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By Rabbi Dovid Cohen, Administrative Rabbinic Coordinator and Mrs. Chana Schorr, RDN
At the Pesach Seder, a person is required to eat a considerable amount of food and beverages, some in a relatively short amount of time. This poses a challenge for many people who have dietary restrictions. This article will review those requirements and consider how people with different medical conditions can fulfill those mitzvos and customs. As with all matters of halacha and medicine, each person should consult with their Rabbi and doctor or RDN before making a final decision.
Part 1 of this article will discuss issues related to foods consumed at the Seder, and Part 2 will address some related issues.
The following is a list of foods which must be eaten at the Seder:
For the first three items listed above, there is a requirement to consume a specific amount of food or drink. While there are differences of opinion regarding the exact amounts required, there are basically three opinions for each:
Many American Poskim, including Rabbi Gedalia Dov Schwartz zt”l, accept the rulings of Rabbi Feinstein on this matter. Accordingly, his will be the only position recorded in the body of this article. Other shiurim will be recorded in the endnotes. That said, there are many situations where a person’s medical condition warrants relying on the shiurim of Rabbi Na’ah, and this is something which a Rabbi will consider when responding to a specific situation.
ADVISORY: EREV PESACH: Do not skip meals on Erev Pesach.
Eat a balanced breakfast and lunch, as well as get healthy snacks – such as fruit and nuts – throughout the day.
At four points in the Seder, a person must drink from a cup of “yayin”. Yayin is loosely translated as “wine”, but, in fact, it also includes grape juice. Nonetheless, there is a difference of opinion whether there is a specific requirement that at the Seder one must use wine (i.e., fermented grape juice), or if grape juice can be used. Many authorities consider wine to be preferable for the mitzvah, but if it is medically recommended that a specific person avoid wine or alcohol then he or she should consult with a Rabbi to determine how to balance these competing issues.
The cup must hold 2.9 ounces of liquid [i] and be filled to the top. (2.9 ounces is what Chazal refer to as a “revi’is”). However, the cup does not have to be only filled with yayin. Rather, the wine or grape juice may be diluted with a certain amount of water. How much water can be added is the subject of dispute in the Poskim, [ii] with some allowing as much as up to 50% water (and some allowing even more). That said, if the bottling company adds water of its own to the product, then that reduces how much water the consumer may add. For details on which wines or grape juices contain water, please contact the manufacturer or the agency who certifies the product as kosher.
ADVISORY: CUP:Traditional kiddush cups hold much more than the 2.9 ounce minimum.
If you want a cup which is the minimum size required, use 3-ounce sauce cups, espresso cups, or shot glasses.
There are different opinions as to how much of the wine or grape juice a person must drink. Some say that a person should drink most (or even all) of the beverage in the cup, [iii] which is to say that if the cup holds 5 ounces, for example, the person will have to drink at least 2.6 ounces. Shulchan Aruch[iv] says that regardless of the size of the cup one is only obligated to drink most of a revi’is of yayin (i.e., 1.5 ounces), [v] but the preference is that the person drink a full revi’is (2.9 ounces). Magen Avraham [vi] suggests that one can satisfy both opinions by using a very small cup which holds just barely 2.9 ounces, so that “most of the beverage in the cup” is the same as “most of a revi’is”.
If we combine all the above information, we see that if a person dilutes wine or grape juice with 30% water and only drinks 1.5 ounces at each kos, the obligation can essentially be fulfilled by just drinking 1 ounce of actual wine or grape juice. Alternatively, if the yayin will not be diluted, one may use a very small cup which holds just 2.9 ounces, and drink just 1.5 ounces (or at most the full 2.9 ounces) of wine or grape juice.
