Gastro-esophageal reflux disease (GERD) is among the most common chronic diseases in the Western world, affecting up to 30% of the general population in Europe and the US. It is a condition which develops when the acidic contents of the stomach flow backwards into the esophagus and cause what’s known as heartburn. While most patients respond well to the standard therapy of proton pump inhibitors which block acid-secreting cells in the stomach, we are still trying to understand the molecular reasons why 30-40% of reflux patients do not respond adequately to acid-suppressant therapy. Not only does GERD have a significant negative impact on health-related quality of life, but the over-subscription of ineffective drugs causes a significant economic burden on healthcare.

Heartburn is the most noticeable and troublesome symptom of GERD. From what we currently understand about the pathophysiology of the disease, we know that the reflux of acid evokes different types of pain, but the basic mechanisms and pathways by which this pain is generated is incompletely understood. The junction between the esophagus and stomach is structurally and functionally designed in a way to ensure that any acid secreted in the gastrointestinal tract flows towards the stomach, and not up onto the lining of the esophagus. This function is served by the muscle structure sitting at this junction, called the lower esophageal sphincter (LES), which ensures that the ingested food following a meal does not reflux. However, there are several factors which can make the LES’s job more difficult. One of the most obvious factors includes the excessive consumption of food, particularly during the later hours of the day. There is convincing evidence that 90% of reflux episodes occur post-prandially, due to minor elevations of intragastric pressure which causes the LES to relax and therefore allow the reflux of acid. In more advanced cases of reflux disease, acid pockets form at the gastroesophageal junction where unbuffered acid collects into a reservoir. When the LES fails in this setting, there is reflux of a higher volume of acid.

Focusing on the microscopic structure of the esophagus and stomach, we can see a minute yet essential difference between the linings of these two gastrointestinal organs. The esophagus has a stratified squamous epithelial lining, which acts as a tight protective barrier against food but is readily damaged when exposed to a chemical environment. On the other hand, the stomach is lined by tall columnar epithelium, which is designed to withstand very low pH and high levels of proteolytic activity. Our gastrointestinal tract (and the human body in its entirety) is perfectly designed to carry out the specific role of transporting food from the oral cavity from the esophagus to the stomach, where it is digested for our nourishment. It is oftentimes our greediness and overindulgence which disrupt the perfect order of our anatomy at a molecular level, resulting in the macroscopic changes we see at endoscopy and the symptomatic discomfort we feel from the painful circumstances of reflux. 

The stomach is our center of nourishment. Given that every food particle has the purpose of nourishing the cells of our body, why do we so commonly make the mistake of eating excessively, nocturnally, and quickly? Fatty foods influence the relaxation of the lower esophageal sphincter, along with alcohol, coffee, and acidic drinks. Large meals and rapid food intake distend the stomach, increase intragastric pressure and facilitating the reflux of acid from the stomach. Given these, it is plain to see that, in most cases, simple lifestyle changes can prevent the development of such chronic and discomforting diseases. The following verse in the Holy Qur’an offers a short but very effective prescription: “Eat and drink, but do not be wasteful” (7:31).

The philosopher and physician Ibn Sina (Avicenna) summarized the science of medicine as follows: “Eat little when you eat, and after eating do not eat again for a certain period of time; health lies in digestion. There is nothing heavier for the body to tolerate than putting food after food in the stomach.” Frugality in eating is also echoed in the teachings of Prophet Muhammad, peace be upon him, who famously said “There is no vessel which the son of Adam can fill more evil than his stomach, for it is sufficient for him to take a few mouthfuls in order to straighten his back; but if he must, then fill one-third with food, one-third with drink, and one-third with air” (Tirmidhi).

The lifestyle factors that are strongly associated with GERD are obesity and smoking. In the 30-40% of GERD patients who do not respond to acid-suppressant therapy, simple lifestyle changes such as cutting out acidic drinks and eating more slowly, and not after 7 pm have been effective alternative treatments. While our understanding of molecular pain mechanisms of the esophagus need further improvement, the simple act of making minor changes in our eating habits can ensure that the anatomy and function of our gastrointestinal tract remains optimal.

Brown and red algae are salt water organisms. These plants grow on rocky shores or in oceans with a rocky bottom. In quiet areas free of excessive waves they can live for up to 15 years. These can be utilized for the special polysaccharides in their bodies. That’s why they are commercially significant. For example, alginic acid and alginates obtained from brown algae can be used in many fields, from the food industry to the medical field, from cosmetics to paper and textiles. An algae species (Macrocystis Pyrifera) that can be found both in North and South America, New Zealand, Australia, and off the African coast is the primary source for the world’s production of alginic acid and alginate. In 2009, 26500 tons of alginate was produced, primarily by the countries of Scotland, Norway, China, and the USA.

Alginic acid is a macro molecule synthesized from mannuronic and gluronic acid molecules. Because of its hydrophilic property, the Na and K salts of alginic acid are used in providing homogeneity to frozen food during defrosting, preventing food decay related to instant temperature spikes, increasing viscosity, preparing jelly like deserts, and stabilizing fruit juices and ice cream. For similar reasons, Alginates are utilized in paper quality enhancement, and the advanced application of ink in glues and in pressed textile products, where they improve the flow of dye. Alginates are also used in cosmetic products, in production of waterproof or fireproof textiles, and in some synthetic dyes because they improve viscosity..

One of the most important uses of alginates is in the medical field. Many people suffer from stomach burn and acid reflux disease. In these treating these symptoms, the percentage of a prescribed medicine containing alginic acid content is 100 %, because in the case of acid reflux, alginic acid contains a preventive property, and antacids. This antacid neutralizes stomach acid. Alginic acid, however, reacts with saliva and Na Bicarbonate ion to produce foam in the upper stomach. In the case of a reflux, this foam barrier prevents the escape of acidic stomach content into esophagus.

According to a study conducted in England in 2010 about obesity treatments, alginic acid added natural fiber and was found to reduce lipid intake 75% in the intestines.

The absorption and removal of drugs in the stomach and intestines plays an important role in ensuring drugs act as intended. For instance a blood clog in a pulmonary vein can be transported to the lungs and may have fatal consequences (a pulmonary emboli). In order to prevent that, low molecular weight, heparin containing, drugs are used. The polymeric alginate beads in these drugs have been found to improve drug efficiency up to 80-90 %. In this kind of controlled release of drugs and enzymes, the use of polymeric alginate additives provides high efficiency.

A new kind of antimicrobial textile that does not stick to wounds is made from the silver coated fibers of an Alginate-carboxymethyl cellulose mixture. This fabric not only provides protection against infections but also, with its non-stick property, prevents traumas; and its high hydrophillic feature allows open wounds to heal faster.

Everything in the universe is beautiful, either directly, by itself, or indirectly, by its consequences. Algae, which many of us dislike, is in fact a great work of art as it is a source of food, a decoration of the seas, and is used to cure various diseases.

