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What is Candida and will healthy eating play a role in the control thereof?

What is candida and what type of symptoms can one experience?

There are many types of fungi living in our body, including yeasts, known as candida. There are small amounts on our skin, intestines, and mouth which in small amounts is normal. When it starts to grow uncontrollably, it is known as candidiasis. Typical symptoms include oral thrush, tiredness and fatigue, recurring urinary tract or genital infections, gut issues (such as cramps, bloating, diarrhea, or constipation), sinus and nail infections, or even joint pain [1].

What factors can lead to an overgrowth of candida?

Healthy or beneficial bacteria in the body helps to control the growth of candida, but when the immune system is weakened or there is a disruption of the healthy bacteria in the body, overproduction of candida can occur. Some factors that can lead to an overgrowth of candida are; taking antibiotics, eating a diet high in sugar and refined carbohydrates, high alcohol intake, a weakened immune system, taking oral contraceptives, diabetes, and high-stress levels [1].

Role of diet and the overgrowth of candida

The food you eat plays an important role in maintaining the beneficial and “bad” bacteria in the gut. Avoid eating a large number of refined carbohydrates, sugary foods and drinks, and high lactose-containing foods and drinks. Candida uses sugar for cellular growth which can lead to an overgrowth of candida and promote the production of other "bad" microorganisms to grow [1].

Gluten can worsen inflammation in the gut, even in people who do not have Celiac Disease. Gluten can worsen the symptoms of candida overgrowth and leave the gut more vulnerable to the overproduction of other "bad" bacteria. Inflammatory foods, such as processed foods, can worsen inflammation in the gut which can also contribute to intestinal permeability [2].

Some changes can be made to help reduce the overgrowth of candida and lower the inflammation in the gut. This includes; avoiding added sugars, eating non-starchy vegetables, use healthy fats which are also rich in omega 3 fatty acids to help reduce inflammation (nuts, seeds, avocado, olives, fish), limit caffeine and alcohol intake, avoid gluten, and include fermented foods [2].

Some foods have been shown to help with candida overgrowth including garlic, coconut and MCT oil, and curcumin. Garlic contains allicin, an antifungal substance, which has been shown to act against candida yeast. Coconut oil is high in lauric acid which has been shown to fight candida infections [1].

Role of probiotics in managing candida

Healthy bacteria in the gut support digestion and absorption of foods and supports a healthy immune system. An overgrowth of candida can put the state of beneficial bacteria out of balance, known as dysbiosis. Probiotics are an effective part of reversing Candida overgrowth because it helps to reintroduce healthy bacteria in the gut. Using a probiotic will help aid in digestion, reduce diarrhea, provide important nutrients such as Vitamin K, Vitamin B, and short-chain fatty acids, strengthen your immune system, and help to maintain gut health [3]. 

Probiotic foods include:

Prebiotics are also important as they are the food for the probiotics. Prebiotics are a form of non-digestible fibers found in foods such as garlic, onions, and artichokes. Because the gut cannot completely break down this type of fiber, it passes through the upper part of the gastrointestinal tract and remains undigested. Then, after reaching the intestines, it is fermented by the microflora in your gut [3].


When candida is left untreated, it can spread to other organs and cause other health problems. When you do experience the symptoms of candida overgrowth, it is best to consult your doctor to receive the necessary treatment. Following a healthy diet rich in fresh vegetables, fresh protein sources, and healthy fats, limiting refined and processed foods, and using probiotics may assist in taking control of candida overgrowth!


  1. Healthline. Kayla McDonell [Internet]. 7 Symptoms of candida overgrowth. Cited 2017 August. Available from: https://www.healthline.com/nutrition/candida-symptoms-treatment#TOC_TITLE_HDR_2
  2. The Candida Diet. Lisa Richards [Internet]. The Candida Diet: An overview. Cited 2019 July 13. Available from: https://www.thecandidadiet.com/candida-diet-overview/
  3. The Candida Diet. Lisa Richards [Internet]. Probiotics for Candida: Sources, benefits & recommendations. Cited 2019 September 22. Available from: https://www.thecandidadiet.com/guide-to-probiotics/

A Keto Cheat day: will it destroy my progress?

To cheat or not to cheat…. Everyone is tempted to have a cheat meal now and then, but will one cheat ruin all the effort you have put in? Having a cheat could be due to several reasons: either you still haven't beat your sugar addiction and you go on a sugar binge, or due to politeness, you don't refuse the piece of birthday cake that was offered to you or you haven't done proper grocery shopping and is left with no plan for dinner except for ordering takeaways. Might there be a way of cheating smarter?

