Moderation in a Fattening World

Although many concerned clinicians and activists have been warning the world about ‘fattening of humanity’, serious attention has been paid to obesity in the western society only recently. The present situation is in such a brink that some advocates have even brought lawsuits against fast food restaurants that serve greasy foods. Perhaps it is because of the overwhelming burden on the national economy that has finally triggered a response from the authority. Obesity is a risk factor of contracting a broad range of debilitating conditions, including heart disease, hypertension, diabetes and cancer. In all, the cost of obesity in the United States alone is estimated to be $99.2 billion annually.i This once affluent-only illness is not limited to the western nations any longer. Obesity and its associated morbidities have fast crept into many parts of Asia and Africa in the past few decades. Time magazine quotes ten percent of Chinese children to be over- weight, with urbanized areas of sub-Saharan Africa not far b e h i n d .i i Without immediate intervention, our future looks bleak indeed. What solutions can Islam present to this worldwide epidemic? Experts agree that obesity, especially fat-eating habits learned in childhood, is associated with familial and socio-cultural factors. A recent article in the Journal of the American Dietetic Association suggested that, ‘Attitudes about food and eating are learned and reinforced within the home.’iii If we are to, therefore, strike at the root of its cause, we must modify eating habits within the family at an early age. The religion of Islam deals with every aspect of human existence. In providing man with a complete and perfect code of life, it has laid out numerous guidelines for his physical and spiritual progress. 48 The Review of Religions – February 2004 Moderation in a Fattening World By Manzurul A Sikder, MD – New York, USA The Qur’an teaches us, ‘O children of Adam! look to your adornment at every time and place of worship, and eat and drink but exceed not the bounds; surely, He does not love those who exceed the bounds.’iv Eating and drinking are natural habits of man that are carried out in order to survive. But even in doing something as simple as eating, one must exercise excellent judgment. In this verse, God admonishes us to set certain limits: while we should keep our physical well being intact, we should also maintain social order and bear in mind the true purpose of our lives. When done properly our eating and abstinence from food should be an extension of our worship, as we are told, ‘On those who believe and do good works there shall be no sin for what they eat, provided they fear God and believe and do good works, and again fear God and believe, yet again fear God and do good. And Allah loves those who do good.’v Paying heed to our eating habits is our duty, it being a part of our state of righteousness. Even of those food items that are lawful, we are urged to eat only the clean and wholesome portions,v i lest it affects our relationship with the Creator negatively. The Holy Prophet of Islam(sa), the personification of the code of living prescribed by the Holy Qur’an, reminds us, ‘Whoever has food enough for two persons, should take a third one (from among them), and whoever has food enough for four persons, should take a fifth or a sixth.’vii And: ‘When your servant brings your food to you, if you do not ask him to join you, then at least ask him to take one or two handfuls, for he has suffered from its heat (while cooking) and has taken pains to prepare it nicely.’viii The Prophet(sa) was very careful against excesses of food. Abu Huraira(ra) narrated, ‘The family of Muhammad(sa) did not eat their fill for three successive days till he died.’ix The Holy Prophet’s pious consort Hadhrat Aisha(ra) reported that the ‘Prophet(sa) died when we had satisfied our hunger with two black things: dates and water.’x He admonished his companions, ‘A Muslim eats in one intestine (that 49 Moderation in a Fattening World The Review of Religions – February 2004 is, he is satisfied with a little food) while an unbeliever eats in seven intestines (eats much).’xi Narrated ‘Umar bin Abi Salama(ra), “I was a boy under the care of Allah’s Apostle(sa) and my hand used to go around the dish while I was eating. So Allah’s Apostle(sa) said to me”‘O boy! Mention the Name of Allah and eat with your right hand, and eat of the dish what is nearer to you.’”xii At the end of meals the Prophet(sa) used to pray, ‘Praise be to Allah Who has satisfied our needs and quenched our thirst. Your favour cannot be compensated or denied, nor can be dispensed with, O our Lord.’xiii Ramadan gave Muslims a timely opportunity to remember and abide by these golden guidelines. During that month, healthy Muslims all over the world abandon food and drink for a great part of the day, and along with spiritual benefits, look to attain physical cleansing. Fasting initiates mobilisation of stored fat. In the long run, it lowers our total blood cholesterol. It gives our digestive tract a well-deserved rest. In addition, it boosts our immune system. Fasting also makes us conscious of worldwide s u ffering through hunger and thirst. It teaches us to curb our self-indulgence, and be mindful of our own eating while so many go without food. It fights against an astonishing statistic that “nearly 80% of all malnourished children in the developing world live in countries that report food surpluses.’xiv Short-term starvation, as in the case of fasting during Ramadan, has been shown to have many health benefits including increased insulin sensitivity, stress resistance, reduced morbidity, and increased life span. x v I n s u l i n resistance seems to play an integral role in many common human disorders such as obesity, diabetes, hypertension, non- alcoholic fatty liver disease, polycystic ovary syndrome and gallstone disease. As energy in the form of sugar becomes readily available due to obesity, cells become more and more resistant to this anabolic hormone. This in turn stores further body fat, and 50 Moderation in a Fattening World The Review of Religions – February 2004 the vicious cycle continues. Newer research also demonstrates that the once known metabolic disease of Syndrome X (combination of obesity, diabetes and hypertension, which often presents as heart attack) is mainly due to body’s increasing resistance to insulin. On the other hand, leptin and adiponectin, two fat-derived hormones, increase sensitivity to insulin, control body weight, prevent atherosclerosis and negatively regulate haema- topoiesis and immune functions.xvi A recent study conducted at University of Louvain Medical School in Brussels, Belgium demonstrated that plasma adiponectin levels were 30% higher in anorectic (food deprivation or fasting state) than in control subjects. When normalised for fatness, adiponectin values almost doubled in these subjects. Insulin sensitivity tended to be 40% higher in anorectic than in control subjects.xvii Heart attacks remain the number one killer of both men and women in the western world, and high blood pressure is the number one cause of heart attacks. Although a salted diet appears to be a sine qua n o n for the development of essential hypertension, low salt diets often have a modest or even negligible impact on blood pressure of hypertensives. Therapeutic fasting, however, has been shown to put a limit on modern, rich diet, and subsequently lower elevated blood pressure. xviii This again is thought to be related to the fact that fasting minimizes insulin secretion and has the potential to break the vicious cycle mentioned earlier. A meta analysis of multiple clinical studies concurred with these results: it was found that along with nearly 10% decrease in body weight and 9% drop in serum cholesterol, twelve weeks of energy-restricted diets were also associated with an 8-9% decrease in both systolic and diastolic blood pressures. Larger reductions in these values were observed with larger weight losses.xix In brief, food deprivation over time decreases insulin resistance, an identified culprit in many life- threatening illnesses. 51 Moderation in a Fattening World The Review of Religions – February 2004 The study conducted by the National Institute on Aging 1 5 further illustrated that rats that were sustained on intermittent (defined as ‘alternate-day’) fasting had a ‘dramatic increase in life span’ in comparison to animals that ate ad libitum. They attributed this to the moderate decrease in blood level of insulin-like growth factor 1 (IGF-1) achieved on intermittent fasting schedule. Furthermore, several other well- designed experiments over the last three decades have demonstrated that dietary restriction reduces cancer formationx x , x x i and kidney d i s e a s e ,x x i i and increases the resistance of neurons to dysfunction and degeneration in experimental models of A l z h e i m e r’s and Parkinson’s diseases as well as stroke and s e i z u r e .x x i i i , x x i v, x x v, x x v i The last effect is thought to be due to increased production of ketone bodies as an e n e rgy source, which provide neuroprotection. Fasting increases the survival of CA3 and CA1 neurons in the hippocampus of the brain. Loss of these pyramidal neurons induce seizures in experimental mice. The researchers concluded that, ‘Intermittent fasting schedule itself is neu- roprotective independent of overall caloric intake.’ Although the next Ramadan is not due until October, the discipline and benefits of the last Ramadan should not be forgotten. Besides spiritual gains, one of the objects of Ramadan is to improve the physical well-being of a person. In a world that is suffering from excessive consumption, Muslims should take the lead under the instructions of the Qur’an and fight against excesses. Encouraging our youngsters to fast for a few days during Ramadan can lower their fat burden and help them achieve a leaner body. Ramadan promotes a sense of health, which will stay with them into their adulthood and will hopefully continue to the next generations. To fight the dangers of obesity and its related health problems, Islamic solution of conscientious moderation and abstinence in the form of fasting can certainly go a long way. 52 Moderation in a Fattening World The Review of Religions – February 2004 References i Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obesity Research 1998; 6:97-106 ii Gibson H. Obesity goes global. Time August 25, 2003 iii Bruss MB et al. Prevention of childhood obesity: Sociocultural and familial factors. Journal of the American Dietetic Association 2003 vol 103, no 3 iv The Holy Qur’an 7:32 v Ibid. 5:94 vi Ibid. 2:169 vii Sahih Bukhari, Volume 4, Book 56, Number 781 viii Ibid., Volume 7, Book 65 (Book of Food and Meals), Number 370 ix Ibid., Number 287 x Ibid., Number 295 xi Ibid., Number 308 xii Ibid., Number 288 xiii Ibid., Number 369 (Arabic prayer: Al-hamdu lillah kathiran taiyiban mubarkan fihi ghaira makfiy wala muwada’ wala mustaghna’anhu Rabbuna) xiv Gardner G, Halweil B. Underfed and overfed: The global epidemic of m a l n u t r i t i o n. Washington, DC: Worldwatch Institute; 2000 xv Anson RM, et al., Intermittent fasting dissociates beneficial effects of dietary restriction on glucose metabolism and neuronal resistance to injury from calorie intake. Proc Natl Acad Sci USA 100:6216-20, 2003 xvi Tierney, Jr LM, et al., Ed., Diabetes mellitus and hypoglycemia. Current Medical Diagnosis and Treatment 1148-9, 2004 xvii Delporte ML, et al., Hyperadiponectinaemia in anorexia nervosa. Clin Endocrinol ( O x f ) 58:22-9, 2003 xviii McCarty MF, Fasting as a strategy for breaking metabolic vicious cycles. Med Hypotheses 60:624-33, 2003 xix Anderson JW, et al., Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. Journal Am Coll Nutr 22:331-9, 2003 xx Blackwell BN, et al., Toxicol Pathol 23:570-82, 1995 xxi Mukherjee P, et al., Br Journal Cancer 86:1615-21, 2002 xxii Fernandes G, et al., Proc Natl Acad Sci USA 75:2888-92, 1978 xxiii Bruce-Keller AJ, et al., Ann Neurol 45:8-15, 1999 xxiv Duan W & Mattson MP, Journal Neurosci Res 57:195-206 xxv Yu ZF & Mattson MP, Journal] Neurosci Res 57:830-9 xxvi Zhu H, et al., Brain Res 842:224-9, 1999. 53 Moderation in a Fattening World The Review of Religions – February 2004