Consider the predicament of diabetics during the holidays. Treats abound. From Halloween through Valentine`s Day, a steady procession of temptations threatens the health-and even the lives-of an estimated 14 million Americans. Many are adults who don`t want to forgo the seasonal favorites that they previously enjoyed. Many are children who can`t understand why they are denied the sugarplums everyone else is enjoying.
Yet their bodies` inability to process nutrients affects their attitudes, alertness or physical state. The absence of food or the sudden intake of surplus calories might cause severe mood swings, send them reeling from shock or render them unconscious.
It is estimated that more than half of all people who have diabetes diabetics are undiagnosed, unaware that they suffer from a condition that suddenly can leave them blind, sexually dysfunctional or at risk of losing a limb, their kidneys or their lives.
”Holidays are a horrendous time for diabetics,” says Gail C. Frank, a doctor of public health from California State University, Long Beach, and adjunct professor of pediatrics at the University of California, Irvine. From Halloween on, ”It`s never really a treat” for diabetics, she says. ”It`s always a trick, figuring out what to do.”
Coping, however, isn`t impossible. Several strategies enable diabetics to get through the holidays.
But diabetes is a highly individualized disease: What works for one person can hamper the progress of another. Discuss any observations and advice that follow with your doctor and dietitian.
Mealtime overindulgence is only the beginning of the problems diabetics face during the holidays. Snacks, libations and other challenges arise.
”From Halloween on, it`s candy, candy, candy,” said Frank, who also is a spokeswoman for the American Dietetics Association. With candy, the body must cope with a sudden influx of sugars, and a big load at that. A portion of candy can contain from 200 to 400 or more calories.
”If you`re on a closely controlled 1,800- to 2,000-calorie diet,” Frank said, ”you`re almost exchanging (that candy) for nearly a whole meal.”
Despite the commonly used term ”sugar diabetes,” sugar does not cause the condition called diabetes mellitus. Diet, heredity, stress, viral complications and other factors may contribute to its onset, characterized by insulin deficiency and excess sugar in the blood.
Complex carbohydrates (grains, legumes, vegetables and fruits) digest slowly and gradually release glucose into the bloodstream. But most candies, desserts and naturally sweetened drinks are composed of simple carbohydrates such as refined white sugar, honey and other common sweeteners. Simple carbohydrates disperse almost instantly.
Normally, carbohydrates and other foods trigger the pancreas, a small gland, to produce the hormone insulin. That substance enables the body`s cells to absorb glucose. But diabetics suffer from diminished or destroyed insulin production. And without insulin, the system cannot properly handle the food.
Many individuals cope with diabetes through a combination of diet and exercise, which simultaneously moderate the flow of sugars into their system while stimulating the body`s metabolism. Some diabetics take oral medication, while tens of thousands of Americans use frequent injections of insulin. Without the synthetic supplement, their bodies` cells would starve.
Yet most diabetic individuals should be able to enjoy an occasional splurge, says Kathy Corbin, area director for the Orange County (Calif.)
Chapter of the American Diabetes Association.
”Doctors tell me they can`t expect their patients to live in a vacuum during the holidays,” Corbin says. ”So (the doctors) tell them, `Plan for it.` They exercise, they indulge moderately. And they understand they can`t do that all the time-otherwise they`ll fall off the wagon.”
Discussing upcoming events with your physician and/or dietitian is the first line of defense.
But dietary control is only one aspect of the challenge. Karen Miller-Kovach, clinical dietitian for the Cleveland Clinic and another American Dietetic Association spokeswoman, says that stress-control, properly maintained exercise programs and home-monitoring of blood-sugar levels are crucial this time of year.
”During the holidays, any and all of those things can be `off,`
” Miller-Kovach says. For example, you may carefully regulate your diet, but if your stress level is high, blood-sugar levels may be skewed. Exercise also can fall off.
Rather than merely regulating your diet, says Miller-Kovach, you should be monitoring blood sugar regularly and making adjustments to keep your blood- sugar levels fairly consistent.
Modifying drug therapy is a viable approach when handled responsibly-but it can be Russian roulette.
”If they know, from past experiences, what foods increase their blood sugar, they can adjust their medication if they`ve already previously discussed this matter with their physician,” says Dr. Francis Rhie, an endocrinologist who is a member of the American Diabetes Association national board and past president of ADA`s California affiliate, who also serves as medical director of diabetes services at St. Joseph Hospital in Orange, Calif. So-called ”sliding insulin therapy” enables individuals to increase their dosage early during the day of a party, or combine slow-acting and fast- acting insulins. The problem, Rhie says, is that if you do that all the time ”you can gain tremendous amounts of weight.”
”And the other side of that coin, (is that) if you take more insulin you get hungrier. So that all has to be planned, and limited in frequency,” Rhie said.
Remember too that the most traditional holiday meals afford healthy-eating options that most individuals-healthy and diabetic alike-can enjoy.
Learning to roll with the condition-rather than using a rigid approach that tempts you to break the rules-makes it easier to stay on track, Rhie says.
