Jewish Diabetes and The Segal Guide to Fasting on Yom Kippur
By: Michael M. Segal, MD, PhD
Each year on Yom Kippur, Jews wish each other a Chatima tova a good seal in the Book of Life and tolerable fast. The route to a Chatima tova is beyond the scope of this article the route to an easy fast is simpler to describe. The following are the essentials of human physiology that will help you have a tolerable fast on Yom Kippur:
Avoid getting thirsty:
Most people think the difficulty about fasting is feeling hungry.  However, avoiding thirst is much more important for how you feel. Not only do you avoid the discomfort of thirst but you are also well hydrated and swallow frequently, so your stomach does not feel as empty.
One important way to remain well hydrated is to avoid drinks or foods that cause your body to get rid of water. Such foods and drinks include alcohol, tea, caffeinated coffee and chocolate. Another important rule is to avoid consuming much salt. Salt causes a person to feel thirsty despite having a normal amount of water, because extra water is needed for the extra salt. For this reason, you should avoid processed foods containing lots of salt such as pickles, cold cuts, or cheese.  Most tomato sauces, canned fish and smoked fish have a lot of added salt. Since Kosher meat has a high salt content it may be best to choose a main course such as fresh fish, canned no-salt tuna fish or a de-salted meat such as boiled chicken.
By avoiding these types of foods and drinks in the several hours before a fast, you can avoid either losing water or needing extra water. Other actions that cause the body to lose water, such as perspiring in warm clothing, should also be avoided during the fast.
Do not start the pre-fast meal on a full stomach:
The pre-fast meal often begins at around 5-6 PM, depending on where you live, so a large lunch could prevent you from eating enough immediately before the fast. It is best to have a small lunch, or no lunch at all. A large breakfast early in the day based on cereals, breads and fruits can provide the energy you need during the day, yet these high-fiber foods will be far downstream by the time of the pre-fast meal and will not keep you from eating enough food at the pre-fast meal. A large breakfast is also helpful because it stretches the stomach. After eating breakfast, it is best to consume beverages during the day. This will not fill you up, since liquids are absorbed quickly, and this will ensure that you have absorbed enough fluids during the day to start the pre-fast meal being well hydrated. Be sure to avoid beverages with alcohol or caffeine. You should also drink at least a glass or two of fluids with the pre-fast meal because many foods need extra water to be digested properly.
Eat foods that are digested slowly:
Include some foods high in oils and fats in the pre-fast meal, since such foods delay emptying of the stomach and effectively prolong your meal. However, beware of fatty meats or salted potato chips that could load you up with too much salt. Salads and other high fiber foods that are so important in
One's normal diet should be de-emphasized for the pre-fast meal since they travel quickly through the digestive system. Fruit, despite its high fiber content, is worthwhile since it carries a lot of water in a time-release form.
Try to avoid getting a headache:
Withdrawing from caffeine produces a headache in people who drink several cups of coffee a day. If you consume this much caffeine in coffee or other foods or drinks you should prepare yourself for the caffeine-free period by reducing or eliminating caffeine from your diet in the days or weeks before Yom Kippur. Don't try to get through the fast by drinking coffee right before Kol Nidre, since this will cause you to lose a lot of water.
Make the meal tasty enough so people will eat:
The pre-fast meal does not have be bland. Spices such as lemon or herbs are fine for fasting, but salt and monosodium glutamate should be reduced as much as possible.
Do not do a complete fast if you have certain medical problems:
People with medical conditions such as diabetes should consult their doctors and rabbis before fasting. Certain medications need to be taken during Yom Kippur, and it is important to swallow them with enough water to avoid pills getting stuck on the way to the stomach and damaging the esophagus. Fasting by women who are pregnant or nursing can also be dangerous. If a young person who has not fasted much before has unusual difficulty fasting you should discuss this with your doctor since this happens in some serious  href=http://www.genereviews.org/query?dz=mcad>metabolic problems in which fasting can be very dangerous.
Do not eat improperly after the fast is over:
Even people who have prepared well for fasting will be hungry after Neila last prayer of the holiday. Be sure not to eat food too quickly at the post-fast meal. Begin the break-fast meal with several glasses of water and or small amounts of milk or juice: these put sugar into the bloodstream and occupy space in the stomach, discouraging you from eating too rapidly. Also, be careful about eating high salt foods such as lox, since you will still be a little dehydrated and will need to drink a lot of fluids to avoid waking up extremely thirsty in the early morning hours. If you take vitamin C, be sure that you are fully re-hydrated beforehand, because one of the vitamin's breakdown products can precipitate out in your urine if you are dehydrated, causing kidney stones, which are painful and dangerous.
An earlier version of this article appeared in the  href=http://www.thejewishadvocate.com/>Jewish Advocate Boston, USA in 1989. Copyright  1989 - 2011 Michael M. Segal, MD, PhD. This document may be reproduced freely on a non-profit basis, including electronically, during 2009 as long as the source at  href=http://www.segal.org/kippur/>www.segal.org/kippur/ is indicated and this copyright notice is included.
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