Side effects of cheating

Having a cheat meal high in carbohydrates will bring back hunger and cravings as carbohydrates will cause an increase in ghrelin (hunger hormone) secretion which in turn makes you feel even more hungry, therefore eliminating your attempt to control your appetite. It will also cause immediate weight gain: with extra carbohydrates, a spike in insulin will put you back into a fat-storing mode, increased hunger and cravings from eating more carbohydrates will cause you to have bigger portions, therefore contributing to a high-calorie intake, and water retention associated with a high carbohydrate intake will return [1].

A high carbohydrate intake will also cause blood sugar and insulin spikes which are both negative for diabetics, both type 1 and type 2. For those who would like to reverse type 2 diabetes, the price of having a cheat meal might be too high. For some people, there are immediate effects as well: bloating, flatulence, diarrhea, constipation, seizures (if you have epilepsy), acne, etc. Having regular cheat meals will also not help your efforts in fighting your sugar addiction [1].

Researchers of the University of British Columbia in Okanagan (UCBO) wanted to know what happens when people have a cheat meal, thereby reintroducing an amount of sugar to the body. The study was looking for reduced tolerance to blood sugar or inflammatory responses. Nine young males participated in this study, which appeared in the journal Nutrients. The participants had to follow a 7-day high-fat, low-carbohydrate diet that was similar to the keto diet, consisting of 70 percent fat, 20 percent protein, and 10 percent carbohydrates [2]. 

They also had to consume a 75-gram glucose drink before and after the diet. They found biomarkers in the blood of the participants, suggesting that blood vessels were being damaged by the sudden increase in blood sugar levels. This was alarming since all the participants were healthy young males, and after consuming the glucose drink, the condition of their blood vessels was similar to people with poor cardiovascular health [2].

Cheating without cheating

Looking at those side effects, it might not be worth having a cheat meal loaded with carbohydrates. But you might be able to have an enjoyable treat now and then as part of a low carbohydrate lifestyle. Let's face it, we all like to have a treat now and then, it is human. Of course, we don't encourage cheats, but we can do it in a much smarter way!


It is normal to be tempted, but make sure that when you do cheat, make the best choices that you can. Sometimes it is better to be stricter with yourself and ditch the cheat to reach your goals, whether it is to lose weight, reverse type 2 diabetes or lower the number of seizures you experience per day. Speak to your dietitian about the best way to have a healthier cheat and when is the best timing to introduce a cheat on your journey to a healthier you!


  1. Diet Doctor. Jennifer Calihan [Internet]. A guide to low-carb & keto diet cheating. 2020 December 22. Available from: https://www.dietdoctor.com/low-carb/cheat 
  2. Medical News Today. Chiara Townley [Internet]. Keto diet: a ‘cheat day’ may undo benefits and damage blood vessels. 2019 April 5. Available from: https://www.medicalnewstoday.com/articles/324894

Low carbohydrate, healthy fat diet and other important nutrients for brain health

What does the lipid-heart hypothesis mean? 

The lipid-heart hypothesis refers to the prediction that when replacing saturated fat in the diet with vegetable oil rich in linoleic acid (polyunsaturated omega 6 fatty acids), it will lower the serum cholesterol which will diminish the deposition of the cholesterol wall, therefore slowing down the progression of atherosclerosis, and reduce the number cardiovascular events [1]. 

Evidence regarding the lipid-heart hypothesis 

The lipid-heart hypothesis is supported by evidence from randomized controlled trials that shows that substituting saturated fats with linoleic fats lowers total serum cholesterol and low-density lipoprotein (LDL) and using observational evidence links total serum cholesterol to cardiovascular disease and deaths. Despite these relations, no randomized controlled trial has shown that substitution of saturated fat with linoleic fatty acids significantly lowers cardiovascular disease or deaths [1]. 

The Minnesota Coronary Experiment (MCE), a randomized controlled trial conducted in the years 1968 to 1973, was the largest trial of cholesterol-lowering interventions by substituting saturated fat with vegetable oil rich in linoleic fatty acids. The MCE was designed to evaluate the effects of increasing omega 6 polyunsaturated fat from corn oil in the place of saturated fat on primary and secondary prevention of cardiovascular events and deaths, and for reducing the degree of coronary, aortic, and cerebrovascular atherosclerosis, and the number of myocardial infarcts and strokes detected at autopsy [1]. 

The intervention group (replacement of saturated fat with linoleic fatty acids), showed a significant reduction in total serum cholesterol. The control diet, which increased dietary linoleic acid by 38% but did not alter saturated fat, produced a modest but significant reduction in serum cholesterol compared with baseline. But it showed no mortality benefit in the full MCE population [1]. 

The lipid-heart hypothesis predicts that participants with a greater reduction in serum cholesterol would have a lower risk of death. MCE participants with a greater reduction in serum cholesterol, however, had a higher rather than a lower risk of death. In a previous study, The Sydney Diet Heart Study, the intervention group had an increased risk of death from cardiovascular disease and all causes, despite a significant reduction in serum cholesterol. Although the MCE was successful in lowering serum cholesterol in all subgroups, there was no clinical benefit in any group [1]. 

