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Letty Cottin Pogrebin wants Jews to own up to the corrosive power of shame

(JTA) — When a lawyer for Donald Trump asked E. Jean Carroll why she didn’t scream while allegedly being raped by Donald Trump, I thought of Letty Cottin Pogrebin. In her latest book, “Shanda: A Memoir of Shame and Secrecy,” she writes about being assaulted by a famous poet — and how the shadow of shame kept women like her silent about attacks on their own bodies.

That incident in 1962, she writes, was “fifty-eight years before the #MeToo movement provided the sisterhood and solidarity that made survivors of abuse and rape feel safe enough to tell their stories.”

Now 83, Pogrebin could have coasted with a memoir celebrating her six decades as a leading feminist: She co-founded Ms. magazine, its Foundation for Women and the National Women’s Political Caucus. She served as president of Americans for Peace Now and in 1982 blew the whistle on antisemitism in the feminist movement

Instead, “Shanda” is about her immigrant Jewish family and the secrets they carried through their lives. First marriages that were kept hidden. An unacknowledged half-sister. Money problems and domestic abuse. An uncle banished for sharing family dirt in public. 

“My mania around secrecy and shame was sparked in 1951 by the discovery that my parents had concealed from me the truth about their personal histories, and every member of my large extended family, on both sides, was in on it,” writes Pogrebin, now 83. “Their need to avoid scandal was so compelling that, once identified, it provided the lens through which I could see my family with fresh eyes, spotlight their fears, and, in so doing, illuminate my own.”

“Shanda” (the Yiddish word describes the kind of behavior that brings shame on an entire family or even a people) is also a portrait of immigrant New York Jews in the 20th century. As her father and mother father move up in the world and leave their Yiddish-speaking, Old World families behind for new lives in the Bronx and Queens, they stand in for a generation of Jews and new Americans “bent on saving face and determined to be, if not exemplary, at least impeccably respectable.”

Pogrebin and I spoke last week ahead of the Eight Over Eighty Gala on May 31, where she will be honored with a group that includes another Jewish feminist icon, the writer Erica Jong, and musician Eve Queler, who founded her own ensemble, the Opera Orchestra of New York, when she wasn’t being given chances to conduct in the male-dominated world of classical music. The gala is a fundraiser for the New Jewish Home, a healthcare nonprofit serving older New Yorkers.

Pogrebin and I spoke about shame and how it plays out in public and private, from rape accusations against a former president to her regrets over how she wrote about her own abortions to how the Bible justifies family trickery.

Our conversation was edited for length and clarity. 

I found your book very moving because my parents’ generation, who like your family were middle-class Jews who grew up or lived in the New York metropolitan area, are also all gone now. Your book brought back to me that world of aunts and uncles and cousins, and kids like us who couldn’t imagine what kinds of secrets and traumas our parents and relatives were hiding. But you went back and asked all the questions that many of us are afraid to ask. 

I can’t tell you how good writing it has been. I feel as though I have no weight on my back. And people who have read it gained such comfort from the normalization that happens when you read that others have been through what you’ve been through. And my family secrets are so varied — just one right after the other. The chameleon-like behavior of that generation — they became who they wanted to be through pretense or  actual accomplishment. 

In my mother’s case, pretense led the way. She went and got a studio photo that made it look like she graduated from high school when she didn’t. In the eighth grade, she went up to her uncle’s house in the north Bronx and had her dates pick her up there because of the shanda of where she lived on the Lower East Side with nine people in three rooms. She had to imagine herself the child of her uncle, who didn’t have an accent or had an accent but at least spoke English.

You describe yours as “an immigrant family torn between loyalty to their own kind and longing for American acceptance.”  

There was the feeling that, “If only we could measure up, we would be real Americans.” My mother was a sewing machine operator who became a designer and figured out what American women wore when she came from rags and cardboard shoes, in steerage. So I admire them. As much as I was discomforted by the lies, I ended up having compassion for them.  

