Food and sweet treats are everywhere this time of year. So, how can you navigate the holidays if you have diabetes? UPMC dietitian, Jacquelyn Klunk, MS, RDN, LDN discusses how you can take care of yourself while enjoying some of your favorite holiday foods.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Oh, the holidays. Food and sweet treats are everywhere. So, how do you navigate that if you have diabetes? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Jacquelyn Klunk, she’s a registered dietitian with UPMC. Thank you so much for joining us.

– Yeah, absolutely. I’m happy to be here.

– This is a big topic for lots of people, especially heading into the holidays. Let’s begin with diabetes in general, and sort of the battle that folks may face, and why regulating their sugar is so important.

– Absolutely. I mean, from a nutrition standpoint, it’s really important for folks to be mindful of the fact that what they eat can impact their blood sugar management. And, keeping your blood sugar within a normal range is really crucial to help prevent and delay any long-term complications like heart disease, or complication of diabetes like vision loss, nerve damage, or kidney disease. And the foods that we eat can be a part of the tools we use to manage our blood sugar, in addition to any medications that your doctor may have prescribed. So, when we eat carbohydrates in food, it affects your blood sugar much more than when you eat proteins or fats. Now, carbohydrates are going to come from foods like milk, yogurt, fruit, grains, and starches. So, you think, your breads, and your pastas, and rices, starchy veggies like potatoes, peas, and corn, legumes – so beans and lentils – and, of course, sugar. So, you should still eat carbs when you have diabetes. Carbs are our body’s preferred source of energy, and it’s what fuels us. So, really, we need to think about choosing more nourishing types of carbs. Think less added sugar, more fiber, vitamins, minerals; choosing the right portions of carbs; and having regular meal timing.

– And a lot of this that we’re discussing, it applies both to type 1 diabetes and type 2 diabetes.

– Yes, absolutely.

– It can be challenging no matter what time of year to watch what you’re eating. But this time of year in particular where there’s a party, it seems, like every day, tons of sweets, tons of food. Every office has people bringing in, “I made this, I made that.” It can be very challenging. But you say there are ways that folks can navigate the holidays without wrecking their diets.

– Yeah, absolutely. And, at the holidays, keeping up with your consistent healthful habits, it can absolutely be challenging. But, at the same time, it’s really important to find ways to enjoy the foods at the holidays without feeling overly restricted. I don’t want anyone to walk away from the holiday season feeling like they were just worried about what they were eating and they didn’t actually take time to enjoy the celebrations with loved ones. Food is so much more than what we put on the plate itself. It’s social, it’s cultural, it’s traditions, it’s mental health. And, when we think about well-being as a whole, we need to think about not just physical health but mental health. So, my goal in working with any individual with diabetes about their health goals is we’re fueling them towards well-being in the long term, so that they can feel good, they have good quality of life, and can do the things they like to do for as long as possible. So, if they’re restricting everything and they can’t eat the foods that they enjoy at the holidays, that tends to set someone up for feeling overly restricted, having a negative relationship with their food, and not having as good of a quality of life. Sweets are going to be there during the holidays, and that’s not inherently a bad thing. We just have to find ways to make it work. And, finding ways to eat those sweets in moderation while still controlling your blood sugar is a way that you’re going to make those lifestyle habits sustainable, and that’s what’s going to make them successful in the long term.

– OK, so what’s the strategy? I’m invited to a party. What do I need to think about? What do I need to do?

– Some people ask, “Well, can I ask the host what should I expect at the meal?” Sure, you can absolutely do that. It’s never a bad thing to advocate for your health. So, if you feel comfortable asking, you know, “When’s the meal going to be? What are you going to serve?” Absolutely. You can ask that. There’s, of course, some situations where you may not feel comfortable doing that or it’s just impossible to know. It’s a big potluck; you don’t know what everyone’s bringing. One thing that I always want to make sure is that you’re not skipping meals all day long to save up for that big holiday meal. That can make it honestly more difficult to control your blood sugar in the long term. You can end up having chances for low blood sugar during the time of the day when you’re skipping meals because you’re not getting any nutrients in. And, then, at the party, you’re more likely to overeat, and that’s going to make your blood sugar higher. So, still eat the regular meals; don’t skip and try to save up.

– Are they smaller regular meals or no? Just stick with your regular meal.

– They don’t need to be smaller than usual, no. If you’re someone who likes sweet treats here and there, you might want to skip the extras earlier, but you don’t need to cut your portions down compared to your normal healthful eating habits to prepare for a party later.

– And is there anything in particular you should be eating in those early meals before a party?

– Not specific to prepping for the party, but, and of course, everyone’s meal plan can look a little bit different with diabetes, but in general, stick with your usual. At breakfast, you have carbohydrates to energize you with fiber to keep you full and stabilize your blood sugar, and protein to keep you full and stabilize your blood sugar. And, at lunch, same thing, but add in some veggies.

