The Great Starvation Experiment

The preliminaries

• In November 1941, Adolf Hitler ordered that Leningrad, a major city in the Soviet Union that is now known as St. Petersburg, Russia, be starved into submission in a siege that lasted 872 days. At the beginning of the Hungry Winter, people first began consuming the zoo animals.
  • Killing dogs and cats was slightly harder than killing zoo animals, but an easy decision nonetheless. Then, wallpaper was stripped away, and leather, too, could be boiled to eat. People began eating corpses, and soon children began disappearing.
  • On January 27, 1944, the siege was lifted. In all, a million Soviet citizens starved to death in that city, more than 1,000 per day.
  • This was an example of hunger’s terrible role in WWII. There were starving survivors of Nazi concentration camps, a hunger crisis spread across China, etc., and the US government began examining the implications of widespread starvation.
    • It would be impossible to teach starving people democracy.
• The Civilian Public Service was the US military’s latest attempt at dealing with the troublesome issue of pacifist draftees–they needed soldiers, but did not want the troublesome optics of forcing pacifists into war.
  • Early in WWII, CPS mainly served as a way to hide idealistic young men in remote forestry camps.
  • Some of the more daring CPS men favored medical experiments (e.g., exposure to severe cold and heat, excessive moisture and thirst) as an outlet for their altruistic urges, and Dr. Ancel Keys capitalized on this.

Dr. Ancel Keys and the K-ration

• In 1941, the US military wanted to design a high-energy, portable, and nutritious meal for paratroopers.
  • During WWI, there was an emergency ration, which consisted of three small beef-powder-and-wheat cakes, and three small chocolate bars.
  • The goal for the nation’s Subsistence Laboratory designers was to create the highest possible caloric value in the lightest possible package.
• This problem was especially acute for paratroopers for whom every ounce mattered.
  • The US military contacted Dr. Ancel Keys, who had done extensive research on the effects of high altitude on the body. 
  • Ultimately, he and the Subsistence Laboratory created the K ration: 2,830 calories of malted milk tablets, canned veal loaf, and instant coffee (breakfast); dextrose tablets, canned ham spread, and bouillon cubes (lunch); chocolate, sausage, lemonade powder, and sugar (dinner). 
• The Subsistence Laboratory employees were some of the early great thinkers on the subject of nutrition, and their ability to feed millions of soldiers was a remarkable and largely unsung contribution to the Allied victory.

The Starvation Experiment

• After this, Keys was named a special assistant to the secretary of war.
  • He moved his lab to the ground floor beneath Memorial Football Stadium on the University of Minnesota campus.
• Soon he began looking at the larger issue of world hunger. The war took a terrible toll not just on the world’s food supplies; it also devastated the world’s food processing and distribution system.
  • His primary argument to the military was that solving the hunger problem would be good for democracy: A famished Europe would be fertile ground for communist and fascist ideas.
    • The military agreed to let him use CPS volunteers.
  • To his scientific colleagues, Keys argued that hunger was an integral part of human history and was long overdue for scientific inquiry.
• The experiment would begin with three months of standardization, during which each man would be brought to a normal weight for his height and build. They would have a normal diet so the scientists could determine the number of calories necessary for each man to maintain his weight given a constant activity level.
  • Then would come six months of starvation, where the diet would be cut roughly in half, approximating 25% weight loss.
    • 25% was an amount of weight loss Keys believed he could reasonably expect to achieve given the time constraints. This amount would likely not cause overly serious health risks while still being significant enough to effect meaningful, measurable biological and psychological changes.
    • He sought to completely catalog every quantifiable change that occurs in a famished human being.
  • Then it would be a three month rehabilitation period during which their recovery would be evaluated. This was the main point–to figure out how to rehabilitate starved people.

The screening process

• They interviewed volunteers, asking the men about their physical and mental health, and performed medical exams. The goal was not only to determine men who were suitable physically, but also those who were genuinely interested in relief and rehabilitation.
• Another criterion was the ability to get along well with others under trying conditions.
• They were on average 25 years old, weighed 152 pounds, and were 5 feet 10 inches tall.
  • Each of the test subjects had at least one year of college; 18 had college degrees. They were all intellectually above average.

Phase one – control

• Calculating the amount of fat stored on each man’s body was crucial. Fat is the body’s energy storage mechanism, and scientists wanted to measure how fat would deplete as the hungry body consumed itself.
• Each subject was required to walk 22 miles a week, and Keys scheduled 25 hours a week of instruction, including classes in language, sociology, and political science.
  • They also had to take the Harvard Fitness Test twice during this period. They walked for 20 minutes at 3.5 mph and 10% grade. Then the grade reduced while the speed doubled, and they ran until they dropped.

