Thursday, March 4, 2010

The first experimental demonstration of hypoxic cells in a tumor.

The dilution assay technique was used by Powers and Tolmach to investigate the radiation response of a solid subcutaneous lymphosarcoma in the mouse. Survival estimates were made for doses between 2 and 20 Gy (200 and 2000 rad). The results are shown in figure 6.10 in which the dose on a linear scale is plotted against the fraction of surviving cells on a logarithmic scale.

The survival curve for this solid tumor clearly consists of two separate components. The first, up to a dose of about 9 Gy (900 rad), has a slope (d0) of 1.1 Gy. The second has a shallower slope (D0 = 2.6Gy). this biphasic survival curve has a final slope about 2.5 times shallower than the initial portion, which strongly suggests that the tumor consists of two separate groups of cells, one oxygenated and the other hypoxic. If the shallow component of the curve is extrapolated backward to cut the surviving-fraction-axis, it does so at a survival level of about 1%. From this it may be inferred that about 1 % of the clonogenic cells in the tumor were deficient in oxygen.

The response of this tumor to single doses of radiation of various sizes is explained readily on this basis. If 99%of the cells are well oxygenated and 1% hypoxic, the response to lower doses is dominated by killing of the well oxygenated cells.for these doses, the hypoxic cells are depopulated to a negligibly small extent. Once a dose of about 9Gy is exceeded, however, the oxygenated compartment of the tumour is depopulated severely, and the response of the tumor is characteristic of the response of hypoxic cells. The biphasic survival curve was the first unequivocal demonstration that a solid tumor could contain cells sufficiently hypoxic to be protected from cell killing by x-rays but still clonogenic and capable of providing a focus for tumor regrowth.

Muslim Alternative Medicine: Al-Habbah Al-Sauda'

What is Alternative Medicine?

In Western culture, the term alternative medicine refers to any healing practice "that does not fall within the realm of conventional medicine", or "that which has not been shown consistently to be effective." Alternative medicine is often based on the belief that a particular health regimen has efficacious effects even while there isn't a body of evidence to support such a belief under the rigorous standards of evidence based medicine. In practice, alternative medicine encompasses therapies with a historical or cultural, rather than a scientific, basis.

Commonly cited examples include naturopathy, chiropractic, herbalism, traditional Chinese medicine, Unani, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and diet-based therapies, in addition to a range of other practices.

Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.

What is Al-Habbah Al-Sauda'?

Al-Habbah al-Sauda', or its scientific name Nigella Sativa is an annual flowering plant, native to southwest Asia. The seed is used as a spice.

In English, Nigella Sativa seed is variously called fennel flower, nutmeg flower, Roman coriander, blackseed, black caraway, or black onion seed. Nigella Sativa has a pungent bitter taste and smell. It is used primarily in confectionary and liquors.

Physical Characteristic

It grows to 20–30 cm (7.9–12 in) tall, with finely divided, linear (but not thread-like) leaves. The flowers are delicate, and usually coloured pale blue and white, with 5–10 petals. The fruit is a large and inflated capsule composed of 3–7 united follicles, each containing numerous seeds. It is in flower in July, and the seeds ripen in September. The flowers are hermaphrodite (have both male and female organs) and are pollinated by bees.

The plant prefers light (sandy), medium (loamy) and heavy (clay) soils and requires well-drained soil. The plant prefers acid, neutral and basic (alkaline) soils. It cannot grow in the shade. It requires dry or moist soil.

History of Usage as Medicine

Nigella Sativa has been used for medicinal purposes for centuries, both as an herb and pressed into oil, in Asia, Middle East, and Africa. It has been traditionally used for a variety of conditions and treatments related to respiratory health, stomach and intestinal health, kidney and liver function, circulatory and immune system support, and for general well-being.

In Islam, it is regarded as one of the greatest forms of healing medicine available. Avicenna, most famous for his volumes called The Canon of Medicine, refers to Nigella as the seed that stimulates the body's energy and helps recovery from fatigue and dispiritedness. It is also included in the list of natural drugs of 'Tibb-e-Nabavi', or "Medicine of the Prophet (Muhammad)", according to the tradition "hold onto the use of the black seeds for in it is healing for all diseases except death" (Sahih Bukhari vol. 7 book 71 # 592).

In the Unani Tibb system of medicine, Nigella Sativa is regarded as a valuable remedy for a number of diseases.

The seeds have been traditionally used in the Middle East and Southeast Asian countries to treat ailments including asthma, bronchitis, rheumatism and related inflammatory diseases, to increase milk production in nursing mothers, to promote digestion and to fight parasitic infections. Its oil has been used to treat skin conditions such as eczema and boils and to treat cold symptoms. Its many uses have earned Nigella the Arabic approbation 'Habbatul barakah', meaning the seed of blessing.

The Usage in the Islamic Medicine

From the book Al-Tibb Al-Nabawi by Ibn Qayyim Al-Jawziyya:

The Black Cumin Seed (Nigella Sativa) is one of the most universally powerful medicines known to man. It is a small triangular seed from a flowering herb of the buttercup family, and also known as the Blessed Seed, Black Caraway or Kalwanji. It has been known and cultivated for over two thousand years, including by the ancient Egyptians and Romans.

Abu Huraira (may God be pleased with him) narrated that God’s Messenger (pbuh) said, “Use this black seed regularly because it contains a cure for every disease except death.”

The oil extracted from the seeds is particularly good for healing cold, wet illnesses, benefits bronchitis and coughs, acts as a digestive tonic, eases belching, stimulates excretion of body wastes, expels intestinal worms, stimulates menstruation in women and increases the flow of breast milk for nursing mothers. Adding a few drops of the oil to coffee helps calm the nervous system dispels fatigue and mild depression and eases a dry cough.

The Black Seed is also particularly beneficial for women suffering from abnormal absence of menstruation and other menstrual difficulties. An ointment made of black seed oil can also stimulate the growth of the beard and slow down the graying of hair. Boiling Black Seeds in vinegar and then rinsing one’s mouth with this liquid can help relieve toothache and heal gum problems.

Placing powdered black seeds in a fine muslin cloth and inhaling them regularly helps reduce the effects of common colds. The Blessed Companions of God’s Messenger (pbuh) used to place 21 seeds in a linen cloth which they soaked overnight in water, and in the morning, they used to place drops of this solution in each nostril to help relieve nasal congestion and head-colds.

The Usage in the Modern Medicine

Unfortunately very few of us in the medical profession are aware of its medicinal properties discovered by the modern scientific techniques. The oil of Nigella Sativa is so beneficial due to its content of over a hundred components such as aromatic oils, trace elements, vitamins and enzymes. It contains 58% of essential fatty acids including omega 6 and omega 3. As oil it is digested through the lymphatic consequently purifying and unblocking the lymphatic system.

