You Are Welcome Ir. CK Cheong

 Dear Ir. CK Cheong,

Thank you for your kind words and encouraging comments in the comment column under: 

"A Poser: Can Excessive Intake of Vitamin C Cause Kidney Damage?" 

Please do not be misinformed that  those foods I mentioned there are the cause of kidney damage. This is not entirely true. I was only talking if they are taken regularly in excess especially when the kidneys are already compromised from other causes such as existing diabetes, high blood pressure, renal stones, autoimmune diseases  such as  lupus, IgA nephropathy, smoking, excessive alcohol, certain drugs like non-steroidal anti-inflammatory drugs (NSAIDs), cyclosporine, etc. 

Normally a healthy pair of kidneys can handle most of the foods we consume, provided we consume them in moderation. If you are concerned, you may measure the status and the health of your kidneys using some simple blood tests such as  measuring the amount of creatinine.

 A glomerular filtration rate (GFR) blood test is possibly the best measurement that tells how well your kidneys remove waste from your blood. A normal eGFR is greater than 90, but values as low as 60 are considered normal if there is no other evidence of kidney disease. However, GFR can drop as you age 

Of course you are very welcome to share my articles in this blog with whosoever you wish. The articles in this blog ranging from astronomy, analytical chemistry, biology, evolution, genetics, mathematics, drugs and medicine, food, nutrition, and health...  all the  way down to the mysteries of life and death, including poetry and slide shows on various lectures I gave...and even on spiritual life beyond death...hundreds of them on various subjects are especially written in simple non-technical language for the general readers 

If you like to ask a question or want me to write an article that may interest you - provided it is within my university training and my expertise please let me know. I shall try, provided I know the subject well 

We are all in this journey of forever learning 

Take care!

jb lim 

The Good Samaritan Law in A Medical Emergency

 

I saw on television last night and read it in the newspaper this morning that Malaysia plans to enact the Good Samaritan Law to encourage more people to become lifesavers in an emergency here:

https://www.malaymail.com/news/malaysia/2024/12/14/good-samaritan-law-will-encourage-more-people-to-become-lifesavers-in-an-emergency-says-health-minister/159852

Today I like to discuss a little bit  on the Good Samaritan law that will legally protect members of the public from being sued should they render aid to a casualty in a medical emergency even if the rescuer does it wrongly or caused more damage when they are not medically qualified or trained. 

Since the Good Samaritan law protects the ordinary man-in-the -street who helps the injured, but does it protect doctors, paramedics, emergency medical technicians (EMT), first responders, first-aiders who are trained and qualified, but they do more harm than good? Follow me all the way down as I shall address these difficult questions. 

Malaysia currently has no Good Samaritan law yet but will soon be passing a law for this. However, there are a number of countries that have the Good Samaritan law. I shall try to answer all these very interesting questions here. 

The Good Samaritan Law proposal in Malaysia, which has been gaining attention recently, is a significant step toward promoting altruism and civic responsibility. This law, if enacted, would aim to protect individuals who voluntarily offer assistance in emergencies from legal liability. The goal is to encourage people to act in good faith without fear of legal repercussions should unintended consequences arise during their attempt to help.

Currently, there are concerns in Malaysia about the legal risks for individuals providing aid in emergencies, which often discourages people from stepping forward.

The Malaysian government plans to table this proposal in Parliament for further discussion, reflecting Malaysia's effort to align with global legal practices and foster a more compassionate society. This initiative also underscores the importance of community responsibility and mutual aid in emergencies.

The law is intended to address this issue, creating a framework similar to laws in other countries that protect "Good Samaritans." For instance, in many jurisdictions, these laws shield helpers from civil lawsuits or criminal charges, provided their actions are reasonable and not grossly negligent.

Even Singapore does not yet have a specific Good Samaritan law that provides blanket legal protection to bystanders rendering medical aid. However, the Singapore Civil Law Act (Section 7) has provisions to encourage assistance during emergencies. It protects healthcare professionals and Good Samaritans acting in good faith, provided their actions are not grossly negligent. Additionally, under Singapore's Penal Code (Section 89), individuals are generally not held liable if they act in good faith for the benefit of another person, such as in a medical emergency.

Despite these general protections, there is no codified "Good Samaritan Law" except those in the U.S., Canada, or Australia.

