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I was looking at this image on Wikipedia of two children during the Russian famine of 1921-1922. The caption reads (my translation):

Famine in Russia. III. The two stages of hunger: the skeletal limbs, the swollen belly (by grass, straw, tree bark, worms, earth). These children can no longer be saved, it is too late. To save them, it would have been necessary to feed them before this degree of exhaustion.

I'm not sure this makes sense. Given that the children are visibly still able to sit and move there would likely have been good evolutionary reasons for being able to go back to normal after such an episode if food is available. More importantly, I couldn't find a reliable source on this, only questions on Quora and on Reddit that were answered with opinions and hearsay, none of which really answer the question.

To clarify, I'm not talking about overfeeding a starved person to death (as apparently happened after the Holocaust). I'm asking whether there is a point at which a person is conscious and able to sit, able to move, and able to understand that although there is food right here, there is nothing that can be done.

  • This claim's also been made in historical texts about sieges (e.g. the Siege of Leningrad) in which starved defenders allegedly still died after the siege ended. – Nat Sep 3 '17 at 1:22
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    I'm sure there's a difference between simply restoring normal feeding patterns and an all-out medical assault on the condition. To someone who is dying of thirst, giving IV fluids will be more effective than simply giving them sips of water. – Daniel R Hicks Sep 3 '17 at 2:10
  • While I can't address the actual issue I can see how it could happen given the medical tech of the day--suppose the digestive system was no longer capable of absorbing enough? Feeding them wouldn't save them, IV nutrition wasn't an option. – Loren Pechtel Sep 3 '17 at 5:15
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tl;dr: Yes, there is a point at which recovery is not possible without significant medical intervention.

Death by starvation is not simply a matter of running out of energy to sustain life, so cannot be treated simply by providing additional energy. Various bodily systems are damaged during the process of starvation and may remain impaired afterward. Additionally, lack of adequate nutrients can lead to potentially-deadly chemical imbalances which the body is not able to recover from without assistance.

An extensive list of such effects can be found in section 3, "Medical", of the paper Refeeding the Patient with Anorexia Nervosa: Perspectives of the Dietitian, Psychotherapist and Medical Physician (DOI 10.12691/jnh-3-2-1). While the paper specifically provides a broad overview of the effects and treatment of anorexia nervosa, the "Medical" section primarily describes the effects of starvation in general.

I will specifically call out here the paper's discussion of "refeeding syndrome", as it relates directly to the question's claim that WW2 concentration camp survivors were simply "overfed to death" (emphasis mine):

The other main medical issue to be concerned with during the refeeding of patients with anorexia nervosa is the actual refeeding syndrome. This syndrome was first described in survivors of concentration camps who were liberated and then fed excessive amounts of high-dextrose containing foods by their well-intentioned liberators. Surprisingly, many died soon after their liberation despite receiving high quality nutrition and despite having lived under horrific conditions in the years prior. Then, further attention was called to this in the “Minnesota Experiment,” wherein conscientious war objectors were noted to have a marked decrease in the size, of their heart size as seen on chest radiographs during their periods of starvation. In 1969, with the invention of total parenteral nutrition (TPN) and its early administration to patients on a burn unit, this lesson was repeated when many of the patients died soon thereafter, and were noted to have critically low serum phosphorous levels. Anorexia nervosa now serves as a sobering model of the inherent calamity which can occur with the refeeding of starved patients if there is inattention to the metabolic responses to the renewed nutrition.

Briefly, phosphate is critical for glucose metabolism. When starved patients shift from a catabolic state to an anabolic state with the provision of calories anew, there is great demand for the production of high energy compounds for glycolysis, the Krebs cycle and the formation of adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3 DPG), resulting in marked utilization of serum phosphorous and a reduction in phosphorus levels. [37] The resultant hypophosphatemia, if severe (<1.5 mmole/L), causes the development of a group of serious adverse sequela including seizures, heart failure, hemolysis, rhabdomyloysis, respiratory failure, coma and sudden death. These phenomena, all or in part, are known collectively as the refeeding syndrome. In theory, any person who has been malnourished and without caloric intake for just a few weeks, is at risk for its development as they begin to reefed[sic] if there is lack of attention to their phosphorous, potassium, magnesium and glucose levels. [38] The risk for refeeding syndrome seems to mostly begin just 2-3 days after the initiation of refeeding and it lasts in general for 1-2 weeks with progressive calorie increases. It best correlates with the severity of malnutrition as defined by nadir percent of ideal body weight. [39] Different series have reported on the incidence of refeeding hypophosphatemia, varying from 15% to upwards of 35%. [7, 40] Prophylactic phosphorous is therefore not indicated, but rather, it is most important to closely monitor the patient during the first weeks of refeeding for clinical and laboratory changes.

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    Good stuff in here, thanks! There definitely seems to be pitfalls when re-feeding a starved person. I'm not sure, however, that I understand how your discussion supports your conclusion that "there is a point at which recovery is not possible without significant medical intervention". I would like to make the distinction between the claims that re-feeding a starved person is dangerous (i.e., could result in death) and that of a point of no return (i.e., will almost certainly result in death no matter what). – Pertinax Sep 3 '17 at 10:19
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    @TheThunderChimp - In all honesty, I know the tl;dr primarily from personal experience, but was not able to turn up an authoritative source which (IMO) states it more clearly than the one I linked to. – Dave Sherohman Sep 4 '17 at 12:30
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    From personal experience? I'm very curious, might you please elaborate? – Pertinax Sep 4 '17 at 17:08
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    @TheThunderChimp - About 10 years ago, I lost the ability to naturally process carbohydrates (type 1 diabetes). This triggered a subset of the metabolic processes triggered by advanced starvation, leading to loss of over a third of my body weight and severe ketoacidosis. When I finally went to the ER, I was still lucid and able to walk, talk, eat, even drive, but the ER doctor said my blood chemistry was so messed up that, if I had arrived an hour later, it would not have been possible to save me. – Dave Sherohman Sep 5 '17 at 7:54

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