The harmful foodstuff eaten is spat out quickly through vomiting and so damages of such foodstuff is minimized. Occurring upon taking of any poisonous food or alcohol, vomiting directly contributes to treatment by ensuring a quick disgorge of the harmful stuff. Variations in amounts of estrogen and progesterone hormones during pregnancy helps in noticing even the least amount of toxins (poisons) found in the blood by way of increasing sensitivity of the chemoreceptor trigger zone within the brain stem. When this zone of the brain takes notice of toxins in the blood, it immediately activates feeling of nausea and vomiting. Margie Profet, a researcher from the University of California at Berkeley was the first person who drew attention to this issue in 1995. She asserted that food craving is a divinely merciful mechanism aiming at protection of the miraculously developing embryo against probable dangers within the human body. She also asserted that food craving protects the embryo from natural toxins in foods. Vomiting may also happen to travellers and sufferers of migraine. Certain psychological factors such as unpleasant smell and excessive fear may result in vomiting as well.

If, however, vomiting recurs and turns out to become a habit, one should be careful, for vomiting causes new problems such as electrolyte losses and dehydration while irritating the alimentary canal, throat, mouth and teeth through which vomited matter passes. In addition to these, regurgitating might be inadvisable and indeed should be avoided in certain cases of poisoning which develop due to ingestion of petroleum products and burning chemicals like hypochlorite and ammonia which are used in house cleaning. The reason for this is because petroleum products may cause pulmonary infection of chemical origin in the lungs and burning chemicals may cause scalds on the tissues they touch during regurgitating.

Just like all the systems that our bodies are equipped with, vomiting also happens in accordance with a plan and program during which a wonderful co-ordination is displayed. The vomiting center in the brain is responsible for such co-ordination.

Rapid increase in salivation and nasal secretion prior to vomiting plays a key role in alleviating damages of the highly acidified vomited matter over the interior surfaces of the mouth and nose. Increased salivation helps with the protection of tooth enamel too. The pushing process of the foods eaten normally occurs from the intestines towards the bowels during the course of digestion. However, it reverses and occurs from the intestines towards the stomach during which the muscles of gastrointestinal tracts relax, open and the contents of the intestines are thus gathered in the stomach. Taking deep breaths prior to vomiting decreases the need for breathing during vomiting and blocking of the air passage by vocal cords’ converging prevents aspiration, that is, the passage of contents of stomach to the lungs. If such mechanisms did not exist, every vomiting attack might have ended catastrophically. Breathing attempts apply negative pressure on the rib cage and convulsion of stomach muscles applies positive pressure within the abdomen in spite of the converging of vocal cords. A pressure decrease is observed in order for contents of the stomach to be regurgitated. Muscles of the gastrointestinal tract tighten while muscles of the gate between alimentary canal and stomach relax just before vomiting. So, regurgitating via alimentary canal occurs without passage of stomach contents to intestines. Upon completion of vomiting, there is the disappearance of abdominal convulsions and the secretion of endorphin in the blood, so a person breathes sigh of relief.

In conclusion, although vomiting is perceived as something which is seemingly unpleasant, it is indeed a fine product of Divine artistry like all other systems and mechanisms of our body. Vomiting, as one of the proofs that God has created nothing useless and unnecessary, is certainly a great blessing bestowed upon us.

References

• “Sickening sounds – research to make your ears cringe.” University of Salford. January 28, 2007.
• Lunsden, K, and Holden WS. 1969. “The act of vomiting in man.” Gut 10: 173-179.
• Margie Profet (1995) Protecting Your Baby-to-Be: Preventing Birth Defects in the First Trimester. Reading, MA: Addison-Wesley. pp. viii, 312.
• Flaxman, S.M. and P.W. Sherman 2000. “Morning sickness: A mechanism for protecting mother and embryo.” Quarterly Review of Biology June 2000. 75:1-36.

Some medications are effective directly over the area they are applied to. Some however are transported to distant regions via blood flow and that is where they are most effective. Medication is either taken orally or through injection. When medicine passes into the blood stream from the place of administration, it is considered to be absorbed. A good example is the transportation of medicine into the blood stream of capillary vessels between the muscle cells when injected into muscle tissue. A drug taken orally however is absorbed through the blood vessels in the gastro-intestinal system.

For orally-taken medication to be absorbed, it should be able to dissolve in gastro-intestinal fluids. First, it is broken into smaller units due to the corroding effects of stomach acid and various enzymes are secreted, then chemicals in the drug composition pass into the gastro-intestinal fluid in a molecular form. This event resembles the dissolving of a sugar cube inside a glass of hot tea. First, the sugar cube gets broken into pieces and then dissolves. A mix with a tea spoon makes this event happen a little faster. In a similar fashion gastro-intestinal movements help with the absorption of medicine. Liquid drugs like syrups dissolve in the gastro-intestinal fluid faster since they are already in smaller units; therefore they get absorbed faster.

Drugs mostly get absorbed through the small intestine. The most important task of this organ is to enable the absorption of nutrients. It is approximately 10 meters long and 4 centimeters wide. The inner lining of the small intestine has finger-like projections called villus and even smaller projections that are located on these villi are called microvillus. One of the reasons, maybe the most important reason, why the our intestines are created in this way is that as a result, the inner surface area of intestines increases multifold. Such that the inner surface area of a human beings small intestine can increase up to 200 m2 and this greatly facilitates the absorption. These projections are made of intestinal cells.

The molecules carrying the medication reach the capillary vessels by passing through these cells and then join the blood stream by crossing through capillary vessel cells. Furthermore, intestinal cell membranes host a special protein that filters unwanted substances for the cell and returns them back to intestinal lumen. Thus these unwanted substances are excreted out of the body along with other unabsorbed matter. In the same way, some drugs are held by this protein and released back into the lumen thus decreasing absorption rate for drugs experiencing this reaction.

Liver: The organ responsible for eliminating the harmful effects of medication

As soon as medication joins the bloodstream after absorption, it is first transported to the liver. This is because pulmonary veins that collect blood from the intestines are connected primarily to the liver. One of the many functions of the liver is the elimination of harmful substances entering the body. For this reason, absorbed substances are directly sent to the liver. The liver is employed with the task of chemical conversion with these substances that are transported to it. One of the wisdoms behind liver metabolism is to reduce the effects of these harmful substances via these events and to convert them into an excretal material. In the same way, drugs are metabolized in the liver, lose their efficacy and prepare for excretion.

