Can
Eating an Unhealthy Diet be Halachically Forbidden?
Is Trans
Fat the New Smoking?
Raphael Hulkower
Introduction[1]
The
growth in popularity of the preventive medicine movement in recent decades has
also produced a concomitant interest in Jewish circles regarding halachic
perspectives on preventive medicine. Many rabbis, doctors, and scholars have
seen a parallel between preventive medicine’s doctrines of minimizing risk
factors for disease and halachic principles regarding the obligation to avoid
endangerment and prevent the loss of human life.[2] For
nearly four decades, the discussion about the dangers of smoking has been at
the forefront of both preventive medicine and halacha.[3] While
smoking, the leading cause of preventable deaths in the United States in 2000,
has received much due attention in halachic discussions, obesity, the second
most cause of preventable death in the United States,[4] has
received fairly little halachic discussion. The purpose of this article is to
review some of the halachic material on preventive medicine and smoking in
order to discuss its applicability to the topic of unhealthy diets and obesity
in general, and specifically the consumption of trans-fat. The goal of this
article is to inspire discussion and introspection on this important topic
rather than to reach a definitive halachic conclusion.
Can
a Kosher Diet be halachically Forbidden?
Dietary
restriction is one of the most fundamental aspects of Judaism. Many non-Jews
are aware that pork or mixing milk with meat is “not kosher” and may not be
eaten by Jews. Once people abide by the rules of kashrut, it is
generally assumed that they have the freedom to choose what they would like to
eat. While this statement is true on the whole, the Ramban,
in his commentary on the Torah, warns that the phrase “kedoshim
teheyu”[5]
teaches us the concept of naval b’reshut haTorah – that a person can still be disgustingly
inappropriate within the bounds of halacha. He explains that by the letter of
the law, once one follows kosher dietary laws, he may eat kosher food to his
heart’s content, even gluttonously. Nevertheless, the phrase kedoshim teheyu is
intended to caution people to curb their physical desires away from excessive
fulfillment.[6]
Throughout this lengthy comment, however, the Ramban
is careful in his wording and never says that one actual violates a commandment
in eating excessively. His actions are purely unethical when viewed from
a religion perspective.[7]
The
Rambam, in Mishnah Torah, goes a step further by giving nutritional dietary
advice. In Hilchot De’ot,
the Rambam records his advice for proper daily conduct in all areas of life. He
reserves the fourth chapter to describe his medical advice for healthy
individuals to remain strong and not become ill. Most of the chapter revolves
around nutrition. The Rambam makes a general warning that “overeating is like a
deathly poison to the body, and is the root of all illnesses. Most illnesses
that afflict a man are caused by harmful food or by overeating even healthy
foods.”[8] He
also specifically lists certain foods, such as aged and salted fish and cheese,
which he believes are extremely harmful to the point that “it is worthy to
never eat them.”[9]
However, like the Ramban, the Rambam also never
declares that any of these foods, or overindulgence, is officially forbidden.
Rabbi Moshe Feinstein notes this omission in his responsum declaring that
smoking is not prohibited by halacha.[10]
Rather, Rambam’s advice is simply preceded by the exhortion
that “maintaining a healthy and sound body is among the ways of God, for one
cannot comprehend or have knowledge of the Creator if he is ill.”[11] The
only foods that the Rambam says are forbidden because they endanger life are
those foods (mostly drinks) already forbidden by the Rabbis of the Talmud as they
may contain poison.[12]
The
question that remains is why did the Rambam not choose to forbid those foods
that he believed are dangerous enough to be avoided completely? Is it because
their effects are not felt immediately, as is the cause with poison? Or did he
believe that they were dangerous enough to recommend against as a doctor, but
not to forbid as a Rabbi. If the later is true, would the Rambam have forbidden
these foods if he had available the scientific knowledge that we are privileged
with today.
The
Obligation to Avoid Danger
Had the
Rambam believed that certain foods or behaviors were dangerous enough to be
prohibited by halacha, what mitzvah or prohibition would be violated? The
Rambam begins Chapter 11 of Hilchot Rotzeach v’Shemirat Nefesh, the
same chapter that lists prohibited foods, with the mitzvah of placing a fence
around one’s rooftop in order to prevent people from falling off and being
injured or killed. At the end of this discussion, he states:
Similarly,
any obstacle which endangers life has a positive commandment to remove it and
to safeguard against it very carefully, as it says, “Guard yourself and guard
your soul…”[13]
And if one does not remove that which is dangerous, one will have disregarded a
positive commandment and transgressed “Do not place blood in your home.”[14] The
Sages have forbidden many things because they endanger life, and whoever
transgresses them and says, ‘I am going to endanger myself, why should anyone
else care about that,’ or ‘I’m just not careful about that’ – we give him
lashes for rebelling.[15]
Rav Yosef Karo quotes this Rambam verbatim in the last
chapter of the entire Shulchan Aruch.[16]
Rav Karo placed the rest of the Rambam’s laws from Chapter 11 of Hilchot Rotzeach in Yoreh De’ah Chapter 116 in the
context of other chapters dealing with forbidden eating practices. In Yorah
Deah, however, he notes that as snakes are now less common, drinking these same
uncovered liquids is no longer prohibited as the source of danger has been
mitigated. Similarly, he says that eating fish and meat together has become
prohibited because it has been determined to pose a threat to human health.
