Holiday Hazards for Diabetics

For anyone, the tempting treats that are part and parcel of the holiday season are a thing to be avoided in excess — from sugary, decorated cookies to free-flowing New Year's champagne.

But for those with diabetes, avoiding these indulgences takes on special importance.

Face it: Many of the finger foods and holiday treats served at your typical get-together are loaded with sugar and fat. In addition to their overall caloric intake, those with diabetes must keep a close eye on what they eat — and how much of it they eat — to avoid potentially dangerous fluctuations in their blood sugar levels.

Dr. Francine Kaufman, head of the Center for Diabetes, Endocrinology and Metabolism at Children's Hospital Los Angeles and past-president of the American Diabetes Association, says that one way to avoid the potential problems posed by holiday parties is simply not to go. But, she adds, there are ways that diabetics can join in the fun of a holiday party without putting themselves at undue risk of a hyperglycemic or hypoglycemic episode.

"Short of staying at home, they have to exercise willpower," she said. "If you are going to indulge — and admittedly it's hard not to — as far as eating is concerned you need to be ready to cover the food you eat with the appropriate amount of insulin."

Fortunately, the medications that diabetics have at their disposal today allow them a fair degree of latitude when it comes to enjoying their holiday favorites.

"The way medications are set up now, a lot of people with diabetes can eat the same way I eat, but they just have to take their medications into account," said Patricia Heanue, a registered dietitian and a specialist in diabetes nutrition at the Joslin Diabetes Center in Boston.

In fact, she says, most of the foods that pose nutritional hazards to those with diabetes are ones that the rest of us would also do well to avoid.

"There's no diabetes diet," she said. "Everyone should eat healthier, whether they have diabetes or not."

Joan Salge Blake, clinical assistant professor and nutrition specialist at Boston University, agrees.

"When you have diabetes, you're really managing a healthy diet," she said. "It's an eating style that all Americans should be following anyway."

Christmas Cookies

When it comes to colorfully decorated holiday cookies, it's tough to say no. Keith Ayoob, pediatric nutritionist at the Albert Einstein College of Medicine in New York City, says these cookies pack about 85 calories per 2-inch treat.

"But the problem is that with sugar cookies, you never just eat one," Ayoob said. "And if it's frosted, that's another 50 calories."



Plus, all that sugar can be a special problem for those hoping to keep their blood sugar levels in check. According to the National Institutes of Health, a cookie that is three inches in diameter constitutes a single serving of sugary food. That means that such a treat contains the same amount of carbohydrate as a slice of bread, a half cup of corn or potatoes or one-third cup rice or pasta.

"On occasion, things can be swapped out," Salge Blake said. "For example, if you wanted to have a sugar cookie, you would swap out another source of carbohydrates."

But, she adds, a sugar cookie will not likely have as much positive nutritional value as other carbohydrate-containing foods. "So you can't do this all the time," she said.

Thus, the best way to head off this holiday threat is to limit yourself to a cookie or two. Rather than sampling each variety of cookie on display, choose only the most delectable for a taste, and follow this treat with fresh, crisp veggies or multigrain crackers to soothe the snacking impulse.

Finger Foods

Perhaps some of the most calorie-heavy options at many holiday gatherings may be the ones that you eat without even noticing.



Hors d'oeuvres and other finger foods, depending on their ingredients, can contain a significant amount of calories, sugar and fat — all packed in a remarkably small package. And their small size makes it easy for you to eat a lot of these bite-size treats — a concern for diabetics and non-diabetics alike.

The key to navigating the finger-food trays, Heanue says, is to stick to options free from fatty sauces and garnishes.

"You want to stick to things like shrimp and salsa, or chicken — plain foods — as opposed to fried foods and puff pastry," she said, adding that creamy types of dessert should also be avoided.

Kaufman says an even better bet may be to bring a healthier alternative to the party yourself for all to enjoy.

"The best thing to bring is a big platter of veggies or cheese," she said.

Pumpkin Pie

What would the holidays be without pumpkin pie?

Much healthier, for one. While the fillings of popular pies are often loaded with sugar, the crust of these pies is often no healthier, adding a considerable dose of fat and calories to the equation.



Fortunately, there are a number of relatively diabetes-friendly recipes available for many of these favorites. These alternative approaches substitute some of the more offending ingredients with less fatty, less sugary alternatives.

"Instead of using cream, you may use low-fat milk as such," Salge Blake said. She adds that other favorites, such as apple pie, can be made healthier by eliminating the crust and adding oatmeal to make apple crisp instead.

"You should be asking yourself, 'how can I add whole grain? How can I add more fruit? Instead of using butter, can I use vegetable oil?'"

