Chap 4

V. Chan, MS, RD

Carbohydrates
Carbohydrates are made of carbon, hydrogen and oxygen atoms These atoms form chemical bonds that follow the laws of nature

Carbohydrates
Two types
Simple carbohydrates
Single sugars (monosaccharides) or linked pairs of sugar units (disaccharides)

Complex carbohydrates
Long chains of sugar (polysaccharides) units to form starch or fiber

Simple Carbohydrates: Monosaccharides

Monosaccharides (hexose & pentose):
Glucose serves as the essential energy source, and is commonly known as blood sugar or dextrose Fructose is the sweetest, occurs naturally in honey and fruits, and is added to many foods in the form of high-fructose corn syrup Galactose rarely occurs naturally as a single sugar

Simple Carbohydrates: Disaccharides

Pairs of monosaccharides, one of which is ALWAYS glucose
Condensation reactions link monosaccharides together. Hydrolysis reactions split molecules and commonly occur during digestion. Maltose (two glucose units)- is produced during the germination of seeds and fermentation. Sucrose (fructose and glucose combined)- is refined from sugarcane and sugar beets (table sugar), tastes sweet, and is readily available. Lactose (galactose and glucose combined)- is found in milk and milk products.

Complex Carbohydrates
Few (oligosaccharides) or many (polysaccharides) glucose units bound/linked together in straight or branched chains

Polysaccharides
Glycogen
Storage form of glucose in the body Highly branched polysaccharide Provides a rapid release of energy when needed

Starches
Storage form of glucose in plants Found in grains, legumes, some vegetables

Complex Carbohydrates: Polysaccharides

Fiber (cellulose), provide structure in plants, cannot be broken down by human enzymes
Two types of fiber:
Soluble fiber Insoluble fiber

Fiber
Soluble Fiber
Readily dissolves in water Adds a gummy/ gel- like characteristic to foods Indigestible by human enzymes May be broken down to absorbable products by bacteria in the digestive tract (fermentability) Found in fruits and vegetables

Fiber
Insoluble Fiber
Does not dissolve in water Tough, fibrous structure of fruits, vegetables, grains Indigestible food by human enzymes Ferments in colon Decreases transition time in colon Found in (cellulose) outer layers of whole grains, hulls of seeds, skins of corn kernels

Resistance Starch
A 3rd type of fiber Resist digestion Passes through the small intestine undigested Ferments in large intestine Some resistance starch can be digested in large intestine Can contribute to fiber intake Sources: under ripe bananas, oatmeal, raw potatoes, bread

Fiber
Could there be consequences to eating too much fiber?

What About Refined Sugars?

Purified, refined sugars (mostly sucrose or fructose) contain no nutritional value
No protein No vitamins/ minerals No fiber

Considered as empty calories Low in nutrient density May lead to obesity if consume too much of May alter blood lipids that may increase risk for heart diseases

Eat Fiber- Rich Foods

Health benefits include:
Promotion of normal blood cholesterol
Fiber binds with cholesterol containing compounds in bile

Reduced risk of heart disease Control of blood pressure (decreasing chances of hypertension) Keeping blood glucose steady Maintaining healthy bowel function Promoting healthy body weight

Recommended Intake of CHO

RDA for carbohydrate is 130 g per day, or 4565% of energy intake Dietary Guidelines encourage a variety of whole grains, vegetables, fruits and legumes daily
Dairy also contribute to total CHO intake

DRI for Fiber:

25 g total fiber/ day for women through 50 21 g total fiber/ day for women 51+ 38 g total fiber/ day for men through 50 30 g total fiber/ day for men 51+

Maintenance of Digestive Tract

Constipation- difficult/ incomplete or infrequent bowel moments associated with discomfort in passing dry, hardened feces Hemorrhoids- swollen, hardened veins in the rectum, usually caused by pressure from constipation Diverticulitis- painful inflammation of diverticula Diverticulosis- pouches form in the wall of the colon

CHO Digestion
Digestion first begins in the ? Enzymes in saliva breaks down CHO
Amylase begins to hydrolyze starch into short polysaccharides and maltose Sweet taste when consuming CHO

Once the CHO is in the stomach, saliva enzymes deactivate

Why?

CHO Digestion
In the small intestine, amylase (pancreas), among other enzymes (maltase, sucrase, lactase) hydrolyzes starch to disaccharides & monosaccharides In the large intestine, fibers remain and attract water, soften stool and ferment

Digestion and Absorption of CHO

CHO Absorption
Primarily takes place in the small intestine Galactose & fructose get converted into glucose by the liver Glucose gets transported to the cells
Excess glucose is stored as glycogen in muscle & liver Cells may split glucose for energy (mitochondria)

Lactose Intolerance
Occurs when the small intestine is unable to digest lactose The small intestine does not make enough lactase
Lactase deficiency As we age, people lose their ability to produce lactase Damaged villi Lactase splits lactose into glucose & galactose

Symptoms include bloating, abdominal discomfort, and diarrhea Undigested lactose remain in the intestine until it is diluted by fluid from surrounding tissue & bloodstream

Lactose Intolerance
Intestinal bacteria will utilize lactose for energy
By product: gas

Those lactose intolerant can tolerate up to 6 g of lactose (1/2 c milk) w/o symptoms
Dont jump the gun that you are lactose intolerant