Many drugs interfere with each other’s metabolism. If one drug’s metabolism is inhibited, blood concentration of such chemicals increase and adverse effects of drugs become more frequent. Irresponsible drug use must be avoided for this reason. Drug interactions may lead to major damage in addition to the drug’s individual adverse effects. Moreover different nutrients also affect drug metabolism. For instance, grapefruit inhibits metabolism of certain medicines, as a result blood concentration of these medicines increase and adverse effects can be observed. On the other hand, some nutrients like broccoli, cabbage, and charcoal roasted meat speed up the metabolism of certain medicines. In this case, the blood concentration of the affected drug drops and may lead to reduced benefits from intended use. Because of this reason, patients on long-term medicine treatment should not consume these types of food.

The rest of the drug molecules that escape these metabolisms is directed towards blood vessels feeding other organs. Some drug metabolisms in the liver present individual differences as metabolic levels change from person to person. Thus, a drug with the same dosage develops desired blood concentrations for some people, fails to meet this level for others or can even cause high blood concentrations enough to generate adverse effects in other individuals. That is why a medicine that has benefited a patient should never be used by somebody else without consulting a doctor.

The function of bile

Bile secretion originating from the liver and gall bladder has critical importance in the digestion and absorption of fats. Bile breaks apart fats into small pieces so that digestive enzymes can affect them. As a result of this, absorption is provided for fats and vitamins like A, D, E, K that are soluble in fats. In a similar fashion bile improves solubility and absorption of some drugs that does not dissolve in gastro-intestinal fluid. Another task of bile secretion is the removal of certain substances from the body. Waste materials in the bile that is dumped into duodenum are excreted through the digestive track. Some drugs are excreted in this way.

Drug intake before or after meals

It is a well known practice that medications are advised either to be taken after or before meals. When medications are taken after a meal, they cause less of the possible unwanted disturbances such as stomach sickness, aches or indigestion.

On the other hand, nutrients may reduce intake of certain drugs, therefore they need to be taken before meals. However medications taken right before a meal does not apply in this case since the food will still mix with the medication in the stomach. When taking these medicines, it should at least be an hour before meals. Generally consumption of a medicine before or after a meal does not really change its absorption level. But medications taken before meals pass the stomach into the intestines without delay and therefore get absorbed faster. This practice is important in cases where an immediate effect is desired such as pain relief. Plentiful water intake also helps with faster and improved absorption of drugs.

Some medications are packed into capsules made of gelatin-like substances. Medicines with undesirable taste and smell can be offered in this form for consumption. Moreover, if a drug is harmful to the stomach or gets degraded in stomach acid, then this drug can be prepared in capsules that are durable to stomach acid but soluble in the intestines. That is why consumption of medication without its intended capsule should be avoided. In a similar fashion, some medicinal tablets are designed to deliver its molecular contents particularly to the intestines. These types of medication must be taken as a whole unit. Otherwise it can be ineffective or may lead to harmful reactions.

Delivery of drugs to targeted regions

The molecules carrying medication that join the blood via absorption get dispersed by blood circulation throughout the body. These molecules reach various parts of the system via blood vessels, and then diffuse into organs via capillary vessels. However, their entry to the brain is difficult because this vital organ of the body has a special protection to guard itself from possible harmful effects of various substances that enter the body from the outside. Capillary vessels in the brain are different from other capillary structures in the rest of the body as they are created without an intercellular space in between vessel cells. Furthermore, these cells are bound to each other with their tight connective regions.

These capillaries are surrounded by a thicker membrane compared to other capillary vessels. This membrane is also host to various cells that wrap around the vessel. Therefore, because of these factors and other similar ones, some medications can enter the brain in very limited amounts. Drug molecules can display their targeted effects when they bind to target proteins, called receptors, in the organs. These proteins, which are very unique to each drug, exist on the cell membrane or in the cell. In addition, drug molecules also bind to other receptors that are not specific for them, and this causes adverse effects as a result.

Excretion of drugs from the body

Drugs are excreted from the body via the liver and kidneys. One function of these organs is to filter the blood from foreign substances. It was previously mentioned that absorbed substances from intestines are transported to the liver first where some amount gets metabolized and the remaining amount rejoins blood circulation that feeds other organs. Drug molecules that pass through the liver return back to it repeatedly many times because of continual blood circulation. In each of these arrivals, some amount is again metabolized. Molecules of metabolized drugs are excreted out of the body via the kidneys and through the bile at a limited level.

Only some portion of drug molecules get excreted via the kidneys without being metabolized. This ratio is higher with some medications. These types of medications are considered to be removed only by the kidneys, whereas some other drug types cannot be excreted without getting metabolized through the liver. As previously mentioned, the purpose of drug metabolism is to convert drugs into easily removable forms. If these types of drugs are not metabolized, they are rejoined to the blood circulation after filtration by the kidneys without joining the urine. It is impossible for the liver to sense these happening within the kidneys if it was not that the liver and every cell in it were employed by one authority who created them in the first place. Drug molecules concentrate in the liver and kidneys since these organs are employed with drug removal. As a result harmful effects of drugs are often experienced in these organs. Therefore unnecessary drug use should be avoided, otherwise the health of these organs deteriorate and eventually fail to carry out their basic functions.

As noted above, events that are taking place within many of our organs, stomach and elsewhere like kidneys impact on the journey of drugs in our body, therefore changing its effect. The harmonious creation of our organs that are home to many miraculous events is the major component of the entire process in which causations have their due role only as much as they are allowed by their Creator. As a test for humankind, both illness and the cure is provided by God, the All-Healer. Therefore it is the duty of a patient to see a doctor, take the medication properly and never forget that cure is only provided by the Almighty, without obsessing over causational chains.

References

• Guyton, Arthur C., John E. Hall. 1991. Textbook of Medical Physiology, Saunders.
• Patton, Kevin T., Gary A. Thibodeau. 1993. Anatomy & Physiology, Mosby.
• Rang, Humphrey P., Maureen B. Dale, James M. Ritter. 1999. Pharmacology, Churchill Livingstone.
• Brunton, Laurence, John Lazo, Keith Parker. 2006. The Pharmacological Basis of Therapeutics. McGraw-Hill Professional

“Honey, you already fasted last year for three days, didn’t you?” replied her mother, hardly able to hide her smile.

“Mom! I don’t mean a ‘kid’s fasting’. I am talking about the real stuff,” she said raising her soft voice.

“It is wonderful that you want to fast but you need to grow up some more. Why don’t you first try your ‘kid’s fast’ again tomorrow, fast until noon, then have your lunch. I am sure even angels will look down at you with admiration. They will say ‘Wow! Such a brave girl! She is only five years old and yet she already fasts for half of the day.'”

Rolling her eyes, she protested to her mother once again:

“Mom I am not a baby anymore! My sister is fasting, my older brother is fasting, you are fasting, and dad is fasting. Everybody is fasting except for my baby brothers and I. Please mom, I can do it, I want to do it, please…”

“Dear, you are a very strong girl, I know, but you see your stomach is still very little. Your hands, your mouth, you are still a little person. You already know that children don’t need to fast until they are a lot older. Maybe next year, or the year after you can try to fast a day or two, and when you become a teenager, you’ll be fasting the entire Ramadan. But this year you’ll only be doing the kid’s fast.”

