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Though food shortages and malnutrition are popular discussion topics for preppers, I doubt that many of us have experienced a real, prolonged lack of food. Certainly we’ve all had a day or two – maybe even more, for the gutsy– with minimal or no food, but often those days happen by choice and are for practice, with a set end in sight. How many of us have gone weeks, months, or more on limited rations? How many of us know what to expect and how we’d feel? How many of us are ready for the surprises and challenges that prolonged malnutrition will bring?

More than ten years ago, as a teenager, I grappled with anorexia nervosa for almost a year. Although dealing with a deadly disease (a mortality rate of 10% is often quoted. ) may not be the way most of us will confront starvation, many of the physical and mental symptoms I experienced will translate. If you’ve never really starved before, then you may be caught off-guard by what you experience if (hopefully never when) it happens. I hope that what I relate will help you know what to expect.

In this article, I plan to describe my physical, mental, and emotional experiences during illness and recovery. I also hope to sketch out some basic treatments and coping mechanisms for staying as healthy as can be possible during starvation. Due to the passage of time, and the memory lapses associated with anorexia, I know I’ll omit some details that could be helpful, and for that I apologize in advance. Moreover, I am not a doctor, and this article is not intended to offer medical advice, to substitute for professional care and consultation, or to guarantee or provide any health outcome.

Finally, anorexia nervosa is a serious physical and mental disorder affecting many men, women, and even children worldwide. If you or someone you know are dealing with it, or want more information about it, please utilize these trusted resources:

• http://www.something-fishy.org/
• http://www.nationaleatingdisorders.org/
• http://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment

What you may experience right at the onset of starvation:

• Emotional issues. Some people experience an initial euphoria (similar to a runner’s high) as they, in the initial phases of starvation, feel invincible. “Look what I can do with less food”, they think. “I still feel great, strong, and healthy, and a lack of food isn’t slowing me down! It’s just mind over matter.” This high won’t last – the body and the mind will grow weaker over time.

Other folks feel an increase in stress. “Food was already in short supply – how will I make it now,” they wonder. All their thoughts and energies start being directed towards meals, eating, and supplies, with little effort left over for life’s other requirements. Stress also takes a toll on the body and mind.

There may be other emotions happening that are quite different, or at least unexpected. This can disrupt your routine and feelings of normalcy, and make it harder to get through a day. Try now, or as soon as possible, to establish and stick to a routine and schedule. As I’ll describe further below, routine, repetition, and structure are incredibly essential to making it through, and recovering from, starvation.
What you may experience in the middle of a period of starvation:

• Emotional issues. The high is probably gone, and the reality of starvation may be kicking in. This can prompt depression, anxiety, and more stress. These emotions and feelings weigh on us even during times of plenty. They may be even harder to deal with as your physical resources are depleted. Try to identify your feelings, verbalize them to someone, and work through as much as possible so that your limited energy can be directed not at carrying tough feelings inside, but at doing what will need to be done in a survival situation.
• Osteopenia and osteoporosis. It’s possible that my bones weren’t robust to begin with; I was always a smaller kid. But what’s known is that at age 16, I had osteopenia in both hip joints and full-on osteoporosis in vertebrae L1-L4 (lower back).These  physical issues are usually found in 80-year-olds;  I was not a normal growing teenager. Three and four years later, I broke my left and right foot, respectively. Though bone scans didn’t explicitly show problem areas in my feet, I’m convinced that the low bone density brought about by starvation was a cause. Fortunately, I haven’t had a break since then. Be extra cautious of bone health. Prepare your medical supplies to take care of breaks and fractures. If possible, supplement your diet with calcium. The best way is via whole foods like leafy greens and raw milk, but if those aren’t available, take calcium in tablet or pill form.
• Memory issues. The human brain needs fats to operate, and fats are in short supply in a starvation experience. I’d had an average to good memory as a child; remembering complicated dance routines or memorizing passages from Shakespeare presented no problems. In the last three months (out of eleven total months of restricted food intake), though, memory work that had formerly been routine became noticeably laborious and nearly impossible. This realization, and the realization that I couldn’t come up with any mnemonic work-arounds, prompted frustration and depression – which you can see is related to emotional state.

