Danger: Mothers Who Fast While Pregnant or Breastfeeding Have the Highest Rate of Mentally Retarded Children


Dr. Zvi Shkedi

Summary

Fasting during pregnancy causes a rapid fall of blood sugar levels, much faster than in women who are not pregnant. When the blood sugar level drops, the only other source of energy available to the brain is ketones (a family of chemicals which includes acetone). Every person's body-fat stores toxins consumed by the person. Fasting increases body fat metabolism in the mother which produces ketones and releases the stored toxins into the blood. Ketones and toxins adversely affect fetal development, can cause brain damage and mental retardation, and lower the IQ of the baby.

The Shulchan Aruch  states that healthy pregnant mothers must fast. In the olden days people did not consume the toxic chemicals which are prevalent today (mostly: pesticides, preservatives, artificial colors and flavors, and air-pollution), so there was no release of toxins during fasting. In the olden days there was also no refined sugar. Refined sugar came into our life from America - many years after the Sulchan Aruch was written. The consumption of refined sugar changes the body metabolism and reduces the ability to retain the necessary blood sugar level for the duration of a full-day fast. This reduced ability to retain the blood sugar level is what causes the production of the brain-damaging ketones.

Shaarei Tzedek hospital in Jerusalem reported that on the 9th and 10th of Av the number of miscarriages and premature deliveries is double the number on a regular day. This is caused solely by pregnant women not drinking during the fast, thus killing or injuring their babies.

Rabbi Yisroel Fisher (the head of the ultra-religious Eida HaCharedit in Jerusalem), Rabbi Halberstam (a member of the Eida HaCharedit in Jerusalem and an expert in the subject of medicine and Hallacha), and Rabbi Brandsdorfer (a member of the Badatz Eidah HaCharedit and an expert in the Hallachot related to women health) have ruled that ALL pregnant women who fast are at a risk much greater than the Hallachic threshold of 1 in 1000 even without a personal risk factor. (The actual statistical risk of miscarriage is higher than 10 in 1000 and the statistical risk of mental retardation is also higher than 10 in 1000.) Therefore, they ruled that ALL pregnant women MUST eat and drink in small amounts, even on Yom Kippur, to avoid any possible risk to the babies.

Great Rabbis were asked how can they be so lax on the obligation to fast on Yom Kippur.  "I am not lax at all" they responded. "On the contrary, I am very stringent - stringent about the obligation to protect the health and safety of the babies."

Some women say: "I fasted and nothing happened to my baby". Such a statement demonstrates a lack of understanding of risk and probability. To better understand the risk, let's use the analogy of playing Russian Roulette. Russian Roulette is a potentially lethal game of chance in which participants place a single bullet in a revolver, spin the cylinder, point the revolver to their head and pull the trigger. Most of the time nothing happens. But, occasionally the bullet gets correctly aligned and then... 

Some pregnant women who fast on Yom Kippur or on the 9th of Av get through with no harm. Others arrive at the hospital for a miscarriage, and others end up with a lower IQ, mentally-retarded, or brain-damaged child. Would you play Russian Roulette on your baby?



תקציר בעברית        Summary in Hebrew

סכנה: לנשים שצמות בהריון או בהנקה יש האחוז הגבוה ביותר של ילדים מפגרים.

צום בהריון גורם לנפילה מהירה של רמת הסוכר בדם. כשרמת הסוכר נופלת, הגוף מפרק שומנים ויוצר קטונים  (קבוצת כימיקלים שכוללת גם אצטון). פרוק השומנים משחרר גם חומרים רעילים לזרם הדם. כשהקטונים והרעלים מגיעים אל מוח התינוק הם גורמים למוח נזק בלתי הפיך שמוביל לירידה ברמת המשכל ולפעמים גם לפיגור שכלי.

בשלחן ערוך כתוב שנשים בריאות בהריון חיבות לצום. בימי קדם האוכל שלנו לא הכיל חומרים רעילים (בעיקר חומרי ריסוס נגד חרקים, חומרי שמור מזון, צבעים וחומרי טעם מלאכותיים, וזיהום אויר). בימי קדם גם לא אכלו סוכר לבן. הסוכר הלבן הגיע אלינו מאמריקה, אחרי כתיבת השלחן ערוך. צריכת הסוכר הלבן פוגעת ביכולת הגוף לשמור על רמת הסוכר בדם. זה מוביל לפירוק שומנים בשעת הצום, ליצירת הקטונים המזיקים, ולשחרור הרעלים.

ד"ר וינטרוב, שהיה מנהל מחלקת הנשים בבית החולים "שערי צדק", אמר לרב יעקב ישראל פישר זצ"ל שביום תשעה באב וביום שלאחריו יש במחלקה כמות מרובה של לידות מוקדמות והפלות פי שתיים מיום רגיל. היובש גורם להתכווצויות ולהפלות.

הרב ישראל פישר (שהיה ראש העדה החרדית בירושלים), הרב הלברשטאם (חבר בעדה החרדית ומומחה ברפואה והלכה), והרב ברנדסדופר (חבר בעדה החרדית ומומחה ברפואת נשים), פסקו שכל הנשים שצמות בהריון נמצאות ברמת סיכון הרבה יותר גבוהה מהסף ההלכתי של 1 ב- 1000 גם אם אין להן שום בעיות רפואיות. (הסכון להפלה הוא יותר מ- 10 ב-1000 והסיכון לפיגור שכלי בתינוק הוא גם כן יותר מ- 10 ב- 1000.) הם פסקו שכל הנשים בהריון חיבות לאכול ולשתות לשעורין אפילו ביום כפור, כדי למנוע כל סיכון לתינוק. סכנתא חמירא מאיסורא. בין החרדים שנשותיהם כן צמות בהריון (וגם בין המוסלמים שנשותיהם צמות בהריון ברמדאן) אחוז הילדים המפגרים הוא הגבוה ביותר בישראל.

אם ביום כפור אסור להן לצום, קל וחומר שאסור להן לצום בצומות האחרים.

