Type 1 Cycling

Type 1 Cycling

Monday, March 25, 2013

Religion and Diabetes - Part 3 - Passover


I cannot speak for other religions but Judaism certainly presents some challenges for a person with Diabetes.  I grew up traditional orthodox and became more observant in my teens.  What that meant throughout my formative years was strict observance to the dietary laws (kashrut), building a temporary dwelling on Succot, fasting on Yom Kippur, cleaning the house for Passover (including changing over the the "passover set" of crockery, pots and pans, and cutlery, and eating so much eating.

Someone once described the Jewish festivals as "Some people tried to kill us, we survived, lets eat!"  Passover is the very essence of the this lighthearted saying.  As the verse goes, "Once we were slaves, now we are free men"

The festival of Passover is a week long festival that has a holy day on the first and last day.  The middle is a semi holy day where many of the the laws of the festival applies but we are not prohibited from doing work.  The first night (Jewish days always begin after dark) we celebrate the Seder, the retelling of the exodus from Egypt.  We read the story (in our house in a mixture of Hebrew and English, so that everyone understands), we eat foods that remind us of the slavery (bitter herbs), and Matza the unleavened bread they took with them on their escape.  We eat Charoset that reminds of the cement they used to use to build the cities of Pitom and Ramses (The Children of Israel did not build the Pyramids). We dip vegetables in salt water to remind us of their tears as they cried out to God for saviour.

As I mentioned we eat Matza on Passover.  We eat it because our ancestors did on their exodus.  But the laws are more strict than that.  We are forbidden to eat anything that is leaven or may become leaven.  So no bread, but also no wheat (or other grain) products of any sort for a week.  We go further.  We may not own, or benefit from leaven in anyway.  Even further, we clean out our house, we change to a different set of plates, cutlery and pots and pans.  We remove all possibility from our lives that we may by accident or otherwise eat or benefit from leaven.

Let me expand, that means no bread, no pasta, no beer, no whisky, not crackers, cookies or biscuits and not cake.  As Ashkenazim (Jews of European descent) we are also forbidden to eat kitniyot.  This is a category of food that is also banned.  The reasons given are: That it swells when cooked (so is sort of leaven); it can be ground into flour of sorts; and that in the olden days they were sold close to or from the same sacks as the wheat so were often intermingled.  As far as I am aware the only truly plausible reason is the last one, and as we are in a day and age where things are packaged and sold in a way where this is unlikely it is certainly time for a change.  This category include all beans and lentils and rice.  At this point carbohydrate wise I am down to matza and potatoes.

So I went to a Rabbi.  The same Rabbi that told me not to fast on Yom Kippur.  He looked into it and got back to me.  He said that as the not eating kitniyot rule was just a tradition and not an actual law or prohibition I was able to eat "the forbidden fruit."  It is a considered a stricture that was undertaken.  I would not have undertaken such a stricture had I known the complications of managing diabetes without some common long chain sugars and so I am able to get out of this undertaking.  Again we come back to the idea that Pikuach Nefesh (saving of life) refers to the maintenance of a healthy life and not just preventing death.  And that this supersedes many laws and strictures that might cause a problem with a chronic condition.

This makes life very easy here in Israel.  As there are many more people of the Sephardi heritage here, who allow the eating of kitniyot in general many foods that are "Kosher for Passover" are only OK if you are allowed to eat kitniyot.  This presents a problem to many Ashkenazim that live here.  Not me, I can eat what I want (as long as it is actually Kosher for Passover).  This is great Houmus and rice are a staple for me and being able to eat the normal foods that I eat the rest of the year allow me to keep balanced for the week of Passover.

This really does make a big difference to me, I do not have to worry about having a range of foods that I can eat to keep me going or give me a pick up.  I still have to worry about the pick family meals.  Over the week there will be at least 6 (both of the festive days at the beginning and end and the Shabbat in the middle).  As I said in part 1 of this series these meals can take a toll and with so many in quick succession I can see I am going to need to find some time to get out on my bike.

