The avocado is a fruit that grows in hot, tropical climates that has a sweet and sour taste. Avocados are a well-known source of carotenoids that provide a multitude of vitamins including vitamin A, minerals, phenolics, and fatty acids. In a number of studies, it has been noted that avocado consumption helps to lower blood lipids and cholesterol, decrease blood pressure, get protection against and heal diabetes, avoid being overweight, inhibit the formation of coagulation inside the veins, fight and cure arteriosclerosis, and protect the heart.

It is also reported that its seed, shell, and leaves are beneficial against abnormalities (when consumed after certain processes) that constitute the metabolic syndrome.

Dried avocado leaves may be brewed using hot water for consumption, or they can be ground to be added to soups or salads. There are many scientific studies that suggest that avocado leaves can prevent diabetes and lower blood pressure. Avocado leaves have also been shown to be effective in protecting the heart and decreasing cholesterol.

Avocado seeds may be consumed after they are baked and grated or ground. They may be brewed in the same way we brew tea, or they may be added to salads, soups, or pasta. Avocado’s fat-burning content is found not only in its flesh, but also in its seeds. The high fiber content of its seeds ensures a feeling of satiety. With nutritional fats, antioxidants, and soluble fibers in its content, avocados help us reduce our cholesterol levels. It is highly efficacious in preventing high cholesterol and coronary artery disease. Patients with high blood pressure should not throw away avocado seeds. The potassium content in avocado seeds helps to expand veins and arteries, lowering blood pressure and reducing the heart attack risk.

Avocado oil is equally popular because of its resemblance to olive oil. It is produced at high quality using cold pressing method that is also used on olives. Highly beneficial to body health due to the minerals and vitamins it contains, avocado oil is studied across the globe. With its high vitamin E content, avocado oil is particularly effective for skin and hair health. As edible oil, it is low in saturated fatty acids and oxidation, and also does not contain any carbohydrates.

In terms of content, avocados differ considerably from other fruits. While other fruits have higher sugar content, avocados are high in oil. Having a rich vitamin and mineral content, avocado oil contains vitamins A, B1, B2, B5, D, and E. As a source of potassium, proteins, and certain minerals, avocado oil is very beneficial to heart and skin health.

A medium-sized avocado contains approximately 25 grams of monounsaturated fatty acids, which are known to be heart-friendly. Another benefit of avocado oil is its impact on cholesterol. Avocado oil is very rich in alpha-carotene and beta-carotene, thus it is said to provide effective protection against cancer. It is particularly effective against prostate cancer.

Numerous clinical studies have recently been conducted concerning the effects of the avocado. Avocado products are proven to be efficacious against metabolic syndrome. Its most important effect is its positive influence over blood lipids. Avocado consumption restores or balances the following blood lipids; low density lipoproteins (LDL-C); high density lipoproteins (HDL-C); triglycerides; and phospholipids. This positive effect on blood lipids is explained as avocado’s ability to disintegrate certain lipoproteins so that they can be absorbed and stored by adipose tissues, or they can be burned in several tissues such as the liver and the pancreas. Avocado products result in an increase in the amount of smooth endoplasmic reticulum that has a special role in the lipid mechanism in the liver cells.

Avocados are tasty and healthy; but as with any fruit, it is best to have a healthy measure and not overeat!

Reference

Jamshid Tabeshpour, Bibi Marjan Razavi and Hossein Hosseinzadeh. Effects of Avocado (Persea americana) on Metabolic Syndrome: A Comprehensive Systematic Review. Phytotherapy Research (2017). DOI: 10.1002/ptr.5805

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).

The name cholesterol originates from the Greek chole- (bile) and stereos (solid), and the chemical suffix -ol for an alcohol, as researchers first identified cholesterol in solid form in gallstones in 1784.1 Cholesterol is a soft and waxy sterol (a combination steroid and alcohol) found among the lipids (fats) in the bloodstream of all animals and humans. Trace amount of cholesterol also exist in plants. Even though cholesterol can be found in almost every cell, it is mostly found in the brain, heart, bowels, and liver. It is an important part of a healthy body because it is used to form cell membranes and some hormones, and is needed for other functions. A small amount of cholesterol circulating in the blood is enough for the body to undertake all these important functions. But a high level of cholesterol in the blood-hypercholesterolemia-is accepted as a major risk factor for coronary heart disease, which may lead to heart attack. As cholesterol and other fats dissolve, in normal conditions, only in oil, they cannot dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins. There are several kinds of these, but the ones to focus on are low-density lipoprotein (LDL, so called bad cholesterol) and high-density lipoprotein (HDL, or the good cholesterol).

