The changing face of hunger: from fasting to the concept of atherogenesis

The history of hunger is a story about natural disasters and wars, but, on the other hand, also about the investigation of evolutionary defense mechanisms concerning quantitative food shortages. The article presents how fasting and the experimental starving oriented the development of physiology, and it is based on a comparative analysis of monographs and articles on starvation in the medical context from library collections and the PubMed database. Over the centuries, doctors have believed that fasting has a beneficial effect on health, and they recommended a restrictive diet during an illness. In the 19th century, the growth of modern physiology was determined by experimental fasting of human subjects and animals. Furthermore, undernourishment and chronic hunger in large populations were recognized as a threat to public health for the first time. During both world wars, depriving civilians of food became a strategy of combat and a method of genocide. The mass nature of war hunger motivated doctors to research the pathophysiology of starvation and refeeding of emaciated people, even in the ghetto or concentration camps. After the Second World War, the invention of the scanning electron microscope enabled systematic studies on the effects of starvation on the human body. As a result, the pathogenesis of atherosclerosis and the cellular metabolism of cholesterol at the submolecular level were clarified. At the turn of the 21st century, the research on the metabolic response to starvation shed new light on atherogenesis and the link between lipid and carbohydrate metabolism.