FIMA YEAR BOOK 2004

LIFESTYLE METABOLIC AND STRESS RELATED MEDICAL  DISORDERS:
SCIENTIFIC AND RELIGIOUS PERSPECTIVES

Editorial

As-salam Alaykum

All praise is to Allah (SWT) the most Merciful, the most Beneficent. May blessings and peace be upon Prophet Muhammad and upon his family and companions?

This issue of the yearbook is addressing lifestyle patterns, their health consequences, and the Islamic concepts regarding them.

There have been significant changes in the eating habits and leisure time activities in the last few decades. Most of the food consumed is processed and has high sugar and fat content with less consumption of fresh foods, vegetables and fruits. It has been initiated by the increasing pace of life that encouraged “fast food”” and the use of snacks, sodas and other soft drinks. This has been encouraged by the food industry which has realized the significant opportunity to make more profits. The food industry is spending billions of dollars to promote the use of these unhealthy products and sadly enough most of this marketing/promoting is directed to the children and youngsters with the aim of making a permanent effect on their eating habits.

At the same time, there have been marked advances in the electronic entertainment with widespread use of video games, even in cellular phones, the expansion of the TV industry with 24 hours availability of hundreds of channels, both broadcast and cable. This led to basically sedentary use of leisure time with minimal physical exercise. Again this affects children more than adults. The combined effect of poor eating habits and less physical exercise led to a significant and continuing increase in the rate of obesity both in children and adults.

Dr. Ajlouni reports that 65% of US adult population is overweight or obese. Comparing the period 1976-1980 with the period 1999-2000, the prevalence of overweight has increased by 40% and that of obesity by 110%. Worldwide over a billion adults and children are obese or overweight.

Unfortunately, the same is happening in the Muslim/Middle Eastern countries.

Dr. Ajlouni cites the sample of Jordan. Surveys reported in 1997 showed the prevalence of overweight in 1997 to be 60% in women and 33% in men. They documented the level of physical activity in a survey. Only 15% of the individuals included in the survey had an average 35 hours of walking, including during their performance of their jobs, while 33% walked < 5 hours/week.

Obesity is a significant health problem. It is associated with diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, elevated LDL, low HDL, heart disease, etc. elements of which have been designated the “Metabolic Syndrome (MS)”. The components of this syndrome as well as the possible pathophysiology are being detailed in the article by Dr. El-Zaheri. He again notes the increasing prevalence of obesity worldwide and in Muslim/Arab counties and stresses its relation to the lifestyle changes.

Dr. Mishal addressed the problem as it related specifically to children and adolescents. He reported that the prevalence of obesity in children in the USA is estimated to be 15%, while it is 25% in Egypt.

Dr. Mishal stresses the relationship of obesity to Type 2 diabetes mellitus. He reports that type 2 diabetes comprised 2-4% of all childhood diabetics before 1992 while in 1994 it accounted for 16% of all new cases in children. He reports that in the Islamic hospital in Amman, Jordan 29% of diabetics at < 18 years are type II and 74% of these are obese.

It is vital that prevention strategies towards childhood obesity should be implemented. Efforts should be exerted by individuals, pediatricians, educators, dieticians, parents was well the media and governments. There should be national programs for inducing favorable dietary modifications and for promotion of physical exercise. The food industry should be asked to accurately and clearly label their products and better still to change their products to healthy foods. Dr. El-Zaheri also stresses that the cornerstone of combating “MS” is primary prevention through changing to a healthy life style beginning in early childhood. As a matter of fact, breast feeding which is encouraged in our Islamic tradition, has been shown to improve insulin sensitivity.

Specifically in the Muslim and Arab societies our religious heritage is privileged with a wealth of guidance that encourages healthy lifestyles. This has to be stressed both in schools and in the media and through the religious leaders. Muslims should promote the prophetic guidelines regarding food habits and exercise. If these were followed we would not have the problem to start with. Prophet Muhammad {PBUH} use to race. Two of his “Ahadith” (sayings) come to mind “Teach your kids horseback riding and swimming” and “Fill only 1/3 of your stomach with food, 1/3 with water and leave the last 1/3 for air.”

Another aspect discussed in this issue of FIMA Year Book is the psychological stress we are all exposed to. Dr. Badri makes the obvious point that “The Islamization of Western secular psychiatric and psychotherapeutic techniques are so vital that one really wonders why it was not done decades ago?” Muslims have definite ideas about life, death, and life in the hereafter, they usually harbor feelings of guilt because of committing sins. Dr. Badri rightly believes that without addressing these issues with a Muslim patient “secular’ therapy can be of no help. He believes that the Western system that teaches therapists to be neutral and nonjudgmental and not to bring religious issues in their therapy, does not work with Muslim patients hence the need for Islamization of psychotherapy.

