Carbohydrates

Chapter 4
Carbohydrates in Our Food
• Carbohydrates provide more than half the calories in the American
diet
• Carbs supply 4 calories/g
• Refined: Carbohydrates that have gone through processing that
removes various components of the original food
• Example: potato chips, cookies, soft drinks
• Unrefined: whole food sources of carbohydrates that have not
undergone processing and maintain original nutrient status
• Example: oatmeal, fresh fruit, brown rice
Carbohydrates in Our Food
• Over the past century the amount of carbohydrates consumed has
changed
• Since the 1960s, our total carbohydrate intake has increased, but our fiber did
not increase with it.
• Suggests an increase in refined carbohydrates and sugar
• Added Sugars: Sugars and syrups that have been added to foods
during processing or preparation
Difference Between Refined and
Unrefined
Unrefined Carbohydrates Refined Carbohydrates
• Whole grains, legumes, vegetables • Cornflakes  many nutrients of the
provide B vitamins, some minerals, corn kernel are lost
fiber and phytochemicals • Grain kernel has been processed
• Fruits provide Vitamins A and C, and and destroyed
fiber
• Whole Grain: The entire kernel of
grain including the bran, germ, and
endosperm
 Whole Grain and Nutrient
Composition
• Bran: The protective outer layer of
whole grains. A source of dietary
fiber, vitamins and minerals
• Germ: The embryo or sprouting
portion of a grain. Contains oil,
protein, fiber, and B vitamins
(riboflavin, thiamin, B6). Rich in
Vitamin E
• Endosperm: The largest portion of
the grain that is primarily starch.
- Fiber, Vitamins, Minerals and Phytochemicals are lost in the Contains most of the protein and
refining process
some vitamins and minerals
- Enriched: a process in which nutrients are added to a food to
restore what was lost in processing
- Enriched foods are still missing the appropriate vitamin E,
magnesium and B6
Limit Added Sugars
• Adds calories without adding
nutrients (other than a
carbohydrate)
• Reduces nutrient density
• Considered empty calories
Types of Carbohydrates

• Carbohydrates are compounds made

up of one or more sugar units that
contain carbon, hydrogen, and oxygen
• Monosaccharide: a carbohydrate unit
made up of a single sugar unit
• Disaccharide: a carbohydrate made up
of two sugar units
• Polysaccharide: a carbohydrate made
up of many sugar units
Simple Carbohydrates
• Simple Carbohydrates: known as sugars and include monosaccharides and
disaccharides
• Example: table sugar, brown sugar, HFCS
• Monosaccharides  one sugar molecule
• Glucose: a monosaccharide that is the primary form of carbohydrate used to provide energy in
the body. It is the sugar referred to as blood sugar.
• Produced in plants
• Rarely found as a monosaccharide in food, and is often found as part of a disaccharide or starch
• Fructose: a monosaccharide that is the primarily found in fruits and vegetables
• Makes up more than half the sugar in honey
• Does not cause a rise in blood glucose like other sugars
• Can cause diarrhea in children
• Most fructose in the US diet comes from HFCS
• Galactose: combines with glucose to form lactose, or milk sugar
• Rarely present as a monosaccharide in foods
 Disaccharides
• Two sugar units in a carbohydrate
• Maltose: made up of two molecules of glucose.
Formed in the intestines when starch is broken down
• When bread is held in the mouth for a few minutes,
salivary amylase will begin digesting the starch, breaking
it down forming a sweet Maltose
• Sucrose: made of a fructose and a glucose
• Commonly known as table sugar or white sugar
• Found in sugarcane, sugar, beets, honey, and maple
syrup
• The only sweetener that can be called “Sugar” on a label
• Lactose: made of galactose and glucose
• Commonly known as milk sugar
• Only sugar found naturally in animal foods
Making and Breaking Sugar Chains
• Forming a Chain
• Dehydration reaction: chemical reaction that links two sugars together
• Combines two molecules by releasing a water molecule
• Taking a hydroxyl group (OH) from one sugar and a hydrogen atom (H) from another
• Breaking down a chain
• Hydrolysis reaction: chemical reaction when the bonds between two sugars is
broken.
• Cleave chemical bonds by adding water
• Adding a hydroxyl group (OH) to one sugar and a hydrogen atom (H) to another
Complex Carbohydrates
• Complex Carbohydrates: carbohydrates composed of sugar molecules
linked together in straight or branching chains
• Include oligosaccharides and longer chain Polysaccharides (glycogen,
starches, and fibers)
• Not sweet to the taste like simple carbohydrates
• Oligosaccharides: short-chain carbohydrates containing 3-10 sugar
units
Oligosaccharides
• Some are formed in the GI tract during the breakdown of larger
polysaccharides. Are then further digested into simple sugars
• Others are found naturally in foods such as beans, legumes, onions,
bananas, garlic, and artichokes.
• Not digested by human enzymes; travel into the colon where they are
broken down by microbiota
• Undigestible, making them a type of fiber
 Glycogen
• Glycogen: a carbohydrate
(polysaccharide) made of many glucose
molecules linked together in a highly
branched structure. Storage form of
carbohydrate in animals
• Branched structure allows it to be broken
down quickly when glucose is needed
• Stored in the muscles and liver (200-
500g)
• Not consumed, but formed when
carbohydrates are stored in the body
Starches
• Starch: A carbohydrate made of many glucose
molecules linked in straight or branching chains
• Storage form of carbohydrate in plants
• The bonds holding the glucose molecules together
can be broken down by human digestive enzymes
• Amylose straight chains of glucose molecules
• Amylopectin  branched chains of glucose
• Found in root vegetables, seeds and lentils
• As starches dry, the bonds created form a gel
• Modified starches are added as thickeners to
processed foods
• Example: cornstarch
Fiber
• Fiber: a mixture of indigestible
carbohydrates and lignin (substances
in plants that are not carbohydrates
but are classified as fiber)
• Soluble Fiber: fiber that dissolves in
water or absorbs water; readily
broken down by intestinal microbiota
• Insoluble Fiber: fiber that, for the
most part, does not dissolve in water
and is less readily broken down by
microbiota
Carbohydrate Digestion and
Absorption
• Digestion begins in the mouth (salivary amylase)
• Majority of starch and disaccharide digestion occurs in the small intestine
• Pancreatic amylases break down starch into disaccharides and oligosaccharides
• Digestion is then completed by enzymes attached to the microvilli
• Maltose  broken down into two glucose molecules by maltase
• Sucrose  broken down into glucose and fructose by sucrase
• Lactose  broken down into glucose and galactose by lactase
• Lactase: an enzyme located in the microvilli of the small intestine that breaks down
lactose into glucose and galactose
• The resulting glucose, galactose, and fructose are absorbed
Lactose Intolerance
• Lactose Intolerance: a condition in which people have digestive
symptoms such as intestinal gas, bloating, and diarrhea after dairy
consumption
• Occurs when there is not enough of the enzyme lactase in the small
intestine to digest milk sugar lactose
• Lactose is not digested and cannot be absorbed
• When it moves into the large intestine, it draws in water
• Lactose is quickly metabolized by intestinal bacteria producing acid
and gas
Lactose Intolerance (Continued)