Additionally, animal fats (grass-fed butter especially) and some plant fats (avocado, coconut oil) are essential brain nutrients. Even if other foods are in short supply, if you still have quality fats available, add more to your diet. Try to avoid processed vegetable fats like canola oil, though.

• Physical symptoms.  Not every person experiencing starvation experiences all the possible physical symptoms of it. For example, it’s often brought up that a starving person will start to grow soft, downy hair in certain places on their body (back, face, arms, etc) to trap heat and keep the person warm. I didn’t experience that. What’s important to take away here is that lack of any particular starvation symptom doesn’t mean that the person isn’t actually starving, it just means that it manifests differently in different individuals. You may grow weaker, feel dizzy more often, start to black out or faint (as I did), and be unable to do more heavy-duty tasks. In a survival situation, where medical help may be non-existent, it’s so important to be careful, especially because there may be outdoor tasks with power equipment. Work with a buddy, don’t over-exert yourself, take breaks, stay hydrated, and be realistic.
• Obsession with food. As the amount of food I actually ate decreased, the amount of time I thought about it increased. In order to direct unwanted thoughts of food away from eating, I started reading cooking magazines and cookbooks, baking food for others, ogling other students’ lunches at school, and in general obsessing over eating (and not eating). In a survival situation, it may be irresponsible and wasteful to just think about food, rather than doing what needs to get done. Unfortunately, it’s really hard not to think about food when you’re starving – that’s how the body keeps telling you that you are, in fact, starving. Find a way (via routine, schedule, structure, and the assistance of others) not to let those thoughts control you.

What you may likely experience while recovering from starvation:

• Long physical recovery time. It took about a decade after the initial diagnosis for my body to be essentially completely healed. My weight no longer fluctuates based on a day’s or week’s eating habits, I no longer have weak bones, my heart beats normally, and I don’t get abnormal dizziness. The dizziness and erratic heartbeat resolved after a few years, the osteopenia and osteoporosis healed (with a closely monitored, high-calcium diet, and weight-bearing exercise) after about eight years, and finally, now in 2013, my body has established a stable set point. The ratio of ten years of healing to make up for one year’s starvation may not be too far off.
• Difficulty regulating normal eating patterns. This remained consistently incredibly difficult for almost a decade after the hospitalization, even under clinical supervision and with a structured meal plan. Don’t think that just because you don’t actually “want” to starve (the relation of will to eating disorders is debatable) that it’ll be easy to start eating regularly again. It won’t be. After the body experiences starvation, when it is presented with sufficient food again, it remembers the starvation state and tries to avoid that in the future. The body plans ahead, in a way, by increasing your food cravings in order to build up reserves (i.e. extra weight) to stave off possible future times of food uncertainty.
• Emotional issues. It’s hard to experience physical changes in one’s own body without accompanying emotions and feelings. Sometimes, when bodies change via starvation or refeeding, it’s a traumatic experience, because it’s out of our control. Feelings of helplessness, being out of control, anger, and confusion can happen. These feelings, while powerful, are normal. You may be surprised to find you’re not thrilled when food is abundant again. Your normal way of life has changed once more, and again you have to cope with something new – plenty to eat. Get support from others during this time – even just talking about it with someone who can relate can be helpful. Again, use the buddy system, have a routine, plan your meals, and keep life as structured as possible during this transition time.

What you probably won’t experience during or after starvation:

• Refusal to eat available food.
• Denial of the problem.
• Aversion to treatment.
• Phobia of gaining weight.
• All these symptoms are more representative of a patient in denial of a real medical and mental issue. If you or someone you know starts to manifest these behaviors, something more serious may be going on, and you should consult with a medical professional about how to proceed. My best guess is that most folks undergoing involuntary starvation will not show these symptoms, but again, YMMV, and I am not a doctor.

