Surviving the Passover with IBD

My friend, Lillian Harvey-Banchik, MD, has provided some great information on foods and Passover especially for those people with IBD.

Here you go:

Passover is a time for family to gather together to celebrate the holiday with two very special meals called the Seder.

Unfortunately the dietary changes which observant celebrants must adhere to can be problematic for patients with Inflammatory Bowel Disease. Some of these changes include the elimination of entire classes of foods from the diets (all products which contain any leavened foods such as bread/cake, legumes such as peas and peanuts (meaning no peanut butter although other nut butters such as almond butter is allowed and even any yeast containing foods such as beer and wine) along with the addition of one very special food, the Matzo.

It is the matzo, in particular, which can cause considerable distress in people with IBD even if they have had surgery to remove the affected portion of the bowel.

Simply stated, matzo is a cracker type of bread made of wheat, water and salt.  What is different is that is it not allowed to rise at all but must be baked essentially as soon as the water is mixed into the flour and the matzo cracker is formed (there are religious reasons for this which we don’t need to discuss in this article).  The cracker is then baked until is it crisp.  This produces a very dry type of ‘bread’ with a high fiber content just the type of food that a person with IBD needs to avoid.  Matzo is well-known to cause constipation even in people who do not have any GI problems which is part of the reason that many Passover foods contain foods such as prunes, dried apricots and other foods which can help elimination. If you want to see how much water matzo can absorb from your GI tract you can try the following.  Take a slice of bread and place it in a bowl, pour room temperature over the bread until it starts to turn soft and begins to fall apart.  Now take a piece of matzo and do the same, you will find that it will take two to three times the amount of water to start softening the matzo.  The same thing will happen in your GI tract, that is, the matzo will absorb fluid and, unlike fiber where that will help with elimination, with form a solid firm mass which can be difficult to pass.  Grinding the matzo into ‘matzo flour/meal’ doesn’t prevent the problem so matzo balls, cakes made of matzo meal and other matzo containing foods can also cause problems.  So the question becomes “How do you celebrate the Passover Seder and survive the matzo”?

Firstly, although matzo is traditional at a Seder and during the entire 8 days of  Passover there is NO BIBLICAL or rabbinic injunction which requires you to eat Matzo.  The requirement is to avoid any type of leven.  During the Seder meal there are two points where matzo is traditional eaten.  The first is the “Hillel Sandwich” eaten during the first part of the service.  This is made of matzo on which some horseradish is placed and it is eaten in memory of the destruction of the temple.  You do not have to eat an entire piece of matzo to take part in this part of the service.  A single bite one square inch in size is more than enough for the symbolic purpose.  The second part is at the conclusion of the meal when it is traditional to take a piece of matzo and eat it as a symbolic ‘dessert’.  Again, if you feel you must, a single tiny bite is more than enough to fulfill that requirement.  If you do feel the need to eat matzo remember what was noted earlier and drink much more water than usual to help prevent the formation of that mass of matzo in your GI tract.

Second, and more important, Jewish religious law forbids you from observing any customs/restrictions which can harm you.  For example, it is forbidden for diabetic people to fast (abstain from any food and water) during holidays which normally require fasting since the changing of the diet can cause harm and they are required to maintain their normal diet.  If eating the special Passover foods would cause you to become obstructed or worsen any symptoms then it forbidden to eat them.

So, enjoy the holiday, the family time together, the special meals including the Matzo ball soup (just enjoy the soup & pass on the matzo ball) but don’t risk your health by thinking that you have to “Survive the matzo”!

PS - There is also gluten free matzo for gluten intolerant patients which they can get in specialty stores or at https://www.glutenfreematzo.com/