Carbohydrates and sugars

Carbohydrates are metabolized into glucose, which serves as the exclusive source of energy for most bacteria. A low-carbohydrate, insulin-resistant diet, which involves restricting consumption of carbohydrates, is recommended for Marshall Protocol (MP) patients but not required. This diet has certain benefits for MP patients: stabilization of blood sugar, weight loss, and appetite control. Additionally, holding carbohydrate intake at a reasonable level can enhance bacterial death. Conversely, eating more carbohydrates than usual can sometimes moderate intolerable immunopathologyAn unbearable or unsafe severity of bacterial die-off reaction..

What are carbohydrates and sugars?

A carbohydrate is a composition of one or more sugar molecules. The two main types of sugars are:

  • naturally-occurring sugars, such as those in milk (lactose) or fruit (fructose), and
  • added sugars, which are those added to foods during processing.

The body breaks down both carbohydrates and sugar into the exact same sugar molecules, so a diet high in carbohydrates will produce the same fuel for bacteria as a diet high in refined sugar. For this reason, the terms carbohydrates and sugars are used synonymously herein.

Carbohydrates and the immune response

Bacteria use carbs for energy

The Krebs Cycle is part of a metabolic pathway that converts carbohydrates, fats and proteins into a form of energy that can be used by the body. The cycle uses sugar to generate molecules of NADH, which humans use as a source of energy. But bacteria such as Borrelia, Treponema, and possibly others do not have proteins in their genomes that allow them to use NADH as an energy source. Instead, they obtain energy directly from sugar. This means that while humans must wait until sugar is broken down in order to put it to use, some bacteria can use it immediately. Consequently, extra sugar inevitably ends up benefiting the pathogen rather than the host.

Sugar has been shown to affect the immune system in ways not yet completely understood. Sugars in the body often bind to proteins, a process called glycosylation. Once attached to a protein, sugars adjust the protein’s ability to react with other molecules. T-shaped molecules named immunoglobulins have a location at the center of their structure which has a high affinity for sugar. Sugars are attracted to this region and, once attached, stay bonded for long periods of time. It is not yet known what changes sugars induce when bound to immunoglobulins, but their ability to bind these molecules does suggest that sugar can modulate the immune response.

Effect of carbs on immunopathology

Carbohydrates are metabolized into glucose, which serves as a direct source of energy for most bacteria. Keeping carbohydrate intake to a reasonable level can enhance bacterial death. Since more bacteria are likely to die in a carbohydrate-deprived environment, some MP patients may be able to use carbohydrate intake to modulate the level of their immunopathology. Those patients who experience strong immunopathology should not worry excessively about keeping carbohydrate intake to a minimum since they are experiencing bacterial die-off. Eating more carbohydrates than usual can sometimes moderate intolerable immunopathology.

Low-carb, insulin-resistant diet

A growing body of research supports the notion that the gut microbiota feeds on simple carbohydrates,1) with the small intestinal microbiota driven by rapid uptake and conversion of simple carbohydrates.2) Indeed, a very low-carbohydrate diet has been shown to improve gastroesophageal reflux and its symptoms.3)

MP patients, in consultation with their health care practitioners, need to find the level of carbohydrate intake that minimizes their symptoms.

The quality of every calorie counts. Nutritiousness is important. Vegetables may be the best source of the “good carbs,” while whole grains, no matter how highly-touted, are the least beneficial of the acceptable carbs, completely inessential in the human diet, and apt to cause adverse reactions in many. The same can be said for many natural alternatives. Honey, for example, is no more nutritious than table sugar.

It's important to note that just because MP patients restrict carbohydrates, that does not mean they can eat unlimited calories from foods high in fat or protein without experiencing adverse consequences.

Managing cravings for sweets

Eating high amounts of carbohydrates can exacerbate sugar cravings. These cravings can be curtailed by reducing consumption of carbohydrates to largely low-carb vegetables and fruits.

Other tips:

  • Try consuming foods which contain one of the approved artificial sweeteners, such as Splenda or stevia.
  • Avoiding foods you should not eat is easier if they are not in your home.
  • You can wean yourself from eating highly-sweetened foods by eating small amounts of fresh fruits.
  • There are also many processed candy products available made with sugar alcohols that can provide the occasional sweet treat if you can tolerate the laxative side effect. These products are highly refined and should be eaten in moderation so they do not take the place of more wholesome foods.
  • Fruit eaten in moderation is fine, especially those that are lower in carbohydrates. Learn which fruits have high nutritional values in relation to their carbs and select those.
  • Fruit juice is high in natural sugars, and fruit drinks have added sugar. Choose whole fruit instead. Most people are not tempted to overconsume whole fruit.
  • Devise a plan to reduce the sugar you feel you must have. Write the plan down and then stick to it, slowly reducing your refined sugar intake.

Low-carb on a budget

Low-carb friendly-vegetables and meats tend to be more expensive than rice, pasta, and breads on a calorie-by-calorie basis. Smart consumers can limit the premium they pay for healthier foods. The following are some tip for eating low-carb on a budget.

