Anna is on fast as are many others all over India. Not only fasting but even re-feeding can be dangerous after a fast.
Once acetone appears in the urine, the fast must be broken slowly else one can end up with re-feeding syndrome which can even be fatal said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.
Facts about hunger strike of Satygraha
1. Most hunger strikers do not wish to die as per the medical literature.
2. Many doctors who graduated before 1990 may not be aware about the guidelines as regards hunger strikers. The first declaration of World Medical Assembly was adopted in 1991, revised in 1992 and then again revised in 2006. It is called the ‘WMA Declaration of Malta on Hunger Strikers’. It describes the duties of a doctor and guidelines for the management of hunger strikers. As per the WMA Declaration, all physicians are bound by Medical Ethics even when not providing therapy. They must try to prevent coercion or maltreatment of detainees and must protest if it occurs. It is the duty of the physicians to take the hunger striker in confidence in isolation and find out his or her intention before and during the fast.
3. The Rough formula of 3 is that one cannot live for three minutes without air, three days without water and three weeks without food. But this formula is for healthy muscular and fatty people. When you fast you can stay healthy for long if you have good muscles and have good fat content.
4. There are three phases of fast: The 1st phase is conversion of stored glycogen into energy and lasts a few days. The 2nd phase is burning of fat into energy. Acetone appears in the urine in this phase, which lasts as long as body fat is up to 10% in females and 7% in males. At this time there will be a strong urge to eat. If one does not eat at this time, the 3rd phase will start, when proteins start breaking down leading to starvation effects which can be fatal due the kidney failure and heart irregularity.
5. The basic aim of breaking any fast is to prevent occurrence of re-feeding syndrome, a metabolic complication that occurs when nutritional support is given to severely malnourished patients or to someone recovering from prolonged fast or hunger strike. Any individual who has had negligible nutrient intake for 5 consecutive days is at risk. It occurs within four days of starting to feed. Patients who weigh less than 70 percent of ideal body weight or lose weight rapidly are at greatest risk for the syndrome.
During prolonged fasting the body conserves muscle and protein breakdown by switching to ketone bodies derived from fatty acids as the main energy source. The liver decreases its rate of gluconeogenesis thus conserving muscle and protein. Many intracellular minerals become severely depleted during this period, although serum levels may remain normal. Insulin secretion is suppressed and glucagon secretion is increased.
During re-feeding, the metabolism shifts from a catabolic to an anabolic state. Insulin is released on carbohydrate intake resulting in increased glycogen, fat and protein synthesis. Insulin release triggers cellular uptake of potassium, phosphate, and magnesium which are already depleted and the stores rapidly become used up.
When the serum concentrations of these electrolytes are reduced, serious complications, such as irregular heart beat can occur. Patients can also develop fluid and electrolyte imbalance, low phosphate levels, neurologic, lung, heart, neuromuscular, and blood related complications. Irregular heart rhythm is the most common cause of death with other significant risks including confusion, coma and convulsions and cardiac failure.
The diagnostic feature is presence of low phosphate, potassium, magnesium, vitamin B1 levels and fluid overload with edema feet. Low phosphate levels are the essential criteria for diagnosis.
If the refeeding syndrome occurs, doctors should immediately slow nutritional replenishment and correct low levels of phosphates, potassium and magnesium while monitoring the cardiovascular system. In patients at risk of re-feeding syndrome, nutritional support is initially delivered at a maximum of 10 kcal/kg/day and raised gradually to full needs within a week. In extreme cases this energy intake is limited to 5 kcal/kg/day.
Before and during the first 10 days of feeding, it is important to give 200-300 mg oral thiamine a day, 1-2 vitamin B complex tablets three times a day or intravenous vitamin B, and a balanced multivitamin and mineral supplement each day.
One should monitor and supplement oral, enteral, or intravenous potassium, phosphate and magnesium in such patients. On average, patients should receive 2-4 mmol/kg/day potassium, 0.3-0.6 mmol/kg/day phosphate, and 0.2 mmol/kg/day intravenous or 0.4 mmol/kg/day oral magnesium.
Moderately to severely ill patients with marked edema or a serum phosphorous < 2 mg/dL should be hospitalized to intravenously correct electrolyte deficiencies. Sugarcane juice is the best juice to break the fast. Unrefined sugarcane contains many minerals and nutrients including phosphorus, calcium, iron, magnesium and potassium. Pure sugar cane has 11 calories per teaspoon.