The MCE intervention group did not have less atherosclerosis or fewer myocardial infarcts (heart attacks) at autopsy [1]. If high serum cholesterol causes atherosclerosis, people with high serum cholesterol should have more atherosclerosis than people with low serum cholesterol. In 1936, Landé and Sperry found that people with low serum cholesterol were just as atherosclerotic as people with high serum cholesterol [2]. The role of triglyceride-rich lipoproteins is increasingly considered as a direct driver of atherosclerosis in diabetic patients, even in those receiving the best standards of care, including the use of statins [3]. 

The MCE also did not show improved survival. The opposite was found. MCE participants who had a greater reduction in serum cholesterol had a higher, rather than lower, risk of death. Meta-analyses of randomized controlled trials that specifically tested substitution of saturated fat with vegetable oil rich in linoleic fatty acids showed no indication of clinical benefit. Thus, collective findings from randomized controlled trials do not provide support for the lipid-heart hypothesis that the serum cholesterol-lowering effects of substituting saturated fat with linoleic fatty acids will lower the risk of cardiovascular disease or death [1]. 


Results of a systematic review and meta-analysis of randomized controlled trials do not provide support for the lipid heart hypothesis. 


  1. Ramsden CE, Zamora D, Majchrzak-Hong S, Faurot KR, Broste SK & Frantz P. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment. BMJ 2016;353:i1246. Available from: http://dx.doi.org/10.1136/bmj.i1246 
  2. Ravnskov U, de Lorgeril M, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, et al. LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature, Expert Review of Clinical Pharmacology. 2018;11(10):959-970. DOI:10.1080/17512433.2018.1519391 
  3. Hermans MP, Valensi P. Elevated triglycerides and low high-density lipoprotein cholesterol level as marker of very high risk in type 2 diabetes. Curr Opin Endocrinol Diabetes Obes. 2018 Apr;25(2):118-129. DOI: 10.1097/MED.0000000000000398

How important is it having a healthy gut microbiome, and could it help control blood sugar levels?


The gut microbiome, as defined by molecular biologist Joshua Lederberg, consists of all the microorganisms in the gastrointestinal tract (GIT). The microorganisms include bacteria, protozoa, viruses, and fungi and their collective genetic material. The gut microbiota consists of all the bacteria, pathogenic and commensal, residing in the GIT. The gut microbiota has been explored for potential interactions between the microbe and host which could affect immunity, metabolism, and neuroendocrine responses. The gut microbiota plays an important role in nutrient and mineral absorption, synthesis of enzymes, vitamins and amino acids, and the production of short-chain fatty acids (SCFAs). [1] 

The fermentation by-products propionate, butyrate, and acetate, are important for gut health and provide energy for epithelial cells, provide immunomodulation and protection against pathogens, and enhance epithelial barrier integrity. The development and alteration of the gut microbiome are affected by a variety of factors including birthing method, infant feeding method, exposure to the environment, stress, diet, medications, comorbid diseases, such as diabetes and obesity, and the stage of the lifecycle. Dysbiosis is described as the alteration in the microbial community that results in decreased numbers and diversity of commensal bacteria. Studies suggest relationships between gut dysbiosis and chronic health conditions such as inflammatory bowel disease, metabolic syndrome, cardiovascular disease, obesity, and cancer. This article will focus on the effect of the gut microbiota on blood sugar control, whether a healthy gut microbiome can help in controlling blood sugar levels and insulin and what foods can help maintain a healthy gut microbiome. [1] 

Effect of the microbiome on gut serotonin production and blood sugar levels 

Australian and Canadian researchers have discovered that certain gut bacteria can directly influence blood sugar levels by promoting the synthesis of gut-derived serotonin. Serotonin is the neurotransmitter that influences feelings of happiness and regulates mood. The molecule has other broad effects across the entire body. Over 90 percent of serotonin produced by the human body is located in the gut. As serotonin is not able to cross the blood-brain barrier, these intestinal secretions are not thought to directly influence our brain. Instead, blood and gut serotonin levels seem to play an important role in our overall metabolic profile. [2] 

In obese people, for example, higher levels of circulating serotonin have been detected than in normal-weight subjects, suggesting that serotonin can influence weight regulation. Using both genetic and pharmacological animal models, the research discovered gut microbiome alterations did result in disruptions to intestinal serotonin synthesis, and these factors could be correlated with improvements in glucose handling. This means that the higher the gut and blood serotonin levels, the worse a body's glucose handling. “We found that the microbiome worsens our metabolism by signaling to cells in the gut that produce serotonin,” says Damien Keating, from Australia’s Flinders University, and corresponding author on the new study. “They drive up serotonin levels, which we previously showed to be increased in obese humans, and this rise in blood serotonin causes significant metabolic problems.” [2] 

