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American Jews created historic summer camps. Or did summer camps create American Jews?

(JTA) — Among Sandra Fox’s most memorable finds during her years mining American archives for materials about Jewish summer camps was a series of letters about the hours before lights-out.

The letters were by counselors who were documenting an unusual window in the day when they stopped supervising campers, leaving the teens instead to their own devices, which sometimes included romance and sexual exploration.

“It was each division talking about how they dealt with that free time before bed in ‘age-appropriate ways,’” Fox recalled about the letters written by counselors at Camp Ramah in Wisconsin, the original iteration of the Conservative movement’s network of summer camps.

“I’ve spoken to Christian people who work at Christian camps and have researched Christian camps. There is no free time before bed,” Fox told the Jewish Telegraphic Agency. “That’s not a thing if you don’t want kids to hook up. So it was just amazing to find these documents of Camp Ramah leaders really having the conversation explicitly. Most of the romance and sexuality stuff is implicit in the archives.”

The letters are quoted extensively in Fox’s new book, “The Jews of Summer: Summer Camp and Jewish Culture in Postwar America.” Fox, who earned a PhD in history from New York University in 2018 and now teaches and directs the Archive of the American Jewish Left there, tells the story of American Judaism’s most immersive laboratory for constructing identity and contesting values.

Next week, Fox is launching the book with an event at Congregation Beth Elohim in Park Slope, Brooklyn. (Tickets for the Feb. 23 event are available here.) Attendees will be able to tour adult versions of some of the most durable elements of Jewish summer camps, from Israeli dance to Yiddish and Hebrew instruction to Color Wars to Tisha B’Av, the mournful holiday that always falls over the summer.

“I never considered doing a normal book party,” Fox said. “It was always really obvious to me that a book about experiential Jewish education and role play should be celebrated and launched out into the world through experiential education and role play.”

Sandra Fox’s 2023 book “The Jews of Summer,” looks at the history of American Jewish summer camps. (Courtesy of Fox)

We spoke to Fox about her party plans, how Jewish summer camps have changed over time and how they’ve stayed the same, and the cultural history of that before-bed free time.

This interview has been condensed and lightly edited for clarity. We’ll be continuing the conversation in a virtual chat through the YIVO Institute for Jewish Research Feb. 27 at 1 p.m.; register here.

Jewish Telegraphic Agency: Given how much Jews like to talk about camp, were you surprised that this book hadn’t already been written?

Sandra Fox: There’s been a lot of fruitful research on the history of various camps, but it’s usually been focused on one camping movement or one camp type. So there are articles about Zionist camps. There are certainly articles out there about the Ramah camps. A lot of camps have produced books — either their alumni associations or a scholar who went to let’s say, Reform movement camps have created essay collections about those camps. And there are also books about Habonim and other Zionist youth movements.

I don’t really know why this is the first stab at this kind of cross-comparison. It might be that people didn’t think there would be so much to compare. I think the overwhelming feeling I get from readers so far, people who preordered and gotten their books early, is that they’re very surprised to hear how similar these camps are. So perhaps it’s that scholars weren’t thinking about Jewish summer camps that came from such diverse standpoints as having something enough in common to write about them all at once.

Also distance from the time period really helps. You can write a book about — and people do write a book about — the ’60s and ’70s and have been for decades, but there’s a certain amount of distance from the period that has allowed me to do this, I think, and maybe it also helps that I’m generationally removed. A lot of the scholars who’ve worked on camps in the postwar period went to camps in the postwar period. It makes a lot of sense that it would be harder to write this sort of sweeping thing perhaps. The fact that I’m a millennial meant that I could write about the postwar period — and also write kind of an epilogue-style chapter that catches us up to the present.

What’s clear is that there’s something amazing about studying summer camp, a completely immersive 24/7 experience that parents send children away for. There’s no better setting for thinking about how adults project their anxieties and desires about the future onto children. There’s also no place better to think about power dynamics and age and generational tension.

I was definitely struck by the “sameyness” of Jewish camps in your accounting. What do you think we can learn from that, either about camps or about us as Jews?

I do want to say that while there’s a lot of sameyness, whenever you do a comparative study, there’s a risk of kind of collapsing all these things and making them seem too similar. What I’m trying to convey is that the camp leaders from a variety of movements took the basic structure of the summer camp as we know it — its daily schedule, its environment, its activities — and it did look similar from camp to camp, at least on that surface level.