As she looked at her little daughter hoping that her words would end the discussion, her heart was overflowing with such a joy and happiness, in the midst of compassion. How proud she was! She uttered a silent little prayer inside, “My little angel, O my dear Lord, please keep the love of worship and devotion overflowing from her heart her entire life with a child-like purity and sincerity, just like now.”

As soon as the little girl’s dark eyes caught her mother’s lips moving, she jump off of her seat. She must have had thought that it was a green light, and that her mother was about to say “yes.”

“Great!” she screamed, her face was enlightened with an excitement. Hardly grasping a breath, she continued: “Then you can wake me up for the early morning breakfast before dawn. Then I can have enough food and water and then be prepared for a day of fasting. I am so happy. And then…”

Her mother and father looked at each other, somewhat reluctant, and then her father interrupted her. “Dear, it seems like you are not listening to what your mother is saying. I know you are a brave girl, and your mother told me that your friends have been calling you ‘fearless’ since the day you challenged them and climbed all the way up to the top of the power pole on the street. I also know you love God, and you want to begin your journey as an obedient servant, and you are excited about your first full fasting, but you are missing something my dear…”

Ready to protest again, her little fingers swayed back and forth over her fork and spoon, and she asked: “What? What is it that I am missing?”

“You also have to be patient. God willing, next year you could try to do one full day of fasting.”

About to burst into tears, she mumbled with a barely audible voice:

“I am fasting tomorrow, whether or not you wake me up for the early breakfast. I am ready and I am fasting tomorrow!”

Her older sister sitting next to her couldn’t help hearing her murmuring and she whispered into her ears: “Oh, you are more stubborn than a goat!”

As she left the table and went back to her room, she wasn’t sure who the winner of the argument was. She climbed up to her bunk bed and closed her eyes tight. She murmured: “Tomorrow will be my first real fasting!”

As soon as she opened her eyes in the morning, she jumped out of bed, almost falling down as she climbed down, and ran to the window. It was already very bright outside. Was it already morning? Had she missed the dawn? Did everybody oversleep? She ran to her parents’ room, screaming:

“Mom, dad, wake up! We overslept, we overslept!”

She saw that her father had already gone, and her mother was about to finish her daily reading of the Qur’an.

“Honey,” said her mother. “I thought we had reached an agreement last night.” She wasn’t able to get any answer from her daughter, so she continued: “Our Creator is so merciful that He never asks us to do anything that is more than we can bear, it is not only children, but many adults are also excused from fasting. For instance, do you remember when I had your baby brother, I didn’t fast for a while, or when your grandmother got very sick and had to take so many medications, she skipped some days of fasting. When you become old enough and your body gets stronger, I know you will be super cool with your fasting, but now I don’t want you to rush into something before you are ready and lose your enthusiasm for later.” She was ready to continue but when she saw the tears in her little angel’s eyes, she stopped and hugged her: “Okay, okay young lady, let’s make an agreement then. You can try and keep your fast as long as you can but it is a summer day, it will be long and very hot so when you get really thirsty, hungry or tired, you can take a few minutes break, then you can continue your fasting. If you forget that you are fasting and eat or drink something, that’s okay, that means angels are trying to help you with the blessings from heaven. And don’t forget, no matter how you do, I am proud of you.”

Finally all the shine and happiness came back to her eyes and the little girl answered: “Deal mom!”

A couple of hours later, she decided to go outside to play. It was really warm outside. She looked around to see if any of her friends were around but she could only see a few shadows from the distance. First she thought about running over to play with them, but then she felt a little tired. Instead, she sat down on the brick pavement.

” I guess I am tired, and it is not even noon yet!” She bent over her stomach and began to chat: “Hey there! How do you feel? Are you hungry?” The only response from her little stomach was a rumbling voice. She smiled and patted herself on the stomach: “Listen, we are growing up today and learning to be patient. Think about all the poor people in the world, they cannot find food most of the time, now do you understand them better?” It seemed like her stomach was convinced and stopped rumbling, she was so proud of herself. With a big smile on her face, she started to watch people passing by on the street.

All of a sudden she heard her favorite sound of summer. A street vendor was calling out: “Snow cones! I have snow cones! Snow cones with all the flavors!” She forgot about everything and quickly checked her pockets. Yes! She had enough money to buy whichever flavor she liked. She rushed to the snow cone vendor and shouted: “Hey, wait! Wait for me! May I have a chocolate flavored snow cone please? You know what, give me the one with lemon and strawberry flavor as well.”

The vendor was a dark skinned young man. As he handed her snow cones wrapped with blue papers, he greeted his favorite customer with a big smile: “Look at you! You have grown up a lot since last year.”

She giggled and handed the money. She was hardly able to hold all three snow cones in one hand, the weather was so warm that they started to melt and drip all over her hands. She didn’t seem to mind, the coolness of the icy drops helped her cool down a little, but it also made her feel her thirst even more. In a hurry as she was trying to unwrap the blue paper from the first one, she noticed the vendor’s dark face, now even darker due to walking under the sun trying to sell all the snow cones and his lips were cracked probably because of thirst. She felt so selfish to have all these three snow cones for herself. A little shy and hesitant, she extended one of them to the man and said: “Please have one of them, three is too much for me anyway.” The man answered: “You are a generous girl, but thank you, I am fasting.” Suddenly, time stopped and she remembered that she also was fasting. “Oh ok,” she said nodding her head goodbye to the vendor and headed back to the brick she was sitting on a few minutes ago. With her stomach rumbling, she mumbled: “So am I, so am I!”

As her vendor friend disappeared around the corner, she didn’t know how to feel. She looked around, there was no one watching her. Well, nobody would think that she was fasting anyway. Her stomach started rumbling again, her lips felt dryer than ever, her hands were covered with the cool-sweet snow cone drips. She took a deep breath, stood up, and began to run towards to children playing in the distance. As she was running her heart was pounding, the ground under her feet felt like it was slipping away and her lips were constantly moving: “I am fasting, I am fasting. My dear God, I promised you, I am fasting today.” As she reached the children, she was gasping for the air and her legs were shaking, she could hardly call out to them: “Hey guys, do you want some snow cones?”

As she walked away from the children enjoying the cool sweet snow cones, her stomach had stopped rumbling, her lips were still dry but wide open with a big smile. Her heartbeat had slowed down and felt like it could fit into it the entire universe. She took her every step with such confidence, she felt like a big oak tree. Her fingers were still sticky and wet, and her lips were still moving: “I am fasting today, I am fasting. I am fasting for the sake of My dear God.”