Phase two – starvation

• The end of the war was in sight when the starvation phase began on February 12, 1945. 
• Keys wanted the decrease in calories to be sudden and shocking to the body.
  • The men shifted overnight from three generous portions a day to only two spartan ones, breakfast at 8:30am and supper at 5pm, for a total of 1,570 calories.
  • The men maintained their constant activity levels.
  • The meals were designed to approximate the food available in European famine areas, with a heavy emphasis on potatoes, cabbage, and whole wheat bread.
  • Water, black coffee, gum, and cigarettes were allowed in unlimited quantities.
• Keys tracked only the vitamins A, thiamine, niacin, D, and C.
• Soon, one of the participants was caught cheating (he would go into town and buy vast amounts of food) and his weight veered sharply from the curve. He confessed to cheating and to having dreams about eating people.
  • Cannibalism had always been linked to famine. While psychologists couldn’t write a precise mathematical formula relating the severity of a famine to the number of cannibals it would generate, it was clear that this could be an outcome. 
  • Eventually, he was removed from the study and sent to a psychiatric ward. With a few days of regular meals, he returned to normal and was released.
• Physical weakness and fatigue were the most noticeable effects during the first half of this stage.
  • Keys carefully monitored the decrease in physical strength, attempting to determine exactly how starvation affected the capacity for work.
  • Strength, speed, coordination, and endurance were all measured with the usual thoroughness; of those four traits, strength showed the greatest deterioration. There was a 21% reduction in strength on average, based on how much they could lift with the back lift dynamometer (a special calibrated machine).
• Another man started chewing 40 packs of gum a day.
• The psychologists tracked three “drives” they considered fundamental to human beings–concern with food, desire for sex, and a need for activity.
  • For all the men, interest in sex was among the first casualties of hunger.
  • Notably, self-denial of food is a highly spiritual act, as is celibacy and meditation. It is curious that monastic orders of all religions seem to police the same three drives.

The psychological and physical misery of phase two

• Keys tried to quantify their misery, noting that the number of complaints from the group had risen sharply during this phase, from 6 on average to 15.
  • Concerned about morale and keen to keep all remaining volunteers in the program, Keys hosted a relief meal with things like chicken, potatoes, corn, gravy, bacon, etc, and the men soon began joking and laughing again.
• Another man cheated and promised he wouldn’t do it again. As with all the volunteers, he also became morbidly fascinated with his own bodily functions, and was alarmed that he hadn’t had a bowel movement in 10 days. Soon, though, he was urinating blood and had to be removed from the experiment. 
• For all the men, sitting for long periods of time became uncomfortable and they were constantly cold. Part of the body’s desperate attempt to conserve energy was to lower body temperature, which went from an average of 98.6F to 95.8F.
• The average heart rate slowed from 55 beats per minute to 35 beats per minute.
• Another man said that he knew he was going crazy, and he often felt a compelling desire to smash and break things.
• Many saw their weight loss plateau around the 20th week of starvation because they suffered from edema.
  • Edema is a puffy swelling caused by retained water in the body. It mostly occurs in the ankles and knees, but also in the face.
  • Edema greatly complicated the weight loss calculations. As the body retained water, it made the weight loss slow even as the man lost fat and tissue at the predicted rate.
• They also discovered that starvation had no impact on vision, but hearing improved across the board, especially at the lower frequencies.
• One participant saw a woman leave food on her plate at a restaurant and he chased her down the street, yelling, “Do you have any idea how much hunger is in the world–hunger that you are contributing to?”

