What happens to the body during a prolonged hunger strike? Doctors explain

Hunger strikes have shaped India's history, but what do they do to the human body? Doctors explain when health risks become life-threatening, and why recovery must be gradual

  Hunger strikes have long been used as a powerful form of protest, with participants willing to risk their health to draw attention to a cause. In recent weeks, activist and educationist Sonam Wangchuk's fast has once again raised questions about what prolonged starvation does to the human body.

 

While the political and social impact of hunger strikes often dominates public debate, doctors say the biological consequences are equally profound. Rather than simply running on empty, the body shifts into survival mode when deprived of food. It fundamentally alters how it produces energy, slows vital functions to conserve resources, and eventually begins breaking down its own fat and muscle just to stay alive.

 

 

The body's first response to starvation

 

"For roughly the first 24 hours, the body relies mainly on glucose stored as glycogen, especially in the liver. As that reserve runs low, it begins burning fat. The liver turns fat into ketones, which become an important fuel for the brain, heart, and other organs," said Dr Salil Malik, senior consultant and head of Department of Emergency Medicine, Marengo Asia Hospital, Gurugram.

 

As the hunger strike continues, the body is forced to tap into its remaining energy reserves to stay alive. Dr Bhanu Mishra, consultant - Nephrology, Fortis Hospital, Shalimar Bagh, explained, "As starvation continues, the body increasingly turns to its own muscle proteins for fuel, leading to weakness, weight loss, poor immunity, metabolic changes, and organ damage."

 

What symptoms appear as the hunger strike continues?

 

The physical effects become more severe as starvation continues because the body has fewer resources to sustain normal functions.

 

During the first few days, people commonly experience:

 

• Severe hunger
• Headache
• Dizziness
• Weakness
• Low blood pressure

 

Over the following weeks, more serious changes begin to develop:

 

• Slower metabolism
• Reduced heart rate and body temperature
• Progressive muscle loss, including the heart and breathing muscles
• Weakening of the immune system
• Vitamin and mineral deficiencies
• Confusion and difficulty concentrating
• Abnormal heart rhythms
• Kidney and liver injury
• Heart failure or respiratory failure in severe cases

 

"The brain, heart, liver, kidneys, and muscles are mainly affected," added Dr Mishra.

 

When does a hunger strike become dangerous?

 

Doctors caution that there is no fixed number of days after which a hunger strike becomes life-threatening because the risks depend on several factors, including age, hydration, existing illnesses, medications, and body weight.

 

However, experts agree that nutritional risk begins much earlier than many people assume.

 

According to Dr Malik, anyone who has eaten little or nothing for more than five days is considered to be at nutritional risk. After around 10 days without meaningful nutrition, the likelihood of dangerous complications increases significantly. Dr Mishra added that the risks rise sharply after two to three weeks.

 

The medical risks have played out in several high-profile hunger strikes. GD Agrawal's prolonged fast ended in his death in 2018, while Irom Sharmila survived her 16-year protest only because she was repeatedly force-fed through a nasal tube.

 

Is a hunger strike the same as fasting?

 

Although the two may appear similar, doctors say they are medically very different.

 

Religious or intermittent fasting usually involves eating within specific time windows, which allows the body to replenish nutrients and calories regularly.

 

A prolonged hunger strike, on the other hand, can continue uninterrupted for days or weeks. As a result, nutrient deficiencies accumulate, muscles continue to break down, and organs face increasing stress.

 

Even if a person continues drinking water with medically balanced salts or electrolytes, starvation still progresses. Dr Malik explained that fluids and salts may delay dehydration and help a person appear stable for longer. However, they cannot provide the calories, protein, vitamins, and minerals required to keep organs functioning normally.

 

Why eating again can also be dangerous

 

Breaking a prolonged hunger strike is not as simple as eating again.

 

"Normal eating right after a prolonged hunger strike may cause a condition called refeeding syndrome. It means that upon eating, there will be a dangerous electrolyte imbalance, which can lead to heart problems, breathing difficulties, seizures, or even death," said Dr Mishra. For this reason, doctors recommend restarting nutrition slowly and under medical supervision.

 

According to Dr Malik, anyone who has eaten little or nothing for over five days should initially receive no more than 50 per cent of their estimated daily nutritional needs. Further intake should only be scaled up after clinical evaluation and blood tests rule out refeeding complications, while high-risk individuals may require an even slower, tailored plan.