Energy and Calories

LEA RN IN G OBJ ECTIV E

1. Estimate your total daily caloric /energy needs based upon your physical activity level.

Energy is essential to life. You must eat to have energy. You must go to bed at a decent time, so that

when you wake up in the morning, you will not be too tired and you will have sufficient energy for

the next day’s activities. Energy is also everywhere in our environment: sunlight, wind, water, plants,

and animals. All living things use energy every day. Energy can be defined as the quantity of work a

particular system can perform, whether it be a growing child’s body or a train transporting

passengers from one place to another. Energy also helps us perform daily functions and tasks such as

breathing, walking up a flight of steps, and studying for a test.

Energy is classified as either potential or kinetic. Potential energy is stored energy, or energy waiting

to happen. Kinetic energy is energy in motion. To illustrate this, think of an Olympic swimmer

standing at the pool’s edge awaiting the sound of the whistle to begin the race. While he waits for the

signal, he has potential energy. When the whistle sounds and he dives into the pool and begins to

swim, his energy is kinetic (in motion).

Some basic forms of energy are:

1. Thermal (heat) energy. We can say that a cup of hot tea has thermal energy. Thermal

energy is defined as the collective, microscopic, kinetic, and potential energy of the molecules

within matter. In a cup of tea, the molecules have kinetic energy because they are moving and

oscillating, but they also possess potential energy due to their shared attraction to each other.

2. Chemical energy. In your body, blood sugar (glucose) possesses chemical energy. When

glucose reacts chemically with oxgen, energy is released from the glucose. Once the energy is

released, your muscles will utilize it to produce mechanical force and heat.

3. Electrochemical energy. In the body, electrical impulses travel to and from the brain

encoded as nerve impulses. Once the brain receives an electrical impulse it causes the release
 of a messenger chemical (glutamate, for example). This in turn facilitates electrical impulses

as they move from one neuron to another.

The Calorie Is a Unit of Energy

The amount of energy in nutrients can be quantified into specific units that can be
measured. The unit of measurement that defines the energy contained in a energy-
yielding nutrient is called a calorie. A calorie is the amount of energy in the form of heat
that is required to heat one gram of water one degree Celsius. To measure the number of
calories in a particular food substance, a certain amount of food is burned in a device
called a calorimeter. As the food burns, heat is created. The heat dissipates to the
surrounding water while a thermometer detects the change in temperature of the water.
You can even perform calorimetry at home with a more basic device. However, it is not
likely that you will use this device to measure calorie content in the foods that you eat
since mathematical formulas have been developed to estimate caloric content.

Estimating Caloric Content

The energy contained in energy-yielding nutrients differs because the energy-yielding

nutrients are composed of different types of chemical bonds. A carbohydrate or a
protein yields 4 kilocalories per gram, whereas a lipid yields 9 kilocalories per gram.
A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient
that raises the temperature of 1 kilogram of water 1 degree Celsius. A kilocalorie of
energy performs one thousand times more work than a calorie. On the Nutrition Facts
panel, the calories within a particular food are expressed as kilocalories, which is
commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories).

Calculating the number of Calories in commercially prepared food is made fairly easy
since the total number of Calories in a serving of a particular food is listed on the
Nutrition Facts panel. If you wanted to know the number of Calories in the breakfast
you consumed this morning just add up the number of Calories in each food. For
example, if you ate one serving of yogurt that contained 150 Calories, on which you
sprinkled one half of a cup of low-fat granola cereal that contained 209 Calories, and
drank a glass of orange juice that contained 100 Calories, the total number of Calories
you consumed at breakfast is 150 + 209 + 100 = 459 Calories. If you do not have a
Nutrition Facts panel for a certain food, such as a half cup of blueberries, and want to
find out the amount of Calories it contains, go to MyFood-a-pedia, a website maintained
by the USDA (see Note 3.48 "Interactive 3.2").

Interactive 3.2

My Food-a-pedia is a tool that calculates the Calories in foods. It also compares the
caloric content between foods.

http://apps.usa.gov/myfood-a-pedia.shtml

Estimating the Amount of Energy from Each Macronutrient

Also listed on the Nutrition Facts panel are the amounts of total fat, total carbohydrate,
and protein in grams. To calculate the contribution of each macronutrient to the total
kilocalories in a serving, multiply the number of grams by the number of kilocalories
yielded per gram of nutrient. For instance, from the Nutrition Facts panel for yogurt
given in Figure 3.7 "A Nutrition Facts Panel for Yogurt", the protein content in one
serving is 7 grams. Protein yields 4 kilocalories per gram. The number of kilocalories
from protein is calculated by using the following equation:

# of grams of protein × 4 kilocalories/gram of protein7 grams × 4 kilocalories/gram =

28 kilocalories

Figure 3.7 A Nutrition Facts Panel for Yogurt

Because the total number of kilocalories in each serving of yogurt is 150, the percent of
energy obtained from protein is calculated by using the following equation:

(# kilocalories from protein ÷ total kilocalories per serving) × 100(28 ÷ 150) × 100 =
18.7 percent

KEY TA KEA WA YS

 Energy is vital to life and is categorized into two types—kinetic and potential. There are
also different forms of energy such as thermal, chemical, and electrochemical.
 Calories are a measurement of a specific quantity of energy contained in foods. The
number of calories contained in a commercially prepared food is listed on the Nutrition
Facts panel.

D ISCUSSION STA RTER

1. Estimate the total number of kilocalories that you have eaten so far today. What
percentage of the kilocalories you consumed was obtained from carbohydrates? Protein?
Fat

3.5 Disorders That Can Compromise Health

LEA RN IN G OBJ ECTIV E

1. Interpret why certain disorders and diseases, such as gastroesophageal reflux disease
(GERD), celiac disease, and irritable bowel syndrome compromise overall health.

When nutrients and energy are in short supply, cells, tissues, organs, and organ systems do not

function properly. Unbalanced diets can cause diseases and, conversely, certain illnesses and

diseases can cause an inadequate intake and absorption of nutrients, simulating the health

consequences of an unbalanced diet. Overeating high-fat foods and nutrient-poor foods can lead to

obesity and exacerbate the symptoms of gastroesophageal reflux disease (GERD) and irritable bowel

syndrome (IBS). Many diseases and illnesses, such as celiac disease, interfere with the body getting
its nutritional requirements. A host of other conditions and illnesses, such as food allergies, cancer,

stomach ulcers, Crohn’s disease, and kidney and liver disease, also can impair the process of

digestion and/or negatively affect nutrient balance and decrease overall health.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a persistent form of acid reflux that occurs
more than two times per week. Acid reflux occurs when the acidic contents of the
stomach leak backward into the esophagus and cause irritation. It is estimated that
GERD affects 25 to 35 percent of the US population. An analysis of several studies
published in the August 2005 issue of Annals of Internal Medicine concludes that
GERD is much more prevalent in people who are obese.Hampel, H. MD, PhD, N. S.
Abraham, MD, MSc(Epi) and H. B. El-Serag, MD, MPH. “Meta-Analysis: Obesity and
the Risk for Gastroesophageal Reflux Disease and Its Complications.” Ann Intern
Med 143, no. 3 (2005): 199–
211. http://www.ncbi.nlm.nih.gov/pubmed/16061918 While the links between obesity
and GERD are not completely known, they likely include that excess body fat puts
pressure on the stomach, overeating increases pressure in the stomach, and fatty foods
are triggers for GERD symptoms. The most common GERD symptom is heartburn, but
people with GERD may also experience regurgitation (flow of the stomach’s acidic
contents into the mouth), frequent coughing, and trouble swallowing. Approximately 35
percent of children born in the United States have GERD. In babies the symptoms are
more difficult to distinguish from what babies do normally. The symptoms are spitting
up more than normal, incessant crying, refusal to eat, burping, and coughing. Most
babies outgrow GERD before their first birthday but a small percentage do not.

Heartburn is a burning sensation that radiates throughout the chest.

© Shutterstock
Additional Facts about GERD

There are other causative factors of GERD that may be separate from or intertwined
with obesity. The sphincter that separates the stomach’s internal contents from the
esophagus often does not function properly and acidic gastric contents seep upward.
Sometimes the peristaltic contractions of the esophagus are also sluggish and
compromise the clearance of acidic contents. In addition to having an unbalanced, high-
fat diet, some people with GERD are sensitive to particular foods—chocolate, garlic,
spicy foods, fried foods, and tomato-based foods—which worsen symptoms. Drinks
containing alcohol or caffeine may also worsen GERD symptoms. GERD is diagnosed
most often by a history of the frequency of recurring symptoms. A more proper
diagnosis can be made when a doctor inserts a small device into the lower esophagus
that measures the acidity of the contents during one’s daily activities. Sometimes a
doctor may use an endoscope, which is a long tube with a camera at the end, to view the
tissue in the esophagus. About 50 percent of people with GERD have inflamed tissues in
the esophagus. A condition known as Barrett’s esophagus may develop over time in
some people who have GERD. Barrett’s esophagus refers to a structural difference in the
tissue of the esophagus, which is caused by recurrent tissue damage. It occurs in 5 to 15
percent of patients diagnosed with GERD and less than 1 percent of these patients may
develop cancer of the esophagus, a highly lethal cancer.