Whether you are trying to keep a handle on your health or you`re a diabetic facing the year`s most challenging season of holidays, two books may help you.
”Holiday Cookbook” (Prentice-Hall, 1986) and ”Special Celebrations and Parties Cookbook” (Prentice-Hall, 1989) are by Betty Wedman, a registered dietitian who produced the books with the American Diabetes Association.
Particularly helpful are tips and guidelines for reducing the sugar, salt and fat in familiar recipes. Hanukkah recipes, strategies for turkey and leftovers, and menus for vegetarians are integrated into the text.
Desserts and treats are one of the greatest challenges for individuals following strict dietary regimens. Here are several sweets from ”Holiday Cookbook.”
CHRISTMAS FRUITCAKE COOKIES
Preparation time: 10 minutes
Cooking time: 10 minutes
Yield: 36 cookies
1/2 cup vegetable oil, plus a little additional oil for greasing baking sheet 1/2 cup dark or light brown sugar
1 egg
1 1/4 cups whole wheat flour
1/2 teaspoon baking powder
1 teaspoon ground cinnamon
1/4 teaspoon each: ground cloves, ground allspice
1/4 cup milk
1/2 cup each: chopped walnuts, dark or golden raisins, chopped dried apricots, chopped pitted dates
1. Lightly grease two baking sheets with vegetable oil and heat oven to 350 degrees.
2. Cream oil and sugar in a large bowl of an electric mixer until light and fluffy. Add egg and mix until blended. Add remaining ingredients and mix until blended. Drop by rounded teaspoonfuls onto prepared baking sheets.
3. Bake for about 10 minutes. Cool on wire rack and store in a tightly closed container.
Nutrition information per cookie: 77 calories; 9 g carbohydrate; 1 g protein; 4 g fat; 7 mg sodium; 8 mg cholesterol.
RAISIN BARS
Preparation time: 20 minutes
Cooking time: 40 minutes
Yield: 16 bars
Vegetable oil
1 cup dark or golden raisins
1/2 cup unsweetened apple juice
1 cup whole wheat flour
1/2 teaspoon baking soda
1 teaspoon each: baking powder, ground cinnamon
1/4 teaspoon each: ground nutmeg, ground cloves
1 egg
2 tablespoons vegetable oil
Grated orange rind, colored part only
1. Lightly grease an 8-inch square baking pan with vegetable oil. Heat oven to 350-degrees.
2. Combine the raisins and apple juice in a saucepan. Heat to boil and cool.
3. Meanwhile, mix flour, baking soda, baking powder, cinnamon, nutmeg, cloves, egg and vegetable oil. Add raisin mixture and blend thoroughly. Spread into oiled pan. Sprinkle on the grated orange rind.
4. Bake in oven for 30 to 40 minutes. Cool in pan on a wire rack. Cut into 16 bars.
Nutrition information per bar: 76 calories; 14 g carbohydrate; 2 g protein; 2 g fat; 47 mg sodium; 17 mg cholesterol.
APRICOT KOLACHY
Preparation time: 20 minutes
Rising time: 1 hour 35 minutes
Cooking time: 15 minutes
Yield: 24 servings
Vegetable oil
1 tablespoon active dry yeast
1/4 cup lukewarm water (105 to 110 degrees)
1/4 cup plus 2 tablespoons sugar
1/4 cup ( 1/2 stick) margarine
1/2 teaspoon salt
2 eggs
1/2 teaspoon lemon extract
1 cup water
1/2-4 cups all-purpose flour
24 dried apricots or prunes
1/2 teaspoon ground cinnamon
1. Grease baking sheet with vegetable oil; set aside. Fifteen minutes before baking, heat oven to 400 degrees.
2. Dissolve yeast in the 1/4 cup lukewarm water. Add 1/4 cup sugar and margarine; stir to blend. When the margarine is soft and blended, add salt, eggs, lemon extract, 1/2 cup water and 3 cups flour. Beat until thoroughly blended. Place on floured surface and knead in extra flour to make a soft, smooth dough. Transfer to a lightly oiled bowl, cover with a damp towel, and let rise in a warm place until doubled, about 1 hour.
3. Meanwhile, cook the apricots in the remaining 1/2 cup water for 15 to 20 minutes, or until softened. Puree in blender or food processor fitted with the metal blade. Add the cinnamon and remaining 2 tablespoons sugar and mix well. Cool until needed.
4. Punch down dough and let it rest 5 minutes. Roll out on floured surface to about 1/2-inch thick and cut into 2-inch circles. Place a spoonful of the apricot (or prune) filling in center. Place on an oiled baking sheet. Let rise for 15 minutes. Place on oiled baking sheet. Let rise for 15 minutes. 5. Bake in a 400-degree oven for 10 to 15 minutes, or until browned.
Nutrition information per kolachy: 114 calories; 20 g carbohydrate; 3 g fat; 3 g protein; 79 mg sodium; 23 mg cholesterol.
