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

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

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

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

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

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

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

Treatment of Metabolic Syndrome

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

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

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

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

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

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

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

Notes

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

To this day, natural breast milk is still regarded as the best nutritional choice for babies. Recent research on stem cells, genetics, and epigenetics [1] from the last three decades, along with information obtained from studies about childhood and youth and testimonials from organizations that guide health policies worldwide, all support this claim. Modern medicine agrees that breastfeeding is the healthiest, most inexpensive, highest quality, and most appropriate choice for protecting both a mother and baby’s health [2]. The World Health Organization holds breastfeeding as an essential gold standard for the immunological development of a child, starting from the first six months to two years of age [3].

Breastfeeding has many benefits. It strengthens the emotional bond between the mother and her baby. It helps ensure that the baby grows in a healthy manner, by establishing its first feeling of trust; positively effects the baby’s intelligence level; and helps bolster the baby’s immune system.

One of the most studied issues in recent studies is the effect of breast milk on respiratory diseases such as asthma. The effects of breastfeeding on asthma, allergic diseases, and respiratory infections has been a topic of concern for the medical world for at least the last 80 years. Recent studies agree that breast milk has a preventive role against lower respiratory tract infections in infancy (0–2 years). However, there are some complications in these studies. Given the challenges in patient standardization, only food-allergy studies can be standardized. Due to the complexity of the environmental and genetic factors that trigger allergies, it should be considered normal that the effect of breast milk has not yet been fully established to protect against a wide range of allergic diseases, particularly asthma [4].

Asthma is the most common chronic disease in childhood and has a complex structure. It has been on the rise lately, and scientists are scrambling to figure out what is causing this increase as well as the best ways to combat the disease. Asthma can be caused by a wide variety of sources, such as genetics, smoking, microscopic ticks and mites in house dust, allergenics such as grass or pollen, obesity, urban life, air pollution, synthetic nutrition, and imbalance in intestinal flora [5]. In addition, premature birth, low birth weight, a young mother, and early exposure to respiratory infections are factors that increase the risk of asthma [6]. Consequently, it is difficult to independently measure the effect of a single determinant in asthma. In a significant study on 3,963 children in the Netherlands, children were breastfed for at least four months and then followed for up to eight years after birth. The outcomes of the study revealed that breast milk significantly reduced the risk of asthma, independent of other variables. It has been observed that the rate of chronic asthma development decreases as the breastfeeding duration increases [7].

Today, breast milk’s benefits have been proven in protecting babies from respiratory infections both early on and later in life. Breastfeeding provides an emergency line of defense against infectious diseases by helping infants whose immune systems are not yet developed enough to fight infections.

Breastfeeding facilitates a beneficial germ exchange between mothers and babies and helps to develop a strong immune system. Enzymes, hormones, bioactive molecules, and growth factors in breast milk are all extremely vital for babies. These crucial molecules help develop the baby’s immune system by interacting with the proximate elements. Thanks to numerous features in its ingredients, breast milk has a significant role in supporting the baby’s immune system with the development of appropriate microorganisms in the intestine. The strength of the microbial structure in the baby’s intestine depends on the way of delivery, diet, and the variety of foods consumed by the mother. This healthy structure in the intestines is essential for the development of the immune system and for building an increased tolerance to new foods that will be taken orally. In infancy, beneficial microbiota in the intestines starts to develop healthily by breastfeeding in the first four to six months.

A comparative study between the intestinal flora of infants fed with breast milk and formula milk showed that the diversity and density of the desired microorganisms increased in a shorter time and in sufficient amount in the breastfed infants. Today, increased hygiene standards have changed the intestinal flora of infants, especially in Western societies. This, however, has increased the risk of diseases such as asthma [8].

Cytokines (a group of proteins and peptides that allow cells to communicate with each other) in breast milk also serve the development and smooth functioning of the immune system and play an important role in protecting the baby against bacterial infections, wheezing, and allergies. Human milk, especially “first milk,” was found to contain more than 20 cytokines [9]. First milk arrives in the first few hours after birth as a miraculous gift to babies when they are most vulnerable to illnesses and helps to protect against diseases. Ig A antibodies in the first milk also protect against infectious diseases that are commonly experienced in early life, besides obesity, diabetes, and allergic diseases that may come later [10].

Infants fed with ready-made foods have lower amounts and types of bacteria in their intestines than those fed with breast milk, which can consequently increase the risk of eczema and asthma. The issue of delaying foods with high allergy potential, especially when switching to supplementary foods, is still being debated. Some researchers suggest that complementary foods should not be introduced to infants up to 12 months. However, the common opinion is that positive intestinal bacteria that develops with sustained breastfeeding can reduce the risk of allergies to additional foods. Another consensus is that the transition to supplementary foods should not be earlier than six months [11].

As breast milk is the most important food for newborns, mothers should diligently endeavor to complete the suggested period of breastfeeding. Breastfeeding, if continued until the age of two and especially in the first six months, is accepted by international pediatric authorities as the cornerstone of nutrition.

Character formation and breast milk

We are physically and emotionally affected by what we eat or drink. Based on this assumption, it can be argued that breastfeeding might also have an influence on the character formation of babies [12]. Although it has been determined that intelligence and brain development are influenced by the emergence or inhibition of some genetic characters in the baby by epigenetic means, no research based on long-term observations has been conducted. In any case, it would be wise for parents to provide the best food both for themselves and their babies. Inasmuch as they make sure the food is hygienic and natural, they should also be cautious that it is obtained through legitimate means. If, for any reason, the mother’s milk is not enough or is suspended, a milk-mother with necessary qualities may be contracted.

Breastfeeding for two years is prescribed in the Qur’an: “Mothers are to suckle their children for two complete years” (2:233). “We have enjoined on human in respect with his parents: his mother bore him in strain upon strain, and his weaning was in two years” (31:14). Likewise, the Prophet Muhammad, peace be upon him, speaking about his son Ibrahim, who died before he could turn two, said, “He has a milk-mother in Paradise, she will suckle him for his remaining milk, (will complete the term of two years).” (Muslim, Fadail, 63, 2316)

References

1. The inherited and non-genetic changes which occur in the disclosure of genetic information i.e. gene expression, without any no change to the structure of DNA.
2. Ballard O, Morrow AL: Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am, 2013; 60: 49–74.
3. World Health Organization Recommendations on Postnatal Care of the Mother and Newborn. Geneva, WHO, 2013.
4. Matheson M, Allen KJ, Tang MLK: Understanding the evidence for and against the role of breastfeeding in allergy prevention. Clin Exp Allergy, 2012; 42: 827–851.
5. Ding G, Ji R, Bao Y: Risk and protective factors for the development of childhood asthma. Paediatr Resp Rev, 2015; 16: 133–139.
6. Oddy WH, de Klerk NH, Sly PD, Holt PG: The effects of respiratory infections, atopy and breastfeeding on childhood asthma. Eur Respir J, 2002; 19: 899–905.
7. Scholtens S, Wijga AH, Brunekreef B, Kerkhof M, Hoekstra MO, Gerritsen J et al..: Breastfeeding, parental allergy and asthma in children followed for eight years: the PIAMA
8. birth cohort study. Thorax 2009; 64: 604–609.
9. Adlerberth I, Wold AE: Establishment of the gut microbiota in Western infants. Acta Paediatr, 2009; 98: 229–238.
10. Goldman AS, Rudloff HE: Are cytokines in human milk? Adv Exp Med Biol, 1991; 310: 93–97.
11. World Health Organization Recommendations on Postnatal Care of the Mother and Newborn. Geneva, WHO, 2013.
12. World Health Organization: Global Strategy for Infant and Young Child Feeding. Geneva, 2003.
13. Ibrahim Canan, Peygamber’in Sunnetinde Terbiye, Istanbul: Isik Yayinlari, 2014, pp. 95.