Once acetone appears in the urine, the fast must be broken slowly else one can end up with re-feeding syndrome which can even be fatal said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.
Facts about hunger strike of Satygraha
1. Most hunger strikers do not wish to die as per the medical literature.
2. Many doctors who graduated before 1990 may not be aware about the guidelines as regards hunger strikers. The first declaration of World Medical Assembly was adopted in 1991, revised in 1992 and then again revised in 2006. It is called the ‘WMA Declaration of Malta on Hunger Strikers’. It describes the duties of a doctor and guidelines for the management of hunger strikers. As per the WMA Declaration, all physicians are bound by Medical Ethics even when not providing therapy. They must try to prevent coercion or maltreatment of detainees and must protest if it occurs. It is the duty of the physicians to take the hunger striker in confidence in isolation and find out his or her intention before and during the fast.
3. The Rough formula of 3 is that one cannot live for three minutes without air, three days without water and three weeks without food. But this formula is for healthy muscular and fatty people. When you fast you can stay healthy for long if you have good muscles and have good fat content.
4. There are three phases of fast: The 1st phase is conversion of stored glycogen into energy and lasts a few days. The 2nd phase is burning of fat into energy. Acetone appears in the urine in this phase, which lasts as long as body fat is up to 10% in females and 7% in males. At this time there will be a strong urge to eat. If one does not eat at this time, the 3rd phase will start, when proteins start breaking down leading to starvation effects which can be fatal due the kidney failure and heart irregularity.
5. The basic aim of breaking any fast is to prevent occurrence of re-feeding syndrome, a metabolic complication that occurs when nutritional support is given to severely malnourished patients or to someone recovering from prolonged fast or hunger strike. Any individual who has had negligible nutrient intake for 5 consecutive days is at risk. It occurs within four days of starting to feed. Patients who weigh less than 70 percent of ideal body weight or lose weight rapidly are at greatest risk for the syndrome.
During prolonged fasting the body conserves muscle and protein breakdown by switching to ketone bodies derived from fatty acids as the main energy source. The liver decreases its rate of gluconeogenesis thus conserving muscle and protein. Many intracellular minerals become severely depleted during this period, although serum levels may remain normal. Insulin secretion is suppressed and glucagon secretion is increased.
During re-feeding, the metabolism shifts from a catabolic to an anabolic state. Insulin is released on carbohydrate intake resulting in increased glycogen, fat and protein synthesis. Insulin release triggers cellular uptake of potassium, phosphate, and magnesium which are already depleted and the stores rapidly become used up.
When the serum concentrations of these electrolytes are reduced, serious complications, such as irregular heart beat can occur. Patients can also develop fluid and electrolyte imbalance, low phosphate levels, neurologic, lung, heart, neuromuscular, and blood related complications. Irregular heart rhythm is the most common cause of death with other significant risks including confusion, coma and convulsions and cardiac failure.
The diagnostic feature is presence of low phosphate, potassium, magnesium, vitamin B1 levels and fluid overload with edema feet. Low phosphate levels are the essential criteria for diagnosis.
If the refeeding syndrome occurs, doctors should immediately slow nutritional replenishment and correct low levels of phosphates, potassium and magnesium while monitoring the cardiovascular system. In patients at risk of re-feeding syndrome, nutritional support is initially delivered at a maximum of 10 kcal/kg/day and raised gradually to full needs within a week. In extreme cases this energy intake is limited to 5 kcal/kg/day.
Before and during the first 10 days of feeding, it is important to give 200-300 mg oral thiamine a day, 1-2 vitamin B complex tablets three times a day or intravenous vitamin B, and a balanced multivitamin and mineral supplement each day.
One should monitor and supplement oral, enteral, or intravenous potassium, phosphate and magnesium in such patients. On average, patients should receive 2-4 mmol/kg/day potassium, 0.3-0.6 mmol/kg/day phosphate, and 0.2 mmol/kg/day intravenous or 0.4 mmol/kg/day oral magnesium.
Moderately to severely ill patients with marked edema or a serum phosphorous < 2 mg/dL should be hospitalized to intravenously correct electrolyte deficiencies. Sugarcane juice is the best juice to break the fast. Unrefined sugarcane contains many minerals and nutrients including phosphorus, calcium, iron, magnesium and potassium. Pure sugar cane has 11 calories per teaspoon.
respected dr agarwal sir please guide me at what stage we should advice hunger striker to take feed and at what stage we should say if he continues hunger strike it will endanger his life ?
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