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Friends With Diabetes • Rabbi Hirsch Meisels31 Herrick Ave. • Spring Valley, NY 10977 • (845) 352-7532 • Fax (845) 573-9276RabbiMeisels@FriendsWithDiabetes.org

F.W.D. is under the rabbinical supervision of Rabbi M. M. Weismandl shlit”a of Nitra – Monsey. Endorsed by many other leading Rabbonim.

The information in this newsletter is meant to be used in conjunction with, and under the guidance of, your healthcare professional. It is NOT meant to diagnose or treat medical conditions, nor as advice or prescriptions. It is pro-vided for educational purposes only. In the event that you use the information without your doctor’s approval, youare prescribing for yourself, which is your constitutional right, but F.W.D. and the authors of this newsletterassume no responsibility. We strongly advise that you inform your doctor of any changes you wish to make.

Please consult your physician for medical questions, and your Rav (Rabbi) for halachic (Jewish law) decisions.

Likewise FWD does not take responsibility on the kashrus of the products advertised.

© Friends With Diabetes Winter ’02-’03

No reprints allowed without prior permission.

Inside ...g DROP US A FRIENDLY LINE

g FOREWORD

g FACING FORWARD —WHAT’S NEW AT FWD?

g YOM TOV GUIDEChanukah — Carbs in Homemade RecipesTu B'Shevat — Effective Carb Factors

Glycemic Index • Esrog/Citron CompotePurim — Alcohol and Diabetes • Exercise on Purim

Carbs in wine • Mishloach Manos Nosh

g IN CONTROLFrostbitsRise and Shine • Breakfast SmartsLow Carb DietingFood Scale GuideFriend to Friend

g SPECIAL FOR PARENTS

g HALACHA TIDBITS

g SHORT AND SWEET

g SWEET SUCCESS

Friends With Diabetesoheu,n ohghr

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Dear Rabbi Meisels;Mere words of thank you do not come close to the depth of gratitudethat we feel towards you and your wife for the most wonderful andincredible Shabbos possible! The weeks of hard work and preparationthat went into this big event produced a Shabbos that will be in thememories of all boys who participated forever. Thank you from thebottom of my heart.B.R.

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To the FWD staff;"Thank you" is just two words,but there is a lot of thoughtbehind it. Your publications are more thangreat. Keep up your phenomenalwork! We are looking ForWarD toyour future events and newsreports!Family U.

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Dear Rabbi Meisels;Although I was in the midst of myPesach cleaning, I stopped as soonas your beautiful publicationarrived. Despite living with diabetesfor fifteen years, I had many ques-tions about the upcoming Pesach.Your publication had it all! ... I wasamazed to read so many things I hadnever known before. Your publications,and everything else this wonderfulorganization does, are literally the ful-fillment of a dream for the Yiddishe dia-betic community!Thank you!C.H.

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Dear Rabbi and Mrs. Meisels;"I would like to thank you for the wonder-ful Shabbaton that FWD arranged. I hada most enjoyable time and still keep intouch with many of the new friends I made.We are all holding our breaths in anticipa-tion of your next smashing event!"Y.K.G.

Dear Going Forward Editors;"Your publications are out of this world! They contain so muchuseful information, that I save each issue for future reference. Timeand again, they have proven to be an unequalled help!"D.E.

D R O P U S A F R I E N D L Y L I N E

145 Saddle River Road • P.O.B. 302 • Monsey, New York 10952 • 845-352-5000

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Dear Rabbi Meisels tWyhka

Please allow me to share my enthusiasm for FWD with all your readers.

Although hardly familiar with the problems you are addressing daily, never-

theless common sense tells me that anyone with a condition of that order will

feel both isolated and stigmatized. Neither of those feelings are very pleas-

ant…

Enter Rabbi & Reb. Meisels, and suddenly everything changes. You now

belong to a growing, active, exclusive club. You are invited to social and edu-

cational events in a warm, informal atmosphere. You regularly receive attrac-

tive, professionally presented magazine in three languages, packed with arti-

cles, letters, halachos, stories, tips, charts, news and events.

It's not long till you ask yourself, "One minute, what isolation? What stigma?"

On the contrary, you have just made meaningful friendships with others cop-

ing with situations similar to your own. You compare notes and share experi-

ences, you chat and laugh together. Quite unexpectedly you have endless

resources available and all the latest developments at your fingertips.

You now look forward to phone calls, letters, simchas, a rich social life with

a unique spiritual, Chassidic flavor.

My own involvement is very limited but, even so, significant. Family Meisels

love to arrange a special Shabbos event for their clients who they see as their

extended family. On two occasions I had the pleasure to address groups of

girls at a Shabbos meal. These were really intelligent, accomplished, heimishe

young ladies, keen to soak in every idea one would share with them. It was

really stimulating to present Torah insights to these delightful groups, relat-

ing, where possible, to their predicament. Their reactions and responses

showed maturity and realism and I must say I was impressed. The participants

invariably walk away from such weekends as changed people with a far

brighter view of the future. They enjoy every activity, the davening, the

meals, the Torah thoughts, the practical advice, the games, the singing. To

sum up, it's little short of a miraculous revival. All credit goes to the Meisels!

Wishing you every possible Hatzlochoh.

Rabbi Pinchos Jung

Dean, Bais Rochel High School for Girls, Monsey, NY

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Aforeword is usually a beginning, an introductionand opening to the pages that follow. But this let-ter, in a sense, represents an ending. With the

publication of this issue, FWD has completed the cycleof the Jewish calendar. Our beautifully printed articlesand guidelines on all Jewish yomim tovim and fast daysattest to the years of research, review, consultation, andimmeasurable effort that were invested toward this pro-ject. B’syata dishmaya, we have reached its conclusion.Endings are cause for reflection. I recall my own child-hood, when it was common knowledge that sugar wasan absolutely forbidden food for diabetics. Potatoes andsugar-free cake (sweetened by any glucose with a nameother than sugar, and full of carbohydrate-laden flour)were okay, of course. I was genuinely puzzled by mysky-high A1cs. A new world unfolded for me when I learned aboutcounting carbohydrates for good glycemic control. Ialso noticed the glaring need for education andresources tailored to the lifestyle of the Jewish commu-nity. One man told me he injected fifteen units ofinsulin prior to each Shabbos meal, and he then con-sumed whatever foods he wanted. When I pointed outthe dangerous inaccuracies that result from such dos-ing, he answered despondently, "You’re right! But whatcan I do? Is it possible to figure the carb contents of aShabbos meal?" It was then that I decided to do something about thedesperate situation. After much research and calcula-tion, our first Shabbos guide was born. Later, a parentasked for a clear and authoritative guide for the intrica-cies involved in fasting on Yom Kippur. Although orig-inally typed in Yiddish and distributed to a handful offriends, public demand necessitated their translation toEnglish and more widespread distribution.The articles were filling an acute and dire need within

the Jewish diabetic community. They were reachingareas all around the globe, and also aiding rabbanimand doctors in better advising Jewish people with dia-betes. Eventually, with the support and guidance ofhalachic and medical professionals, and seeking toquench a thirsty public, we undertook to clarify all theunique issues related to each event on the Jewish calen-dar.The hand-outs changed gradually to stapled bookletsand we finally merited releasing a beautiful, easy-to-read publication for Tishrei 5762. The literally hun-dreds of hours of accumulated work continued to reapbenefits. Our Pesach edition was another leap ahead inprofessionalism, and the invaluable content aided thou-sands of Jewish families worldwide. The grateful feed-back is still pushing us ForWarD.This guidebook, too, is a compilation of new articlesand tidbits, and others that have been extensively edit-ed, revised, and improved.It is with gratitude to the Ribono Shel Olam thatwe look back at all that He has helped us accom-plish. May He grant that these publicationsindeed have the desired influence, instruct-ing and encouraging more and morepeople, so that all Jews will behealthy and strong until the daywhen there will no longer beany sickness.

F O R E W O R D

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Rabbi Hirsch MeiselsFriends With Diabetes

With thanks to the Ribono Shel Olam for being with us all along, we would like to express our feelings of gratitude tothose individuals who helped us in Going ForWarD:• To all the corporate manufacturers who advertised in this issue, and aided us in financing this massive undertaking.• To the medical professionals who gave of their precious time, to preview this entire book, and shared their comments

and compliments.• To all those, wealthy and potentially wealthy, who gave donations to FWD.• To all our members who shared their feelings, helpful tips and articles which are interspersed throughout this issue.• Last but not least: a family who has devoted their selves, time, effort, house, and computer to enable this book!

(respecting their wish we kept their name confidential)May Hashem grant all of them much Hatzlacha in every way! RHM-FWD

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Alot has been happeningat Friends With Diabetesover the spring & sum-

mer! Following are some high-lights:

Tammuz 5762/June 2002:Word of FWD’s phenomenal activitiesreached as far away as Eretz Yisroel,where Mrs. Lefkowitz, a wonderful dia-betic woman, had been working forsome time to encourage and bolsterJews affected by diabetes. With FWD’ssupport, direction, and advice, thisenergetic woman coordinated the firstmeeting in Eretz Yisroel. Fifteen fami-lies participated in the instructive sup-port group and each participant gainedtremendously. The informal gatheringpulsated with warm friendship, educa-tional tidbits and practical tips. In theworks now is a schedule of upcomingmeetings, and also the release ofHebrew translations of some of FWD’spublications.