רבנים גדולים נשאלו כיצד הם יכולים להיות כל כך מיקלים בחובה לצום ביום כפור. הם ענו: "אני בכלל לא מיקל. להפך, אני מאד מחמיר בחובה לשמור על בריאות התינוק."

יש נשים שאומרות: "צמתי ושום דבר לא קרה לתינוק." אמירה כזאת מעידה על חוסר הבנה של הסתברות לסיכונים. כדי להבין את הסיכון נשתמש בדוגמה של משחק ברולטה רוסית. רולטה רוסית היא משחק מסוכן מאד שבו טוענים אקדח עם כדור אחד, מסובבים את מיכל הכדורים, מכוונים את האקדח לראש, ולוחצים על ההדק. ברוב המקרים שום דבר לא קורה. אבל לפעמים הכדור כן מכוון מול הקנה ואז...

יש נשים בהריון שצמות ביום כפור ובתשעה באב ולא קורה שום דבר לתינוק. הן אפילו לא יודעות שרמת האינטליגנציה של התינוק נפגעה. אבל יש גם נשים שמגיעות לבית החולים ומפילות את התינוק, ויש תינוקות שנולדים עם פיגור שכלי או עם נזק אחר למח. האם תשחקו רולטה רוסית על הראש של התינוק שלכן?


Introduction

The purpose of this article is to present sufficient information to show that fasting while pregnant or breast-feeding poses a serious risk to babies, a risk which is  ספק פקוח נפש - potential threat to life or to healthy life. Fasting for more than 12 hours causes the body to produce ketones[5][6] (a family of harmful chemicals which includes acetone) and releases toxins into the blood stream. Ketones and toxins can cause brain damage and mental retardation in babies. The primary objective of this article is to prevent exposure of babies to this risk.

Rabbis generally agree that people are obligated to guard themselves and their family against potential risk and potential bodily harm, even at the expense of violating the Shabbat or eating on Yom Kippur. The information presented in this article is not widely known and is intended predominantly for those who need to make Hallachic decisions which involve  ספק פקוח נפש  of babies.

In the Gmara (Chulin, p.10a) we find a fundamental rule which governs possible conflicts between the need to be safe and healthy and the obligation to observe the Mitzvot. The rule is: חמירא סכנתא מאיסורא - avoiding danger is more important than avoiding a prohibition [1].

Our hope is to prevent brain-damage tragedies, in circumstances similar to what happened to a pregnant woman in Jerusalem. She asked a leading Rabbi for permission to eat and drink on Yom Kippur and the Rabbi ruled that she must fully fast. At the end of Yom Kippur she had a miscarriage. Till the end of his life, this Rabbi could not forgive himself for being responsible for the death of a baby. Who knows how many brain-damaged and mentally-retarded babies were born because of similar rulings?

Disclaimer: Full scale research on Jewish fasting mothers has yet to be performed. The author is a research scientist. He is not a Rav Posek and is not a medical doctor. This article is intended to be only an alert and an introduction to the subject; it is not a complete medical or Hallachic treatment of the subject.

Warning: Never never never drink any "diet" drinks. The aspartame artificial sweetener in them (e.g. NutraSweet) is a dangerous neurotoxin which can cause severe brain damage.

The Risks of Fasting

Fasting during pregnancy or breast-feeding exposes the baby to a variety of risks:
  • Contractions: Lack of liquids during pregnancy can trigger contractions. Contractions can lead to premature delivery or miscarriage.
  • Drying of milk: Lack of liquids while breast-feeding can trigger drying up of the milk.
  • Ketones: A drop in the blood sugar level triggers metabolism of body fats which produces brain-damaging ketones.
  • Toxins: Body fats store various toxins which were absorbed by the mother during her lifetime. Exposure to toxins in recent generations is hundreds, maybe thousands, of times higher then in the olden days. Metabolism of body fats releases these toxins into the mother's bloodstream [2][3][4]. Toxins are then easily transferred into the baby's bloodstream or into the mother's milk.
The risks associated with lack of liquids are well known and documented. On the other hand, the risks associated with drops in the blood sugar level and the subsequent metabolism of body fats, producing ketones and toxins, are much less known. To date, there are no known Hallachic rulings which take into account the risks associated with ketones and toxins.

Fasting during pregnancy causes a rapid fall of blood sugar levels, much faster than in women who are not pregnant [5][6]. When the blood sugar level drops, the only other source of energy available to the brain is ketones (acetone is one of the ketones). Ketones are produced when the body breaks down fat instead of carbohydrates to derive energy. Fasting increases body fat metabolism in the mother which produces ketones and releases toxins. Instead of glucose, the fetus is forced to utilize ketones to get energy. Ketones adversely affect fetal development, can cause brain damage, and lower the IQ of the baby [7][8][9][10][11][12][13][14][15][16][17][18][19]. Whatever the IQ of a child could be, ketones and toxins can cause it to be lower. Some of these studies describe diabetic women (rather than fasting women) who also suffer from an elevated level of ketones. However, the link between ketones and their damaging effect on the brain was clearly established.

Acetone, in general, is known to be neurotoxic and to cause brain damage and other birth defects.[12][20]

Research in Israel showed significant changes in the nutritional contents of breast milk after a fast. The most dangerous change was a decrease in the lactose (sugar) contents of the milk; a decrease which continued to last for more than 24 hours after the end of the fast [21]. Lack of sugars causes an increase in ketones and toxins which are readily transferred to the baby via the breast milk (ketones were not measured in this research). Again, the baby is exposed to brain-damaging ketones and toxins. Whatever the IQ of a child could be, fasting can cause it to be lower because of the ketones and toxins.