***

“Excuse me, could you speak a little louder?” With the kind voice of the moderator, she was pulled back from her childhood. It was an interfaith group meeting where people were discussing various faith related topics including their stories in regards to how they shaped them as adults. She must have zoned out in the midst of the last question.

“Oh I’m sorry!” she said, clearing her throat nervously and a little embarrassed. “Where were we?”

As her group-mates smiled at her, the moderator answered:

“So it was your turn. Would you care to share with us your first memory of when you felt the presence of God in your life? It might be very difficult to pin-point, maybe in your teenage years or later? It’s okay if you can’t recall the exact moment, we are just causally sharing.”

She quickly glanced at the wondering faces of her friends. After 20 some years, she could still feel the cold-sugary drips on her hands. With a smile, she took a deep breath before she started to tell her story….

“That’s okay, I know exactly what moment it was.”

Ayse Kubra Coskun, MD, is currently serving as Vice President of Boston Dialogue Foundation.

Digestion in grain-eating birds

The digestive system of the chicken, which is a representative of the world of birds, is comprised of organs lined up in straight line succession: a beak, mouth, gullet, craw, front stomach (with gland), gizzard, small intestine, caecum, large intestine, cloacae and anus. In addition, enzymes secreted from the pancreas, liver and gallbladder also have digestive duties. Ending in a sharp point, the beak was created especially to be able to pick up single pieces of feed. Chickens do not have assisting organs like the palate, cheek, tongue or teeth that are normally found in the mouth, the first door of digestion in most animals. Ruminating animals like cows, sheep, goats and camels use the tongue instead of a beak for taking food into their mouths, and then their teeth are used to begin the breakdown of food. In chickens, however, this breakdown is initiated with the bottom and top beak. In ruminants there are taste buds in different shapes on the tip, sides and middle of their tongues which also function as the organ for the sense of taste. Since such taste buds are not found in chickens, there is also no perception of taste like that experienced in ruminating animals.

The structure and function of the gullet, or food pipe, has similar characteristics in chickens and other animals. However, just as in all birds that eat single seeds and grains, there is another digestive organ in chickens in the shape of a bag opposite to where the gullet expands. Called a craw, this tiny pouch is a place for the storage, wetting and softening of feed, and it serves the purpose of bringing food to the consistency needed for further digestion; consequently, it lightens the burden of the stomach (just like when we leave food that is difficult to cook, like chick peas or beans, standing in water overnight before we cook it).

A chicken’s stomach is composed of two different sections, the front stomach and the gizzard. The feed the chicken eats passes from the gullet and the craw to the front stomach, where digestive secretions are made. The food is stored here briefly and mixed with the special fluids of the stomach. Found in this secretion are both the pepsin enzyme, which starts the digestion of proteins, and hydrochloric acid, which is secreted to generate the pH level that makes this enzyme effective (and which also helps in the dissolution of minerals). These two important secretions are produced by different glands in the stomach. Like the craw, the gizzard, which comes after the front stomach, is the place where mechanical digestion, which is particular to all birds that eat grains, takes place. The gizzard is called the stomach with muscles because it is comprised of a pair of thick and strong muscle layers. As a result of these muscles constricting strongly, feed is broken down mechanically and ground up. While gathering feed, the chicken usually also swallows small pieces of sand, stone and limestone as if it knows how its digestive system works. Although many of us think that chickens swallow stones because they cannot distinguish them from feed, it is obvious that there is a purpose why they are doing it. If these stones, which are like “mill stones” for the digestive tract, are not found in the gizzard, the feed is not fully ground; consequently, it will pass to the small intestine in a form that will not be fully beneficial to the body.

Depending on its characteristics, the feed eaten can stay in the gizzard for a few minutes or several hours. The small intestine, which comes after the stomach, is comprised of the duodenum (twelve-finger intestine), the jejunum and the ileum. The small intestine is similar in grain-eating birds to those of other animals. The duodenum empties the secretions coming from the pancreas and the bile coming from the gall bladder. The digestion and absorption of the feed actually takes place in the small intestine due to these secretions. Final digestion and the absorption of carbohydrates and protein are effected by bacteria found at the point where the small intestine ends, in the 10-15 centimeter-long, V-shaped caecum.

The large intestine and the cloacae are found in the advanced sections of the digestive system. The role of the large intestine, which is twice as large in diameter as the small intestine, is to temporarily store the waste from the digested food and to maintain the balance of water in the body. The cloacae is a small orifice with a structure formed by the widening of the large intestine towards the anus and where the digestive, defecation and reproduction tracts open up.

While giving grain-eating birds the above mechanisms in order to nourish them, God equipped ruminating animals with different oral, dental, gastric and intestinal structures as well as different digestive strategies.

Digestion in ruminating mammals

While secreting saliva is essential for ruminating animals, it is not necessary for chickens because of differences in their digestive system. As a result of the secretion of saliva the fodder of ruminants is softened and dryness of mouth is prevented. Ptyalin (or alpha amylase), which is found in saliva, has antibacterial properties that protect animals from infections in addition to playing a role in digestion. The mother cows constantly licking their newborn calves is both an expression of compassion and also of wisdom in protecting the newborn from probable infections (Similarly, animals like dogs and cats licking their wounds and thus speeding up healing is no coincidence, but a sign of universal wisdom and mercy). This wisdom shows that saliva, of which cows secrete 90-180 liters and sheep 5-8 liters per day, is not a waste.

The stomachs of ruminants are comprised of four sections; the first three are the rumen, the reticulum and the omasum. These three sections are called the front stomach. The section that does the real work is called the abomasum. Because the nutritional value of grass is very low in comparison with meat, it is obvious that a large bodied ruminant will need a lot of grass. Consequently, the capacity of rumen being 150 liters is a wise and fitting design. In addition, the cellulase enzyme that digests the cellulose walls in plant cells is not produced in the tissues of any mammals. The possessor of infinite knowledge and power, God placed high concentrations of bacteria, protozoa, yeast and fungus-all of which can produce the cellulase enzyme needed to break down cellulose-in the rumen of ruminating mammals. The rumen acts as a fermentation factory because of these microorganisms. Breaking down the cellulose-rich food consumed by ruminants, these microorganisms both fulfill their own nutritional needs and help to meet the host’s energy, protein and vitamin (especially B12) needs within a symbiotic relationship. I wonder where the microorganisms in the rumen learned about this synthesis and assistance mechanisms!

What a magnificent engineering wonder is the “sulcus esophagus,” a semi-duct structure in the shape of a canoe that extends from the end of the food pipe in newborn ruminants to the abomasum where the essential stage of digestion takes place. Due to this structure, milk drunk reaches the last stage of the stomach without passing through the rumen, for there is no matter like cellulose in the content of milk that needs to be broken down. Consequently, there is no need for the milk to go to the rumen. If it were not like this, the milk would go directly to the rumen where it would be ruined by microorganisms, lose its nutritional quality and be like a bribe given in vain to the microorganisms in the rumen.

