Week 4 Carbohydrates and Diabetes - Student PDF

Carbohydrates and Diabetes Chapter 5 Learning Objectives (LOs) 1. Identify the major types of carbohydrates and give examples of food sources for each 2. List the functions of carbohydrates in the body 3. Explain how carbohydrates are digested and absorbed 4. Explain the caus...

Carbohydrates and Diabetes Chapter 5 Learning Objectives (LOs) 1. Identify the major types of carbohydrates and give examples of food sources for each 2. List the functions of carbohydrates in the body 3. Explain how carbohydrates are digested and absorbed 4. Explain the cause, effects, and dietary treatment for lactose intolerance 5. Describe the regulation of blood glucose, conditions caused by blood glucose imbalance, types of diabetes, and dietary treatments for diabetes 6. Describe acute and long-term complications associated with poor blood glucose control 7. Describe the Diabetes Prevention Program Outcomes Study, the significance of its results and how lifestyle measures including dietary measures can decrease the risk of developing Type 2 diabetes 8. Describe recommendations for carbohydrate intake and health risk caused by low or excessive intakes Diabetes Prevention Program Paper Learning Objective 1 Identify the major types of carbohydrates and give examples of food sources for each. Food Sources of Carbohydrates  Carbohydrates – Structure What is a carbohydrate? Composed of _________________, and _______ Plants produce glucose (simple sugar) through photosynthesis Carbohydrates Are Classified Based on the Complexity of their Structure Simple sugars 1. _________________ 2. _____________ Complex carbohydrates 3. _________________ 4. ________________ Simple Sugars: Monosaccharides Single Sugars C6H12O6 Simple Sugars – Monosaccharides ________ Most abundant ‘blood sugar’ _________ Sweetest In fruits, honey, high-fructose corn syrup __________ In the diet – primarily combined with glucose to form lactose Simple Sugars – Monosaccharides Sugar alcohols Examples include sorbitol, mannitol, xylitol Sweeten low- or no- sugar foods Excess may cause GI upset Pentoses Monosaccharides with 5 carbons Ribose, deoxyribose Building blocks of RNA and DNA Simple Sugars – Disaccharides Two monosaccharides joined together Condensation reaction links monosaccharides Links are through _____ or ____ bonds Simple Sugars – Disaccharides ________ Glucose + Glucose Source: seeds, alcoholic beverages ________ Glucose + Fructose Table sugar ________ Glucose + Galactose Milk and milk products Complex Carbohydrates – Oligosaccharides 3-10 linked monosaccharides Raffinose and stachyose Found in onions, cabbage, broccoli, legumes Contain beta-bonds Indigestible Fermented by bacteria Complex Carbohydrates – Polysaccharides _______ – digestible Amylose Amylopectin Storage form of carbohydrate in plants __________ – not in diet Storage form of carbohydrate in animals Storage is limited _______ – indigestible Complex Carbohydrates – ___________ Polysaccharides Complex Carbohydrates – ___________ Polysaccharides Glucose molecules in fiber are linked by beta-bonds Indigestible! Pass into the large intestine where bacteria: Metabolize Form short-chain fatty acids and gas Dietary fiber – naturally occurring in foods Functional fiber – added to foods Total fiber = dietary fiber + functional fiber Dietary fiber is reported on the food label Cellulose, hemicellulose, pectins, gums, and mucilages The Type of Bond Linking Monosaccharides Determines Digestibility Alpha-bond Digestible starch E.g., amylose Beta-bond Indigestible fiber E.g., cellulose We don’t have the enzymes to break the beta-bonds Two Types of Fiber: Soluble fiber Delays gastric emptying Decreases blood glucose levels Inhibits absorption of cholesterol and reabsorption of bile acids Insoluble fiber Decreases intestinal transit time and constipation Examples of Insoluble and Soluble Fiber Function of Carbohydrates The principal function of dietary carbohydrate is to provide ________ Carbohydrates Simple sugars 1. Monosaccharides 2. Disaccharides Complex carbohydrates 1. Oligosaccharides 2. Polysaccharides 1. Digestible (starch: amylose and amylopectin; glycogen) 2. Indigestible (fiber)  What About Whole Grains? Whole grains are fiber-rich Labels are often confusing “Wheat” flour or “wheat” bread contains enriched white wheat flour “Whole-wheat” flour or bread must have whole wheat as the first ingredient This ensures that it is truly a whole-grain bread and contains more fiber  What Is a Whole Grain? Contains all essential parts and naturally occurring nutrients from the entire grain seed Bran – antioxidants, B-vitamins, and fiber Endosperm – starch, protein, small number of vitamins, and minerals Germ – B-vitamins, protein, minerals, and healthy fats  Whole vs. Refined Grains Refined grains contain only the ___________ Also known as processed grains What is lost during “refinement”? 