Douglas Almond, of Columbia University, conducted research on fasting Muslim women in the US, Iraq, and Uganda. The research revealed that pregnant Muslim women who fast during Ramadan are likely to have smaller babies who will be more prone to learning disabilities in adulthood. The trend was clearest if the fasting was done early in the woman's pregnancy, and during the summer months (when fasting lasts longer). "Rates of adult disability are roughly 20% higher, with specific mental  disabilities showing substantially larger effects."[6]

Research in Israel showed similar results. The largest occurrence of mentally retarded children was found in ultra religious Jews and Muslim Arabs (where women fast also while pregnant and breast-feeding) with a rate of 4%-4.5% compared to an average rate of 3% in the general population [22]. The popular theory to explain this difference is a reduced rate of tests during pregnancy by ultra religious Jews and Muslim Arabs. However, except for a few known genetic defects, there is no test that can predict the future IQ of an unborn baby. Therefore, this theory is not supported by the facts. It is also interesting to note that approximately 7-15% of women in our generation are diabetics, and in some of them, their babies were exposed to ketones during pregnancy and breast-feeding. It is not yet known how many of the mentally retarded children were born to such mothers. Diabetes is equally found in all populations in Israel, therefore, it cannot explain the increased percentage of mental retardation in ultra religious Jews and Muslim Arabs.

Jewish religious women think that fasting while pregnant is holy, even though there are Rabbis who exempt them from fasting [23]. Little do they know what ketones and toxins can do to their baby's brain. Many Mitzvot were given to women to be holy. Fasting while pregnant or breast-feeding is NOT one of them.

Muslim women also fear a loss of connection with their communities or feel guilty if they do not observe Ramadan. Sheikh Ibrahim Mogra, an imam from Leicester, said that sharia (Islamic law) would never expect a woman to fast if it had an adverse effect on either the mother or child.

Jewish law is the same. On all the fasts, including also fasting by men, fasting is prohibited if it involves a health risk. If you are pregnant or nursing, exposing your baby to the risk of brain damage from ketones and toxins is an Aveira, not a Mitzvah. You can fast as much as you want when it is only you who fasts. But, exposing a little baby to the consequences of fasting, can be a crime - a brain damaging crime.

Fasting deprives the baby of essential nutrients and exposes the baby to hormonal imbalance and toxins. Some believe in the theory that the babies get everything they need from the mother's body. This is simply not true. The fact is that fasting mothers can cause their babies to eject. At the end of every fast day in Israel, delivery rooms get swamped with religious pregnant women arriving for premature delivery or miscarriage [23][24]. Premature deliveries following a fast are well known by Rabbis and mothers. What is not so well known is the alarming rate of miscarriages, because mothers tend to keep miscarriages a secret.

Hallachic Considerations

One question which comes to mind is: "Why does the Shulchan Aruch say that pregnant and nursing women have to fast on the 9th of Av and on Yom Kippur?" To answer this question we need to consider the following factors

  • In the olden days, refined sugar did not exist. There was no such thing as adding sugar to foods. The body was used only to complex carbohydrates which take longer to digest and last longer. Upon fasting, the body probably did not begin to metabolize fats (and produce ketones, and release toxins) as early as it does today. Dangerous drops in blood sugar level were rare. That's why pregnant and nursing women were permitted and able to fast. Rabbi Yosef Yedid said that in our generations women and children are weaker, therefore, the Hallachic ruling today is not the same as what it used to be in the past [24]. Today, drops in blood sugar levels, the production of ketones, and the release of toxins, are known to begin after about 12 hours of fasting [5], which means that after a night's sleep, food intake must begin in the morning to avoid producing ketones and releasing toxins. The change in body metabolism is also evidenced by the much higher percentage of diabetics in our generations compared to the past.
  • In the olden days, exposure to toxins was minimal and insignificant. Exposure to toxins in recent generations is hundreds, maybe thousands, of times higher then in the olden days. Fasting releases these toxins into the mother's bloodstream. Toxins are then easily transferred into the baby's bloodstream or into the mother's milk.
  • Hallachic rulings apply to specific realities. The reality must be fully known before a Hallachic ruling can be made. When the reality or our understanding of the reality changes, it may be necessary to adjust a Hallachic ruling.
For example: In the Tosefta (Horayot ch. 1.5), in the Gmara (Yevamot, p.92a), and in the Rambam (Hilchot Shgagot ch. 14.7) we find a fundamental rule which governs the relationship between the scientific reality and the Hallachic opinion of the Rabbis:  "A court of Rabbis ruled that it is the end of Shabbat and later the sun became visible. This is not a Hallachic ruling but a mistake."  From here we learn two lessons. a) The scientific reality supersedes the opinion of the Rabbis, and, b) It may sometimes be necessary to change a Hallachic ruling, if the scientific reality was not sufficiently known.
Then, we find in the Gmara (Nidah, p.22b): "Rabbi Elazar, the son of Rabbi Zadok said that two questions his father has presented to the Rabbis in Yavneh... about a woman who had a certain miscarriage... his father asked the Rabbis and the Rabbis asked the doctors. Then, again, on a similar question, his father asked the Rabbis and the Rabbis asked the doctors."  Here we learn that the Rabbis need to know what the doctors have to say on a subject, before they can issue a Hallachic ruling. This approach is common practice. Many questions relevant to a determination of whether something is kosher or not, require consultation with technical experts. Many questions relevant to human health are also answered based on recommendations by medical experts.
The Shulchan Aruch explicitly says that eating and drinking on a fast day is permitted, or mandatory, when there is a risk to health. All mothers are permitted by the Rabbis to eat and/or drink if there is a risk to the mothers' health or a risk to the baby. Just because the risk of exposure to ketones and toxins is not widely known, does NOT mean that it does not exist.

Based on the risk of exposure to brain-damaging ketones and toxins, fasting while pregnant or breast-feeding is a  מצוה הבאה בעבירה - a Mitzva (fasting) which is performed while doing an Aveira (risking the health of the baby). Exposing a baby to ketones and toxins is an Aveira, not a Mitzva. As we have seen above, avoiding danger is more important than avoiding a prohibition. This applies even to a potentially remote risk, not only to actual danger[1].  Avoiding a potential health risk to a baby is more important than avoiding a prohibition of eating or drinking during a fast day. In such a case, eating or drinking during a fast day is no longer a prohibition; it is a Mitzva of saving a baby from potential harm.