Advancements in the methods of analytical chemistry, physiology, pharmacology and microbiology, etc have led to the discovery of many active principles of the Nigella Sativa like: thymoquinone, dithymoquinone, thymohydroquinone, nigellone, thymol, arvacrol, oxy-coumarin, alpha-hedrin, steryl-glucoside as well as rich amounts of flavinoids, tannins, essential fatty acids, essential amino acids, ascorbic acid, iron and calcium.

It also has a number of pharmacological effects of profound therapeutic value, like: Analgesic, anti-inflammatory, antihistaminic, anti-allergic, anti-oxidant, anti-cancer, immune stimulation, anti-asthmatic, antihypertensive, hypoglycemic, anti-bacterial, antifungal, anti-viral and anti-parasitic.

Even in the veterinary medicine, besides the beneficial effects of Nigella Sativa seed and its oil in many infectious diseases. There are reports that the addition of Nigella Sativa seed cakes in the feed of buffalo and lambs improved their body weight and reproductivity; and the addition of Nigella Sativa seed in the food of broiler chicks improved their immunity and feed conversion efficacy.

Scientific Researches

Recently, there are many researches conducted throughout the world regarding the benefits of Nigella Sativa on human health. Since 1959 there have been over 200 different studies at universities and laboratories regarding the subject. At the Cancer Research Laboratory of Hilton Head Island, South Carolina, USA, one of the largest experimental studies so far proved that Nigella Sativa oil had enormous success in tumour therapy without the negative side effects of common chemo-therapy. They found that it increased the growth rate of bone marrow cells by a staggering 250% and it inhibited tumour growth by 50%. It stimulated immune cells and raised the interferon production which protects cells from the cell destroying effect of viruses.

Below are some other researches that have been conducted in several field of health.

• Thymoquinone and pancreatic cancer treatment

Researchers at the Kimmel Cancer at Jefferson in Philadelphia have found that thymoquinone, an extract of Nigella Sativa seed oil, blocked pancreatic cancer cell growth and killed the cells by enhancing the process of programmed cell death, (apoptosis). While the studies are in the early stages, the findings suggest that thymoquinone could eventually have some use as a preventative strategy in patients who have gone through surgery and chemotherapy or in individuals who are at a high risk of developing cancer

• The antioxidative and antihistaminic effect of Nigella Sativa and its major constituent, thymoquinone on ethanol-induced gastric mucosal damage

An experiment has been conducted to assess the possible protective effects of Nigella Sativa and its constituent, thymoquinone on ethanol-induced gastric mucosal damage in an experimental model. The results has shown that both drugs (Nigella Sativa and thymoquinone ) could protect the gastric mucosa against the injurious effect of absolute alcohol and promote ulcer healing as evidenced from the ulcer index values.

It is to be noted that Gastric damage was confirmed histomorphometrically by significant increases in the number of mast cells (MC) and gastric erosions. However, the Nigella Sativa treatment significantly decreased the number of MC and reduced the area of gastric erosions.

Likewise, thymoquinone treatment was also able to reduce the number of MC and the gravity of gastric mucosal lesions, but to lesser extent compared to Nigella Sativa. Apart from that, it also has been proven that Nigella Sativa and thymoquinone treatment was also able to decrease and reduce the Gastric tissue histamine levels as well as myeloperoxidase activities.

Recently, clinical and animal studies have shown that the extracts of the black seeds have many therapeutic effects such as bronchodilatation, immunomodilative, antibacterial, hypotensive, hepatoprotective and antidiabetic. Nigella Sativa extracts and its main active component, thymoquinone have been shown to possess antioxidant and anti-inflammatory activities.

However, there is little information about the effect of Nigella Sativa and its major constituent on the gastrointestinal system. Studies have proved that Nigella Sativa has a cytoprotective effect on human T cell and an antioxidant effect on cardiovascular tissue.

It has been reported that recently, Zonguldak Karaelmas University in Zonguldak, Turkey was conducting an experiment to evaluate the anti oxidative and antihistaminic effect of Nigella Sativa in ethanol induced gastric damage, and to compare actions of Nigella Sativa and its constituent thymoquinone. For this purpose, changes in tissue histology, number of mast cells (MC), the histamine levels (as the marker of final chemo-stimulant of gastric secretion), and myeloperoxidase (MPO, as marker of neutrophil infiltration) activity were determined and documented.

The results gained shown that pre-treatment with Nigella Sativa or thymoquinone were found to inhibit the ethanol induced gastric mucosal injury. The pre-treatment of Nigella Sativa significantly reduced the Ulcer Index while thymoquinone has significantly shown an inhibit effect to the ethanol induced gastric lesions. In conclusion, the result obtained from this study suggest that both drugs, particularly Nigella Sativa could partly protect gastric mucosa from acute alcohol-induced mucosal injury, and these gastro protective effects could be due to their antiperoxidative, antioxidant and antihistaminic effects.

• Antibacterial activity of Nigella Sativa against clinical isolates of methicillin resistant Staphylococcus Aureus

An experiment was conducted in the University of Health Sciences, Lahore, Pakistan regarding the subject. Methicillin resistant Staphylococcus aureus (MRSA) continues to be one of the commonest pathogens encountered in clinical as well as laboratory practice. It has become a major health problem worldwide. Newer antimicrobials/agents are urgently needed to combat this problem MRSA resistance to various anti-staphylococcal agents. In the back-drop of this difficult situation Nigella Sativa commonly known as black seed (ethanolic extract) was aimed at to evaluate if it had any anti-staphylococcal activity.

The extract was prepared by reflux extraction method. Disc diffusion and in agar dilution methods were performed to assess the antibacterial activity. Staphylococcus aureus ATCC 25923 was used as the standard reference strain.

The reason of choosing Nigella Sativa is because; Nigella Sativa extract has been extensively studied for its antimicrobial activity against a wide range of bacterial, fungal and parasitic organisms. However only a limited data is available so far regarding its efficacy against MRSA. The present study was therefore designed to evaluate this aspect of N. Sativa.

The results of disc diffusion assay demonstrated that MRSA strains were completely inhibited at 4 mg/disc. Thus, it may be concluded from this study that N. Sativa seed extract has antimicrobial activity against MRSA. It is expected that using natural products as therapeutic agents will probably not elicit resistance in microorganisms. It is essential that research should continue to isolate and purify the active components of this natural herb and use in experimental animals.

• A new treatment of Opioid dependence: Nigella Sativa 500mg

In this modern age, scientific research is done on this wonderful plant and its seeds. There are certain chemical inside the seed that can help us maintain or improve our health. There are some researches done nowadays concerning about the medicinal properties or the pharmacology aspect of the seed.