The link between gut microbiome and diabetes 

There is good evidence that the gut microbiome plays an important role in glucose metabolism, insulin sensitivity, and overall energy homeostasis. However, researchers have not been able to establish which specific bacteria can be associated with positive metabolic outcomes regarding type 2 diabetes. [3] 

Bacteroides and Bifidobacterium are the two bacterial genera most frequently identified as potentially protective against type 2 diabetes. Ruminococcus, Fusobacterium, and Blautia, on the other hand, are more consistently detected in higher levels in patients with type 2 diabetes. [3] 

The most common combination was with Bifidobacterium, leading the researchers to suspect the microbes may work in a synergistic way to protect against type 2 diabetes. In a recently published study, it is suggested that gut bacteria might be somewhat responsible for the onset of type 2 diabetes and it could be the result of bacteria crossing the intestinal barrier into other tissue in the body. This process is called bacterial translocation. [3] 

André Marette, the lead author of the study found the following: “Our findings suggest that in people suffering from severe obesity, bacteria or fragments of bacteria are associated with the development of Type 2 diabetes. We know that the intestinal barrier is more permeable in obese patients. We hypothesize that living bacteria and bacterial fragments cross this barrier and set off an inflammatory process that ultimately prevents insulin from doing its job, which is to regulate blood glucose levels by acting on metabolic tissues." [3] 

How can you keep your gut microbiome healthy to promote an overall healthier body? 

What you feed your microbiome may have the biggest impact on its health. The healthier your microbiome is, the healthier you are. Nourishing a balance among the nearly 1000 different species of bacteria in your gut is key to a healthy microbiome. There are two ways to maintain this balance: adding living microbes directly to your system (probiotics) and helping the microbes already there to grow by giving them the foods they like (prebiotics). [4] 

Probiotics contain live organisms, usually specific strains of bacteria that directly add to the population of healthy microbes in your gut. You can take probiotics through both food and supplements. The most common probiotic food is yogurt. Yogurt is made by fermenting milk with different bacteria, which are left in the final product. Other bacteria-fermented foods, such as sauerkraut, kimchi, and kombucha, are also good sources of probiotics. [4] 

Prebiotics are specialized plant fibers. They act like fertilizers that stimulate the growth of healthy bacteria in the gut. Prebiotics are found in many vegetables and fruit, especially those that contain complex carbohydrates, such as resistant starch and fiber. These vegetables and fruit include artichokes, garlic, onion, leeks, asparagus, apples, cocoa, and grapefruit. These carbohydrates are not digestible by your body, so they pass through the digestive system to become food for the bacteria and other microbes. [4] 


As discussed above, the gut microbiome has many essential functions in the body and making sure it is healthy is important for overall health. Feeding the healthy bacteria in your gut with pre- and probiotics are essential for positive gut microbiome alterations which could improve glucose handling. A healthy gut microbiome will also help with intestinal barrier integrity. This would prevent bacterial translocation which would help in preventing insulin resistance caused by inflammatory processes. A healthier gut microbiome means a healthier you. Make sure to feed your gut bacteria today! 


  1. Cresci G, Izzo K. Chapter 4: Gut Microbiome. Adult Short Bowel Syndrome. Academic Press; 2019. p.45-54. Available from: https://www.sciencedirect.com/science/article/pii/B9780128143308000044 
  2. New Atlas. Rich Haridy [Internet]. Microbiome found to influence gut serotonin production and blood sugar levels. Cited 2019 September 16. Available from: https://newatlas.com/medical/microbiome-gut-bacteria-serotonin-blood-sugar-metabolism/ 
  3. New Atlas. Rich Haridy [Internet]. Gut microbiome studies reveal new bacterial links with diabetes. Cited 2020 March 10. Available from: https://newatlas.com/science/gut-microbiome-bacteria-diabetes-metastudy-metabolism/ 
  4. Mayo Clinic [Internet]. Prebiotics, probiotics and your health. Cited 2019 May 21. Available from: https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058

Role of omega 3 and 6 long chain fatty acids in weight management and improving lipid profile

Consuming omega 3 and 6 are very important for your health for several different reasons. Both are essential since they are not synthesized by the body and should be obtained from dietary sources. These fatty acids can affect weight gain or weight loss, it has some protective effects in terms of cardiovascular health and also affects your lipid profile (blood panel which screens for abnormalities in lipids such as triglycerides and cholesterol). This article will discuss how omega 3 and 6 affects weight management, the role of these fatty acids in improving the lipid profile as well as where to find dietary omega 3 and how much is necessary. 