A person who must limit the intake of liquids, such as someone on dialysis, suffering from edema, or who just received a gastric sleeve, should consult with a doctor or dietitian. The medical professional will help the patient understand whether it will be acceptable to drink 1.5 ounces of grape juice or wine at each of the 4 kosos, and what dietary modifications might be necessary to accomplish that goal. If one is advised not to drink that much, he or she should consult with a Rabbi who may say that the condition warrants drinking less than all 4 kosos. In that case, the preference is as follows: if he is drinking one cup, it should be for the 1st cup of the night (kiddush); if he is drinking two cups, they should be for the 1st and 3rd cups; and if he is drinking 3 cups, they should be for the first three cups of the Seder. [vii]
Patients with dysphagia are unable (and/or not allowed) to swallow standard grape juice or wine and will need to have it thickened before consumption. A thickened beverage with a nectar-thick or honey-thick consistency is considered “liquid” and suitable for the mitzvah, but those with a pudding-thick consistency are treated as a “solid” and cannot be used.[viii] Those who have their own (kosher for Pesach) thickener, should add the appropriate amount of thickener to grape juice or wine for use at the Seder. Alternatively, it may be possible to purchase thickened grape juice which is approved for use on Pesach. What if neither of these options is appropriate, such that the person will be unable to fulfill the obligation of drinking the four kosos? In that case, one may perform the mitzvah with chamar medinah.[ix] This is defined as any respectable beverage which people commonly enjoy drinking even when not thirsty.[x] For our purposes this means that they may use (thickened) fruit juice.[xi]
There are many people who must measure or limit the amount of carbohydrates they eat. This includes diabetics, people on a ketogenic diet to avoid seizures, and people with certain other conditions, who will be looking to minimize the amount of carbs they consume in the four kosos. These people will want to drink just 1.5 ounces of beverage at each kos and will also want to choose their beverage carefully. Some good choices are “light” grape juice, watering down grape juice or wine (as noted above) or using wine (bearing in mind that the drier the wine, the fewer carbs it will contain). [Kedem light grape juice has about 1.5 grams (or 6.25 calories) per ounce, while Kedem regular grape juice has 3.9 grams (or 16 calories) per ounce.]
For some diabetics, wine is not a good option because (a) the alcohol may cause blood sugar to drop, especially at the first kos which is consumed on an empty stomach, and (b) the medicines they take might be incompatible with alcohol. (Similarly, recovering alcoholics, those with liver disease or who are pregnant may be unable to consume alcohol). A related issue is that people with edema or who are on dialysis, may have restrictions as to how much liquid they can consume per day.
These issues should be discussed with a dietitian or doctor before Pesach, so that the patient can plan accordingly and participate in the Seder in a healthy manner.
There are three times at the Seder when we are obligated to eat matzah – Motzi Matzah, Korech, and Afikomen. The mitzvah d’oraisah (Torah obligation) is to eat 1 kezayis of matzah on the first night of Pesach, but there is a Rabbinic obligation to eat much more than that. Specifically, we must eat two kezaysim at Motzi Matzah, one at Korech, and two at Afikomen.[xii]
How much matzah is that? The amount depends on how thick the matzah is, as follows: [xiii] [Amounts given are for handmade sh’murah matzah which is the preferred matzah to use for the mitzvah.]
As noted, the Torah only requires that a person eat one kezayis of matzah, and the amounts noted above reflect many kezaysim. These are the optimal amounts which should be consumed by everyone who has no medical conditions to consider. However, if it is medically advised that a person not consume so much matzah, then a Rabbi may advise that it is acceptable to eat less than these amounts. Essentially, due to the Rabbinic nature of most parts of this mitzvah, the Rabbi may deem it appropriate to either rely on the lenient shiurim articulated by Rabbi Na’ah [xiv] or say that it suffices for the person to eat less than the optimal amount.