Live long and stay healthy

Have a happy and kosher Passover

Sunday, March 24, 2013

Religion and Diabetes - Part 2 - Yom Kippur and other fast days

I cannot speak for other religions but Judaism certainly presents some challenges for a person with Diabetes.  I grew up traditional orthodox and became more observant in my teens.  What that meant throughout my formative years was strict observance to the dietary laws (kashrut), building a temporary dwelling on Succot, fasting on Yom Kippur, cleaning the house for Passover (and changing over the the "passover set" of crockery, pots and pans, and cutlery, and eating so much eating.

Yom Kippur is the most holy day of the year.  It is the day of atonement, we fast for 25 hours, pray in synagogue all day and at the end of it we are forgiven for everything we have done wrong over the year.  We wish each other that they should be inscribed in the book of life.  Many people who observe nothing all year observe Yom Kippur.  The synagogues are overflowing, some reaching out specifically to the "Once a year Jews".  Here in Israel there is an additional part of the festival that you do not get anywhere else.  Everyone (ok not everyone - doctors and critical workers may have to work) is off work.  People will still fast but often not go to synagogue, they will walk the streets.  And I mean the streets, people will be out on their bikes too.  There is an unwritten rule that people do not drive for the whole 25 hours of Yom Kippur.  The streets are alive with people wandering with nothing else to do.  It is quite an experience.  Though I would suggest to any potential tourists that they do not come at this particular time as there is literally nothing to do (except of course walk the streets).

Yom Kippur is not the only fast day on the calendar there are 6 more.  Only 1 of these other than Yom Kippur,  is for 25 hours (and is the summer, which is hard work) the rest are dawn till dusk.  Before Yom Kippur and after there are big meals, as you might expect.  This presents a double problem of balancing taking insulin for the meal, as I talked about in part 1, and getting it right for the fast. The first year I after  I was diagnosed I checked with my medical team and my Rabbi whether I could fast.  I did. I checked my BG every hour and I had dextrose tablets on me in case.  I was fine.  Probably because I was still in my honeymoon period.  The trick was not to take much insulin at all.

The following year I had moved to Israel, and my Rabbi called me up a few days before the fast.  He said that some Rabbi that he knew of and respected had taken out a full page advert in a religious newspaper.  The advert said that under no circumstances should a Diabetic fast on Yom Kippur.  Well that solves that one.  I think something may have happened to someone who tried to fast the previous year.  As a result, under the law of Pikuach Nefesh (saving life) Diabetics are now prohibited from fasting on Yom Kippur.  He went on to say that not only should I eat, but I should eat proper meals as if it was a regular Jewish festival (ie not just enough to keep my alive).

This makes Yom Kippur weird for me, I am in synagogue praying but not starving, I am thinking when am I going to skip out and get some lunch.  I put much more effort into my prayers as I cannot fulfil the commandment to fast, despite being told that because I have to eat, then eating is counted as if I had fasted.  It's a strange religion sometimes, but it can be bent so that I am able to manage my disease and still observe what I wish to observe.

Live long and stay healthy. 

Saturday, March 23, 2013

Religion and Diabetes - Part 1 - Eating so much eating

I cannot speak for other religions but Judaism certainly presents some challenges for a person with Diabetes.  I grew up traditional orthodox and became more observant in my teens.  What that meant throughout my formative years was strict observance to the dietary laws (kashrut), building a temporary dwelling on Succot, fasting on Yom Kippur, cleaning the house for Passover (including changing over the the "passover set" of crockery, pots and pans, and cutlery, and eating so much eating.

Someone once described the Jewish festivals as "Some people tried to kill us, we survived, lets eat!"  This appears to be mostly true, along with some other crazy things too.

So lets start with just the eating.  Every Friday night the Shabbat (the sabbath) starts and after evening prayers there would be a meal, often with guests and usually at least 3 courses.  Standard meals growing up in the UK would be something like:

Starter: one of Smoked salmon/Chopped liver/ Houmus and dips (with Challah - the traditional platted loaf, very tasty but white flour and often sweet)

Soup: Chicken soup (Jewish penicillin  - NB it does NOT cure diabetes) , with coutons and vermicelli, and more Challah.