However, many countries have implemented Good Samaritan laws in one form or another to encourage bystanders to assist in emergencies without fear of legal repercussions. Here are some of these countries:

In the United States Good Samaritan laws exist in all 50 states. Each state has variations, but they generally protect individuals who provide emergency aid in good faith and without gross negligence. The Aviation Medical Assistance Act (1998) extends similar protections for in-flight emergencies.

In Canada, most provinces have Good Samaritan laws, such as the Good Samaritan Act (2001) in Ontario, protecting anyone who voluntarily provides aid.

In the United Kingdom though they have no formal Good Samaritan law, common law principles shield rescuers acting in good faith from legal action, provided they are not negligent.

In  Australia, all Australian states and territories have Good Samaritan laws that protect volunteers providing first aid or assistance, such as the Civil Liability Act (2002) in New South Wales.

India has the Good Samaritan Guidelines (2016) that protect bystanders helping road accident victims. It ensures they won’t be harassed by police or hospitals.

France and Germany  are very exceptional. French law explicitly requires individuals to render assistance during an emergency, whether trained or not, under Article 223-6 of the French Penal Code. Failing to do so can result in criminal charges. France’s approach to making it mandatory by law for bystanders to render aid in emergencies is unique and worth exploring. Under Article 223-6 of the French Penal Code, individuals who fail to assist someone in danger can face. Fines: Up to €75,000 and imprisonment up to 5 years.

This law applies to anyone witnessing an emergency, not just medical professionals, unless assisting poses a risk to the rescuer's safety.

Germany’s Criminal Code (Section 323c) also makes it mandatory for bystanders to assist in emergencies. Failure to act can lead to fines or imprisonment.

China passed a Good Samaritan Law (2017) that protects people from being sued or held liable for rendering emergency aid.

Japan’s Good Samaritan laws provide limited protection to rescuers but hold them liable if their actions are negligent or exceed their training.

Other Countries like New Zealand, South Africa, Sweden, and Italy also have versions of Good Samaritan laws or common-law protections for emergency aid.

My Opinion on Mandatory Aid Laws.

Mandatory aid laws like France's are both admirable and complex. Here are the key considerations:

Pros of Mandatory Aid Laws, encourages a culture of responsibility. Such laws reinforce the moral and ethical duty to help others, fostering a more compassionate society. In emergencies, timely intervention by bystanders can save lives (e.g., CPR or stopping severe bleeding).

Deters Inaction:

These laws address the "bystander effect," where individuals fail to help because they assume someone else will step in.

By making inaction punishable, these laws ensure more people take responsibility in emergencies.

Boosts Public Awareness:

Mandating aid encourages governments to invest in public education on basic first aid, making more people confident and capable of responding to emergencies.

Challenges of Mandatory Aid Laws:

Risk to the Rescuer:

In some situations, rendering aid may endanger the rescuer (e.g., a dangerous accident site, exposure to infectious diseases). The law must account for these scenarios.

Lack of Training:

Forcing untrained bystanders to assist may result in well-meaning but harmful actions (e.g., incorrect CPR techniques or improper handling of spinal injuries).

Potential for Misuse:

In countries with strict litigation cultures, mandatory aid laws might expose rescuers to accusations of negligence if the outcome is unfavourable, even if they acted in good faith.

I believe encouraging voluntary aid through Good Samaritan protections is generally more effective than mandating aid. While mandatory laws like those in France promote altruism, they should also:

Provide clear exceptions for situations where aiding would endanger the rescuer.

Include robust public education programs to ensure citizens have the necessary skills to assist effectively.

A hybrid approach might work best, where citizens are encouraged (and sometimes obligated) to act, but also protected by Good Samaritan principles when doing so.

Some discussions around the proposal highlight potential challenges, such as defining the scope of "reasonable assistance" and ensuring the law isn't abused. Legal scholars have also debated how the law would balance the need to protect Good Samaritans while safeguarding victims' rights​

However, I think most people will act instinctively in good faith to help an injured person in a road accident or rescue someone from drowning or in a fire, with or without the Good Samaritan law unless it poses a danger to himself or others acting in good faith. I don't think they will think of the legal aspect in an emergency

I believe in many cases, people instinctively step in to help during emergencies, driven by human empathy rather than a concern for legal consequences. Whether it's pulling someone from a car wreck, attempting CPR, or rescuing someone from a fire or drowning, these actions are often reflexive and motivated by the desire to save a life or alleviate suffering.