Iyar 5762/May 2002:FWD reached a milestone when itsthird super-successful boys’ Shabbostook place in the spring. For thisShabbos, teenaged boys from all overNew York and surrounding states con-verged in Monsey, NY. The top-notchprogram included masterful halachicorations alternated with inspirational,encouraging words. There was plentyof mingling with diabetic adults whowere wonderful role models for theseyoung boys. A highlight of theShabbos was the powerful speech deliv-ered by Rabbi Weismandl, in which hestated clearly that diabetes is nothing to

be ashamed of and nothing to hide. Hepraised all those in attendance who hadchosen not to be ashamed of diabetes,but rather to come join this extraordi-nary gathering which would have apositive influence on the rest of theirlives. The participants left on an emo-tional "high", feeling almost lucky tohave diabetes, and looking forward tothe next FWD event!

Iyar 5762/April 2002:A successful local support group forparents of young, newly diagnosedchildren was held by Friends WithDiabetes. A most inspiring and encour-aging speech was delivered by AviShulman, a renowned speaker/ writer.He pointed out that teaching a child tocope and overcome a challenge, giveshim/her the courage to overcome notonly this challenge, but also any hurdlein life that might come up. In this per-spective, we can view diabetes as a giftfrom Hashem that can strengthen us,teach us, and make us into betterpeople.

The parents left with pages full of notesto help them remember the usefuladvice they had learned on dealing withextra activity during summer, storinginsulin in the heat, and so much more.Perhaps most important of all, they leftwith the wonderful feeling that theyhave supportive Friends With Diabetes.

4

What’s New at F.W.D.?

www.FriendsWithDiabetes.orgOur new and improved website is now up and running! Check out some of thesefabulous features:

FWD publications & many other useful articles available to download (in PDF format)Links to many other wonderful websitesList of recommended books, plus you can even buy these books fromAmazon.com with just one easy click! A margin of the profits of any books soldthrough our website will go to FWD.Links to our email discussion listsLink to a site that will accept your credit card for donations to FWD.

Available...Think back: Have you misseda Going ForWarD?TISHREI 5762(Yiddish and English)• Fasting on Yom Kippur• How to Deal with your Shabbos Meal• Teshuvas from Rabbonim about

checking BGs on Shabbos • The Unused Insulin Rule for the

Square Wave Bolus• & much, much more….

PESACH (Yiddish and English)• A thorough guide to the Kazaisim

Matzah, Four Cups, and many Pesachtips, plus;• Exercise• Glycemic Load• Halacha Tidbits and more.

TISHREI 5763 (English)• Carb values for foods commonly eaten

on Rosh Hashanah• Yom Kippur: all your questions

answered

FILES TO DOWNLOAD:SUMMER TIPS (Yiddish)• Exercise during summer• Avoiding dehydration• Storing diabetes supplies in summer

DIABETES & SHABBOS• We have written a comprehensive 5-

page Hebrew article of frequentlyasked questions about diabetes onShabbos. This can be presented to aRav who does not possess medicalknowledge, to help him understandthe concept of diabetes, so that heshould be able to give psokim on thistopic. Feel free to contact us for a copy.

GUIDE FOR TEACHERS(Yiddish)

• As the Cheder year began, we receivedan overwhelming number of requeststo educate the melamdim/teachers. Inresponse we have translated a pagefrom the CWD website to Yiddish.

ALL OUR BOOKS ARE AVAILABE TODOWNLOAD FROM OUR WEBSITE

F A C I N G F O R W A R D

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It’s no secret… Keeping a secret ishard! Although living with diabetesmeans leading a normal, sometimeseven above-average life, many childrenwith diabetes long for someone whocan share and understand their condi-tion. Knowing that their peers cannotrelate to this unique aspect of theirlives, youngsters sometimes feel self-conscious and "different", imaginingthat they are the only ones in the worldchecking blood sugars and countingcarbohydrates.That’s why the Friends With Diabetesboys’ Shabbos at the beginning of Maywas such a grand success. The partici-pants, teenaged boys from all overNew York and surrounding states, con-verged in Monsey, NY, for an excitingand uplifting program of speakers andactivities. But perhaps even moreimportant than the invaluable inspira-tion and education they absorbed, wasthe priceless feeling of empathy andfriendship that served as a bondbetween them. The day-to-day detailsof dealing with diabetes were discussedopenly and informally throughout theShabbos. The delicious feeling of beingunderstood warmed the boys.FWD places a strong emphasis on pro-tecting the privacy and confidentialityof its members. At the same time,while carefully bearing these wishes inmind, it aims to provide opportunity

for interaction and support among thediabetics themselves. In addition tomingling and delighting with diabeticboys their own age, those in attendancegained immensely from meeting adultswith diabetes. These positive rolemodels reinforced the belief that dia-betes would not deprive anyone ofbuilding a beautiful family and suc-ceeding in life.There was much more to be gainedfrom that Shabbos. One of the majorgoals of FWD is to educate its mem-bers on incorporating good diabetespractices with a Yiddishe lifestyle. Thiswas achieved by speeches, explanationand clear demonstrations. RabbiHoltzer of Monsey, NY, treated theboys to a masterful halachic oration.Also featured at the Shabbos wasrenowned educator, Rabbi YaakovHorowitz.A highlight of the Shabbos was thepowerful speech delivered by RabbiWeismandl, in which he stated clearlythat diabetes is nothing to be ashamedof and nothing to hide. He pointed outthat secrecy, which can ch"v lead to

neglect in diabetes control, is actuallythe only thing a person need be embar-rassed of. For some children, keepingdiabetes a secret may be harder thandealing with the condition itself! TheRabbi also praised all those in atten-dance who had chosen not to beashamed of diabetes, but rather tocome join this inspirational gatheringthat would have a positive influence onthe rest of their lives.This Shabbos is only a part of FWD’songoing effort to educate, unite, andsupport youngsters with diabetes, liter-ally from throughout the world! FWDhosts these inspirational and successfulShabbosim on a steady, ongoing basis,for both girls and boys separately.Many of the participants have vouchedthat a Shabbos with Friends WithDiabetes has completely changed theirperspective, their entire life. It’s goodto know, at least, that these childrennow have one less secret to keep.FWD is continuing to fill a vital needin the Jewish community. Our futureplans iy"h, also include a support groupfor women dealing with type 2 dia-betes. If you are interested in joining,or know someone who may benefit,don’t hesitate to pass along the secret!

5

Whoops. . . We slipped!PLEASE NOTE: We invested maximum effort toinsure the accuracy of all calculations in ourPesach issue, both halachic and carb-related.However, we apologize for overlooking oneimportant sentence. As stated, one need onlyeat a k'zayis of matzo in order to wash andbentch. However, we neglected to add that onewould need to eat a k'baitzah (almost doublethe amount of a k'zayis) in order to make thebracha of al ntilas yodayim after washing.

“IT’S MATHEMATICALLY IMPOSSIBLE BUT TRUE: When you’re feeling small, you’ll feel bigger

after giving some of yourself away!”

I recently received a wonderful, frummagazine in the mail, entitled "GoingForWarD: Friends with Diabetes." Themagazine is written and produced byRabbi Hirsh Meisels, the dedicateddirector of "Rayim Mesukim; Friendswith Diabetes," a non- profit supportgroup for people with diabetes. The magazine was professional, eye-catching, and chockfull of informativeand timely articles. It dealt with man-aging one’s diet during the YomimTovim, special halachos regarding

Pesach, and general ‘chizuk’ articles forpeople belonging to this special group.Rabbi Meisels also organizesShabbatons and get-togethers for chil-dren with diabetes, arranging for infor-mative workshops and inspiring guestspeakers. I truly admire Rabbi and Mrs. Meisels,who invest so much time and koachinto this special mission, making theworld sweeter for diabetics. May theRibbono Shel Olam give them thestrength to continue helping so many.

The Meisels Speak Out(Printed in the Yated)

The SECRET is out:FWD Boys’ Shabbos a Smashing Success! Printed in

the Yated

7 C H A N U K A H - j c y n i h f ,

One point about the components of this issue:

There is a popular anecdote of a little boy who

returned from cheder one day, displaying unusual

respect and honor toward his parents. After a

week of this exemplary behavior, he returned to his

former, less-than-respectful self. When his mother

questioned him, he explained, "Mommy, last week

was Parshas Yisro (when we read the Ten

Commandments, including the command to revere

and honor father and mother). This week is no

longer Parshas Yisro, so I can stop making an

effort to respect my parents!"

The reader will note that this guide discusses vari-

ous methods and aids for good blood sugar con-

trol, applied under a specific holiday. For example,

carb factors are stressed in relation to Tu B'Shevat,

and we explore the carb contents of homemade

recipes in relation to Chanukah. This format

has been kept, as the articles are specifically

relevant during those times, but please

remember that these techniques are

meant to be used all year round! Let's

not act like the cute five-year-old in

the story above.RHM YO

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M any of us are fairly successful and confidentwith carb counting, as long as we are eating

foods that have nutrition information labels.However, when dealing with a homemade recipe, itis easy to get discouraged. At FWD, we have receivedcountless desperate phone calls from diabetics ortheir parents who were wondering just how manygrams of carbs were hiding in one Chanukah potatolatke, a slice of cake, or a bowl of vegetable soup.

