“God contracts and expands.” (2:245)

The heart is a fairly small muscle that beats 100,000 times a day and produces roughly 115,000 Joules of energy, enough to boil a cup of water for some tea. Like a flowing river, deoxygenated blood travels from the right side of our body to the right side of our heart via valves and chambers until passing through our lungs, where each breath we take facilitates the oxygenation of every individual blood cell with 4 molecules of oxygen. The now oxygenated blood, continues to progress, never stopping, now through the left side of the heart, again passing through valves and chambers, eventually being pushed out to the rest of our body with the help of the left ventricle. The left ventricle is the thickest, largest, strongest, and most muscular part of the heart because it has the responsibility of pumping oxygenated blood through the aortic valve and aorta to the rest of our body. If this continual circulation is ever interrupted, it can lead to catastrophic outcomes.

There are several ways this flow can be interrupted, many of which happen before birth and require immediate surgery after delivery. Congenital heart defects (CHD) are some of the most common types of birth defects, but as medical care and treatment have advanced many of the babies that suffer from them usually end up living long and healthy lives. Treatment isn’t required while babies are in their mother’s womb, because the circulation of the heart is different before the baby takes its first breaths, and there is normally a mixing of oxygenated and deoxygenated blood. CHD can be mild, like a hole in the heart between two chambers that allows the mixing of oxygenated and deoxygenated blood. Ventricular septal defects and atrial septal defects (holes in the heart) are some of the most common forms of CHD. Sometimes these defects can be resolved on their own or may not be realized until much later in life, or they may require a “patch” repair if they are larger. VSDs and ASDs are associated with Down’s Syndrome, and maternal risk factors including diabetes, obesity, and smoking. Patent foramen ovale (a hole in the heart that fails to close) is found in up to 30% of the general population. It usually requires no treatment and isn’t discovered unless complications like a stroke occur later in life by having a blood clot form, requiring the blood to then travel through the hole, and then be shot up through the aorta into the brain. All babies are born with patent (open) ductus arteriosus – the ductus arteriosus is a fetal blood vessel that allows flow from the right heart to the aorta, necessary when the baby is in their mother’s womb, but incompatible for life after the baby is born. Within the first few days of life, this blood vessel should close and eventually transform into a ligament that helps tether the pulmonary artery and aorta to each other. If closure fails and the ductus arteriosus remains patent, a continuous machine-like murmur can be heard with a stethoscope, and treatment with indomethacin is started. Untreated, a PDA would result in cyanosis (blue/gray skin) and Eisenmenger Syndrome due to decreased oxygen delivery [1].

The heart’s responsibility is not only to provide oxygenated blood to the rest of the body but to also somehow feed itself. The heart’s muscles exhaust 11.6% of the body’s total oxygen consumption in order to maintain its own contractile activity, coming in 3rd after the liver (20.4%) and the brain (18.4%). During contraction or systole, the heart pumps at 120 mm Hg to provide blood through the aorta and arteries. During relaxation, or diastole, the heart expands and allows for blood to fill into its chambers and also flow through the coronary arteries. These coronary arteries are the arteries that will feed the heart itself. Thus, in order to feed itself the heart must relax and therefore allow its coronary arteries to expand and provide blood to itself. When the heart is contracting and providing blood to the rest of the organs it is too constricted to provide blood to itself. Since these branches are located within grooves of the heart, when the heart is systole the arteries are too constricted for blood flow due to increased tension. This is especially true regarding the arteries supplying the left ventricle since it is larger and more muscular – remember this is where the aorta will branch off, providing oxygenated blood to the rest of our body.

This balance between contraction and expansion may remind some readers of the concepts of Qabd (contraction) and Bast (expansion) in Sufism or Tzimtzum in Jewish mysticism, and how one truly feeds the other thus allowing for growth through this cycle of contraction and relaxation. Tzimtzum is used to explain the process of creation, a contraction of infinity happening to give birth to a finite universe [2]. The Sufi tradition is a personal journey described as “contraction and openness are mysterious ‘bargains’ that have been made without the will or intention of the traveler. The first one blocks his or her way; the second one gives him or her wings to fly to new heights [3].” What is perhaps most interesting is that our physical heart performs this contraction and expansion perfectly so long as we take care of it, whereas our spiritual heart can have lapses in this critical exercise. Maybe, if we understand how to take care of our physical heart, we will also find the answer to keeping our spiritual heart healthy. Prophet Muhammad, peace be upon him, emphasizes this connection as follows: “Verily, in the body is a piece of flesh which, if sound, the entire body is sound, and if corrupt, the entire body is corrupt. Truly, it is the heart.”

Some ways to take care of our physical hearts include incorporating more physical activity into our daily lives, eating less and healthy, and controlling our stress. Perhaps our spiritual health would also benefit from these and similar activities, including regular acts of worship, fasting, controlling our temper, and being kind to others. When we don’t take care of our physical heart, it begins to fail since oxygen ceases to be delivered to our heart and the electrical currents can no longer travel effectively, thus resulting in a heart attack.

Coronary artery disease is the leading cause of death worldwide, and especially in developed countries. The deadliest heart attack occurs if there is a blockage of the left anterior descending coronary artery, which is why it is tragically termed the “widow maker.” Beginning from adolescence, arteries begin to accumulate fatty streaks and progress to an atherosclerotic plaque. This plaque can lead to several disastrous complications such as follows:

• a narrowing or complete obstruction of an artery, impairing blood flow and leaving the heart thirsty for oxygen
• a stroke due to a blood clot caused by decreased movement, breaking off and flowing to the brain
• a weakening of the vessel wall leading to an aneurysm, the vessel bursting

For some patients, a heart attack becomes a wakeup call in order to make the many necessary lifestyle changes that are necessary in order to live a long and healthy life. However, 20% of patients will experience a second heart attack. As the heart gets weaker and weaker it can eventually develop cardiorenal syndrome, a complication that results from the heart being unable to pump effectively resulting in it getting backed up in the heart and the right side of the body. This increase in volume in the body is further exacerbated by the kidneys, which continue to retain fluids and thus cause the body to become overloaded. This leads to edema, or swelling, in the legs that can eventually progress to the lungs and cause congestive heart failure. As the kidneys try to ameliorate the fact that the heart is not pumping effectively, they ultimately worsen the situation leading to end-stage renal disease and stage D heart failure.

Of course, as with almost all medical conditions, these fatal results can be prevented much earlier with lifestyle changes, even before introducing medical intervention with prescription drugs or other procedures. These lifestyle modifications include moderate aerobic exercise at least 3 times a week, a diet rich in vegetables and low in fats, sugars, and carbohydrates, smoking and alcohol cessation, and weight reduction (which would come as a result of these modifications). It is also important for patients that are already dealing with hypertension, diabetes, and hyperlipidemia should keep them well-managed and controlled.

Maybe similarly, some simple lifestyle changes, such as putting aside a few minutes every day to reflect, can be the secret to keeping our spiritual heart healthy. Our heart must remain healthy to keep the rest of our body healthy. Considering the close relationship between our physical and spiritual heart, our spiritual heart must be kept healthy to keep the rest of our spiritual body healthy. Spiritually healthy individuals will further reinforce the health of our community, for Prophet Muhammad, peace be upon him, says, “The believers in their mutual kindness, compassion and sympathy are just like one body. When one of the limbs suffers, the whole body responds to it with wakefulness and fever.”

“As the whole of existence is in His grasp and at His free disposal, it is He Who directs and disposes of all things, from the heavens to the human heart… When God wills, He contracts a heart so tightly for what only He can provide that only He can satisfy it. By contrast, He expands and exhilarates it to such an extent that it needs nothing. Contraction is caused by God’s Majesty; openness is caused by His Grace. (Fethullah Gülen, Emerald Hills of the Heart).”

References

• https://www.heart.org/en/health-topics/congenital-heart-defects
• https://www.britannica.com/biography/Isaac-ben-Solomon-Luria#ref163236
• http://fgulen.com/en/fethullah-gulens-works/key-concepts-in-the-practice-of-sufism-1/qabd-and-bast-contraction-and-openness

Cancer is a prevalent disease among humans and animals, affecting millions of lives across the globe. It can be caused in a variety of ways and can affect virtually every part of our bodies, ranging from skin cancer caused by prolonged exposure to the sun’s harmful UV rays to lung cancer that results from carcinogenic substances smokers inhale. However, plants do not die of cancer despite sometimes being exposed to the sun for over a thousand years – and they do not use any sunscreens!

