Insatiable: A Life Without Eating - Longreads

🌈 Abstract

The article explores the psychological and social impact of being on total parenteral nutrition (TPN), a form of artificial feeding, on a man with Crohn's disease. It delves into his struggles with the loss of the sensory and social aspects of eating, as well as his obsession with watching cooking shows despite being unable to eat. The article also discusses the historical development of TPN and the broader implications of food deprivation on human psychology and well-being.

🙋 Q&A

[01] The Psychological Impact of TPN

1. What were the psychological effects experienced by the author while on TPN?

• The author experienced a constant sense of hunger and craving for food, even though his nutritional needs were being met through the TPN.
• He became obsessed with watching cooking shows, which he described as "picking a scab" - providing both relief and suffering.
• He felt socially isolated and disconnected from his housemates and wife, who continued to engage with food in their daily lives.
• He experienced anxiety, depression, and a loss of identity due to the lack of the social and cultural aspects of eating.

2. How did the author's brain react to being deprived of the sensory experience of eating?

• The author's brain continued to crave the cephalic phase of digestion, which is triggered by the sight and smell of food, even though he was not actually consuming anything.
• Researchers have found that patients on TPN or enteral nutrition often experience psychological effects similar to those seen in people who are physically deprived of food, such as an obsession with food and a desire to change careers to become a chef.
• The slow, gradual infusion of nutrients through TPN means the brain is never fully aware that nutrition is being provided, leading to a lack of the homeostatic feedback that normally occurs when eating a meal.

3. How did the author's social life and relationships change while on TPN?

• The author avoided the kitchen and social gatherings where food was being prepared and consumed, as it was a constant reminder of what he was missing.
• His wife, Erica, also began eating less, feeling guilty about consuming food in front of him.
• The author felt like he was "adrift and missing a functional language" without the ability to engage in the social and cultural aspects of food.
• Surveys of patients on enteral nutrition have found that most report feeling socially isolated and experiencing a loss of identity due to the lack of food-related activities.

[02] The Development of TPN

1. How was TPN developed, and who was responsible for its invention?

• TPN was developed by Stanley Dudrick, a surgical resident at the University of Pennsylvania, in the 1960s.
• Dudrick was determined to find a way to bypass the digestive system and provide patients with all the necessary nutrients directly through the veins, after observing that several of his patients had died due to malnutrition.
• After years of experimentation, Dudrick was able to develop a stable mixture of water, carbohydrates, proteins, trace elements, fats, salts, and multivitamins that could be safely administered intravenously.
• Dudrick's invention of TPN has since saved millions of lives, allowing patients who cannot eat to receive the necessary nutrition.

2. How does TPN differ from previous methods of artificial nutrition, such as enteral nutrition?

• Enteral nutrition, which involves feeding patients through a tube placed in the nose or stomach, relies on the patient having a functioning digestive system.
• TPN, on the other hand, bypasses the digestive system entirely, delivering all necessary nutrients directly into the bloodstream through a vein.
• This was a significant breakthrough, as doctors previously believed it was impossible to provide enough nutrition through the veins without causing inflammation and burning.
• Dudrick's innovation of administering the concentrated nutrient mixture close to the heart, allowing for faster dilution, was a key factor in making TPN a viable treatment option.

[03] The Impact of Food Deprivation on Humans

1. How does the psychological impact of food deprivation compare to physical starvation?

• While the physiological effects of food deprivation are different from physical starvation, the article suggests that some overlapping psychological effects may occur.
• Patients on TPN, who are functionally fed but not neurologically aware of it, can experience an obsession with food and a heightened focus on its location and preparation, similar to the effects seen in the Minnesota Starvation Experiment.
• This is likely due to the brain's base instinct to notice and remember the location of food, which becomes heightened when the body is deprived of the sensory and social aspects of eating.

2. How important are the sensory and social aspects of eating to human well-being?

• The article emphasizes that eating is not just about obtaining nutrients, but also about the sensory experience and the social and cultural rituals surrounding food.
• Patients on TPN or enteral nutrition miss out on the cephalic phase of digestion, which is triggered by the sight and smell of food and contributes to the feeling of satiety.
• Food also serves as a form of communication and provides structure to daily life, and the loss of these social and cultural aspects can lead to a sense of isolation and loss of identity.
• Surveys of patients on artificial nutrition have found high rates of depression, anxiety, and a general decrease in quality of life, highlighting the importance of the psychological and social aspects of eating.