Joseph F. Berenato
Beware of overindulgence and stress during the holidays
For many, the holiday season—the span of time between the middle of November and the beginning of January—conjures images of eating, drinking and being merry. However, this is also a time that frequently encourages overindulgence, which can present health risks.
Dr. Salman Siddiqui, medical director of the AtlantiCare Heart and Vascular Institute’s heart failure program, said that the holidays are “notorious for temptation in terms of food and drink.”
“It’s not unusual; we’ve all been there—I’ll be the first to raise my hand and say I’m guilty of this as well—during the holiday season to eat more than you would otherwise eat, and this is particularly the case with things that might have high saturated fats, high salt intake and excess alcohol,” Siddiqui said.
Siddiqui said that portion control is key, particularly during this time of year.
“If you’re going to a party—if you’re going to a gathering or get-together—maybe you can eat a small meal or a small snack before you go, or a high-protein intake snack, so that you can avoid some of the saturated fats and the sugars, high-salt intake foods. If you’ve got a plate, make sure to have half of it is going to be leafy greens, or vegetables or fruit, and the other half is going to be stuff that you might want to fill your plate with,” Siddiqui said.
Siddiqui also cautioned against consuming processed foods like ham, bacon and sausage and instead eating chicken and fish dishes.
“The whole idea is to avoid overindulging, both in terms of the amount of food that you’re eating and especially the amount of excess salt that you’re consuming, because there’s a lot of salt in all of these foods that we don’t necessarily pay attention to. It’s not like we’re topping it off with salt, but it’s certainly there,” Siddiqui said.
Siddiqui acknowledged that alcoholic beverages are also often consumed in high quantities.
“Perhaps you can have a bubbly water or a lime or something before. A lot of times, people are thirsty, so they tend to drink more than they might otherwise. That’s a good way of portion-controlling,” Siddiqui said.
Siddiqui said that high-sodium and high-sugar foods—as well as alcohol—can lead to atrial fibrillation (AFib) and heart failure, and make heart failure difficult to manage in existing patients. Chronic heart failure patients, Siddiqui said, often know symptoms of which to be mindful, but new patients may not recognize the signs.
“Maybe what they feel like what they’ve been able to do on a regular basis in terms of their daily routine, now they’re getting a little winded. It’s nothing dramatic, but they feel like they don’t have the same amount of energy; they’re a little off. They’re getting tired easily and getting short of breath easily. Sometimes they might complain about not being able to lie flat in bed; when they go to sleep, they feel like they have to prop their head with a few pillows because their breathing’s not right the other way,” Siddiqui said.
There are also weight-gain symptoms which Siddiqui said may be subtle.
“They feel like their legs are starting to swell; nothing dramatic, but their shoes and socks are a little tighter than normal. Their weight all of a sudden goes up because their body starts accumulating fluid, so there’s water weight that goes up. Typically that goes up much more quickly; that’s why we want them to weigh themselves daily,” Siddiqui said.
Siddiqui also outlined several AFib symptoms, which oftentimes have similar symptoms to heart failure because the former may cause the latter.
“They may complain that their heart is racing or they’re having palpitations. They might have some chest pain with that, as well, a squeezing sensation,” Siddiqui said.
Chronic heart failure patients, Siddiqui said, usually have a routine to which they must adhere.
“It’s not unusual that we find that people get caught up in the fun, and perhaps they feel like interrupting the fun is going to be a problem ... It’s important for them to remind themselves that, despite the holidays, it’s important to stick to that routine. That probably involves a lot of different medications, maybe weighing themselves every day, and that should not be interrupted. That should continue through the holidays,” Siddiqui said.
Siddiqui said that this is particularly vital for those who travel during the holidays.
“It’s important to pack all of your medications and pack sufficient supplies so that you don’t run out of medications. Typically, heart failure patients need to weigh themselves every day, so it’s a good idea to take a portable scale with you. Usually, they have very strict instructions in the event of overnight weight change, or if it suddenly goes up over the course of a few days they need to double-up on certain medications. It’s important to keep on top of that even if you’re traveling or even if you’re away from your home base,” Siddiqui said.
Siddiqui noted a close correlation between heart failure and sleep apnea, as well.
“People who have sleep apnea, there’s a close correlation between that and heart failure. These patients have CPAP [continuous positive airway pressure] machines, and because of the burden of travel and carrying this extra machinery around, we recommend that people take everything that they need to take with you, and that’s not just medicines or a scale, but don’t leave your CPAP machine behind. You’re going to come back a week later, and things might be out of control,” Siddiqui said.
Managing stress, particularly during the holiday season, is also very important, Siddiqui said.
“It’s really important going into the holidays to take a pause, step back and understand that stress can certainly precipitate heart failure. Your hormones change, you have an adrenaline surge, your heart pumps harder and gets weaker. It’s really important to manage that stress. I think everybody manages that differently, so exercise is probably universal in heart failure and also in overall cardiovascular health,” Siddiqui said.
Siddiqui said that it is important to “take some time out for yourself and keep the stress level under control.”
“Stress is an important contributor and a precipitant for tipping people into heart failure ... When we see increased admissions to the hospital right after the holiday season, a lot of it has to do with all of these things working in tandem. Stress control is very important,” Siddiqui said.
Vince Austin-Cole, an addictions therapist with AtlantiCare Physician Group Behavioral Health, also noted the increased stress that many experience during the holidays, often from family.
“Family is defined very differently in this day and age, because it has to do with a DNA connection and it has to do with extended family connections where you make choices; you pick people to be your confidante or your pseudo brother or sister or aunt or uncle. These systems have developed themselves over the previous years, based on what families have gone through in transition, where there’s divorce, separation, death, moves, things like that,” Austin-Cole said.
With families, Austin-Cole said, come expectations.
