Co-Written by Talia Cecchele & Andrea Clares
We live in a society where weight loss is seen as the solution to ultimate health and wellbeing. So it is no surprise that many people are driven to pursue weight loss (through dieting) at some point in their lives. Dieting put simply, is when we restrict our intake of food to influence our weight, shape or other physical health outcomes. It has now been established as a predicting factor for the development of an eating disorder, for which the prevalence of this serious illness has more than doubled in the last twenty years (1).
What is Starvation Syndrome?
When our body is deprived of energy, either by dietary restriction or through compensatory behaviours the body responds with physical and psychological changes to protect itself against the adverse effects of food deprivation. This survival mechanism is what we call starvation syndrome (or famine response) and was well documented in ground-breaking research in the 1940s.
The Starvation Study
The consequences of starvation have long been studied since the 1940s when Ancel Keys carried out an experiment on a group of men during WWII, the Minnesota Starvation Study. He studied the psychological and physical effects of semi-starvation during a 6 month period of dietary restriction followed by 3 months of refeeding. The physical and psychological symptoms of starvation experienced by these men are similar to what we see in people living with an eating disorder or restrictive diet. The men experienced effects such as low body temperature, lethargy, slowed metabolism, depression, food obsession and neurological impairments.
Important to note, is that all of these symptoms returned to normal with proper refeeding during the experiment, and in the months following. There is an informative video where one of the volunteers talks about his experience during the study and how it impacted his relationship with food even after the year-long study was complete. It is definitely worth a watch*
*consider mindfully - there is talk of calories and images of the participants in an emaciated state
Physical and Psychological Effects of Starvation
All of the symptoms experienced from under-fueling the body mirror the symptoms many people (regardless of their weight) will experience while following a restrictive diet, which is really a form of starvation. For people living with an eating disorder, this can be a relief to know that the side effects are a result of malnutrition, not because of the eating disorder itself and can be reversed with good nutrition. The following symptoms are commonly reported when the body is in "starvation mode".
● Decreased metabolic rate (hypometabolism)
● Increased fat storage
● Gastrointestinal issues (constipation, bloating, abdominal pain etc.)
● Loss of hunger and satiety cues
● Reduced heart rate and blood pressure
● Hormonal changes and loss of periods
● Fluid retention
● Feeling cold all the time
● Hair falling out, dry skin, brittle nails
● Low self-esteem
● Anxiety & depression
● Loss of control over eating (binge eating)
● Difficulty concentrating and poor memory
Did you know that the brain uses approximately 20% of our daily energy intake (2)? It is a hungry organ, which is why many functions are reduced when the body is starved.
Eating behaviour changes
● Food obsession and preoccupation
● Cycles of binging and food guilt
● Meticulous food planning and preparation
● Increased interest in food and cooking
● Reduced sex drive
● Feeling socially inadequate
● Loss of sense of humour
Starvation Syndrome in Eating Disorder Recovery
Every single function in the human body has the potential to be compromised as a result of starvation. If someone has undergone a prolonged period of starvation and is severely malnourished they can be at risk of developing refeeding syndrome.
Refeeding syndrome is a metabolic disturbance that can occur as a result of the body switching from using lean tissue (muscle) and fat as a fuel source back to carbohydrates. As the body uses vitamins and minerals (such as potassium, phosphate. magnesium and calcium) to break down carbohydrates into energy, the refeeding process can leave less energy for other vital functions in the body which can lead to fluid and electrolyte imbalances, and cardiac and neurological impairments.
It is paramount that both patients and clinicians are aware of refeeding syndrome risk and how to best manage it. The Medical Emergencies in Eating Disorders (MEED) guidelines (previously MARSIPAN until May 2022) were created for guidance on the recognition and management of medical emergencies such as refeeding syndrome. The MEED guidelines also provide guidance on nasogastric (tube) feeding, support for families and carers, and behavioural manifestations of eating disorders.
The first step to reverse any symptoms of starvation is through safe refeeding and weight restoration (if needed). The length of this process will largely vary from patient to patient depending on the duration and severity of their ED and/or their history of dieting. It is important to also bear in mind that many of these symptoms will persist during recovery until the brain is well nourished again and all organs have returned to optimal functioning. Please speak to your GP or Dietitian for support during this phase of treatment.
Andrea Clares, ANutr
Andrea is a Registered Nutritionist and Intern at TCN! Her mission is to empower and equip you with all you need to live a healthy and fulfilling life, diet and guilt-free. You can find Andrea on Instagram @andreacm_nutrition and check out her website here.
1. Galmiche M, Déchelotte P, Lambert G and Tavolacci MP (2019) Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American Journal of Clinical Nutrition. 109(5): pp. 1402-1413.
2. Raichle, ME and Gusnard, DA (2002) Appraising the brain's energy budget. Proceedings of the National Academy of Sciences of the United States of America. 99(16): pp. 10237–10239.
Talia Cecchele Nutrition is a team of registered dietitians that specialise in eating disorder recovery, disordered eating, digestive issues and sports nutrition. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. We offer virtual consultations and group programs so whether you are based in London, the United Kingdom or around the world we would love to support you. To enquire about a private consultation please fill out a contact form.