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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Our body is perfectly coordinated to regulate our blood sugar level. But when our insulin levels are artificially altered, serious diseases can occur.

The human body needs energy. ATP (Adenosine Triphosphate) is to each cell in the body what gasoline is to a car. This energy is stored inside the bonds of the three phosphate molecules attached to an adenosine nucleotide. The light energy that exists in the sun’s rays is converted into chemical energy, stored in the form of carbohydrates, proteins, and fats through the photosynthetic reactions taking place in the chloroplasts of plants. Molecules of chemical energy are broken down in the mitochondria organelle of the cells in order to utilize their energy for ATP synthesis. This chemical energy (ATP) derived from nutrients is used by the eyes to see, the ears to hear, the hands to grab, the feet to walk, the heart to pump blood, the stomach to digest foods, the kidneys to filter blood, red blood cells to carry oxygen, white blood cells to fight germs, and the brain to think, memorize, and remember.

ATP is primarily synthesized from glucose – commonly known as blood sugar (glycolysis) – in approximately 100 trillion cells in our body. Glucose means fast energy. A sensitive metabolic balance is established (homeostasis) to maintain a blood glucose concentration in between 70-100 mg/dl for a nonstop energy flow and to prevent any cellular damage. If this balance is thrown out of order, many medical problems will ensue, primarily cardio-vascular diseases. How is the homeostatic balance of blood sugar maintained in healthy people?

Maintenance of blood sugar balance

The blood sugar balance is provided by the assistance and cooperation of the pancreas, liver, fat tissue, muscle tissue, the brain, the digestive system, and the kidneys. The chiefs of the orchestra here are the insulin and glucagon hormones synthesized in the pancreas, which operate in great harmony and yet have opposite functions. Insulin is in charge of dropping blood sugar; however glucagon increases it.  

The fine balance of blood sugar is conserved before we sense it for various energy situations such as exercise, sleep, or various energy intake cases such as overeating or skipping a meal. The real hunger is the 8-10 hour long “night fasting” period. During this time, since there is no food intake, the glucose that cells require for energy production is obtained from reserves in the liver. Thus, cells get their energy and blood sugar levels are kept at normal levels. If there is no additional food intake and the fasting time becomes longer, the glycogen reserves of the liver get consumed within 10-18 hours and necessary energy is obtained from fats and proteins. However, real fullness corresponds to a period of 4-6 hours “after meal.” During this time, the complex and macro size carbohydrates are converted to glucose in the liver and this glucose is stored as glycogen. Because the glucose storage capacity of the liver, which has numerous tasks, is limited, the excess glucose is stored by conversion into fatty acids. The unspent excess calories from three meals eaten in five hour intervals will be stored in either the liver or as fat tissue during the 12-18 hour long fullness period. The utilization of fats stored in the humps of camels which form by food intake to compensate for their energy and water needs during long desert travel can be given as an example of this.

In fact, when we say “I am hungry,” we acknowledge that the time has come to resupply our ATP reserves of nearly 100 trillion cells. The most important stimulator for the secretion of insulin from the pancreas is glucose. With the first bite, the readied insulin reserves of the pancreas are released into the bloodstream. This event, which takes place approximately within the first 6-10 minutes, is called the first-phase insulin response. With the language of reduced glucagon as a result of increased insulin, the message that it is no longer necessary to release glucose into the blood is transmitted to the liver. The blood sugar levels increase with continuing food intake (hyperglycemia) and this information is relayed to the pancreas through hormones secreted by intestinal cells. As directed by this signal, the proper insulin amount necessary for blood sugar levels is secreted into the bloodstream from the pancreas. This is called the late-phase insulin response.

The tasks of insulin

Cells are in need of insulin to uptake glucose into capillary vessels. Insulin binds itself to its specific receptor on the membrane of a cell, conducting its message, especially to muscle tissue. It’s saying, “The glucose food that you need is brought here by the blood vessels, and you can retrieve it.” After receiving the message inside the cell, GLUT (glucose transporters) molecules, which are in charge of glucose intake and are stored in the cytoplasmic vesicle pool, are carried to the cellular surface. Molecular gates are established once these molecules merge with the cellular membrane for the entrance of glucose through it. Glucose is inserted into the cell via this gate. The retired GLUTs are collected back in the cytoplasmic pools after cellular energy demand is met.

While these events are taking place, commands are given to the liver to prepare for the load of glucose arriving from the intestines and for adipose tissue to store the excess fat. These meticulous processes last for approximately two hours. The blood sugar level recedes back to its normal limits, but the activities of the liver and the adipose tissue continue at a rapid pace. If overeating occurs, the liver cannot take such a load. This can cause a delay in its functions, which will cause the body to feel tired.

The insulin and glucagon hormones have a half life of 3-5 minutes and are rendered ineffective in the liver and kidneys once they conclude their tasks. Thus, the body prevents lower blood sugar levels because of high insulin concentrations (hypoglycemia) or because of higher glucagon levels; it also prevents higher blood sugar levels (hyperglycemia).

The disruption of the blood sugar balance

Diabetes is the chronic observation of blood sugar above normal limits. This happens when the insulin hormone levels secreted from the pancreas are reduced and not able to carry out their function. There might be genetic factors present that contribute to diabetes; however, stress, a lack of exercise, obesity, and the consumption of processed foods containing elevated levels of carbohydrates often lead to the onset of diabetes in adults. The fine balance in between the liver, pancreas, muscles, and fat tissue can be disrupted by the following reasons:

1. If the number of cells in charge of insulin production in the pancreas decreases, sufficient insulin cannot be produced.
2. The message of insulin cannot be retrieved completely because of a disruption occurring at the receptors where insulin binds on cells, or due to lower numbers.
3. There may be a problem with reactions regarding GLUT production in accordance with the internal message retrieved upon bondage of insulin to the receptors.
4. During fullness, if the necessary suppression of glucagon production in pancreatic cells is not adequate, the glucose release from the liver continues.
5. The secretion of late-phase insulin response hormones in charge of pancreatic stimulation from the intestines is reduced.
6. Emptiness of the stomach is delayed, and a longer absorption time of nutrients occurs.
7. The appetite center is over stimulated and the urge to eat increases.

If the reasons above take place, then the blood sugar level is above normal. Normal blood sugar drops below 140 mg/dl two hours after a meal in healthy people, whereas this cannot be maintained in diabetic patients.

