Chapter 4

 Carbohydrates: carbon, hydrogen,

oxygen (CHO)
 Energy Cycles:
 Through photosynthesis, plants combine
carbon dioxide, water and the sun’s energy
to form glucose (Fig 4.1).
 When humans metabolize glucose, energy
and carbon dioxide are released (Fig 4.11).
 Types of CHO

 Types:
 Simple CHO (sugars)
 Complex CHO or polysaccharides
(fibre and starch)
 Simple Sugars (Fig 4.2)
 1. Monosaccharides
 Glucose
 Galactose
 Fructose
 2. Disaccharides
 Sucrose (glucose + fructose)
 Maltose (glucose + glucose)
 Lactose (glucose + galactose)
 Complex or Polysaccharides
 Fig 4.3: chains of glucose linked together
 Plant forms: starch and fibre
 human digestive enzymes can break the
bonds between glucose units in starch but
not in fibre e.g. cellulose
 Animal form: glycogen (more branched)
 human digestive enzymes can break the
bonds
 found in liver and muscle (meat) – broken
down at slaughtering
 Recommendations (Table 4.1)
 DRI
 45-65% of energy from carbohydrates, emphasis
on complex and whole grain
 <25% of energy from added sugars
 Nutrition Recommendation Canadians (2003)
 55% energy from CHO

 Food sources: pasta, rice, cereals, breads,

milk/milk products, fruits, starchy vegetables
(potatoes, peas, corn, squash)
 Dietary Fibre

 Suggested intake:
 WHO: >25 g per day
 DRI: <50 yrs: males 38 g/d; females 25 g/d;
>50 yrs: males 30 g/d; females 21 g/d
 Fibre content of common foods, Fig 4.4
 Types of Fibre (Table 4.2)

 1. Water soluble fibre

 Types: gums, mucilages, pectins,
psyllium, some hemicellulose
 Sources: oats, oat bran, barley, rye,
seeds, fruits, vegetables, legumes
 Water Soluble Fibre
 Benefits:
– Lower blood cholesterol (Fig 4.5)
– Slow glucose absorption
– Slow transit of food through upper digestive
tract
– Hold moisture in stools, softening them
– Yield small, fat-like molecules after
fermentation that the colon can use for
energy
– Lower risk of heart disease and diabetes
 Types of Fibre

 2. Water Insoluble Fibre

 Types: cellulose, lignin, and some
hemicellulose
 Sources: brown rice, wheat bran,
whole grains, seeds, fruits,
vegetables, legumes
 Water Insoluble Fibre
 Benefits:
– Increase fecal weight
– Increase colonic transit
– Alleviate constipation
– Reduce risk for diverticular disease (Fig. 4-
6, intestinal wall bulges out due to
weakening of muscle layers), hemorrhoids
and appendicitis
– Provide bulk and feeling of fullness
– Weight management
 Consumer Corner

 Refined, Enriched and Whole-Grain

Bread
 Table 4.3
 Figure 4.8
 Figure 4.9
How carbohydrates in food becomes
glucose in the body (Fig 4.10 & p. 117)

 Mouth: minor digestion by salivary

amylase
 Small intestine: digestion by pancreatic
amylase (starchdisaccharides) and
enzymes on intestinal wall
(disaccharides monosaccharides)
 Fibre travels unchanged to the colon
 Fig 4.10 cont’d
 Absorption of glucose, fructose and
galactose into bloodstream  liver
 Liver converts galactose and fructose to
glucose
 All digestible CHO becomes glucose in the
body and is used for
 energy (directly, or from glycogen stores)
 glycoproteins (CHO attached to proteins)
e.g. mucus, cell membranes
Postprandial CHO Metabolism
 Blood glucose rises after eating CHO and
amount of increase reflects
 amount of CHO consumed
 rate of digestion and rate of glucose
entry into bloodstream
 rate of glucose uptake by the cells
 Blood Glucose
 Under homeostasis: is tightly regulated
 Normal fasting blood glucose level is 4 – 6
mmol/L
 Hypoglycemia = low blood glucose
 Hyperglycemia = high blood glucose
 Blood Glucose
 When blood glucose is high (fed state), the
pancreas releases insulin
 2/3 glucose taken up by muscle and stored as
glycogen
 1/3 glucose taken up by liver and stored as
glycogen or converted to fat
 Glucose is transported into most cells via
insulin (hormone) i.e. insulin “opens the
gate” to let glucose into the cells
 except brain, nerves, red blood cells, mammary
glands
 Blood Glucose
 When blood glucose is low, the pancreas
releases glucagon (hormone)
 breakdown of liver glycogenglucose
blood tissues for energy
 glucose is produced from protein
(gluconeogenesis)
– if this occurs on a longterm basis (e.g.
disease states) then muscle wasting
 Ketosis
 Need minimum 130 g CHO/day to prevent
ketosis & to spare protein (muscle)
 Usually consume 200-400 g CHO/d
 Liver glycogen lasts 4-6 hrs depending on
CHO intake, exercise, etc.
 If liver glycogen is depleted, then ketosis
occurs
 Diabetes (Table 4.8)

