Thread by @AnorexiaMyths

Prisoners of war in Belgium were considered starved on a caloric intake of not much less than the figure the government considers normal for an adult today. It was half the standard caloric intake prior to the war.

#minnesotastarvationstudy

50% of the POEs suffered edema, a classic sign of undernourishment.

Stay tuned for more nuggets from Ancel Keys et al.

Keys frequently notes that most historical studies failed to look at the psychological effects of starvation. It’s extraordinary that he felt that this was important and we are lucky to have the results of his work.

In the control group of men in the Carnegie Experiment, who were given a significant reduction in calories over a short period, their average body temperature fell slightly. Keys describes this as ‘highly significant’.

*The Carnegie Nutrition Laboratory Experiment took place in 1919. It was far more limited than Keys’ later study.

The men in the CNLE complained of weakness, lack of ‘pep’ and fatigue. This contrasts with what many with AN describe and exhibit in movement.

During the second month of the Minnesota Starvation Experiment, led by Ancel Keys, emotional and personality changes became apparent.

As far as I know most studies of AN that have referred to the MSE have looked for similarities. I’m particularly keen to find any differences between AN and ‘normal’ starvation.

Perhaps that’s because I’m not a scientist, just an interested lay person…

The study is nearly 80 years old and sometimes it shows. One of the things measured at the beginning of the rehab period was ‘hysteria’.

After a period of rehab and restricted renourishment, the men were allowed to eat freely. This resulted in daily intake of several times their normal requirement. Feasting in other words.

This did not last for more than a few weeks and then they began to eat a normal amount (although this is still way higher than the government’s current recommendation)

During the Russian famine after WWI after 3 years there was little change in weight despite a slight increase in calories. Also younger people lost weight more quickly than older people and women more quickly than men.

Keys notes that in anorexia, ‘in contrast to ordinary famine victims’ there’s often a v low intake of liquids. (Is this true?) and this prevents edema that would be expected.

I’d be curious to know if we do see less edema in people with AN nowadays. Anyone know? Was Keys right?

‘During the controlled phase of rehab… the recovery of fat lost in semi-starvation was faster than the recovery of body weight in all caloric groups except the lowest one.’

12 men remained after the controlled rehab period. In the first week each ate upwards of 3 times the calories they’d eaten in the starvation phase. Some commented that they were still hungry at the end of v large meals, even though they were unable to ingest more food.

All ate snacks between meals and in the evenings.

At weekends some men ate up to 7 times what they’d been allowed during the starvation phase.

Not sure why I’m doing this as a Twitter thread, but I guess it’s worth sharing. Is this going to be the longest thread in history? It’s a huge book and this is only volume 1…

#minnesotastarvationexperiment #ancelkeys

Have lost three followers today…

Coincidence?

After the men in the experiment reached their pre-starvation weight, they continued to gain, 21 men adding 9% on average. This extra gain was determined to be increased fat storage.

MinnesotaStarvationExperiment

In time the weight returned close to the control value.

Body fat as a percentage remained slightly elevated.

Keys refers to another study on fasting observed by Benedict in 1907. These were a series of short 2 day fasts. After recovery, all subjects weighed more than at the start of the experiment.

The amount of weight gained, which I won’t list here, was significant. It seems this is absolutely normal in recovery from starvation or any kind of restriction.

‘It has been universally observed that women withstand semi-starvation better than men.’

‘One of the factors contributing to the better resistance of women to starvation may be the larger stores of body fat.’

Perhaps one of the reasons why more women than men develop anorexia, particularly if it is a genetic famine adaptation as Shan Guisinger hypothesises…

In the rehab phase of the MSE, the recovery of adipose tissue was more rapid than that of muscles. Also, the fat content of the body grew to well above pre-starvation levels initially. This returned to near normal after 58 weeks.

The lesson: after malnutrition, the body stores fat against future famine and also, I presume, to protect the body as it repairs. This is normal and evens out in time.

Amazing! Keys refers to Quetelet, whose index became the basis of BMI. Of note: Keys refers to Quetelet’s ‘very primitive formulas’ and notes that it’s based solely on Europeans. Hmm…

‘It is certain that Quetelet’s values are far from precise even for Europeans.’

#bmi

(Ancel Keys used Quetelet’s index as the basis for modern BMI. But it’s pretty clear that even he wasn’t convinced of it’s accuracy as a measure for all bodies.)

In case it’s not clear what this thread is about (I did kind of just launch into it). I am reading this:

‘The evidence is quite consistent that the human thyroid atrophies during the starvation phase’. We know that thyroid problems can cause MI. Is there a link in AN?

I forgot to mention earlier but not only was the diet given to the volunteers in Keys’ experiment low in calories, it also consisted largely of turnips and cabbage…

Those poor men. What suffering they endured in the name of science.

#minnesotastarvationexperiment

There was indirect evidence of reduced blood flow through the skin in the men in the MSE. Skin was cold to the touch and many showed a mild degree of cyanosis of the lips and nail beds. Even in July they complained of feeling cold and slept with 3 woolen blankets at night.

