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Passover Guide for Diabetics These are real concerns for people with diabetes and related health issues that, until now, had few answers. After being inundated with questions of this nature, the staff at the Star-K turned to the Jewish Diabetes Association for guidelines. JDA has been answering these questions for thousands world wide for more than two decades and has now written this article. Since this year the first Seder is on a Motzoei Shabbos—almost all chometz must be out of the house by Friday morning, leaving just enough for washing and benching. This certainly does not leave many choices for carbs, since matzoh may not be eaten until the Seder. Some people use egg matzoh, but keep in mind that it is quite high in carbs. Since no chometz may remain in the house past Shabbos morning (check for specific times for your city) and we want to avoid making any crumbs, a good solution for Friday night for many will be small pitas (whole wheat are available). This is also a good time to start getting used to filling up with vegetables, salads and soups. Pesach does not necessarily have to mean matzoh, potatoes, and eggs all of The following information will help you prepare your matzoh and wine. MATZOH Remember that failing to prepare is preparing to fail. If you have everything ready you are less likely to run into problems The following is 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 matzoh.
THE ARBA KOSOS (FOUR CUPS) A. WINE: THE REQUIRED AMOUNT: The cup must hold at least 3.8 fl. oz. (112 ml) of wine, (a reviis). One who has a medical condition should drink at least 1.5 fl. oz. (45 ml). One who is in good health should drink at least 1.9 fl oz. (56 ml). One should not drink so much wine at the Seder that he becomes drunk. The beverage used for the four cups must have enough alcohol in it to be uplifting. However, one is not obligated to become sick because of it. The lowest percentage of alcohol that qualifies as usable for the four cups is 4%. One should drink each of the four cups of wine within a half a minute. B. ADDING WATER FOR WINE AND GRAPE JUICE: Wine may be diluted in the following maximum ratios, while still retaining enough of its properties to qualify its usage for the four cups: However, the diluted beverage must have at least 4% alcohol, in order to fulfill one’s obligation of drinking wine on Pesach.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 has 4% alcohol – otherwise there is a chance that it may no longer be considered wine. If one follows these guidelines correctly, one will consume less than 3 fl. oz. of wine throughout the entire Seder. 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 into the becher of choice, so that you can recognize how much you will be drinking. Here is an example of how one would mix wine and water. Assume one has a wine that has 10% alcohol content. If one makes a mixture of 40% wine and 60% water, one will have wine with 4% alcohol content which is enough for the arba kosos. This can be done by mixing 2 cups of wine with 3 cups of water. One would fill a becher that holds at least 3.8 fl. oz. and drink at least 1.5 fl. oz. (the amount one may drink to fulfill the mitzvah, when medically necessary). The following illustrates how much wine is drunk.
In order to prepare in advance, simply pour 2 cups 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”. C. 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 states 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 some time to acquire a taste for it. Here are some examples of wines we tested for sugar content on a glucose meter:
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. Therefore, we suggest showing the wine combination options to your health care team. After the dilution, as explained previously, the remaining alcohol content for the total 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. Being able to participate in the Seder much the same as everyone else, has strong influence on normal quality of life. This is an important aspect when living with any long-term condition. Those with Gestational diabetes (diabetes in pregnancy) or T1 and 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 One should use wine or, if necessary, a wine/grape juice combination for the arba kosos. If one is unable to drink wine, one may use grape juice instead. If, due to medical reasons, one is unable to drink pure grape juice for the arba kosos, (and cannot drink any percentage of wine), one may dilute the grape juice. When mixing grape juice with water, at least 50% of the mixture should be grape juice (e.g. the cup is half grape juice and half water). One may wish to prepare a “special reserve” mixture before Yom Tov. Fill a bottle with 2 full bechers of grape juice and 2 full bechers of water. This will suffice for the arba 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 differs. Those that we have researched range from 32-60 gr. of carbs per cup. Please make sure to check the label, as previously indicated, in order to cut down the amount of carbs one can use in a combination of grape juice with wine and/or water. Please note: Kedem’s Concord dark grape juice, scored the lowest amount of carbs, 16 grams of carbs in a 4 oz. serving. SUMMARY PREPARATION LIST
Other Products: Today we are lucky to have a much larger variety of kosher for Pesach products. The following are some products with their nutrition facts. Sugar Substitutes: Sugar Substitutes - Gefen - Kosher For Pesach Sweet’N Low, Sweetie with Badatz supervision from Eretz Yisroel (liquid & tablets). There may be others but they must have specific Pesach supervision. Powdered Equal, Splenda and Nutrasweet are NOT kosher for Pesach, and may not be used by Ashkenazim or Sefardim, unless specifically noted. It was once thought that products containing sugar, even in minute am-ounts, 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 that it is consumed 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 may be cut down significantly and/or combined with sweeteners. Common Cooking Ingredients:
This is just a partial list. Since most 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 Pesach products are made from potato starch, sugar and/or matzoh meal, they are all basically, almost pure sugar. With enough preparation time one should have no problem making some snacks with fewer carbs on their own. As always, the best way to go is good old fashioned “home made.”
The following is just one example of the more than 250 recipes and over 100 full color photographs that you will find in EnLITEned Kosher Cooking: (With more than 140 kosher for Pesach recipes. It is the only kosher diet cookbook for Pesach.) Gefilte Fish Recipe EnLITEned Low-Carb Gefilte Fish For fish:
For fish stock:
To make the fish, put onion, carrot and eggs in a food processor or blender. Process until completely smooth. Add to ground fish, along with sugar substitute and seasonings. Mix, preferably with an electric mixer. Add drops of cold water and continue beating for a few more minutes until the mixture holds together well. There is no need to add matzoh meal. If the mixture seems too loose, add finely ground almonds, 1 tablespoon at a time. Mix between additions, and stop once it holds together nicely. When using carp alone, you won’t need any almonds. When combining different fish, the consistency may be looser and then you may need to add 1-3 tablespoons. With wet hands, form mixture into medium balls and drop into the boiling stock, making sure they are covered. Add water if necessary. Cover pot, lower heat and cook for 1½ hours. Check every 15 minutes or so to make sure that there is at least 1-2 cups of liquid, adding water if necessary. Cool. Remove fish and carrot with a slotted spoon and put in a container. Cover with the cooled liquid or place liquid in a separate container for garnish when serving. The fish stock will gel. Serving suggestion:
1 . This assumes the whole matzoh (before it is broken) has a diameter of at least 10.25 inches, which means the entire matzoh has an area of 83 sq. in. Hence, 1/6 of the matzoh is 13.75 sq. in. This is the minimum shiur for someone with a medical condition. 2 . This assumes a full rectangular matzoh is 6 1/8“ x 7“, which means the entire matzoh has an area of 43 sq. in. Hence, 1/4 of the matzoh is 10.75 sq.in. (This also means that one could eat a piece of matzoh that is square, with each side being 3.3 in. in length and width.) This is the minimum shiur for someone with a medical condition. 3. This assumes the whole matzoh (before it was broken) had a diameter of 10.25 in., which means the entire matzoh has an area of 83 sq.in. Hence, l/3 of the matzoh is 27.5 sq.in. 4. This assumes a full rectangular matzoh is 6 1/8” x 7”, which means the entire matzoh has an area of 43 sq. in. Hence, 1/2 of the matzoh is 21.5 sq.in. (This means one could eat a piece of square matzoh that is four and two-thirds inches [4 .66 in.] on each side.) |
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