Dr. Abu Dannoun explains that the Islamic life style influences positively our response to stressful events. Central among these is Muslim belief in destiny. We believe that one has to exert the most effort he can muster but eventually the outcome is not totally dependent on such efforts/talents but is determined by Allah. The glorious Quran cites many examples of the difficulties experienced by various prophets, e.g. “Ibrahim” (Abraham), “Yaqub” (Jacob), Yusuf (Joseph), Ayyub (Job) (peace be upon them all) that provides us guidance as to how to respond to life’s difficulties.

Islam prohibits the use of addicting substances and inflicting harm on oneself or others. Islam mandates the care of the feeble, elderly, and needy. Islam engenders the sense of hope. Allah says “Allah puts no burden on any person beyond that what he can cope with.” â€œAllah will grant ease after hardship”. Dr. Abu Dannoun states this concept renders the Muslim who falls under stressful circumstances, properly equipped with hope and confidence in the blessings and grace from his Creator. Dr. Abu Dannoun correctly concludes that the Islamic lifestyle has been influential in minimizing social and individual maladies.

Dr. Shaharam describes the post traumatic stress disorder (PTSD) and the different models used to explain its cause, course and outcome and hopefully help to manage it.There are biologic, psychodynamic, behavioral and spiritual models. Dr. Shaharan states that the elements of the Islamic paradigm include: the belief in fate, the belief that sickness whether physical or mental is a test of one’s faith. Divine reward awaits those who are patient in the face of tribulation and that finding the panacea of an illness is wisdom and in compliance with the “Sunnah”. He states that in the management of victims of PTSD especially those who are spiritually minded, prayers and supportive religio-spiritual counseling is invaluable.

Drs. Takriti and AL-Khayyat discuss delusions and hallucinations. They can be caused by medical conditions like hepatic or renal failure or be due to substance abuse or heavy mental poisoning. However they are mostly a manifestation of psychosis. They stress that religious content of hallucinations (i.e., involvement of God, Jin, evil spirit or magic) is more common in Muslim countries. Unfortunately in Muslim countries some families believe in the mystical origin of the hallucinations and resort to “religious” healers rather then to psychiatrists. They stressed the absolutely obsolete claim that these hallucinations are caused by supernatural phenomena. Muslim physicians and religious leaders/Imams should dispel these myths.

Drs. Sarhan and Sartawi discuss the role of culture and religion in the incidence of suicide. While the rate of suicide is increasing worldwide it is lowest in Muslim countries 1.5-10/100,000. They then discuss causes of suicide; biological, psychological, sociological, global influences, mental status, sexual orientation, socioeconomic status, and urban versus rural living.

They give interesting four case histories and discuss the Islamic jurisprudence position on each. While case 2 seems to me straightforward, the others are not so.

Cases 1 and 4 illustrate the problem of not recognizing depression as what it really is. Depression is a disease like hypertension, diabetes, etc and is not personal weakness. While this is a worldwide misconception it is probably more so in Muslim countries. It is considered shameful to seek psychiatric help for depression. Public education/media should address this misconception. While in Case 1, the individual himself did not seek help, in Case 4 the family was responsible. In addition, the Shaikh who claimed that the woman is possessed with Jin, has to be held responsible. In reality, the whole society and the Muslim scholars are responsible to dispel these myths. Case 3 is different. The person was known to be schizophrenic. Was he under treatment? Was he properly cared for? Is the society in general and the medical profession doing its job of ensuring proper mental health care for all individuals These are our responsibilities and Drs. Sarhan and Sartawi are to be commended for bringing this to our attention. While I do not necessarily disagree with their juridical assessment of the 4 cases, some may consider cases 1, 3 and 4 also suicide. This is something that we Muslim physicians/theologians need ponder about i.e. under which conditions a person’s actions can be considered unwillful and thus he can not be accountable for them. I believe that how Allah will judge these four individuals is up to Him and only to Him. As Muslims we believe in His infinite Wisdom, Justice and Mercy.

I hope this issue will bring to light many of the issues that endanger our physical and mental health. That it will encourage physicians to take the lead in promoting strategies to tackle these problems both on the individual and societal levels. Hopefully this book will reach Muslim physician in most if not all of the Muslim countries to spread the word in these diverse communities. That is the basic concept of having a Federation of Islamic Medical Associations (FIMA).

I would like to thank Dr. Mishal and the executive committee for honoring me by asking me to be the editor of this yearbook. I thank the distinguished authors who submitted their work, Dr. Mishal, Dr. M. A. A. Khan for their help and guidance throughout the preparation of the book. I also thank the staff of FIMA for printing and publishing the book.

May Allah bless our efforts and accept our deeds and guide us to and keep us on the straight path.

Wasslam

Hossam E. Fadel, MBBCh, PhD, FACOG

Augusta, Georgia