Sleep is a period of renewal that prepares us for the new day and enables our brain and body to perform duties that they cannot while awake.

Growing numbers of businesses are including good sleep in their wellness programs for their employees. Many of them now have sleep pods in their offices to improve productivity. In addition to diet, weight, exercise and smoking cessation, sleep wellness is now becoming part of our tools to prevent health problems; and this is a good thing.

Sleep is a period of renewal that prepares us for the new day and enables our brain and body to perform duties that they cannot while awake. Having a sufficient amount of high-quality sleep is vital for us to be healthier and to feel better during the day. Yet the number of people experiencing sleeping problems is on the rise.

The duration of healthy sleep varies from person to person. If the night’s sleep lacks quality –say, for instance because of frequent interruptions for the need to go to toilet – the total duration spend in bed extends. The craving or need for more sleep as a result becomes a sleep problem.

Sleep deprivation prevents certain brain functions that are enabled only during sleep. Sleep is necessary for learning and memory. Moreover, healthy sleep is crucial for appetite regulation, so insufficient sleep may result in weight gain.

In the general sense, sufficient and quality sleep is also essential for overcoming diseases and disorders. Therefore, many patients in the intensive care unit, especially those suffering from cerebral bleeding, edemas, or a heart attack, are put to sleep with drugs. Studies have shown that sleep is crucial for fast recovery of post-operational scars. It is essential that long hospital visits should be avoided so that the patient can have the much needed sleep.

Because metabolism slows down during sleep, all the bodily energy is redirected towards curing the brain and the body. Sleep is the time for repairing any part damaged during the day. Sufferers of sleep problems run a higher risk of developing illnesses such as Alzheimer’s and dementia. The number of neurons is important for memory as well. Their number decreases with age, weakening our memory. Age-related memory impairment stems from a breakdown of the brain’s communication network and can be prevented by healthy sleep. In addition, sleeplessness correlates with depression and cancer, too. The immune system also deteriorates in people experiencing sleep deprivation because it cannot be renewed and strengthened during sleep.

Coffee, tea, energy drinks, and other substances containing caffeine can prevent sleep for as long as six hours. That is, black coffee or strong tea you have in the afternoon may make it difficult for you to fall asleep at night. Similarly, if you have food that is high in fat and protein at a late dinner, you may experience problems drifting into sleep.

Working hours

Some people have to work at night so they can sleep during the daytime. People doing night shifts, for example doctors, nurses and police officers, frequently develop serious heart and brain problems. Our brains are created so as to stay asleep at night and awake during the day, so people who go to bed late at night experience more health problems. Sleeping during the day after a sleepless night leads to sleeplessness the following night. However, a nap (siesta) in the afternoon is extremely useful in that it virtually enables renewed morning freshness thanks to re-regulation of hormones.

Our body clocks are influenced by sunrise and sunset. Modern people are exposed to less sunlight during day and more artificial light at night, which has an impact on the time we fall asleep. Increased exposure to the morning sun and decreased exposure to artificial light (especially from phones and computers) can help our body clock readjust to a normal sleep schedule and hence help us sleep earlier.

Fixed waking hour

One of the most critical conditions for healthy sleep is to have a fixed waking hour. You should wake up at the same time no matter what time you went to bed the previous night. In fact, as a rule of thumb, you should get up from your bed at the same time in the morning whether it is weekend or weekday, work day or holiday, so that you can have a good sleep the following night.

The more tired you are when you go to bed, the harder it gets to drift into sleep. You should therefore avoid vigorous physical activity within a few hours before bedtime.

Contrary to widespread belief, reading books in bed, watching TV, or spending time on the mobile phone or computer makes it harder to fall asleep. Such activities should be done out of bed in another room, if possible, and the bed should be used for sleeping. In fact, sleeping somewhere other than your bed may also harm your healthy sleeping cycle.

Residents in big cities generally wake up very early to arrive at work or school on time and get back home quite late due to traffic. Sleeping late during the weekdays and waking up too early lead to an accumulation of sleeplessness, which needs to be made up for. Some research studies also have shown that late risers run higher health risks than early risers.

Certain regulations can be put into effect to help reduce sleep problems. For one thing, flexible working hours would enable more employees to start work later but more refreshed. Moreover, some businesses can arrange work schedules of their employees according to their body clocks. As a result, the performance and efficacy of the employees could be improved. Buildings can be made to let in more sunlight and thus dependence on blue light can be reduced.

Our need for sleep, daily and weekly, is more or less stable. This need is also related to your age. Sleep duration increases with your age: it peaks in your twenties and then your body clock tends to move back as you get on in years. As you get older, you need less sleep.

Sleep for physical formatting

Sleep used to be considered to be a time of rest until recently. Today, however, sleep is accepted as a time for restructuring and physical formatting. Snoring, sleep apnea, and frequent visits to the toilet prevent high quality sleep.

Growth hormones are produced the most during deep sleep. We should therefore be particularly careful about ensuring that children get enough and healthy (deep) sleep schedules.

Position

Sleep position is important, especially for the elderly. A position should be chosen that is least painful. For instance, the heart is believed to be more at ease when one sleeps on the right side. In this position, breathing takes place more through the left nostril rather than the right, enabling the sympathetic system to rest and the parasympathetic system to take over. When the parasympathetic system starts to work, drifting into sleep becomes easier and the duration as well as the quality of sleep increase. Sleeping on the right has been reported to be the tradition of the Prophet Muhammad, peace be upon him.

When you lie in bed, gaps remain between the bed and our neck, waist and knees. These gaps may need to be filled particularly for the elderly and those who suffer from pain in one’s back or neck. Herniated discs have become more common in employees doing desk jobs. A pillow can be folded slightly to support the neck, or special pillows that take the shape of the head and neck can be used. It may not always be necessary to fill in the gaps but if you have backache or hernia it might be necessary to support the waist. The support of a small pillow can be helpful in some cases of knee problems. In other cases, a soft pillow placed between the knees can be helpful.

Numerous studies in recent years have reported that cupping (hijama) and foot reflexology therapy can increase sleep quality. These two methods reportedly help discharge excessive static electricity and psychological stress that have accumulated in the body and thus make it easier to drift into sleep.

