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 Sugar: to eat or not to eat? 

It’s a common dilemma. Excess sugar consumption over last decades has made this substance our number one health enemy. Even if you don’t eat sweets, you are probably exposed to more sugar than you realize. There is also some confusion around sugars. Some say sugars are healthy, others that they are not. Some say we need them whereas others say we don’t. Sugar substances have many faces as they come in natural and artificial forms. Apart from shared sweetness they may have various properties such as calorie high and calorie free. Sugar substances can also exert various effects on our body including blood glucose swings, inflammation, dysregulation of hormonal system and gut microbiome. Their effect is also dose-dependent and sugar type-dependent.

Sugars belong to carbohydrates, compounds constructed from carbon, oxygen and hydrogen atoms. Carbohydrates comprise of simple carbohydrates and complex carbohydrates. Simple carbs often refer mostly to sugars and act as quick-burning fuels because they elevate blood sugar quickly and therefore you want to eat less of this type. Complex quality carbs are broken down in a steadier manner with a less dramatic effect on blood sugar, and therefore considered a better choice.

I am not extreme to the point where we all need to be a on a sugar-free regimen. My goal is rather to educate so you avoid Excess Sugars, unhealthy sugars, have overall healthy carbs and feel guilt-free if you have a cake once in a while. It’s all about balance and moderation. To my opinion, more than exclusion of certain macronutrients like carbs – is a skill of balancing macronutrients and having the right proportions on your plate.

Sugar reality check

To give an example, 1 teaspoon of table sugar equals about 4 grams of sugar. Some popular “health” foods such as fruit yoghurts typically contain 3 - 8 teaspoons of sugar, granola between 3 – 6 teaspoons, protein bars between 3 to 6 teaspoons, orange juice between 4 to 6 teaspoons, and the list goes on.

Now, if you have what’s commonly considered a “healthy” breakfast consisting of fruit yoghurt with granola, a french toast and a glass of orange juice, guess what? You are set for a morning sugar bomb, 15 – 30 teaspoons of sugar (60 – 120 grams) to start a day!

Now, let’s look at how much glucose circulates in your bloodstream, do you know? There is about 8 grams of glucose (2 teaspoons) circulating in your bloodstream. So, what happens with all the sugar if you consume 60 – 120 grams of it for breakfast only? You wish it disappears, right? But it does not.  It needs to be burned off or stored. There is however only a certain amount you can burn, the rest will be stored: first as glycogen in your liver and muscles and then, all over the body as fat. Moreover, excess sugar wreaks havoc your health, your hormones get out of balance, your cardiovascular system and various tissues get inflamed, your gut health gets under fire, your sleep is disrupted, your brain outperforms.

RED FLAGS: worth to realize is that when you frequently FEEL MORE TIRED, or MORE ENERGETIC (or both at times) after your meals, it suggests that your blood sugar is imbalanced. In the past, oftentimes after my meals (with plenty of pasta, rice or potatoes and little veggies) I had a dip and felt like going to bed or I was having sugar cravings. I did not know why, now I know it was due to a blood sugar imbalance. Right now, I do not experience that because I pay attention to what I eat and to the proportions of different food groups. My blood sugar is stable and energy steady throughout the day, simply by balancing the proportions. If I could change it, so you do!

Check my blog on insulin resistance and hypoglycemia to learn more.

Dose matters

As with many substances, small quantities can be quite safe whereas large quantities lethal, think of alcohol, drugs, medicines, certain foods and herbs. It’s quite similar with sugar too. Sugar is toxic at the certain dose. It’s not a secret that long-term excess sugar consumption is killing us slowly. Be sugar smart and mind your sugar dose!

Tip: If you want to stay on a save side, reduce your sugar intake to minimum. Stay away from any foods and drinks with over 4-6 grams of sugar per serving and any foods & drinks listing sugar (including all fancy sugar names) as one of the first 3 ingredients on food and drink labels.

Also, don’t get tricked by thinking that:

  • Coconut sugar or date sugar is a healthy alternative to high-fructose corn syrup and table sugar. It may sound healthy but your body will recognize it and process it as sugar.
  • Sugar is just empty calories so it’s ok – no, it’s more than that. Excess sugar causes inflammation, insulin resistance, diabetes, heart problems, hormonal issues, GI issues, cancer.
  • Replacing sugary drinks with “diet” or “sugar free” drinks is a better alternative. Both are harmful for you.

The bitter-sweetness of Artificial Sweeteners

The food industry, in order to find a “solution” to side effects such as risk of insulin resistance and diabetes of sugar consumption due to its high glycemic index, high glycemic load and high calorie load, came up with what might seem like a “magic” answer – artificial sweeteners. You may have heard of artificial sweeteners such as aspartame, saccharin, sucralose and acesulfame. Artificial sweeteners brought to the table the sweetness, stable blood glucose levels and few or no calories. What else can you ask for, one might think? Seems like a perfect solution. Yet, not quite. They are often hidden in “sugar free” - “diet” drinks. There are studies showing that the frequent consumption of artificial sweeteners can increase the risk of heart disease, diabetes, weight gain, can disrupt the gut microbiome and promote glucose intolerance. On the top of it, intake of artificial sweeteners tricks our brain to consume even more by dysregulating hunger and satiety feeling. When you drink a calorie free “diet coke” which is sweet, your brain will be confused as to why this “sweet drink” is calorie free. In nature, our physiology is trained to associate sweet foods and drinks with calories. So what may happen when it’s sweet but contains no or little calories – our body may ask for more sweets and drinks to correct this imbalance! It’s a dangerous zone. Cutting calories in this way might create a vicious cycle, is harmful and still keeps you hooked by sweetness. Artificial sweeteners and sugar make you crave sweetness, they alter your brain chemistry and metabolism.

Remember: if you are craving sweet foods and drinks – it indicates your blood sugar is off balance.  

“Free Sugars” trap

You probably came across a term “FREE SUGARS” and you might be confused as to what exactly it refers to. Free sugars refer to any sugars added to a food. It includes natural and industrial sugars and the “free sugars” list is quite long. The common ones include table sugar, glucose-fructose corn syrup, agave, honey, maple syrup, brown rice syrup, date sugar, glucose, grape sugar, fruit juice, caramel, carob syrup, coconut sugar, maltodextrin, dextrose, dextran, maltose. Your body does not need these free sugars to be added to your foods and the industry adds it to most foods and drinks they manufacture. We are being chronically overdosed with free sugars. In the pre-agriculture times sugar wasn’t common, people ate it seasonally and occasionally from fruits and honey.

Watch out for sugar alcohols

Sugar alcohols are sweet and are naturally present in fruits and vegetables. It inspired the food industry to use them as sweeteners. They are added to sweets, confectionary products, chewing gums, medicines, dietary supplements, and tooth pastes. They have different chemical structure than sugars and they are usually less sweet than artificial sweeteners. Similarly to artificial sweeteners they don’t influence blood glucose levels but they have calories, only less than sugar. They became quite popular and are commonly recommended instead of sugar or artificial sweeteners. The most common sugar alcohols include mannitol, xylitol, sorbitol, maltitol. You can easily spot them by reading food labels because their names end with suffix “-ol”. Commonly one of the problems with sugar alcohols is that we don’t absorb them very well (except erythritol). As a result, they can cause gastrointestinal discomfort including diarrhea, flatulence, and bloating. Sugar alcohols can be partly metabolized by your gut microbes, so if eaten in excess they can alter your gut microbiome. Again and again, because they are sweet – they keep you craving sweetness and sugar. If you consume them in quantities as present in real foods such as in fruits and vegetables you probably will not have any problems. If you consume unnatural quantities however, by adding few spoons of xylitol to your every drink or food, your body will protest and manifest it one way or the other. The best is to keep sugar alcohols consumption to minimum.

Let’s give a little bit attention to stevia, it became quite popular as a sugar substitute over past years. Stevia corresponds to Stevia rebaudiana plant which contains steviol glycosides (Rebaudioside A) responsible for the sweet taste. Steviol glycosides derived from stevia are naturally low in calories and do not raise blood sugar levels when consumed. There is however some controversy and probable safety issues around the use of stevia plant extracts, high-quality purified steviol glycosides (Rebaudioside A) are considered generally safe for use in food. If you use stevia, make sure you know what you buy and use as “stevia”: plant extract or purified steviol glycosides and always use it sparingly.

How our body reacts to carbohydrates?

One of the main reasons, sugars gained so much negative attention is because they can mass up with our blood glucose levels, oftentimes consequently leading to insulin resistance and diabetes type 2. It happens when we over consume sugars. Our body constantly thrives to maintain normal blood glucose concentration by removing glucose from the blood (for example after sugar ingestion) or by returning glucose to the blood (when blood glucose level is too low) from cells and tissues. What we eat, at what quantity and how often can impact blood glucose levels. Simple sugars like glucose and complex sugars like starches which are easily digestible to glucose, can impact blood glucose levels the most. Insulin is responsible than for lowering the blood glucose levels, it drives the cellular uptake of glucose so if you eat a lot glucose and/or starch your body will produce more insulin accordingly, at least at the beginning. Long term overconsumption of foods rich in glucose and starch can alter your hormones and disrupt many physiological processes resulting in health problems including insulin resistance, inflammation, weight gain, depression, dementia, cancer, skin issues to name a few. This vicious sugar cycle makes you crave even more sugar.

