The Telegraph, Calcutta, India, August 25, 2011
New Delhi, Aug 25: The energy that Anna Hazare has displayed after a week of fasting has baffled doctors who say that by this time, his brain has probably begun using the byproducts of fatty acids broken up in his liver and kidneys as fuel, instead of glucose.
A senior doctor who is a member of the team monitoring Hazare said today that the results of his daily tests have indicated early signs of starvation, including evidence of ketone metabolism — the use of fatty acid byproducts called ketone bodies as fuel for the brain.
Several doctors who were not part of the team observing Hazare but who specialise in body metabolism said they were surprised by his activity yesterday and today — Hazare stood up for several minutes and delivered a speech at times at unusually high decibels, or raising both his arms to wave to the crowds.
“This is very odd for someone in his 70s who claims he has had nothing but water for more than eight days,” said a senior internal medicine specialist who is not a part of the team observing him. “For energy, you need calories. Water has zero calories, no carbohydrates, no proteins, no fats.”
But doctors say the response to starvation varies from person to person, and individuals who have fasted repeatedly are likely to have greater endurance to starvation. Such persons may be able to endure calorie restriction longer than those who have never fasted.
“The activity we have seen is unusual, but not impossible,” said Ambrish Mithal
, chairperson of the division of endocrinology and diabetes at Medanta, a private hospital in Gurgaon whose doctors are monitoring Hazare’s health.
When a person stops taking food, the body first turns to stored calories to extract energy for essential functions, including to provide vital glucose to the brain. In the first 24 to 48 hours without food, the body turns to glycogen in the liver, said Prashant Joshi, head of medicine at the Government Medical College, Nagpur. “Then it uses up glycogen from muscles and when this is exhausted, it turns to fatty acids in the liver and kidneys.”
After three to five days into fasting, the body begins to extract ketone bodies from fatty acids, Mithal
said. “At this point, the brain begins to adapt to using ketone bodies as fuel instead of glucose which has depleted.”
Doctors say the energy levels that Hazare has demonstrated over the past two days thus pose a medical enigma. A cardiologist in Pune, Abhijit Vaidya, had claimed earlier this month that during an encounter with Hazare more than a decade ago, he was informed by an associate of Hazare that Hazare was given glucose and electrolyte solutions during a fast. But Vaidya has also said that he had no idea whether what he was told by the associate was true or not.
A doctor who is familiar with the results of Hazare's daily medical tests over the past week told The Telegraph that the results are consistent with readings expected from someone who has been fasting. The doctor said a medical team is watching over Hazare 24 hours a day.
“If he has taken anything in addition to plain water, the medical community observing him doesn’t know about this,” the doctor who requested anonymity said, but declined to comment on swirling speculations that Hazare may be taking some combination of electrolytes or glucose with water.
Some doctors believe Hazare’s claims that he is getting energy from the crowd cannot be dismissed as nonsense. “Obviously, there is no transfer of calories from crowds, but inspiration from crowds can lead to a positive mental attitude which can have beneficial impacts on overall health even during fasting,” Joshi said.