1. What is omega 3 and 6?

Omega 3 and 6 are both essential fatty acids since they are not synthesized in the body. Long- chain omega 6 fatty acids include arachidonic acid, linoleic and gamma-linolenic acids. Omega 3 fatty acids include the long-chain alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The Western diet is mostly rich in omega 6 fatty acids due to the use of sunflower and safflower oil. Only a small amount of omega 3 is obtained from foods such as fatty fish and plant oil products [1]. 

Omega 6 and 3 are used by cell membranes for gene expression, protein function and cellular signaling. Omega 3 competes with omega 6 for uptake into cell membranes. When omega 6 are used by cells, pro-inflammatory markers are released such as leukotrienes, thromboxane and prostaglandins (increasing inflammation), whereas omega 3 is anti-inflammatory (decreases inflammation) [1]. 

2. Role of inflammation in weight management

A study done by Ramallal et al, assessed the association between yearly weight changes and the inflammatory potential of a diet using the dietary inflammatory index (DII). Seven thousand and twenty-seven university graduates with body mass index lower than 25 were followed up over 8.1 years where 1433 incident cases of overweight or obesity were observed. The study showed that following a pro-inflammatory diet (meaning rich in omega 6 fatty acids) was associated with an increased annual weight gain compared to an anti-inflammatory diet [2]. 

3. Role of omega 3 as a cardio protective fatty acid

Omega 3 also has the following cardio protective effects: reduces triglyceride levels, reduces non-HDL (high-density lipoprotein) levels and increases HDL (high-density lipoprotein), there for improving the lipid profile, reduces plaque in arteries, lowers systolic and diastolic blood pressure and improves endothelial function [1]. 

A study done by Zibaeenezhad et al, compared the effect of a certain diet on the lipid profile of two groups of people (106 patients) with hyperlipidemia. One group received 250 g trout fish twice per week (for dinner and lunch) for a period of 8 weeks and the other group received 2 g/day of omega-3 capsules for the same time period [3]. 

In both groups, triglyceride levels, total cholesterol, non-HDL cholesterol and total cholesterol/HDL ratio were reduced significantly following the treatment. However, the intake of dietary-fish had a more pronounced effect. HDL levels were increased in both groups with a higher effect in the group consuming dietary fish. LDL levels were increased in the supplementation group, while it was significantly reduced in the group consuming dietary fish [3]. 

The American Heart Association recommends the omega 3 docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) for patients with hypertriglyceridemia (excessive amounts of triglycerides in blood) and cardiovascular disease. Risk factors for cardiovascular disease are specifically high triglyceride level, low HDL and high non-HDL levels [1]. 

Dietary intervention for increased omega 3 intake

Adequate intakes for omega 3 

Gram omega 3 

Food item 

Serving size 

Omega 3 content (g) 

Females older than 19 years 





Males older than 19 years 


Tuna (canned in water) 



Breastfeeding women 


Spinach, cooked 



Breastfeeding women 





Pregnant women 


Pumpkin seeds 



Pregnant women 


Chia seeds 

1 Tbsp 


The table summarizes the adequate intake for omega 3. The recommendation for omega 3 is higher in women that are pregnant or breastfeeding. The table above also shows some foods with a high omega 3 content. Fatty fish and plant oil products contains the most omega 3 [4]. 


Following a diet with food sources rich in omega 3 helps to improve your lipid profile by lowering triglyceride and non-HDL levels. Omega 3 also has anti-inflammatory effects which has been shown to lower the risk for annual weight gain compared to pro-inflammatory diets. Omega 3 also lowers the risk of cardiovascular disease by providing cardio protective effects. 


  1. Bradberry C & Hilleman DE. Overview of omega-3 fatty acid therapies. Pharmacy and Therapeutics. 2013; 38(11):681-691. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3875260/ 
  2. Ramallal R, Toledo E, Martínez JA, Shivappa N, Hébert JR, Martínez-González, and Ruiz-Canela M. Inflammatory Potential of Diet, Weight Gain, and Incidence of Overweight/Obesity: The SUN Cohort. Obesity. 2017; 25:997–1005. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28544794 
  3. Zibaeenezhad MJ, Ghavipisheh M, Attar A and Aslani A. Comparison of the effect of omega-3 supplements and fresh fish on lipid profile: a randomized, open-labeled trial. Nutrition and Diabetes. 2017; 7:1. Available from: https://www.nature.com/articles/s41387-017-0007-8 
  4. Mahan LK, Escott-Stump S., Raymond JL. Krause’s food and the nutrition care process. 13th ed. St Louis: Elsevier Saunders; 2012.

Effect of alcohol ingestion on ketosis and weight management

When we start with our new ketogenic journeys, we can easily remove alcoholic drinks from our daily intakes. But after a few social events, we start missing the glass of wine in our hands around the fire. We do believe that finding a balance between healthy eating and still enjoying life is crucial. In this article, we would like to express whether alcohol consumption can form a healthy part of your lifestyle and if yes, how to achieve this. 

