ABSTRACT
Chapter 2 reviews in detail how the human body “hibernates” physiologically in order to spare calories when in a starved state. It outlines how I begin the initial office consultation process with patients, taking a non-assumptive stance and inviting them to share with me their goals and values. The body conserves heat through development of acrocyanosis (cool reddish-purple fingers and toes), increased sense of chilliness, and production of lanugo hair. The heart slows (bradycardia) as the body’s vagal tone rises. A starving person’s heart is distinguishable from an athletic heart because the former will speed up markedly during minimal exertion (relative tachycardia). This is a different process from orthostatic vital signs. Thinking becomes more rigid and anxious, understandable through the lens of the famous 1940s Minnesota Starvation Experiment conducted by Ancel Keys. Gastroparesis and constipation occur due to a slowed digestive system, causing nausea, fullness, bloating, and abdominal pain. This chapter discusses optimal management of both. The blood tests of a malnourished person are often completely normal, and this can be invalidating. However, the patient remains far from well.