Taken together, these two statements demonstrate that certain foods can be
permitted or prohibited for health reasons based on the current information of
the times in which one is living. Furthermore, at the end of Yoreh De’ah 116,
Rav Moshe Isserles (Rama) adds that “one should avoid all forms of danger
because anything dangerous is treated more stringently that something forbidden
by law. And one should be more concerned about a possible danger than a
possible prohibition.”[17]
It is
based upon these rulings of the Rambam and Shulchan Aruch
that many later halachic authorities would source one’s obligation to avoid
health risks as Devarim 4:15, “Rak
hishamer lechah u’shemor nafshecha [Only
guard yourself and guard your soul],” or the similar Devarim
4:9, “V’nishmartem m’ode l’nafshoteichem
[And guard your souls exceedingly].” This is despite the fact that in context,
clearly neither verse is referring to the obligation to protect one’s health,
but rather one’s obligation to remember the Torah and to avoid idolatry,
respectively.[18]
In addition to these verses in the fourth chapter of Devarim
and to the mitzvah of placing a fence on one’s rooftop, other halachic
authorities believe that the obligation to protect one’s health can also be
based upon the mitzvah to return a lost object, which is based upon the verse “V’hasheivota lo.”[19] The Sifrei[20]states
that this obligation to restore an item applies even to one’s own health and
Rav Yehuda Leib Zirelson holds that this obligation
applies even before a person becomes injured or ill.[21] Rav
Eliezer Waldenberg in Responsa Tzitz Eliezer also
rules that there is an obligation to prevent illness based upon the mitzvah of
“V’hasheivota lo.”[22]
Shomer
Peta’im Hashem and its Limitations
Although
there is debate over the exact source that obligates one to avoid danger, there
is a general consensus that Jewish law forbids self-endangerment. The
difficulty this raises is that life is full of dangers to the point that it is
inconceivable that a person could vigilantly follow this halacha without being
paralyzed by it. As Rabbi J. David Bleich writes in his article on hazardous
medical procedures, “it is universally recognized that life is fraught with
danger. Crossing the street, riding in an automobile, or even in a horse
drawn-carriage, for that matter, all involve a statistically significant
danger. It is, of course, inconceivable that such ordinary activities be denied
to man.”[23]
The answer to this pragmatic difficulty is based the phrase in Tehilim 116:6, “Shomer Peta’im
Hashem,” [Hashem protects the simple]. Based upon this phrase, the Rabbis
of the Talmud in Shabbat 129b, Yevamot 12b, Ketubot 39a, and Niddah 31a, allow a person to engage in
certain dangerous activities due to the fact that “Since many people have
undertaken such activities, shomer peta’im Hashem – God will protect the simple.” In later
generations, many halachic authorities would apply shomer
peta’im Hashem to new situations which they
believed were analogous to those permitted by the Talmud. Thus, a general
principle was derived that although in general one is obligated to avoid
danger, one is still permitted to engage in risky activities or behaviors if
these same actions are common occurrences in our society. Under such a
situation, a person may rely upon the fact that God generally protects people
from the “everyday” dangers of life. This reliance upon shomer
peta’im Hashem is cited by Rabbi Moshe Feinstein
in both his responsa in which he permits smoking.[24]
In
theory, it would appear that as long as a dangerous activity is normal behavior
in one’s society, it should be halachically permitted to follow the masses. As
such, if many people smoke, smoking should be permitted, and if many people eat
unhealthy diets or dangerous foods, this behavior should be permitted as well.
However, many halachic opinions assert that there are rules and limitations to
when one can invoke the permission of shomer
peta’im Hashem.
Rabbi Yacov Ettlinger in Teshuvot
Binyan Tzion explains that although normally there is a principle that we
do not follow the rov, majority, when
it comes to life saving situations, this is only true for immediate dangers.