Oversleeping is as dangerous as sleep deprivation. It has been found that people who sleep more than eight hours a day have a higher risk of heart failure. A Norwegian study has shown that sleep that is more than eight hours or less than four hours increases the risk of heart failure. Conducted at the Norwegian University of Science and Technology, the study included 50,000 subjects aged 20-89 whose sleep patterns were monitored for 11 years. According to the results, people who slept more than eight hours or less than four hours had a 35 percent greater risk of dying from heart failure than people who sleep between six and eight hours. People who slept less than four hours were reported to have a 34 percent higher propensity for dying from heart failure.

It is important to make sure we have enough amount of sleep for both our physical and spiritual health; not more, not less. Having a siesta for 1-1.5 hours during the day can also prove useful. Oversleeping numbs the human mind, may bring gloom to the heart, and may cause us to lose our ability to make good judgments. Going to bed immediately after eating and drinking may also be a cause for various illnesses, including obesity.

References

1. Munshi, Neil. “Sleeping on the job can improve your work.” Financial Times, September 13, 2017.
2. Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I, “Insomnia and the risk of incident heart failure: a population study”, Eur Heart J. 2014 Jun 1;35(21):1382-93. Epub 2013 Mar 5.

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.

In recent years, people have been divided by conflicting studies about the risk of cancer posed by cell phone radiation. Does the current conflicting research eradicate or support the cell phone-cancer controversy?

Cell phone use has shown a dramatic increase in the world during the 1990s. The heated controversy today is about whether there is a relationship between cell phone use and the risk of developing malignant and benign brain tumors. This controversy did not exist—at least in the eyes of the public—until accumulating anecdotal evidence began suggesting a link between cell phone use and cancer. Since the first pieces of anecdotal evidence, numerous studies have investigated the cell phone-brain cancer link and a general summary of the findings is, at best, confusing. The substantial room for improvement in the experimental designs of these studies, the appearance of brain cancer after a long period of exposure, and some conflicts of interest among researchers prevented the results from being conclusive. More recent studies provide growing evidence for the link, suggesting there is reason to be suspicious about the studies that refute the relationship between cell phone use and brain cancer.

Possible health issues regarding exposure to radio frequency (RF) energy were described in a previous Fountain article (Tombak, 2002). This article also stated that proving or disproving the existence of RF exposure’s biological hazards remains an issue for epidemiology due to relatively low exposure levels, relatively small populations, and a lack of reliable dose estimates. The National Cancer Institute (NCI) is now maintaining an up-to-date web page to inform the public on key points that can be drawn from epidemiological studies investigating the cell phone-brain cancer link. It would be advisable that individuals concerned about this potential link become familiar with this web page and visit frequently to check the updates. A regular visitor will notice that the language on this page is evolving in every update in a way that the most recent version is less likely than the previous one to discredit the link as “out of the question”. This is because we are starting to see—albeit still opposed as weak—stronger signs of the alleged link as there is an increase in both the sheer number and the experimental design quality of relevant studies.

The first two key points that NCI draws on concern the type of electromagnetic energy emitted by cell phones, and the factors that determine a users energy exposure level. It would not be surprising if this train of thought followed with a third key point that stated that the cancer risk depended on the amount of energy that each individual was exposed to. However, the third key point quickly draws the conclusion that “studies thus far have not shown a consistent link between cell phone use and cancers of the brain, nerves, or other tissues of the head and the neck.” It further states “more research is needed because cell phone technology and how people use cell phones have been changing rapidly”.

Regardless of what type of general message one gets from these three key points, I want to emphasize that there is benefit in avoiding a lump-sum conclusion, and in making oneself aware of the results of individual studies. Before I move on to individual studies, however, I will point out how scientifically sound interpretations of statistical power and significance may lead to categorizations as ‘non-existent’ or ‘weak’, but how this scientific reasoning can potentially be misleading for the population at large. In this manner, one would better be able to make sense of why cell phone companies are, on one hand, highlighting the studies that have failed to find a causal link between cell phone use and brain cancer, but on the other hand, are taking all legal precautions necessary to prevent a future litigation by inserting a warning slip in fine print that cautions users not to hold the phone closer than a certain distance against one’s head or body.

The null vs. the alternative

A statistical hypothesis test involves two hypotheses: the null and the alternative hypothesis. The null hypothesis represents the status quo; it assumes that there is no real difference between the two groups under study and the observed difference can be attributed to random chance. Drawing a parallel with legal systems, the presumption that a defendant is innocent until proven guilty can be interpreted as saying that his or her innocence is the null hypothesis. There has to be sufficient evidence on the contrary, i.e showing the guilt, in order to be able to convict the defendant. In a similar fashion, an epidemiological study investigating the presence of a link between cell phone use and brain cancer would have a null hypothesis that states the absence of such a link. The cell phone technology is assumed to be innocent unless the data prove otherwise.

The alternative hypothesis, the latter of the two, represents the claim that there actually is a statistically significant link between cell phone use and brain cancer, and the observed link cannot be attributed to random chance. In our legal analogy, the alternative hypothesis is laying the charges against cell phone technology, thus as the Latin maxim “semper necessitas probandi incumbit ei qui agit” states, the burden of proof lies with the alternative hypothesis.

As a consequence of this construction, a hypothesis test can have only one of two conclusions. If the data shows results that are beyond some predetermined significance level, the null hypothesis is rejected and the researchers believe that there is sufficient evidence to say that the alternative is true. Such a conclusion would establish a link between cell phone use and brain tumors. On the other hand, if the results do not reach the desired significance level, the conclusion is not the confirmation of the null hypothesis, but a failure to conclude that the alternative is true. In other words, when the desired significance level is not reached, the only outcome is a lack of conclusion; the test would not falsify the null hypothesis but would not declare it to be true either. The accused would be vindicated on the basis of insufficient evidence.

News on the innocence of cell phone technology, or any technology for that matter, should be read primarily with this perspective in mind. The conclusions of research studies are reported on the basis of whether the results “reach or fail to reach significance”. However, a more meaningful statistic to report from the study would be the deviation of the results from significance, if they were not significant. Results that are close to statistical significance can still be “meaningful”. After all, the significance level chosen for most studies relies more on traditional scientific habits than anything else. In this perspective, it can even be called arbitrary. In reality, we may not have expertise in today’s world to determine whether a 5% significance level is more meaningful than a 10% when it comes to studying the link between cell phone use and brain cancer. So when the NCI officials mention “lack of a consistent link,” all of what they mean is that the desired significance level has not been reached in most credible and up-to-date studies. Yet, the public is not informed about how significant the results were. Furthermore, as we see in the much-acclaimed Interphone study, failure to reach significance in the entire study may be overshadowing the fact that significance was attained for a subgroup of people, for instance, the top 10% of the population with highest cell phone use (The Interphone study group, 2010).