Humans and animals who live to a certain age are very likely to get cancer one day. We see this situation mostly in our pets which have been specially bred and protected from predators and diseases. Cancer has become part of our lives and remains a top world health priority. The probability of prostate cancer is roughly 80% in 80-year-olds, 90% in 90-year-olds, and 100% in 100-year-olds. However, these statistics yet again do not apply to trees.

What is cancer?

Cancer is a disease caused by the uncontrolled growth of cells that have become abnormal in a part of the body. These abnormal cells are not foreign invaders that have entered our bodies from outside but are instead our own cells. However, in time, various factors such as radiation, viruses, and chemical substances that they are exposed to cause the accumulation of errors, or mutations, in the genetic codes of cells. Some of them then acquire very different characteristics and become alien to their own body.

With old age, errors arise in the genetic code in an increased rate when our cells divide by copying their own DNA. External factors, such as “free radicals” and various radiations that affect our DNA, play a role in these errors. For young people, when there are too many errors in a cell’s genome, a process called “apoptosis” takes place after which faulty cells die before they can multiply in a potentially cancerous manner and forming a tumor. However, sometimes these accumulated errors cause the cell’s growth process to become stuck in the “on” position, and the cell begins to grow and divide continuously. Cells that emerge with out-of-control divisions ignore the commands coming from the healthy cells of the body, continue to grow and reproduce according to the erroneous commands from the cell’s disrupted genome. This situation lasts until death.

What is a tumor?

Cell growths that result from defective genome proliferation will eventually form a mass called a tumor. Some cells grow very slowly and stop at a certain size after a while and do not spread anymore and are called benign tumors. Masses formed by fast-growing, defective (cancerous) cells are known as malignant tumors. Cells that detach from malignant tumors and grow rapidly can attach to another organ where they will begin to grow again when they enter the bloodstream. The process by which cancerous cells start from a tumor and spread all over the body to different organs is known as metastasis.

Why does this process not happen in plants?

One of the most destructive features of cancer when it enters metastasis is the mobility of malignant cells to varying degrees according to their type. Blood vessels, i.e. the transportation pathways of the circulatory system, act like a highway for cancer cells. As the blood vessels surround the entire body, a single cancerous cell can travel to and settle almost anywhere in the body, from the toes to the head.

Plant cells have a vital feature that is different from human and animal cells. In plants, cells do not change their locations because their cells are surrounded by a very rigid, strong, and impenetrable wall outside of normal plasma membranes. Cell walls are made of cellulose, which constitutes the main substance of plants, and form the wooden structures that ensure the plants stand upright and harden while at the same time locking each cell in place and preventing it from migrating within the organism.

Another important difference that is unique to plants is that they do not have blood circulation in which cells are carried; they have a circulatory system in which only water and food are carried. This system is often used to pump water from the roots to the leaves and to transport organic products such as sugar, which is a product of photosynthesis, from the leaves down. Therefore, there are no blood cells or immune system cells in these carrier channels, which are known as wood and roe tubes (xylem and phloem), in plants.

In addition, animal cells are specifically employed in tissues and organs such as muscle, bone, liver, and skin during embryonic development. Thus, when they divide only new cells of the same type are created. Tumors that occur in animal tissues can metastasize into different tissues and disrupt different organs. We can think of animal and human biology as a very complex system in which each cell, tissue, and organ has a task and purpose. In such a system, all elements work in cooperation for the continuation of life. This system is of a kind of irreducible complexity. A human being cannot live without organs like brain, heart, or lungs, while plants, on the other hand, have fewer simpler internal structures which are not as vital. When plant cells divide, they retain their ability to form new cells of any type. This is called totipotency.

In plants, every necessary structure can be recreated from the few tissues they have. For this reason, a gardener can grow new plants from the roots, branches, or leaf parts of a plant.

Plants are equipped with very powerful antioxidants to protect them from the sun’s harmful rays and mutations that may be caused by radiation. Therefore, tumors can develop only due to bacteria, viruses, fungi, parasites, and insects. For example, in a situation that we can call “information confusion” that occurs when Agrobacterium Tumefaciens bacteria insert some of its DNA into the plant’s DNA, an anomaly occurs in the plant’s genome. Cells that go through a rapid growth process and form tumors are not normally classified as cancer, since they simply remain in that area and cannot be transported elsewhere. Since the tumors cannot spread to the whole plant, they may cause only minor distress at most in a specific area rather than a fatal disease such as cancer. Just as the plant continues to grow around a rock that it encounters, it grows around the tumor as well. The tumor can continue to grow for years, but does not spread to the rest of the plant, meaning there is no metastasis.

In summary, plants can also be cancerous, but a cancerous tumor is not a deadly threat to a plant, as its cells are immobile and do not have vital and complex organs like humans and animals. Thanks to the cellulose walls gifted to the them, plants continue their role in the ecosystem by continuing to grow with healthy cells around the tumor as if nothing had happened.

References

• Luis Villazon. “Can a plant die of cancer?” www.sciencefocus.com/nature/can-a-plant-die-of-cancer
• Sam Westreich. “Do Plants Get Cancer?” medium.com/@westwise/do-plants-get-cancer-60eb435c6d1a
• Stuart Thompson. “Plants couldn’t run away from Chernobyl—but that’s what saved them. Why plants don’t get cancer.” www.popsci.com/chernobyl-plants-radiation-cancer

Washing our hands has become one major way to protect ourselves from Covid-19. However, ablutions have always had a central place in the practices and beliefs of many religious traditions. Christians perform baptism with water, in amounts varying from small sprinkles to larger vessels, to bring about purification, cleanliness, revival, and rebirth. Jesus’ washing the feet of his disciples as narrated in the Gospel makes the washing of feet an important practice in Christianity to promote cleanliness and is still carried out to this day. The Jewish tradition also has many instances of ablution where water is specifically used to promote cleanliness, including washing hands to reclaim or preserve purity and mikveh in which the feet or whole body is immersed in water.

The Islamic ablution, also known as “wudhu,” contains 24 washing movements to be carried out several times a day for the five daily prayers. If performed for all five prayers, it would consist of about 120 repeated actions as Muslims washed parts of their body.

A lover must undertake the required preparation to cleanse and beautify oneself before meeting with their Beloved. Likewise, a believer is required to wash specified parts of their body to stand before God in supplication, as instructed in Chapter Maidah of the Qur’an, verse 6: “O believers, when you stand for prayer, wash your faces, and your hands up to the elbows, and wipe your heads, and wash your feet up to the ankles. If you are unclean, bathe and purify your bodies fully. But if you are ill or in the middle of travelling or … you cannot find water, then take wholesome dust and wipe your faces and hands with that. For God does not wish to burden you, rather He desires to purify you and to complete His blessing and favor upon you so that, perhaps, you may be grateful” [5:6].

The spiritual cleansing that the act of wudhu provides is highlighted by the Prophet Muhammad (pbuh) in numerous hadiths, or prophetic sayings, which has been collected under The Book of Purification. While water literally cleans the face and limbs, with every pure intention to do wudhu, the water droplets that meet the body also wash away the minor sins that were committed by the hands, mouth, face, ears, and feet. The famous hadith that “cleanliness is half of faith” [Sahih Muslim, 223] can be interpreted as applying primarily to doing wudhu in one translation [Wudhu: Fiqh, Rules, Purification and Blessings, Qadri]. Therefore, to perfect the faith, to be cleansed of our mistakes continuously, God has given us a simple mechanism through which to be purified and recalibrated countless times in a day.

Many of us perform this pattern of washing with little thought. It has become a routine that we seldom consider a medical protection that we apply to our body. Besides its effects on the soul, washing also has wonderful effects on the body. Over fourteen hundred years ago, the Prophet (pbuh) advised ablution before going to bed. Interestingly, yoga experts in recent years have also started to encourage the washing of the legs, hands, arms, eyes, and the mouth before sleep with cool water for a deeper undisturbed sleep. This is not surprising considering the relief that comes with the touch of water on a busy day.

