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Nutrition Midterm 3 Study Guide

Carbohydrates:
-

4 kcals per gram


Sugars + starches
RDA 60% of mainly starch, no alcohol, 20-30 gm of fiber
Broken down into monosaccharides
o Maltose = glucose + glucose
o Lactose = glucose + galactose
o Sucrose = glucose + fructose
Glucose is major energy source for the brain and most of the body functions
Breakdown:
o Begins in the mouth with salivary amylase
o No digestion in the stomach
o Continues digestion in small intestine with pancreatic amylase
o Humans are unable to breakdown cellulose
Glycogen is from animals
o Cholesterol is the cell wall of animals
Starch and fiber are from plants
o Fiber is the cell wall of plants (cellulose)
*Know examples of simple and complex sugars, starches and fibers (listed on
pg. 117)

Sugars

Starch
es

Fiber
(nonstarch
polysa
ccharid
es)

Simple
Monosaccharide
glucose
fructose
(1.5x
sweeter)
galactose

Disaccharide
sucrose (glucose
+ fructose)
lactose
(galactose +
glucose)
maltose
(glucose +
glucose)

Complex CHO
Amylose
Amylopectin
Modified food starches
Insoluble
Cellulose
Hemicellulose

Oligosaccharides
Alpha-galactosides
(raffinse, stachyose)
Fructans (FOS
fructo-oligosaccharide)

Soluble
Pectins
Beta glucans
Fructans (fructo-oligo-sacchariades)
Gums
Musilages
Algal polysaccharides (carrageenan,
agar)

*be familiar with sources of carbs and whether they are starch, sugar, or fiber

Whole
grains
Mostly:
Starch
Insoluble
fiber

Fruit

Vegetables

Milk

Alcohol

Mostly:
Sugar
(fructose)
Soluble
fiber
(pectin)

Mostly:
Starch
Insoluble
and
soluble
fiber

Sugar
(lactose
and
galacto
se)

Sugar

Sweetener
s
Sugar

Refined
foods
Sugar
Starch
Little to
no fiber

Enzyme defects:
o Lactose intolerance
Insufficient lactase
Causes bloating, pain, cramps, flatulence, diarrhea
Treatment includes avoiding dairy products and taking lactase
Not usually life threatening; can cause dehydration
o Fructose intolerance (fructosemia)
Autosomal recessive disorder - <1 in 2000
Deficiency of fructose 1 phosphate aldolase (toxic build up of
fructose-1-phosphate)
Causes hypoglycemia, abdominal pain, jaundice, kidney
damage, mausea/vomit, hepatomegaly, liver cirrhosis, seizures
Treatment includes deleting all fruit and fructose from diet
(including sucrose and sorbitol)
o Galactose intolerance (galactosemia)
Deficiency of galactose 1 phosphatate uridyl transferase 1 in
60,000
Diagnosed by dipstick urine analysis
Hypoglycemia, failure to thrive, mental retardation, cataract
formation, vomit/diarrhea, hepatomegaly/jaundice/cirrhosis,
renal tubule damage
Treatment includes avoiding galactose and lactose; must use
special baby formula; rice or almond milk are not good for
babies

Intolerance
Usually CHO
Usually due to enzyme defect
Usually gut signs and symptoms
No IgG, IgA, or IgE

Allergy
Always protein
Related to leaky or permeable gut
Usually allergy signs and symptoms
Food allergy panel; will have IgG, IgA,
IgE

Residue = undigested food debris


-

Ex:
o
o
o
o
o
o
o

Seeds
Nut pieces
Strings (celery, beans, peas)
Husk
Skins
Shells
Bones

Fiber for inflammatory


Stage
Acute
inflammation/bleedin
g
Less when inflamed
but no bleeding
When healed, no
inflammation/bleedin
g

bowel disease
Residue
Low

Low
try

Macronutrie
nt
FAT

RDA

CHO

60% of mainly
starch
no alcohol
20-30g of fiber

PRO

20% maximum
(12-15% for most)
of mainly plant
sources

30% of mainly
plant/fish sources

Fiber type
High soluble, low
insoluble
High soluble, try
insoluble
High soluble, high
insoluble