Perspectives on brain cancer risk

News regarding cell phone tumor risks is plainly confusing because a battle continues among different international panels and interest groups over how to analyze and interpret cell phone tumor data. An article (July 6, 2011) on Microwave News explains why there is no overlap in the conclusions made by the International Commission for Non-Ionizing Radiation Protection (ICNIRP) and the International Agency for Research on Cancer (IARC), the two panels that are supposed to work together, but fell into deep disagreement as the data started showing some link between cell phone use and brain cancer. This piece is a highly suggested read for anyone who would like to be able to make more sense of the past and potentially future news on cell phone tumor risks.

The Interphone study

Much of the current debate on cell phone tumor risks actually revolve around the Interphone study, which was conducted by a consortium of researchers from 13 countries, and is the largest health related case control study of the use of cell phones and head and neck tumors. According to NCI’s summary, “most published analyses from this study have shown no statistically significant increases in brain or central nervous system cancers related to higher amounts of cell phone use. One recent analysis showed a statistically significant, albeit modest, increase in the risk of glioma among the small proportion of study participants who spent the most total time on cell phone calls. However, the researchers considered this finding inconclusive because they felt that the amount of use reported by some respondents was unlikely and because the participants who reported lower levels of use appeared to have a reduced risk of brain cancer.”¹

The general message that comes across in NCI’s summary of Interphone results is that we do not have enough reason to believe that cell phones are dangerous. However, it is very important to remember that one can never accept the null hypothesis that “cell phones are safe.” The only conclusion that can be drawn is on the basis of insufficient evidence, which is to say that cell phones are dangerous since the desired significance level has not been reached.

As the Interphone study is the largest of its kind, it has drawn substantial attention from concerned parties, and a significant part of this attention has been in the form of harsh criticisms for the experimental design, data analysis, and stated conclusions. For instance, one of Interphone’s biggest critics, the International Electromagnetic Field (EMF) Collaborative, published a paper in May 2010 detailing the flaws of the study. Among other things, these flaws included using data from 2004 and before when cell phone use was much less common, categorizing subjects who used cordless phones (which emit the same microwave radiation as cell phones,) as ‘unexposed’; exclusion of many types of brain tumors; exclusion of people who had died, or were too ill to be interviewed, as a consequence of their brain tumor; and exclusion of children and young adults who are more vulnerable.

In August 2009, more than forty leading independent scientists, physicians and other experts from fourteen countries endorsed the white paper “Cell-phones and Brain Tumors: 15 Reasons for Concern, Science, Spin and the Truth Behind Interphone” by US researcher Lloyd Morgan. Investigating the research on cell phone tumor risks including the Interphone study, this paper concluded that “there is a risk of brain tumors from cell phone use; telecom funded studies underestimate the risk of brain tumors; and children have larger risks than adults for brain tumors”. Unlike the Interphone study, some industry funded research also accepts the risks associated with cell phone use. In 1999, Dr. George Carlo, head of a $25m research body funded by the mobile phone industry in the US, said his study showed an increased risk of getting a type of rare brain tumor from using mobile phones. This early in the debate, he was probably one of the first researchers with links to industry who stopped ruling out the tumor risks of cell phones.

A review of other main studies

Hardell et al.

Dr. Lennart Hardell, from Örebro University in Sweden, is one of the most adamant leaders in cautioning the world about cell phone tumor risks. In 2007, he and his team reported that cell phone users were at an increased risk of malignant glioma, and that a daily one-hour exposure significantly increased the risk for developing a brain tumor after 10 years (Hardell et al., 2007). In a more recent study also cited by NCI, they found statistically significant trends of increasing brain cancer risk for the total amount of cell phone use and the years of use among people who began using cell phones before the age of 20 (Hardell et al., 2011). They also published a number of other papers in epidemiological journals pointing to the risks associated with cell phone and cordless phone usage.

The Danish cohort study

A 2011 cohort study in Denmark linked billing information from more than 420,000 cell phone subscribers with brain tumor incidence data from the Danish Cancer Registry (Frei et al., 2011). This study was an update on the 2006-update of a 2001 cohort study (Schüz et al., 2006; Johansen et al., 2001) that has been dogged by controversy and political suspicions since the first results were published ten years ago. NCI cites the study and states that the analyses found no association between cell phone use and the incidence of glioma, meningioma, or acoustic neuroma, even among people who had been cell phone subscribers for 10 or more years. However, there is no mention of the published or vocal criticisms of the study.

The main criticism for the study is that more than 200,000 corporate mobile subscribers were excluded from the cohort as cell phone bills were not in users’ names. Microwave News states, “In the time period covered in the Danish project—from 1987 through 1995—cell phones were expensive and it’s no stretch to assume that those who did not have to pay their own bills racked up the most talk time.”² Thus, the study designers effectively removed one-third of the population with the heaviest cell phone use. Dr. Lennart Hardell had also criticized the original 2001 paper by publishing on the shortcomings that make the conclusions premature (Hardell and Mild, 2001). Concerning the 2011 update, the Microwave News bluntly suggests, “Don’t believe a word of it”.

It is also interesting to note that the results came just five months after a panel of experts from the World Health Organization’s International Agency for Research on Cancer (IARC) deemed cell phones a possible cause of cancer—a statement that sparked fear in many of the world’s 5 billion cell phone users.

Conclusion

While there is still no established causal link between cell phone use and cancer, we know as a fact that different research groups have found an increased risk of a rare type of brain cancer among heavy users. Even though children are known to be at a greater risk because of being in earlier stages of neural development, it is unfortunate that data from children were not included in studies until very recently. Concerned citizens of the world need to raise awareness about the behind-the-scenes battle taking place between different international panels and interest groups. This will make a reliable interpretation of conflicting news more possible. Further corroboration for both statistical and anecdotal evidence on the relationship between cell phone use and brain cancer may be necessary to “prove” a link, but this should, by no means, be interpreted as a vindication of cell phones. In the meantime, it is only safe to take precautions oneself, and encourage loved ones to reduce exposure to electromagnetic energy from cell phones by using a hands-free device and by reserving the use of cell phones for shorter conversations.

Notes

1 http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones

2 http://www.microwavenews.com/DanishCohort.html#Continued

References

• Frei P, Poulsen AH, Johansen C, et al. 2011. “Use of mobile phones and risk of brain tumours: update of Danish cohort study.” British Medical Journal; DOI: 10.1136/bmj.d6387.
• Hardell, L., Walker, M. J., Walhjalt, B., Friedman, L. S. and Richter, E. D. 2007. “Secret ties to industry and conflicting interests in cancer research.” American Journal of Industrial Medicine,; 50: 227–233. doi: 10.1002/ajim.20357.
• Hardell L, Carlberg M, Soderqvist F, Hansson-Mild K, Morgan LL. 2007. “Long-term use of cellular phones and brain tumours: Increased risk associated with use for > or = 10 years.” Occup Environ Med. 64:626–632.
• Hardell L, Carlberg M, Hansson Mild K. 2011. “Pooled analysis of case-control studies on malignant brain tumours and the use of mobile and cordless phones including living and deceased subjects.” International Journal of Oncology; 38(5):1465–1474.
• Hardell L, Mild KH. 2001. “Re: Cellular Telephones and Cancer—a Nationwide Cohort Study in Denmark”; JNCI J Natl Cancer Inst. 93(12): 952.
• Johansen C, Boice Jr. JD, McLaughlin JK, Olsen JH. 2001. “Cellular telephones and cancer: a nationwide cohort study in Denmark.” Journal of the National Cancer Institute; 93(3):203–207.
• Schüz J, Jacobsen R, Olsen JH, et al. 2006. “Cellular telephone use and cancer risk: update of a nationwide Danish cohort.” Journal of the National Cancer Institute; 98(23):1707–1713.
• Tombak, Ali. 2002. “Biological Effects of Cellular Phones.” The Fountain, 37 (1).
• The Interphone Study Group. 2010. “Brain tumour risk in relation to mobile telephone use: results of the Interphone international case-control study.” International Journal of Epidemiology; 39(3):675–694.

