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).

Our hearts are broken today” said the President Obama after the school shooting in Connecticut on December 14, 2012. These words reflected most concisely the emotions all of us felt that tragic day, as our minds and hearts failed to grasp how possibly this could have happened, how come a seemingly human being could go this much lower than the wildest beasts. One of the ideas that was proposed to explain this murky situation was that the gunman had an Asperger’s syndrome, which was immediately refused by experts. “First and foremost, our thoughts go out to the families,” says Lisa Goring, vice president of family services for Autism Speaks. “We are all searching for answers, but it can be so irresponsible to label autism as the cause of this because we endanger totally innocent kids” (1). This article aims to explain what the Asperger’s Syndrome is about in an effort to save especially kids with this syndrome from another stigma that they have to deal with on top of so many other things.

Thirty years ago, only 4 or 5 Autism spectrum disorder (ASD) cases were reported per 10,000 people. Today, however, approximately 1 in 150 children across the U.S. is diagnosed with it; so chances are, you know someone affected either directly or indirectly by these disorders (2). This being the case, the debates, advocacy, and awareness activities are on the rise. Individuals with ASD show abnormal social interactions, language difficulties, repetitive or restrictive behaviors, and special interests. ASD includes Autism, Pervasive Developmental Disorder and Asperger’s Syndrome (3).

Asperger’s syndrome was first recognized by Hans Asperger in 1944 and the term was popularized by English psychiatrist, Lorna Wing, in 1981. The incidence of this syndrome is not well established, but experts in population studies estimate that two out of every 10,000 children have the disorder. It is more common in boys. They are three to four times more likely than girls to have Asperger’s syndrome (ninds.nih.gov). However, the prevalence in females might be lower because of the fundamental lack of awareness of what Asperger’s Syndrome looks like in females. A female with Asperger’s Syndrome might be considered as shy, quiet, perfect at school, tomboyish, moody, overly competitive, aloof, Gothic, depressed, anxious, or a perfectionist (disabled-world.com).

It is always challenging for people with Asperger’s to lead a normal life in spite of it because this disorder makes it hard to develop social and conversational skills. Affected people display socially and emotionally inappropriate behavior, limited facial expressions, body gestures and inability to recognize nonverbal signals. They lack interest in other people; however, they are obsessively interested in unusual and specific subjects. In addition, they prefer to follow repetitive routines or rituals because they cannot cope with unexpected changes.

Children with Asperger’s Syndrome

A child with Asperger’s syndrome may have the listed signs and symptoms (kidshealth.org):

• inappropriate or minimal social interactions
• conversations almost always revolving around self rather than others
• “scripted,” “robotic,” or repetitive speech
• lack of “common sense”
• problems with reading, math, or writing skills
• obsession with complex topics such as patterns or music
• average to below-average nonverbal cognitive abilities, though verbal cognitive abilities are usually average to above-average
• awkward movements
• odd behaviors or mannerisms
• lack of eye contact

Parents usually sense there is something abnormal about a child with Asperger’s by the time of his or her third birthday, and some children may exhibit symptoms as early as infancy. Their early language skills retain but motor development delays (for example, crawling or walking late, clumsiness) are sometimes the first indicator of the disorder (ninds.nih.gov).

Hans Asperger called the children with these behaviors “little professors” because they could talk continuously and in great detail about their favorite subjects. These little professors may have an amazing ability to recall dates, names, and events. One parent laughs about how her ten-year-old knew the scientific name of everyday things—from the sugar in the kitchen to the trees in the backyard. He would keep discussing things using the scientific classification (yourlittleprofessor.com).

Most children with Asperger’s syndrome have difficulty interacting with their peers due to the problems in understanding figurative language and tendency to use language literally. Children with this syndrome do not recognize non-literal language that includes humor, irony, and teasing. They struggle just to understand common social cues so they are mostly loners and may display odd behaviors. A child with Asperger’s, for example, may spend hours each day preoccupied with counting cars passing on the street or watching only the weather channel on television. Children with Asperger’s syndrome are also at risk for other psychiatric problems including depression, attention deficit disorder, schizophrenia, and obsessive-compulsive disorder (aacap.org).

