Passover Guide for Diabetics
These are real concerns for people with diabetes and related health issues, who wish to fulfill the requirements of Pesach al pi halacha without compromising their health. After being inundated each year with questions of this type, the Star-K turned to the Jewish Diabetes Association (JDA) for answers. The JDA has kindly provided the following guidelines to help you prepare your matza and wine.
The stipulations for minimum shiurim for matza, which follow, are based on the psak of Rav Moshe Heinemann shlit”a.
NOTE: These calculations from the Star-K are based on the use of a Tzelem Pupa hand matza.
In the case of a medical condition, one may fulfill the mitzva of achilas matza, including korech and afikoman with the following:
HOW TO CALCULATE THE AMOUNT OF CARBS IN MATZA:
Machine Matza: Most machine matza is uniform in size and shape. The portion size and carbs are listed on the box. It might be a good idea to keep the amount that you intend to eat near your plate.
Hand Matza: Hand matza varies according to size and thickness. Our calculations use a Tzelem Pupa hand matza. In order to simplify the calculations, we recommend that you weigh the matza before Yom Tov in order to become accustomed to the weights and sizes.
FOR THOSE WHO PREFER TO DO THEIR OWN CALCULATION: Matza has an average carb factor of 0.75 (75% of its weight is carbohydrates). Whole wheat matza has almost 12 grams of dietary fiber per 100 grams, allowing one to deduct 4 grams per slice.
II. THE ARBA KOSOS (FOUR CUPS)
One Must drink at least 1.9 fl.oz. (56 ml) for each of the four cups.
B. DILUTING WINE WITH GRAPE JUICE AND WATER
NOTE: The diluted beverage should contain at least 4% alcohol to fulfill the obligation of drinking wine on at the Seder.5 If necessary, one may make a mixture of 2/3 water and 1/3 wine (66% water and 34% wine) as long as the diluted amount still contains 4% alcohol. Otherwise, there is a chance that it may no longer be considered wine for the Seder.
The following chart illustrates how much wine to drink:
If these guidelines are followed correctly, as seen in the above chart, one’s total consumption of wine at the Seder will be less than 3 fl. oz. One who wishes to estimate the actual amount that he should drink at the Seder should measure the exact amount that he will need before Yom Tov. He should choose the becher (Kiddush cup) that he will be using at the Seder, and pour the measured amount into it so that he can recognize how much he will be drinking.
The following is an example of how to mix wine and water. Assume one has a wine with 10% alcohol content. If he makes a mixture of 40% wine and 60% water, he will have wine with 4% alcohol content, which is enough for the arba kosos. This can be done by mixing two cups of wine with three cups of water. He could fill a becher that holds at least 3.8 fl. oz. of this wine and water mixture, and drink at least 1.9 fl. oz. (the amount one may drink to fulfill the mitzva, when medically necessary). For the fourth cup, he could ask someone else to be motzee him in the bracha achrona.
To prepare in advance, simply pour 2 cups of wine into an empty bottle and add 3 cups of water. (The size of the measuring 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.”
C. TYPE OF WINE:
The best option for the Seder would be a dry wine, which has very few carbs. [Most dry wines contain approximately 4 grams of carbs per 8 oz. cup.] If the sour taste bothers you, try adding an artificial sweetener such as Kosher for Passover saccharin tablets, which can be dissolved in water.
Since manufacturers do not have a legal requirement 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 a HI reading. If it is a dry, low-carb wine, the meter will read it as LO. Many of the dry wines will not give a LO reading, but the numbers are a very good reference. For those who are not accustomed to drinking high quality dry wine, it may take some time to acquire a taste for it.
Here are some of the wines we tested for sugar content using a glucose meter:
The above wines are only examples. As you can see, sugar content from wine to wine and bottle to bottle can range widely. Remember to test the specific wines you are planning to use. Less expensive wines are rarely sugar-free. Checking with the meter confirms this statement, as some inexpensive, supposedly dry, wines actually tested HI on the meter.