It’s also a story of thwarted women, and all that lost potential of a generation in which few could contemplate a college degree or a career outside the home. Your mother worked for a time as a junior designer for Hattie Carnegie, a sort of Donna Karan of her day, but abandoned that after she met your dad and became, as you write, “Mrs. Jack Cottin.”

The powerlessness of women was complicated in the 1950s by the demands of the masculine Jewish ideal. So having a wife who didn’t work was proof that you were a man who could provide. As a result women sacrificed their own aspirations and passions. She protected her husband’s image by not pursuing her life outside the home. In a way my feminism is a positive, like a photograph, to the negative of my mother’s 1950s womanhood.

“I’m not an optimist. I call myself a ‘cockeyed strategist,” said Pogrebin, who has a home on the Upper West Side. (Mike Lovett)

You write that you “think of shame and secrecy as quintessentially Jewish issues.” What were the Jewish pressures that inspired your parents to tell so many stories that weren’t true?

Think about what we did. We hid behind our names. We changed our names. We sloughed off our accents. My mother learned to make My*T*Fine pudding instead of gefilte fish. Shame and secrecy have always been intrinsically Jewish to me, because of the “sha!” factor: At every supper party, there would be the moment when somebody would say, “Sha! We don’t talk about that!” So even though we talked about what felt like everything, there were things that couldn’t be touched: illness, the C-word [cancer]. If you wanted to make a shidduch [wedding match] with another family in the insular communities in which Jews lived, you couldn’t let it be known that there was cancer in the family, or mental illness.

While I was writing this memoir, I realized that the [Torah portion] I’m listening to one Shabbat morning is all about hiding. It is Jacob finding out that he didn’t marry Rachel, after all, but married somebody he didn’t love. All of the hiding that I took for granted in the Bible stories and I was raised on like mother’s milk was formative. They justified pretense, and they justified trickery. Rebecca lied to her husband and presented her younger son Jacob for the blessing because God told her, because it was for the greater good of the future the Jewish people.

I think Jews felt that same sort of way when it came to surviving. So we can get rid of our names. We wouldn’t have survived, whether we were hiding in a forest or behind a cabinet, a name or a passport, or [pushed into hiding] with [forced] conversions. Hiding was survival.  

I was reading your book just as the E. Jean Carroll verdict came down, holding Donald Trump liable for sexually assaulting her during an encounter in the mid-’90s. You write how in 1962, when you were working as a book publicist, the hard-drinking Irish poet Brendan Behan (who died in 1964) tried to rape you in a hotel room and you didn’t report it. Like Carroll, you didn’t think that it was something that could be reported because the cost was too high.

Certainly in that era powerful men could get away with horrible behavior because of shanda reasons. 

Carroll said in her court testimony, “It was shameful to go to the police.” 

You know that it happened to so many others and nobody paid the price. The man’s reputation was intact and we kept our jobs because we sacrificed our dignity and our truth. I was in a career, and I really was supporting myself. I couldn’t afford to lose my job. I would have been pilloried for having gone to his hotel room, and nobody was there when he picked up an ashtray and threatened to break the window of the Chelsea Hotel unless I went up there with him.The cards were stacked against me.

In “Shanda,” you write about another kind of shame: The shame you now feel decades later about how you described the incident in your first book. You regret “how blithely I transformed an aggravated assault by a powerful man into a ‘sticky sexual encounter.’” 

I wrote about the incident in such offhand terms, and wonder why. I wrote, basically, “Okay, girls, you’re gonna have to put up with this, but you’re gonna have to find your own magical sentence like I had with Behan” to get him to stop. 

You write that you said, “You can’t do this to me! I’m a nice Jewish girl!” And that got him to back off.

Really painful.

I think that’s a powerful aspect of your book — how you look back at the ways you let down the movement or your family or friends and now regret. In 1991 you wrote a New York Times essay about an illegal abortion you had as a college senior in 1958, but not the second one you had only a few months later. While you were urging women to tell their stories of abortion, you note how a different shame kept you from telling the whole truth.  

Jewish girls could be, you know, plain or ordinary, but they had to be smart, and I had been stupid. I could out myself as one of the many millions of women who had an abortion but not as a Jewish girl who made the same mistake [of getting pregnant] twice.

