Jewish Diabetes Association

BSD

Passover/Pesach Guide for Jewish Diabetes

PASSOVER PESACH - HELP! Not the help we all scream about. This time it's not the cleaning, getting organized, trying to figure out where to start and where to end. This time it's diabetes! The challenge of diabetes seems ten-fold when it comes to Passover/Pesach. Our whole routine has changed!

Four cups of wine at one meal!

Hand matzo- what's that?

How do we know how many carbohydrates are in one hand matzo?

These are real concerns for people with diabetes and related health issues, which until now, had few answers.

For more than three decades the Jewish Diabetes Association JDA has been answering these questions for thousands world wide and has now written this article.

So how does one manage on Passover/Pesach without forfeiting the benefits of a healthy regimen and healthy lifestyle?

Let us begin to address these issues.

This year the first Seder is on Monday night the 22nd of April 2024. In the diapora the 2nd seder is on Monday night.

All unleavened bread/chametz must be out of the house by Monday morning. This certainly does not leave many choices for carbs, since many hold that matzo may not be eaten on the day that the holiday begins until the Seder. So try to keep full with light protein and lots of vegetables. Remember that kugels need not be only potatoes-use your imagination.

The following will help you prepare your matzo and wine. If you have everything ready you are less likely to run in to problems. Remember that:

Failing to prepare is preparing to fail!

The Matzo

The stipulations for minimum shiurim for matzo, which follow, are based on the psak of Rav Moshe Heinemann shlita.

NOTE: These calculations from the Star-K are based on the use of a Tzelem Pupa hand matzo. In the case of a medical condition, one may fulfill the mitzva of achilas matzo, including korach and afikoman with the following:

Hand matzo round one-sixth 1/6 of a matzo 13.75 sq in. =16 gr. Carbs.

Machine matzo 1/4 of a matzo 10.75 sq. in= approx 10 gr. Carbs.

One who is in good health should eat the following for achilas matzo, korach and afikoman:

Hand matzo round one-third 1/3 of a matzo 27.5 sq. in. 31gr. Carbs.

Machine matzo 1/2 of a matzo 21.5 sq.in= 15 gr. Carbs.

CALCULATING THE AMOUNT OF CARBS:

Most machine matzo has the portion size and carbs listed on the box and are uniformed in size and shape. We suggest that one keep the amount that you intend to eat near your plate.

For the convenience of those that would like to calculate the carbohydrates in the minimum amounts shiur we have also listed these with permission from Feldheim Publishers, as brought forth by Rabbi Bodner, in the Hebrew Book of law sefer & Halachos of Kzayis.

Hand matzo varies according to the size and thickness. Rabbi Bodner lists them as follows:

In order to simplify the calculations, we recommend that you weigh the Matzo before the holiday in order to become accustomed to the weight and sizes.

For those that prefer to do their own calculation matzo has an average carb factor of 0.75. In other words 75 of its weight is carbohydrates. Whole wheat matzo has almost 12 grams of dietary fiber per 100 grams, bringing the total amount of carbs down almost 4 grams per slice. The more whole wheat products that one uses throughout the year, and especially during Passover Pesach when there are so many meals, are advantageous for most people.

Hand matzos have been divided in to four categories: all weights & measurements are approximated and rounded to the nearest 10th:

TYPE of MATZO	PIECES PER KILO	WEIGHT	CARBS	CALORIES
THIN	20	53 gr.	40 gr.	160
MEDIUM	17	64 gr.	48 gr.	192
THICK	13	75 gr.	60 gr.	236
MACHINE	10 PER BOX	30 gr.	25 gr.	115

The following are the requirements by Jewish law to eat throughout the Seder nighttime holiday meal for the first-tree blessings made for the eating of the matzo

Achilas Matzo Hand Matzo

TYPE of MATZO	PORTION SIZE	CARBS
THIN	53 OF WHOLE MATZO	22 gr.
MEDIUM	41 OF WHOLE MATZO	20 gr.
THICK	35 OF WHOLE MATZO	21 GR.

