How long can one survive on a hunger strike?

Attawapiskat Chief Theresa Spence talks with her family and Native American actor Adam Beach as she continues her hunger strike in a teepee on Victoria Island in Ottawa, early Tuesday, Dec. 25, 2012. (Cole Burston / THE CANADIAN PRESS)

As Attawapiskat Chief Theresa Spence’s hunger drags on into its third week, the risks to her health tick upwards with each passing day.

Spence stopped eating solid food on Dec. 11, though she continues to drink lemon water, fish broth, and “medicinal teas” prepared each morning by a friend. CTV’s Craig Oliver, who visited Spence this week at her teepee on Victoria Island just across from the Parliament buildings, says those with Spence say the chief is beginning to lose weight. Others say she appears weak, though alert.

Spence offers this response to the question of whether she is willing to die for her cause.

"I get asked that a lot. Yes it is. If this is my journey, to create a path for me, then I am going to go that journey," she told Oliver.

But for how much longer she will still feel well is unclear, because frankly, there hasn’t been much research on the science of self-starvation.

One review in the British Medical Journal found that hunger strikers who choose to continue taking in fluids begin to feel severe starvation symptoms after around 35 to 40 days. That’s when many develop confusion, hallucinations and convulsions. Shortly after, they begin to experience organ failure, which can lead to death on its own or to fatal heart attacks.

Rita Chretien, the 56-year-old B.C. woman who became lost in the Nevada wilderness with her husband last winter, survived 49 days of starvation white awaiting rescue. She later said she got by on a small amount of leftover trail mix, hard candy and melted snow.

By the time she was found by a group of hunters, she had lost nearly 30 pounds. When they tried to give her some of their food, she was so ill, she vomited it back up.

Chretien had to be nursed back to health carefully because of her high risk for something called “refeeding syndrome,” a condition first observed in rescued Second World War prisoners. When those affected by starvation are fed too quickly, the sudden shift in fluid and electrolyte levels can cause fatal heart problems.

How long does fluid factor in?

How long one survives without food is thought to be affected by a few factors, most importantly, whether one is also taking in fluids. (Without fluids, most die within 10 days.) One’s health before the strike can be another big factor affecting how long they survive. A high amount of body fat appears to also be important.

But it’s possible that one’s experience with fasting could also have an effect. Mahatma Gandhi famously entered 10 hunger strikes while he fought for India’s independence from British rule, most achieving at least some measure of success after just a few days.

In his longest hunger strike, meant to protest his 1943 imprisonment, Gandhi lasted 21 days on just sips of citrus juice and water. Though he failed to achieve his freedom, his fortitude astonished his doctors, in part because he carried so little body fat before the fast.

One of the most tragic hunger strikes occurred in 1981 in Northern Ireland’s Maze Prison. That’s where 10 imprisoned members of the Irish Republican Army (IRA) stopped eating to protest the removal of their Special Category Status in the prison, which granted them extra prisoner-of war-like privileges.

Prisoner Bobby Sands, a former IRA commanding officer, helped lead the revolt and was actually elected into the British House of Commons one month into his hunger strike – a move that helped to raise awareness for his group’s cause even further.

When British Prime Minister Margaret Thatcher refused to concede to the prisoners’ demands, the strike dragged on and on the 66th day of his hunger strike, Sands died from starvation.

The other nine prisoners died one by one as well, after hungers strikes lasting from 46 to 73 days.

The day that Sands died, British Prime Minister Margaret Thatcher famously showed little regret, telling the British House of Commons: "Mr. Sands was a convicted criminal. He chose to take his own life. It was a choice that his organization did not allow to many of its victims." But his death captured headlines around the world and sparked protests in several cities throughout Europe.

The British government eventually granted the prisoners partial concessions. But the affair led to a surge of new IRA membership and extremism and eventually, an intensification of the fighting in Northern Ireland that went on for years until 1998’s Good Friday Agreement.

Whether Spence will achieve her demand of a meeting with Prime Minister Stephen Harper to discuss the longstanding  issues affecting aboriginal peoples in Canada remains to be seen. She has said she is willing to die for her cause. But she also feels confident that others will take up the movement so that it will continue on, even after her death.