.080 --> 0:10:33.240 and because food is almost never, like constantly available, we 0:10:33.720 --> 0:10:38.480 all have All animals have mechanisms physiologic adaptations in order 0:10:38.559 --> 0:10:41.720 to survive in times of food scarcity or food deprivation, 0:10:42.679 --> 0:10:45.840 and the exact adaptations are going to vary a lot 0:10:45.880 --> 0:10:48.600 by species, which is why bears can hibernate for months 0:10:48.600 --> 0:10:52.000 on end, salmon can traverse thousands of kilometers without eating, 0:10:52.080 --> 0:10:53.880 snakes can only eat a couple of times a year. 0:10:54.840 --> 0:10:59.960 But humans, we have relatively high metabolic rates, especially relative 0:11:00.160 --> 0:11:04.440 to our body stores of energy, so we actually need 0:11:04.559 --> 0:11:07.679 food on a pretty regular basis in order to survive. 0:11:08.280 --> 0:11:11.640 There are also behavioral adaptations like caching food, which I mean, 0:11:11.760 --> 0:11:14.960 of course humans, but like like we talked about in hypothermia, 0:11:15.080 --> 0:11:16.000 I know as. 0:11:15.800 --> 0:11:17.280 I was writing this I was like, we just went 0:11:17.320 --> 0:11:23.840 over this in hypothermia. So when animals, including humans, are 0:11:23.880 --> 0:11:28.920 deprived of food, we experience hunger, and the feeling of 0:11:29.040 --> 0:11:33.880 hunger is driven by a pretty complex interplay between hormonal 0:11:33.960 --> 0:11:39.400 and neurologic signals. But hunger is also a biological drive, 0:11:40.080 --> 0:11:44.160 So in animals, including in humans, it's a driving force 0:11:44.360 --> 0:11:48.479 of behavior. And in a lot of animal studies, animals 0:11:48.960 --> 0:11:53.480 across the spectrum, like mammals, birds, everything, will engage in 0:11:53.640 --> 0:11:58.360 riskier and riskier behavior in an attempt to access food 0:11:58.520 --> 0:12:03.000 if they are hungry or starve, and in many animal models, 0:12:03.160 --> 0:12:08.240 the hunger drive actually out competes or overrides nearly all 0:12:08.440 --> 0:12:10.200 other biologic incentives. 0:12:10.880 --> 0:12:13.120 How does it compare it to like thirst drive? 0:12:13.640 --> 0:12:16.040 That's actually a good question. I didn't see any things 0:12:16.080 --> 0:12:18.960 directly comparing that, but they're also very closely related because 0:12:18.960 --> 0:12:21.319 a lot of times, you know, if you are deprived 0:12:21.360 --> 0:12:24.280 of food, you may also be deprived of water. There's 0:12:24.280 --> 0:12:29.520 also some animals who get their water primarily from their food. So, yeah, 0:12:29.559 --> 0:12:31.000 it's a good question, but I don't have like an 0:12:31.040 --> 0:12:34.520 exact answer to it. Yeah, so I'm going to go 0:12:34.679 --> 0:12:37.600 into a little bit mechanistically about what's happening during that 0:12:37.760 --> 0:12:42.320 time during starvation, and there are a lot of hormonal 0:12:42.520 --> 0:12:46.040 drivers and things at play that are controlling our hunger 0:12:46.120 --> 0:12:50.280 cues and our satiety cues. But I think what's important 0:12:50.320 --> 0:12:53.360 to keep in mind as we go through this is that, 0:12:53.440 --> 0:12:56.800 in my opinion, maybe this is an opinion, none of 0:12:56.840 --> 0:13:02.520 this explanation is really adequate to explain what happens to 0:13:02.960 --> 0:13:08.560 people and animals but also humans when they feel hungry 0:13:09.440 --> 0:13:13.600 all the time, for days or weeks on end. I 0:13:13.640 --> 0:13:15.960 think that our first hand account helped to explain some 0:13:16.040 --> 0:13:19.600 of that bigger picture about how it feels to be hungry, 0:13:19.679 --> 0:13:22.320 but the biology doesn't quite I think, do that justice? 0:13:23.800 --> 0:13:26.520 Yeah, I mean it can't. 0:13:26.640 --> 0:13:27.160 It can't. 0:13:27.400 --> 0:13:29.240 It can't because it's so clinical. 