He suggested that she go on a diet and starve herself a bit before he would consider treating her. She told him that she was starving and that her body was starving itself because she was unable to keep down food, which is why she went to the doctor. He told her that "starvation mode" was not a real thing. I was flabbergasted when she was relaying to me what he said. Additionally, she is also diabetic, so she cannot exactly "starve" herself (There is a lot of controversy regarding whether or not "starvation mode" is real. There are arguments on both sides but I will write about it, with arguments from both sides, and share sources, for you to make up your own minds).
I told her to see another doctor immediately because I know "starvation mode" is a real thing. My own doctor has told me that my body is starving itself from all of the vomiting and barely eating. I came home and did research immediately.
Some medical professionals see that patients are overweight and because they have this preconceived notion of what Gastroparesis is supposed to look like, they do not take the heavier Gastroparesis warriors seriously. I want to clarify that people can gain weight with Gastroparesis and they can also lose weight with it, too.
These are both complex issues with complex answers. I am glad my friend reached out to me to ask questions instead of following her doctor's advice to the letter, because I really do not know what would have happened to her if she had. I am so glad she was curious and smart enough to question the advice she was told, and went to get a second opinion. Sadly, this is not the first time I have heard this story. I have had a lot of people tell me that their doctors wanted them to lose weight first, before they would treat them, and/or some alternate versions of they did not need a feeding tube because they were too overweight for one. Let me make this VERY clear, your weight has nothing to do with malnutrition, vitamin deficiencies, or anything like that. I really hate it when medical professionals bring up weight, because it really sounds demeaning, patronizing, and I feel like I am being judged.
I made a survey to ask people with Gastroparesis whether or not they were treated differently because of their weight. I received sixty-three responses, which is amazing. They can be found HERE. To summarize the surveys I received, basically some doctors (not all), friends, and family members do not believe people have Gastroparesis if they are overweight. When you have Gastroparesis, you can gain weight or lose weight. Let's talk about weight gain first.**
“Eating too few calories, for too long of a period will cause your metabolism to slow down so much that it will prevent weight loss and even cause weight gain.”
Weight gain can not only be attributed to starvation mode, where your metabolism slows, but could be caused by stress and anxiety in addition to your metabolism rate: http://www.emilysstomach.com/2017/01/mental-health-and-gastroparesis-part-1.html
Some of these sources refer to weight gain and starvation mode for dieting for healthy people, but it can be applied to Gastroparesis as well, since we do not have the luxury of eating to consider a diet.
Starvation is a severe deficiency in caloric energy intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, death, according to the World Health Organization. The bloated stomach represents a form of malnutrition called kwashiorkor which is caused by insufficient protein despite a sufficient caloric intake.
My article called, "What Gastroparesis Does to the Body" that you can find HERE.
My article on Vitamin Deficiencies can be found HERE.
According to MedLine Plus,
"Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet.
Causes:
Kwashiorkor is most common in areas where there is:
Famine
Limited food supply
Low levels of education (when people do not understand how to eat a proper diet)
This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition.
Kwashiorkor is rare in children in the United States. There are only isolated cases. However, one government estimate suggests that as many as 50% of elderly people in nursing homes in the United States do not get enough protein in their diet.
When kwashiorkor does occur in the United States, it is most often a sign of child abuse and severe neglect.
Symptoms
Symptoms include:
Changes in skin pigment
Decreased muscle mass
Diarrhea
Failure to gain weight and grow
Fatigue
Hair changes (change in color or texture)
Increased and more severe infections due to damaged immune system
Irritability
Large belly that sticks out (protrudes)
Lethargy or apathy
Loss of muscle mass
Rash (dermatitis)
Shock (late stage)
Swelling (edema)
Exams and Tests
The physical exam may show an enlarged liver (hepatomegaly) and general swelling.
Tests may include:
Arterial blood gas
BUN
Complete blood count (CBC)
Creatinine clearance
Serum creatinine
Serum potassium
Total protein levels
Urinalysis
Treatment
Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth.
Treatment depends on the severity of the condition. People who are in shock need treatment right away to restore blood volume and maintain blood pressure.
Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.
Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly.
Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzyme lactase so that they can tolerate milk products.
Outlook (Prognosis)
Getting treatment early generally leads to good results. Treating kwashiorkor in its late stages will improve the child's general health. However, the child may be left with permanent physical and mental problems. If treatment is not given or comes too late, this condition is life threatening.
Possible Complications
Complications may include:
Coma
Permanent mental and physical disability
Shock
When to Contact a Medical Professional
Call your health care provider if your child has symptoms of kwashiorkor.
Prevention
To prevent kwashiorkor, make sure the diet has enough carbohydrates, fat (at least 10% of total calories), and protein (12% of total calories).
Alternative Names
Protein malnutrition; Protein-calorie malnutrition; Malignant malnutrition
Kwashiorkor is a condition resulting from inadequate protein intake. Early symptoms include fatigue, irritability, and lethargy. As protein deprivation continues, one sees growth failure, loss of muscle mass, generalized swelling (edema), and decreased immunity. A large, protuberant belly is common. The incidence of kwashiorkor in children in the United States is extremely small and it is typically found in countries where there is drought and famine.
Image Source: In the Article
References
Ashworth A. Nutrition, food security, and health. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 46.
Kumar V, Abbas AK, Aster JC. Environmental and nutritional diseases. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 9.
Manary MJ, Trehan I. Protein-energy malnutrition. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 215.
Review Date 2/19/2018
Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team."
I had no idea there was a hunger scale, like the pain scale, until I started doing research for this article.
According to Medical News Today,
"Malnutrition results from a poor diet or a lack of food. It happens when the intake of nutrients or energy is too high, too low, or poorly balanced. Undernutrition can lead to delayed growth or wasting, while a diet that provides too much food, but not necessarily balanced, leads to obesity. In many parts of the world, undernutrition results from a lack of food. In some cases, however, undernourishment may stem from a health condition, such as an eating disorder or a chronic illness that prevents the person from absorbing nutrients."
According to Fitness,
"Starvation is dangerous to deal with and leads to all sorts of problems, both mental and physical. Want to know what they are? Read this post and find out about the harmful and potentially dangerous side effects of starving yourself.
Starvation is a condition that is often accompanied by severe deficiency in your calorie intake. Starvation can be self-inflicted (hardcore dieters) or due to the presence of other conditions like anorexia or bulimia. Starvation can also lead to severe malnutrition and may permanently damage your internal organs.
Starvation isn’t something pleasant, and you should try and refrain from starving yourself, especially under the pretext of following a diet regime. To discourage you further, let’s look at some of the adverse effects of starvation in detail:
1. MALNUTRITION:
This is perhaps the most damaging effect of voluntary or forced starvation. Malnutrition is a terrible condition, and it affects most children in developing countries. Starvation usually means that you don’t eat much at all. This leads to many essential nutrients and vitamins being excluded from your diet. Malnutrition can lead to various mineral and nutrient deficiencies like Night blindness (vitamin A deficiency), Scurvy (Vitamin C deficiency) and even Anemia (Iron deficiency) (2).
2. DEHYDRATION:
The second most obvious result of starvation; just like a lack of food induces malnutrition, a lack of water can induce dehydration. This dehydration may in turn aggravate other problems and lead to cracked and exceedingly dry skin, along with other conditions like constipation, among others. Thus, it is important to remember to drink enough water, even if you are on a starvation diet. Starvation and dehydration depletes glycogen levels and disturbs electrolyte balance (3).
3. Decreased Resting Metabolic Rate:
Starvation can lead to a reduced resting metabolic rate. Your Basal metabolic rate or BMR is defined as the minimal rate of energy expenditure per time unit while you rest. Tests found that fasting prior to rest can lead to an increase in white adipose tissue (WAT) and decrease in flow to the brain. Other studies determine that starvation can induce a decrease in your basal metabolic rate.