Scientifically known as Daucus Carota, carrots categorically are in the same family as fennel, cumin, dill, celery and parsley. They mainly originated in geographies of Central Asia and Middle East and their original flavor were somewhat different to the contemporary ones. The carrot as a plant stores its foodstuff in its roots. Besides their common use for consumption, they can be juiced or grated. They bring a distinct flavor when used in salads and meals. Although generally considered to be orange, yet carrots’ color can be as diverse as green, red, white and even purple.

Some astounding medical benefits

Created rich in Vitamin A carotene, carrot is an excellent source of antioxidant for the treatment of cancer and protection from some cardiovascular diseases. They are also instrumental for the regulation of sugar in our blood. The findings of a survey conducted on 1,300 patients, reveal those who eat carotene-rich foods such as carrot or squash, at least once a day, have about 60% less risk of cancer than those deficient in their carotene intakes. In specific terms, while the regular consumption of carotenoid reduces the risk of post-menopause breast cancer by an estimated 20%; on the other hand esophageal cancer, bladder cancer, uterine cancer, prostate cancer, colon cancer, throat cancer and lung cancer are believed to reduce the risk by an astounding 50%.

Scientists state that the risk-reducing influence of the carrot comes not only as a result of its beta-carotene ingredient but also from its alpha-carotene and some other elements.

How does carrot improve the quality of vision?

Unsurprisingly carrots are known for the goodness they bring to the eyes; particularly valuable for improving night vision. The beta carotene has been made to play a pivotal role in this respect. An incredibly sophisticated process eventuates as Vitamin A is converted in the liver into beta-carotene and is then carried to the retina of the eye. It is here when beta-carotene is converted to rhodopsin, imperative pigment that aids night vision. It is with rohdopsin that vision is sharpened and sight becomes possible in darker environments. On the contrary however, when there is Vitamin A deficiency in the body, night sight is adversely impacted. Moreover the antioxidant in beta-carotene has been equipped with an additional protective role against macular degeneration as well as cataract.

Carrot’s falcarinol and colon’s well being

The natural pesticide (falcarinol) found in carrots is believed to reduce the risk of cancer. In order to ascertain this relationship between falcarinol and cancer risk reduction, the Journal of Agricultural and Food Chemistry, conducted an experimental study on the subject. Three different groups of laboratory animals had been given precancerous colon lesions. The first group was fed with standard diet, the second group with freeze-dried carrots that contained a natural level of falcarinol while the third group was exclusively fed falcarionol/g derived from carrots. After 18 weeks period, the number of lesions which were given to potentially increase the class size, significantly decreased in those rats fed with one of the two experimental treatments. The finding demonstrated that dietary treatments with carrot’s falcarinol caused delay and in some cases the retardation in the development of large tumors.

This established a significant relationship between those critical endowed carrot contents and the risk-reduction of cancerous tumors.

Carrots and lung protection

Overtime a number of studies have been conducted and research have established direct link between Vitamin A and its role in the protection of lungs. The scientifically established relationship between Vitamin A, pneumonia and emphysema, found that the benzo(a)pyrene, the main carcinogen in cigarette smoke causes the Vitamin A to diminish. This is especially true when long term smoke addicts who have also had poor Vitamin A diet, causes more cancer-related diseases and emphysema.

Earlier studies have also demonstrated that a diet poor in Vitamin A causes emphysema. Subsequent studies have further substantiated that a diet rich in Vitamin A can help reduce emphysema. Indisputably carrots are rich in their Vitamin A reserves. Carrots have been also made with the capacity to aid and protect our lungs.

Experts are therefore of the opinion that carrot is stomach and intestines’ close friend. It can be said that their overall benefits can range from blood-formation, to strength, from diarrhea control, to being laxative, to their help with bile discharges and the strengthening of the liver brings to attention the remarkably latent benefits within carrots and makes them an indispensable vegetable beyond the immediate value of taste and color.

This discovery about carrots, amongst innumerable other vegetables, virtually makes the earth a mighty pharmacy which is orderly fashioned with numerous therapeutic qualities in the form of vegetables and herbs spread out in abundance. Quite substantially it appears that not only do they attract with their beauty and color the gazes of our eyes; not only do they afford us with innumerable varieties of tastes and flavors but in addition with the use of their innate given potentials they work extraordinarily and in remedial manner whilst in our bodies.

All this appropriately recalls to mind the Might and Power of God Almighty as eloquently expressed in the Quran “Who is it that provides for you from heaven and earth?” (Quran Al-Yunus, 10:31)

All parents do everything they can to keep their children healthy. The creation of a baby in a mother’s womb still remains a wonder not fully explained by scientists. Birth has been a mystery in the life of human beings since the beginning of history. Religious sources show the phases of a baby’s growth in the mother’s womb, the perfect design of the environment that supports the needy baby with everything it needs, and its birth, all as examples of God’s mercy and power. Although the whole process of pregnancy develops with almost no interference from outside, there are some precautions that parents can take to have a healthier baby.

How to start taking care of a baby even before pregnancy

Science makes it clear that we should not wait until we hold a baby in our arms before we start taking care of him or her. But how can we take care of a baby even before conception? Well, one of the answers is quite simple: by taking folic acid! If women have enough folic acid, vitamin B complex, in their bodies before pregnancy, this vitamin B complex can reduce the risk of neural birth defects by up to 70%. Neural tube defects (NTD) are a group of congenital birth defects that influence the central nervous system. The neural tube forms in the embryo between 4 to 6 weeks after conception and then closes. The neural tube eventually becomes the baby’s spinal cord, spine, brain, and skull. If the neural tube does not close properly, the baby may have neural birth defects, in which case the baby lacks either a developing brain, spinal cord or both. NTDs occur very early in pregnancy, even before most women know that they are pregnant. The most common neural birth defects are anencephaly and spina bifida. In anencephaly, the brain is either not fully developed or is completely absent, while in spina bifida part of the baby’s spinal cord remains outside the body.

Folate deficiency and folic acid

Folate, also called vitamin B9, is a water-soluble vitamin. It is essential to human life and is found naturally in some foods such as liver, citrus fruits and juices, whole grains, and dark green leafy vegetables. Folic acid is the synthetic form of folate. Folic acid can be obtained from supplements and fortified breads and cereals. Both folic acid and folate work for the same purpose, and in this article the terms are used interchangeably.