An iron pipe with salty sea water running through it for years is similar to a capillary vessel that has blood with high sugar levels inside it in terms of the damage that they undergo. Once hypertension and cholesterol joins diabetes, the heart, eyes, and kidneys will not function properly. These organs are great blessings granted to our body which we often appreciate only once we lose them. Therefore we must follow an intermediate path in eating and drinking, just as in every situation, avoiding excess.

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

A sugar is a monosaccharide if it is made up of a single sugar molecule; it is disaccharide if it is built by two sugar molecules; and a polysaccharide if it is composed with multiple sugar molecules.

Sugars that we ingest are broken, in the digestive system, into monosaccharides of glucose, fructose, and galactose. Almost all of the absorbed monosaccharides are first converted into glucose in the liver. This conversion is a very important task of the liver: 80% of the sugars passing into the blood are glucose. As a result, very limited amounts of fructose and galactose are present in the blood. Therefore, when blood sugar is mentioned, normally glucose is taken into consideration and the fructose and galactose levels in the blood are ignored. Glucose, which is also called grape sugar, is most abundantly found in grapes, while fructose is called fruit sugar, as it is plentiful in fruits, and galactose is named milk sugar after its dense presence in milk. The most important characteristic of fructose is that it is sweeter compared to other simple sugars.

Insulin is secreted from the pancreas in order to lower elevated blood glucose levels after digestion. Insulin functions in the transport of glucose from the blood into cells to provide necessary energy, therefore reducing blood sugar levels; furthermore, it also plays a role in the storage of excess glucose as glycogen, which is found primarily in the liver. Once glycogen storage limits are reached in the liver and muscles, glucose is then stored as fat. Fat tissue acts as sustenance during long fasting periods.

Differences between fructose, glucose, and galactose

Glucose and galactose are absorbed actively, depending on salt. They cannot be absorbed without salt while passing through the intestines. Salt is necessary for the absorption of glucose which is present in the starches of potatoes and other foods. Thus, when potato is consumed with salt, the transport of glucose into the blood is facilitated.

However, salt is not necessary in the case of fructose absorption. The intestinal absorption of fructose contained in fruit is delayed by fruit fibers, since these fibers prevent or balance the transport of fructose into the bloodstream. However, when fructose is ingested as a fruit juice, it is absorbed and joins the bloodstream much faster because of the lower fiber content.

A person feels full after a meal when neurons in the satiety center of the hypothalamus are stimulated by elevated blood glucose. Then, hunger center neurons are repressed, eliminating the feeling of hunger. Therefore, a person reduces their food intake during a meal as their blood glucose levels increase. Increased levels of amino acids and fatty acids in the blood also suppress hunger and stimulate fullness after meal. However, one important point is that fructose does not stimulate fullness in the brain. Therefore, if the blood fructose levels are elevated instead of glucose, a person cannot generate a sensation of fullness sensation. As a result, a person desires to intake more food during consumption of fructose. It is only possible for fructose to generate fullness after it has been converted into glucose by liver.

How to consume fruits?

We should prefer direct consumption of fruits instead of drinking natural or industrial fruit juices because of the high fructose content of fruits. The Prophet Muhammad, peace be upon him, consumed fruits before meals, the wisdom of which we learn only today. Fruits should be consumed at least an hour before or two hours after a meal, for sufficient time should be given for the fructose of an ingested fruit to be absorbed by the intestines and converted to glucose by the liver. Such practices will result in a reduced appetite and food intake. If fruit is consumed after a meal, a delay occurs in the conversion of fructose into glucose since the liver will be occupied by other biochemical processes, along with a full storage of nutrients; this will increase blood fructose levels and fail to reduce appetite. Fatty liver occurs as a consequence of high fat content of the blood. Arteriosclerosis and cirrhosis of the liver may be seen in people with a habit of excessive post-meal fruit consumption.

In a research carried out on laboratory animals, it was found that glucose induces fullness in the hypothalamus and suppresses food intake, whereas fructose was found to repress this effect of glucose, stimulating food intake.¹ Insulin reduces the harms of accumulating sugar in the blood by increasing lipid synthesis. Insulin also takes place in leptin secretion from adipose (fatty) tissue. Leptin is important in the prevention of obesity; therefore, insulin helps in weight loss, too. The leptin hormone causes reduced food intake by stimulating nerve cells in certain parts of the hypothalamus.² Fructose does not cause any leptin secretion because it does not stimulate an insulin release; therefore, it is not effective in generating a sense of fullness.

Ghrelin is a hormone secreted into blood by stomach cells during hunger. This hormone, which produces stomach acids, is enacted through the hypothalamus. It induces hunger, and therefore increases appetite. Insulin secretion increases along with the blood glucose levels during satiety. This eventually causes the increase of the leptin hormone, which also leads to a decrease in ghrelin secretion. As a result, fructose gets absorbed more than glucose in the intestines. Elevated fructose in the blood leads to insufficient or reduced insulin secretion. In this case, a person continues eating.

Fructose and diseases

Free circulation of lipids in the blood damages arteries and veins. For this reason, lipids are transported in “molecular vehicles” that are called as high, low, and very low density lipoproteins (HDL, LDL and VLDL). Neutral lipids (triglycerides) that are present on VLDL (very low density) vehicles are broken down with an enzyme. These lipids are then unloaded from the vehicles by cellular uptake and stored as fats. This transfer of lipids into adipose (fatty) tissue is enhanced via the insulin hormone. In the case of fructose intake, without its insulin secretion effect, lipids accumulate in the blood and liver and eventually prepare ground for liver damage and arteriosclerosis.As the result of a fructose based diet in laboratory animals, it was discovered that lipid production shifted from adipose tissue into the liver, therefore elevating the risk of high blood and liver fat levels.

There are two reasons for this shift. The first one is that fructose acts on the fat producing enzymes of the liver whereas it does not act likewise in adipose tissue.

Secondly, fructose plays an inhibitory role in the conversion of glucose into lipids in adipose tissue. Also, fructose consumption in humans has been linked to elevated blood fat levels.