Yes, people with diabetes CAN eat all thesethings, and there IS a way to figure out how manycarbs they contain. The following article will guideyou in calculating the carb contents of any home-made recipe.

Essential ToolsItems you will need in order to calculate the car-

bohydrate content of any recipe are:

AA ggoooodd bbooookk ooff ccaarrbboohhyyddrraattee vvaalluueess – Your bookshould include the carbohydrate contents of basicingredients like flour and potatoes, in several dif-ferent increments. An example of such a book is“Food Values of Portions Commonly Used”.Smaller, handier references include “The ProteinPower Gram Counter”, and the heimishe book,“Kosher Calories”. (Sorry, this book is already outof print.) You may even benefit from the USDAdatabase on the Web. Remember that it is alwaysadvantageous to have access to as many gramcounters as possible; you never know when eachone will come to use.

KKiittcchheenn ggrraamm ssccaallee – This should be able to weighseveral pounds at a time. (For a recipe such asapple pie, it would be easier if you could weigh allthe apples at once.) See our full article about foodscales in this issue.

CCaallccuullaattoorr – You might also want to have paper anda pencil handy.

MMeeaassuurriinngg ccuuppss aanndd ssppoooonnss – Make sure you have acomplete set of measuring spoons and measuringcups for both dry and liquid ingredients.

The Basic ProcedureCalculating the carbohydrate content of a recipe

involves five simple steps. (It is a good idea to writedown all the details of your calculation so that if youalter the recipe, you won’t have to refigure the car-bohydrate grams for all the ingredients, just for theones you change.)

1. Using food labels or carbohydrate-countingbooks, find out the carbohydrate grams in eachingredient.

2. Add the carbohydrate grams to determine thetotal carbohydrate for the recipe.

3. Divide the recipe into the number of servings youprefer, and write on the recipe “Yields X amountof servings,” for future reference.

4. Divide the total carbohydrate grams in the recipeby the number of servings you decided on. Younow know the amount of carbs per serving. Forexample, if the total carbs from the recipe is 400grams and it yields 40 servings, you will have 10grams of carb per serving. [400/40=10.]

5. Write on the recipe the number of carbohydrategrams per serving.

Divide every recipe according to the serving sizeyou will actually use. For example, some recipes,especially liquids, are divided most easily into one-cup servings. In that case, you would divide the totalgrams of carbohydrate in the recipe by the numberof cups it yields. This will tell you how many gramsof carbohydrate there are per cup. (See our soupexample below.)

The recipes used in the following examples aretried-and-true. You can really follow our step-by-stepdirections and make them yourself. Bon Apetit!

An Example:This Chanukah recipe, handed down through the

generations, contains no nutritional information.However, we can easily figure its carb content usingthe steps detailed above.

Calculating Carbs forHomemade Recipes

Now you can bake your favorite cake… and eat it too!

C H A N U K A H - j c y n i h f , 9

Reminder: Please remember that anychange in regimen should

be discussed with your doctor

or health care professional.

How to figure the amount of carbohydrates in this recipe:

Using a gram counter, you will discov-er that a small potato without skincontains 18.3 grams of carbs (afterfiber is subtracted). We therefore cal-culate 18.3 X 4, to arrive at 71.5

grams of carb for thepotatoes used inthis recipe. Eggs arelisted at 0.6 gramsof carb, which wemultiply by 2. Thetotal carb contentof the eggs is 1.2grams of carb.

We will add the amount of carbs in the potatoes

(71.5 g.) with the amount of carbo-hydrates in the eggs (1.2g). We nowknow that the complete recipe con-tains about 72.7 grams of carb.

This recipe makes approximately 7latkes. We will jot down a number 7on the recipe so that we rememberthe number for future reference.

Next, we divide 71.5 (the amount ofcarbs in the recipe) by 7 (the amountof servings this recipe makes). We canconclude that each serving, or onelatke, of this recipe contains 10.2grams of carb.

Write down 10.2 on the recipe so thatyou don’t have to recalculate its carbcontent next Chanukah.

Potato Latkes

4 potatoes

2 eggs1 Tbsp. oil

pinch salt

How to figure the amount of carbohydrates in this recipe:

We have already done the first step,which is researching the amount of carbsin each ingredient of the recipe.

Note: You may be wondering why it isimportant to count even the tiny

amounts of carbsfound in somevegetable ingredi-ents (such as cel-ery). Rememberthat ultimately,any carb amountwe calculate isonly an educat-ed estimate.The more accu-rate we canget, the betteroff our bloodsugars will be.Also, evens m a l l

amounts of carbs eventuallyadd up to make large amounts of carbo-hydrates!

Adding together all the carb amounts,we discover that the entire recipe con-tains 398.5 grams of carb.

Since we are dealing with a liquid, ouraim is to find out how many cups therecipe can fill. (Although soups are oftenlabeled with serving sizes of half a cup,

this is an impractical suggestion formost of us!) We will then divide the totalcarbs in the recipe by the amount of cupsit fills.

The most practical way to decide howmany cups of soup this recipe makes isby estimation. After cooking, the pot ofsoup appears to be more than ¾ full, sowe will approximate that it currently fills10 quarts. Knowing that one quartequals four cups, we figure that therecipe yielded 40 cups of soup.

We now divide the total amount ofcarbs in the recipe (398.5) by 40. Eachcup of soup contains about 10 grams ofcarbohydrates. (Again, you may want tojot this number down on the recipe sothat you can refer to it at a later date.)

Hint: For convenience, simply servethe soup with a soup ladle and you willautomatically be serving half a cup ofsoup!

Remember also to mix the soup priorto serving, in order to distribute the veg-etables (and the carbs) evenly through-out the broth.

2 lb split peas (cooked with a

drop of baking soda) = 316

Blend in food processor:

2 lg onions = 20.4

6 cloves garlic = 5.6

2 big squash (zucchini) = 10.9

4 celery sticks = 5

5 carrots = 25.7

1 lg red pepper = 7.3

1 lg green pepper 7.6

Vegetable Soup (submitted by Mrs. T.)

The numbers next to the ingredients

represent each item’s carb content.

Cook all ingredients in a 12 qt. pot.

Even if you're a beginner at carb counting and you're not yetup to using the advanced ECF (effective carb factor) method,you can still make good use of this simple and convenient tip:If you want to eat any soft baked good, like bread, rolls, cake,etc., simply weigh your portion. Half of the weight is the

amount of carb in your serving. For example, if you would like to eat a doughnut weigh-ing 30 g (1 0z.) you would count 15 g of carb.

Halve the weight, Have your carb!

The Carb Factor for Latkes(Based on the previous example)

1. Weigh the entire batch of latkes. Yourresult will be 477 g.

2. Divide the total number of carbs inthe recipe [72.7 g] by the weight[477 g] to get the amount of carbo-hydrate in one gram. Your calculation:72.7 / 477 = 0.15. The effective carbfactor for potato latkes is 0.15.

THE RULE OF FIFTY!

10 C H A N U K A H - j c y n i h f ,

In some cases, thereare drawbacks to the

technique we justdetailed. When figuring

carbs based on a preset servingsize, we sometimes lack accuracy

and flexibility. We will know the carbcontent of a very specific serving size of the

recipe, but what happens when we want to vary thatserving size?

There is a more advanced method to use, inwhich the recipe’s carbohydrate factor is calculated.If you know the food’s carb factor,you will be able to figure the amountof carbs in any serving size of thefood. (For more details on EffectiveCarb Factors, see the Tu B’Shevatsection of this issue.)

1. Calculate the amount of carbohy-drates for each of the recipe’singredients.

2. Add all these numbers together todetermine the total amount of

carbs in the recipe.

3. Divide the total number of carbohydrates in therecipe by the weight of the finished food. Nowyou know this recipe’s carb factor, or what per-centage of the food is made up of carbohydrates.[This is the general rule you need to know inorder to find the carb factor for any item: “Dividethe total carb by the total weight”. For example:The label on a small bag of potato chips reads,“weight- 21 grams, carbohydrates- 12 grams”.So we would divide 12 by 21. The carb factor forthe potato chips is .57.]

An Advanced Method

How to figure the amount of carbohydrate in this recipe,

using the carb factor: Using books and packagelabels, find the carb contentsof all the ingredients:

12 Eggs = 7.2 1 cup sugar = 1921/2 cup oil = 01.5 cup flour = 1281.5 cup coconut (4.5 oz,

7g carb/oz.) = 31.51 tsp baking powder = 1.11/4 cup water = 01 tsp Almond extract (opt.) = 3

NNOOTTEE:: This recipe is lower in car-bohydrates than most cakerecipes, because the coconut

(whichcontains less carbs than flour)adds to its bulk and takes theplace of additional flour.

Adding all these numberstogether, we find that therecipe contains a total of362.8 g. of carb.

The finished cake weighs1,040 grams. We will dividethe recipe’s carb contents,362.8 g., by this weight, andfind that the carb factor of thecake is 0.35. We now know

that 35% of the cake’s weightis made up of carbohydrates.

You can now cut any size sliceof this cake, weigh it, andmultiply its weight by 0.35 todetermine the precise amountof carbs in the slice.

Of course, you may alwayschoose to use the simplermethod of figuring carbs accord-ing to a preset portion size. Inthis case, the cake yields about32 slices, so each slice wouldcontain approximately 11.3grams of carbohydrate.