0:13:29.200 --> 0:13:36.600 Yes exactly, yeah so, but metabolically absolute food deprivation proceeds 0:13:36.600 --> 0:13:40.400 in relatively predictable stages. It starts with what's often called 0:13:40.440 --> 0:13:46.160 fasting and then proceeds through starvation, and without intervention this 0:13:46.320 --> 0:13:50.600 will end in death. So the first phase of food 0:13:50.600 --> 0:13:54.439 deprivation is it's often called fasting, and there's arguments about 0:13:54.480 --> 0:13:57.959 like when do you hit the threshold between fasting and 0:13:58.000 --> 0:14:00.800 starvation and et cetera. But the point is that this 0:14:00.920 --> 0:14:04.240 is just the first few hours after you've eaten food. 0:14:05.440 --> 0:14:08.040 Once we've absorbed all that we can from our meal, 0:14:08.200 --> 0:14:10.000 the first thing that our body is going to do 0:14:10.200 --> 0:14:14.280 is start using glycogen, which is the long branchy chains 0:14:14.280 --> 0:14:17.320 of glucose that we store in our liver, right, and 0:14:17.360 --> 0:14:20.040 we start breaking this down in order to keep our 0:14:20.080 --> 0:14:21.800 blood sugar levels up. 0:14:22.320 --> 0:14:25.400 Okay, so this is what happens after you eat a meal. 0:14:25.800 --> 0:14:28.320 After you eat and you've digested and used up all 0:14:28.320 --> 0:14:29.760 the glucose in your meal. 0:14:29.880 --> 0:14:30.560 Right, got it? 0:14:30.640 --> 0:14:33.960 Yep. Yeah, we'll also start to use some of our 0:14:34.000 --> 0:14:37.360 adipose tissue storage, especially to like fuel our muscles and 0:14:37.400 --> 0:14:41.320 things like that. This phase, though, the glycogen storage that 0:14:41.320 --> 0:14:43.280 we have in our liver only lasts for about a 0:14:43.320 --> 0:14:45.840 few hours, which is why we usually start to feel 0:14:45.920 --> 0:14:51.640 hungry a few hours after eating. After a few hours 0:14:51.680 --> 0:14:56.080 without food, our livers glycogen stores are depleted, and our 0:14:56.240 --> 0:15:01.880 brain requires glucose in order to function in the rest 0:15:01.920 --> 0:15:04.600 of the tissues in our body can use other energy sources. 0:15:04.640 --> 0:15:07.600 They can go through these biochemical pathways to like directly 0:15:07.720 --> 0:15:12.360 use proteins or fats in order to make energy. In 0:15:12.440 --> 0:15:15.920 order to make ATP. But our brain really needs glucose. 0:15:15.960 --> 0:15:19.680 That's what it is dependent on. So our liver abides 0:15:19.880 --> 0:15:24.880 and starts making glucose. And this is a process called gluconeogenesis, 0:15:24.960 --> 0:15:26.520 literally making new glucose. 0:15:27.200 --> 0:15:30.000 This is it's like I remember all of this in 0:15:30.040 --> 0:15:33.720 such vague terms from like bio one oh one, right, 0:15:34.200 --> 0:15:37.680 and it's I don't know if it's coming back to me, 0:15:37.800 --> 0:15:40.600 but by the end of this it would be back. 0:15:40.920 --> 0:15:43.640 You have certainly come across this, I'm sure in like 0:15:43.760 --> 0:15:48.240 most biology, gluconeogenesis. Yeah, yeah, it's actually one of my 0:15:48.280 --> 0:15:49.360 favorite words. 0:15:49.600 --> 0:15:50.360 It's a good word. 0:15:50.640 --> 0:15:51.360 It's a good word. 0:15:51.600 --> 0:15:51.920 Yeah. 0:15:52.320 --> 0:15:55.600 We go through glycogenolysis, and now we make gluga eugenesis. Anyways, 0:15:56.840 --> 0:16:00.120 at first, like the very first, our body starts to 0:16:00.120 --> 0:16:03.560 do this with some protein because protein is very easy 0:16:03.600 --> 0:16:06.760 for our bodies to make glucose from. Okay, so we'll 0:16:06.800 --> 0:16:09.040 start breaking down a little bit of protein in order 0:16:09.080 --> 0:16:13.640 to feed our brain. But proteins in our body are 0:16:13.680 --> 0:16:19.160 not really there for energy storage. We use proteins in 0:16:19.200 --> 0:16:23.000 our body for building stuff. We use it to make 0:16:23.040 --> 0:16:28.120 our muscles, we use it as enzymes. Right, So our 0:16:28.120 --> 0:16:31.920 body tries to preserve protein aside from