• Most infants produce enough lactase, but many people show a

decrease in the enzyme activity with age
• Uncommon under 6 years of age
• 65% of adults have a reduced ability to digest lactose
• More common in African Americans, Native Americans, Hispanic
Americans, and Asian Americans
• Lactose intolerance may occur as a result of an intestinal infection or
other disease
Lactose • Dairy products are a main source of Calcium in the US
Intolerance • Can also meet calcium needs through tofu, fish, and
vegetables
(Continued)
Fiber in the
Digestive
Tract
• Not digested not readily
absorbed
• Fiber affects GI function,
intestinal microbiota, the
amount of intestinal gas, and
nutrient absorption
Fiber and GI Function
• Fiber increase the volume of material in the lumen of the intestine
• Extra mass is due to the bulk of fiber, the water held by the fiber, and
the increase in the number of bacteria
• Fiber in the diet results in a larger, softer stool and promotes healthy
bowel function  stimulating peristalsis
• Increased peristalsis trains the colon muscle to work more frequently
preventing constipation and increasing transit time
Fiber and Microbiota
• Fermentable fiber in the colon are broken
down by bacteria
• Produces short chain fatty acids (SCFA)  a
fuel source for cells
• SCFA make the colon more acidic which
inhibits growth of bad bacteria and
promotes the growth of beneficial bacteria
• The beneficial bacteria will help prevent
inflammation in the bowel and can protect
from colon cancer
Fiber and Nutrient Absorption
• The added bulk from fiber slows nutrient absorption (and slows
stomach emptying)
• Beneficial for those wanting to lose weight because they will feel full
sooner
 • After absorption, monosaccharides travel to the
liver via the hepatic portal vein
• Fructose and galactose are metabolized for
energy
Bringing • Glucose can be broken down for energy or to be
Glucose stored as glycogen
• Glucose in the blood provides energy to body
into Body cells
Cells • Brain cells, red blood cells and a few others
must have glucose to stay alive  some body
cells can use fatty acids; example: the keto diet
• Blood glucose is regulated by the liver and
hormones from the pancreas
Glycemic Response
• Glycemic Response: The rate, magnitude, and duration of the rise in blood
glucose that occurs after a particular meal or food is consumed
•  How quickly and how high blood glucose rises after carbohydrates are
consumed
• Affected by both the amount and type of carbohydrate eaten, and is relative
to the amount of fat and protein in that meal
• Refined sugars cause a greater glycemic response
• Unrefined carbohydrates that contain fiber cause a smaller glycemic response
• Glycemic Index: a ranking of how a food affects blood glucose compared to
the response of the same amount of carbohydrates from a reference food
such as white bread or sugar
Glycemic Index
• Reference food is assigned a value of
100  white bread or pure glucose
• Other foods are expressed relative to
this
• Glycemic index of 70 or more is
considered a high glycemic index food
• 55 or less is considered a low glycemic
index food
• Used to evaluate the effect of a specific
food on blood glucose, but not relative
to normal portions
• Example: a whole watermelon has a high
glycemic index compared to 1 cup of
watermelon
Glycemic Load
• Glycemic Load: a method of assessing
glycemic response that takes into account
both glycemic index of the food and the
amount of carbohydrate in a typical portion
• Calculated by multiplying a food’s glycemic
index by the amount of available
carbohydrate in a serving of the food.
• A Glycemic Load of 20 or more is
considered high
• Less than 11 is considered low
• Determined for individual foods, not full
meals. Not determinant for full meals
Glycemic Index vs. Glycemic Load