However, fear of potential legal repercussions can weigh heavily on people's minds in certain scenarios, particularly in countries where no Good Samaritan protections exist. This is especially true for situations where the helper is unsure about the consequences of their actions, such as inadvertently causing harm while attempting CPR or moving an injured person. The uncertainty about being sued or facing criminal charges might discourage some individuals from acting, even when they feel compelled to help.

The enactment of Good Samaritan laws aims to reduce this hesitation, providing peace of mind that acting in good faith will not lead to punishment. These laws serve not only as a safety net but also as a societal encouragement for bystanders to step forward and assist without fear. However, most individuals don’t deliberate on legal matters in the heat of the moment; their primary instinct is to save a life, especially if they believe they can make a difference without significant risk to themselves or others.

In cases of imminent danger—like a fire, drowning, or other life-threatening emergencies—people often weigh the risks to themselves before acting. Good Samaritan laws do not compel people to put themselves in harm's way, but they do promote a culture of mutual aid and responsibility by protecting those who act in good faith. France’s mandatory duty to assist reflects this ideal, though it raises questions about personal freedom and the line between moral and legal obligations.

In Malaysia’s context, while the instinct to help exists widely, implementing a Good Samaritan law can further reassure the public, fostering a stronger sense of community and ensuring legal clarity for those willing to help. It bridges the gap between moral duty and legal safety.

Let me explain how the law is going to apply for various groups.

1.      Members of the Public (Untrained Rescuers):

Protection scope for these individuals is generally the primary focus of Good Samaritan laws. If a bystander with no formal medical training tries to help but unintentionally causes harm (e.g., performing CPR improperly or exacerbating an injury), they are protected as long as:

They acted in good faith.

They did not act with gross negligence or reckless behaviour.

They did not demand compensation for their help.

2.      Medically Trained Individuals (Doctors, EMTs, Paramedics, Nurses, First Responders, and Trained First-Aiders)

Protection for Volunteering Off-Duty: If these individuals voluntarily offer help outside their professional setting (e.g., witnessing an accident while off-duty), they are usually protected under Good Samaritan laws, provided they:

Act within the scope of their training and competence.

Render assistance in good faith without reckless or wilful misconduct.

Liability for Errors: The law generally assumes that trained professionals are held to a higher standard of care than untrained individuals. If a trained rescuer performs a procedure incorrectly or goes beyond their expertise (e.g., attempting surgery at the scene), they could be at risk of liability if the act is deemed negligent.

Does the Law Protect Them if They Do More Harm?

The key issue here is negligence vs. reasonable effort in an emergency:

Reasonable Effort: If a trained professional acted in good faith and provided care that would be considered reasonable given the circumstances, they are often protected. For example, a doctor performing CPR may accidentally break ribs; this would likely fall under protected actions because broken ribs are a common side effect of proper chest compressions.

Gross Negligence or Wilful Misconduct:

If a trained individual acts recklessly, beyond their expertise, or in a way that shows disregard for the standard of care expected of them, they may lose protection. For example, a paramedic performing an unnecessary invasive procedure at a scene without proper tools or justification.

A first responder failing to follow basic protocols they were trained to observe.

Key Differences Between Untrained and Trained Rescuers:

Standard of Care: Trained individuals are generally held to a higher standard than untrained bystanders. Courts may evaluate whether their actions was in line with the expectations of their training.

Professional Duty: In some jurisdictions, doctors or EMTs may have a legal obligation to assist in emergencies (even off-duty), unlike laypersons who can choose not to intervene. This duty adds another layer of complexity to liability questions.

What Else Influences the Protection?

Jurisdiction:

Good Samaritan laws vary by country and state. Some provide explicit protection for trained individuals; others are less clear about this.

In certain jurisdictions, off-duty professionals may be treated differently from lay rescuers or those acting within the scope of their job.

Compensation:

Good Samaritan laws typically apply only when the help is voluntary and unpaid. If the rescuer is on duty or compensated for their aid, they may be judged under different legal standards.

Consent:

If a conscious individual refuses aid, and a rescuer still intervenes against their wishes, this could complicate liability. During my training in emergency medicine, I was told there are people who wish to die, and they tattooed on their chest this message:

"Do Not Resuscitae (DNR)" 

A DNR order means they do not want any CPR in the event their hearts or breathing stop. We have to comply 

However, in emergencies where the casualty is unconscious or unable to consent, implied consent is assumed.

