In a disturbing turn of events, three sisters, aged eight, four and two years, were found dead in east Delhi’s Mandawali area, with initial postmortem report hinting that it was a case of starvation.
According to the initial postmortem report, the girls died due to ‘malnourishment/starvation and its complications’ as they had not eaten for 8 days.
Their bodies had allegedly gone into a state of shock on the night of 23rd July.
A second autopsy was conducted at GTB Hospital said that the case looked like a ‘typical case of malnutrition’ with ‘no trace of fat in the bodies’.
What happens to your body when it is denied any form of nutrition for a long period of time? How does it shut down?
What is Starvation?
Starvation is not a specific event or sickness, explains Dr Ashwini Setya, Gastroenterologist and Programme Director in Delhi’s Max Super Speciality Hospital.
It is a process of malnutrition of protein and carbohydrates and other such nutrients to a point where life can’t sustain itself. Extreme malnutrition can lead to starvation and different bodies react differently to the process of starvation.Dr Ashwini Setya
So what exactly happens in the body when a person doesn’t eat, or is denied food for a long period of time?
Why is Food Important?
Our body needs energy to function. This energy comes from the food we eat.
The body digests the food by breaking it down into carbohydrates, protein and fats. Carbohydrates further breaks down into glucose which is released into the bloodstream. Glucose is one of the primary sources of energy for our body. It can be used up by the body instantly or can be stored.
These dietary elements are also mixed with other acids and enzymes in the gastrointestinal tract, converting them into fragments that are easily absorbed by the different organs of the body. Food is what keeps every organ ticking.
What Happens When the Body is Denied Food?
Glucose keeps us going when we on a regular eating schedule by supplying energy to our bodies. Usually, glucose provides energy for about 6 hours post which we might begin to feel hungry and grumpy. Replenishing our body with food restores the glucose levels.
24 hours - 72 hours of No Food
The body is resilient, and when denied food, it will start converting the body’s natural fat into energy.
Dr Setya says that a day’s fasting cannot be equated to starvation.
But yes, kids might show some symptoms when they don’t eat for a day. A day’s fasting might make kids irritable and apathetic.Dr Ashwini Setya
But in metabolic terms, when you don’t eat for a day then your body begins to enter the state of what’s called ketosis.
Once the supply of carbohydrates is stopped, the body begins to burn fats for energy. This process is called ketosis when the body produces ketones for energy. This process may keep the body fuelled for a day or two.Dr Ajay Agarwal, Director, Department of Internal Medicine, Fortis Hospital, Noida
While ketosis is also used as a part of the keto diet for weight management, but that is usually done by people who are normally healthy and are consuming a balanced diet.
Even then, presence of high levels of ketones in the body is not considered to be a good sign as it may lead to dehydration and also significantly alter the chemical composition of the blood.
Post 72 hours of No Food
Usually our bodies try to extract all the glucose stored in the body before relying solely on ketones for energy. Initially the dependence on ketones is 30% which gradually increases to 70% post 72 hours of no eating.
Post 72 hours, the body begins to break down the proteins present in our muscles resulting in severe muscle loss. This period may also be accompanied with severe weight loss with the person losing as high as 18% of their body weight.
Physical Effects of Starvation
Dr Agarwal explains that surviving without food and water can have severe side-effects on the body.
Some of the symptoms of starvation includes:
- Extreme weakness
- Excessive sweating, thirst
- Severe muscle loss resulting in acute weight loss
- Dehydration
- Dizziness
In children, the impact is that much more.
The metabolic rate of children is on the higher side so their bodies use the stored glucose quickly resulting in severe loss of energy. Not eating for long duration might also cause acute gastritis (a condition where the lining of the stomach is inflamed) resulting in liver or kidney failure and eventual shutdown of all organs.Dr Ajay Agarwal, Director, Department of Internal Medicine, Fortis Hospital, Noida
Could All Three Girls Have Died of Starvation?
Though statistics show that deaths due to hunger are not uncommon in India, Dr Setya suggests there could be other reasons that contributed to the death of the girls.
Usually when a person loses approximately 40% of his/her body weight due to serious lack of food is when s/he can be medically termed as being ‘severely starved’ and in such cases, the probability of death increases as the condition is mostly irreversible.Dr Ashwini Setya
But even then, death becomes a process and cannot come instantly and certainly not at the same time, as is being reported in the case of these little girls.
Glaring Stats on Hunger & Starvation in India
Even as the capital comes to grips with this tragedy in the heart of the city, the truth is India fails its children miserably on all indices. 15 lakh children die in India every year and of these, over 3 lakh children die due to hunger, as per a report in Indian Express.
India ranked 100 out of 119 countries according to Global Hunger Index 2017 (GHI) . And like most of its south Asian neighbours, India had a “serious” hunger problem with 15.2% of its citizens undernourished and 38.7% of under-five children stunted.
The GHI ranks countries based on four key indicators — undernourishment, child mortality, child wasting (acute malnutrition) and child stunting. India had a score of 31.4, which placed the country in the “serious” category.
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