Principles of Nutrition in Islamic and Traditional Persian Medicine

Abstract

Nutrition has a crucial role in maintaining body health. Eating and drinking has a special place in Islamic doctrine and traditional Persian medicine. Traditional Persian medicine is a holistic medicine and provides great attention to the spiritual aspects of life as well as somatic aspects to maintain human health. In this view, people are not going to eat and drink for pleasure but to maintain a good life and physical health, due to daily tasks, as well as observing moral aspects of a human life and spiritual satisfaction.

Introduction

According to Islamic medicine and traditional Persian medicine, nutrition has a crucial role in maintaining body health. Furthermore, Iranian sages of medieval Persia believed that the quality and quantity of foods would influence mental health. Type, source, and recipe were also considered very important in physical and mental health.

Seemingly, the diagnosis and treatment in traditional Persian medicine have taken from Hippocratic medicine, but the footprint of Islamic thought and spirituality is seen in many resources of traditional Persian medicine. Based on Islamic teachings, there is a 2-side relationship between diet and spirituality. Avicenna mentioned in Canon of Medicine that a tabib (physician) should know the causes of disease and health for treatment of the patients. Sometimes, the causes of disease are evident, but most of the times the causes are hidden and should be known from the symptoms and signs. The causes of disease and health comprise air, foods, drinks, physical activity and repose, wake and sleep, mental condition, age, sex, habitant, occupation, habits, race, as well as evacuation and retention. The physician should know these variables and then start the treatment. ¹ The Physician should correct the nutritional habit of the patients in the first step. Eating and drinking has a special place in Islamic doctrine and traditional Persian medicine. Many diseases are the result of poor and improper nutrition. Nutritional schemes based on the quoted sayings (hadiths) of the Prophet Muhammad (PBUH) have proposed different aspects to eating and drinking compared to conventional medicine. In the traditional Persian medicine resources, we deal with a topic named hifz-al-sehah, which is equivalent to preventative measures in conventional medicine. Hifz-al-sehah is an artful integration of humoral medicine with Islamic sayings. Disease and pain in an organ show the involvement of the whole body; for treatment of the afflicted organ, the patient should be treated not the individual organ and not the disease per se. Tabi’at (nature), the sober force of the body, protects the body from the internal and the external enemies. Every alien who wants to disturb the system of the human body microcosm first should overcome tabi’at. The stomach is the first and the most important route for the arrival of the intruders, because of the body need to countervail the energy loss through this route. Prophet (PBUH) has stated that the stomach is the origin of every disease, and therefore observing a healthy diet is the best method of preventative medicine.

Traditional Persian medicine is a holistic medicine that emphasizes good health in both spiritual and physical dimensions of humans. In this study, the authors aim to review the most important points of traditional Persian medicine and Islamic medicine about nutrition and health.

Methods

Canon of Medicine (in Persian) was the main source for this study. The other traditional Persian medicine resources, including Zakhireh Kharazmshahi of Jorjani and Makhzan al Advieh of Aghili Shirazi were also reviewed. Furthermore, relevant articles in databases PubMed, Scopus, IranMedex, and SID were reviewed with the following keywords: nutrition, traditional Persian medicine, Avicenna.

Principles of Proper Eating

Habits

Everybody is accustomed to eat certain foods and dislike some; everybody has his/her own taste. Some of the nutritional habits are harmless and some of them are harmful. According to traditional Persian medicine, the physician should not change improper habits rapidly, because habits are considered as the second nature. If a person is accustomed to a harmful habit, the physician should warn him/her to gradually change the harmful habit to a beneficial one. ¹