In folate deficiency, the body is unable to transport folic acid to the brain, resulting in mobility problems, blindness and seizures. Pregnant women in particular can be at great risk of giving birth to low-birthweight, premature babies who may have neural birth defects. In children, folate deficiency can slow general development. In adults, a type of anemia appears in long-term folate deficiency. There are also other signs of folate deficiency such as headaches, loss of appetite, sore tongue, diarrhea, forgetfulness and irritability.

Why folic acid is important

Folic acid plays a very important role in various body processes including cell maintenance and repair, formation of red blood cells (which provide oxygen to tissue), formation of white blood cells (which defend the body against infectious disease), synthesis of DNA (hereditary material) and amino acid metabolism. It also plays a crucial role in preventing human illness. Folic acid supplements cannot prevent stroke or heart disease, but studies have shown that it can reduce the risk of heart attack and stroke. Recent research shows that it supports the functioning of blood vessels, which improves the blood flow to the heart. In addition, folic acid helps to protect against the development of some forms of cancer, particularly colon, cervical, esophageal, breast, and stomach cancers.

A number of scientific experiments have shown that people who suffer from Alzheimer’s disease have low levels of folic acid in their blood. Thus, it is not surprising that folic acid is crucial for brain function and plays an important role in mental and emotional health.

If you are a married woman and have plans to have a child some day, you should definitely start to take folate because by the time you know you are pregnant, your baby’s brain and spine will already have been formed. This is why it is important for women to maintain sufficient levels of folic acid all through their child-bearing age even if they are not planning a pregnancy.

Should only women take folic acid?

No, not really. Every adult man and woman should consume it every day to reduce their risk of heart disease, colon cancer, and stroke.

If this is a vitamin that could change our life forever, how much should we consume and where can we get it from? You can get your folic acid naturally from foods such as liver, nuts, peanut butter, dried peas and beans, oranges, tomato and pineapple juice, avocados, cantaloupes, asparagus, and leafy green vegetables. Some breakfast cereals with 100% of the recommended daily allowance per serving are Crunchy Nuggets, Multi-Grain Cheerios Plus, Product 19, Whole-Grain Total, Total Corn- Flakes, Total Raisin Bran, and Special K. It can also be obtained from other, less processed grain products such as bread, pasta, and rice. Taking a multivitamin containing the recommended daily allowance of 400 micrograms is another option. The following table suggests a variety of dietary sources of folate.

Table 1: Selected Food Sources of Folate and Folic Acid

* Items marked with an asterisk (*) are fortified with folic acid as part of the Folate Fortification Program.

^ DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient.

Sehnaz Dogu Ekicikol obtained a master’s degree on Microbiology from Georgia State University.

References

• Zittoun J. Anemias due to disorder of folate, vitamin B12 and transcobalamin metabolism. Rev Prat 1993;43:1358–63.
• Herbert V. Folic Acid. In: Shils M, Olson J, Shike M, Ross AC, ed. Nutrition in Health and Disease. Baltimore: Williams & Wilkins, 1999.
• Kamen B. Folate and antifolate pharmacology. Semin Oncol 1997;24:S18-30-S18-39.
• Agriculture’s Nutrient Database Web site: http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.
• http://dietary-supplements.info.nih.gov/factsheets/folate.asp
• http://www.cdc.gov/ncbddd/folicacid/

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

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

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

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

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

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

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

Notes

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

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

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

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

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

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

HIV/AIDS is one of the most devastating health issues in modern history. Since the first case was reported in 1981, over 25 million people have died of HIV/AIDSrelated causes. Despite a better understanding of the disease, extensive knowledge about virus-human interaction, improved preventive measures, and medical treatment options, most experts agree that the pandemic is still in its early stages and rapidly spreading. According to the World Health Organization, in 2006 4.3 million people became infected with HIV and a total of 2.9 million people died of HIV/AIDSrelated causes. As of 2007, over 40 million people are living with HIV/ AIDS around the world and nearly half of them are females between the ages of 15 and 24.

With a vaccine still perhaps decades away, the best hope for impeding the spread of this deadly disease lies in effective prevention, early diagnosis, and successful treatment. For more than two decades, thousands of researchers from the most prestigious institutions around the globe have been struggling to discover more effective screening, diagnosis, and treatment options against HIV/AIDS, but a great deal has yet to be accomplished. At the moment, the high cost of the current medical treatment options and limited accessibility to HIV testing worldwide remain as additional obstacles to be overcome. Below is a table showing the spread of HIV/AIDS worldwide, based on the best available information provided by WHO in 2006. Additionally, the map below represents the regional distribution of adult HIV/AIDS cases by region based on UNIAIDS 2006 Report on the global AIDS epidemic.

What is HIV/ AIDS?

Healthy human bodies have a wellprogrammed defense mechanism (the immune system) that fights infections and helps prevent the development of cancer cells. Human immunodeficiency virus (HIV) primarily targets vital elements of the immune system, such as helper-T cells, macrophages, and dendritic cells. Due to the damage and destruction of these cells, the human body loses its ability to fight against infections and cancerous developments. This makes the body more susceptible to certain types of cancers, such as Kaposi sarcoma, and to opportunistic infections that would normally be easily defeated, such as pneumonia (Pneumocystis carinii) and Cryptococcal Meningitis. These infections might result in severe damage or the death of the patients. Therefore, it is not the Human Immunodeficiency Virus that causes death in HIV(+) individuals, but opportunistic infections or cancerous developments that a weakened immune system cannot repel. Hence, the later stages of HIV infection are called Acquired Immunodeficiency Syndrome (AIDS).

In spite of many obstacles, in industrial countries there has been a remarkable improvement in the medical care of HIV/AIDS individuals as a result of testing for HIV on a regular basis, particularly among high risk groups. This facilitates early diagnosis and therefore an early start in medical treatment, which allows HIV(+) individuals to live for decades after diagnosis. However, worldwide, particularly in developing countries, 90% of those carrying HIV have not been tested or do not have access to adequate treatment for the disease. Furthermore, every year a considerable number of HIV(+) individuals in developing countries die without even knowing what HIV is and leave thousands of orphans behind who do not have any idea what took their parents away. The number of people living at critical poverty levels in some of these hardest-hit regions, such as sub- Saharan Africa, has reached over 43 percent in recent years. Women encompass 80 percent of those who are living on less than a dollar a day. For people who live in such abject poverty, neither treatment for an HIV+ /AIDS individual (which normally costs around $25,000 annually) nor routine HIV screening seems realistic. On the other hand, even though testing and medical treatment options are available in developed countries, the economic burden on the health care system is becoming greater with every passing day.

