A Conversation with Nicole Ehrhardt, MD
With the holiday season in full swing, many of us find ourselves indulging in unhealthy food and drinks. This busy time results in many people being more sedentary, and facing higher stress levels as our normal routines change. These things can often lead to an imbalanced endocrine system with symptoms like fatigue, moodiness, gastrointestinal distress, and general malaise.
To ensure we stay healthy and happy during the holiday period we can aim every day to work on
The recent consensus report by The American Diabetes Association and the European Association for the Study of Diabetes highlight how we can best take care of our bodies throughout the year, but the challenge is finding the right balance during the holidays.
This is a complex question as I think we are learning more every day about hormones and their pathways. Two weight and appetite hormones are ghrelin and leptin. We know that restricting calories increases ghrelin which can increase our appetite. Conversely, leptin reduces hunger. As you lose body weight, leptin levels become lower than ghrelin which also makes us feel hungrier.
I think the first step is to have a plan well in advance of the holidays. Choosing a plan that works best for you and is maintainable all year round is important. Harvard’s public health blog is a great resource for patients and healthcare providers. One particular blog post titled “Diet Reviews”, goes over various nutritional lifestyle plans and gives the medical evidence behind each plan.
Two nutrition lifestyle plans that might be worth trying are intermittent fasting and the Mediterranean diet. If you want to try intermittent fasting, you will only eat between 11 AM and 6 PM. Limiting the time period when you eat helps to avoid eating excess calories, especially if those holiday cookies are available 24-7. If a Mediterranean lifestyle plan works for you, fill half of your plate with vegetables at your next holiday gathering and choose a small portion of lean protein. Also, focus on eating good monounsaturated fats (such as olive oil and nuts) and only eating higher fiber foods (complex carbohydrates in smaller portion sizes). This plan might have you skipping the holiday treats altogether except on one or two “splurge” days during the holidays.
Additionally, reading nutrition labels on foods is very important when eating out or eating on the go. When you are at the airport convenience store, grab a small bag of nuts (make sure you only eat 1 serving (150-180 calories as often there are 1.5-2 servings in a bag) rather than a bag of chips or a cookie. At the airport restaurant, be aware that the calories in the Caesar salad may be similar to a cheeseburger, Save the “splurge” for a more meaningful family gathering, and instead of either of these options, you might want to opt for a green salad with a vinaigrette. Make sure to add protein to your salad, like grilled chicken, to help keep you full for longer.
Pick one day to have the pumpkin spice latte or another seasonal beverage but then stick to the lower sugar options for the rest of the season. You should enjoy the holidays but with moderation, you are going to be happier and healthier. In the short term, restricting ourselves can increase cravings but usually, cravings reduce if we can follow through with them in the long term.
I think tips 1, 2, and 3 are to try not to indulge for the entire holiday period and instead choose moderation. For example, I tell my patients living with diabetes that I do not care if their blood sugar is running in the 200 ‘s mg/dl on Thanksgiving but I hope you have a plan to give away the leftovers and that heavy carbohydrate meal after 24 hours.
In addition to moderation in your diet, ensuring you get enough sleep and physical activity will help you maintain balance during the holiday. Sleep deprivation can lead to weight gain, so it is important to practice good sleep hygiene, avoid screen time 1-2 hours before bed, avoid staying up too late and try to aim for at least 7-8 hours of sleep at night.
In addition to getting enough sleep, I always tell my patients living with pre-diabetes and diabetes to walk for 10-15 minutes after meals since this is a natural way to bring down blood sugar and improve total steps. One of the most common things I hear is “I do not have time to exercise,” which is why we try to promote briefer but multiple daily engagements in “activity”, like walking after meals, and not formal exercise throughout the day.
Drinking more than four drinks in one setting suppresses gluconeogenesis (new glucose production in the liver) by more than 40% so I always counsel patients living with diabetes about the risk for hypoglycemia when consuming alcohol. I also tell patients that have high triglycerides (>500mg/dl) to avoid alcohol given the increased risk for pancreatitis, which can be a life-threatening condition. With alcohol, moderation is key and not adding further empty calories from sugary mixed drinks is one suggestion to limit calories from alcohol. Additionally red wine increases our protective cholesterol (HDL) but it unfortunately does not decrease your bad cholesterol (LDL). HDL is also increased by exercise, so exercise may be the “better” plan for raising HDL.
Serotonin is one of the most important neurotransmitters influencing mood and mental health. As it gets colder, and darker people can develop seasonal affective disorder (SAD) and the regulation of serotonin may be part of the cause. Also, a hormone produced in the pineal grand called melatonin is thought to be increased by shorter/darker days which causes sleepiness.
Being active despite the darkness and cold is our natural defense against SAD. Additionally, as the risk for vitamin D deficiency increases during the winter, taking a supplement of vitamin d may also help support mood, overall health, and be good for the bones. A review and meta-analysis concluded that low levels of vitamin D are associated with depression.
Talk to your doctor if you are feeling more down during the winter months as light therapy, psychotherapy, and medications for depression can also be used to support you. The take-home point is to let your doctor know if you have the seasonal blues.
All diabetes medications have some risk for low blood sugars, but low blood sugars are much more common for those on insulin and sulfonylureas. My tip is to try to plan in advance and keep 15 grams of carbohydrates available for when your glucose is low, or you have symptoms of low blood sugar. Additionally, if you are about to shovel snow or rush out to the store to shop for the holiday meal make sure you take the time to test your blood sugar prior to leaving. If you have insulin or sulfonylureas on board then you may want to take a small snack even if your glucose is still in the 100-110mg/dl range so that you are proactive when your glucose is in a normal range rather than reactive to a low glucose after activity .
A recent study showed that peaks for hot flashes and trouble sleeping occurred in July and night sweats peaked in May, while troughs occurred in January and November, respectively. However, menopausal symptoms may be more pronounced if you are experiencing seasonal affective disorder.
Talk to your doctor if menopause symptoms are significantly affecting your quality of life. Estrogen and progesterone replacement may be appropriate especially if you are perimenopausal or recently post-menopausal, until age 60. If you have a personal risk for breast cancer or blood clot, alternative therapies could also be considered.
I am not aware of any study on hormones specific to the holiday time but…. Often people feel more stress during the holiday season. Stress can lead to changes in the serum level of many hormones including glucocorticoids, catecholamines, growth hormone and prolactin. Moderation, planning. and asking for help is important so you can get the sleep, exercise, and relaxation you need throughout the holiday period.
A special thank you to Laura Montour, MD for her help in developing this resource.
Dr. Ehrhardt is a board-certified endocrinologist at the University of Washingon Diabetes Institute Clinic and UW assistant professor of Medicine and Metabolism, Endocrinology and Nutrition. She has served many roles in the clinical setting: hospitalist, staff endocrinologist, core faculty member of an endocrine training program, 16 years as an army doctor, and has over 10 years of experience in diabetes and obesity.
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