what we eat 0:16:31.960 --> 0:16:35.720 and then have to use. Right, So pretty quickly our 0:16:35.720 --> 0:16:39.680 body switches and we start relying more on our adipose tissue, 0:16:39.680 --> 0:16:45.280 our fat in order to fuel our body. We cannot, though, 0:16:45.640 --> 0:16:51.160 make glucose directly from the fatty acids part of fat. Okay, 0:16:51.600 --> 0:16:53.720 but we store fat and sorry this is getting a 0:16:53.720 --> 0:16:56.440 little technical, but we store fat in the form of 0:16:56.440 --> 0:17:00.880 something called triglycerides, which is three fats and a glycrool, 0:17:01.320 --> 0:17:04.000 and that one glycerol we can make glucose from. 0:17:05.480 --> 0:17:09.120 Okay, could we just pause and start so now can 0:17:09.160 --> 0:17:11.920 you put me in like a timeline of what is happening, 0:17:12.119 --> 0:17:15.800 and when like step one you eat, step two you digest, 0:17:15.920 --> 0:17:21.480 step three you start to pull the glycogen from your liver, 0:17:22.160 --> 0:17:25.639 and then step four where does proteins that what happens 0:17:25.640 --> 0:17:26.960 with the proteins and fats at that point. 0:17:27.080 --> 0:17:30.159 It's not like an exact like this day you switch, 0:17:30.200 --> 0:17:33.080 because it's going to depend on your body composition and 0:17:33.440 --> 0:17:35.680 like what your last meal was and all of those 0:17:35.720 --> 0:17:38.560 sorts of shits. Right, But in general, after a meal, 0:17:38.680 --> 0:17:41.520 the first few hours you're going to be mostly using 0:17:41.560 --> 0:17:45.520 glycogen stores. After those glycogen stores are depleted. Your body 0:17:45.600 --> 0:17:49.119 is going to start breaking down your own body in 0:17:49.359 --> 0:17:53.000 order to get the glucose that you need. It might 0:17:53.160 --> 0:17:55.879 use a little bit of protein at first, but primarily 0:17:56.000 --> 0:17:59.479 it's going to rely on using your fat stores. Where 0:17:59.520 --> 0:18:02.560 are fat stores, I mean, all over your whole body. 0:18:03.600 --> 0:18:06.119 It's just everywhere. It's just sort of a shop. 0:18:07.119 --> 0:18:10.359 Yep, exactly. Yeah, Okay, So we start seeing a lot 0:18:10.400 --> 0:18:14.679 of this process called fatty acid oxidation, and that is 0:18:14.720 --> 0:18:17.240 the majority of what we're going to see for potentially 0:18:17.320 --> 0:18:21.240 weeks on end, depending on how much fat storage you have. 0:18:23.440 --> 0:18:26.280 The process of fatty acid oxidation will also result in 0:18:26.320 --> 0:18:27.880 the formation of keytone bodies. 0:18:27.960 --> 0:18:29.040 People who have heard. 0:18:28.840 --> 0:18:31.320 Of the whole keto diet thing will have heard of this. 0:18:31.640 --> 0:18:33.720 We should do an episode on the Keto diet, though 0:18:33.760 --> 0:18:34.600 we probably should. 0:18:35.520 --> 0:18:39.560 Our brains can actually use keytone bodies. They can use 0:18:39.720 --> 0:18:43.640 ketones as fuel. Our brain prefers glucose, but it will 0:18:43.800 --> 0:18:47.920 use this as it is required to. But this whole 0:18:47.960 --> 0:18:51.800 process is basically our body adapting to this starvation. We 0:18:51.920 --> 0:18:55.720 will use up all of our fat stores, and how 0:18:55.840 --> 0:18:59.240 long we can survive in this particular phase is going 0:18:59.280 --> 0:19:02.399 to depend pretty much on our body composition, our age, 0:19:02.840 --> 0:19:05.960 our comorbidity, is all of these things. But it's usually 0:19:06.040 --> 0:19:11.119 a period of a few weeks or so. After that 0:19:12.080 --> 0:19:15.280 we enter what's kind of called phase three, and that 0:19:15.840 --> 0:19:18.040 I think of it as when our body is really 0:19:18.080 --> 0:19:21.080 not able to compensate anymore, because this is the point 0:19:21.080 --> 0:19:24.040 at which we've run through these fat stores and now 0:19:24.080 --> 0:19:28.199 we have to rely on skeletal muscle. Yeah, and our 0:19:28.240 --> 0:19:32.359 body has to start breaking down our muscle proteins in 0:19:32.600 --> 0:19:35.800 order to use them for energy. And you can imagine 0:19:35.800 --> 0:19:39.400 that that's not good for our body. We need our muscles, 0:19:40.960 --> 0:19:43.680 but that is what our body will do in order 0:19:43.720 --> 0:19:47.040 to keep it alive in the short term. Right. 