Current Ave. US
intake
40% of mainly
hydrogenated,
animal and
margarine fats
sources
55-75% of mainly
sugars
1/5 of kcal (20%
comes from
alcohol)
10g of fiber

12-15% of mainly
animal

Best health based


on research
20% or less of
mainly plant/fish
sources

55-65% of mainly
starch
little alcohol
(moderate = 1-2
drinks/day)
1 oz hard, 4 oz
wine, 12 oz beer =
1 drink
30g+ of fiber
20% maximum
with 12-15% for
most of mainly
plants

Fiber
The portion of plants that is indigestible and supplies bulk/volume and little or no kcals (energy)
Soluble
Insoluble
Most common pectin (fruit)
Most common - Bran (wheat, rice), Psyllium husk
Legumes, Beta glucans, Gums, Musilages, Algal Whole grains, whole seeds and nuts, husks from
polysaccharides (carrageenan, agar)
seeds, vegetables (cellulose), corn flakes are high
Fructans (fructo-oligo-saccharides)
Pre-biotic/food for probiotic gut flora
Intestinal metabolites of short chain fatty
acids (butyrate, propionate, valate,
acetate)
SCFA food for intestinal cells
Oats contain equal amounts of both
Lack of associated with:
Lack of associated with:
Diabetes (uncontrolled blood sugar, glycemic
Constipation, diverticular disease (if bleeding,
index)
acutely inflamed = diverticulitis), hemorrhioids,
Hypercholesterolemia/atherosclerosis
colorectal cancer, gallstones
(absorbability of fats)
Duodenal ulcers
Ulcerative colitis/Crohns disease
Leaky gut (poor gap junction function)
Aids in weight loss (satiety)
Dumping syndrome
Viscosity
Decrease gastric
Particle formation/water Increased gastric
emptying
holding capacity
emptying
Gums, pectin,
Increased
mouth
to
Decreased mouth to

Wheat
bran,
mucilage
cecum transit
cecum transit
pentosan, lignin
Decreased sm.
Decrease total GI
Intestine absorption
transit
(glucose, bile salts)
Decrease colonic
intraluminal pressure
Increased fecal bulk
Cation exchange
Increased small
Anti-oxidant
Decreased free radicals
intestine
losses
(**trace
in GI tract (due to
Pectins (acidic
Lignin (reducing
polysaccharides) minerals, heavy
phenolic groups) reduced exposure from
metals)
increased transit time)
(Anti-toxic effect)
Phytates/phytic
acid
(Anti-carcinogenic)
Absorption and non
Increased fecal steroid
Absorption and non
Increased fecal steroid
specific effects
output, fat loss and
specific effects
output, fat loss and
nitrogen loss
nitrogen loss
Pectin
Lignin
Degradability (colonic
Increased SCFA
Degradability (colonic
Increased SCFA
bacteria)
production
bacteria)
production
Increased
bowel
gas
Increased bowel gas
Fructans (FOS)
Free lignin
Decreased cecal pH
Decreased cecal pH

Fiber: (roughage)
-

The portion of plants that is indigestible and supplies bulk/volume and little or
no kcals (energy)
Soluble:
o Fruit pectin, most legumes, agar and carrageenan, carrots, corn,
spinach, kale, peas, squash, sweet potatoes, brussel sprouts, alfalfa;
(oats have both soluble and insoluble)
Insoluble:
o Whole grains (barley, wheat, rice, quinoa), bran, whole seeds and nuts,
husks from seeds, vegetables; (oats have both soluble and insoluble)
Conditions with lack of soluble fiber:
o Hypercholesterolemia/atherosclerosis (soluble fiber binds dietary
cholesterol and binds/excretes bile acids)
o Diabetes
o Ulcerative colitis
o Leaky gut syndrome aids in maintaining gap junctions of the intestine
by protecting against carcinogens
o Fiber helps weight loss (feel full)
Conditions with lack of insoluble fiber:
o Constipation
o Colorectal cancer
o Hemorrhoids
o
**know the clinical implications on page 121