Temperament

The mezaj (temperament) of the individual is unique. Everybody is born with a unique mezaj known as mezaj-e-khelghati, or hereditary temperament. The body organs have a special mezaj depending on their function. In traditional Persian medicine, the 4 elements air, fire, water, and soil (arkan) are considered as the main constituents of all living and nonliving beings including minerals, plant, and animals. Each arkan consist 2 qualities. Fire, air, water, and soil are warm-dry, warm-wet, cold-wet, and cold-dry, respectively. The concept of arkan is a philosophical implication and differs with fire, air, water, and soil that we are confronted with in the environment. Mezaj (constitution or temperament) means blending in the lexical view and conceptually is the result of the interaction of arkan with each other. Human body and the body organs are the product of mezaj (blending and interaction) of the basic elements with each other. As a whole, mezaj shows the final quality of each body organ. According to traditional Persian medicine, the first stage of digestion is in the stomach. The chyme that is produced in the stomach enters the small bowel and gets to the liver through mesenteric veins. The second stage of digestion happens in the liver, and the 4 humors (sanguine, phlegm, bile, and black bile) are produced. These humors consist of 2 qualities, the same as arkan. Sanguine, phlegm, bile, and black bile are warm-wet, cold-wet, warm-dry, and cold-dry, respectively. Humors nourish the body organs. Each organ needs sanguine as the main source of nourishment, more than one of the other humors depending on its structure and function. For example, the brain needs phlegm, the bone needs black bile, and the lung needs bile to maintain their normal functions. The body organs have a special mezaj depending on their function. Mezaj of the brain is cold-wet, and the mezaj of the heart and the liver are warm-dry and warm-wet, respectively. The mezaj of average belongs to the skin. In fact, every vital organs own warm-wet mezaj and the organs in comparison with each other are considered warm, cold, wet, or dry depending on their function. ² For example, the heart is warm and dry because it has nonstop movement that produces the warmth and dryness, and the liver that is the center of metabolism and homeostasis is warm and wet to have the best functionality. ³ Different foods have different mezaj. The dominant diet of human should be selected from the average foods that add the body no extra quality. Bread, lamb, and some fruits like grape and fig are considered average foods. ⁴ Disease is the result of imbalance in mezaj of body organs. The most important cause of this imbalance is improper eating. Eating extreme foods that do not have average temperament adds an extra quality to the body and organs and may result in dystemperament (imbalance in mezaj); however, age, sex, season, and mezaj of the patient also contribute. Dystemperament disturbs the normal function of body organs and leads to the disease state. Dystemperament (deviation from the average temperament) is classified as hot, cold, dry, moist, hot-dry, hot-moist, cold-dry, and cold-moist depending on the causes. For example, eating too much pepper and mustard may cause hot or hot-dry dystemperament, especially in young people who have hot-dry temperament compared to older people. Warm season and warm places are also considered as the risk factors for developing hot or hot-dry dystemperament. Accordingly, eating too much dairy products, living in cold places, and older age increase the risk of developing cold or cold-moist dystemperament.

Abstinence

Abstinence is the mainstay of treatment in Islamic medicine. Abstinence does not mean avoiding some foods for a long time. It means average eating in quantity and quality and avoiding the harmful foods and drinks that are banned in Islam. ⁵

Discipline of Eating

Different foods need different times for complete digestion. According to traditional Persian medicine, eating different foods with different durations of digestion jeopardize the body health, because it induces indigestion, dyspepsia, and consequently other illnesses. ^1,6 Eating different foods in a same meal disturbs the digestion in 3 ways:

The stomach is involved with the digestion of the newly ingested food and could not work perfectly on the previously ingested food. ¹

Indigested and digested food blend with each other and it affects liver function and puts the liver at risk of disease (fatty liver). ³

Tabi’at (nature) keeps the first food for a longer time to complete the digestion of the second one, and it causes spoiled digestion (fesad-e-hazm). ⁶

Thin and Dense Foods

In traditional Persian medicine, foods are divided into 3 groups: latief (thin), kassief (dense), and mo’tadel (moderate). Thin foods are the foods that are light for the gastrointestinal tract and have a rapid digestion. Dense foods have slower digestion compared to thin foods. Some foods are considered moderate and need an average time for digestion. However, this classification shows the extremes. For example, beef is denser compared to the lamb, and the lamb is denser than chicken. The extreme foods are classified as thin and dense foods. White bread, chicken wing recipe, barley soup, and vegetable soup (without meat) are considered thin, whereas beef, mushrooms, haleem (a recipe made of meat and whole wheat), and whole-meal bread are considered dense foods. Moderate foods such as lamb, veal, camel calf’s meat, turnip, and carrot need the median time of the extreme foods (thin and dense foods) to be digested. ¹

According to traditional Persian medicine, eating different foods with different times of digestion jeopardize the body health, because of indigestion and dyspepsia and consequently other illnesses. ^1,6 Imam reza (PBUH) states, “Start your meal with the thinnest foods in the amount that you can tolerate and find pleasure in.” Avicenna mentioned in Canon of Medicine that introduction of rapid digestion foods to slow digestion foods is necessary, whereas if rapid digestion foods are eaten after the slow digestion foods, it is digested rapidly and wants to go out of the stomach but it is trapped by the slow digestion foods, and it is spoiled; hence, the introduction of thin on dense is necessary. ¹

Water and Beverages

Drinking water and the other beverages should be avoided throughout the meals. If someone is very thirsty, he/she may sip a little cold water slowly. Everybody should avoid drinking about half an hour before meal; and it is better to postpone drinking for the time that he/she feels lightness in the stomach. ⁵

Fruits

According to traditional Persian medicine, eating fruits should be in a separate meal, and eating fruit with other foods and water is harmful for health. It is quoted in the hadiths that eating fruits does not harm the body, if it does not coincide with eating other foods. ⁵

Quantity of Meals

The quantity of the meals is very important in traditional Persian medicine. People who do not observe the average in their eating are prone to develop disease.