If the Rabbi says that it is appropriate for a person to just eat one kezayis of matzah then Motzi Matzah and Korech should be skipped, and after the festive meal should (wash, recite hamotzi and al achilas matzah, and) eat the one kezayis to fulfill the dual mitzvos of matzah and afikomen simultaneously.[xv] (Nothing may be eaten after this afikomen). In other cases, the Rabbi will rule that the person can/should eat two small portions of matzah (i.e., one kezayis each) in which case one kezayis should be eaten at Motzi Matzah and the other at Afikomen (skipping Korech).[xvi]
People who are diabetic or on a ketogenic diet to avoid seizures may need to be aware of – and sometimes also limit – the amount of carbohydrates which they eat. The approximate number of carbs for each of the mitzvos (assuming the person is using handmade matzah) is 28 grams for Motzi Matzah, 12 grams for Korech, and 24 grams for Afikomen.[xvii]
Matzah used at the Seder must be made from one of the five primary grains – wheat, spelt, rye, barley, or oats – and may be produced from “white” flour or “whole grain” flour.[xviii] A person who suffers from Crohn’s, IBS, has a colostomy, or certain other conditions, might be advised to maintain a low-fiber diet, and should choose matzah made from “white” flour. Others have exactly the opposite need and would, therefore, choose to use matzos made of whole grains.
Rema [xix] records a custom to only use wheat-based matzah at the Seder. This is understood [xx] to be due to an assumption that people prefer this type of matzah, such that it is an example of using the “best” type of matzah for the mitzvah. However, if a person is allergic to wheat or has some other reason to prefer to use spelt or rye matzah, it is permitted to use a different type of matzah. Similarly, those who are celiac have no choice but to use gluten-free oat matzah at the Seder. Some celiacs, especially those who have recently been diagnosed, are advised not to eat oats (even if the oats are gluten-free). A person in this situation should speak to a Rabbi who will determine (a) whether the need to avoid oats outweighs the mitzvah to eat matzah at the Seder, and/or (b) if the person should eat a smaller shiur or less matzah, as noted above.
The only ingredients which can be in matzah at the Seder are flour (from one of the five primary grains) and water. Although those who are ill or infirm (or of a Sephardic background) are allowed to eat “egg matzah” during other parts of Pesach, [xxi] this is not permitted at the Seder.[xxii] What should a person do if they have dysphagia, severe gum disease, or TMJ, require an altered consistency diet (e.g., pureed food), or have other conditions which make it difficult to chew or swallow standard matzah? Mishnah Berurah [xxiii] rules that such a person should choose one of the following options (in descending order of b’dieved):
The soaking should not be for too long, so that after it is completed, each piece of matzah is still larger than a kezayis, and the water used for soaking does not become “clouded”.
A somewhat different concern is that to fulfill the mitzvah, the matzah must be consumed within a given amount of time known as, “k’dei achilas pras”. Poskim differ as to exactly how long this is, with most assuming it ranges from 2-5 minutes.[xxiv] Many individuals can consume all the matzah within the shortest of those times (2-3 minutes), and this is obviously preferred. But this may be very close to impossible for those who have a difficult time chewing or swallowing, who must swallow twice for each bite (e.g., some patients with dysphagia), or who cannot eat very much at one time (e.g., someone with a stomach sleeve or band). These individuals should discuss with a Rabbi whether to rely on a longer measure of k’dei achilas pras, [xxv] and whether to possibly just “rush” when eating motzi matza but not for the other mitzvos.
We eat marror twice at the Seder – at Marror and Korech – and in both cases the mitzvah is Rabbinic in nature. The Mishnah [xxvi] records that there are five vegetables which are suitable as “marror”, but there is some question as to what each of those five are. Accordingly, most people use either romaine lettuce or ground horseradish, [xxvii] and some have a custom to use endives.
