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Paper presented at The Annual Training for Better organization and Islamic Health Conference organized by the Islamic Medical Faculties of Indonesia at Universitas Islam Sultan Agung Semarang on 20th December 2008 by Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine Institute of Medicine Universiti Brunei and Visiting Professor of Epidemiology Universiti Malaya. EM: http://omarkasule.tripod.com
ABSTRACT
The paper discusses the Qur’anic concept of rizq distinguishing it from diet and nutrition. It then explains the levels of human nutrition and the levels of satiety. It ends by discussing methods of appetite control and dealing with diseases of malnutrition.
1.0 BASIC CONCEPTS
1.1 The concept of rizq
The Qur'anic term rizq translates better as sustenance because it is narrower in scope than food. It deals with sustaining physiological life. As is known biologically some of the food ingested is not utilized by the body and does not contribute to sustenance of the body. Some food is actually dangerous to the body and some is useless. So rizq refers to food or components of food that specifically provide sustenance. Thus rizq should refer only to the food that is useful to the body. It excludes useless food, food that is not absorbed, or food that is not metabolized.
1.2 Levels of human nutrition
At the lowest level, humans eat to satisfy basic survival needs and necessities, dharuuraat. At the next level humans eat to satisfy wants, haajiyaat. At the next level humans eat food with refinements and embellishments, tahsiinaat. At the highest level feeding is associated with several complementaries, mukammilaat.
Cooking rice is a pot of water and consuming it directly from the pot will satisfy dharuuraat. Cooking the rice with some sauce and flavoring will satisfy haajiyaat and will enable the person to eat more because the food is more palatable. Serving the rice on nice plates and with other foods and drinks is tahsiinaat. Eating the rice with friends on nice decorated tables with music in the background is considered mukammilaat.
The level of nutrition depends basically on the level of socio-economic development. The higher the socio-economic level the higher the level of nutrition. However from the biological point of view, a higher level of nutrition does not translate into better health outcome. It seems that the basic foods are more healthy and there is now a movement to return to simple healthy foods.
1.3 Levels of human satiety, maraatib al ghadha
Satiety can be described in three states: the necessary, dharurat; the needed, haajat; and the excess, fadhl. Dharurat is the minimum nutritional intake necessary to maintain health in the best status. It represents the balance between excessive and too little intake. Haajat is intake that is more than dharurat but which prevents the feeling of hunger. It is however recommended not to eat to full satisfaction, shaba’u. Fadhl is the excess intake beyond need.
1.4 The obligation to eat, wujuub al ta’am
The human needs food to survive. Eating is waajib according to the principle ‘ma la yatimmu al waajib illa bihi fahuwa waajib’ because without proper nutrition other religious and social obligations will not be carried out. The human body requires food to provide energy and raw materials for its break-down (catabolic) and building (anabolic) activities.
2.0 CONTROL OF APPETITE
2.1 Control of appetite by iman
There is a difference in attitude to feeding behavior between the believer and non-believer[1]. The etiquette of eating is determined by the underlying vision. The believer eats to get energy for ‘ibadat. The non-believer may eat for enjoyment or to get energy for evil. The Prophet described Muslims as a community who ideally eat only when hungry and who do not fill their bellies when they eat, nahnu qawmu la na akul hatta najuu’u wa idha akalna fala shabi’ina. There is blessing in the food of the believer; he gets satisfied easily. The non-believer has to eat more food to get satisfaction. The Prophet Muhammad (PBUH) in a very revealing hadith mentioned that a believer eats in one stomach whereas a non-believer eats in 7 stomachs. This means that a believer is satisfied with less food than a non-believer.
2.2 Control of appetite by saum / puasa
Both obligatory and non-obligatory saum / puasa help in controlling excess intake. They involve decrease of the total amount of food intake. They are also a form of training in appetite control.
2.3 Limitation of food intake
The Prophet taught the rule of the thirds (Musnad Ahmad) as a guide for food intake: one third for solid food, one third for water, and one third for air. He also taught that Muslims are a community who do not eat until they are hungry and when they eat they do not fill their belly. Ibn al Qayim defined three levels of food inatke: necessary, hajat, sufficient, kifayat, and excess, fadhlat. The necessary amount of food is that necessary for maintenance of life and health. The sufficient is more than the necessary and satisfies the psychological desire for food. The excess is what is beyond the body's needs and is definitely harmful to health.