6 Examples of Whole and Refined Grains Common types of whole grains: Common milled/processed grains: – Whole wheat flour – White flour and foods made from – Brown rice white flour: – Oatmeal – White bread – Popcorn – Pasta – Wild rice – Pastries, e.g.: cookies – Flour tortilla – White rice  Sweeteners Nutritive Non-nutritive  Nutritive Sweeteners Metabolized to yield energy Monosaccharides (e.g., glucose) and disaccharides High-fructose corn syrup (HFCS) Sugar alcohols Contribute energy but absorbed less efficiently Used in sugar-free candy and gum 1.5-3 kcal/g Mannitol, xylitol, sorbitol  Non-nutritive Sweeteners Alternative or artificial sweeteners providing very little or no kcal Include: Saccharin Aspartame Sucralose Stevia Cyclamate Neotame Acesulfame-K Monk fruit  Non-nutritive Sweeteners Safety determined by FDA Acceptable Daily Intake (ADI) guideline Amount of alternative sweetener considered safe for daily use over one’s lifetime Based on animal studies Set at 100 times less than the level where no harmful effects were seen Sweetness of Sugars and Alternative Sweeteners  Learning Objectives (LOs) 1. Identify the major types of carbohydrates and give examples of food sources for each 2. List the functions of carbohydrates in the body 3. Explain how carbohydrates are digested and absorbed 4. Explain the cause, effects, and dietary treatment for lactose intolerance 5. Describe the regulation of blood glucose, conditions caused by blood glucose imbalance, types of diabetes, and dietary treatments for diabetes 6. Describe acute and long-term complications associated with poor blood glucose control 7. Describe the Diabetes Prevention Program Outcomes Study, the significance of its results and how lifestyle measures including dietary measures can decrease the risk of developing Type 2 diabetes 8. Describe recommendations for carbohydrate intake and health risk caused by low or excessive intakes Learning Objective 2 List the functions of carbohydrates in the body  Digestible vs. Indigestible Carbs Digestible (sugars, starch) Indigestible (fiber) Primarily serve as a Improve bowel health ________________ Improve blood glucose Spare protein control Prevent ketosis Reduce cholesterol absorption Reduce the risk of obesity Reduce the risk of diverticula Learning Objective 3 Explain how carbohydrates are digested and absorbed  Starch Digestion Mouth – ________________ Enzyme Begins to break down polysaccharides into smaller polysaccharides and disaccharides Stomach – action is halted Stomach acid inactivates amylase No chemical digestion Small intestine and pancreas – responsible for most carbohydrate digestion Pancreatic amylase Breaks down polysaccharides into smaller polysaccharides and disaccharides Intestinal enzymes break down disaccharides into monosaccharides Starch Digestion  Indigestible Carbohydrates Cannot be broken down and pass into the large intestine intact In the large intestine: Bacterial enzymes digest select fibers and produce short-chain fatty acids and gas as end products Other fibers pass through undigested Fiber holds water, helps regulate the activity of the bowels, and binds substances such as bile, cholesterol, and some minerals Bound substances leave the body without being absorbed Absorption of Monosaccharides Active transport for glucose and galactose Active = absorption requires a carrier and energy input (ATP) Facilitated diffusion for fructose Carrier is needed, but no energy Transport, Usage, and Storage Monosaccharides are transported through the ____________ and used by cells as a source of energy Excess glucose that is not used for energy is Stored as _________ in the _________________ Converted to fat and stored in fat cells Learning Objective 4 Explain the cause, effects, and dietary treatment for lactose intolerance  Lactose Intolerance Lactase – enzyme that breaks down lactose Production decreases after early childhood Primary lactose intolerance – insufficiency of lactase production Symptoms: abdominal pain, diarrhea, gas, bloating Tolerance level varies by individual Secondary lactose intolerance – due to conditions that damage lactase producing cells in the small intestine E.g., Crohn’s disease  Lactose Intolerance Treatment Recommendations are based on individual tolerance: Up to 12 g of lactose (amount in 1 cup of milk) may be tolerated at one time Consume dairy products with meals Try small amounts at a time Yogurt and hard cheeses (cheddar and Swiss) are lower in lactose Use lactase products Eating, Diet, & Nutrition for Lactose Intolerance | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/eating-diet-nutrition. Published 