Did you know that (white) bread, rice, pastas, corn flakes and flour-based products are rich in starch? To know what effect certain foods, have on our blood glucose levels, scientists came up with the terms of glycemic index (GI) and glycemic load (GL). Glycemic index tells you how ingested carbohydrates (from various foods) impact your blood glucose levels, which may be influenced by your capability to digest and absorb (glycemic response to the food). For example, high-GI foods (white bread, mashed potatoes) that are rapidly digested and absorbed cause a quick raise in blood glucose levels whereas low-GI foods (leafy greens) which are not rapidly digested and absorbed will cause a much lower peak in blood glucose levels, keeping it stable. Glycemic load considers the quantity and the quality of the carbohydrate in a food, it is the glycemic index times the grams of carbohydrates on a given amount of the food. Therefore, one food’s GI and GL can differ as in case of carrots. The carbohydrates in carrots have a high GI score however carrots have a low GL factor because they don’t contain many carbs per serving.

TIP: I recommend eating healthy starches such as starches from legumes, root vegetables, quinoa, buckwheat, potatoes, oats or brown rice. You just don’t want to overeat them, typically try to keep them around ¼ - 1/3 portion of your main meals, and have plenty of veggies, adequate protein and healthy fats next to it. The effect of these carbs (eaten in moderation) on your blood sugar will be minimal as long as there is fiber, protein and fat as well.

How to go around sugars and carbs?

  • Avoid excess sugars (simple carbs)
  • Have complex carbs (veggies, legumes, whole grains) over simple carbs (natural and artificial sugars, fruit, honey, syrups, table sugar, juices)
  • In particular avoid added sugar (free sugar) – it is a real health trouble maker and if you pay attention to what you buy you can quite easily do it
  • Read labels if you purchase pre-packed products
  • If you want some sweetness, get sugar from natural food sources like fruits and honey (alternatively stevia, or erythritol, or xylitol), in moderation of course
  • Carbs are best when they come from vegetables, fruits, intact whole grains and beans.
  • Break the vicious cycle of sweetness, the more sweetness you eat the more you crave = the more your blood sugar is imbalanced. Break the cycle by introducing more healthy foods.
  • Keep our blood sugar stable by having the right proportions on our plate. For example, you can simply combine following to prepare a balanced lunch and dinner: non starchy veggies (about 40-60% by volume) + Protein source (about 15-25% by volume) + Healthy Fat (about 10- 25% by volume) + Healthy starches (about 10-20% by volume) + herbs and spices.
  • Red flags: if you frequently feel more tired, or more energetic after your meals, it suggests that your blood sugar is imbalanced. Are you Feeling more tired/sleepy/brain fog after eating? If yes, you probably had too many carbs such as starches, sugar in your meal. Reduce carbs, have more veggies and see how you feel after your next meal. Are you Feeling more energetic/concentrated after eating? If yes, then your blood sugar was probably too low, indicating low blood sugar – hypoglycemia. To avoid blood sugar swings (high and low), it’s important to have balanced meals/snack by having protein, healthy fats and not too much healthy carbs. Ideally, when you eat healthy foods at the right proportions you will feel no difference after and between your meals. Your energy will be stable through the day.

For those who are carving more info, let’s briefly present CARBOHYDRATES.

Carbohydrates comprise of simple carbohydrates and complex carbohydrates. Sugars belong to carbohydrates, compounds constructed from carbon, oxygen and hydrogen atoms.

Simple carbohydrates are structurally the simplest carbohydrates and two groups can be distinguished: monosaccharides and disaccharides.

  • Monosaccharides (1 sugar unit), often called simple sugars, can’t be broken down to smaller carbohydrate units, the most common include glucose, fructose and galactose.
  • Disaccharides (2 sugar units) consist of two simple sugar units (two monosaccharides), examples include lactose, sucrose, maltose and trehalose. Sucrose is a table sugar.

Complex carbohydrates are structurally longer carbohydrates including oligosaccharides containing 3 to 10 saccharide units and polysaccharides containing more than 10 units.

  • Oligosaccharides (3-10 sugar units) consist of 3 to 10 simple sugar units and the most common include raffinose, stachyose, and verbacose.
  • Polysaccharides (more than 10 sugar units) are long chains of simple sugar units ranging from several units up to the hundreds. You can find among this group plant starch and cellulose, and animal derived glycogen. Starch, cellulose and glycogen consist of only glucose units. Dietary fiber belongs to this group.

Reference list:

  1. Gropper SS and Smith JL. Advanced Nutrition and Human Metabolism. Sixth Edition. Wadsworth Cengage Learning. 2012.
  2. World Health Organization. Sugars Intake for adults and children. March 2015
  3. American Heart Association. Kids and added sugars: how much is too much?
  4. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014 Apr;174(4):516-24.
  5. Zupanič N, Miklavec K, Kušar A, Žmitek K, Fidler Mis N, Pravst I. Total and Free Sugar Content of Pre-Packaged Foods and Non-Alcoholic Beverages in Slovenia. Nutrients. 2018 Jan 30;10(2).
  6. Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010. Circulation. 2015 Aug 25;132(8):639-66.
  7. Suez J, Korem T, Zilberman-Schapira G, Segal E, Elinav E. Non-caloric artificial sweeteners and the microbiome: findings and challenges. Gut Microbes. 2015;6(2):149-55.
  8. Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, Israeli D, Zmora N, Gilad S, Weinberger A, Kuperman Y, Harmelin A, Kolodkin-Gal I, Shapiro H, Halpern Z, Segal E, Elinav E. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Oct 9;514(7521):181-6.
  9. Stephan BC, Wells JC, Brayne C, Albanese E, Siervo M. Increased fructose intake as a risk factor for dementia. J Gerontol A Biol Sci Med Sci. 2010 Aug;65(8):809-14.
  10. Ruanpeng D, Thongprayoon C, Cheungpasitporn W, Harindhanavudhi T. Sugar and artificially sweetened beverages linked to obesity: a systematic review and meta-analysis. QJM. 2017 Aug 1;110(8):513-520.
  11. Yang Q. Gain weight by "going diet?" Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. Yale J Biol Med. 2010 Jun;83(2):101-8. Review.
  12. Tryon MS, Stanhope KL, Epel ES, Mason AE, Brown R, Medici V, Havel PJ, Laugero KD. Excessive Sugar Consumption May Be a Difficult Habit to Break: A View From the Brain and Body. J Clin Endocrinol Metab. 2015 Jun;100(6):2239-47.
  13. Malik VS. Sugar sweetened beverages and cardiometabolic health. Curr Opin Cardiol. 2017 Sep;32(5):572-579.
  14. Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev. 2008;32(1):20-39. Epub 2007 May 18. Review.
  15. Kuhnle GG, Tasevska N, Lentjes MA, Griffin JL, Sims MA, Richardson L, Aspinall SM, Mulligan AA, Luben RN, Khaw KT. Association between sucrose intake and risk of overweight and obesity in a prospective sub-cohort of the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk). Public Health Nutr. 2015 Oct;18(15):2815-24.
  16. Jennifer A. Nettleton, Pamela L. Lutsey, Youfa Wang, João A. Lima, Erin D. Michos, David R. Jacobs, Jr. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009 Apr; 32(4): 688–694.
  17. Glenda N. Lindseth, Sonya E. Coolahan, Thomas V. Petros, Paul D. Lindseth. Neurobehavioral Effects of Aspartame Consumption. Res Nurs Health. Author manuscript; available in PMC 2017 Sep 27.Published in final edited form as: Res Nurs Health. 2014 Jun; 37(3): 185–193.
  18. Durán Agüero S, Angarita Dávila L, Escobar Contreras MC, Rojas Gómez D, deAssis Costa J. Noncaloric Sweeteners in Children: A Controversial Theme. Biomed Res Int. 2018 Jan 8;2018:4806534.
  19. Belloir C, Neiers F, Briand L. Sweeteners and sweetness enhancers. Curr Opin Clin Nutr Metab Care. 2017 Jul;20(4):279-285. Review.
  20. Stanhope KL, Havel PJ. Endocrine and metabolic effects of consuming beverages sweetened with fructose, glucose, sucrose, or high-fructose corn syrup. Am J Clin Nutr. 2008 Dec;88(6):1733S-1737S.
Information provided above is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional. 
There is no one-size-fits-all healthy plate but most people will benefit from the tips provided here. Others may need more strict and individualized approach to address their health issues such as with allergy, intestinal dysbiosis, diabetes, autoimmune disease, nutritional deficiencies, or food intolerance. Generally speaking, if you are eating health promoting foods, you follow a healthy life style - then don’t overanalyze or get obsessed in what you’re eating and just enjoy your real food. After all, there’s more to life than food! But now let’s focus on food. I want to help you to compose health promoting meals. No dieting and calories counting as long as you chose the best quality of health-promoting real foods. The quality is more important than the quantity. You want to have foods on your plate that were alive because they promote life and health, on the contrary factory and processed foods promote disease. Follow the mother nature principles and you are on the safe side.

What should be on your plate?

Real Food. Mostly plants. Not too much. I based it on the Michael Pollan’s quote stating “Eat food. Mostly plants. Not too much.” It’s the essence and your primary goal. I have made 6 rules to make it more precise and helpful for you so you can start creating your healthy plates. This is how proportions of different food groups should look like on a healthy plate, according to me.  