4. Loss Of Monthly Menstrual Periods:
Starvation leads to many problems. One of these problems is it upsets how your periods are regulated. So, for those of you thinking about starvation diets, you might want to consider this before you begin. In some cases, if you are too underweight your body may simply cease to produce estrogen. A lack of fat can restrict your cells from converting cholesterol to extra estrogen. As starvation can lead to organ damage, body processes tend to slow down, which usually causes menstruation to stop (4).
5. Constipation:
Starvation can also induce constipation in many individuals. Studies on many anorexic individuals conclude that people who suffer from the disorder may suffer from severe starvation, which can lead to many disorders and requires the use of regular laxatives to be treated wholly. A case study on three severely anorexic women found that these women needed regular laxatives or enemas to help flush their colon. These women also ran a higher risk of suffering from rectal prolapse due to the overuse of laxatives (5).
6. Bone Loss:
A starved or starving individual may continue to lose weight at an alarming rate. Although the changes in your skin and musculature are quite obvious, but what about the changes in your bone structure! Did you know that starvation may lead to bone density loss? Well, usually when you consume a calorie-restricted diet, your bones are remodeled. The older bone breaks down and new bones form rapidly. However, your bone density reduces, which can lead to fragility (6).
7. Fatigue:
One of the most common side effects of starvation is fatigue. You have all heard about ‘eating to keep your strengths up,’ this idiom cannot ring any truer as eating a balanced diet helps provide energy for the body primarily, while helping keep diseases and infections at bay. Starvation upsets the balance of essential vitamins in your body and slows down physiological processes, which can also lead to fatigue and a feeling of faintness. Starvation is often associated with a feeling of lightheadedness (7).
8. High Blood Pressure:
Malnutrition and starvation can subject your body to many conditions, including high blood pressure. When you starve, essential nutrients like potassium and vitamin D aren’t consumed, which leads to a spike in blood pressure and many other deficiencies. All these factors ensure that starvation inevitably raises your blood pressure. In a study conducted on three groups of children, it was found that two groups: one malnourished and one recovering from malnourishment had significantly higher blood pressure readings than the children who weren’t malnourished at all.
9. Electrolyte Imbalance:
Starvation leads to a loss of nutrients, which results in the consumption of fewer electrolytes with each passing day. Heart-healthy Minerals like potassium, sodium, calcium and magnesium that promote proper heart function and heart health aren’t consumed when you don’t have enough food. Starving not only results in lesser nutrients, but also promotes electrolyte imbalance. Thus, remember to have mineral supplements if you are on a starvation diet.
10. Affects The Brain:
There have been many studies on how starvation can affect cognitive abilities and make you feel depressed. Try and recall how your friend snaps at you when she’s on a starvation diet. When we miss a meal, we often find ourselves dwelling on food and how it would feel to be properly fed.
You know that starvation can lead to many other physical symptoms like dehydration and fatigue that can impair your thinking abilities and also make you aggressive and jumpy. Starvation can also affect how you react to stress and can induce feelings of anxiety, irritability and even lead to chronic or clinical depression in some cases.
Now that you know how starvation can adversely affect your body, we hope that you will rethink about those starvation diets. They are just a quick fix and offer little long term benefit. Opt for a balanced regimen to lose weight."
According to Health Line,
"Is 'Starvation Mode' Real or Imaginary? A Critical Look
Weight loss is generally seen as a positive thing. It can bring improved health, better looks and all sorts of benefits, both physical and mental. However, your brain doesn't necessarily see it that way. Your brain is more worried about keeping you from starving, making sure that you (and your genes) survive. When you lose a lot of weight, the body starts trying to conserve energy by reducing the amount of calories you burn. It also makes you feel hungrier, lazier and increases your cravings for food. This can cause you to stop losing weight, and may make you feel so miserable that you abandon your weight loss efforts and gain the weight back.
This phenomenon is often called 'starvation mode,' but is really just the brain's natural mechanism to protect you from starvation.
What Does 'Starvation Mode' Imply?