However, when dealing with a long term danger, we do follow the majority and
must evaluate the exact level of risk entailed. As such, if the likelihood of
danger for a certain activity is less than 50%, such an activity is
permissible. However, if the likelihood of danger is greater than 50%, the
activity would be forbidden.[25] Thus,
according to the Binyan Tzion, the allowance of shomer
peta’im Hashem would only apply to situations of
risk lower than 50%. A risk greater than 50% is quite a high level of risk, and
it is likely that even Rabbi Feinstein would agree to this restriction, as
throughout his responsum in 1981 he mentions that he believes that the damage
caused by smoking is still a “small minority.”[26]
Other
opinions agree with the Binyan Tzion, but without placing the 50% guideline.
Rabbi Chaim Ozer Grodzinsky states explicitly that we
only rely on shomer peta’im
Hashem when the risk is “far removed and occurs in the minority of minority
cases.”[27] Rav
Ovadia Yosef writes similarly in Yabia Omer that shomer peta’im Hashem
only applies when the potential risk is in the minority but not to a likely or
certain risk.[28]
Finally, the Chatam Sofer writes that shomer peta’im Hashem
only applies when one is unaware that their actions are causing danger or risk,
but if the danger is known, then one will not be protected.[29]
Perhaps most important to note when evaluating health risk
is that some halachic authorities, such as Rabbi Chaim Ozer Grodzinsky,
specifically contrast dangers recognized by doctors with “minor risks” that are
covered by shomer peta’im
Hashem. As such, medical opinion is viewed as reliable source for
evaluating which risks are significant enough to no longer be permitted based
upon shomer peta’im
Hashem. The Avnei Nezer states that one may only
rely on shomer peta’im
Hashem regarding the constant dangers of life, but not in a situation where
the doctors say that a certain action will put life in danger.[30]
Others
hold that the Talmud only permitted one to rely on shomer
peta’im Hashem and undertake dangerous activities
for a mitzvah or pressing matter, but not for recreational or unnecessary
activities.[31]
The
Smoking Debate and the Advancement of Medical Data
As
mentioned above, it is primarily based upon the allowance of shomer peta’im Hashem
that Rabbi Moshe Feinstein ruled that smoking was not officially prohibited by
halacha in 1964 and again in 1981.[32] In
the 1981 responsum, Rabbi Feinstein specifically makes mention that the “damage
to health caused by smoking is a small minority [of cases].”
As
medical evidence increased in the last two decades of the 20th
century regarding the severity of the detrimental effects of smoking, however,
many other halachic authorities have chosen to rule that smoking is indeed
prohibited by the Torah. The crux of their arguments was not that they
disagreed with the concept of shomer peta’im Hashem, but rather that it now became apparent
that the level of danger caused by smoking is clearly above the level permitted
by shomer peta’im
Hashem. By 1982, Rabbi Eliezer Waldenberg was already convinced that
smoking was dangerous enough to be forbidden.[33]
Rabbi Avigdor Nebenzahl wrote in 1986 that one cannot rely upon shomer peta’im Hashem
when we clearly see that God is not protecting smokers from harm.[34] This
change in thinking is most clearly seen in the halachic rulings of Rav Ovadia
Yosef. Although Rav Ovadia Yosef rules similar to Rabbi Feinstein in 1983,[35] he
later reversed his opinion in a ruling published in 1998.[36]
The fact
that medical evidence along with societal consensus about the dangers of
smoking had reached a new climax in the 1980s and 1990s is also evident from
the secular legislation passed around the turn of the century. The state of
California enacted its first smoking ban of all enclosed workplaces in 1994,
and later included bars in 1998.[37] The
success of the ban influenced other states, such as New York, to enact their
own smoking bans. By 2009, 37 states now have some form of smoking ban.[38] Many
other countries enacted their own anti-smoking legislation as well during this
same period.
This
societal recognition also played a role in Rabbinic rulings as well. In 1998,
Rabbi Efraim Greenblatt published a responsum in which he ardently states that
smoking is not only prohibited but outright suicide. He compares the use of shomer peta’im Hashem
to permit smoking to someone lying down in the middle of the highway, assuming
that God will protect him. In addition, Rabbi Greenblatt specifically notes
that smoking is already prohibited in many public establishments, even in
businesses that serve alcohol – thus demonstrating that smoking is viewed as
even more dangerous than alcohol.[39]
Finally,
in 2006, the Rabbinical Council of America issued a ruling by their Va’ad halacha not only stating that they firmly believe
smoking is prohibited, but also declaring that “given the increased knowledge
and awareness of the health risks of smoking, it is safe to assume that even
Rav Moshe zatzal would have agreed that it is
forbidden.”[40]
Obesity
and Trans Fat – the New Smoking?
