Managing the Holiday Season with Diabetes

This “Dialed in on Diabetes” post will wind down National Diabetes Awareness Month. As we post this, it is Thanksgiving week, and the beginning of the holiday season that includes Hanukkah, Kwanzaa, Christmas and runs right on through New Year’s Day. Honestly, it kind of continues on with Valentine’s Day, St. Patrick’s Day and Easter! All these events also coincide with the cold winter and shorter daylight hours. This combination can sabotage diabetes management unless we can offer practical strategies for patients to manage the holidays and all the feasts throughout the season.

Be flexible with nutrition
Remember nutrition is fun, yet also very powerful. There are so many ways to get this right, and only a few nutrition rules that are the game changers. On the other hand, there is a lot of misinformation and a lot of rapidly changing information. It’s genuinely difficult for patients to know what they should and shouldn’t eat to lose weight or control their diabetes. What was completely standard a decade ago is completely off the table this year. As one article put it: “The 1800 kcal ADA diet is dead!” Portion control or healthy food choices may be an acceptable first step for patients, especially older patients, patients new to nutrition choices, or those with poor health literacy.
The American Diabetes Association suggests that there is not an ideal percentage of calories from carbohydrates, protein, and fat for all people with diabetes. Although patients on insulin may benefit from consistent carbohydrate intake, the precise amount may vary based on each patient’s needs. Nutrition needs truly are individual.

Set a goal; budget time

First: ask your patients to clarify their goal. Then, schedule a dedicated appointment, either with you or a trusted member of the patient care team, to make a plan. Have your patient bring a food log to that appointment so that the current eating patterns and preferences are clear. Remember each member of the health care team should agree on nutrition therapy principles for people with all types of diabetes.

At that dedicated visit, review the food log. Consider personal preferences like holiday traditions, culture, religion, health beliefs and economic factors as well as metabolic goals and work together to determine the best eating pattern. 
Reassure your patients that they can be mindful and intentional about their food choices, including deviations. It is a great time to focus on connecting with loved ones and introducing some extra physical activity at Thanksgiving time such as taking a walk together after dinner. When Thanksgiving is over, re-establish a healthy routine.
As for the holiday, if your patients can host the meal, then they are in the driver’s seat! Let’s talk about Thanksgiving and all the upcoming holidays that celebrate religion, joy, friends, family and typically include FOOD!

Gratitude for the body
One way to help our patients prepare for the Thanksgiving feast ahead of time is to encourage them to be grateful for their bodies. Patients cannot take care of something they don’t value or appreciate! Too often we are hard on ourselves and forget all the wonderful things our bodies do for us, despite having a challenge like diabetes. Our patients can show gratitude to their bodies by nurturing every one of the cells in their bodies with healthy foods that make their body function better and make them feel better. That’s a Thanksgiving feast indeed!
Here are some suggestions for the holiday meal you make or items to share wherever you go!

Holiday swap-outs
The traditional Thanksgiving turkey is a lean protein choice! If your patient is open to new traditions, try a main dish of fish that is high in omega-3 fatty acids like Albacore tuna, herring, mackerel, rainbow trout, and salmon. Other fish ideas are catfish, cod, flounder, haddock, halibut, orange roughy, and tilapia. Shellfish options include clams, crab, imitation shellfish, lobster, scallops, shrimp,or oysters. Consider chicken or even a cornish hen.

Recommend delicious lower carb alternatives to traditional holiday foods. It’s a great time of year to have fun with others finding new holiday favorites. There are many recipes available online. For example, instead of mashed potatoes, try mashed cauliflower for a tasty and healthy side dish. Vegetables are colorful and can be fresh, frozen or canned without sugar. They are delicious roasted, steamed, stuffed or turned into a salad or casserole. Cooking Light, Eating Well, and Diabetic Gourmet are examples of recipe websites with sections specifically for patients with diabetes.
Some people look forward to the cookies, pies and sweets during the holidays. We do! A small serving of a family favorite is just fine. Encourage patients to plan for that special treat and then enjoy it! Remember to help patients appreciate the chef who makes that special dessert.

Sugar substitutes

So what about sugar substitutes? Patients may ask about alternative sweeteners, and the answers are surprisingly complicated! 

