We all focused on one topic throughout 2020: Covid-19. No single day passed without news on the pandemic as we counted numbers of positive cases and the death toll while anticipating for a vaccine. In the meantime, we got more familiar with some of the medical processes, like phases, clinical trials, mutations, etc. for all this had to deal with the most precious gift we are given: life.

In our last issue, we touched upon the history of pharmacology and how modern-day drugs are made in an article titled “Pharmacology: The Journey of a Chemical Compound into a Drug.” Now, we will explore the multiple, lengthy phases of clinical trials that drugs must undergo and why they are imperative in order for new medicines to get approved for the marketplace.

Clinical trials are a way to test new methods of diagnosing, treating, or preventing health conditions. The goal is to determine whether a substance is both safe and effective. A clinical trial is only done when there is strong reason to believe that a new test or treatment may improve the care of patients.

A variety of treatment methods such as medications, medication combinations, new uses for existing medications, and medical devices are evaluated through clinical trials. In the United States, all new treatments must go through these trials before being approved for public sale by the Food and Drug Administration (FDA).

At the discovery and development stages, thousands of compounds may be potential candidates for development into a “drug”. After early testing, however, only a small number of compounds look promising and call for further study. The entire process of developing a drug from its pre-clinical research stage to its final marketing phase can take approximately 12 to 18 years and often costs well over $1 billion [3, 4].

Clinical trials show us what works and what does not in the realm of healthcare and are designed to answer some important questions such as:

• Does the new treatment work in people? If it does, how effective is it?
• Is it better than currently used treatments?
• If it is not better, is it just as good and cause fewer side effects?
• Does it work in some people who do not benefit from current treatments?
• Is the new treatment relatively safe? There is virtually no treatment or procedure that is without risk, but do the benefits of the new treatment outweigh the risks?

Answering these questions, while giving as few people as possible an unknown treatment, often requires several clinical trials in different phases. Each phase is designed to answer certain questions while keeping trial participants as safe as possible.

Preclinical phase

Before clinical trials can begin in humans, tests and treatments are assessed in pre-clinical research, which can involve extensive laboratory research over several years of testing on animals and human cells. This research may aim to learn the chemical compound of a drug [1]. If the initial laboratory research is successful, researchers send the data to health authorities for approval in order to begin research and testing on humans.

Once pre-clinical research results are approved, human testing of experimental drugs can begin and is typically conducted in four phases that are denoted by Roman numerals (Phase I, II, III and IV). Each phase is considered a separate trial and, after completion of a phase over many years, researchers are required to submit their data to, and then wait for approval from their local health agency (the FDA in the US) before continuing onto the next phase. If the drug successfully passes through Phases I, II, and III then it will usually be approved by the national regulatory authority for use in the general population. Phase IV trials are “post-marketing” or “surveillance” studies that are conducted to monitor how safe the product is over several years [2].

Phase I

This is the first clinical phase that involves humans. Phase I trials most often include healthy volunteers, however there are some circumstances when clinical patients are used, such as patients who have terminal cancer or HIV. These treatments possess a much higher risk for healthy individuals and could cause to become ill and contract serious adverse side effects.

In a Phase I clinical trial, doctors collect information on:

• The dose or treatment
• When it should be taken, and how often
• Any side effects or complications
• How the treatment affects patients and their preexisting conditions

One of the primary goals of Phase I studies is to find the highest dose of a new treatment that can be given safely without causing severe side effects. Although the treatment has been tested in laboratory and most likely been used in animal studies, the side effects in people cannot be known for sure. During Phase I of a clinical trial, researchers spend several months to evaluate safety, side effects, optimal dosage amounts, and formulation method for the drug on about 20 to 80 people who have no underlying health conditions.

In addition to evaluating safety and ideal dosage, specialists also look at the best way to administer the drug such as orally, intravenously, or topically. These trials are often conducted in a clinical trial clinic where the subject can be observed by full-time staff. Safety always remains the foremost concern in Phase I. The research team keeps a close eye on the people and watches for any severe side effects.

Researchers start by giving very low doses of the drug to a few patients while higher doses are given to other patients until side effects become too severe or desired effects are seen. The drug may help patients, but Phase I trials are to test a drug’s safety. If a drug is found to be safe enough, it can be tested in a Phase II clinical trial. According to the FDA, approximately 70 percent of medications move on to Phase II.

Phase 2

Phase II of a clinical trial usually involves anywhere from 50 to several hundred who are living with the condition that the new medication is meant to treat. They are usually given the same dose that was found to be safe in the previous phase. Investigators monitor participants for several months, or years, to see how effective the medication is and to gather more information about any side effects it might cause.

Most phase II studies are randomized trials where one group of patients receives the experimental drug, while a second “control” group receives a standard treatment or placebo. These studies are mostly “blinded” which means that neither the patients nor the researchers know who has received the experimental drug in order to avoid from bias. Doctors use a computer program to randomly sort volunteers into these two separate groups. Each volunteer has an equal chance of ending up in any of the groups and are randomly put in any group.

This allows investigators to provide the pharmaceutical company and the health authority with comparative information about the relative safety and effectiveness of the new drug. When the development process for a new drug fails, this usually occurs during Phase II trials when the drug is discovered to not to work as planned or to have toxic effects. The FDA estimates that roughly one-third of experimental drugs successfully complete both Phase I and Phase II studies.

Phase II clinical programs historically have experienced the lowest success rate of the four development phases. In 2010, the percentage of Phase II trials that proceeded to Phase III was 18% [5] and only 31% of developmental candidates advanced from Phase II to Phase III in a large study of clinical trials conducted during the period of 2006 – 2015 [6].

Phase III

Phase III of a clinical trial usually involves up to 3,000 participants who have the condition that the new medication is meant to treat. These participants must include men, women, and people of different ages and ethnic groups in many places across the country (or even around the world) at the same time. This helps doctors learn how treatment works in different people with different genetic backgrounds, races, and ethnicity. These studies tend to last longer – up to several years – than Phase I and II studies.

One of the additional purposes of Phase III is to evaluate how the new medication works in comparison to existing medications for the same condition. To move forward with the trial, investigators need to demonstrate that the medication is at least as safe and effective as existing treatment options. Due to the larger number of participants and longer duration of Phase III, rare and long-term side effects are more likely to show up during this phase.

There can be more than two treatment groups in Phase III trials. The control group may receive the current standard-of-care treatment for their illness while other groups receive the new treatment on trial. Phase III trials are usually double blinded to eliminate bias when interpreting results.

Placebos may be used in some Phase III studies, but they are never used alone if there is a treatment available that works. Sometimes, a patient who is randomly assigned to the placebo for part of the study will at some point be offered the standard treatment as well. As with other trials, patients in Phase III clinical trials are watched closely for side effects, and treatment is stopped if they become too hard to manage.

Every patient in a Phase III study is watched closely, and the study will be stopped early if the side effects of the new drug are too severe or if one group has significantly better results. Phase III clinical trials are often needed before the FDA will approve the use of a new drug for the general public. If researchers demonstrate that the medication is at least as safe and effective as others already on the market, then the FDA will usually approve the medication.

In the United States, when Phase III clinical trials (or sometimes Phase II trials) show a new drug is more effective or safer than the current treatment, a new drug application (NDA) is submitted to the FDA for approval. The FDA reviews the results from the clinical trials and other relevant information.

Based upon the review, the FDA then decides whether to approve the treatment for use in patients with the illness the drug was tested on. If approved, the new treatment often becomes a standard of care and newer drugs may be tested against it before they can be approved. If the FDA feels that more evidence is needed to show that the new treatment’s benefits outweigh its risks, it may ask for more information or even require that more studies be done. Once Phase III is complete, a pharmaceutical company can request FDA approval to begin marketing the drug. Roughly 25 to 30 percent of medications move on to Phase IV.

Phase IV

Phase IV trials test new drugs that are approved by health authorities and often are called Post Marketing Surveillance Trials. The drugs are available for doctors to prescribe to patients, but Phase IV studies might still be needed to answer important questions. In previous clinical phases the drug may not have been tested for interactions with other drugs, or on certain population groups, such as pregnant women, who are unlikely to subject themselves to trials. This phase involves thousands of participants and can last for many years. Investigators use this phase to get more information about the medication’s long-term safety, effectiveness, and any other benefits.

This is often the safest type of clinical trial because the treatment has already been studied a lot and has likely been given to many people. Phase IV studies look at safety over time. These studies may also look at other aspects of the treatment, such as quality of life or cost effectiveness.

Phase IV studies can result in a drug or device being taken off the market or restricted depending on the findings in the study. Unless an adverse effect of the approved drug is shown or the drug is accepted as safe, it will stay on the market and also in Phase IV forever.

This clinical trial algorithm has come out after many scientific studies. Every point of the clinical trials, and possible problems, have been clarified by policies which may differ from country to country. At the end, clinical trials are a very safe and cautious method of finding out the safest and most effective treatment, or diagnostic method, for people. During clinical trials, scientists are very careful about ethical issues and try not to harm any living organisms, be them animals or humans. There is an ongoing public debate over pharmaceutical companies. While some think they play a major role in the emergence of many methods and scientific developments to benefit human health, others doubt their motivations and questions their contribution to the public good. This debate will surely continue for a long time, but under the current circumstances, pharmaceutical companies are found in the center of all these clinical trials described in this article. Regardless of the truth behind these doubts, it is important to be always aware of the priceless value of life, that it has been given to us and all living things as an inalienable right and a precious gift, and that it is a major responsibility take care of it well and seek healing when needed.