Three of our principal systems benefit from wudhu; the circulatory system, the immune system, and the electrostatic balance of the body. In this way, the health benefits from the ritual of washing are threefold…

Circulatory system

The circulatory system is a magnificent circuit of blood vessels between the heart and the tissues that make up every other system of the body. The systemic circulatory system circulates oxygenated blood from the heart to the tissues around the body and back to the heart, whilst the pulmonary circulatory system transports deoxygenated blood to the lungs for detoxification and returns clean blood to the heart. The correct functioning of the blood vessels, which act as wires that connect our major organs, are essential to the efficiency of this circuit. These vessels divide into thinner branches called arterioles which in turn split into smaller capillaries which surround the cells of the body. The vascular resistance generated by blood vessels is overcome by the blood pressure generated by the heart to enable blood flow. Over time (due to ageing, or a diet high in fat), our blood vessels often harden and become constricted meaning that the heart has to work harder to overcome increased vascular resistance to maintain steady blood flow. The vessels in the limbs are the most peripheral to the heart and thus the most vulnerable to the process of hardening and narrowing over a long period.

The application of water in our daily routine “exercises” these blood vessels by alternately contracting and dilating them. Water can act as an agent of temperature gradients, thereby affecting the thermoregulatory response of the cutaneous circulation. When hot, water ensures that vessels in the limbs dilate, and when cold, that they contract. In this way, water ensures the flexibility of vessels distant from the heart, forcing nutrients deposited in tissues as a result of poor circulation back into the bloodstream through a temperature gradient.

Lymphatic system

The lymphatic system, on the other hand, is probably not the first to come to mind when we think of the body’s organ systems. Yet without this quietly working system our cardiovascular system would collapse and our immune system would be impaired. Our lymphatic vessels transport “leaked” blood fluids into our capillaries to prevent the accumulation of fluid in the interstitial spaces and eventual tissue damage. The vessels of the lymphatic system are much thinner than those of the cardiovascular system, ensuring the circulation of white blood cells which have an essential role in protecting the body against invaders and resisting disease. It is this fluid that we see oozing out when we have a cut or wound.

The optimal functioning of this system and its thin vessels, like those of the circulatory system, can be said to be closely linked with the effect of washing. The phagocytes and lymphocytes, which make up the immune system are housed by our lymphoid tissues and organs, are supported by the act of wudhu. The nasopharyngeal region behind the nose leads to the tonsils, which are small masses of lymphoid tissue that trap and remove pathogens that are entering the throat. Washing the mouth and nose three times with every wudhu therefore helps to remove the bacteria that builds up in the region of the body most exposed to the external environment. Moreover, the act of washing both sides of the neck during wudhu stimulates our cervical lymph nodes – a specialized mass of tissue which houses lymphocytes and particularly helps to protect the body by removing bacteria and tumor cells from lymphatic circulation. Our lymphocytes are arguably the most important component of our immune system, patrolling every point of the body many times a day and destroying cancer cells and pathogens along the way. Considering that the act of wudhu enhances the filtration effect of our lymphoid circulation, one can see the blessings that come with the divine command to “wash…and purify your bodies fully….”

Electrostatic balance

Our physiology is also closely related to the electrostatic balance of the body. While many psychosomatic diseases result from electrostatic imbalance, the most pronounced effect of static electricity is exerted on the subcutaneous muscles located under the skin, mitigating their function and inducing the onset of wrinkles which often start in the face. Maintaining the regular habit of washing the skin – particularly the face which is most frequently exposed to ultraviolet radiation – protects the surface and internal layer of our skin cells by constantly dampening the skin surface with clean water. It is a much simpler alternative to spending hundreds and hundreds of dollars on expensive skin care and makeup products to maintain a healthy complexion.

In regards to how wudhu can benefit our electrostatic balance, the part of the verse which sheds light to tayammum, “if you cannot find water, then take wholesome dust and wipe your faces and hands with that” highlights that the water substitute for wudhu significantly reduces static electricity, like water. This is why when wudhu is performed calmly with care, it often leaves one feeling refreshed and discharged.

The Quran is a grand source containing many prescriptions for good health. While every civilized person may wash their face and hands throughout the day, wudhu ensures that cleanliness and a sense of well-being is sustained by virtue of its association with worship. The worth and significance of wudhu is not limited to the medical benefits discussed here. However, for anyone else wondering why taking a pause on a busy day with wudhu feels so rejuvenating, I hope this humble article sheds some light to a grand prescription from among the many medicines revealed in the Qur’an.

Diabetes is one of the most serious public health risks today. The United Nations declared diabetes as a global threat in 2007 in order to highlight just how widespread and destructive diabetes had become.

Diabetes is one of the oldest known diseases, and was even mentioned in the ancient Egyptian, Indian, and Chinese texts. Ancient Egyptian texts defined diabetics as “… so thirsty that if they drank all the water of the Nile, their thirst would still not be quenched.” The ancient Indian and Chinese texts mention insects and flies swarming over the urine discharged by the diabetics.

Ancient scientists Al-Razi and Ibn Sina (Avicenna) made important findings about diabetes. Al-Razi linked diabetes with obesity and nutrition habits. Ibn Sina specified that no tissues or organs could survive diabetes, which additionally caused sexual dysfunctions and gangrenes.

There are two main problems that emerge in relation to diabetes:

• Type 1: Lack of adequate secretion of the insulin hormones from the pancreas
• Type 2: Non-functional and insulin-resistant tissues, regardless of adequate insulin secretion

These two types do not coexist in one patient. The first occurs mostly among children or young people. The second occurs mostly among the elderly who largely contract diabetes due to obesity. Diabetes can be detected by a surge of sugar in the blood and urine. If blood sugar exceeds a certain limit then sugar will appear in urine.

Diabetes reveals itself by a surge of sugar in the blood and the urine. It not only impairs the sugar balance of the body, but also disrupts the fat and protein metabolism. Cells fail to absorb sugar, fats, and amino acids, which in turn increases sugar, fat, and amino acid levels in the bloodstream. It can plainly be said that diabetes complications originate from an increase in fat levels, not sugar levels, in the blood. Additionally, diabetic disorders in fat metabolism cause the lethal appearance of acid levels in the blood (acidosis) and vascular stiffness (arteriosclerosis). Decrease in protein-synthesis ability among patients with long-term diabetes leads to depletion of tissues and multiple cellular dysfunctions. Consequently, diabetes originating from insulin deficiency disrupts the fat and protein metabolism along with the sugar metabolism.

The pancreatic gland is where insulin is released in our body. The surgical removal of this gland in experimental animals showed that fat levels in their bloodstreams increased faster than sugar levels. In diabetics, fat around the abdomen and hips oozes into the bloodstream, thus leading to an increase in neutral fat (triglyceride) and cholesterol levels in the blood along with an accumulation of fat in the liver.

If fats remain in the bloodstream after nutrition, then they begin to adhere to vein walls which can cause clogging and stiffness in blood vessels. That is why it is crucial to transfer fat from the bloodstream to fat storage around the abdomen and hips by means of sugar and insulin. The storage fat is called neutral oil, or triglyceride. A triglyceride molecule contains three units of oil and one unit of sugar. Therefore, almost 25% of the fat storage is sugar. Without sugar supply from bloodstream, as in the case of diabetes, the cells which by default store fat are unable to do so. Diabetes, as a serious disorder, even reverses this mechanism: fats start moving from the storage to the bloodstream, not from the bloodstream to the storage. This causes the surge of all fats including the triglycerides, cholesterol and phospholipids, and this is when the body becomes even more prone to disease.

Obesity or excessively fat-based (steatopygic) diet is one of the main causes of diabetes. People are already overweight before the disorder strikes. However, if they do not receive treatment after contracting diabetes, the diabetics start losing weight quickly and more than they should. This happens because relatively harmless fats in storage start to dissolve into the bloodstream.

The entity called metabolic acidosis, which can cause coma and death in diabetics, actually originates from the surge of fat products in the blood and the liver, not from the surge in blood sugar. In diabetics, when the cells cannot use sugar, they resort to obtaining their energy from fats. Consequently, stored fats start to dissolve and ooze into the bloodstream. Fats traveling to the liver through the bloodstream turn into acidic substances called ketone bodies (acetoacetic acid, beta hydroxy butyric acid, and acetone). These acidic substances pass from the liver to the bloodstream and are received by the cells to meet their energy needs. However, in diabetics, cells cannot convert these acidic fat products i.e. ketone bodies, into energy. Oxaloacetic acid from sugars is required for the energy production cycle called the Krebs cycle. In short, humans need sugar to burn fat. This is why it is normal for some people to feel the need to eat something sweet after a fatty meal, because they need sugar to dissolve the fats in their bloodstreams. Since the cells cannot draw sugar from the blood, they suffer from the deficiency of oxaloacetic acid to convert fats into energy. Fats and ketone bodies teem in the bloodstream and, since ketone bodies are acidic, they can cause acidity levels to surge to extremely high levels in the bloodstream which can result in a coma or even sudden death. The lethal substances here are not sugars but ketone bodies, or fat products.

