1. EXAM #1 on FRIDAY, FEB. 21. AROUND 50 QUESTIONS. STUDY GUIDE IS ON LINE

2. Chapter 4: Carbohydrates

3. Plants Synthesize Glucose

4. Monosaccharides Structure Glucose Fructose Galactose

5. Fructose (fruit sugar) Metabolized to glucose in the liver Found in fruit, honey, and high fructose corn syrup Is in sucrose

6. Galactose Usually bound with glucose (lactose) Converted to glucose in the liver Available fuel source

7. Disaccharides “Simple sugars” Maltose (Gluc + Gluc) Fermentation Alcohol production Sucrose (Gluc + Fruc) Sugar Lactose (Galactose + Gluc) Milk products

8. Complex Carbohydrates Polysaccharides: Starch & Glycogen Amylose Amylopectin Dietary fiber

9. Oligosaccharides 3-10 monosaccharides Found in beans and legumes Not digested Metabolized by bacteria in the large intestine Beno®

10. Polysaccharides: Starch 3,000 or more monosaccharides bound together Starch Amylose--straight chain polymer Amylopectin--highly branched polymer

11. Glycogen Storage form of CHO for animals and human Structure similar to amylopectin More sites for enzyme action Found in the liver and muscles

12. Dietary Fiber Undigested plant food Body cannot break the bonds Insoluble fiber Cellulos, hemicellulose, lignin Not fermented by the bacteria in the colon Soluble fiber Gum, Pectin, Mucilage Fruit, vegetable, rice bran, psyllium seed

13. Soluble and Insoluble Fiber

14. Health Benefits of Dietary Fiber Absorbs and holds water Soften stool Larger stool promotes peristalsis Promotes regularity Lower risk for cardiovascular disease Decrease hemorrhoids and diverticula

15. Diverticula

16. CHO in Food

17. Sweeteners Sucrose--benchmark of all sweeteners Same caloric content (4 kcals/gm) No health benefit over another Consumption ranges: 14-48 lbs/yr per person

18. Types of Sweeteners High-fructose corn syrup cornstarch treated with acid and enzymes conversion of glucose into fructose same degree of sweetness as sucrose cheaper and used in many food products Brown sugar Maple syrup Honey Sugar alcohols 1.5-3 kcal/g Absorbed and metabolized slower Large amount causes diarrhea

19. Sugar Substitutes Saccharin First produced in 1879 180-200x sweeter than sucrose Excessive intake is linked to bladder cancer in lab animals Not a potential risk in humans

20. Aspartame (NutraSweet) Composed of phenylalanine, aspartic acid, and methanol 180-200x sweeter than sucrose 4 kcal/gm, but only a trace amount is needed to sweeten foods Not heat stable Complaints of sensitivity to aspartame headaches, dizziness, seizures, nausea, etc. Not recommended for people with phenylketonuria (PKU)

21. Acesulfame-K (Sunette) Newest sugar substitute 200x sweeter than sucrose Not digested by the body Heat stable Diabetisweet used in baking

22. Sucralose (Splenda) 600x sweeter than sucrose Substitute chlorines for hydroxyl groups on sucrose Heat stable Tiny amount digested

23. Digestion

24. Effects of Cooking Softens fibrous tissues Easier to chew and swallow

25. Digestion of Carbohydrate in the Mouth Saliva contains amylase Starch is broken down to shorter saccharides Taste the sweetness with prolong chewing Proceeds down the esophagus

26. Digestion of Carbohydrate in the Stomach The acidic environment stops the action of salivary amylase No further starch digestion occurs

27. In the Small Intestine Pancreatic amylase is released Intestinal cells release enzymes Maltose + maltase glucose + glucose Sucrose + sucrase glucose + fructose Lactose + lactase glucose + galactose Monosaccharides are absorbed

28. CHO Digestion 1.Salivary amylase 2.Inactivation of amylase s. 3.Pancreatic amylase 4.Disacs are broken down on villi 5.Adsorption of mono-sacs 6.Fiber digestion?? 7.Feces contain some fiber

29. CHO Absorption Glucose and Galactose Active absorption Energy is expended Going from low to high concentration gradient Fructose Facilitated diffusion using a carrier No energy expended

30. Active absorption of glucose/galactose

31. Portal Vein Transport absorbed monosaccarhides Delivers them to the liver Liver can: transform them into glucose release them back into the blood stream store as glycogen (or fat)