2019. Accessed January 9, 2019. Learning Objective 5 Describe the regulation of blood glucose, conditions caused by blood glucose imbalance, types of diabetes, and dietary treatments for diabetes Classifying Blood Glucose Levels Blood Glucose Level Classification (fasting) 70-99 mg/dL Normal 100-125 mg/dL Pre-diabetes ≥ 126 mg/dL Diabetes < 50 mg/dL Hypoglycemia Regulation of Blood Glucose Liver and pancreas are key players Liver is storage site of glycogen Releases glucose into the blood when needed Pancreas secretes hormones that regulate blood glucose _______ _________ Regulation of Blood Glucose  Hormones Regulating Blood Glucose Hormone Source Target Overall Effects on Organ or Effect on Organ or Tissue Blood Tissue Glucose Insulin Pancreas Liver, Increases glucose uptake by Decrease muscle, muscles and adipose tissue, adipose increases glycogen synthesis, tissue suppresses gluconeogenesis Glucagon Pancreas Liver Increases glycogen breakdown Increase and release of glucose by the liver, increases gluconeogenesis Epinephrine, Adrenal Liver, Increase glycogen breakdown Increase norepinephrine glands muscle and release of glucose by the liver, increase gluconeogenesis Cortisol Adrenal Liver, Increases gluconeogenesis by Increase glands muscle the liver, decreases glucose use by muscles and other organs Growth Pituitary Liver, Decreases glucose uptake by Increase hormone gland muscle, muscles, increases fat adipose mobilization and utilization, tissue increases glucose output by the liver Impaired Glucose Tolerance  Diabetes Mellitus Fasting blood glucose ≥ 126 mg/dL OR Hemoglobin A1c (HbA1c) ≥ 6.5% Two main forms of diabetes Type 1 Diabetes Type 2 Diabetes Gestational diabetes occurs during pregnancy Usually resolves after pregnancy Increases risk of developing Type 2 diabetes Type 1 vs. Type 2 Diabetes  Type 1 Diabetes Typically presents between ages 8 and 12 Can occur at any age Genetic predisposition Caused by _____________________ that destroys insulin-producing cells Presentation: Insulin Blood glucose Glucose present in urine  Type 1 Diabetes Symptoms include: _______________________________, weight loss, exhaustion, blurred vision Treatment Insulin therapy Nutrition therapy Regular meals and snacks Individualized dietary plans Reductions in saturated fats and cholesterol  Type 2 Diabetes Most common form of diabetes Associated with inactivity and obesity _________________ = loss of cell responsiveness Glucose builds up in bloodstream Treatment: Dietary modifications Physical activity Weight loss Potentially – oral medications or insulin injections  Dietary Strategies for Managing Diabetes Gycemic Index: Ratio of blood glucose response of a food compared with a standard – glucose with value of 100 Influenced by food characteristics: Starch structure Fiber content Food processing Temperature Amount of protein and fat in a meal Limitation: based on serving of food that would provide 50 g of carbohydrate, which may not be a realistic serving size  Dietary Strategies for Managing Diabetes Glycemic Load: Considers the glycemic index and the amount typically eaten Formula: glycemic index × grams of CHO in serving GL = 100 Better reflects a typical food’s effect on blood glucose Glycemic Index vs. Glycemic Load Glycemic Index (GI): Low GI foods: below 55 Intermediate GI foods: 55-69 High GI foods: above 70 Glycemic Load (GL): Low GL foods: below 10 Intermediate GL foods: 11-19 High GL foods: 20 Learning Objective 6 Describe acute and long-term complications associated with poor blood glucose control Long-Term Complications of Diabetes Type 1 and Type 2 may result in: Degenerative conditions that arise from regularly elevated blood glucose levels Cardiovascular disease Retinopathy – blindness Nephropathy – kidney disease Neuropathy – nerve damage Increases risk of amputation Long-term Complications of Diabetes __________________ – cluster of health factors, diagnosed when 3 or more of the following criteria are present: Learning Objectives (LOs) 1. Identify the major types of carbohydrates and give examples of food sources for each 2. List the functions of carbohydrates in the body 3. Explain how carbohydrates are digested and absorbed 4. Explain the cause, effects, and dietary treatment for lactose intolerance 5. Describe the regulation of blood glucose, conditions caused by blood glucose imbalance, types of diabetes, and dietary treatments for diabetes 6. Describe acute and long-term complications associated with poor blood glucose control 7. Describe the Diabetes Prevention Program Outcomes Study, the significance of its results and how lifestyle measures including dietary measures can decrease the risk of developing Type 2 diabetes 8. Describe recommendations for