• https://www.nccn.org/patients/resources/clinical_trials/phases.aspx
• “The drug development process”. US Food and Drug Administration. 4 January 2018. Retrieved 17 August 2020
• Holland J (2013). “Fixing a broken drug development process”. Journal of Commercial Biotechnology. 19. doi:10.5912/jcb588.
• Adams CP, Brantner VV (2006). “Estimating the cost of new drug development: is it really 802 million dollars?”. Health Affairs. 25 (2): 420–8. doi:10.1377/hlthaff.25.2.420. PMID 16522582.
• “New drugs failing Phase II and III clinical trials”. MedCity News. 2011-06-02.
• “Clinical Development Success Rates 2006-2015” (PDF). bio.org. Retrieved 2018-02-11.

It has been over half a year since Covid-19 swept across the world and forced many countries into quarantine. Hopes of a quick resolution of the disease in many countries have since been, unfortunately, proven to be wrong, and it is evident that the virus is here to stay for a while [1]. The virus is so difficult to deal with considering it can be transferred from person to person even if the carrier does not outwardly display symptoms. Even animals, ranging from mice to tigers, can contract and transmit it to humans [2, 3], and we cannot quarantine or force them to wear facemasks. The virus will eventually hit each person; it is just a matter of time. The virus may additionally arrive in multiple waves, as it is possible to be reinfected [4]. COVID-19 will most likely have a lifespan of a few years, much like other major virus outbreaks of the past such as the swine flu in Hong Kong or Spanish flu. It will probably come and go like a common flu in never ending waves. So, each of us need to be ready until a successful vaccine is developed, and the wisest action for each person to be ready would be to boost our immune systems and practice effective social distancing and sanitation measures, while we deal with this virus for however long it may last.

Vaccines are critical for stunting the development and spread of viruses; however, they can be costly, time-intensive to develop, and not always perfect. It is worth exploring alternative methods to help protect our bodies from these pathological invaders while vaccines are being researched. As it so happens, the best method of prevention to date for HIV infections is not a vaccine, but is instead a tradition that is as old as thousands of years: male circumcision [5]. To give a comparison, the current widely popular and heavily promoted influenza vaccine is considered “50% effective against influenza B/Victoria viruses and 37% effective against influenza A(H1N1)” [6]. On the other hand, according to an article published in the prestigious medical journal, The Lancet, circumcision is up to 88% effective in preventing heterosexual transmission of HIV [7]. Male circumcision does not have any medicinal side effects, and the only risks that are involved are those related to any minor surgery – bleeding and infection.

In the 1980s, when I first heard of HIV, I remember reading articles which claimed, quite arrogantly, that vaccines and cures for the condition would be found within two or three years [8]. Forty years later, and after spending many billions of dollars on research, we are still nowhere near an HIV vaccine. At best, we found treatments which helped keep the HIV virus at bay [9]. To date, only two people have been fully cured with a method far too expensive to be applied to the general public [10]. In the meantime, at least 30 million people have died with more than half a million in the year 2019 alone [11]. While vaccines are critical for helping to eradicate viruses, putting all of our eggs into that basket alone can be a risky public health strategy due to how difficult and time consuming they are to discover, verify, and distribute. It is impossible to know for sure how long it will take to develop a vaccine for the coronavirus. In the meantime, communities should heavily consider following the instructions of their local health officials which often include social distancing, limited size gatherings, and frequent hand washing as these methods are already proven to help reduce the spread of the virus.

Development, and even the rushed development of a vaccine, is always a very tedious and dangerous process. The science behind them is exceptionally complex, and imperfect results can have disastrous consequences upon thousands of people. This is further complicated by the fact that phase 2 and phase 3 trials can have quite diverging results [12]. In the USA, AstraZeneca’s COVID-19 vaccine trials were stopped after trial participants fell ill [13]. Third phase trials, which encompass thousands of people [14], still can give little indication of the long-term side effects to any vaccine. Besides, even though there is human life at risk, the vaccine has already become an instrument for many political and economic disputes and conspiracy theories. Some governments claim they have already developed a vaccine, while others find them unreliable, or try to lure a foreign company to work for themselves [15]. In August of this year Russia rushed registration of an unproven Coronavirus vaccine and named it, in Cold-War-like fashion, the “Sputnik V” [16]. The announcement was made by none other than Vladimir Putin himself. It was offered to the USA, but was rejected due to safety concerns stemming from a belief that the drug was not adequately researched and developed [17]. In the meantime, Russia announced the development of a second vaccine [18]. Surely enough, it was dismissed and downplayed by the West as unproven and unreliable. On the other hand, a vaccine developed by a Chinese company Sinovac proved to be the most successful in its phase 3 trials in Brazil [19]. Sao Paulo Governor João Doria purchased 47 million shots of the vaccine. However, the transaction was stopped, arguably for political reasons, by the Brazilian President Jair Bolsonaro [20]. Bolsonaro’s comments when rejecting the purchase of the Sinovac vaccine on the basis that “the Brazilian people will not be anyone’s guinea pig” are not totally without merit. Recalls of “proven and tested” vaccines have happened in the past [21].

It is important for all people to continue exploring methods to develop their immune systems and prevent the spread of the virus while we wait for a vaccine. In an article I had previously published, I discussed the benefits of fasting, vitamin C, and Wim Hof breathing methods to help protect the body from disease [22]. All of these methods are well known and quite benign with respect to side effects, however they are unable to cure Covid-19 or prevent its spread. Additionally, the Center for Disease Control (CDC) has heavily stressed practices included social distancing and the wearing of non-ventilated face masks. Our hope is that going above and beyond to protect ourselves and our neighbors will give scientists the time that they need.

One way of giving that time to scientists is fasting. Fasting, like circumcision, is a tradition that is thousands of years old. In recent studies, a three-day water fast has been shown to reset the immune system of elderly people to the level of a twenty-year old’s [23]. At this current level of emergency in the world it would be very easy to find thousands of willing volunteers to trial monthly three-day water fasts and/or to take extra doses of vitamin C, not as a cure, but as a shield against COVID-19. This kind of study would not pose much risk and would definitely be very cost-effective. We could dive straight into the third phase of trials, for any side effects of fasting are already well known. And finally, if proven effective, its uptake by the population at large would be basically cost free and readily available across the whole world.

Our world has been enduring a difficult and challenging period for the better half of a year now. Time has given us the ability to learn more about the virus, how it disrupts our bodies, and how it spreads. This knowledge has, in turn, allowed us to research it and develop effective social guidelines for limiting its spread. Still, there is much work to be done. Hysteria and haste are not conducive to producing a vaccine that is thorough, effective, and efficient. It should be the responsibility of every able-bodied citizen to do what they can to learn more about how they can protect themselves from the virus and thus prevent it from spreading even more while we wait for a vaccine.

1. https://www.wuky.org/post/beshear-next-few-weeks-will-be-critical#stream/0
2. https://www.washingtonpost.com/science/2020/09/03/coronavirus-deer-mice-spread/
3. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326402/
5. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)03421-2/fulltext?_eventId=login
6. https://www.aafp.org/news/health-of-the-public/20200226interimfluve.html
7. Halperin, D. T., & Bailey, R. C. (1999). Male circumcision and HIV infection: 10 years and counting. The Lancet, 354(9192), 1813-5. doi:http://dx.doi.org/10.1016/S0140-6736(99)03421-2
8. https://www.immunology.org/publications/bsi-reports/60-years-immunology-past-present-and-future/the-hunt-for-hiv-vaccine
9. https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html
10. https://www.medicalnewstoday.com/articles/2nd-person-cured-of-hiv-thanks-to-stem-cell-transplant
11. https://www.unaids.org/en/resources/fact-sheet
12. https://www.fda.gov/media/102332/download
13. https://www.usatoday.com/story/news/health/2020/09/09/covid-vaccine-astrazeneca-trial-hold-what-does-mean/5757590002/
14. cancer.org/treatment/treatments-and-side-effects/clinical-trials/what-you-need-to-know/phases-of-clinical-trials.html
15. 15 https://www.nytimes.com/2020/03/15/world/europe/cornonavirus-vaccine-us-germany.html
16. https://www.theverge.com/2020/8/11/21363135/russia-coronavirus-vaccine-unproven-registration
17. https://www.techtimes.com/articles/251792/20200814/covid-19-us-says-no-to-russias-vaccine-sputnik-v-saying-theyll-never-use-it-on-monkeys-let-alone-people-vietnam-and-philippines-say-otherwise.htm
18. https://abcnews.go.com/Health/wireStory/russia-approves-2nd-virus-vaccine-early-trials-73614460
19. https://fortune.com/2020/10/20/covid-vaccine-china-brazil-testing-ground-safest-most-promising-sinovac/
20. https://apnews.com/article/virus-outbreak-brazil-state-governments-health-sao-paulo-b7b5b620ba54f402dbf803e26fe6b842
21. https://www.cdc.gov/vaccinesafety/concerns/recalls.html
22. https://medium.com/@arasweb/surviving-the-pandemic-370b47120d8d
23. https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/

“Free radicals” are a special type of atom that have been linked to many age-related diseases. They form as a result of a process called Oxidative Stress, which takes place when an oxygen molecule splits into single atoms with unpaired electrons. The nature of electrons is such that they like to be in pairs and as a result will “freely” and “radically” search throughout the body for another electron to pair with. They could almost be considered romantic if they were not so dangerous!

Their main danger comes from the damage that they cause to cells or cell membrane, proteins, and DNA. Cellular damage occurs when free radicals travel through cells and disrupt the structures of other molecules. The gradual accumulation of them, and the increased damage that builds as more and more of them collect, is what helps cause many of the aforementioned aging diseases. Our body is under constant assault from oxidative stress, and cells may function poorly or die if it occurs too frequently and without proper bodily maintenance.