There are those who believe that Chazal knew all of science and medicine from the Torah. Therefore, if they said that a pregnant woman must fast, they must have known about the risks to the baby, yet decided that she must fast. The reality, however, is that Chazal themselves said that their knowledge of science and medicine is NOT from the Torah but from their own observations and evidence learned in a natural way [25][26][27][28][29][30]. The most famous example is the Rambam who explicitly said that "the books composed by the Jewish scholars from the tribe of Issachar at the times of the prophets, did not reach our hands."[31] The Rambam makes it very clear that he learned science from the Greeks[31][32] and medicine from gentile doctors[33].

The most striking statement by any Torah scholar on the subject of Chazal's knowledge of science, comes from Ralbag - Rabbi Levi Ben Gershon (1288-1344). He said that even a prophet (using the prophet Ezekiel as an example) does not necessarily know all the secrets of science:
"It is not self evident that a prophet will have all the correct knowledge in the subject of the secrets of scientific reality."[41]
A Rabbi who knows about the risks posed to babies by brain-damaging ketones and toxins released during fat metabolism, can never permit a pregnant or breast-feeding woman to fast; he is obligated to follow the rule that - סכנתא חמירא מאיסורא - avoiding danger is more important than avoiding a prohibition. A Rabbi who does not know about these risks is not permitted to ignore them and must learn about them before advising a pregnant or breast-feeding woman what to do.


Hallachic Rulings by Prominent Rabbis

All the Rabbis agree that pregnant and breast-feeding women are exempt from fasting on the 9th of Av and on Yom Kippur, if they have any personal hardship or risk factor.

In matters of risks to health and safety, when one Rav or two doctors say that there is a need to eat and drink in order to avoid a risk, it supersedes the opinions of all other Rabbis and doctors who say that there is no such need [24][39].

The shorter fasts

Practically all the Rabbis agree that pregnant and breast-feeding women should not fast on the shorter fasts, even if they have no personal hardship or risk factor.

The 9th of Av

Shaarei Tzedek hospital in Jerusalem reported that on the 9th and 10th of Av the number of miscarriages and premature deliveries is double the number on a regular day. This is caused solely by pregnant women not drinking during the fast, thus killing or injuring their babies.

Rabbi Aviad Stollman concluded that Breast-feeding mothers (even if they have no personal hardship or risk factor) do not fast on the 9th of Av[36]. Rabbi Mordechai Eliahu ruled that all pregnant and breast-feeding women (even if they have no personal hardship or risk factor) are exempt from fasting on the 9th of Av, and on all the shorter fasts[37]. Rabbi Yaakov Yosef (the son of Rabbi Ovadia Yosef) ruled that all pregnant women (even if they have no personal hardship or risk factor) are permitted to eat and drink on the 9th of Av, as long as they do not eat delicatessen [23][24]. See also "Yom Kippur" below. All the rules which were decided for Yom Kippur apply also to the 9th of Av.

Yom Kippur

Rabbi Neventzal ruled[34] that all breast-feeding women (even if they have no personal hardship or risk factor) are permitted to drink on Yom Kippur in small amounts[35] to avoid the risk of drying up the milk.

Rabbi Yisroel Fisher (the head of the ultra-religious Eida HaCharedit in Jerusalem), Rabbi Halberstam (a member of the Eida HaCharedit in Jerusalem and an expert in the subject of medicine and Hallacha), and Rabbi Brandsdorfer (a member of the Badatz Eidah HaCharedit and an expert in the Hallachot related to women health) have ruled that ALL pregnant women who fast are at a risk much greater than the Hallachic threshold of 1 in 1000 even without a personal risk factor. (The actual statistical risk of miscarriage is higher than 10 in 1000 and the statistical risk of mental retardation is also higher than 10 in 1000.) Therefore, they ruled that ALL pregnant women MUST eat and drink in small amounts, even on Yom Kippur, to avoid any possible risk to the babies. [23][24][38].  In other words, since the risk is greater than 1 in 1000, it is PROHIBITED to take the risk.

Rabbi Aviad Stollman, after consultations with expert obstetricians, also concluded that all pregnant women should drink nutritious juice in small amounts on Yom Kippur. Rabbi Stollman quotes the Hallachic ruling in the Shulchan Aruch[39] that if two doctors say that a person needs to eat on Yom Kippur, then he must eat even if a hundred other doctors and the person himself say that he does not need to eat.

All of these permissions to eat or drink, even on Yom Kippur, were published BEFORE the Rabbis knew of the risk that brain-damaging ketones and toxins pose to the babies. If they were to know of this additional risk, the permissions to eat/drink and the prohibitions of full-fasting would be much more prevalent. The only Rabbis who do not agree with the idea of allowing all pregnant and breast-feeding women to eat and drink in small amounts on Yom Kippur, are those who are not yet aware of the risk of exposing little babies to brain-damaging ketones and toxins; a risk which nowadays begins in almost all pregnant women after about 12 hours of fasting [5]. It is important to note that Hallachic rulings which require asking the mother how she feels do not apply in this case because there is no way for the mother to feel anything with respect to the impact of ketones and toxins on the baby.

Fasting may be easy for you.
Your fasting is NEVER easy for the baby.

You can fast as much as you want,
When it is only you who fasts. But,
Exposing a baby to the consequences of fasting,
Can be a crime, a brain-damaging crime.

The risks to the babies, together with the Rabbis' rulings,
Take away from all pregnant and breast-feeding women
The right to be "extra holy" and fast anyway.

Great Rabbis were asked how can they be so lax on the obligation to fast on Yom Kippur.  "I am not lax at all" they responded. "On the contrary, I am very stringent - stringent about the obligation to protect the health and safety of the babies."

The risk to the baby begins long before the mother feels anything. If you usually feel good, drink milk or soy milk with honey or fruit juice, in small amounts[35] at a time, beginning in the morning - it must add up to a few cups during the day. You may also eat in small amounts at designated intervals. If you suspect that you may feel even the slightest weakness, drink and eat BEFORE you get weak or dizzy. By the time you feel weak or dizzy (after 12 hours of fasting overnight) the damage to the baby has already started. Dizziness during a fast is particularly harmful - it indicates severe low blood sugar which immediately triggers production of ketones and release of toxins.