The book was written before the Supreme Court overturned Roe v. Wade. In the book you write powerfully about the shame, danger  and loneliness among women when abortion was illegal, and now, after 50 years, it is happening again. Having been very much part of the generation of activists that saw Roe become the law of the land, how have you processed its demise?  

Since the 1970s, we thought everything was happening in this proper linear way. We got legislation passed, we had litigation and we won, and we saw the percentage of women’s participation in the workplace all across professions and trades and everything else rise and rise. And then Ronald Reagan was elected and then there was the Moral Majority and then it was the Hyde Amendment [barring the use of federal funds to pay for abortion]. I was sideswiped because I think I was naive enough to imagine that once we articulated what feminism was driving at and why women’s rights were important, and how the economic reality of families and discrimination against women weren’t just women’s issues, people would internalize it and understand it and justice would be done. 

In the case of Roe, we could not imagine that rights could ever be taken away. We didn’t do something that we should have done, which is to have outed ourselves in a big way. It’s not enough that abortion was legal. We allowed it to remain stigmatized. We allowed the right wing to create their own valence around it. That negated solidarity. If we had talked about abortion as healthcare, if we had had our stories published and created organizations around remembering what it was like and people telling their stories about when abortion was illegal and dangerous…. Instead we allowed the religious right to prioritize [fetal] cells over a woman’s life. We just were not truthful with each other, so we didn’t create solidarity. 

Are you heartened by the backlash against restrictive new laws in red states or optimistic that the next wave of activism can reclaim the right to abortion? 

I’m not an optimist. I call myself a “cockeyed strategist.” If you look at my long resume, it is all about organizing: Ms. magazine, feminist organizations, women’s foundations, Black-Jewish dialogues, Torah study groups and Palestinian-Jewish dialogues. 

Number one, we have to own the data and reframe the narrative. We have to open channels for discussion for women who have either had one or know someone who has had one, even in religious Catholic families. The state-by-state strategy was really slow, but Ruth Bader Ginsburg wanted that. She almost didn’t get on the court because she didn’t like the nationwide, right-to-privacy strategy of Roe but instead wanted it won state by state, which would have required campaigns of acceptance and consciousness-raising.

So, the irony is she hasn’t lived to see that we’re going to have to do it her way. 

You share a lot of family secrets in this book. Is this a book that you waited to write until, I’ll try to put this gently, most of the people had died?

I started this book when I was 78 years old, and there’s always a connection to my major birthdays. And turning 80 – you experience that number and it is so weird. It doesn’t describe me and it probably won’t describe you. I thought, this could well be my last book, so I needed to be completely transparent, put it all out there. 

My mother and father and aunts and uncles were gone, but I have 24 cousins altogether. I went to my cousins, and told them I am going to write about the secret of your parents: It’s my uncle, but it’s your father. It’s your family story even though it’s my family, but it’s yours first. And every cousin, uniformly, said, “Are you kidding? You don’t even know the half of it,” and they’d tell me the whole story. I guess people want the truth out in the end.

Is that an aspect of getting older?

I think it’s a promise of liberation, which is what I have found. It’s this experience of being free from anything that I’ve hid. I don’t have to hide. Years ago, on our 35th wedding anniversary, we took our whole family to the Tenement Museum because we wanted them to see how far we’ve come in two generations.


The post Letty Cottin Pogrebin wants Jews to own up to the corrosive power of shame appeared first on Jewish Telegraphic Agency.

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Why NBA Teams Start Defending Before Half Court

Image Source: Infographic by author

An NBA defender who meets a ball handler near the opposite baseline is trying to interfere with the possession before the offense gets organized. The immediate reward need not be a steal. Making a guard change direction, protect the ball, or find another receiver can interrupt the route into a play. But pressure has several possible results, and slowing that first journey does not necessarily slow the whole game.