The most crucial abnormality caused by diabetes is vascular stiffness (arteriosclerosis), which originates not from excess sugar but excess fat in the bloodstream. In diabetics, triglyceride, cholesterol, and phospholipid levels increase in the bloodstream due to the reasons described earlier. Fats in the bloodstream do not circulate freely; they are carried in micro-droplets called lipoprotein. The liver loads the fats onto lipoprotein “trucks” and sets them into the bloodstream to be used by the cells. However, due to insulin deficiency in diabetics, lipoproteins cannot empty their shipments of fat into fat storages. The most dangerous lipoproteins for vascular stiffness are classified as LDL (low-density lipoprotein) and HDL (high-density lipoprotein) types. HDLs are like empty trucks specially produced by the liver, which dispatches them into the bloodstream. While circulating in the bloodstream, these “trucks” collect the fat and cholesterol stuck on the vein walls like magnets and, after cleaning the inner vein walls, they return as loaded trucks back to the liver. Using the HDL “trucks,” the liver removes fat from the bloodstream. Physicians gauge the LDL and HDL levels while checking their patients for the risk of vascular stiffness. An increase or decrease in LDL rate is not good for patients, whereas high HDL rate is a positive sign.

Other causes of vascular stiffness include lack of exercise, sedentary life and work habits, smoking, alcohol consumption, obesity, overconsuming foods rich in animal fat, and high blood pressure. Vascular stiffness is one of the leading causes of cardiac dilatation (enlarged heart), cardiac insufficiency (heart failure), and heart attack. In addition to these complications, vascular stiffness may also lead to high blood pressure, cerebral hemorrhage, paralysis, kidney failure, and vascular occlusion in the brain or other organs. If not treated, almost all of these disorders result in death.

Diabetics should follow an effective treatment regime to keep their blood sugar level under control. Fasting is known to be beneficial for controlling blood sugar. If blood sugar is normal, the fats in the bloodstream will move to the storage and not damage the blood vessels. Among the elderly and the obese diabetics, any damage originating from high blood sugar does not surface immediately, and this may mislead patients. It is extremely crucial to check blood sugar in order not to fall into this error. Treatment should never be neglected. If blood sugar can be effectively reduced, it is not right to give up sugar completely in the diet. As mentioned earlier, humans need sugar for storing fats or converting fats (or ketones) into energy in the Krebs cycle.

In short, high blood fat is a more serious cause of diabetes than high blood sugar.

Sometimes, your back itches slightly and scratching it at that perfect spot fills you with an odd sense of happiness. Other times, you notice a biting itch on your arm and a chickpea-like redness shows up there. Oh, those mosquitoes! It is rarely likely to catch a mosquito in the act, and sometimes it even feels as if their bites just appear out of thin air. As you scratch the blister to soothe the itchiness, your eyes scan the room to locate its infamous proboscis. You see it on a wall, plump with the blood it sucked from you. You cannot help thinking: Why do their bites always leave so much itching? Or even, what is the purpose of itching at all?

Itching is an unpleasant feeling we perceive by our skin and mucous membranes, and an occasionally uncomfortable and sometimes very excruciating feeling.

Itching, just like pain, is a sensation intrinsic to our body to protect itself [1].  It is the way our skin “talks” to us. Indeed animals, even fish, itch too. When itched, our skin instinctively and in its own tongue tells us, “There is something that bothers me and I want you to push it away from me immediately!” If it was not for itching, we would not notice a spider walking on our arm. We would not be disturbed by lice and scabies mites or even fungi that settled on our skin, and we would not try to protect ourselves from these pests either.

An ordinary scabies patient has an average number of about 15-20 adult scabies mites on their skin. In the case of Norwegian or crusted scabies, which is most commonly observed among the elderly, the bedridden, people with seriously weakened immune systems, or those who are unable to itch themselves sufficiently, there are thousands of parasites under the thick crusts of the skin [2]. Itching accelerates the blood circulation on the itched parts, and tissues virtually prepare to fight infection by the rushing blood cells and substances [3]. Yet, millions of people also suffer from chronic itching and scratch their itches much more than usual. To understand this, we need to set on a journey from our skin to our brain.

Human skin consists of three layers: epidermis, dermis and subcutis (also known as hypodermis). The dermis layer in the middle makes glove-like protrusions upward into the epidermis. At the top of these protrusions are mechanoreceptors and nerve endings that allow our skin to sense stimulus (such as temperature, sharpness, pressure, vibration, pain, or itching) [3]. With these receptors, our skin functions as one of our five sensory organs and more like an “alarm system” of our body against changing conditions outside. This alarm system has been created so perfectly that each component knows exactly what stimulus to detect.

Previously, it was thought that pain and itching were sensed by the same receptors (nociceptors) and that mild stimuli were responsible for itching while strong stimuli were responsible for pain [4]. Yet, a contradiction existed because while pain triggered an avoidance reflex, itching activated the scratching reflex. In recent years, it was discovered that the receptors (pruriceptors) that perceive the itching sensation on the skin are the free boundary terminations of C-fibers with myelin-free, slow conduction velocity extending in the form of tree branches toward the upper layer of the skin. Furthermore, it was found that the skin cells themselves behave like itch receptors [3, 4]. When we receive a stimulus that induces itching, such as a mosquito bite which leaves anticoagulant substances on our skin, the mast cells in the skin tissue spring to defense against those alien substances. This ensues the secretion of the bodily defense system called mediators, substances that are produced and stored by mast cells as precursor for emergency conditions. Histamine is the most known of these substances and is the most important mediator in itching conditions [5]. Histamine binds to receptors found for itself in myelin-free C fibers that are tasked for detecting itching on the skin. If we consider histamine as a key, the lock that it fits into is on the nerve that senses itching. Thus, the itching nerve is stimulated by histamine.

The nerves receiving this stimulus connect to the spinal cord at their respective levels and transfer the message to another nerve. Each of these transfer processes is mediated neurotransmitters. The last message transmitted to the brain through these nerves is assessed by the brain and labeled as “itching” [6]. The brain determines the coordinates of the itching location and orders the scratching action to the related muscle system. A new journey that conveys messages from the brain to the arm muscles ends with scratching. Considering the swift rubbing action when we feel an ant walking on our face and scratch to push it away, we may value how fast and perfect our brain and transmission system work.

It is also rather odd how soothing itching can be despite its initially uncomfortable feeling, almost as if our body is rewarding us for saving it from a threat. There are several reasons for this contradiction. Scratching causes a low-intensity pain on the skin. Pain and itch are positioned on the skin alternately. The transmission of the sensation of pain is prioritized while the transmission of itching is prevented [7]. Consequently, our brain senses the pain and, in response, secretes the hormone called serotonin to soothe the body. Although this makes us feel relaxed for a short time, the brain continues to transmit virtual sense of itching by connecting to the receptors that are located on the spinal cord along the same nerve path with the receptors for serotonin [8]. This condition, which may be termed as a vicious cycle of itching-scratching, unsurprisingly infuriates patients. Scratching the same area on the skin continuously causes the production of new mediators and oversensitivity of itching nerves, which can thus turn itching into a chronic distress. Chronic itching can often result as a complication from skin diseases such as scabies, lice, eczema, fungal diseases, or drug allergies. It can also result from a systemic disease such as chronic renal failure, cholestatic liver diseases, thyroid problems, iron deficiency anemia, blood diseases and, rarely, cancers [7]. Itching in systemic diseases can be triggered by mediators on the skin but also by neurotransmitters in the intermediate pathway. This kind of itching cannot be controlled by drugs called antihistamines which block the histamine pathway. Sometimes the brain will receive false itching alarms due to post-shingles contraindications or nerve damage in the vertebrae. Such episodes of itching need to be addressed to prevent adverse outcomes. At times, the reason an itch can occur can even be psychological when there seems to be no need for an itch. According to research, scratching activates the brain’s reward center which triggers the addiction mechanism. Patients in that case are thrilled as they itch constantly [9].

As doors in this mysterious journey of science are opened one after another, we discover that nothing has been created without a purpose, including apparently discomforting sensations such as itching, which, it turns out, is how our skin communicates with us!