Playing Russian Roulette on Babies

There are many more than two expert doctors who say that all pregnant women MUST eat and drink on Yom Kippur to avoid the risk of miscarriage and the risk of exposure to brain-damaging ketones and toxins. Based on the Shulchan Aruch, this medical advice prevails over all other opinions, even if a hundred other doctors and the mother herself say that she does not need to eat or drink[39]. According to this ruling of the Shulchan Aruch, it no longer matters how many other doctors permit fasting while pregnant. The opinion of doctors who are not familiar with the risks of babies' exposure to ketones and toxins is irrelevant according to the Shulchan Aruch [40].

The same applies to Rabbis. The only Rabbis who tell pregnant women to fast are Rabbis who are not sufficiently familiar with the risks of babies' exposure to ketones and toxins. The general Hallacha is that a Rabbi is not allowed to permit what another Rabbi prohibited. However, this rule does NOT apply to questions of health and safety. Therefore, if one Rabbi told a pregnant woman not to eat, another Rabbi is permitted to negate the first Rabbi's ruling, because of the risks involved, and permit the woman to eat and drink [24]. As stated above, Rabbi Yisroel Fisher, Rabbi Halberstam, and Rabbi Brandsdorfer, have ruled that all pregnant women should eat and drink in small amounts, even on Yom Kippur, to avoid any possible risk to the babies.

Some women say: "I fasted and nothing happened to my baby". Such a statement demonstrates a lack of understanding of risk and probability. (If you are one of them, you are in good company. In 1926 Albert Einstein too did not understand the role of probability in the laws of physics.) To better understand the risk, let's use the analogy of playing Russian Roulette. Russian Roulette is a potentially lethal game of chance in which participants place a single bullet in a revolver, spin the cylinder, point the revolver to their head and pull the trigger. Most of the time nothing happens. But, occasionally the bullet gets correctly aligned and then...

That's what happened to the mother in Jerusalem and her Rabbi. Despite their good intentions, they played Russian Roulette and lost the baby. Some pregnant women who fast on Yom Kippur or on the 9th of Av get through with no harm. Others arrive at the hospital for a miscarriage, and others end up with a lower IQ, mentally-retarded, or brain-damaged child. Would you play Russian Roulette on your baby?