What this means for you (with concrete steps to take):

• As food availability decreases, access to warmth, shelter, and good hygiene must increase. Your body will have essentially zero extra resources to spare to keep your temperature up and to fend off infection. It’s crucial that you take as much physical stress off it as possible. Wear hats, warm clothes, down, and wool. Keep your extremities covered – they’re often very difficult to warm back up, especially if you are prone to Reynaud’s Syndrome. Mittens can be better than gloves for this. You must also keep warm enough when asleep, which is when body temperature can often fall and the heart rate decrease. In the hospital, patients were often cocooned in Bair Hugger blankets (heavy-duty medical grade electric blankets). You might not have access to something of that caliber, but if electric blankets are a possibility, they could save your health. If not, again, use down and wool, and sleep with someone else if possible to utilize body heat (much like hypothermia treatment). Finally, it will be harder to stave off infection and disease – your body is working overtime just keeping basic systems going. Clean out cuts and scrapes, brush and floss your teeth, don’t pick your nose, wear a surgical mask… do whatever it takes to avoid unnecessary infection and exposure. You don’t have the physical leeway that a healthy, non-starved person does.
• Physical exercise, while not a panacea, shouldn’t be totally avoided. It’s true that you won’t have a lot of energy to spare. However, if you, afraid of wasting energy, just sit inside and do nothing all day, your muscles will atrophy even further. It’s essential to maintain some kind of muscle tone, especially as your bones may become weaker. I’m convinced that one of the reasons I didn’t suffer a disastrous break in my back or hips was because of the level of weight-bearing activity I maintained during illness and recovery. Gardening, child care, and cleaning the house could be good lower-impact options.
• It is very unlikely that you will be able to recover from starvation alone. Your brain won’t be working right, your body will be startlingly weak, and you won’t be able to correctly assess your physical, mental, or emotional states, or your physical needs, for that matter. You need an external point of view on your situation, which is hard enough to do when well fed. One of the more helpful things I practiced in recovery was making lunches for the younger kids in treatment. It would’ve been too easy to skimp a little (or, in a SHTF-type situation, to give yourself a little more than everyone else) on my own meals – I had no such investment in their lunches. I made their sandwiches with exact, measured amounts ; because of my mind not working so well about myself, I’d never have been able to do that for my own lunch. Find a buddy in your group who will do this for you; do it for them, as well. Plan ahead of time, when you’ve got enough food, how you’ll go about caring for each other when it’s a starvation situation. Develop a schedule and framework now to follow then. Get it on paper and put it in your resources binder. Chances are not good that you’ll be able to do all this under stress and without food.

If I had to narrow down the take-away message about real starvation to just the essentials, they would be these two points:

• You cannot think straight when you’re starving. No matter how much you think you’ll be different – that you’ve got more willpower, more backup plans, more experience, more toughness, whatever – starvation is going to affect your mind, and affect it drastically. Your memory, emotional stability, perception of reality will all change. In fact, in some ways, starvation affects the brain more than it does the physical body, and I don’t think many people will be ready for that.
• You cannot recover from starvation alone. Again, no matter how much willpower, toughness, backup planning, or whatever you have, I posit that it’ll be essentially impossible to return to mental, emotional, and physical health by yourself. Each of those strands of health weaves into the others, so if you, alone, are struggling emotionally, that’ll affect your mental and physical health – it’s the same for any of those strands. Having even one other person supporting you means you now have a source of strength and objectivity that you didn’t have when you were alone. Get a group; make a plan; find a partner – it’ll save your life.

I don’t wish starvation upon anyone. It can be not only physically but also mentally and emotionally devastating. I hope this article serves to highlight the seriousness of starvation, whether voluntary or involuntary, and helps those dealing with it to find the resources they need to survive and thrive.