Although
smoking remains the number one preventable cause of death in the United States,
other health risk factors are increasing drawing the attention of the medical
community. While tobacco accounted for 18.1% of total U.S. deaths in 2000,
obesity accounted for 15.2% of total U.S. deaths. Researchers believe that poor
diet and physical inactivity may soon overtake tobacco as the leading cause of
death.[41] As
such, perhaps halachic authorities and Jewish communities should begin
evaluating whether an unhealthy diet or certain unhealthy foods may be
forbidden by halacha. The comparison of smoking to unhealthy food intake should
not be considered a novel idea. Rabbi Feinstein’s 1981 responsum makes this
same comparison (in the opposite direction) as a support for his belief that
smoking is not prohibited by halacha. After citing the Rambam’s warnings in Hilchot De’ot against overeating
or eating unhealthy foods, Rabbi Feinstein writes that “smoking cigarettes is
comparable to these matters.”[42] In
the same way that new medical evidence has led nearly all modern halachic
authorities to prohibit smoking, it is entirely plausible for medical evidence
regarding the dangers of obesity or dangerous substances, such as trans-fat, to
inspire similar modern halachic rulings. If the Rabbinical Council of America
believes that Rabbi Moshe Feinstein would have changed his opinion regarding
smoking due to changes in medical knowledge over the course of two decades, is
it possible that the Rambam would have changed his opinion[43]
about overeating or eating dangerous foods due to medical knowledge accumulated
over the past 800 years?
Obesity
– Current Evidence
Is
obesity really as bad as smoking? To give a global perspective in terms of what
preventable risk factors lead to death – after smoking (18.1%) and obesity
(15.2%), the next highest cause of death is alcohol consumption, which
accounted for only 3.5% of the total U.S. deaths in 2000.[44]
Obesity increases one’s risk of morbidity from high blood pressure, high
cholesterol, Type 2 diabetes, coronary heart disease, stroke, gallbladder
disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial,
breast, prostate, and colon cancer. Higher body weight is also associated with
increases in all-cause mortality. Currently, obesity has reached epidemic
levels and is especially problematic in developed countries. As people vary
greatly in height, defining obesity purely based on weight alone is
ineffective; instead, the convention of Body Mass Index (BMI) is nearly
universally used.[45] Body
mass index is defined as a person’s weight in kilograms divides by their height
in meters squared. Overweight is commonly defined as a BMI of 25 to 29.9 kg/m2
and obesity as a BMI above 30 kg/m2.[46] For
example, a 5’8” person would be considered overweight at 165 lbs and obese at
195 lbs. Currently, one third of U.S. adults are overweight and an additional
third are obese.[47]
As a significant majority of the population is overweight, it is certainly
tenable to say that one is protected by shomer
peta’im Hashem being that so many people are
engaged in the same behavior.
However,
as mentioned above in the discussion about the limitations of shomer peta’im Hashem,
there are also numerous reasons to say that one would not be allowed to rely on
shomer peta’im
Hashem in the case of negligent obesity.[48]
Firstly, the risks of obesity are known and recognized by doctors across the
world. Some of the leading health national organizations, such as the National
Institutes of Health and the American Heart Association, have produced pamphlets
to educate people about the dangers of obesity and guidelines for physicians on
how to treat obese patients.
Secondly,
according to many research studies, the risks associated with obesity may not
be considered a “minority” risk or one that is “far removed and occurs in the
minority of minority cases.” One’s risk of diabetes increases 25 percent for
each additional unit of BMI over 22. This would mean that compared to someone
of average weight, an overweight person has almost twice the risk and an obese
person has more than three times the risk. 27 percent of new cases of diabetes
are attributable to weight gain in adulthood of approximately 11 lbs or more.
With regard to coronary heart disease (CHD), weight gains of around 15 lbs
increase one risk of nonfatal heart attack or death by 25 percent, and weight
gains of 44 lbs increase risk more that 2.5 times. One British study showed
that for every unit increase in BMI, risk of CHD increases by 10 percent. Risk
of stroke has been shown in women to be 75 percent higher at BMI of 27 and 137
percent higher with a BMI over 32. Women with a BMI over 29 had were shown to
have twice the incidence of colon cancer as women with a BMI of 21 or less.