6 keys rules to compose healthy plates (for breakfast, lunch and dinner)

#1 Have only real foods on your plate and resist processed foods – real foods contain information (proteins, fats, carbohydrates, vitamins, minerals and phytonutrients, water) that our bodies utilize to run and optimize countless number of processes. A handful of candies can’t be compared with a handful of wild blackberries, the first one has no nutritional value and undermines our health whereas the second one is laden with nutrients and promotes our health. Highly processed foods disrupt our biology, the flow of information and are devastating to our health. They are not made to promote our health but to promote addiction. In nowadays world reading labels is essential. Remember that foods that are the best for us come as mother nature designed them: naked and not packed, labeled and processed. To give you a feeling of do’s and don’ts, read some of Michael Pollan’s quotes:
  • “Don't eat anything incapable of rotting”, “Eat only foods that will eventually rot”.
  • “Don't eat anything your great-grandmother wouldn't recognize as food.”
  • “If it came from a plant, eat it; if it was made in a plant, don't.”
  • “Avoid food products containing ingredients that no ordinary human would keep in the pantry”
  • “Don’t eat anything with more than five ingredients, or ingredients you can't pronounce”
I could not agree more. #2 Have lots of non-starchy vegetables on your plate – vegetables should be the largest portion on your plate, it truly can be a game changer for you and your gut microbes! Have a variety of colors from various vegetables (leafy greens, cruciferous vegetables, stalks and stems). Vegetables are your main source of dietary fiber (complex carbohydrates), various phytonutrients, minerals and vitamins. You don’t need to have a plenty of various vegetables with every single meal but strive to have at least 1-4 different vegetables. #3 Have adequate quality protein on your plate – think of pastured meat, eggs, poultry, wild fish or nuts and seeds, legumes, nuts, seeds, and  mushrooms.  For some plant protein sources you may need to have a relatively more protein volume to get the same amount of protein as from animal source, for example 100 grams of beef or chicken contains about 25 grams protein whereas 100 grams of cooked chickpeas about 7 grams protein,  lentils about 9 grams protein, and quinoa about 12 grams protein. Peanuts, nuts and seeds are more protein dense plant foods. Noteworthy, animal proteins all contain every single of the essential amino acids, so they're called complete proteins. On the contrary, each plant food you eat has a different amino acid composition. For example, grains and cereals are extremely low in lysine. If you only eat grains and cereals, you won't get enough lysine. Whereas, legumes such as peanuts, peas, dry beans and lentils contain a lot of lysine. On the other hand, legumes aren't good sources of tryptophan, methionine and cystine, but those amino acids are found in grains and cereals. Grains and legumes are called complementary proteins because when you combine them (for example quinoa + lentils), you get all of the essential amino acids. Nuts and seeds are also complementary to legumes because they contain tryptophan, methionine, and cystine. #4 Have healthy and real fats on your plate and avoid fake fats - include unsaturated fats (most of plant origin) and saturated fats (most of animal origin, except coconut oil), the best is to eat them in most natural forms, non-processed. We need both types of fats, in the right balance and of high quality. Many people often have: too high intake of commercial saturated fats by consuming too much dairy (cheese), meat (pork, lamb), ready-to-eat products, cookies, chips, chocolate, margarines; and too high intake of unsaturated omega-6 rich foods  such as grains, nuts, seeds, and plant oils. Omega-3 fatty acids are anti-inflammatory and omega-6 fatty acids pro-inflammatory. We need both of them but in the right balance. Sources of omega-3 fatty acids include fat fish, spinach, purslane, or flax seeds, pastured eggs, poultry and grass-fed beef. Include in your menu foods rich in unsaturated fats (which are essential for proper cell function) such as fat fish (wild), avocado, olives, hazelnuts, wild meat, pastured poultry and have naturally occurring saturated fats in your diet including coconut oil, ghee/butter, lard, duck fat, eggs or meat/poultry. Tip: Unsaturated fats are prone to oxidation which is promoted by heat, improper storage, light, processing therefore use unsaturated fats such as cold pressed extra virgin plant oils such as olive oil, flax seed oil, avocado oil, or borage oil for cold meals. If you buy an olive oil that’s suitable for cooking, baking – it means it’s refined oil. For warm/hot meals use (unrefined) saturated oils which are more stable during heating (lower oxidation risk) including extra virgin coconut oil, grass-fed butter, ghee, lard, goose fat, duck fat. Fake fats include processed vegetable oils, margarines and oil spreads – stay away from them. #5 Have herbs, spices and unrefined salt – herbs help to stimulate digestion, detoxification and offer an antimicrobial effect. Spices offer immune boosting, anti-inflammatory and anti-disease properties. Salt is an important micronutrient that helps to regulate fluid balance, blood flow, the function of muscles, heart, nervous system and our brain. Unrefined sea salts and mine salts contain trace minerals that support our physiology, refined table salt however is stripped of these micronutrients. Moreover, herbs, spices and salt stimulate our senses, enrich our meals and simply make our food tasteful. Tip: combine your spices and herbs with high quality oil to promote absorption of certain phytochemicals. #6 Watch your starch intake – starch overconsumption is a common problem in our western diet, where grain based products (breads, pastas, rice) over flow our plates. It’s like asking for trouble. Why? Because of too much starch and too little nutrients and as a result you are on a right track to get blood glucose swings, GI complaints and gut dysbiosis, to name a few issues. Let me cite here another brilliant quote of Michael Pollan: “The whiter the bread, the sooner you’ll be dead”. I suggest eating starches in moderation, in a size of a side dish. Also, instead of wheat use quinoa, buckwheat, or high quality oats and millet. Your carbohydrate intake may depend on your activities and daily needs but try to keep a moderate-carbohydrate intake. Think of vegetables as a source of complex carbohydrates and tubers, (sweet) potatoes as a source of healthy starch (simple carbs). Listen to your body, observe how you feel after starchy rich meals and find the balance of your starch intake. If you have carbohydrate intolerance, meaning your blood sugars stay elevated after eating, you may need to go down with starch and sugar consumption to stabilize it. Tip: refrigerate starchy cooked foods such as grains (pasta, rice), stem and root tubers (potatoes, beets), legumes (beans) for at least about 12 hours before consumption. Refrigeration will promote starch retrogradation, meaning that amylose and amylopectin chains reform and firm-up, become more resistant to our digestive enzymes. It has a positive effect on your blood glucose as it slows the rise of blood sugar following a meal and prolongs satiety. In addition beneficial microbes may also utilize it as food.

Let’s talk about proportions

Keeping below ratio of different food groups works well for most people. Strive to have on your plate:
  • About 50-70% of non-starchy vegetables
  • About 10-15% of quality protein
  • About 15-30% of healthy fats
  • About 5-15% of healthy starches (optional)
  • Herbs, spices and salt
Some foods combine both high fat and high protein content: sardines, herring, pork, chicken with skin, red meat with fatty tissue, nuts and seeds. Strive that most of your meals will have this composition of nutrients. If it feels overwhelming now, don’t get discouraged but take small steps: first start optimizing one meal, for example your breakfast or your dinner. Once you mastered it, you can upgrade another meal. Healthy eating also includes eating fruits but preferably have them as a snack or a dessert.

Meal composition

I combine my meals by putting together lots of cooked, steamed or raw veggies (Brussel sprouts, cauliflower, broccoli, cabbage, asparagus, carrots, celery, chard, spinach, kale, leek, garlic, tomatoes, peppers, cucumber, lettuce, onion, sugar snaps, green beans etc.) with quality protein (eggs, poultry, wild caught fish, grass-fed beef, mushrooms, wild game, seeds, nuts, legumes, sheep cheese, goat cheese etc.) accompanied by healthy fats (naturally present in foods like avocado, olives, seeds and nuts and extracted oils in a form of olive oil, coconut oil, ghee, flax seed oil etc.), herbs, spices and salt. For some meals, I add healthy starches (buckwheat, quinoa, oats, potatoes, sweet potatoes, red beets, legumes etc.). If you have digestive issues, it may help if you avoid meals comprised of simple carb and starch rich foods with protein rich foods, meaning don’t combine meat with grains, potatoes or rice but go for meat, egg, seeds, nuts with vegetables or for grains, legumes, potatoes with vegetables.

