What is Starvation Syndrome and how to help?

Starvation Syndrome is sometimes known as starvation mode and can occur when you restrict your diet or lose weight too quickly. It is a physiological response that occurs when the body is deprived of adequate nutrition over an extended period of time. This can occur when food and calories are reduced for an extended period of time. It is not limited to people of a certain size or weight, and can occur for a variety of reasons, including an eating disorder.

The effects are the same, regardless of why the restriction occurs. For example, it can occur due to eating disorders, or an external cause, like the Minnesota experiment below. In this semi-starvation state, the body’s metabolism slows down and its energy requirements decrease in order to conserve energy and preserve vital organs. This affect your bodies physical function and also the brains function too. This response is an adaptive mechanism that the body uses to cope with a lack of food.

What is Starvation Syndrome?

Think of starvation mode as a unique setting in your body, triggered when it senses insufficient food intake over an extended period. It’s not just about feeling hungry; it’s a physiological response to a potential scarcity of nutrients. Being in semi-starvation doesn’t necessarily correlate with being extremely underweight. If you consistently consume fewer calories than your body requires, you may be at risk. This symptoms ofstavtion do not only affect your physical wellbeing; they can also impact your emotional and mental health. If thoughts about food, weight, or body image dominate your mind, it’s crucial to pay attention to these potential red flags.

Starvation syndrome is commonly associated with an eating disorder, such as anorexia nervosa and bulimia nervosa. These involve restriction of food intake or episodes of bingeing and purging. When the body is restricted of nutrition in this way the bodies may enter a state of starvation mode. In an attempt to conserve energy and protect against further weight loss.

You may have heard that your body will go into “starvation mode” if you try to lose weight too quickly, making it harder to lose weight in the long run. Restricting your calories can, counterintuitively, make your body hold on to fat stores. One reason for this is because your body simply doesn’t know the difference between intentional weight loss and actual food scarcity, and so it will try to protect you from a perceived famine. For example, your body will down-regulate some pathways to slow down your metabolism, making weight loss harder. Ultimately the body does not want to be sick or to die, so it will do its best to preserve itself.

Signs of Starvation Syndrome:

Starvation Syndrome is not all about feeling hungry, whilst this is a part of it, there are more side effects. In addition to physiological changes, starvation syndrome can also have psychological effects. These can include increased anxiety, irritability, and depression. You may have noticed these in yourself, think about times you have skipped a meal and reached “hangry” status. In semi-starvation this is a lot worse. Then of course these effects may contribute to the development and maintenance of eating disorders.

Physical effects:

When the body is in a state of semi-starvation, it slows down its metabolism in order to conserve energy. As a result, weight loss occurs, and the body may start to break down muscle tissue for energy. There may be hair loss, headaches, decreased heart rate, dizziness, lower body temperature. You are likely to feel fatigue and a lack of energy. Hormone production can be affected, including thyroid and sex hormones. In woman the menstrual cycle may stop and sex drive can be lower for all genders. The immune system also weakens, making individuals more susceptible to infections and illnesses. Nutrient deficiencies can also occur, leading to a range of health problems, such as anaemia, vitamin deficiencies, and osteoporosis.

Mental Effects:

Signs of starvation can also include significant psychological effects as the brain decreases in size. Individuals may experience increased anxiety, irritability, and depression, as well as difficulties with concentration and memory. There may also be a preoccupation with food which takes over your mind and mental health. As well as intense feelings of guilt and shame surrounding eating. These can be quite subjective and not always obvious. Try to look at these symptoms with compassion and without judgment, recognising that these responses are your body’s way of signalling a need for attention.

Whilst the brain is only about 2% of our body weight, it uses around 20% of our energy intake, it needs glucose to function which is why it physically shrinks where there is not enough energy coming in.

Social Effects:

Starvation mode can impact an individual’s social life, as it may interfere with their ability to engage in social activities or maintain relationships. This could mean not wanting to eat out, eat with others, attend parties and family meals. There can be more emotions and conflict over mealtimes. Additionally, it may lead to isolation, as individuals may feel ashamed or embarrassed about their eating habits or physical appearance.

Eating disorder development:

Starvation syndrome can also contribute to the development of eating disorders, such as anorexia nervosa and bulimia nervosa. Individuals who engage in semi-starvation may develop an unhealthy relationship with food and body image, leading to disordered eating patterns.

The Effects of Starvation Syndrome: The Minnesota Starvation Experiment.

