Just desserts: Your patients can enjoy holiday festivities without guilt
With planning, even festive treats can fit into a diabetes regimen
Diabetic patients need not feel excluded from the coming holiday festivities, say nutrition experts. In fact, they have two words of advice for health care professionals and family members alike who want to help their patients keep blood sugars under control during the holiday season: Lighten up!
"It’s once a year. They can have it and enjoy it. I mean really enjoy it," says Karen Chalmers, MS, RD, CDE, director of nutritional services at Joslin Diabetes Center in Boston. "Forget about that yucky sugar-free chocolate that will give them a stomach ache. Tell them instead they can savor a piece or two of the real thing."
Chalmers warns that too often, people with diabetes feel the watchful eyes of well-meaning friends and family members who look over their shoulders and say, "tsk-tsk" at every bite they eat. "It’s important for friends and families not to take on the role of the food police and for people with diabetes to be able to enjoy the holidays and to enjoy what they are eating." She offers another a bit of advice to clinicians: "We have to be realistic about what we are asking."
In terms of the numbers, falling off the strict glycemic control wagon for a handful of holiday meals is not really a big issue, adds Nadine Pazder, RD, CDE, a dietitian at Morton Plant Hospital in Clearwater, FL and a spokeswoman for the American Dietetic Association.
"If you eat three meals a day, 365 days a year, that’s 1,095 meals a year," Pazder says. "Splurging for two or three meals a year is not a big issue in the overall picture. We look at glycemic control in terms of quarterly HbA1c [levels], not a spike that lasts 24 hours or less."
But, Pazder adds, "It’s not a big deal if it’s just one meal, but it’s important to draw clear boundaries that it is just one meal."
"If they know they’re going to go overboard with a particular meal or at a party, what’s important is to help them rope themselves back in and control it instead of setting off some sort of bing-eating pattern," says Chalmers. Best of all, she recommends, "If they know ahead of time they will be stretching the glycemic limits, they can plan for it and prepare for it."
The average American gains seven pounds between Thanksgiving and Super Bowl Sunday, says Chalmers. Add that up over a few years, and an explanation for the current epidemic of obesity in America becomes apparent, she says. So her recommendation is to help patients find a way to enjoy themselves during the holidays, avoid guilt, and avoid weight gain.
Chalmers and Pazder both say the message is not to give diabetic patients permission to gorge themselves on enormous quantities of food. Enjoying favorite dishes doesn’t mean eating mountains of mashed potatoes with butter and gravy or huge wedges of pumpkin pie and whipped cream.
Small portions of a variety of favorite foods can satisfy that desire for holiday merry-making without causing major blood sugar swings, adds Jeannette Jorden, RD, CDE, prevention, detection, and education coordinator at the Medical University of South Carolina in Charleston.
Jorden subscribes to the diabetics-can-eat-anything theory but says the portions must be small. Diabetic patients can savor a few bites of pie or cake just as well as the next person, she says, "But they don’t need three or four desserts."
Pazder agrees. "We have to be real cognizant of portion size, especially in people who are diet-controlled with a little bit of leniency for special occasions." She also praises the newer short-acting insulins that allow patients to inject right when a meal is served.
At the same time, Jorden cautions against the "guilt trap" for those who overindulge. "Tell them they can start over each day. The main thing is just getting back on track."
"If they are going to have a piece of candy or some other indulgence, they should enjoy it and not feel guilty about it," Chalmers adds. "Guilt just creates more cravings."
Here are some recommendations to help people with diabetes sail smoothly and happily through the holidays:
- "Eat a small meal before leaving the house for a party," suggests Chalmers.
This can help offset the urge to devour an entire platter of hors d’oeuvres (and avoid the swings in blood glucose levels) when eating time is later than usual. Or "flip-flop a snack and an evening meal," says Pazder.
- Patients can still go to parties and big family assemblies.
"The key is carbohydrate counting because it allows for a lot more flexibility," says Chalmers. "Their carb allowance can be spent at snacks while they still stay on track." For example, a cupcake with frosting contains about 30 g of carbohydrate or two exchanges by Joslin’s standards.
And, says Pazder, depending on the caloric allowance, the average diabetic patient will have three to five carbohydrate choices per meal, so an occasional sweet option is "affordable" in the meal plan.
- Work off a heavy meal.
Instead of napping in front of the television after Thanksgiving dinner, Pazder suggests getting the entire family and guests out on a walk immediately after a meal to help rev up glucose metabolism.
- Take it easy on the alcohol.
Alcohol is loaded with calories. A 4-ounce glass of wine is 100 calories, a 12-ounce glass of beer is 150 calories (110 for light beer), and a 1.5-ounce shot of liquor like whiskey or vodka contains 100 calories.
"You need to make people aware of the calories and the fact that alcohol lowers blood sugar, so they need food in their stomachs to slow things down," says Chalmers.
- Take it easy with other kinds of beverages.
Watch for drinks laden with sugar and calories. Jorden notes that a glass of sugar-sweetened iced tea is 150 calories, but unsweetened tea with diabetic-friendly sweeteners added is a free food, so that’s a place to make a painless trade.
Chalmers adds that a can of regular soft drink is 45 g of carbohydrate, "But they can spend that carbohydrate allowance on something else by taking a diet drink instead. They should spend their carb allowance on something they really like." (For some festive recipes from Joslin Diabetes Center, see insert.)
[Contact Karen Chalmers at (617) 732-2400, Nadine Pazder at (727) 462-7459, and Jeannette Jorden at (843) 876-1949. For more information on counting carbohydrates, see Joslin’s Web site at http://www.joslin.org.]
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