Overall, persons with a BMI of 30 or more (obese) were twice as likely to die
from all causes as persons with BMI in the 20-25 range.[49]
Although these values of risk may or may not reach the Binyan Zion’s 50% level
of risk required to declare shomer peta’im Hashem inapplicable (50% or even 100% increased
risk is not the same as saying that 50% of people will be injured or killed),
these statistics are certainly comparable to those cited in the Rabbinical
Council of America’s assessment of the risks from smoking.[50]
The major
caveat with comparing overeating to smoking halachically is that, in general,
food is an essential and necessary part of life. It may prove hard to declare
one bite of food as necessary and the next as “prohibited.” Smoking, on the
other hand, is purely voluntary and recreational in nature, to the point that
perhaps some halachic authorities would never say it is protected by shomer peta’im Hashem
even if the health risks were not as high as currently estimated. Thus,
although smoking one cigarette a year technically may not bear a significant
risk, it may still be prohibited due to its lacking in any positive value in
the eyes of halacha. Furthermore, one must acknowledge the strong role that
genetics plays in obesity (as one should with regard to addiction) – some
people are more susceptible to the effects of their dietary intake than are
others. As such, if one is willing to consider the possibility that dietary
intake can be a halachic matter – the prohibition would be on the behavior, on
the act of eating irresponsibly, not on the state of being overweight or obese.[51]
Trans
Fat
As the above caveats may make it more difficult to consider
overeating a violation of halacha, declaring certain very unhealthy food
substances as halachically forbidden may be more on par with smoking. Perhaps
the best modern test case is Trans-Fatty Acids, or “Trans-Fat.”
Trans-fats
are produced commercially in the making of shortening and margarine. The word
“trans” refers to the molecular structure, a specific feature which causes them
to remain solid at room temperature allowing food products which contain them
to appear more desirable and to have a longer shelf life. They are commonly
used in commercially baked products, fast foods, packaged snack food, and
crackers. The most common household source is stick margarine. Currently in the
United States, the average person’s trans-fat intake is about two to three
percent of their total calories.[52]
Although
trans-fat is not associated with as many illnesses as general obesity, it
became a popular topic in nutritional discussions in the 1990s when research
made it clear that it is associated with an increased risk of coronary heart
disease. Much like saturated fat, which people are more familiar with,
trans-fat increases a person’s LDL cholesterol (“bad” cholesterol). What makes
trans-fat particularly dangerous, however is that is also deceases a person’s
HDL cholesterol (“good” cholesterol), so that the net effect of trans-fat on
the ratio of bad to good cholesterol is approximately double that of saturated
fat.[53] This
ratio is especially significant in that cholesterol levels are a much more
significant factor in CHD death than even smoking, BMI, or physical activity.[54]
Current research has also shown that trans-fats may also impact cardiovascular
health in other ways such as by producing inflammation.[55]
In some
studies, persons with the highest level of trans-fat intake in their diets had
2.4 times the risk of having an acute heart attack as compared to those with
the lowest intakes. Two major studies found that even a two percent increase in
the intake of trans-fats was associated with a significant increased risk of
CHD.[56] One
study found that simply replacing two percent of one’s dietary intake with
other fats instead of trans-fats caused a 53 percent decrease in risk and
replacing two percent with carbohydrates decreased risk by 93%.[57]
Accordingly, a review article in the New England Journal of Medicine already
noted in 1999 that this would mean that the average person’s intake of two
percent of calories from trans-fat in the United States “would be predicted to
account for a substantial number of deaths from coronary heart disease.”[58]
As of
2006, the Food and Drug Administration (FDA) required that all conventional
foods indicate their content of trans-fat on the label. Later studies reported
that the increased risk for coronary heart disease may be closer to 25%, but
there is also an increased risk of cardiac related sudden death in the range of
47% to almost 300%. In 2006, the New England Journal of Medicine estimated that
10-19 percent of CHD events in the U.S. could be prevented by reducing
trans-fats.[59]
Thus, in
many ways trans-fat contains the same halachic concerns that caused smoking to
be prohibited. The health risks of trans-fat consumption are significant,
known, and recognized by doctors internationally. Also, although trans-fat does
provide energy, it essentially adds no nutritional benefit to foods[60], and
in this respect is quite comparable to smoking. Finally, the dangers of
trans-fat are becoming apparent in the eyes of government and society as a
whole. In 2006, New York City’s Board of Health voted to ban trans-fats from
use in restaurant food.[61] The
city of Philadelphia passed a similar ban, and many other cities across the
United States are working on legislation. In 2008, California became the first
state to ban trans-fat in restaurants, a ban which becomes effective in 2010.[62] This
societal change is reminiscent of Rabbi Efraim Greenblatt’s responsum
prohibiting smoking, where he noted that it is banned even in restaurants where
alcohol is served. Although the bans on trans-fats are no where nearly as
widespread as the bans on smoking, this shift in societal awareness highlights
how well recognized the risk of trans-fat consumption has become, and how it is
slowly becoming the new “smoking” of the 21st Century.