Yom Tov Cake (submitted by Mrs. T.)

Bake in 9x13 pan at 350° for 1 hour.

12 Eggs

1 cup sugar

1/2 cup oil

1.5 cup flour

1.5 cup coconut

1 tsp baking powder

1/4 cup water

Desired flavor

ENRICH YOUR KNOWLEDGE!Before you eat your CHOCOLATE CHANUKAH GELT,

make sure you’ve got your carb calculations right. A bag consisting of 2 large & 3 small coins has 6g of carbs!

The idea for this article originated fromthe Insulin Pumpers website. The firsttime we calculated the carbs in a recipewas when making potato latkes onChanukah. We still use the same calculations to figure the carbs in potato latkes and potato kugel!

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references (graphs, charts, tables) • Easily access a 2,500 item Food List with serving sizes and carbohydrate values • Conveniently enter your personal diabetes management plan and helpful

reminders

12 T U B ’ S H E V A T - i h e u , n l h , u r h p

Many of us arealready familiar with

the standard techniques ofcarb counting, which usually

entail researching the carb contents of afood using nutrition labels and carb counting books.The following method, although somewhat more com-plicated, is much more versatile and precise. It is par-ticularly useful on Tu B’Shevat, when many people eatodd portions of a large variety of fruits, whose carbcontents can only be accurately determined by usingthe Effective Carb Factor method (ECF).

Why make such a big deal about this one day, TuB’Shevat? In reality, the ECF can and should be usedall year round, not just on Tu B’Shevat. Many peoplehave discovered the benefits of this method; theyappreciate its accuracy and the fact that they can nowpartake of a greater variety of foods without sufferingunpredictable high blood sugars afterwards. It is infact almost impossible to know the exact carb countfor a piece of cake or kugel without using a scale andthe ECF method.

The truth is that it pays to learn about ECF even ifit would help us maintain better control just for thisone day! Until this technique was employed, many peo-ple experienced the uncomfortable and potentially dan-gerous consequences of high blood sugars on TuB’Shevat. Others chose not to partake of the fruit, andinstead watched in uncomfortable silence as their fam-ily members enjoyed the fruit feast. It is our goal atFWD to incorporate a high quality of life with highquality diabetes control.

So what are effective carb factors? Let’s start withan introduction.

What are Carbs?Many foods, such as fruits, vegetables, breads and

cereals, and even nuts, seeds and dairy products, con-tain carbohydrate-some just a little, others, quite a lot.For any such food the standard gram-counting bookswill specify a total number of carbohydrate grams con-tained in a specific portion. For instance, a mediumbaked potato would contain about 32 grams of totalcarbohydrate.

The total carbohydrate content of a food is the sumof all types of carbohydrate it contains-the sugars, the

starches, and the fiber. But all carbohydrates are notcreated equal. The body can quickly absorb the sugarsin a food, and it’s easy to see that drinking a 12 oz.Cola (containing 35 to 50 grams of plain old sugar)would very quickly raise your blood sugar. But simplesugars aren’t the only culprits; starches are nothingmore than long chains of sugars linked together. It’sthe business of the digestive system to quickly breakthose links and reduce complex carbohydrates (suchas starches) into simple sugar molecules for absorp-tion. [You can demonstrate the speed with whichdigestive enzymes can accomplish this task yourself.Simply take a saltine cracker, bite off a corner, and holdit in you mouth for 15 to 20 seconds to give theenzymes in your saliva (the first ones in the digestiveprocess) a chance to work their magic. Before youknow it, the salty cracker begins to taste a little bitsweet. Your digestive process has already begun toturn the wheat starch in the cracker into glucose.] Thismeans that both the sugar content and the starch con-tent of any food can quickly raise blood sugar andinsulin levels.

There is a common misconception that people withdiabetes have to control the amount of “sugar” theyeat. According to what was just explained, however, itis not the sugar, but the total carbohydrate in a foodthat counts. 18 sugar cubes require the same amountof insulin as a standard (3 ounce) slice of challah; bothcontain 45 grams of effective carbohydrates. Once inthe body, a starch has the same affect as a simplesugar.

Effective CarbsThe “effective carbs” in a food are all the sugars it

contains — both simple and complex — that will causea rise in blood sugars and a need for insulin. But whatabout the fiber content? Fiber, like starches, is nothingmore than a long chain of sugar molecules hookedtogether. So fiber is a carbohydrate too, but with abeautiful twist: human digestive enzymes can’t breakthe links between the sugars. Since the human intes-tine is designed to normally absorb single simple sug-ars, these large complex fiber molecules pass onunchanged into the colon, where friendly resident bac-teria work on them and turn them into fatty acids tonourish the intestinal lining cells. In other words, fiberhas no effect on our blood sugar or our insulin control

Effective Carb Factors

and as such doesn’t count against us.It’s not an effective carbohydrate.

You can easily find the ECC of anypackaged food that has a nutritional labelby taking the total carbohydrate count ofthe portion listed and subtracting from itthe number of grams of fiber containedin that portion. For example: a slice ofwhole wheat bread will often list 14grams of total carbohydrate in a singleslice, but that slice will also contain 2grams of fiber. Therefore, the ECC wouldbe 14 grams - 2grams = 12 grams ofeffective or available carbohydrate. Inyour gram counting scheme, you’d onlyaccount for the 12 usable grams in yourmeal.

(Adapted from the book “Protein PowerLifeplan gram Counter” by Dr. Michael R.Eades M.D.)

Many nutritionists teach theirpatients to subtract fiber only if a foodcontains at least 5 grams or more.However, we have deducted even smalleramounts of fiber for the sake of greateraccuracy. Also, it is always preferable toerr by dosing too little insulin, asopposed to taking too much insulin.

Effective CarbFactors

The CARB FACTOR is the percentageof carbohydrates in a particular food. Forinstance, the carb factor for apples is0.13. This tells you that 13% of anapple’s weight is carbohydrate. Effectivecarb factors means that we only countthe carbohydrate that will cause a rise inblood sugars, so fiber is not included inthe total carbohydrate factor.

To determine the number of effectivecarbohydrates contained in a serving offruit, simply weigh the fruit and multiplythis number by its effective carb factor.Let us go through a step-by-step calcula-tion of a few different fruits.

• Faigy would like to start with 10grapes. According to her digital gramscale, the grapes weigh 37 grams. Theeffective carb factor for grapes is 0.16.She now multiplies its weight (37grams) by the ECF (0.16) to get thetotal carbohydrates: 37 X 0.16 = 5.9.Faigy now knows she will be ingesting5.9 grams of effective carbohydratealong with the grapes.

• Now she wants to add pieces of appleand pear. Since these two fruits sharean ECF of 0.13, Faigy weighs them allat once. Her scale notifies her that theslices weigh 94 grams. Faigy multi-plies the weight of the fruits (94grams) by 0.13, as follows: 94 X 0.13= 12.2 grams of carbohydrate.

• Now she would like to add four piecesof tangerine. They weigh a total of 21grams. The ECF for tangerines is 0.09.Faigy multiplies the weight of the tan-gerine (21 grams) by 0.09, its effec-tive carb factor: 21 X 0.09 = 1.9grams of carbohydrate.

Finally, Faigy adds up all the carbohy-drates: 5.9 from the grapes, 12.2 fromthe apple and pear, and 1.9 from the tan-gerine = 20 grams of effective carbohy-drate.

Faigy’s insulin-to-carb ratio (amountof insulin used to cover a certain amountof carbs) is 1 unit of insulin for every 10grams of carbohydrates. (Rememberthat this ratio differs for each individual.)She will therefore administer 2 units ofinsulin to cover the 20 grams of carb.

Do Keep In Mind…Those individuals who are on a rigid

insulin regimen would need to calculatehow much fruit would fit into their indi-vidual plan. But the ECF method wouldbe equally beneficial for them.

Fruits that have the same carb factor,such as apples and pears (which areboth 13% carb- as noted in the aboveexample) or oranges, peaches, tanger-

ines, and honeydew (which all have anECF of 0.09) can be weighed together.You can also combine fruits that havealmost the same ECF, and average theireffective carb contents. For example, kiwi(11) nectarine (10) and plum (12) wouldhave an average ECF of 0.11.

When calculating fruits with carb fac-tors less then 0.10, don’t forget the zeroafter the decimal. For example, incorrect-ly figuring olives with an ECF of 0.3instead of 0.03 would make a big differ-ence with the end total of carbs.

Please note: The carb factor we arediscussing is not to be confused with thepercent daily values found on all nutritionlabels. However, in some cases, thenutrition label on a food item can behelpful towards determining the item’scarb factor. This is when the nutritionfacts are not based on serving size, buton 100-gram or 100-ml portions (asmost Israeli foods are labeled). For exam-ple, if a food label states that a 100-gramportion of the product contains 55grams of carbohydrates, then 0.55 is thecarb factor for that food. Another exam-ple: An Israeli brand of soda states thatit contains 12 grams of carbohydratesper 100 ml. However, the can contains360 ml of soda. So, one would have tomultiply 360 by the carb factor of 0.12.There are 43.2 grams of carb in a can ofthis soda.

Just be careful with the decimalpoints when converting whole numbersto percentages!

Carb Factor Lists:FWD has a database on file containing

the ECFs of 6,000 foods.