If you look at the daily schedules in comparison, they might have a lot of the same features but they’ll be called slightly different things depending on if the camp leans more heavily towards Hebrew, or Yiddish, or English. But the content within those schedules would be rather different. It’s more that the skeletal structure of camp life has a lot of similarities across the board and then the details within each section of the day or the month had a lot of differences.

But I think what it says is that in the postwar period, the anxieties that Jewish leaders had about the future of Judaism are really, really similar and the solution that they found within the summer camp, they were pretty unanimous about. They just then took the model and inserted within it their particular nationalistic, linguistic or religious perspectives. So I think more so than saying anything about American Jewry, it shows kind of how flexible camping is. And that’s not just the Jewish story. Lots of different Americans have embraced summer camping in different ways.

So many people who have gone to camp have a fixed memory of what camp is like, where it’s caught in time, but you argue that camps have actually undergone lots of change. What are the most striking changes you documented, perhaps ones that might have been hard for even insiders to discern as they happened?

First of all, the Israel-centeredness of American Jewish education as we know it today didn’t happen overnight in 1948, for instance. It was a slower process, beyond the Zionist movements where that was already going on, for decades before 1948. Ramah and the Reform camps for instance took their time towards getting to the heavily Zionist-imbued curricula that we know.

There was considerable confusion and ambivalence at first about what to do with Israel: whether to raise an Israeli flag, not because they were anti-Zionist, but because American Jews had been thinking about proving their loyalty to America for many generations. There were some sources that would talk about — what kind of right do American Jews have to raise the Israeli flag when they’re not Israeli? So that kind of Israel-centeredness that is really a feature of camp life today was a slower process than we might think.

It fit camp life really well because broader American camps used Native American symbols, in some ways that are problematic today, to create what we know of as an iconography of camp life. So for Jews, Israel and its iconography, or Palestine and iconography before ’48, provided an alternative set of options that were read as Jewish, but it still took some time to get to where we are now in terms of the Israel focus.

One of the reasons I place emphasis on the Yiddish summer camps is to show that in the early 20th century and the mid-20th century there was more ideological diversity in the Jewish camping sphere, including various forms of Yiddishist groups and socialist groups and communist groups that operated summer camps. Most of them have closed, and their decline is obviously a change that tells a story of how American Jewry changed over the course of the postwar period. Their legacy is important, too: I have made the argument that these camps in a lot of ways modeled the idea of Yiddish as having a future in America.

What about hookup culture? Contemporary discourse about Jewish camps have focused on sex and sexuality there. What did you observe about this in the archives?

I think people think of the hookup culture of Jewish camps today and certainly in my time in the ’90s and 2000s as a permanent feature, and in some ways I found through my research and oral history interviews that that was the case, but it was really interesting to zoom out a little bit and think about how Jewish summer camps changed in terms of sexual romantic culture, in relationship to how America changed with the sexual revolution and the youth culture.

It’s not it’s not useful to think about Jewish hookup culture in a vacuum. It’s happening within America more broadly. And so of course, it’s changed dramatically over time. And one of the things I learned that was so fascinating is that Jewish summer camps were actually their leaders were less concerned in a lot of ways about sexuality at camp in the ’40s and ’50s, than they were in the late ’60s and ’70s. Because earlier premarital sex was pretty rare, at least in the teenage years, so they were not that concerned about what happened after lights out because they kind of assumed whatever was going on was fairly innocent.

In the late 1960s and 1970s, that’s when camps have to actually think about how to balance allowance and control. They want to allow campers to have these relationships, to have their first sexual experiences, and part of that is related to rising rates of intermarriage and wanting to encourage love between Jews, but they also want to control it because there’s a broader societal moment in which the sexuality of teenagers is problematized and their and their sexual culture is more public.

There’s been a real wave of sustained criticism by former campers about the cultures that they experienced, arguing that the camps created an inappropriately sexualized and unsafe space. There’s been a lot of reaction to that and the broader #MeToo moment. I’m curious about what you can speculate about a future where that space is cleaned up, based on your historical research — what is gained and what, potentially, could be lost?

Without being involved in camping today — and I want to really make that disclaimer because I know a lot of change is happening and lot of organizations are involved to talk about this issue better, to train camps and camp leaders and their counselors to not create a pressured environment for camper — I think what the history shows is that this hookup culture did not come about out of nowhere. It was partly related to the broader changes in America and the sexual revolution.

But it was also partly created because camps really needed to have campers’ buy-in, in order to be “successful.” A huge argument of my book is that we think about the power of camps as if camp directors have campers as, like, puppets on strings, and that what they do is what happens in camp life. But actually, campers have changed the everyday texture of life at camp over the course of the decades in so many different ways by resisting various ideas or just not being interested.

