CARBOHYDRATE FAMILY

CARBOHYDRATES

• Hydrated Carbon atoms• Organic Compounds• Ratio (C H2 O)• Hexoses = 6 Carbon sugars***• Bonds Monosaccharides = 1 Disaccharides = 2 Oligosaccharides = 3-10 Polysaccharides = 10 - thousands

MONOSACCHARIDES

• GLUCOSE• part of every disaccharide• main component of polysaccharide• body’s final form of fuel• GALACTOSE – rarely free in nature• FRUCTOSE• sweetest sugar• converted to glucose in small intestine/liver• requires insulin

MONOSACCHARIDE STRUCTURES

CONDENSATION OF MONOSACCHARIDES

DISACCHARIDES

• MALTOSE 2 Glucose units Malt sugar Intermediate product of starch digestion• LACTOSE Glucose + Galactose Milk sugar• SUCROSE Glucose + Fructose Table sugar

SWEETNESS OF SUGARS

• FRUCTOSE …………...170

• SUCROSE……………...100

• GLUCOSE………………70

• MALTOSE……………...46

• LACTOSE………………35

• GALACTOSE…………..32

OLIGOSACCHARIDES

• OLIGO = Scent

• 3-10 single glucose units

• Raffinose and Stachycose beans, legumes

• No digestive enzymes large intestinegas

COMPLEX CARBOHYDRATES

POLYSACCHARIDES

GLYCOGEN

• Storage form of energy for animals

• Not found in plants

• Humans store glucose as glycogen

• Released with hormone signal

STARCH

• Storage form of glucose for plants

• Found in grains, legumes, tubers

• Long, branched or unbranched chains (amlyopectin or amylose)

• Hydrolyze starch glucose energy

FIBER

• Structural part of plants

• Polysaccharide but not starch

• Not digested by human enzymes

• Contribute little or not energy

• Nonstarch polysaccharides

• Nonpolysaccharides

• Resistant starches – starches classified as fiber, resist digestion

FIBER BY SOURCE

• Dietary fibers – found naturally intact in plants

• Functional fibers – extracted from plant or manufactured, beneficial health effects

• Total fiber – sum of dietary fiber and functional fiber

PHYSICAL CHARACTERISTICS

SOLUBILITY

SOLUBLE FIBERS

• Form gels – viscous, hold water• Fermentable- bacteria in colon• Protect against heart disease by lowering blood

cholesterol levels – traps bile which is then excreted

• Protect against diabetes by lowering blood glucose levels

• Delays transit time and stomach emptying• Provides feeling of fullness

EXAMPLES

• Gums and Mucilages• Guar gum• Psyllium• Carrageenan• Barley • Oats

• Used as stabilizers in food industry

• Pectins• Apples• Citrus fruits• Strawberries• Carrots

• Used in food industry as thickeners, control texture and consistency

WATER INSOLUBLE FIBER

• Do not form gels

• Less readily fermented

• Promote bowel movements and prevent constipation

• Provide feeling of fullness and satiety

• Delays gastric emptying

EXAMPLES

• Cellulose from fruits, vegetables, legumes, bran

• Hemicellulose-main part of plant fiber, bran and whole grains

• Lignin• Found in fruits with

edible seeds (strawberries, tomatoes)

• Woody structure of plants

DIGESTION

Mouth SALIVARY AMYLASE Some starch digestion, chewing high fiber foods Stomach ACIDS – NO ENZYMES Chyme – NO starch digestion Small Intestine PANCREATIC AMYLASE Most starch digestion Dextrins and Disaccharides (Maltose) Intestinal Mucosa (Villi) – fibers attract water to soften

stool Bacteria in large intestine ferment fibers Sugars and most starches digested within 1-4 hours

HYDROLYSIS

ABSORPTION

Nutrient absorption in small intestine Blood from intestines circulates through

liver Liver Converts sugars to glucose to

cells for fuel or storage Storage – liver, muscle, adipose tissue Heart, kidney, brain, liver – No insulin Muscle, adipose tissue – Insulin required

DIGESTION AND ABSORPTION

METABOLISM

• Glucose – major in metabolism• Stored as glycogen in liver – about 1/3 of body’s

supply• 2/3 stored in muscles• Glycogen made when blood glucose is high• Glycogen dismantled when blood glucose is low

– from liver• Muscle glycogen used for muscle usage• Glycogen is bulky because of water – limits

storage

GLUCOSE FOR ENERGY

• Fuels most of body activities; energy for brain and CNS• Frequent replenishing due to low storage amounts• Gluconeogenesis-Carbohydrates are protein sparing• Fat for energy – need carbohydrates to release energy

Fat + glucose energy + CO2 + H2O Fat + fat Ketones (ketosis) upsets acid/base

balance• Glucose fat; excess glucose stored as fat after

glycogen stores are filled

BLOOD GLUCOSE LEVELS

• Normal blood glucose level = 80-120 mg/dl (FBS)

• INSULIN – Beta cells of the Pancreas respond to HIGH blood glucose levels

• GLUCAGON – Alpha cells of pancreas respond to LOW blood glucose levels

• EPINEPHRINE – Adrenal glands “flight” or “fright” – glucose released from glycogen

REGULATION OF BLOOD GLUCOSE

GLYCEMIC RESPONSE

• Glycemic response – how fast glucose is absorbed after a person eats, how high blood sugar rises, how fast returns to normal

• Glycemic index – classifies food according to their potential to raise blood sugar levels

• May help control diabetes, heart disease and weight management

• Not many foods have been analyzed, values vary greatly, eat foods in combination