A complete list of over 300 carb fac-tors for various foods is available in anyof these books from John Walsh:“Pumping Insulin”, “Stop theRollercoaster”, and “The PocketPancreas”. However, keep in mind thatthese books do not list the effective carbfactors of the food items. (We spent aconsiderable amount of time and laborsubtracting fiber from these values andconverting them to ‘Effective’ CarbFactors.)

See our web site for more resourcesand valuable aids for carb factors.

13T U B ’ S H E V A T - i h e u , n l h , u r h p

14 T U B ’ S H E V A T - i h e u , n l h , u r h p

Preparationfor the fruit feast:• One of the most important and obvi-

ous factors for succeeding in goodglycemic control, especially when cov-ering something like fruit, is startingout with a good blood sugar number.If your blood sugar is elevated beforethe feast, treat accordingly and/or goout for a brisk walk. An energeticstroll, especially in cold weather, goesa long way toward lowering bloodsugars and is excellent when imple-mented in addition to a small amountof insulin. [THIS IS IMPORTANT FOR AALLLLTYPES OF DIABETICS].

•When eating large amounts of fruitwhich might spike your after mealblood glucose, it would be wise toallow some time before eating for theinsulin to start working. If usingRegular, one should wait at least (butnot too much more than) 30 minutes.Wait a short while after administeringHumalog or Novolog, making sure notto exceed 15 minutes for Humalogand 5-10 minutes for Novolog.

• Since short acting insulin should pre-ferably be administered before themeal, how can one know how muchinsulin to take before s/he evenweighed the fruits and calculated theircarb amounts? We would advise asfollows: At the beginning of the feast,approximate how many carbohydratesyou will be consuming and cover withinsulin accordingly. While eating, keeptrack of the precise amounts of carbsyou consume. At the end of the feast,if you have eaten more carbs than were

covered for, supplementwith additional insulin.

Although the ideal way ofcovering for the fruits would

be to weigh and figure theexact carb amounts in advance,

this is not always practical and weare trying to be realistic. (You can usethe chart supplied in this issue so thatyou only have to fill in the weight ofyour fruit portion while eating and youcan do the carb calculations after thefeast.)

•When Tu B’Shevat falls on Shabbos,everything can be weighed & preparedbefore Shabbos. (It will occur in theyears 5763, ‘64, ‘67, and ’70- or2003, ‘04, ‘07, and ‘10 on theEnglish calendar). Or, you can use anaccurate, non-digital scale onShabbos.

Balancing the fruitswith other foods:• If the fruits are eaten at mealtime, use

them to replace some or all of theother carbs that would have normallybeen eaten, to help avoid an overloadof carbohydrates. [Although a Type 1diabetic on flexible insulin therapy(multiple daily injections or an insulinpump) would have the option to givemore insulin and eat more, overload-ing on carbs is never ideal.] However,if they are eaten as a separate meal,you will need to cover for them withadditional insulin.

• It is advisable to eat the protein of themeal before the fruits. Fats and pro-tein will slow the digestion and theabsorption of the carbs in the fruits.

• It would also be wise to eat the fattyfruits first. Example: avocados, olives,& nuts. (Remember that according to halacha also, the olives must be eaten first, because they are closest to the word “eretz” in theverse describing the fruits of EretzYisroel.)

Smart fruit choices:• In general, try to stick to slower act-

ing fruits. (See the GI list below.) Ifyou do choose the faster acting fruits,make sure to eat them together withsome slower fruits. (Together, thevarious choices will cause a “mediumspeed” BG rise.) Also eat the slowerones first so your digestive systemwill attack those first, and the fastacting fruits will be delayed.

• Remember that the riper the fruit, thefaster it will raise blood glucose (high-er GI).

• Dried fruits coated with sugar shouldbe avoided by all means (except whentreating a low blood sugar).

• Avoid canned fruit in heavy syrup.Fruit canned in its own juice or withno sugar added can be used, but payattention to the nutrition facts on thelabel.

• Keep in mind that the fruits whichhave higher carb factors are very con-densed with sugars. Eat less ofthese. On the other hand, the fruitswhich have lower carb factors are bet-ter choices.

• Fruit peels are healthy, containingmany vitamins and nutrients. Theyalso have fiber, which helps slow theglucose rise.

• Remember the general rule: Any foodwhich is more processed, cooked, orcut into smaller pieces will contain agreater amount of carbs than itsunprocessed or raw counterpart. Thisis because cooking, shredding, orgrounding a food reduces its volume,so that the carbohydrates becomemore condensed. Also, since they arealready somewhat processed, thebody has an easier time breakingthem down and they raise blood sug-ars faster. (They have a higher GI.)

The GGllyycceemmiicc IInnddeexx measures howfast the carbohydrate of a particular foodis converted to glucose and enters thebloodstream. The lower the number on

Tu B’Shevat Tips

15

1) Find the fruit you want to eat andweigh your portion size.

2) Record this weight in the blank boxnext to the fruit. (This column is titled“weight”.) For practical reasons, we rec-ommend doing just these two steps asyou eat your meal. Soon after the feastis over, you can go on doing the stepsthat follow to figure precisely how muchinsulin to administer for the fruits youjust ate.

3) Using a calculator (or your good oldbrain!), multiply the weight of your serv-ing by the fruit’s ECF, and write theresults in the column with the “equalsign”. For even greater convenience, wesupplied the last column, entitled“scale”. Here, you will find the food codenumbers for any of the fruits which canbe found in the Soehnle diet computerscale database. (If you have manuallyentered additional fruits into the data-base, you can record their code numbersin this last column. Or, if you followedour instructions for entering all possibleECFs into the scale, from 0.1 to 0.99,then you don’t have to record the foodcodes at all! See our full article in thisissue.) If the fruit is in the scale’s data-base, there is no need to do any math.Simply weigh the fruit, press the appro-priate food code number, and record theamount of carbs shown in the “equalssign” column in the chart.

4) For the final total of the amount ofcarbohydrates consumed in your meal,add up all numbers you entered in thecolumn with the “equals sign”.

Compiled by Rabbi Meisels© Friends With Diabetes

Instructions for using the Tu B’Shevat Chart:

Before I was familiar with effective carb factors, I wouldsometimes become exasperated with the vague carb amountsoffered in standard carb counting books. For example, accord-ing to the gram counter book I was using, a 4” by 8” wedgeof watermelon contains 35 g. of carbs. My question alwayswas, what about the third dimension of my slice? Can that beANY size I choose, and the wedge will still contain 35 grams ofcarbohydrates?Another book stated that one serving size of watermelon is1/6 of a melon. Exactly what size, I still want toknow, is a watermelon supposed to be? Asfar as I’ve always noted, fruitsdo not grow with standardmeasurements. ~I.P

B

T U B ’ S H E V A T - i h e u , n l h , u r h p

FRUIT WT. ECF = SCALE

FRUITS FROM THE SEVEN SPECIES.gv kg '.gv

Dates dried & pitted .66 128

Figs fresh (vbt,) .16 130

~ Dried .56

Grapes (ipd) .16 156

Pomegranate (iunr) .17

Olives (ina ,hz) .03 144

Raisins .76 152

OTHER FRUITS,uapb truc '.gv

Apple fresh .13 119

~ Dried .57

Apricot fresh .09 122

~ Dried .53

Avocado California .02 124

Florida .04

Blackberries .08 127

Blueberries .11 133

Carob .45

Cherries fresh .14 153

Grapefruit .07 131

Kiwifruit .11 138

Mango .15 142

Nectarine .10

Orange .09 121

Peach fresh .09 147

Pear fresh .13 126

Persimmon Japanese .15

~ Native .34

Plum fresh .12 149

Prickly Pear – Cactus .06

Prunes dried .56

~ Dried cooked .22

Star Fruit .05

FRUIT WT. ECF = SCALE

.09 141

OTHER FRUITS,uapb truc 'vnstv

Banana .21 125

Cantaloupe .08

Honeydew .09 158

Papaya .08 145

Pineapple fresh .11 117

Raspberries fresh .05 134

Strawberries fresh .05 129

Watermelon .07 155

NUTS,uapb truc 'vnstv '.gv

Almonds dry roasted .11 110

Oil roasted .05

Brazil nuts .08 112

Cashews dry .30 105

~ Oil .25

Coconut .06 109

Filberts dry .11

~ Oil .13

Macadamia dry .05

~ Oil .04

Peanuts dry .14 106

~ Oil .10

Pecans dry .13

~ Oil .10

Pistachios dry .17 113

Sunflower seeds dry .13 115

~ Oil .08

Walnuts black dried .07 116

~ English/Persian dried .14

Tangerine

this scale, the slower the action of thefood. The numbers are percentages withrespect to a reference food. They aregiven here with respect to glucose. Inother words, on the scale glucose equals100. (Another acceptable reference usedin the United States is white bread.)Factors such as variety, cooking, andprocessing may affect a food’s GI. Inaddition, the glucose response to a par-ticular food may be somewhat individual.So it is probably a good idea to carefullywatch your own blood glucose level aftereating foods you have questions aboutand determine if they have high or low GIfor you.

The glycemic index is of particularbenefit to those with type 2 diabeteswho are not taking insulin. They are stillproducing enough insulin to cover foodsthat will not cause an alarming spike inblood glucose. By making use of the GI,they can choose foods that will cause aslower rise in blood sugars and will beadequately covered by their naturalinsulin.