While the more obvious symptoms of autism are usually at their most florid in early childhood, the symptoms of Asperger’s syndrome may only become noticeable with the social and functional demands of adolescence (autism.net.au). Luke Jackson, a thirteen-year-old boy with Asperger’s Syndrome from England, wrote a book named Freaks, Geeks and Asperger’s Syndrome: A User Guide to Adolescence. He wrote this informative, sincere and entertaining book about complicated topics such as bullying, friendships, when and how to tell others about Asperger’s syndrome, school problems, dating, relationships and morality (4).

The idea that every child with Asperger’s syndrome is a potential genius can put excessive pressure on a child with Asperger’s syndrome (yourlittleprofessor.com). Luke Jackson, for example, complains that he is always watching television about high functioning autistic people who can do things like play the piano brilliantly without taking lessons, draw detailed renditions of buildings they had only seen once or add numbers in their heads like Rain Man. “I find these television programs depressing,” he says. “I got all the nerdiness and freakishness but none of the genius.”

Seeing a child struggle socially and emotionally can be particularly heartbreaking for parents. Children who had seemed to be developing in normal and delightful ways suddenly retreat into their own world, excluding their loving moms and dads in the process after being diagnosed with ASDs. Learning more about ASDs can help parents take charge of their child again and find treatments and therapies that work (specialchildren.about.com). In some states, expanded services are available through public school programs. The most valuable service might be “parent in-home training” with a behavior specialist sponsored by the school. Moreover, parent education and skill building groups organized by some hospitals or health centers can be helpful for parents of youth with ASDs.

Speculations about famous people with Asperger’s Syndrome

There are many famous people for whom there is a lot of speculation that they had Asperger’s Syndrome (5 and 6), such as Albert Einstein, Benjamin Franklin, Leonardo da Vinci, William Shakespeare and Ibn al-Haytham. We may never know for sure if all these people have been affected by Asperger’s syndrome. However, most of the listed geniuses focused on something which interested them and their works were not disrupted by the everyday interactions that take up so much time for the rest of us. This might be the key factor behind all their great inventions. Then we can think of their Asperger’s syndrome as a blessing for humanity, because it does give certain strengths and brilliance to these scientists or pioneers that others do not have. In brief, Asperger’s syndrome is not a handicap, but rather a collection of strengths and challenges. If Asperger’s individuals are supported as they explore their capabilities, they can build on their strengths; they can even be the most successful people in history.

References

1. http://shine.yahoo.com/parenting/why-asperger-8217-didnt-cause-sandy-hook-school-164900109.html
2. Delaney T. and Madigan T. 2009. The Sociology of Sports: An Introduction. Jefferson, NC: McFarland.
3. Llaneza DC, DeLuke SV, Batista M, Crawley JN, Christodulu KV, Frye CA. 2010. “Communication, Interventions, and Scientific Advances in Autism: A Commentary.” Physiol Behav. 100, 268-276.
4. Jackson, L. (2002). Freaks, geeks and Asperger syndrome: A user guide to adolescence. Philadelphia, PA: Jessica Kingsley Publishers.
5. Steffens, B. 2007. Ibn al-Haytham: First Scientist (Profiles in Science). Greensboro, NC: Morgan Reynolds Publishing.
6. www.news.bbc.co.uk/2/hi/3766697.stm

What is malformation? If a little girl, with six fingers on one hand, says she loves her sixth finger very much, how do we tell her she is malformed?

Blepharoptosis is a condition in which the upper eyelid droops in consequence of paralysis of muscles or nerves. But would we say that having drooping eyelids, eyes with short palpebral fissures, is a malformation? Would we not then have to say that most Chinese and Japanese have somewhat ‘malformed’ eyes?.

If the little girl’s sixth finger causes her no impediment, except for its appearance, would it be right to think of it as a ‘disability’ or a ‘problem’? On that criterion, obesity or anorexia nervosa could also be considered as disability. They are not only disagreeable in appearance but also impair physical and social function. Such impairment must surely be part of any definition of disability.