Overconsumption of fructose causes increased liver fat synthesis. Phosphofructokinase is the limiting enzyme regarding the breakdown of glucose in the liver. This enzyme is regulated by citrates and ATP produced by glucose catabolism and the Krebs cycle, limiting glucose breakdown. However, there is no such limitation in fructose breakdown. Through fructose catabolism, glucose, glycogen, pyruvate, lactate, glycerol and the acyl part of acylglycerol are synthesized. This synthesis can not be limited. As a result of this excessive output and high amounts of triglycerides, VLDL is produced.³ It has been found that persons who consume two or more boxes of fructose sweetened beverages every day carry a 35% higher risk of heart disease.⁴

This isn’t the only disease associated with fructose. In some studies on laboratory animals, it has been reported that a high fructose diet is associated with hypertension.⁵ A lot of research exists suggesting that excessive fructose consumption leads to insulin resistance in both the liver and peripheral tissues, which can often cause diabetes.⁶ In a recent study, it was claimed that excessive fructose intake poses risks for renal diseases leading to glomerular hypertension, renal damage, and inflammation and damage to renal tubules and tissues.⁷

In a study conducted on 21,483 Americans who were older than two years, daily consumption of 37 gr. of fructose (8% of total calorie need) was found to be elevated to 54.7 grams (10.2% of total calorie need) gradually between the years of 1988-1994, mostly consumed by younger people. Increased use of fructose syrup was linked to obesity during the last 35 years.⁸ Furthermore, in a study carried on 1,749 male and female children and teenagers, a positive relation was found between body mass index (BMI) and excessive consumption of carbonated beverages containing high fructose concentrations.⁹ There many studies that support this report.¹⁰ Excessive fructose consumption is known to cause “metabolic syndrome” in which many diseases like obesity, arteriosclerosis, and diabetes emerge together.

Are fruit juices harmful?

Fructose syrup is being used at increasing rates in the food industry. According to the annual report of US Food and Drug Administration (FDA) for the year 2000, fructose syrups are sugar solutions containing approximately more than 50 % fructose. It is often synthesized by a conversion of corn starch into glucose by glucose isomerase.¹¹ There is also a third syrup type containing 90% fructose, however this has limited uses.

The sweetness of fructose syrup is similar to that of table sugar. It prevents the dehydration of food with its hydrophilic character. It is mostly used in aromatic foods, especially carbonated beverages and fruit juices. It prevents the proliferation of microbes with its high osmotic pressure property and makes food more resistant against them. Syrups containing 42 to 55% of fructose are used in baked goods, cereal products, dairy products, processed foods, both carbonated and regular beverages, ice creams, and frozen desserts. High fructose syrups are used in foods to decrease water activity and prevent spoilage.

Fructose syrups have a very low ash level due to application of intense purification processes during production and product color is water-white. Therefore colors of fructose used industrial foods are white as well. Fructose syrups have a lower viscosity and density compared to glucose syrups and therefore it is runny like water and not as sticky.

How to consume sugars after a meal?

Especially after a fatty meal, our body seeks sugar. The reason behind this is the requirement of sugar for the storage of lipids into fat tissue. However, this sugar should absolutely be glucose instead of fructose. Therefore, some amount of sugar can be consumed to facilitate the removal of lipids from blood after meals. This is recommended to lower blood lipid levels. However, this should not be done with fruits but with natural sugars like grape molasses. A baklava or a dessert made with industrial sugars (fructose) will not be beneficial but harmful.

In conclusion, the consumption of corn-derived fructose syrup is gradually increasing in recent years. Fructose syrup is used both in various carbonated or regular soft beverages, and in desserts. The reason for our fructose syrup preference is that it helps preserve foods longer and it leads to food addiction because it enhances appetite due to its strong sweetness. Fructose syrup is synthesized by the conversion of natural glucose in corn into fructose by isomerase enzymes. In this sense, today’s increased consumption of fructose is altering the existing sugar balance of natural food items. Overconsumption of fructose can pave the way to obesity, metabolic syndrome, arteriosclerosis, diabetes, hypertension, and arteriosclerotic heart and kidney diseases.

Arifagaoglu is a professor of medicine in Ankara, Turkey.

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9. Forshee RA, Storey ML. Total beverage consumption and beverage choices among children and adolescents. Int J Food Sci Nutr. 2003; 54: 297–307.
10. Forshee RA, Anderson PA, Storey ML. The role of beverage consumption, physical activity, sedentary behavior, and demographics on body mass index of adolescents. Int J Food Sci Nutr. 2004; 55: 463-478.
11. Melanson KJ, Angelopoulos TJ, Nguyen V, Zukley L, Lowndes J, Rippe JM. High-fructose corn syrup, energy intake, and appetite regulation. Am J Clin Nutr. 2008; 88(6):1738S-1744S.

The genera Escherichia is thought to have emerged around 102 million years ago and is known as a gram-negative pathogenic bacteria mostly found in the intestines of warm blooded animals [1]. German pediatrician and bacteriologist Theodor Escherich discovered E. coli in 1885, and for many years the bacterium was simply considered to be a commensal organism of the large intestine. It was not until 1935 that a strain of E. coli was shown to be the cause of an outbreak of diarrhea among infants [2]. The reason its pathogenic properties were discovered so late is that many of its strains are harmless. However, virulent strains of E. coli can cause various diseases in humans and in domestic animals, and are also sometimes responsible for product recalls due to contamination. Gastroenteritis, urinary tract infections, and neonatal meningitis are the most commonly observed diseases in humans, and in rare cases virulent strains are also responsible for haemolytic-uremic syndrome, peritonitis, mastitis, septicaemia and Gram-negative pneumonia [2]. Various outbreaks all around the world have been caused by E. coli, causing millions of deaths and sick people and billions of dollars have been spent fighting it. Even though death rates have decreased with the evolution of modern medicine and the discovery of antibiotics, the outbreaks are still a major concern for all countries, such as the recent outbreak in Germany in 2011 affecting 3,950 people and killing 53 [3].

Its reputation has not been one of great dignity, and it has ruined the reputation of many. You may recall in 1993, the fast food chain restaurant “Jack in the Box” suffered a major corporate crisis involving E. coli O157:H7 bacteria. Four children died of hemolytic uremic syndrome and 600 others were reported sick after eating undercooked patties contaminated with fecal material containing the bacteria at locations in Seattle and the Pacific Northwest, USA. The chain was faced with several lawsuits, each of which was quickly settled but left the chain nearly bankrupt and losing customers.

But don’t these creatures have any properties to be appreciated, I wonder…

Compared to eukaryotic cells, bacteria have a pretty basic mechanism of functioning. They don’t have sophisticated organelles, and they do not have a cell nucleus where their DNA is stored. Everything is floating along all together in the cell cytoplasm (which shocks me when I reflect upon how such a small and simple organism can cause such severe pain on “highly evolved modern humanity”). It has the basic metabolic tools for survival. And even though, at first sight, it is tempting to look down on its simplicity, today we know that it is this simplicity that gives us space for making many modifications and experiments on it, whereas in more complicated cells, like animal cells, the moment a modification is made, the entire system reacts to that and causes much trouble in the process.