3.0 PROBLEMS OF SATIETY and HUNGER
3.1 The principle of equilibrium, mizan
Satiety is the desire to stop eating further because of feeling satisfaction. It is controlled by the hypothalamus. Eating causes a rise in body temperature that signals to the hypothalamus to activate the satiety mechanisms. The distension of the stomach during a meal also sends signals that activate satiety. High blood sugar and high lipid levels may also cause satiety. Emotional and psychological factors also control satiety. In normal circumstances these negative feedback mechanisms can keep food ingestion within physiologically acceptable levels. However human will is able to overrule normal physiological control mechanisms. The body may crave for more food but the will can overrule it. In the same way the will can cause stopping feeding even before satiety is reached. Over eating or under-eating due to the action of the human will can be the basis for malnutrition and human disease.
3.2 Over-nutrition
The diseases of over-nutrition are: obesity, diabetes mellitus, ischemic heart disease, and atherosclerosis. These diseases are more common in the rich communities with a higher prevalence of over-nutrition. Early man in agricultural societies could use up all the food ingested because of the hard physical work of looking for food and assuring the basic necessities of life. Sedentary man in the modern industrial society still eats the same number of meals as early man without the same amount of physical work with the result that obesity develops.
Obesity is a social and medical disease that was condemned by the prophet. He considered it a sign of social degeneration. Obesity is deviation from homeostasis. Most cases of obesity are due to excess food intake although emotional, genetic, and endocrine factors play a role. Obesity may also be familial with no genetic basis when children grow in a family with excessive nutritional intake and grow into overweight or obese adults. In obesity the equilibrium between lipolysis and lipid storage is shifted in favour of storage. Regular food intake without any physical activity may also lead to obesity. Factors that encourage over eating include: abundance of food with a lot of leisure time leading to social eating as entertainment and stress that finds relief in food.
Obese persons have a shorter life-expectancy. Obesity is associated with hypertension, atherosclerosis, and diabetes. Obesity is an increased burden for the heart and also the skeleton and joints. Behavioral problems may be due to feeling bad about one self and may progress to neuroses and psychoses. Besides its association with disease, obesity in its extreme forms interferes with performance of physical acts of ‘ibadat such as saum / puasa, salat, and hajj. Obesity is treated by reducing food intake under medical supervision
3.3 Nutritional deficiency
Nutritional deficiency may be quantitative or qualitative. Quantitative deficiency manifests as protein-calories malnutrition of children in poor countries and hospitalized adults in developed countries. Kwashiorkor is a form of protein energy malnutrition due to protein deficiency in the presence of adequate energy intake. Qualitative deficiency is usually of vitamins of minerals. It may be primary due to inadequate dietary intake or may be secondary to mal-absorption.
The Qur’an emphasized the virtues of giving food to the needy[2]. The prophet taught the virtue of feeding others, fadhl al ‘it’aam[3] especially the hungry, it’aam al jai’u[4]. This can take any of the following forms: sadaqat, kaffaarat, zakat al maal, and zakaat al fitr. The prophet taught the virtue of sharing food when he said that the food of suffices 4[5]. He also taught that food not needed should be given to the needy, man kaana ghaniyan ‘an al ta’aam faliyuwajihahu ila ghayrihi [6].
3.4 Food security
Food security has been an important factor in the growth of human civilization. Early humans were hunter gatherers who spent most of the waking day looking for food and even with that they could not be sure that they could get their day’s meal. When humans settled down in communities and started domesticating plants and animals they were able to assure themselves of food without having to search the whole day. With the problem of food security solved humans could devote energy to tasks of building a sophisticated human civilization.
The family unit must ensure food security especially since it has children and pregnant women who are very vulnerable to malnutrition. The prophet recommended putting aside food reserves for a whole year to ensure food security for the family.
There is no true problem of food security in the world as a whole. The problem is poor distribution. Whereas food is being wasted in rich countries, humans in poor countries are starving. Situations of war and civil disturbance also create conditions of temporary food insecurity.
[1] Bukhari
[2] Qur’an 2:184, 5:89, 22:28, 22:36
[3] Bukhari
[4] Bukhari
[5] Bukhari
[6] Ahmad