The volume of blood plasma increased in the men in the study relative to blood volume ‘reflecting the fact that there was a considerable degree of anaemia’.

Anyone who knows my story will see that anaemia can have an enormous impact on mental health.

anorexiamyths.com/am-blog/do-our…

In one case it took the better part of a year of rehab for the subject’s normal range of plasma volume to return to pre-starvation levels.

This just goes to show how long it takes the body to reach equilibrium after a period of starvation.

(Although many of the others’ plasma levels returned to normal far quicker.)

Welcome to my Saturday morning!

‘It might seem entirely reasonable that the energetic processes of the body diminish in intensity as the exogenous food supply… is reduced.’

Of course, we know that many people with AN increase their exercise and movement with starvation.

‘The total blood circulation is apparently reduced more than in proportion to the basal metabolism’ in starvation.

Keys calculates that overall metabolism is reduced but ‘… there remains the question as to how much of the reduction in in metabolism can be accounted for by the lowered body temperature of the starving organism.’

‘… But this again raises a question. What is the mechanism of the reduction in body temperature?’

Ooh, I do hope we get to find out.

#minnesotastarvationexperiment #ancelkeys

Keys states that morphologists agree that the brain loses little weight in starvation.

Recent studies have shown that the brain of someone with anorexia reduces in size significantly during starvation and presumably in weight too.

Keys notes an interesting study on rats fed a restricted diet. Those refed on a higher proportion of fats compared to carbs did better. The study concluded that fat was more important in metabolism than previously thought.

Keys et Al note that ‘Reduction of physical activity is a prominent feature of undernutrition’.

This is, of course, one of the key differences between anorexia and normal starvation. In people with AN compulsive exercise or movement is often a key part of the illness.

‘Burning Feet Syndrome’ was a condition recorded in various famine areas. The cause was unclear, whether it was related to vitamin deficiency or something else. Cold foot baths and massage offered little relief.

I have heard people with AN talk about pains in their feet.

Over the 6 months of the MSE no thiamin deficiency was noted in the volunteers.

Skipping most of the biochemistry section because science…

Might come back to it later

Keys describes bradycardia (slow heart rate) in the men in the MSE and a quickening in recovery. I suspect the same thing is seen in people with AN.

Keys describes ‘mild cyanosis’ (cold skin) in the starving man as well as reduced body temperature.

We know the latter occurs in AN. Does the skin of someone in malnutrition from AN always feel cold to the touch?

Tests in the MSE showed that vision was unaffected and hearing ‘actually becomes more acute’.

I wonder if this is true if people with AN, and I also wonder if this improved hearing could be related to the sensation of calm and peace that some describe as a result of restriction

The nervous system: Keys says that the senses otherwise seem little affected by starvation. Pressure, taste and smell remain the same.

Objectively this may well be true of people with anorexia, but I have heard people seeing colours more vividly after recovery, for example. Perhaps this is more related to mental state, having capacity to notice more outside yourself, rather than improved sight.

Keys notes that in a study of 34 women and 84 men (Keller and Reller 1947) that in some of the women the decline in metabolic rate was disproportionately great. ‘Only small losses in body weight sufficed to produce large declines in metabolism.’

Keys notes that reduced reactivity to some stimuli have been seen in severely starved men and ‘there are suggestions also that allergic and anaphylactic phenomena are repressed. In some cases eczema and asthma become less troublesome or even disappear.’

In the MSE tests showed that gastric motility was decreased, in other words the movement of food through the bowel was slowed.

Lungs: in the MSE the the vital capacity of the lungs was progressively diminished and this was reversed in rehab.

Heart: ‘Apart from emaciation and loss of weight, probably the most constant finding in reports on severe undernutrition is the slowness of the heart rate.’

Again, Keys notes that ‘The complaint of coldness is very common among undernourished people, and the skin has often been reported as cold to the touch.’

I would be interested to know if this is generally true for people with anorexia.

‘This might, of course, be attributed to the general reduction in body temperature which is usually observed.’

He cites studies where the temperature has been observed at around 35 degrees and lower. (35 degrees is normally classed as hypothermia.)

‘But the suggestion that the peripheral circulation is diminished is also supported by the pallor of the skin… and by the fairly frequent appearance of slight cyanosis without dyspnea.’ (laboured breathing)

Keys cites several studies where circulation time was shown to be lowered in severely undernourished men, as expected.

He mentions reports of a tendency to thrombotic phenomena in severely undernourished people.

The physical risks of malnourishment are acute and terrifying for anyone, like me, with a loved one with anorexia.

Keys mentions that during refeeding one of the men in the MSE experienced ‘transient heart failure’.

During the semi-starvation stage of the MSE ‘there was a definite tendency towards hypotension’, with the exception of 5 men who showed no lowering of blood pressure and one showed a steady rise in systolic pressure.

With unlimited feeding the blood pressure was rapidly restored to the pre-starvation level.

The capacity for the body to recover never fails to astound me.