Korech mid way through the reading of the seder

And Bentching/grace after the meal

Minimum of bitter herbs Kzayis of marror sandwiched in a minimum Kzayis from the bottom Matzo

TYPE of MATZO	PORTION SIZE	CARBS
THIN	31 OF WHOLE MATZO	13 gr.
MEDIUM	24 OF WHOLE MATZO	11.5 gr.
THICK	20 OF WHOLE MATZO	12 gr.

Afikoman at the end of the meal

Based on 2 minimums Kzayisim of the smallest shiur

The following is a chart that can assist with the calculations of carbs by weight and choice of Matzo:

Carbs / Whole Wheat & Spelt	Carbs for Whole Wheat	Carbs for Regular Wheat Matzo	Portion of Matzo in grams
6	7	8	10
18	21	24	30
30	35	40	50
36	42	48	60
48	54	64	80
60	70	80	100

THE ARBA KOSOS/FOUR CUPS

A. WINE/ CUP REQUIREMENTS:

The cup must hold at least a reviis of wine 3.8 fl. oz., or 112 ml.

MINIMUM SHIUR TO FULFILL ARBA KOSOS:

Individual Minimum Shiur One with a medical condition at least 1.5 fl. Oz. 45 ml

One in good health at least 1.9 fl. Oz. 56 ml

ADDITIONAL REQUIREMENTS: The lowest percentage of alcohol that may be used for the four cups is 4.

One should drink each of the four cups of wine within half a minute.

B. DILUTING WINE WITH GRAPE JUICE AND WATER:

Wine may be diluted in the following maximum ratios these ratios allow the wine to retain enough of its properties to qualify it being used for the four cups:

Wine/ Grape Juice/ Water 1/3 2/3 1/3

NOTE: The diluted beverage must contain at least 4 alcohol to fulfill the obligation of drinking wine on Pesach.

If necessary, one may make a mixture of 2/3 water and 1/3 wine 66 ml water and 34ml wine as long as the diluted amount still contains 4 alcohol. Otherwise, there is a chance that it may no longer be considered wine.

The following chart illustrates how much wine to drink.

Cup size / Amt of wine after dilution

1st cup 1.5 oz. 0.6 oz.

2nd cup 1.5 oz. 0.6 oz.

3rd cup 1.5 oz. 0.6 oz.

4th cup 1.5 oz. 0.6 oz.

TOTAL 6.0 oz. 2.4 oz. Footnotes 1 HaGaon HaRav Karelitz Shlita rules that in the case of a sick person, one goes by the more lenient ruling of 4.6 oz. 135c.c. even according to the Chazon Ish Ztl

ADDING WATER FOR WINE AND GRAPE JUICE:

One can add water to dry wine, and it is still considered wine and is Kosher in upholding the commandment. However, the taste of the wine must remain, and should not acquire the taste of a light drink. The acceptable combination is 60 water to 40 wine. There are some wines, due to a stronger taste that allow up to 75 water and 25 wine. However, a taste test should be done before the holiday to insure that this mixture does not lose the taste of the wine.

The ruling for grape juice is that one is not allowed to add water since this alters the taste.

However, one is allowed to mix the grape juice with the wine/water combination which will bring down the amount of carbs in the grape juice and the amount of alcohol from the dry wine considerably.

If one follows these guidelines of mixing 3 cups water to 1 cup of wine correctly, one will consume only 2-3 oz. of wine throughout the entire Seder.

If the largest shiur is used, it will amount to 5-6 oz of wine. In order to be able to estimate the actual amount to drink at the Seder, measure the exact amount that you will be using, before Yom Tov. Choose the Kiddush cup that you will be using and pour the measured amount in to the cup of choice so that you can recognize how much you will be drinking.