Even those with Type 1 diabetes canrefer to the GI to make smarter foodchoices. Everyone will have a betterinsulin response to foods that cause aslower rise in blood sugars and allowtime for the injected insulin to takeaffect. If you do eat a fast acting food,some medical authorities believe that itwill have to be covered with some addi-tional insulin. Based on our experience,a high-GI food would not require moreinsulin, but the insulin would have tobe administered earlier, so that it wouldbe available immediately to deal withthe fast glucose rise. (Administering agreater amount of insulin would alsominimize the blood sugar spike, butone would probably experience a lowblood sugar later on.)

The GI value shows only how rapid-ly a particular carbohydrate turns intosugar. It doesn’t tell you how much ofthat carbohydrate is in a serving of a

particular food.There is a new

extension to the glycemic index calledthe GGllyycceemmiicc LLooaadd. This is the glycemicindex of a food times its carbohydratecontent in grams. The GL is a somewhatmore realistic and applicable value, and itmakes certain foods appear much betteror worse than was previously thought bylooking just at the GI. For a more in-depth article on the glycemic load, seeour Pesach issue.

The following charts list the glycemicindex and glycemic load for some com-mon fruits, in ascending order fromslower to fastest acting. You may beamazed if you compare and contrast.

Note in particular the high GI and lowGL of watermelon. Although watermelonis almost as fast acting as dried dates, ithas one of the lowest carb factors of allfruit choices. This is why it has a muchlower GL than the dried dates, becausethe GL takes into account the amount ofcarbs and not only their speed.

An ounce of watermelon with anEffective Carb Factor of .07 has a total of2.0 grams of carbs. An ounce of raisinswith a carb factor of .75 has a total of21.4 grams of carbs. So even thoughboth watermelon and raisins are veryfast acting fruits, the watermelon is thechoice that will give you a larger portionsize for fewer carbs.

It is also interesting that cherries,despite their sweetness, are the slowestacting of all the fruits.

All fresh dates were originally rated tohave a much higher GI than the ones list-ed (even higher than glucose!) but thelower glycemic index seems to be moreaccurate. This is probably because thedates used in original studies weresteeped in glucose, or perhaps the fruitamounts were measured inaccurately.

NNoottee:: The GI for fruits has varied fromone study to another, sometimes by asmany as 30 points! We used only themean data.

The GI for Bananas can vary from 30to 52, depending on the fruit’s ripeness.(Obviously, the GL will reflect thechanges.)

The DiniverRav in his sefer Bnei Yisoscher quotesthat on Tu B'Shevat it is approperiate topray for a nice Esrog for the upcomingYom Tov Succos. Therefore, it is a cus-tom to eat a dessert made from Esrog.But most recipes have almost moresugar than Esrog, so here is a sugar-free version of one of the many recipes.

Directions:

RR Keep the Esrogim refrig-erated and soaked in waterfrom Succos until cooking,to preserve freshness.

RR Slice the Esrogim intothin slices, and remove allseeds.

RR Cook the Esrog withplenty of water. After water boils, spill

and change the water and cook it again.Repeat this procedure several times(about 6 times) to reduce its bitterness.

RR Cut the quince apple into small pieces;now cook it together with the Esrogimwith fresh water (enough to cover allfruits in the pot).

RR Add splenda (sugar substitute) aftercooking to reach the desirable taste.

3 Esrogim (Citron) = 32 g carb

1 Quince Apple = 12 g carb

1 Cup Splenda = 24 g carb

Plenty of water

This recipe yields 10 half cup servings,

with 6.8 g of carb per serving.

Sugar Free (Low Carb) Esrog Compote

The “Glycemic Index”list for fruits

16 T U B ’ S H E V A T - i h e u , n l h , u r h p

To find the most complete lists of GI and GL visit Rick Menodosa’s website at www.mendosa.com/gilists.zip

Fruit

Cherries, raw 22

Grapefruit, raw 25

Apple, dried 29

Prunes, pitted 29

Apricots, dried 31

Apples, raw 38

Peach,canned in natural juice

38

Pears, raw 38

Plums, raw 39

Strawberriesfresh, raw

40

Oranges, raw 42

Peaches, raw 42

Pear halvescanned in natural juice

43

Grapes, raw 46

Mango, raw 51

Banana, rawmean of 10 studies

52

Peach,canned in light syrup

52

Kiwi fruit, raw 53

Apricots, raw 57

Papaya/Paw Paw, raw 59

Pineapple, raw 59

Figsdried, tenderized

61

Apricotscanned in light syrup

64

Raisins 64

Cantaloupe/Rockmelons,raw

65

Breadfruit, raw 68

Watermelon, raw 72

Fruit

Strawberries, fresh, raw 1

Cherries, raw 3

Grapefruit, raw 3

Peach,canned in natural juice

4

Pears, raw 4

Cantaloupe/Rockmelon,raw

4

Watermelon, raw 4

Apricots, raw 5

Oranges, raw 5

Peaches, raw 5

Pear halvescanned in natural juice

5

Plums, raw 5

Apples, raw 6

Kiwi fruit, raw 6

Pineapple, raw 7

Grapes, raw 8

Mango, raw 8

Apricots, dried 9

Peachcanned in light syrup

9

Apple, dried 10

Papaya/Paw Paw, raw 10

Prunes, pitted 10

Apricotscanned in light syrup

12

Banana, rawmean of 10 studies

12

Figsdried, tenderized

16

Dates, dried 17

Breadfruit, raw 18

Raisins 28

GlycemicIndex

GlycemicLoad

17T U B ’ S H E V A T - i h e u , n l h , u r h p

WinterIt's the time of year when

ragged brown branchesappear listless, lifeless and limp.The vibrant green of summer isslowly replaced by a gray, angrysky and damp, shivering trees.Yet, Chassidishe Rebbesteach us, as Tu B'Shevatapproaches alongwith the peak ofthe winter sea-son, life is begin-ning to stir with-in those somberbranches. It isduring these icywinter monthsthat the tree is col-lecting the sap thatwill enable it to bloomonce again. Somewhere,concealed from humanvision, the dead-looking tree isbeginning to undergo a physicalrevival which will ensure that itwill once again explode withvitality, come spring. So too is a person, "like the treeof the field". There are times

when a situation seems bleakand hopeless as the dead of win-ter. But just look at those trees!During the very harshest timesof tribulation, when suffering ismost severe, that is precisely

when a glimmer ofrevival and redemp-

tion is growingbeneath the sur-face. In these daysof so muchtrial and dis-tress, on bothpersonal and

national levelsthroughout the

Jewish world, let usremember: The nature

of the Jewish people islike that of the tree, which

in the days of winter receivesnew life!May we merit to thrive even dur-ing the winter and to speedilyencounter the "Spring" of ournation, tWcc esm ktud ,thcc!

Bare Trees...Bare

Trees...and

BlossomingHopes

andBlossomingHopes

TTYYPPEE TTWWOOSS CCAANN DDOO IITT 22!!A diabetic who controls glycemic action with insulin may have moreleeway in choosing the amounts and kinds of fruit s/he wants to eat,since insulin allows for faster coverage of glucose than oral medica-tions or just exercise. Those with Type 2 diabetes (non-insulindependent) who do not take insulin should definitely stick to thecarb limits set by their medical team, (using the carb factors toattain more exact portion control, and not just approximating), andstick to the slower acting fruits (see the Glycemic Index For Fruits).A quick walk before or after the feast would be very beneficial.

You mean… I can reallyEat all that Fruit?!Yes, we do mean that.When people hear diabetes, they still think you need to eliminate sugarand sweets and be on a strict “diabetic diet.” Today that’s simply not true!The American Diabetes Association recommends that you eat sugar andsweets in moderation and to work them intoyour food choices based on your individualneeds and desires. That’s because all carbohy-drate, whether from bread, an apple, or pastry,raises blood glucose to about the same level inabout the same amount of time.

It is okay to have sugar andsweets - moderation is the key!

Dates, dried 43

18

MISHLOACH MANOSSefer Nishmas Avraham states as follows [p. 339]:

“I wonder whether one has fulfilled the mitzvahof sending gifts of food to a friend, if the friend ismedically forbidden to eat that food — for exam-ple, a box of chocolates to a diabetic (when boththe sender and the recipient are aware of thediagnosis).The Pischei Teshuvah writes that themain reason for the mitzvah is to give joy. Itwould appear that since the diabetic will have nojoy in receiving the gift and, on the contrary, willpossibly even be embittered by it, the sender willnot have fulfilled the mitzvah.”

We would like to comment upon the above state-ment:

We strongly enforce that the most forbidden wordin the language of a diabetic is the word “forbidden”.Every food that Hashem created can be incorporatedin a diabetic’s meal plan, with proper education andforesight.

The specific food item used in theabove ruling, chocolate, is not amongthe “bad foods” on a diabetic’s list. Itis usually combined with fat, whichslows down absorption, and it is lowon the Glycemic Index.

As has been noted, even somereally fast-acting sweets, such as can-dies, which are not normally recom-mended for a diabetic, could be vitalin the case of hypoglycemia. So, whyshouldn’t one fulfill the mitzvah ofMishloach Manos by giving a diabetica gift that can save his life?