Conclusion
In Jewish
communities that respect both halacha and modern science, the idea of
prohibiting a food or substance based upon changes in medical information is
not a new concept. For much of the 20th century, smoking was the reasone d’etre of both preventive
medicine and modern halachic discussion. While the medical and halachic battle
against smoking is unfortunately not a closed case, there are other newer
concerns in the 21st century, which also deserve the attention of
the medical and halachic community. For the past two decades, the discussions
about the health risks caused by obesity in general and trans-fat in particular
have intensified in the medical community. Even local and state governments
have started to mobilize against these health concerns. Perhaps is it time for
halachic authorities, local Rabbis and synagogues to start considering whether
action should be taken on the part of Jewish communities. Perhaps behavior
leading to obesity should start being viewed not only as irresponsible, but
also as a violation of halacha. Furthermore, even if Rabbis find it too
difficult to actually prohibit overeating, perhaps certain recognized dangerous
foods, such as trans-fats, should be officially forbidden (at least above some
minimal quantity).
Even if
one does not feel that the evidence at the moment is strong enough to make any
formal prohibitions, local communities should consider whether such significant
health risks should be supported publicly. As the Rama writes in Yoreh De’ah 116:5,
“we treat danger even more strictly that forbidden behaviors.” Perhaps
synagogues should ask their caterers to reduce or refrain from using trans-fat
in their products. Perhaps baked products at kiddushes should be encouraged
to be free from trans-fat. This approach would not mean that one could never
indulge in another donut or cookie, but simply that as a community that values
Torah, halacha, and life, health consciousness should also take precedence at
certain times and places.
Finally,
recently the idea of an “ethical hechsher (kosher supervision)” has
grown in popularity in some Jewish circles. Perhaps such hechshers
should require that the companies or products that they oversee are stringent
about the health consequences to those who eat their products in addition to
the health of the workers who make the products.
[1] I
would like to thank Rabbi Dr. Edward Reichman for his
advice and input on this article.
[2] See
also Dr. James DiPoce and Dr. Shalom Buchbinder’s article, “Preventive Medicine” in the Journal
of Contemporary halacha and Society, Volume 42.
[3] In
1957, the surgeon general of the United States declared it the official
position of the U.S. Public Health Service that there was a causal relationship
between smoking and lung cancer. Rabbi Moshe Feinstein’s responsum
discussing the permissibility of smoking was first written in 1964. In 1965,
Congress required all cigarette packages in the U.S. to carry a health warning
label. In 1981, Rabbi Feinstein repeated his opinion that smoking is not
prohibited even if it should be avoided. In 2006, the Rabbinical Council of
America issued a formal ruling that smoking is forbidden according to halacha, and they believe even Rabbi Feinstein would agree
based on current medical information.
[4] Mokdad et al., ”Actual Causes of Death in the United
States, 2000,” Journal of the American Medical Association
291(10): 1238-45.
[5] Vayikrah 19:2
[6] Ramban ad loc.
[7] This
sentiment is echoed in the Rabbi Moshe Feinstein’s comment at the end of this
1981 responsum on smoking. Although he rules that
smoking is not prohibited due to its health risks, he adds that one should
still avoid smoking and that there is “still a prohibition to become habitual
in smoking and thereby indulge one’s desires and pleasures.” Iggrot Moshe, Choshen Mishpat II, no. 76
[8] Rambam Hilchot De’ot 4:15
[9] Ibid
4:9
[10] Iggrot Moshe Choshen Mishpat II no. 76
[11] Rambam Hilchot De’ot 4:1
[12] Hilchot Rotzeach v’Shemirat Nefesh, chapter
11. Technically, even these foods are not forbidden, but rather the
circumstances under which they are consumed makes it likely that they contain
poison. The consumption of the poison is the root of the prohibition.
[13] Devarim 4:9
[14] Ibid
22:8
[15] Hilchot Rotzeach v’Shemirat Nefesh 11:4-5
[16] Shulchan Aruch, Choshen Mishpat 427:8-10
[17] Rama,
gloss on Shulchan Aruch, Yoreh De’ah 116:5
[18] For
a discussion of how many commentators have understood and addressed this
difficulty, See Ye Shall Surely Heal by Rabbi Yaakov Weiner, Ch. 14 and
the RJJ article on Preventive Medicine by Dr. DiPoce
and Dr. Buchbinder cited above.
[19] Devarim 22:2
[20] Ad loc.
[21] Responsa Atzei HaLevanon, no. 61. See also Nishmat
Avraham Vol. II, Yoreh
De’ah 336:4
[22] Responsa Tzitz Eliezer Vol. 15, no. 40.
[23] Rabbi
J. David Bleich, “Hazardous Medical Procedures,” Tradition
37:3 76-100. See also Teshuvot Chelkat Yaakov, Choshen Mishpat 31 who cites Shomer
Peta’im Hashem as the
reason behind why we are allowed to travel in a car or plane despite knowing
that such travel entails a certain amount of risk.