Last but not least: snacks and desserts

Below are foods I eat if I snack or have a dessert. Real food Snack ideas: olives, seeds, nuts, fresh and dry fruit, raw vegetables without or with a dip (pesto, avocado, tomato tapenade, tahini etc.), vegetable chips, chickpea chips, sweet potato toast with a grass-fed butter or a nut butter, vegetable smoothie, grass-fed cow yoghurt, coconut yoghurt, a piece of quality sheep cheese (manchego) or goat cheese, homemade chocolate milk, avocado, pickled sardines, radish, hard-boiled egg, light salad, coconut flesh, healthy sushi, quinoa cookie, banana bread, soup, bone broth, unsweetened coconut water. Real food dessert ideas: A piece of dark chocolate (preferably min 80% cacao), avocado-cacao pudding, fruit ice cream (blended frozen fruits alone or with yogurt/kefir), dates, oatmeal cookies, coconut cookies, fresh or dry fruit, nuts, banana bread, fried banana slices with cinnamon, home-made apple or berries crumble, home-made brownie.
Combat your sweet tooth
Why some people do have sugar cravings whereas others do not? Have you ever wondered why or have envied people who say easily “no” to a chocolate bar or a deliciously looking cake?  Why some can say “no” without feeling deprived and others can’t? It’s a combination of factors, it’s partly because of your genes and partly because of your environment which includes what you eat, how you sleep, how stressed you are, how you feel emotionally, physically and mentally. People who crave carbs have following in common:
  1. Low serotonin. Serotonin is a neurotransmitter that quiets the brain. Most of it is produced in your gut. One explanation you may be prone to low serotonin lies in your genes.  For example, by having a single nucleotide polymorphism a so called SNP (pronounced “snip”) in a MAOA gene (monamine oxidase), you may be more susceptible to carb cravings. This gene plays a role in metabolism of serotonin, dopamine, and norepinephrine and therefore relates to mood swings and carb cravings. If you have a “fast” MAOA gene, you will process serotonin quickly resulting in low serotonin which can make you feel down, helpless, and pessimistic. Low serotonin will make you crave carbs and sweets to get a temporary serotonin boost. The precursor of serotonin is tryptophan.
  2. Blood glucose swings. Western diets rich in simple sugars and starch (grains) lead to unhealthy glucose blood swings and high production of insulin which has negative short and long term effects on health. When you eat foods made up of simple carbohydrates (sugars and starches), your blood glucose rises and your body releases insulin, a hormone responsible to get the glucose into your cells. Too much glucose and too much insulin affects growth and functioning of many organs, including brain and pancreas, it promotes inflammation, and eventually may lead to insulin resistance and to diabetes type 2. Children are particularly vulnerable, being exposed to processed and sugary foods early in life when their bodies need nutritious building blocks to promote their health and not to undermine it. Glucose blood swings can lead to a vicious cycle of sugar/foods cravings & hunger & thirst, energy picks, tiredness, or restlessness. In addition, the body needs extra micronutrients (vitamins & minerals) to deal with high sugar intake (B-vitamins, chromium, zinc). For example B-vitamins (such as vitamin B3) are involved in sugar metabolism and sugar-addicts are prone to B-vitamins deficiencies. When the blood glucose levels are stable there is less need and cravings for snacks, sugar and carbs.
  3. Low beta-endorphin. Beta-endorphin is a neuropeptide (peptide hormone) that is associated with hunger, pain, self-esteem, and reward cognition. People with low beta-endorphin tend to to feel insecure, helpless, inadequate, unworthy and overwhelmed. Low beta-endorphin results in low self-esteem so to feel better about yourself, you experience drug-seeking behavior (including sugar cravings, exercise, alcohol, codeine, gambling or sex). So, if you have low beta-endorphin you will go for what makes you feel better: sugar for example.
How can you combat carb cravings? First, you need to work on a strong foundation consisting of nutritious foods, adequate sleep, positive mindset, emotional support and manageable stress levels. The tips below worked for me, my family, friends and my clients. The key elements you should consider are: Find your motivation. To make the changes happen, define an important enough reason for you for a sugar-free/sugar-low life. Find something that motivates you. Do you want to feel better and have more energy? Do you want to be healthier? Do you want to prevent having a chronic illness? Do you want to be an example for your children? Address your emotions. Feeling inadequate, having low self-esteem, feeling that life is out of control can make you more vulnerable to addictive behavior. Looking into emotions and asking yourself why you do it - may help on a journey to break up with sugar cravings. Eat Real Food and Nourish your body. Have a good nutritional foundation. The quality of the food you eat—and most importantly, the nutrients it contains—is what determines whether you simply survive or thrive. When you don’t nourish your body, it can’t function as it should -cravings begin and disease may develop. Base your diet on real, whole foods like vegetables and fruits, meat and fish, nuts and seeds, and starchy plants like potatoes and sweet potatoes. If your food comes in a bag or a box, be skeptical and read the labels, as often it has nothing to do with real food. Keep your blood glucose stable. Eating balanced meals will help you to keep your blood sugar stable and neurotransmitters in balance. Thrive for adequate protein, healthy carbohydrates and healthy fats every time you eat. Limit foods with high glycemic index such as refined grains flour and flour products (pasta, bread, crackers), sugar and other sweeteners, processed and refined foods, unhealthy snacks AND have adequate amount of protein with your meals, especially with your first meal (breakfast). This will reduce your food cravings, mood swings, a tendency to binge eating and it will promote more restful sleep. Distinguish between “good carbs” and “bad carbs”. "Good carbs" are those that are both unrefined and nutrient-dense, such as vegetables, fruits and starchy plants like potatoes, sweet potatoes, plantains, taro, etc. "Bad carbs" are highly processed, refined, and nutrient-poor, like most things made with flour and sugar. Eating sweet potatoes and whole fruit does not equal eating cookies and cakes. Have adequate sleep. You need sleep for basic maintenance and repair of the neurological, endocrine, immune, musculoskeletal and digestive systems. Allow between seven and eight hours for sleep each night. Sleep deprivation is associated with low grade chronic inflammation and worsening insulin resistance, dysregulation of hormones, as well as increased emotional reactivity, more carb and unhealthy food cravings. The hormone melatonin, a key hormone to good sleep, naturally increases after sundown and during the night in a normal circadian rhythm. To make melatonin we need serotonin so if you are low in serotonin, you may as well have low melatonin and therefore more difficulty to fall and stay asleep. If you eat balanced meals with adequate protein through the day, your neurotransmitters and hormones will be more stable. More stable serotonin = more stable melatonin. Monitor your stress levels. When you are feeling stressed (emotionally, physically, mentally) you often crave more carbs, right? Stress affects a lot of processes in your body, for example it impairs the production of serotonin from tryptophan (amino acid). Stress can steal your tryptophan. Earlier I have mentioned that low serotonin can increase carb cravings. Now imagine, when you are under a lot of stress - your body instead of making serotonin from tryptophan makes quinolinic acid from tryptophan. As a result, you have low serotonin (=carb cravings) and you have high quinolinic acid (=mood swings, mood disorders). By managing stress, you allow your body to work more optimally, to have more balanced hormones and neurotransmitters; you also promote turning your tryptophan into a happy hormone serotonin and a sleep-well hormone melatonin instead of into brain-damaging quinolinic acid. Stress management is as important to your health and carb cravings as a solid breakfast and proper nutrient intake. Team up. If you find it difficult to go through the process of reducing/eliminating sugar too challenging, team up with other people who go through it. Look for support groups and friends who have the same challenge. It’s easy to get into a vicious cycle of carb cravings when you are on a poor diet, when you are under a lot of stress, when you are sleep deprived and when your genetics make you sugar sensitive but there is a lot you can do about it. My take home massage for you to significantly decrease or eliminate sugar and starch cravings includes eating right (adequate protein), reducing sugar and starch intake, finding an emotional balance, managing stress and sleeping deep. If you need more support, seek some professional help.
Abdominal bloating nightmare
Many people suffers from abdominal bloating and if you are one of them you know that’s no fun. Majority of people that come to see me struggles with it, therefore I decided to give it a brief attention. If bloating interferes with your daily life, your work, your social of recreational activities, it’s something you need to look into. Symptoms Your abdomen feels bloated when your GI tract increases its volume due to presence of air or gas. It is a nasty feeling of fullness, swelling, tightness, or hardness. You may also experience pain, flatulence, abdominal distension, nausea, burping, belching, or gurgles. Some people feel like they “look pregnant” when bloating strikes. What are the most common causes of abdominal bloating? There can be various causes of being bloated, some of which are quite easy to tackle and some may need a professional help. Consider following if you feel regularly bloated: Eating and drinking too fast. Eating too much. When you eat and drink fast you may swallow too much air and promote gas formation, also rushing while eating impairs digestion. Chewing gum, smoking may also worsen the problem. Our digestive system has certain capacity to digest efficiently, if we eat too much food (too fast) it will obviously not be able to digest optimally. Eat slowly, not too much and chew your food thoroughly for better digestion. Diet rich in starch and/or nuts. Overconsumption of starch (grains), nuts, processed foods, sugar, difficult to digest meal combinations such as high starch and high protein content in one meal. Overconsumption of starch intensifies the complaints related to candida and intestinal parasites. Low gastric acid & indigestion. Low gastric acid and/or deficiency of digestive enzymes can result in abdominal bloating. I write about low gastric acid here. Microbial GI dysbiosis. When your gut microbes get out of balance resulting in dysbiosis (beneficial and bad microbes are out of balance), the bloating may occur. Think of candida (Candida albicans) or other yeast overgrowth, parasitic infection (Dientamoeba fragilis or Blastocystis hominis), gastric Helicobacter pylori infection, or small intestinal bacterial overgrowth (SIBO). Food Intolerance (lactose, histamine, fructose). People with inability or decreased ability to break down lactose (milk sugar), fructose or histamine may feel bloated. Reactivity to gluten. You may feel bloated when your body does not tolerate gluten, sometimes it’s just too much gluten in your diet and sometimes it is a non-celiac gluten sensitivity or a celiac disease. Crohn disease or ulcerative colitis. People with intestinal inflammation such as in Crohn disease or ulcerative colitis may experience abdominal bloating as well. Impaired pancreatic function or bile production. Pancreatic -under or -overactivity, too little or too much bile can influence digestion of fats, starch and as a result aggravate the abdominal bloating. Constipation. If you have a bowel movement only every few days, your abdomen will have a tendency to bloat because of an increased abdominal pressure. Dehydration. The more dehydrated your body is, the higher chance you may feel bloated. Drinking too much alcohol, too little water and eating salty snacks can promote bloating. Hormonal Changes such as during PMS and period. Due too hormonal changes and hormonal imbalances many women tend to feel bloated before and/or during their period. Abdominal Water retention. Abdominal water retention called ascites takes place when fluid fills the space between the lining of the abdomen and the organs. It usually occurs as a result of liver problems. What can you do? Find the root cause. First, you can experiment yourself by eating slowly, chewing properly, avoiding drinking with meals, eliminating processed and junk foods, eliminating sugar and starch rich foods, excluding diary, gluten, or histamine rich foods. If after your detective work you still experience abdominal bloating, get yourself tested. I would suggest starting with a fecal analysis that would include your microflora profile, parasites, digestion profile, inflammation markers, gluten reactivity markers, pancreatic elastase, bile salts, histamine) and a blood test. For occasional bloating you can have a peppermint, ginger, fennel or chamomile tea, or other herbal remedies. Preferably avoid gassy fruits and vegetables, sodas, artificial sweeteners, sugar, starch, gluten and diary.
