From Nuts to Diabetes, How to Manage Food Health Over Christmas

Christmas is a time when we traditionally eat and drink more than is good for us, but some people have to take particular care when there’s lots of food around that isn’t in their everyday diet. Here from Patient Info are some tips for those with nut allergies or diabetes who might find Christmas diets a problem.

Authored by Amberley Davis · Reviewed by Dr Sarah Jarvis MBE

How to cope with a nut allergy over Christmas

Approximately 2 in 100 children and 1 in 200 adults have a nut allergy in the UK. Nuts are a staple ingredient in many Christmas recipes, and sometimes they are not easy to spot. It’s important to stay vigilant over the festive season and protect yourself from allergic reactions.

In the UK and USA, the prevalence of nut allergies is increasing. According to Allergy UK, there are nearly 100,000 new cases each year. Peanut allergies among children in Western countries have doubled in the last 10 years. In addition, in the UK over the last 20 years there has been a 615% rise in hospital admissions for anaphylaxis – extreme allergic reactions that can result in death.

Christmas time can see a surge in hospital admissions for those with nut allergies. Nuts enjoy the spotlight in many of our festive recipes, and in others their presence can be hard to spot.

See also: New Year, New Diet? Why You Shouldn’t Embrace Food Fads

Adam Fox, consultant paediatric allergist at a leading London teaching hospital, describes how Christmas can be a chaotic time of family gatherings and social events. The abundance of food and party snacks puts people with nut allergies at risk and makes it hard for parents to always keep an eye on what their children are eating.

What happens when you have an allergic reaction to nuts?
Both tree nuts and peanuts – the latter not strictly classed as a nut – can cause allergic reactions in some people. This happens when your body’s immune system overreacts to a foreign substance which wouldn’t cause you harm. Your immune system releases a substance called histamine, and this can trigger several symptoms of an allergic reaction.

What are nut allergy symptoms?
“Look out for classic food allergy symptoms such as hives/nettle rash (urticaria), swelling and an itchiness around the mouth immediately after eating,” advises Fox. “In rare cases, people may experience difficulty breathing. This is an anaphylactic reaction and requires emergency medical attention.”

Other signs and symptoms of an allergic reaction can include:

  • Your mouth and lips tingling.
  • Nausea.
  • Colicky pains in your stomach
  • A feeling of tightness around your throat.

Signs and symptoms of a more severe allergic reaction (anaphylaxis) can include:

  • All of the above.
  • Wheezing or difficulty breathing
  • Swelling around your throat.
  • A sense of impending doom.
  • Dilation (opening up) of your blood vessels, which can cause skin redness, a quick heart rate, or low blood pressure which can cause you to feel faint.

Nuts in Christmas favourites

There are some obvious nutty festive food favourites, and some not so obvious uses of nuts at Christmas. Roasted chestnuts and salted peanuts are popular party snacks often found on tables for people to peruse. The sheer amount of food and people at some gatherings can make it hard for parents of children with nut allergies to keep a watchful eye and to stop their children from grabbing nuts.

Rocky road ice cream, hot chocolate, and other chocolate-based products may also contain nuts and it pays always to read the label or be wary of food provided by others. Walnuts also feature over Christmas and can be found in many savoury and sweet dishes, including salads and cake.

Beware of Christmas favourites that sometimes – but not always – contain nuts:

  • Stuffing – can be made with a wide variety of ingredients including all different kinds of nuts.
  • Brussels sprouts – look out for garnishes such as flaked almonds or walnuts when eating out.
  • Pine nuts – commonly used in salads and in festive sauces.
  • Festive breads – special occasion breads are often studded with walnuts, pecans, or other nuts.
  • Festive sauces – nuts are sometimes used in cranberry sauce, bread sauce, and special gravies.

Nuts are also frequently used in Christmas desserts and sweets:

  • Christmas cake.
  • Christmas pudding.
  • Panettone.
  • Mince pies.
  • Stollen.
  • Nougat.
  • Peanut brittle.
  • Gingerbread.
  • Marzipan and praline.

Tips to help you avoid nuts at Christmas

Despite the abundance of food and people over Christmas time, there are some things you can plan for to make avoiding nuts a little easier:

If buying or cooking food yourself:

  • Check every label – peanuts and tree nuts are 2 of the 14 allergens that are required by law to be clearly signposted in bold on all food labels.
  • Look up alternative nut-free recipes for your festive favourites – if you or your family crave a traditional Christmas recipe that usually contains nuts, there are plenty of alternative recipes that you can find easily online.

Eating other people’s food:

  • Speak to the host ahead of the gathering – they can either provide nut-free options, or you can offer to contribute your own nut-free cuisine.
  • Prepare your child – if your child has a nut allergy, explain to them that there may be food at the party that they can’t eat. Tell them to ask you before eating anything on offer, and bring some treats that you know they can enjoy.