Much of our understanding of the science of starvation syndrome comes from the Minnesota Starvation Experiment. This was a landmark piece of research by Ancel Keys in the 1940’s. He wanted to study the effects of starvation and how best to refeed people post-war. This type of study can’t be repeated today due to it’s unethical long-term restriction of nutrition. It looked at the psychological, physical changes and behavioural changes during starvation. A group of 36 young (20-33yrs), healthy men had their calorie intake reduced by half for 6-months to measure the impact on their health. The impacts of this restriction included:

• Heart muscle reducing in size
• Reduced blood pressure and heart rate
• Feeling cold
• Dry skin
• Fatigue
• Hyperfixation or obsession with food -such as planning, thinking about food, hoarding recipes, eating very quickly (or slowly)
• Binge-eating
• Impaired focus, concentration and decision-making skills
• Reduced alertness
• Depression, anxiety, irritability and a lack of interest in life
• Social withdrawal and strained relationships, feeling more critical of others

So what does a decades-old study have to do with you? The Minnesota Starvation diet demonstrates what can happen after a few weeks or months of calorie-restriction. It shows how semi-starvation affects the mind and body, your mood, personality and emotions. What may surpsie you here is that the amount of calories eaten by the participants of the study was of a similar amount to some popular diets.

When it came to refeeding the men they trialled different calorie amounts from 2000kcals a day to 3200kcals a day. It was found 4000kcals a day were needed to rebuild strength. As the men refed with regular eating, their minds and bodies started to heal. they all regained their original weight, some men gained an extra 10% but this declined over the next 6 months.

Is starvation syndrome real?

Semi starvation isn’t just something that occurs only in the most extreme of restricted diets or for eating disorder in-patients. It can occur through prolonged dieting and restriction. It also isn’t limited to a certain body weight. Even if your body weight is above the “underweight” BMI category, you may still be affected by semi-starvation. Starvation syndrome occurs in response to the intensity of and time spent in caloric restriction, not the number on the scales.

According to the Centre for Clinical Interventions, “Starvation syndrome may be observed if a person’s nutritional intake is poor, irregular, or unbalanced, or if they engage in compensatory behaviours that reduce energy absorption, irrespective of their weight. Individuals with anorexia nervosa, bulimia nervosa and binge eating disorder are therefore all vulnerable to experiencing symptoms of semi-starvation.” This shows how eating irregularity, cutting out food groups or engaging in compensatory behaviours can also lead to semi-starvation, as well as restriction.

How to recover from starvation syndrome?

The only way to recover from semi-starvation is to increase calories and/or nutritional intake, and to restore weight to a healthier level where needed. Regular eating of meals and snack is so key. This will likely involve eating a balanced diet that includes all food groups (excluding those removed for allergies/intolerances or cultural reasons), eating at regular intervals and reducing compensatory behaviours. If you have an eating disorder, this will understandably feel scary so you will need support.

Refeeding Syndrome:

There is a risk of refeeding yourself too quickly with a condition known as refeeding syndrome. This may occur when your body switches from uses muscle and fat as a fuel source, back to using carbohydrates. Electolytes including potassium, phosphate, magnesium and calcium are needed to break down carbohydrates anad this can led to less being in the blood stream, leading to problems for the bodies vital organs. Refeeding syndrome can impact the heart and breathing system which is why it really is key to work with an eating disorder specialist team. If you are at all concerned about this please speak to your medical team and ask for blood tests. There is a set of specialist guidelines called the MEED guidelines that are available for your medical team to use.

Because of this, a structured “renourishment” period is recommended. Here, food intake is gradually increased to meet the body’s needs in a safe, supported manner. Because long periods of restriction can impact your feelings of hunger/fullness or control around food, there can be an adjustment period. Having a renourishment plan gives time to return to more “normal” levels of control and hunger cues. You can read more on meal plans for eating disorder recovery here.

Recovery takes time:

Recovery can take time, and symptoms of semi-starvation may persist for a while after food and calories have increased. Know that this is normal, and expected, and not a sign that you can’t recover. Consistency is key, as irregular eating can be a driver of semi-starvation. This may mean eating by the clock and mechanical eating at times you feel full or like you do not need more food. Focus on following a structured approach to recovery and eating to best support your recovery and relationship with food.

It is important to note that while starvation mode is a natural response to a lack of food, the impacts of this on your body can be complex and long lasting -there is a much bigger picture going on than just how easily you may lose weight. Prolonged starvation can lead to nutrient deficiencies, organ damage, and even death. Therefore, it is important for individuals with eating disorders to seek treatment to restore their physical and mental health.