Recommendations for Trained Rescuers

To reduce the risk of liability while still helping:

1.      Stay within the scope of your training.

2.      Clearly communicate your actions to bystanders and the casualty (if conscious).

3.      Provide aid that is reasonable under the circumstances.

4.      Avoid invasive procedures unless necessary to save a life.

Trained individuals are generally protected by Good Samaritan laws, but their higher standard of care means they are more vulnerable to legal scrutiny if their actions deviate from accepted medical practices. Ensuring that their assistance aligns with their training and is delivered in good faith is key to retaining legal protection.

I was told during my advanced training in medical emergency and trauma care at the University Hospital of the National University of Malaysia (HUKM) and also during my training at the Kuala Lumpur Hospital, as well as in Selayang Hospital when I joined St. John Ambulance Malaysia as a Regional Staff Officer for Training  that doctors need to be careful in rendering  any medical treatment even in an  medical emergency in a passenger aircraft  flying over the air space of another country because their medical qualifications may not be recognized above that country, and even if it is recognized, was not registered for any medical treatment or practice in the air space of a foreign country.

This is a fascinating legal and ethical question that underscores the complexity of practicing medicine in emergencies, especially in international airspace or foreign jurisdictions. The situation touches on jurisdictional law, licensing requirements, and Good Samaritan principles. Here are  the relevant considerations

1.      Jurisdictional Challenges in International Airspace

Territorial Law: When an emergency occurs on a passenger aircraft flying over a foreign country, the legal framework governing the situation can be ambiguous. Generally:

The Law of the Country of Aircraft Registration: Most international conventions, including the Tokyo Convention (1963), state that the aircraft is governed by the laws of the country in which it is registered, even if it is flying over another nation's airspace.

Foreign Jurisdiction: However, if the aircraft lands in a foreign country for an emergency (e.g., a medical evacuation), the doctor’s actions may be subject to that country’s laws. In such cases, the doctor might face issues related to licensing or malpractice claims.

2.      Licensing and Recognition of Qualifications

Medical Licensing Laws: Most countries require medical practitioners to be licensed and registered within their borders to practice medicine legally. Even if a doctor’s qualifications are recognized globally, they are not automatically authorized to practice in every country unless registered.

For example, a doctor licensed in Malaysia, or the UK may not be registered to practice in the U.S. or Germany, leading to potential liability if they render care without legal standing.

Good Samaritan Protection:

Some jurisdictions and airlines extend Good Samaritan protection to doctors providing emergency assistance during a flight, as long as the care is given in good faith and within their scope of training.

However, this protection may not universally apply in all countries.

3.      Ethical Duty vs. Legal Risk

Doctors often face a dilemma in such scenarios:

Ethical Duty to Assist. The Hippocratic Oath and professional ethical standards obligate doctors to assist in emergencies whenever possible, regardless of location.

Refusing to help in a life-threatening situation could lead to moral, ethical, or even reputational consequences.

Legal Risk: Doctors may worry about malpractice lawsuits, particularly in countries with a litigious culture, even if their actions are well-intentioned.

Some countries’ laws might hold them to a higher standard of care due to their professional training, increasing the risk of liability compared to an untrained rescuer.

 4.      Protections for Doctors Assisting on Flights

Airlines' Policies:

Many airlines encourage doctors to assist in emergencies and have procedures in place to mitigate their liability. Some airlines explicitly extend indemnity coverage or Good Samaritan protection to doctors who step in to help.

Medical Kits and Ground Support:

Airlines are required to carry medical kits and often provide real-time medical consultation with ground-based professionals to support doctors onboard.

If a doctor works under the guidance of airline protocols or ground medical advice, their liability may be reduced.

5.      Practical Considerations for Doctors

Identify Yourself Clearly:

If asked to assist, the doctor should inform the crew of their qualifications, experience, and any limitations (e.g., a cardiologist may not be familiar with paediatric emergencies).

Document Actions:

Keep a clear record of the assistance provided, including steps taken and the reasoning behind them.

Ensure actions are limited to what is necessary and within the scope of their training.

Act in Good Faith:

The focus should always be on doing what is reasonable to save a life or prevent further harm, given the circumstances.

6.      International Conventions and Legal Precedents

Tokyo Convention (1963): Provides a legal framework for actions taken on international flights, generally applying the laws of the aircraft’s country of registration.

