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What American Jews fight about when they fight about Israel

(JTA) — Eric Alterman, born in 1960, says the view of Israel he absorbed growing up in a Jewish family in suburban Scarsdale, New York, was decidedly one-sided. 

“I went on this nerdy presidential classroom thing when I was in high school,” he recalls, “and some Christian kid from the South raised his hand and said to the rabbi, ‘I don’t get it, if the Jews could have a state, why can’t the Palestinians?’ And I was like, ‘How dare you?’”

Alterman would go on to attend Cornell University, where he wrote his honors thesis on Israel, Vietnam and neoconservatism; spend a semester abroad at Tel Aviv University; study Israeli military history while earning his master’s degree in international relations at Yale, and research a dissertation on American liberalism and the founding of Israel as a doctoral student at Stanford.

Although he frequently writes about Israel as a contributing writer at the Nation and the American Prospect, Alterman is best known for his liberal analysis of the media and U.S. politics. He’s written 11 previous books, including one on Bruce Springsteen.

Yet he never stopped thinking about the widening gap between the idealized Israel of his youth and the reality of its relations with the Palestinians, its Arab neighbors and the West. Even when Israel’s revisionist historians were uncovering evidence of massacres and forced expulsions of Palestinians during the War of Independence, and Israeli politicians and intellectuals began asking why, indeed, the Palestinians didn’t deserve a state of their own,  he saw that such discussions were considered blasphemous in most American Jewish circles.

Alterman, now a CUNY Distinguished Professor of English at Brooklyn College, explores that gap in his latest book, We Are Not One: A History of America’s Fight Over Israel.” The book surveys U.S.-Israel relations, but with a focus on the ways defending Israel have shaped public discourse. It’s a book about arguments: within the administrations of 14 presidents, between Washington and Jerusalem, and mostly among Jews themselves. 

Earlier this month we spoke about how the pro-Isael lobby became a powerful political force, the Jewish organizations and pundits who fight to limit the range of debate over Israel, and what he thinks is the high price American Jews have paid for tying their identities so closely to Israel. 

“I try to take on shibboleths that in the past have shut down conversation and take them apart and sympathetically show the complexity of the actual situation that lies beneath — so that [criticism and disagreement] over Israel can be understood rather than whisked away by changing the subject, or what-aboutism, or by demonizing the person who is raising them,” said Alterman.

Our conversation was edited for length and clarity.

Jewish Telegraphic Agency: Let me start by congratulating you: It’s the first book about U.S.-Israel relations with a chapter named after a Bruce Springsteen album: “Working on a Dream.” 

Eric Alterman: Nobody else has caught that. But it’s not about U.S.-Israel relations. It’s the first book about the debate over Israel in the United States. There’s a million books on U.S.-Israel relations. 

So let’s define that more narrowly. The title reminds me of the United Jewish Appeal slogan over the years, “We Are One,” which was about American Jewish solidarity. So who is the “we” in your title, “We Are Not One”?

There are three or four different meanings. The “we” in this book are obviously the United States and Israel. An awful lot of people argue that the United States and Israel have identical interests in the world and that’s crazy, because Israel is this tiny little country in the Middle East and we’re a global superpower thousands of miles away. So obviously, we’re going to have differences. Number two, American Jews and Israeli Jews are very different people. They have very different life experiences. And they see things quite differently as evidenced by the political split between them. The title also refers specifically just to Americans, because we can’t even discuss most things anymore. The pro-Israel community, such as it ever was, is enormously split and it’s split in angry ways. 

Much of your book is about what happens to American Jews when the idealized portrait of Israel’s founding and its presumed blamelessness in its actions toward the Palestinians comes up against reality. In that context, tell me a little about your choice to devote a chapter to the Leon Uris novel “Exodus,” an extremely sanitized version of Israel’s founding, and the 1960 movie based on it.

The influence of “Exodus” is something I didn’t understand until I wrote the book. It’s crazy, because Leon Uris was this egomaniac who wrote kind of a shitty book and said that he wanted to add a new chapter to the Bible, and he kind of succeeded. I was born in 1960. When I was growing up in suburban New York, every single family had “Exodus” on their shelves. When the movie came out Israelis understood this. They said, “We can just shut down our public relations office now.” And from the standpoint of reality the movie is worse than the book because it has Nazis — the Arabs in the book are working with Nazism. Uris didn’t have the nerve to do that. So the book created this idealized Israel and this idea of [Palestinians as] evil, subhuman Nazis. 

What most Americans don’t understand, or choose not to understand, is that before the 1940s most Jews were anti-Zionist, or non-Zionist. This changed in the 1940s, when, as a result in part of the Holocaust, and the reaction to that, and the triumph of Zionists, they became intensely pro-Zionist, leading up to the creation of Israel. But after that, they kind of forgot about Israel. One might have given their children JNF boxes to carry on Halloween instead of UNICEF boxes, or maybe they paid to plant trees. But Israel doesn’t show up in the American Jewish Committee’s 1966 annual report until page 35 or 36, and Nathan Glazer’s 1957 book “American Judaism” says that the creation of the Jewish state has had “remarkably slight effects on the inner life of American Jewry.”