Alcohol is not an essential macronutrient, but it does contribute to energy consumption. There are 7 calories (29 kilojoules) in 1 gram of alcohol. Alcohol can be seen as empty calories, as it contains no protein, fiber, vitamins or minerals. While alcohol intake in moderation can help to increase HDL (good) cholesterol levels as well as reduce your risk of coronary heart disease, excessive alcohol intake might cause nutritional deficiencies and effect weight loss attempts [1]. 

1. How does alcohol affect ketosis and weight loss? 

If you follow a ketogenic diet, your body metabolizes fat stores as a form of energy due to depleted glycogen (glucose stored in the liver). When you ingest alcohol, the liver prioritizes alcohol metabolism above fat metabolism. This means that fatty acid oxidation (the process of creating ketones) is slowed until all the alcohol has been processed. Due to decreased fat metabolism and increased ingestion of total energy caused by the ingestion of alcohol, weight loss is reduced [2]. 

2. How does the ketogenic diet affect alcohol tolerance? 

Carbohydrates (such as pasta, pizza, crisps, bread, etc.) reduce blood alcohol levels by slowing down alcohol metabolism because carbohydrates are broken down into glucose (then stored as glycogen in the liver) which gets processed first. When you follow a ketogenic diet, there is a limited amount of glycogen within the liver which means that alcohol is processed much faster [2]. 

Carbohydrates cause water retention whereas decreased carbohydrate intake, such as on the ketogenic diet, causes increased fluid and electrolyte losses. Because alcohol is processed faster and water is retained less, you might find that you feel intoxicated much faster. A typical hangover, but only sooner than anticipated [3]. 

3. What better choices can I make when consuming alcohol when following a ketogenic lifestyle? 

The table below compares different types of alcohol (spirits and beer) mixed with normal mixers, water or sugar-free drinks. Women should limit alcohol intake to one drink and men two. One drink counts as 30ml spirits (such as gin, whiskey, rum or vodka), 330ml beer or 125ml wine. 


    1. Toffoloa MCF, de Aguiar-Nemera AS, da Silva-Fonsecab VA. Alcohol: Effects on nutritional status, lipid profile and blood pressure. J Endocrinol Metab. 2012; 2(6):205-211. Available from: https://www.researchgate.net/publication/267642672 Alcohol Effects on Nutritional Status Lipid Profile and Blood Pressure doi: 10.4021/jem128e
    2. Bulletproof blog. Jessica Digiacinto [Internet]. Your guide to keto & alcohol – will drinking kick you out of ketosis? Available from: https://blog.bulletproof.com/keto-alcohol-guide/
    3. Perfect keto. Devan Ciccarelli [Internet]. Keto diet and alcohol: The best and worst drinks to choose. Available from: https://perfectketo.com/keto-diet-alcohol-rules/
    4. Noor NM, Basavaraju K, Sharpstone, D. Alcoholic ketoacidosis: a case report and review of the literature. Oxford Medical Case Reports. 2016:31–33. Available from: https://www.researchgate.net/publication/297596484 Alcoholic ketoacidosis A case report and review of the literature doi: 10.1093/omcr/omw006
    5. Livestrong.com. Stephen Christensen [Internet]. Vitamins depleted by alcohol. Available from: https://www.livestrong.com/article/415965-vitamins-depleted-by-alcohol/

Non-nutritive sweeteners and its effect on metabolism

When starting with your new low carbohydrate, healthy fat lifestyle, we might initially struggle to leave the sweet-tasting foods behind. Sometimes you imagine gulping down a bottle of cooldrink when actually it is just your plain third bottle of water. When doing grocery shopping you find these colorful labels marketing that it is sugar-free and is often available from cooldrinks, chocolates, etc. and you might think “What? Yes, take everything, it is sugar-free after all!”. It seems like it should be fine consuming all these sweetened foods and beverages, but is it really? It is important to have a look at the different types of sweeteners and what they can do to the body. 

Types of sweeteners and sugar substitutes 

Products that contain sweeteners are mostly sugar-free candy, chocolates, gum and cooldrinks. Look out for names such as Stevia, Sucralose, Xylitol, Isomalt, Erythritol, Sorbitol, Aspartame and Acesulfame K. Three sweeteners considered safe when following a low carbohydrate, healthy fat lifestyle, are Stevia, Erythritol, and Sucralose (but only in moderation and if well-tolerated). 

Many products contain Stevia, a natural sweetener made of the plant called Stevia rebaudiana [1]. It’s considered a non-nutritive sweetener, which means that it contains little to no calories or carbohydrates [2]. 

Erythritol is made by fermenting a variety of glucose with the natural microorganism Moniliella pollinis. Its sweetness comes from non-digestible carbohydrates similar to those that you would find in fruit. Your body can’t absorb these, which is why they don’t have any adverse effects on your gastrointestinal system [1]. 