Good Samaritan Laws and Airline Practices: Some countries and airlines extend legal protections to doctors rendering emergency aid during flights. For example:

The U.S. Aviation Medical Assistance Act (1998) protects individuals providing emergency medical assistance on flights to or from the U.S.

Other jurisdictions may not have similar explicit protections.

My opinion is, while the concern about licensing and legal recognition in foreign jurisdictions is valid, I believe the ethical obligation to assist in life-threatening emergencies outweighs the potential legal risks in most cases. Key considerations include:

Good Faith and Reasonableness: 

If a doctor acts within their training and in good faith, most legal systems and airlines will offer some protection against liability.

Moral Responsibility: 

As a physician, providing aid could mean the difference between life and death. Even if legal concerns exist, rendering assistance balances well with the fundamental values of the medical profession.

Practical Safeguards: 

Doctors should communicate their limitations, follow established protocols, and document actions carefully to mitigate risks.

Ultimately, each doctor must weigh their ethical duty against the potential legal implications, but in most cases, stepping in to help during an emergency is the right decision both ethically and practically.

See another separate essay I wrote published on Wednesday, March 6, 2024

Doctors Facing Medical Emergencies: What They Can and Cannot Do?

 https://scientificlogic.blogspot.com/2024/03/doctors-facing-medical-emergencies-what.html

I shall write how effective is CPR and other medical emergencies for my next article, followed by a few other articles on health, nutrition, medicine, drugs, ..

Acute myocardial infraction (heart attack) is not the only medical emergency we need to manage. There are  dozens of other emergencies too

A Poser: Can Excessive Intake of Vitamin C Cause Kidney Damage?

 

 A Structural Engineer friend of mine asked me very early  predawn  morning even before the sun could rise yesterday whether high doses of vitamin C can damage   

the  kidneys?

Frankly, I wanted to post my much more interesting article yesterday on:

 

  “We are Only on Transit here in This World to The Next World”

 

This article I wrote 3 weeks ago  has been in the queue waiting for posting ever since. I wanted to get that out first. But since  you ask me this question on vitamin  C and nutrition, I have given  my priority for your sake. After this  I need to publish my thoughts on that more interesting question.

 

Following that,  I shall then  write a few articles on health, drugs, and on medicine that are also my areas of specialization, including  Part 2 of this article on vitamin C, its effect when taken in excess and compare it with fat-soluble vitamins like retinol (vitamin A). I believe more people, especially readers would be more interested if I should write on health, nutrition and medicine that may affect them directly, rather than me writing  on spiritual entities they cannot see or understand that are mysteries beyond them - but not for me with God Guidance to "see"  

 

Thank you, Engineer CK Cheong, for bringing up this excellent question! The relationship between high doses of vitamin C and kidney damage is indeed an area that has been studied, albeit with some mixed findings. Let me address your query systematically.

 

Vitamin C and Kidney Damage:

Vitamin C (ascorbic acid) is a water-soluble vitamin, and excess amounts are typically excreted in the urine. However, taking very high doses (above the tolerable upper intake level of 2,000 mg/day for adults) can lead to potential complications. These are:

 The formation of oxalate and kidney stones. High doses of vitamin C are metabolized into oxalate, which can combine with calcium to form calcium oxalate crystals—the most common component of kidney stones. Some studies suggest that excessive vitamin C supplementation increases urinary oxalate excretion, thereby raising the risk of kidney stone formation in predisposed individuals, such as those with a history of nephrolithiasis.

A 2013 Swedish study found that men taking 1,000 mg or more of vitamin C per day had a higher risk of kidney stones compared to those not supplementing with vitamin C. This association wasn't observed in women.

However, I have to say this occurs rarely.  High doses of vitamin C may precipitate acute kidney injury (AKI) in individuals with pre-existing kidney disease. This is primarily due to hyperoxaluria (excess oxalate in the urine) or the precipitation of crystals in the renal tubules.

 Excessive calcium intake can also lead to kidney stones more than excessive vitamin C intake. High levels of urinary calcium (hypercalciuria) can combine with oxalate or phosphate to form kidney stones. In fact, recent studies suggest that dietary calcium intake actually protects against kidney stones by binding oxalate in the gastrointestinal tract, reducing oxalate absorption and excretion. But unfortunately, calcium supplements, especially when taken without food, may slightly increase the risk of kidney stones.

