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Dr. Michael Evans

Well, one more brownie couldn't hurt Add to ...

'Come, woo me, woo me; for now I am in holiday humour and like enough to consent." So said Rosalind in Shakespeare's As You Like It. The festive season is upon us and, for better or worse, we are consenting to a lot of things.

For some, the holiday season is just another few weeks on the calendar. For many, it is all about family and rejoicing. Some view it as a chance to heave off the bonds of normalcy and over-subscribe to hedonistic pleasures. For most of us, it is various combinations of all three.

We self-indulge at Christmas for many good and bad reasons: stress relief, expectations, family roles, seasonal marketing, over-familiar or novel settings, and seeing people we don't usually see, to name a few.

But there is healthy self-indulgence, and there is unhealthy indulgence. Phyllis Diller may have captured the latter group best when she remarked, "What I don't like about office Christmas parties is looking for a job the next day."

A study in the journal Circulation in 2004 delivered a sombre analysis of the effects of the large-scale behavioural changes that go on at the Christmas-New Year's holiday. During this period, the study found, the death rate jumps dramatically - by almost 5 per cent - "for both cardiac and non-cardiac mortality."

The researchers linked the spike in deaths in part to the way millions of people "change their patterns of travelling, eating, drinking, exercising, working and vacationing."

Cold weather, suicides, alcohol, stress and shovelling probably all contribute to the higher death rate. Another reason postulated by the researchers seems to be people delaying treatment. Going to the hospital is not very festive.

For most of us, a little partying is not a life-and-death matter. But you may still feel some pain.

Perhaps the most vulnerable part of our anatomy at Christmas is a small membranous fold that sits above our stomach with a strangely off-putting name: the lower esophageal sphincter (LES). This sphincter acts like a valve to let the food drop down while preventing the acid from coming back up. When it stops working, acid regurgitates up your esophagus, and holiday heartburn ensues.

So what compromises this sphincter and leads to heartburn? Think chocolate, peppermint, fried foods, fatty foods, sugars, coffee, carbonated drinks and alcohol. Sound familiar?

Once heartburn occurs, the back flow of stomach juices can cause the esophagus to become sensitive to other foods such as citrus fruits, tomatoes, spicy foods, garlic and onions. It's not just the holiday food that puts undue pressure on the LES, but other Christmas activities such as cinching belts over expanding waist lines, and frequent bending over and lifting. Naturally, smoking makes it worse, as do medications commonly used during the festive season such as ASA and ibuprofen.

Another common malady of the holiday season that won't kill you, even though it may feel like it will, is a well-known medical condition called veisalgia, otherwise known as a hangover.

I bring up the medical terminology because the definition says it all: The term veisalgia comes from the Norwegian 'kveis', which refers to the uneasiness following debauchery, and 'algia', the Greek term for pain.

I would say this uneasiness is what I see most commonly in the holiday clinic. Not just because of over-imbibing, but because of over-everything. Whether it's overeating, overbuying or oversleeping, it's the overdoing of Christmas that creates a chain reaction of repentance and a desire to make amends - or New Year's resolutions.

The need to purify and resolve to be better is admirable, and certainly goal setting seems a worthy task. But my clinical experience tells me that it doesn't work.

A patient suggested a different approach that resonates for me. Replace the New Year's Resolution List with a New Year's Gratitude List. The best way to improve oneself is paradoxical - start by being grateful for what you already have. This turns your aspirations from the negative (fixing your bad health habits) to the positive (making your healthy behaviours stronger).

Health resolutions that focus on the negative don't seem to work for most in the long run. Maybe this year, think about change in the context of gratitude and what's good in your life, rather than making a list arising from guilt and self-dissatisfaction. What's on your New Year's Gratitude List?

Dr. Michael Evans is an associate professor and physician at the University of Toronto, where he is leading both the Health Media Lab at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Patient Self-Management at the Centre for Effective Practice in Family & Community Medicine.

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