The first approach to GERD treatment is dietary and lifestyle modifications. Suggestions
are to reduce weight if you are overweight or obese, avoid foods that worsen GERD
symptoms, eat smaller meals, stop smoking, and remain upright for at least three hours
after a meal. There is some evidence that sleeping on a bed with the head raised at least
six inches helps lessen the symptoms of GERD. People with GERD may not take in the
nutrients they need because of the pain and discomfort associated with eating. As a
result, GERD can be caused by an unbalanced diet and its symptoms can lead to a
worsening of nutrient inadequacy, a viscious cycle that further compromises health.
Many medications are available to treat GERD, including antacids, histamine2 (H2)
blockers, and proton-pump inhibitors. Some evidence from scientific studies indicates
that medications used to treat GERD may accentuate certain nutrient deficiencies,
namely zinc and magnesium. When these treatment approaches do not work surgery is
an option. The most common surgery involves reinforcing the sphincter that serves as a
barrier between the stomach and esophagus.

Irritable Bowel Syndome

Irritable bowel syndrome (IBS) is characterized by muscle spasms in the colon that
result in abdominal pain, bloating, constipation, and/or diarrhea. Interestingly, IBS
produces no permanent structural damage to the large intestine as often happens to
patients who have Crohn’s disease or inflammatory bowel disease. It is estimated that
one in five Americans displays symptoms of IBS. The disorder is more prevalent in
women than men. Two primary factors that contribute to IBS are an unbalanced diet
and stress. There is no specific test to diagnose IBS, but other conditions that have
similar symptoms (such as celiac disease) must be ruled out. This involves stool tests,
blood tests, and having a colonoscopy (which involves the insertion of a flexible tube
with a tiny camera on the end through the anus so the doctor can see the colon tissues).

Symptoms of IBS significantly decrease a person’s quality of life as they are present for
at least twelve consecutive or nonconsecutive weeks in a year. Large meals and foods
high in fat and added sugars, or those that contain wheat, rye, barley, peppermint, and
chocolate intensify or bring about symptoms of IBS. Additionally, beverages containing
caffeine or alcohol may worsen IBS. Stress and depression compound the severity and
frequency of IBS symptoms. As with GERD, the first treatment approaches for IBS are
diet and lifestyle modifications. People with IBS are often told to keep a daily food
journal to help identify and eliminate foods that cause the most problems. Other
recommendations are to eat slower, add more fiber to the diet, drink more water, and to
exercise. There are some medications (many of which can be purchased over-the-
counter) to treat IBS and the resulting diarrhea or constipation. Sometimes
antidepressants and drugs to relax the colon are prescribed.

Celiac Disease

Celiac disease is an autoimmune disorder affecting between 0.5 and 1.0 percent of
Americans—that is, one in every one- to two-hundred people. It is caused by an
abnormal immune reaction of small intestine cells to a type of protein, called gluten.
Gluten forms in the presence of water and is composed of two protein parts, glutenin
and gliadin. Glutenin and gliadin are found in grains that are commonly used to make
bread, such as wheat, rye, and barley. When bread is made, yeast eats the flour and
makes a waste product, carbon dioxide, which forms bubbles in the dough. As the dough
is kneaded, gluten forms and stretches. The carbon dioxide gas bubbles infiltrate the
stretchy gluten, giving bread its porosity and tenderness. For those who are sensitive to
gluten, it is good to know that corn, millet, buckwheat, and oats do not contain the
proteins that make gluten. However, some people who have celiac disease also may have
a response to products containing oats. This is most likely the result of cross-
contamination of grains during harvest, storage, packaging, and processing.

Figure 3.8 Celiac

Not everyone with celiac is diagnosed—many have “silent” or “latent” celiac disease.

© Shutterstock

Celiac disease is most common in people of European descent and is rare in people of
African American, Japanese, and Chinese descent. It is much more prevalent in women
and in people with Type 1 diabetes, autoimmune thyroid disease, and Down and Turner
syndromes. Symptoms can range from mild to severe and can include pale, fatty, loose
stools, gastrointestinal upset, abdominal pain, weight loss and, in children, a failure to
grow and thrive. The symptoms can appear in infancy or much later in life, even by age
seventy. Celiac disease is not always diagnosed because the symptoms may be mild. A
large number of people have what is referred to as “silent” or “latent” celiac disease
(Figure 3.8 "Celiac").

Celiac disease diagnosis requires a blood test and a biopsy of the small intestine.
Because celiac disease is an autoimmune disease, antibodies produced by white blood
cells circulate in the body and can be detected in the blood. When gluten-containing
foods are consumed the antibodies attack cells lining the small intestine leading to a
destruction of the small villi projections. This tissue damage can be detected with a
biopsy, a procedure that removes a portion of tissue from the damaged organ. Villi
destruction is what causes many of the symptoms of celiac disease. The destruction of
the absorptive surface of the small intestine also results in the malabsorption of
nutrients, so that while people with this disease may eat enough, nutrients do not make
it to the bloodstream because absorption is reduced. The effects of nutrient
malabsorption are most apparent in children and the elderly as they are especially
susceptible to nutrient deficiencies. Over time these nutrient deficiencies can cause
health problems. Poor absorption of iron and folic acid can cause anemia, which is a
decrease in red blood cells. Anemia impairs oxygen transport to all cells in the body.
Calcium and vitamin D deficiences can lead to osteoporosis, a disease in which bones
become brittle (we will explore this in detail in Chapter 9 "Nutrients Important for Bone
Health").

If you think you or someone close to you may have celiac disease, do not despair; it is a
very treatable disease. Once diagnosed, a person follows a gluten-free diet for life. This
requires dedication and careful detective work to seek out foods with hidden gluten, but
some stores carry gluten-free foods. After eliminating gluten from the diet, the tissues of
the small intestine rapidly repair themselves and heal in less than six months.
Food Allergies

Paying attention to the way individuals react to various foods is essential in determining
what foods may specifically affect a person adversely. Food allergies are one of the many
ways in which different body make-ups affect nutritional concerns. Although an
estimated twelve million Americans have food allergies, there are likely many more
people who say they have food allergies than actually do. This is because food
sensitization is different from a medically-determined food allergy. When someone has
a food allergy, the immune system mistakenly attacks a certain kind of food (usually the
protein component of a food), such as peanuts, as if it were a threat and IgE antibodies
are produced. Doctors sometimes test for food allergies by using skin-prick tests or
blood tests to look for the presence of IgE antibodies. However, these types of tests are
not always reliable as they can sometimes yield a false positive result. By far, the most
valuable tests for determining a food allergy is the Double Blind Placebo Controlled
Food Challenge (DBPCFC), which involves administering the food orally and then
denoting the signs and symptoms of the allergic response.

Many people with food allergies experience skin rashes after eating an allergenic food.

© Shutterstock

Food allergy symptoms usually develop within a few minutes to two hours after a person
has eaten a food to which they are allergic. These symptoms can range from the
annoying to the potentially fatal, and include:

 A tingling mouth
 Swelling tongue and/or throat
 Difficulty breathing
 Hives
  Stomach cramps
 Diarrhea
 Vomiting
 Drop in blood pressure
 Loss of consciousness
 Death

There are no clear treatments for food allergies. Epinephrine is sometimes used to
control severe reactions, and individuals with known and dangerous allergies may get
prescriptions for self-injectable devices. The only certain way to avoid allergic reactions
to food is to avoid the foods that cause them. Beyond avoidance, this can mean reading
food labels carefully, or even calling manufacturers for product information.

Ninety percent of food allergies are caused by these eight foods:

1. Milk
2. Eggs
3. Peanuts
4. Tree nuts
5. Fish
6. Shellfish
7. Wheat
8. Soy

The prevalence of food allergies is a complex and growing problem. In response to this
situation, the National Institute of Allergy and Infectious Diseases (NIAID) collaborated
with thirty-four professional organizations, federal agencies, and patient-advocacy
groups to develop a comprehensive guide to diagnosing and managing food allergies and
treating acute food allergy reactions. The guide defines various food allergies, allergens,
and reactions, provides comprehensive information on the prevalence of different food
allergies, tracks the history of food allergies, and reviews medical management
techniques for people with food allergies.

