Health Risks and High Rewards for Contestants

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The idea of stranding oneself in the wilderness with only your wits to depend on is a concept too terrifying for most people to contemplate. Facing down wild animals, battling extreme weather, and living without the internet are just a few of the challenges that off-the-grid survival involves.

Nevertheless, we are still fascinated by other people attempting the challenge, which could explain the enduring popularity of survival competition shows such as Alone, one of the most popular reality shows on television today, and Survivor, now on its 43rd show cycle. Both Alone and Survivor test the mental and physical mettle of contestants to see who can last the longest in a challenging environment and win a pile of cash. But the health risks are as real as the rewards.

 

Alone: Frozen & Starving

On Alone, contestants are dropped into cold, remote locales such as Patagonia and Mongolia, without even the comfort of a production crew. The survivalists are expected to figure out how to utilize their wilderness skills and primal instincts to feed and keep themselves alive. They build log cabins or yurts, attempt to set up food systems such as fish nets and rabbit traps, and scavenge for edible flora – all while filming themselves and avoiding the psychological perils of isolation.

Many will “tap out”, the mercy cry of Alone, and ask to be evacuated due to extreme hunger or overwhelming homesickness, but for those that stay the course, intense cold and starvation may also take a toll.

Medical evacuations are common on Alone, often because of the associated health risks of massive weight loss. In anticipation of starvation conditions, some contestants put on significant weight before the show, including one to the scale of 60 pounds. Without regular food, most contestants lose weight, though few survive as long on as little food as Colter Barnes, who lost 86 pounds.

But dropping serious pounds over a short period can cause a loss of muscle mass and bone density, low immunity, digestive issues such as constipation, fatigue, or low energy, and even hair loss.

Audiences watched a medical team evacuate contestant Rose Anna Moore from the British Columbian wilderness during season 8, after she blacked out, alone in the woods, without the communication gear all participants are supposed to carry.

Moore, who had lost 20 percent of her body weight over the course of her time on the show, had begun to experience symptoms like shivering, stomach pain, and hearing loss, and then lost consciousness away from her shelter when the temperature dropped to 7 degrees F. She had been among the five contestants who remained in the competition after 37 days, vying for a $500,000 prize.

“People that are starving cannot maintain their metabolic heat production as efficiently and for as long a time as people that are well nourished,” said Howard J. Donner, MD, an expedition doctor and co-author of The Field Guide to Wilderness Medicine.

Our bodies hold potential energy in the form of glycogen, the stored version of glucose, or sugar from carbohydrates. The body may adapt to cold by attempting to raise its temperature via shivering, one of the first signs of hypothermia, or a potentially dangerous drop in body temperature.

If the glycogen stores in a person’s muscles are depleted due to malnutrition, they won’t shiver as vigorously or for as long as when they have “normal glycogen stores and have a higher degree of nutritional integrity,” Donner said.

And shivering can burn as many calories as a recreational jog, Donner said. That’s detrimental for contestants trying to conserve every bit of energy they have, particularly when the timing of their next meal is uncertain. And when that meal is often not just mouse-sized, but actual mouse.

Another hazard of declining body temperature is that as it drops, and a person starts to go from mild to moderate hypothermia, they may experience a decline in cognitive function from exposure to the cold, colloquially known as getting “stupid.”

Survivor: Into the Fire

Contestants on Survivor have a different set of challenges. Dropped in tropical climates, they’re more likely to face heat stroke than hypothermia. They’re not alone, and they face a peer vote elimination each week instead of isolation without an end date. But Survivor contestants must also build shelters, subsist on minimal food, compete against one another in physical feats, and solve puzzles – all while maintaining the emotional intelligence to manipulate other contestants in endless rounds of elimination voting.

Living on small coconut shell bowls of rice and boiled well water, contestants often consume 60 calories or less per day as they compete for a $1 million “Sole Survivor” prize. Winners of episode challenges often receive prizes of food, but those prizes can be elusive to team “tribes” or individual contestants. All must face the heat, and medical evacuations are common.

Russell Swan, whose eyes famously rolled back in his head before he collapsed during a “Roll with It” reward challenge on season 19 of the show in Samoa, was removed from the game after his blood pressure dropped dangerously low due to dehydration.

Dehydration alone can cause a great deal of stress to the body, said Stephanie Lareau, MD, an emergency medicine doctor in Roanoke, VA. It can even cause a condition known as orthostatic hypotension, a drop in blood pressure that can cause someone to pass out.

“In a hot environment, your body tries to cool itself and some of the first mechanisms of cooling are vasodilation, so your blood vessels get bigger and it shunts your blood away from the core to the periphery,” said Lareau. “So you sweat and lose temperature through your skin.”

Major organs like the kidneys, heart, and brain may also not function optimally if blood flow gets rerouted to compensate for fluid loss.

“It’s going to kind of compound the effects of dehydration when that fluid gets shunted to try to stay cool,” Lareau said.

Caloric deficits can also take a toll, as Lareau points out there is no effective way to adapt oneself to starvation. Attempting to undertake physical activity in this state will cause the heart to pump faster, straining the muscle and exacerbating the effects of the stress from dehydration and the heat, a “potentially dangerous triad,” according to Lareau.

“When you’re in a starvation state and your body is not getting the nutrition it needs, you’re already doing damage to your brain, your kidneys,” said Lareau. “And that’s compounded by the fact of the extreme heat that you’re exposed to and the stress of needing to exercise and needing to do physical things to try to survive. So they kind of interplay with each other.”

This can be exacerbated by exhaustion, which contestants also face from sleeping (or not) in uncomfortable, rough, open structures with each other. Constant rain, hard and uneven “floors,” and other people are common complaints.

A lack of sleep also increases stress on the body, impacting brain function and decision making over time, while the rapid weight loss brought on by limited food can potentially impair one’s ability to physically perform.

“I think they’re not only losing fat but they’re probably also losing muscle mass and deconditioning themselves,” said Lareau. “So they probably run the risk of doing some long-term damage to the body by having those giant weight shifts.”

Even given the extreme conditions reality show contestants endure in pursuit of high-stakes cash prizes, many seem to be betting that the risks and the experience are worth the eventual reward. With Survivor in its 22nd year and Alone in its ninth with two spin-offs, fans seem to agree that watching competitors battle the elements as well as the limits of their own bodies is worth tuning in for.

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