On cyanosis (blue skin) again: in the latter half of the semi-starvation period many of the subjects at rest had ‘a distinct appearance of cyanosis in the nail-beds’. It didn’t get worse with exercise. If the exercise was severe the cyanosis sometimes appeared to be lessened.

Cold ‘much accentuated the cyanosis, which would then be apparent in the lips.’ The cyanosis quickly disappeared in rehab.

For anyone following along, I am planning to write up my thoughts on this book in more detail as a blog post. Stay tuned!

#Minnesotastarvationexperiment #ancelkeys

Keys’ experiment was so thorough. There’s an entire chapter on fainting and posture in this book, in which he talks about putting the volunteers in a ‘tilt table’ to see how the angle affects blood pressure.

4 of the 31 men fainted on the tilt table.

Almost all the men complained of transitory dizziness upon standing, although this didn’t actually lead to loss of consciousness. This increased during early rehab but disappeared as weight was gained.

See previous tweet but one. This was in the control phase of the experiment.

This seemed to improve as the men lost weight. One man, after weight gain, fainted again at ‘approximately the same time of tilting’.

Others who had fainted during the control withstood twice as long.

Keys says a complete explanation for this isn’t possible. But blood volume in cc per kg of body weight increased to 120 per cent of the normal figure and ‘it is quite possible that this relative plethora would counteract pooling and filtration in the abdomen and extremities’.

Chapter 32: Special Senses. Keys et al look at the folkloric belief that starvation sharpens the senses.

There was a pattern of men suffering blurring vision in internment camps in the Far East during WWII. However, this may not have been the direct result of starvation as many had vitamin deficiencies, illness etc.

In fasting experiments by Glaze in 1928, there was no noticeable change in vision but the subjects reported their ability to detect odours had increased.

Keys concludes that previous experiments show that the senses are ‘remarkably resistant to starvation’.

In his experiment, Keys didn’t see any changes in vision.

Hearing was a different story and under Keys’ experiment ‘in semi-starvation not only was there no deterioration but the auditory acuity actually improved.’ This was, he says, ‘statistically highly significant throughout the frequency range except at the highest frequency’.

Outside the lab, some the men said their tolerance for loud music, speech and noises was lowered. Observers noted that they spoke in v low tones. Keys says they had been struck by the frequency of statements from famine victims about keen hearing and intolerance for loud sounds.

In the MSE this was reversed in nutritional rehabilitation.

Keys attributes the effect of improved hearing to less earwax and weight loss, ie a thinning of tissues in the ear.

‘It is a common experience that under normal conditions deprivation of food at the time of day at which one is accustomed to eat results in a feeling of discomfort and restlessness.’

So the compulsive movement in anorexia is… a normal response to hunger?

Richter (1927) carried out an experiment on rats and notes that ‘entrance into the smaller eating cage was preceded by about 1/2 hour on intensified general movements… As a rule it was during the period of greatest activity that the animal entered the cage to obtain food’.

Keys concludes this indicates a connection between general activity and hunger.

Btw I’d say that this also indicates that the way to stop feeling the need to compulsively move/exercise in anorexia is to stop being hungry and eat.

Wada (1922) observed that there was a tendency for movement of the body to occur simultaneously with stomach contractions when hungry.

This is all fascinating stuff.

Keys, however, noted no change in movement during sleep in the subjects in the MSE throughout the study.

He also found a loss of strength, speed, gross coordination, fine coordination and endurance.

I’m not sure that all of these would be seen in people with anorexia.

Keys concludes: ‘It is evident that under conditions of famine… the ability to climb, walk long distances or stand for prolonged periods of time will be diminished.’

This is certainly not true of many people with anorexia.

‘Weakness is one of the cardinal symptoms of starvation.’

Odd then that so many with anorexia describe feeling a sense of power. Just one of the lies anorexia will tell you, I guess…

The men’s ‘capacity to work’ was measured during the MSE. All lost capacity and became severely weakened by semi-starvation.

Unsurprisingly, all improved with renourishment in the rehabilitation phase of the study.

Guess what? Starving makes you weak. Eating makes you strong.

Amenorrhea: Keys cites clinical descriptions of hunger in Germany during WWI. Knack and Neumann noted that ‘menses occurred regularly in many of their cases of famine edema and in only one woman did the cycle stop for no other apparent cause’.

Odd then that this was used as a diagnostic tool in anorexia for so many years…

He goes on to note many instances in WWII when loss of periods was observed in starving women.

Keys was so often ahead of his time:

‘Although anorexia nervosa is frequently accompanied by amenorrhea there are still a sufficient number of severely ema coated women who maintain regular menstruation to make any categorical statement hazardous.’

Nobody took any notice.

Motility of the sperm of the men in the MSE was reduced by more than 50 per cent of normal at the end of semi-starvation. Again this was reversed in rehab.

And that concludes my read of ‘athe Biology of Human Starvation: Volume I’.

I hope someone has found this useful. I will write up some thoughts on this on my blog soon. Thanks for reading!

You can read the archive of anorexia myths and more here:

anorexiamyths.com

(Also, I will do a new thread for Volume II. Fun times!)

@threadreaderapp unroll