[24] Iggrot Moshe Yoreh De’ah II no. 49 and Choshen
Mishpat II no. 76
[25] Teshuvot Binyan Tzion no. 137
[26] Iggrot Moshe Choshen Mishpat II no. 76
[27] Teshuvot Achiezer Vol. 1 no. 23
[28] Yabia Omer Volume 6 Yoreh De’ah no. 13 and Volume 3 Yoreh De’ah no. 7
[29] Teshuvot Chatam Sofer Volume 1 Orach Chaim no. 196.
[30] Teshuvot Avnei Nezer, Even Ha-Ezer no. 1. Note,
however, that the Avnei Nezer
is different in that he is not contrasting doctor’s opinions with low level
risks, but doctor’s opinions with common risks. Perhaps he would consider
smoking or diet related dangers as common risks if they were considered normal
everyday behavior in one’s society.
[31] Binyan Tzion cited above holds
this way. See also Rabbi Shlomo Cohen-Duras, “Shomer Peta’im Hashem,” Techumin 24: 228-34 who discusses other sources that
demonstrate that shomer peta’im
Hashem only applies for a mitzvah or for a
pressing need. He also presents opinions who hold that this the Talmud only
applies this principle to supernatural dangers, but not to natural risks even
for a mitzvah. Furthermore, many of the responsa
already cited deal with situations where a mitzvah is involved such as having
children. Although not all opinions say so explicitly, it is likely that these halachic authorities would be less inclined to allow even
minor risk taking if it is not for a necessary purpose or mitzvah. Rabbi Cohen-Duras also notes that there is one opinion, Rabbi Yehuda Assad, who appears to hold that shomer
peta’im Hashem applies
even to cases of known and certain danger, although he as well is discussing a
case involving the mitzvah of having children.
[32] Iggrot Moshe Yoreh De’ah II no. 49 and Choshen Mishpat II no. 76. There is a commonly assumed reading of
Rabbi Feinstein’s 1981 responsum that assumes that
while still holding that smoking is permitted for those who already smoke, he
forbids non-smokers to start smoking. A careful reading, however, reveals that
he only says it is “worthy” for one not to smoke, or “one should not
become addicted.” The only time Rabbi Feinstein uses the assur,
prohibited, is when he states, “And aside from the concerns of danger involved,
it should be prohibited to become habitual [in smoking] for one should
certainly not cause himself to be drawn towards increasing his desires and
pleases.” This comment seems less judicial in nature, and more of an ethical
comment, similar to the Ramban’s concept of naval b’reshut haTorah.
[33] Teshuvot Tzitz Eliezer Volume 15 no. 39
[34] Asyah Volume 5, p. 261
[35] Teshuvot Yechave Da’at Volume 5 no. 39
[36] Sefer Halichot Olam 1:265-66.
[37] California
Labor Code §6404.5 Retrieved on Auguest 18, 2009 at
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=lab&group=06001-07000&file=6400-6413.5
[38] “How many Smoke Free Laws?” American
Nonsmokers’ Rights Foundation. Retrieved on August 18, 2009 at
http://www.no-smoke.org/pdf/mediaordlist.pdf
[39] Teshuvot Rivevot Efraim 8:586. Rabbi Greenblatt
was also a one of the most prominent students of Rabbi Moshe Feinstein.
[40] The
Prohibition of Smoking in halacha. Retrieved on
August 18, 2009 at http://www.rabbis.org/pdfs/Prohibition_Smoking.pdf
[41] Mokdad et al., ”Actual Causes of Death in the United
States, 2000,” Journal of the American Medical Association
291(10): 1238-45. See also Mokdad, et al.,
“Correction: actual causes of death in the United States, 2000,” Journal of
the American Medical Association 293(3): 293-4.
[42] Iggrot Moshe Choshen Mishpat II no. 76
[43] i.e the Rambam’s choice to list
these health risks in Hilchot De’ot
as strong recommendation, instead of in Hilchot Rotzeach as formal prohibitions.
[44] Mokdad et al., ”Actual Causes of Death in the United
States, 2000,” Journal of the American Medical Association
291(10): 1238-45.
[45] Although
many institutional guidelines translate these values back into approximate
weight gain ranges for the convenience of use by patients and physicians.
[46] National
Institutes of Health. “Clinical Guidelines on the Identification, Evaluation,
and Treatment of Overweight and Obesity in Adults.” Retrived
on 8/5/09 at
http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf.
[47] Lichtenstein
et al. “Diet and Lifestyle Recommendations Revision 2006: A Scientific
Statement from the American Heart Association Nutrition Committee,” Circulation:
Journal of the American Heart Association 2006; 114; 82-96.
[48] As
there may be a genetic component to an individual’s obesity, the prohibition
being discussed would be regarding eating behaviors leading to obesity,
regardless of the person’s actual BMI, or weight.
