Many powerful themes carry us through the holiday of Pesach:
The focus on freedom. The triumph of redemption. The call to remove leavened aspects of our souls and purify ourselves. The joys of tradition and singing and spending time with family.
And then there’s the food.
As much as we emphasize the spiritual aspects of Pesach, we can’t fully separate them from food. Hashem gave us very specific halachot regarding food on Pesach. It’s a challenge for many to remove the chametz from their yearlong diets, even for just those seven or eight days.
But for some, this task is greatly magnified, since food significantly impacts their health and day-to-day lives. How do they navigate this holiday healthfully and with as little stress as possible?
Here’s a close look at several common food-related health conditions and how to manage them over Pesach.
Irritable Bowel Syndrome (IBS)
Ella, 42, loves Pesach, but dreads the matzah. Its dry, crispy crunch is a harbinger of miserable days to come. Ella has irritable bowel syndrome, or IBS, a disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits. It’s a year-round syndrome that can be aggravated over Pesach — specifically by matzah.
“Matzah can be very hard for people with IBS to digest,” says Tamar Feldman, RDN CDE, a registered functional dietitian and founder of thegutdietitian.com. Instead, Tamar recommends whole wheat matzah for the additional fiber; however, even that is often not easily tolerated, especially in combination with wine or grape juice.
“Eat only what you need,” Tamar suggests. “Ask your rabbi how much you need, and stick to just that.”
To counteract some of matzah’s impact on the gut, Tamar suggests that those with IBS drink twice their usual amount over the first few days of Pesach. For additional fiber, eat three fruits plus three to five cups of vegetables on the first days.
“Once you get past those first two days, many people actually feel better on Pesach than during the rest of the year,” Tamar says. “A kosher-for-Pesach diet can be very healthful if it’s done right and if you don’t overeat.” Not overeating is crucial. “For many people with IBS, much of their GI distress primarily comes from overeating and the late timing of large meals,” Tamar says.
Inflammatory Bowel Disease (Crohn’s and ulcerative colitis)
Those with inflammatory bowel disease (IBD) — a condition characterized by chronic inflammation and damage to the digestive tract — face similar challenges. And the solutions are also similar: Eat the smallest amount of matzah that is okayed by your rabbi; try gluten-free oat matzah; (gluten can exacerbate IBD); and eat fiber-filled food like fruits and vegetables.
Careful reading of food labels is essential, since matzah meal — and therefore gluten — can be found in foods you might not expect, such as tomato sauce. Look for the “non-gebrochts” label, which ensures a food is matzah-meal free. Staci, who takes medication for her mild IBD, can essentially follow her year-round diet on Pesach too. The hardest part for her is that her regular fiber supplement contains wheat, and the substitute she has found doesn’t work as well.
“I’ll drink a lot and eat lots of vegetables to compensate, and I usually feel pretty good, thank G-d,” she says.
Celiac Disease & Food Allergies
Margo’s 18-year-old son has celiac disease, an autoimmune condition in which gluten (a protein found in wheat and other grains) cannot be tolerated. Back when he was first diagnosed at age 7, few kosher gluten-friendly options existed. Pesach — with its plethora of gluten-free foods — was a boon for their pantry.
The biggest issue for people with celiac disease on Pesach is the matzah, which traditionally is made with wheat. Of the five grains that can be the basis of haMotzi, the only one that a person with celiac disease can eat is oats. However, oats can become cross-contaminated with wheat, so someone with celiac disease may react from eating oats that are not certified gluten-free.
A corollary challenge for people with celiac disease: matzah, matzah everywhere. “My husband will crack the matzah over a tin so it doesn’t splatter crumbs all over. We’ll pass it around the table in that tray,” says Margo. “When we eat out, we ask the host to keep the matzah on the side.”
Margo’s 13-year-old son is allergic to peanuts (as well as tree nuts). During Pesach she must be especially vigilant about reading food labels, because food companies may change the ingredients, making a typically safe food off-limits for Pesach. For example, nuts are ubiquitous in Pesach products, even those you wouldn’t necessarily expect to have nuts — like plain chocolate, for example.
Substituting safe alternatives for the food allergen is one workaround. For egg allergies, for example, a chia-based substitute can work. Per OU, chia seeds require checking against foreign materials.
To avoid potential problems for both her food-sensitive sons, Margo does all her own baking for Pesach. “When you’re making meals at home, you know which ingredients are around and what you put in,” she says.
To find tips and tricks for managing, Margo encourages crowdsourcing; in fact, that’s what prompted her to start her 6,000-member Facebook group, Kosher Me & Gluten Free.
“My best advice,” says Margo, “is to talk to other people and learn what they’re doing to manage, so you’re not dealing with it alone.”
Diabetes
Matzah. Grape juice. Matzah ball soup. Potato kugel. For someone with diabetes, a typical Pesach menu may look like a long list of carbohydrates.
Diabetes is a metabolic disorder that impacts the way people process carbohydrates in food. With Type 1 diabetes, the body doesn’t produce insulin, the hormone that enables cells to absorb glucose from the blood. In Type 2 diabetes, cells become less sensitive to insulin, often requiring greater amounts of insulin to lower blood glucose. High glucose levels in the blood can cause long-term damage to multiple organ systems in the body. And dangerously high or low blood glucose levels can pose an immediate threat to an individual’s health.
“With diabetes, whenever you’re off your regular routine, it can upset blood sugar — and Pesach throws off your routine,” says dietitian and diabetes educator Rivka Breuer, RDN, CDCES. “Whether they take medication or insulin, people with diabetes need to be ready to adjust.”
That’s why it’s so important to plan ahead, Rivka asserts. “Ask your questions to your rabbi in advance: how much matzah do I need to eat? How much water can I add to the wine?”
General meal-planning guidelines for diabetes don’t change over Pesach: skip high sugar foods like juice and soda; eat combination meals that include protein and fat, along with carbohydrates; choose plenty of fiber-rich foods like vegetables; and read labels carefully.
“I’m a big fan of frozen vegetables,” says Rivka. “They are so convenient, especially when there’s only so much room in your packed fridge over yom tov.”
Another strategy to help moderate the blood sugar ups and downs of the Seder is to eat before yom tov, preferably a snack with protein and fiber, like chicken soup with vegetables, or a small apple with a handful of nuts.
Physical activity is a critical component of a healthy diabetes lifestyle over Pesach too. Even taking a walk after your meal can make a difference in your blood sugar levels, says Rivka.
Finally, as Pesach wraps up, it’s important to review how the holiday went, healthwise. “Keep track of what worked for you — which products were well tolerated, which caused your blood sugar to skyrocket,” Rivka says. “Write it all down so you can look it over before next Pesach and get a head start.