References

1. Arıcan O. Kasintinin patofizyolojisi, klinigi ve tedavisi Turkderm 2005;39(2):88-97
2. Jonston G, Sladden M. 2005 Scabies: diagnosis and treatment BMJ;17;331(7517):619-22
3. Guyton AC, Hall JE. Tıbbi Fizyoloji 10. Baski 2001.p815-42
4. Schmelz M. Itch and pain. Neurosci Biobehav Rev 2010;34(2):171-6
5. Arck P, Raus R. From the Brain-skin connection. Neuroimmunomodulation 2006;13(5-6)347-56
6. Metz M, Stander S. Chronic pruritus pathogenesis clinical aspects and treatment. J Eur Acad Dermatol Veneral 2010;24(11)1249-60
7. Metz M, Grundman S, Stander S. Pruritus: an overview of current concepts. Vet Dermatol 2011;22(2):121-31
8. Chen ZF et all. Descending control of itching transmission by Serotonergic System via 5-HT1A-facilitated GRP-GRPR signaling. Neuron Vol.84(4) Nov.19-2014

9. Chan YH et all. Brain’s Reward Circuits Mediate Itch Relief. A functional MRI Study of Active Scratching. Dec. 2013

Life is in the center of existence, and food is in the center of life. All living things are in pursuit of their sustenance to continue their lives. Failing this pursuit means the end of it all. Yet, it is not only the lack or scarcity of food, but also its abuse that is a major cause for disorders. Consuming food without any criteria of lawfulness, or with no heed to virtues like contentedness or gratitude, but with greed and wastefulness, leads to many health problems – mental and physical – at both individual and societal levels. Among these problems are many notorious eating disorders such as obesity, anorexia, and bulimia nervosa. Illnesses that relate to overeating, such as obesity, are now beginning to be considered as food addictions, even as a type of substance abuse, in some medical literature [1].

One serious consequence of eating and food addictions is a clinical condition that is called “metabolic syndrome” (MetS). Characterized by multiple cardiovascular disease risk factors such as obesity and high blood pressure, this syndrome has been recognized as a crucial public health problem worldwide. Characteristics such as geography, race, age and gender are influential in the frequency of the disease, which spreads daily as a pandemic that affects approximately 20-30% of the global adult population [2]. Among US adults aged 18 years or older, the prevalence of metabolic syndrome rose by more than 35% from 1988–1994 to 2007–2012, increasing from 25.3% to 34.2% [3].

First described by Dr. Gerald Reaven, MD, in 1988, metabolic syndrome is also referred to as “insulin resistance syndrome,” “deadly quartet,” and “civilization syndrome” [4]. In 2001, the Adult Treatment Panel (NCEP-ATP III) defined metabolic syndrome in adults as the combination of central obesity (waist circumference >102 cm in men, >88 cm in women), hypertriglyceridemia (>150 mg/dl), low HDL (<40 mg/dl in men, <50 mg/dl in women), hypertension (blood pressure> 130-85 mm-Hg), and hyperglycemia (fasting blood sugar >110 mg/dl). In 2005, the International Diabetes Federation (IDF) published a global guideline describing different thresholds for different ethnic groups. According to this guideline, the diagnosis of metabolic syndrome should be based upon central obesity and high triglyceride, low HDL, high blood pressure, and high fasting glucose. The IDF also reported that the presence of at least two factors sufficed for diagnosing anyone as a patient of metabolic syndrome.

as one of the likely pathological findings in metabolic syndrome, central obesity is observed in one in three adults. Hypertension, another crucial factor, is generally acknowledged to be originating from insulin resistance in metabolic syndrome, but the actual features of its development mechanism still remains controversial. Global awareness about hypertension, its treatment, and how to control it is low, and there are significant differences in between people worldwide. A National Health Examination Survey (NHANES) spanning 2011-2014 revealed that 34% of US adults aged 20 years and older are hypertensive and NHANES 2013-2014 data showed that 15.9% of these hypertensive adults are unaware they are hypertensive [5].

Dyslipidemia, which increases as a result of central obesity and insulin resistance in patients with metabolic syndrome, is characterized by low HDL cholesterol and high triglycerides, the most crucial factors that increase the risk of cardiovascular disease. In one study done in 2008, the average total cholesterol levels for American men and women were found to be 197 mg/dl [6].

The presence of overt diabetes or impaired glucose tolerance (fasting blood sugar above 110 mg/dl) indicates the first step of the diagnostic criteria of the metabolic syndrome, and insulin resistance is not sought for further. People diagnosed with metabolic syndrome are 2.34 times more likely to contract diabetes [7]. A 2011 study conducted in America reported that roughly half of all adults have impaired glucose metabolism as a result of type 1 diabetes, type 2 diabetes, and prediabetes. Diabetes has been a prevalent global ailment similar to asthma, autoimmune diseases, and cancer [6].

Insulin resistance, which can be observed in metabolic syndrome, increases the risk of cardiovascular disease by 2.35 times, deaths by cardiovascular disease by 2.40 times, risk of myocardial infarction by 1.99 times, and stroke by 2.27 times, as independent of other risk factors. However, the presence of metabolic syndrome, not obesity, increases the risk of cardiovascular disease [7]. Another significant result is that women with metabolic syndrome have a higher risk of cardiovascular disease than men. Women are more likely to have central obesity than men, have a different cholesterol profile, and higher triglyceride levels that cause more coronary artery disease, while polycystic ovary syndrome, hormone support therapies, and pregnancy diabetes pose additional risk for women [8]. Fatty liver disease, cirrhosis, chronic kidney disease, polycystic ovary syndrome, gout, dementia, and decreased cognitive functions are more common in individuals with metabolic syndrome than the normal population [7].

Treatment of Metabolic Syndrome

Since metabolic syndrome is caused by environmental and genetic factors, and is appearing in people with increasing frequency, the best treatment approaches involve a well-regulated lifestyle, with the main objective being to prevent diabetes and cardiovascular diseases that cause fatal or disabling conditions. Weight loss that results from an appropriate nutrition and exercise program has a corrective effect on almost all disorders observed in metabolic syndrome.

In the treatment of metabolic syndrome, prevention of central obesity seems to be a priority solution. This can be achieved by a lifestyle planning that provides and maintains a 7-10% reduction in total body weight by limiting caloric intake and increasing physical activity. Even methods that increase weekly physical activity by 150-300 minutes and provide only a 5-7% reduction in body weight are considered sufficient to correct the metabolic syndrome. This has especially been reported to have a positive effect on lipid disorders, glucose intolerance, and hypertension, with a 58% reduction in the risk of diabetes with additional lifestyle changes [9].

Since a well-regulated diet is one of the focal points of life style change for people with metabolic syndrome, dietary models that are limited to saturated fats and cholesterol, rich in complex carbohydrates, based upon an abundant consumption of fruits and vegetables, and a restricted use of salt (for those with hypertension) are strongly recommended.

Even though the traditional Mediterranean diet is lauded as one of the vibrant treatment options in the prevention of coronary heart disease and metabolic syndrome, it is not sufficient to correct the metabolic syndrome unless the diet is in tandem with significant weight loss [10]. According to numerous studies, increasing the consumption of nutrients such as fish, vegetables, fruits, dried legumes, and unrefined grains that are rich in olive oil, omega-3 fatty acids, and antioxidants reduce the risk of coronary diseases and death. It goes without saying, that smoking and alcohol use may increase cardiovascular, metabolic and hepatic complications in patients with metabolic syndrome.

Patients with metabolic syndrome should have their blood lipids checked annually, and should be determined to keep low-density lipoprotein (LDL) cholesterol lower than 100 mg/dL, high density lipoprotein (HDL) cholesterol higher than 40 mg/dL, and triglyceride levels lower than 150 mg/dL. Diabetic patients should set their blood pressure target as lower than 130/80 mm-Hg. Changes in lifestyle such as regular exercise and a controlled diet are extremely vital. The use of low-dose aspirin to prevent complications in patients with coronary artery disease is also among treatment recommendations.

The basic sustenance that is provided to us in the form of fruits, animals, grains, and other bounties is such a precious, rich and full-fledged treasure, for which we should be grateful for. However, gluttony and wastefulness pave the way for thanklessness, disease, and even conflicts with the wisdom in the universe.

Almost all living beings are engaged in the pursuit of sustenance and revolve around this goal. We humans have been equipped with the ability to taste and appreciate all kinds of food, and can draw an appreciation for the Divine through these gifts. Just as everything revolves around sustenance, thankfulness has been placed in the center of sustenance. That is, gratitude should be at the center of all sustenance. Through gratitude, we live healthier physical, spiritual, and mental lives.