References

  1. מרן הבית יוסף - רבי יוסף קארו "וכן כל מכשול שיש בו סכנת נפשות, מצוות עשה להסירו ולהשמר ממנו ולהזהר בדבר יפה, שנאמר: 'השמר לך ושמור נפשך' (דברים, ד, ט). ואם לא הסיר והניח המכשולות המביאים לידי סכנה, ביטל מצוות עשה ועבר ב'לא תשים דמים' (דברים, ד, ט). ("שולחן ערוך", חושן משפט, סימן תכ"ז, סעיף ח) הרמ"א: "וכן יזהר מכל דברים המביאים לידי סכנה, כי סכנתא חמירא מאיסורא... וכל אלו הדברים הם משום סכנה, ושומר נפשו ירחק מהם." (רמ"א, "שולחן ערוך", יורה דעה, סימן קט"ז, סעיף ה). רבי ישראל בעל שם טוב: "כאשר גופו חולה גם הנשמה נחלשת, ואינו יכול להתפלל כראוי אף על פי שהוא נקי מעבירות, לכך צריך לאדם לשמור בריאות גופו מאוד." ("צוואת הריב"ש". הרמח"ל: "כי הנה האדון ברוך הוא עשה את האדם בעל שכל נכון וסברה נכוחה, לשינהג עצמו על דרך טוב, וישמר מן הדברים המזיקים אשר נבראו לענוש את הרשעים, ומי שירצה שלא ינהג עצמו בדרך החכמה ויפקיר עצמו לסכנות, הנה אין זה בטחון, אלא הוללות. והנה הוא חוטא במה שהוא נגד רצון הבורא יתברך שמו, שרוצה שישמור האדם את עצמו. ונמצא שמלבד הסכנה המוטבעת בדבר אשר הוא עלול אליה מפני חסרון שמירתו, הנה עוד הוא מתחייב בנפשו בקום עשה בחטא אשר הוא חוטא, ונמצא החטא עצמו מביאו ליענש." (מסילת ישרים, פרק ט). רבי שניאור זלמן מלאדי: "שצריך להזהר בגופו שלא לאבדו ולא לקלקלו ולא להזיקו." (שלחן ערוך הרב, הלכות שמירת גוף ונפש, סעיף י"ד). באר הגולה - רבי משה בן נפתלי הירש רבקש מוילנא: "המסכן את עצמו כאילו מואס ברצון בוראו ואינו רוצה לא בעבודתו ולא במתן שכרו, ואין לך זלזול אפקירותא יותר מזה; ולשומעים יונעם." (פירוש "באר הגולה", על "שולחן ערוך", חושן משפט, סימן תכ"ז, סעיף קטן צ). הבן איש חי - רבי יוסף חיים: "אמרו חכמים חמירא סכנתא טפי מאיסורא, שיש לחוש לספק סכנה טפי [יותר] מספק איסור, וכל אדם חייב לשמור עצמו ובני ביתו מכל ספק סכנה ונזקי הגוף." (בן איש חי - הלכות, שנה שנייה, פרשת פנחס, פתיחה). י
    http://vitaminim.org/briut/?file=kop9.php
  2. http://www.wellnessresources.com/weight_tips/articles/detoxification_during_weight_loss/
  3. "The fast does not merely detoxify; it also breaks down superfluous tissue - fat, abnormal cells, atheromatous plaque, and tumors--and releases diseased tissues and their cellular products into the circulation for elimination. Toxic or unwanted materials circulate in our bloodstream and lymphatic tissues, and are deposited in and released from our fat stores and other tissues. An important element of fasting detoxification is mobilizing the toxins from their storage areas." Fasting and eating for health, Joel Fuhrman, M.D., p.10
  4. Fasting in pregnancy or lactation results in an overload of toxins to the baby.
    http://www.fredericpatenaude.com/articles/fasting.html
  5. Writing in The Lancet, Metzger et al. [1982] documented a set of divergent biochemical measures among pregnant women who skipped breakfast in the second half of pregnancy. Relative to twenty-seven non-pregnant women with similar characteristics, “circulating fuels and glucoregulatory hormones” changed profoundly in twenty-one pregnant women when the “overnight fast” was extended to noon on the following day (relative to post- prandial baseline). Further, plasma glucose and alanine was lower in the pregnant women than in the non-pregnant women after 12 hours of fasting while levels of free fatty acids and beta-hydroxybutyrate, a ketone, were significantly higher. This set of biochemical changes, also known as “accelerated starvation”, occurred after only “minor dietary deprivation” for both lean and obese women. Metzger et al. [1982] concluded that mealskipping “should be avoided during normal pregnancy.” Meis and Swain [1984] found that daytime fasts during pregnancy caused significantly lower glucose concentrations than nighttime fasts. Accelerated starvation has been associated with diminished cognitive function [Rizzo et al., 1991] and animal studies have linked ketone exposure very early in pregnancy to neurological impairments[Hunter and Sadler, 1987, Moore et al., 1989, Sheehan et al., 1985].
  6. Health Capital and the Prenatal Environment: The Effect of Maternal Fasting During Pregnancy. Douglas Almond and Bhashkar Mazumder (2010).
    http://www.chicagofed.org/digital_assets/publications/working_papers/2007/wp2007_22.pdf
  7. Nondiabetic acetonuria occurring during pregnancy (presumably as a result of fasting) is associated with a significantly lower IQ in the offspring than in a matched control group without acetonuria. In a neutral-quality case-control study by Churchill et al (1969), the neurological and psychological status of 237 babies from diabetic pregnancies was compared with babies from nondiabetic pregnancies. Measurements were evaluated at 8 months, 12 months and 4 years of age. Diabetic mothers with acetonuria had offspring with lower IQ than controls (mean scores of 93 versus 102, P < 0.001), while the offspring of diabetic patients without ketonuria had IQ equal to controls (mean score of 101). Churchill JA, Berendes HW. Intelligence of children whose mothers had acetonuria during pregnancy. In: Perinatal Factors Affecting Human Development. Proceedings of the Special Session of the Eighth Meeting of the Pan American Health Organization Advisory Committee on Medical Research, June 10, 1969. Washington, DC: Sci Publ No. 185, 1969:30-35.
  8. Based on detailed data from 55,000 pregnancies,[Obesity and Fad Diets. U.S. Senate Select Committee on Nutrition and Human Needs. 12 April 1973 CIS S581-13.] acetone and other ketones may cause brain damage in the fetus, which may result in the baby being born mentally retarded. [Maryland State Medical Journal 1974:70.] The fact that ketones seemed to cause "significant neurological impairment" and an average loss of about 10 IQ points was well known [Clinics in Endocrinology and Metabolism 12(1983):413.]