– OK. So, I’ve done the right thing. I’ve eaten the appropriate meals before going to this party. I walk in, though, and, you know, there are temptations everywhere. What does that look like? How do I navigate this?

– Yes. Sure. So, one way you can prep rather than skipping a meal is before the party you could have a healthful snack. And when I say healthful snack, I usually mean pair a fiber with a source of protein. So, for example, like, a slice of whole wheat bread with peanut butter, or veggies and hummus, or fruit and nuts. That can kind of make it so that when you walk in the door at the party, you’re not bombarded with, “Oh, there’s so many foods and I’m starving.” You’ve kind of taken something to take the edge off your hunger and you can make more mindful choices at the party. Go for the foods that you truly enjoy rather than foods that are just there. Ideally, we wouldn’t do a lot of grazing between meals with diabetes, but if you are going to have an appetizer or two, again, think of that same concept as the snacks. Pair something with fiber with a protein, and that’s going to steady your blood sugar a little bit more than something that’s all carbohydrate.

– So, if you’re looking, let’s say, at the buffet table, and there’s something that you don’t normally eat because it doesn’t fit into your diet regarding diabetes, is that the time to have that? Or, resist that temptation and go with the things you know are healthy and good for you?

– I think that can really depend. So, for example, let’s say you’re looking at the buffet and it’s dinner time, and you’re trying to figure out how to fill your plate. And what can be a really good visual aid for people is something called the healthy plate for diabetes. So, what that is is kind of dividing your plate up into sections to make sure you get good foods in proper portions in a way that’s balanced. So, first, with that healthy plate, we want to fill up about half your plate with non-starchy vegetables. So, think any veggie except for potatoes, peas, corn, winter squash. So, half veggies, quarter lean protein, and quarter carbohydrate. So, let’s say you’re walking down that buffet and you see all those good carbs that are part of holiday meals – your mashed potatoes, your yams, your stuffing, your cornbread, your rolls – these might not be things you normally eat or eat a lot of as part of your normal eating habits. So, when it comes to healthy eating with diabetes in the holidays, if you think of the healthy plate, you could choose to, you know, have just one of those items and make it take up a quarter of your plate, or you could have a couple small spoonfuls of each of those items, but the total portion of carb on your plate doesn’t exceed a quarter. So, it’s OK to eat foods that you don’t normally eat that you really look forward to at the holidays, but we want to think about how big are those portions on your plate? And, do you also have some protein and veggies with fiber there to help kind of stabilize out and balance your blood sugar? ‘Cause they basically slow down digestion a little bit. So, instead of having that blood sugar spike up quickly and crash down quickly, it kind of steadies things out a little bit.

– OK, so that’s the main course. Let’s talk about the dessert table.

– Yes, the dessert table. So, same kind of idea as I mentioned before is that we want to go for dessert items you’re really looking forward to and not just dessert items that are there. So, for example, let’s say every year you look forward to your sister’s pumpkin pie recipe, but you’re kind of hit or miss on the cookies. I mean, they’re good, they’re cookies, but you could take ’em or leave ’em. When you hit that dessert table, have your slice of your sister’s pumpkin pie, but maybe don’t go back for the cookies because that’s not what you’re really there to enjoy. Try to not go back for seconds with that dessert, too, even though you love that pumpkin pie recipe. Or, if you are someone who loves the cookies, you could, you know, take some home and freeze them. Cookies freeze really well, so you don’t have to feel like you’ve missed out by not getting to try them all.

– We’ve been through the high-calorie, high-sugar dessert table, but there are lots of options of diabetic-friendly desserts.

– Yeah. Utilizing fruits’ natural sweetness can be a way to make a dessert a little bit more diabetes-friendly. So, for example, think like an apple crisp, that maybe in the crumble topping, you use, you know, oats and a little bit of butter, a little bit of brown sugar, but it’s not too much. And we rely on things like cinnamon, and nutmeg, and vanilla in the apples to kind of bring that flavor out. Some recipes you can also substitute some or all of the sugar with unsweetened apple sauce, or mashed bananas, or pureed pumpkin. It’s important to note with any of these, though, is that even though they are a healthier choice in the sense that they give you more fiber and vitamins and minerals, less added sugar, they still do have natural sugar, so they still are going to affect blood sugar. It’s not like they are kind of a green light to eat as much of it as you want. It’s just that because that fiber’s there, it might have less of a spike effect on your blood sugar as something that’s just straight added sugar. And some people do choose to use sugar-free baking blends; think like sucralose, which is Splenda or Stevia. And that’s an option, too.

– Are there any sources of information or resources that you recommend to your patients to go for recipes?

– Yeah. Absolutely. The Diabetes Food Hub is the recipe resource of the American Diabetes Association. That can be a good option. And the American Heart Association also has a recipes page that you can filter for diabetes-friendly recipes.