TYPE OF WINE:

The best option would be a dry wine, which has almost no carbs. [Most dry wines contain approximately 4 grams of carbs per 8 oz. cup.] If the sour taste bothers you, try adding some artificial sweetener.

Because the law does not require manufacturers to print nutrition facts on wine bottles, it is often hard to know exactly how many carbs a glass of wine contains. If you are trying to find a wine that is very low in sugar, you can use a glucose meter before Yom Tov to test a sample. We tested it with a Glucometer Ascentia XL, not all meters will give accurate results. Test a sample of the wine just as you would test a drop of blood on your meter. If the wine you are testing is a sweet wine, your meter will give you a HI reading. If it is a dry, low-carb wine, the meter will tell you that it is LOW.

Many of the dry wines will not give you a LOW reading, but the numbers you will get are a very good reference. Diabetes Forecast stated that a cup of regular soda contains 4 mg/dl of sugar, which would give a very high reading. It pays to remember this, so that you keep the meter reading of a dry wine in proper perspective. [By the way, this is a good way to test diet soda from fountains that could easily be interchanged with regular soda. To be certain that the soda you are drinking is really sugar free check it out on your meter.]

For those who are not accustomed to drinking high quality dry wine, it may take a while to acquire a taste for it. Here are some examples of wines we tested for sugar content on a glucose meter: Meter reading for

Chardonnay was 225.

Cabernet Sauvignon was 87

Sauvignon Blanc from Gamla was 27.

These are only a few examples. Remember to test the specific wines that you are planning to use. Less expensive wines are rarely sugar free. Checking on a finger stick meter seems to have proven this correct, as some inexpensive, supposedly dry wines, actually tested HI on a meter. An important point: Since alcohol may cause a drop in your Blood Sugar, discuss with your doctor whether or not to cover the carbs in wine with insulin. There is more of a chance that wine will cause a low BG on an empty stomach. If you use pure unmixed wine for the first cup, make sure to follow the above guidelines and not to overdue your alcohol intake. One might want to consider having some food in your system before the meal. Protiens vegetables and nuts are good choices.

Grape juice, on the other hand, will elevate BG drastcally! Considering that we are heading in to a holiday meal, we should really check these factors in advance!

Those with Type 2 diabetes: should discuss with their doctor and Rabbi if it is better to drink wine rather than grape juice. According to Biblical law wine is preferable, and the juice has high sugar content, however, many of the oral medications used for treating Type 2 diabetes, non-insulin dependent diabetes are not compatible with alcohol. Remember to show these options to your doctor! Many health care professional have been very pleased with these options since they allow for a normal quality of life.

Those with Gestational diabetes diabetes in pregnancy or T1 and pregnant should check with their health care professionals and Rabbi to determine which way to go. Again show them the charts in order to guide them in their decision.

GRAPE JUICE

Some Rabbis say that it is preferable to use wine or a wine/grape juice combination for the 4 Cups. Keep in mind that as far as diabetes and carb counting is concerned, dry wine is certainly the way to go. If you drink grape juice, please note: the carbohydrate content of the various grape juices differ. Those that we have researched range from 32-60 gr. of carbs per cup. Please make sure to check the label. In order to cut down the amount of carbs one can use a combination of grape juice mixed with the diluted 60/40 wine. In order to prepare in advance, simply pour 1 cup of wine into an empty bottle, and add 3 cups of water. The size of the cup does not matter. Just make sure that you use the same cup for the water and the wine. It is always advisable to prepare this bottle in advance and label it as your own SPECIAL RESERVE.

SUMMARY PREPERATION LIST!!!

Discuss with your Rabbi the shiurim of rov reviis and mixing wine with water.

Choose the wine/grape juice of your choice and check the carb content remember the meter test.

Prepare the right size Cup.

Train your eye to recognize the amount that you will be drinking during the Seder.

Mix the wine with water and or grape juice following the instructions of your Rabbi and doctor.

