U[dated February 2026<\/p>\n\n\n\n
The challenges of diabetes and other health conditions are magnified on Pesach. Aside from the numerous large meals that we have on any Yom Tov, Pesach adds a new set of concerns: the consumption of four cups of wine and set amounts of matzah during the Seder. Before discussing the challenges specific to the Seder, let\u2019s begin by addressing eating during Pesach generally.<\/p>\n\n\n\n
Enjoying our Yom Tov meals is an important aspect of how we celebrate Pesach. A health concern that may impact how you eat need not decrease your enjoyment of Pesach. There are many aspects of meals on Pesach that can be optimized to enhance your enjoyment.<\/p>\n\n\n\n
When your health is your concern, think twice if you feel you need to prepare a meal that conforms with what \u201ceverybody else\u201d is doing or what you experienced growing up. Feel free to create the menu that best suits your family\u2019s needs.<\/p>\n\n\n\n
Consider the d\u00e9cor if that is a factor that makes a meal nicer for you. Get pretty napkins, buy flowers, and use pretty dishes if doing so will enhance your meal. For some, the lighting affects the ambiance, so use candles or softer lighting to give your meal a cozier feel.<\/p>\n\n\n\n
Other factors that can make the meal more pleasurable are the social aspects. Invite family or other guests, if you enjoy that. Talk to your family members and guests during the meals. Some families plan discussion starters related to the chag<\/em> or other acceptable topics to keep the environment pleasant. If your family likes to share divrei Torah<\/em>, make sure they are age-appropriate for all children if you expect them to sit quietly. Otherwise, set realistic expectations for your children\u2019s behavior to keep the environment calm and happy. Other families like to sing together, tell stories or get the children involved in the conversation.<\/p>\n\n\n\n Taking steps to prevent extra stress at meals will make your meals more pleasurable. Often, our unmet expectations can lead to stress and anxiety, so stay realistic. Allow yourself to prepare easier dishes if that will make your Yom Tov more manageable. Don\u2019t expect your children to share divrei Torah<\/em> or be patient beyond what is age-appropriate. Remember that the meal is primarily for yourself and your family and not to impress your guests.<\/p>\n\n\n\n When both the food and the environment of the meal are considered and optimized, you can have a delicious and comfortable meal that is satisfying, from both a gashmius<\/em> and ruchniyus<\/em> aspect.<\/p>\n\n\n\n Two Sedarim<\/em> will not \u201cmake or break\u201d someone’s diabetes care. If someone’s blood sugar averages at normal levels throughout the year, and then over the first two days of Pesach it averages somewhat higher, that is unlikely to cause long-term diabetes complications.<\/p>\n\n\n\n Although it is important to care for one\u2019s health every day, it is important to understand \u2013 in the context of a person\u2019s normal life \u2013 what two days per year means. In contrast, if someone has very high blood sugar at baseline, the Seder is the least of their worries, as this person is at high risk of complications even if they use the smaller shiurim<\/em>.<\/p>\n\n\n\n Besides using smaller shiurim<\/em> at the Seder, there are other things one can do to improve blood sugar on Pesach. These choices are more impactful on blood sugar than using smaller shiurim<\/em>.<\/p>\n\n\n\n Type 1 Diabetics:<\/strong><\/p>\n\n\n\n Type 2 Diabetics:<\/strong><\/p>\n\n\n\n Diabetes technology is used to improve diabetes care and outcomes. Some types of diabetes technology include glucometers, continuous glucose monitors (CGMs,) and insulin pumps.<\/p>\n\n\n\n Using a device to check blood sugar, whether a glucometer or CGM, allows the person to make care decisions based on their blood sugar reading in the moment. For example, one who uses insulin and whose blood sugar is trending low may choose to eat something that contains carbohydrates or decrease insulin provision. Alternately, those with type 2 diabetes who note their blood sugars are high at the Seder may realize that smaller shiurim<\/em> are necessary for them.<\/p>\n\n\n\n In general, those who use any of these devices daily to manage their diabetes are permitted to use them on Shabbos and Yom Tov. According to Rav Moshe Heinemann shlit\u201da<\/em>, if the glucose testing draws blood, on Shabbos and Yom Tov \u2013 if practical \u2013 it is preferable to do so with a shinui<\/em>.<\/p>\n\n\n\n Those who do not currently use diabetes technology but who would benefit from doing so should use it daily, without interruption. Check with your healthcare provider if your health can benefit from using diabetes technology. Regarding the use of this technology during the Seder and on Yom Tov, in general, the earlier you start using it, the better. Consult with your rav regarding all technology usage on Shabbos and Yom Tov.<\/p>\n\n\n\n One with Alcohol Use Disorder who is practicing abstinence should not drink any alcoholic beverages, including wine, at the Seder or at any other time on Pesach. These individuals should drink grape juice instead. One who regularly drinks larger amounts of alcohol should not suddenly stop because doing so can lead to withdrawal. The best time to work on reducing alcohol intake or detox is well before Yom Tov, and under medical supervision.