The holidays are a time for celebration but they can also be fraught with nutrition-related challenges, especially for our patients dealing with chronic medical conditions, such as diabetes and obesity.
Celebrations often feature calorie-dense foods, high in added sugars, fats, and sodium, culminating in unintentional weight gain and the subsequent resolution to lose it in the New Year. This begs the question: Is it possible for our patients to enjoy holiday foods and celebrations without compromising their health? The answer is a resounding yes!
Educating patients about healthier diets, such as plant-based eating, and equipping them with healthier spins on their favorite holiday recipes can help them maintain good health throughout the holiday season and beyond.
The Benefits of Plant-Based Eating
As most health providers understand, nutrition plays a key role in health. In 2012 alone, 45% of cardiometabolic deaths (due to diabetes, heart disease, and stroke) were associated with suboptimal nutrition -- defined as a diet high in processed meats, sodium, and added sugars, and low in fruits, vegetables, and whole grains.
Plant-based diets have been growing in popularity in recent years, and with good reason: a growing body of evidence points to their role in improved management of chronic disease. In one study, participants with type 2 diabetes who followed a low-fat plant-based diet for 22 weeks saw a 1.23-point drop in their A1C compared with 0.38 points in those following the American Diabetes Association diet. This is comparable to the reductions seen with commonly used medications but without the side effects and costs.
In the BROAD study, participants following a whole food plant-based diet experienced an average weight loss of 11.5 kg after 12 months. The Lifestyle Heart Trial demonstrated that dietary interventions coupled with lifestyle changes were associated with reversal of coronary artery disease.
Why are plant-based foods associated with positive health outcomes? Plant-based foods are generally lower in fat and rich in essential fiber, resulting in a lower caloric density. Furthermore, plants are naturally cholesterol free. This, coupled with the high fiber content, helps reduce serum cholesterol levels. In contrast, animal products are devoid of fiber and oftentimes high in fat and cholesterol.
Plant-based foods are also rich in antioxidants, which help fight inflammation and disease. In contrast, the World Health Organization has classified processed meat as a Group 1 carcinogen, similar to asbestos and tobacco, and red meat as a probable carcinogen. Despite these warnings, processed meats are commonplace during the holidays, as well as year-round.
Even with the myriad health benefits of plant-based foods, their consumption is subpar in the American diet. Only one in 10 American adults meet the federal fruit and vegetable recommendations. While some healthcare providers and patients are concerned that plant-based foods won't provide sufficient protein, most vegetables and whole grains do meet the recommended dietary protein guidelines, and legumes (beans and lentils) and tofu exceed these levels. However, legumes and tofu are not staples in most Americans' diets.
While not everyone will want to follow a plant-based diet during the holidays or year-round, patients can benefit from incorporating some plant-based meals or recipes into their diets.
Preparing Patients for the Holidays
As healthcare providers, we are at the forefront of nutrition and health, and every patient encounter is an opportunity to educate our patients about the power of the plate. The following tips can help patients enjoy the holidays while improving their health:
- Many patients avoid grains or "carbs" in an effort to lose weight or lower blood sugar. It is important to note that refined grains -- stripped of their nutrients -- are the problem, rather than whole grains, which are chock full of fiber, vitamins, and minerals. Encourage your patients to enjoy whole grains, such as brown rice, quinoa, oats, millets, and whole-wheat pastas and breads instead of refined grains (white rice, white bread, and pastas). Offer a recipe for whole-grain pumpkin bread.
- Choose plant-based sources of protein, such as lentils, beans, or tofu. These are naturally cholesterol free and low in saturated fat. Share this spiced sweet potato hummus recipe for their Thanksgiving dinner.
- Enjoy fresh fruits but avoid fruit juices and sugar-sweetened beverages, such as sodas and cocktails.
- Aim for three to four servings of vegetables daily, which are rich in fiber and nutrients. Even starchy vegetables, like potatoes, are healthy as long as they are not fried (fries or chips) or loaded with fat. Instead of traditional mashed potatoes -- often high in saturated fat when prepared with butter and cream -- offer patients a recipe for a healthier lower-fat version.
- Holiday desserts are often loaded with added sugars and fat and contribute to weight gain. A vegan pumpkin pie can be a tasty and nutritious alternative.
- Share other healthy Thanksgiving recipes.
- Holiday parties can be tricky. Encourage patients to eat healthy snacks before heading out and bring a healthy dish to share.
- Remind patients to look out for alcohol, which is not an essential nutrient and loaded with empty calories that quickly add up -- there is a reason wine bottles don't carry nutrition labels. For those patients who want to drink during the holidays, recommending they drink in moderation is a smart approach.
Many healthcare providers appreciate the health benefits of plant-based foods but may not incorporate them into treatment plans due to concerns about patient acceptance and adherence. But research has shown that patients are interested in plant-based dietary interventions -- patient acceptance and adherence should not be a deterrent. After all, quitting tobacco is difficult, but we still counsel patients about the benefits of cessation and provide resources and support. We should take the same proactive approach with nutrition-based interventions, both during the holidays and beyond.
Vanita Rahman, MD, is the clinic director at the Barnard Medical Center and the Physicians Committee for Responsible Medicine, a clinical instructor in medicine at the George Washington University School of Medicine, and author of Simply Plant Based: Fabulous Food for a Healthy Life.