Glycemic Index Glycemic Load

• How fast the CHO is digested • The amount of carbohydrate in
into the blood and how quickly the food
that raises blood sugar • Raw Carrot is a 1
• Raw Carrot is a 91 • Specific to portion size
• All the same portion; example: 1 • Takes fiber into account
pound
• A better measure of the impact
the food has on blood sugar
Supply Glucose to Cells
• A rise in blood glucose triggers insulin secretion from the pancreas
• Insulin: allows the uptake of glucose by muscle and adipose tissue
• Stimulates protein and fat synthesis and the synthesis of glycogen in the liver
and the muscle
• Promotes storage of glucose as glycogen (small amount of fat)
• Stimulates uptake of glucose for ATP production
• Synthesis of muscle glycogen for energy storage
• These actions remove glucose from the blood, decreasing blood glucose
levels
Supply Glucose to Cells (Continued)

• When no carbohydrate has been ingested for a few hours, blood

glucose and glucose available for cells decrease
• Glucagon: a hormone secreted by the pancreas that stimulates the
breakdown of glycogen into glucose which is then released into the
bloodstream to increase blood sugar
• Gluconeogenesis: The stimulation of new glucose molecules from non
carbohydrate molecules.
• Amino acids are the primary source of carbons for glucose synthesis
• Example: Tracking in the Keto Diet
• Can be stimulated by the hormone epinephrine (adrenaline) to cause a quick
release of glucose into the blood to supply energy needed for action
 • Anaerobic metabolism: oxygen is not needed for
the reaction
Glucose • Aerobic metabolism: metabolism in the presence
of oxygen
Providing • Reactions to bring glucose into the cell:
• Glycolysis
Energy • Acetyl-CoA Formation
• Citric Acid Cycle
When Carbohydrate is Limited
• Blood glucose level must be maintained to fuel the brain
• Low levels can cause confusion, seizures, and coma
• When carbohydrate is low, the body will create glucose out of the breakdown of
glycogen and from gluconeogenesis
• Glucogenic amino acid: an amino acid that can be used to synthesize glucose through
gluconeogenesis
• Ketogenic amino acid: an amino acid that breaks down to form acetyl-CoA which then
contributes to ketone synthesis
• Ketones: When fatty acids are broken down for energy; Formed in the liver when the
amount of carbohydrate is not sufficient to be metabolized
• Can be used as an energy source
• Ketosis: High levels of ketones in the blood; can occur during starvation
Diabetes Mellitus
• Diabetes Mellitus: insufficient insulin production and/or decreased sensitivity of cells to insulin.
Results in elevated blood glucose levels
• Type 1 Diabetes: an autoimmune disease in which the bodies immune system destroys the
insulin-secreting cells of the pancreas, leaving the body unable to make insulin
• Usually diagnosed before 30 and known as juvenile-onset diabetes
• Type 2 Diabetes: When the body does not produce enough insulin to keep blood glucose in
normal range; Cells lose their sensitivity to insulin
• More common; 90-95% of cases
• Obesity, poor food choices, sedentary lifestyle, and diets high in refined carbohydrates are risk factors
• Used to be diagnosed after age 40, but now the incidences are beginning at a younger age
• Metabolic Syndrome: A cluster of health risks that increase the chance of developing heart
disease, stroke, and diabetes
• AKA Syndrome X, insulin resistance syndrome, dysmetabolic syndrome
• Includes high blood pressure, high blood glucose, large waist circumference, obesity, elevated blood lipid
levels
Diabetes (Continued)

