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Hereditary cancers aren’t just a women’s problem. Jewish men need to take precautions too.

Bill Harris, a veteran Los Angeles photojournalist, didn’t think much of it when one morning in 2012 he woke up and found a tiny blood spot on the T-shirt he’d slept in. The next morning, he found blood in the same place on his chest — and went straight to his computer.

“Online, I could find only three things that would cause a man’s nipple to discharge blood: being an avid runner, which I wasn’t; having a subtropical fungus, which I didn’t; and breast cancer,” he said. “That was a pretty big shock.”

Harris, then just a few weeks shy of his 61st birthday, immediately called his doctor, who ordered a mammogram and ultrasound. They confirmed a cancerous growth in his right breast. Ten days later, a biopsy came back positive. The next month Harris got a right mastectomy, followed by the removal of his left breast half a year later.

“I walked into a woman’s imaging center and had to get into a pink paper robe,” he recalled. “All the women in the waiting room were staring at me.”

Like many other Ashkenazi men, Harris never had considered that he might have been born with a harmful mutation of the BRCA gene, which elevates the risk not only of breast cancer, but also of melanoma and prostate, ovarian and pancreatic cancer.

“Hundreds of other mutations in the BRCA gene are just as dangerous, but they’re not specific to Ashkenazim,” said Dr. Robert Sidlow, director of the Male BRCA Genetic Risk Program at New York’s Memorial Sloan Kettering Cancer Center. About 1 in 40 Ashkenazi Jews (those of Eastern European descent) carries the harmful mutation, compared to about 1 in 400 in the general population.

“The vast majority of patients I see are relatives of women who have breast or ovarian cancer and then get tested,” he said. Of BRCA mutation carriers, Sidlow added, “Most men are pretty happy to enroll in some kind of surveillance program once they get over the initial shock.”

Sidlow is on the Men’s Leadership Council at Sharsheret, the national Jewish nonprofit organization that educates the community about cancer risks and supports those with breast cancer and ovarian cancer.

Elana Silber, CEO of Sharsheret (Hebrew for “chain”), says it’s crucial that men with a family history of cancer undergo genetic counseling screening for BRCA and other hereditary cancer mutations.

Genetic testing is possible via a standard blood or saliva sample.

While Sharsheret is primarily considered a women’s organization, it has been using November — nicknamed Movember for its focus on men’s health — for an awareness campaign focused on Jewish men’s cancer risks.

“This is not only a women’s issue,” Silber said. “Family history is so important. When a man shares his family history with his doctor, he may not realize that he should mention that his mother had breast cancer or that his sister had ovarian cancer, as these are not generally ‘men’s diseases.’ They are not aware that these cancers could mean that they themselves are at increased risk for cancer and that they can pass on these mutations to the next generation – their daughters and their sons.”

If someone discovers he (or she) is a carrier of one of the genetic mutations with elevated cancer risks — not just BRCA but also such mutations as ATM, TP53, CHEK2, and PALB2 — there are various precautions they can take for themselves and their children. They can monitor their own health more closely, they can get encourage their children to test to see if they are carriers and, for any future children, take steps to prevent the mutated genes from being passed down.

For example, couples can conceive via in vitro fertilization, or IVF, and then test the embryos before implantation to ensure that only those unaffected by the genetic mutation are implanted.

While most women are aware of the risks of breast cancer, men generally are not — even though the disease strikes 2,500 men in the U.S. every year and kills about 500 of them, according to Sidlow. About 1-2% of men with the BRCA1 mutation and 6-7% of men with the BRCA2 mutation will develop cancer by age 80.

“This is why we recommend periodic mammograms starting at about age 50 for men who carry a BRCA2 mutation,” Sidlow said. “We like to educate these men on how to check their chests once a month and have a clinician do a breast checkup on them once a year.”

Since the BRCA1 and BRCA2 mutations also make prostate cancer more likely, men with either mutation should get PSA (prostate-specific antigen) levels in their blood tested annually beginning at age 40, rather than 50, the age at which screening generally begins, Sidlow said.

Sharsheret has been promoting the importance of learning one’s family history, genetic counseling and screening among both men and women. The 20-year-old organization also runs various peer support networks, offers financial assistance to cancer patients, provides mental health counseling and guidance to patients, caregivers, and their friends, and seeks to educate the broader Jewish community about cancer risks and support.

Peggy Cottrell, a certified genetic counselor at Sharsheret, said men in general are more reluctant to get regular checkups than women.

Ashkenazi Jewish men are at elevated risk not just of breast and prostate cancer but also of pancreatic cancer. Pancreatic cancer is particularly difficult because it’s tough to detect early enough and hard to treat. The five-year survival rate is only 11%. About 2% of BRCA1 carriers and 4% of BRCA2 carriers will develop pancreatic cancer, Sidlow estimated.

“Usually by the time pancreas cancer is clinically detected it has already spread microscopically to the liver,” Sidlow said. “But pancreas cancer is potentially curable if caught when the tumor is extremely small.”