Prepare a separate labeled bottle for yourself in order to avoid mixing up with other bottles. You can call it you Special Reserve!

Weigh Matzos in advance in order to be better prepared for deciding insulin doses.

Make sure you have prepared in advance your choice of glucose for treating hypoglycemia.

Review chart and details with your health care team.

Prepare all medical supplies, medications and equipment for Yom Tov Holiday and Shabbos in advance l&rsquokovod yom tov in honor of the holiday & Sabbath.

Sugar Substitutes

Sugar Substitutes - Gefen - Kosher L'Passover Pesach Sweet'N Low not Equal Sweetie with Badatz supervision from Israel liquid & Tablets, Stevia and other stevia based sweeteners may or may not be kosher for Passover always check the labels. There may be others but all products must have specific Passover Pesach supervision on the label.

Powdered Equal, Splenda and Nutrasweet are NOT kosher for Passover/Pesach, and may not be used by Ashkenazim and not by Sefardim unless specifically noted.

It was once thought that products containing sugar, even in minute amounts, were totally off limits for people with diabetes or at risk for diabetes or other related health conditions. However, the American Diabetes Association opposes totally restricting sugar provided they consume it in the context of a healthy food choice. Therefore, foods with sugar listed as a lower ingredient on the label can be included in one's meal plan, as long as they are counted in the appropriate food group. Sugar should be consumed in small amounts and in most recipes can be cut down significantly and/or combined with sweeteners. Today we are lucky to have a much larger variety of kosher for Passover Pesach products.

The following are some products with the nutrition facts.

Common Cooking Ingredients:

Food Amount Carb Calories Fat

Choc. 72 cocoa 2 tbsp 3.5 gr 57 4.5

Baking choc lg sq 10 79 4

Choc chips 1 T 10 75 4

Choc chips 1/2 cup 80 600 32

Cocoa 1 T 3 20 1

Cocoa 1 cup 50 350 15

Eggs 1 L 0.7 70 7

Honey 1 T 12 48 0

Honey 1/2 cup 112 448 0

Matzo Meal 1 T 5 8.5 0

Matzo Meal 1 cup 96 134 0

Oil 1 T 0 90 10

Oil 1 cup 0 1440 160

Potato Starch 1T 8 36 0

Potato Starch 1 cup 128 576 0

Sugar 1 T 15 60 0

Sugar 1/4 cup 60 240 0

PASSOVER PESACH COOKIES AND CAKES

This is just a partial list. Since most Passover Pesach products are similarly manufactured it is probably safe to assume that similar products will have more or less the same amount of carbohydrates.

Since Passover Pesach products are made from, potato starch, sugar and/or matzo meal, they are all, basically, almost pure sugar. With enough preparation time one should have no problem making some snacks with fewer carbs on your own. As always the best way to go is good old fashioned home made.

Product Company Serving size. Carbs

Brownie Cake Hagadda 38 gr. 20 gr.

Choc Cake Oberlander 42 gr. 23 gr.

Rainbow Cake Hagadda 28 gr. 11 gr.

Sponge Cake Oberlander 42 gr. 24 gr.

Apricot Cookies Hagadda 28 gr. 16 gr.

Leaf Cookies Hagadda 33 gr. 14 gr.

Nut Cookies Hagadda 28 gr. 11 gr.

Rasp Cookies Hagadda 28 .gr 15 gr.

Choc Macaroons Hagadda 33 gr. 18 gr.

Finally, remember, Pesach does not have to mean matzo, potatoes, and eggs throughout Holiday. Instead of high-fat soups and potato kugel, you can substitute other vegetables and vegetable combinations.

NOTE: Holidays should be enjoyed!! Having these guidelines will help you do just that!! CHAG SAMEIACH!!

Halachic measurements by Rabbi Heinnaman Shlit'a

Take Very Good Care of YourselvesDeuteronomy 4:15

Take Very Good
Care of YourselvesDeuteronomy 4:15