HIV and children

As of 2007, over 2.3 million children are suffering from HIV/AIDS worldwide. A small percentage of these children were exposed to the HIV in medical settings, due to unscreened blood transfusions or reused or insufficiently sterilized equipment. Pediatric HIV outbreaks in Romania in 1989 and in Libya in 1998 are two devastating examples of the consequences of negligent or insufficient precautions taken by medical personnel in hospitals. Currently, health care professionals are required to take strict precautions when cleaning and sterilizing medical equipment, while blood banks are monitored closely to ensure the careful screening of blood. These precautions seem to have led to a significant reduction in the number of HIV infections which are acquired in hospital settings. However, motherto- child transmission still constitutes 90% of pediatric HIV cases. An HIV (+) mother has about a 35% risk of transmitting the virus to her child during her pregnancy, child birth, or nursing. This risk can be reduced by administering AZT (an antiretroviral drug) to the mother during the last trimester of pregnancy, delivering the child by C-section, giving one dose of prophylactic antiretroviral therapy to the baby after birth, and by avoiding breast-feeding the infant. As a result of widespread screening and the use of prophylaxis for mother-to-child transmission, the rapid spread of HIV among the pediatric population in industrial countries is relatively under control.

Sadly, not all nations have benefited uniformly from the recent advances in our knowledge about the prevention of transmission. Mothers and infants in developing countries face a different scenario than those in the “modern world.” In places like sub-Saharan Africa, where the majority of HIV/AIDS cases are due to mother-to-child transmission, the number of new infections is rapidly increasing; it seems that ensuring the abovementioned precautions are in place is extremely difficult due to several limitations. These limitations should be discussed in another paper, however to give a brief idea to the reader, one of these instances can be examined. It is a fact that if an HIV(+) mother avoids breastfeeding her newborn baby the risk of her infecting the child with HIV is dramatically reduced. Although this sounds like a wonderful way to combat HIV infection in infants, it poses many problems to mothers in sub-Saharan Africa. Every year, more than one million babies die in the first 28 days of their life in Sub- Saharan Africa. Most of these deaths are due to malnutrition and infections. In most situations breast-feeding is the only clean source of nutrition a mother can offer her child. It also provides natural immunization against most of the infectious agents to which a newborn can be exposed in the later days of his/her life. Babies who are not breastfed have almost no other alternative source of clean nutrients and stand little chance against infections. An HIV(+) mother in Sub-Saharan Africa has to face this dilemma every single time her baby cries from hunger: either take the risk of infecting your baby with HIV or let your child die of malnutrition or infections which kill approximately 3,000 African children every day.

Another issue concerning children in the hard-hit HIV regions is the loss of one or both parents or primary care-givers at a very early time of their life. So far in Africa, HIV/AIDS related deaths have left 14 million orphans. The United Nations estimates that the number of orphans will reach 25 million by the year 2010. Only in rare cases do these children have access to clean water, food, shelter, and education. Furthermore, the orphans who have been infected with HIV by their parents do not have access to adequate treatment options. The number of orphans is so high and resources are so limited that unfortunately most of these children fall through the cracks of society, succumbing to poverty, abuse and even death. Some of these orphans are relatively lucky and have healthy grandparents to care for them. It is not uncommon to find 75-80 year old grandparents who are already living under the critical poverty level taking care of three or four AIDS orphans, and wondering who will care for their grandchildren when they pass away.

Education

Success against the HIV/AIDS epidemic cannot be accomplished only with scientific and medical means. Preventive education plays a key role in the battle against HIV/ AIDS. The first step in preventive HIV/AIDS education is to inform individuals about the disease and answer their questions, such as, “What causes AIDS?”, “How is HIV/AIDS spread?”, “What are the preventive measures to be taken?” If one is already infected with HIV then one must ask “What are the treatment options?”

Preventive education for risk groups who are not aware of HIV/ AIDS and the consequences of the infection helps to decrease the overall number of new infections, particularly those in developing countries. However, another issue appears as education level increases: according to current studies, the number of people who continue risk-taking behavior is increasing in spite of the knowledge they have about HIV/ AIDS prevention and the consequences of the disease. This suggests overthat effective HIV/AIDS prevention should include not only education about the facts of the illness, but also education that focuses on teaching people to avoid behavior that puts them at high risk. It is also worth noting that the widespread dissemination of information by governmental organizations may not be effective on its own, and that different types of intervention may be necessary by groups with the potential to motivate people on a personal level. In other words, it is important to individually instill a sense of consequence and personal responsibility within those at risk, rather than broadly reminding them of the dangers that they face. As a result of recent thinking along these lines, various institutions, professional groups, and government organizations have realized the need for strong collaborative efforts and have aligned themselves in order to begin taking the steps necessary to effect this type of change.

Working together

Around the globe, government agencies have been initiating and sponsoring several efforts aimedat HIV-prevention. However, the complexity of the HIV epidemic and the involvement of many sociologic and behavioral factors require a shared commitment among government agencies and civil society organizations. For example, the Center for Disease Control (CDC) is the leading federal agency in HIV prevention in the United States. In their strategic plan for HIV prevention in 2005, the CDC admits that the HIV epidemic is not a matter that can be handled by only one agency, group, or organization. Therefore, for success in HIV prevention the CDC recognizes the need for other domestic partners, such as:

~ Other federal agencies;

~ State and local health and education departments;

~ HIV prevention community planning groups;

~ Community-based organizations;

~ Academic institutions;

~ The private sector;

~ Faith-based groups and

~ Foundations and nonprofit groups

(Centers for Disease Control and Prevention HIV Prevention Strategic Plan Through 2005)

In addition to domestic partnership, worldwide cross-cultural and cross-faith collaborations are establishing a strong global response to eradicate HIV/AIDS. People from all over the world should contribute, in whatever capacity and with whatever resources they can, to the solution; their involvement is critical. The World Health Organization, UNICEF, UNESCO, and similar organizations are doing their parts to bring multinational aid to the hardest hit regions. Additionally, many faith-based national and international organizations around the globe have started working in collaboration towards the eradication of HIV/AIDS. Among these faithbased efforts there are recent examples of interfaith partnerships. The Africa HIV/AIDS Faith Initiative, a successful example of this type of collaboration, has been active since 2001 in five African countries: The Ivory Coast, Kenya, Nigeria, Tanzania and Zimbabwe. One of their noticeable accomplishments is promoting interfaith dialogue in these countries where ethnic and religious variations often cause serious clashes. A report from The Global Health Council lays the power of Interfaith partnership before our eyes:

“In Kenya, the Supreme Council of Kenya Muslims, the Anglican Church of Kenya and the Pentecostal Churches of Eastlands, a low socioeconomic community outside Nairobi, have teamed up to reach bishops, pastors, men, women, youth, children and people infected with HIV/AIDS through education and service initiatives. In Tanzania, the national staffs of the Episcopal, Christian and Muslim HIV/AIDS offices meet monthly to exchange ideas and plan together for the effective development, implementation and coordination of HIV education and service interventions.

But it is in Nigeria, with its welldocumented history of religious conflict and recent violence, where the partnering of Christians and Muslims is most remarkable. Observing the establishment of separate offices in each of the four other countries, Nigeria’s religious leadership said “it won’t work here,” and charged The Balm In Gilead to set up the Interfaith HIV/AIDS Coalition of Nigeria. Christian and Muslim clerics going out on the street together can draw curious crowds, and “people will come into the office just to see us working together,” said one reverend.