KEY TA KEA WA YS

 Unbalanced diets can cause diseases and, conversely, certain disorders and diseases can
cause an inadequate intake and absorption of nutrients simulating the health
consequences of an unbalanced diet.
 Unbalanced, high-fat diets can exacerbate the symptoms of GERD and IBS.
 Celiac disease and anorexia can lead to nutritional deficiencies, which compromise
functioning of the organ systems and decrease health.
 Food allergies affect roughly twelve million Americans, with symptoms that range from
mild to deadly. Proper diagnosis leads to better management of food allergies and
sensitivities.

D ISCUSSION STA RTER

1. The next time you visit the grocery store, be a “gluten detective” and use the ingredients
list to identify all the foods you might normally purchase that contain gluten. Discuss how
you can use food labels to avoid products containing gluten

Carbohydrates
Big Idea

Whole grains are an energy source with nutritional punch.

Video 4.1

The History of Bread

(click to see video)

Watch the History of Bread, part one, from The History Channel. To further satiate your
interest go on to watch the other five parts, available on YouTube.

You likely eat grains every day—cereal, a sandwich, pasta, or your favorite rice dish. Whole grains are

vital to a healthful diet. In addition to fiber, whole grains offer other slow-releasing carbohydrates,

antioxidants, vitamins, and minerals, all of which are needed for good health. Maybe you are on a

diet and have been told to limit or restrict your carbohydrate intake. How much is too much and

which carbohydrates are better for you? Can you promote a healthy weight with a balanced intake of

whole grains? Before we answer these questions, let’s examine in brief the history of grain.

In ancient times whole grains were cracked open using quern stones that required hours of hand

labor. As technology slowly advanced, the quern stone was modified into the millstone. It wasn’t

until the advent of water wheels that human labor to produce grains was reduced. About 2,500 years

ago the Romans started milling flour by turning one millstone wheel against another that did not

move. The turning was done by animals, slaves, and later by waterwheels. The process of milling

breaks the hard outer bran coat of the wheat seeds. The bran and germ, which contain the majority of

fiber, vitamins, and minerals, are removed by sifting. In the earliest days, the whitest flour was

chosen to make bread for the wealthy, and the coarsest was given to the poor. One’s economic status

was depicted by the color of bread they ate. Wheat was the grain of choice for many cultures, as it not

only produced white flour but also contained gluten which gives wheat bread its elasticity and

lightness in texture. The word “flour” comes from a French word meaning “blossom” and is

metaphoric for the finest part of the meal. Bakers highly prized their art and it was kept from the

masses. In fact the baker’s mark was one of the first trademarks.
The 2010 Dietary Guidelines recommend that half of all grains in your diet come from whole
grains. What percentage of your diet is whole grain?

© Thinkstock

In America, Oliver Evans built the first flour mill, which was powered by a watermill. It used a series

of elevators that moved grain through the mill, cleaning it first, then grinding and sifting it. Today,

modern milling produces three types of flour; whole meal containing 100 percent of the grain, with

nothing added or removed; brown flour, containing 85 percent of the original grain with some bran

and germ and white flour, containing 75 percent of the wheat grain with the most bran and germ

removed. The vast majority of flour milled and used in foods and cooking in America is white flour.

The modern milling process of preparing white flour removes between 50 and 85 percent of B

vitamins, vitamin E, calcium, iron, potassium, chromium, phosphorus, zinc, magnesium manganese,

and cobalt.
Wheat kernel anatomy and composition.

In the early nineteenth century several diseases stemming from vitamin and mineral deficiencies,

such as pellagra (niacin, B3), beriberi (thiamine, B1), and anemia (iron), plagued many inhabitants of

the nation. One of the first public health campaigns was to improve the health of Americans by

enriching flour, a dietary staple. The B vitamins, niacin, thiamine, riboflavin, and folate were added

along with iron to combat dietary deficiencies and proved a successful strategy to improve public

health. However, enriched flour contains only 6 percent or less of the recommended daily intake of

the vitamins and minerals it “replaces.” Overwhelming scientific evidence now shows that diets
containing high amounts of whole grains rather than refined white flour decrease weight gain and

the risk for many chronic diseases, including certain types of cancer and diabetes. Whole grains

contain a whole nutrient package that is not replaced by enriched flour. Consumers are becoming

more aware of the many health benefits of whole grains. However, the food industry has created a

puzzle for consumers in determining if a product is made from 100 percent whole grains. “Whole

wheat” does not always mean the product is made with 100 percent whole grains, and brown breads

are not always healthier than white as the color may come from added caramel. The Food and Drug

Administration (FDA) has provided the food industry with specifics on how to label whole-grain

foods—to label it as made from 100 percent whole grains. The best method to ensure the product is

made from 100 percent whole grains is to check the ingredient list. One-hundred percent whole-

grain products list whole grains or whole-wheat flour most often as the first ingredient and do not

contain wheat flour, white flour, yellow corn flour, semolina flour, degerminated flour, or durum

flour. In America, whole-grain choices are improving, but progress still needs to be made on

reducing the added sugar content of many industrially prepared breads, assuring added fiber comes

from good sources, eliminating ambiguous labels and claims on packaging, and reducing the costs of

whole-grain breads, which still exceed that of white bread.

You Decide

What 100 percent whole-grain products can you include in your diet to improve health,
prevent disease, and be tastefully satisfied?

As you read on, you will learn the different types of carbohydrates, their essential roles in the body,

the potential health consequences and benefits of diets rich in particular carbohydrates, and the

many foods available that are rich in carbohydrates as well as nutritious and satisfying. After reading

this chapter, you will be better equipped to decide the best way to get your nutritional punch from

various carbohydrates in your diet.

“If thou tastest a crust of bread, thou tastest all the stars and all the heavens.”

Robert Browning, English poet and playwright (May 1812–December 1889)

Closer Look at Carbohydrates
LEA RN IN G OBJ ECTIV ES

1. Describe some of the distinguishing features of carbohydrates.

2. Describe the differences between fast-releasing and slow-releasing carbohydrates.

What Exactly Are Carbohydrates and How Many Types Are There?

Carbohydrates are the perfect nutrient to meet your body’s nutritional needs. They
nourish your brain and nervous system, provide energy to all of your cells (and within
proper caloric limits), and help keep your body fit and lean. Specifically, digestible
carbohydrates provide bulk in foods, vitamins, and minerals, while indigestible
carbohydrates provide a good amount of fiber with a host of other health benefits.

Plants synthesize the fast-releasing carbohydrate, glucose, from carbon dioxide in the
air and water, and by harnessing the sun’s energy. Recall from Chapter 3 "Nutrition and
the Human Body" that plants convert the energy in sunlight to chemical energy in the
molecule, glucose. Plants use glucose to make other larger, more slow-releasing
carbohydrates. When we eat plants we harvest the energy of glucose to support life’s
processes.

Figure 4.1 Carbohydrate Classification Scheme

Carbohydrates are broken down into the subgroups “fast-releasing” and “slow-releasing”

carbohydrates. These subgroups are further categorized into mono-, di-, and polysaccharides.

Carbohydrates are a group of organic compounds containing a ratio of one carbon atom
to two hydrogen atoms to one oxygen atom. Basically, they are hydrated carbons. The
word “carbo” means carbon and “hydrate” means water. Glucose, the most abundant
carbohydrate in the human body, has six carbon atoms, twelve hydrogen atoms, and six
oxygen atoms. The chemical formula for glucose is written as C6H12O6. Synonymous with
the term carbohydrate is the Greek word “saccharide,” which means sugar. The simplest
unit of a carbohydrate is a monosaccharide. Carbohydrates are broadly classified into
two subgroups, “fast-releasing” and “slow-releasing.” Fast-releasing carbohydrates are
further grouped into the monosaccharides and dissacharides. Slow-releasing
carbohydrates are long chains of monosaccharides. (Figure 4.1 "Carbohydrate
Classification Scheme").

Fast-Releasing Carbohydrates

Fast-releasing carbohydrates are also known more simply as “sugars.” Fast-releasing

carbohydrates are grouped as either monosaccharides or dissacharides.
Monosaccharides include glucose, fructose, and galactose, and the dissacharides
include, lactose, maltose, and sucrose.