Nigella Sativa Linn belongs to family Ranulaceae. The herb is widely known in different parts of the world and its seeds are used as condiment. The chemical composition that is inside Nigella Sativa can be determined by phytochemical studies on seeds and it revealed the presence of volatile oil (1.5%), fixed oil (37.5%), nigellin, melanthin and thymoquinone. Carvone (45–60%), carvene, cymene and thymoquinone. Nigellidine, nigellimine, and nigellicine are the alkaloids from the black seeds.

Ns.Cr (the black seeds) causes a dose-dependent relaxation of spontaneous contraction. Ns.Cr also inhibited potassium-induced contractions in a similar dose range, suggestive of calcium channel blockade. This activity is concentrated in the organic fraction. The seeds of Nigella Sativa contain a yellowish white volatile oil (0.5–1.6%) fixed oil (35.6–41.6%), proteins, amino acids, e.g., albumin, globulin and valine reducing sugars, mucilage, alkaloids, organic acids, tannins, resins, toxic glucoside, metarbin, bitter principles, glycosidal saponins, melanthin resembling helleborin, melanthigenin (1%), ash, moisture, and Arabic acid.

In a certain study on opioid dependence treatment, Nigella Sativa is used due to its chemical content to suppress (not act as a replacement) to the withdrawal syndrome after abstaining oneself from opioid. Nigella Sativa is in use for the treatment of variety of ailments since ancient times. Research has based its many effects on their efficacy of blocking calcium channels. As calcium channels have been tried for the treatment of opioid dependence, so Nigella Sativa was used in this study.

• The effect of Nigella Sativa seeds on certain aspect of carbohydrates and key hepatic enzymes in serum of rat

On another study on Nigella Sativa, it has an effect on the liver enzyme that causes an increase of the enzyme. When enzyme concentrations increase, it helps in the digestion of food, in this case, fats and lipid. This study was done on adult, male albino rats and it has shown certain increase in the hepatic enzyme concentration. The increase is proportional with the time given that the administered regime is to remain constant.

• The clinical and therapeutic benefit of Nigella Sativa

In recent study, Nigella Sativa has been noted for its anti-oxidant properties and its ability to suppressed cancer cell in our body. There is also research on antibacterial, antihistamic and antinflammatory property that exist in the seed of the Nigella Sativa. Many of the research on Nigella Sativa are still being conducted and incomplete. Although, the result are certain but the mechanism is still largely unknown. The mechanism process is not accurate and more research needs to be done but they have discovered suspected derivation from Nigella Sativa that could be the key player in its adverse properties of Nigella Sativa. That is thymoquinone a protein base component inside Nigella Sativa.

• Nigella Sativa relieves the effects of Ischemia reperfusion injury

Reduction of ischemia reperfusion in our body can be reduced by Nigella Sativa. Ischemia is local anemia due to mechanical obstruction that happen mainly arterial vessel. The obstruction in vessel can lead to reperfusion injury that is heart muscle impairment, usually with unstable rhythm, following the opening of arterial blockage and is due to oxygen-derived free radicals.

The reperfusion always gives limitation to a surgeon. It is hard to do surgeries in such condition, surgeon uses drug for anti-inflammatory and anti-oxidant drugs to heighten vision in the surgery table. Free radical that exist when reperfusion occur can lead to liver failure due to metabolic and structural damage. The test utilizes rats to find the free radicals and the antioxidant capacity. The rats are induce with the damage from reperfusion and the blood sample are gather and analyze the fluctuation of anti-oxidant and free radicals in the blood.
The result showed that the rat with Nigella Sativa in their body have lower numbers compare with the other subjects. Therefore, shows the ability of Nigella Sativa in reducing the fluctuation component. Nigella Sativa acts as free radical scavengers and complete the free radical in the body decreasing the severity of reperfusion.

• Nigella Sativa as clinical and therapeutic medicine

Recent studies showed that Nigella Sativa decrease the number of damage DNA prior toxic agent such as Azoxymethene. This is gold because the mechanism can inhibit the built up of carcinogenic cell in the liver. The derivative of Nigella Sativa that is thymoquinone can help in shedding the cancerous cells that accumulated. With combination from hemidusmis indicus the medication can decrease the number of changing cancerous cell that migrating throughout the body.

• Nigella Sativa in diabetic disease

In diabetes recent study showed that Nigella Sativa can accentuates glucose induces secretion of insulin. Nigella Sativa stimulates cells in the pancreas to secrete insulin. As we know insulin is important to decrease the quantity of glucose in our blood vessel. The increase of glucose can create concentrated blood and can damage sensitive cell throughout our body. Cells such as nerve cells in our body can only repair itself but cannot reproduce. If there were damaging force such as blood glucose increase that inflict large area can leave to paralyzation to the effect area.

The increase of insulin can attenuates glucose level in our body inhibiting cell atrophy. In diabetic patient, if he is expose to cadmium that can give up toxic material in our body Nigella Sativa can lower the beta cell number in the pancreas to withstand the toxic exposure of cadmium.

• Nigella Sativa parasitic effect

Schistosomiasis is infection with a species of trematodes, manifestations of this often chronic and debilitating disease vary with the infecting species but depend in large measure upon tissue reaction (granulation and fibrosis) to the eggs deposited in venules and in the hepatic portals, the latter resulting in portal hypertension and esophageal varices, as well as liver damage leading to cirrhosis. Nigella Sativa also has properties to destroy the existence of parasite inside the intestinal tract especially schistosomiasis. Nigella Sativa target eggs form the parasite.

• Nigella Sativa in decreasing the side effect of drugs

There are also other benefits like reducing side effect of some medication. In some medicine, the dose inside have adverse effect on the body some can also leave the patient at a critical such as treatment in cancer. The medication uses material that can actually destroy working with disease cells all together. In Nigella Sativa, the side effect of cyclosporine can be reduced. Cyclosporine consumption can lead to nephrotoxin or damaging the cells in the kidney. The toxic side effect can further developed into complication of diseases from the kidney failure because of kidney is one major organ for to maintain blood balance that is our lifeline.


Throughout time, science has proven that whatever comes from Allah or His messenger, are always in accordance with the laws of nature. This is yet another proof of the existence of Allah and the truth brought by Prophet Muhammad (pbuh). The health benefit that’s in the Al-Habbah Al-Sauda’ has been proven through extensive researches and findings. It’s so obvious that even a blind person can’t deny it.

We apologize for any defects arise, and we hope that Allah count this as one of our effort to gain His pleasure. May Allah bestows His Mercy upon us, forgive our sins, and include us among His chosen people.

