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Passover Guide for Those with 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 (JDA) for guidelines. JDA has been answering these questions for thousands of affected individuals world wide for more than two decades, and has now written this article. So how does one manage on Pesach without forfeiting the benefits of a healthy regimen and healthy lifestyle? Let us begin to address these issues. Pesach does not necessarily have to mean matza, potatoes, and eggs throughout Yom Tov. Use your imagination. Instead of high fat soups load up on vegetables, and instead of potato kugel substitute other vegetables and vegetable combinations. Our book EnLITEned Kosher Cooking (available at most bookstores or online at www.jewishdiabetes.org) has more than 140 recipes for Pesach, and the rest are easily adaptable. The following information will help you prepare your matza and wine. Remember that failing to prepare is preparing to fail. If you have everything ready you are less likely to run into problems. MATZA 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 matza. In the case of a medical condition, one may fulfill the mitzva of achilas matza with the following:
A. CALCULATING THE AMOUNT OF CARBS IN 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 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, bringing down the total amount of carbs to almost 4 grams per slice. The more whole wheat products one uses throughout the year, especially during Pesach when there are so many meals, the more advantageous it is for most people. Hand Matzas: There are about 10 pieces of matza per lb. (22 pieces per kilo). Each piece weighs 46g and has 35g of carbs per matza. If we calculate 1/6 of a matza (the shiur specified above for one with a medical condition), it would amount to 6g of carbs for the shiur. Machine Matzos: One whole machine matza (rectangular) weighs about 28g, which is between 23 and 27g of carbs per matza (depending upon the brand). B. PERFORMING THE MITZVA OF ACHILAS MATZA:
THE ARBA KOSOS (FOUR CUPS)
The cup must hold at least a reviis of wine (3.8 fl. oz., or 112 ml). Someone who has a medical condition should drink at least 1.5 fl. oz. (45 ml); someone 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 contain enough alcohol to be uplifting. However, he is not obligated to become sick because of this. 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. ADDING WATER TO 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 contain at least 4% alcohol in order 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. If one follows these guidelines correctly, he will consume less than 3 fl. oz. of wine throughout the entire Seder. In order to estimate the actual amount that he should drink at the Seder, he 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. Here 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. The following chart illustrates how much wine to drink.
In order to prepare in advance, simply pour two cups of wine into an empty bottle 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. 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. Since 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 read it as LO. Many of the dry wines will not give a LO reading, but the numbers 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 can 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:
The above wines 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 prove this statement, as some inexpensive supposedly dry wines actually tested HI on a meter. Please note: 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 do 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. Being able to participate in the Seder with everyone else has a 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 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 One should use wine or, if necessary, a wine/grape juice combination for the arba kosos. If one is unable to drink wine he may use grape juice instead. If due to medical reasons he is unable to drink pure grape juice for the arba kosos, (and cannot drink any percentage of wine), he 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). He may wish to prepare a “special reserve” mixture before Yom Tov and should fill a bottle with two full bechers of grape juice and two full bechers of water. This will suffice for the arba kosos. Add more at the same ratio as necessary. Keep in mind that as far as diabetes and carb counting are concerned, dry wine is certainly preferable. If he drinks grape juice, please note that the carbohydrate content of the various grape juices differs. Those that we have researched range from 32-60g of carbs per cup. As previously noted, please make sure to check the label, in order to cut down the amount of carbs used 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 Commonly Used On Passover: 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 (when label states Kosher for Pesach): Gefen brand Sweet’N Low, and Paskez brand Sweetie are available. 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 amounts, were totally off limits to people with or at risk for, diabetes and 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 may 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:
PESACH COOKIES AND CAKES Below is just a partial list of the cookies and cakes that are available for Pesach. Most Pesach products are similarly manufactured and 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 matza meal they are all basically almost pure sugar. With enough preparation time, one should have no problem making his own snacks with fewer carbs. As always, the best way to go is good old fashioned "home made"6
Below are examples of more than 250 recipes with 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.) EnLITEned Passover Blintzes (Crepes) and “Noodles” Carb Free, Low Fat / Yield: 12 crepes or 2 cups noodles These marvelous crepes are great on Passover and all year round. Once you get the hang of it, they really are easy to make. You can also use this recipe to make kosher for Passover noodles. (see below) INGREDIENTS:
DIRECTIONS: Beat eggs and egg whites together with salt and set aside. Mix potato starch with part of the water to form a smooth paste. Add the rest of the water and beaten eggs and mix well. Add remaining ingredients and mix well again. (A blender or food processor is handy for mixing the batter, but be careful to mix just until blended. Overmixing will create a foam that must be removed, or it will affect the texture of the finished crepes.) Transfer batter to a pitcher that is wide enough to allow mixing Heat olive oil and non-stick spray in an 8- inch, non-stick frying pan. Pour off extra oil into a dish. Keep a paper towel in this dish to use for wiping the pan after every few crepes (this helps keep the amount of oil needed down to a minimum), or spray with non-stick cooking spray. When the pan is hot, lower the heat to medium and pour in ¼ -½ cup of batter. Tilt pan to cover the bottom and pour any extra batter back into the pitcher. This will ensure very thin blintzes. As soon as the batter is firm, loosen the edges and turn over onto a dish towel or slightly greased piece of aluminum foil. Then return it to the pan to cook on the other side. (You can flip it with a spatula, but most people find it easier to turn it out and then return it to the frying pan.) Cook on the second side for no more than a few seconds and remove to a towel. Before making the next crepe, mix batter with a fork in order to blend in any potato starch that settles. Unless you’re a real pro, the first 1 or 2 blintzes will probably not come out easily and will tear. For Noodles: When blintzes are cool, roll up a few at a time and slice into ultra-thin strips. For smaller noodles, slice down the length as well. Allow noodles to dry a bit and then store in an airtight container or plastic bags. These freeze well. For Crepes (Blintzes): Use the filling of your choice (see next page) and either fold the crepe around it blintz-style (like an envelope) or roll up. The unfilled crepes freeze well, either stacked or in layers divided by wax paper. Fillings: You can certainly use the standard mashed-potato filling, but if you want a lower carb count and something more interesting, here are a few suggestions:
Fresh and Natural Applesauce Low Carb, Fat Free / Yield: 20 servings
INGREDIENTS:
For Fruit Compote: Use fruit of choice. Place apples in a 5-quart pot. Add lemon juice, salt, vanilla, tea bags and water, covering not more than half the apples so that the end result will not be too watery. Bring to a boil. Lower heat and simmer until apples are soft. Hand-blend and mash to desired consistency. For additional sweetness, you can add sugar substitute. Variations: For a Crunchy Fruit Compote: Bring ingredients to a boil and cook on high heat for 7 minutes. Turn off heat and cover. Let stand overnight. In the morning, put into a jar and refrigerate. This can be frozen in an airtight container. For a Strawberry-Rhubarb Apple Compote: Add 1½ cups of sliced strawberries and 1 cup of sliced rhubarb to the apples. Rhubarb is quite tart, so add sugar substitute according to taste. Blend well and refrigerate. For Cinnamon Applesauce: Add 1 tablespoon ground cinnamon to blended apples. For a beautiful crimson color, as well as additional flavor and fiber, add 1-1½ cups frozen blueberries.
1. This assumes 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. |
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