Starving to the point of collapse: This is what happens in the body during a hunger strike

Wolfgang Metzeler-Kick has not eaten any solid food for almost two months. The 49-year-old is on hunger strike. Until now, he has kept himself alive with vitamins and juices. He is now on a “dry hunger strike”, which means that he is also refusing to drink anything. His health has deteriorated massively in the last seven days and, according to the “Starve until you’re honest” campaign, is now life-threatening. The risk of cardiac arrest or infection increases with each passing day. The activist could collapse, fall into a coma – or die at any time.

Nevertheless, he wants to continue.

The only question is: How long?

Call to Susanne Koch. The doctor and lecturer at the Charité in Berlin is one of three nurses and doctors who visit the activists in front of Robert Habeck’s climate ministry every few days. Koch is also a member of the Scientist Rebellion group. She was asked via their mailing list of the Health 4 Future Signal group whether she would like to supervise the hunger strike. It is not the first time. In 2021, she was supposed to look after the first group of climate activists who starved to death a conversation with Chancellor Olaf Scholz. At the time, Koch declined “because the activists were very young.” It is different with Metzeler-Kick and his fellow campaigners. “I can accept their decision to go on hunger strike better,” says the doctor.

But she cannot hide the fact that she is worried about the activists. Whether it is 61-year-old Michael Winter, 56-year-old Richard Cluse, 41-year-old Titus Feldmann or 34-year-old Adrian Lack – Koch has taken them all to her heart. The fact that Winter had to be admitted to the hospital and Metzeler-Kick is starving his way to the end of his life is difficult for her to bear.

Health risks of hunger strikes

But the three-person medical support team cannot break the activists’ stubbornness. They can only provide support and supervision, monitor blood pressure and blood sugar, and measure heart rate.

For weeks, Koch and her two colleagues have been watching the strike wear on the activists’ bodies. First, the sugar reserves in the liver are used up. This usually takes one to two days, says Koch. Then the fat reserves are used up. “The more reserves there are, the longer the hunger strike can last.” Metzeler-Kick’s fat reserves were used up within four to six weeks. Now he is only losing his muscle mass. Doctors also speak of muscle atrophy. This can be dangerous: “It becomes particularly critical when the heart muscle is attacked,” says Koch. The risk of cardiac arrhythmia and even heart failure increases with each passing day.

To prevent permanent damage, the hunger strikers consume a few grams of carbohydrates, vitamins and electrolytes every day in the form of effervescent tablets and juices. “We communicated from the beginning that this was important and the activists stuck to it,” says Koch. But now the first person is rebelling. Wolfang Metzeler-Kicke announced at a press conference just over a week ago that he would go on a “dry hunger strike”. He is now refusing to eat carbohydrates. The 25 grams per day that he had previously consumed were already too little. The WHO recommends that people aged ten and over consume around 400 grams a day in the form of vegetables, fruit and whole grain products. This is the only way the body gets the energy it needs for metabolism, among other things. Women need slightly less than men.

Vitamin B1 is also on the activists’ “menu”. It is essential for the nervous system. A deficiency can cause fatigue, nausea and headaches. In the worst case, nerve pain, muscle and heart weakness and swelling of the body are also possible. These symptoms are characteristic of the disease Beriberi, which is actually only widespread in developing countries.

Treatment against one’s will?

The activists themselves know that they are starving to death. “If the situation becomes too serious in terms of health, we will of course address it,” says Koch. But she does not want to intervene – not even in an emergency.

In any case, a person may not be treated medically against their will, says Jan Moeck, a specialist lawyer for medical law. This applies to forced treatment and feeding as well as to admission to hospital. Anything else would be contrary to medical ethics and is illegal in Germany. “The principle of ‘informed consent’ applies. After being informed about a treatment, patients decide for themselves which medical measures will be carried out and which will not,” explains Moeck.

If a hunger striker is unconscious, doctors are obliged to act according to the person’s previously expressed will. Koch and her colleagues therefore believe it makes sense to find out about the activists’ will. Ideally, this is recorded in writing. “If the will is not known or the patient can no longer reliably express his or her will, it depends on the presumed will,” says Moek.

So far, the activists have rejected the advice of the medical support team to end the strike, says Koch. “But that also means that we support the hunger strike without becoming angry, disappointed or afraid. You just have to put up with it,” says the doctor. The two people who were treated in hospitals had previously collapsed and then decided to be admitted themselves.

“For the most part, hunger strikers are unlikely to want to accept their own death. However, should this be the case, doctors do not (any longer) have to take responsibility for treatment, especially since according to the professional code of conduct of the medical associations, it is not the job of doctors to assist in the suicide of a patient,” says medical lawyer Moeck.

“Wish for a happy ending”

Susanne Koch wants to accompany the hunger strikers in Invalidenpark until the end – whatever that means. If the activists decide to end the strike, they must be slowly introduced to eating again. Anything else would be life-threatening, because otherwise, for example, their electrolyte balance could become unbalanced.

The doctor cannot say exactly how long the activists can continue their hunger strike. This depends on their state of health, but also on their “diet.” If the activists stop drinking, they could die within two to three days. With water, it would be around 40 to 50 days. And with electrolytes, vitamins and juices, even longer, Koch estimates.

No matter how the story in Invalidenpark continues, Koch wishes “nothing more than that there is a happy ending for everyone involved”.