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December 10, 2003

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Palo Alto Online

Publication Date: Wednesday, December 10, 2003

Sweet temptations Sweet temptations (December 10, 2003)

People with diabetes need to be more vigilant about nutrition during the holidays

by Lia Steakley

The holiday season is synonymous with feasting for many people. It's one of the few times out of the year when diets are broken and the decision between having a slice pecan, pumpkin or buttermilk pie is supposed to be a non-issue.

For adults and children who are diabetic, though, going back for a second helping of mashed potatoes or indulging in a super-sized dessert can be a dangerous.

Obesity and type 2 diabetes are on the rise in the United States, requiring more people to safeguard their health by watching what they eat. But passing on favorite foods during the holidays -- when everyone else is piling their plates high -- can be depressing.

Diabetics should take heart, however: Doctors and dieticians say there are several ways to keep the holiday cheer, and individuals need only discover which method works best for them.

"Only by really delving into and understanding the disease, your body and your body's relationship to that disease can you be the best manager of it," said Dr. Mike Nichols of Tempus Clinic, which takes a holistic approach to disease management. "Patients need to develop this skill. It's like acquiring wisdom -- it happens over time. They need to also keep themselves open to new ideas and to further understanding."

Terri Ramos' 15-year-old son, Pierre, was diagnosed with diabetes at age 11. Over the years, Ramos and her husband developed their own method of ensuring their son is both healthy and happy.

"Because there is a whole psychology that comes with being diagnosed after living a normal eating life, we allow him a free-for-all on Christmas Eve, Christmas Day, New Year's Eve and New Year's Day," Ramos said. "People don't want to feel deprived, and children don't want to be deprived. So he is allowed to eat whatever he wants four days out of the year as long as he is checking his glucose more often throughout the day and giving himself enough insulin to cover what he is eating."

Dr. Nichols urges caution about splurging, however, when the individual's system is more sensitive to changes in nutrition. In that case, it could be hazardous.

Another way Ramos allows her son to not be deprived of his favorite foods is to help him understand how to calculate portions.

"Because food is big in the Mexican culture and we have tamales a lot, I took a recipe of tamales and broke it down entirely. I had to measure out how much corn meal was used and how much sugar and what normally took two hours lasted five hours. But now he knows when he goes to a friend's house or a restaurant he knows how much he can eat," she said.

Sem Lee, a dietician with the Diabetes Society of Santa Clara Valley, said that learning how to eat in proper nutritional proportions is key during the holidays.

"These days it is hard because our portions are a lot bigger and we tend to over-consume during the holidays. You really have to focus on carbohydrates," Lee said. "You have a set plan. ...It's okay to have the holiday treats as long as you plan it into your meals and try to get a smaller piece."

Depending on if someone is diagnosed with type 1 diabetes at a young age or with type 2 or adult diabetes, the nutritional guidelines can be very different, Dr. Nichols said.

Palo Alto High School student Kelly Jensen was administering her own insulin shots by the age of 8 and said the holidays are not drastically different than other days for her.

"I don't really change anything. I never feel like I am deprived of anything. I know can have desserts or whatever and I just take insulin for it," she said.

Armed with a wallet-sized medical kit, 16-year-old Jensen pricks her fingers four times a day and dabs the droplet of blood on a meter to test her blood sugar. To keep her body healthy she takes three shots of various types of insulin to help her system remain stable throughout the day.

"It's not like I am really on a diet. It's just the carbs you have to watch out for because they can really make your blood sugar jump," she says.

For adult diabetics who grew up without the dietary restraints, giving up their favorite foods can be a little bit harder.

"There is a profound emotional component when you tell someone, 'You are diabetic.' Many people become depressed and feel they will never enjoy food again," Dr. Nichols said. "I tell people, 'This is a great opportunity for you to start getting healthier.' And instead of embracing some theory, they should adopt fundamentals that are recognized and build behavior that is improving their overall health."

Lee agreed, saying that a good way to combat unhealthy eating habits is to fill one's plate with a balance of vegetables and protein.

"Just get that staple in and it will fill you up and last longer. Then you will be so stuffed that you can't overeat because you can't eat anymore," she said.


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