Are supplements useful or useless?
Over past 3 years I have learned a lot about supplements and I still do learn. Before I became a parent, I was never rigorously taking any supplements, once in a while perhaps I got a low quality multivitamin from a drug store. Of course I have never noticed any significant effect. After my second daughter was born, I was not only deficient in sleep, I was deficient in various vitamins, minerals, and trace elements. At one point I decided to try a mineral and trace elements formula, of high absorption. And I was blown away, on the days I took it I felt and functioned much better, and I even looked much better. My nutrient deficiencies became obvious then. It was the time when I realized that proper supplementation can be quite powerful. With the knowledge and experience I have now, I am quite critical as to what I supplement myself and what I recommend to my clients. I always look for high quality, high purity, high bioavailability products, and preferably hypoallergenic. No trash supplements are on my list. In general, I think that it does not make sense health wise and wallet wise to take poor quality supplements. If you do use supplements, do it wisely. Take the supplements that have the potential to help you. The first question many of you might have: Do we need to take supplements at all? If we lived in a perfect world, ate nutrient dense foods, had no chronic stress, no sleep issues, no environmental toxins and chemicals, if we had plenty time to relax, if we were born naturally to a healthy mother, if we were breastfed for few years, if we used no drugs and antibiotics - then none of us would ever need to take supplements. Does it describe your life? It does not mine and I am afraid there are only very few lucky ones who would fit this description. Unfortunately, for most of us - being chronically stressed, malnourished, sleep deprived, and over-medicated is normal, rather than exceptional. It is always essential for your wellbeing to build a healthy foundation by eating a clean diet, reducing exposure to toxins, managing stress, cultivating a positive attitude, having a quality sleep and getting most nutrients from foods. If you are able to get and absorb sufficient amounts of all essential nutrients naturally from foods, and your body is able to utilize them, that's the best way to go. Sometimes however - it’s not optimal, especially with chronic health problems. Then, the right supplementation can be very valuable in achieving good health. On the contrary, if you focus only on taking supplements without addressing your stress, sleep, attitude and a diet – the supplements will not be enough to sustain good health. Some people do well without supplements but they would do better with them. For some people, supplements are completely out of discussion as it does not feel right to take them. That’s ok. If you are open to taking supplements, at first try to find out what you need and what you want to achieve. The best way is to use supplements as a supportive tool to enhance health, prevent disease, and/or reach certain health goals. Maintenance supplementation vs therapeutic supplementation? Nutritional supplementation incorporates the use of vitamins, minerals, other various molecules and botanicals to promote good health and to prevent or treat disease. You can take supplements as a form of a maintenance regimen or to meet some specific therapeutic goals. Maintenance supplementation involves supplementing with basic micronutrients that may be difficult to obtain from a healthy diet. Examples might include vitamin D, vitamin A, omega-3 fatty acids such as EPA and DHA. Even if you eat a healthy diet, it can be very difficult to get all the required nutrients from food alone. Firstly, the vitamin and mineral content of conventionally grown foods has decreased over past decades. Secondly, not everyone can digest, absorb and assimilate nutrients very well. Therapeutic supplementation is focused on addressing a particular health condition or symptom, like anxiety or insomnia. Therapeutic supplementation is beyond the scope of this blog as it largely depends upon the individual health status and the problems to be addressed. Even though maintenance supplementation may also vary based on your circumstances, there are some common guidelines I want to share with you. Nutrients and supplements worth to consider supplementing with A high quality multivitamin and mineral supplement. It will provide you with the essential nutrients, can be highly effective in preventing common deficiencies and more convenient to take than few separate mineral and vitamin supplements. Multis are best taken with meals, for example breakfast or lunch. My favorite brands for synthetic multivitamins include Pure Encapsulations, Thorne Research, or a Dutch brand Vitals and from food based multi products consider Garden of Life or New Chapter. Fish oil - Cod liver oil. It can be a quite potent food based supplement if you want to boost your immunity for example. It is an excellent source of omega-3 fatty acids, such as EPA and DHA, vitamin D3, and vitamin A. My favorite brand at the moment is Rosita cod liver oil (CLO). If you do not take a multivitamin and/or fish oil, consider individuals nutrients such as: Vitamin D. Vitamin D deficiency is quite common however get your vitamin D level tested before supplementation. We can get vitamin D from two sources: food and sunshine. Seafood is the only significant source of vitamin D, but you’d still have to eat a lot of it to get enough. The D3 produced after sun exposure, along with the D3 we get from food, gets converted by the liver into 25-hyrdroxy-vitamin D (25D), which is what typically gets measured when you have a vitamin D test. The optimal blood serum level of 25D level is around 50 ng/mL. One of the best sources of vitamin D is high-vitamin cod liver oil. It contains not only vitamins A & D, but also omega-3 and natural vitamin E and other quinones. Magnesium. Magnesium is essential for activity of hundreds of enzymes within our body and most of us, to lesser or greater extent, is deficient in magnesium. High stress, poor diet and lack of sleep increase our need for this nutrient. Most multivitamin supplements do not contain enough magnesium to meet our daily needs. Magnesium is also difficult to obtain from food, nuts and seeds are the highest source. Therefore most people will benefit by supplementing with magnesium, for example between 250– 350 mg daily. Select chelated forms of magnesium such as magnesium glycinate, or magnesium malate because they’re better absorbed and tend to have fewer side effects. If you are constipated, try magnesium citrate. EPA & DHA. EPA and DHA are omega-3 fats found primarily in cold-water fish like salmon, mackerel, herring, sardines, anchovies, and halibut. EPA and DHA play an important role in fetal development, cardiovascular and immune health, weight management, cognitive function, and much more. Low intake of these important nutrients has been associated with a wide range of health problems. It’s a good idea to supplement with a high quality DHA/EPA if you do not eat fatty fish, approximately 500–1,000 mg per day of EPA and DHA combined or have a cod liver oil as it contains EPA and DHA and fat soluble vitamins like vitamin A and D. Plant-Based Antioxidants such as Flavonoid Extracts or “Green Foods”. Consider these supplements in particular if your diet is deprived in vegetables, fruits, and herbs. Consider grape seed extract, pine bark extract, green tea extract, ginkgo biloba extract, milk thistle extract, bilberry extract, Hawthorn extract, or spirulina. Vitamin B-complex. B vitamins are essential to coordinate various processes within our body such as neurological function and energy production. Most B vitamins do not remain stored in the body, so they must be acquired daily from the diet to help maintain optimal health. Especially when you have chronic health issues, the chance is high you don’t get enough of them from foods to meet our daily needs. Probiotics. Supplementing with probiotics may be very valuable if you have compromised gut microbiota due to a history of antibiotic use, poor diet, intestinal infections, or conditions like IBS or inflammatory bowel disease. Check this link for tips on how to select a probiotic supplement. How to select a high quality supplement? Not all supplements are created equal. It’s important to choose high quality supplements that contain bioavailable vitamins and minerals, high quality plant extracts, or alive beneficial bacteria in case of probiotics. You also want to use supplements that do not contain unnecessary additives, fillers, coatings, colorings, sweeteners, hydrogenated fats, allergens, heavy metals and other unwanted contaminants. Form of supplements: select a powder or capsule form over tablets, if possible. In general, tablets contain more additives than powder/capsule forms, or liquid forms. In addition to product quality choose the formula that’s right for you, a child formula for children, an adult formula for adults, or a prenatal formula during pregnancy. Food based (natural) vitamins and minerals versus synthetic ones? Sometimes natural is better (vitamin E, K), sometimes synthetic and sometimes it does not matter with respect to their activity. They all can be helpful at the right dosages and harmful at too high dosages. Most of us think that food-based vitamins are a better idea than synthetic ones. They do work for some people but not everyone will tolerate food-based supplements. For me, not all food based supplements work well as I can develop an allergic reaction. On the other hand, I see great results with high quality synthetics. If you tolerate food-based multivitamins, then take them. If you don’t, then try synthetic ones. Sometimes you just need to try. What you should consider when taking food based vitamin and mineral supplements: i) food-based products can cause mild to severe reactions (reactivity to foods) as they contain food based compounds ii) many food based supplements contain - apart from food based nutrients - also synthetic ones, these products often contain misleading labels such as “natural”, “whole food based” iii) food based supplements will not necessarily provide you more vitamin and minerals, dosages of vitamins and minerals are often inexact and low in food based supplements but you may get other plant compounds of potential health benefits iv) food based supplements may be contaminated with heavy metals such as lead v) food based supplement can consist of a dry extract from plants or a combination of purified compounds from plant food vi) food based supplements are often more expensive My favorite supplement brands Some of my favorite supplement brands include Pure Encapsulations, Thorne Research, NOW Foods and Jarrow Formulas with their good quality and price ratio, Gaia Herbs, Bio-kult probiotics, from food based supplements I recommend Garden of Life or New Chapter, and from Dutch brands AOV, Vitals and Bonusan.
Tips for skin problems
ACNE, ECZEMA, PSORIARIS AND OTHER SKIN PROBLEMS Skin problems are often a manifestation of underlying health issues. The problem lies not in a lack of a particular soap, anti-bacterial remedy or a corticosteroid immunosuppressant cream. You need to look deeper than the skin. When I have clients with skin problems we look at their wellbeing holistically, we don’t focus on a skin itself, we look underneath. To heal your skin, you need to heal your gut and address possible root causes. Skin problems may partly be determined by our genetics but our environment, our food, our water, our air, pollution are the important factors too, they may promote or reduce the flare-ups. So if common skin disorders can be influenced by environment, factors such as nutrition and lifestyle may be sufficient to prevent and even reverse many cases. So this is what we want to focus on, we want to find our triggers and our soothers. Below you can find some tips on what to pay attention to when skin problems affect your life. Managing your skin health with nutrition, improving digestive function, making dietary changes, and optimizing lifestyle habits can provide benefits not only for your skin, but for your overall well-being. Try to identify the root cause(s) of your skin problems by taking into account:
  • Allergies (IgE driven), food sensitivities (IgG driven), food intolerance (histamine intolerance) and/or gluten reactivity
  • Gut health issues (dysbiosis, infection)
  • Nutrient deficiencies/Poor diet (diet poor in nutrients can be the root cause of skin disease as well as GI dysfunction, which can cause maldigestion and malabsorption of nutrients. Many nutrients work together so that a deficiency of one can make the other ineffective)
  • Toxins, pollution, skin irritants
  • Genetics