Even among those with elevated risks, certain behaviors can improve one’s odds, such as avoiding obesity, smoking and excessive alcohol consumption.

Harris, the California photojournalist, is still fighting at age 71. While he overcame breast cancer 10 years ago, last year he was diagnosed with ampullary cancer, a rare disease related to his BRCA2 status that was discovered thanks to his participation in a UCLA study. Surgeons have removed his gall bladder, half his pancreas and part of his small intestine, and he has had to endure eight rounds of chemotherapy.

“I’m still working through the aftereffects of the chemo. I have to eat smaller quantities than before and take enzymes to supplement my digestive processes,” Harris said.

Meanwhile, his 37-year-old son discovered that he, too, carries the BRCA2 mutation, and he had a double prophylactic mastectomy and reconstruction at age 30 — just to be on the safe side.

“If there’s any history of breast, ovarian or prostate cancer in your family, get tested genetically so that you’re informed,” Harris advised. “Diagnoses happen way too late for men, and the danger is too big.”


The post Hereditary cancers aren’t just a women’s problem. Jewish men need to take precautions too. appeared first on Jewish Telegraphic Agency.

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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.

The post Sacred fasting meets Ozempic appeared first on The Forward.

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A comedian went viral for saying he supports Israel onstage — he wasn’t even there

Menachem Silverstein’s High Holidays were interrupted by what he calls a beautifully ironic “monkey paw situation.”

“Like any good Jewish comedian, I’m in Rosh Hashanah services praying to God for a little bit of a boost in my career, for something to go viral, for something to hit,” Silverstein, a 30-year-old comic in Los Angeles, told me. “I turn my phone after hag. I have about 40-plus messages from people being like, ‘What the hell’s happening? Is this you?’”

Friends were sending him links to a video of a crowd leaving a theater in the middle of a standup set. The caption overlaid on the clip said, in English and Arabic, “audience walks out after comedian backs Israel.” On an X post with more than 2 million views, an account named “Truthseeker” identified the comic as Silverstein.

Silverstein knew immediately the video was of the Laugh Factory in Chicago, a venue he last played this summer. He had no memory of the crowd walking out — a traumatic experience for any standup. In fact, as he took a closer look at the video, he realized it wasn’t even him onstage.

“My most viral thing was not showing up to a comedy club, which is hilarious in itself,” said Silverstein, who estimates across platforms the clip has been seen more than 10 million times. “If I would have known, I would have missed more shows.”

By the time Silverstein was clued into his virality, it was too late to contain the disinformation.

Alex Jones picked the clip up, commenting, “It’s got one guy in a yarmulke. He literally says, ‘If you don’t support what Israel is doing in this war, leave.’”

No such statement is made in the clip. There’s no guy in a yarmulke, only a man in a dark t-shirt who appears to be blindfolded. This didn’t stop news outlets like Palestine Chronicle and the 1.1 million follower Global Reports Instagram account from running with the story.

Someone captioned the original clip — now deleted — indicating the comedian stated their support for Israel, leading to a mass exodus. From there, Truthseeker identified Silverstein as the comic, based, Silverstein believes, on a joke he retired about three years ago.

“Basically, the joke was, ‘Hi, my name is Menachem. I stand with Israel. It’s not political; they’re just the only people that can pronounce my name.’”

Grok and other AI models reinforced the claim that Silverstein was the person in the clip. But the real reason for everyone leaving their seats was something much less loaded: a prank.

David Fuhrer, president of the Laugh Factory said, based on an account confirmed by the Chicago Laugh Factory’s head of operations, that the video was from a Sept. 10 performance of a regular show called “What Could Go Wrong?,” in which practical jokes are played on comics.

“In this particular case, we had a comedian named Kieron Harrell and we blindfolded him and put headphones on him,” Fuhrer said. “They walked the entire audience out into the lobby as a joke so he had an empty room he was performing to.”

Fuhrer said it had “nothing to do with antisemitism or people walking out on Menachem.” He doesn’t know who repurposed the video, only that it had gone viral.

“It’s a shame because he’s a wonderful person and a great performer and a part of our family here.”

If you go to the “What Could Go Wrong?” Instagram, you’ll see a better image of the real comic, Harrell, who looks nothing like Silverstein.

A better look at the comic from the clip. Screenshot Instagram

Daniel Cassilagio, who produces “What Could Go Wrong,” captioned the images of the performer, saying the show was “so good that it was used as a geo political [sic] disinformation campaign.”

Cassilagio wrote on Instagram that the clip was recorded, uploaded without the producers’ knowledge and “then virally shared by what are most likely bots from China.”

People who don’t check their sources have “been harassing both the comic that was on stage, and a comic from LA who I’ve never even heard about or met,” Cassilagio wrote on a post that, judging by its 166 likes, has far less visibility than the fake account. “He wasn’t even in Chicago at the time.”