Monosaccharides

For all organisms from bacteria to plants to animals, glucose is the preferred fuel source.
The brain is completely dependent on glucose as its energy source (except during
extreme starvation conditions). The monosaccharide galactose differs from glucose only
in that a hydroxyl (−OH) group faces in a different direction on the number four carbon
(Figure 4.2 "Structures of the Three Most Common Monosaccharides: Glucose,
Galactose, and Fructose"). This small structural alteration causes galactose to be less
stable than glucose. As a result, the liver rapidly converts it to glucose. Most absorbed
galactose is utilized for energy production in cells after its conversion to glucose.
(Galactose is one of two simple sugars that are bound together to make up the sugar
found in milk. It is later freed during the digestion process.)

Fructose also has the same chemical formula as glucose but differs in its chemical
structure, as the ring structure contains only five carbons and not six (Figure 4.2
"Structures of the Three Most Common Monosaccharides: Glucose, Galactose, and
Fructose"). Fructose, in contrast to glucose, is not an energy source for other cells in the
body. Mostly found in fruits, honey, and sugarcane, fructose is one of the most common
monosaccharides in nature. It is also found in soft drinks, cereals, and other products
sweetened with high fructose corn syrup.

Figure 4.2 Structures of the Three Most Common Monosaccharides: Glucose, Galactose, and

Fructose

Red circles indicate the structural differences between the three.

Less common monosaccharides are the pentoses, which have only five carbons and not
six. The pentoses are abundant in the nucleic acids RNA and DNA, and also as
components of fiber.

Lastly, there are the sugar alcohols, which are industrially synthesized derivatives of
monosaccharides. Some examples of sugar alcohols are sorbitol, xylitol, and glycerol.
(Xylitol is similar in sweetness as table sugar.) Sugar alcohols are often used in place of
table sugar to sweeten foods as they are incompletely digested and absorbed, and
therefore less caloric. The bacteria in your mouth opposes them, hence sugar alcohols do
not cause tooth decay. Interestingly, the sensation of “coolness” that occurs when
chewing gum that contains sugar alcohols comes from them dissolving in the mouth, a
chemical reaction that requires heat from the inside of the mouth.

Disaccharides

Disaccharides are composed of pairs of two monosaccharides linked together.

Disaccharides include sucrose, lactose, and maltose. All of the disaccharides contain at
least one glucose molecule.
Sucrose, which contains both glucose and fructose molecules, is otherwise known as
table sugar. Sucrose is also found in many fruits and vegetables, and at high
concentrations in sugar beets and sugar cane, which are used to make table sugar.
Lactose, which is commonly known as milk sugar, is composed of one glucose unit and
one galactose unit. Lactose is prevalent in dairy products such as milk, yogurt, and
cheese. Maltose consists of two glucose molecules bonded together. It is a common
breakdown product of plant starches and is rarely found in foods as a disaccharide.

Slow-Releasing Carbohydrates

Slow-releasing carbohydrates are polysaccharides, long chains of monosaccharides that

may be branched or not branched. There are two main groups of polysaccharides:
starches and fibers.

Starches

Starch molecules are found in abundance in grains, legumes, and root vegetables, such
as potatoes. Amylose, a plant starch, is a linear chain containing hundreds of glucose
units. Amylopectin, another plant starch, is a branched chain containing thousands of
glucose units. These large starch molecules form crystals and are the energy-storing
molecules of plants. These two starch molecules (amylose and amylopectine) are
contained together in foods, but the smaller one, amylose, is more abundant. Eating raw
foods containing starches provides very little energy as the digestive system has a hard
time breaking them down. Cooking breaks down the crystal structure of starches,
making them much easier to break down in the human body. The starches that remain
intact throughout digestion are called resistant starches. Bacteria in the gut can break
some of these down and may benefit gastrointestinal health. Isolated and modified
starches are used widely in the food industry and during cooking as food thickeners.

Figure 4.3 Structures of the Plant Starches and Glycogen

Humans and animals store glucose energy from starches in the form of the very large
molecule, glycogen. It has many branches that allow it to break down quickly when
energy is needed by cells in the body. It is predominantly found in liver and muscle
tissue in animals.

Dietary Fibers

Dietary fibers are polysaccharides that are highly branched and cross-linked. Some
dietary fibers are pectin, gums, cellulose, and lignin. Humans do not produce the
enzymes that can break down dietary fiber; however, bacteria in the large intestine
(colon) do. Dietary fibers are very beneficial to our health. The Dietary Guidelines
Advisory Committee states that there is enough scientific evidence to support that diets
high in fiber reduce the risk for obesity and diabetes, which are primary risk factors for
cardiovascular disease.US Department of Agriculture. “Part D. Section 5:
Carbohydrates.” In Report of the DGAC on the Dietary Guidelines for Americans, 2010.
Accessed September 30,
2011. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/
Report/D-5-Carbohydrates.pdf. Dietary fiber is categorized as either water-soluble or
insoluble. Some examples of soluble fibers are inulin, pectin, and guar gum and they are
found in peas, beans, oats, barley, and rye. Cellulose and lignin are insoluble fibers and a
few dietary sources of them are whole-grain foods, flax, cauliflower, and avocados.
Cellulose is the most abundant fiber in plants, making up the cell walls and providing
structure. Soluble fibers are more easily accessible to bacterial enzymes in the large
intestine so they can be broken down to a greater extent than insoluble fibers, but even
some breakdown of cellulose and other insoluble fibers occurs.

The last class of fiber is functional fiber. Functional fibers have been added to foods and
have been shown to provide health benefits to humans. Functional fibers may be
extracted from plants and purified or synthetically made. An example of a functional
fiber is psyllium-seed husk. Scientific studies show that consuming psyllium-seed husk
reduces blood-cholesterol levels and this health claim has been approved by the FDA.
Total dietary fiber intake is the sum of dietary fiber and functional fiber consumed.

KEY TA KEA WA YS

 Carbohydrates are a group of organic compounds containing a ratio of one carbon atom
to two hydrogen atoms to one oxygen atom. Carbohydrates are broadly classified into
two subgroups, fast-releasing and slow-releasing carbohydrates.
 Fast-releasing carbohydrates are sugars and they include the monosaccharides and
disaccharides. Slow-releasing carbohydrates include the polysaccharides, amylose,
amylopectin, glycogen, dietary fiber, and functional fiber.
 Glucose is the most important monosaccharide in human nutrition. Many other
monosaccharides and disaccharides become glucose in the body.
 Fiber-rich foods are scientifically proven to reduce the risk of obesity and diabetes.
Functional fibers are added to foods because they are proven to have added health
benefits.

D ISCUSSION STA RTERS

1. What do you eat most of: fast-releasing carbohydrates, starches, or fiber?
2. Bring in the packages for the breads you eat and compare the different ingredients
lists with your classmates. Are they labeled well? Do they contain any health
claims? Are they made from 100 percent whole grain? Do they contain added
sugars? For more help on defining products made with whole grains, visit the
website of the Whole Grains Council

Digestion and Absorption of Carbohydrates

LEA RN IN G OBJ ECTIV E

1. Discuss how carbohydrates are digested and absorbed in the human body.
Whole grains provide satisfaction from the beginning to the end of the digestion process.

© Thinkstock

Sweetness is one of the five basic taste sensations of foods and beverages and is sensed by protein

receptors in cells of the taste buds. Fast-releasing carbohydrates stimulate the sweetness taste

sensation, which is the most sensitive of all taste sensations. Even extremely low concentrations of

sugars in foods will stimulate the sweetness taste sensation. Sweetness varies between the different

carbohydrate types—some are much sweeter than others. Fructose is the top naturally occurring

sugar in sweetness value. See Table 4.1 "Sweetness Comparison of Carbohydrates" for sweetness

comparisons among different naturally-occurring carbohydrates. Sweetness is a pleasurable

sensation and some people enjoy the taste more than others. In a colloquial sense we identify such

people as having a “sweet tooth.” This does not mean that the less-sweet whole grains containing

more starches and fiber are less satisfying. Whole grains take longer to chew and get sweeter the

more you chew them. Additionally, once in the stomach, whole-grain foods take longer to digest, and

keep you full longer. Remember too that they contain fiber which makes elimination much smoother.

Whole-grain foods satisfy the body the entire way through the digestive tract and provide the

nutrients that also better satisfy the body’s functional needs.

Table 4.1 Sweetness Comparison of Carbohydrates

Carbohydrat
Sweetness (percentage of sucrose)
e
Sucrose 100
Glucose 74
Galactose 33
Fructose 173
Maltose 33
Lactose 16
Starch 0
Fiber 0
Source: Carter, J. Stein. “Carbohydrates.” © 1996 by J. Stein Carter. All rights
reserved. http://www.biology.clc.uc.edu/courses/bio104/carbohydrates.htm.