The American Heart Association suggests that the risk of coronary heart disease increases in adults with total cholesterol and LDL greater than 200 mg/dl and 130 mg/dl, respectively. It is also advised to keep HDL greater than 35 mg/dl to avoid cholesterol-related diseases. HDL level for young healthy adults is found to be, on average, around 55 and 45 mg/dl for women and men, respectively. Aging, diet, obesity, and menopause are among the factors which increase cholesterol, especially LDL, in addition to hereditary causes. While exercise helps in reducing LDL and increasing HDL, smoking, alcohol, and stress cause the opposite effect.

As you eat, cholesterol from food is absorbed by your digestive tract. It then makes its way into your liver and can circulate through your body in your bloodstream. That is one source. There is also a little-known second source of cholesterol-your body. Cholesterol from food is hard to get away from, even though you may be watching your diet. All foods of animal origin contain cholesterol, including eggs, red meat, and shrimp. Generally, it is also suggested to limit foods that are high in saturated fats or trans-fats. Egg is one of the most controversial foods in our fight against coronary heart disease. On average, one egg contains 66% water, 12% protein, 11% minerals, 10% fat, and 1% carbohydrate. The cholesterol level in one egg ranges from 180–210 mg based on its weight. It is found that each egg cause a temporary cholesterol spike of 3–4 mg/dl in the body, which tend to normalize after its digestion.

The American Heart Association recommends reducing daily intake of dietary cholesterol to reduce the risk of coronary heart problems. However, there are quite a few studies to suggest the contrary2–6. The “dietary cholesterol equals blood cholesterol” view is a standard of dietary recommendations, yet few consider whether the evidence justifies such restrictions.4 Over fifty years of cholesterol-feeding studies show that dietary cholesterol does have a small effect on plasma cholesterol concentrations. The 167 cholesterol feeding studies in over 3,500 subjects in the literature indicate that a 100 mg change in dietary cholesterol changes plasma total cholesterol by 2.2 mg/dL.4 In 1999, Frank B. Hu of the Harvard School of Public Health and his colleagues reported no increased risk of coronary heart disease or stroke in people who ate more than one egg per day. The analysis compared diet and cardiovascular risk among nearly 38,000 participants of two long-running epidemiologic studies.3, 5 In a separate study, Dr. Song and colleagues from the University of Michigan analyzed the diets and blood-cholesterol data of more than 27,000 people selected carefully to be a representative cross-section of the US population.5 They reported that cholesterol was lower in people who ate more than four eggs per week than among people who avoided eggs in their diet. However, a researcher cautioned, “this study should not be used as a basis for recommending higher egg consumption for regulation of serum cholesterol.” Nonetheless, until recently, there were no scientific findings to explain why it is so. Studies have shown that vitamin A, E, B, B6, B12 and folate, which can be found in egg, reduce the risk of coronary heart disease. But it was not until recently that we knew the scientific reasons behind the findings of all the earlier studies. Recent studies have shown that our body is quite intelligent in managing the extra cholesterol increase after eating eggs in a way that limits damage to the heart.

