carbohydrate: the efficient fuel chapter 3 copyright © 2010, 2005, 1998 by saunders, an imprint of...
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CARBOHYDRATE: THECARBOHYDRATE: THEEFFICIENT FUELEFFICIENT FUEL
CHAPTER 3CHAPTER 3
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
22Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Carbohydrate: The Efficient FuelCarbohydrate: The Efficient FuelThe popular belief that carbohydrates have some The popular belief that carbohydrates have some
mysterious “fattening” power is unfounded. They:mysterious “fattening” power is unfounded. They:Add variety and palatability to the diet Add variety and palatability to the diet Are the most economical form of energyAre the most economical form of energy
Americans likeAmericans like
it sweetit sweetAverage intake is Average intake is
139 pounds annually139 pounds annuallyNeed to choose moreNeed to choose more
whole grainswhole grainsFrom Wells HF, Buzby JC: High-fructose corn syrup usage may be leveling off. From Wells HF, Buzby JC: High-fructose corn syrup usage may be leveling off.
Amber Waves, February 2008, USDA.Amber Waves, February 2008, USDA.
33Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Classification: Simple SugarsClassification: Simple SugarsMonosaccharides Monosaccharides
Glucose-dextrose, fruits, vegetables, corn syrup, honeyGlucose-dextrose, fruits, vegetables, corn syrup, honeyFructose-levulose, fruits, vegetables, corn syrup, honeyFructose-levulose, fruits, vegetables, corn syrup, honeyGalactose-lactoseGalactose-lactose
Disaccharides Disaccharides Lactose—milk onlyLactose—milk onlyMaltose—beer, cerealsMaltose—beer, cerealsSucrose—cane, beet, maple sugar,Sucrose—cane, beet, maple sugar,
fruits, vegetablesfruits, vegetables
44Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Classification: Other Nutritive Classification: Other Nutritive Sweeteners—Sugar AlcoholsSweeteners—Sugar Alcohols
Sugar alcohols or polyols sweeten with less Sugar alcohols or polyols sweeten with less energy per gram than sucrose (averaging energy per gram than sucrose (averaging 2.4 kcal/g)2.4 kcal/g)Common characteristicsCommon characteristics
Provide calories but are used in smaller amounts Provide calories but are used in smaller amounts Potential to cause gastric upsetPotential to cause gastric upset
Sorbitol and mannitolSorbitol and mannitol Essentially noncariogenicEssentially noncariogenic Maximum recommended amount <20 g/dayMaximum recommended amount <20 g/day
55Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Classification: Other Nutritive Classification: Other Nutritive Sweeteners—Sugar AlcoholsSweeteners—Sugar Alcohols
XylitolXylitolThe only CHO that is anticariogenic The only CHO that is anticariogenic Mechanisms of action against caries:Mechanisms of action against caries:
Inhibits growth of cariogenic bacteria Inhibits growth of cariogenic bacteria (Streptococcus mutans)(Streptococcus mutans) Inhibits plaque growthInhibits plaque growth Decreases transmission of cariogenic bacteriaDecreases transmission of cariogenic bacteria Promotes remineralizationPromotes remineralization Complements fluoride toothpaste useComplements fluoride toothpaste use
66Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Classification: Non-Nutritive Classification: Non-Nutritive SweetenersSweeteners
Five non-nutritive sweeteners with intense Five non-nutritive sweeteners with intense sweetening power have FDA approvalsweetening power have FDA approvalAspartame (phenylalanine and aspartic acid—two AAs)Aspartame (phenylalanine and aspartic acid—two AAs)
NutraSweet and EqualNutraSweet and EqualSaccharin (derivative of petroleum)Saccharin (derivative of petroleum)
Sweet’n LowSweet’n Low
Acesulfame-KAcesulfame-K Sweet OneSweet One
SucraloseSucralose SplendaSplenda
NeotameNeotame
77Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Alternative SweetenersAlternative SweetenersName/Brand NameName/Brand Name Sweetness Compared to Sweetness Compared to
SucroseSucrose