The turning point of E.coli making a huge impact on our lives was in 1973, when Stanley Cohen and Herbert Boyer discovered the “Recombinant DNA Technology.” This technology allowed specific genes to be isolated from one organism and cloned to another organism by the help of bacterial plasmids. The first commercial product to be synthesized by this technology was human insulin, which is used for the treatment of diabetes [4]. This brought an amazing amount of recognition and appreciation for the technology, as the practical aspect of the technology was now proven to be commercially profitable. For the insulin to be produced, the DNA sequence that encodes human insulin was synthesized and transplanted into a plasmid that could be maintained in a non-pathogenic strain of E.coli [4]. Now the bacterial host cells acted as biological factories for the production of the two peptide chains of human insulin, which, after being combined, could be purified and used to treat diabetics who were allergic to the commercially available porcine (pig) insulin, or for diabetics from certain religious groups who abstain from pork products such as Muslims, Jews, some Christian groups, and many more who have similar concerns.

This was only the start of an incredible new technology which used bacteria to produce different proteins or enzymes to cure human diseases. Today more than 200 new drugs have been produced by recombinant DNA technology and have been used to treat over 300 million people for diseases such as cancer, multiple sclerosis, cystic fibrosis, and stroke, and to provide protection from other infectious diseases. Over 400 new drugs are in the process of being tested in human trials to treat such diseases as Alzheimer disease and heart disease (to name only two) [4].

Today E.coli is frequently used as a model organism for all kinds of microbiological experiments. In the lab, E. Coli. is one of the first micro-organisms that is thought of for testing a biological experiment. The reason is that E.coli cells are cheap to purchase and to sustain. They grow easily and rapidly in lab conditions and have non-pathogenic strains, so they are not dangerous for the researches doing the experiment. Whereas purchasing more complicated cells such as cancer cells or stem cells may be very costly, and moreover, may need special lab conditions to be sustained; so before more complicated cells are purchased, the experiments are usually tried out with E.coli or some other kind of model organism. More importantly, E. coli was one of the first organisms to have its genome sequenced; the complete genome of E. coli K12 was published by Science in 1997 [5]. Other areas in which modified E.coli has helped humanity are vaccine development, bioremediation (fighting pollution), and production of immobilised enzymes [6].

One specific example of the benefit of recombinant DNA technology for the environment is its use in the paper industry. Before the 1970’s, when there wasn’t much environmental awareness in the paper producing industry, poisonous chlorine compounds were conventionally used to achieve pulp brightness of a high order in the manufacture of high-quality paper products [7]. This chemical bleaching technique precipitated a tremendous environmental concern considering the magnitude of the industry. Plants treated with elemental chlorine produced significant amounts of dioxins. Dioxins are highly toxic, and their health effects on humans include reproductive, developmental, immune and hormonal problems. They are also known to be carcinogenic. Over 90% of human exposure is through food, primarily meat, dairy, fish and shellfish, as dioxins accumulate in the food chain in the fatty tissue of animals [7]. One alternative for these chemical bleaching processes is the use of the enzyme “xylanase,” which degrades the linear polysaccharide beta-1,4-xylan into xylose, thus breaking down hemicellulose, one of the major components of plant cell walls. Even though the use of xylanases in this industry has increased significantly with the discovery of Viikarri et al. (1986), the enzyme needs further improvements for it to be commercially acceptable [6]. To ensure the commercial utilization of hemicellulosic residues in the pulp and paper industries, the production of higher xylanase yields at low capital cost is required [6]. Such studies are ongoing with the purpose of partially mutating the amino acid sequence for the purpose of especially increasing the thermal stability of the enzyme and also increasing its metabolic activity. The gene mutation and gene expressions are generally done in either E.coli or yeast cells. Davoodi et al. has mutated the enzyme up to the point where the transition temperature increased 12 0C by introducing disulfate bonds in the enzyme [8]. The wonders this enzyme can do for the health of the environment is breathtaking, and is an area which should be further studied until finding the commercially viable kind that will eliminate chemicals from the paper industry during bleaching.

Even though some controversy remains on gene transferring, its tremendous positive impact on humanity cannot be denied. I personally think that it does need constraints and strict regulations, but this technique is one of the most remarkable techniques discovered in modern times, and E.coli has no doubt played a great role in the availability of this technology.

Even though condemning E.coli and stating its “evilness” seems like the most obvious path, we all ought to appreciate the variety and uniqueness of these creatures which also allow us to produce such large varieties of drugs. We ought to appreciate its simplicity, which allows it to have a chance of producing such sophistication. We ought to reflect upon the fact that something can be classified as “good” or “bad” only by the means in which we perceive it, and the reality of it may be completely opposite of what we had thought initially.

McPen is a freelance writer in natural sciences, Montana, US.

References

1. Battistuzzi FU, Feijao A, Hedges SB. 2004. “A genomic timescale of prokaryote evolution: insights into the origin of methanogenesis, phototrophy, and the colonization of land”. BMC Evol. Biol.
2. Todar, K. “Pathogenic E. coli”. Online Textbook of Bacteriology. University of Wisconsin–Madison Department of Bacteriology.
3. “German-grown food named likely culprit in deadly outbreak”. CNN. (5 June 2010).
4. Glick, Bernard, Jack Pasternak, and Cheryl Patten. 2010. “MOLECULAR BIOTECHNOLOGY Principles and Applications of Recombinant DNA . 4th Edition.” Washington,DC: ASM Press, pp. 3-13.
5. Blattner FR, Plunkett G, Bloch CA, Perna NT, Burland V, Riley M, Collado-Vides J, Glasner JD, Rode CK, Mayhew GF, Gregor J, Davis NW, Kirkpatrick HA, Goeden MA, Rose DJ, Mau B, Shao Y (September 1997). “The complete genome sequence of Escherichia coli K-12”. Science 277 (5331): 1453–62.
6. Cornelis P. 2000. “Expressing genes in different Escherichia coli compartments”. Curr. Opin. Biotechnol. 11 (5): 450–454.
7. Beg, Q.K., M. Kapoor, L. Mahajan, and G.S. Hoondal. 2001. “Microbial xylanases and their industrial applications: a review.” Springer.
8. Davoodi J., Wakarchuk W.W., Carey P.R., Surewicz W.K. 2007. “Mechanism of stabilization of Bacillus circulans xylanase upon the introduction of disulfide bonds.” Biophysical Chemistry, 125 (2-3) , pp. 453-461.