It is well known that the consumption of several eggs a day does tend to increase blood concentrations of cholesterol, particularly the amount circulating in LDLs. However, a new study from the University of Connecticut showed that eating eggs can also increase the amount of cholesterol in HDLs.2 When people ate three or more eggs per day their bodies made bigger LDL- and HDL-lipoprotein particles than when they ate no eggs. That is important because other recent studies have suggested that larger LDLs are less likely than small ones to enter artery walls and contribute their cholesterol load to artery-clogging plaque.3, 4, 6 Similarly, larger HDLs are more effective than smaller ones at moving cholesterol out of the bloodstream and, ultimately, out of the body. In addition, researchers from the University of Connecticut found that not all people respond similarly to cholesterol. Studies have shown that 30 to 40 percent of any given population is made up of “hyperresponders.” In these people, blood-cholesterol concentrations increase disproportionately in response to dietary cholesterol. Surprisingly, such people are found to put an egg’s cholesterol into larger-sized lipoproteins than most other people do. In contrast, among normal responders, only small increases in blood cholesterol occurred during the egg diet, and the size of LDL- and HDL-cholesterol particles covered the full range of lipoprotein sizes.2 These results suggest that any LDL-cholesterol reading that ignores lipoprotein size may exaggerate the heart risks posed by eggs’ cholesterol. Several recent studies have also shown that healthier people tend to package relatively more of their cholesterol in these large LDLs than do people with diabetes or heart disease and the differential effects of small and large LDL lipoprotein particles could be used as a marker for coronary heart disease risk.4, 6

In conclusion, limiting eggs or other foods in our diet cannot be the solution to reduce cholesterol level and thus the risk of coronary heart diseases. Our fight against any disease requires a holistic approach, better understanding of our body and the world around us in addition to choosing a more balanced diet and stress-free lifestyle. Recent scientific findings allow us to put an important question: Is it too simplistic to believe that the One who placed the cholesterol in the egg yolk is the One who created a defense mechanism in the body in a way that limits its damage to the heart?

Bulent Aydogan, PhD, is a research fellow at the University of Chicago Department of Radiation and Cellular Oncology.

Notes

1. http://en.wikipedia.org/wiki/Cholesterol.

2. Greene CM, Waters D, Clark RM, et al. Plasma LDL and HDL characteristics and carotenoid content are positively influenced by egg consumption in an elderly population1. Nutr Metab (Lond) 2006;3:6.

3. Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. Jama 1999;281:1387–1394.

4. McNamara DJ. The impact of egg limitations on coronary heart disease risk: do the numbers add up? J Am Coll Nutr 2000;19:540–548.

5. Song WO, Kerver JM. Nutritional contribution of eggs to American diets. J Am Coll Nutr 2000;19:556–562.

6.Yeomin Yoon JS, Hyung Doo Park, Kyoung-Un Park and Jin Q. Kim. Significance of small dense low-density lipoproteins as coronary risk factor in diabetic and non-diabetic Korean populations. Clinical Chemistry and Laboratory Medicine 2005;43:431–437.

No religion commends self-indulgence;all religions, and all traditional ways of life inspired by religious principles, commend self-discipline, that is containing and limiting, rather than expanding, one’s needs. Islam, with its conspicuous patterns of regular prayers, fasting and taxation of one’s wealth and property is particularly emphatic about the importance of self-discipline. Within the norms of Islam, self-discipline means a controlled, moderate, balanced way of living – not orgies of self-denial, followed (inevitably enough) by orgies of self-indulgence. Modern Western ways of life are not traditionally based, not inspired by religion, but motivated instead by what the economic market requires, which is for individuals to spend more and more, regardless of need. One area of such spending is food and drink: certainly among the better-off classes in Western societies, food is purchased, partly eaten and partly wasted, on an unimaginable scale. Muslims who are responsive to the Qur’an’s command to avoid squandering and waste, and to avoid activities or habits which cause harm to oneself (as over-indulgence always does), can never feel at ease living according to the modem Western values and norms.

But the reality is that non-Muslims cannot do so either, at any rate not for long, certainly not for ever. Just as over- exploitation and abuse of the environment demands, sooner or later, a return to saner and ethically more sound relationships with the earth’s finite resources, so too overindulgence at the level of individual lives demands, sooner or later, a return to a healthier life-style, a simpler, more sustainable diet. For the present, this reassertion in Western societies of the saner traditional norms (which, as we have noted, are common to all religious traditions) appears in many individual lives as an unpredictable swing between extreme over-indulgence (visible as obesity) and extreme self-denial (seen in crash courses to lose weight). It is true that vast, even obscene, amounts of wealth are engaged in the slimming industry which (as it were) feeds on the inability of many people to achieve a change in life-style and eating habits which they can sustain. Nevertheless, there is a growing understanding that, in the end, fat-free fats are a real waste of energy: the only point in slimming foods and dieting generally is to train oneself to live in a different, healthier way, and do it for good.