والله ولي التوفيق


• Al-Jawziyya. Ibn Qayyim, Medicine of the prophet (4th edition), Pearl Publishing House (2006)
• (3/10/2009)
• 20-3/Hannan.pdf (26/9/2009)
• (26/9/2009)
• (4/10/2009)
• (4/10/2009)
• (7/10/2009)
• (7/10/2009)

The Common Ground of Muslim Scientists as a Factor of Scientific Progress in Islamic Civilization


It is a fact that nobody can deny that Islam used to rule the world where in that time the non-Muslim is the one who left behind in every single fields especially knowledge, civilization and worldly achievements. At that time, Islam has been the one who leads in every field of knowledge including science, architecture, arts and others. There are numerous evidences found supporting this fact and it has been preserved and past along from one generation after another until today. However, being realistic in today’s world, we found that Islam has no longer become famous with prosperity as it used to especially in the field of knowledge. One of them is Islamic science.

For all we know, Islamic science, however, has gone through its declining periods; therefore, the most significant question for every Muslim should have a thought of in their mind is that: how we Muslims achieved the scientific progress and civilization then subsequently we lost it. In other words: what was the main factor behind flourishing of Islamic science? Discussion of this issue is necessary because awareness of factors behind flourishing of Islamic science, as well as that caused to its decline, is a crucial step to any attempt for reconstruction of Islamic science.

Actually, our Muslim scientists have contributed a lot to the developing of scientific progress which led to the flourishing of Islam. Unfortunately, our generation today has fail to appreciate that fact and if this condition continues without having it fixed, there’s more likely that Islam would forever never finds it path to prosper and flourish like it used to!

Factor one: Al-Qur’an and Sunnah of the Prophet

As a matter of fact, when it comes to the scientific progress of Muslim scientists during the flourishing of Islam, there are many historians of science who noted various platforms and common grounds that led Islamic scholastic to the success. Among of them is the unity of their worldview and their source of knowledge, which is the Quran and hadith of the prophet Muhammad (May peace be upon him) which also emphasized on knowledge inquiry. Quranic revelation has become the primary source of the Islamic civilization. Since the existence of Quran, this divine guidance has lead and guide individual and social life of the Muslim community. The practice of the Prophet Muhammad S.A.W (sunnah) on the other hand also plays major roles in Islamic civilization and Muslim communities all around the world. Hence, the tradition in Muslim educational system begins with learning and memorizing the Quran. The purpose of this is to create a person who conducts life of piety and strictly following Islamic laws.

The learning in Islam traditional system does not stop only here, in fact, Islam tradition of learning includes various branches such as in medicine, astronomy, engineering, mathematics, botany, human science, physics, and various other disciplines which existed in an interconnected form and in concord with each other. Knowledge was acquired not by itself but through means and involves period of apprenticeship, reverence and respect for teachers. The purpose of seeking knowledge is to gain pleasure of Allah and as religious act (ibadah). However, the purposes of acquiring knowledge nowadays among Muslim are merely for the gains of this temporary world and for the sake of getting a job. This is different from the objectives of previous Muslim scholars in which they seek knowledge because seeking knowledge is compulsory (fardhu) to each Muslim and they learnt to understand the nature of this life and universe. This Islamic traditional education system has created generation of educated Muslim who is with knowledge and committed to their religious beliefs.

The Qur`an and the traditions of the Prophet are saturated with references to learning, education, observation, and the use of reason . However, this Islamic emphasis on knowledge inquiry can be simply put as the Qur`an has been inspiring and motivating the Muslims especially the scientific scholars for seeking the knowledge. This is actually among the common ground that Muslim scientists share in achieving scientific progress and later on develop prosperity and success in their time.

The Qur`an stimulates interest in scientific investigation, through various means, such as exploration on natural phenomena, study of historic events and human self. The crucial strategy of the Qur`anic stimuli for knowledge inquiry, however, is clearly demonstrated in its motivation of man to practice the creative thinking;

“Are the blind man and who sees are equal? You don’t think?” (6:50),
“You request others to conduct rightly while you forget to practice it yourselves and yet you studding the Scripture? Do you not understand?” (2:44),
“Do they not look at the Camel how it is made? And at the Sky how it is raised high? And at the Mountains how they are fixed firm? And at the Earth how it is spread out?” (88: 17-20)
The holy Qur`an frequently raised such thought provocative questions to human intellect, not to seek simple answers, but for creative and critical thinking. The Qur`an motivates people to practice critical thinking, not to follow views of others blindly without valid reasons. It liberates man even from his own self. In the Qur`an, Allah invites people to reject blindly accepting the beliefs and values society imposes upon them and ask them to ponder by pushing aside all the prejudices, constraints on their minds. Freedom of intellect in the Islamic worldview, therefore, exists within the framework of belief system (Iman), to follow its course into the entire knowledge activities. In other wards, the Islamic worldview has an epistemological content.

Motivated by such Qur`anic revelation Muslim scientists devoted themselves in knowledge inquiry of higher learning. Al-Khawarizmi, for instance, laid dawn the foundations of modern algebra in his (Muggdimah fil al-Jabr wal muqabalah); al-Battani measured the solar year as being only 24 seconds longer than the current accepted value; al-Khazini in his (The Books of Balance of Wisdom) was the first to introduce the concept of centre of gravity; Ibn Sina’s Qanun fi tibb (Canon of Medicine) was the standard medical text in Europe for some 800 years. Muslim scholars, through such great works, have provided the world with major contributions to mathematics, algebra, trigonometry, chemistry, physics and medicine. Their works were behind a civilization that surpassed all others in its prosperity and achievement. For these scholars, science was an integral component of faith and equivalent to worship. They were certain that when you know more you can see more evidence of God, as
the holy Qur`an pointed out;
“Those truly fear Allah among His Servants who have knowledge” (35:28)
The same motives led to the establishment of education centres and institutes of higher learning, such as al-Azhar in Egypt which was the first university in the world, al Shammsiyyah observatory, the first of its kind, and the celebrated Baitul Hikmah (House of the Wisdom) in Baghdad, which was great center for knowledge and cultural activities.

It is obvious the Qur`anic motivation for knowledge inquiry is based on four components:

First: The emphasis on freedom of human intellect “Are the blind man and who sees are equal? You don’t think?”.

Second: Adoption of accurate scientific method via rejection of all hinders of true investigation on knowledge inquiry, such as superstitious beliefs.

Third: Thought provocation, “Do you not understand?”.

Fourth: Empirical test “Do they not look at the Camel how it is made?”.

It is clear, from this Qur`anic approach, there is nothing in Islam hinders knowledge inquiry or against development of science and technology.