    http://www.atkinsexposed.org/printer-friendly.html
  9. "Correlations between antepartum maternal metabolism and child intelligence", T Rizzo, BE Metzger, WJ Burns, and K Burns, New England Journal of Medicine, V. 325:911-916, No. 13, September 1991.
  10. Rizzo TA, Dooley SL, Metzger BE, Cho NH, Ogata ES, Silverman BL. Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers. Am J Obstet Gynecol. 1995;173:1753–8.
  11. FELIG P: Body fuel metabolism and diabetes mellitus in pregnancy. Med Clin North Am 1977; 61: 43-56
  12. CHURCHILL JA, BERENDES HW, NEMORE J: Neurophysiological deficits in children of diabetic mothers. A report from the Collaborative Cerebral Palsy. Am J Obstet Gynecol 1969; 105: 257-268
  13. Maternal nutrition in pregnancy. Part I: a review. ARTHUR LEADER, KEVIN H. WONG, MERVYN DEITEL,
    http://www.google.com/url?sa=t&source=web&cd=1&ved=0CBIQFjAA&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1862616%2Fpdf%2Fcanmedaj01351-0027.pdf&ei=pA5HTO7PGoa0lQeR462HBA&usg=AFQjCNEoWqQrQ_eUWljYZCgborDMZg-BJg&sig2=aY92-_ch6B990MvXwl5_aQ
  14. some studies emphasize that women with large amounts of ketones spilled in urine during pregnancy may have babies with learning disabilities or reduced IQ later in life.
    http://www.buzzle.com/articles/ketones-in-urine-during-pregnancy.html
  15. some studies emphasize that women with large amounts of ketones, may have babies with learning disabilities or reduced IQ later in life.
    http://www.buzzle.com/articles/ketones-in-urine-during-pregnancy.html
  16. There were several studies that showed that babies exposed to a lot of ketones had learning problems and reduced IQ later in life. These have since been disputed by other studies, but just in case, everyone plays it safe during pregnancy, which is very prudent.
    http://www.plus-size-pregnancy.org/gd/gd_ketones.htm
  17. While the research available on the impact of spilling ketones is still limited and the recommendations about ketone testing vary, my hospital participated in a long-term study of children who were born to diabetic moms that found a correlation between moms who regularly spilled ketones and lowered IQs of 10-15 points.
    http://community.babycenter.com/post/a13028005/managing_your_ketone_levels_-_be_proactive
  18. Ketones are produced when the body breaks down fat instead of carbohydrates to derive energy. This adversely affects foetal metabolism and development and lowers the foetus' IQ.
    http://www.rediff.com/getahead/2005/oct/13preg.htm
  19. Ketones are produced when the body breaks down fat instead of carbohydrates to derive energy. This adversely affects foetal metabolism and development and lowers the foetus' IQ.
    http://www.ammas.com/topics/Pregnancy/a139662.html
  20. Small amounts of acetone are metabolically produced in the body, mainly from fat. In humans, fasting significantly increases its endogenous production. Acetone levels can be elevated in diabetic individuals... Pregnant women should avoid contact with acetone and acetone fumes in order to avoid the possibility of birth defects, which include brain damage (Likhodii, et al., 2003).
    http://toxipedia.org/display/toxipedia/Acetone
  21. תוצאות המחקר הראו, כי רמות הנתרן והסידן הממוצעות עלו משמעותית מיד לאחר הצום, בהשוואה לנקודת תחילת הצום. בנוסף, רמות הזרחן הממוצעות ירדו משמעותית באופן מובהק סטטיסטי. רמות החלבון הממוצעות עלו משמעותית באופן מובהק סטטיטסטי ורמות הזרחן והלקטוז הממוצעות ירדו משמעותית. רמות הטריגליצרידים לא השתנו באופן משמעותי. בהשוואה בין נקודת תחילת הצום ל-24 שעות לאחר סיום הצום, הפרמטרים שנבדקו כבר לא היו שונים משמעותית מנקודת ההתחלה, לבד מרמת החלבון הממוצעת, שעלתה באופן מובהק סטטיסטי ורמת הלקטוז, שעדיין הייתה ירודה בצורה משמעותית. מסקנות המחקר מראות, כי צום של יותר מ-24 שעות גורם לשינויים משמעותיים במספר רכיבים בחלב אם. השינויים המשמעותיים ברמות הלקטוז והחלבון נמצאו גם לאחר 24 שעות נוספות לפחות. המחקר הוצג במסגרת כנס של "מכון מטרנה למחקר" על ידי ד"ר דינה ר. צימרמן, ד"ר לי גולדשטיין, ד"ר אלי היימן, רוני בראונשטיין, דבורה שטחי, עדינה בר-חיים וד"ר מתתיהו ברקוביץ'. י
    http://www.doctors.co.il/ar/5954/%D7%A6%D7%95%D7%9D+%D7%AA%D7%A9%D7%A2%D7%94+%D7%91%D7%90%D7%91+%D7%95%D7%94%D7%A9%D7%A4%D7%A2%D7%AA%D7%95+%D7%A2%D7%9C+%D7%94%D7%94%D7%A0%D7%A7%D7%94
  22. י 3% מסך הילודים בעולם בכל שנה, נולדים עם פיגור שכלי. הממוצע בישראל דומה לעולם אך גבוה יותר במגזר החרדי ובמגזר הערבי ומגיע ל-4% עד4.5%.  י
    http://www.ynet.co.il/articles/0,7340,L-3734137,00.html 
  23. לפני שנים ניגש ד"ר וינטרוב, שהיה מנהל מחלקת הנשים בבית החולים "שערי צדק", לרב יעקב ישראל פישר זצ"ל ואמר לו שביום תשעה באב וביום שלאחריו יש במחלקה כמות מרובה של לידות מוקדמות והפלות פי שתיים מיום רגיל. היובש גורם להתכווצויות ולהפלות. על סמך הדברים פסק הרב פישר בספרו "אבן ישראל" שאפילו ביום הכיפורים יכולה המעוברת לאכול ולשתות שהרי גם על עובר בן פחות מארבעים יום מחללים את יום הכיפורים. כדבריו פסקו גם הרב הלברשטאם והרב ברנדסדורפר זצ"ל ופטרו את המעוברות מלצום כיון שאחת מתוך מאה מסתכנת. ... הרב יעקב יוסף פסק שכל אישה בהריון בין בתחילת ההריון, בין באמצעו ובין בסופו יכולה לאכול ולשתות בתשעה באב, אלא שלא תאכל מעדנים.  י
    http://www.inn.co.il/Articles/Article.aspx/8408
