Survival of Taiwanese hiker Liang Sheng-yueh who was stranded on a gorge at Tyangro Bhir around 20 kilometers from Tipling in Dhading on the edge of a waterfall for 47 days, the last five weeks or so on just salt and ice/water, has been called miraculous by everyone including doctors.
The 21-year-old, he turned 22 today on April 28, was airlifted to Grande International Hospital in Kathmandu at around 4:30 on Wednesday April 26 after being found by one Dawa Tamang, a local, at around 11 am on the day.
He told doctors at the hospital that he and his girlfriend 18-year-old girlfriend Liu Chen-chun, who tragically died just three days before the missing duo was found, had food for around two weeks after which the stock of boiled potatoes, noodles, and other dry foods they had carried ran out.
The first thing he said after being carried out of the chopper at the helipad on the top of the hospital building was 'I am fine' and preliminary tests showed that he was indeed fine.
His vitals were normal and all the blood tests turned up normal with elevated hemoglobin of 19 grams/dl (normal range for men is 13.8-17.2 ), possibly due to hemoconcentration according to Medical Director at the hospital Dr Chakra Raj Pandey, the only abnormal result.
"His blood pressure was 125/70, pulse rate 76, oxygen saturation 100%, and blood sugar level 153 mg/dl," according to head of the emergency section at the hospital Dr Ajay Thapa.
He looked extremely exhausted and malnourished, almost like skin wrapped around the skeleton according to Dr Thapa—immobile, his right foot was infested with maggots that had eaten the calf, and there were worms in between the toes, and he had washerwoman skin (like the hands of a washerwoman who has immersed her hands in the water for prolonged periods while washing clothes) in the feet.
"But he seemed to have no physical injury due to the fall in gorge. He only had a small bruise on his left cheek probably due to insect bite," Dr Thapa revealed.
His survival for almost five weeks on just water/ice and salt has once again showed how human beings are evolutionary designed to survive extremities.
International media had carried news reports about how Naveena Shine, 65, from Redmond, Seattle had continued for 47 days while trying to live on nothing but water for up to six months before calling it quits in June, 2013.
There are not many examples of people surviving on water alone for many days as they usually also have access to vegetation or insects which Liang and his girlfriend stranded on a very narrow area did not have. Liang had to survive in extreme conditions at an altitude of over 3,000 meters and not comforts of the home that Shine had when she carried out her extreme self-experiment.
But the boy seemed to be a well-informed trekker who knew how to survive in extreme conditions. Trekkers who like to try extreme conditions swear by the Rule of Threes of basic survival skills that states one can survive for three minutes without air, three hours without shelter for regulated body temperature, three days without water and three weeks without food.
Liang and his girlfriend Liu had a cave for shelter and water due to the waterfall of Norchet River nearby. They also had set up a small tent, that they had carried along, inside the cave. "He had worn three down jackets, three pairs of trousers, two pairs of socks, and a monkey cap which meant the only uncovered part of his body were eyes, nose and cheeks," Dr Thapa pointed.
That he insulated himself well meant he did not have to spend extremely rare energy to maintain his body temperature when his body went into starvation response, like power-saving mode of our electronic gadgets, which allows human brains to function without ingestion of glucose.
Liang's survival has showed that human bodies are not like vehicles whose engine immediately shuts down when they run out of gasoline. Once switched to starvation mode his body started to re-allocate resources to buy him time to find some food and ultimately must have allocated energy only for brain, heart and kidneys, according to the doctors.
He survived probably because he had water to carry out renal functions to flush the toxins out from the body. "He also had sodium from salt and the water there are rich in minerals," Dr Pandey reasoned.
The human body can survive a surprisingly long time on water alone, according to the Columbia University. "When the body is deprived of new fuel (i.e., food), it breaks into its energy reserves to keep going. The body stores energy in the form of carbohydrates, fats, and proteins," the section adds. "After one day without food, the body will have used up its carbohydrates, which are stored as glycogen in liver and muscle cells. After that, it's on to the fat reserves."
The liver begins to synthesize ketone bodies after around three days of fasting acting on signals obtained from breakdown of fatty acids. The brain then uses these ketone bodies as fuel to cut its requirement of glucose.
"Your average Joe/Jane, weight-wise, has enough fat reserves to live for four to six weeks without food," the Columbia University states but Liang and Leu were not average Joe/Jane. They were adventure freaks who were biking from India to Nepal on a 'dream adventure', according to a friend of the pair Chou Chiang-chieh quoted by news agency AFP, and may have had lower level of body fat than normal persons.
The body begins to use its protein reserves (basically, the body itself) after the fat reserves also run out. "Body proteins are used up at a much faster rate than fat, and you could really only get another two to three weeks out of protein," the Columbia University adds.
Dr Alan Lieberson in an article in Scientific American explains that the length of survival without food is influenced by factors such as body weight, other health considerations and, most importantly, the presence or absence of dehydration. Liang did not have any health problem and he drank a lot of water, as he told the doctors at Grande Hospital.
The most common cause of death in these extreme cases of starvation is myocardial infarction (heart attack) or organ failure, and said to occur most often when a person’s body mass index (BMI) reaches approximately 12.5, according to Dr Lieberson. Doctors at the hospital say Liang lost around 30 kilograms from his weight of around 65 kilograms before the trip. His BMI would be 12.1 for his height of around five foot seven inches. Many do not survive till that stage and die of some infections due to many possible reasons but Liang apparently did manage to reach the last stage.
"Bottom line: an average person could live for about eight weeks on water alone, give or take about a week for an over- or underweight person, respectively," the Columbia University says.
Liang's girlfriend Liu also survived for 44 days. Her body has been kept at the Tribhuvan University Teaching Hospital and an autopsy has yet to be done. "He says she was irritated, panicked and cried a lot. She was not as frugal as him in energy saving," Dr Thapa estimated the probable cause of Liu's death.
Doctors at Grande Hospital are surprised that tests on Liang returned normal results. But the ability to use ketone bodies by human brain as major fuel sources allows the body to not break down muscles at a very high rate, according to biochemistry of starvation mode, thereby maintaining both cognitive function and mobility for up to several weeks.
This response must have been extremely important in human evolution and allowed humans to continue to look for food even in the face of prolonged starvation.
"He seemed very positive and careful about everything," Dr Thapa summarizes.
Liang's survival, in this manner, can be medically explained even if it seems miraculous and unbelievable. This incident once again shows how human beings can survive extremities with positive spirit and willpower.