From the Mouth to the Stomach

The mechanical and chemical digestion of carbohydrates begins in the mouth. Chewing,
also known as mastication, crumbles the carbohydrate foods into smaller and smaller
pieces. The salivary glands in the oral cavity secrete saliva that coats the food particles.
Saliva contains the enzyme, salivary amylase. This enzyme breaks the bonds between
the monomeric sugar units of disaccharides, oligosaccharides, and starches. The salivary
amylase breaks down amylose and amylopectin into smaller chains of glucose, called
dextrins and maltose. The increased concentration of maltose in the mouth that results
from the mechanical and chemical breakdown of starches in whole grains is what
enhances their sweetness. Only about five percent of starches are broken down in the
mouth. (This is a good thing as more glucose in the mouth would lead to more tooth
decay.) When carbohydrates reach the stomach no further chemical breakdown occurs
because the amylase enzyme does not function in the acidic conditions of the stomach.
But mechanical breakdown is ongoing—the strong peristaltic contractions of the
stomach mix the carbohydrates into the more uniform mixture of chyme.
Salivary glands secrete salivary amylase, which begins the chemical breakdown of
carbohydrates by breaking the bonds between monomeric sugar units.
From the Stomach to the Small Intestine

The chyme is gradually expelled into the upper part of the small intestine. Upon entry of
the chyme into the small intestine, the pancreas releases pancreatic juice through a duct.
This pancreatic juice contains the enzyme, pancreatic amylase, which starts again the
breakdown of dextrins into shorter and shorter carbohydrate chains. Additionally,
enzymes are secreted by the intestinal cells that line the villi. These enzymes, known
collectively as disaccharides, are sucrase, maltase, and lactase. Sucrase breaks sucrose
into glucose and fructose molecules. Maltase breaks the bond between the two glucose
units of maltose, and lactase breaks the bond between galactose and glucose. Once
carbohydrates are chemically broken down into single sugar units they are then
transported into the inside of intestinal cells.

When people do not have enough of the enzyme lactase, lactose is not sufficiently
broken down resulting in a condition called lactose intolerance. The undigested lactose
moves to the large intestine where bacteria are able to digest it. The bacterial digestion
of lactose produces gases leading to symptoms of diarrhea, bloating, and abdominal
cramps. Lactose intolerance usually occurs in adults and is associated with race. The
National Digestive Diseases Information Clearing House states that African Americans,
Hispanic Americans, American Indians, and Asian Americans have much higher
incidences of lactose intolerance while those of northern European descent have the
least.National Digestive Diseases Information Clearing House. “Lactose Intolerance.”
Last updated April 23,
2012. http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/. Most people
with lactose intolerance can tolerate some amount of dairy products in their diet. The
severity of the symptoms depends on how much lactose is consumed and the degree of
lactase deficiency.

Absorption: Going to the Blood Stream

The cells in the small intestine have membranes that contain many transport proteins in
order to get the monosaccharides and other nutrients into the blood where they can be
distributed to the rest of the body. The first organ to receive glucose, fructose, and
galactose is the liver. The liver takes them up and converts galactose to glucose, breaks
fructose into even smaller carbon-containing units, and either stores glucose as glycogen
or exports it back to the blood. How much glucose the liver exports to the blood is under
hormonal control and you will soon discover that even the glucose itself regulates its
concentrations in the blood.
Carbohydrate digestion begins in the mouth and is most extensive in the small intestine. The

resultant monosaccharides are absorbed into the bloodstream and transported to the liver.

Maintaining Blood Glucose Levels: The Pancreas and Liver

Glucose levels in the blood are tightly controlled, as having either too much or too little
glucose in the blood can have health consequences. Glucose regulates its levels in the
blood via a process called negative feedback. An everyday example of negative feedback
is in your oven because it contains a thermostat. When you set the temperature to cook a
delicious homemade noodle casserole at 375°F the thermostat senses the temperature
and sends an electrical signal to turn the elements on and heat up the oven. When the
temperature reaches 375°F the thermostat senses the temperature and sends a signal to
turn the element off. Similarly, your body senses blood glucose levels and maintains the
glucose “temperature” in the target range. The glucose thermostat is located within the
cells of the pancreas. After eating a meal containing carbohydrates glucose levels rise in
the blood.

Insulin-secreting cells in the pancreas sense the increase in blood glucose and release
the hormonal message, insulin, into the blood. Insulin sends a signal to the body’s cells
to remove glucose from the blood by transporting to the insides of cells and to use it to
make energy or for building macromolecules. In the case of muscle tissue and the liver,
insulin sends the biological message to store glucose away as glycogen. The presence of
insulin in the blood signifies to the body that it has just been fed and to use the fuel.
Insulin has an opposing hormone called glucagon. As the time after a meal increases,
glucose levels decrease in the blood. Glucagon-secreting cells in the pancreas sense the
drop in glucose and, in response, release glucagon into the blood. Glucagon
communicates to the cells in the body to stop using all the glucose. More specifically, it
signals the liver to break down glycogen and release the stored glucose into the blood, so
that glucose levels stay within the target range and all cells get the needed fuel to
function properly.

Leftover Carbohydrates: The Large Intestine

Almost all of the carbohydrates, except for dietary fiber and resistant starches, are
efficiently digested and absorbed into the body. Some of the remaining indigestible
carbohydrates are broken down by enzymes released by bacteria in the large intestine.
The products of bacterial digestion of these slow-releasing carbohydrates are short-
chain fatty acids and some gases. The short-chain fatty acids are either used by the
bacteria to make energy and grow, are eliminated in the feces, or are absorbed into cells
of the colon, with a small amount being transported to the liver. Colonic cells use the
short-chain fatty acids to support some of their functions. The liver can also metabolize
the short-chain fatty acids into cellular energy. The yield of energy from dietary fiber is
about 2 kilocalories per gram for humans, but is highly dependent upon the fiber type,
with soluble fibers and resistant starches yielding more energy than insoluble fibers.
Since dietary fiber is digested much less in the gastrointestinal tract than other
carbohydrate types (simple sugars, many starches) the rise in blood glucose after eating
them is less, and slower. These physiological attributes of high-fiber foods (i.e. whole
grains) are linked to a decrease in weight gain and reduced risk of chronic diseases, such
as Type 2 diabetes and cardiovascular disease.

A Carbohydrate Feast
Thanksgiving dinner: A feast of high-carbohydrate foods.

© Shutterstock

It’s Thanksgiving and you have just consumed turkey with mashed potatoes, stuffing
smothered in gravy, green beans topped with crispy fried onions, a hot roll dripping
with butter, and cranberry sauce. Less than an hour later you top it all off with a slice of
pumpkin pie and then lie down on the couch to watch the football game. What happens
in your body after digesting and absorbing the whopping amount of nutrients in this
Thanksgiving feast? The “hormone of plenty,” insulin, answers the nutrient call. Insulin
sends out the physiological message that glucose and everything else is in abundant
supply in the blood, so cells absorb and then use or store it. The result of this hormone
message is maximization of glycogen stores and all the excess glucose, protein, and
lipids are stored as fat.

Figure 4.4

The glycemic index measures the effects of foods on blood-glucose levels.

A typical American Thanksgiving meal contains many foods that are dense in
carbohydrates, with the majority of those being simple sugars and starches. These types
of carbohydrate foods are rapidly digested and absorbed. Blood glucose levels rise
quickly causing a spike in insulin levels. Contrastingly, foods containing high amounts
of fiber are like time-release capsules of sugar. A measurement of the effects of a
carbohydrate-containing food on blood-glucose levels is called the glycemic response
(Figure 4.4).

Glycemic Index

The glycemic responses of various foods have been measured and then ranked in
comparison to a reference food, usually a slice of white bread or just straight glucose, to
create a numeric value called the glycemic index (GI). Foods that have a low GI do not
raise blood-glucose levels neither as much nor as fast as foods that have a higher GI. A
diet of low-GI foods has been shown in epidemiological and clinical trial studies to
increase weight loss and reduce the risk of obesity, Type 2 diabetes, and cardiovascular
disease.Brand-Miller, J., PhD, et al. “Dietary Glycemic Index: Health Implications.” J
Am Coll Nutr 28, no. 4, supplement (2009): 446S–
49S. http://www.jacn.org/content/28/4_Supplement_1/446S.long.