What is obesity?

Generally, obesity is regarded as being synonymous with being overweight. This is not strictly accurate. What actually matters is the excess of fat present in the body. One man may be overweight because he sits all day and eats but does no exercise; another, say an athlete, may be overweight because intensive training has increased his muscle bulk. The first man might be called obese, the second could not. However, as it is difficult to measure the amount of fat present in the body but easy to measure weight by simply using scales, the terms overweight and obesity are for everyday purposes interchangeable.

Does obesity matter?

Statistical studies (done by life assurance companies who have to be good at assessing health risk) provide undeniable evidence that obesity increases morbidity (illness) and the likelihood of early death. Fat people are more likely to suffer, among other things, from increased blood pressure (which may be the cause of stroke, kidney disease or coronary thrombosis), diabetes, arthritis, gallstones, varicose veins, complications of pregnancy or labour, and post-operative problems. Other illnesses not necessarily directly caused by obesity may be aggravated by a person being overweight. For example, a man suffering from angina (pain caused by impaired circulation of blood to the heart muscles) is more likely to die suddenly if he is overweight than if he is of normal weight. Obesity matters therefore because it can lead directly to illness (often serious) and reduces lifespan.

Causes of obesity

The one obvious and direct cause of obesity is that food intake is in excess of the body’s energy requirements or, in plain English, overeating. Why do some people eat more than they need?

By far the commonest reason is that their energy use slows down while their food intake remains the same. This happens in many people as they grow older because little by little they slow down physically, whereas their eating habits remain unaltered. This leads to the well-known condition of middle-age spread. Just one potato or one slice of bread more than the body needs each day can add to its weight each week until, perhaps, by the end of the year the excess amounts to a whole stone.

The genetic make-up of some individuals can make it difficult for them to avoid putting on excess weight because their bodies function at a low metabolic rate. Many fat children, though by no means all, probably fall into this category. It is well recognized that fat parents often produce fat children, and it is unlikely that this phenomenon can he explained entirely on environmental grounds as the children adopted by fat parents are no more likely to become fat than other children.

There are people who overeat because they have a psychological or psychiatric disorder of a lasting kind. Others may overeat when they are temporarily depressed or under emotional stress: they look for consolation for their trouble in eating. For example, some cigarette smokers when trying to give up their bad habit try to compensate by eating. It has also been suggested that, after giving up smoking, the bowel tends to absorb food more efficiently which may aggravate the problem of increased weight.

According to a theory that has been popular for some years now children who are allowed to become fat during the first two years of their lives form a large number of fat cells. They then spend the rest of their lives filling up these cells with fat that is, they have an increased predisposition towards depositing fat within their bodies. However, though popular, this theory has not yet been proved.

Cultural norms and expectations influence people in all sorts of ways, among them, in the way they look. In most Western societies of the present, the cultural preference is for slimness. But this is not true of all societies, not even all Western ones – for example, in southern Italy and elsewhere in Europe, a mother is expected to be ‘well-rounded’.

Treatment of obesity

Treatment of obesity requires a reduction of calorie intake to below the level of the body’s daily energy requirements. Weight will he lost only if there is a negative calorie balance. Eating less food than the body requires means that the body uses up its own fat to meet its energy requirements. In extreme cases, where losing weight is of paramount importance and where, for one reason or another (usually psychological), dieting has failed, surgical procedures may be necessary. These can include wiring up the jaws to prevent entry of solid food while allowing liquid matter to enter the mouth, or even more rarely, short-circuiting large sections of the bowel, a high risk procedure that carries with it a very significant mortality rate.