What people generally refer to as 'starvation mode' (and sometimes 'metabolic damage') is the body's natural response to long-term calorie restriction. It involves the body responding to reduced calorie intake by reducing calorie expenditure in an attempt to maintain energy balance and prevent starvation. This is a natural physiological response, and isn't really controversial. It is well accepted by scientists, and the technical term for it is 'adaptive thermogenesis.' I will use the term starvation mode in this article, although it really is a misnomer because true starvation is something that is almost completely irrelevant to most weight loss discussions. Starvation mode was a useful physiological response back in the day, but does more harm than good in the modern food environment where obesity runs rampant.
Calories In, Calories Out
Obesity is a disorder of excess energy accumulation. The body puts energy (calories) into its fat tissues, storing it for later use. If more calories enter the fat tissue than leave it, we gain fat. If more calories leave the fat tissue than enter it, we lose fat. This is fact. Pretty much all weight loss diets cause a reduction in calorie intake. Some by controlling calories directly (counting calories, weighing portions, etc), others by reducing appetite so that people eat fewer calories automatically. When this happens, calories leaving the fat tissue (calories out) become greater than the calories entering it (calories in). So we lose fat. However, the body doesn't see this in the same way as you do. In many cases, it sees this as the beginning of starvation. So the body fights back, doing everything it can to make you stop losing.
The body and brain can respond by making you hungrier (so you eat more, increasing calories in), but what is most relevant to this discussion here is what happens to the amount of calories you burn (calories out). Starvation mode implies that your body reduces calories out in an attempt to restore energy balance and stop you from losing any more weight, even in the face of continued calorie restriction. This phenomenon is very real, but whether this response is so powerful that it can prevent you from losing weight, or even start gaining despite continued calorie restriction, is not as clear.
What people refer to as 'starvation mode' is the body's natural response to long-term calorie restriction. It involves a reduction in the amount of calories your body burns, which can slow down weight loss. The amount of calories you burn can change.
The amount of calories you burn in a day can be roughly split into 4 parts:
Basal Metabolic Rate (BMR): The amount of calories your body uses to maintain vital functions, such as breathing, heart rate and brain function.
Thermic Effect of Food (TEF): The calories burned while digesting a meal. Usually about 10% of calorie intake.
Thermic Effect of Exercise (TEE): Calories burned during physical activity, such as exercise.
Non-Exercise Activity Thermogenesis (NEAT): Calories burned fidgeting, changing posture, etc. This is usually subconscious.
It involves a reduction in movement (both conscious and subconscious), and a major change in the function of the nervous system and various hormones.
There are several ways that the body burns calories. All of them can go down when you restrict calories for a long time. Studies Show That Calorie Restriction Can Reduce 'Calories Out.' Studies clearly show that weight loss reduces the amount of calories you burn. According to a large review study, this amounts to 5.8 calories per day, for each pound lost, or 12.8 calories per kilogram. What this means, is that if you were to lose 50 pounds, or 22.7 kilograms, your body would end up burning 290.5 fewer calories per day. The reduction in calorie expenditure can be much greater than what is predicted by changes in weight. For example, some studies show that losing and maintaining 10% of body weight can reduce calories burned by 15-25%. This is one of the reasons weight loss tends to slow down over time, and why it is so difficult to maintain a reduced weight. You may need to eat fewer calories for life! Keep in mind that it is possible that this metabolic 'slowdown' is even greater in some groups that have a hard time losing weight, such as postmenopausal women.
Muscle Mass Tends to Go Down
Another side effect of losing weight, is that muscle mass tends to go down. As you may know, muscle is metabolically active, and burns calories around the clock. However, the reduction in calorie expenditure is actually greater than can be explained by a reduction in muscle mass alone. The body becomes more efficient at doing work, so less energy than before is required to do the same amount of work. So calorie restriction makes you expend fewer calories for the physical activity (whether deliberate or subconscious) that you perform.
Weight loss and reduced calorie intake can lead to reduced burning of calories. On average, this amounts to about 5.8 calories per pound of lost body weight.
How to Avoid the Metabolic Slowdown
Keep in mind that your metabolism slowing down is simply a natural response to reduced calorie intake. Although some reduction in calorie burning may be inevitable, there are a number of things you can do to mitigate the effect. The single most effective thing you can do is resistance exercise.