  • Eat what's in season. This avoids having to pay for the increased transportation, storage and distribution costs of imported food.
  • Do as much preparation of food as you can. Bagged salad and skinned chicken will cost more than the original ingredients.
  • Many cheaper cuts of meat are just as nutritious as the more expensive ones. Long, slow cooking methods will increase tenderness. Your body does not care if you get your protein from steak and boneless, skinless chicken breast or from hamburger and chicken leg-and-thigh quarters.
  • Buy in bulk. When hamburger, butter, canned broth, natural peanut butter, or the like goes on sale, stock up. A freezer lets you take advantage of meat specials.
  • Cut way back on eating out. The same food is always far cheaper at home.
  • Bag lunches are a great way to use up leftovers.
  • One of the lowest carb-and-calorie desserts is also one of the cheapest: store-brand sugar-free gelatin.

Benefits of eating low-carb

Although restricting intake of carbohydrates alone will not resolve existing chronic disease, high amounts of sugar consumption have been implicated in everything from gout to cancer. Carb restrictions can have other benefits as well.

Weight management

Those who want to lower their blood sugar levels or who are very inactive or who want to lose weight or who want to control their appetite may want to keep their daily carbohydrate count very low. Others are able to progress well on the MP by simply avoiding refined sugars and eating a moderate amount of high-food-value carbohydrates.

Reduction in gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD or GORD) typically has symptoms of reflux and heartburn. These symptoms may be relieved by eating a low-carbohydrate diet or by not eating protein and carbohydrates together.

Proteins digest in the stomach, in an acid medium, while carbohydrates digest in the small intestine, in an alkaline medium. This means that eating the two together can trap undigested carbohydrates in your stomach, waiting for proteins to digest, and those carbohydrates can start to ferment in your stomach, leading to indigestion and heartburn. No fun. This is one of the reasons that many people find that reflux clears up on a low-carb diet.

Dana Carpender, HoldtheToast Press

Specific foods


Vegetables lowest in carbohydrates (from low to high):

  • sprouts - beans, alfalfa, etc.
  • greens – lettuces, spinach, chard, etc.
  • hearty greens - collards, mustard greens, kale, etc.
  • herbs - parsley, cilantro, basil, rosemary, thyme, etc.
  • bok choy
  • celery
  • radishes
  • sea vegetables (nori, etc.)
  • broccoli
  • cauliflower
  • cabbage (or sauerkraut)
  • jicama
  • avocado
  • cucumber (or pickles without added sugars)
  • peppers (all kinds)
  • summer squash (including zucchini)
  • scallions or green onions
  • asparagus
  • bamboo shoots
  • leeks
  • brussels sprouts
  • snow peas (pods)
  • green beans and wax beans
  • tomatoes
  • eggplant
  • artichoke hearts
  • fennel
  • onions
  • okra
  • spaghetti squash
  • celery root (celeriac)
  • carrots
  • turnips
  • water chestnuts
  • pumpkin

Vegetables highest in carbohydrates:

  • beets
  • carrots
  • corn
  • parsnips
  • peas
  • plantains
  • potatoes in all forms
  • winter squashes (particularly acorn and butternut)

When counting carbohydrates in vegetables, the grams of fiber are not included, so it can be subtracted from the total.


Fruits lowest in sugar:

  • rhubarb
  • strawberries
  • cranberries
  • raspberries
  • blackberries
  • blueberries
  • grapefruit
  • melons
  • apricots
  • plums
  • peaches
  • pears
  • guava
  • cherries
  • apples

Fruits fairly high in sugar:

  • grapes
  • tangerines
  • oranges
  • pineapple
  • kiwi

Fruits very high in sugar:

  • bananas
  • dried fruit
  • mango
  • papaya

Cocoa and chocolate

It is likely that humans have stuck to any brew containing compounds with psychoactive properties, resulting in a better daily life, i.e., more efficient thinking, exploring, hunting, etc., however, without the serious side effects of drugs of abuse. 4)

Patient recommendations

  • “We found pasta “Bionaturae” organic made w/whole duram wheat and water-2 ingredients. No folic acid, nothing added. Tastes great! He always thought it was the sauce that made him sick. No, it was the the D.”
  • “I have found the Quaker All Natural Cereal has NO added D or Folates! It makes a nice cool breakfast on these hot humid days! I cover it in watered down half and half and add more sliced almonds as they add very few.”
  • “We have been eating Eziekel bread and it is absolutely delicious. They even have a cinnamon raisin bread. No flour and no Vit D and no folic acid.”
  • “I also find that oats (Quaker) are okay to eat and I do not find Vit d listed in shredded wheat. (I am talking name brands, I do not know about generic.)”
  • “The new low-carb tortillas (4 carbs per 8 inch tortilla) are a good alternative to bread.”
  • Kavli's “All Natural Whole Grain Crispbread” is low in carbs (no vitamin D or folic acid) and the crispy garlic is very flavorful. You'll find it in the bread aisle.“
  • “Brownberry has a bread that is carb controlling and does not contain added vitamin D or folic acid.”
  • “Sprouted grain bread made by Healthway called Alpine Chipmunk has no added D and only 2% of the RDA of folic acid per slice.”
  • Ross Chocolates makes a very good dark chocolate bar.“