Original Article: Wang, M. et al., PNAS (published online before print on March 1, 2010).

Periodic injections of insulin to manage blood sugar levels is critical for the treatment of diabetes patients. It requires continuous monitoring of glucose levels in the blood and multiple injections of insulin in order to mimic the natural balance of sugar-insulin levels in the human body. Yet, it is often difficult to maintain this extremely sensitive hormone balance without major side effects. These complications include blindness, leg ulcers and amputations, heart vessels problems, renal insufficiency, stroke, and nerve damage in the legs and arms. Moreover, the long-term use of insulin causes the increase of body fat and bad cholesterol. A new research study on non-obese diabetic mice shows that adding leptin- a hormone responsible for appetite control- to the insulin therapy results in better control of blood sugar levels and decreases the bad cholesterol and body fat of Type 1 diabetic mice. This is promising, as it could reduce heart and circulatory complications of Type 1 diabetes. However, the leptin therapy may not have an effect on type 2 diabetes, adult type, because in this type patients already have high levels of leptin. However, it has to be shown that leptin therapy is safe and effective on humans as well. There is a long way to go before we can use leptin in practical areas.

2- Re-teaching speech with music

Original Source: Schlaug G, Annual Meeting of the American Association for the Advancement of Science (AAAS), San Diego (2010).

Nearly 800,000 people in the U.S. are faced with strokes each year, and a quarter of those are affected by aphasia, a deficit in language. Using a new melodic intonation therapy, therapists treat patients by teaching them how to sing words and phrases consistent with the underlying melody of speech. As a result, the patients continue to speak in a more “sing-songy” way than a person with normal speech patterns, according to Dr. Schlaug, professor of neurology at Harvard Medical School. After 15 weeks, 1.5 hour-long daily sessions with a therapist, the patients gradually learn to piece the sung words together into organized speech. There are two separate brain networks associated with vocal output, with the one in the left hemisphere being engaged with speech and the other one in the right hemisphere strongly responding to music and melody. For the stroke patients that had damage to the left hemisphere, this therapy may help to train similar areas on the right hemisphere, helping them to initiate a speech region in the right hemisphere. Singing facilitates necessary engagement to the right hemisphere. Images of patients’ brains before and after the therapy reveal striking structural and functional changes in the right hemisphere. This study also reminds us of the brilliance of musical therapies employed in early hospitals in the Islamic world.

3- Renewable Jet-Fuels

Original Article: Bond, J.Q. et al., Science 327, 1110 (2010).

The global need for sustainable energy resources is ever increasing and the use of renewable fuels offer promising solutions. Among others, biofuels are especially important due to the presence of direct conversion routes from plant-based waste materials to conventional liquid fuels. However, high synthesis costs and complex processing steps are major hurdles to overcome before putting biofuels forward as economically viable alternatives to fossil fuels. Researchers are therefore trying to come up with more efficient methods -and one group, from the University of Wisconsin appears to have done so. Unlike commonly utilized routes involving microorganisms, they use a novel and environmentally-friendly chemical process which is easier to control and maintain. By using an inexpensive catalyst, they convert the majority of the wasted biomass to gaseous butene and carbon dioxide, with a water-based solution of gamma valerolactone as the intermediate chemical. The butene gas is then easily transformed to high-energy transportation fuels such as gasoline and jet fuel. As an added advantage, the stream of carbon dioxide can be efficiently captured, preventing the atmospheric release of this major greenhouse gas. Under optimized conditions, the system can operate uninterrupted for 90 hours with an overall efficiency of over 75%. Successful work like this will help make biofuels cheaper for mass production, pending the meticulous analysis of its economics.

4- Salt controversy: How much is too much?

Original Article: Bibbins-Domingo, K. et al., NEJM 362, 590 (2010).

Modern humans suffer from high rates of obesity (for instance, 64% of Americans are classified as either overweight or obese) and cardiovascular diseases, with the latter being the no.1 cause of all deaths. A recent study conducted by researchers at the University of California at San Francisco suggests that reducing dietary salt by half a teaspoon a day (~ 3g) would lower the annual number of new coronary heart disease, stroke and myocardial infarction cases. Strikingly, such a modest decrease is expected to decrease deaths from any cause by 44,000 to 92,000. According to the National Salt Reduction Initiative, Americans eat at least twice as much salt as they need where 80 percent of the salt in the American diet comes from processed or restaurant-prepared foods. However, eating too much salt is not a problem for people with healthy kidneys since kidneys are designed to flush out unneeded salt. However, when people have a high salt diet, then their kidneys are over-worked. Taking into account that modest salt reduction in one’s diet won’t likely cause harm and taste buds will likely adapt to this minor change effortlessly, it seems wise to refrain from using too much salt. This would trigger bigger health benefits ranging from not overworking the kidneys to reducing the risk of deadly diseases.

5- Why don’t we get thirsty during sleep?

Original Article: Trudel, E. & Bourque, C.W., Nature Neuroscience (published online before print on February 28, 2010).

In mammals, the “internal-standard-time” is kept by a particular subset of brain cells known as “clock-neurons” which display high activity during the day and low activity during the night. A group of scientists recently reported that the clock-neurons also function as a dimmer for water regulation, allowing bodily water content to be controlled by the body. A specialized group of cells, called osmo-sensory-neurons, detect and regulate water levels in the body, through balancing the water intake via thirst and loss via urine production. When water levels are low, the sensory-neurons communicate with some hormone-releasing cells which instruct the body to store water by ceasing urine production. By using isolated brain slices from rats, the researchers showed that the clock-neurons – when active – interfere with the communication between sensory-neurons and hormone-releasing-cells to suppress the water-storage-hormone release. In contrast, when the clock-cells are inactive (i.e., ‘sleep period’) the communication is restored, resulting in an increase of hormone levels to enable water-storage. Such regulation is the reason why we are not much disturbed during sleep by neither frequent trips to the bathroom, nor excessive thirst (that would both impair the sleep quality), and reminds us the verse from the Holy Qur’an: “..and He has made the night for rest…” (Chapter Al-Anaam, 96).

6- A passage to vegetative state through fMRI

Original Article: Monti MM et al., NEJM 362, 579 (2010).