So if holiday desserts are among your favorite holiday indulgences, you might want to consider baking a healthier version of one of them yourself and bringing it to a holiday party for everyone to enjoy.

Stuffing

It's a perennial holiday favorite — and it may also be one of the unhealthiest foods in your holiday spread.

"There's no better name for this dish," Ayoob noted. "First, it stuffs the bird, then it stuffs our bellies, then it stuffs our thighs — a culinary trifecta if there ever was one."



Indeed, stuffing can represent a significant source of both carbs and calories — as well as fat. And because it is a side dish, many diners may be eating much more of it than they think.

But a bit of common sense — along with portion control — can go a long way in making this dish more healthy.

"Stuffing doesn't have to make you stuffed," Salge Blake said. She notes that diabetics may want to even consider bringing their own stuffing to holiday get-togethers — one that incorporates whole grain bread, healthier vegetable oils instead of butter and a generous complement of high-fiber vegetables and fruits.

Ideally, most people, diabetic or not, should also try to limit the amount of stuffing that finds its way onto their plates. Instead, leave more room for vegetables and other healthier options.

Alcoholic Beverages

In addition to increasing the risk of everything from minor social blunders to major accidents, alcoholic beverages in excess also pose a special risk to diabetics hoping to keep their blood sugar levels in check.

In fact, for many with diabetes, certain alcoholic drinks can represent a "double whammy" — first raising blood sugar, and then causing it to drop later.



"As for alcohol, a lot of fruity drinks can bring blood sugar up initially, but later they can lead to hypoglycemia," Kaufman said, adding that this paradox has to do with the way the liver breaks down alcohol.

Complicating this is the fact that that intoxication can often mask or emulate the effects of high and low blood sugar.

Kaufman notes that because of this, it is important for those with diabetes to control their alcohol intake, as well as check their blood sugar levels frequently to ensure that it is not too high or too low.

Heanue adds that those taking medications for their condition need to be particularly vigilant, particularly when it comes to any contraindications having to do with alcohol.

"Alcohol, depending on the interactions with the medicine their taking, is something that they need to be aware of," she said.

For diabetics and non-diabetics alike, there are many ways to avoid the problems associated with drinking too much at a holiday party. For example, follow your first drink with two mandatory glasses of club soda or some other non-alcoholic, non-sugary beverage. You'll probably find that this keeps you out of the alcohol trap, while still giving you the opportunity to raise a glass whenever necessary.

And in most cases, diabetics are safe as long as they drink in moderation. According to the American Diabetes Association, those with diabetes are likely still safe if they stick to a limit of two equivalents of alcohol — for example, two glasses of white wine, or two 12-ounce light beers.

Champagne

It's the drink of choice for a New Year's toast. And diabetes experts say that like other alcoholic beverages, champagne can be safely enjoyed by those with diabetes, as long as it's in moderation.

And in terms of avoiding a blood sugar roller coaster, you could do worse than the light, bubbly drink.



"Obviously they can take sips, or even a glass of champagne if they are also eating," Kaufman said. "Champagne does not have a lot of extra sugar in it."

But Heanue adds that going overboard can result in the same kind of hypoglycemia seen with overindulgence in other alcoholic beverages.

"Even if they are drinking champagne, this still needs to be limited," she said. "The end result of drinking alcohol is low blood sugar."

The trick here is to limit yourself to one glass — or even just a few sips — right after the ball drops. It's also a good idea to make sure you have a healthy snack in hand while you enjoy your drink, as a bit of extra sugar can act as a buffer against a blood sugar crash later in the evening.

The Chocolate Fountain

The chocolate fountain has become a popular addition to many holiday parties. And the good news is that despite its decadent appearance, it can be safely enjoyed by diabetics and non-diabetics alike.

The key, Salge Blake says, is to make sure that whatever you're dipping in the cascading ripples of chocolate has some semblance of nutritional value.



"I only use fruit, so my guests are not dunking in cookies, cake or biscotti," she said. "It's a fabulous way for them to get that chocolate, but it's also sneaking a heck of a lot of fruit into their diet."

Also, Heanue adds it would be wise not to overindulge.

"If [people with diabetes] stand there next to it and keep dunking strawberries in there and eat 40, then they will probably have a problem with their blood sugar," she said. "But if it's just three strawberries, it probably isn't going to do anything."

So if a bit of moderation can work at the chocolate fountain, it makes perfect sense that it will work elsewhere at the party as well. In addition to not going overboard with certain holiday treats, proper preparation — for example, eating a healthy dinner before heading out to a party — can also go a long way for those with diabetes. Maintaining your normal exercise schedule throughout the holidays, Heanue says, is also a huge help.

But most importantly, those with diabetes should not let their condition get in the way of the most anticipated holiday treat of all — a good time with family and friends.

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