Pesach Guide for Individuals with 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 matzah.

These are real concerns for people with diabetes and related health issues, who wish to fulfill the requirements of Pesach al pi halachah without compromising their health. STAR-K has turned to the Jewish Diabetes Association (JDA) for answers and the JDA has kindly provided the following guidelines to help you prepare your matzah 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 mitzvah of achilas matza, including korech and afikoman, with the following:

Type Minimum Shiur Dimensions Carbs
Hand matza (round) one-sixth (1/6) of a matza 14.5 sq. in. in size.1 6 g
Machine matza one-quarter (1/4) of a matza 12.25 sq. in. in size.2 8 g

One who is in good health should eat the following for achilas matzah3, korech and afikoman:

Type Minimum Shiur Dimensions Carbs
Hand matza (round) one-third (1/3) of amatza 29 sq. in.4 12 g
Machine matza one-half (1/2) of a matza 25.5 sq. in.5 15 g

 

How to calculate the amount of carbs in Matzah:

Machine Matzah:
Most machine matzah 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 Matzah:
Hand matzah varies according to size and thickness. Our calculations use a Tzelem Pupa hand matzah. Try to arrive at an accurate gram content for the matzah in advance, including possibly weighing it.
For those who prefer to do their own calculation: Matzah has an average carb factor of 0.75 (75% of its weight is carbohydrates). Whole wheat matzah has almost 12 grams of dietary fiber per 100 grams, allowing one to deduct 4 grams per piece.

Hand Matzah:
There are about 10 pieces of matzah per lb. (22 pieces per kilo). Each piece weighs approximately 46g and has approximately 35 g of carbs per matzah.
Machine Matzah:
One whole machine matzah (rectangular) weighs about 30-35g, which is between 23 and 27g of carbs per matzah (depending upon the brand).
A very thin matzah is approximately 30 grams; a “regular” matzah is approximately 40 grams; a thick matzah is approximately 50 grams.

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 drink to fulfill Arba Kosos: One must drink at least 1.9 fl. oz. (56 ml) for each of the four cups.
Additional Requirements:
The lowest percentage of alcohol that may be used for the four cups is 4%.
One should drink each of the four cups of wine within half a minute.

B. Diluting Wine with Grape Juice and Water
Higher carbohydrate wine may be diluted in the maximum ratios listed below. 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 2/3 (see NOTE below)

NOTE: The diluted beverage should contain at least 4% alcohol to fulfill the obligation of drinking wine at the Seder.6 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:

Kos Amount you drink Amount of wine
after dilution
First cup 1.9 oz. 0.7 oz.
Second cup 1.9 oz. 0.7 oz.
Third cup 1.9 oz. 0.7 oz.
Fourth cup 1.9 oz. 0.7 oz.
TOTAL 7.6 oz. 2.8 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 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 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 mitzvah, when medically necessary). For the fourth cup, he could ask someone else to be motzee him in the brochah achrona.
To prepare in advance, simply pour two cups of wine into an empty bottle or pitcher and add three 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 an artificial sweetener that is Kosher for Passover (see list page 14).
There are also lower carbohydrate sweet wine products which might serve as suitable options.
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 halachah, 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 regular grape juice. When mixing grape juice with water, it is best to make at least 51% of the mixture regular grape juice (i.e., the other 49% is water). In general,
“light grape juice” may not be further diluted by the consumer (if there is a necessity, check with the certifying agency). As suggested earlier, you may wish to prepare a “special reserve” mixture before Yom Tov and fill a bottle with four full bechers of grape juice and four full bechers of water. This will suffice for the arba kosos for both nights. 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.
  • 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 right size 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.
  • Try to arrive at an accurate gram content for the matzah in advance, including possibly weighing it.
  • Prepare 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.

Finally, remember that Pesach does not have to mean matzah, 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:

Food Amount Carb. Calories Fat
Choc. Roughly chopped 72% cocoa 2 tsp. 3.5 57 4.5
Bitter sweet choc small squares 72% cocoa 10 13 226 18
Baking Choc large squares 2 10 79 4
Choc. Chips packaged 1 tbsp 10 75 4
Choc. 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
Matzah Meal (machine matzah) 1 tbsp 8.6 5 0
Matzah 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

The following sugar substitutes are available this year for Pesach, when stating Kosher for Passover or “P” next to the kosher symbol: California Delight brand Sucralis (STAR-K P Certified), Gefen brand Sweet’N Low, Gefen brand Nutra Taste Gold, Paskesz brand Sweetie, Lieber’s brand Sweetees, and Health Garden brand Xylitol (Regular and Vanilla).
Note: Powdered Equal, Splenda and NutraSweet are NOT Kosher for Passover and may not be used on Pesach.

 


1. This assumes the whole matzah (before it is broken) has a diameter of at least 10.5 inches, which means the entire matzah has an area of 86.6 sq. in. Hence, 1/6 of the matzah equals 14.5 sq. in. This is the minimum shiur for someone with a medical condition.
2. This assumes a full rectangular matzah is 7“ x 7“, which means the entire matzah has an area of 49 sq. in; hence, 1/4 of the matzah equals 12.25 sq. in. (This also means that one could eat a piece of matzah that is square, each side with a length and width of 3.5 in.) This is the minimum shiur for someone with a medical condition.
3. For korech see the Kashrus Kurrents article, “The Pesach Seder”.
4. This assumes the whole matzah (before it was broken) had a diameter of 10.5 in., which means the entire matzah has an area of 86.6 sq. in., hence, l/3 of the matzah is 29 sq. in.
5. This assumes a full rectangular matzah is 7” x 7”, which means the entire matzah has an area of 49 sq. in. Hence, 1/2 of the matzah is 24.5 sq. in. (This means one could eat a piece of square matzah that is 5 in. on each side.)
6. This is to fulfill the obligation of wine. If one cannot drink wine, he can fulfill his obligation with grape juice. This will be discussed later.