Safe Doses and Recommendations:

 For most healthy individuals, doses of vitamin C below 1,000 mg/day are considered safe. People prone to kidney stones or with pre-existing kidney issues should limit vitamin C supplementation and focus on dietary sources instead. To avoid kidney stones, calcium intake should ideally come from food rather than supplements, and sufficient hydration is crucial.

While vitamin C at high doses can contribute to kidney stone formation in certain individuals, the risk isn't universal. Excessive calcium intake also poses risks, particularly when taken as supplements. Ensuring balanced nutrition, drinking plenty of water, and avoiding excessive supplementation are key preventive measures.

But what is more damaging to the kidneys is not vitamin C in high doses, but  certain foods can have nephrotoxic effects (poisoning effects on the kidneys), particularly in individuals with pre-existing kidney conditions.

Since nutritional toxicology is one of my areas of expertise when I was working at the Massachusetts Institute of Technology (MIT) in the late 1960’s, let me explain in a simple way for ordinary lay-readers, an overview of starfruit, petai (stink bean), and other foods known to be potentially harmful to the kidneys

The first is  starfruit (Averrhoa carambola). This fruit contains a neurotoxin called caramboxin, as well as oxalates. The effect on kidneys is that the neurotoxin can accumulate in people with kidney disease and cause neurological symptoms like confusion, seizures, and even coma. It is also high in oxalate content. This  increases the risk of kidney stone formation, especially in predisposed individuals.

The second is petai (stink bean, bitter bean) very popular among the Malays who coincidentally also suffer from higher rates of kidney failures than the Chinese and Indians in Malaysia, besides their higher rates of diabetes can also cause kidney failures. The toxin in petai is djenkolic acid, a sulphur-containing amino acid.

The effect on kidneys is, djenkolic acid is poorly soluble and can crystallize in the kidneys or urinary tract, leading to djenkolism. Symptoms include abdominal pain, difficulty urinating, and acute kidney injury. It is particularly harmful in individuals with compromised kidney function.

There are also foods high in oxalates such as spinach, rhubarb, beets, nuts (like almonds), chocolate, and sweet potatoes.

The effect on kidneys is, oxalates can bind with calcium to form insoluble calcium oxalate crystals, a major component of kidney stones. Excessive intake increases the risk of kidney stone formation, particularly in susceptible individuals.

High-protein Foods (excessive consumption), examples like  red meat, poultry, eggs, and dairy products may also be harmful to the kidneys. The effect of high protein is, it increases the workload of the kidneys due to higher urea production during protein metabolism.

Thus, a high protein diet may accelerate kidney damage in individuals with chronic kidney disease (CKD). Then there are also processed foods with high sodium content such as chips, canned soups, processed meats. High sodium intake can lead to fluid retention, increased blood pressure, and strain on the kidneys. Over time, this contributes to CKD progression.

Besides high sodium, there are also foods high in potassium such as  bananas, oranges, avocados, tomatoes, potatoes. In individuals with CKD, the kidneys may struggle to excrete potassium effectively, leading to hyperkalaemia (high potassium levels), which can cause irregular heartbeats and cardiac arrest.

There are also artificial sweeteners in excess that can also damage the  kidneys, such as aspartame, saccharin, sucralose. Studies suggest chronic excessive intake of these artificial sweeteners  may affect kidney function, but evidence remains inconclusive. Moderation is key.

Consider also grapefruit and grapefruit juice. These contain toxins like furanocoumarins that interfere with enzymes like CYP3A4.

Its effect on kidneys is, this toxin may alter the metabolism of medications processed by the kidneys, potentially causing nephrotoxicity. It is particularly dangerous if combined with certain medications like statins or immunosuppressants.

Ah! You may be surprised that excess caffeine in coffee, tea and energy drinks  can also damage the kidneys. Excessive caffeine can increase calcium excretion in urine, promoting the formation of kidney stones. Chronic overuse may reduce kidney function over time.

Alcohol (ethanol)  and its metabolites are toxic too. Chronic alcohol consumption can lead to dehydration and impair kidney function. In severe cases, it may result in acute kidney injury.

 Cola drinks with high phosphoric acid content are toxic to the kidneys The phosphoric acid can lead to kidney stone formation and has been linked to decreased kidney function in long-term studies.

Certain  herbal supplements such as Aristolochia, St. John’s Wort, liquorice root can be toxic to the kidneys. Aristolochia contains aristolochic acid, which is directly nephrotoxic and carcinogenic. Liquorice root in excess can cause hypokalaemia and high blood pressure, damaging the kidneys.