Main course: Roast chicken, roast potatoes, vegetables and salad

Desert: one of Ice cream (non milky - I will get to that in a minute) / sorbet / mouse / pie

If it was just the nuclear family it might not be as extravagant as that, and there were of course some variations but the more guests the more people.  And more often than not there were guests.  Either we went to another family or we were in with one.  On Shabbat morning there was a Kiddush after services (a pseudo communal meal - ranging from snacks like crisps and nuts and pickled or chopped herring to sandwiches and sometimes even hot food).  After finishing at the synagogue we had another meal, usually cold meats and salads (as there is a prohibition of cooking on Shabbat).  The prohibition of cooking does not extend to something cooked on continual heat since before the Shabbat starts on Friday evening.  Which is where we get Cholent from, a delicious meat stew with potatoes and other vegetables.  Everyone has their own recipe and they range in style.  The Sephardic tradition - Eastern and Spanish (I am from the Ashkenazi tradition - European) has a similar thing with rice called Hamin.

As a student we regularly had 10 - 15 people for Friday night dinner and again for Shabbat lunch.  There were a lot of Jewish students in Manchester and once  we gained a reputation for catering they would call us up (before hand - no using the phone on Shabbat) and invite themselves over.

The one thing to mention is that there really was not much alcohol involved, sure when we were students there was a bit more than with my family but honestly I did not grow drinking at these meals, nor did I see the adults consuming alcohol either, certainly not in any quantity.

I did not grow up with Diabetes myself, but my brother was diagnosed when he was 13 and I was 15.  I remember every Shabbat meal out at friends when the desert came out.  My brother taking some, and my mother asking "Are you sure?" and the irritated reply "I asked what was for desert and took extra insulin".  I don't doubt it was hard for him, so much food and estimating the right amount of insulin to take must have been hard, and then sticking to eating the right amount of food too.

I wont lie, cooking and eating together as a family, extended or otherwise, or a group of close friends has a lot of merits.  You eat slower, you know what is in your food.  We never bought much processed or prepared (I mean no sauces, no pizzas, no microwaveable meals) food growing up or as students.  The strict laws of kashrut make this very difficult.  You must only have Kosher meat, not mix meat and milk products, even vegetarian products cannot always be relied upon.  As a result things were cooked from scratch.  Less additives, you know exactly what you are eating.  It HAS to be healthier.  Its just the quantity, and something I have always suffered from second helpings.  I might estimate for a plate of food, but if its delicious and there is more I will go back for seconds.  But I didn't estimate for that.  Getting it right takes practice.  But being involved with food helps a lot.

I must add that there is a very important law in Judaism, and that is Pikuach Nefesh.  The commandment to save someones life, be it your own or someone elses.  It extends to protecting ones health in many ways too.  This is very important.  It means that if there is no kosher sensible alternative I can eat what ever I need to stay alive.  In fact any commandment (and there are many) can be broken in order to protect the health or life of an individual.  The Rabbi of my community would drive kids to hospital on Shabbat if they fell and broke their arm.  There are somethings that cannot be done to save a life, like kill someone else, but otherwise most things are fair game in an emergency.

I have been cooking Friday night dinners since I was 14 and unsupervised since I was 15/16.  Since then I have expanded my repertoire and I still have a kosher home.  Mostly I would say that Kashrut itself does not pose a problem with living with Diabetes, if anything strict adherence can help, by having to do it all yourself.  But the attitude too food is where the problem starts.  My wife always says her family likes to show love through food.  Its true, her parents and grandmothers are fantastic cooks.  And there is always leftovers to take home to put in our fridge.

Often on a Friday night with guests I am so busy that by the time I sit down to say the blessings before we start I have completely forgotten to test and take Insulin.  I usually remember half way through soup.  Its not the end of the world but it is frustrating.  Everyone is eating and I am busy swapping needles, and pricking my finger.  Over the years I have gotten better at estimating and if we are out I am not afraid to ask whats in something.  At one family who knows me well, I will be taken aside and and given a guided tour of all the food before hand so I know what I can and cannot eat.

I am thankful for what I have got from Judaism but its not always easy on the Diabetes.

Live long and healthy

Shabbat Shalom