===== Notes and comments =====

Dana Carpender's website, HoldTheToast Press Protein Power by Drs. Eades, MD is an easy-to-understand explanation of the science of carbohydrate metabolism and low carbohydrate eating You may find it helpful to use a low carbohydrate cookbook, such as any by Dana Carpender. Just remember to modify the recipes to exclude the use of foods high in vitamin D. Low-Carb Atkins Pulls Ahead in Four-Diet Face-Off Low glycemic index diet Dr Bernstein's Low Carb Diet

The ISME Journal (2011) 5, 220–230; doi:10.1038/ismej.2010.118; published online 5 August 2010

Dominant and diet-responsive groups of bacteria within the human colonic microbiota

Alan W Walker1, Jennifer Ince2, Sylvia H Duncan2, Lucy M Webster2, Grietje Holtrop3, Xiaolei Ze2, David Brown2, Mark D Stares1, Paul Scott1, Aurore Bergerat2, Petra Louis2, Freda McIntosh2, Alexandra M Johnstone2, Gerald E Lobley2, Julian Parkhill1 and Harry J Flint2

1Pathogen Genomics, Wellcome Trust Sanger Institute, Cambridge, UK 2Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK 3Biomathematics and Statistics Scotland, Aberdeen, UK Correspondence: HJ Flint, Microbial Ecology Group, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK. E-mail: H.Flint@abdn.ac.uk

Received 25 January 2010; Revised 11 May 2010; Accepted 21 June 2010; Published online 5 August 2010.

Topof page Abstract The populations of dominant species within the human colonic microbiota can potentially be modified by dietary intake with consequences for health. Here we examined the influence of precisely controlled diets in 14 overweight men. Volunteers were provided successively with a control diet, diets high in resistant starch (RS) or non-starch polysaccharides (NSPs) and a reduced carbohydrate weight loss (WL) diet, over 10 weeks. Analysis of 16S rRNA sequences in stool samples of six volunteers detected 320 phylotypes (defined at >98% identity) of which 26, including 19 cultured species, each accounted for >1% of sequences. Although samples clustered more strongly by individual than by diet, time courses obtained by targeted qPCR revealed that ‘blooms’ in specific bacterial groups occurred rapidly after a dietary change. These were rapidly reversed by the subsequent diet. Relatives of Ruminococcus bromii (R-ruminococci) increased in most volunteers on the RS diet, accounting for a mean of 17%of total bacteria compared with 3.8% on the NSP diet, whereas the uncultured Oscillibacter group increased on the RS and WL diets. Relatives of Eubacterium rectale increased on RS (to mean 10.1%) but decreased, along with Collinsella aerofaciens, on WL. Inter-individual variation was marked, however, with >60% of RS remaining unfermented in two volunteers on the RS diet, compared to <4% in the other 12 volunteers; these two individuals also showed low numbers of R-ruminococci (<1%). Dietary non-digestible carbohydrate can produce marked changes in the gut microbiota, but these depend on the initial composition of an individual's gut microbiota.

Why shouldn't MP-patients eat as much protein and fat as they want?

It's important to note that just because MP patients restrict carbohydrates, that does not mean they can eat unlimited calories from foods high in fat or protein without experiencing adverse consequences.

See for instance: https://www.garytaubes.com/2010/12/inanity-of-overeating/ =====References=====

Payne AN, Chassard C, Lacroix C. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obes Rev. 2012 Sep;13(9):799-809. doi: 10.1111/j.1467-789X.2012.01009.x. Epub 2012 Jun 11.
[PMID: 22686435] [DOI: 10.1111/j.1467-789X.2012.01009.x]
Zoetendal EG, Raes J, van den Bogert B, Arumugam M, Booijink CCGM, Troost FJ, Bork P, Wels M, de Vos WM, Kleerebezem M. The human small intestinal microbiota is driven by rapid uptake and conversion of simple carbohydrates. ISME J. 2012 Jul;6(7):1415-26. doi: 10.1038/ismej.2011.212. Epub 2012 Jan 19.
[PMID: 22258098] [PMCID: 3379644] [DOI: 10.1038/ismej.2011.212]
Austin GL, Thiny MT, Westman EC, Yancy WSJ, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006 Aug;51(8):1307-12. doi: 10.1007/s10620-005-9027-7. Epub 2006 Jul 27.
[PMID: 16871438] [DOI: 10.1007/s10620-005-9027-7]
Franco R, Oñatibia-Astibia A, Martínez-Pinilla E. Health benefits of methylxanthines in cacao and chocolate. Nutrients. 2013 Oct 18;5(10):4159-73. doi: 10.3390/nu5104159.
[PMID: 24145871] [PMCID: 3820066] [DOI: 10.3390/nu5104159]
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