Factor two: The unity of language

Muslim scientists share other significant elements of knowledge inquiry, such as unity of scientific terms that offered by unity of language (Arabic). Being the language of the holy Quran, Arabic language became a common language used by speakers of different languages. However, in countries where it was not the daily spoken language, it was generally taught at the elementary level and those who continued their studies beyond the basic level constantly learned it as the language of scholarship. This shared language was the single most important medium of communication in the Muslim world. This enables sharing and spreading of scientific progress among people of all regions. For example, Indian Muslim can communicate with an Egyptian trader or a fellow student in a language that is not foreign to either of them. More than the just a language, it was also a sharing in the flow of ideas, concepts, technical terminology, metaphors and parables. It is like a river of wisdom and the teachings of the ancestors nourished generation after generation in all regions of the Muslim world which further lead to development of scientific progress in Islamic civilization.

According to John Perkins, success of Islam was, also, due to its provision of a common language and its moral code which provided a great advance over tribal culture, assisting commercial relations, trade and trust between traders .

Factor three: the unity of brotherhood

Another common ground of Muslim scientist is the concept of unity among Muslim (ummah) and strong brotherhood bond. With this concept, Muslim societies work as units of a larger community and this concept of community surpassed national, ethnic, and also regional barriers. There are certain centres of learning that were open to all Muslims which nourished the intellectual tradition. For examples, there is Makkah and Medina, two sacred cities for all Muslim which nurture a spiritual unity among Muslim when they go for Hajj and Umrah. Through constant interactions, the transnational concept of Ummah was further strengthened. These centres not only serve as place for religious acts but also provide a forum for Muslim scholars to discuss and exchange ideas and knowledge that affected the whole community. Thus, when the scholars and pilgrims returned to their respective regions, they had knowledge of developments in other regions. This contributes to the spread of knowledge and scientific findings all over Islamic communities in which later used to improve their quality of life as well as improving scientific progress in the Islamic civilization.

The Characteristic of Islamic civilization

When we discuss about the common ground of Muslim scientist that set a foundation of scientific progress, it is important to look on the characteristic of Islamic civilization as well. The relationship can simply be understood that the characteristics are shaped by those common grounds. When we look into the history, one cannot fail to recognize the importance posed by Islamic civilization towards humanity. Islamic civilization has set a firm foundation which modern science nowadays are build upon.

Before we move into further discussion, it is important that we are clear with the definition of civilization. Ibn Khaldun, in his monumental book Al-Muqaddimah, defines civilization as sophistication and luxury and the mastery of crafts used to advance it in various aspects such as cooking, clothes, decoration, architecture, and all social situations. He further argues that civilization is the supplementary welfare added to the basics of life for any human society.

Based on that, it can be understood that civilization consists of interaction between various cultures, of various people differing in origin and geographical locations. It then being merged together and constituted what we call the civilization.

Islamic civilization, when being put under the lens of history and comparison, is unique not only by its nature, but also by the vast array of diversity that unify under one central theme; the faith to Allah. It is the outcome of interaction between the cultures of the people who converted to Islam, either by faith or out of allegiance and affiliation.

Based on the broad and comprehensive concept, we can see that Islamic civilization is not the property of a specific race, nor it is a national civilization belonging to a specific people. It is rather a comprehensive civilization which encompasses all the races and ethnic groups that contributed to the rise, prosperity and radiance of this civilization, as well as its expansion and influence throughout the world for centuries.

When discussing about Islamic civilization, there are five main characteristic that distinguishes it from other civilizations. The first one is the fact that it is a civilization based on Islamic faith and influenced by its values and principles. The firm belief in oneness of God has provided a sturdy religious foundation which man can build his worldly matter, all according to the teachings of Islam. This is in fact a strong factor which made Islamic civilization flourished for centuries.

The second characteristic is its being a civilization with human, universal dimension, and not associated with a particular geographic region, race or historical area. Although Islam emerged within the Arabic peninsular, the advancement of civilization is not dominated by Arabic people, but rather throughout the Islamic empire. They considered the pursue of knowledge as an act of worship, and since all Muslims are brothers, the achievements are associated with Islam rather than based on race or tribe.

The third characteristic is its being generous civilization which drew the human civilizations and cultures experienced by peoples of the ancient world, while contributed to the advancement of science, knowledge and the value of justice, equality, beauty and virtue. Islam never discriminates human beings; all are equal in the sight of Allah. Its output benefited humanity at large, regardless of race, color or even religion. Muslims and non Muslims, be they Christians, Jewish or pagans, coexisted together within the Islamic civilization.

The fourth characteristic is its being a well-balanced civilization which secures fair equilibrium between the materialistic and the spiritual sides with exemplary moderation that has always been a characteristic of Islamic thought and a distinctive feature of the Islamic civilization throughout its history. The path of moderation is always the best path in Islam. Extreme sides, whether towards worldly matters or religious, are prohibited.

The fifth characteristic is its being a perennial civilization which will last as long as Islam, because it is based on the very principles of Islam which Allah will preserve eternally. The teachings and principles of Islam never withers, since it is not based on racial or regional, nor does it depends on human nature. Thus, the roots of Islamic civilization are always sound and viable.


Due to all these factors, and based on the Qur`anic emphasis on knowledge inquiry, respecting learning, and forbidding the destruction, Muslim scholars were able to develop moral code of knowledge exploration, and sense of respect to authority of knowledge, discipline, and tolerance to other views. Based on this discipline of knowledge inquiry, Muslim intellect became the reference to the world for science, technology, and development. Muslim scholars of today might not aware of the crucial role that these factors play in knowledge progress, but it was clearly noted by historians of science. Thus, it is up to us Muslims to revive the grandeur and flourishing of scientific legacy in Islamic civilization.

Breaking the Bad News


Breaking bad news is never easy for anyone, especially those who worked in the healthcare field. Often the healthcare personnel find themselves in extremely stressful situations, whether to tell their patients the truth and risking unpredictable negative responses, or just telling them the superficial diagnosis without going deep into the facts. In assessing the best way to break a bad news, excellent verbal and non-verbal skills are required, because breaking bad news is a complex communication task. If the news is poorly delivered, misunderstanding can arise and patient can be hard to cooperate with.

Breaking bad news comes in various forms. It is a regrettable but important duty that must be done very carefully, yet it tends to receive a little attention in medical training. This assignment will discuss a hypothetical situation of breaking a bad news in different level of patient’s awareness, typical responses from patient, how to approach the situation, and the next steps that need to be taken after the news has been delivered. The case involves Mr. X, a 35-year-old man who has just been diagnosed as having a terminally ill disease. The doctor who did the diagnosis is assigned to break the news to him.