Lactose Free Milk Over the counter pills/ drops Calcium fortified foods
Ca Fortified Orange juice Canned sardines -Soy Milk -Salmon w/ bones

Newborns & Milk

Infants produce abundant lactase
Aids in absorbing sugar from breast milk & milk based formula Very few inborn babies suffer from lactose intolerance

Infants/ young children in developing countries are severely at risk of lactose intolerance due to diseases, malnourished, parasites Girls in developing countries who fail to consume enough calcium may develop weak bones

The Bodys Use of Glucose

Glucose provides energy Glucose is utilized by every cell in the body Brain cells and nervous system depend almost exclusively on glucose Red blood cells utilize glucose alone

The Bodys Use of Glucose

The body stores glucose as glycogen The body uses glucose for energy if glycogen stores are available If glycogen stores are depleted, the body makes glucose from protein (Gluconeogenesis)
Protein-sparing action is having adequate carbohydrate in the diet to prevent the breakdown of protein for energy

The Bodys Use of Glucose

The body can also utilize fat
Making ketone bodies from fat fragments
The accumulation of ketone bodies in the blood is called ketosis Ketosis upsets the acid-base balance in the body

The body can use glucose to make body fat when CHO are consumed excessively

Glucose in the Body

Maintain glucose homeostasis
Low blood glucose may cause dizziness and fatigue High blood glucose may cause fatigue Extreme fluctuations can be fatal

Regulating Hormones (Pancreas)

Insulin moves glucose into the cells
help to lower blood sugar levels

Glucagon brings glucose out of storage

raise blood sugar levels

Glucose in the Body

Balance glucose within the normal range by eating balanced meals regularly with adequate complex carbohydrates Blood glucose can fall outside the normal range with hypoglycemia or diabetes

Carbohydrate

Protein

Fat

Diabetes
Type 1 diabetes (less common type)
Autoimmune disease- body develops antibodies and destroys the cells no insulin produced by the body

Type 2 diabetes (more common type)

where fat cells resist insulin

Prediabetes
blood glucose that is higher than normal but below the diagnosis of diabetes.

Hypoglycemia (<70 mg/ dL) is low blood glucose and can often be controlled by dietary changes

Normal Glucose Levels

Glycemic Index
Glycemic response is how quickly the blood glucose rises and elicits an insulin response Glycemic index classifies foods according to their potential for raising blood glucose Glycemic load refers to a foods glycemic index and the amount of carbohydrate the food contains
Benefits of the glycemic index is controversial Pg 129

Management of Diabetes
Daily routine: monitoring blood glucose & taking medication, eating healthy, exercise
Establish eating patterns to control blood glucose Weight management Person living with diabetes is at a higher risk for heart and blood vessel disease

Management of Diabetes
Nutrition
Medical nutrition therapys goal: keep blood glucose within normal range or close to normal Control CHO intake (to control blood glucose) NOT A LOW CHO DIET!
Low CHO diet is less than 130 g CHO/ day

Half of grains should be whole grains Meal & snack times should be in the same amount of CHO each day on a regular schedule

Sugar Replacers: Sugar Alcohols

Maltitol, mannitol, sorbitol, xylitol, isomalt, and lactitol Found in baked goods, candies, sugarless gum, jam/ jelly Provides about half the calories of sugar Absorbed more slowly and metabolized differently in the body Low glycemic response Side effects include GI discomfort
if ingested in large quantities

Sugar Replacers: Artificial Sweetners

Also called nonnutritive sweeteners Sweeten foods w/o calories Saccharin (Sweet N Low) Used as a table top sweetener, found in baked goods, etc Rapidly excreted in the urine Does not accumulate in the body Controversial finding that may have caused cancer in rats
Use of this product may be hazardous to your health. This product contains saccharin which has been determined to cause cancer in laboratory animals Original study gave the rats an amount that was hundreds of times higher than "normal" ingestion for humans In 2000, Saccharin was removed from the list of possible carcinogens

Sugar Replacers: Artificial Sweetners

Aspartame (Equal)
Commonly found in diet sodas, lite yogurts, table top sweetener, gelatin, etc Provides calories, however ~ 200 times sweeter than sugar
Digested and absorbed

Not heat stable, not meant for baking Warning about phenylalanine for those with PKU
Made from phenylalanine & aspartic acid

Sugar Replacers: Artificial Sweetners

Neotame (newer version of aspartame)
Does not include phenylalanine

7,000- 13,000 times sweeter than sugar Approved by the FDA in 2002 Can be used in cooking

Sugar Replacers: Artificial Sweetners

Acesulfame K (Sunette, Sweet One) Approved by FDA in 1988 Found in many foods and beverages Controversial issues
Improper testing & lack of long term studies Researchers know less about this product

Heat stable Contains methylene chloride (carcinogen)

Sugar Replacers: Artificial Sweetners

Sucralose (Splenda) Structure similar to sugar
Cl atom instead of an OH group

600 times sweeter than sugar Heat stable Is not actually calorie free
Made with dextrose & maltodextrin
Used to increase bulk & are CHO that have calories

1 cup of splenda= 96 cal & 32 g CHO

Often goes unnoticed due to food label claiming that its a no calorie sweetener

Would be a concern for those who have Diabetes