But this too raises a question. If an abnormality does not cause impairment of function, but only makes a person ugly, do we consider it a disability? Who will judge the level of ugliness, the individual or society? A schoolgirl with polydactylism – more than five fingers or five toes; a young man with alopecia universalis – absence at all hair, on the head and body; a teenage girl with ichthyosis vulgaris (xeroderma) – a severe skin disorder which causes an ugly appearance – if such conditions do not cause any impairment, if people have got used to seeing them, the individuals may not perceive themselves as ugly and therefore not feel distress. But if their appearance does disturb others and they feel distressed as a result, should we describe them as normal or disabled’? A little girl in a nursery school may be afraid of holding up a polydactyl hand; his co-workers may be upset by sharing a workplace with a man suffering from alopecia universalis; a hair dresser may not want to cut the hair or manicure the nails of a girl who suffers from ichthyosis vulgaris.

Plainly, clinical definitions do not define or cover disability. Sociological reflections are also important. Sometimes it is more important to ask how people around a particular individual perceive that individual, than to ask how medical science defines his or her condition.

There are situations where individuals do not feel handicapped and find their lives valuable and worth living, but people around them are upset by them and label them as disabled. In contrast to this, there are some cases, in which, the individual is considered medically ‘normal’, is perceived as ‘normal’ by society, and his or her condition does not cause any impairment, but that individual thinks that a particular part of his or her body is a problem and tries to find a ‘solution’ to it. These ‘solutions’ are an important part of the plastic surgeon’s workload. It is not easy to explain the circumstances which disturb people so much that they take the risk of surgery. But we may infer another factor to define disability namely the psychological state of the individual. The individual may not have any physical abnormality but psychologically he or she feels abnormal. Hospital records abound with such cases.

Among the most difficult ‘abnormalities’ are anomalies affecting the newborn and congenital malformations. There are 200 such ‘disabilities’ (see Goodman and Gorlin 1983). Among them are Downs Syndrome, Spina Bifida and Fetal Alcohol Syndrome. The distress caused by such illnesses has led to attempts to identify cases as early as possible. In order to do this, scientists have established new prenatal diagnostic methods such as USG (ultrasound), amniocentesis, CSV (cholonic villi sampling) and photocopy. 60-65% of malformations can be diagnosed with these methods (Goodman and Gorlin, 1983, p.83). However, we must define our aims clearly to protect humankind from being victims of these improvements. Goodman (1986, pp2l4-17) suggests that prenatal diagnosis is used for monitoring the pregnancy, to localize the placenta, to detect multiple pregnancies, to know fetal age correctly, to monitor probable congenital malformation and to make studies about the genetic, biochemical and chromosomal structure of the fetus. These are all aims which are innocent and for the benefit of humankind. But, like all other new technologies, they do raise moral questions.

Before 1977, prenatal diagnosis was rare in Sweden. The number of late terminations because of fetal abnormality was 34 in that year. By the end of the 1980s, this number had reached 100 per year. 40% of these terminations were because of Downs Syndrome and 15% because of NTD (Neural Tube Defect) (Reid, 1991, p.77). Introduction of the technologies to Portugal, Greece and Germany led to new legislation on the termination of pregnancies (Reid, 1991, p.9).

Despite all measures and methods of elimination, disabled babies continue to be born. Maybe attention should be turned to treatment and rehabilitation. Although it is not always possible to correct impairment completely, quality of life can be improved through a variety of rehabilitation methods.

Almost half of handicapped newborns die in the first year of life and 80% of the rest need corrective surgery or lifetime therapy. For this reason, treatment and rehabilitation are costly options. But after the improvement of surgical sciences, especially plastic surgery in recent years, the remediability of many conditions has increased.

Remediability or irremediability of disabilities is of crucial importance in determining the treatment offered to handicapped newborns. Decisions about remediability or irremediability are made by doctors. The reasoning and judgments of philosophers, theologians, sociologists, other experts (and, of course, parents) are informed by data supplied by doctors. The objectivity of that data is not unquestionable. Dr John Freeman (quoted in Kuhse and Singer 1985, p.63) observed: ‘It concerns me greatly that a given child born in Sheffield has a 75% chance of being dead; that the same child born in Baltimore…has a 95% chance of being alive. And yet this is a decision made by the parents on the advice of either Dr Lorber or myself. That is scary.’

In this discussion of the definition of ‘disability’, we have tried to show that it and related terms cannot be solely the domain of doctors. It is true that scientists are vital in this area but they need to be aware of societal and religious issues. We cannot leave decisions about ‘disability’ to scientists who worship only science.