Consciousness in medicine is defined as the patient’s alertness and responsiveness to the outside world. If a patient does not respond to external stimuli, his/her medical state is considered a “vegetative state”. Researchers from Cambridge, England performed functional magnetic resonance imaging (fMRI) experiments on 54 patients who had been previously classified as either “vegetative” or “minimally conscious”. Interestingly, 5 of 54 patients exhibited distinct neuronal activities in the corresponding regions of their brains, when they are given imaginary motor and spatial tasks. For the motor task, patients are asked to imagine playing a tennis game. For the spatial task, patients are asked to imagine navigating through a familiar location. A 22 year-old man who had been in coma for five months was further evaluated by being subjected to a simple set of yes-or-no questions such as “Do you have any brothers?” and was instructed to answer these questions using one type of mental imagery, that is a motor imagery for “Yes” and a spatial imagery for “No”. He answered 5 out of 6 questions correctly. This is the first evidence that through fMRI approach one can reach the residual cognitive activity in vegetative patients and establish functional communication, raising question marks about our current handling of these so-called vegetative patients.

1. Genes and inheritance
2. Obesity
3. Lack of exercise

The diagnosis of diabetes is described as a level of sugar that is above a certain amount in the blood stream. In fact, diabetes itself is the metabolic disorder of three food sources: carbohydrates, proteins, and lipids (Cholesterol and especially triglycerides). As healthcare providers we, doctors and scientists, are very much aware that the physiology-that is, the mechanism-of this wonderful sugar metabolism is one of many harmonies existent in the human body. While patients with diabetes seek help from us, our help is limited to what we have learned-and are still learning-from the human body. Thus, the medication we use today are not miracles, but rather a good example of understanding how one of the many mechanisms in body works.

Since the discovery of insulin in 1921, a hormone that is secreted from the pancreas and the only one to work at lowering the level of sugar in the body (several others increase the sugar level)-the development of treatments for diabetes has been focused on greatly in an effort to better serve humankind. Such developments include tiny, sharp needles and pens to deliver the insulin-known as insulin pens. Currently many alternative insulin delivery methods have been developed-via the skin or lungs-yet none of these are as successful as the human body’s normal program for dealing with a rise in the sugar during stressful conditions and after meals. Despite the incredible efforts and impressive studies carried out on both animals and humans, not every method of diabetes management (treatment) is suitable for every individual. Each person is unique regarding the capacity of their pancreas to generate insulin.

In the United States, more than 20 million people have diabetes; however this number is well below the actual number of sufferers. Having enough insulin is not the solution to the problem, while resistance to the action of this hormone can limit its efficacy leaving the glucose (sugar) level high. This further suppresses the pancreas’ ability to provide insulin and the remaining glucose becomes toxic to many vital organs, causing several of the following conditions:

• Heart (heart attack)

• Liver (fatty liver)

• Brain (stroke)

• Vessels (hardening of the arteries)

• Blood (easy clotting)

• Feet (gangrene and amputation)

• Immune system (suppression of the immune system, in turn leading to a tendency to infections, giving the opportunity of germs to invade various parts of the body; in the same way increase of tuberculosis bacteria, yeast infections, pneumonia)

• Skin (late healing after abrasions or trauma)

Excess sugar is converted into cholesterol which will further accelerate the detrimental effects to the vital organs (brain, heart, kidney).

Current suggestions for the management of the problem with sugar are education, better diets, correct and regular exercise, correct medication and careful follow-up. We know that God created cures for every illness. Respecting and thinking of this will encourage many of us to concentrate on solving the problem of diabetes. Prophet Muhammad, peace be upon him, indicates “Eat and drink, but never waste” and “Leave the food table before you are full.” The diet that is recommended for people with diabetes is to eat small amounts of food during the 3 main meals and to add 3 snacks to control the undesirable rise in sugar that occurs after eating a large amount. We are informed that we are full due to the induction of tension receptors in the stomach after the meal, the induction of the brain, and the digestion of food that leads to an increase in the level of sugar in the blood stream… etc. Unfortunately, most diabetics wait for the third mechanism to operate before leaving the table; as a result, they may continue to eat and further increase their blood sugar level, and this may in turn be the reason for early or late complications in diabetes.

Today, the greatest number of diabetics per population are the Pima Indians living in Arizona. Interestingly, a new molecule that has recently been developed seems to have a preventive efficacy for the development of diabetes and to assist in its satisfactory management, even after the diagnosis of diabetes. This molecule was actually found to be present in the saliva of Gila Monster again that is fairly close to the area where these affected tribes live.

Kelly J. Smith is a clinical diabetes research scientist in Arizona. 

I hang between your stomach and your duodenum under it, attached to the intestinal mesenteries. I have two different identities in terms of my structure and function. I carry out two very different duties as a compound gland made up of both exocrine and endocrine tissues. So, I am granted a very special structure and chemical abilities to function well. One of my duties is related to the physiology of digestion: I break up the food passing from the stomach to the duodenum by pouring on it the four types of digestive enzymes I have been enabled to produce. These juices are carried through a tiny pipe to your duodenum. Two of them are used for breaking up proteins, one for carbohydrates, and one for fats. You don’t even realize it! As the food you take in passes from the stomach to the duodenum, my enzymes begin flowing faster. This is a very fine balance: while food is being digested, neither the enzymes should be wasted, nor should your intestinal walls be harmed. I don’t control the release of the enzymes. That duty is given to two hormones produced in your intestinal mucosa by the stimulus of the vagus nerve. When those hormones reach me by the bloodstream, my cells are stimulated and they secrete water, bicarbonate, and the digestive enzymes I mentioned and they flow into your duodenum through my duct.

My second job is the production of insulin and glucagon hormones, as the endocrinal pancreas. My cell clusters, which are also known as islets of Langerhans, have different types as separate groups, which you call alpha and beta. The insulin, which is produced by my beta cells, is used for regulating the glucose level in your blood. The duty of insulin is to stimulate your body cells to take the glucose in your blood and use it.

After you have a meal, the carbohydrates in it are broken down into glucose molecules, pass into the blood, and increase your blood sugar. For your body to function in a healthy way, the amount of glucose should be around 100mg/ml (it varies from 80–120). When the level is above the normal value, I secrete insulin. In this way, the sugar is carried to your cells and burned to produce energy, and its increase in your blood is brought back under control. Also, insulin helps you to store sugar in fat tissues and to turn them into fatty acids, and it slows the breaking down of fatty acids. Moreover, insulin helps you to make protein in your body by holding amino acids within your muscle tissues and storing glucose in your liver and turning it into glycogen.

