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JDA Logo - Click to go to home page UPDATED PASSOVER/PESACH GUIDE for DIABETES
Enlightened

BS'D

 By Nechama Cohen/Jewish Diabetes Association

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. The Jewish Diabetes Association (JDA) has been answering these questions for thousands world wide for more than two decades 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 18th of April 2011—all unleavened bread (chametz) must be out of the house by Monday morning. This certainly does not leave many choices for carbs, since matzo may not be eaten until the Seder.  So try to keep busy with light protein ands lots of vegetables—remember that kugels need not be only potatoes---use your imagination and our cookbook.

 

Passover (Pesach) does not necessarily mean matzo, potatoes, and eggs throughout the Holiday.  Use your imagination.  Instead of high fat soups—load up on vegetables.  In place of only potato kugels substitute completely with other vegetables or in combination.  Our book, EnLITEned Kosher Cooking/BISHULITE (Hebrew translation) has more than 140 recipes for Passover (Pesach) and the rest is easily adaptableit is the only kosher diet cookbook for Passover.

 

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

 

FAILING TO PREPARE IS PREPARING TO FAIL!!!!!!

 

The Matzo

IN THE CASE OF A MEDICAL CONDITION:

HaGaon HaRav R Shlomo Zalman Aurbach ZT”L wrote, that one that has a medical condition, can rely on the opinion that in order to fulfill the Jewish law (Halacha), the minimum required amount (shiur), is the size of a natural olive. This is very small, and equals a bit less than 4 gr. in weight of Matzo. In the Jewish Book (Sefer ”Midos Chen,pg. 28), it is written, that this is less than a square measuring 6.5 cm x 6.5 cm) 2.6 in x 2.6 in. (see illustration) matzoimage

actual size recommended for one with a medical condition. Please note that one must check with a physician and Rabbi in order to determine how to apply the laws of matzo  to each individual case.  For those with sensitivity to wheat and gluten there are available both spelt and oat matzo.  For those that are watching their weight, remember that this is just one night and perhaps it would be a good idea to compromise with the desserts as opposed to the matzo that is a Torah commandment--Here's to wise choices! 

 

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 K’zayis).

 

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 (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.

40.8 gr.

160

MEDIUM

17

64 gr.

48 gr.

192

THICK

13

75 gr.

60 gr.

236

MACHINE

10 PER SMALL 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-third blessings made for the eating of the matzo*

 

Achilas Matzo Hand Matzo (round)

 

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 Passover event)

And Bentching (Grace after the meal)

Minimum of bitter herbs (K’zayis of marror) sandwiched in a minimum (K’zayis) 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 (K’zayisim) of the smallest shiur)

 

TYPE of MATZO

PORTION SIZE

CARBS

THIN

39% OF WHOLE MATZO

16 gr.

MEDIUM

30% OF WHOLE MATZO

14.5 gr.

THICK

26% OF WHOLE MATZO

15.5 gr.

          

 

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

 

 *(There are three specific times that blessings are made on the Matzo).

 

The Arba Kosos (Four Cupsof Wine)

WINE: THE REQUIRED AMOUNT THAT ONE MUST DRINK:

 

Minimum quantity (Shiur):

The required amount is called a Reviyis. There are differences of opinion as to the exact measurement of a Reviyis. According to the Jewish Book of Laws (Shulchan Aruch) the accepted size of a Reviyis is: 3 oz. (86 c.c.) (This is much smaller than the average Kiddush cup {Becher}).

 

The larger portion size, according to the Chazon Ish of blessed memory (Zt”l) is 5 oz. (150 c.c.). 1. There are the minimum required amounts of wine that needs to be in the cup. 2. Required amount that one must drink:

 

The law states that one must drink (rov reviyis) ‘most of the minimum required amounts that need to be in the cup. However, it is best to drink the entire amount. For an individual with a medical condition it is acceptable to drink ‘most of it. (This is a bit more than 1⁄2 of what is in the cup).

 

It is commendable (a Hiddur) to follow the ruling of drinking ‘most or even the entire amount that is in the cup (becher) even if it is a large cup. Therefore, the funny pictures Mishna Brurah recommends that if one does not intend to drink a large amount, he should not use a large cup, but one that holds the smallest required amount (reviyis).

 

For the 4th cup at the end of the Seder, it is necessary to follow with a Blessing after drinking wine (Bracha Acharona). In order to recite this blessing, one is required to drink the full minimum amount (reviyis). One that, for medical reasons, cannot drink the full reviyis, may drink ‘most of it and request that someone else say the blessing (Bracha Acharona) out loud and have him in mind.

 

(Footnotes)

1 HaGaon HaRav R’N Karelitz Sh”lita 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 Zt"l

 

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 Mitzvah. 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 Yom Tov (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 75% (3 cups) water to 25% (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 becher (Kiddush cup) that you will be using and pour the measured amount in to the becher 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, such as saccharin tablets, which can be dissolved in water. 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 LO. Many of the dry wines will not give you a LO reading, but the numbers you will get are a very good reference. Diabetes Forecast stated that a cup of regular soda contains 4,500 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:

 

Chardonnay was 225. (meter reading)

Cabernet Sauvignon was 87

Sauvignon Blanc from Gamla was 27.

 

These are only examples. Remember to test the specific wines that you are planning to use. Less expensive wines are rarely sugar free. Checking on the 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.

 

Those with Type 2 diabetes: should discuss with their doctor and Rav if it is better to drink wine rather than grape juice. According to Halachah 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. There is not much alcohol left. 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 Rav to determine which way to go. Again show them the charts in order to guide them in their decision.

 

GRAPE JUICE

Some Poskim say that it is preferable to use wine or a wine/grape juice combination for the 4 Kosos. 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.

 

Please note: Kedem’s Concord dark grape juice, came in with the lowest amount, which has 16 grams of carbs in a 4 oz. serving. 

 

This is one example.  One may choose to use different percent combinations after speaking to a Rav and health care professional

MIXING 40% WINE WITH 60% WATER 

 

For the smallest shiur:

 

                 Amount to drink                  Amount after dilution

 

First cup           1.6 oz.  (rov reviis)          0.6 oz.

Second cup       1.6 oz.                          0.6 oz.

Third cup           1.6 oz.                           0.6 oz.

Fourth cup         3.0 oz.                          1.25 oz.

Total                7.8 oz.                          3.05 oz.

 

 

For the largest shiur:

First cup           2.6 oz.                          1.5 oz.

Second cup       2.6 oz.                          1.5 oz.

Third cup           2.6 oz.                          1.5 oz.

Fourth cup         5.0 oz.                          2.0 oz.

Total                12.8 oz.                         6.5 oz.

 

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 Rav the shiurim of rov reviis and mixing wine with water. 
  • Choose the wine of your choice and check the carb content (remember the meter test). 
  • Prepare the right size Becher. Train your eye to recognize the amount that you will be drinking during the Seder. 
  • Mix the wine with water following the instructions of your Rav and doctor. Prepare a separate labeled bottle. 
  • Weigh Matzas 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 (the holiday) and Shabbos in advance l’kovod yom tov and Shabbos (in honor of the holiday and/or the Sabbath).

 

Copyright  2011 Jewish Diabetes Association/Nechama Cohen

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