carbohydrate intake and health risk caused by low or excessive intakes Learning Objective 7 Describe the Diabetes Prevention Program Outcomes study, the significance of its results, and how lifestyle measures including dietary measures can decrease the risk of developing Type 2 diabetes  Diabetes Prevention Program Intensive Lifestyle Change Group Lifestyle change through diet, physical activity, and behavior modifications, and frequent follow-up Lose 7% of body weight and maintain that weight loss by eating less fat, fewer calories, and exercising 150 min per week Researchers met with participants individually at least 16 times in the first 24 weeks, and then every 2 months with at least 1 phone call between Metformin Group Participants took metformin twice a day and were provided standard advice about diet and physical activity Placebo Group Participants took a placebo twice a day and were provided standard advice about diet and physical activity A change for life video (5:27) Mike's Prediabetes Journey | Type 2 Diabetes Prevention | Ad Council (3:25) Diabetes Prevention Program Outcomes After ~3 years: Lifestyle Change Program lowered chances of developing type 2 diabetes by _____ compared with participants who took a placebo After 10 years, intensive lifestyle changes: Reduced the rate of developing type 2 diabetes by 34% compared with placebo At the 15-year follow-up: Participants from the Lifestyle Change Group continued to have a delay in the development of diabetes by 27% compared with participants who took a placebo Learning Objective 8 Describe recommendations for carbohydrate intake and health risks causes by low or excessive intakes  Recommended Intake of CHO RDA is __________ Ensures sufficient supply of glucose for brain and central nervous system Prevents shift in fuel to ketone bodies AMDR is _______ of total kcal intake Sources should primarily include fiber-rich fruits, vegetables, and whole grains Limit added sugars and caloric sweeteners  Recommendations for Intake of Added Sugars DGA recommend limiting added sugars to no more than 10% of total daily energy intake Recommended Intake of _________ Adequate intake for fiber: 14 g per 1000 kcal ~25 g/day for women ~38 g/day for men AI intended to reduce the risk of: Diverticular disease Cardiovascular disease Dietary Fiber Content of Common Foods  Actual Carbohydrate Intake Average American diet consists of ~50% carbohydrates Types of carbohydrate are problematic and do not meet recommendations Added sugars: ~14.5% of total kcals Fiber intake: 25-50% below recommendations  Health Concerns Related to High Added Sugar Intake Risk of weight gain and obesity Development of dental caries (cavities) Fiber intake Key Takeaway Points Categories of carbohydrate include monosaccharides (glucose, fructose, galactose), disaccharides (maltose, sucrose, lactose) and polysaccharides (starch, glycogen, fiber). Sugar alcohols provide minimal kcal contribution, but may cause GI upset in high amounts Starch may consist of amylose (unbranched glucose chains) or amylopectin (highly branched glucose chains) Fiber is indigestible by humans Soluble and insoluble; both have health roles Digestible carbohydrates provide energy, spare protein, prevent ketosis Indigestible carbohydrates promote bowel health, reduce risk for cardiovascular disease and diverticular disease, and enhance glucose control Carbohydrate digestion Begins in the mouth with salivary amylase Halts in the stomach due to stomach acid Small intestine action includes pancreatic amylase, maltase, sucrase, lactase Indigestible carbohydrates reach large intestine intact; fermented by gut bacteria  Key Takeaway Points (cont.) Glucose absorption is active; fructose absorbed through facilitated diffusion Transport through bloodstream to liver; stored as glycogen in liver and muscles with excess stored as fat Lactose intolerance as a results of insufficient lactase Common; lactose containing products can be incorporated Blood glucose is tightly regulated via hormones, particularly glucagon and insulin Pancreas is a major player Type 1, type 2, and gestational diabetes Type 1 is ~5-10% of cases – autoimmune disorder Type 2 is most common, associated with obesity Lifestyle changes are critical Diet management may include carbohydrate counting Insulin injections or oral medications may be required (definitely required for type 1!) Long-term complications of diabetes include metabolic syndrome, retinopathy, neuropathy, nephropathy, and CVD Intensive lifestyle modification is effective in managing T2DM The RDA for carbohydrates is 130 g/day, the AMDR is 45-65% of kcal Added sugars should contribute no more than 10% of total kcal daily Excess associated with weight gain, dental caries, and lack of fiber