Yom Kippur Fast: Who Should Avoid Fasting and How to Manage Medications
As Yom Kippur, the Day of Atonement, begins on the evening of September 20th in Israel, many will observe the traditional 25-hour fast from food and water. However, certain individuals are strongly advised against fasting to avoid serious health risks, according to Israeli physician Itai Gal.
Individuals with chronic conditions such as hypertension, heart failure, diabetes, ischemic heart disease, kidney failure, and malignant tumors are generally not recommended to fast. The prolonged abstinence from food and water can lead to life-threatening complications including severe drops in blood pressure and sugar levels, electrolyte imbalances, arrhythmias, and impaired cerebral circulation.
Patients on diuretic medications must not interrupt their treatment without consulting their doctor. If a temporary cessation is planned for the fast, medical advice is crucial on how to manage medication and food intake before and after the fasting period. Similarly, those undergoing antibiotic treatment for life-threatening conditions should not interrupt it. For less severe infections, consultation with a physician is necessary to adjust medication schedules.
For those taking birth control pills, the schedule can typically be maintained by taking the last pill before the fast and the next one after it concludes. Psychiatric patients are also advised against interrupting their medication due to potential life-threatening risks, and any fasting plans should be discussed with their doctor.
In some cases, a partial fast may be recommended. For instance, individuals with inflammatory bowel disease might need to drink water periodically. The necessity of taking certain medications with water or food requires medical consultation to determine if pills can be swallowed without water or if water is mandatory.
Diabetics' ability to fast is now assessed individually, with doctors adjusting treatment plans accordingly. Migraine sufferers may experience headaches due to dehydration during the fast, similar to migraine symptoms. Pain relievers are recommended, and consultation with a doctor about medications like Arcoxia, an arthritis drug that may prevent headaches, is advised. Some medications, if they irritate the stomach lining, can be taken as suppositories.
Healthy pregnant women may fast if they are not anemic, weak, or dehydrated. However, those with complicated pregnancies should not fast and must consult their gynecologist. If dizziness, nausea, fainting, or vomiting occur during the fast, pregnant women should immediately drink small amounts of sweetened water. Staying home in an air-conditioned environment is preferable to attending synagogue.
Breastfeeding mothers, especially those whose infants rely solely on breast milk, are advised not to fast. Maintaining hydration is important to ensure milk production. If the baby also consumes solid food, fasting is possible, but staying in a cool environment and avoiding physical exertion is recommended. All breastfeeding mothers should consult their doctor.
Women undergoing fertility treatments with daily injections will have these administered by emergency medical personnel. Arrangements must be made in advance by calling 101, bringing the medication, and a doctor's note specifying the dosage and administration details. The paramedics will administer the injection if the woman has received at least one previous dose of the same medication.
Dehydration, a serious condition that can impair bodily functions and contribute to kidney stones, is a risk of fasting. Symptoms include weakness, drowsiness, headache, blurred vision, lack of urination for over 10 hours, nausea, vomiting, loss of consciousness, and seizures. Young children, pregnant women, and the elderly are at higher risk. Spending most of the time in an air-conditioned environment can mitigate dehydration risk. Emergency services should be called if dehydration is suspected.
In urgent situations, emergency services can be reached at 101. For non-urgent needs, central emergency aid stations (MARAM) will operate on a Saturday schedule. Chronic patients should ensure they have an adequate supply of medications, and a stock of over-the-counter drugs like fever reducers and painkillers is advisable. Information on on-call pharmacies can be found on local municipal websites.