IMPORTANT: Since alcohol may cause a drop in your blood sugar, discuss with your doctor whether or not to cover the carbs in the 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 overdo your alcohol intake.
Those with Type 2 diabetes should discuss with their health care team and Rav whether it is better to drink wine or grape juice. According to halacha, wine is preferable. Furthermore, grape juice with its high sugar content, is not ideal for those with diabetes. However, many of the oral medications used for treating Type 2 diabetes (non-insulin dependent diabetes) are not compatible with alcohol.
Therefore, we suggest showing the wine combination options to your health care team. As previously noted, after the dilution, the remaining alcohol content of all four cups is not significant. Many health care professionals have been very pleased with these dilution options and allow this small total amount of alcohol even with medication.
In addition, those with gestational diabetes (diabetes in pregnancy) or T1, or who are pregnant, should check with their health care team and Rav to determine which way to go. Again, show them the charts in order to guide them in their decision.
D. GRAPE JUICE
As noted above, one should use wine or, if necessary, a wine/grape juice combination for the arba kosos. If you are unable to drink wine, you may use grape juice instead. If due to medical reasons you are unable to drink pure grape juice for the arba kosos (and cannot drink any percentage of wine), you may dilute the grape juice. When mixing grape juice with water, at least 50% of the mixture should be grape juice (i.e., the cup is half grape juice and half water).
As suggested earlier, you may wish to prepare a “special reserve” mixture before Yom Tov and fill a bottle with two full bechers of grape juice and two full bechers of water. This will suffice for the arba kosos. Add more using the same ratio as necessary. Keep in mind that as far as diabetes and carb counting are concerned, dry wine is certainly preferable. If you drink grape juice, note that the carbohydrate content of the various grape juices differs. The juices that we tested ranged from 32 to 60g of carbs per cup. Always check the label to ensure you are consuming the least amount of carbs when combining grape juice with wine and/or water.
NOTE: Kedem’s Concord dark grape juice scored 16 grams of carbs in a 4 oz. serving, while the labels on Kedem’s Sparkling Chardonnay and Catawba list 13 and 12 grams of carbs, respectively, in the same 4 oz. serving.
SUMMARY PREPARATION LIST
Remember that failing to prepare is preparing to fail. If you have everything ready ahead of time, you are less likely to run into problems.
Finally, remember that Pesach does not have to mean matza, potatoes, and eggs throughout Yom Tov. Instead of high-fat soups and potato kugel, you can substitute other vegetables and vegetable combinations.
JDA has published a cookbook, EnLITEned Kosher Cooking, with more than 140 recipes for Pesach, along with year-round recipes that are easily adaptable. A Hebrew version, BishuLITE, is now also available.
To order either cookbook, get more information about diabetes, or a list of Pesach recipes from the book, visit www.jewishdiabetes.org.
III. OTHER PRODUCTS COMMONLY USED ON PASSOVER
Today we are lucky to have a much larger variety of Kosher for Pesach products. Below we list some products with their nutrition facts.
Common Cooking Ingredients:
Powdered Equal, Splenda and Nutrasweet are NOT Kosher for Pesach and may not be used.
PESACH COOKIES AND CAKES
Below is a partial list of the cookies and cakes that are available for Pesach. It is probably safe to assume that similar products will have more or less the same amount of carbohydrates, as their manufacturing processes are nearly identical. Since Pesach products for the most part consist of potato starch, sugar and/or matza meal, they are basically almost pure sugar. To ensure a healthier alternative, one should opt to make “homemade” snacks with fewer carbs.6
1. This assumes the whole matza (before it is broken) has a diameter of at least 10.5 inches, which means the entire matza has an area of 86.6 sq. in. Hence, 1/6 of the matza equals 14.5 sq. in. This is the minimum shiur for someone with a medical condition.