Free radicals are a waste byproduct that form as a result of various chemical reactions that take place during our bodies’ normal metabolic processes. They are then “dumped,” and their eventual buildup will often harm our bodies much like how factory waste harms the environment However, they are not entirely useless; it is impossible for our bodies to turn air and food into chemical energy without a chain reaction of free radicals. Free radicals are also a critical part of the immune system, as they additionally move through our veins and can confront foreign invaders [1].

What are free radicals?

Understanding free radicals necessitates an elementary knowledge of chemistry.

Electrons orbit around atoms in levels called shells. Each shell is filled by a fixed number of electrons, and when the first shell is full then electrons will start to fill the next shell.

If there is an atom whose outer shell is not full then it may bond with another atom by using the electrons to fill its outer shell. These types of atoms are known as free radicals.

Atoms that have a full outer shell become stable, however free radicals are unstable. They are “desperate” to acquire the full number of electrons that are necessary to fill all of their shells and will therefore react quickly with other substances.

Take the example of oxygen molecules. If they split into single atoms that have unpaired electrons then they too will become unstable free radicals that seek other atoms or molecules to bond to. If this procedure continually occurs, then it will begin a process called oxidative stress.

Smoking, UV rays, air pollution, fast food, pesticides, ionizing radiation, drugs, and inflammation have all been linked to the formation of free radicals. We must be diligent when it comes to understanding how these influences can affect our bodily health, and then fight back with natural antioxidants.

Free radicals are heavily linked to aging

One of the effects of oxidative stress is that it can damage our body’s cells and thus promote many of the diseases and symptoms related to aging, such as wrinkles and gray hair. They will take electrons from other atoms in order to become more stable, a process that may cause diseases or signs of aging [2].              

In 1956, the “Free Radical Theory of Aging” was outlined as a way to understand how exactly our bodies age over time. Everybody ages, and as we age our body loses its ability to fight the effects of free radicals. Over time our bodies produce more free radicals and more oxidative stress, which increases the rate at which cells are damaged and thus can bring about degenerative processes.

Many age-related diseases such as muscular degeneration, certain cancers, atherosclerosis, cardiovascular disease, emphysema, Alzheimer’s disease, Parkinson’s disease, ulcers and all inflammatory diseases such as arthritis and lupus, and many others are linked to free radicals. Free radicals can be found in the food we eat such as fried foods, the medicines we take, the air we breathe, and the water we drink. Free radicals are also found in alcohol, tobacco smoke, pesticides, and air pollutants.

Several studies and theories have been linked to oxidative stress and the buildup of free radicals including: [3]

• Genetic degenerative diseases, such as Huntington’s disease or Parkinson’s
• Age-related changes in appearance, such as loss of skin elasticity, wrinkles, graying hair, hair loss, and changes in hair texture
• Cataracts and age-related vision decline
• Diabetes
• Cancer, which is associated with chromosomal effects and oncogene activation due to the reaction of free radicals [2]
• Central nervous system diseases, such as Alzheimer’s and various forms of dementia
• Cardiovascular diseases due to clogged arteries
• Autoimmune and inflammatory disorders, such as rheumatoid arthritis and cancer

The free radical theory of aging is comparatively new; however, several studies boost its credibility. Researchers focused on cell’s mitochondria, the “powerhouse” that process nutrients to power the entire cell. Experiments on rats, for example, showed a noteworthy increase in free radicals as the rats aged. These alterations coincided with age-related declines in their health. These experiments also showed that free radicals produced in the mitochondria harm the substances that the cells need in order to work properly. This damage causes mutations that produce more free radicals, thus accelerating the process of damage to the cell. This helps explain aging since aging quickens over time. The gradual, but increasingly rapid buildup of free radicals, offers one explanation for why even healthy bodies age and depreciate over time [2].

Antioxidants can stave off free radicals

Antioxidants, molecules that prevent other molecules from oxidizing and thus undergoing oxidative stress, can help to avert the harmful effects of free radicals. They can also decrease or even nullify the effects of free radicals, as they can provide an electron to free radicals and thereby reduce their reactivity. The uniqueness of antioxidants is that they can donate an electron without becoming reactive free radicals themselves.

There is no single antioxidant that can combat the effects of every free radical. Free radicals have different effects in different areas of the body, and every antioxidant performs differently due to its chemical properties. Antioxidants such as vitamins C and E, beta-carotene, glutathione, and plant estrogens called phytoestrogens all scavenge the body and help remove free radicals. Honey can also function similar to antioxidants by removing free radicals. Additionally, selenium, a trace metal that is required for proper function of one of the body’s antioxidant enzyme systems, is sometimes included in this category. The body cannot manufacture these micronutrients so they must be supplied in the diet.

Foods that are rich in antioxidants include citrus fruits such as oranges and limes, berries, and many other fruits that are rich in vitamin C. Carrots are known for their high beta-carotene content, while the soy in soybeans, and some meat substitutes, are high in phytoestrogens. Apricots, spinach, mangoes, pumpkins, broccoli, and eggplants are all also helpful, along with a plethora of other fruits and vegetables [4].

More research needed

A 2010 study on antioxidant supplementation for the prevention of prostate cancer found no benefits. Furthermore, a 2012 study found that antioxidants did not lower the risk of lung cancer. On the other hand, the study found that people who were already at a heightened risk of cancer, such as smokers, actually had a slightly elevated risk of cancer due to antioxidants.

Some investigators have found that supplementation with antioxidants is injurious when people take more than the recommended daily allowance (RDA). A recent analysis found that high doses of beta-carotene, or vitamin E, appreciably increased the risk of dying. One study found that long-term use of beta-carotene could reasonably reduce the risk of age-related mental problems [4]. But perhaps one of the most important discoveries is that antioxidants are unable to “cure” the effects of free radicals completely [5].  

Additionally, we do not yet fully understand why free radicals form in the first place. They may result as an early sign of cells fighting diseases, or that free radical formation is simply a natural expectation that comes with aging. It is not possible to understand them completely without more conclusive research, which should be encouraged considering the significant impacts that free radicals can have upon our bodies.

References

1. https://www.rice.edu/~jenky/sports/antiox.html
2. https://www.medicalnewstoday.com/articles/318652#How-do-free-radicals-damage-the-body
3. http://www.mytruehealth.info/mytruehealth_antioxidants_freeradicals.html
4. https://www.medicalnewstoday.com/articles/318652#Antioxidants-and-free-radicals
5. https://www.medicalnewstoday.com/articles/318652#What-we-do-not-know

We all may appreciate the difference between the positive impact made by a smile of pearly-white teeth and the repulsion triggered by yellowed and blackened rotten teeth, but the health issues run much deeper: as our medical knowledge grows, we are discovering that many diseases originate from dental cavities where microbes teem and nest, causing inflammations in many organs and tissues, most notably in the heart, kidneys, and joints.

The use of herbal sticks for cleaning teeth dates back to around 3500 BC, the time of the Babylonians. In several works of Ancient Greek and Roman literature, chewable sticks to aid dental and mouth hygiene are mentioned [1]. Hippocrates (355 BC) advises rubbing a ball of cotton wrapped around a stick and dipped in honey on teeth, to maintain dental hygiene, whereas Romans used pastes obtained from gumwood [2]. Dental hygiene is coming throughout history.

Arabs utilized the miswak for many years [3]. The Japanese used wooden sticks called “koyoji” and Jews used wooden sticks called “kesam.” In the 1920s, in some rural areas across the United States, a stick of blood-twig was used for rubbing on the teeth [3]. And according to a Chinese encyclopedia published in the seventeenth century, the first-ever toothbrush was made in China, in 1498.

Prophet Muhammad, peace be upon him, warned those of his Companions who visited him with bad teeth about the need for dental hygiene (Ahmad ibn Hanbal, Musnad 1/214):

“I oft reiterated my recommendations to you about the miswak.” (Bukhari, Jum’a 8; Nasai, Taharah 5; Ahmad ibn Hanbal, Musnad 3/143; Darimi, Wudhu’ 18)

“(The Archangel) Gabriel counseled me to use the miswak so much that I thought a verse might be revealed about the miswak to decree its use as obligatory for all.” (Ibn Majah)

Obviously he assigned the utmost importance to dental hygiene. It should be noted here that the Araq tree (Salvadora persica) from which the miswaq is obtained has features that are not present in other trees, and the Prophet particularly specified using the roots of that tree as the miswak.

Research has been conducted to discover the scientific and modern medicinal effects of the miswak, which has been used by Muslims in adherence to the Prophet’s practice. In 2010, a Ph.D. study at Karolinka Institute, Sweden, provided a significant message about its effectiveness [4] (Picture 1).

The Araq tree, which is used as the miswak across a geography spanning from Africa to the far east, is a short tree or bush with a slanted trunk, and it is easy to chew its spongy roots, parts of which generally expand and soften when dipped in water (Picture 2).

The roots of the Araq tree are washed to remove the soil, and approximately 1 cm from the tip of the root stick is peeled to be used as the toothbrush. The stick is pummeled or chewed until the fibers become softer (Picture 3). Fresh and soft miswak are preferable: If the miswak is dry, it is advised to dip it in freshwater for 24 hours before use. It is better to peel frequently, so the tip is renewed. The most practical advice is to use the peeled tip until it loses its tang and fragrance, because the fragrant components indicate the beneficial effect of the miswak. According to a study, using the same tip for more than 24 hours lowers its cytotoxic ability to get rid of microbes.