So hookup culture is also part of making campers feel like they have freedom at camp and that’s essential. That’s not a side project — that is essential to their ability to get campers to come back. It’s a financial need, and it’s an ideological need. If you make campers feel like they have freedom, then they will feel like they freely took on the ideologies your camp is promoting in a really natural way.

The last part of it is rising rates of intermarriage. As rates of intermarriage rose in the second half of the 20th century, there’s no doubt in my mind from doing the research that the preexisting culture around sexuality at camp and romance at camp got turbo-boosted [to facilitate relationships that could potentially lead to marriage between two Jews]. At that point, the allowance and control that camp leaders were trying to create for many decades leans maybe more heavily towards allowance.

There are positives to camp environments being a place where campers can explore their sexualities. There’s definitely a lot of conversation about the negative effects and those are all very, very real. I know people who went through horrible things at a camp and I also know people who experienced it as a very sex-positive atmosphere. I know people in my age range who were able to discover that they were gay or lesbian at camp in safety in comparison to home, so it’s not black and white at all. I hope that my chapter on romance and sexuality can maybe add some historical nuance to the conversation and give people a sense of how this actually happened. Because it happened for a whole bunch of reasons.

I think there’s a consensus view that camp is one of the most “successful” things the Jews do. But it’s hard to see where lessons from camp or camp culture are being imported to the rest of Jewish life. I’m curious what you see as kind of the lessons that Jewish institutions or Jewish communities have taken from camp — or have they not done that?

Every single public engagement I do about my work has boiled down to the question of, well, does it work? Does camp work? Is it successful? And that’s been a question that a lot of social scientists have been interested in. I don’t want to oversimplify that research, but a lot of the ways that they’ve measured success have been things that are not necessarily a given to all Jews as obviously the right way to be a Jew. So, for instance, in the ’90s and early 2000s, at the very least, a lot of research was about how, you know, “XYZ” camp and youth movement were successfully curbing intermarriage. A lot of them also asked campers and former campers how they feel about Israel, and it’s always if they are supportive of Israel in very normative ways, right, giving money visiting, supporting Israel or lobbying for its behalf — then camps have been successful.

I’m not interested in whether camps were successful by those metrics. I’m interested in how we got to the idea that camp should be successful in those ways in the first place. How did we get to those kinds of normative assumptions of like, this is a good Jew; a good Jew marries a Jew; a good Jew supports Israel, no matter what. So what I wanted to do is zoom out from that question of success and show how camp actually functions.

And then the question of “does it work” is really up to the reader. To people who believe that curbing intermarriage is the most important thing, then camps have been somewhat successful in the sense that people who go to these heavily educational camps are less likely to marry out of the faith.

But I am more interested in what actually happened at camp. And in terms of their legacies, I wanted to show how they changed various aspects of American Jewish life, and religion and politics. So I was really able to find how camping was essential in making kind of an Israel-centered Jewish education the norm. I was also able to draw a line between these Yiddish camps over the ’60s and ’70s that closed in the ’80s and contemporary Yiddish. The question of success is a real tricky and political one in a way that a lot of people have not talked about.

And is camp also fun? Because you’re creating a camp experience for your book launch next week.

Camp is fun — for a lot of people. Camp was not fun for everyone. And so I do want to play with that ambivalence at the party, and acknowledge that and also acknowledge that some people loved camp when they were younger and have mixed feelings about it now.

The party is not really a celebration of Jewish summer camp. People will be drinking and having fun and dancing — but I want them to be thinking while also about what is going on and why. How is Tisha B’Av [the fast day that commemorates the destruction of the ancient Jewish temple in Jerusalem that falls at the height of summer] commemorated at camp, for example?

Or what songs are we singing and what do they mean? I think a lot of people when they’re little kids, they learn songs in these Jewish summer camps that they can’t understand and later they maybe learn Hebrew and go, whoa, we were singing what?! My example from Zionist summer camp is singing “Ein Li Eretz Acheret,” or “I Have No Other Country.” We were in America and we obviously have another country! I don’t think anyone in my youth movement actually believes the words “Ein Li Eretz Acheret” because we live in America and people tend to kind of like living in America and most of them do not move to Israel.

So at the party we’ll be working through the fun of it, and at the same time the confusion of it and the ambivalence of it. I want it to be fun, and I also want it to be something that causes people to think.


The post American Jews created historic summer camps. Or did summer camps create American Jews? 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.

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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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