In Logan Murdock’s November 2025 report on full-court defense, Phoenix Suns guard Jordan Goodwin described his aim: “Try to make them take at least six seconds off the clock.” That was his target, not a measured average. Indiana Pacers coach Rick Carlisle described another purpose: getting opponents to play faster than they prefer. Both approaches interfere with timing, though one delays the setup while the other hurries decisions.

The shot clock helps explain the difference. In a normal NBA possession following a made basket, the offense has 24 seconds, with the countdown starting when the inbound pass is legally touched on the court. It must also advance out of the backcourt within eight seconds. Crossing half court does not start a fresh shot clock. Time spent getting there leaves less time to create a shot. A defensive deflection that stays inbounds does not restart the countdown.

Defensive pressure also needs careful interpretation in basketball betting. An NBA matchup on the Bovada website cannot be reduced to whether one team presses: the combined score depends on how often both sides get the ball and what they do with their chances. A defender delaying the first pass into an offense can leave less time for a good attempt. A turnover followed by a quick basket has a different effect.

Those possibilities make defensive intensity an incomplete description of a scoring outlook. A team can force its opponent to work harder while creating quick attacking chances for itself. It can also concede an easy chance when pressure fails. Understanding the tactic means separating its purpose from its outcome, rather than treating an aggressive defender as evidence that the game must produce fewer points.

Pressure does not always mean a trap

One defender following the ball is different from two defenders closing around it. The first can contest the dribbler while teammates remain with their own assignments. A trap commits another player to the ball, so teammates elsewhere must cover the passing options and protect the basket.

A stopped dribble changes the contest. Once a player voluntarily picks up the ball, he cannot simply start dribbling again. He can still pivot, pass, or shoot, but moving away from pressure with another dribble is no longer an option. A defender can therefore restrict movement without taking possession. This is also why a guard’s choice to keep the dribble alive deserves attention: it preserves a way to move while searching for a pass.

Watch where the ball goes next. A trap can succeed by forcing an awkward pass that another defender intercepts. The players surrounding the ball do not have to be the ones who take it away. Reaching for a steal also differs from keeping the ball handler contained; abandoning position can give the guard a route past the pressure.

The offense has answers. In the Murdock report referenced earlier, Golden State guard Brandin Podziemski described using his body to shield the ball against smaller defenders and quickness to get beyond longer opponents. Beating the first defender can leave that player trailing, creating a temporary advantage farther upcourt. The remaining defenders then have to respond to an attack before their teammate has time to recover.

Three possible outcomes of early pressure: delayed setup, hurried decisions, or an attacking advantage when pressure is beaten

The work before a highlight

Former NBA guard Keith Bogans gives a defender’s perspective in his conversation with Vernon Maxwell. Discussing Jaden McDaniels, Bogans says that seeing a defender pick up a superstar across the court gets him excited in the way a dunk or crossover excites other viewers.

*

His reaction focuses on the challenge being accepted. The scorer has someone to deal with before reaching a preferred attacking position. Bogans also describes the recognition that such defensive work receives from teammates and coaches, even when it attracts little attention elsewhere.

The assignment does not end when the scorer passes. The defender still needs to follow the play and be ready for the ball to return. Early pressure can force a star to give up the ball without removing him from the possession. Watching the next pass shows whether the defense has actually disrupted the attack or merely moved it.

When defense creates offense

Indiana scored 19 points off turnovers in Finals Game 6 against Oklahoma City on June 19, 2025. The figure does not isolate full-court pressure.

A change of possession ends one team’s opportunity and begins another’s. The team winning the ball can attack immediately or organize its offense, depending on the space and defenders ahead. Pressure therefore cannot be assessed only by the time an opponent spends bringing the ball forward.

Look beyond the pickup point. Does the offense arrive late but still organized? Does it make a hurried pass? Does the ball handler escape and make the remaining defenders cover extra ground? The first defender can use up time without winning the ball. If the guard gets past him, watch whether the other defenders can stop the drive without leaving someone open.