Sucralose is an artificial sweetener that is not metabolized in the body, meaning it passes through your body undigested and thus does not provide any calories or carbohydrates. Some studies have found that sucralose could produce harmful compounds when exposed to high temperatures and is therefore not suitable for cooking purposes [2]. 

Even though most of the sweeteners are low in carbohydrates, they contain chemicals that might increase blood sugar and insulin levels, the exact opposite of what you want when trying to stay in ketosis and reverse insulin resistance. The sudden increase in blood sugar and insulin levels can worsen sugar cravings, making it harder to stick to your low carbohydrate lifestyle [1]. 

Here is a few sugar substitutes that you want to avoid completely when following a low carbohydrate lifestyle: white sugar (including powdered or confectioner’s sugar), all varieties of honey, maple syrup, high fructose corn syrup, golden syrup, coconut palm sugar, coconut sugar, brown sugar, aspartame and sugar alcohols [1]. 

Sugar alcohols like xylitol, glycerol, sorbitol, and mannitol might seem like a good replacement for sugar, but they are not created equal. Some sugar alcohols can take your body out of ketosis and can cause cravings. Sugar alcohols (polyols) are a natural sugar found in many foods, for example, fruits, and are used to sweeten “sugar-free foods”. When compared to regular sugar, some have the same amount of calories and carbohydrates as sugar [1]. 

Another concern of sugar alcohols is the effect on the gastrointestinal system. Xylitol has been associated with digestive problems such as abdominal cramps, nausea, and diarrhoea when used in large quantities, so it might be a good idea to start with a small quantity and increase when well tolerated. The use of xylitol should be stopped when any adverse effects are experienced [2]. 

Metabolic effects of sugar and sweeteners on the body

Blood sugar and insulin levels

When we consume sugar, it moves from the gastrointestinal system into the bloodstream, causing our blood sugar levels to rise. The pancreas secretes hormones, such as insulin, into the blood to help regulate our blood sugar levels. Certain studies suggest that some artificial sweeteners may impact blood glucose levels, or/and insulin levels. Thus, when following a low-carbohydrate lifestyle to lower insulin resistance, a high intake of sweeteners can counteract these efforts. For example, a study conducted in 2016 showed that the consumption of artificially sweetened beverages on a daily basis by pregnant mothers was associated with a 2-fold higher risk of infants being overweight at 1 year of age [3]. 

Gut microbiota

The gut microbiota (microorganisms in our digestive system) help break down the food we eat. The gut microbiota reacts differently to artificial sweeteners compared to real sugar. These microorganisms become less able to break down real sugars the more that they are exposed to artificial sweeteners. When the microbiota is not able to break down sugars efficiently, it can affect the amount of nutrients we are able to absorb from the foods that we eat, leading to vitamin and mineral deficiencies even when eating the correct foods [4]. 

Receptors in brain “tasting” sweetness

Even though our brains and bodies process real and artificial sugars in a different way, the sweetness of any kind increases the brain’s tolerance and desire for sweetness. This simply means that the more sweet things we consume, the more you will have to eat in order for your brain to know that something is sweet. Craving sugar because the brain has become tolerant of sweetness is an unwanted symptom that can lead to overconsumption, which can then lead to unintended weight gain [4]. 


Although it might seem like a good idea to consume sweetener-containing products rather than regular sugar, it might have adverse effects on your insulin sensitivity, the ability to efficiently absorb nutrients from the gut as well as causing tolerance to sweetness as perceived by the brain. For this reason, sweeteners should be used in moderation and only if tolerated by the body. Instead of replacing the usual starchy foods like bread and biscuits with a “sugar-free” option, forget about the need for starches and focus on eating natural fresh whole foods! 


  1. The Keto Summit. Louis Hendon [Internet]. Is Erythritol Keto? Available from: https://ketosummit.com/keto-sugars/ 
  2. Healthline. Rachael Link [Internet]. The 6 Best Sweeteners on a Low-Carb Keto Diet (And 6 to Avoid) Available from: https://www.healthline.com/nutrition/keto-sweeteners 
  3. Jane Shearer. Artificially sweetened taste of insulin resistance? NRC Research Press. 2019. Available from: https://www.nrcresearchpress.com/doi/pdfplus/10.1139/apnm-2016-0294 
  4. Frontiers for Young Minds. Michael Hout [Internet]. Trick or Treat? How Artificial Sweeteners Affect the Brain and Body. 2019. Available from: https://kids.frontiersin.org/article/10.3389/frym.2019.00051

Dietary management in Hirschsprung’s disease after total colectomy

Hirschsprung’s disease is a rare motor disorder of the gastrointestinal system that affects children as well as adults. The disease can cause complications that have to be managed. This article includes a brief overview of what Hirschsprung’s disease is, signs and symptoms and the treatment for the disease. The article also includes functions of the colon as well as dietary management after a colectomy as the treatment for Hirschsprung’s disease specifically in adults. 