With the events of 1967, Uris’ idealized notion of Israel came together with this terrible fear of a second Holocaust, and the terror and shame and frightening nature of that combined to transform American Judaism overnight to an enormous degree.

You are referring to Israel’s lightning victory in the Six-Day War, which even non-religious Jews saw as a kind of miracle, and redemption two decades after the Holocaust. And that transformation, you argue, put defense of Israel, combined with Holocaust consciousness, at the center of Jewish identity. 

More than just the center: It basically comprised almost all of it, for many secular Jews. I quote the neoconservative Irving Kristol in the book saying in 1976 that “the Holocaust and the founding of the state of Israel” was 100% of what Judaism means. 

Which in turn led to a the tremendous pro-Israel lobbying efforts, political activism and punditry.

The budgets of American Jewish organizations overnight went from social services and liberal social justice causes to defense of Israel. And rabbis were replaced at the center of public discourse by the heads of these organizations — most of whom had no religious training or knowledge of history or Judaism. 

Joe Biden, then vice president, speaks at the AIPAC 2016 Policy Conference in Washington, DC, March 20, 2016.
(Molly Riley/AFP via Getty Images)

One distinction you repeatedly make is between what most Jews believe compared to the Jewish organizations that claim to represent them. Surveys show the rank and file is consistently more liberal on Israel and less hawkish than the big organizations — a gap that showed up markedly around the Iraq War and the Iran nuclear deal

Right. The big mistake that so many in the media make is that they go to the heads of these organizations who pretend to speak for American Jews when they don’t speak for American Jews. They speak for their boards and their donors. 

The shift to Jewish lobbying on behalf of Israel coincides with an era in which there is seldom daylight between what Israel wants and what the United States wants or agrees to — often to the frustration of presidents. You are critical of those who exaggerate the pro-Israel lobby’s influence — folks like Stephen Walt and John J. Mearsheimer, authors of the 2007 book “The Israel Lobby and U.S. Foreign Policy” — but, at the same time, you write, referring to the Israel debate in America, about “the continued stranglehold that money, power, organizational structure, and clearly defined paths to personal career advancement continue to hold over the shape of foreign policy.” How will you respond to critics who will say your book is trafficking in the myth of Jewish power and its conspiracy-minded hold over American policy?

The short answer is, that’s why I wrote a 500-page book — basically, for two reasons: One, everything is incredibly complicated. And some of those complications are consistent with antisemitic myths, and therefore they have to be teased out and broken down in such a way that you’re telling the truth rather than portraying the myth. 

If you say things without context, they sound antisemitic. I say that yes, Jews are very powerful in the media and many use that power on or about Israel. But I think if you lay out the examples that I use, if you look at them and examine them, I don’t see how you can conclude otherwise. The people I describe often say that about themselves — how much power and influence they yield.

Secondly, I’ve always found it just about impossible to discuss Israel with anyone, because you have to share exactly the same assumptions with that person. And if you don’t, then they take it personally, or you’re an antisemite, or, at best, you’re insufficiently sensitive to how important antisemitism is. And if you describe ways in which American Jews act in ways that are consistent with antisemitic myth, it has a way of shutting down the conversation. 

Undoubtedly there’s some criticism of Israel that is motivated by antisemitism, but there’s an awful lot of reasons to be critical of Israel, particularly if you are a Palestinian or care about Palestinians. This accusation [antisemitism] has shut down the discourse and part of my hopes in demonstrating the complexities of this history is to open this up.

So let me ask about your own stake in this. Your educational background and relationship to Israel are similar in many ways to the writers and thinkers in your book who tolerate no criticism of Israel. I don’t know if you call yourself a Zionist, but you have some connection to Israel, and you’re also willing to tolerate critiques of Israel. What’s the difference between you and some of the other people who went on the same journey?

For the longest time I was comfortable with the words “liberal Zionist,” but I don’t think they have any meaning anymore. I don’t think it’s possible to be a liberal Zionist — you have to choose. Israel is the only putatively democratic country that prefers Trump to either Obama or Biden, and it’s not even close. And young Israelis are moving further in that direction and young American Jews are moving further in the opposite direction. 

So you ask me if I am a liberal Zionist. I don’t think the word “Zionist” is useful at all anymore, because Israel is a country and it’s not going anywhere. I sometimes call myself an anti-anti-Zionist, because anti-Zionism is dumb. I’m very anti-BDS. If I thought [the Boycott, Divestment and Sanctions movement] could end occupation, I would support it, even though the idea of boycotting Jews puts a bad taste in my mouth. But the theory behind BDS apparently, and I’ve spent a lot of time on this, is that the world will force Israel to give up its identity and turn the country over to its enemies. It’s inconceivable that Israel would do that and inconceivable the United States would pressure them to do that. So BDS is entirely performative. It’s more of a political fashion statement than anything else. 