Nigerian faith institutions involved in this historical decision included the Episcopal Conference of Nigeria, Christian Association of Nigeria, the Christian Health Association of Nigeria and the Supreme Council of Islamic Affairs. This interfaith approach in Nigeria is being seen as a model that can be replicated by other countries. The Kenyan Muslim leaders have already requested that it be presented as a best practice model and replicated in other parts of the continent.” http:// www.globalhealth.org/reports/ text.php3?id=194

Conclusion

We have witnessed many harsh discussions, questions and speculations about HIV/AIDS such as, “How and where did HIV/AIDS start?”, “Whose fault was that?”, “Why don’t people simply stay away from risky behavior and put a stop to it?”, “What are the roles of faith traditions, family values and public wisdom in terms of preventing and fighting against HIV/AIDS?”, “If I am not involved with certain risky behavioral elements am I safe? Are my children safe from HIV?”, “Is contributing to the solution for HIV the same as trying to legitimize the life-style preferences which are the primary cause of the spread of HIV in the first place?”

As a matter of fact, how this epidemic started, whose fault it was, why precautions were not taken on time does not matter that much anymore. What matters is that hundreds of people are dying, thousands of children have been orphaned, and millions of mothers are crying in desperation everyday. We do not have the luxury to sit back in our comfortable seats and be the judge who decides who is right and who is wrong in this drama. We are all human… we are citizens of the earth… we breath the same air, sleep under the same sky. When we cut ourselves, our blood runs red, our tears are salty. Pain is pain… a cry is a cry… desperation is desperation…No matter where we go, what language we speak, or how we live our lives… We are obliged to put the differences to one side and to become a part of the solution…to think about it… to talk about it… to do something about it… or at least with a sore heart cry and pray for our HUMAN sisters and brothers who are suffering from HIV/AIDS… who might not be able to do much for themselves.

Cancer is a major cause of illness and death in developed countries. The risk of death from cancer has also been increasing in the less developed countries. As improvements in medical care have reduced deaths from infectious diseases and increased life expectancy, cancer has become the leading cause of death in many societies. For example, according to the American Cancer Society, about one in three people in the USA will develop cancer at some point in their life, and about one in four will die from it. Each year about 500,000 individuals die of cancer, a rate of about one death per minute, and more than one million new cases of cancer are diagnosed annually in the US. Currently more than 10 million individuals are receiving medical treatment for cancer in US hospitals and medical centres.

What are the causes of cancer?

Scientific evidence gathered over the last hundred years has dispelled the superstition, once prevalent, that cancer is a contagious disease. But, despite significant advances in the last decade, its underlying mechanisms are still a mystery.

The link between cancer and genetic mutation was shown early in this century: normal cells mutate into malignant ones because of changes in chromosome constitution.

There are four points which support the idea that cancer has a genetic origin:

1. More than 50 forms of cancer are known to be inherited to one degree or another
2. Some tests detecting mutations have shown that most environmental toxic agents which are called carcinogens are also mutagens.
3. Work with cancer-associated viruses has revealed the presence of some mutant genes, known as oncogenes, that promote and maintain tumour growth.
4. The chromosomal abnormalities found in particular forms of cancer, especially leukemia.
5. The environment and behaviour can also play a significant role in the genesis of cancer.

The existence of high rates of specific cancers in particular families has been known since early in the 19th century. Many explanations have been offered for this phenomenon, including multiple gene inheritance, environmental agents or even mere chance.

Hereditary forms of cancer

Recent advances in cancer research have provided some clues about the relationship between mutant genes and the cellular events that lead to tumour formation. Experimental evidence suggests that as few as two mutational events may be sufficient to cause a cell to become cancerous (see Figure I). In those forms of cancer that show a heritable predisposition, the first mutation is present in the germ cells and is transmitted genetically. The second mutations are acquired by somatic cells through spontaneous replication errors or exposure to environmental agents that cause genetic damage, resulting in cancer. On the other hand, not all individuals who inherit the first mutation will develop cancer.

If the second mutational event does not occur, then no tumour will develop. Research has focused particularly on two classes of genes in carcinogenesis: tumour suppressor genes which normally function to suppress cell division, and proto-oncogenes which normally promote cell division. 

Tumour suppressor genes

Tumour suppressors are detected in the form of chromosomal deletions (or other inactivating mutations) that are tumorigenic. The strongest evidence for their nature is provided by certain hereditary cancers. There is also now evidence that changes in these genes may be associated with the progression of a wide range of cancers. About 10 tumour suppressors are known at present. These genes act at certain points to inhibit cell division. These and or their gene products must be absent or inactive for normal cell division to take place. If tumour suppressor genes become deleted or inactivated by mutation, control over cell division is lost, and the cell can proliferate in unchecked fashion. The example of breast cancer illustrates how mutations in tumour suppressor genes are involved in the development of cancer:

The genetic link to breast cancer

In the USA, the ratio of women getting breast cancer is approximately 1 in 8. It is the most common form of cancer in women: 46,000 women die and 182,000 new cases are diagnosed each year. Epidemiological factors may also be involved in breast cancer, but geneticists have focused on the question – Is there a genetic predisposition to breast cancer? Their answer, for the present, is Yes: though involved in only about 5% of all eases, a particular gene has been identified and located on chromosome 17. It is responsible for susceptibility to a form of breast cancer that appears in the third and fourth decades of life. About one in 200 females inherits this gene, and 80% to 90% of these will develop breast cancer. Besides breast cancer, a gene has been found on chromosome 17 in sufferers from astrocitoma (brain tumours), colon, lung and bone cancers. This finding suggests that there is a mutation on this gene (called p53), and as a result the cells start growing abnormally.

The Future

Investigations into the tumour suppressor genes are an example of the recent progress in molecular aspects of cancer research. A better understanding of molecular carcinogenesis and molecular epidemiology will eventually decrease the quantitative and qualitative uncertainties associated with the current state of cancer risk assessment. It may be possible to immunize patients against their tumours by using these findings about genes-cancer relationships. Indeed, determination of the type and number of mutations in p53 and other cancer-related genes in tissues from ‘healthy’ individuals may allow the identification of those at increased cancer risk and their consequent protection by preventive measures.

Although there have been many and most welcome developments in the diagnosis and treatment of diseases, including cancer, there is a definite and reliably cure only for some of the infectious diseases. However, we firmly believe there are definite remedies for all diseases in the universe except death.

References

• HARRIS, ADRIAN L. (1990) ‘Mutant p53-The commonest genetic abnormality in Human Cancer?’ The Journal of Pathology.
• HARRIS, CURTIS C. (1993) ‘p53: At the Cross-roads of Molecular Carcinogenesis and Risk Assessment’, Science, 262.
• CUMMINGS, M. (1994) Human Heredity, West Publishing Company, St Paul. Lewm, B. (1994) Genes 5, Oxford University Press, New York.
• LEWIN, B. (1994) Genes 5, Oxford University Press, New York.