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In ex-Knick Michael Sweetney, Jewish friends mourn a beloved coach ‘who knew exactly how to show up’

Tamir Goodman stuck out like a sore thumb, a yarmulke-wearing redhead at a practice for a showcase of Greater Washington’s top high school talent. The year was 2000, and Goodman, an Orthodox Jewish hoops prodigy, had already been on the cover of Sports Illustrated. What he did not have at that practice was a friend.

But when the all-star team’s coach had players pair up for shooting practice, one teammate approached Goodman: the 6-foot-8, Georgetown-bound power forward Michael Sweetney.

“He’s like, “Hey, I’ll be your shooting partner,” Goodman, 44, recalled by phone Thursday. “And from that moment, we just never left each other.”

Sweetney, who went on to play for the New York Knicks, later said he had never met a Jewish person before that day. But when he died Wednesday of complications from a heart attack, he had not only one Jewish friend mourning his passing, but hundreds.

Mike Sweetney, left, with Tamir Goodman on a trip to Israel in 2019. Courtesy of Tamir Goodman

Orthodox Jewish New Yorkers, who got to know Sweetney through his years teaching basketball at their schools, summer camps, synagogues and even birthday parties, remembered him in tributes Thursday as a humble mentor, a model of courage and a loyal friend in times of Jewish vulnerability.

Those early shooting sessions with Goodman, it turned out, had planted the seed for Sweetney’s post-NBA basketball endeavors, including a four-year stint at Yeshiva University, where he served as an assistant during the men’s team’s famous 50-game win streak.

“The world lost a giant today,” Elliot Steinmetz, Yeshiva’s head coach, wrote Thursday on X. “I lost a close friend. The basketball world lost a beloved star. Our Jewish community lost an ally and someone who knew exactly how to show up.”

Sweetney, who was 43, is survived by his wife, India, and three children.

A perfect matchup

Sweetney brought undeniable but understated starpower to the basketball-obsessed Orthodox community. That community’s embrace also helped Sweetney find purpose after his playing career and reignite his love for the game.

After starring at Georgetown, Sweetney was selected ninth by the Knicks in the 2003 NBA Draft — eight picks after LeBron James. But Sweetney’s career in the league lasted just four years, derailed by struggles with weight and depression that followed his father’s sudden death. (He later revealed he had contemplated suicide as a rookie.) He played another decade for pro teams in China and Latin America before washing out of the sport.

Sensing that his friend was in a bad place, Goodman invited Sweetney to Israel in 2019 to help with a basketball camp he had started.

“I told him a lot of good things happen when you come to Israel,” Goodman said. During the visit, Sweetney opened up about the challenges he had been experiencing. Goodman suggested he go into coaching, and soon connected him with Steinmetz — a Knicks die-hard — who offered him a job.

“When Tamir called me about him, initially, I’m like, ‘Oh, cool, I get to talk to Mike Sweetney, that’ll be fun,’” Steinmetz said Thursday in an interview. “Once I spoke to him the first time, I’m like, ‘That’s just such a nice guy.”

A Yeshiva League staple

Sweetney’s entry into the world of Orthodox Jewish basketball, initiated by Goodman, helped facilitate his turnaround, transforming a point of professional failure into a source of inspiration for others.

A classic back-to-the-basket player in his day, Sweetney relished working with the Yeshiva forwards, who delighted in trying their post moves on a former NBA lottery pick.

“All the bigs’ favorite part of practice was going up against Mike,” recalled Gabriel Leifer, a team captain during Yeshiva’s win streak.

Sweetney was getting something out of the work, too. Those who worked with him up close could see his passion for the sport — which had become a dark place for him — coming back to life.

Sweetney signs autographs on Yeshiva’s home court. Courtesy of Elliot Steinmetz

Harold Katz, a coach who occasionally helped with the Yeshiva program, said that despite his NBA pedigree, Sweetney had no pretenses when it came to learning the school’s motion offense. Instead, he seemed to enjoy it. “He would always say it’s fun — like playing this way is fun.” Katz remembered. “He’d say, ‘I wish I played in this.’”

Sweetney told the New York Post in 2019 that the Jewish world had helped him find stability after basketball.