Based on these points, I feel morecomfortable with the psak of RavZilberstien shlita, which affirms thatone who gives sweet foods to a dia-betic has fulfilled the mitzvah.

EXERCISE ON PURIMMany people do a lot of walking on

Purim, giving Mishloach Manos orcollecting money. Remember thatexercise has a blood sugar loweringeffect.

For long periods of exercise, such as a few hoursof walking, a slow acting form of carbohydrate maybe appropriate. Some people may find that half ablueberry muffin or a chocolate chip cookie everyhour kept their blood sugar levels stable.

Dr. Bernstein recommends eating a slice of breadbefore leaving home. The bread will start to raiseblood sugars in about 10 minutes, and will continueto do so for about 3 hours. The cookies and blue-berry muffins contain mixtures of simple and com-plex sugars, so they start working rapidly but alsocontinue to raise blood sugar for about 3 hours. Hediscourages the use of fruits, which can raise bloodsugar less predictably.

Whatever your plans for covering exercise withcarbohydrate, always carry glucose tablets (orWinkies) with you!

(Adapted from “Diabetes Solution” by Dr. R. Bernstein)

For Those Who Go Around Collecting vesm on Purim$Make sure to wear your medical ID necklace

or bracelet.$Have enough Winkies in your pocket. Don’t rely on the

fact that there will be plenty of candy around.$Keep your meter, strips, and lancets in your pocket.$DON’T DRINK! If someone offers you a drink, accept the

cup graciously, but DO NOT drink. This way, your hostwill be happy … and you will be safe.$Don’t smoke. Once you get used to it,

it’s very hard to stop.$ If you dance, make sure to eat enough

carbs to avoid a low.$Last, but not least: We hope you make a

lot of money … and keep FWD in mind!

P U R I M - u v g r k a h t

h

THE HALACHICVIEWPOINT

Before we begin describing exactlywhat happens when a person with dia-betes drinks alcohol, let’s explore thesimple question: How much do wereally have to drink to fulfill the mitz-vah on Purim?

The Gemarah says that one isrequired to drink, Wgsh tks sgW — untilhe can no longer differentiate between‘cursed is Haman’ and ‘blessed isMordechai’. Many people are under themistaken assumption that the onlyway to fulfill this obligation is by imbib-ing in alcohol without limit. Buttzadikim explain that it is quite to thecontrary: If one reaches the state of“ad d’lo yodah” (meaning, if hebecomes completely drunk), thenhe can no longer fulfill the mitz-vah at all. As David Hamelechdescribes (Psalms: 104, 15),“V’yayin yisamach levav enosh” -Wine makes happy the heartof man. On Purim, we havea mitzvah to drink, feast,and be happy. However,the mitzvah can only befulfilled properly as longas we remember theessence of Purim: thatHaman is cursed andMordechai is blessed.Once one has passed thisstate, no amount of drink-ing will be considered a mitz-vah. Just as a person who is

drunk cannot pray, he cannot do themitzvah of mishteh v’simcha, eatingand drinking on Purim.

In a nutshell: The gemarah’s refer-ence to “ad d’lo yodah”- “until he canno longer differentiate”- is the MAXI-MUM, and not the minimum require-ment.

(Some seforim derive this from theword “ad” in the above phrase. Theyexplain that the obligation is to drink‘until’ one can no longer distinguishbetween the cursed and the blessed,but the actual condition must not bereached.)

It is also interesting to note thatRav Avigdor, one of the authors ofTosefus, states that the mitzvah on

Purim is to observe someoneelse who is drunk, as this

causes happiness andlaughter. However, theindividual who is drink-ing beyond reason isnot fulfilling the mitz-vah at all.

The smallest amountone may drink to fulfillthe mitzvah is one revios

of an alcoholic beverage,equivalent to approximately

3 to 5 ounces.

If you still want to fulfillthe obligation of “ad d’lo

yodah” in the literal sense, youcan take a nap on Purim, as

many tzadikim do [according tothe p’sak of the Remah in 695:2].

THE MEDICALVIEWPOINT

Medical science remains inconclu-sive as to whether there are any bene-fits to be gained from drinking wine.(Seems that they get so drunk…they’re starting to get confused!)However, even if one will argue thatthere are some advantages to moder-ate consumption of alcohol, there is noquestion that complete intoxication isfoolish and dangerous.

19P U R I M - u v g r k a h t

Drinking on PurimDiabetes and Alcohol: A Dangerous Combination

DON’T GO LOW!

Follow these guidelines to avoid low blood sugar levels,

if you do want to have some wine:

• Never drink on an empty stomach.Plan to have your drink with a mealor after eating a snack. You needglucose from food, since your liverwill stop producing it once you drinkalcohol.

• Make sure you don’t exceed a maxi-mum of two drinks. One drink isdefined as: 12 ounces of regularbeer, 5 ounces of wine, or 1.5ounces of 80-proof distilled spirits.

• Carefully check the alcohol level ofwhat you are drinking. If you drinkbeer, don’t forget to count 12 gramsof carbohydrates per cup.

• Make sure at least one friend ortrusted companion knows that youare a diabetic and is aware of whatshould be done in case of a hypo-glycemic attack. This is extremelyimportant, because hypoglycemiacan resemble intoxication, and oth-ers may assume you are drunk. Yourfriend should know how to checkyour blood sugar and how to treat alow, bearing in mind that usingGlucagon is not an option.

• A low blood sugar is the main con-cern. Check your blood sugar beforeyou go to sleep and eat a bedtimesnack (solid protein and some car-bohydrate) in the evening afterdrinking. Do this even if the bedtimeblood sugar level is high, to avoid alow blood sugar reaction while yousleep.

• The next morning, get up at theusual time, test your blood sugar,take insulin, eat breakfast, and thengo back to bed if you feel ill.“Sleeping-in” can result in a badreaction.

• NEVER drink and drive. Ask a friendwho has not been drinking to drive,or call someone to come and getyou.

We would like to emphasize:Although we have published

extensive guidelines concerningfasting on Yom Kippur, they areby no means meant to be used

on other fast days! Our Rabbinical advisors

do not recommend that diabeticsfast more than the required

minimum.

Ta’anis Esther (Fast of Esther):

C H A N U K A H - j c y n i h f ,

HOW YOUR BODYMETABOLIZES ALCOHOL

Alcohol moves very quickly intothe blood without being brokendown (metabolized) in your stomach.Your liver does most of the job ofbreaking down the alcohol once it’sin your body, but it needs time. If youweigh 150 pounds, it will take abouttwo hours to metabolize a drink.

If you drink alcohol faster thanyour liver can metabolize it, theexcess alcohol moves through yourbloodstream to other parts of yourbody. Brain cells are easy targets.[When someone acts up on Purim,this is why.]

RISK OF EXCESSIVELYLOW BLOOD SUGAR

If you take insulin shots or oraldiabetes pills, you risk low bloodsugar when you drink alcohol. It allhas to do with your liver.

Insulin and oral medications workcontinuously to clear glucose fromyour blood. Remember that the pri-mary reason we take basal insulin orlong acting insulin is because of theconstant glucose output from theliver. If the liver will be busy cleaningout alcohol and it will not put out itsusual amount of glucose, then therewill be extra basal insulin circulatingin the blood, which will cause a lowblood sugar. Unless you eat, or yourliver adds glucose to your blood, youcould be heading for a low bloodsugar level. Therefore, hypoglycemiabecomes a risk for diabetics, particu-larly if you drink on an empty stom-ach or shortly after taking insulin orglucose-lowering oral medications.

There is another danger involvedas well. When blood sugar levelsstart to drop, the liver normally

attempts to cor-rect the situationby convertingstored carbohy-

drate into glucose.This glucose is sent

out into the blood andhelps avoid or slow down

a low blood sugar reaction.

But when alcohol enters your sys-tem, the process is disturbed.Alcohol is a toxin, which means thatyour body treats it as if it were a poi-son, and the livertries to clear itfrom the blood asquickly as possi-ble. In fact, theliver won’t putout glucose againuntil it has taken careof the alcohol. If yourblood glucose levelbegins to fall and youare under the influ-ence of alcohol, you can quickly windup with very low blood sugar. This iswhy drinking as little as two ouncesof alcohol (about 2 drinks) on anempty stomach can lead to extreme-ly low blood sugar. And because ittakes 2 hours for just one ounce ofalcohol to metabolize and leave yoursystem, the risk continues long afteryou’ve emptied your glass.

Since alcohol affects your body’sability to raise a low blood sugarlevel, you may need to treat a low BGmore than once, if you have beendrinking.

ADDITIONAL DANGERSOF DRINKING ON PURIM

When you combine alcohol andexercise (which is usually the case onPurim), you increase the risk ofextreme low blood sugars. This isbecause exercise naturally lowersblood sugar levels. Hours after youdo exercise, your body is busy replac-ing the energy your muscles used upby clearing glucose from the bloodand adding it to the muscles’ store.For a person who has diabetes, com-bining alcohol AND exercise is clearlya deadly partnership.

Also, some of the signs of a lowblood sugar reaction (such as confu-

sion and slurred speech) are similarto the effects of drinking too much. Ifsomeone with diabetes were to passout CH”V due to low blood sugar, thealcohol in his breath might confusespectators into believing that he wassimply drunk. His sugars would con-tinue to drop to hazardous levels.