Regardless of which vegetable is used, the amount which must be consumed is the same. Namely, it is the amount of lettuce (for example) which will fill up a 1-ounce shot glass when pressed tightly into the glass leaving no empty air spaces.[xxviii] People who must maintain a low-fiber diet, such as those suffering from Crohn’s, IBS, SBO (small bowel obstruction), or a person who has a colostomy, should speak with their dietitian to see whether this amount of marror will be deleterious to their condition. If so, they should ask a Rabbi for guidance as to how they should conduct themselves at the Seder. (Cooked vegetables may not be used as marror.)[xxix]
As noted above regarding matzah, the marror must be eaten within the time of k’dei achilas pras. For people with dysphagia, or others with difficulty chewing or swallowing, it may be difficult to consume the entire amount in the 2-3 minutes of k’dei achilas pras. As with matzah, they should consult with a Rabbi as to whether they should possibly rely on a longer shiur for fulfilling the mitzvah.
If a person realizes that they cannot possibly fulfill the mitzvah due to one of the issues noted above, a small taste of marror should nonetheless be taken at the appropriate time in the Seder. This is not a true fulfillment of the mitzvah – and, therefore, no bracha is recited – but still a piece of marror should be eaten to remind the person of the bitterness (marror) which the Jews suffered in Egypt.[xxx]
Before we eat marror at the Seder, the marror is dipped into charoses. The Gemara does not give much direction as to what should be in the charoses and merely mentions that it should be of a thick consistency to remind us of the cement used by the Jews when they were enslaved in Egypt.[xxxi] However, Rishonim suggest a number of different ingredients which are appropriate to use, and Rema [xxxii] records that it should contain apples, pomegranate, figs, walnuts, and almonds, all of which are ground to a thick, mortar-like consistency. Furthermore, one should add broken cinnamon sticks and strands of ginger since they have an appearance like the straw which was also used by the Jewish slaves. Lastly, Rema notes that a person should add wine or wine vinegar to the charoses just before it is used, so that the liquid – which is not absorbed into the charoses – will remind us of the Jewish blood spilled during this part of our history.
Since the specific items used in charoses are based on customs rather than on formal halachic requirements, if a person is allergic to nuts or one of the other ingredients, or cannot tolerate wine or vinegar, charoses should be made without that ingredient.
Towards the beginning of the Seder each person is required to eat a small piece of a vegetable.[xxxiii] This part of the Seder is referred to as “Karpas” because some earlier Poskim suggest that one should specifically use karpas (celery) as that vegetable, but in truth one may use any vegetable.[xxxiv] (The only criteria are that it be in a form in which one recites ha’adamah before eating it, and that it not be something suitable for marror.)[xxxv] Thus, if someone has an allergy to the specific vegetable which their family customarily uses for karpas, or has some other reason to avoid it (e.g., difficulty chewing), a different vegetable may be substituted. It is worth bearing in mind that there is no requirement to eat a kezayis of karpas, and the truth is that a person is supposed to specifically eat very little of it; it may be tolerable to consume this small amount as a way of preserving a family custom.
Karpas is dipped into a liquid before it is eaten, and the most common custom is that saltwater is used as the liquid. In fact, Shulchan Aruch and later Poskim [xxxvi] records that one may use wine, vinegar, or saltwater for this purpose. Accordingly, if someone with hypertension wants to be very careful to avoid even the slightest amount of unnecessary salt, the karpas may be dipped into wine or vinegar instead of saltwater.
It is customary to begin the festive meal (Shulchan Oreich) by eating hard-boiled eggs dipped in saltwater, as a reminder that we are bereft of the Beis HaMikdash and, therefore, unable to bring a korban Pesach.[xxxvii] Someone who is allergic to eggs should not partake in this custom, and a person who avoids unnecessary salt due to hypertension or another condition may just eat the egg without dipping it into saltwater.
ADVISORY – MEAL CHOICE: The Seder food is carb-heavy, so choose protein and vegetables instead of carbs for the festive meal.
