High A1C? You can enjoy your holiday foods with a generous helping of moderation

The advice, "Everything in moderation," is traced to Greek and Roman philosophers and poets. And while its actual source has been debated through centuries, its meaning has not: Strive for balance in all aspects of your life - a valuable piece of wisdom as the holidays approach.

After all, when most of us anticipate the holiday feast, moderation probably isn't our uppermost thought. Instead, we dream of filling - and refilling - our plate with creamy casseroles, succulent ham, roast turkey, grandma’s biscuits and irresistible pies with buttery crust.

For a large segment of our population, the hundreds of thousands who must monitor their A1C, or average glucose measurement, balancing servings is a must to avoid dangerous spikes in blood sugar.

The good news is that can be achieved without foregoing traditional holiday fare, says James Klauder, an MUSC Health registered dietitian who specializes in diabetes.

"I never tell people they can't enjoy Thanksgiving and Christmas," says Klauder, who counsels patients at MUSC Health and throughout the state via telemedicine. "They can have their favorite foods as long as they focus on eating protein and vegetables alongside of them."

Klauder's first recommendation to patients is to learn what foods contain carbohydrates, the culprit behind increased blood sugar. "A lot of people are confused over that," he says. "For example, corn and potatoes are considered vegetables, but they're very starchy and can also raise blood sugar."

Once a patient understands carbs, Klauder's advice is simple: Eat "MyPlate," a modified version of the government's new alternative to the food pyramid.

"Fill up half your plate with a sizable portion of non-starchy veggies, such as salad or collards," he says. "Vegetables contain fiber, which helps you feel full and can keep blood sugar from spiking."

Klauder says the next quarter of the plate can contain a starch, such as corn, rice potatoes or bread. He suggests taking one type of starch at a time instead of piling all the different starches onto the plate at once.

"It's a lot harder to have a smaller helping of all those foods instead of a moderate serving of one starch," he says. “If I give you one cup of rice, that looks like a lot more food than very small portions of multiple starches."

The last quarter of the plate should contain lean protein, such as chicken, turkey, lean cuts of beef or pork, or a meatless protein substitute.

"That's how I approach that first round of helpings," Klauder says. "You're still getting that favorite food and you're just getting the right portions. A mix of carbs with protein and fiber dulls the blood sugar spike because the carbs are absorbed more slowly into the blood stream than they would be if consumed without protein or fiber."

Now for round 2: Take a certain amount of time, around 10 to 15 minutes, before getting seconds, Klauder says.

"We have a culture of overeating and making ourselves sick. Give your stomach time to signal your brain that you're full. Have that first round, then wait 10-15 minutes before getting seconds. Otherwise, you might be eating past the point of comfort."

Make a concerted effort after to move after you eat.

"Going for a 15-minute walk can lower blood sugar naturally," Klauder says. "I've never had a patient tell me, 'Man, I regret walking after I ate a big meal.'"

Klauder tells people monitoring their A1C they can have dessert if they're aware of what else they're eating. After all, Thanksgiving and Christmas are festive events, and A1C measures blood sugar over 3 months.

"If you're going to have dessert and you're conscious of what you're eating, make an effort to have more protein and fewer carbs as part of the main course and wait about 15 minutes before dessert," he says. "On days leading up to or after a holiday meal, be mindful of your carb intake. Don't forget your goals and don't turn one festive day into a holiday week of overindulging."

Try to limit your beverage to plain water or a sugar-free drink. And if you do drink alcohol, don't overdo it, Klauder says. "If you have diabetes and drink alcohol, there's a risk of a blood sugar drop, especially if you're not eating. Your liver is preoccupied with metabolizing alcohol rather than maintaining glucose levels, and you could pass out if you don't know your signs of a low blood sugar. The unfortunate fact is that you could wind up being transported to jail instead of an ER if this happens while you're out."

Bottom line: If you go out, avoid drinking on an empty stomach. Tell a friend that you have diabetes and, in the event of a medical emergency, to give you a low blood sugar treatment (15 grams of a fast-acting carbohydrate, such as 4 oz of juice or 3-4 glucose tablets). Make sure you have a treatment nearby. Check your blood sugar 15 minutes later and repeat as necessary, seeking medical treatment if needed.

And what advice does he have for the cook?

If you're in charge of the meal, prepare a few dishes that are carb free. Instead of a green bean casserole, serve sauteed or roasted green beans or roasted asparagus prepared with a healthy oil such as olive or avocado oil. Go easy on the salt and instead substitute herbs and spices for flavor, such as garlic powder, onions and shallots.

Klauder's overall advice for enjoying a healthy holiday meal:

• Emphasize non-starchy veggies.
• Limit your starches.
• Wait between courses.
• Eat protein with non-starchy sauce or topping.

Klauder says he doesn't believe in telling people not to enjoy the foods they love on holidays, but he reminds them to focus on more than the food.

Talking to your grandma or catching up with your brother or sister helps slow down the meal," he says. "Remember what the holiday is about."

A variety of programs are offered through MUSC Health Nutrition Services. Call 843-876-0888 to schedule an appointment. Klauder also encourages his patients to go the American Diabetes Association site to see full lists of foods that raise blood sugar.