SorbitolSorbitol 0.5x0.5x
MannitolMannitol 0.7x0.7x
XylitolXylitol 1.0x1.0x
Saccharin (Sweet’n Low)Saccharin (Sweet’n Low) 200200––700x700x
Aspartame (NutraSweet & Equal)Aspartame (NutraSweet & Equal) 160160––220x220x
Acesulfame-K (Sunett)Acesulfame-K (Sunett) 200x200x
Sucralose (Splenda)Sucralose (Splenda) 600x600x
Neotame (not yet available)Neotame (not yet available) 8000x8000x
88Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Classification: Polysaccharides Classification: Polysaccharides (Complex CHOs)(Complex CHOs)
Starch-grains, legumes and potatoesStarch-grains, legumes and potatoesAmylose Amylose AmylopectinAmylopectin
FiberFiberSolubleSoluble
Gums and mucilages: barley, legumes, oat branGums and mucilages: barley, legumes, oat bran Pectin: fruitPectin: fruit
Insoluble: speed stool through bowel reducing contact Insoluble: speed stool through bowel reducing contact w/carcinogensw/carcinogens Cellulose: wheat branCellulose: wheat bran Hemicellulose: cereals, vegetables, legumes, fruit/vegetable skinsHemicellulose: cereals, vegetables, legumes, fruit/vegetable skins Lignin: vegetablesLignin: vegetables
99Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Physiologic Roles of CHOPhysiologic Roles of CHOProvides energyProvides energy
Sole source of energy for the Sole source of energy for the RBCs, brain (CNS) and lens of the RBCs, brain (CNS) and lens of the eyeeye
Required for oxidation of fatsRequired for oxidation of fatsRequired for components Required for components
needed for development of needed for development of collagen and nervous tissuecollagen and nervous tissue
1010Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Physiologic Roles of CHOPhysiologic Roles of CHO
Spares proteinSpares proteinProvides the chemical structure that combines Provides the chemical structure that combines
with nitrogen to form nonessential amino acidswith nitrogen to form nonessential amino acidsNondigestible CHOsNondigestible CHOs
Involved in growth of bacteria in the gut that Involved in growth of bacteria in the gut that synthesize nutrientssynthesize nutrients
Involved in gastric motilityInvolved in gastric motility
1111Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Carbohydrate RecommendationsCarbohydrate RecommendationsFirst RDA set for total CHO in First RDA set for total CHO in
20022002Minimal level to support brain Minimal level to support brain
activityactivityRDA: 130 g/dayRDA: 130 g/day
Dietary reference intake Dietary reference intake recommendationsrecommendationsAMDR for CHO: 45%-65%AMDR for CHO: 45%-65%Focus on whole grains, legumes, Focus on whole grains, legumes,
vegetables, fruits, and low-fat dairyvegetables, fruits, and low-fat dairy
1212Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Fiber RecommendationsFiber Recommendations
AI for fiber intakeAI for fiber intakeMen 19-50 yr: 38 g/dayMen 19-50 yr: 38 g/dayWomen 19-50 yr: 25 g/dayWomen 19-50 yr: 25 g/day
How much fiber?How much fiber?Apple (4 g)Apple (4 g)11½½ cups salad greens (2 g) cups salad greens (2 g)1 slice white bread (0.5 g)1 slice white bread (0.5 g)
vs. 1 slice whole wheat bread (2 g)vs. 1 slice whole wheat bread (2 g)½½ cup cooked beans (7.5 g) cup cooked beans (7.5 g)
1313Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Added Sugar GuidelinesAdded Sugar GuidelinesMyPyramid MyPyramid
Discretionary calories includes Discretionary calories includes added sugars and fatadded sugars and fat Calorie allowances are very Calorie allowances are very
small:100small:100––300 calories300 calories
Dietary reference intakesDietary reference intakesMaximal intake 25% of energy Maximal intake 25% of energy
intakeintakeAs intakes of added sugars As intakes of added sugars , ,
intake of vitamins A, Fe, Ca, Zn intake of vitamins A, Fe, Ca, Zn Age groups most likely to exceed Age groups most likely to exceed
25% are 925% are 9––18 years18 years
1414Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
SourcesSourcesMilkMilk
Only animal product with significant quantities of CHOOnly animal product with significant quantities of CHO