– And, so, if you are the host of a holiday gathering, what are some things that I should make sure on my list so there’s something for everyone?

– Yeah. I mean, I think it’s always a good thing to plan ahead, whether it’s a potluck and you’re figuring out who’s bringing what, or you’re making all the food yourself, just to make sure that you’re offering things from all food groups. You don’t want to end up with, you know, five starch dishes, no protein, no veggies. So, just kind of plan ahead to make sure that there’s going to be protein, there’s going to be some carbohydrate dishes, but that you’re also offering fruits and veggies. It’s good to have that variety.

– Also at a party, alcohol.

– Yes.

– What’s the best way to navigate that? Are there alcoholic beverages that are better for you if you have diabetes?

– So, if you choose to drink, and if your doctor has told you that it is safe to drink with your medical history and any medications that you’re taking, first we want to think about amount. We want to drink in moderation. The American Diabetes Association defines that as less than one drink per day for women, two drinks per day for men. That moderation piece is important because alcohol itself can cause blood sugars to drop fairly low. That can be pretty dangerous for someone on insulin. So, we don’t want to exceed a huge amount. We also don’t want you to drink on an empty stomach. Have that drink with your meal rather than on an empty stomach. But in terms of types of alcohol, something like light beer or a dry wine can generally be a better choice because it is lower in carbs. It is also lower in alcohol compared to some of the other options. But, that doesn’t give you the kind of clearance to drink as much of it as you want; we still want that moderation. Things like mixed drinks or dessert wines, they can definitely be a lot higher in added sugar. So, something we want to avoid if we can. But if you are going for a mixed drink, choose a sugar-free mixer like a diet soda or a seltzer water. In terms of distilled spirits and liquor, across the board, they’re all fairly similar in terms of, like, their carbohydrate content and, depending on the proof, the alcohol content, so it doesn’t have to be one type or the other. The main keys would be whatever mixers go with them, they should be sugar-free, and the moderation. So, for distilled spirits, one drink would be considered 1 1/2 ounces of 80-proof spirits, 1 ounce of 100-proof spirits. And for beer and wine, it would be 12 ounces of beer, 5 ounces of wine.

– In general, how important is it to stay hydrated?

– It’s very important to stay hydrated. And, diabetes or not, hydration keeps our body temperature normal, our blood pressure normal, takes nutrients and oxygen where it needs to go, lubricates our joints, keeps our bowels regular. But, with diabetes too, if you’re dehydrated, your blood sugar can be higher because your blood’s more concentrated, meaning that there’s less water there, so it looks like there’s more blood sugar there. So, it’s important to stay hydrated as another tool to help regulate your blood sugars. And, yes, with water. Sugar-free drinks can also be a fair bridge between sugary drinks and water, but water is the best choice.

– Especially this time of year, exercise is always important, or staying active is always important. How does that play into someone’s health when they may be at a party tempted by all this food?

– Activity can be a great tool to help manage blood sugar. So, you know, when we exercise, it can lower blood sugar levels. So, doing things like if it’s a family dinner, seeing if the family’s willing to go out for a walk together after dinner. Some families like, you know, active board games, or even just, you know, dancing with the kiddos that are at the event. Things that can keep you active and moving are things that can also help control your blood sugar. Also, if you have any regular physical activity, it’s still good to keep up with it during the holiday season, even if you might skip a day or two here with holiday events. But one thing I do want to note is that you never have to earn your food or work it off. Exercise should be about positives – so, well-being, blood sugar control, mental health – not about negatives.

– That’s an excellent point. As we close, what do you want to leave people with about making it your way through the season doesn’t have to be that difficult?

– Yeah, absolutely. Health looks like a lot of things, and health has a lot of factors. So, I never want someone to walk away feeling like I’ve created more anxiety for them about the holidays by talking to them about nutrition. My first and foremost priority is, how can you enjoy it? So, really it is, you know, make sure when you’re eating your meals, have good veggies, have protein there, and eat moderate amounts of the carb foods that you enjoy at the holidays. Have dessert, but have less of it. And learn to really honor your cravings to eat the foods that you look forward to, not the foods that just happen to be there ’cause it’s the holidays. It’s OK to say no if someone offers you food. Just be kind and respectful, but firm, because you’re advocating for your health, and that’s always OK to do. And stay active and enjoy the time with your loved ones.

– Well, Jacquelyn Klunk, we thank you so much for coming in and spending time with us today. Some really great information. We certainly appreciate it.

– Yeah, absolutely. Thank you for having me.

– You’re welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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Nutrition is vital for maintaining your overall health. UPMC Nutrition Services offers comprehensive diet and nutrition counseling on a variety of topics, including eating disorders, weight management, and heart disease. Our team provides medical nutrition therapy for chronic conditions such as celiac disease, cancer, and diabetes. UPMC’s network of registered dietitians is available to help guide all patients toward a healthier life.