Table 4.2 The Glycemic Index: Foods in Comparison to Glucose

Foods GI Value
Low GI Foods (< 55)
Apple 44
Pear 38
Banana (under-ripe) 51
Grapefruit 25
Barley 25
Navy beans 38
Green peas 48
 Foods GI Value
Oat bran (Quaker Oats) 50
Spaghetti (whole wheat) 37
Mashed sweet potatoes 54
Baked beans 48
Butter beans 44
Banana bread 47
Bread (sourdough) 52
Soy milk 31
Skim milk 32
Whole milk 27
Yogurt (sweetened) 33
Yogurt (plain, artificial
14
sweetener)
Medium GI Foods (56–69)
Apricots 57
Cantaloupe 65
Mashed potatoes 70
Whole-wheat pita bread 57
Whole-wheat bread 69
Couscous 65
Brown rice 55
Cheese pizza 60
Rye bread 65
Hamburger bun 61
Black bean soup 64
Macaroni and cheese 64
Coca-Cola 63
High GI Foods (70 and higher)
Dates 103
Banana (over-ripe) 82
Parsnips 97
 Foods GI Value
Corn chips 72
Pretzels 83
White bread 70
White rice 72
Spaghetti (durum flour) 78
White rice (instant) 87
French baguette 95
Bagel 72
Bread stuffing 74
Cheerios 74
Cream of wheat 71
Raisin Bran 73
Fruit roll-up 99
Gatorade 78

Source: University of Sydney. Glycemic Index Database. © 2011 The University of

Sydney, all rights reserved. http://www.glycemicindex.com/.

The carbohydrate type within a food affects the GI, but so does its fat and fiber content
(which reduce the GI). Increased fat and fiber in foods increases the time required for
digestion and delays the rate of gastric emptying into the small intestine. Processing and
cooking additionally affect a food’s GI by increasing their digestibility. Advancements in
the technologies of food processing and the high consumer demand for convenient,
precooked foods in the United States have created foods that are digested and absorbed
more rapidly, independent of the fiber content. Modern breakfast cereals, breads,
pastas, and many prepared foods have a high GI. In contrast, most raw foods have a
lower GI. (However, the more ripened a fruit or vegetable is, the higher its GI.) Table 4.2
"The Glycemic Index: Foods in Comparison to Glucose" provides the GI for various
foods. The GI can be used as a guide for choosing healthier carbohydrate choices but has
some limitations. One is that the GI does not take into account the amount of
carbohydrates in a portion of food, only the type of carbohydrate. Another is that
combining low- and high-GI foods changes the GI for the meal. Also, some nutrient-
dense foods have higher GIs than less nutritious food. (For instance, oatmeal has a
higher GI than chocolate because the fat content of chocolate is higher.) Lastly, meats
and fats do not have a GI since they do not contain carbohydrates.

Interactive 4.1

Visit this online database of glycemic indices of foods.

http://www.gilisting.com/

Balancing the Thanksgiving Feast

To balance the high-GI foods on the Thanksgiving table with low-GI foods, follow some
of these suggestions:

 Serve a winter fruit salad.

 Leave the skins on the potatoes. The skin contains fiber and adds texture to
mashed potatoes. Do not use instant potatoes.
 Instead of canned green beans with cream of mushroom soup and fried onions
for a side dish, combine butter beans and green peas for a colorful, low-GI food.
 Make your stuffing with whole-grain bread and add mushrooms and extra celery
and onions.
 Try a new low-sugar pumpkin pie recipe and make the crust from whole-grain
flour.
 Offer homemade banana bread for dessert.
Balance the high-GI foods at the Thanksgiving table with low-GI foods.

© Shutterstock

KEY TA KEA WA YS

 Carbohydrate digestion begins in the mouth with the mechanical action of chewing and
the chemical action of salivary amylase. Carbohydrates are not chemically broken down
in the stomach, but rather in the small intestine. Pancreatic amylase and the
disaccharidases finish the chemical breakdown of digestible carbohydrates.
 The monosaccharides are absorbed into the bloodstream and delivered to the liver.
 Some of the indigestible carbohydrates are digested by bacteria in the large intestine.
 Glucose itself participates in regulating its levels in the blood. Not all carbohydrates have
the same effect on blood-glucose levels. The glycemic response is a measurement of the
effects of a carbohydrate-containing food on blood-glucose levels.

D ISCUSSION STA RTERS

1. Experience the taste sensations of different carbohydrates. What are some foods that
satisfy your sweetness sensation?
2. Even though fiber contains calories, albeit less than half of other carbohydrates, why do
we generally discount its caloric contribution from our diets?
3. How long a person feels full after eating a carbohydrate-rich meal depends on the type of
carbohydrate consumed and what other nutrients are in the meal. Conduct an
experiment and determine how long you feel full after eating a candy bar; after eating a
slice of whole-grain bread; after eating an apple; and after eating a potato. Compare your
results with your classmates and discuss why some of these carbohydrate foods make
you feel full longer than others.

The Functions of Carbohydrates in the Body

LEA RN IN G OBJ ECTIV E

1. List four primary functions of carbohydrates in the human body.

There are five primary functions of carbohydrates in the human body. They are energy production,

energy storage, building macromolecules, sparing protein, and assisting in lipid metabolism.

Energy Production

The primary role of carbohydrates is to supply energy to all cells in the body. Many cells
prefer glucose as a source of energy versus other compounds like fatty acids. Some cells,
such as red blood cells, are only able to produce cellular energy from glucose. The brain
is also highly sensitive to low blood-glucose levels because it uses only glucose to
produce energy and function (unless under extreme starvation conditions). About 70
percent of the glucose entering the body from digestion is redistributed (by the liver)
back into the blood for use by other tissues. Cells that require energy remove the glucose
from the blood with a transport protein in their membranes. The energy from glucose
comes from the chemical bonds between the carbon atoms. Sunlight energy was
required to produce these high-energy bonds in the process of photosynthesis. Cells in
our bodies break these bonds and capture the energy to perform cellular respiration.
Cellular respiration is basically a controlled burning of glucose versus an uncontrolled
burning. A cell uses many chemical reactions in multiple enzymatic steps to slow the
release of energy (no explosion) and more efficiently capture the energy held within the
chemical bonds in glucose.

The first stage in the breakdown of glucose is called glycolysis. Glycolysis, or the

splitting of glucose, occurs in an intricate series of ten enzymatic-reaction steps. The
second stage of glucose breakdown occurs in the energy factory organelles, called
mitochondria. One carbon atom and two oxygen atoms are removed, yielding more
energy. The energy from these carbon bonds is carried to another area of the
mitochondria, making the cellular energy available in a form cells can use.
Cellular respiration is the process by which energy is captured from glucose.

Energy Storage

Figure 4.5
The structure of glycogen enables its rapid mobilization into free glucose to power cells.

If the body already has enough energy to support its functions, the excess glucose is
stored as glycogen (the majority of which is stored in the muscle and liver). A molecule
of glycogen may contain in excess of fifty thousand single glucose units and is highly
branched, allowing for the rapid dissemination of glucose when it is needed to make
cellular energy (Figure 4.5).

The amount of glycogen in the body at any one time is equivalent to about 4,000
kilocalories—3,000 in muscle tissue and 1,000 in the liver. Prolonged muscle use (such
as exercise for longer than a few hours) can deplete the glycogen energy reserve.
Remember also from Chapter 3 "Nutrition and the Human Body" that this is referred to
as “hitting the wall” or “bonking” and is characterized by fatigue and a decrease in
exercise performance. The weakening of muscles sets in because it takes longer to
transform the chemical energy in fatty acids and proteins to usable energy than glucose.
After prolonged exercise, glycogen is gone and muscles must rely more on lipids and
proteins as an energy source. Athletes can increase their glycogen reserve modestly by
reducing training intensity and increasing their carbohydrate intake to between 60 and
70 percent of total calories three to five days prior to an event. People who are not
hardcore training and choose to run a 5-kilometer race for fun do not need to consume a
big plate of pasta prior to a race since without long-term intense training the adaptation
of increased muscle glycogen will not happen.

The liver, like muscle, can store glucose energy as a glycogen, but in contrast to muscle
tissue it will sacrifice its stored glucose energy to other tissues in the body when blood
glucose is low. Approximately one-quarter of total body glycogen content is in the liver
(which is equivalent to about a four-hour supply of glucose) but this is highly dependent
on activity level. The liver uses this glycogen reserve as a way to keep blood-glucose
levels within a narrow range between meal times. When the liver’s glycogen supply is
exhausted, glucose is made from amino acids obtained from the destruction of proteins
in order to maintain metabolic homeostasis.