In breaking a bad news, strategy must be planned in order for the news to be conveyed effectively and to avoid unnecessary negative circumstances. First of all, the doctor must familiarize himself with the patient’s background, medical history, and test results. Next, set up a consultation session with the patient. This is important because a bad news must be transmitted in person and not over the telephone. Arrange some privacy to the patient, such as in a consultation room.

When conveying the message, the doctor must not do it while standing up. The appropriate way is for him to sit down and talk calmly, as this is less intimidating and shows that it is not done in rush. If it is possible, provide a written report to support the verbal news. This is to provide a mean of repeating the information later at home. Recording the consultation is also one of the ways to provide later review of information.


As the consultation took place, the doctor needs to assess Mr. X’s awareness regarding his condition, whether he is unaware, aware but do not want any information, or unaware and do not want any information.

Situation 1: When Mr. X is unaware

In this situation, it is more difficult to break the news. For example, Mr. X feels healthy, suspects nothing about his illness and lived a normal life before. Suddenly the doctor told him that he has a terminally ill disease. It is more likely that Mr. X will not believe the news. Consider the following conversation.

Doctor: Mr. X, I hope you can be calm, be patient and remember God. I’ve just got your test result…I’m so sorry to tell you that you have lung cancer.

Mr. X: Lung cancer? No, doc. You must be wrong. I never feel anything abnormal before. You must be wrong!

At this point, the doctor must change Mr. X’s perception regarding his health. He must tell him that cancer can affect anyone without their knowing. He also must not push him into the state of denial by stating the facts about his medical history and background.

Doctor: No, actually this can affect anyone; even the healthy person can get cancer. First of all, do you smoke or live near to those who smoke?

Mr. X: (Pause momentarily)…but I have quit it a month before…

Doctor: That’s the problem. You have been smoking for years, and that means the risk of getting cancer is elevated. It takes time for cancer to manifest its effect. But don’t worry, we will try our best to treat you.

Give some time to Mr. X to think about what the doctor has just said, and look if he is interested in knowing more about the disease and the treatment plan. If Mr. X is ready to cooperate with the doctor, offer him the plan of treatment in the simplest terminology, as to avoid Mr. X to think that it is too complicated.

Situation 2: Mr. X is aware but doesn’t want more information

Consider the following conversation:

Doctor: Mr. X, we have just got your test results. I want to ask you a few questions; do you notice some changes, like fever or anything abnormal?

Mr. X: Wait a minute. What are you trying to suggest here, doc?

Doctor: Well, we have noticed the lump on your lymph nodes has enlarged and…

Mr. X: So it has gotten serious? I knew the treatment is useless!

Doctor: I hope you don’t panic, please be patient, and don’t worry because we still can…

Mr. X: Look, doctor. Just predict how month I have left, spare your medical jargon and let me out of here. Ok? Just a waste of money and time, that’s what you are.

In this situation, the doctor must respect Mr. X’s wish and let him out. Don’t try to force him to hear the explanation as he is already blocked his mind. What the doctor can do is to get the closest relative and explain to them about the seriousness of his disease. Get them to talk to him about the possible treatment and consequences. If then Mr. X has come to his reasons and want the information, explain it to him patiently.

Situation 3: Mr. X is unaware and doesn’t want more information

10% of patients will deny the seriousness of their illness and don’t want to hear the rest of the diagnosis. It is as the first situation, but has gone all wrong. Consider the continuation from the first conversation:

Doctor: No, actually this can affect anyone; even the healthy person can get cancer.

Mr. X: I have a grandfather who smokes all his life. He never got any cancer. How come that I got that? You must have the test conducted wrongly!

Doctor: Mr. X, please understand. As I said, cancer can affect anyone...

When this happens, what the doctor can do is to challenge Mr. X by stating his medical history. If there is medical jargon, explain the meaning by the simplest term a layman can understand.

Although Mr. X is reluctant to hear the rest of the diagnosis, in this situation, he will usually ask about possible treatment. The fact that Mr. X doesn’t want any information might be due to the frightening that he might get if he knew the details. If he asks about the possible treatment, explain it to him. Respect his wish not to go deep into the facts. But if Mr. X is ready at a later time and wanted to know the details, always provide it to him.

By analyzing these situations, sometimes it is the healthcare personnel that need to be patient more than the patients themselves. Because healthcare field deals with a wide range of people, patience is an essential skill that personnel must acquire. A doctor who suddenly gets mad and throw a patient out from his room just because the patient asks too many question is a situation most undesirable.


The bad news would somehow have an impact on the patient, whether noticeable or not. At this time, healthcare professionals must provide the emotional support to the patient. As in case of Mr. X, the doctor must first observe for his emotion; such as shock, anger, or silence. Give him some time to vent his emotion, expressing his concerns and what he thinks. If Mr. X is just being silent, the doctor must ask open questions, asking him how he feels and what he’s thinking. Don’t immediately offer more information or reassurance to him. This will help him to articulate his emotion and concerns better.

It is important that the doctor elicit all Mr. X’s concerns and emotion as to assist the effectiveness of the treatment. When he hides anything from the doctor what might have been an important fact, then it is difficult to move on to discuss other relevant issues. Conduct this in negotiating manner, not by force or rush.

After the concerns and emotions have been expressed, the doctor must acknowledge the emotions and show empathy. Avoid saying ‘I know how you feel’ because no one ever know what the other person feels, even if he had the same experience before. Instead, he can say, ‘I think I understand how you feel.’

Sometimes a doctor is unable to be with a patient for a long time. When this happens, the doctor must stress on what he judged as the major concern of the patient. Advise Mr. X the conditions of his disease and recommendations (based on his major concern) as preliminary information before he can set up a later meeting. In this situation, Mr. X needs to feel that his concerns are being identified and understood by the doctor. In that sense, explain to him that the other concerns are not being ignored; it will be dealt at a later time.


Sometimes, in an overwhelmingly emotional situation, Mr. X can asks, ‘am I going to die?’ This is indeed a difficult question to answer as the matter of life and death is only in God’s absolute knowledge. What the doctor can do is acknowledge the question and try to understand why Mr. X asks that question. Sometimes it is due lack of knowledge regarding the disease. If that’s what it is, the doctor can explain again the possible treatment and state that within the extent of power given to human and by God’s will, the disease can be cured or at least managed.

If it is because the seriousness of the disease that has reached the grave danger, the doctor must reflect the question back to Mr. X and ask if he really want to know the truth. Acknowledge his distress and try to comfort him by religious means. Ask if Mr. X wants to share his concerns, such as what will happen to his children and family. This might not help much, but at least the burden is lighten by sharing it.