The failure of my beta cells to secrete insulin is a serious problem; the consequence is “diabetus mellitus,” or what we commonly know as diabetes. A person with this disorder must abstain from various delicious foods and drinks. In cases where a strict diet does not solve the problem, patients may have to take insulin shots every day. Diabetes can cause many complications by damaging your nerves and blood vessels; I won’t go into types of diabetes so I don’t get sidetracked too much. I just wished to make a point: even a substance produced by a tiny cluster of cells can upset the functioning of many of your mechanisms. After having a meal, put your hand to the left of your abdomen below the stomach and remember what a blessing I am!

As for the glucagon hormone I secrete from my alpha cells, it does just the opposite of insulin and causes the sugar stored in your cells to be released into your bloodstream. When your blood sugar decreases-due to hunger, overwork, exercise, and so on-it causes the glycogen in your liver to be used in order to increase the level of your blood sugar. As adrenalin secreted by the adrenal glands helps glycogen to be broken down and to be released into the blood as glucose, they function as an integrated system. Glucagon also slows down the synthesis of glycogen, and it accelerates the break-up of proteins and fat metabolism. I think now you get it, Peter. Insulin and glycagon are parts of a biological feedback mechanism controlling one another. People discovered all these facts after years of lab research; now do you see how ridiculous it is to see me as a work of blind chance?

Like any other organ, I can also contract various diseases. The most common ones are acute or chronic inflammation, tumors, and cysts. I am easily troubled with inflammation in people with alcohol habits. Since enzyme secretions-and therefore digestive processes-are then not carried out properly, some undigested fats and fibers with proteins are excreted with the feces. A problem can arise with the intestines due to digestive deficiency. And if I completely fail to fulfill my duty owing to a chronic inflammation or tumor, then doctors take me out and you become dependent on insulin and a special liquid obtained from the pancreas.

It is sad to say that my cancer is not quickly recognized. It develops very fast and I try to keep up my duty as long as possible. Therefore, it is usually too late when diagnosed. There is nothing much modern medicine can do after it spreads. Although it is not definite yet, I suspect cigarettes play a role in my cancer.

As for diabetes, even though a promising method of treatment has been discovered, certain problems haven’t been overcome yet. The transplant of beta cells from the pancreas of someone who has just died-with as much tissue compatibility as possible-has had partial success. As with every other organ transplant, tissue rejection is a challenge. If the human genome project succeeds and the genetic code of the human body is thoroughly solved, it may be possible to cure diabetes by genetic engineering techniques. This is only at research level for now, but if scientists do their best, it is possible to find a way, since there is a treatment for every disease except for old age and death. You see Peter, as the vicegerents on earth, you humans are supposed to explore the secrets of the universe and appreciate the beauties you discover. I think I have said enough now. Thanks for listening, Peter!

Irfan Yilmaz is a professor of biology at Dokuz Eylul University, Izmir, Turkey.

I am sure, to most of us who have learned about scientists as unapproachable figures sitting on top of Mount Everest (and somehow almost all of whom are Western), this viewpoint may seem quite new. Yet, there is more to it. The same thinker points to another equally important factor in the development of civilization and advancement of sciences: with a great strength in his weakness and potency in his impotence, man is very much like a pampered child in creation. If he recognizes his weakness and performs his worship with his words, actions and state of mind, if he knows his own impotence and asks for God’s aid, he will then have fulfilled the obligation of gratitude for the subjugation of creation to his needs.

As with a petted child who by means of a little cry or simply a sad look obtains the assistance of adults to serve him: even the tiniest part of what they do for him by far exceeds what lies in the child’s own power to do for himself, and their great help he owes to his great weakness. So too, the apparent dominance of man over the rest of creation and his progress in civilization are not the result of his own deserving but they were subjugated to him because he himself was weak: he received aid because he was helpless; he was enriched thereby because he was poor; he was inspired because he was ignorant; he was bestowed with favours because he was in need of them (Nursi, 23rd Word). 

Penicillin

Most people believe that great discoveries are results of deliberate, directed effort, planning. exhaustive experiment and logical inference. The discovery of penicillin is the most famous counter example. Although the role of planning, experimenting and research has an undeniable role in scientific discoveries, events do not always form a logical sequence, and this is what I am here trying to emphasize.

During World War I, doctors depended on antiseptics to cure battIe wounds. A. Fleming, a bacteriologist, observed that phenol (or carbolic acid, the most common antiseptic at that time) did more harm than good, in that it killed the leukocytes (white blood cells) faster than it killed the bacteria, and he knew this was bad because the leukocytes are the body’s natural defenders against bacteria.

In 1922, while suffering from a cold, Fleming made a culture from some of his own nasal secretions. As he examined the culture dish filled with yellow bacteria, a tear fell into it from his eye. The next day, when he examined the culture, he found a clear space where the tear had fallen. He correctly concluded that the tear contained a substance that caused rapid destruction of the bacteria, but was harmless to human tissue. The antibiotic enzyme in the tear he named lysozyme. It turned out to be of little practical importance because the germs that lysozyme killed were relatively harmless, but this discovery was an essential prelude to that of penicillin.

In the summer of 1928, Fleming was engaged in research on influenza. While doing some routine laboratory work involving microscopic examination of cultures of bacteria grown in petri dishes (flat glass dishes provided with covers), Fleming noticed in one dish an unusual clear area. Examination showed that the clear area surrounded a spot where a bit of mould had fallen into the dish, apparently while the dish was uncovered. Remembering his experience with lysozyme, Fleming concluded that the mould was producing something that was deadly to the staphylococcus in the culture dish. Later he would say: ‘There are thousands of different moulds and there are thousands of different bacteria, and that chance putting the mould in the right spot at the right time was like winning the Irish sweep.’

Fleming’s own words are enough as a response to those who attribute scientific discoveries to chance or idolize scientists. However, I will give other examples to make the point clearer.

Teflon

From non-stick frying pans to space suits to artificial heart valves, Teflon has found several areas of application. Its discovery resulted from an apparently ‘accidental’ observation by a young chemist, R. Plunket, working in Du Pont laboratories. On April 6, 1938, Plunket opened a tank of gaseous tetrafluoerothylene in the hope of preparing a non-toxic refrigerant from it, but no gas came out, to the surprise of Plunkett and his assistant. Plunkett could not understand this because the weight of the tank indicated that it should be full of the gaseous fluorocarbon.