Notes

1. Meule A, Rezori V, Blechert J. Food addiction and bulimia nervosa. Eur Eat Disord Rev. 2014;22:331–337.
2. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008; 28: 629-36.
3. Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis 2017;14:160287
4. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-53.
5. Alexander, Matthew R.; Eric H. Yang. “What is the prevalence of hypertension (high blood pressure) awareness of in the US?” https://emedicine.medscape.com/article/241381-overview#a2
6. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
7. Balcı M.K, Metabolik Sendrom, Türkiye Klinikleri J Med Sci 2008;28:102-106.
8. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010; 56: 1113-32
9. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403
10. Carbonneau É1, Royer MM2, Richard C3, Couture P4, Desroches S5, Lemieux S6, Lamarche B7. Effects of the Mediterranean Diet before and after Weight Loss on Eating Behavioral Traits in Men with Metabolic Syndrome. Nutrients. 2017 Mar 19;9(3).

Over time, the pressures that accumulate from our commitments and responsibilities can affect our mental health. Through prolonged periods of stress, cortisol and adrenaline poison our body, which can lead to anxiety disorders. To maintain our emotional and mental health, we must consider the state of our spirituality and be mindful of the metaphysical aura which is in continuous interaction with our physical body.

Our cardiovascular system meticulously delivers oxygen and nutrients to body tissues and in turn removes carbon dioxide and waste products. The average rate of contraction is 75 beats per minute, meaning that a human heart contracts 108,000 times a day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan. However, this magnificent center of our being is not only related to our physical, but also our spiritual, well-being. The blood that our heart pumps contains more than just oxygen and nutrients for the body. It acts as both a radiator of goodness from the spirit (ruh) and evil from our carnality (nafs). The Arabic language has eight different translations for the word “soul,” with each of them accounting for a different element of the soul, including the heart, reinforcing the link between the physical and metaphysical.

Basic cardiovascular physiology denotes that deoxygenated blood returns to the right ventricle, which pumps it into the pulmonary trunk and then to the lungs, where carbon dioxide is released and oxygen is absorbed. Oxygenated blood then travels back to the left side of the heart into the left atrium, then into the left ventricle from where it is pumped into the aorta and subsequently the arterial circulation.

Based on this circulatory system, one may speculate about an interaction between our heart and soul. The right ventricle, where our deoxygenated or “dirty blood” returns, might be the location point of our evil-commanding carnal soul or nafs-al ammara. In contrast, the left ventricle, which pumps clean, oxygenated blood, might be the locus of the presence of our spirit (ruh). Thus, one can think of the heart as a tool of the soul, and the soul as a mirror of the heart [1]. If the mirror is kept clean, one can see. If it is dirty, then we are blinded. In this way, the state of the heart affects the soul; the two are in a directly proportional relationship.

Long before the advancement of modern psychology, emotional and mental well-being were highlighted in the Qur’an. The verse “And We have already created man and know what his soul whispers to him, and We are closer to him than his jugular vein,” (50:16) is a perfect example of the spiritual psychology that is immanent throughout the Qur’an. Not only does it demonstrate the proximity of God to His servants at times of inner turmoil, but it also sheds light on the notion of delusion, or whisperings of the heart (waswasa), and that He is aware and understanding of moods of doubt.

Prophet Muhammad (pbuh) also refers to the relationship between the heart and soul: “Truly in the body there is a morsel of flesh which, if it be sound, all the body is sound and which, if it be diseased, all of it is diseased. Truly it is the heart” (Bukhari). This hadith refers to the close relationship between the bodily organs and the subtle psychic organs of the human soul; the spiritual heart is the center of human consciousness and is interrelated to the bodily, physical heart.

Our conscience, or mind, must acknowledge and make sense of all the thoughts, feelings, and sensations that arise. Muslim scholars describe possible sources for inner voices to be God, the angels, the devil, and the physiological body [2, 3]. With the appropriate depth of perception, self-regulation and spiritual expertise, one can distinguish between them. While waswasa has a negative connotation and usually refers to the whisperings from the devil and our nafs, we can also receive sources of inspiration from other metaphysical beings such as angels [4]. The mind’s ability to see the world through patterns and metaphors are the workings of the heart, and a gift from God to help us see the meaningful connections in life and to learn by reflecting upon experience. In this way, mindfulness provides an innovative approach to treat mental health issues. By having awareness and a clear comprehension, one can pay attention with patience and care to what happens and try to resolve it accordingly.

It is an understatement to say that we have an incredibly complex and dynamic aura, where the interaction of the metaphysical and physical matter that make up the human body are continually interacting. We’re constantly receiving input from other existing beings around us. There are mechanisms of action we can adopt to make a protective shield against these forces, some of which can have a negative impact on our soul.

The most obvious constituent of this shield is being immaculate in performing prescribed worships. These “must-do’s” are a reference point for us. If we slack off in our worship, our protective shield against waswasa is inevitably weakened. The ablutions we take throughout the day, even before we sleep, are another protective mechanism, while in the remembrance of God (dhikr), our hearts will “find tranquility and satisfaction” (13:28). However, even saints have lamented over periods of “dark nights” when the believer is tested by God who, for a short period, withholds from the devotee all delight in prayer and worship. Sufis describe this state of the soul as qabd, literally meaning being grasped by hand. This causes distress and makes one suffer from spiritual blockage. On the other hand, the soul can also reach a state of bast, or openness, expansion, development, or relief, when one is freed from spiritual blockage and develops inwardly. Thus, “God contracts and expands” (2:245) and believers must make both of these states fruitful by being thankful during openness and seeing contraction as an effective remedy for the sickness of the soul.

Trying to solve psychological problems solely with spiritual therapies is a mistake. Mainstream, pharmacological therapy can be necessary, just like in physiological disease. We rarely hesitate to see a doctor when we have an allergic reaction or the flu, but a psychological disease is assumed to be resolved through worship. While prayer is an incredibly powerful metaphysical tool that eases and lessens mental health problems, it might not be enough to completely cure a person of their condition. Psychological problems can be considered a cancer of the soul and should be treated with the appropriate therapy – that is, professionally. While prayer will undoubtedly have an anesthetic effect on the patient, going to see a psychologist would be the active prayer. Only then can you leave the outcome to God, after having done your part of fulfilling both verbal and active prayer.

As Imam al-Ghazali said, “Knowing the definition of these diseases, their causes and their cures, and remedies to fix them, is personally obligatory on every Muslim” (Al-Majmua). Thus, we are obliged to not only realize what is going on in our hearts and our conscious minds, but also to cure ourselves from any of the diseases that may have a negative impact on our mental or physical health.

Notes

1. Aysel, M.; Yavas I.; Akdag, M. 2016. Ruh ve Psikolojisi. (unpublished draft).
2. Nursi, Bediuzzaman Said. 1926, The Words, the Second Station of the Twenty-First Word.
3. Gülen, Fethullah. 2008. Varligin Metafizik Boyutu, Istanbul, 2008, pp. 322-336.
4. Aysel, M. 2018. “The Dynamic Vesvese Model,” Association for Psychological and Spiritual Sciences. (unpublished draft).

“It is He who created the night and the day, and the sun and the moon; all (the celestial bodies) swim along, each in its orbit with its own motion.”  (Quran 21:33)

Almost everyone – depending on his or her age, experience, and education level – is aware of certain facts about nature. We know that the Sun rises in the east and sets in the west; water boils at 100 centigrade; humans have five basic senses; birds can find their way back after migrating thousands of miles; and many more. Likewise, laws of thermodynamics, laws of motion, universal law of gravitation, and laws of planetary motion are among the many tools scientists use to explain how nature and the universe work. In the same context, whether or not we are conscious of it, there is this ubiquitous fact of “revolving, rotating, and circling” in the universe in relation to science, religion, and culture. From the Milky Way, sun, planets, and moons to human eyes, circling is everywhere in the universe. Also, it’s imprinted everywhere in the natural world. Giving examples from scientific, spiritual, and social life, this article aims to inquire the “revolving, rotating, and circling” phenomenon to see if it has any implications for humanity.