[49] National
Institutes of Health. “Clinical Guidelines on the Identification, Evaluation,
and Treatment of Overweight and Obesity in Adults.” Retrived
on August 5, 2009 at
http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf
[50] The
Prohibition of Smoking in halacha. Retrieved on
August 18, 2009 at http://www.rabbis.org/pdfs/Prohibition_Smoking.pdf. In
footnote 16 of the RCA’s responsum, they cite the
following statistics from various medical sources: “Cigarette smokers are 2-4
times more likely to develop coronary (heard) disease than non smokers.
Cigarette smoking approximately doubles a person’s risk for stroke…it is
estimated that 15% of smokers die of lung cancer. Accordingly, this would
indicate a mortality of 50% or more from all tobacco related causes.” It is
unclear how the RCA reached their final calculation of a 50% mortality rate,
the actual statistics cited are comparable to those increases risks assumed by
obese persons (BMI over 30). Furthermore, in general, statistics regarding
smoking are cited without detailing how heavy the level of smoking is being
studied. Smoking one pack a day obviously entailed significantly more risk than
one cigarette a day. Many statistics are probably reporting morbidity or
mortality for heavy smokers. Similar statistical manipulation can be made with
regard to obesity which is why specifying the level of obesity is important.
For example, “Morbid Obesity” – BMI 40 or above – is associated with 6-12
times!! the mortality of normal middle age individuals. See Rashid et al.,
“Obesity and the Risk for Cardiovascular Disease,” Preventive Cardiology 2003;
6:42-47.
[51] Accordingly, an obese person who tries
to control their weight, but it unsuccessful due to their genetic
predisposition, would not be in violation of halacha,
while another individual with the same BMI could be in violation if he or she
chooses to retain unhealthy eating habits.
[52] Mozaffarian
et al. “Trans Fatty Acids and Cardiovascular Disease,” New England Journal
of Medicine 354 (15): 1601-1613. Naturally occurring trans fat are also
found in small quantities in meats and dairy products.
[53] Ibid.
See also Lichtenstein et al. “Effects
of different forms of Dietary Hydrogenated Fats on Serum Lipoprotein
Cholesterol Levels,” New England Journal of Medicine 340 (25):
1933-1940.
[54] Menotti et al. “Inter-Cohort
Differences in Coronary Heart Disease Mortality in the 25-year follow up of the
Seven Countries Study,” European Journal of Epidemiology 9: 527-536.
[55] Mozaffarian
et al. “Trans Fatty Acids and Cardiovascular Disease,” New England Journal
of Medicine 354 (15): 1601-1613.
[56] Ascherio et
al. “Trans Fatty Acids and Coronary Heart Disease,” New England Journal of
Medicine 340 (25): 1994-1998. See also Kromhout
et al. “Dietary Saturated and trans Fatty Acids and Cholesterol and
25-Year Mortality from Coronary Heart Disease: The Seven Countries Study,” Preventive
Medicine 24: 308-315.
[57] Hu et al.
“Dietary Fat Intake and the Risk of Coronary Heart Disease in Women,” New
England Journal of Medicine 337 (21): 1491-1499. This same study also noted
that replacing 5 percent of one’s calories from saturated fat with unsaturated
fat would reduce their risk of CHD by 42 percent. The authors also noted that
reducing this amount of saturated fat is actually much more feasible that
reducing 2 percent of trans fat. In this regard, perhaps saturated fat would
also have proven an interesting test case for halacha.
However, saturated fat is still considered a more acceptable part of one’s
diet. The American Heart Association recommends that saturated fat intakes be
less than 7% of ones diet, but trans fat should be less than 1%. See Circulation:
Journal of the American Heart Association 2006; 114; 82-96 cited above.
[58] Ascherio et
al. “Trans Fatty Acids and Coronary Heart Disease,” New England Journal of
Medicine 340 (25): 1994-1998. Italics added.
[59] Mozaffarian
et al. “Trans Fatty Acids and Cardiovascular Disease,” New England Journal
of Medicine 354 (15): 1601-1613. According to this review article, one
study showed a 39% increased risk for diabetes.
[60] Ascherio et
al. “Trans Fatty Acids and Coronary Heart Disease,” New England Journal of
Medicine 340 (25): 1994-1998.
[61] “New York City
passes Trans Fat Ban,” MSNBC.com. December 5, 2006. Retrieved on 8/23/09
at http://www.msnbc.msn.com/id/16051436/
[62] McGreevy, Patrick, “Gov.
Schwarzenegger signs law banning trans fats in restaurants,” Los
Angeles Times. July 25,
2008. Retrieved 8/23/09 at
http://articles.latimes.com/2008/jul/26/local/me-transfat26