By Nechama Cohen/Jewish Diabetes Association

PESACH (PASSOVER) - 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 Pesach (Passover). 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 that until JDA took upon itself the responsibility, there was no one to provide the answers in detail. JDA has been answering these questions for thousands world wide for more than two decades and now brings you a proper guide.

So how does one manage on Pesach (Passover) without forfeiting the benefits of a healthy regimen and healthy lifestyle? Let us begin to address these issues.

Since this year the first Seder is on a Motzoei Shabbos—almost all chametz must be out of the house by Friday morning, leaving just enough for washing and benching (grace after meals). This certainly does not leave many choices for carbs, since matzo may not be eaten until the Seder. Some people do use egg matzo, but keep in mind that they are quite high in carbs. A good solution for Friday night and early Shabbos morning for many will be small pitas (whole wheat available) since no bread or bread products may remain in the house past Shabbos morning (check for specific times for your city) and we want to avoid making any crumbs.

Pesach (Passover) does not necessarily mean matzo, potatoes, and eggs all of Yom Tov (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, (available at most bookstores or online at: www.jewishdiabetes.org), has more than 140 recipes for Pesach (Passover) and the rest is easily adaptable.

The following will help you prepare your matzo and wine. Remember that failing to prepare is preparing to fail. If you have everything ready you are less likely to have problems.

The Matzo

IN THE CASE OF A MEDICAL CONDITION:

HaGaonHaRav 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 Halacha, the shiur (minimum required amount), 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 Sefer”MidosChen”,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)

Actual size recommended for one with a medical condition.

CALCULATING THE AMOUNT OF CARBS:

Most machine matzo has the portion size and carbs listed on the box and are uniformed in size andshape. It might be a good idea to 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 shiur amounts we have also listed, with permission from Feldheim Publishers, the shiur kezaisim as brought forth by Rabbi Bodner, in the sefer “Halachosof 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 Yom Tov so that you can 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—there are various calculations but since Passover Matzo has no additional added ingredients and many use whole wheat we have gone with an average of 0.75 for all the calculations). 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.

Hand matzos have been divided in to three categories: all weights measurements are approximated:

Thin - 9 pieces per lb (20 per kilo). Each piece weighs 53 gr. and has 40.8 gr. of carbs. Per Matzo

Medium- 7 1/2 pieces per lb. (17 per kilo), weighs 64 gr. and has 48. gr. of carbs.

Thick- 6 pieces per lb (13 per kilo), weighs 80 gr. and has 60 gr. of carbs.

Machine Matzo

1 whole Matzo (1 square about 1oz 30 gr. ="app." 22 gr.carbs.)

THE FOLLOWING IS THE MINIMUM NEEDED FOR EACH OF THE TIMES TO EAT MATZO DURING THE SEDER (Using round Hand Matzo):

Achilas Matzo

Thin: 53% of a Matzo = 21.6 gr. of carbs

Medium: 41% = 22.6 gr. of carbs

Thick: 35% = 21 gr. of carbs

Korech

(K’zayis of marror sandwiched in a K’zayis from the bottom Matzo)

Thin: 31% = 18.6 gr. of carbs

Medium: 24% = 11.5 gr. of carbs

Thick: 20% = 12 gr. of carbs

Afikoman

(Based on 2 K’zayisim of the smallest shiur)

Thin: 39% = 16 gr. of carbs

Meduim: 30% = 14.5 gr. of carbs

Thick: 26% = 15.5 gr. of carbs

The Arba Kosos (Four Cups)

WINE: THE REQUIRED AMOUNT THAT ONE MUST DRINK:

Shiur (quantity):

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

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

The law states that one must drink (rov reviyis) ‘most’ of the above amounts. 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 the amount in the cup)

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

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

(Footnotes)

1 HaGaonHaRav R’N Karelitz Sh”lita rules that in the case of a sick person, one goes by the more The 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 by Rabbi Yitzchak Rubin Shlit’a, for grape juice is that one is not allowed to add water since this alters the taste.

The following amounts are based on the guidelines of Rav Heinneman Shlit’a of the StarK

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 Tovto 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 withtheir 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, according to Rabbi Heinneman Shlit’a one can use a combination of grape juice mixed with the diluted 60/40 wine.

Please note: Kedem’s Concorddark 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.	2.6 oz.	1.5 oz.
Third cup 2.6 oz. 1.5 oz.	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

aseparate labeled bottle.

• Weigh Matzo 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 and Shabbos in advance l’kovod yom tov

Sugar Substitutes:

Sugar Substitutes - Gefen - Kosher L'Pesach (Passover) Sweet'N Low (not Equal) Sweetie with Badatz supervision from Eretz Yisroel (liquid & Tablets).

There may be others but must have specific Pesach (Passover) supervision.

Powdered Equal, Splenda and Nutrasweet are NOT kosher for Pesach (Passover), and may not be used by Ashkenazim and not by Sefardim unless specifically noted.

It was once thought that products containing sugar, even in minute amounts, 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 they consume it 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 can be cut down significantly and/or combined with sweeteners.

Today we are lucky to have a much larger variety of kosher for Pesach (Passover) products. The following are some products that are used most often for cooking and baking, with the nutrition facts.

PESACH/PASSOVER NUTRITION FACTS

Nutrition Facts for Wine and Matzo

PLEASE NOTE: DUE TO NUMEROUS VARIABLES AND OPINIONS, ALL NUTRITION FACTS FOR WINE, GRAPE JUICE AND MATZO HAVE BEEN APPROXIMATED AND ROUNDED OUT

Nutrition Facts for Frequently Used Passover Ingredients

Food	Amount	Carbs (g)	Calories	Fat (g)
Baking Chocolate	2 squares	8	70	3.5
Chocolate chips	1 tablespoon	10	75	4
Cocoa	1 cup	48	192	11.2
Cocoa	1 tablespoon	3	12	0.7
Eggs	1 large	0.6	70	5
Honey	1/2 cup	136	480	0
Honey	1 tablespoon	17	60	0
Matzo meal	1 cup	96	440	3.2
Matzo meal	1 tablespoon	6	27	0.2
Oil	1 cup	0	1920	224
Oil	1 tablespoon	0	120	14
Potato flakes	1 tablespoon	11	50	0.1
Potato starch	1 cup	128	480	0
Potato starch	1 tablespoon	8	30	0
Sugar	¼ cup	50	192
Walnuts ground	1/2 cup	2.7	262	26
Walnuts chopped	1/2 cup	5	383	38
Almonds slivered	1/2 cup	5	310	26
Almonds ground	1/2 cup	4.3	273	23.4
Coconut flaked unsweetened	1/2 cup	3.6	141	13.4

PESACH COOKIES AND CAKES

Nutrition facts will vary with different manufacturers. 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 Matzo meal, they are all, basically, almost pure sugar. With enough preparation time one should have no problem making some snacks on their own with fewer carbs. See some of our recipes below. As always the best way to go is good old fashioned “home made”.

PRODUCT	SEVING SIZE	CARBOHYDRATES
Brownie Cake	38 gr.	20 gr.
Chocolate Cake	42,gr.	23 gr.
Rainbow Cake	28 gr.	11gr.
Sponge Cake	42 gr.	24 gr.
Apricot Sandwich Cookies	28 gr.	16.gr.
Leaf Cookies	33 gr.	14 gr.
Nut Cookies	28 gr.	11 gr.
Raspberry Sandwich Cookies	28 gr.	15 gr.
Chocolate Macaroons	33 gr.	18 gr.
Nut Macaroons	33 gr.	16 gr.