32. Functions of Carbohydrate Supplies energy Protein sparing Prevent ketosis Sweetener

33. Regulation of Blood Glucose Hyperglycemia Hypoglycemia

34. Blood Glucose Control Role of the liver Regulates glucose that enters bloodstream Role of the pancreas Release of insulin Release of glucagon

36. Functions of Insulin Promotes glycogen synthesis Increases glucose uptake by the cells Reduces gluconeogenesis Net effect: lowers the blood glucose

37. Functions of Glucagon Breakdown glycogen Enhances gluconeogenesis Net effect: raises blood glucose

38. Epinephrine/ Norepinephrine “fight or flight” response breakdown glycogen raises blood glucose

39. Diabetes Mellitus-Type 1 Genetic link Decreased release of insulin Insulin dependent Hyperglycemia Immunological disorder Early introduction of cow’s milk

40. Treatment for Type 1 CHO counting Insulin therapy Risk for heart disease

41. Diabetes Mellitus-Type 2 Genetic link Associated with obesity Non-insulin dependent to start Accounts for majority of cases of DM Defective insulin receptors on the cells Over secretion of insulin to compensate Leads to beta cells failure Treatment: medication and diet therapy (weight loss)

42. Consequences of Uncontrolled Blood Glucose Ketosis leading to ion imbalances, dehydration, coma, death Degenerative diseases Nerve damage, Heart disease, Kidney disease, Blindness Atherosclerosis Increase risk for wound infections

43. Who is at risk for Diabetes I or II Type I Family ties Type II +45 years old – recent trends with kids family history overweight low HDL (good cholesterol) or high TGs certain ethnic groups gestational diabetes

44. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

45. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1995 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

46. DNPA Graphics: Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1999 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

47. DNPA Graphics: Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2000 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

48. DNPA Graphics: Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2001 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

49. Glycemic Index A ratio used to measure the amount of glucose appearing in the blood after eating a specific food compared to eating white bread Considers: dietary fiber content of the food digestion rate of the body total fat content of the food

51. Hypoglycemia Reactive hypoglycemia Occurs 2-4 hours after eating a meal Possibly due to over secretion of insulin Fasting hypoglycemia Usually caused by pancreatic cancer Leads to overproduction of insulin

52. Sweetener Function Enhances flavor Use in moderation

53. Recommended Intake No RDA (yet) Consume at least 50 gm to prevent ketosis National Cholesterol Education Program recommends 50-60% of kcal from CHO Current intake is ~50%

54. Health Benefits of Dietary Fiber--Recall Promotes softer, larger stool and regularity Slows glucose absorption Reduces blood cholesterol Reduces heart disease Reduces hemorrhoids and diverticula

55. Recommended Dietary Fiber Intake 20-35 gm of fiber/day (10-13 gm/1000 kcals) Children: age +5gm/day Ave. U.S. intake: ~16 gm/day Too much fiber (>60 gm/d) will: require extra intake of fluid bind to some minerals develop phytobezoars fills the stomach of a young child quickly

56. Recommendation for Simple Sugar Intake Low nutrient density Recommends no more than 10% of total kcal/day Ave. U.S. intake: 16% of total kcal/day Added to food and beverages during processing Glycemic index

57. High Sugar Diets Empty calories Soda replacing milk Calories adding to excess Dental caries exposure to teeth High glycemic index Blood glucose response of a given food Influence by various factors

58. Effects of High Glycemic Index CHO Stimulates the release of insulin Insulin’s effect blood triglycerides level Insulin’s effect LDL Insulin increases fat synthesis Return to hunger quicker Develop insulin resistance

59. Lactose Intolerance Reduction in lactase Lactose is undigested and not absorbed Lactose is metabolized by large intestinal bacteria causes gas, bloating, cramping, discomfort Primary lactose intolerance disease Secondary lactose intolerance disease

60. What To Do If You Are Lactose Intolerance Determine amount you can tolerate Eat dairy with fat Cheese & yogurt are usually tolerated well Use of Lact-Aide

61. Counting Carbs How much carbohydrate do you need? minimum of 50 – 100 grams/day 55-60% of total calories required A serving of carbohydrate is considered to be 15 grams of carbohydrate ½ c pasta, 1 slice of bread, ½ bagel 1 medium piece of fruit Full strength soda = x g sugar