Rotation of planets

Earth is one of the eight planets in our solar system, all of which orbit the sun, a giant burning star. We know from astronomy that the sun can fit more than one million Earths inside it. Throughout human history, stargazers have realized that all these planets move in a systematic way. The planets orbit due to the immense gravitational pull generated by the sun. Even though the rate may change, each planet rotates around the sun and on its own axis, an imaginary line running through the center of every planet. Also, there are more than one hundred terrestrial, gas, and dwarf moons that revolve around the planets. Every planet, except Mercury and Venus has at least one moon. For example, the Earth has only one Moon (Luna) which orbits around Earth every 29 days; on the other hand, Jupiter has at least 67 moons such as Ganymede, Callisto, and Europa in orbit around it. In addition, our solar system is swarming with different types of bodies (e.g. comets, meteors, asteroids, and space dust) that rotate around the sun along with Earth. Furthermore, it is believed that the Sun is one of about 200 billion stars (maybe more) just in our galaxy, the Milky Way. Galaxies move and gravitationally pull each other, and they do so while rotating around a center. That is, nothing is truly at rest. (1)

Orbiting an atom

In the 1920s, scientists of quantum mechanics discovered that an atom acts like a small solar system. While planets circle elliptically around the sun, electrons rotate around the atom’s nucleus in diffuse, cloud-like waves; these are known as orbitals since they tell us only the probability of detecting the electron at various places within the atom (Choe 2004). These orbitals can blend together to constitute a clump-like “wave packet” that includes the electrons and does rotate around the nucleus. It looks like this quantum phenomenon seems to support rotation in the universe. (2)

The circulation of blood

Doubtless, the heart is one of the most vital and fascinating organs in the human body. It incessantly pumps fresh blood with necessary nutrients throughout the body so that we can survive. Even though it is as big as your fist, it works like a powerhouse by expanding and contracting 100,000 times each day, pumping approximately five quarts of blood per minute, around 2,000 gallons every day. While the heart beats, it pumps blood through blood vessels in the circulatory system to every area of the human body, which takes about 20 seconds to circulate all over the vascular system. It is reported that the blood travels approximately 12,000 miles per day – nearly half the distance of the Equator (24,902 miles). Blood circulation is vital and fundamental to human life: it not only transfers fresh oxygen and nutrients to organs, but also carries away waste such as carbon dioxide from the organs, which is necessary to maintain a healthy life. (3, 4)

Five stages in the human life cycle

Similar to the cycle of four seasons (spring, summer, fall, and winter) in a year, the human life cycle has five or six different stages (Birth, infancy, childhood, adolescence, and adulthood). Human life begins as a single tiny cell, not bigger than a mustard seed, in a mother’s womb. After nine months, circa 40 weeks of pregnancy, the mother gives birth to a newborn. During the first year of infancy, the baby is entirely dependent on the parents’ care, but babies develop very quickly to independency. Childhood includes a period from age 4 to 13, when children learn to eat with utensils, dress and undress without assistance, make friends, play with other kids, and other things. Adolescence is the when a child develops into an adult, when teenagers undergo a rapid transformation of their bodies known as puberty. After the age 20, the human body reaches peak fitness and fertility by stopping development and growth. As we age in adulthood, it takes our body a longer time to repair itself and we become less efficient in many skills. (5)

Circling and prayer

It looks like that this one important pillar of Islam reminds us of the spinning motion in the universe, atoms, the circulatory system, and the life cycle. According to Islamic scholars, millions of pilgrims circulating the Holy Ka’ba in Mecca represents the deep reverence in Oneness of Almighty God. It is believed that these seven compulsory circumambulations of the Ka’ba (the most sacred site in Islam) include individual and social meanings like solidarity and maintaining unity. One explanation as to why Muslims circle the Holy Ka’ba seven times, is the Qur’anic verse that describes the sky above as of seven layers:

“The seven heavens and the earth and whatever is in them exalt Him. And there is not a thing except that it exalts [God] by His praise, but you do not understand their [way of] exalting. Indeed, He is ever Forbearing and Forgiving” (Al-Isra17:44).

It is known in Islam that the spiritual part of the human being includes seven different souls known as nafs. Therefore, every circumambulation of the Holy Ka’ba is meant to move from one spiritual level to the next in order to reach and complete the final expectation to turn our self (nafs) from meat and bone into a more delicate, sensitive, and loving form of soul, one even superior to the Angels. This act of circling the House of God, the Holy Ka’ba, shows how man is sincerely, spiritually, and lovingly attached to the divine.

Conclusion

The planets circle the sun, electrons circle the nucleus in an atom, blood circles the human body, pilgrims circumambulate Holy Ka’ba, and seasons and life cycles circle. There are many more examples of circling in the universe. Even though we cannot see all of them with the naked eye, the entire cosmos, ranging from invisible particles to the moons, planets, stars, and galaxies, are in rotation. Remember that all these rotations happen in accordance with the laws that govern the nature. There is no free choice in any of it.

People are members of this infinite universe, and, unlike planets, electrons, flowers, and cells, they can reason and decide, since we are blessed with free will. As Muslims circumambulate the House of God, this pulling motion between the Ka’ba and pilgrims escalates divine love by changing spiritual dimensions in a way similar to moths flying and circling a light source. Without doubt, a visit to the House of God is an obligatory and praised pillar of Islam, but I believe that the Merciful God wants us also to circle many other divine values and social qualities to deserve His love, mercy, and grace. As long as we circumambulate these highly valued vital qualities such as prayer, selflessness, charity, affection, forgiveness, respect, love, truth, compassion, modesty, patience, and all other good qualities, they will pull us closer both to each other and to Almighty God. Ignoring circling these divine and social qualities would be as if Earth left its orbit.

References

• https://spaceplace.nasa.gov/review/dr-marc-space/solar-systems-in-galaxy.html
• “A Tiny Solar System After All,” April 7, 2004. Rev. Focus13, 15. https://physics.aps.org/story/v13/st15
• “Amazing Heart Facts” in Arkansas Heart Hospital. https://www.arheart.com/heart-health/amazing-heart-facts/
• Jody Braverman, “The Human Life Cycle Stages” www.livestrong.com
• “Growing Older,” in Dorling Kindersley, findout!

Circular motions are all around us. Some are visible or perceptible, while many are not. In a contemplative piece in this issue, Jacob Hardy, a dear friend, writes about this fantastic phenomenon that permeates the universe: “Circling in the Universe.” From the smallest forms of existence at the atomic level to the giant galaxies in outer space, circular motions define a key dynamic in how the universe functions. One of these motions discussed in Hardy’s piece is the circulation of blood in our body. In what could be described as no less than a miraculous system, blood travels nearly the half the length of the equator, only in our body, in just a single day. Our circulatory system brings fresh oxygen and nutrients to our muscles and organs, while carrying away waste. We are thankful to Dr. Hardy for this contemplative piece, and we pray that his healthy blood circulation enables a quick recovery.

9/11 has been a turning point in world history. It was not only a devastating day for the lives lost and their families, but also for millions of people around the world – not least for those who had devoted their lives to a dialogue of civilizations as opposed to the “clash of civilizations.” Professor Ron Messier was one of those who had been studying and teaching Islam for more than three decades by 2001. Though saddened by a prospect that his life’s work would possibly be wasted, he chose to find a channel of communication for dialogue between Muslims and non-Muslims. And he chose Jesus as the focus of this dialogue, for he knew how important Jesus is to both Christians and Muslims. Professor Messier has written for this issue a brief summation of his book Jesus – One Man, Two Faiths: A Dialogue between Christians and Muslims. His conversations with both Muslims and Christians on Jesus offer interesting perspectives, from which much can be learned.  

Also in this issue is a memoir by Kerri Davidson: “In the Eye.” Her piece is a beautiful reminiscence of how parents and kids communicate with their eyes, exchanging feelings of fear, love, and trust. Davidson narrates how she connected with her parents through eye contact. This connection saw them through experiences as mundane as watching horror movies and as traumatic as surviving natural disasters, from leaving home for college to hospital visits. Her story offers many ups and downs, encapsulating the hope and anxiety that every one of us goes through in our lives.

A rainbow is a celestial marvel stretching across the sky after the rain. Along with its spectacular beauty, a rainbow is also a mathematical miracle. By using the language of mathematics, Ali Kaya shows in detail what rainbows offer us.

Happy start

Your blood type is one of the least important matters in your life unless you are in a medical situation where blood transfusion is needed. It also matters when you decide to have a baby. This is when your doctor says, “Let’s see what your blood tells us about your pregnancy and child.” Incompatibility of parents’ blood types may be a cause for some health problems in the baby which are serious but not without cure.