  24. איסור צום בתשעה באב: א. ביום הכיפורים שהצום הוא מדין תורה, לא פוסקים פסיקה גורפת לכל הנשים ההרות. אם הרופא בודק ואומר שהמעוברת יכולה לצום - תצום. אבל בתשעה באב כשהויכוח בין הפוסקים לגבי חובת הצום למעוברות בו הוא על צום מדרבנן, כלל נקוט בידינו שספק דרבנן לקולא, כך שאין מקום להחמיר. כל אישה בהריון בין בתחילת ההריון, בין באמצעו ובין בסופו יכולה לאכול ולשתות בתשעה באב (אלא שלא תאכל מעדנים). ב. הגאון הרב יוסף ידיד זצ"ל כתב שאומרים ספק נפשות להקל כנגד דעת מרן. בדורנו נשים הרות לא חייבות לצום בתשעה באב כי הצום עלול לגרום להפלה, ללידה מוקדמת או לנזק בלתי הפיך לעובר. אמנם מצליחים להתגבר היום על מחלות ילדים, אך עם זאת הילדים בדורנו חלשים, ולכן אין פסק ההלכה דומה למה שהיה פעם כי ירדה חולשה לעולם. כמו כן, בשו"ע, יו"ד סימן רמ"ב, נפסק להלכה שאין חכם רשאי להתיר את שאסר חכם אחר. אך יוצאים מן הכלל דיני נפשות ועל כן אישה הרה שהלכה ושאלה חכם והורה לה שהיא חייבת לצום בתשעה באב כמו שפסקו הרמב"ם והשו"ע, רשאי חכם אחר לעקור את מה שהורה לה החכם הראשון ולהתיר לה לאכול כי היום המציאות השתנתה והצום עלול לסכן את ההריון. י
    http://www.dulot.co.il/shulamit/show.asp?art=18&t=l
  25. The Rambam, in Moreh Nevuchim (V.3 ch.14) tells us that the source of the scientific knowledge of the Jewish sages was not divine, but was learned by them through observation or from the gentile scientists. ואל תבקשני לתאם כל מה שאמרו מענייני התכונה עם המצב כפי שהוא, לפי שהמדעים באותו הזמן היו חסרים, ולא דברו בכך משום שיש להם מסורת באותם הדברים מן הנביאים, אלא מצד שהם ידעני אותם הדורות באותם המקצועות, או שמעום מידעני אותם הדורות.  י
  26. In Tshuvot HaGeonim 394 we find the following: "Our sages were not doctors and said what they said based on experience with the diseases of their time. Therefore, [in this regard] there is no obligation to listen to the sages because they spoke only from their opinion based on what they saw in their days."
  27. The most striking statement by any Torah scholar on the subject of Chazal's knowledge of science, comes from Ralbag - Rabbi Levi Ben Gershon (1288-1344). He said that even a prophet (using the prophet Ezekiel as an example) does not necessarily know all the secrets of science. כי לא יחויב שיהיו לנביא כל הדעות האמתיות בענין סודות המציאות. רלב"ג (רבי לוי  בן גרשון) פירושי התורה, ביאור דברי הספור, בראשית טו, ד
  28. כי הדברים העיוניים לא דבר בהם כל מי שדבר אלא כפי שהביאו אליו העיון, ולפיכך צריך לסבור מה שנתקיימה ההוכחה עליו. רמב"ם, מורה נבוכים ב, ח
  29. אין להאמין בדבר רק בגלל אומרו ... לא נתחייב מפני גודל מעלת חכמי התלמוד ותכונתם לשלמות תכונתם בפירוש התורה ובדקדוקיה ויושר אמריהם בביאור כלליה ופרטיה, שנטען להם ונעמיד דעתם בכל אמריהם ברפואות ובחכמת הטבע והתכונה, [ולהאמין] אותן כאשר נאמין אותן בפירוש התורה... אתה רואה החכמים, במה שלא נתברר להם מדרך סברתם ומשאם ומתנם, אומרים: "האלהים, אילו אמרה יהושע בן נון לא צייתיה ליה". כלומר לא הייתי מאמין ביה, ואע"פ שהוא נביא, כיון שאין בידו יכולת להודיע העניין בכוונה מדרך הסברא והמשא והמתן, והדרכים שבהם ניתן התלמוד להידרש. אברהם בן הרמב"ם, מאמר על דרשות חז"ל
  30. http://torah-science.blogspot.com/2008/12/torah-science-and-greek-philosophy.html
  31. וטעם כל אלו החשבונות, ומפני מה מוסיפים מניין זה, ומפני מה גורעין, והיאך נודע כל דבר ודבר מאלו הדברים, והראיה על כל דבר ודבר--היא חכמת התקופות והגימטריות, שחיברו בה חכמי יוון ספרים הרבה, והם, המצויים עכשיו ביד החכמים; אבל הספרים שחיברו חכמי ישראל שהיו בימי הנביאים מבני יששכר, לא הגיעו אלינו. ומאחר שכל אלו הדברים, בראיות ברורות הם, שאין בהם דופי, ואי אפשר לאדם להרהר אחריהם--אין חוששין למחבר, בין שחיברו אותם נביאים בין שחיברו אותם גויים: שכל דבר שנתגלה טעמו, ונודעה אמיתתו בראיות שאין בהם דופי--אין סומכין על זה האיש שאמרו, או שלימדו; אלא על הראיה שנתגלתה, והטעם שנודע. רמבם, ספר זמנים, הלכות קידוש החודש, פרק יז, כד
  32. ספר מדע, הלכות יסודי התורה, פרק ג, ה
  33. http://torah-science.blogspot.com/2009/12/chazal.html
  34. לענין מניקות פוסק הגר"א נבנצל שליט"א [מובא במקראי קודש פ"ט הע' נז], שבזמננו יש חשש שיפסק החלב, ולכן מותר למניקה, אפילו אם מניקה בצורה חלקית, לשתות ביום הכיפורים לשיעורין, אלא אם בטוחה שלא יחסר לה חלב עקב הצום.  י
  35. The term "drink in small amounts" means drinking one sip at a time, with an interval of at least 7 minutes between sips. This is called in Hebrew: פחות מכשיעור - less than the amount which can constitutes a violation of the fast. A person who drinks in such small amounts is still considered to be fasting.
  36. http://atranet.co.il/aviadstollman/responsan_new.asp?m=19
  37. למעשה: מעוברות ומניקות, זקנים, או חלשים - פטורים מן הצום, ואף לא יתחילו לצום, אך יאכלו רק כדי קיום הגוף, ולא מעדנים.  י
    http://www.yeshiva.org.il/midrash/Shiur.asp?id=3726
  38. הגרי"י פישר זצ"ל פוסק [בהסכמתו לספר פני ברוך, בהערות לסי' ד סעיף יג]: "כיום הזה שנחלשו הדורות, ועשרות רבות של נשים מפילות ע"י התענית, צריכין כל הנשים המעוברות עד החודש התשיעי לאכול ביוהכ"פ פחות מכשיעור".  י
  39. כאשר מתעורר ויכוח בין הרופאים, קבע הרמב"ם בהלכות שביתת עשור, פרק ב, הלכה ח: "רופא אחד אומר צריך ואחד אומר אינו צריך — מאכילין אותו". מאידך, כאשר "מקצת הרופאין אומרין צריך, ומקצתן אומרין אינו צריך, הולכין אחר הרוב או אחר הבקיאין". אבל האחרונים כתבו (ראה: מגן אברהם, סעיף קטן ה; טורי זהב, סעיף קטן ה; משנה ברורה, סעיף קטן י; ערוך השולחן סעיף יא) בשם הרמב"ן (תורת האדם, שער הסכנה): שאם האחד מופלג בחכמה חוששים לדבריו להאכילו אפילו כאשר הוא בעמדת מיעוט. ומכל מקום — אם ישנם לפחות שני רופאים האומרים שצריך החולה לאכול — לכל הדעות יש להאכיל את החולה. כך פסק השולחן ערוך, או"ח, תריח, סעיף ד: "אם שנים אומרים צריך, אפילו מאה אומרים אינו צריך, ואפילו החולה אומר עמהם שאינו צריך, מאכילים אותו מאחר ששנים אומרים צריך".  י
    http://atranet.co.il/aviadstollman/responsan_new.asp?m=80
  40. אם הרופא אומר שאינו מכיר את החולי הרי הוא כאדם דעלמא ואין דבריו מעלין ולא מורידין. שו"ע, או"ח, תריח, סעיף ו
  41. כי לא יחויב שיהיו לנביא כל הדעות האמתיות בענין סודות המציאות. רלב"ג (רבי לוי בן גרשון) פירושי התורה, ביאור דברי הספור, בראשית טו, ד