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

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

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

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

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

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

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

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

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

Dear Peter, in order for you to understand me better, keep in mind a basic principle about the functioning of living organisms-they all depend on energy use. If no energy enters a living system, then no metabolic activity, no life function can be carried out. Think about a car without fuel. No matter how great the car is, it simply won’t work without any fuel in the tank. The human body is no different. Plants and animal products which people consume as food provide the body with fuel. However, you cannot make use of the energy in nutrients in the form in which you take them in. They need to undergo a process so that they become usable fuel for us, like crude oil being refined into gasoline to make a car work. This is roughly what my duty is. Without my functioning, you would be devoid of the energy to move a finger, and eventually die. Do you understand now how important a set of pipes I am? You just think that I look like a soft and hollow canal and misjudge me as simple. Well, I know that I don’t have such complex parts as the heart, lungs, and kidneys, but I’m created as a perfect work of art in plain design.

Although the hoses you use for watering your garden wear out and break in a relatively short time, my walls made of four layers keep functioning through a lifetime without any holes unless I contract a disease like cancer. My outer layer consists of a durable connective tissue, the next one consists of two sets-one horizontally and one vertically laid-of straight muscles, the next layer under that consists of glands spread in a soft connective tissue, and the innermost layer is the epithelial mucosa where the actual absorption takes place.

Now, let’s come to how I achieve digestion, one of your body’s vital activities. Actually, there is no place for me to take any pride in it; I’m just doing as I am ordered. Anyway, the complex processes occurring within my simple-looking walls are just fascinating! Every one of my cells producing the particular enzymes to break up each nutrient is like a separate factory. Some of these enzymes break proteins into different levels of peptides, some break the peptides into amino acids, some break fats into fat acids and glycerin, whereas some break carbohydrates down into glucose. All of these particular enzymes have their sub-branches within themselves. For example the enzymes breaking down fructose (fruit sugar), lactose (milk sugar), and starch are all different. In order for the enzymes to be effective, my inside needs to have the right pH level; the enzymes work in very sensitive conditions. To give you an idea, the enzymes in the stomach-which happens to be the second station the nutrients are destined for before they come to me-work in an acidic environment (pH: 2.5–3). In my case however, basic fluids are secreted and this strong acidity is neutralized for my enzymes to work.

My overall length is around 8.5 meters from the first entrance at the stomach to the last exit. The small intestine is nearly 7 meters long and the remaining 1.5-meter section is the large intestine. Although the small intestine is the longest section of the digestive tract, it is still called small since it is smaller in diameter than the large intestine.

The small intestine is also divided into three sections. The very short (25–30cm) and relatively thicker part right after the stomach is the duodenum. Bile-which works like detergent and facilitates breaking up fats-produced by the liver and digestive enzymes from the pancreas enter the duodenum. Thus, the nutrients are digested one step further and pass on to the second section (jejunum) and then to the third (ileum). You cannot easily tell apart these final two sections. As blood circulation is more intense in the second section, this section is more reddish and the contractions here are faster and stronger. The third section is narrower and has thinner walls. The blood circulation here is relatively lower and the movements are more limited. The thin membrane of connective tissue (mesentery) around me which attaches me to the abdomen wall and prevents me from knotting up is relatively fatty in this third section.

My most vital parts are the villi-tiny nipples covering the curly surface of my inner wall like a carpet. Shaped like the fingers of a glove, villi yield an enormously large inner surface. They contain a net of capillaries and lymph canals. In addition to the glands secreting the enzymes to break down nutrients, the secretion of certain glands protects me against the destructive effect of the stomach acid. Some cells secrete mucus for lubrication and protection of the passing nutrients. As some cells of the villi secrete digestive enzymes, some of my cells absorb the nutrients broken down until the final phase and pass them to the bloodstream.

Peter, how can some guys mistake such a splendid mechanism as a work of unconscious nature? What I’m telling you about is a manifestation of such great knowledge and might that it leaves you spellbound. I know the characteristics of foods, I know about the other organs’ needs, I adjust various enzymes and an absorption system, I fit them in a limited space… In addition, I do all these in the most ideal way, without any waste or flaw! C’mon Peter, can all these happen by themselves? Now, if I were to start telling everyone about the absorption mechanism in detail, they would probably see those cells as divine beings! The One who assigned special carrier molecules and a system for every nutrient molecule, has placed two transfer systems as blood and lymph pathways in every single one of those millions of villi! The blood pathway passes amino acids, water and salts into the blood directly, whereas the lymphatic pathway absorbs fats to pass them to the blood indirectly. After absorption, the nutrients become a property of the body and they are carried in the bloodstream to all the cells waiting for them in need.

Well, what about the waste then? Since everything you eat is not beneficial and usable, and some things are even toxic, they should be disposed of as soon as possible. The unabsorbed remnants are still too watery to be disposed of; sending them away as they are will be a waste of water and minerals. But don’t worry, everything is perfectly planned! Now the large intestine comes on duty. In this 1.5-meter section, the water of the waste and certain minerals are absorbed, and the waste solidifies. The large intestine is also divided into three sub-sections. The pouch connected to the junction of the small and large intestines is named the cecum and there’s the appendix at its end. This end sometimes festers and you have to have it removed in an appendectomy. Now, there’s this made-up story that the appendix was once longer since your ancestors only ate plants, that it has evolved into a shorter form for I now eat more meat, so on and so forth… Bah! Nothing is created in vain, Peter. If it didn’t have a duty, it simply wouldn’t be created. Only after some time did it dawn on them, after researchers proved that it is so necessary, that as a lymphoid organ, rich in blood vessels, it produces antibodies to fight the germs which somehow make their way into me.

The rest of the large intestine is the colon and the rectum. The mucosa covering my inner surface is rather smooth. It secretes mucus to facilitate the removal of waste. In addition, useful bacteria are made to work in abundance in the large intestine for your needs. These bacteria synthesize the group B vitamins like B12, thiamin, and riboflavin, along with vitamin K. You see how all the processes are carried out so splendidly? If it weren’t for vitamin K, your blood would fail to coagulate, and the slightest injury to your blood vessels would kill you. Could you ever have imagined that what looks to you like a sewage canal could produce vitamins of vital significance? Your Creator has infinite wisdom.

Peter, now you may wonder how the acts of this organ which resembles a long hose are regulated, how the nutrients inside are propelled, and then thrown out. To put it briefly, the “willful” part of your brain does not even know about it. Indeed, if it knew, it would be constantly busy with me and unable to do anything else.

Under the control of the autonomous nervous system, the straight muscles of my walls gradually contract in waves-this is squeezing act is called peristalsis. The nerve fibers connected to me fall into two basic categories-sympathetic and parasympathetic. As the sympathetic fibers pressure me to slow down, parasympathetic fibers stimulate me to act. Thus, I try to keep a balanced functioning between these two opposite effects. When the waste material I propel this way assumes a state to be disposed of, it reaches the rectum, and when the walls here strain, I make a natural call to you that I need to get rid of garbage. This is the step where your will has a partial interference.