WHAT CAN HELP? DIET Avoid processed foods, sugar, food additives, foods from the package, and go for real foods, home-made meals, whole-food sources containing healthy skin nutrients as mentioned above. Your skin and your gut will be thankful. Be aware of nutrients for healthy skin Certain nutrients are particularly important for healthy skin. These include vitamins A, C, E, and K2, zinc, biotin, sulfur, pantothenic acid (B5), niacin (B3), silica, selenium, the omega-3 fatty acids, and beneficial bacteria (probiotics). When we lack these nutrients our skin can manifest it by dermatitis, rashes, acne, poor wound healing, raised bumps on the backs of the arms, and loss of skin firmness. Of note, many nutrients act in concert with other nutrients so a deficit of one can make the other ineffective. Therefore focusing on one nutrient only, may not entirely address the problem. Solution: Eat real foods, eat colors, and diversity of foods. Top nutrients required for healthy skin:
  • Vitamin A, lack of which causes the skin to be rough and dry which often first appears as rough, raised bumps on the back of the arms. Vitamin A-rich foods include liver and cod liver oil, kidney, cream and butter (pastured cows), and egg yolks (pastured chickens). If you take cod liver oil, it will provide you a balance of vitamin A and vitamin D that will reduce the risk of vitamin A over-dosage.
  • Vitamin C plays an important role in the regulation of the structural protein collagen, which is necessary for the extracellular stability of the skin. Inadequate vitamin C can contribute to the development of hyperkeratosis pilaris, the common problem with the follicles being damaged when collagen formation is impaired. True deficiency of vitamin C is uncommon but often we consume suboptimal levels, particularly in a diet with few fruits and vegetables. The highest sources of vitamin C include bell peppers, guava, dark leafy greens, broccoli, Brussels sprouts, kiwi, citrus fruits, strawberries, cilantro, chives, thyme, basil, and parsley.
  • Vitamin E is a potent fat-soluble and anti-inflammatory agent, found in our skin. Our bodies store vitamin E in our fat cells, and we depend on adequate dietary intake to maintain optimum levels. Adequate levels of this vitamin in the skin may prevent inflammatory damage from sun exposure. Food sources of vitamin E include spinach, turnip greens, chard, sunflower seeds, almonds, bell peppers, asparagus, collards, kale, broccoli, Brussels sprouts, and with moderate amounts in olive oil.
  • Vitamin K2 is an important player in protecting us from heart disease, forming strong bones, promoting brain function, supporting growth and development, helping to prevent cancer, ensuring healthy skin, and this vitamin is likely beneficial for preventing wrinkles and premature aging. Vitamin K2 is also necessary for the proper functioning of vitamin A- and D-dependent proteins. Vitamin A is essential for proper skin cell proliferation and cannot work properly if vitamin K2 is not available. Vitamin K2 is important in the treatment of acne, keratosis pilaris, and other skin symptoms of vitamin A deficiency. Good sources of vitamin K2 include butter and other high-fat dairy products from grass-fed cows, egg yolks, liver, natto, sauerkraut and cheese.
  • Zinc supports immune function, protein synthesis, wound healing, DNA synthesis, cell division, regulation of gene expression. It also improves wound healing, has anti-inflammatory properties, and protects against UV radiation. People with serious acne are found to have lower levels of serum zinc than healthy individuals. You can find zinc in animal sources including seafood (oysters, scallops, and other shellfish), kidney, liver, and red meat. Plant foods such as pumpkin seeds and other nuts can also be high in zinc as well, but are less bioavailable if not properly prepared by soaking, because the zinc is bound to phytates.
  • Biotin (vitamin B7) acts as a cofactor for enzymes that regulate fatty acid metabolism with fatty acids being critical for the health of the skin. When biotin intake is insufficient, fat production is altered, and the skin cells are the first to develop symptoms. Low biotin intake/levels may promote hair loss, dandruff, erythematous (red and inflamed) dermatitis around the mouth and other areas of the face and scalp. In infants, inadequately low biotin amounts may contribute to “cradle cap” and seborrheic dermatitis in adults. Biotin rich foods include egg yolks, liver, Swiss chard, romaine lettuce, almonds, and walnuts.
  • Sulfur is a critical mineral for skin health and overall wellness. Sulfur is necessary for collagen synthesis, which gives the skin its structure and strength. Having enough sulfur in your diet can help maintain collagen production and keep your skin looking firm. Foods containing sulfur include egg yolks, meat, poultry, and fish, garlic, onions, Brussels sprouts, asparagus, and kale. Fermented foods, like sauerkraut, with well bioavailable sulfur serve as an excellent source of sulfur and a healthy component of a diet for radiant skin.
  • Pantothenic acid (vitamin B5) is required for proper growth, metabolic function, energy production and protein and fat synthesis, and is needed by many different types of skin cells for regeneration and growth. Vitamin B5 is also involved in the growth and differentiation of keratinocytes, which are essential for maintaining a healthy skin barrier. Keratosis pilaris (chicken skin) is a common skin condition caused by impaired keratinocyte growth, which may improve from increased pantothenic acid consumption. Pantothenic acid also significantly increases levels of glutathione in the cells, which acts as a potent antioxidant in the skin. Pantothenic acid can be found in various foods, some of the richest sources include liver and kidney, egg yolk, broccoli, fish, shellfish, chicken, dairy products, mushrooms, avocado, and sweet potatoes. Majority of healthy individuals meet their daily required intake of this vitamin however factors such as stress, pregnancy, and a diet high in processed foods can increase the need for this vitamin.
  • Niacin (vitamin B3) is a vital payer in cell metabolism as a coenzyme in energy producing reactions involving the breakdown of carbohydrates, fats, and proteins, as well as anabolic reactions such as fatty acid and cholesterol synthesis. Niacin deficiency is uncommon however in some health conditions such as in celiac disease, IBS, Crohn’s disease may cause inadequate niacin absorption from the diet. Impaired absorption can lead to the skin-related symptoms such as dermatitis and scaling. Niacin rich foods include meat, poultry, red fishes such as tuna and salmon, and seeds. Milk, green leafy vegetables, coffee, and tea also provide some niacin. For most healthy people, a diverse diet with adequate meat consumption should be enough to meet niacin’s nutritional needs.
  • Silica is required for normal collagen formation. It maintains the health of connective tissues by interacting with the formation of glycosaminoglycans (GAGs) such as hyaluronic acid, which are structural building blocks of collagen tissues. Inadequate silica content can result in reduced skin elasticity and wound healing. To ensure adequate silica intake include leeks, green beans, garbanzo beans, strawberries, cucumber, mango, celery, asparagus, and rhubarb in your diet. Other natural sources of silica certain types of (mineral) water or in trace mineral supplements.
  • Selenium is a crucial trace mineral with numerous health benefits, for general health as well as the skin health. One of the most important jobs of selenium is being a component of glutathione peroxidase, an enzyme necessary for the antioxidant function of glutathione (master antioxidant in our body that protects against cellular damage from the free radicals that cause inflammation and aging and promote skin cancer). Individuals with acne have been shown to have low levels of blood selenium, as well as low levels of selenium-dependent glutathione activity. The richest food sources of selenium are organ meats and seafood, followed by muscle meats. Fish such as cod, tuna, halibut, sardines, and salmon are excellent sources, along with liver and meats like beef, turkey, lamb, and Brazil nuts. The selenium content of food depends heavily on soil conditions, so eating a range of selenium-rich foods on a regular basis will ensure adequate selenium intake.
  • Omega-3 fatty acids (EPA and DHA) have anti-inflammatory properties and are a crucial element of a well-balanced diet. In our modern diet, the high ratio of omega-6 to omega-3 fatty acids likely contributes to the prevalence of inflammatory skin conditions such as acne, psoriasis, and rosacea. Increasing dietary omega-3 fats is a vital step to promote the skin healing. High levels of omega-3 fatty acids have been shown to decrease inflammation and may reduce the risk of acne and other skin problems by decreasing insulin-like growth factor (IGF-1) and preventing hyperkeratinization of sebaceous follicles. These fatty acids are abundant in cold-water fatty fish such as sardines, salmon, mackerel, tuna, anchovies, and black cod. The added value of eating fish rather than taking fish oil is that apart of getting these omega-3s, you also get other nutrients such as vitamin D and selenium.
  • Beneficial bacteria and prebiotic foods. As skin conditions often relate to gut health issues, this is why probiotics and prebiotics can shine. Our gut microbiota can influence systemic inflammation, oxidative stress, glycemic control, and tissue lipid content which have important implications in skin conditions such as acne, rosacea, atopic dermatitis, and psoriasis. Prebiotics serve as “food” for beneficial gut bacteria and are indigestible by humans. Probiotics on the other hand are the beneficial bacteria themselves. You need to eat prebiotic rich foods (dietary fiber) if you want to promote the growth of beneficial bacteria in your gut. If you have skin issues (and no histamine intolerance) include fermented foods such as sauerkraut, kimchi, yogurt, and kefir in your diet, alternatively supplement with probiotic and/or prebiotic if needed.
If you want to experiment with foods you may try a Paleo diet, a Low-histamine diet, or a Low-FODMAP diet. LIFESTYLE
  • Stress management. Try to find ways that work for you to deal with stress (meditation, mindfulness, sports, therapy and so on). Find and have available three “go-to” stress relievers that work for you. These could be taking a few deep breaths, stepping outside for a few minutes, reminding yourself to just “let it go,” perking up your posture and carrying yourself confidently (stress can make you hunched over) or planning something you look forward to at the end of your stress-filled day. Taking a detox bath is one of the best ways to relieve stress. In the evening after dinner, add one cup of Epsom salts and 20 drops of lavender oil to a hot bath and soak for 20 minutes. Then drink a warm glass of chamomile tea. Stress is associated with numerous skin conditions as the skin is influenced by many of the hormones and neuropeptides involved in the stress response, such as corticotropin-releasing hormone, adrenocorticotropin hormone (ACTH), cortisol, epinephrine and norepinephrine. (Chronic) Stress compromises the effectiveness of the gut barrier as well as the skin barrier, impairing the integrity and protective function of these barriers, leading to an increase risk of infection and inflammation in the gut and/or skin.
  • Increase ultraviolet exposure especially if you spend most of the time indoors. Ultraviolet light (from sunlight or alternatively UVA/UVB tanning beds) can be helpful in the management of psoriasis, vitiligo, acne, eczema, dermatitis, and lichen planus. In addition, sunlight promotes vitamin D3 synthesis and offers additional cognitive benefits of spending time outdoors. Be mindful that sun exposure or too much sun exposure (particularly if it leads to sunburn) can make skin conditions worse, and not all skin conditions (such as rosacea) benefit from ultraviolet light. If you’re your skin condition worsens after sun exposure, then reduce sun exposure until your skin condition is under control.
  • Get enough rest! Sleep deeply for eight hours a night: minimize electronic media and distractions. Don’t use smartphones or other screen/electronic devices in your bedroom. Go to bed around 22.00 o’clock.
  • Incorporate regular physical activity to your routine but avoid overtraining, choose an activity you enjoy doing
  • Try to apply a 8x8x8 rule: 8 hours of sleep, 8 hour of work, 8 hours of rest and for children more sleep
  • Reduce exposure to electromagnetic field from electric devices
  • Reduce exposure to toxic substances
  • Reduce exposure to plastic
  • Make contact with nature
  • Cultivate pleasure and connection
  • Make time for play and laugh
SUPPLEMENTS Next to dietary recommendations which should serve as foundation of any therapy, there are certain supplements that may be helpful for people with skin disease.
  • Vitamin C
  • Quercetin and bromelain
  • High quality multivitamin or Vitamin B complex including Folate, vitamin B12, and vitamin B6 to support methylation
  • Cod liver oil or omega-3 fatty acids
  • Probiotics such as Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus plantarum may help to reduce histamine levels
  • Prebiotics (inulin, resistant starch) to increase the levels of beneficial bacteria in the gut such as Bifidobacteria
  • Diamine oxidase supplement for people with histamine intolerance
If you do all the right things: eat healthy, exercise, sleep well, have stress under control, take the right supplements and yet your skin does not improve – dig deeper to find the reason why. Asses your gut health, digestion, possible infection, allergies, or food intolerances.
Do you react to foods?