Blood typing

Identifying a blood type is a simple procedure. A, B, and O are the three blood antigens – immune proteins. These antigens compose the four main blood types by making different combinations: A, B, AB, and O. Rhesus (D antigen) is also another factor that goes along with typing. The D antigen is basically another inherited immune protein in our blood and is used for further classification of blood types. It is categorized as Rh positive for people who have D antigen, and Rh negative for people without it. The prevalence of the D antigen differs among populations: Caucasians 15%, African Americans 8%, and East Asian populations less than 1%. The difference among populations is again due to inheritance.

Some races and ethnicities have a higher percentage of certain blood types presumably for protection from diseases endemic in their area. A good example of this would be the lack of the Duffy blood type in some malaria endemic areas of Africa which is considered to be the reason for “a distinct survival advantage.” The “absence of the Duffy antigen provides a measure of protection against malaria. The percentage of people lacking the Duffy antigen is much higher in these locations than in areas not endemic for malaria” (Scientific American).

D antigen exists in both females and males but it is especially important in pregnant females. Naturally, D negative people don’t make antibodies to attack D antigen. The person has to encounter Rh (D) positive blood in order to start producing anti-D antibodies. Bleeding during labor is the main reason for the Rh (-) mother to start making antibodies. Even small amounts of Rh (+) blood from the fetus can flame the process. Therefore, it is important to consider the possibility of a fetus being Rh (+). If the dad is Rh (-), the fetus will be Rh (-), and there will be no issues regarding anti-D production in the mother. If the dad is Rh (+) there is still a small possibility that fetus may be Rh (-), yet there is no way to predict it. So, if the mother is Rh (-) and father is Rh (+), medical professionals take precautions to prevent the mother from making anti-D antibodies.

What is the problem if the mother makes anti-D? Most of the time it is the mixing of the fetus’ blood with the mother’s blood during labor that starts antibody production, the first baby is not affected. Once sensitized, it takes approximately one month for Rh antibodies in the maternal circulation to equilibrate in the fetal circulation and therefore the upcoming pregnancies carry the risk of the destruction of the baby’s red blood cells (RBCs). Destruction of the RBCs is called hemolysis, and the disease caused by destruction of fetal RBCs is the hemolytic disease of the fetus and newborn (HDFN).

An untreated pregnancy may have up to a 16% risk of future fetuses developing HDFN for the next pregnancies. The sensitization process is as follows: sensitized Rh antibodies of the mother cross the placenta and find Rh spots on fetal RBCs. They then coat them and, in a way, trigger the destruction. The more RBCs are destroyed, the more the hemoglobin of the fetus drops, trying to compensate for the loss. RBC production at the bone marrow, spleen, liver, and some other sites is increased. As the fetal anemia becomes severe, less oxygen is carried in the blood so tissues start showing signs of hypoxia (lack of oxygen). Damage caused by hypoxia leads to fluid accumulation in various spaces and the deadly condition called hydrops fetalis occurs. It is basically the swelling of the baby due to the reasons mentioned above.

Whether a primary immune response occurs depends upon several factors besides the volume of fetal blood to which the mother was exposed. These variables include the frequency of fetomaternal transfusion and whether the mother and fetus are ABO compatible. Both the immunogenicity of the fetal RBCs and the immunogenic response capacity of the mother play a role in the development of the condition. Interestingly, some patients, like those with AIDS, may not form Anti-Ds. In addition, the incidence of Rh incompatibility in the Rh-negative mother who is also ABO incompatible (the mother has different ABO blood type than the father) is reduced dramatically to 1-2% and is believed to occur because the mother’s serum contains antibodies against the ABO blood group of the fetus. The few fetal red blood cells that are mixed with the maternal circulation are destroyed due to ABO difference before Rh sensitization can proceed to a significant extent. 

Let’s emphasize one point before proceeding further: Anti-D production can be important in anyone who needs blood transfusions for certain diseases. Yet, we can choose which blood to give to the patient and obviously prefer the most compatible blood we have available. The problem arising in pregnant patients is due to the fact that we have no control over baby’s blood type, and the mother’s body can identify the baby as a foreign object at any time during pregnancy. The whole purpose of identification and treatment is to make the incompatible baby unseen by the fighting cells of the mother.

Screening and prevention of anti-D production

Every pregnant woman is screened for blood type and antibody titers at the beginning of pregnancy. If she is Rh (-) as mentioned above, she gets a second screening at 28 weeks to measure the titers of anti-D. If the titer is low, she gets an intramuscular shot called Rh immunoglobulin (RhIg) which is, interestingly, anti-D itself. Some theories suggest that it coats the fetus’ red blood cells and shields it from the mother’s immune system; yet none of these theories is proven. We still don’t know how giving the anti-D from an outside source keeps the mother’s immune system from producing its own anti-D antibodies that actually cause the hemolysis.

RhIg is produced from Rh (-) males and post-menopausal females. These donors are purposefully injected with Rh (+) blood and then measured for anti-D antibody production. The ones that have enough anti-D in their blood are harvested regularly to collect immunoglobulins that contain anti-D.

When harvesting is done, not only are anti-D immunoglobulins collected but also some others, too. That is why the RhIg might cause some side effects and allergic reactions and must be given under doctor’s control.

A second RhIg shot is done within 72 hours of birth. If the routine guidelines are followed and RhIg shots are properly administered, there is less than a 0.1% possibility of seeing the disease in the following pregnancies.

Prevention of hemolysis in the situation of anti-D antibody presence

At the 28 weeks’ screening, if the titer is high, it implies that the woman has already encountered Rh (+) blood at some stage of her life, possibly in a previous pregnancy. Then comes the hard part of preventing the fetus from developing the disease.

The first step is trying to diagnose if the fetus is Rh (+). An Rh (-) fetus will not need any more testing or follow-up. Paternal blood type can be used to estimate the likelihood of the fetus’ blood type, yet misattributed paternity issues make it difficult for clinicians to trust on the typing results of the father. Therefore, more tests are usually done to confirm the fetus’ Rh status rather than solely trusting on the father’s Rh type.

The most common method used for Rh typing of a fetus is cell free DNA testing (cfDNA). Cells of the fetus can be detected in the mother’s blood as early as 38 days of gestation. Usually maternal plasma is sampled at 10 weeks and reverse transcriptase PCR is used to get the fetal Rh status from the DNA.

CfDNA is routinely done to every pregnant patient, at least in some European countries. But in the USA, it depends on the patient’s wishes and is not under routine prenatal care.

If it is not possible to perform cfDNA, an aminocentesis (getting a sample of the baby’s amnion fluid) is the second option. Nevertheless, it is associated with comparably high risk of losing the pregnancy, so it is reserved for high titer, high risk pregnancies.

Serial titers are done to predict the disease. If the pattern shows an increase and reaches a critical titer, then the pregnancy becomes more of a high-risk pregnancy, one complicated by severe anemia.

If the fetus is at risk of severe anemia, a Doppler study must be done to assess middle cerebral artery (MCA) blood flow. As the anemia increases, peak systolic velocity (PSV) increases. When MCA-PSV indicates high risk, fetal hemoglobin levels must be measured by taking blood from the umbilical cord (the cord between fetus and mother) to determine the degree of anemia. If the criteria for severe anemia are met, the fetus is transfused with RBCs. The transfusion is usually done between 18 and 35 weeks. Before 18 weeks, the fetus is too small, and after 35 weeks, the fetus is just too big. Hemoglobin tests are repeated every two weeks until the baby is delivered.

More research on the way

Let’s mention this incredible fact again in case you missed it: what hurts the baby is Anti-D antibodies made by the mother. What we give to the mother to prevent this disaster is the Anti-D antibody (RhIg) made by some unknown donor. When the mother does it herself, the fetus gets harmed; when it is given from an outside source, it protects the fetus. Despite all the research, we still have no idea how this miracle works. Yet more studies are on the way to enlighten us on how RhIg functions.

A happy ending

Routine prenatal care is essential in screening and prevention of HDFN. Simple tests and treatments can easily lower the possibility of acquiring the condition. Each subsequent pregnancy after the first affected pregnancy is likely to find the fetus suffering from more severe hemolytic disease, and at an earlier gestational age. For this reason, pregnant women must consent to screening and receiving RhIg. Any type of bleeding must be reported to the doctor immediately.

Your blood type doesn’t affect you from having healthy babies. Just a little bit of awareness and taking the appropriate precautions recommended by your doctor can lead you to the happy ending of a 9-month journey.

References

Scientific American. “Why do people have different blood types?” Mar 7, 2005.
Uptodate.com
Medscape.com