Whole grainsWhole grainsFruitFruitVegetablesVegetables
Potatoes, beets, corn, peasPotatoes, beets, corn, peas
LegumesLegumesAdded sugars Added sugars
Baked goodsBaked goodsJams, jellies, honey, syrupsJams, jellies, honey, syrups
1515Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Hyperstates and HypostatesHyperstates and Hypostates
Excess carbohydratesExcess carbohydratesEvidence suggests CHO intake at current levels does Evidence suggests CHO intake at current levels does
not directly contribute to chronic diseasenot directly contribute to chronic disease Rather excess intake may result in energy imbalance and Rather excess intake may result in energy imbalance and
weight gainweight gain
WHO recommends limiting intake to 10% of total WHO recommends limiting intake to 10% of total calories vs. DRI maximum intake of 25% of calories calories vs. DRI maximum intake of 25% of calories from added sugarsfrom added sugars
Rise in consumption of soft drinks hasRise in consumption of soft drinks has
negatively affected milk consumptionnegatively affected milk consumptionSugar is not the cause of obesity; it is intake of excess Sugar is not the cause of obesity; it is intake of excess
calories whether from CHO, protein, fat, or alcoholcalories whether from CHO, protein, fat, or alcohol
1616Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Hyperstates and HypostatesHyperstates and HypostatesCarbohydrate does not independently cause Carbohydrate does not independently cause
cariescariesDental caries is a process involving a tooth, bacteria Dental caries is a process involving a tooth, bacteria
and environment factors (e.g., saliva, CHO, fluoride)and environment factors (e.g., saliva, CHO, fluoride)
Sucrose promotes the volume and growth rate of Sucrose promotes the volume and growth rate of plaque biofilmplaque biofilmPromote production of used to facilitate adherence of Promote production of used to facilitate adherence of
plaque biofilm to the toothplaque biofilm to the toothMetabolism of sucrose by bacteria lowers the pH, Metabolism of sucrose by bacteria lowers the pH,
leading to decalcificationleading to decalcification
1717Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Hyperstates and HypostatesHyperstates and HypostatesStudies have not correlated caries rate with total Studies have not correlated caries rate with total
sugar consumptionsugar consumptionDanger of soda and energy drinks is acidic content in Danger of soda and energy drinks is acidic content in
addition to fermentable CHO contentaddition to fermentable CHO content
Cooked and refined carbohydrates readily Cooked and refined carbohydrates readily hydrolyzed by salivary amylase to lower pH and hydrolyzed by salivary amylase to lower pH and demineralize enameldemineralize enamel
Cariogenicity of CHO is mostCariogenicity of CHO is most
affected by:affected by:Frequency of consumptionFrequency of consumptionForm of CHO (e.g., liquid, sticky, solid)Form of CHO (e.g., liquid, sticky, solid)
1818Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Nutritional DirectionsNutritional DirectionsLimit between-meal snacks; eat cariogenic foods Limit between-meal snacks; eat cariogenic foods
with a mealwith a mealInclude whole grains, vegetables, whole fruits, Include whole grains, vegetables, whole fruits,
and low-fat dairy as snacksand low-fat dairy as snacksLimit simple and retentive CHOs like crackers, soft Limit simple and retentive CHOs like crackers, soft
drinks, sports drinks, fruit juicedrinks, sports drinks, fruit juiceRecommend xylitol gum and/or mints when Recommend xylitol gum and/or mints when
brushing is not possiblebrushing is not possibleUse calcium-rich foods such as low-fat cheese or Use calcium-rich foods such as low-fat cheese or
low fat-milk for snackslow fat-milk for snacksEncourage daily self-care and home fluoridesEncourage daily self-care and home fluoridesRefer patients with complex medical issuesRefer patients with complex medical issues