<\/p>\n\n\n\n The category of eating disorders encompasses a wide variety of disordered eating behaviors. In general, treating eating disorders is benefitted by increasing variety of foods and decreasing food restrictions.<\/p>\n\n\n\n One should discuss with their rabbi regarding eating egg matzah and kitniyos<\/em> on Pesach if there is a potential therapeutic benefit.<\/p>\n\n\n\n Additionally, all food chumros<\/em> the person follows on Pesach and throughout the year must be discussed with a rav.<\/p>\n\n\n\n Individuals with eating disorders may have comorbid gastrointestinal diseases or symptoms, and sometimes those conditions are benefited by eating foods that can be easier to digest, such as egg matzah rather than regular matzah. Although egg matzah can not be used to fulfill the obligations to eat matzah during the Seder, there may be a therapeutic benefit of eating egg matzah during other occasions on Pesach. Consult with your rav.<\/p>\n\n\n\n Constipation can range from easy to manage to quite serious in some individuals. Those at risk for constipation include those on some psychiatric medications, GLP-1s, elderly individuals, pregnant women and people with limited mobility. Constipation can be managed a variety of ways, and for many people with constipation, with a bowel regimen: a few medications and\/or supplements that are used in combination. Most of these are acceptable on Pesach. Check Rav Gershon Bess\u2019 Medicine List in the STAR-K Pesach Guide<\/em> for approved items.<\/p>\n\n\n\n Matzah is known to worsen constipation. For some individuals, this can be remedied by drinking plenty water throughout the Seder and throughout Pesach. Maintaining physical activity, even a short 10-minute walk after the Seder and meals can help with constipation. Those who do not use medication for constipation year-round may need to on Pesach.[1]<\/a> If you have experienced constipation in past years, familiarize yourself with available medications and products that can be used on Pesach. Some individuals may need to use the smaller shiur<\/em> of matzah due to constipation.<\/p>\n\n\n\n Remember that whole wheat matzah is higher in fiber than regular matzah. For those who regularly consume a low-fiber diet, suddenly increasing fiber intake can lead to constipation. Fiber intake should be slowly increased over a few weeks. If you rarely eat high fiber foods, it is advisable to choose regular matzah rather than whole wheat matzah.<\/p>\n\n\n\n Those with celiac disease must not eat any gluten. Eating gluten with celiac disease can cause gastrointestinal pain in the short term, nutrient deficiencies in the medium term, and increased risk of rare intestinal cancers in the long term. Oat matzah may be used by those with celiac disease to fulfil the mitzvah of matzah at the Seder.<\/p>\n\n\n\n Kosher for Passover foods labeled \u201cnon-gebrokst<\/em>\u201d do not contain matzah meal[2]<\/a> and are gluten-free, a plus for those with celiac disease. Often, those with celiac disease stock up on non-gebrokst<\/em> Kosher for Passover baked goods to use year-round as gluten-free options. <\/p>\n\n\n\n See also \u201cAdvice for People With Celiac, Food Allergies and Gluten-Free Restrictions on Pesach<\/a>\u201d on the STAR-K website for more guidance for individuals with celiac.<\/p>\n\n\n\n The key to a successful Pesach with a medical condition is preparation. See your healthcare providers regularly throughout the year and take your medication as prescribed. This can allow you to enter Pesach optimized and in good health. You will have already discussed with your healthcare provider what Pesach requires of you, and it won’t be a last-minute scramble to get in touch with your provider. It is always best to talk to the provider who knows you best, not whoever you can get in touch with last minute because you forgot to address your Pesach-related health concerns earlier.<\/p>\n\n\n\n Halacha tells us how much wine and matzah one must eat at the Seder. Anyone whose healthcare providers recommend dietary modifications that affect eating matzah or wine should consult with a rav to find out how to follow those health recommendations within halachic guidelines.<\/p>\n\n\n\n The guidelines for minimum shiurim<\/em> for matzah shown below are based on the psak<\/em> of Rav Moshe Heineman shlit\u201da<\/em>. For hand matzos, the regular shiurim <\/em>are based on the AVERAGE SIZE Pupa-Tzelem matzos. The regular shiurim <\/em>for machine matzos are based on the AVERAGE SIZE of the brand indicated. Note that matzos baked by other matzah bakeries have different sizes and measurements, which affect the amount required for a shiur<\/em>. Numbers are different than in previous years and were obtained through 3D scanning of the various types of matzos and brands noted below.<\/p>\n\n\n\n Those in good health should eat the following for Achilas Matzah <\/em>and Afikomen<\/em>:[3]<\/a><\/sup><\/p>\n\n\n\nMedical Conditions<\/h1>\n\n\n\n
\u25ba Diabetes<\/h2>\n\n\n\n
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At the Seder: Type 1 vs Type 2 Diabetics<\/h3>\n\n\n\n
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Using Diabetes Technology<\/h3>\n\n\n\n
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\u25ba Alcohol Use Disorder<\/h2>\n\n\n\n
\u25ba Eating Disorders<\/h2>\n\n\n\n
\u25ba Constipation<\/h2>\n\n\n\n
\u25ba Celiac Disease<\/h2>\n\n\n\n
Preparing for Pesach with a Medical Condition<\/h1>\n\n\n\n
Shiurim for Matzah<\/h1>\n\n\n\n
Regular Shiurim for Matzah<\/h3>\n\n\n\n