Thanksgiving kicks off the season of holiday get-togethers, but for vulnerable guests, visits with family can pose an unhealthy risk. Whether it's severe food allergies or fragile sobriety, toxic relatives or family food pushers, experts sort out whether staying put is your best option and how to get through the holidays whole.
Food Allergies: Potluck Peril
When certain foods trigger severe allergic reactions, prevention trumps holiday togetherness. "When you deal with big tables of desserts and everything else that people have brought in, for a lot of people, those food allergies could literally be land mines," says Dr. Howard Mell, an assistant professor of emergency medicine at Wake Forest Baptist Medical Center.
Mell speaks from personal experience: His 10-year-daughter is allergic to tree nuts and peanuts, "with true anaphylaxis," a potentially life-threatening reaction. She was diagnosed two years ago, and everyone in the household knows how to use an EpiPen.
Thanksgiving stuffing made by well-meaning relatives or brownies prepared nut-free might not be as benign as they seem, Mell warns. "Without being able to control all the cooking that goes on, and doing so to be assured that people are cooking in kitchens free of cross-contamination – it becomes a real challenge."
Homemade stuffing prepared with commercially baked bread could be contaminated from whole-grain nut breads baked in that factory. Similarly, Mell says, those seemingly safe brownies might have come into contact with residual nutty oil on a mixer blade.
"It's unbelievable how cautious you need to be," Mell says. "And for a lot of people whose extended families may not understand, it becomes easier to stay at home." Potlucks are too risky, he says: "There are too many variables, and the stakes are just too high."
Even so, Mell's family will be traveling this year to a join a family gathering for a traditional Thanksgiving dinner. "We'll have all the things you'd normally have – it's just that my wife will oversee the preparation. It won't be a potluck." The extended family is on board with a new tradition and will spend the day scrubbing all kitchen surfaces.
On a professional note, Mell emphasizes that the emergency department is always open 24/7, holidays included. "If you're having an allergic reaction, take your treatment and please come in. We're here for you, we're open and we want to help," he says.
Toxic Family? Try Portion Control
When holiday visits plunge you into a downward spiral of unresolved issues and angst, how do you know it's time to stay home? "It's different for everyone, but basically when the bad outweighs the good," says Anita Gadhia-Smith, a psychotherapist who practices in the District of Columbia and Bethesda, Maryland. "If it's too emotionally destabilizing for the person. If their families are abusive. If the family is extremely toxic."
Anxiety and depression spikes could signal that a holiday visit home may be harmful. To those who feel remorse about not going home, Gadhia-Smith says, "Guilt passes. Sometimes people take a time out [and] they'll get stronger."
If you choose to attend, "the first line of defense is portion control," Gadhia-Smith says. She's talking about socializing, not turkey and trimmings. "I personally recommend to my patients, if they're having problems with their family of origin, to go for no more than four hours at a stretch without a break." Booking a hotel room can help. "Doing what works for you can actually enhance the family visit," she says.
Bringing along a supportive partner or friend "can make all the difference in the world," Gadhia-Smith adds. Hosts and guests are more likely to be on their best behavior to avoid ancient family dynamics that could otherwise erupt. "Adding another person in the equation can make a big difference and change the energy in the group," she says.
You're a newly recovering alcoholic, and you're afraid holiday festivities could derail your efforts to stay sober. When circumstances are likely to lead to a lapse or relapse, it's better to stay home, says Dr. Eric Collins, an addiction psychiatrist and physician-in-chief at Silver Hill Hospital in New Canaan, Connecticut.
While other, active alcoholics or drug users, or nonsupportive family members can threaten sobriety at any time, "the holidays are times when the alcohol flows more readily," Collins says. "If it's a very young person in recovery, the night before Thanksgiving is when virtually everyone's home from college or wherever they've been away." That can mean running into friends a person used to get drunk or high with, upping the risk of relapse.
Usually, holiday hosts and guests are supportive, Collins says: "Most of the time, by the time somebody is struggling with alcohol problems – has decided he or she should stop drinking – the family is way ahead of them." If families are willing to go the extra mile and host a "dry" celebration, that helps.
For those in early recovery, practicing with a therapist ways to refuse extended hospitality or turn down "just one drink" can be useful, Collins says. So can bringing along a party wingman to help people say no.
"Millions of people get through the holidays without relapsing," Collins says. "It's possible. And all the millions of people who have maintained sobriety for a long time all went through their first holiday season and subsequent ones. It's doable. It's really a function of getting the help one needs from a therapist, a substance use counselor, an AA sponsor and family and loved ones and friends."
You're eating healthy, watching your weight and making progress, but Thanksgiving treats are sotempting. Should you shelter in the safety of your own kitchen, packed with diet-friendly foods? "It's hard for me to tell someone not to go home for the holidays," says registered dietitian Keri Gans, an author and U.S. News Eat + Run blogger. "However, if indeed it causes them extreme stress around mealtimes, then it's something to strongly consider."
It's stressful for people trying to lose weight among a non-supportive family, Gans says, or a family full of food pushers. "Or the family is questioning and bombarding them: 'Why aren't you eating this?'" she says. "And making them feel uncomfortable with their food choices. Mealtime should not be a time that anybody should feel uncomfortable."
With all the high-calorie Thanksgiving options, Gans advises portion control. "Whatever you can fit – not pile on – put a portion on your plate. So there's room for turkey, a little stuffing. There's room for mashed potatoes and hopefully a vegetable. When you think about it, that's really all the room your plate holds."
And skip seconds, she adds. Same with dessert: "Yes, maybe there's a pecan pie, an apple pie," she says. "But choose one dessert and be done with it. So you can feel that you've enjoyed the holiday and the meal and the dishes it provides, but also feel proud of yourself for not overdoing it."
Gans also recommends a relaxed attitude, at least for the short term: "It's just a single day. Eat what you want and don't worry about it. But don't come home with leftovers." Sometimes people fall short, though, and Thanksgiving Day turns into a long weekend of sumptuous meals, leftover snacks and follow-up feasts. The trick, Gans says, isn't eating less to make up for holiday indulgence when you return, but getting right back into your healthy routines. "Gradually you'll get back in sync," she says.
Think of it like a weekend in Vegas, she suggests: "What goes on at Thanksgiving stays at Thanksgiving."
Should You Skip The Holiday Family Visit? was originally published on U.S. News & World Report.
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