“A lot of the expectations are internalized by the person who is feeling the most pain—and it’s sometimes externally put out there, where a family will actually say, ‘This is what we expect from you’ ... Often, that has to do with who you’re going to spend your time with, which can be stressful. There are marriages where the husband is expected to spend time with his family and the wife is expected to spend time with hers. A lot of times, the two don’t mix well, so there has to be a choice made—and that can be very stressful; who wants to see the grandkids or the nephews or nieces,” Austin-Cole said.
There are other stressors that come with the holiday season, Austin-Cole said.
“There’s expected gift-giving. Even if the family says they’re not doing that this year, or there’s a Secret Santa ... it’s interesting if you don’t really know that person very well, or don’t know what they like or want, that puts stress out there. Then, there’s monetary stress, because you might not have a job that pays very well, but you’re expected to chip in or make a meal,” Austin-Cole said.
Additionally, some overindulge in food and drink as a way to cope with stress.
“We refer to that as emotional eating. All of us have a tendency to want immediate gratification or a quick fix. You have a headache, you take an aspirin. You have a joint ache, you take acetaminophen. We have a tendency to need comfort as quickly as possible,” Austin-Cole said.
Sometimes, Austin-Cole said, food is used as a comfort mechanism because “it feels safe.”
“Sometimes we do that through food because it seems safe. Sweets are always very enticing, and they’re tempting. Beverages with sugar or alcohol can be tempting, and they can give us the impression that we’re soothing ourselves, or make us feel better or feel like we can relate to others in a more comfortable way. We’re always looking for comfort,” Austin-Cole said.
Austin-Cole said that emotional eating is often difficult to manage because it is “very much internal.”
“That internal mechanism, we have to find something that we desire that motivates us ... the internal mechanism has to shift over, and we have to want something different,” Austin-Cole said.
Like Siddiqui, Austin-Cole espoused portion control.
“Allow the taste to be the thing that satisfies, as opposed to the amount,” Austin-Cole said.
Austin-Cole recommended communication as a healthy way to help manage stress.
“In family systems, it’s important to have someone close with you that you can communicate with, someone you can trust. For people who don’t really have a lot of connections—friends, family, extended family—it’s important to reach out to support groups. That might be a time where, if they’re noticing that they’re feeling a certain painful emotion—sadness, loneliness or something that’s bringing them down—that might be a time to reach out to a professional agency where they can establish a relationship with a therapist,” Austin-Cole said.
Austin-Cole said that, because of the novel coronavirus (COVID-19), it is not always possible to join a therapy group. However, some agencies, such as AtlantiCare’s certified community behavioral health clinics, have gone virtual.
“That also has its pitfalls, because you’re required to have access to electronic devices to connect with those groups, and sometimes that can be a challenge. If people are noticing that they’re feeling a certain way and they don’t have someone to reach out to, they should reach out via social media—and I mean non-controversial social media, where they might have things in common. It’s important for people to get in touch with their hobbies, interests and activities that they might enjoy. It might be a time to reach out to people that they don’t know well, which could be neighbors in an apartment building, and they see people in the hallways to actually say hello as opposed to just staying in their silo,” Austin-Cole said.
The holiday season also comes during the return to Eastern Standard Time, which brings with it shorter days, longer nights and colder temperatures.
“Cold weather constricts your blood vessels and makes your heart pump a little harder, so keep warm. A lot of times, people feel very invincible at this time—especially under the influence of alcohol—but it’s important to stay warm. That helps the heart, so it’s not pumping against severely constricted vessels ... Even though the weather gets colder this time of year, keep active. Keep moving, even if it’s small durations for short periods of time. It’s important to keep that going, especially if you have that routine during the course of the year. This is not the right time to stop,” Siddiqui said.
The shorter daylight hours can also have a deleterious effect on stress management, Austin-Cole said.
‘What we try to recommend for people, since there is less daylight, is to try to utilize light in their homes or where they live. Grow lights or daylight bulbs are things that are considered more healthy, because it stimulates the eyes and the emotions. It’s not really great to have a lot of dim light or candlelight or romantic light, or even colored lights, unless that’s something that the person enjoys,” Austin-Cole said.
The lower light, Austin-Cole said, tends to take away the desire to be active, causing people to be more sedentary.
“The problem with that is that we sleep longer or we’re restless for longer periods of time, because we don’t really understand what’s going on or why we feel this way,” Austin-Cole said.
Austin-Cole said that, particularly during the darker months, he encourages people to get involved with social connections, such as family, friends, a support group or an activity group.
“There are ways of locating, online, game night groups, or even setting up game nights with friends, sharing meals together as opposed to eating alone. They can be very simple and they’re not very costly,” Austin-Cole said.
Austin-Cole confirmed that the holiday season often brings with it a rise in stress among patients.
“This is the time of year where people slide backwards a little bit. We refer to that in general terms as ‘relapse,’ even though we use that, generally, in addiction terms. In overall health and well-being, relapse is sliding back to anything that you didn’t want to do in the past, anything that you considered wasn’t what you wanted for yourself, and you’re trying to do something better,” Austin-Cole said.
Austin-Cole also advised to be mindful of changes in mood.
“You could notice that your mood is down, and you’re talking negatively to yourself—and you don’t do anything to change that. That slide backwards gives us room to start working with the person, to help them with their self-esteem, to help them with their self-image, to help them with how they actually see themselves fitting in the world,” Austin-Cole said.
Siddiqui said that, particularly during the holidays, people who feel that they “need to seek medical attention tend to delay it.”
“Always reach out to your provider, and don’t delay seeking care. If the off chance that things get bad during the holiday season, don’t wait until a week or three until you seek medical attention,” Siddiqui said.
For more information, visit atlanticare.org. For those in crisis, call (800) 273-8255.