And to me, it speaks to the failure of Palestinian politics throughout history. I have a great deal of sympathy for the Palestinians and their bad politics because it’s based on two problems. One is that they have never been able to see the future very well. So they should have agreed in 1921 and 1937, or whenever they would have had the majority and they were being given a country by the British. They should have taken the lousy offer from Ehud Barak and Bill Clinton in 2000. I kind of get it because they have so many competing constituencies, and it’s impossible to satisfy all of them at the same time. I understand that. It’s hard to imagine a Palestinian politician who could say yes, and if you look at Hamas and the Palestinian Authority, in both cases, it’s hard to imagine making peace with them.

I read that in your book, and my first thought was, well, isn’t that basically just confirming what the pro-Israel right has always said — that Israel has no partner for peace? So maybe the best it can do is maintain a status quo that assures some security for Israel and a workable something for the Palestinians.

Well, number one I hold Israel significantly responsible for the conditions under which that has developed and that they can change those. And number two, that’s no excuse for the way Palestinians are treated, either in the occupation or in Israel. So yes, I agree. There’s no one to make peace with today, but there are many steps Israel could take that could vastly improve the lives of the Palestinians, both in the occupied territories and inside Israel. And there are a lot of steps they could take that could build confidence for a future that could weaken Hamas, that could strengthen the Palestinian Authority, so that one day peace would be possible. But they do the opposite.

An Israel supporter at a New York rally to tell the United Nations “no more anti-Israel documents or resolutions,” Jan. 12, 2017. (Don Emmert/AFP via Getty Images)

You talk about funding of Israel studies and Jewish studies departments as a reaction against fears of a pro-Palestinian takeover of academia. At the same time, you write how Palestinian supporters “succeeded in colonizing Middle East studies departments, student faculty organizations, and far-left political organizations.” Why does that matter in the long run if, as you also write, nothing’s really going to change American policy on Israel?

I gave a talk before the book came out at Tel Aviv University and someone asked me that question. I said, You care about these transformations for two reasons. One, you really will be all alone in the world. You’ll have the support of conservative [Evangelical] Christians who are in many respects antisemitic and are using you for their own purposes. So if you lose American Jews, you will be existentially alone in a way you’re not now and that strikes me as very unpleasant. 

I do think that the quote-unquote pro-Israel community has a stranglehold on American politics that I can’t see changing anytime soon, and I think the change in the Democratic Party [that it will turn more pro-Palestinian] is very much exaggerated by both sides for their own reasons. 

That being said, the people who are being trained now to be in the State Department and the National Security Council and the Defense Department and the think tanks and the places where the intellectual foundation of U.S. policy is made are learning something very different from what you and I learned in college. Right now, there’s no such thing as an influential Palestinian lobby in this country. There’s no pushing back. There’s no percentage for anyone opposing Israel who has a career interest in the future. That will change, and the whole shaping of the discourse will change and that will change the relationship between the United States and Israel. It’s not going to happen anytime soon, but it’s definitely going to happen. 

As Jews in this country have remained largely liberal, Israel appears to be getting more illiberal, as we’ve seen with a new government that is more right-wing than any previously. And Israel has become more of a divisive element among Jews than a unifying force. As this gap appears to be widening, do you have any real hope for changing the discourse?

No, I don’t have any hopes for that. I don’t have anything optimistic to say about Israel. I think, politically speaking, from the standpoint of American Jews, everything is going in the wrong direction. But by demonstrating just how different Israeli Jews are than American Jews, and how little Israeli Jews care what American Jews think, I do think that it presents an opportunity for American Jews to think about what it means to be an American Jew in the Diaspora. Roughly half of the Jews in the world live in the United States. And since 1967 American Jews have defined themselves vicariously through Israeli Jews and taking pride in Israel. They expressed their identities by defending Israel and attacking the media when the media didn’t defend Israel.

Meanwhile, American Jews hardly ever go to synagogue. According to Pew, 20% of American Jews regularly attend synagogue and half of them are Orthodox, who are 10% of the community. What brought me back into Judaism was studying Torah. And hardly any American Jews are ever exposed to that. 

So I think there’s an opportunity to reimagine Diaspora Jewry now that the Israel story doesn’t work, and it’s clear that it doesn’t work. Young American Jews are leaving or voting with their feet. They’re walking away. Israel-centric Judaism is in part responsible, although it’s not the whole story. Intermarriage is a big part of the story. The de-religionization of all groups is part of the story. But personally, I don’t see what a liberal American Jew would see in a Judaism that defines itself as it has for the past 50 years as defending Israel and remembering the Holocaust.


The post What American Jews fight about when they fight about Israel 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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