Building Macromolecules

Although most absorbed glucose is used to make energy, some glucose is converted to
ribose and deoxyribose, which are essential building blocks of important
macromolecules, such as RNA, DNA, and ATP (Figure 4.6). Glucose is additionally
utilized to make the molecule NADPH, which is important for protection against
oxidative stress and is used in many other chemical reactions in the body. If all of the
energy, glycogen-storing capacity, and building needs of the body are met, excess
glucose can be used to make fat. This is why a diet too high in carbohydrates and
calories can add on the fat pounds—a topic that will be discussed shortly.

Figure 4.6
The sugar molecule deoxyribose is used to build the backbone of DNA.

© Shutterstock

Sparing Protein

In a situation where there is not enough glucose to meet the body’s needs, glucose is
synthesized from amino acids. Because there is no storage molecule of amino acids, this
process requires the destruction of proteins, primarily from muscle tissue. The presence
of adequate glucose basically spares the breakdown of proteins from being used to make
glucose needed by the body.

Lipid Metabolism

As blood-glucose levels rise, the use of lipids as an energy source is inhibited. Thus,
glucose additionally has a “fat-sparing” effect. This is because an increase in blood
glucose stimulates release of the hormone insulin, which tells cells to use glucose
(instead of lipids) to make energy. Adequate glucose levels in the blood also prevent the
development of ketosis. Ketosis is a metabolic condition resulting from an elevation of
ketone bodies in the blood. Ketone bodies are an alternative energy source that cells can
use when glucose supply is insufficient, such as during fasting. Ketone bodies are acidic
and high elevations in the blood can cause it to become too acidic. This is rare in healthy
adults, but can occur in alcoholics, people who are malnourished, and in individuals
who have Type 1 diabetes. The minimum amount of carbohydrate in the diet required to
inhibit ketosis in adults is 50 grams per day.

Carbohydrates are critical to support life’s most basic function—the production of

energy. Without energy none of the other life processes are performed. Although our
bodies can synthesize glucose it comes at the cost of protein destruction. As with all
nutrients though, carbohydrates are to be consumed in moderation as having too much
or too little in the diet may lead to health problems.
 KEY TA KEA WA YS

 The four primary functions of carbohydrates in the body are to provide energy, store
energy, build macromolecules, and spare protein and fat for other uses.
 Glucose energy is stored as glycogen, with the majority of it in the muscle and liver. The
liver uses its glycogen reserve as a way to keep blood-glucose levels within a narrow
range between meal times. Some glucose is also used as building blocks of important
macromolecules, such as RNA, DNA, and ATP.
 The presence of adequate glucose in the body spares the breakdown of proteins from
being used to make glucose needed by the body.

D ISCUSSION STA RTERS

1. Discuss two reasons it is essential to include carbohydrates in your diet.

2. Why is it necessary for the body to spare protein?

 Looking Closely at Diabetes

LEA RN IN G OBJ ECTIV E

1. Summarize the long-term health implications and the dietary approaches to living with
Type 1 and Type 2 diabetes.

What Is Diabetes?

Diabetes is one of the top three diseases in America. It affects millions of people and
causes tens of thousands of deaths each year. Diabetes is a metabolic disease of insulin
deficiency and glucose over-sufficiency. Like other diseases, genetics, nutrition,
environment, and lifestyle are all involved in determining a person’s risk for developing
diabetes. One sure way to decrease your chances of getting diabetes is to maintain an
optimal body weight by adhering to a diet that is balanced in carbohydrate, fat, and
protein intake. There are three different types of diabetes: Type 1 diabetes, Type 2
diabetes, and gestational diabetes.

Type 1 Diabetes

Type 1 diabetes is a metabolic disease in which insulin-secreting cells in the pancreas are
killed by an abnormal response of the immune system, causing a lack of insulin in the
body. Its onset typically occurs before the age of thirty. The only way to prevent the
deadly symptoms of this disease is to inject insulin under the skin. Before this treatment
was discovered, people with Type 1 diabetes died rapidly after disease onset. Death was
the result of extremely high blood-glucose levels affecting brain function and leading to
coma and death. Up until 1921, patients with Type 1 diabetes, the majority of them
children, spent their last days in a ward where they lapsed into a coma awaiting death.
One of the most inspiring acts in medical history is that of the scientists who discovered,
isolated, and purified insulin and then went on to find out that it relieved the symptoms
of Type 1 diabetes, first in dogs and then in humans. Frederick Banting, Charles Best,
and James Collip went into a hospital ward in Toronto, Canada and injected comatose
children with insulin. Before they completed their rounds children were already
awakening to the cheers of their families.

A person with Type 1 diabetes usually has a rapid onset of symptoms that include
hunger, excessive thirst and urination, and rapid weight loss. Because the main function
of glucose is to provide energy for the body, when insulin is no longer present there is no
message sent to cells to take up glucose from the blood. Instead, cells use fat and
proteins to make energy, resulting in weight loss. If Type 1 diabetes goes untreated
individuals with the disease will develop a life-threatening condition called ketoacidosis.
This condition occurs when the body uses fats and not glucose to make energy, resulting
in a build-up of ketone bodies in the blood. It is a severe form of ketosis with symptoms
of vomiting, dehydration, rapid breathing, and confusion and eventually coma and
death. Upon insulin injection these severe symptoms are treated and death is avoided.
Unfortunately, while insulin injection prevents death, it is not considered a cure. People
who have this disease must adhere to a strict diet to prevent the development of serious
complications. Type 1 diabetics are advised to consume a diet low in the types of
carbohydrates that rapidly spike glucose levels (high-GI foods), to count the
carbohydrates they eat, to consume healthy-carbohydrate foods, and to eat small meals
frequently. These guidelines are aimed at preventing large fluctuations in blood glucose.
Frequent exercise also helps manage blood-glucose levels. Type 1 diabetes accounts for
between 5 and 10 percent of diabetes cases.

Type 2 Diabetes

The other 90 to 95 percent of diabetes cases are Type 2 diabetes. Type 2 diabetes is

defined as a metabolic disease of insulin insufficiency, but it is also caused by muscle,
liver, and fat cells no longer responding to the insulin in the body (Figure 4.7). In brief,
cells in the body have become resistant to insulin and no longer receive the full
physiological message of insulin to take up glucose from the blood. Thus, similar to
patients with Type 1 diabetes, those with Type 2 diabetes also have high blood-glucose
levels.

For Type 2 diabetics, the onset of symptoms is more gradual and less noticeable than for
Type 1 diabetics. The symptoms are increased thirst and urination, unexplained weight
loss, and hunger. The first stage of Type 2 diabetes is characterized by high glucose and
insulin levels. This is because the insulin-secreting cells in the pancreas attempt to
compensate for insulin resistance by making more insulin. In the second stage of Type 2
diabetes, the insulin-secreting cells in the pancreas become exhausted and die. At this
point, Type 2 diabetics also have to be treated with insulin injections. Healthcare
providers is to prevent the second stage from happening. As with Type 1 diabetes,
chronically high-glucose levels cause big detriments to health over time, so another goal
for patients with Type 2 diabetes is to properly manage their blood-glucose levels. The
front-line approach for treating Type 2 diabetes includes eating a healthy diet and
increasing physical activity.

The Centers for Disease Control Prevention (CDC) estimates that as of 2010, 25.8
million Americans have diabetes, which is 8.3 percent of the population.Centers for
Disease Control and Prevention. “Diabetes Research and Statistics.” Accessed
September 30, 2011. http://www.cdc.gov/diabetes/consumer/research.htm. In 2007
the cost of diabetes to the United States was estimated at $174 billion.Centers for
Disease Control and Prevention. “CDC Statements on Diabetes Issues.” Accessed
September 30, 2011. http://www.cdc.gov/diabetes/news/docs/dpp.htm. The incidence
of Type 2 diabetes has more than doubled in America in the past thirty years and the
rise is partly attributed to the increase in obesity in this country. Genetics, environment,
nutrition, and lifestyle all play a role in determining a person’s risk for Type 2 diabetes.
We learned in Chapter 1 "Nutrition and You" that we have the power to change some of
the determinants of disease but not others. The Diabetes Prevention Trial that studied
lifestyle and drug interventions in more than three thousand participants who were at
high risk for Type 2 diabetes found that intensive lifestyle intervention reduced the
chances of getting Type 2 diabetes by 58 percent.Knowler, W. C. et al. “Reduction in the
Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin.” N Engl J Med
346, no. 6 (2002): 393–403. http://www.nejm.org/doi/full/10.1056/NEJMoa012512.

Figure 4.7
Type 2 diabetes is a metabolic disease characterized by high blood-glucose levels.

© Shutterstock

Video 4.2

Do You Have High Blood Sugar?

(click to see video)

A more in-depth view of blood sugar and your health.