Often doctors can’t give a certain answer to patients. This might due to the advancement of the treatment, lack of knowledge or unavailability of the treatment in the country. In this situation, the doctor must acknowledge the uncertainty. Don’t risk the pride for a price of life. If it is due to unavailability of the technology, inform Mr. X that he might need to go to other hospital where the technology is more advanced. If it is due to lack of knowledge, inform him that the doctor needs to do more research regarding his disease before a firm decision can be made.


No matter how bad the news is, or how negative the response is, the task still needs to be done. It is a matter of ethics. By developing excellent communicating skill, showing empathy, and understanding how patient feels, the task can be eased. These skills, however, require experiences and guide. Thus, all staff, especially the senior ones, needs to share experience and guide the new member of the healthcare team. Communicating bad news to patients well is not an optional skill; it is an essential part of professional practice (Breaking Bad News – Regional Guidelines, 2003).


1. (8/10/2009)
2. (8/10/2009)
3. (8/10/2009)

Protection against Radiation Hazard for Healthcare Personnel, Patients and Public


Since the discovery of x-ray, it has been extensively used in healthcare field. While it is a very useful tool in diagnosis, it could also be a potential threat to human health if not handled properly. Fortunately, the radiation-safety standards were introduced to prevent radiation hazards from occurring. Awareness and education grew, and throughout the 1920s and 30s, more guidelines were developed and various organizations were formed to address radiation protection. Malaysia has passed the Radioactive Substances Act in 1968, and eventually the Malaysian Standard Code of Practice for Radiation Protection (MS 838) was introduced in 1985.


In the early days before radiation-safety standards were introduced, many have suffered various health problems as a result from excessive radiation dose. For example, skin cancer was common in early x-ray workers as a result of working around accelerators. There are also cases when patients with tuberculosis, who were flouroscoped many hundred times during artificial pneumothorax, have an elevated incidence of breast cancer. This was first reported in Nova Scotia, and confirmed by a similar study in New England.

The characteristic of those exposed to radiation varies depending on the amount of exposure they absorbed. For example, exposure of 5-10 rem will results in changes in blood chemistry, nausea (50 rem), and diarrhea (90 rem). Time taken for the sign and symptom to manifest are also varies. For example, exposure of 400 rem will result in death within 2 months, while exposure of 1000 rem will result in death within 1-2 weeks if untreated.

However, the modalities used in diagnostic imaging field only produce radiation in milirems. The range varies according to modalities: conventional x-ray (5-270 mrem), CT scan (200-400 mrem), and fluoroscopy (500-800 mrems). Although the radiation is relatively low, there is no firm basis for setting a "safe" level of exposure above background for stochastic effects.

Stochastic effects are associated with long-term, low-level exposure to radiation. Increased levels of exposure make these health effects more likely to occur, but do not influence the type or severity of the effect. Cancer is considered the primary health effect from radiation exposure. Radiation can cause changes in DNA that ensure cell repair and replacement produces a perfect copy of the original cell. Changes in DNA are called mutations. The mutations can be teratogenic or genetic. Teratogenic mutations are caused by exposure of the fetus in the uterus and affect only the individual who was exposed. Genetic mutations are passed on to offspring.

This assignment will focus on how to make sure that healthcare personnel know about the safety standards and apply it towards patients and themselves. The primary target audiences are the radiographers, radiologists, physicists and nurses, as they play an important role in ensuring the safety of their clients. It also targeted the public to inform them about their rights and safety while undergoing radiographic interventions.


Because the primary audiences are healthcare personnel, the best way to reach to them is by interpersonal communication, such as conducting seminars and courses. It can be optional or obligatory (for example, as a requirement of a promotion). The reason why this channel is the most effective is because it can build skill and stress on the subject’s importance, as well as reinforcing positive behavior change. It’s in a form of two way communication and in this case, can be focused into the radiation protection issue. Therefore, if there is any doubt arising regarding the subject, participants can ask directly to the speakers.

While for public, publications such as newspaper can be used, as well as events such as Hospital Day or Health Fair, for example, a section in the local newspaper to answer question about radiation safety, and a booth or exhibition about the same subject. By using this channel, public’s concern and enquiries can be answered by healthcare personnel themselves. For a long-term campaign, pamphlet can also be used and distributed.

Another form of channel is posters and signage that can be placed throughout the diagnostic imaging department. By using this, basic information about radiation protection and reminder can be constantly viewed and reminded, by both healthcare personnel and public.


The material should discuss the importance of radiation safety, specification of the proper shielding, how to provide proper shielding to the patient as well as staff, and patient education regarding the subject. It can be presented in the form of paperwork, guidelines, slides presentation, lecture, and printed notes.

The ways of presenting the subject shouldn’t be a problem for the healthcare personnel to understand, as it is presented in an academic manner according to their level of qualification. The early way to test the effectiveness of the subject is by circulating the MS 838 Code of Practice for Radiation Protection. Then, the feedback is collected to see whether they fully understand the subject or is that any need for further clarification.

The materials used should base on the Malaysian Code of Practice for Radiation Protection. However, because the code of practice is passed on 1985, it may need changes and amendments so that it stays current and relevant according to today’s technological advancement. For that matter, the International Atomic Energy Agency (IAEA) Safety Report No. 39 on Applying Radiation Safety Standards in Diagnostic Radiology and Interventional Procedures Using X-Rays (2006) can be used as guidelines together with the Malaysian Code.

The materials should also include the guideline on how to educate the patients and public when they have to undergo certain radiographic examination. This is to train the healthcare personnel to convey the message effectively to the patients and public, so that they will feel secure and safe during the examination.


For seminars, it can be conducted as one-day seminar, or weekend course. For more effectiveness, weekend course (2 days) is preferred as it does not obstruct normal working days. The seminar can be conducted in a hotel or resort to attract participants and provide a comfortable accommodation and nice learning environment. Experienced speaker is to be invited to give a clear view and be able to answer participant’s questions.

The drawback of this program is that it needs a lot of money to conduct as to provide a nice location and to invite an experienced speaker. Furthermore, it needs to be organized in a centralized location (as to minimize the cost), so the participants from distant hospital may have some difficulty to come.

Conducting a Hospital Day or Health Fair is one of the ways to inform the public about their rights and safety. It is usually conducted during weekends to attract more people to come. However, the effectiveness of this program relies on the number of people coming, as well as the effectiveness of healthcare personnel in answering public’s concern and questions. Thus, it needs a large coverage of advertisement to inform public about the event, well prepared personnel to answer questions, and the activities must be interactive and fun.

A section in local newspapers can also provide information regarding the subject as well as answering publics’ enquiries. It is similar to publication of pamphlet that can be provided in the waiting area of a hospital. However, it depends on how many people will read the section and pamphlet, and how much they really understand the subject discussed.