“I’m comfortable here. I’m treated well here. It’s been amazing,” he said at the time. “To be happy and be at peace, I would’ve been shocked. I wouldn’t have thought it was possible.”

The coaching roles — at Yeshiva and at Ramaz, an Orthodox high school where he coached the girls’ team — also helped Sweetney book speaking engagements and countless youth basketball clinics. He also became an advocate for Black-Jewish relations.

“It starts off that, ‘Oh my God, there’s this big NBA guy who’s at all the YU games,’” Steinmetz said, “but then people start talking to him and they fall in love with his personality because he’s just such a warm, caring guy.”

Driving to and from Yeshiva games over the years, Steinmetz and Sweetney grew close — a friendship that held even after the latter left Yeshiva in 2023 to work in the mental health arena.

The true testament to the kind of person Sweetney was, Steinmetz said, came after they stopped working together, on Oct. 7, 2023. Steinmetz was in Israel at the time; the first text message he received as the attacks were unfolding, he said, was from Sweetney.

“He’s like, ‘Please confirm for me that you’re okay,’” Steinmetz said. “Two days later: ‘Hey, did you get home yet?’ He just cared. He wasn’t checking a box — he cared.”

If you are in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

The post In ex-Knick Michael Sweetney, Jewish friends mourn a beloved coach ‘who knew exactly how to show up’ appeared first on The Forward.

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Sacred fasting meets Ozempic

Millions of people worldwide – as many as 1 in 8 adults in the U.S. – are on GLP-1 medication, such as Ozempic, Mounjaro, Wegovy and Zepbound, for treating diabetes or for weight loss.

These drugs are adding a medical twist to religious observances that involve fasting, such as the Jewish holiday of Yom Kippur, which will be observed from sundown on Sunday until nightfall on Monday. Traditionally, fasting on Yom Kippur means forgoing food and water for about 25 hours, which can strongly affect a person’s metabolism.

Other religious traditions include different types of fasts. For example, Muslims who fast during Ramadan neither eat nor drink from dawn to sunset, but they break their fast each night. Christian and Hindu traditions also include dry fasts as well as partial fasts, such as Lent and Navratri, in which people avoid certain foods.

As a specialist in obesity medicine, I work with many patients who take GLP-1 drugs. Most people can safely fast for Yom Kippur or other religious or cultural observances. But depending on their circumstances, they may need to plan ahead, take certain precautions and be clear on when it’s medically advised that they break their fast.

Common GLP-1 side effects and fasting

GLP-1 drugs such as Ozempic, Mounjaro, Wegovy and Zepbound mimic a natural gut hormone– glucagon-like peptide 1 – that lowers your blood sugar by triggering insulin release when your blood sugar is high. These drugs also slow how quickly food passes through the stomach, which reduces appetite to aid in weight loss.

GLP-1s have some common side effects that can occur in anyone taking them, including nausea, vomiting, dizziness, constipation and dehydration. Fasting may exacerbate them, especially in people who are prone to an upset stomach. GLP-1 side effects are also more common when a patient is increasing their dose, which usually happens monthly as tolerated until they reach their full dosage.

That’s why, if you’re planning to fast for Yom Kippur, it’s best to avoid starting a new GLP-1 medication or increasing the dose of your medication sooner than two weeks or so before the holiday.

GLP-1 drugs work by simulating a gut hormone produced in the body, spurring the release of insulin and slowing down digestion.

Timing your dose

If you take GLP-1 drugs as weekly injections, which is the most common way of dosing these medications, you should stick to your schedule even if you plan to fast. These drugs stay in your system during the entire week, so moving or skipping that weekly dose right before fasting can interfere with their effects on blood sugar or weight loss.

If your weekly injection falls on Yom Kippur, you can generally go ahead and administer it as scheduled. Some patients do report increased nausea on their injection day – if that happens to you, you may wish to delay the injection until after the fast, if you’ve cleared it with your doctor.

Patients who inject GLP-1 drugs daily may need to adjust the timing. For patients taking these medications for diabetes treatment, it may make sense to do the injection right before the meal that breaks the fast or to hold off until after the fast. This helps reduce the risk of stomach side effects, which can occur when these medications are taken on an empty stomach.