0:19:47.400 --> 0:19:50.679 Can I ask a question about like how food consumption 0:19:51.680 --> 0:19:53.119 changes this process? 0:19:53.560 --> 0:19:57.280 Yeah, it's a really good question. So it's not common 0:19:57.440 --> 0:20:00.880 that people are completely deprived of food and how absolutely 0:20:00.920 --> 0:20:01.960 no access to food. 0:20:02.040 --> 0:20:02.200 Right. 0:20:02.400 --> 0:20:05.000 More often people are going to get very small amounts 0:20:05.000 --> 0:20:07.600 of food a little bit at a time, or maybe erratically, 0:20:08.080 --> 0:20:11.280 and that is what is sometimes called this like semi starvation. 0:20:12.760 --> 0:20:14.600 The way to think about that is it's going to 0:20:14.680 --> 0:20:18.480 kind of fluctuate where you are in this continuum. As 0:20:18.480 --> 0:20:20.840 soon as you eat, your body is going to use 0:20:20.960 --> 0:20:24.320 up all of that food that it can. Is it 0:20:24.359 --> 0:20:26.639 going to be able to store any extra? It totally 0:20:26.720 --> 0:20:30.919 depends on how deprived you have been, right, But you 0:20:30.960 --> 0:20:33.440 can think of it as kind of keeping people cycling 0:20:33.560 --> 0:20:37.000 between these first few phases for a potentially more prolonged 0:20:37.040 --> 0:20:40.560 period of time. But it could be that you're kind 0:20:40.600 --> 0:20:43.760 of going your body is doing all things at once, right, 0:20:43.840 --> 0:20:46.080 You've if you've used up all of your fat stores, 0:20:46.160 --> 0:20:48.520 and then you get access to food, then your body's 0:20:48.520 --> 0:20:50.520 going to use that food. But then as soon as 0:20:50.640 --> 0:20:53.119 you've used that up, you don't have any fat stores, 0:20:53.119 --> 0:20:54.600 so you're going to go right back to using your. 0:20:54.600 --> 0:20:56.320 Protein something straight back to protein. 0:20:56.400 --> 0:21:01.400 Okay, okay, yeah, so that's I mean, Actually, what happens 0:21:01.560 --> 0:21:04.439 this process, especially once you get to the point of 0:21:04.440 --> 0:21:08.960 breaking down your own skeletal muscle for fuel, can progress 0:21:09.000 --> 0:21:12.240 fairly rapidly, and if food does not become available, this 0:21:12.280 --> 0:21:17.240 will end in death kind of directly from starvation. There 0:21:17.359 --> 0:21:21.399 are in the literature kind of two different syndromes that 0:21:21.440 --> 0:21:24.880 we most often see in people who are affected by starvation, 0:21:25.680 --> 0:21:29.879 and collectively this is called severe acute malnutrition. This is 0:21:29.960 --> 0:21:33.600 like the end stage of this This is like phase three, 0:21:33.840 --> 0:21:38.040 end stage of lack of access to food. This used 0:21:38.080 --> 0:21:40.080 to be called it was when I learned it actually 0:21:40.080 --> 0:21:45.760 called protein energy malnutrition. But separately, within this there's two 0:21:45.800 --> 0:21:49.880 different syndromes. One is known as quashiocore and the other 0:21:50.040 --> 0:21:54.440 is Marasmus. Yes, and a lot of the literature around 0:21:54.560 --> 0:21:58.040 severe acute malnutrition or SAM, focuses on children under the 0:21:58.080 --> 0:22:01.520 age of five because they are by far the most 0:22:01.720 --> 0:22:06.680 vulnerable too severe acute malnutrition and the complications that can arise. 0:22:07.280 --> 0:22:10.960 But it's not the only they are not the only people. 0:22:11.040 --> 0:22:14.240 It's really important to remember that other groups are very 0:22:14.359 --> 0:22:19.800 vulnerable to food deprivation, including pregnant or breastfeeding people, including 0:22:19.840 --> 0:22:24.160 the elderly, and including children and adults with certain disabilities 0:22:24.240 --> 0:22:28.120 or comorbid conditions, things like cystic fibrosis or cerebral palsy. 