Doctors interviewed by Mission Local say that even with the liquids the five San Francisco hunger strikers are taking in, a fast depletes the nutrients their bodies need to survive. With every passing day, the threat of considerable damage increases.
The five strikers pressing for the resignation or firing of Police Chief Greg Suhr have consumed broth, coconut water, and, on occasion, juices, for between 12 and 14 days, which doctors said will allow them to endure longer.
Nevertheless, they have lost weight – by their individual estimates on Wednesday, between 15 and 20 pounds – and at Tuesday’s demonstration at City Hall they looked visibly weak.
In long-term fasting, says Dr. Tirun Gopal at St. Luke’s Hospital, the main complications that may arise come from the body going into a catabolic state.
“[The body will] shunt the nutrients it does have to the parts of the body that matter the most, such as the brain, the heart, etc., without which life cannot be sustained,” Gopal said.
In doing so, he said, it takes away nutrients from from other potentially less important organs, such as the liver and kidneys.
“But that can only last for a short period of time before that deference mechanism fails,” he said. “Then it starts affecting the important organs such as the brain and the heart.”
Already, two of the strikers have experienced dizzy spells, first 29-year-old Edwin Lindo and then 66-year-old Maria Cristina Gutierrez. To protect her health, Gutierrez has been sleeping in a van near the Mission police station, where the strikers have been camping in the cold. Until Tuesday’s march to City Hall, the strikers had been speaking with passers-by and even participating in rallies.
Gopal said that based on their level of activity, he was skeptical that the hunger strikers were really consuming as little as they claimed.
“If it’s just a couple of sips of coconut broth…The fact that they are able to sustain conversation is an indication that there is something that we are not being told,” he said.
By Wednesday, however, strikers had become visibly more subdued and exhausted. One was taken to the emergency room, and another was told her breath was irregular.
Whether total or non-total, hunger strikes carry the risk of a battery of medical problems, including kidney failure, electrolyte disturbances and in extreme cases, even death, wrote Dr. Rupa Marya, a hospitalist at UCSF who also practices at the free Clínica Martín Baró in the Mission and has been monitoring the hunger strikers’ health.
“On average, people do not survive hunger strike past 10 weeks, although deaths have been reported as early as 4 weeks,” Rupa wrote in an email. “I guess if I could convey anything it would be this – the body is a fragile thing. The body without real substantive food is a more fragile thing. This is not a game. I am concerned for the health and safety of the people undergoing strike.”
Gopal, though skeptical of the strike and the amount of liquids the strikers are taking in, also voiced some concern.
“Personally I don’t believe that there is any cause in which I should be doing harm to myself. It doesn’t make any sense to me to do that,” Gopal said. “All of us have causes that we are passionate about, but if we inflict harm to ourselves for that cause it ceases to [have] meaning.”
Dr. Estell Williams, a third-year surgery resident at the University of Washington in Seattle, had a different perspective. She is the partner of Edwin Lindo, one of the hunger strikers.
“While I have my own strong feelings because, yes, this is the man I love and the man I want to be with, and I want to make it so we have a long full life together,” Williams said, “I have to respect his wishes and understand those wishes and when he would want interventions.”
Gopal said that first fat, later muscle and other tissues, are broken down in order for the body to sustain its basic functions. Such a state can begin to develop after the first 48 to 72 hours of complete fasting, Gopal said, resulting in the rapid build-up of lactic acid and possible irreversible kidney damage.
With the hunger strikers at Mission Station taking in some liquids, the immediate consequences are not as severe, but will eventually set in.
“This is somewhat of a grey zone, because they are providing themselves with some [nutrients]…They can last longer than a person who is doing complete fasting,” Gopal said. “The fact that they are getting some potassium and hydration can potentially prolong this process. And it depends on how frequently they’re consuming it, how much they are consuming of it.”
Williams, too, noted the possibility of going into a catabolic state after prolonged extreme fasting, and said that the hunger strikers have been consuming liquids in order to prevent electrolyte irregularities that can have symptoms of varying severity but in extreme cases cause cardiac arrest.
“Changes in people’s sodium in their blood levels, potassium, magnesium, and phosphorous, in any individual, if you have abnormalities in these, it can cause predominantly cardiac arrhythmia that can lead to a cardiac arrest,” Williams explained.
The exact length of time the hunger strikers may hold out depends largely on the individual and the nutrients they are ingesting. According to Gopal, supplements of the type carried by mountain climbers, for instance, can pack quite a nutritional punch. The hunger strikers said they are taking vitamin pills, thin juices (after one evening where they did consume juice but decided it was too sugary), and have eased off the broth, too.
The strikers are also spending their nights out in front of Mission Station. The past 13 days have seen lows between 45 and 50 degrees Fahrenheit.
“When you don’t have your normal fuels that physically help you to regulate your body temperature, it’s going to increase the rate at which you’re metabolizing additional stores in order to maintain homeostasis [regulate your body temperature],” Williams said.
Williams said she has heard enough from people who think that broth and coconut water (and in some cases the occasional juice) invalidate the hunger strike.
“Yeah. To those who have that commentary: Let’s see you go 11 days on broth,” she said. “Unless you’re willing to do it, their opinion doesn’t count.”