Colon cancer, which troubles many people today, appears in this final section. The major reason is consuming too much meat and fatty foods, lack of movement, and leading a stressful life. When these are combined, I fail to function properly. If you want to help me at that, you should consume fiber-rich foods such as fruit and vegetables, and also lead a peaceful life. My web of nerves is amazingly rich and complex. Therefore, I am sensitive to nervous changes. If you feel down or sad, and if you suffer too much stress, I begin to go into spasms. Then I fail to dispose of waste, the toxic material inside me begins to damage my inner walls and eventually increases your cancer risk. Therefore, you’d better take up the habit of a glass of warm water when you get up in the morning, and try to have regular meals at the same times of the day. Most importantly, always have fresh green vegetables on your table, reduce meat intake… and it would be great if you could afford to consume olive oil rather than any other.

Hey, wait! I was about to forget the most important point. If you don’t have any peace of mind, all of these will be useless. This doesn’t mean that you will never worry; after all, this world is a testing ground and you are a human being like anyone else. However, if you give in to troubles and get overcome by feelings like panic, fatigue, and hopelessness, then my functioning will be upset. So, troubles faced with active patience and effort without giving up hope do not harm me much.

Peter, I do not wish you to wait until you see colon cancer patients disposing of waste through a hole in their belly into a plastic bag before you feel grateful for the blessings you enjoy. Actually, maybe I have told you at most a tenth of what I know about myself. Anyway, I think even this much will give you an idea of what a work of art I am. Thanks for listening to me, Peter!

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

It is worth contemplating that humans are in need of microorganisms to survive and that living things as insignificant (!) as bacteria are necessary to synthesize B12 vitamin. Why our so-called bacteria ancestors (!) from which we evolved – as some claim – lost this ability to synthesize B12 vitamin which was, and still is, vital for survival, is a challenging question for those scientists who support the theory of evolution.

The journey of B₁₂ in our body

Cobalamin, which is taken in with food, is absorbed by the final section (ileum) of the small intestine and transported into the blood by receptors on the cell membrane. For B12 to be absorbed into the blood, it is necessary to have an “intrinsic factor” bound to this vitamin. The intrinsic factor is a glycoprotein produced in parietal cells that secrete gastric acid. After the absorption, the vitamin binds to transcobalamin, a carrier protein found in the blood, and it is then being bound with transcobalamin II so that it can penetrate the cells. B12 can be stored in the liver to meet the needs of our body for a long time. A deficiency in cobalamin due to a poor diet (e.g., vegetarians) or a failure to produce the intrinsic factor in the stomach may result in pernicious anemia, which is fatal. Cobalamin deficiency negatively affects DNA synthesis, which is necessary for production of new cells, particularly in the division of the stem cells that are assigned to construct new red blood cells. This is followed by the circulation of cells that will generate underdeveloped red blood cells; these cells will not be able to function properly and will have larger diameters.

The training of parietal cells

If the stomach is removed or cannot produce the intrinsic factor, it is impossible for B12 to be absorbed. It is worth reflecting on the wisdom of why an organ like the stomach, the main duty of which is to partially digest food and convey it to the intestines, synthesizes intrinsic factor. How can the stomach know that our body is in need of this protein? How did it become able to synthesize this very special composition of glucose and protein which is so necessary to absorb intrinsic factor through the gastrointestinal tract? Why doesn’t our body produce the vitamin in the first place, instead of binding it to such a complex molecule? And how do the parietal cells know what is necessary to bind this vitamin, the use of which they cannot understand, although they have never been trained in bio-chemistry, physiology, or pharmacology? In which laboratory did these cells synthesize and test this compound?

The intrinsic factor

In order to decompose proteins into amino acids, the stomach secretes hydrochloric acid and an enzyme called pepsinogen. Parietal cells that secrete acid also produce a protein (intrinsic factor) which is not damaged by the acid or the pepsinogen enzyme. How were these cells able to develop a synthesis in which proteins do not decompose, which can protect them from the acid in the stomach, and bind themselves to a vitamin like B12, which is absorbed only in very small quantities?

The hydrochloric acid secreted in the stomach is like bleach and it irritates anywhere that it goes other than the stomach. Should even the slightest quantity of this acid pass into esophagus (reflux, diaphragm boiling) it can cause severe burning. It is amazing that B12 is found and bound in a cauldron like the stomach, but is not damaged by the acid produced when the stomach is filled with food and drink.

The intrinsic factor bound with the vitamin goes on its journey and it reaches the absorption region in the last section of the small intestines. During absorption, the gates on the cell membrane of the intestines open up only to allow the B12 intrinsic factor compound. Maintained in the intestinal cell for a while, the B12 vitamin binds to the transporter transcobalamin and is conveyed to the cells through the blood. After reaching a cell, the vitamin, needed by the entire body, is bound to another transporter: transcobalamin II.

Some components, although they appear to be very simple, must be supplied from outside our bodies if we are to survive. B12 vitamin is one such component, and it certainly deserves to be studied well.

I have been placed under the cavity of the chest. So that we do not harm each other, the Creator has placed a membrane between me and my neighbors, the heart and lung; I can hear them, but cannot see them. They are further protected by the rib cage, because they are more sensitive than I. Of course that does not mean that I am without protection. Our Lord has placed all of us in the most appropriate way. If I had bones covering me you would have a lot of difficulty eating and drinking and since you could not store what you eat you would need to eat little portions throughout the day. But since I have been placed in the stomach cavity and all the walls are flexible I can easily store all that you eat and drink until you digest them. This means that you are busy with eating only at certain times, allowing you to spend your time with other things.

I look like a kettle and this rather simple-looking shape might make you undermine my skills. It is for this reason that some people speak of me in a rude way, describing me as “a sack-like organ.” To understand how important I am, ask those with stomach ulcers or stomach cancer. God forbid, should I stop functioning; life would become a living hell. Each drop that you drink and each morsel you eat would be like poison and all of the world’s pleasures would vanish.

My walls, which seem like a simple sack, are made of four layers of special tissue. On the outer layer there is a strong tissue, below this are layers of muscle that have been placed vertically and horizontally in a diagonal manner, and under this there is tissue engulfed in a flexible layer and a final lining called the epithelium. Of course, we should not forget the web of blood vessels and nerves that nourish these thick walls. My system of nerves is such a complex system that you would be amazed; it resembles a second brain and it is aware of your whole body without you being aware. When you hurt your foot or you are upset with the slightest thing or laugh because of joy I am affected by this. This nervous system is so sensitive that it affects all my actions and my digestive excretions.