More recently, many patients have switched to oral GLP-1 medications. These pills must generally be taken on an empty stomach with a small amount of water, at a set time before taking any other drugs or any food or beverages.

Because fasting for Yom Kippur includes abstaining from drinking, taking the pill as directed may involve breaking the fast. That means you’ll need to decide in advance whether to take the medicine before the fast begins, after the fast ends or on an alternative schedule. It’s best to avoid simply skipping the daily dose scheduled for Yom Kippur and taking a double dose after the fast.

Skipping the dose won’t be harmful if you’re taking the medication for weight loss. But if you have diabetes, skipping it could dangerously elevate your blood sugar. And doubling the dose later could lead to serious side effects, such as pancreatitis, an inflammation of the pancreas that can lead to hospitalization.

Diabetes versus weight loss

If you’re using GLP-1 medications solely for weight management, fasting for 25 hours should not pose serious issues beyond stomach upset. In rare cases, though, combining these drugs with fasting can stress the pancreas enough to cause pancreatitis.

Fasting on GLP-1s carries the biggest risks for diabetic patients. That’s because GLP-1 medications are often used alongside other drugs that work primarily by lowering blood sugar, which raises patients’ overall risk of a blood sugar crash.

The greatest concern is in patients taking a GLP-1 medication together with insulin or drugs that stimulate insulin production, such as sulfonylureas. The GLP-1 medication itself may not cause a drop in blood sugar. But because it suppresses appetite and lowers glucose levels, these other medications can magnify the risk of low blood sugar during a prolonged fast.

If that’s your situation, talk to your doctor about whether you can adjust the timing, dose and type of insulin you take and reduce your dose of sulfonylurea in order to fast safely.

In general, people who have Type 1 diabetes or poorly controlled diabetes are strongly advised not to fast – as are people who:

  • Experience frequent or severe drops in blood sugar.
  • Have hypoglycemia unawareness – an absence of warning signs for high blood sugar.
  • Are managing diabetes during pregnancy.
  • Have severe kidney disease with a high risk of dehydration.
  • Experience severe gastrointestinal side effects from GLP-1 medications.
Not overeating along with drinking plenty of water beforehand is helpful for anyone fasting – but crucial for people on GLP-1 medications.

From prefast prep to the post-holiday meal

Regardless of what GLP-1 medication you take and for what indication, if you plan to fast you’ll need to do some pregaming, monitor how your fast is going and be mindful of how you break it.

  • First, if you are unsure about anything, talk to the clinician who is monitoring your GLP-1 drug treatment so you can decide together whether fasting is safe for you and whether your situation requires any special precautions.
  • Before fasting, it’s important to eat a normal meal that includes protein and to avoid both overeating and undereating. Overeating is never recommended when on GLP-1 medications, and undereating can set you up for more side effects during the fast. Although GLP-1 therapy can substantially reduce appetite, patients should avoid skipping the prefast meal entirely.
  • GLP-1 medications don’t just decrease appetite – they can also suppress the body’s natural thirst signals. So before your fast begins, aim to stay hydrated to prevent getting dehydrated while fasting.
  • If you are diabetic, make sure you fast under close guidance from your doctor – and make sure you are checking your blood sugar during fasting. Using a glucose monitor is a good idea, particularly if you are taking insulin or other glucose-lowering medications. The goal is for your blood sugar to remain within your usual daily nonfasting range.
  • Be ready to break your fast right away if you start feeling dizzy, confused, faint, nauseated or acutely ill, or if your blood sugar dips too low or spikes too high. These symptoms are dangerous and need to be addressed immediately. Stash a rapid source of carbohydrates – even just some glucose tablets or a few hard candies – within reach so you can access them quickly if needed.
  • Finally, plan a gentle, balanced meal to break the fast rather than an unusually large meal, which may provoke nausea, abdominal pain, reflux or vomiting. It’s generally best to avoid higher-fat foods, too, since they can slow down digestion.The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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