1. Overview of the disease
1.1 What is Hirschsprung’s disease?
Hirschsprung’s Disease is characterized by the decreased number of neurons found in the distal colon. This is the result of decreased migration of neural crest cells during fetal development to the colon. These nerve cells aid as a signal for the muscles in the colon to contract to move the stool towards the anus. Without these nerves, stool doesn’t move through the colon. Hirschsprung’s disease is usually diagnosed during childhood before the age of five years, but can also be diagnosed at a later stage during adulthood. The severity of the disease depends on the length of the large intestine that lacks these nerve cells. 

1.2 Signs and symptoms of the disease
Patients present with constipation, abdominal distention (swelling of the abdomen), intestinal obstruction or abdominal pain. Constipation occurs when there is fewer bowel movements and stools can be very difficult to pass. When no stools can be passed, intestinal obstruction or blockage may occur. Other symptoms include flatulence, diarrhoea that contains blood or anaemia (lack of red blood cells). Hirschsprung’s disease is diagnosed based on the presence of clinical symptoms as well as tests. Tests include an x-ray, manometry or a biopsy. When an x-ray is performed, signs of a dilated colon can be seen or even a dilated colon with impacted stool. This means that a part of the large intestine will look narrower than normal and before this part, the large intestine will bulge. This is where the stool blocks the intestine. During Manometry, the doctor will place a balloon within the rectum and inflate the balloon. Usually, the muscles relax, but if this fails to happen, it may be an indicator of Hirschsprung’s disease. The doctor may also perform a biopsy where a piece of the intestine is inspected under a microscope. If there is a lack of nerve cells, it may be Hirschsprung’s disease. 

1.3 Treatment of the disease
Surgery is recommended in adult patients. These surgeries are extremely complicated due to the fact that the walls of the colon, sigmoid or rectum are thickened. The affected part of the colon can be removed and the two parts are then joined together, or the whole colon can be removed (total colectomy). 

2. Functions of the colon in vitamin and mineral absorption
Bacteria in the colon digest small quantities of fibre. Due to this bacterial activity, small amounts of thiamin (vitamin B1), riboflavin (vitamin B1), vitamin B12, biotin, and vitamin K are formed. Although these vitamins are formed in extremely small quantities in the colon during bacterial activity, it is not absorbed in the colon but in the small intestine. The main function of the colon is to absorb water, potassium, sodium and vitamin K. Potassium is required to maintain a normal water balance together with sodium, it plays a role in neuromuscular activity as well as maintaining a normal pH balance. Sodium regulates extracellular and plasma volume, it also plays a role in the neuromuscular function and maintains the acid-base balance. Vitamin K is required for blood clotting, bone formation and regulation of certain enzyme systems. 

3. Dietary management after removal of the colon (colectomy)
The most important part is to increase fluid intake, especially water, to prevent dehydration due to the fact that water is not reabsorbed and is lost through faeces. Other nutrients as discussed below should also be taken in larger quantities due to faecal losses. Potassium can be found in fruits, starchy vegetables, non-starchy vegetables and dairy products such as avocado, cantaloupe, mango, papaya, kiwi, cabbage, spinach, tomato, sweet potatoes, pumpkin, cooked mushrooms, and yoghurt. Sodium can be consumed by using iodized salt when cooking. Vitamin K is found mostly in dark green leafy vegetables such as spinach, broccoli, cabbage, green beans, and cucumber. Any fried foods should be avoided for example doughnuts and deep-fried meats. High sugar-containing beverages, as well as foods (cakes, biscuits, sweets, chocolates, etc.), should be avoided as this may worsen diarrhoea and thus fluid and electrolyte losses. Consumption of sugar-free drinks and sweets should also be avoided since sugar substitutes used may worsen diarrhoea and cause abdominal discomfort. When the patient has a stoma (an opening from the intestines towards the skin), special care should be taken when consuming certain foods. Some foods may cause unpleasant odours and should be avoided: onions, garlic, eggs, cabbage, fish, asparagus and broccoli. Gas-forming foods should also be avoided since it can cause the pouch covering the stoma to enlarge causing some discomfort and can also cause dislodgement of the pouch in extreme cases. These foods, for example, are onions, legumes, cabbage, broccoli, and cauliflower. Foods that may obstruct the stoma should be avoided such as apple peels, whole nuts, large seeds, pineapple, mushrooms, and corn. 

As discussed above, Hirschsprung’s disease is a rare disorder but affects children and adults. The disease can be managed by making suitable dietary changes to manage symptoms, or the patient’s diet can be altered to suit the surgery performed as a treatment for Hirschsprung's disease. 


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