The practice of using miswak in the Muslim World is widespread in Asia, Africa, and some regions in the Middle East. As many Muslims opt for miswak use to maintain a practice of the Prophet, the World Health Organization (WHO) also advises and encourages the use of miswak as an effective dental hygiene tool along with the conventional toothbrush. The miswak is easy to use and effective; it also has chemical properties that help control dental plaque. Based on the basic information we have about the miswak, we can easily say that deeper research is needed for its different components, like its fibers, essence, and essential oils.

Antibacterial effects of the miswak

The antibacterial activities of the essences obtained by crushing different roots of the miswak have been analyzed by microbiological techniques. It was discovered that the miswak essence has a very strong antibacterial effect, predominantly against Gram-negative bacteria, including mouth-cavity microbes like Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Two additional studies conducted on five different types of bacteria i.e. Streptococcus mutans, S. faecalis, S. aureus, Haemophilus influenzae, Salmonella enterica, and Candida albicans, and a type of fungus [5, 6, 7, 8] revealed that the miswak essence stops the reproduction of micro-organisms, has a lower effect on Lactobacillus acidophilus, is active against Herpes simplex virus which causes blistered lesions, and suppresses acid production.

The essential oil obtained from miswak essence includes 70% benzyl isothiocyanate, 9.4% limonene, 8.7% I-pinene and 2.55% flavonoid. As the miswak’s main antibacterial component, benzyl isothiocyanate kills bacteria by forming protrusions on their cell membranes. The volatile nature of this substance may open doors to new practices requiring antibacterial treatment. It has been proven that fresh miswak is effective at preventing the formation of dental plaque and gum inflammation, and it has also been acknowledged that it may play a potential role in preventing periodontal diseases.

The miswak essence hinders acidic (pH) conditions causing tartar and dental plaque, leads to a long-term increase of pH in the mouth, stimulates saliva flow in the parotid glands (located in front of both ears), and prevents tartar formation.

It is necessary to conduct further lab and clinical research to augment the positive results shown so far about the effects of the miswak against the inflammation of the palate and gums, as well as its antiviral and antifungal activities. Some research has additionally suggested that the miswak has antioxidant, analgesic, and anti-inflammatory effects. It is claimed that potassium chloride, salvadourea (a urea derivative), alkaloids, and oleic and linoleic acids in the miswak sap increase the viscosity of saliva, helps it to soak into hard-to-reach corners in the mouth, and contributes to overall dental hygiene. It is reported that a substance named Xylitol in the miswak essence suppresses acid production and the reproduction of mutant streptococci [9, 10].

An interesting substance in the miswak oil

Benzyl-isothiocyanates are effective molecules in the defense systems of several plants such as cabbage, watercress, and broccoli. Secreted after damage to plant tissues, benzyl isothiocyanate forms a protective antibacterial layer on the damaged part of the plant. While dental plaque and tartar are mechanically removed by rubbing the miswak on teeth, this action also helps the substance secreted from the miswak reach deeper parts of the oral cavity. It is especially proven that benzyl isothiocyanates are strongly effective as bactericide on Gram-negative bacteria and have minimal effect on Gram-positives.

Lab tests conducted on animals indicate that these components also have anti-carcinogenic activity, and people who get isothiocyanates by nutrition have a lower risk of cancer. It is fascinating that the miswak, too, has the same substance.

While introducing a new set of ethical principles, Prophet Muhammad, peace be upon him, revoked some customs and habits inherent to the pagan culture before Islam (Age of Ignorance) and kept others. Using miswak was a practice among the Arabs in the region; the Prophet encouraged its use and emphasized its benefits. Eventually, Muslims have adopted it as not only a habitual practice, but also as a healthy spiritual activity and are keeping the memory of the Prophet alive.

References

1. Wu, C.D., Darout, I.A. and Skaug, N. (2001): Chewing sticks: timeless natural toothbrushes for oral cleansing. Journal of Periodontal Research 36, 275-84.
2. Hyson, J.M., Jr. (2003): History of the toothbrush. Journal of the History of Dentistry 51, 73-80.
3. Bos, G. (1993): The Miswak, an aspect of dental care in Islam. Medical History, 37, 68-79.
4. Sofrata, A. H. (2010): Salvadora persica (Miswak). An effective way of killing oral pathogens. Thesis for doctoral degree (Ph.D.). From the Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
5. Al-Lafi, T. and Ababneh, H. (1995): The effect of the extract of the Miswak (chewing sticks) used in Jordan and the Middle East on oral bacteria. International Dental Journal, 45, 218-222.
6. Almas, K., Al-Bagieh, N. And Akpata, E. (1997): In vitro antimicrobial effect of extracts of freshly cut and 1-month-old miswak (chewing sticks). Biomedical Letters, 56, 145-149.
7. Almas, K. (1999): The antimicrobial effects of extracts of Azadirachta indica (Neem) and Salvadore persica (Arak) chewing sticks. Indian Journal of Dental Research, 10, 23-26.
8. Almas, K. (2001): The antimicrobial effects of seven different types of Asian chewing sticks. Odontostomatolgie Tropicale, 24, 17-20.
9. Kakuta, H., Iwami, Y., Mayanagi, H. and Takahashi, N. (2003): Xylitol inhibition of acid production and growth of mutans Streptococci in the presence of various dietary sugars under strictly anaerobic conditions. Caries Research, 37, 404-409.
10. Miyasawa, H., Iwami, Y., Mayanagi, H. and Takahashi, N. (2003): Xylitol inhibition of anaerobic acid production by Streptococcus mutans at various pH levels. Oral Microbiology and Immunology, 18, 215-219.

Is it why we cannot attain maximum mental performance?

If you are one of those people who are unsatisfied with their foreign language competence after many years of hard work, practice, and exposure, then this article may be for you. Even though research in foreign language learning enumerates several factors for foreign language failure – social, psychological, cognitive and affective – whose roles cannot be overlooked, my own view is somewhat different: I firmly believe that one of the main reasons why so many people cannot attain maximum performance, not only in foreign languages but also in other subjects, is largely because of “mental pollution.” This is why, I think, children are superior to adults at learning foreign languages, for they are devoid of severe mental pollution.

Let me first clarify what I mean by “mental pollution.” Certain images of different sizes, qualities, and shapes displayed on billboards, shop windows, posters, brochures, magazines, ads, TV, movies, videos, websites – these are mental pollution. Depending on their form and characteristic, they may greatly abuse a person’s mental energy and lead to chaotic and disturbing emotions. The more irrelevant, enticing, or lustful images are, the more detrimental they are to our social and academic life. For example, a small logo of a computer game – perhaps the size of a 5 cent coin – such as the dragon from Mortal Kombat, contains at minimum three kilobytes (3072 characters), which is equal to about 400 English words. Despite the premise that we only use 8-10 percent of our mental capacity, the amount of visual data the human brain is permanently exposed to cannot be underestimated when so many people, especially children, watch TV, play computer games, and surf the internet. Obscene pictures, in particular, are a common form of mental pollution nowadays, and they are some of the most deleterious to the human mind; they drastically increase blood pressure and heart rate and thus weaken the memory. As an example, a study by Brad J. Bushman has apparently revealed that watching violent television programs has adverse effects on one’s ability to remember.

Fethullah Gülen, a renowned modern Islamic intellectual, reminds us of the seriousness of the topic, while more people than ever before complain about forgetfulness and memory weakness. According to Gülen, the process of learning now takes longer than in the past, and forgetfulness, like an infection, has become prevalent among all levels of society due to polluted minds teeming with irrelevant information. He also points out that long ago people complained when they were not able to memorize and recite by heart a page after only one reading. In this day and age, people complain about weak memory and confess that they have great difficulty memorizing a short text that they have read more than 20 times. For a keen memory, his message to the present generation is to stay away from useless routines, frivolous conversations, irrelevant knowledge, and sources of obscenity.

Similar to a computer, the untrained human mind whose protection filter is set to a low level is under constant visual attack. Given this, mental pollution acts like a computer virus, a code that replicates by copying itself to another program, document, or e-mail, thereby seriously slowing down memory operations. Also, it can erase data or damage the computer’s hard disk, which is analogous to long-term memory in the human brain. Interestingly enough, lab experiments on rats have revealed that these animals simply choose to starve to death when they are tempted by brain reward-stimulus circuits in quests for neuro-orgasms. These rats rarely attain balanced brain chemistry, while the orgasm they experience results in a hangover that lasts for weeks. The same condition is also true for the human mind: the unnecessary over-discharge of hormones triggered by electrifying visual stimuli can lead to long-lasting forgetfulness, fatigue, and serious concentration problems. In such a case, a person cannot make sense of whatever he is studying until the side effects of mental pollution are over.

Foreign language learning also substantially suffers from the harmful effects of copious amounts of mental pollution. The modern methodology and technology to facilitate foreign language learning can be hampered by overwhelming exposure to mental pollution. Although they did not have the contemporary language learning resources and facilities, many early scholars and polyglots managed to learn numerous foreign languages. For instance, Guiseppe Caspar Mezzofanti, an Italian cardinal and famed linguist, is believed to have spoken 38 languages and 50 dialects fluently. Similarly, Sir John Bowring (100), Emil Krebs (68), Ziad Youssef Fazah (56), Ali Ufki (16), Muhammad Hamidullah (22), Pamulaparthi Venkata Narasimha Rao (13), Jose Rizal (22), and Sir Richard Francis Burton (29) were able to speak and read in many languages and dialects, as shown in parentheses, and their success is considerably astonishing when we compare them to present academics who have problems at mastering only one foreign language despite the available modern resources. I believe that these past scholars and polyglots, besides their talent and enthusiasm, did not suffer from widespread mental pollution as we do today. For example, the polyglot Mezzofanti was a prodigy in languages mostly because he spent his life in a monastery and therefore was not subject to any form of mental pollution that could preoccupy his mind and weaken his memory.