Starvation mode is real, but it's not as powerful as some people think. It can make weight loss slow down over time, but it won't cause someone to gain weight despite restricting calories. It's also not an 'on and off' phenomenon, like some people seem to think. It's an entire spectrum of the body adapting to either increased or decreased calorie intake. Starvation mode is actually a terribly inaccurate term. Something like 'metabolic adaptation' or 'metabolic slowdown' would be much more appropriate. This is simply the body's natural physiological response to reduced calorie intake. Without it, humans would have become extinct thousands of years ago. Unfortunately, this protective response can cause more harm than good where overfeeding is a much, much greater threat to human health than starvation."
Let's talk more about starvation mode. I want to quote a couple of different sources, and they may say similar things, but I want to look at this closely since my friend's doctor said it wasn't a real thing or problem. I just do not believe that. My doctor, when I was in high school (when I first started vomiting and getting sick, but didn't know what was wrong) told me that my body was starving itself. He had to explain to me what that meant and at that time, I was sixteen and ninety pounds (I am 5'4"). He told me I had to supplement what I ate with Ensure, so I had to eat an entire meal and drink Ensure on top of it. I actually really started gaining weight in 2009, when I fell down a mountain and broke both of my knees. But, I digress, because that isn't the point.
The point is, I had a doctor confirm to me, personally, that starvation mode is VERY real and people's bodies handle it in different ways. My body was feeding off of itself, consuming my muscle mass and things like that. Starvation is VERY real and VERY dangerous. It is SO dangerous for medical professionals to tell anyone that.
You have to be your own advocate and research things that you may not understand, that you may have questions about, and/or even doubts about.
I do not want to disparage doctors in any way, but they do not know everything. They do their utter best to rule things out and to help you as much as they are able to, and there are REALLY great doctors out there who care, but there are also doctors who do not even know about Gastroparesis or the effects it can have on someone (and given as much knowledge as they have to retain, I do not fault them for this). I do not want to alienate any medical professionals out there, as I respect the job that you do. This article is mainly to help misunderstandings and to educate the medical professionals, hopefully, that told my diabetic friend with Gastroparesis, to lose some weight before he would treat her for Gastroparesis, and that 'starvation mode' did not exist. Well, I'm going to research it and prove it does.
According to InBodyUSA,
"Research indicates people who used starvation diets for weight loss, eating 50% of their energy needs for three weeks, did decrease their body weight overall. However, they also reduced their lean muscle mass by 5%. If the state of starvation is maintained chronically, lean muscle mass and organ size are decreased by 20%.
Likewise, a study on mice found lean mass and lean muscle mass were sacrificed during starvation; however, body fat stores were relatively the same in mice on a control diet and obese mice on starvation diets.
Weight loss via starvation causes individuals to lose significant amounts of lean muscle mass and Lean Body Mass, which encompasses water, bones, organs, etc. Reducing the mass of your bones is problematic, as that decreases bone density and can make you more prone to injury. Conversely, increasing Lean Body Mass increases bone strength and density, a common concern for many Americans as they age.
One study using human participants indicated dropping significant amounts of calories from the diet lead to significant weight loss and decreased lean muscle mass. However, participants also gained back nearly all of the fat they lost, within 8 years.
This prompts the discussion and understanding of an important topic- metabolism. More so, chronic starvation leads to changes in metabolism. Metabolism and resting metabolic rate are directly linked to Lean Body Mass. A person with greater body mass will require more energy to function day to day, thus will have a larger basal metabolic rate (BMR). As weight decreases, so does BMR.
This means that there’s a certain number of calories necessary to maintain your lean mass. If you go below this number, your body will be forced to break down these muscle stores in order to create energy.
Starvation diets have far-reaching negative effects on the body. Starving to lose weight changes the metabolism, reduces lean muscle, reduces bone density, and decreases strength."