Silverstein told me that, while he added around 200 followers, he’s been inundated with hateful comments and his reach has dropped as people have been reporting his account. If you search his name now, the top hits are for his nonexistent scandal. When he’s looking to play clubs, he’s concerned that bookers will see he “walked a crowd” and deny him a slot.

Beyond the made-up controversy, there’s not much about geopolitics in Silverstein’s act. His material includes jokes on fatherhood, being 5’9” (“a Jewish 6’2”) and some well-deserved ribbing of Kanye West. In videos, he can be seen circumcising a baby carrot.

In an age when performers like Macklemore and Jerry Seinfeld have been canceled for their views on Israel and Palestinians, Silverstein sees a new frontier in his experience.

“It used to be you watch a podcast or watch a stand-up clip, clip someone out of context, post it, and get them canceled,” he said. “Now they’re getting away with just posting a random thing, putting your name on it, and then people believe it.”

The post A comedian went viral for saying he supports Israel onstage — he wasn’t even there appeared first on The Forward.

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‘Run, hide, fight’: Synagogues make threat preparedness part of High Holiday services

Rabbi Yosef Kanefsky plans to open his Yom Kippur sermon this year in an unusual way: with an emergency evacuation plan.

It’s how he opened his Rosh Hashanah sermon, too.

“I mentioned [that] people should understand where the exits are,” Kanefsky said. “I mentioned what our plan is, God forbid, if we need to evacuate the children in the youth program — that we have volunteers for that.”

Kanefsky, senior rabbi at B’nai David-Judea Congregation in Los Angeles, acknowledged that the reminder to prepare for the worst could be “potentially a little bit jarring” on the holiest days of the year. But with synagogues on heightened alert, he said, it felt unfortunately necessary.

“It’s just part of our lives right now,” he said. “That extra measure of vigilance.”

Extra security measures at synagogues are nothing new. Since the 2018 shooting that killed 11 worshippers at Pittsburgh’s Tree of Life synagogue, Jewish institutions have invested heavily in infrastructure, personnel and training to counter the threat of violence. But this High Holiday season, several synagogues are taking the unusual step of integrating emergency preparedness into the services themselves, whether through verbal instructions like Kanefsky’s or written plans handed out alongside prayer books.

A flyer distributed at Beth Tzedec Congregation in Toronto outlines a three-point plan in the event of an attack: Run, hide or — as a last resort — “Be prepared to defend yourself.”

“Remember: Your actions before police arrive may save your life,” it reads in all-caps.

In August, the Jewish nonprofit Secure Community Network released a safety card that synagogues can customize with their own evacuation maps then place in their pews. While a range of scenarios could prompt a building evacuation, like a fire or earthquake, the card focuses on reacting to an attack.

It includes instructions for how to make a tourniquet to stop bleeding and tips for fleeing or fighting “the shooter.”

And at Congregation Emanu-El in San Francisco, a flyer advising congregants to run, hide, or fight in the event of an attack was placed on every other seatback during Rosh Hashanah.

“It brought home the potential dangers in a way I hadn’t seen before,” Frances Dinkelspiel, a member of Congregation Emanu-El, told the Forward. “You’re going in for services. You’re opening your heart. There’s a sense of community. You’re embracing one another. And then there’s this piece of paper that’s reminding you: Don’t relax too much.”

Kanefsky said he felt a responsibility to his congregation to provide safety instructions, noting that the High Holidays may attract out-of-town visitors unfamiliar with the building.

But he also acknowledged that such warnings “can take away from the spiritual mood that we’re working so hard on building,” he said.

Kanefsky said he tried to make the announcement as unobtrusive as possible — giving the instructions in what he called “a spiritual and emotional envelope” by thanking the synagogue’s security team and framing preparedness as “part of the devotion to one another and our devotion to God.”

Michael Masters, Secure Community Network’s CEO, said the High Holidays present an elevated security risk at synagogues compared with other times of year. Even basic preparedness measures, like knowing where the exits are, can make a meaningful difference in a threat situation, he said.

He cited the ramming attack on Temple Israel in West Bloomfield, Michigan, in March as a prominent recent example. Seconds after the assailant drove a truck filled with explosives through a building entrance, a security guard opened fire on the vehicle; after the vehicle caught fire, the campus was safely evacuated.

“The guard was there, and he was well trained, and he did an amazing job, as did law enforcement,” Masters said. “But the faculty and the staff and the students were all trained as well.”

Dinkelspiel emphasized that she feels safe at her synagogue, which has a modern security system and bollards around the sidewalk to prevent cars from driving onto the property. But that sense of safety, she said, was part of what made the flyer so unnerving.

“After all these security measures the congregation has,” Dinkelspiel said, “there was still this reminder on this flimsy piece of paper that Jews can be attacked at any time.”

The post ‘Run, hide, fight’: Synagogues make threat preparedness part of High Holiday services appeared first on The Forward.

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