Hunger: The Biology and Politics of Starvation

[8] Responses to Malnutrition

[8] Responses to Malnutrition A hungry man is not a free man. —Adlai Stevenson (1900–1965) The man who has bread has many problems. The man who has no bread has one. —folk wisdom The Pathophysiology of Starvation: Protein-Energy Malnutrition In chapters 3 and 4 we discussed the basics of the biochemistry and physiology of nutrition. We learned that the three macronutrients carbohydrates, fats, and proteins are generally treated similarly by the processes of digestion via chemical reactions that hydrolyze the bonds that hold their constituent building blocks together. The simpler sugars, fatty acids, and amino acids are then transported across cell membranes, internalized, and used for immediate energy requirements , storage for future energy requirements, or growth via biosynthesis. We are now prepared to discuss the mechanisms by which our bodies defend this process and what happens when access to nutrients becomes inadequate. In order that we might fully understand the abnormal states of malnutrition, semistarvation, and eventual starvation, it will be helpful for us to answer some basic questions. What are the biological mechanisms that regulate our intake of macronutrients? What causes us to seek food; that is, what is hunger? What happens when we do not get enough food to fill either our requirements for energy or our need for essential nutrients to maintain our bodies? Answers to these questions will help us understand hunger as a primary driver of human behavior . It will also demonstrate how the complexities and needs of our biological systems compel us to seek adequate nutrition. It additionally enables us to understand the deterioration of our minds and bodies when we fail to obtain food, when we become malnourished, or when we suffer from chronic hunger. Hunger—the Physiology of Food-Seeking Behavior Webster defines hunger as “a craving or urgent need for food or specific nutrient, an uneasy sensation occasioned by the lack of food, a weakened condition brought about by the prolonged lack of food.” In chapter 2 we advanced 158 [] the genesis of response the definition used by investigators in the fields of the social sciences. Although these definitions are grammatically accurate and useful for the purpose of scientific study, they do not do justice to the human sensation of hunger. Kamala Purnaiya Taylor (1924–2004), an Indian novelist who wrote under the pseudonym Kamala Markandaya, described hunger in more evocative, experiential terms in her defining novel Nectar in a Sieve: For hunger is a curious thing; at first it is with you all the time, waking and sleeping and in your dreams, and your belly cries out insistently, and there is a gnawing and a pain as if your very vitals were being devoured, and you must stop it at any cost and you buy a moment’s respite even while you know and fear the sequel. Then the pain is no longer sharp but dull, and this too is with you always, so that you think of food many times a day and each time a terrible sickness assails you, and because you know this you try to avoid the thought, but you cannot, it is with you. Then that too is gone, all pain, all desire, only a great emptiness is left, like the sky, like a well in drought, and it is now that the strength drains from your limbs and you try to rise and find you cannot, or to swallow water and your throat is powerless , and both the swallow and the effort of retaining the liquid tax you to the uttermost.1 However we might define it, hunger is the basic driving force of human behavior. Abraham Maslow (1908–1970), considered the father of humanistic psychology, first published his Theory of Human Motivation in 1943.2 In his model, known as Maslow’s hierarchy of needs, he defined five levels of human needs: physiological, safety, love/belonging, esteem, and self-actualization. Maslow pointed out that the more basic, primitive needs have to be fulfilled before any attention is paid to those higher in the hierarchy. The basic or more primitive physiological needs include food, water, homeostasis (including maintenance of body temperature), and as Maslow quite correctly points out, For the man who is extremely and dangerously hungry, no other interests exist but food. He dreams food, he remembers food, he thinks about food, he emotes only about food, he perceives only food and he wants only food. The more subtle determinants that ordinarily fuse with the physiological drives in organizing even feeding...