One of the halachos of the Seder is that one cannot eat meat or poultry which was broiled. This is because the korban Pesach must specifically be broiled; therefore, we avoid eating foods that might be confused with the korban Pesach.[xxxviii] That said, a person may eat a piece of meat which was originally broiled and subsequently cooked.[xxxix] This is a suitable choice for those who are on a low-sodium diet (such as those suffering from hypertension) and, therefore, kasher their own meat via broiling rather than using the traditional salting/melichah method. [Please ask a Rabbi for guidance before attempting this type of kashering.] One may not eat the broiled meat as-is at the Seder but may eat it if the already-broiled meat is cooked in water.
After the meal, each person will be required to eat afikomen and drink the two final cups of wine. Accordingly, Rema [xl] recommends that people not eat too much at the festive meal, so that they will be able to perform those mitzvos without being overstuffed. Rema provides this advice for all Seder participants, but it has extra significance for those who are medically advised to control their weight. There is a mitzvah to enjoy the meals on Shabbos and Yom Tov, but even that must be done in a manner which is consistent with maintaining our overall health.
Most Poskim rule that if fulfilling a positive mitzvah, such as eating matzah, will cause a person to become bedridden or otherwise severely ill, he or she is excused from performing that mitzvah.[xli] Thus, if none of the suggestions given in this article are suitable for a given patient, a Rabbi may rule that the fulfillment of the matzah may be omitted rather than having one perform it and become (more) ill.
The simplest way to know if one’s kiddush cup holds the required amount of liquid is by using a measuring cup. Fill the cup with water, and empty that water into a measuring cup to see if it holds the required amount. The same is true when determining if a shot glass is the right size to use in measuring for Marror.
In this article, the required amounts needed for matzah are given in linear inches (e.g., 8 X 7 inches) such that the matzah can be measured with a ruler or measuring tape.
It is prudent to do all measuring before Yom Tov to avoid last minute aggravations, but if one forgot, it is permitted to perform these measurements on Shabbos or Yom Tov (since they are being done for a mitzvah).[xlii]
The details provided in the article assume that the person can eat and swallow food and liquid down their throat. However, some people receive their nutrition through a gastric tube, nasal tube, or PEG, such that the food has no contact with the person’s throat, in which case it is likely that they have not fulfilled the mitzvah if they are fed matzah (for example) through one of these devices.
There are multiple diets which individuals choose to follow for a variety of reasons. In some cases, they are medically indicated and nutritionally sound, and in others they are a personal choice or a fad which the person is following. If one of those diets conflict with Seder requirements, the person must present this issue to a Rabbi who will consider the person’s needs and practices, as compared to the mitzvos of the Seder, and direct them how to resolve any potential issues.
[i] 2.9 ounces is the amount required according to Rabbi Feinstein and Rabbi Na’ah. (When the Seder is on Friday night, Rabbi Feinstein requires 4.4 ounces for the first cup). Chazon Ish requires 5 ounces.
[ii] See Shulchan Aruch OC 204:5 as per Mishnah Berurah 204:29, that in the days of the Gemara one could add considerable amounts of water, but nowadays there is a lesser amount that is acceptable.
[iii] Second opinion in Shulchan Aruch 472:9.
[iv] Primary opinion in Shulchan Aruch 472:9, as per Mishnah Berurah 472:33.
[v] 1.5 ounces if a bit more than half of the 2.9 shiur for a revi’is, and therefore meets the requirement for “rov revi’is” (most of a revi’is). (Children, and those who are physically very small may be allowed to consume even less wine or grape juice; see Biur Halacha 271:13 s.v. v’hu & 472:9 s.v. v’yishteh). According to Chazon Ish that a revi’is is 5 ounces, 2.6 ounces would be required for rov revi’is.
For the fourth cup at each Seder, one should drink at least a full revi’is so that there will be no question about reciting the bracha of al hagafen after drinking the wine (Mishnah Berurah 472:30).
[vi] Magen Avraham 472:10, cited in Mishnah Berurah 472:33.