DIABETES

• Normal blood sugar 80-120 mg/dL

• Type 1 diabetes – pancreas doesn’t make insulin – unsure why

• Type 2 diabetes – cells not reacting to insulin due to age, obesity

• Type 2 epidemic in children and adolescents in US

• Type 2 most common form of diabetes

ORAL GLUCOSE TOLERANCE TEST

• Nothing by mouth for at least 12 hours before test• Administer CHO load 75-100 gms CHO• Blood draws: Normal range Fasting <140 mg/dl 30, 60 minutes <115 mg/dl 120 minutes <200 mg/dl 180 minutes <140 mg/dl• If two high values – one must be at the 2 hour interval -

> 200 mg/dL diagnose DM• 2 hours post prandial (pp) =138-205 mg/dl is normal

NORMAL HORMONE BALANCE

GLYCOSYLATED HEMOGLOBIN (HbA1C)

Provides accurate, long term index of average blood glucose levels

With high blood glucose levels certain Hemoglobins become glycosylated-glucose attaches to hemoglobinsugar coated

Irreversible average blood sugar level 100-120 days prior to test

Adult/elderly…………..2.2-4.8% Good Diabetic control….2.5-6% Fair Diabetic control……6.1-8% Poor Diabetic control…..>8%

HYPOGLYCEMIA

• Normal blood sugar rises after eating then returns to normal

• Hypoglycemia – blood sugar drops quickly – below normal

• Caused by too much insulin, strenuous physical activity, illness, inadequate food intake

• Some people do have hypoglycemia and must regulate carbohydrate intake

HYPOGLYCEMIA

LACTOSE INTOLERANCE

• Missing adequate amount of lactase

• Lactase Glucose + Galactose

• Amount produced decreases as we age

• Deficiency due to intestinal villi are damaged (disease, medication, malnutrition, surgery)

• May be temporary

• May be genetically determined

TREATMENT

• Limit – not necessarily avoid milk and milk products

• Read labels for milk, milk solids, whey, casein, lactose in medications as filler

• Symptoms – diarrhea, gas, abdominal discomfort

• Can use lactaid pills or “milk”, acidophilus milk, yogurt

TESTING

• Give lactose load – 50-100mg of lactose• Blood draws to check glucose levels at 1 min.,

15 min., 30, 60, 120 min.• Watch for 20-30mg/dl ^ in blood glucose levels• No increase in glucose levels and positive

symptoms lactase deficient• Second method is Breath H test-Check

hydrogen level in breath after lactose challenge

HEALTH EFFECTS OF SUGAR

• Nutrient deficiencies

• Dental caries

• Causes obesity

• Causes heart disease

• Causes behavior problems

• Causes cravings and addictions

RECOMMENDED INTAKE

• Carbohydrate = 130 gms/day (45-65% of calories)

• Daily value = 300 gms/day (60% of 2000 cal)• Added sugar = empty calories• Discretionary calories• Hard to distinguish between naturally occurring

or added• Read label – HFCS, sugar, lactose, glucose,

honey, corn syrup, corn sweetener

HEALTH EFFECTS OF FIBER

• Heart disease

• Diabetes

• GI health

• Cancer

• Weight management

• Causes abdominal discomfort

• Nutrient bioavailability may be affected

FIBER FORM

DIVERTICULA

RECOMMENDATIONS FOR FIBER

• Intake of 25-35 Grams /Day (14 gms/1000 calories)

• Using fiber rich foods – not supplements

• Use fruits, vegetables, legumes, whole grains

• Increase gradually over several weeks to give GI tract time to adapt

• Drink adequate fluids

FIBER

EXCHANGE LISTS

• Introduced in 1950 by American Diabetes Association and American Dietetic Association

• 3 groups based on the macronutrients• Carbohydrate group (CHO)• Meat and meat substitute group (protein)• Fat• Portion sizes adjusted so that CHO, Fat, Protein

and Kcals are approximately equal• Does not consider micronutrients

MEMORIZE

GOOD DIABETIC CONTROL

• DIET

• MEDICATION

• SKIN AND FOOT CARE

• VISIT DOCTOR REGULARLY

• BLOOD/URINE TESTING

• EXERCISE

• EDUCATION

INSULIN ACTIVITY

DIABETES CONTROL AND COMPLICATIONS TRIAL

• FOOD PYRAMID

• EXCHANGE LISTS

• CHO COUNTING

• TAG SYSTEM (TOTAL AVAILABLE GLUCOSE

• TO INCREASE COMPLIANCE MUST INDIVIDUALIZE

CARBOHYDRATE COUNTING

Need to identify the carbohydrate to insulin ratio: Insulin through CSII (Continuous subcutaneous

insulin infusion) Most closely resembles body Need to count grams of carbohydrate in food

items Builds on knowledge of food exchange lists and

portion sizes Multiple daily injections

ESTIMATED INSULIN-TO-CARBOHYDRATE RATIO

WEIGHT (LB)100-109110-129130-139140-149150-169170-179180-189190-199200+

RATIO INSULIN TO CHO1:161:151:141:131:121:111:101:91:8

ARTIFICIAL SWEETNERS

• Non-nutritive – no energy• Saccharin – oldest, no more warning label• Aspartame – amino acids, PKU• Acesulfame-K – tumors and rat studies• Sucralose – changed structure of sugar, used in

cooking, not digested• Neotame – newest• Tagatose – fructose related• Alitame and Cyclamate – approval pending• Stevia – herbal, no FDA approval needed

SWEETENERS

• Acceptable daily intakes – amount considered safe if stable throughout lifetime

• Weight control – confusing studies

SUGAR ALCOHOLS

• Sugar relatives – sugar replacers, nutritive sweeteners

• Yield energy – less than glucose• Low glycemic response• Used extensively in food processing – provide bulk

and sweetness• Examples: Mannitol Sorbitol (diarrhea) Xylitol lactitol isomalt