There is an interesting book about Starvation Mode by Leigh Peele (that is in ebook form, too). This is her research and take on Starvation Mode and the Effects and Symptoms,
"Different Effects and Symptoms of Starvation Mode
Starvation happens when the body is deprived of the essential nutrients it requires for proper function and survival. When the body does not receive these nutrients that come from food and liquids, side effects occur. One of the effects of starve mode is weight loss and many people use this method to lose unwanted weight. This is often done as an act of desperation because of stubborn weight that they are unable to lose with all other weight loss techniques they have tried in the past. Going on starvation mode is not recommended to be done often since it can have irreversible effects that could eventually lead to death.
On starvation mode, the body feeds itself with what is inside it. Because you take in only a few calories, you lose weight. It should, however, be noted that when few calories enter the body, the metabolism also slows down. Because the metabolism burns calories, it burns only a few calories once it slows down. The moment you start consuming food regularly, the weight will come back. This is because the body begins to comprehend that it is starving and so it shuts down your weight loss efforts for it to survive.
Some of the bad effects of starvation mode include failed diets and other mental and physical ailments. These results are brought about by the malnourishment and depression. Eventually you will gain the weight that you lost back due to your coping mechanisms when you are depressed.
Starvation obviously makes you lose weight. The body does not have any sustenance inside it. You can lose up to two pounds a day with starvation. While it may initially sound good, the effects of such drastic weight loss might result in a medical emergency. Your body and your organs might not be able to cope with not having sustenance for days at length.
Starvation can cause dehydration because the body lacks fluid it needs. It then uses water and fluids already stored in your body. The first organ to be affected is the kidneys and they shall fail and eventually stop working once your urine output stops. Your skin will lose rigidity and turgor and shall become extremely dry and stiff. When you become dehydrated, your heart rhythms become irregular and this shall lead to heart diseases.
Another one of the effects of starvation mode is electrolyte imbalance. Because there is loss of fluids and nutrients, there is no fuel available for the body to work properly. Electrolytes make the heart, nerve impulse and muscle impulse function properly. They also make oxygen flow steadily in the body. If the flow is disrupted severely, you may slip into a coma. Blood sugar levels quickly drop because of the absence of glucose even if the pancreas produces just a small amount of insulin.
During the ultimate stage of starvation, severe muscle atrophy happens. The muscle crumbles and lessens because the body feeds from itself. It uses its muscle mass so as to give energy to the bloodstream so that the organs will not shut down. Muscle spasms and twitches happen when the potassium level becomes dangerously low. Extreme weakness and paralysis may also happen. When the muscles break down, the nerve cells deteriorate, especially those in your spinal cord area which regulates movement. If the muscles are weak and do not function, you may not move freely at all.
Low blood pressure or hypotension is also a side effect of starvation mode. Aside from such bouts, the temperature of the body also drops. When the blood pressure becomes so low, shock may happen and this is a very dangerous condition because the body shots down just to survive. If hypotension is left untreated, death or coma will happen."
Gastroparesis can effect everyone differently. Everyone's bodies are different and so Gastroparesis is harder to treat because it varies so widely from person to person. I wrote about this in detail, and if you would like to read that article, you can find it here: http://www.emilysstomach.com/2018/04/gastroparesis-different-ways-it-effects.html
For the many different causes of Gastroparesis and the available treatment options, you can read here: http://www.emilysstomach.com/2018/10/the-many-causes-of-gastroparesis.html
I also do not want anyone to think that Gastroparesis is an eating disorder. It is not. It can be caused by an eating disorder, but Gastroparesis, itself, is a chronic, invisible illness. For specifics on the differences between the two, please read this article: http://www.emilysstomach.com/2015/04/gastroparesis-vs-eating-disorders.html
More sources can be found at:
NDTV.
SIGN OF THE TIMES.
LIVESTRONG.COM. "A lack of food can cause the body to go into starvation mode over time. Starvation mode is a metabolic response to the body being deprived of food, which may occur during periods of famine or economic depression, when using a fad diet, or when suffering from anorexia nervosa. A variety of specific signs and symptoms affect those whose body has gone into starvation mode."
SOURCE:KHAN ACADEMY.
SOURCE: https://www.youtube.com/watch?v=eZNu5bsCyEc
THE CONVERSATION.
**You can click on the all capitalized bold words for additional information
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