Our taste for both sweet and salt get upregulated over time. In other words, as we eat more salty foods, or as we add salt to our food, unsalted food tastes bland. At the same time, if we restrict salt for a week or two, the food that was perfectly salted a couple of weeks ago would suddenly seem inedibly salty! 

The same is true for sweeteners. One person’s perfectly sweetened coffee is undrinkable to another person. If we restrict sugar and other sweeteners for a couple of weeks, our taste for sweetness will down-regulate, and we’ll notice that things taste sweet with less sugar or less sweetener. 

Ideally, patients will limit added sugars and caloric (or ‘nutritive’) sweeteners because of the effects on blood sugar and added calories, if weight management is a concern. We recommend that patients mostly choose foods and drinks without added sugars, and that they limit the sugar and nutritive sweeteners they add. Nutritive sweeteners include honey, maple or corn syrup, and agave, among others. 

If patients use non-nutritive sweeteners or “diet” products containing them, let them know that there is some low-level evidence connecting these products to an increased risk of weight gain. More studies need to be done to figure out if this is due to a direct effect of the non-nutritive sweeteners.

Hit the ground running - or walking!
For many, Thanksgiving is a four-day weekend. Encourage your patients to use some of that time to get out of the house for some physical activity! Some communities hold a 5K Turkey Trot - which is a gift-wrapped 30 to 45 minutes of cardiovascular activity to kick off Thanksgiving Day with a nice walk or even a jog.

If the big meal is in the middle of the day, encourage patients to enjoy taking a family walk while the dishes are soaking or drying. Get together a game of touch football while you wait for this year’s NFL or high school championship games to start. In fact, holiday shopping can be a great workout. Parking far away and making multiple trips back to the car to store your purchases can be a workout. Those steps will add up quickly.

The New Year’s Resolutions- and diets!
Yes, making a New Year’s Resolution to eat better or lose weight is a common step for many people and good idea! But you need to get a little more specific with that new goal. Your patients may ask about some of those “specific diets” they’ve heard about.

  • The Mediterranean diet incorporates a plant-based diet with fish, olive oil, nuts, and sparing amounts of dairy and red meat.
  • Low-carb and very low carb diets restrict carbohydrates to 30-100 grams of carbs per day, focusing on vegetables, protein, and fats as calorie sources.
  • Vegan or plant-based diets restrict eating to only plant-based foods.
  • Ketogenic or “keto-diet” is also an option based on a low-carb and high-fat food menu.

Dietary Approaches to stop hypertension includes fruits, vegetables, whole grains, low-fat dairy, and lean meats.
Each of these has some evidence of benefit for modest weight loss and modest impact on diabetes outcomes or incidence. Individualized planning should focus on personal preferences, needs, and goals.

With any plan, keep it easy to follow. Here are three key rules for designing a plan:
1. Avoid sugars and starchy carbs.
2. Eat proteins and vegetables. Proteins include eggs, meat, fish, poultry, cottage cheese, yogurt, legumes. Focus on the NON-starchy vegetables -so avoid the potatoes and corn. Potatoes and corn can spike blood sugar in many individuals with diabetes.
3. Choose whole when possible. Whole foods are better than processed foods. Frozen food, like frozen vegetables, is okay. Whole foods can be easier to find than patients might think.

Intermittent fasting or time-restricted feeding may also be useful for some patients. Those patients who aren’t hungry for breakfast may benefit from deliberately using one of these techniques to manage their diabetes.
Together, choose an eating plan that fits your patient’s life, that they can stick with most of the time, for the long term!

Giving thanks
Find strategies you can use with patients to successfully navigate the holiday season and continue on their path to better health. Partner with patients and families to enjoy the season and stay on track to improving and even reversing type two diabetes. We give thanks for all our blessings and we wish you a joyful and healthy holiday season. Let’s all celebrate National Diabetes Awareness Month and all the upcoming holidays with our patients by working with them on a healthier future.  Happy Holidays!  

Healthy Eating Resources:
Choosing Your Veggies
Carbohydrate Considerations
Holiday recipes from the Diet Doctor - from appetizers, main dishes, sides, sauces, desserts and drinks all in one place
Sample food log you can use to track eating patterns
Diabetes-friendly recipes   
2-years of data illustrates low-carb diet effect on cardiovascular risk factors and weight loss in patients with type 2 diabetes
Intermittent fasting

Recommendations for Diabetes and the Ketogenic diet (10-minute video - Medscape)

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