Let’s use some common sense:Rabbonim have ruled that we areallowed to check blood sugars onShabbos, even though there aresome Rabbinical prohibitions

involved, all because of the potentialdanger of a low blood glucose. If thisis enough of a consideration to war-rant the violation of Shabbos, howcan we put ourselves into such adangerous risk by getting drunk?

WARNING: Glucagon shots arenot affective in the case of severe lowblood glucose caused by drinking.This is because Glucagon works byprompting the liver to release moreglucose into the blood, but alcoholstops this process. One would haveto treat this type of reaction with acarbohydrate, such as oral glucosetablets (Winkies) or gels. If thepatient loses consciousness, glucosewould have to be injected into thebloodstream by a health care profes-sional.

Note also that heavy drinking overtime can permanently harm the liver;to the point where it can no longermake adequate amounts of glucose.When this happens, diabetesbecomes much more dangerous andharder to control.

The instruction insert forGlucophage, a Type 2 medication,states as follows:

“Do not drink a lot of alcoholicdrinks while taking Glucophage orGlucophage XR. This means you

20 P U R I M - u v g r k a h t

Why is it particularly risky for aperson with diabetes to imbibe too

much wine?Let’s explore thesubject a bit more deeply…

should not binge drink for short peri-ods, and you should not drink a lot ofalcohol on a regular basis. Alcohol canincrease the chance of getting lacticacidosis [ch”v].”

Many other medications carry simi-

lar warnings, so a Type 2 diabetic onany medication should also exerciseextreme caution as far as drinking isconcerned.[Low blood sugar when drinking is less of a riskfor those with type 2 diabetes who control theirdiabetes with meal planning and exercise alone.]

WHEN ALCOHOL IS ANESPECIALLY POOR CHOICE

Some people with diabetes shouldnot drink alcohol. If you have nervedamage in your arms or legs, drinking can make it worse. Alcohol istoxic to nerves. Drinking can increasethe pain, burning, tingling, numbness,and other symptoms associated withnerve damage. Some studies showthat even regular light drinking (lessthan two drinks per week) can causenerve damage. Heavy drinking mayalso make eye disease worse. If youhave high blood pressure, you canlower it if you stop drinking alcohol.

Many people with type 2 diabeteshave high levels of the fat calledtriglyceride in their blood. If you do,you should not drink alcohol. Alcoholaffects how the liver clears fat fromthe blood.

Alcohol also spurs the liver to makemore triglycerides. Even light drink-ing can raise triglyceride levels.

ON A LIGHTER NOTE... Can you find a reference in theMegillah to the fact that even inthose days people disagreedabout whether wine was benefi-cial to drink?Answer: It says, “V’hashtiyakados ain oneis, la’asos kirtzonish vaish”— At the party ofAchashveirosh, no one wasforced to drink wine, [and it wasserved only] as per the desire ofeach person. The midrashexplains that the words “eachperson”, refer to Mordechai andHaman. Nu, isn’t it obvious?Mordechai already understoodthat it is not wise to drink toomuch wine.

TThheerree iiss nnootthhiinngg nneeww uunnddeerr tthhee ssuunn!!

P U R I M - u v g r k a h t 21

H

PPPPositive PPPParenting: SOME PPPPURIM PPPPOINTERSPPPPurim is a joyous and delightful Yom Tov, eagerly anticipated by adultsand children alike. However, as gaily-wrapped gifts of sugar-drenchednosh pile up on tables and countertops, parents of children with diabetesare presented with a challenge: How to minimize sugar intake and maxi-mize BG control without robbing our children of their whimsical simchasYom Tov?

Here are some tips for rising to the challenge and proving that Purim canbe enjoyed and anticipated even without Pringles and Peppermint sticks.

· PPPPreparation is PPPParamount: Before the usual whirlwind of happy activi-ty begins, speak to your child! Explain to him/her why too much candywould be a poor choice. Point out to your child that s/he will not bedeprived of a fair share of the Purim nosh. However, to avoid an overloadof sweets, come up with an alternate plan together, or choose one of thefollowing suggestions.

· PPPPrivileged Character: Establish a system with your child in which s/hecan trade in Purim junks for small prizes, coins, or other sugar-free treats.This way, your child will feel important and special instead of miserableand deprived.

· PPPPirates, PPPPrincess, PPPPolar Bear: Shift your perspective altogether.Instead of concentrating on the food this year, turn the Purim costumeinto a family project. Beginning at least a few days prior to the Yom Tov,let each child choose a costume, and then work together to make theirdreams come true. Remember to take lots of pictures; the memories arePriceless!

· PPPPick and PPPPackage with PPPPride: As soon as Purim is over, collect mostof the nosh. Pick those sweets such as winkies and save them for possi-ble future low BG treatments. Then, together with the children, donatethe spare goodies to any of the countless Jewish organizations who willreally put the treats to good use. What a beautiful chinuch for the entirefamily!

· PPPPractice what you PPPPreach: While emphasizing to your child howunhealthy the excess sugar is for him/her and for all children in general,how about taking the ideas one step further? This Purim, send yourMishloach Manos with a healthy theme. For the kids, send crayons, stick-ers, novelty pencils, or small prizes instead of the usual junk. You’llbecome the most popular address on the block.

Have a PPPPhenomenal PPPPurim!

22 P U R I M - u v g r k a h t

The Numbers the Label Won’t Show you

Analyzing the carb contents of winesIn honor of Purim, we are

reprinting the following interesting tid-bits about the carb contents of wines. For moredetails, see our Pesach issue, in which we discussthis topic at length.

In contrast with most foods and beverages, reg-ulations in the U.S. and most other countries do notrequire wine producers to disclose ingredient ornutritional labeling on wine, and the industry hasstrongly resisted any legislative efforts to changethat. Accordingly, there’s no way (other than askingthe winery, which is underno obligation to respond)to determine the exactnutritional analysis of aspecific wine.

Wines are essentiallymade from carbohydrates,but the sugars are brokendown during fermentationand converted to alcohol. Many winesare not completely fermented in orderto maintain some sugar to add sweet-ness. In general, higher quality (and,unfortunately, higher priced) wines willhave a lower sugar content as they areusually fermented dry (with little or nosugar). Cabernets and merlots in the $15/bottle(and up) price range are probably your best bet.The best choices would be reds, as opposed towhites, as they usually have lower grams/liter sugarcontent.

As for the label, there unfortunately is not a com-pletely reliable way to check the residual sugar inthe wine. In general, a higher alcohol content(which is listed on every wine label by law) mayindicate lower residual sugar, but this will varywidely by vintage and growing region. Many winer-

ies give more detailed info (including RS - residualsugar) about their wines on their websites.

Since this question comes up often, we havetaken the liberty - using information from the U.S.Department of Agriculture and other public sources- of putting together a set of nutritional analysesbased on typical wines. We think they'll give you ageneral idea of what to expect from any glass of red,white or dessert wines. Please note that specificbottles may vary. Even slightly sweet wines, forexample, like White Zinfandel or many Rieslings, will

carry more calories from sugar andmore carbohydrates than the fully dryred and white wines listed. Winesstronger than usual in alcohol content,

like a Chardonnay orZinfandel at 13.5 percentor more, will also contain

a few more calories than the average examplesshown. These charts are presented in the familiarU.S. nutritional-analysis format. We hope you'll findthem interesting and useful.

FFoorr aaddddiittiioonnaall iinnffoorrmmaattiioonn,, ggoo ttoo wwwwww..wwiinnoo..nneett.. AAllssoo,, wwwwww..wwiinneelloovveerrssppaaggee..ccoomm hhaass

aa nnuuttrriittiioonnaall aannaallyyssiiss tthhaatt bbrreeaakkss ddoowwnn ssoommee wwiinneess..

FFoorr aa lliisstt ooff tthhee ccaarrbb ccoouunnttss ffoorr mmaannyy ooff tthhee KKoosshheerr wwiinneess,, rreeffeerr ttoo oouurr PPeessaacchh iissssuuee..

Dry Red WineServing Size 1/2 cup (4 oz.)

Calories 87

Total Carbohydrate 1.9g

Dry White WineServing Size 1/2 cup (4 oz.)

Calories 77

Total Carbohydrate 0.9g

Dessert WineServing Size 1/2 cup (4 oz.)

Calories 173

Total Carbohydrate 13.3g

READER FEEDBACK HELPS US GO FORWARD…IN THE PESACH ISSUE, WE MENTIONED THAT ONE WOULD BE ABLE TO MEASURE THE CARB CONTENT

OF A WINE USING A STANDARD GLUCOSE METER. ~ R.S. COMMENTED AS FOLLOWS:You can not measure wine directly with a BG meter and make any sense of it. There are sucrose and fructose sugars in the wine, and the meter is cali-brated to read glucose. However, if you know how much one gram of glucose raises your blood sugars, then you can use the following reverse formula: Drink a specific amountof wine (for example, ½ cup), and see how much your blood sugar is raised. You can now figure out how many carbs the wine contained.For example: Suppose your blood sugars go up by 4 mg/dl for every gram of sugar that you ingest (X=4), and the wine raised your BGs by 48 mg/dl(Y=48). You would divide 48 by 4 (Z=Y/X) to determine that the wine contained 12 grams of carb.

R.S.

ROYAL WINE CORPORATION

brings youAward Winnning Winesfrom Around the World

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