DEAR DR. BLONZ: My close friend continues to recover from an emotional blow, after which she was unable to eat for many days. With no real appetite, and at my insistence, she finally started to eat, but it made her nauseous. Her doctors are on this and have found nothing serious, physically; they counsel patience and continued effort.
My concern is that she has lost a lot of weight and doesn't look healthy to me. I hope to better understand what might be happening and what I might do to help her. -- C.F., San Jose, California
DEAR C.F.: Your friend is fortunate to have you for support as she works through this challenging time. I cannot provide medical advice, so it remains essential to keep her health care professionals apprised of developments. I hope that the team includes someone with expertise in emotional support. The passage of time is likely to be the most potent ally.
Without food, the body undergoes a series of coordinated adaptations that pare down any unnecessary energy usage. There will be a tapering of systems not being used; this includes those involved with digestion. The body also slows down its metabolic rate and lowers its temperature as systems shift to a general energy-sparing "budget." This involves less circulation near the skin's surface, helping explain why those deprived of food might have a sallow look.
After being without sustenance for days, any reintroduction of foods must be done slowly and strategically -- beginning with simple foods, such as fruits and fluids -- to limit negative effects. These can range from minor queasiness and nausea to more serious metabolic effects. As there may be additional complexities with her ongoing health conditions and medications, your friend (or you as her proxy) should be in touch with the health team to be sure there are no missteps during the process of reintroducing foods.
Consider glucose, the building block of carbohydrates -- a primary fuel in the body and essential for specific cells. The human body has only a small amount stored for special circumstances. We can survive without a dietary source of carbohydrates (and the glucose it becomes) due to our ability to break down proteins and turn certain amino acids into glucose. This is life-preserving during a prolonged absence of food, but it's not an ideal situation.
The bottom line is that the body will be digesting itself during a fast, in essence -- repurposing its substances for more critical uses. Like other metabolic processes, these create waste; water is the conduit to get these out before they can jam up the works. This explains why we require more water than any other nutrient we ingest. We can survive for weeks without food, but only days without water. Consider encouraging your friend to start with consuming water, or perhaps a drink that provides electrolytes, other minerals and a minor source of carbohydrate calories.
The health team should provide recommendations as the situation evolves. I hope that your friend gets the support she needs during this dark period.
Send questions to: "On Nutrition," Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.