Instead of discarding the tank and getting another in order to get on with his refrigerant research, Plunkett decided to satisfy his curiosity about the ‘empty tank’. Having determined that the valve was not faulty by running a wire through its opening, he sawed the tank open and looked inside. There he found a waxy white powder and, being a chemist, he realized what it must mean.

The molecules of the gaseous tetrafluoroethylene had combined with one another ‘polymerized’ to such an extent that they now formed a solid material. The waxy white powder did indeed have remarkable properties: it was more inert than sand – not affected by strong acids, bases or heat and no solvent could dissolve it – but, in contrast to sand, it was extremely slippery.

X (Roentgen) Rays

Physicist W. Roentgen discovered the rays which were later to be named after him, in an unexpected and unplanned manner. Roentgen was repeating experiments by other physicists in which electricity at high voltage was discharged through air or other gases in a partially evacuated glass tube. We now know that cathode rays are actually streams of electrons being emitted from the cathode, and the impact of these electrons on the walls of the glass tubes produces the phosphorescence.

In 1892, it was demonstrated that cathode rays could penetrate thin metallic foils. Discharge tubes having thin aluminium windows allowed the cathode rays to pass out of the tube where they could be detected by the light they produced on a screen of phosphorescent material (such screens were also used to detect ultraviolet light), but they were found to travel only two or three centimetres in the air at ordinary pressure outside the evacuated tube.

Roentgen repeated some of these experiments to familiarize himself with the techniques. He then decided to see whether he could detect cathode rays issuing from an evacuated all-glass tube, that is, one with no thin aliminium window. Na one had observed cathode rays under these conditions. Roentgen thought the reason for the failure might be that strong phosphorescence of the cathode tube obscured the weak fluorescence of the detecting screen. To test this theory, he devised a black cardboard cover for the cathode tube. To determine the effectiveness of the shield, he then darkened the room and turned on the high voltage coil to energize the tube. Satisfied that his black shield did indeed cover the tube and allowed no phosphorescent light to escape, he was about to shut off the coil and turn on the room lights so that he could position the phosphorescent screen at varying short distances from the vacuum tube:

Just at that moment, he noticed a weak light shimmering from a point in the dark room more than a yard from the vacuum tube. At first, he thought there must be, after all, a light leak from the black mask around the tube, which was being reflected from a mirror in the room. However, there was no mirror. When he passed another series of charges through the cathode tube, he saw the light appear in the same location again, looking like faint green clouds moving in synchronism with the fluctuating discharges of the cathode tube. Hurriedly lighting a match, Roentgen found to his amazement that the source of the mysterious light was the little fluorescent screen that he had planned to use as a detector near the blinded cathode tube, but it was lying on the bench more than a yard from the tube.

Roentgen realized immediately that he had encountered an entirely new phenomenon. These were not cathode rays that lit up the fluorescent screen more than a yard from the tube! With feverish activity, he devoted himself single-mindedly in the next several weeks to exploring this new form of radiation. He reported his findings in a paper published in Wunburg, dated December 28, 1895, and entitled ‘A New Kind of Ray, a Preliminary Communication’. Although he described accurately most of the basic qualitative properties of the new rays in this paper, his acknowledgement that he did not yet fully understand them was indicated by the name he chose for them, X-rays. (They have also often been called Roentgen rays.)

He reported that the new rays were not affected by a magnet, as cathode rays were known to be. Not only would they penetrate more than a yard of air, in contrast to the two or three inch limit of cathode rays, but also (to quote his paper):

‘All bodies are transparent to this agent, though in very different degrees. Paper is very transparent; behind a bound book of about one thousand pages I saw the fluorescent screen light up brightly. In the same way the fluorescence appeared behind a double pack of cards. Thick blocks of wood are also transparent, pine boards two or three centimetres thick absorbing only slightly. A plate of aluminium about fifteen millimetres thick, though it enfeebled the action seriously, did not cause the fluorescence to disappear entirely. If the hand be held between the discharge tube and the screen, the darker shadow of the bones is seen within the slightly dark shadow image of the hand itself.’

He found that he could even record such skeletal images on photographic film. This property of X-rays captured the attention of the medical world immediately. In an incredibly short time X-rays were used routinely for diagnosis in hospitals throughout the world.

Insulin

If a relative or a friend of yours has diabetes, you will probably know how important insulin is for them. As a partial remedy for most diabetics today, insulin was discovered as an answer to the prayers of hundreds of thousands of diabetics by the Most Merciful One. Perhaps, even better relief and remedy are awaiting discovery in some unexpected time or place.

In 1889, while studying the function of the pancreas in digestion, two researchers removed the pancreas from a dog. The very next day a laboratory assistant called their attention to a swarm of flies around the urine from this dog. Curious about why the flies were attracted to the urine, they analysed it and found it was loaded with sugar. Sugar in urine is a common sign of diabetes.

The researchers realized that they were seeing for the first time evidence of the experimental production of diabetes in an animal. The fact that this animal had no pancreas suggested a relationship between that organ and diabetes. The researchers subsequently proved that the pancreas produces a secretion that controls the use of sugar, and that lack of this secretion causes defects in sugar metabolism then exhibited as symptoms of diabetes.

Many attempts were made to isolate the secretion, with little success until 1921. A young Canadian medical student extracted the secretion from the pancreas of dogs. When they injected the extracts into dogs rendered diabetic by removal of their pancreases, the blood sugar levels of these dogs returned to normal or below, and the urine became sugar-free. The general condition of the dogs also improved.

Until recently, all insulin used for the treatment of human diabetes came from the pancreases of some animals. As a result of genetic engineering, based on knowing how DNA controls protein synthesis, a major pharmaceutical firm has begun to produce human insulin by using bacteria. The fact that a microscopic creature, like the bacterium can be made to work for the wellbeing of human beings is a subject worthy of study on its own.

Of course, these are by no means the only examples worth mentioning of ‘happy, chance discoveries’. Here are some more to add to the list: the discovery of molecular structure of organic compounds, saccharin and nutra-sweet (sugar substitutes, again for diabetics), ‘safety glass used in automobiles and planes, oxygen and several other chemical elements, radioactivity, astronomical discoveries like pulsars and background Big Bang radiation, many mathematical theorems, high temperature superconductors, synthetic dyes, etc., etc.

Can one really call all of these marvellous discoveries simply ‘happy, chance accidents’? I believe human conscience and reason must resist such a misconception. Surely, any person of common sense would say: ‘I am thankful to the Merciful One, who has bestowed upon us the favour of these discoveries, enabled us to benefit from them, among His innumerable other bounties’.