Phase three – rehabilitation

• The 32 men who made it to the rehabilitation phase dropped from 152 pounds to 115 pounds, an average weight loss of 24%.
  • They lost an average of ⅓ a centimeter in height. 
  • Their total blood volume fell by almost 500 cubic centimeters. 
  • Their hearts shrunk by 17%.
• Then, the men heard that they had been secretly divided into four subgroups, each receiving either 400, 800, 1200, or 1600 more calories than they had in starvation.
  • Some received a protein supplement. Some received a vitamin supplement. Most felt like they were in the lowest group.
• For those actually in the lowest groups, the disappointment was crushing. 400 additional calories amounted to little more than a few slices of wheat bread.
  • They still had to walk 22 miles a week, and the temptation to cheat was as strong as ever, as was the depression, fatigue, and physical discomfort.
• Many of them began to lose weight even more rapidly in the recovery period.
  • The scientists determined that the weight loss was caused by the reduction of edema as the body healed; the body was shedding heavy fluid weight faster than it could regenerate healthy flesh. It was, in other words, a sign of recovery.
• Many of the men had coarse and thin hair that would fall in clumps. Some had distinct patches of darkened skin, and blue fingernails and lips. Their corneas were unnaturally white. Overall, many of them deteriorated badly.
  • One man chopped off three of his fingers in hopes of going to a hospital and eating hospital food. Afterwards, he begged to stay in (and was allowed to stay) because he didn’t want to waste all his efforts.
• Keys was worried, because at this stage, WWII was over. Every doctor in the world had a theory about how to best heal the famished, and he knew it would be months or years before the mountain of data they had accumulated would be officially reported.
  • The protein and vitamin supplements the scientists gave the men were frustrating, because it appeared that neither had any effect on recovery.
  • The four caloric groups recovered at rates almost exactly proportional to the number of calories they were receiving. He wanted to tell relief workers that they shouldn’t trouble themselves preparing special protein feedings. 
• Keys worried about the slow pace of physical recovery. The men in the lower two caloric groups were barely gaining weight.
  • Even the men with the most calories regained only 6.5 pounds, less than ⅕ of their total weight loss. Keys also wanted to tell relief workers that it would take more than 3,000 calories a day to facilitate recovery.
  • Fat had dropped more dramatically than body weight during starvation, and in recovery, it increased slightly faster. 
• Keys changed the model and had each group increase by an average of 800 calories, so the men received an additional 1,200, 1,600, 2,000 or 2,400 more calories. This shifted to three meals a day, and weights slowly rose but spirits soared.
• Scientists tracted intelligence with timed tests and starvation did not appear to significantly impact their abilities.
  • But 28% of the men said their memories worsened and they couldn’t understand written material very well. Personality also changed as the neurotic element of the test soared. But in the end, some of them were actually better than when the experiment began.
• During this time, one of the men presented Keys with a note, twice, that they demanded changes in the program, threatening strikes and non-cooperation.
  • A fellow doctor was ecstatic, saying that it was the ultimate validation of Keys’s theory: hungry people mindlessly follow orders, but you feed them enough and they demand self-government.
• At the end of rehabilitation, the average weight had risen to 129 pounds, regaining only 36% of the weight lost. Even with 2,400 extra calories a day, recovery was not complete.
• Keys concluded that the human body was supremely well equipped to deal with starvation. Eons of erratic food supplies and natural disasters had built into the body an array of mechanisms for conserving energy until the floodwaters receded, crops restored, etc.
  • Keys wondered if the mind was as resilient, as it was the mind that ultimately surrendered first.
• Keys published an interim report on October 15, 1945, five days before the end of the experiment but nearly five months after the end of the war in Europe.

The aftermath

• Relief workers had prepared to nourish victims through intravenous and oral tube feeding on a massive scale, in the belief that among the severely starved, the digestive tract would be too deteriorated to sustain normal eating and digestion.
  • Keys insisted that the vast majority of the famine victims could eat normally without any special difficulty, making relief efforts much easier.
• Finally, in 1950, the report was published by the University of Minnesota Press: The BIology of Human Starvation was 1,385 pages and was immediately hailed as the seminal work on the subject of starvation.
• The men reunited in 1991, and more than 80% agreed that the experiment increased their capacity to cope with adversity, and would encourage their own sons to participate in a similar experiment. 

• The complicated relationship between pacifists and the US military, which ultimately resulted in CPS.
  • For instance, 48 CPS men volunteered to wear lice-infested underwear to contract typhus. Others gargled the sputa from those infected with pneumonia. More strapped mosquito-filled boxes to their stomachs to contract malaria.
• Detailed background of Dr. Ancel Keys and participants like Max Kampelman, Henry Scholberg, and Sam Legg
• The complicated history of the pacifist churches
• The importance of (what is now considered) unethical medical research and its results, including research done by German and Japanese doctors during WWII
• The importance of Life coming conducting a photo essay about the experiment
• The Helsinki Declaration and the push-back against doctors, including those in the US (for instance, doctors in rural Alabama experimented with syphilis on black men so they could track the disease’s progress all the way through autopsy, sponsored by the US public health service)
• Keys’s other research that ultimately linked a diet of saturated fats to heart disease