Food allergies and food sensitivities became more prevalent over the past few decades. Some common food reactions keep raising. It certainly has a lot to do with the way we live (stressed, overstimulated), with the quality of foods and drinks we consume (processed and toxic), the air we breathe in (polluted) or the cosmetics, detergents we use. These factors can make us more vulnerable and susceptible to all sort of maladies. Our bodies have to work hard to process everything from surrounding us environment and ingested foods, to stay in balance and to provide our bodies with what it needs for optimal functioning. When our body is overwhelmed our immune system and other parts may overreact inducing food reactions.

Reactions to foods we may experience include:

-        Psychological reactions (exorphins present in wheat/gluten and diary/casein bind to opioid receptors within our body influencing our brain, our behavior)

-        Toxic reactions (food contamination or food poisoning)

-        Immune-mediated reactions such as food allergies and food sensitivities (type I, II, III, or IV hypersensitivity)

-        Food intolerance reaction (enzyme deficiency)

There is often confusion around what is what and sometimes “allergy”, “intolerance”, and “sensitivity” are used improperly, which may  depend on naming convention as well as on how you look at the reaction to foods; whether you look at the reaction itself or symptoms it causes. Without going into depth and complexity of these reactions, I describe below the key differences.

What are they?

Let’s focus here only on two immune-mediated reactions (IgE & IgG) and food intolerances. Be aware that a person may also experience a combination of food reactions after ingesting one food, which may involve an immune reaction and non-immune reaction, cell-mediated food reactions.

Generally, we can distinguish:

-        immediate and often severe immune responses to IgE antibodies for food allergies

-        milder and delayed immune responses to IgG antibodies for food sensitivities

-        metabolic or gastrointestinal responses caused by a lack of enzymes or other inability to digest certain foods for food intolerances

Food allergies (IgE mediated) are associated with immediate-type gastrointestinal hypersensitivity, oral allergy syndrome, acute urticaria and angioedema, allergic rhinitis, acute bronchospasm, and in severe reactions anaphylaxis. Some symptoms include: reddening of the skin (hives, itching); swelling (lips, eyelids), tightness of the throat; impaired breathing; vomiting; or diarrhea. Most of these symptoms appear right after eating the offending food, for example nuts, fruits, raw vegetables, eggs, diary, or chicken. A person is always aware of symptoms and reaction to the allergenic food. In some people it’s a lifelong reaction whereas in others it disappears.

Food sensitivities (IgG mediated) involve delayed (hours, days) allergic-like responses/hypersensitivities that can last for days. The mechanism is based on triggering an immune system by producing IgG antibodies after a repeated exposure to a food antigen. The reaction can be dose-dependent and often involves common foods. Some delayed food sensitivity symptoms can include fatigue, abdominal pain, bloating, vomiting, diarrhea, asthma, joint stiffness, swelling and pain, skin itching, rushes, hives, psoriasis, memory disturbances, behavioral changes or fever. A person is not always aware about having this food reaction as it can be difficult to connect a particular food reaction with its delayed symptoms. It disappears weeks/months after elimination of a trigger food.     

Food intolerances are associated with an inability (often genetically determined) to break down particular food compounds caused by a lack of enzymes or their low expression. This type of reaction does not directly involve the immune system and in some individuals response can be dose-dependent. It typically causes abdominal cramps and pain, diarrhea, bloating, sometimes headaches. The most frequent food intolerances include lactose intolerance, histamine intolerance, or fructose intolerance.

Do reactions to foods have health consequences?

Exposure to foods causing allergic, intolerance reaction or food sensitivities can be a contributing factor in many health conditions such as arthritis, eczema, psoriasis, depression, anxiety, migraine headaches, muscle pain, chronic fatigue, as well as in inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). So if you have chronic health complaints it is worthwhile to give your food reactions a closer look.


There is a number of ways to test for food reactions and the methods become more sophisticated to meet the growing demand. Different tests are appropriate depending on the immunologic reaction a person is trying to discover. Most common methods include elimination/challenge, skin testing, patch testing, ELISA antibody tests for IgG, IgE, IgG4, and IgA antibodies, biochip technology, and energetic testing methods. Each and every method has its advantages and disadvantages and particular methods investigate only a specific aspect of food reactions. For some people, laboratory testing results can be a great motivational trigger to promote dietary changes serving as a “proof” that a particular food is reactive. Also tests can be recommended to people unwilling or unable to do an elimination diet or for those who can’t easily identify the food related responses. Elimination diet you can do on your own and it is in principle very easy but it takes the time and diligence and can be overwhelming whereas an accurate and reproducible food allergy test allows nutritious foods to remain in a patient’s diet while removing offending foods. If you want to do some testing discuss possibilities with your health care professional. Below I provide the principles of an elimination diet.

Elimination & Challenge Method

The most common solution currently available is to begin identifying potential sensitivities by following an elimination and challenge of the specific foods. The basic idea is to eliminate a suspect food for a period of time to see which symptoms subside and then reintroduce it to see which symptoms reappear.

How to do it:

  1. Eliminate a single suspect food, group of foods (for example nightshades) or the 10 most common food allergens (milk, eggs, wheat, grains, soy, shellfish, peanuts, tree nuts, sugar and alcohol) for a certain period of time (from days to weeks or months)
  2. Reintroduce one food at a time for three days, eaten 1-3 times a day (Note: this type of testing should not be done with foods known to cause a severe or anaphylactic reaction).
  3. Keep a diary to record how you feel for up to three days after a food is reintroduced. Some reactions may appear 24-72 hours after food consumption.
  4. Follow the same steps for each food.

a)  If a food causes a reaction such as brain fog, fatigue, itchy skin, stool changes etc., then eliminate it. Wait with introducing a new food for two-three days.

b)  If you don’t have a reaction, preferably leave that food temporarily out of your diet and put it back into your diet at the end of the food-reintroducing phase.

The food elimination/challenge approach can be time-consuming, carries a risk of producing a severe reaction (especially for IgE-mediated food allergies), can be difficult to reproduce, coincidental factors may affect the outcomes and it may result if false negatives. Therefore, it’s good to have some background info before applying this or any other testing approach.


  1. “Adverse food reaction and functional gastrointestinal disorders: the role of dietetic approach” F. Pasqui et al. J Gastrointestin Liver Dis, September 2015 Vol. 24 No 3.
  2. “Food allergies” Wendy Hodsdon. Natural Medicine text book, fourth edition. J. Pizzorno & M Murray. Elsevier 2013.
  3. “Testing for food reactions: the good, the bad, and the ugly” G. E. Mullin et al. Nutrition in Clinical Practice, Vol. 25 No 2, 2010.
Can probiotics prevent flu and colds?

Respiratory tract infections and probiotics

During the 2013-2014 winter, my family accounted many episodes of Respiratory Tract Infections (RTIs). I, my husband, and both my daughters were experiencing recurrent RTIs, and this saga lasted for about 6 months. My older daughter missed about 60% of her daycare days and my younger one about 90% of daycare because of RTIs. It was a tough burden (physically, emotionally and financially) for me and for my husband. Luckily, the last winter of 2014-2015 was much better; my daughters were only sick a few times and it was quite mild. Having the entire family suffering from recurrent RTIs, it was a wake-up call for me to look for ways to improve our health. The changes we have made were mostly around our diet and included the consumption of probiotic supplements, more fermented food, more vegetables, more salads, more fiber, more bone broths, less sugars, reduced intake of diary milk products, reduced consumption of wheat and gluten, and no processed food.