Over Christmas and throughout the year, if you have been issued an adrenaline auto-injector (AAI) always have this ready for emergency use.

Eating out

Allergy UK has some useful tips to help you stay in control of what you’re eating when dining out, both over Christmas and throughout the year.

Do remember that even food which doesn’t have nuts in the ‘official’ ingredients may have been cooked in oil containing nuts or sesame seeds. And cross-contamination of food cooked in the same oil as nut-containing food can also cause an allergic reaction.

Allergy UK’s tips for eating out

  • Research the restaurant in advance – look at the menu options online or call the restaurant to ask about their nut-free options, how the food is prepared, and whether cross-contamination with allergens is controlled.
  • Avoid buffets or salad bars – shared utensils increase the potential for cross-contamination between dishes.
  • Ask for allergy-friendly menus at catered events.
  • Always remember to bring your AAI and tell at least one other attendee how to support you – in case of an allergic reaction.
  • Speak to the staff on arrival – make them aware of your nut allergy so that your food doesn’t come into contact with an allergen in the kitchen, and maybe ask for the chef to use clean cooking equipment, depending on your nut allergy severity.
  • Choose simple dishes if possible – Christmas dinner options may include plainer options such as meat, steamed vegetables, and potatoes. (You may need to check if nuts are used in marinades and sauces.)
  • Check your food carefully when it arrives – send it back if you suspect it contains, or has been in contact with, any nuts.

How to eat well and enjoy Christmas food when you have type 2 diabetes

When you’re managing type 2 diabetes, it’s possible to eat healthily while still enjoying a lot of the delicious, festive food on offer over the Christmas season.

If you have type 2 diabetes, you’ll be aware that following a healthy diet is one of the most effective ways of managing your diabetes and reducing the risk of developing complications, including cardiovascular disease, blindness, amputation, kidney disease and depression. Maintaining this over Christmas day – as well as the festive celebrations that fill December – can feel daunting.

While it’s true that many Christmas treats are high in sugar, refined carbs, saturated fats and salt, there’s plenty of healthy festive food. By managing your portions and finding a balance between treating yourself and restraint, you can still enjoy your food this Christmas. Azmina Govindji, registered dietician and member of the Diabetes Research and Wellness Foundation (DRWF) editorial advisory board, champions realistic goal setting over deprivation during the festive period:

“Trying to lose weight during the holidays is likely to be a self-defeating goal. Instead, strive to maintain your weight. Depriving yourself of festive foods or feeling guilty when you do have them isn’t part of an empowering healthy eating strategy.”

According to the National Institute for Health and Care Excellence (NICE), people with type 2 diabetes need to consider the best times to eat, how many carbohydrates to have per meal, and reducing their alcohol intake. Your healthcare team should help to create the best diet plan for your needs.

Christmas food to avoid or limit with type 2 diabetes

Starchy and sugary carbs
When it comes to managing your diabetes over Christmas, knowing which festive treats greatly impact your blood glucose (sugar) management is a good place to start. Carbohydrates – both starchy and sugary – can cause your blood glucose to rise. These foods contain a surprisingly large amount of sugar.

This is particularly true of ‘refined’ carbs, like white bread/flour/sugar, which can be found in many Christmas canapes like mince pies, breaded chicken, and sausage rolls.

Food that’s high in salt
You’ll also need to limit food that’s high in salt. Too much salt can raise your blood pressure and increase your risk of heart disease and stroke. The charity Action on Salt warns that a Christmas dinner can contain over 15 grams (g) of salt – over twice the recommended daily maximum of 5-6 g.

Checking food labels, as well as limiting your consumption of shop-bought processed foods, can significantly reduce your salt intake. Some top Christmas culprits include crisps, sausage stuffing, salted peanuts, and shop-bought gravy.

Food that’s high in fat
It’s also important to maintain a healthy weight if you are living with type 2 diabetes, as research shows that health risks are increased if you are living with obesity or overweight. A key factor in avoiding weight gain is limiting your intake of fatty foods, especially saturated fats and trans fatty acids. These can raise your blood glucose, your cholesterol and your blood pressure.

Saturated fats can be found in dairy foods like cheese, cream and full fat milk, as well as fatty, processed meats like bacon and sausages. Trans fats are sometimes present in highly processed treats like cakes, biscuits, pastries, crackers and takeaways.

Healthy Christmas food to embrace
While it’s true that you need to manage your intake of many festive favourites carefully with type 2 diabetes, there’s plenty of Christmas food that’s healthy and delicious: “Perhaps surprisingly, many traditional Christmas treats are nutritious foods, moderate in calories and rich in health-promoting vitamins, minerals and phytonutrients,” says Govindji.