 Foods high in purines, examples, organ meats, sardines, anchovies can be harmful.

Their effect on kidneys is that during the metabolism of purines it produces uric acid, which can crystallize and cause kidney stones or gout.

Foods  high in sugar contents, examples,  sweets, sugary drinks, pastries can have a deleterious effect on kidneys as excessive sugar intake can contribute to diabetes, a leading cause of CKD. Sugars may also promote obesity, indirectly straining the kidneys.

Last, but not least on my list is, unripe avocado leaves. The toxin present in these leaves and seeds too is persin.  This toxin can lead to kidney failure in animals and potentially in humans if consumed in large amounts.

My advice as a former research nutritionist, food scientist, analytical food quality controller,  and a clinician is, people with healthy kidneys can generally handle these foods in moderation, but those with compromised kidney function or at risk for kidney disease should consult a healthcare provider who specializes in nutrition or a dietitian for personalized dietary advice.

The key focus is on a balanced diet, rich in fruits and vegetables but low in excessive sodium, sugar, protein, and harmful toxins, is critical for kidney health.

Nutritional medicine and nutritional toxicology are  very complex subjects  should I explain further in greater depth and in technical details. So is toxicology in forensic science I studied at Cambridge for my postdoctoral  

Take care and enjoy your journey of learning with me dear CK Cheong. Your curiosity is truly a gift to yourself and others! 

Out-of-Body Near Death Family Experience

 

My youngest sister during our discussion in the WhatsApp Chat was right on the spot about her own out-of-body-experience 

She briefly narrated an account of her own near-death experience.  It  was a follow up  about the existence of of a soul in our body, and what happens to the soul in death - essays I penned a few times in this blog of mine.  

She had this out-of-the-body experience when she suffered  clinical death during a surgery. She told us about her experience when she saw her own body lying there in the surgical theatre and how the doctors desperately revived her. She is my own sister, and she couldn’t have lied to members of our own family.

Besides her own experience, there were also so many, many documented accounts told by people who have  died a clinical death and returned to tell what they saw and experienced in the other dimensions. They saw their own body lying there on the death bed before flying away. This event is also described in Psalm 90. In verse 10 it says:

” The days of our years are threescore years and ten; and if by reason of strength they be fourscore years yet is their strength labour and sorrow; for it is soon cut off, and we fly away”.

Their souls and spirits could even fly and enter locked rooms and go through concrete walls. I  had a story told to me by my former high school classmate whose grandmother often visited him, appearing through and disappearing through the walls when the house was locked from inside.

There were also several accounts told by people who died in road accidents who saw themselves floating over high buildings to see their own bodies lying on the road. They  saw everything so very clearly to retell what they saw to the surprise of doctors and paramedics trying to revive them.

However, there is no account from any person who have died an irreversible biological death after many days and returned to tell what's on the other side  

One book which is the best seller called “Life after Life” out of body experience was written by Dr Raymond A Moody MD, PhD, a psychiatrist who wrote a collection of those who have that near death experience.

 These people who died came from different races, different cultures and religions with different beliefs systems, from different countries.  Some of them were highly educated, as well as those who have no education at all. Eerily, they  all shared the same experience. All of them told exactly the same out of the body experience and their accounts of travelling through a dark tunnel. At the end of the  dark tunnel they saw a bright light, beyond which they saw a beautiful field where their long dead relatives were waiting for them. These accounts were recorded by psychiatrists and well-trained medical doctors. Their accounts were recorded randomly from those who died clinically, like randomized samples taken in a well-designed statistical study in a population. Their experiences showed the same results and experiences.  

Since a long time ago I knew the body can only live when it has a soul inside.

Today I am more than convinced the soul controls the entire biochemistry of the body and all its physiological functions. I have always reasoned to myself it is not biochemistry or electrical impulses in the body that control the heart, lungs, liver, brain or any other organ on the working and functions of the body and life. It’s the living soul that is the Master Controller. It is the eternal living soul that controls all these living biochemistries and their highly regulated pathways, whether metabolic, anabolic, catabolic, cellular signalling or genetic expression etc, etc.  It is the soul that controls all of them.

 Once the soul leaves the physical body due to illness or injuries that it can no longer repair,  it just leaves the body. And once it leaves, all its living chemistries are arrested  since the soul is part of the inseparable physical body.

However,  if the injury  or the  ailment is mild and repairable,  the soul stays and  directs the body repair mechanisms, immunological system , and its DNA repair ability how to deal with them to make the body whole again.