• Gestational Diabetes: a form of diabetes that occurs during pregnancy due to

hormonal changes
• Usually resolves after the baby is born, but the mother now has an increased risk of
developing Type 2 diabetes
• Diabetes Complications:
• Excessive thirst, blurred vision, weight loss, frequent urination
• Ketoacidosis  elevated ketones that causes acidity in the blood
• Damage to the heart, blood vessels, kidneys, eyes and nerves due to prolonged exposure to
blood glucose
• Manage Diabetes:
• Diet
• Exercise
• Medication
Carbohydrates and Weight
Management
• Carbohydrates are not more fattening than any
other macronutrient
• 4 cal/gram compared to 9 cal/gram
• Refined vs Unrefined
• Refined sugar sweetened beverages cause weight
gain
• Unrefined  fiber can increase fullness by adding bulk
and slowing digestion; lower in fat and more nutrient
dense
Carbohydrates and Heart Disease
• Diets high in sucrose and HFCS can raise blood lipid levels increasing risk of
heart disease
• Diets high in fiber reduce the risk of heart disease
• Whole grains provide omega-3 FA, vitamins, minerals, antioxidants and other
phytochemicals  protective against heart disease
• Soluble fiber binds to cholesterol and bile acids
• Bile acids are secreted in the GI tract when fat is digested -- are absorbed and reused
• When fiber comes in, the fiber binds to it and they are excreted rather than absorbed
• Now, the liver must use blood cholesterol to synthesize new bile acids
• Bile  from the gallbladder  helps digest fat
Bowel Health and Fiber
• Fiber adds bulk and absorbs water in the GI tract making feces larger
and softer.
• Reduces pressure during elimination
• Hemorrhoids: Swollen veins in the anal or rectal area
• Diverticulosis: a condition in which pouches (diverticula) protrude
from the wall of the large intestine
• Diverticulitis: a condition in which fecal matter accumulates into the
diverticula causing irritation, pain, inflammation and infection
Fiber and Colon Cancer
• Carcinogen: a cancer-causing substance from
the environment or diet
• Cells undergo mutations and become cancerous
• Mutations: changes in DNA caused by chemical
or physical agents
• Malignancy: a mass of cells showing
uncontrolled growth with a tendency to invade
and damage tissues with ability to plant many
areas of growth
• Cancer cells eventually invade and replace
normal cells
Fiber and Colon Cancer (Continued)

• Epidemiology shows the incidence of colon cancer is lower in people

with high fiber and whole grain diets
• Fiber can decrease the contact between fecal matter and mucosal
cells
• Fiber increases the growth of gut bacteria and short chain fatty acid
(SCFA) production
• SCFAs support colon cell health, reduce inflammation, and inhibit growth of
cancer cells
Carbohydrate Recommendations
• No Tolerable Upper Intake Level (UL)
• RDA for adults and children is 130 g/day  25%
of cals in a 2000 cal diet
• This would look more like a high protein/high fat
diet
• Recommended 45-65% of energy come from
carbohydrate
• Weight loss/cutting may look closer to 40%

Calculate grams of carbs needed:

1800 cal diet x 45% of carbs= 810
810 4cal/g= 202.5 g of carbs per day
Let’s Practice Calculating!!!

• 50% of carbs in a 1400 calorie diet

• 65% of carbs in a 1650 calorie diet

• 40% of carbs in a 2000 calorie diet

Calculations
• 50% of carbs in a 1400 calorie diet

1400 x 50% of carbs =700

700 4 cal/gram= 175 g carbs/day

• 65% of carbs in a 1650 calorie diet

1650 x 65% of carbs = 1072.5

1072.5 4 cal/gram = 268 g carbs/day

• 40% of carbs in a 2000 calorie diet

2000 x 40% of carbs = 800

800 4 cal/gram = 200 g carbs/day
Including Recommendations into the
Diet
• A diet high in complex carbs from whole
grains, legumes, fruits, and vegetables.
• High fiber, micronutrients, and
phytochemicals
• Consume more whole grains, fruits, and
vegetables
• Limit added sugar
• Limit refined carbohydrates
A Look at Alternative Sweeteners
• May reduce calorie intake in the short term, but long-term weight
management is not proven.
• No added calories in the sweetener, but paired with foods to increase
general weight
• May stimulate appetite leading to weight gain
• Common sweeteners: saccharin, aspartame, sucralose, stevia
• Sugar Alcohols: sweeteners that are structurally related to sugars but
provide less energy than monosaccharides and disaccharides because
they are not well absorbed
• Examples: sorbitol, mannitol, lactitol, xylitol, erythritol