Very long fasts.
Fasting and starvation.
A health and nutrition post.
Lead photograph : assumed to be by Christopher McCandless (Feb 12 1968-c August 1992)
As of right now i’m confident enough with the theory and practice of fasting to undertake regular (weekly) fasts of up to 48 hours and i think that there may be value in doing a longer fast of 5 days or so but only say once or twice per year. Just to say right at the start that i began this year with a longer fast myself after several months of becoming accustomed to moderate duration fasting. In this post though i want to take a look at much longer fasts and what happens when fasting becomes starvation, either accidental or deliberate. In a change of pace today i’m going to look at this subject via a series of case examples starting with one of the longest known , recorded, and medically supervised fasts ; that of Angus Barbieri in 1965/66.
Case 1. Angus Barbieri.
In 1965 a 27 year old man from Tayport in Scotland checked in to the Maryfield hospital in Dundee to start a short , planned and medically supervised fast. (this was later written up for the BMJ post graduate journal….abstract below *) Their plan was only a short fast as they believed at the time that short fasts were preferable but Barbieri decided to continue because he felt well on the fast. At the start of his fast Barbieri weighed in at 207 Kg (456 pounds), he fasted for 382 days and weighed out at 82 Kg (180 pounds) which was his goal weight. During the fast he took no solid food at all and only drank tea coffee and water although he did add vitamins and minerals and occasionally had small amounts of milk and sugar in his drinks.
(Frank Barbieri died in 1990 aged 51…..cause of death not recorded)
*Abstract from the post graduate journal of the BMJ ‘Features of a therapeutic fast of 382 days’ (Stewart and Fleming 1973)
“A 27-year-old male patient fasted under supervision for 382 days and has subsequently maintained his normal weight. Blood glucose concentrations around 30 mg/100 ml were recorded consistently during the last 8 months, although the patient was ambulant and attending as an out-patient. Responses to glucose and tolbutamide tolerance tests remained normal. The hyperglycaemic response to glucagon was reduced and latterly absent, but promptly returned to normal during carbohydrate refeeding. After an initial decrease was corrected, plasma potassium levels remained normal without supplementation. A temporary period of hypercalcaemia occurred towards the end of the fast. Decreased plasma magnesium concentrations were a consistent feature from the first month onwards. After 100 days of fasting there was a marked and persistent increase in the excretion of urinary cations and inorganic phosphate, which until then had been minimal. These increases may be due to dissolution of excessive soft tissue and skeletal mass. Prolonged fasting in this patient had no ill-effects.”
Case 2 Christopher McCandless…..accidental starvation.
Christpher Johnson McCandless (1968-1992), also known by his trail name (pseudonym) Alexander Supertramp was a college graduate and hiker/outdoorsman who essentially abandoned his family and background to undertake an increasingly itinerant lifestyle after graduating from college. His emaciated and decomposing body was found in an abandoned bus 28 miles from the nearest town of Healy (Alaska). Various theories have been put forward about his death from ‘simple’ starvation from eating lean meat to poisoning from 2 possible plant sources.
In April 1992, Christopher McCandless hitchhiked from South Dakota to Fairbanks Alaska, He was last seen alive at the head of the Stampede trailon April 28 by a local electrician named Jim Gallien, who had given McCandless a ride from Fairbanks to the start of the rugged track just outside the small town of Healy. Jim Gallien later said he had been seriously concerned about the safety of McCandless (who introduced himself as “Alex”) after noticing his light pack, minimal equipment, meager rations, and obvious lack of experience. Gallien said he had deep doubts about “Alex’s” ability to survive the harsh and unforgiving Alaska back country.
McCandless then hiked along the Stampede trail , during which he crossed the Teklanika river at low flow and shortly after the crossing he found an abandoned bus which had been used as a temporary trail camp, McCandless tried to hike further, in fact he was aiming for the Bering sea, but he was deterred by thick bush and difficult hiking conditions. Of note…his only real food supply was a 10 pound bag of rice as his intention was to feed himself through hunting small game : his journal later showed that his diet consisted of porcupines, squirrels, ptarmigan and geese…..he also foraged for native wild plants using a botany guide which he’d bought for that purpose. At one point he stalked and shot a moose for food but was unable to preserve the meat, most of which spoiled and which seems to have been a kind of crisis point for McCandless.
McCandless’s journal documents 113 days in the area at which point he decided to hike out and return to ‘normal’ society however he was unable to re-cross the now summer swollen Teklanika river which he had previously crossed in easy winter conditions. He hiked back to the bus and re-established his camp there after which time his journal indicates that he was much less successful in procuring game. One of his many (alleged) mistakes is that he didn’t have a topographical map of the area which would have shown him the existence of a cable across the river just 800 meters downstream from his original crossing point.
In September 1992, a group of local hunters crossed the river in their all-terrain vehicles and came across the abandoned bus….on entering they smelled what they thought was decaying food but which on further investigation turned out to be McCandless’s emaciated and decomposing body. After recovery and examination the body was found to weigh only 67 lbs so the initial cause of death was thought to be starvation and even later theories considered that simple starvation would have played a major part in his death.
The early theories of his death were initially that of : 1. ‘rabbit’ (lean meat) starvation, 2. Poisoning from an alkaloid (swainsonine) after eating seeds from a local plant ( Alpine Sweetvetch) or from poisoning related to a fungus which can develop on the seeds, and 3. Lathyrism ( a poisonous amino acid) also from the same plant (Hedysarum Alpinum) which would have been exacerbated by his already poor nutritional state.
Christopher McCandless. (from his own camera)
Hunger strikes…..deliberate starvation.
In Angus Barbieri’s case he didn’t die of starvation because he had some 125 Kg (276 pounds) of fat as a source of fuel ; at 9 Kcal per gram of fat that works out as 1.12 million available Kcal and also quashes the lie that we need a regular intake of carbohydrates to survive. Christopher McCandless most likely did die of unintended starvation after around 100 days on a mainly lean meat diet and possibly exacerbated by plant poisoning : by all accounts though of people who knew him he was already a lean individual with little in the way of spare body fat to burn.
What do we know then or what is the evidence for what happens when a person of normal weight stops eating……how long on average would such a person survive without food ?
Well, in 1981 just as i was starting my nursing career there were two highly publicized hunger strikes by IRA (Irish Republican Army) prisoners at HMP Maze. From the outset this was a highly political action intended to force then prime minister Margaret Thatcher into concessions : the ‘5 demands’, and of course the PM refused resulting in the deaths of 10 prisoners. Leaving all of the politics aside what we know is that all of the prisoners who did not voluntarily end their hunger strikes died within a range from 46 days to 71 days. On that cheerful note i think i’ll finish this post for now.
In the last post in this series i am going to take a look at fasting as a mode of medical management for various diseases including cancer therapy and i’m going to talk about the strange world of medical ‘quackery’ has included death by fasting/starvation.