Take Very Good
Care of YouselvesDeuteronomy 4:15

BS'D We consider Pesach the ultimate nutritional challenge of the year. However, it is doable and can/should be enjoyable. Learning how to do it will take you far. We thank the StarK and Rabbi Heinaman for taking on this task together with us. PESACH GUIDE FOR DIABETES Adapted from Jewish Diabetes Association article by Nechama Cohen The challenge of diabetes seems ten-fold when it comes to Pesach. There are a whole new set of considerations — four cups of wine at each Seder; a many-hour wait until Shulchan Aruch; knowing the carb content of a single hand matza. 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. I. MATZA 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 korach and afikoman with the following: Type Min Shiur Dimensions Carbs Hand matza(rnd) 1/6 matza 13.75 sq.in. 16g Machine matza 1/4 matza 10.75 sq.in. 7-8 g One who is in good health should eat the following for achilas matza, korach and afikoman: Type Minimum Shiur Dimensions Carbs Hand matza (rnd)1/3)a matza 27.5 sq.in. 12g Machine matza (1/2)a matza 21.5 sq.in. 15g 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 weight 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. Hand Matzas: There are about 10 pieces of matza per lb. (22 pieces per kilo). Each piece weighs approximately 46g and has approximately 35g of carbs per matza. Machine Matzos: One whole machine matza (rectangular) weighs about 30-35g, which is between 23 and 27g of carbs per matza (depending upon the brand). II. 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%.  He 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 1/3 1/3 1/3 — 2/3see NOTE below NOTE: The diluted beverage must contain at least 4% alcohol to fulfill the 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 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. Kos Amount to drink Amount after dilution First cup 1.5 oz. 0.6 oz. Second cup 1.5 oz. 0.6 oz. Third cup 1.5 oz. 0.6 oz. Fourth cup 1.5 oz. 0.6 oz. TOTAL 6. 0 oz. 2.4 oz. 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 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 1.5 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. TYPES 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 artificial sweetener, such as 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: Wine Carbs g per cup Chardonnay 25 gr. 0.2% residual sugar Cabernet Sauvignon- 25 gr. 0.2% residual sugar Sauvignon Blanc from Gamla- 27 gr. 1.9% residual sugar 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 wine/grapr 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: ADVANCE 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.  Discuss with your Rav the shiurim of rov reviis and mixing wine with water.  Select the wine of your choice and check the carb content (remember the meter test).  Prepare the correctly sized becher.  Train your eye to recognize the amount that you will be drinking during the Seder.  Mix wine with water following the instructions of your Rav and doctor, and prepare a separate, labeled bottle (“Special Reserve”) for this mixture.  Weigh matzos to be better able to determine insulin doses.  Prepare your choice of glucose for treating hypoglycemia.  Review chart and details with your health care team.  Prepare all needed medical supplies, medications and equipment for Yom Tov and Shabbos l’kovod Yom Tov. Finally, remember, 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 now also available in Hebrew BishuLITE (available at most bookstores or online at www.jewishdiabetes.org) with more than 140 recipes for Pesach (for more information about diabetes and a list of Pesach recipes from the book go to : www.jewishdiabetes.org), along with year-round recipes that are easily adaptable. III. OTHER PRODUCTS COMMONLY USED ON PASSOVER Today we have a much larger variety of Kosher for Pesach products. Below we list some products with their nutrition facts. Common Cooking Ingredients, Food Amount Carb.(g) Calories Fat Chocolate, roughly chopped, 72% cocoa 2 tsp. 3.5 57 4.5 Bittersweet chocolate, 72% cocoa 10 small squares 13 226 18 13 Baking chocolate, 2 large squares 10 79 4 Chocolate chips, packaged 1 tbsp 10 75 4 Chocolate chips, packaged 1 cup 80 600 32 Cocoa 1 tbsp 3 20 1 Cocoa 1 cup 50 350 15 Eggs 1 large 0 .7 101 7 Honey 1 tbsp 12 48 0 Honey 1/2 cup 112 448 0 Matza meal (machine matza)1 tbsp 8.6 5 0 Matza meal 1 cup 137.5 96 0 Oil 1 tbsp 0 9 10 Oil 1 cup 0 1440 160 Potato starch 1 tbsp 8 36 0 Potato starch 1 Cup 128 576 0 Sugar 1 tbsp 15 60 0 Sugar 1/4 Cup 60 240 0 Sugar Substitutes: Gefen brand Sweet’N Low, and Paskez brand Sweetie are available (when label states Kosher for Pesach). 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. 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. Product/Company Serving Carbs g Brownie Cake (Hagadda) 38g 20g Chocolate CakeOberlander’s 42g 23g Rainbow Cake (Hagadda) 28g 11g Sponge Cake (Oberlander’s) 42g 24g Apricot SandCookiesHagadda)28g 16g Leaf Cookies (Hagadda) 33g 14g Nut Cookies (Hagadda) 28g 11g Raspberry SandCookies(Hagadda)28g 15g Chocolate Macaroons (Hagadda) 33g 18g 6. When baking, our recommendation is to use a combination of both ground walnuts and almonds, since walnuts are lower in carbs. NOTES: 1. Assuming the whole matza (before it is broken) has a diameter of at least 10.25 inches, which means the entire matza has an area of 83 sq. in. Hence, 1/6 of the matza equals 13.75 sq. in. This is the minimum shiur for someone with a medical condition. 2. Assuming a full rectangular matza is 6 1/8“ x 7“, which means the entire matza has an area of 43 sq. in. Hence, 1/4 of the matza equals 10.75 sq.in. (This also means that one could eat a piece of matza that is square, each side with a length and width of 3.3 in. ). This is the minimum shiur for someone with a medical condition. 3. Assuming the whole matza (before it was broken) had a diameter of 10.25 in., which means the entire matza has an area of 83 sq.in. Hence, l/3 of the matza is 27.5 sq.in. 4. Assuming a full rectangular matza is 6 1/8” x 7”, which means the entire matza has an area of 43 sq. in. Hence, 1/2 of the matza is 21.5 sq.in. (This means one could eat a piece of square matza that is 4 2/3 in. [4.66 in.] on each side.) 5. This is to fulfill the obligation of wine. If one cannot drink wine, he can fulfill his obligation with grape juice. copywrite Jewish Diabetes Association 718-303-5955, Israel Cell: 058-763-1500 www.jewishdiabetes.org, nechama@jewishdiabetes.org the entire StarK Passover guide can be seen: http://issuu.com/star-k/docs/passoverdirectory2014_web?e=9357117/7083983