To fast or not to fast Local rabbis and a doctor weigh…

Come Yom Kippur, almost every local rabbi has seen some congregants re-enacting the behavior of young Frank Sinatra's teenage fans — swooning or fainting.

But the congregants aren't overwhelmed by an intense all-day spiritual experience — or an encounter with Old Blue Eyes. Rather, it's an absence of food.

"Oh yeah. Almost every year, somebody faints," affirmed Rabbi Alan Lew of San Francisco's Conservative Congregation Beth Sholom. "Several times people have been taken to the hospital, but we've never had any serious consequences."

Rabbi Judah Dardik of Oakland's Orthodox Beth Jacob Congregation recalled seeing a New York congregant hit the deck several years ago.

"He was fasting and it was late in the day and he stood up a little too quickly," he said. "Fortunately, the synagogue floor was carpeted."

While a few overzealous fasters across the nation are keeling over and becoming well-acquainted with the undersides of the pews, Bay Area rabbis across all streams of Judaism carry a unanimous message: Lighten up!

"Jewish law has the principle of l'chai b'chem, 'you shall live by the commandments, not die by them.' If fasting is injurious to your health, you should not do it," said H. David Teitelbaum, rabbi emeritus at Redwood City's Conservative Temple Beth Jacob. "When I was at my synagogue, I always said, 'Listen to what your doctor says, and if he prohibits it, you must not fast.'"

Rabbis from all movements contacted by the Bulletin insisted that anyone requiring medication should take it, and medication requiring food should be eaten with a meal. Period. Well, almost.

"If the medication is for an ingrown toenail, maybe you shouldn't take it," said Rabbi Yaakov Kagan, spiritual leader of Chabad of Contra Costa. "If it's for blood pressure, I imagine you should. Take it with a shot of water if necessary, without if possible. Every situation is different, but [eat] as little as necessary. Use common sense — it's a medical issue, not a religious one."

Kagan added that, if someone requires last-minute Yom Kippur fasting advice, "most synagogues have at least one Jewish doctor in there."

Berkeley's Reform Congregation Beth El is no exception. Congregant Marc Hellerstein is a professor of nutritional science at U.C. Berkeley and endocrinology and metabolism at U.C. San Francisco. He is also a medical doctor who works with diabetics.

According to Hellerstein, the biological effects of fasting are "a lot of fun," "very potent" — and, in some cases, extremely beneficial.

"A lot of people in the Western world are overweight or have diabetes, high cholesterol or high blood pressure. If you take someone who is say, 300 pounds for example, has a very high blood sugar of 300, a blood lipid level of 300 and hypertension and put them on a diet for two days where they basically don't eat or have 400 or 500 calories a day, within two days all those numbers are normal but they still weigh 298 pounds," he said.

"The intrinsic response is almost like a magic-bullet cure tempering almost all the diseases of Western life. There is a school of thought in the diabetes world that one way of getting around being on a 'real diet' is to eat very little every Sunday or perhaps two days a month. For people with diabetes, even a couple of days of fasting can improve blood sugar for several weeks."

Hellerstein points out that mammals in general and humans in particular have developed a remarkable evolutionary response to brief periods of food insufficiency. After only a day or more of fasting, the body responds by burning fewer calories, thereby requiring less food intake to maintain weight and stay alive.

And, after only days of minimal eating, testosterone in men and estrogen levels in women fall dramatically.

"This is a response that is present throughout the animal kingdom: If you don't eat, you don't want to have babies," said Hellerstein. "What is surprising is how quickly it happens in humans; within 24 to 48 hours, there is a striking drop in hormonal levels. Some people may feel that in terms of libido if they don't eat for a day or two."

A diabetic who maintains blood-sugar level through medication can fast "within constraints," according to Hellerstein. However, those who suffer from hypoglycemia — a deficiency of blood sugar levels which affects the brain — are high on his list of those who should not fast.

He recalls a patient he worked with years ago in which the combination of hypoglycemia and fasting led to "the sleeping beauty story." A young woman born minus an enzyme and, therefore, susceptible to hypoglycemia was "all revved up" because of her imminent high school graduation. She was so excited that she fasted for a short period of a day or more. Hellerstein treated her at UCSF Medical Center throughout her resultant three-month coma.

"That's a very unusual story," said the doctor. "Unless someone has a rare disorder, you will not get hypoglycemia from fasting. You can fast for weeks and not get hypoglycemia. You can run a marathon on an empty stomach and not get hypoglycemia."

Medications such as insulin, beta-blocking blood pressure pills and, possibly, excessive quantities of aspirin can put one at risk, however.

In addition, Beth Sholom's Lew points out that the "unusually weak" should also not fast on Yom Kippur.

"I don't mean weak physically, but somebody who has a low threshold of pain, a weak constitution. Woody Allen wouldn't have to fast," said the rabbi with a laugh. Yet not all nebbishes get off so easy.

"Somebody once told me that they get mild headaches from fasting," Lew continued. "Well, I get mild headaches too. I get severe headaches from lack of caffeine. But I always couch [my recommendation] as my suggestion. The final decision is, of course, up to them."

In fact, a number of health authorities recommend tapering off on caffeine during the week or two before Yom Kippur.

If one isn't up to a total fast, rabbis urge fasting for as long as one can.

"If you feel like you're not up to it, break your fast with water first. If you can break it by just drinking water, that's a first step," said Rabbi Mark Bloom of Oakland's Conservative Temple Beth Abraham. "But just because you break your fast doesn't mean your obligation is done. If you're a person who physically can't do it, eat breakfast and then fast the rest of the day. Do whatever you're capable of doing."

Dardik points out that for fasters whose suffering goes beyond mild discomfort, 16th-century talmudic sources recommend imbibing an ounce or less of water once every 10 minutes until they feel well. This, says the rabbi, is considered an "insubstantial" amount of food. If someone requires more sustenance, then he or she should eat "whatever they need."

"If indeed a person is ill, not only is there dispensation to eat, they should eat. To care for one's life is a mitzvah, a Torah commandment," said Dardik. "If someone is really not capable, and [fasts] to the point of hurting themselves, that's inappropriate. It is not a level of piety to put one's life in danger."

Children under the age of 13 are not required to fast, though rabbis suggest that, starting at age 9, kids fast a little bit more each year in preparation. Hellerstein notes, however, that fasting does stunt growth.

A lack of food inhibits the production of the growth hormone IGF-1 (insulin-like growth factor) within a day or two. The stunted growth of those who suffer recurrent illnesses in their youth is not necessarily from the afflictions but rather from periods of not eating, according to Hellerstein.

Because of an understandable lack of experimentation on young human subjects, Hellerstein is unsure how long a day or two's fasting will set back a child's IGF-1 levels. He proudly points out, however, that his daughter became a bat mitzvah earlier this month, and "now she can fast."

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Joe Eskenazi

Joe Eskenazi is the managing editor at Mission Local. He is a former editor-at-large at San Francisco magazine, former columnist at SF Weekly and a former J. staff writer.