I am greatly convinced that an oft-overlooked but very serious barrier – mental pollution – which is very common among people, is a crucial reason for many people’s failure to learn a foreign language, among other subjects. In any discipline (academic or non-academic) where memory involvement is important, it is necessary to be aware of mental pollution. As long as we are unable to control our contact with mental pollution, learning new material will be very difficult and time-consuming, no matter how hard we try, and forgetfulness will continue to be unavoidable.

Enveloping our body like a piece of clothing, our skin is a miraculous organ that both forms a barrier against potential invaders and plays a crucial role in the maintenance of vital functions. It is a mirror that reflects our experiences, memories, and fate with the lines and marks on it. With a surface area of 1.72 square meters and a weight of approximately 9.6 kg, including the fatty tissue under it, the skin is the largest organ in our body and life cannot possibly be maintained without it.[1] It is through the skin that we learn knives cut, fire burns, and our mother has very soft hands. We don’t even realize, but the skin quietly carries out other numerous functions such as sweating toxins out of the body, maintaining body temperature, and synthesizing vitamin D.[2] Some of these functions are related to the sun and the protection of our body from it.

The sun emits all kinds of rays across the electromagnetic spectrum. The lethal ones among these rays are filtered by the atmosphere that envelops the Earth, so very few of these dangerous rays reach the land.[3] The rays that reach Earth are visible (wavelengths of 400-700 nm) and ultraviolet (wavelengths of 100-400 nm) rays. Ultraviolet radiation comes in three types: UVA, UVB, and UVC.

Having wavelengths of 320-400 nm, UVA rays make up 90% of the UV that reaches Earth’s surface. Regardless of whether it is cloudy or sunny, the same amount of these rays reaches Earth and penetrates as far as the lower layers of the human skin. UVA rays damage the connective tissue under the skin, causing the skin to get old and the formation of free radicals, which indirectly cause DNA damage, hence terminal skin cancers or melanoma. Rays that come in these wavelengths are also largely responsible for allergic reactions on the skin.

With wavelengths of 280-320 nm, UVB rays make up 5-10% of the UV radiation reaching Earth. These rays help with the synthesis of vitamin D but also cause sunburns and the synthesis of melanin in the skin. UVB rays also have a role in mutating genes that prevent growth of tumors, thus leading to the development of skin cancers other than melanoma.

With wavelengths of 100-280 nm, UVC rays are harmful to living things. When they reach the Earth’s atmosphere, UVC rays interact with the oxygen atoms here. This interaction leads to the formation of the ozone layer, which prevents UVC rays from almost never reaching the ground. These dangerous waves have been put into humankind’s service by being employed in the creation of the protective ozone layer.

Ultraviolet rays and the harmful effects of visible light on the skin

There are short-term and long-term effects of UV rays on the skin.

The short-term effects are sunburn, heat stroke, allergic reactions, suntan, and viral diseases such as herpes, which are usually felt shortly after exposure to the sun and can be triggered by suppression of the immune system. The long-term, accumulative effects are photo-aging (the skin getting wrinkly due to solar rays), sunspots, cataracts, and the development of skin cancers.[4]

On the other hand, our skin is not entirely unprotected against the dangerous effects of the sun. The keratin layer in the epidermis, the uppermost layer of the skin, absorbs or disperses light, so the amount of light penetrating into the layers below is significantly lowered. Beta-carotene in the skin along with some enzyme systems reduce free oxygen radicals released after exposure to the sun and thus eliminate solar damage. Likewise, melanin, which gives our skin its color, lies above the nuclei in skin cells and acts as an umbrella that protects the cellular DNA from solar radiation.[5]

Six subgroups of skin types have been determined according to color of the hair, eyes, and skin, as well as the skin’s reaction to solar rays. This classification is widely accepted for identifying risk groups and determining specific protection measures.[6]

Although the number of melanosomes, or melanin-producing cells in the human skin, is the same in all humans, the color of the skin is determined by the genetic differences in the type, amount, and size of melanin pigments. Melonosomes in Europeans are small and light, while those of Africans are larger and darker.[7]

The importance of protection from the sun

The frequency of skin cancer has been increasing, which is precipitated by the fact that the ozone layer has gotten thinner and people are not well informed about UV protection. Many people take beach vacations and sunbathe, do mountain sports, have tanned skin, work in open air professions (such as construction workers, lifeguards, and tour guides), and they do so without much care.

For protection, we should first know that harmful effects of solar rays accumulate over time. The damage caused by the sun is stored in the body, just like change we save in a piggy bank. Unfortunately, we accumulate 40-50% of the total damage we are exposed to in a lifetime in the first quarter of life – that is, during childhood and our teenage years.[8] The skin’s natural protection mechanisms are not fully developed during these periods, nor is our understanding of protection. A research study carried out in Australia has shown that the rate of malign melanoma seen in young people can be reduced by 73% through effective solar protection methods.[9]

The major reason for wrinkles, the primary and fundamental indication of aging skin, is not in fact our age but the sun. UVA and UVB rays break down the connective tissue below the skin, disrupt the skin’s repair mechanisms, and cause skin aging (or photo-aging). Therefore, photo-aging takes place faster and earlier in people who work outside.[10]

{Picture: Photo-aging visible on one side of a truck driver’s face}[11] 

It’s imperative that we begin teaching children and adolescents about UV protection: having suffered five sunburns in childhood and early youth increases the risk of developing melanoma by 80%.[12] Children shouldn’t spend long hours in the midday, summer sun. 

Solar damage isn’t just more likely in children and teenagers, but also in people with skin type 1 or 2 (light skin), red hair, and/or colored eyes (blue); people, especially light-skinned people, with many skin moles; people whose family members have or had skin cancer; those who have a skin disorder triggered by the sun (lupus, dermatomyositis, rosacea); and people who have innate light sensitivity (albino, xeroderma pigmentosum, etc.). All these groups must be particularly careful about protecting themselves from the sun.

What are some ways to protect ourselves from UV Rays? Well, because UV radiation bombards the Earth most intensely at noon during the summer, staying indoors is greatly recommended between the hours of 10:00 am and 4:00 pm.  Additionally, the reflection rate of solar rays is higher by the seaside and in snowy environments.[13]

Wearing appropriate clothes is still the most effective and the least expensive method of sun protection. Clothing can have a solar protection factor (SPF) of 15-30. The level of protection is determined by the type of fabric, number of pores, and type, color, and thickness of weaving. The best clothes are made from cotton, silk, and denim and are unbleached and woven tightly. Wet clothes are more permeable. The use of wide hats, sunglasses, and umbrellas are also important for protection.

In addition to these measures, sun protection creams should also be used. The idea that protection creams will prevent the synthesis of vitamin D, voiced frequently lately, should not prevent the use of sun protection because the solar rays we receive during the day from the face and hands are sufficient for the synthesis of vitamin D. A person should pick a sun cream appropriate for their skin and apply it in sufficient amounts 20 minutes before going out. Babies should be protected through natural means, and physical sun protection should be used for children and pregnant women. A person should reapply sun protection products every two or three hours while outside, and, if planning to swim, they should choose water resistant products.

Besides physical protection that blocks, scatters, or reflects solar rays, there are also skin-absorbable chemical protections with cosmetically accepted formulations that eliminate light by absorbing it.

Generally speaking, a good sun protection should protect against both UVA and UVB rays. It should be cosmetically acceptable, non-toxic, water and perspiration resistant, and at the appropriate SPF (sun protection factor) level. However, because reapplication is required every two to three hours, protection above SPF 50 is the same. Therefore, it is no use buying a more expensive, higher protection product.[14] For people with type 3 skin (darker white skin with gold tone), SPF 30 is sufficient. For light skinned people, children, and pregnant women, however, SPF 50 is recommended.

SPF is the number indicating by how many more times a sunscreen protects the skin against UVB than the skin itself. Skin type is very important in sunscreen choice. The natural protection period of a person with type 1 skin is 5-10 minutes, while it may go up to 90 minutes for a person with type 6 skin. In other words, a light-skinned person gets a sunburn in 5-10 minutes of exposure, while a dark-skinned person may not get one at all. Therefore, these people should not choose products at the same SPF level. For example, if the skin’s self-protection duration is five minutes, a sunscreen with a SPF of 30 provides the same protection for 150 minutes.

Apart from sun protection creams, oral products can also help with sun protection. For example, oral zinc intake is proven to prevent cellular and DNA damage caused by UV radiation. Vitamin C is effective at preventing UVA rays due to its antioxidant properties and vitamin E at preventing UVB rays. In addition, the intake of beta carotene (a precursor of vitamin A) and bioflavonoids (also called vitamin P which generally has effects similar to vitamin C), found in orange and red fruit, protects against UV damage. Polyphenolic compounds in green tea also display protective properties against UV radiation.[15]

Finally, we should remember that using a sun protection product is a small part of our attitude toward your overall protection from the sun. Considering the role of the ozone layer in filtering the sun’s harmful rays, we should protect the perfect balance in the universe and re-evaluate our responsibilities and future actions for the maintenance of this balance.

Notes

[1] livescience.com.

[2] Gilchrest BA. “Sun exposure and vitamin D sufficiency,” Am. J Clin Nutr. August 2008, Vol. 88 # 2 570S-577S.

[3] Understanding UVA and UVB. skincancer.org.