Overeating and Undernourishment

People who are accustomed to overeating are at risk for disease. ⁷ Overeating causes emtelaa. Emtelaa or surfeit is a state in which the body organs deal with an overload of foods. It is quoted in hadith that “man fill no worse than the stomach” and “the stomach is the house of every disease and abstinence is the cure for every disease.” On the other hand, eating less than normal is also harming the body. Although it is recommended in Islamic resources that everybody who seeks health should eat less and stop eating before satiety, it has a limit. Long duration starvation causes weakness of the body and the person becomes susceptible to disease. ⁸ Avicenna stated in the Canon of Medicine that the ultimate of poor eating is degh (cachexia) especially in the elderly. ¹

According to traditional Persian medicine and Islamic resources, moderation is the secret of health and long life. “Do not start eating unless you are really hungry and stop eating while you have the appetite for eating yet before feeling fullness in your belly”; it is the essence of Islamic sages’ opinion. ⁹

Number of Meals

The number of meals differs in different age groups. The general rule for a normal, healthy adult is 3 times in 2 consequent days. The individuals who want to maintain their body in a healthy state should eat a breakfast and a dinner on the first day and a lunch on the day after. However, these are considered as the main meals and people can eat small snacks throughout the day according to their physical needs. Children may need more frequent meals because they need more energy for their growth and development. The number of meals should increase in the elderly because their gastrointestinal tract is not as competent as young adults for the digestion of a normal volume meal. Hence, the volume of the meal should be decreased and the number should be increased. ¹

Quality of Meals

The main food according to traditional Persian medicine should have an average mezaj. It means that the body should not be affected qualitatively by the ingested food. Wheat, lamb, and some fruits like grape that have little drug properties and do not change the mezaj of the body are considered as the qazay-e-motlaq or the main foods. Qazay-e-motlaq is the main daily and routine food for human being. People should avoid routine use of foods such as pepper, ginger, garlic, and tamarind that have some drug properties. ¹⁰

Chewing Food

The stomach is a place for digestion and not a place for chewing. People who do not chew the morsels well enough develop dyspepsia. ^11,12 Dyspepsia is a disease of the elderly and affects individuals who cannot cope with their stress and eat their meals carelessly and swallow the morsel instead of chewing it. Islamic sages advised people to chew the food well and eat their meals in a peaceful place without haste and preoccupation with another task. ⁴

Time of Meals

The time of the meals should be set in a regular order, because the nature is accustomed to eat each meal at a specific time. If people eat sooner or later than their normal routine, they may develop dyspepsia and indigestion.

True Appetite

The best time for eating is when a healthy person really feels hungry. The hunger of a patient who suffers from a gastrointestinal problem is not a real appetite. Sometimes, because of a blockage in the mesenteric veins or sticking of the thick phlegm to the vault of the stomach patients develop anorexia. On the other hand, when the secretion of abnormal black bile on the cardia is increased, appetite increases abnormally. Based on the traditional Persian medicine resources, the pancreas secretes normal black bile and induces appetite. If the secretion of the black bile stops or decreases the patient develops anorexia. ⁴

Temperature

Hot weather and warm places blind appetite, and cold weather stimulates the appetite in a healthy person. The warm season and warm climates cause poor appetite, and the cold season induces appetite. ⁵ Young people who have warm-dry mezaj should avoid heavy exercise in hot weather and rest more in cold places. They should eat light and cold foods and drinks. These schemes maintain their healthy appetite and keep them away from gastrointestinal problems.

Physical Activity

Eating food just before and after physical activity harms the body. The best time for eating food is while people feel no fullness in their stomach, but they are not hungry. For a healthy adult it is about 2 to 4 hours after meal.

Bath

Long stay in bath, especially Turkish sauna, is harmful with a full stomach. Bathing at the time of hunger is also harmful, even more than bathing with a full stomach.

Intercourse

Intercourse after a meal harms the body. The Avicenna believed that intercourse just after the meal causes gout. ¹³

Stress

Eating in time of rage, fright, and stress disturbs the normal digestion, and people should not eat in time of nervousness and rage.

Sleep

The individual who wants to have a normal and healthy life should postpone sleep until the ingested food passes the cardia and gets to the bottom of the stomach. Sleep helps digestion, if the people observe the proper interval between eating and sleep. At the time of sleep, the body heat deviates to the internal organ, and hence the digestion is facilitated. If a person sleeps in time of hunger, this heat causes gastrointestinal problems. According to traditional Persian medicine, while the stomach is empty and access no foods, it starts to digest the phlegm slicked to its internal wall and it causes production of smoky steams that causes headache and feeling fullness in the head. ⁵

Conclusion

The major difference between Islam and modern approach to nutrition in medical schools is rooted in a different perspective. Nutrition is a tool to maintain physical health in conventional medicine. The mental and spiritual dimensions of human being are also considered in the Islamic perspective even more than physical health. In this philosophy, people not only eat or drink for pleasure but they do so to sustain a good life inculcated with moral behavior and spiritual satisfaction.