 Type 1 (early or mid-life, <10% cases)

 hyperglycemia due to little or no insulin
produced by the pancreas
–auto-immune response
 untreated: glucose wasting (urine) and
weight loss
 treatment: insulin is injected to match
food intake and physical activity
 Diabetes
 Type 2 (usually adult, now children/teens;
>90% cases)
 hyperglycemia due to insulin resistance
(associated with overweight and obesity)
–pancreas produces lots of insulin but
cells respond poorly
 chronic hyperglycemia increases risk of
cardiovascular disease, kidney disease,
cataracts/blindness, amputations, etc.
 Risk Factors

 Family history
 Sedentary lifestyle
 Overweight / obese
 Moderate weight gain in adulthood
 History of gestational diabetes
 Genes: Aboriginal, African American,
Hispanic, Asian, Pacific Island descent
 Warning signs of diabetes
(Table 4.7)

 Excessive urination and thirst

 Glucosuria (glucose in urine)
 Weight loss, nausea, weakness, irritability
 Cravings for food, especially sweets
 Drowsiness
 Vision disturbances (cont’d)
 Warning signs of diabetes
(Table 4-7)

 Frequent infections e.g. skin, & itching

 Slow healing of cuts and bruises
 Pain in legs, feet, or fingers
 Abnormally high glucose tolerance test
results
 Management
 Management of Type 2 diabetes:
 1. Diet and physical activity NB
• 10% weight loss is beneficial

 2. Oral agents
 3. Sometimes insulin injections
 Glycemic effect of food (p. 123)

 Extent to which foods elevate blood

glucose compared to a glucose solution
or white bread
 Low number is best: legumes, peas
 High number: white bread, juice
 Glycemic effect of food

 Factors:
 type of food:
–apple < apple juice
 cooking method:
–baked potato < mashed
 eaten alone or part of a mixed meal
 Figure 4.12
 CHO Counting

 Simple, flexible meal planning tool

 Want consistent CHO intake at meals
 Grains, fruits, milk, sweets all CHO choices
 1 Grains & Starch choice = 15g CHO
 1 Fruits choice = 15g CHO
 1 Milk & Alternatives choice = 15g CHO
 Meat & Alternatives and Fat choices do not
contain CHO
 Lactose Intolerance (p. 120)

 insufficient lactase enzyme activity to

digest lactoseglucose+galactose
 develops in adults of non-Northern
European background
 signs: nausea, pain, diarrhea and gas
 more osmotic particles draws water
 bacterial fermentation in intestine
 Lactose Intolerance

 Management:
 Consume milk in small amounts (1/2 - 1
cup) with meals
 Yogurt, aged cheeses
 Products treated with lactase e.g.
Lactaid milk, ice cream
 Add enzyme drops to milk-based foods
 Lactaid pills
 Milk Allergy

 immune response to protein in milk

 need non-dairy sources of calcium:
 calcium-fortified soy milk and orange
juice
 canned sardines or salmon with bones
 vegetables e.g. broccoli, bok choy
 consider a calcium supplement
 Controversy 4
 Sugars and Health: a role in
 Obesity?
 Aggravating diabetes?
 Increasing risk for heart disease?
 Behavioral problems?
 Dental problems
 Use sugar in moderation: <10% Calories
from added sugars [DRI: <25%]
 Sugar: 200 Calories = 13 teaspoons
 Terms that Describe Sugar: Table 4-9
 Empty calories of sugar: Table 4-10
 Sweeteners
 Sugar alcohols:
 Members of chemical alcohol family
(structure)
 sorbitol, mannitol, xylitol, isomalt, maltitol,
lactitol
 Not readily used by mouth bacteria
 All have 3-5 Calories/g but poorly absorbed
 Table C4.2
 Sweeteners
 Artificial Sweeteners
 aspartame (200 x sweeter than sucrose),
acesulfame-K (200 x), sucralose (600 x)
[cyclamate and saccharin have restricted uses in
Canada]
 calorie-free because so little is used
 aspartame = phenylalanine + aspartic acid, 4
cal/g from the amino acids but calorie-free;
product warning for people with PKU
(phenylketonuria)
 Table C4.4
 Do they reduce obesity?
 Artificial Sweeteners - Safety
 Acceptable daily intake (ADI) is the
estimated amount of sweetener that can be
consumed daily over a person’s lifetime
without any adverse effects
 ADI = 40 mg/kg body weight for aspartame
in Canada
 150 lb (68 kg) person: ~72 packets of Equal or
~13 diet soft drinks;
 NB. Children & food choices
 NB. Moderate intake