0:22:28.280 --> 0:22:30.679 I mean, there are so many conditions that might make 0:22:30.720 --> 0:22:32.800 you more susceptible to malnutrition. 0:22:33.280 --> 0:22:34.560 Yeah, but I. 0:22:34.520 --> 0:22:36.640 Want to go through these two syndromes in a little 0:22:36.640 --> 0:22:39.120 bit of detail, and then we'll talk bigger picture about 0:22:40.040 --> 0:22:42.639 all of the complications that happen as your body has 0:22:42.680 --> 0:22:48.800 gone through this starvation process. So Marasmus is also known 0:22:48.840 --> 0:22:53.560 as acute wasting, and this is when you lose a 0:22:53.680 --> 0:22:57.000 very substantial amount of weight, and usually in a relatively 0:22:57.040 --> 0:23:01.199 brief period, although some people, if they have been experiencing 0:23:01.240 --> 0:23:04.000 prolonged semi starvation, it might be over kind of a 0:23:04.000 --> 0:23:07.800 longer time period. But it's diagnosed based on specific like 0:23:07.920 --> 0:23:11.200 body weight and height measurements, or by measuring the upper 0:23:11.320 --> 0:23:15.960 arm circumference and having that be below a certain circumference. 0:23:16.400 --> 0:23:19.359 It's like a good indicator of how much weight someone 0:23:19.400 --> 0:23:24.040 has lost. And this is really the kind of most 0:23:24.160 --> 0:23:29.160 classic process that happens as what I described of starvation. 0:23:29.640 --> 0:23:33.119 So as you have no food, you use up all 0:23:33.160 --> 0:23:35.080 of your fat stores, and then you start to eat 0:23:35.080 --> 0:23:39.080 away at your muscles and then you are experiencing Marasmus. 0:23:39.119 --> 0:23:40.359 Does that make sense? Yes? 0:23:40.680 --> 0:23:40.960 Yes. 0:23:42.280 --> 0:23:46.760 The other condition is quashiocore, which historically was thought of 0:23:46.920 --> 0:23:49.720 as primarily a protein malnutrition. 0:23:51.720 --> 0:23:52.360 What does that mean? 0:23:52.720 --> 0:23:54.240 Yeah, it used to be. 0:23:54.320 --> 0:23:54.399 So. 0:23:54.480 --> 0:23:57.760 It was first seen in certain populations in association with 0:23:57.800 --> 0:24:01.080 a very low protein diet or in infant after they 0:24:01.119 --> 0:24:03.800 switched from breast milk to very low protein like say 0:24:03.800 --> 0:24:06.800 all corn diets or something like that. Okay, And so 0:24:07.000 --> 0:24:10.360 based on those kind of like epidemiological studies, and in 0:24:10.560 --> 0:24:13.960 contrasting that to Marasmus, which was thought of as purely 0:24:14.040 --> 0:24:18.840 like a calorie deficit uh huh, without necessarily only a 0:24:18.880 --> 0:24:23.320 protein deficit. This was classified initially as like, oh, this 0:24:23.440 --> 0:24:26.720 is a protein deficit rather than like a total energy deficit. 0:24:27.960 --> 0:24:30.120 But it turns out that that's not really quite as 0:24:30.160 --> 0:24:32.879 clear cut, and the exact path of physiology is not 0:24:33.240 --> 0:24:37.800 entirely understood. We really don't understand quashio court right now, 0:24:38.600 --> 0:24:44.160 but it does look different physiologically than Marasmus or wasting. 0:24:44.520 --> 0:24:48.880 It's characterized by this edema, this fluid collection and swelling 0:24:49.000 --> 0:24:51.880 underneath the skin especially, and it starts in the lower 0:24:51.960 --> 0:24:55.400 legs but can also be in the face, in the arms. 0:24:56.200 --> 0:25:00.040 And there's also fatty liver infiltration that we see, and 0:25:00.119 --> 0:25:02.720 you can get from that like distension of the abdomen, 0:25:03.880 --> 0:25:06.679 and then we'll have like flaky skin and other changes 0:25:06.720 --> 0:25:12.040 that we don't necessarily see with Marasmus or wasting. We 0:25:12.240 --> 0:25:14.720 think from what I could tell from the literature that 0:25:14.960 --> 0:25:19.400