1. Carbohydrate Storage & Disorders By Jennifer Turley and Joan Thompson © 2013 Cengage Module 3.4

2. Presentation Overview Storage 1. Blood Sugar (glucose) 2. Starch vs. glycogen 3. Glycogen (in detail) 4. Blood sugar regulation  Insulin & Glucagon Disorders 1. Lactose intolerance & mal-digestion 2. Hypoglycemia 3. Diabetes

3. What is glucose used for?  Immediate carbohydrate energy &/or glycogen storage (Liver & Muscle)  Brain, central nervous system (CNS), & red blood cell (RBC) function  Requires a minimum of 100-150g carbohydrate day (continuous)  Muscle functioning (muscle glycogen)  Fat synthesis (excess energy intake)

4. Glycogen  The storage form of glucose  Made from dietary carbohydrate sources  All carbohydrates are converted to glucose then 1) used immediately or 2) stored as glycogen

5. Glycogen  The storage form of glucose  Made from dietary carbohydrate sources  All carbohydrates are converted to glucose then 1) used immediately or 2) stored as glycogen Diets should be planned to meet the 45-65% of Calories AMDR & the minimum DRI for carbohydrate (130g/day for adults).

6. Glycogen Storage  The Liver (100 grams; 400 Calories)  Is used for blood sugar (glucose) regulation  The Muscle (1-4 grams/100 grams of muscle)  The level increases with high carbohydrate diets & exercise  Is used for the working muscle

7. Blood Sugar ( glucose ) Regulation  By hormones that are produced in the pancreas  The hormones effect the liver & muscle cells  Insulin: decreases blood sugar levels  Glucagon: increases blood sugar level

8. Blood Sugar ( glucose ) Regulation Insulin

9. Blood Sugar ( glucose ) Regulation Glucagon

10. Carb Related Disorders  Lactose Intolerance & Lactose Mal-digestion  Hypoglycemia  Diabetes

11. Lactose Intolerance  NOT a food allergy  Caused by lactase deficiency  Enzyme to break down lactose is missing  strongly tied to evolution with several gene mutations identified  Symptoms: Gas, bloating, cramps, diarrhea

12. Lactose Intolerance

13. Dairy Products & Lactose Intolerance  Use a product like lactaid  Consume yogurt with live cultures  Consume aged cheese -OR-  Avoid dairy products

14. Food Allergy vs. Intolerance  An allergy elicits an immune reaction & involves antigens & antibodies  Antibody: Protein structures produced by immune cells that inactivate antigens (allergens)  Antigen (allergen): Foreign protein substances that elicit an immune reaction  Allergic responses cause the formation of mucous in the respiratory tract, GI distress &/or hives

16. Hypoglycemia (low blood sugar)  Reactive: Blood sugar levels drop after eating sugar  Too much insulin is secreted in response to sugar consumption. Hyperinsulinemia  Drug-induced: Improper insulin or oral hypoglycemic drug use with diabetes.  Low blood sugar from a drug reaction  Anti-inflammatory and thyroid medications are known to cause hypoglycemia  Spontaneous: Liver stores of glycogen are depleted, the ability to maintain blood sugar is diminished  Happens to everyone in between meals or when food has not been consumed. 4-6 hours during the day, 10-12 hours with sleep

17. Diabetes (a chronic disease)  Is characterized by hyperglycemia (high blood sugar)  Affects >20 million Americans, many unaware  Increases risk of heart disease, stroke, kidney disease, retinopathy, and neuropathy  Decreases life expectancy  Exists as Type I or Type II

18. Type I Diabetes (less common)  5% of cases  Juvenile onset  More difficult to control ( without treatment )  Insulin administration is essential in the control of blood sugar  Auto-immune disorder caused by genetic or viral factors  Immune system attacks pancreatic beta cells and disrupts ability to produce insulin

19. Type I Diabetes (less common) 1.Antibodies attack the insulin producing cells of the pancreas. 2.No insulin is made. 3.Blood glucose/sugar levels are high. 4.Liver & muscle cells cannot take up glucose because there is no insulin to bind the cell receptor. Blood Stream

20. Type II Diabetes (very common)  ~95% of cases  Typically adult onset  May be controlled with lifestyle changes & oral hypoglycemic agents  Is caused by insulin resistance (decreased insulin receptor response)  Can have a genetic pre-disposition or can develop with obesity

21. Type II Diabetes (very common) 1. The pancreas produces insulin. 2. Blood glucose/sugar levels are high. 3. The insulin receptor on the liver and muscle cells are insensitive to the insulin. Blood Stream

22. Diagnosis of Diabetes  Normal blood glucose <100 mg/dL  Pre-diabetic levels are between 100-125 mg/dL  Fasting glucose level ≥ 126 mg/dL  2 hour post prandial (fed) blood glucose level ≥ 200 mg/dl.

23. Diagnosis of Diabetes

24.  Glucose Tolerance Test  Normal diet for 3 days prior to test  Baseline fasting blood sugar level  Glucose load. 1g carbohydrate /Kg body weight or a max of 100g for adults  Monitor blood sugar every half hour for six hours.

25. How Overweight  Hyperglycemia

26. Case Studies: Dick & Jane

28. Food Composition: The glycemic response/ index  Simple sugars & foods with a high glycemic index burn up fast & elicit an insulin response  Complex carbohydrates sustain energy better.

29.  The rise in blood sugar in response to food (as compared to glucose)  Glucose is assigned 100  The Glycemic Index of a food can be useful to anyone concerned with blood sugar control. Glycemic Response/ Index

30.  Those with diabetes should eat foods that have a lower glycemic response (for slower entrance of glucose into the blood stream)  Foods with high protein, fat, & fiber lower the glycemic response  Diabetics can still eat carbs… but need to be careful Glycemic Response of Foods

32. Summary  Glucose is required by the brain, RBCs & CNS for energy (ATP)  Carbohydrate is the preferred energy source of the body  All carbohydrate is converted to glucose for energy  Excess carbohydrates are stored as glycogen (liver & muscle)  If glycogen stores are full, excess carbohydrates are stored as fat References for this presentation are the same as those for this topic found in module 3 of the textbook

33. Summary  Liver glycogen maintains blood sugar for brain, RBCs & CNS function  Muscle glycogen maintains the working muscle in high intensity exercise  The hormones insulin & glucagon regulate blood sugar levels  Insulin decreases & glucagon increases blood sugar References for this presentation are the same as those for this topic found in module 3 of the textbook

34. Summary  Lactose intolerance occurs when the enzyme lactase is missing  Milk allergy involves immunity  Hypoglycemia is low blood sugar. Can be reactive, spontaneous, or drug induced  Hyperglycemia is a sign of diabetes References for this presentation are the same as those for this topic found in module 3 of the textbook

35. Summary  Diabetes occurs as type 1 & type 2  Unmanaged diabetes has health implications  Individuals with diabetes should consider the glycemic response of foods for diet planning  Selecting low glycemic index foods is useful in controlling blood sugar rises References for this presentation are the same as those for this topic found in module 3 of the textbook