It is through this nervous system that I control my actions and my excretions when the scent of the food comes and you are getting ready to eat, saving you trouble after you have eaten. I can also be easily trained. If you can stick with it you can get me used to a new life after three days. Some stomachs are used to three meals, while others are content with two or one meal a day. My recommendation is that you get me used to two meals a day.

Not a lot of chemical decomposition can occur in the mouth, so all the nourishment you have eaten needs to pass through me before it is digested by the intestines and it becomes part of your body. What happens is that the things you have eaten are broken up mechanically into little pieces by the teeth so that I can accept them. If you hurry and swallow without chewing and do not soften the morsels you tire me out. In addition to this, if the morsels are sharp or too large they can rip the walls of the esophagus and make them bleed. It is best to chew the morsel 30 times, but unfortunately most people do not do this. They send me mouthfuls after having only chewed on it once or twice. They do not realize that they are full and therefore eat too much, disturbing the balance. If you eat slowly I will let the relevant section of the brain know and the feeling of hunger will stop after you have received enough nutrients. In this manner you do not tire me out too much and the nutrients do not go to waste. If you eat too fast I will be full before I get a chance to bring to the surface the molecules that give the sensation of being full and there will be no room for water or air, which allow me to move comfortably.

There are three different types of cells on the mucous layer that lines the inner layer of my walls and which is in contact with the food. One of these excretions is hydrochloric acid (HCl). This acid, which can dissolve even a piece of rock, is used not only to digest all the meat and proteins, but it also kills any bacteria that may come with the food and beverage. Without this acid the pepsinogen enzyme, which breaks down the protein, cannot be activated. The pepsinogen enzyme also synthesizes some other cells. This enzyme cannot function on its own and cannot be excreted if I do not have food in me. It starts to be excreted together with the hydrochloric acid as soon as I start to be filled with food. So how is it that such a strong acid and protein digesting enzyme do not harm my walls? My Creator has provided my lining with a temporary protective layer. The goblet cells that excrete this protective mucous are so sensitive that they excrete a protective liquid that coats it. Every day I sacrifice one and a half million cells to these enzyme and acids. In other words, every three days my inner layer is destroyed by these corrosive enzymes and acids. But thank God, I have been given me such a revitalizing strength that each day this lining is renewed with new cells.

Sometimes, if there is a problem with the excretion of this protective liquid, the acid and enzyme can start to eat at the stomach walls, leading to blood leaking from the arteries that are in the outer layer; this is known as an ulcer, a wound on my walls. Nervousness and tension affect the excretions in me, and therefore people who have a nervous character can develop ulcers more easily than relaxed people. The best thing to do is to live a life where one faces things with patience, neither being too panicky nor too happy, but living in a balanced and mature way. If you try to live in a balanced way then you will maintain order in the stomach and I will be happy.

You cannot move the muscles of my walls like you can your arm or leg muscles. The muscles are commanded and start working according to orders from an autonomous nervous system that you are not even aware of. An important feature of these muscles is that they work slowly, but take a long time to get tired. At the same time, they are very susceptible to growing if you do not take care of yourself properly; if you are not careful I can swell up quickly like a balloon. The evil side of human character has a very close connection with me; so you have to be very careful not to eat and drink too much and consume unlawful food. Otherwise, you might become weak and be easily misled and consequently this makes me nothing more than a waste container and then I become a pest.

Let me tell you some of the things that I do not like. At the top of the list is very hot or very cold food or beverages. Both ruin the enzymes and make them dysfunctional. The best condition for enzymes to work is at your body temperature-that is 36-37 degrees. There are more scientists today than before who think that overly hot or burnt food can cause my cells to turn cancerous. If you heat very cold items in your mouth and then swallow you protect me from getting cold – because if I get cold I contract and my working balance becomes dysfunctional so that I am no longer able to do my job.

When I finish my job of extracting the nutrients and treating them with the enzymes the food takes on a liquid form. When the food has achieved the desired texture I send it through to the intestines that are right below me. In this regard, I am like this transitory worldly life, which is nothing more than a two-door guesthouse-one door for entrance and the other door for exit. I never retain anything in me-I receive from one end and send it out the other. There is no door between myself and the esophagus, so I can take out what is in me if I have to by vomiting. At first, this vomiting reflex might seem a bad thing and you might wonder why there is nothing to prevent this? But let me remind you of something, what if you mistakenly eat something poisonous or something that has gone off, what would you do if you could not vomit? You would have to be taken to hospital so that you do not die of food poisoning and an incision would have to be made in the stomach; I would have to be cleansed out, but by this time you might have died. However, if I feel that something you have eaten is bad I can remove it. But with the gateway that is placed between myself and the intestines I am able to stop the food in the intestines from coming back to ruin the acidic atmosphere in me, as the enzymes in the intestines work under more neutral conditions. My acidic structure would disrupt the intestine’s enzymes. In particular, if the bile salts excreted from the liver and the pancreas enzymes should spill into me the situation would be very chaotic.

Another important piece of advice I can offer to you Peter is not to play any sports when I am full and not to strain yourself. The thick muscle lining on the walls requires a lot of blood to move. After eating a significant amount of blood is withdrawn from other parts of the body and sent to me. If you try to be active in this state you will suffer, as the rest of your organs will not be nourished properly and stress will be put on your heart.

Here’s another secret I’m going to let you in on: the more you fill me up without thinking about whether it is necessary and lawful or not, the more likely it is that you will make spiritual mistakes. Your spiritual well-being and health are inversely proportional to a full stomach. If you make me grow too much all your veins, starting with your heart, will start to gather fat and therefore their functions will slow down. Also your spiritual side will be dulled. Actually it is enough for a person to eat only what they need to survive. Serving your senses of taste and eating within the allowed parameters by remembering the Giver will not only give me peace but will also take you to spiritual horizons. After the food passes through your mouth it does not make much of a difference to me whether it is sweet or salty. Therefore, if you can take charge of your mouth, which acts as a gatekeeper, you can protect yourself from waste and from putting on extra kilos.

Some time ago some people would laugh at my above advice, and they would say, “Good food is the backbone of life and one should feed well.” But now modern medicine and dieticians have started to give the same advice I have been giving for years and they state that eating enough for sustenance is adequate. Most illnesses arise from over-eating; good food may be the backbone of life, but too much of it is a prescription for an early death.

In particular, with the dietary change that you make during the month of Ramadan, I and my team are able to renew ourselves; it is like a fitness camp that prepares us for a new term. This is an important need for us to start the new season. The time for this is approaching. I expect you will use your will power and allow me to rest as commanded. To continue with your life you need me to provide you the nutrients and energy, because without me even your heart could not function. At the root of all biological sustenance there is a need for food intake. Accordingly, I am like a double bladed sword. You should neither neglect me nor indulge me too much. I hope that you will display this balanced outlook and behavior.