[4] sciencelearn.org.nz.

[5] “The Protective Role of Melanin against UV Damage in Human Skin.” Photochem Photobiol. 2008; 84(3):539-549.

[6] laserdocs.co.uk/easy-way-to-find-out-your-fitzpatrick-skin-type/

[7] Ibid.

[8] Adele CG, Sarah C Wallingford and Penelope M. “Childhood exposure to UV radiation and harmful skin effects: Epidemiological evidence.” Prog Biophys Mol Biol. December 2011, 107(3): 349-355.

[9] Green AC, Williams GC, Logan V, Srutton GM. “Reduced Melanoma after Regular Sunscreen Use: Randomized Trial Follow-Up,” Journal of Clinically Oncology. 20 January 2011, Vol. 29 # 3:257-263.

[10] Fitzpatrick’s Dermatology in General Medicine.

[11] www.nejm.org/doi/full/10.1056/NEJMicm1104059.

[12] Markovic SN, Erickson LA, Rao RD, et al. “Malignant Melanoma in the 21^st Century, part 1: Epidemiology, risk factors screening, prevention and diagnosis.” Mayo Clin Proc, 2007; 82: 364-380.

[13] Skin cancer prevention and early detection. www.skincancer.org.

[14] www.dermnetz.org.

[15] Halliwell B. “Free radicals, antioxidants and human disease.” Lancet 1994; 344-:721-724.

It is widely accepted in modern culture that people should eat three meals: breakfast, lunch, and dinner. Nutritionists generally recommend adding two snacks (one in the morning and the other in the afternoon) to help control appetite.

Interestingly, the practice of eating three meals a day is a recent phenomenon. Ancient Romans had only one meal, which they usually had at about four in the afternoon, and they believed it was unhealthy to eat more than once a day. What the Romans ate in the morning and at noon was very light and fast [1]. Later, rules in monasteries affected people’s behavior around food and drink.

During the industrial revolution, breakfast gained importance; workers needed food before work. And dinner didn’t become popular – at least in its current form – until the prevalence of artificial lighting made it possible to eat before dawn and after dusk [2]. The understanding that eating three meals a day is a healthy choice stems from a combination of belief, culture, and early epidemiological studies [3].

There are studies suggesting that having a regular eating habit positively impacts health, regardless of frequency of meals. On the other hand, in a recent and comprehensive study by Kahleova et al., which studied 50,660 adult members of churches in the USA and Canada, it was found that eating one or two meals a day caused lower weight than eating three meals, and also a relatively lower body-mass index (BMI) which got even lower as overnight fasts got longer [4]. The authors state that the positive effects of such a diet are caused by a combination of timing, meal frequency, and overnight fasting, as well as having less frequent meals coupled with precise timing. These results indicate that eating one or two meals is better than eating three or more.

The Prophet’s example

The Prophet Muhammad’s, peace be upon him, recommendations and behaviors lend support to modern medical studies in the area of nutrition, as in many others. He would eat no more than two meals and ensure that one of the meals should consist of light food (such as dates). The Prophet recommended that dinner be eaten, even if it was only a small meal. “Do not leave dinner, even if it is only a handful of dates, because abandoning it makes one weak” (Sunan Ibn Majah).

He defined dinner as the second and last meal of the day, and that it should be eaten after dusk or immediately after the evening prayer.

The Prophet set so many examples about nutrition. He highlighted the dangers of obesity, stating that “What I fear most about my community are developing a belly, oversleeping and idling.” This was centuries ago; nowadays, obesity is an epidemic raging across the world, and its prevalence has almost doubled in more than 70 countries since 1980. In 2015, a total of 107.7 million children and 603.7 million adults were obese [5]. Seventy-five percent of the world’s population is overweight. Obesity, along with dyslipidemia and hypertension, is one of the major factors in cardiovascular diseases. Studies have shown that exercise, as well as meal timing and frequency, are quite effective in weight control [6].

As for table manners, the Prophet said, “The human does not fill any container that is worse than his stomach,” and, “It is sufficient for the son of Adam to eat what will support his back.” Throughout his 63-year-long life, the Prophet never left the table on a full stomach or ate before getting hungry; he recommended that food should not be swallowed without chewing, a practice he maintained. By refusing to sit at tables where there were several types of food, our Prophet was occasionally unable to find anything to eat. There is also no information that our Prophet ever had lunch.

The Prophet’s insistence on fewer meals looks very wise. Not only does eating fewer meals lead to lower incidences of obesity; if it includes a reduction in carbohydrate intake, it can also lead to decreases in total and LDL (bad) cholesterol levels [7]. Considering meal frequency and timing, it is crucial which meals are maintained. In general, breakfast-eaters tend to run a lower risk of weight gain than non-breakfast-eaters – and a significantly lower risk of heart disease [4].

Current studies indicate that food content has as much impact on blood lipids and insulin as meal frequency. Although we cannot fully explain the effects of a single factor on physical health, we are pretty much sure that meal frequencies are closely related to meal timing and which kind of foods are eaten.

The Prophet’s main requirement of food was that it should be lawful and clean, as well as beneficial for the body. His two meals consisted of breakfast and dinner, as is recommended by modern medicine. In a nutshell, the amount of intake and eating etiquette recommended by our Prophet is allocating “one third of the stomach for food, one-third for drink, and one-third for air” (Tirmidhi, Zuhd, 47) and completing meals without getting full. Increasingly, science suggests this may have been good advice!

References

1. Flandrin, J.-L.; Montanari, M. Storia dell’alimentazione; Laterza: Bari, Italy, 2003. 2.Affinita, A.; Catalani, L.; Cecchetto, G.; De Lorenzo, G.; Dilillo, D.; Donegani, G.; Fransos, L.; Lucidi, F.; Mameli, C.; Manna, E.; et al. Breakfast: A multidisciplinary approach. Ital. J. Pediatr. 2013, 39, 44.
2. Potter, C.; Griggs, R.L.; Brunstrom, J.M.; Rogers, P.J. Breaking the fast: Meal patterns and beliefs about healthy eating style are associated with adherence to intermittent fasting diets. Appetite 2018, 133, 32–39.
3. Kahleova, H.; Lloren, J.I.; Mashchak, A.; Hill, M.; Fraser, G.E. Meal frequency and timing are associated with changes in body mass index in adventist health study 2. J. Nutr. 2017, 147, 1722–1728
4. Collaborators, G.B.D.O.; Afshin, A.; Forouzanfar, M.H.; Reitsma, M.B.; Sur, P.; Estep, K.; Lee, A.; Marczak, L.; Mokdad, A.H.; Moradi-Lakeh, M.; et al. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 2017, 377, 13–27.
5. Paoli, A.; Moro, T.; Marcolin, G.; Neri, M.; Bianco, A.; Palma, A.; Grimaldi, K. High-intensity interval resistance training (hirt) influences resting energy expenditure and respiratory ratio in non-dieting individuals. J. Transl. Med. 2012, 10, 237.
6. McGrath, S.A.; Gibney, M.J. The effects of altered frequency of eating on plasma lipids in free-living healthy males on normal self-selected diets. Eur. J. Clin. Nutr. 1994, 48, 402–407.

Every thirty minutes, a person dies in an alcohol related car accident. Alcohol is the most common addictive substance used in the US, according to the National Council on Alcoholism and Drug Dependence (1). Alcoholism continues to create great burdens in societies throughout the world due to its cost or the consequences brought to families suffering from its abuse. It has a toll on people of every race, gender, age, and ethnicity. Social and moderate drinkers justify their habit by stating that a few drinks would even be good for health, yet they do not realize that their habit could lead to a destructive future addiction. In a world where alcohol is viewed as a necessity for social gatherings and environments, it is easy to overlook the risks associated with its consumption.

Research studies have shown that alcohol drinking significantly increases the risk of developing cancers throughout the body. With at least fifteen carcinogenic compounds such as ethanol, acetaldehyde, arsenic, benzene, formaldehyde, aflatoxins, (2), alcohol can have a direct carcinogenic effect on gastrointestinal cancers through indirect effects by over-expression of oncogenes in cells that trigger cancer development. In addition to a carcinogen effect, it also has a co-carcinogen effect by boosting carcinogenic properties of chemicals (3).

Upon consumption, ethanol is oxidized by bodily enzymes to form acetaldehyde, a very toxic product, during alcohol metabolism (2). High level concentrations of acetaldehyde trigger mucosal hyperproliferation when in contact with the mucosal layer of the digestive tract (4). Alcohol also causes common diseases referred directly by its name such as; alcoholic cirrhosis (alcohol is the most common causative factor of cirrhosis), alcoholic liver disease, alcoholic steatohepatitis, alcoholic cardiomyopathy, alcohol induced chronic pancreatitis, alcoholic hypoglycemia, alcoholic neuropathy, alcoholic anemia, alcoholic dementia, alcohol induced depression and seizures, etc. A beneficial effect of alcohol is that it is one of the agents which can increase the level of good cholesterol called high density lipoprotein (HDL). On the other hand it also deteriorates hypertension and leads to alcoholic cardiomyopathy with its toxicity. The question then is, “Is it safe for a person to use a toxin due to its only one beneficial effect although it is the most common factor of many diseases that are referred directly by its name?” Considering even beyond the organic effects, alcohol can also harm our relationships and cause legal problems such as driving while drunk or intoxicated.

