How To Avoid Holiday Overindulging

By Dace Trence, MD, FACE

With the holiday season rapidly approaching and planning for upcoming festivities and special times with family and friends in full swing, there may be challenges with making healthy, sensible choices at these gatherings, particularly if you have diabetes, high cholesterol or high blood pressure.

Below are some helpful tips to enjoy this time of year in a healthier way.

Cheers?

Even though alcohol consumption is prevalent all year-round in the U.S., with estimates suggesting that one-third of Americans drink alcohol on a regular basis (and this might be a conservative number), there is scientific data from observational types of studies that suggests moderate alcohol intake can have a protective effect on the development of diabetes. But the studies made an important point: that this was indeed moderate alcohol intake—that is, 0.5–2.5 drinks per day. There was no associated benefit with drinking more.

In fact, it appears that there may be a relationship between alcohol and type 2 diabetes in which there is a higher risk of developing diabetes with both low and high intake of alcohol. However, there is a lower risk with moderate intake. This does not mean that you should treat alcohol as a diabetes preventative. Data are lacking as to what difference might be made by specific choice of alcoholic beverage, whether the frequency of drinking makes a difference, and whether the same effect is seen in those who might have other risk factors for diabetes such as being overweight, being a smoker or having a family history of diabetes. So, if you’re thinking that glass of wine could decrease the blood sugar effect of eating that fudge brownie, sorry to say there is no data to support this.

The negative effects of alcohol are numerous. It can temporarily increase blood pressure in anyone after an estimated three drinks. Alcohol can interfere with some blood pressure medications, increasing the side effects of some and making others less effective. Plus, alcohol has calories, which are often handled as fat calories by the body, increasing your risk of weight gain with regular alcohol intake. And that weight gain also creates the risk for high blood pressure.

Cutting back on alcohol can decrease systolic blood pressure (the top number in a blood pressure reading) by as much as two to four points (usually reported as millimeters of mercury—denoted by the symbol mmHg) and diastolic blood pressure (the bottom number in a blood pressure reading) by one to two mmHg.

Additionally, if you are using blood sugar-lowering medications, there can be potential side effects: for example, your risk of hypoglycemia (low blood sugar) can be significantly higher if you drink alcohol. And, although data are conflicting, if you have type 2 diabetes and have more than moderate alcohol use, you might be at more risk of developing diabetes-associated eye disease.

Alcohol intake also can increase the “heart protective” type of cholesterol, namely HDL cholesterol (high density cholesterol—the “good” kind), but drinking too much alcohol can increase the levels of sugar fats (called triglycerides) in the blood. When elevated, triglycerides can cause an inflammation of your pancreas, a very painful condition called pancreatitis which, over time, can actually destroy the pancreas. Triglycerides might also contribute to heart disease, potentially more so in women than men.

Alcohol intake can lead to heart muscle disease (cardiomyopathy), irregular heartbeat (arrhythmia) and stroke. And heavy alcohol use can leave the heart too weak to pump efficiently, a condition called congestive heart failure.

So how much alcohol is safe? It is generally agreed that ”moderate alcohol intake” is safe. Moderate drinking can be defined as: 12 ounces of beer, five to six ounces of wine or 1.5 ounces of 80-proof distilled spirits. Also considered a “safe” alcohol consumption rate: two drinks a day for men younger than age 65, one drink a day for men 65 and older, and one drink a day for women of any age.

And if you drink, you should also make sure that you eat to reduce the risk of hypoglycemia (low blood sugar). Drinking alcohol inhibits the liver’s ability to release glucose (the sugar your body converts into energy), into the bloodstream. This is particularly troublesome for those on insulin, as the liver is not able to produce and release enough glycogen (the sugar your body stores in both your liver and muscle cells) to keep blood glucose levels from going too low under the influence of the insulin. This liver impairment can last for several hours after drinking. To counteract this effect, stick to non-sugary drinks and eat plenty of foods with protein, fats and complex carbohydrates, which your body can convert and absorb as glucose.

‘Tis the Season for Temptation

Aunt Clarice’s pecan pie, sister Jane’s macaroon cookies, mom’s raisin bread pudding - almost every family has traditional holiday foods along with expectations that these items will be shared enjoyed by all. And while they may be difficult to resist and feelings might be hurt by resisting that wonderfully tasty item, it’s wise to steer clear of these types of items, especially if you’re watching your weight, your blood sugar levels, blood pressure or cholesterol.

If you plan on indulging later in the day, start your day with a small meal that includes whole grains and low-fat or fat-free dairy and protein. Don’t starve yourself beforehand. Eat a small, lower-calorie meal before you head off to a soiree. Don’t rush to eat. Socialize and settle into the festivities before eating...and move your socializing away from the buffet or appetizer trays. This will minimize unconscious “nibbling.”

“Taste” rather than eat. This means choosing the smallest plate available, asking for a small piece or slice, or even asking someone to share a plate or a dish (that fudge brownie, for example). At a buffet, you might even limit your “plate” to a napkin. Another approach to help yourself is to take one bite of an item and then toss the remainder away, wrapped in your napkin. These approaches allow you to decrease portion size while tasting the food and being able to fully participate socially.

Make better choices. This means reaching for the vegetable tray or fruit tray at buffets rather than the baked goods. Grab a bottle of water, or if you must choose punches or juices, try filling your glass with ice first; this will dilute and decrease your drink portion size of drink. Sparkling water can be another festive way to dilute a carbohydrate-rich drink.

And watch out for hidden salt (sodium) that can worsen blood pressure. Unfortunately, many prepackaged foods use sodium for its preservative effects. So foods such as broths used as bases for gravy, sauces or soups can be high in sodium. Keep these food choices to a minimum. Ask if stuffing has been prepared with salt--and if so, have a taste instead of eating a full portion.

Offer to bring a dish or two (or more). You then have control over a food choice, or several choices, that you fully know the contents of.

Stress-Busting Strategies

As joyous a time as the holidays can be, they can also be very stressful. High expectations for a perfect party, family tensions, even depression can play a major role in creating a not-so-perfect time of year. Some people avoid celebrating the holidays altogether for this reason.

Stress can play a major role in interfering with any disease self-management. Missing medication, disrupted sleep, “stress eating” and making poor choices with alcohol intake can become more prevalent at the end of the year.

To reduce your stress, make expectations reasonable. Set a limit on your social event commitments to one or two per week. Suggest to friends that you meet after the holidays when schedules are more flexible. Offer a buffet rather than sit-down dinner if you’re hosting an event. Or limit your gathering to just appetizers or desserts rather than a sit-down meal. Agree to meet for breakfast or coffee rather than dinner to limit calorie temptations. Limit gifts to specific dollar amounts and have a family lottery to see who gives to whom.

Take care of yourself. Will anyone really remember if you didn’t have multiple meal choices or if there was dust on the bookshelves? Make sure to get as much sleep as possible, slip some exercise into your busy schedule and make good meal choices. Following these tips will increase your enjoyment of this special time of the year.

Dr. Dace Trence is Director of the Diabetes Care Center and Professor of Medicine at the University of Washington Medical Center in Seattle. She is also the University of Washington Endocrine Fellowship Program Director and Director of Endocrine Days, a medical education program for endocrinologists practicing in the Pacific Northwest. She is on the American College of Endocrinology Board of Trustees and chairs the CME Committee and is also chair of the AACE Publications Committee.