Foods that are high in fibre and protein, and also contain low-glycaemic-index sources of carbohydrate – such as fruit, vegetables, whole grains and pulses – are recommended by NICE for managing type 2 diabetes. Research has shown that this diet can keep blood glucose, cholesterol, and blood pressure at healthier levels which in turn reduces the risk of associated conditions.

Govindji argues that Christmas day could even be the perfect opportunity to reach your five portions of fruit and vegetables a day without having to try. The DRWF monthly newsletter ‘Diabetes Wellness News’ is a useful source of information for people managing diabetes, and here Govindji has highlighted several popular Christmas foods:

Roast turkey – rich in protein and low in fat.
Smoked salmon
– high-protein, low-fat and rich in cardio-protective omega-3 fatty acids (exercise moderation due to high salt content).
Potatoes – source of vitamin C and other nutrients (roast in spray oil rather than butter or fat to reduce saturated fats).
Carrots – source of vitamins and fibre.
Brussels sprouts – source of vitamins and fibre.
Unsalted nuts – source of unsaturated oils, fibre and the antioxidant vitamin E.
Satsumas – source of vitamins.
Christmas pudding – source of iron, fibre, and potassium (although moderation is key as this is also high in added sugars and saturated fat).

Diabetes UK also provides resources to help you plan a healthier Christmas, including several festive, healthy recipes.

Other tactics to help you eat well at Christmas

Knowing what Christmas food to embrace and what to limit will empower you to make healthier choices throughout the festive season. Being mindful of portion sizes is also important for avoiding weight gain.

Other tactics can make your Christmas diet goals more effective and easier to maintain. Remember, it’s OK to enjoy the odd high-calorie treat. Following these rules can help you to stay in control:

  • Stick to smaller portions.
  • Eat slowly and chew more – a proven technique that helps you to feel fuller.
  • Balance out any less healthy eating by eating better at other times.
  • Fill up most of your plate with healthier options, like vegetables.
  • Consider healthy alternatives – such as natural yoghurt instead of double cream.
  • Enjoy every bite – it’s OK to enjoy yourself at Christmas, and a little indulgence can help you to stick to your long-term diet goals.
  • Tips for eating out over Christmas
  • You may find yourself attending a few Christmas dinners with friends, family, or work colleagues over December. Eating out can limit your control over what you eat and can offer temptation.

Eating out

  • Before attending, check if the restaurant provides nutritional information online – you can plan ahead and learn which options are healthier.
  • Be the first to order – to avoid being swayed by other people’s choices.
  • Consider ordering a starter as a main meal if you have a smaller appetite.
  • Order meals that are high in protein (such as lean meat, egg, fish, or beans).
  • Only order dessert after you’ve eaten your main meal – you may find you’re too full for one.
  • If your meal is delayed, and your blood glucose levels are in danger of dropping too low, ask if there is a bread roll to tide you over.
  • If possible, add extra vegetables to your plate – filling up on vegetables is a low-calorie, nutritious option.

Type 2 diabetes, Christmas, and alcohol

There is usually an abundance of alcohol at Christmas celebrations, and everyone should be wary not to succeed the recommended limit of 14 units per week. If you have type 2 diabetes, you can usually enjoy drinking in moderation; however, you need to be extra cautious.

If you treat your diabetes with medications such as insulin or sulfonylureas, you’ll be aware that alcohol interferes with your blood glucose levels and can make you more likely to have a ‘hypo’ (hypoglycaemia) when your blood glucose drops too low. Alcohol reduces your liver’s ability to store glucose, halting recovery when your blood glucose is dropping.

If you enjoy a drink at Christmas, opt for drinks that have lower sugar levels. Alcoholic drinks with high sugar content include:

  • Liqueurs (cream liqueurs like Baileys are also high in fat).
  • Cocktails made with fruit juice.
  • Sweet wines.
  • Sugary spirit mixers such as fizzy drinks.
  • Sherries.
  • Beers, ales, and ciders (contain carbs which will increase your blood glucose levels initially).
  • Diabetes UK advises caution with low-sugar beers and cider – sometimes called ‘diabetic drinks’. While they have less sugar, there’s often a higher alcohol content. On the other hand, low-alcohol wines often have more sugar and should also be consumed with caution.

If you do enjoy a drink during the festive season, you can better manage your blood glucose by following these recommendations:

  • Stick to spirits, dry wines, and Prosecco (they’re lower in carbs and sugar).
  • Use spirit mixers (such as tonic water) with no added sugar.
  • Don’t drink on an empty stomach.
  • Have a pint of water before bed.
  • Eat breakfast the following day and check your blood glucose levels if you have a meter – your risk of having a hypo can last up to 24 hours after drinking.
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