[vii] The order of preference presented in the text is based on Mishnah Berurah 483:1. If the person can drink four cups but only for one Seder, he should do so at the first Seder (Mishnah Berurah 472:41).
[viii] As relates to the halacha of kovush, “liquid” is defined as anything which is מתנענע (moves) (see Pri Megadim MZ YD 105:1, Chochmas Adam 58:1, Mishnah Berurah 648:54, and Sha’ar HaTziun 648:61), and the text assumes that the same criterion applies in this halacha as well.
[ix] See Rema 483:1.
[x] As per Iggeros Moshe OC 2:75.
[xi] See Shemiras Shabbos K’hilchaso 53:9. (Most other examples of chamar medinah are either not kosher for Pesach or not available in thickened form).
[xii] Additionally, the mitzvah to eat matzah on the second night of Pesach is completely d’rabannan in nature.
[xiii] The shiurim given in the text are per Rabbi Feinstein. The following would be the shiurim in inches for average thickness matzos according to Rabbi Na’ah (RN) and Chazon Ish (CHI): Motzi Matzah – 9 X 6 (RN) / 12 X 7 (CHI); Korech – 4.5 X 6 (RN) / 6 X 6 (CHI); Afikomen – 9 X 6 (RN) / 11.5 X 6 (CHI).
[xiv] See the previous endnote.
[xv] See Mishnah Berurah 482:6.
[xvi] See Mishnah Berurah 482:6.
[xvii] The data given in the text are per the shiurim of Rabbi Feinstein. The following would be the grams of carbohydrates as per the shiurim of Rabbi Na’ah (RN) and Chazon Ish (CHI): Motzi Matzah – 37 (RN) / 58 (CHI); Korech – 19 (RN) / 25 (CHI); Afikomen – 37 (RN) / 48 (CHI).
[xviii] Shulchan Aruch 453:1 and 454:1.
[xix] Rema 453:1.
[xx] See Mishnah Berurah 453:2.
[xxi] Rema 462:4.
[xxii] Shulchan Aruch 462:1.
[xxiii] Mishnah Berurah 461:18 and Biur Halacha 461:4 s.v. yotzeh.
[xxiv] Some of the opinions noted in this context are Aruch HaShulchan 202:8 (3-4 minutes), Kaf HaChaim 210:8 (4-5 minutes, but possibly even 7 minutes), Shemiras Shabbos K’hilchaso 54:30 (4 minutes, but preferably in 2 minutes), and Iggeros Moshe OC 4:41 (less than 3 minutes).
[xxv] See the previous endnote.
[xxvi] Mishnah, Pesachim 2:6.
[xxvii] Mishnah Berurah 473:34.
[xxviii] The shiur given in the text is for Marror as per Rabbi Feinstein; for Korech he requires that the person eat only the volume of 0.7 ounces. According to Rabbi Na’ah, a person should eat the volume of 0.9 fluid ounces for both Marror and Korech, and according to Chazon Ish one should eat the volume of 1.2 fluid ounces.
[xxix] Shulchan Aruch 473:5.
[xxx] Mishnah Berurah 473:43.
[xxxi] See Rema 473:5.
[xxxii] Rema 473:5.
[xxxiii] Shulchan Aruch 473:6.
[xxxiv] See Shulchan Aruch 473:4.
[xxxv] Mishnah Berurah 473:20.
[xxxvi] Shulchan Aruch 473:6, as per Rema 473:4 and Mishnah Berurah 473:54.
[xxxvii] Rema 476:2.
[xxxviii] Shulchan Aruch 476:1-2 as per Mishnah Berurah 476:1.
[xxxix] Mishnah Berurah 476:1.
[xl] Rema 476:1.
[xli] See, for example, Tzitz Eliezer 14:27 and 19:22. For more on this see the article on celiac by this author in Journal of Halacha and Contemporary Society Volume LIX.
[xlii] See Shulchan Aruch 306:7 and Mishnah Berurah ad loc.