Sugar:
-

Glucose is the preferred energy source for muscle and brain (95%)
Problems with sugar metabolism:
o Dental carries
o Decreased immune response
o Hypoglycemia
o Hyperglycemia/diabetes
o Gout (increased uric acid levels)
o Obesity
o Increased risk of heart disease in men (due to sugar increasing
estrogen levels)
Glucose tolerance test:
o 2 hour post-prandial Most commonly used
Done if suspect diabetes or hypoglycemia
o 6 hour glucose tolerance test Done in research
o Fasting blood sugar ** better than random
o Random blood sugar

HgA1c- glycosylated hemoglobin


Measures RBCs; indication of damaged or healthy cell formation
Can tell average blood sugar over past 3 months

Glucose tolerance = determined by rate at which inherent mechanisms (for


removing excess glucose from the blood) perform their functions
o
Glucose tolerance factors:
o Chromium
o Niacin
o Zinc
o B6 - pyridoxine
o Fiber
o Fish oils for Essential fatty acids (mainly omega 3s)
o Vanadium (heavy metal)
Hyperglycemia:
o Higher than normal fasting blood glucose level
o Higher than normal fasting peak
o Peak stays for longer (sugar damages blood vessel wall)
o Failure to return to normal fasting level
Hypoglycemia:
o Normal or low fasting blood sugar
o Lower than normal fasting peak
o Low nadir (low point)
o Delay in return to normal levels
Glycemic index:
o The ability of a carb containing food to raise and maintain elevated
blood sugar during the first two hours after it is eaten
o Crucial factors to determine GI
Amount of glucose present in food (raisin vs. grape)
Rate of food ingestion
Rate of gastric emptying (fats, fiber)
Ability of digestive enzymes to interact efficiently with the food
carb (how much chewing)
Amount of digestion required to produce free glucose (raw vs.
cooked)
Degree of glucose tolerance or intolerance of individual (fitness
level, health status)
o Low GI:
< or = 49 mg/dL
**know examples of foods in each GI category (pg. 126)
o Moderate GI:
50-69 mg/dL
o High GI:
> or = 70 mg/dL
Very starchy foods

Change hormones and metabolism


Risks of disease:
Diabetes
CVD
Decreased HDL
Increased oxidative stress
Increased post meal insulin levels
Increased triglycerides
Increased obesity
Insulinemic index:
o Blood sugar and insulin dont always increase together
o Carbs, protein, and fat all stimulate insulin secretion (beef has higher
insulin index than some carbs)

Alternative Sweeteners:
-

Natural:
o Sugar alcohols:
Used in moderation because they cause bloating, gas, and
diarrhea
Sorbitol
2.6 kcals per gram
Large doses cause cell damage
Used for sweetness and moisture
Xylitol
Inhibits growth of cavity producing bacteria
2.4 kcals per gram
Can cause tumor growth in animals
Mannitol
Causes significant diarrhea due to effect on osmotic
gradient
o Fructose:
Sweeter than sucrose
4 kcals per gram
Low glycemic index (30 vs sucrose 86)
o Stevia:
250-300 times sweeter than sucrose
No kcals
Heat stable
o Licorice root:
No kcals
No elevation of blood sugar or insulin
Very high doses may cause increased blood pressure
Artificial:
o Aspartame/nutrasweet
200 times sweeter than sucrose

amino acids = aspartic acid and phenylalanine (PKU pts should


avoid)
4 kcal per gram
calorie free if there is less than one gram per serving size
Neurotoxin (aspartic acid); can cross the blood brain barrier and
change neurotransmitters
Not heat stable turns into formaldehyde like molecule
Changes gut microflora
Stimulates appetite
Adverse reactions:
Seizures
Memory loss
Extreme irritability
Slurred speech
Headaches
Increase in appetite
etc
o Cyclamates and saccharine
First artificial sweeteners developed
Cause tumor and cancer growth in rodents
No calories
Low GI, low insulinemic index
o Sucralose/Splenda
600 times sweeter than sucrose
No calories
Increase leukemia in animals
Thymus and thyroid gland atrophy
Promotes growth of bad gut flora; lowers good gut flora
o Acesulfame K
Worst of all!
Linked to cancer (thyroid tumors)
2000x sweeter
NO calories
o Adventame should be avoided by PKU patients, similar to aspartame
Ingestion of intense sweeteners is correlated to significant weight gain
o Lack of adequate micronutrients
o People think they can eat more because sweetener has no kcals