 On this note, I  wish to echo this verse in the bible again.

“I will praise thee; for I am fearfully and wonderfully made, marvellous are thy works; and that my soul knoweth right well”

(Psalm 139:14).

 The soul is like the captain of a ship. If the ship is sailing in calm waters (good health) the captain will steer the ship towards the end of its life journey. But if the storm is very fierce and stormy, and the ship is out of control, the captain will abandon ship and let it sink to its watery graves, just like in a severe illness that is out of control that lands us into our earthly grave.

In short, the soul is the captain of its body.  If we are severely ill or injured, the soul as the Master Control – the captain of our living body (ship)  will let all its body chemistry and functions come to a complete irreversible death. It will then return to the soil from where it originated

 "By the sweat of your face you shall eat bread, till you return to the ground, for out of it you were taken; for you are dust, and to dust you shall return"

(Genesis 3:19)

"and the dust returns to the ground it came from, and the spirit returns to God who gave it" 

(Ecclesiastes 12:7)

I write this essay to share this deeply personal and thought-provoking account of my sister’s out-of-body experience. It was both fascinating and moving for me to hear my own sister describe something so extraordinary. Experiences like these often leave us pondering the profound connection between life, the soul, and the body—subjects that blend science, philosophy, and spirituality.

The phenomenon of near-death experiences (NDEs), such as the one my sister experienced, has been documented extensively, including in Dr. Raymond Moody’s seminal work Life After Life. What stands out in these accounts is their remarkable consistency across cultures, belief systems, and levels of education. Many people report similar elements: floating above their body, perceiving efforts to revive them, and even moving through walls or traveling to other places—all of which seem inexplicable through conventional scientific frameworks.

The Soul as the Master Controller

My  interpretation of the soul as the "Master Controller" of the body’s living chemistry and their functions is an intriguing perception at least for me. While modern medicine and science often focus on the brain, heart, and other organs as central to life, what I propose challenges us to think beyond the physical components of the body. My analogy of the soul as the captain of a ship is particularly evocative—it captures the essence of balance and control during life and the ultimate release during death.

If we think of the soul as the source of life, guiding the body’s repair mechanisms and maintaining the intricate harmony of biochemistry and physiological processes, it offers a framework to connect the spiritual and physical aspects of existence. The immune system, DNA repair, and cellular regeneration  indeed exhibit an intelligent design, as if orchestrated by a higher, guiding force—what I identify as the soul.

Science and the Mystery of the Soul

Though science has yet to provide concrete evidence of the soul, many aspects of human consciousness, self-awareness, and life itself remain mysterious. The field of consciousness studies, for instance, has uncovered fascinating insights into how the brain processes thoughts and emotions, but it cannot yet explain what gives rise to the self—the "I" that we experience as individuals.

Psalm 139:14 verse  that our body is "fearfully and wonderfully made" supports beautifully the view that the soul is an essential part of this miraculous design. It bridges the gap between the physical intricacy of our bodies and the ineffable qualities of life, consciousness, and spirit.

Shared Experiences and Universality

One compelling aspect of NDEs is their universality. That people from diverse backgrounds describe similar phenomena suggests that there may be fundamental truths about the soul and its relationship with the body. Whether one interprets these experiences as spiritual journeys, the workings of the soul, or even manifestations of brain activity at the edge of life, they point to the profound mystery of existence.

 Sharing this reflection and my sister’s experience,  reminds us all that life is much more than the sum of its parts and that the human experience, with its blend of the physical, emotional, and spiritual, remains one of the greatest wonders.

They offer an opportunity for us to explore the deeper dimensions of existence, blending science, philosophy, and spirituality in ways that enrich  us.

My belief in the soul as the "Master Controller" rings profound truths for my inner still small voice, not just scientifically or philosophically but also spiritually where even science began with wonder and questions that dared to imagine the unseen.

The analogy of the soul as the captain of the body’s intricate vessel is beautiful and deeply meaningful to me - that provides a perspective that is both intuitive and poetic, one that bridges the gap between the measurable and the immeasurable. Life’s mysteries—whether they are found in NDEs, the complexity of biology, chemistry, biochemistry, medicine, physiology - areas I am familiar, or the awe-inspiring harmony of nature—are what make existence so profound and worth contemplating in my ever quest for spiritual revelation through God's Guidance beyond science.