Even though it's not the season of colds and flu now, I want to give some attention to “RESPIRATORY TRACT INFECTIONS AND PROBIOTICS”. RTIs typically include cold, upper respiratory tract infections, influenza-like illness and flu, the majority of which is caused by a virus.  Associated symptoms include runny nose, sneezing, sore throat, cough, sometimes fever and may last between 5 to 10 days. Children, on average, suffer from 6 to 12 RTI incidents annually, whereas adults average from 1 to 5 incidents. The management of RTIs typically includes the use of over-the-counter medications to relieve some of the symptoms.

The average cost of an RTI incident is by itself low, however the high incidence and recurrence leads to a high burden for the individuals affected, their families, health care practitioners and health care systems worldwide. High recurrences of RTIs affect the quality of life, leading to absenteeism at work or at school, and may involve extra costs such as hiring a baby sitter.

It is well known that a healthy, diverse and balanced diet, regular physical exercise and no stress contribute to one’s wellbeing, but what about probiotics? Can probiotics have an effect on the prevention, recurrence, duration or severity of RTIs?


Probiotics, in comparison to placebo, were shown to contribute to:

- lower risk of RTIs

- lower incidence of RTIs

- reduced number of days with RTIs related symptoms

- reduced antibiotic use

- fewer abstinence days from work, school, or daycare

Below you can find a summary of results from relevant clinical studies.


Based on the results that probiotics may reduce the RTI duration, reduce absenteeism at work, at school, and reduce the use of medications, could the use of probiotics have an economical aspect in the management of RTIs? In order to answer these questions, a health-economic analysis (Lenoir-Wijnkoop et al)  was undertaken to determine the public health and budget consequences of a generalized probiotic intake in France. Scientists used the existing data from the two meta-analyses (Cochrane meta-analysis and YHEC meta-analysis) and applied it to the French population to estimate common RTI events, comparing subjects on and without a probiotics regimen. They looked at the cost savings related to the decreased incidence of RTIs, reduced number of sick days, number of antibiotics courses, sick leave days, and other related costs. Based on one of the analysis, authors estimate that probiotics’ economic impact could save the society, during the 2011-2012 winter, €84.4 million according to the YHEC data, and €253.6 million according to the Cochrane data. The authors emphasize also that the incidence of common RTIs during the 2011-2012 winter was low compared to the average rate over the five last winters.

shutterstock_193442804TO USE PROBIOTICS OR NOT?

This is the most important question for the consumer: should I use probiotics for the prevention and management of RTIs? And if yes, then which?

There is no wonder probiotic strain against all RTIs and no wonder probiotic strain that works in all individuals. Everyone’s gut microbial make-up is unique so the probiotics may have different impact. The clinical findings available now are certainly encouraging, but on the other hand, there are also conflicting results where the users seem not to benefit from using probiotics in the prophylaxis and the management of RTIs, such as in a recent study with Bifidobacterium animalis subsp. lactis (Hojsak et al). Therefore, all published data needs to be confirmed in larger and more homogenous study populations. There are differences in study designs, including the various numbers of participants, various group ages, different sex, and different durations of the studies, different probiotic strains given, and different probiotic preparations, at different concentrations and at different times. This heterogeneity makes definite conclusions and recommendations – on whether, when, which probiotic and at what dosage in management of RTIs – difficult. We need to have a better understanding of the effects of different probiotic strains in the prevention and management of RTIs, and more specifically on their immune-modulating potential.

I believe that if we gain more knowledge we will be able to select the most beneficial probiotic strains for the management of RTIs, based on their proven properties.


To help you to select appropriate probiotic strains, I list below the bacterial strains shown to have, to greater or lesser extent, a beneficial effect in the prevention and/or the management of RTIs.

Lactobacillus strains:
Lactobacillus rhamnosus GG (ATCC53103), Lactobacillus rhamnosus (LC705), Lactobacillus casei (DN-114 001 and 431), Lactobacillus paracasei (8700:2), Lactobacillus gasseri (PA 16/8), Lactobacillus bulgaricus, Lactobacillus acidophilus (CUL21 and CUL60), Lactobacillus plantarum (HEAL9), Lactobacillus brevis (KB290)
Bifidobacterium strains:
Bifidobacterium breve (P), Bifidobacterium lactis (BB-12 and CUL34), Bifidobacterium bifidum (MF20/5, R0071 and CUL20), Bifidobacterium longum (SP 07/3)
Other strains:
Streptococcus thermophilus


shutterstock_196400357The study of Hojsak et al has shown that children (376 children) receiving probiotic Lactobacillus rhamnosus GG were at a lower risk of respiratory tract infections, gastrointestinal infections, vomiting episodes, and diarrhea when compared to the placebo group (366 children). Another study (Rautava et al) with infants (probiotic group) receiving daily formula supplemented with Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 until the age of 12 months showed that infants in the probiotic group, in comparison to the placebo group, had lower incidence of RTIs, of ear infections (acute otitis media) and of antibiotic courses. Moreover, Japanese clinicians (Waki et al) demonstrated that schoolchildren receiving a probiotic drink containing Lactobacillus brevis KB290, for 2 months/5 days per week had lower incidence of influenza infections, with a more pronounced affect in children not vaccinated with the influenza vaccine. The authors of this study reported no significant difference in incidence of common cold or gastroenteritis between the probiotic group and the placebo group. Another recent study (Garaiova et al) investigated the efficacy of probiotic consortium containing bacteria (Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20, and Bifidobacterium animalis subsp. lactis CUL34) and 50 mg vitamin C for prevention of respiratory tract infections in 69 healthy children aged 3-6 years. Children received probiotic (28 children) daily or placebo (29 children) daily, for a period of 6 months. The authors observed significantly reduced incidence of upper RTIs, reduced numbers of days with upper RTI associated symptoms, and reduced absenteeism from preschool in the placebo group. In addition, children on probiotic and vitamin C regimen used cough medicines, painkillers, nasal sprays, and antibiotics for shorter periods of time than children receiving a placebo.

Furthermore, probiotics – in comparison to control groups – were found to contribute to the prevention and reduced rate of RTIs, also in reduced antibiotic use, as based on the Cochrane meta-analysis (Hao et al, updated Hao et al) of 10 clinical trials with 3,451 participants (infants, children, and adults). These results, however, did not find any effect on the duration of each single sickness episode. Yet, another data review (King et al) including a meta-analysis revealed the effectiveness of probiotics (Lactobacillus and Bifidobacterium strains) on the duration of RTIs in children and adults. The meta-analysis including 20 clinical trials revealed that participants receiving probiotic, in contrast to placebo participants, had shorter illness episodes by almost a day, had fewer abstinence days from work, school, or daycare.

The above studies report no adverse events associated with probiotic intake. Probiotics used in the studies – Lactobacilli and Bifidobacteria – are generally considered to be safe. Patients at high risk for a probiotic-induced sepsis include immunocompromised patients and premature neonates.


Ingredients (for about 2 liters)

  • 1 kilogram white cabbage
  • About 1 1/2 tablespoons sea salt


  • Widemouth jar or ceramic crock
  • Plate that fits inside jar/crock
  • Smaller jelly jar (filled with water) that fits inside the larger jar/crock or clean stones, marbles, or other weights for pressing ferment under brine
  • Cloth cover (towel or kitchen cloth) for covering the jar


  1. Clean all equipment properly
  2. Chop the cabbage finely. I first cut the cabbage into quarters, cut the core out, and slice each quarter further into fine pieces.
  3. Place chopped cabbage in a big bowl and sprinkle salt over the cabbage. I massage cabbage with my hands to distribute the salt into all cabbage pieces. Thanks to the salt, water will be pulled out of the cabbage making a brine solution, after about 10 min the cabbage will become watery. Presence of salt keeps the cabbage crunchy but it’s also possible to make sauerkraut with less or no salt at all.
  4. Optionally, you can add other vegetables, herbs or spices to the mix if you like. I like plain cabbage the most but you can get creative by adding onions, garlic, beets, brussels sprouts, or dill seeds, and more.
  5. Pack the cabbage into the jar. Use handful portions of cabbage (including any already released liquid) at the time then tamp it down hard using your fist. Tightly tamped cabbage will release more water.
  6. Weight the cabbage down. Once all the cabbage is packed, place a small plate or other glass/ceramic lid inside the jar to cover kraut. On the top of it place a clean weight (smaller jar filled with water, clean rocks). It will keep kraut submerged under the brine and will force more water out of the cabbage. Note: I have also made sauerkraut without weighting it down with weight, just with a lid on a jar, and it worked fine.
  7. Cover the mouth of the jar with a cloth to keep dust and insects away.
  8. Press the weight down every few hours until the brine rises above the cover (after about first 24 hrs). It will add pressure and force more water out the cabbage. Add extra liquid with salt (about 1 teaspoon of salt in 1 cup of water) if the brine does not rise above the cabbage by the next day.
  9. Leave the cabbage to ferment for about 3 to 14 days but it’s up to your own preference on how fermented you like it. In general, the lower the storage temperature the slower fermentation. Also, smaller batches ferment quicker than larger batches.
  10. Taste the kraut every day or two. Each time you take some kraut out of the jar, make sure that the remaining kraut is packed tightly in the jar again, and the cover and weight are clean before weighting the kraut down. Add more salty water if necessary. When you are happy with the result just enjoy it. You can transfer it to a smaller jar and refrigerate your batch for 1-3 months!
  11. As the fermentation proceeds you may see some white layer, foam on the top, it’s often called “scum”. You can skim it off of the surface.
  12. I love eating sauerkraut with chopped red onion, some salt & peper and olive oil. It’s simple and delicious! Don’t forget that sauerkraut juice is a great digestive drink.