Alcohol:
-

Fermented carb
7 kcal per gram
Absorbed in stomach
Drinking in moderation: 1-2 drinks/day
o A drink= 1 oz distilled/12 oz beer/ 4-6 oz wine
o Distilled liquor has no carbs in it

Adverse effects of alcohol:


o Promotes obesity
o Enhances breast, colorectal, gastric, oral cancers
o Depresses immune function
o Interferes with vitamin/mineral absorption and utilization
o Liver damage
o Diuretic
o Stimulates appetites, reduces satiety
o Increases depression and intereferes with REM sleep
o FAS
o Etc
Benefits of alcohol:
o Decreased fibrinogen levels and decreased platelet aggregation Thins
blood *** - decreased thrombosis
o Poly phenolics (antioxidants) *** red wine only decreased plasma
peroxide, and lipid peroxide, decreased LDL oxidation
o Antibiotic topically (kills bacteria on contact, sore throats)
o Cough suppressant
o Analgesic
o Muscle relaxant
o Decrease tension
o Base for herbal tinctures (preservative)

Hypoglycemia:
-

<50 mg/dL plasma glucose


2-hour post prandial not accurate, can miss nadir
Can be caused by many things including:
o Fasting
o Exercise
o Too much insulin taken
o Liver disease
o Increased cortisol*
Low blood sugar response
High cortisol response
Headache/migraines
GI tract disturbances
Low energy
Sweaty palms
Dizzy, light-headed, shaking,
Shaking, trembling
trembling
Depression
Anxiety, irritability
Drowsy
Tachycardia, arrhythmias
Hunger
Tachycardia, arrhythmias, angina
Reactive (peak followed by drop) may be due to hyperinsulinemia, elevated
cortisol, rate of glucose decline, hysteria (psychosomatic), epinephrine
(anaphylaxis treatment)
Treatment:
o Eat small frequent meals (high fiber, low GI)

o
o
o
o
o
o
o
o

Avoid refined foods


Decrease fat intake to <30%
Whole fruits
Avoid caffeine, alcohol, drugs
Supplements (including chromium, B vits, zinc)
High quality protein
Regular aerobic exercise
Stress reduction

Diabetes:
-

Types:
o One:
Due to genetic or autoimmune failure of pancreas to produce
adequate insulin
Insulin dependent
o Two:
Usually obese, initially non-insulin dependent
Accounts for 90% of diabetes mellitus cases
Diagnosed mainly through glycosalated hemoglobin levels
Major nutritional causes:
Exposure to years of sucrose
Exposure to years of saturated fat
o Cell membrane stiffening/rigidity can change
receptors and cause insulin resistance)
o Vascular narrowing
o Increased inflammatory response
Prevention and treatment:
Regular aerobic exercise
Small frequent meals of low glycemic index
High fiber (soluble and insoluble)
Moderate amount of complex, low glycemic index carbs
Avoid sugar
Vegetarian or Mediterranean diet
B vitamins
GTF zinc (aids in insulin production and storage),
chromium (aids in insulin attachment)
magnesium, copper
Antioxidants (against sorbitol damage)
Increase essential fatty acids (DHA/EPA)
Reduced sodium (1500mg)
L-carnitine (fatty acid shuttle for energy)
Herbs
Complications:
Blindness, kidney failure, heart disease, decreased life
expectancy

American diabetic association goals (1994):


o Maintain proper blood glucose levels
o Restore optimal blood lipid levels
o Maintain optimal blood pressure
o Maintain proper weight

Progression of diabetes

Early or prediabetes with hypoglycemia


o Hyperinsulinemia
Hypoinsulinemia (cellular glucose deficiency cause sorbitol
pathway activation, causes tissue damage in kidney, nerves,
eyes)
Insulin dependent diabetes mellitus

Green tea aid in diabetes increases glutathione (antioxidant) and vitamin C levels,
anti-glycating, antihyperglycemia
Coffee alters gut flora and aids in SCFA
Gut bacteria

Saccharolytic increased SCFA


Proteolytic increased toxic metabolites and decreased SCFA