Recently, Bagnardi et al. (5) reported a meta-analysis about alcohol drinking and cancer in a medical journal, the Annals of Oncology, showing that alcohol consumption even in small amounts increases the risk of oral cavity, pharynx, esophagus, larynx, liver, breast, and colo-rectum cancers. Most of the data derives from studies of moderate to high alcohol intake. For the first time, the researchers evaluated the association between light alcohol drinking (even 1 drink daily) and cancers by evaluating 13,814 non-unique papers identified through literature search. 222 unique papers were included in the meta-analysis, comprising ~92,000 light drinkers and 60,000 non-drinkers with cancer. Most notably, even light drinking was associated with the risk of oropharyngeal cancer, esophageal squamous cell cancer, and female breast cancer (5). These findings show that even though some findings have suggested health benefits for light alcohol consumption, risk of cancer increases with any sort of alcohol consumption.

Previously, there was some support that light consumption of alcohol – one glass for women and two glasses for men – might improve cholesterol levels, lower the risk of forming blood clots, decrease inflammation, and increase antioxidant activity. However, this mere suggestion has quickly been generalized to the overall public. Potential benefits of light drinking depends on the patients’ age, general health, lifestyle, nutrition, history of alcoholism, and many other factors. According to research evidence, any amount of alcohol consumption poses and increases the risk of alcohol linked cancer (6). Because alcohol consumption is a modifiable risk factor for cancer and many diseases, the more a person consumes alcohol products, the greater the risks are (7). These risks are also lowered by reduction in alcohol consumption; thus there is no truly “safe” level of alcohol intake (6).

Alcohol reduces the blood levels of vitamins A and E, zinc, iron and some B vitamins, including folate and thiamin, leading to vitamin deficiency, nutritional disorders, and toxicities, all of which can trigger cancer development. Alcohol suppresses the immune system and makes alcoholics more susceptible to developing cancer (8). Considering these data, drinking alcohol for older people has no potential benefits. The risk-to-benefit ratio is a little higher in younger individuals, as they have higher rates of binge drinking and acute intoxication.

The sensitive question to consider is: should individuals consciously poison themselves if they think that a toxin might have a potential beneficial effect? Can a clinician recommend a toxic drug use for its effect on nausea? For alcohol, the evidence of harmful effects is stronger than evidence of the beneficial effects (6). There are many other proven safer ways of maintaining our heart health on track, without any risk of alcohol-related hypertension, stroke, coronary artery disease, diabetes, congestive heart failure, cancer, dementia, violence, or accidents.

Then, why is alcohol so praised nowadays? The alcohol industry tries to maintain and endorse alcohol consumption. In some countries, alcohol production is very high and is an important element in the economy. Public health has a very powerful opponent known as the alcohol industry; Bagnardi et al. (5) have reported a meta-analysis published against the alcohol industry and their enormous power against public health.

Even light drinking practice may turn many vulnerable people into alcoholics. Alcoholism is a prodigious defect behind many physiological and psychological problems, not only in individuals but also within many families and societies. It can also result in drunk driving accidents, which claim thousands of lives in the US every year. One simply cannot become an alcoholic if they do not drink. It would be beneficial to have people re-think their stance about this real toxin to fight against alcohol abuse and dependence.

Tahan is a student at the College of Sciences, University of Iowa.

References

1) https://ncadd.org/for-the-media/alcohol-a-drug-information

2) Lacshenmeier DW, Przybylski MC, Rehm J. Comparative risk assessment of carcinogens in alcoholic beverages using the margin of exposure approach. Int J Cancer. 2012; 131(6):E995-1003.

3) Haas SL1, Ye W, Löhr JM. Alcohol consumption and digestive tract cancer. Curr Opin Clin Nutr Metab Care. 2012;15(5):457-67.

4) Homann N, Kärkkäinen P, Koivisto T, Nosova T, Jokelainen K, Salaspuro M. Effects of acetaldehyde on cell regeneration and differentiation of the upper gastrointestinal tract mucosa. J Natl Cancer Inst. 1997 Nov 19; 89(22):1692-7.

5) Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Bellocco R, Negri E, Corrao G, Rehm J, Boffetta P, La Vecchia C. Light alcohol drinking and cancer: a meta-analysis. Ann Oncol. 2013; 24(2):301-8.

6) http://www.medscape.com/viewarticle/824237

7) Holman DM, Grossman M, Henley SJ, Peipins LA, Tison L, White MC. Opportunities for cancer prevention during midlife: highlights from a meeting of experts. Am J Prev Med. 2014; 46(3 Suppl 1):S73-80.

8) Pericleous M1, Mandair D, Caplin ME. Diet and supplements and their impact on colorectal cancer. J Gastrointest Oncol. 2013; 4(4):409-23.

MicroRNAs as tiny regulators with big roles

Tiny RNAs, known as microRNAs, have been shown to regulate many components of the body’s cellular machinery. They are called microRNAs because they are only 22 nucleotides in size (compared to the 2200 nucleotide-long messenger RNA). Amazingly, these small non-coding RNAs can turn off the translation of their target genes. They act as control switches by targeting the 3′ untranslated regions of messenger RNAs (mRNA) for translational repression or cleavage, thus resulting in a reduction of protein levels. Because each microRNAs can regulate hundreds of messenger RNAs, there are probably few cellular processes not affected by microRNAs. For instance, microRNAs have recently emerged as playing important roles in a variety of cellular processes, such as heart development, stem cells, insulin secretion, and cholesterol synthesis. MicroRNAs were first discovered in worms more than 20 years ago. For many years, scientists thought that DNA was transcribed to RNA, and then translated to protein. Those proteins are major regulators in the cell. Now, they appreciate that there are more levels of control and a number of non-coding RNAs that regulate the level of cellular components. About one thousand microRNA genes have been discovered in the human genome. This makes the microRNAs one of the most abundant classes of regulatory genes. As a result of the discovery of this new and major level of regulation in the cell, Dr. Andrew Z. Fire and Dr. Craig C. Mello were awarded the 2006 Nobel Prize in Physiology or Medicine.

MicroRNA biogenesis

Unlike other RNAs, the production of microRNAs is quite different. As depicted in figure 1, the generation and activity of microRNAs requires special microprocessors, known as RNA polymerase II, Drosha, Exportin, Dicer, and RISC complex. RNA polymerase II transcribes (reads the microRNA DNA code) primary microRNA transcripts; then the Drosha process transforms primary microRNA into precursor microRNA in the nucleus. For activity and further processing, precursor microRNA are exported into cytoplasm by Exportin. In the cytoplasm, Dicer cuts precursor microRNA and generates mature 22 nucleotide long microRNA. Then, mature microRNA are incorporated into the RNA inducible silencing complex (RISC) where they target messenger RNAs (mRNA), either for degradation or translational repression. Even though there are extensive studies on microRNAs, it is still mostly unknown how microRNAs target specificity is determined and how they target messenger RNAs for mRNA degradation or translational repression. For a functional microRNA in the cell, it is amazing that a series of microprocessors should take place. They recognize different microRNAs as substrates and do their job as they are supposed to. It seems that the existence and regulation of microRNA processing abilities cannot be by mere chance.

MicroRNAs as therapeutics

MicroRNAs are considered “fine tuners” of cellular processes because of their subtle effects on their targets. However, because microRNAs can target a number of genes and genetic pathways, the study of microRNAs and their regulation and role in diseases is highly promising in terms of developing new therapeutic approaches. Treatments by targeting microRNAs using microRNA inhibitors (antisense RNA nucleotides) are under intense study and several of them have been shown to be effective in animal models. A MicroRNA known as miR-122, for instance, has been shown to regulate cholesterol levels. Scientists targeted this liver-specific microRNA by using a microRNA inhibitor and they found that the downregulation of miR-122 resulted in a 40% decrease in cholesterol levels in the blood.

MicroRNAs in cancer therapy

With the discovery of new and better tools to detect and manipulate microRNA levels in cell cultures and tissues, researchers are now attempting to identify the specific features of each microRNA and their role in cancer and other devastating diseases. There are some microRNAs that are highly correlated with cancer formation. Cancer is cellular anarchy characterized by a proliferation of cells without control. A group of miRNAs known as the miR-17-92 family have been found to increase, and their higher levels result in cancer formation as found in some lymphomas and solid tumors. It is believed that better understanding and use of microRNAs or microRNA inhibitors could enable doctors to treat diseases like cancer. In the near future, microRNA studies are also expected to provide early detection of progressive diseases, better markers for cancer initiation, and cancer specific drug selections.

MicroRNAs as cancer drug boosters

The most straightforward application of microRNA research has been cancer chemotherapies. The potential of use of microRNA applications to increase the effectiveness of current cancer drugs seems highly likely. Companies and universities are looking for microRNA partners to increase the effects of drugs like Taxol, which is currently used in chemotherapy. Taxol, for example, currently works for about 30% of lung cancer patients. But, if we can find a microRNA partner with that drug to make it 40%, it will mean saving thousands of lives. This is a hopeful sign for the future of cancer treatment. On the other hand, it is known that in the case of any chemotherapy, there are unwanted side effects. Although use of higher dose of drug will kill more tumors, the side effects of this drug will cause other issues. Discovery of partners like microRNAs that boost the effectiveness of cancer drugs or decrease side effects can help to treat more patients or help them overcome unwanted side effects.

Taking microRNAs to the heart of the matter

Heart diseases represent the primary cause of death in developed countries. Recent studies have identified microRNAs associated with heart diseases, including cardiac hypertrophy, heart failure (inability of the heart to pump sufficient blood to the organism), and myocardial infarction (the death of the cardiac muscle resulting from interruption of the blood supply). Mir-1 expression levels, for example, are low in human heart disease and it is known to regulate Hand2, a protein required for the growth of heart muscle cells. The levels of another microRNA, called miR-21, have consistently increased through cardiac stress and have been shown to regulate cardiac growth as well. Importantly, miR-133 is believed to repress cardiac hypertrophy, thus the use of synthetic miR-133 molecules is possible as a therapeutic for patients with pathological hypertrophy. However, more studies to understand heart-associated miRNAs are needed in order to have clinical trials for the treatment of heart diseases.