Figure 4.8 Metabolic Syndrome: A Combination of Risk Factors Increasing the Chances for

Chronic Disease

Having more than one risk factor for Type 2 diabetes substantially increases a person’s
chances for developing the disease. Metabolic syndrome refers to a medical condition in
which people have three or more risk factors for Type 2 diabetes and cardiovascular
disease (Figure 4.8 "Metabolic Syndrome: A Combination of Risk Factors Increasing the
Chances for Chronic Disease"). According to the International Diabetes Federation
(IDF) people are diagnosed with this syndrome if they have central (abdominal) obesity
and any two of the following health parameters: triglycerides greater than 150 mg/dL;
high density lipoproteins (HDL) lower than 40 mg/dL; systolic blood pressure above
100 mmHg, or diastolic above 85 mmHg; fasting blood-glucose levels greater than 100
mg/dL.International Diabetes Federation. “The IDF Consensus Worldwide Definition of
the Metabolic Syndrome.” Accessed September 30,
2011. http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf. The IDF estimates
that between 20 and 25 percent of adults worldwide have metabolic syndrome. Studies
vary, but people with metabolic syndrome have between a 9 and 30 times greater chance
for developing Type 2 diabetes than those who do not have the syndrome.International
Diabetes Federation. “The IDF Consensus Worldwide Definition of the Metabolic
Syndrome.” Accessed September 30,
2011. http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf.

Gestational Diabetes

During pregnancy some women develop gestational diabetes. Gestational diabetes is

characterized by high blood-glucose levels and insulin resistance. The exact cause is not
known but does involve the effects of pregnancy hormones on how cells respond to
insulin. Gestational diabetes can cause pregnancy complications and it is common
practice for healthcare practitioners to screen pregnant women for this metabolic
disorder. The disorder normally ceases when the pregnancy is over, but the National
Diabetes Information Clearing House notes that women who had gestational diabetes
have between a 40 and 60 percent likelihood of developing Type 2 diabetes within the
next ten years.National Diabetes Information Clearing House. “Diabetes Overview.”
Accessed September 30,
2011. http://diabetes.niddk.nih.gov/dm/pubs/overview/. Gestational diabetes not only
affects the health of a pregnant woman but also is associated with an increased risk of
obesity and Type 2 diabetes in her child.

Prediabetes

As the term infers, prediabetes is a metabolic condition in which people have

moderately high glucose levels, but do not meet the criteria for diagnosis as a diabetic.
Over seventy-nine million Americans are prediabetic and at increased risk for Type 2
diabetes and cardiovascular disease.National Diabetes Information Clearing House.
“Diabetes Overview.” Accessed September 30,
2011. http://diabetes.niddk.nih.gov/dm/pubs/overview/. The National Diabetes
Information Clearing House reports that 35 percent of adults aged twenty and older,
and 50 percent of those over the age of sixty-five have prediabetes.National Diabetes
Information Clearing House. “Diabetes Overview.” Accessed September 30,
2011. http://diabetes.niddk.nih.gov/dm/pubs/overview/.

Long-Term Health Consequences of Diabetes

The long-term health consequences of diabetes are severe. They are the result of
chronically high glucose concentrations in the blood accompanied by other metabolic
abnormalities such as high blood-lipid levels. People with diabetes are between two and
four times more likely to die from cardiovascular disease. Diabetes is the number one
cause of new cases of blindness, lower-limb amputations, and kidney failure. Many
people with diabetes develop peripheral neuropathy, characterized by muscle weakness,
loss of feeling and pain in the lower extremities. More recently, there is scientific
evidence to suggest people with diabetes are also at increased risk for Alzheimer’s
disease.

Video 4.3

Diabetes and Associated Complications

(click to see video)

Watch this video to learn more about the whole-body complications associated with
diabetes.

Diabetes Treatment

Keeping blood-glucose levels in the target range (70–130 mg/dL before a meal) requires
careful monitoring of blood-glucose levels with a blood-glucose meter, strict adherence
to a healthy diet, and increased physical activity. Type 1 diabetics begin insulin
injections as soon as they are diagnosed. Type 2 diabetics may require oral medications
and insulin injections to maintain blood-glucose levels in the target range. The
symptoms of high blood glucose, also called hyperglycemia, are difficult to recognize,
diminish in the course of diabetes, and are mostly not apparent until levels become very
high. The symptoms are increased thirst and frequent urination. Having too low blood
glucose levels, known as hypoglycemia, is also detrimental to health. Hypoglycemia is
more common in Type 1 diabetics and is most often caused by injecting too much
insulin or injecting it at the wrong time. The symptoms of hypoglycemia are more acute
including shakiness, sweating, nausea, hunger, clamminess, fatigue, confusion,
irritability, stupor, seizures, and coma. Hypoglycemia can be rapidly and simply treated
by eating foods containing about ten to twenty grams of fast-releasing carbohydrates. If
symptoms are severe a person is either treated by emergency care providers with an
intravenous solution of glucose or given an injection of glucagon, which mobilizes
glucose from glycogen in the liver. Some people who are not diabetic may experience
reactive hypoglycemia. This is a condition in which people are sensitive to the intake of
sugars, refined starches, and high GI foods. Inviduals with reactive hypoglycemia have
some symptoms of hypoglycemia. Symptoms are caused by a higher than normal
increase in blood-insulin levels. This rapidly decreases blood-glucose levels to a level
below what is required for proper brain function.
The major determinants of Type 2 diabetes that can be changed are overnutrition and a
sedentary lifestyle. Therefore, reversing or improving these factors by lifestyle
interventions markedly improve the overall health of Type 2 diabetics and lower blood-
glucose levels. In fact it has been shown that when people are overweight, losing as little
as nine pounds (four kilograms) decreases blood-glucose levels in Type 2 diabetics. The
Diabetes Prevention Trial demonstrated that by adhering to a diet containing between
1,200 and 1,800 kilocalories per day with a dietary fat intake goal of less than 25 percent
and increasing physical activity to at least 150 minutes per week, people at high risk for
Type 2 diabetes achieved a weight loss of 7 percent and significantly decreased their
chances of developing Type 2 diabetes.Knowler, W. C. et al. “Reduction in the Incidence
of Type 2 Diabetes with Lifestyle Intervention or Metformin.” N Engl J Med 346, no. 6
(2002): 393–403. http://www.nejm.org/doi/full/10.1056/NEJMoa012512.

The American Diabetes Association (ADA) has a website that provides information and
tips for helping diabetics answer the question, “What Can I Eat” (see Note 4.34
"Interactive 4.2"). In regard to carbohydrates the ADA recommends diabetics keep track
of the carbohydrates they eat and set a limit. These dietary practices will help keep
blood-glucose levels in the target range.

Interactive 4.2

The ADA has a website containing great information and tips on how to eat a healthy
diet that helps keep blood-glucose levels in the target range. Visit it to learn more on
how to prevent serious complications of this disease.

http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/?
utm_source=WWW&utm_medium=
DropDownFF&utm_content=WhatCanIEat&utm_campaign=CON

An unfortunate problem is that most diabetics do not adhere to the lifestyle

interventions long-term. This is partly because of individual disinclination, but is also
because health insurance companies do not provide continued financial support for
dietary guidance and because primary care physicians do not prescribe dietary guidance
from a dietitian. This shifts the way diabetes is treated away from lifestyle intervention
toward medications, as the goal still remains to manage blood-glucose levels. Numerous
oral medications are available on the market and are often prescribed to Type 2
diabetics in combination.

KEY TA KEA WA YS

 Diabetes is a disease of insulin deficiency and glucose oversufficiency. Like other

diseases, genetics, nutrition, environment, and lifestyle are all involved in determining a
person’s risk for developing diabetes.
 Type 1 diabetes was once a death sentence, but now can be treated with insulin
injections. However, insulin injections do not cure the disease, and diabetics can suffer
many disease complications. Diabetes complications can be relieved by strictly managing
blood-glucose levels, adhering to a healthy diet, and increasing physical activity.
 The incidence of Type 2 diabetes has more than doubled in America in the past thirty
years and the rise is partly attributed to the increase in obesity. The front-line approach
for treating Type 2 diabetes includes eating a healthy diet and increasing physical activity.
 The long-term health consequences of diabetes are severe. They are the result of
chronically high glucose concentrations in the blood and other metabolic abnormalities
such as high blood-lipid levels.

D ISCUSSION STA RTERS

1. If you owned a grocery store what are some practices you could introduce to combat the
epidemic of Type 2 diabetes in this country?
2. What are some options for you to intervene in your lifestyle and decrease your risk for
Type 2 diabetes?