Nutrition and diet

Nutrition is concerned with the correct provision of essential factors for body growth, maintenance and repair, together with the necessary number of calories to meet the body’s energy requirements. A correct slimming diet is one that reduces the daily intake of calories without depriving the body of its nutritional needs. Some understanding of nutrition and correct dieting is important not only for those who are already obese, but for many young, normal individuals who, without this knowledge would be likely in the course of time to become obese. A well-balanced diet must have adequate amounts of proteins, carbohydrates, fats, vitamins, minerals, mineral salts and water. Proteins, fats and, particularly, carbohydrates, are important sources of calories and hence of energy. Proteins also supply the amino acids essential to body growth and repair. Fat in addition to being a subsidiary source of energy is the principal source of some vitamins.Vitamins are important in the utilization of energy and in the body metabolism but are not themselves a source of energy and do not contribute to body weight. Lack of vitamins causes disease but so too can an excessive intake of some vitamins. 

A number of mineral salts are essential for the human body. Iron, for example, is essential for the formation of hemoglobin. Calcium is necessary for ossification of bone (the change of cartilage into bones). Phosphorus is required for many purposes including the manufacture of ATP. Iodine is necessary for the correct functioning of the thyroid gland. Other important minerals include potassium and sodium.

Water is one of the most important elements in our diet. It makes up about 70% of body weight and shortfall in its intake results in dehydration. Caloric foods are essential for body energy requirements. To appreciate their importance it is necessary to understand both how calories are expended by the body and how these calories are provided by the food eaten. The total calories expended by the body each day is the sum of the calories required for basal metabolism and those required for physical activities. Basal metabolism is the chemical change occurring within the body in the state of complete physical rest when the only bodily functions that are occurring are respiration, growth and repair of body tissues. Physical activity includes obvious exercise such as walking or running and other activities such as digestion and absorption of food. The requirements of basal metabolism depend on the size of the person, but on average about 1,700 calories per day. For comparison it is interesting to note that walking utilizes about 200 calories per hour, household work about 100 calories per hour, and mental work no calories.

Calories are provided by certain constituents of the diet. The most prolific source on a calorie-per- weight basis are fats, which yield 9 calories per gram, followed by carbohydrates and proteins which each yield 4 calories per gram. It would appear that, in order to lose weight with maximum efficiency, the part of the diet which should be reduced is the fat content. However, the average diet contains nearly twice as much carbohydrate as it does protein and fat put together. Therefore, in practical terms, most slimming diets concentrate on the reduction of the carbohydrate content of the food eaten.

Dieting

By ‘dieting’ people usually mean a ‘reducing diet’, that is, a programme of eating less in order to achieve weight reduction. But there are other types of diets used for different purposes such as lowering the level of cholesterol or increasing the bulk content of food in the bowel.

Reducing diets are designed to provide less calories in the food intake than are used by the body in the expenditure of energy. There are infinite variations, both in the content of such diets and in their efficacy.At its simplest, good diets are diets that work. The important criteria of such diets are:

1. Palatability: it is pointless following a diet which forbids all foods that one likes and allows only foods that one dislikes.
2. Practicability: that is a diet that can be followed with a minimum of fuss and preparation and can be used when one is out at work or at a restaurant.
3. Moderation: a diet should be one that ensures a weight loss of not more than 2 lb a week. Diets which produce weight loss in excess of 2 lb are usually crash diets and come into the second category namely, bad diets.

Bad diets fail to satisfy the criteria described above. They fail because they are monotonous or cause tremendous hunger and are soon abandoned, with a consequent return to previous eating habits and the regaining of weight lost. Even if maintained with perseverance and weight is successfully lost, when the diet is eventually stopped, when the desired weight has been achieved, former eating habits are almost always resumed and weight rapidly regained. Weight rapidly lost is weight rapidly regained in almost every instance. It hardly needs saying that the most important aspect of dieting is the re-training of one’s eating habits so that after a time dieting is no longer a conscious activity but a totally natural and permanent way of eating for health. In practical terms the most effective way of achieving this is by gentle reduction of the amount of food eaten. For example, one potato less, one slice of bread less, substitution of artificial sweeteners instead of sugar, are all ways of reducing calorie intake in a gentle and painless manner. There are numerous other tactics (usually classed as behaviour therapy) such as eating from a smaller plate, which can all help different individuals to adapt gradually and permanently to a different regime of eating.