Signage in the diagnostic imaging department might be the easiest way of informing healthcare personnel as well as public about the radiation protection. For healthcare personnel, they can be constantly reminded, and patient can also ask for their rights and safety when they see the signage. However, the information inside the signage might be limited and concise.


The effectiveness of the program can be assessed by observing the healthcare personnel whether they apply the protection to the patient or not. This can be done by the superior officers, or by asking the patients themselves. As for the public, a survey can be conducted to see whether they have known their rights and safety. If a high percentage of persons surveyed know about the subject, and they can ask about their protection if the healthcare personnel forgot to apply it, then the program has achieved its objectives.

However, the feedback of the program is still needed, whether it has achieved its objectives or not. This is to improve the effectiveness of the program and to make future programs more successful. Feedback about the program can be asked directly to the audience after the completion of each program; whether it needs any improvement or lacks any important information. The ways of presenting the subject can also be asked so that in the next session, the subject can be presented in a more clearly way . The number of participants can be measured and improved by the next cycle of the program by better planning and organization.


1. Radiobiology for Radiologist

2. Standard and Industrial Research Institute of Malaysia, Malaysian Code of Practice for Radiation Protection (1985)

3. International Atomic Energy Agency (IAEA), Safety Report No. 39 on Applying Radiation Safety Standards in Diagnostic Radiology and Interventional Procedures Using X-Rays (2006)

4. (22 August 2009)

5. (22 August 2009)

Sunday, February 28, 2010

EAP 2nd Argument

ARGUMENT 2: It causes permanent changes of patients’ lifestyle

Many people thought that their life will change after undergoing a bariatric surgery. Although it is true, unfortunately, the changes are unpleasant and permanent. Adolescents have to face an array of lifestyle modifications that are not only severe but radical as well. Because of their immaturity, this often leads to psychological, emotional, and social problems.

One thing that is going to change is dietary habit. Because the stomach is smaller, patients have to eat in smaller portions. While this is a change that one could hope for, it is very difficult to deal with, and they are having a hard time to adjust to their new dietary routine. If they eat more than their new stomach can handle, they will vomit (Lee, 2009). On the other hand, Benson-Davies and Quingley (2008) reported a case study on a woman who “suffered from severe food aversions that inhibited a normal eating progression from liquids to solid food following surgery” (p. 357). Seven weeks following the surgery, she still took liquid-form foods without protein from meat sources or supplements. The reason she stated was “phobia of food textures and taste alterations” (p358).

Besides dietary changes, patients also have to be prepared for changes in their emotion and psychology. Many of them cannot cope with the loss of food and become depressed. Roker (2004) reported about a teenager who underwent bariatric surgery, hoping that it is the solution to her overweight problem. However, she was unprepared emotionally for post-surgical dietary regime. She felt as though she has lost her best friend and a few months following her surgery, she was depressed. Other patients were gone through addiction transfer, where they shift the addiction with food into something else, like shopping and alcohol (Fry, 2008).

Furthermore, patients are tied to a lifelong commitment to a hospital for post-operative care. They need to be assessed whether there is any medical problem or presence of complication from the surgery. According to Warman (2005), “adolescents’ follow up visits are scheduled after discharge at one week, four weeks, three months, then every three months, with laboratory evaluation every six months, until weight loss is stabilized (usually one to one and a half year after surgery), then twice per year” (p. 283).

Apart from that, they need to take a lifetime nutritional supplementation and be closely monitored for vitamin and mineral deficiencies (August et al, 2008). This can be quite challenging as adolescents often do not listen to advices and recommendations. Xanthakos and Inge (2006) stated that less than 15% of 34 adolescents who underwent gastric bypass took the recommended supplements.

Because of permanent changes following bariatric surgery, one should really think before opting to surgery and be prepared for these consequences. Saunders (2009) reasoned that “it is hard enough to ask adults to tackle these issues, but a lot of people are asking whether or not this a burden that we should be putting on teenagers.”

EAP 1st Argument

ARGUMENT 1: It causes deficiencies of nutrients essential for growth

Our body requires nutrients in order to function normally. In addition for a still-growing person, nutrients are needed for growth. However, after undergoing bariatric surgery, nutritional deficiencies are prone to happen. It is a problem that cannot be avoided because it is closely related with changes of the gastrointestinal tract. This, if no medical attention is given, can lead into serious and life-threatening complications.

Sullivan et al (2006) stated that, “nutritional deficiencies documented in patients post Roux-en-Y gastric bypass include thiamine, folate, calcium, vitamin B12 and D, and iron deficiency.” It also stated that neuropathies and skin integrity breakdown are demonstrated among patients who did not take appropriate dietary supplements (p. 408). In addition, Alvares-Leite (2004) also agreed that thiamine deficiency along with regular vomiting is frequent among patients who underwent bariatric surgery.

Weight loss in bariatric surgery is achieved primarily by two mechanisms; restricting food intake, and bypassing the absorptive and secretory areas of stomach and small intestines (Xanthakos and Inge, 2006). Along with that, nutritional deficiencies are also presented because of these mechanisms. Restricting food intake means smaller food amounts, hence fewer nutrients are taken. Bypassing certain parts of stomach and small intestines reduces the capability of the organs to absorb nutrients effectively. It is further confimed by Alvares-Leite (2004) who stated that “nutrient deficiency is proportional to the length of absorptive area and to the percentage of weight loss” (p 569).

Xanthakos and Inge (2006) further clarify on how macronutrient (protein and fat) and micronutrient (vitamins and trace minerals) deficiencies can occur because of the mechanisms. Reduced food intake leads to protein deficiencies, while bypassing the gastrointestinal tract decreases the secretion of gastric acid, resulting in reduced bioavailability of certain nutrient that requires gastric acid for it to be released. Moreover, because of shorter phase of gastric digestion, nutrient supplements that are not in liquid, suspension or chewable form are passed into the colon unabsorbed.

A review done by Matrana and Davis (2009) emphasizes the effect of vitamin deficiency following gastric bypass surgery. A case is presented regarding a 37-year-old female who underwent gastric bypass surgery, yet did not receive any post-operative care. She developed complications, which arises from deficiency of thiamine rather than the surgery itself. After three weeks of hospitalization and rehabilitation, the patient has showed a slow but progressive improvement.

It is clear that nutritional deficiencies are dangerous and can risk life. If the deficiencies can cause problems in adults, it will be more prominent in adolescents who need nutrients not only for maintaining normal bodily functions, but also for development and growth. It is agreed that bariatric surgery is offered to correct obesity problem, but it introduces another problem – nutritional deficiencies – which needed another lifelong corrective measure. Thus, based on this argument, bariatric surgery should not be offered to adolescents.