Figure 2. MicroRNAs in the heart. Recent studies have identified microRNAs that are associated with heart diseases, including arrhythmic heartbeat (Arrhythmias), cardiac hypertrophy (enlarged heart), septation defect, and cardiac muscle overgrowth (myocyte hyperplasia).

Micromanaging insulin secretion

MicroRNAs are also associated with the onset of diabetes. Diabetes affects about 23.6 million people in the United States. It can lead to serious health issues and even early death. Diabetes is marked by high levels of blood glucose (also called blood sugar). Complications of the disease are due to defects in insulin production and insulin action. Insulin is among the major regulators of sugar levels in the blood. The human genome contains a number of microRNA genes, whose functions are only beginning to come to light. One such microRNA, miR-375, is already implicated in the secretion of insulin from pancreatic cells, thus it represents a novel pharmacological target for the treatment of diabetes.

The mentioned cases above are examples of the tiny RNAs which regulate cellular processes. The loss of the control in such a small component of the cellular machinery can lead to serious problems, like cancer. To use a metaphor, the regular and healthy government of a state does not allow for the presence of multiple governors. Similarly, regulatory tiny RNAs require a controller who knows how the human body works at the macro and micro levels. This forces us to consider that whomever is controlling the human body must be all sustaining and all knowing. With each new scientific breakthrough, the wisdom of creation becomes more and more apparent. The field of miRNAs is a young research area. New discoveries about microRNAs have brought us new hopes for novel therapies to human diseases. However, future discoveries are required before these therapies can be used in a clinical setting.

Resources

• Qur’an: The Family of Imran 191 and The Cow 255.
• Caldas & Brenton. “Sizing up microRNAs as cancer genes”. Nature, 2005.
• Scott M. Hammond. “MicroRNA therapeutics: a new niche for antisense nucleic acids” Trends in Molecular Medicine, 2006.
• Rooij et al. “Toward MicroRNA–Based Therapeutics for Heart Disease” Circulation Research, 2008.
• National Diabetes Statistics, 2007. Retrived from http://diabetes.niddk.nih.gov/DM/PUBS/statistics/
• ScienceDaily. Not ‘Junk DNA’ After All: Tiny RNAs Play Big Role Controlling Genes. 2007.
• Callis & Wang. Taking microRNAs to heart. Trends in Molecular Medicine. 2008.
• Poy et al. A pancreatic islet-specific microRNA regulates insulin secretion. Nature,2004.
• Average mRNA length: B. Lewin, Genes 5, Table 2-2. Oxford University Press.
• MicroRNA biogenesis figure: http://content.nejm.org/content/vol359/issue25/images/large/14f1.jpeg

Harming our bodies or health is a betrayal against this incredible gift. One of the major ways people harm the body is through smoking cigarettes.

Smoking harms human health in countless ways. It is one of the main causes of many diseases, such as lung and throat cancer, along with cardiovascular and respiratory track diseases, such as chronic bronchitis. According to the latest report from the World Health Organization, smoking remains the fourth of the top ten risks that threaten human health. Approximately 20-30% of adult fatalities are caused by ailments contributed to by smoking. Recent studies have shown the negative effects smoking has on human reproductive functions.

Effects on fallopian tubes

Smoking has a negative impact on female reproductive organs; this impact is determined by how long, and how much, a woman smokes. It may cause infertility by damaging the fallopian tubes that serve as a ground for the egg to be fertilized by sperm. In many studies, the risk of damage to the fallopian tubes was very high – this danger increases if a woman starts smoking a pack a day before the age of 18.

Effects on female hormones

Many toxic substances in cigarette smoke, including nicotine, directly inhibits the activity of the enzyme called aromatase, which plays a major role in the synthesis of the female hormone (estrogen) in the ovaries. Depending on the biological function, estrogen can be found in three different forms: as estrone, estriol and estradiol. Polyaromatic hydrocarbons found in cigarette smoke stimulate the microsomal cytochrome P-450 enzyme system that degrades hormones in the liver and, consequentially, increases conversion of estradiol with high biologic activity into estriol with the lowest activity. Alkaloids, one of the harmful substances found in cigarette smoke, were discovered to prevent production of progesterone in the ovaries. This plays a role in preparing the womb and in continuation of the pregnancy during the first three months. Therefore, smoking leads to progesterone deficiency during the early stages of pregnancy, causing miscarriages.

Effects on the maturation of the egg

The concentrations of the FSH hormone that is involved in the maturation of reproductive cells in the ovaries are especially high in young female smokers. In other words, a resistance develops against the FSH hormone in the ovaries and higher FSH hormone levels are required for the maturation of the egg. Thus, fertilization problems and missed periods can occur because of an absent reproductive cell. During the treatment of such patients with insufficient egg cell maturation, there is a 50% decrease in the success of the implantation (placement of the fertilized egg into the womb) and the continuation of the pregnancy in smokers when compared to nonsmokers. This means smoking significantly reduces ovarian functions, and ovarian stimulation becomes inadequate at earlier ages in women.

The negative effects of smoking on the reproductive system are also observed during the implementation of reproduction methods such as in vitro fertilization and assisted fertility technologies. The presence of high androgenic hormone levels (pre-metabolites of gender related hormones: androstenedione, DHEAS and testosterone/SHBG) in female smokers has been found to decrease the possibility of pregnancy during in vitro fertilization efforts.

Effects during pregnancy

There are many harmful consequences of smoking during pregnancy, especially for older women who are pregnant. Some of these consequences are premature birth, miscarriage, retardation of development, inadequate baby weight, perinatal mortality, ectopic pregnancy, placental praevia, and placental abruption. Placental praevia is the abnormal placement of placenta in the womb. In this case, depending on the excessive bleeding that occurs after the eighth month of gestation, the lives of the mother and fetus become imperiled, and fetal development is hindered. Placental abruption occurs depending on the premature separation of placenta from the womb, causing excessive bleeding that can also endanger the lives of the mother and baby.

In pregnant smokers, the postnatal ratio of infant mortality and disability increases as a consequence of deficiencies involving lung function and nerve development. These effects are directly proportional to how much a woman smokes. There are also negative impacts when a pregnant woman is exposed to second hand smoke by a spouse or close friend. Harmful metabolites of nicotine reach the baby via the placenta. Furthermore, nicotine is degraded slowly in the liver of a pregnant woman. Inadequate baby weight is related to smoking dosage and time.

Due to smoking in the early stages of pregnancy, the hormone levels of estriol, estradiol, progesterone and hCG, hPL which is secreted from the placenta, have been found to decrease. This reduction, which is observed in parallel with the amount of smoking, can result in miscarriages.

Toxic polyaromatic hydrocarbons have been found to accumulate at elevated ratios in the wombs of women who were exposed to cigarette smoke for a long time. During pregnancy, this situation leads to the deterioration of sertoli cells located in the reproductive glands of male fetuses. These glands assist in sperm production during adulthood, and damage to them can therefore cause a reduction in sperm generation.

An insufficient placental development occurs because of the negative effects of nicotine, cadmiums, and polyaromatic hydrocarbons damage the reproduction of trophoblast cells that make up the placenta. This situation explains the increasing miscarriage ratios among female smokers.

The free T4/TSH ratio in the serum of the umbilical cord, which connects the fetus to the placenta, increases in the babies of smokers compared to those of nonsmokers. This means that in babies of smokers, the thyroid glands may become overactive during birth. Depending on a mother’s smoking habits, this hyperactivity of the fetal thyroid increases the metabolic speed and the amount of consumed oxygen in the body, thus leading to the inadequate development of fetus.

Menopause occurs two-to-four years earlier due in women who smoke, as compared to non-smokers. This is due to the aging of the eggs. The risk of entering menopause before the age of 45 in women who quit smoking at least ten years prior is 87% less than smokers who don’t quit. Therefore, the earlier a woman stops smoking, the lower the risk of early menopause.

Effects of smoking on men

In research studies, it has been discovered that smoking has many harmful effects on testicular development and functions. These effects can be summarized as follows:

• Reduction of semen volume and quality, increase in its adhesiveness, delay in its becoming liquid, and resulting deformation of the sperm.

• Reduction in the number and mobility of sperm cells.

• Delayed sperm nucleus maturation, deteriorated DNA integrity.

• Decrease in the production of testosterone from Leyding cells.

• Decrease in the egg fertilization capacity of the sperm.

As a consequence of these negative effects, male infertility can occur. As the amount of daily cigarette consumption increases, the number, strength, and types of anomalies also increase. In a study conducted in 2010, smoking has been showed to decrease zinc levels in the seminal plasma. As a result of this decrease, oxidative agents populate and DNA breaks take place, thus causing a disruption of sperm functions and infertility. Zinc deficiency at the same time leads to the destruction of seminiferous tubule cells where sperm cells are produced. Paternal smoking generates negative results during the application of assisted fertility methods (such as in vitro fertilization). The damage in the sperm DNA of the father can disrupt the embryo development. The risk of anomalies, cancer, and genetic diseases increases for the fetus.

Cigarette smoking clearly occupies a position as one of the worst enemies of mankind because of its destructive effects on the body. In this case, it does not make any sense to try finding excuses for smoking, for it is harmful to the body that has been loaned to us as a gift and a temporary property.

Cihanoglu is a professor of medicine in KATU, Trabzon, Turkey.