Slimming tablets are controversial. Opinion as to their usefulness is divided. They appear to be very popular with patients but not so popular with doctors. It is possible that tablets have a use particularly when hunger is a problem during sensible dieting or when the reduction of weight has reached a plateau which appears to be permanent or long-lasting. A short-term plateau is a common occurrence while on a reducing diet and perseverance is required as weight loss is usually resumed after a short period. The problem with slimming tablets is that they can cause unpleasant side effects such as insomnia or, conversely, drowsiness, and they may cause dependency. 

Exercise

The importance of exercise in the context of weight reduction is frequently overstated. For example, a walk of one mile will probably use up less than 60 calories. If this activity is undertaken every day it will probably achieve a weight loss of less than 1 lb a month. However studies have shown that sedentary individuals appear to lose weight with more difficulty than active individuals on identical diets.

Bran

Recently doctors have become aware of the importance of something that has been missing in the refined diets of Western societies for a long time: this is vegetable fibre. Observation of peoples in the African continent have shown that the local inhabitants rarely suffer from constipation, bile and other bowel disorders so common in Western countries. This has been convincingly explained as being due to the presence in their diet of vegetable fibre. The theory has been advanced that if vegetable fibre is added to our Western diet the incidence of such bowel disorders will be reduced and this appears to be borne out. The addition of vegetable fibre, generally in the form of bran, may well prove to be a useful constituent of our everyday diet. A further advantage of bran, particularly while on a reducing diet is that it has a tendency to fill up one’s stomach and thus alleviate hunger.

Diet and corona heart dease

Cholesterol is a fatty substance present in everyone’s blood. It causes problems as it is deposited in the lining of arteries making them narrower. Cholesterol also forms an important constituent of arteromatous plaques (lumpy deposits on the inner lining surface of arteries) which may cause narrowing or blockage of the coronary arteries (those supplying the heart), leading to pain on exertion (angina pectoris). Blockage of the coronary arteries causes coronary thrombosis which results in destruction of the heart muscles. The relationship between high blood cholesterol levels and coronary heart disease is undisputed. Numerous studies have shown that the risk of dying from coronary heart disease is more than doubled if one has an abnormally high level of cholesterol in the blood. The relationship between blood cholesterol levels and coronary heart disease is probably a direct causal one. The classic observation is that Japanese men who came to live in San Francisco acquire high blood cholesterol levels and suffer an increased incidence of coronary heart disease in similar proportions to those of the indigenous population and in marked contrast to the low cholesterol levels and low incidence of heart disease of the indigenous population of Japan. However, the possibility remains that some other factor or factors are responsible for both the high cholesterol level and coronary heart disease has been postulated.

Cholesterol is derived partly from the diet and partly from the breakdown of other food substances within the body. The main sources of cholesterol are animal fats and dairy products. These include fatty meats, liver, milk, cheese, cream and butter. All these foods contain a good deal of saturated fatty acid which in the body breaks down to form cholesterol. In addition, eggs contain pure cholesterol. When the amount of cholesterol and saturated fatty acids in the diet is reduced the level of blood cholesterol is also reduced.

What does seem likely is that even a moderately raised level of cholesterol over a long period of time may predispose towards coronary heart disease. Doctors and nutritionists are therefore becoming increasingly aware of the importance of correct diet starting in childhood. It is likely (and certainly it is to be hoped) that, with increased general awareness of the importance of cholesterol levels, there will be some alteration of the present eating habits in schools – informed teachers could provide an important impetus. This is particularly desirable as the eating habits of adults and their likes and dislikes are acquired largely during childhood. There should be a trend towards a reduction of the animal fat and dairy product content of the diet (though by no means their total exclusion because they still form an important source of certain essential nutrients) together with an increase in food containing more polyunsaturated fats (which do not lead to the rise in cholesterol levels) such as lean meat and the substitution of soft margarine high in polyunsaturated fats in place of butter, and the use of corn oil, sunflower oil and safflower oil in cooking instead of cooking fat.

As Muslims, of course, we must be abstemious and refrain from overindulgence. Good health is a valuable gift from God Almighty and we shall he held accountable for how we treated our bodies. In the inimitable words of the Wise Qur’an: Let not your own hands contribute to your own destruction’.