CARBOHYDRATE

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CARBOHYDRATE

• Cynthia K. Abrams, Ph.D., R.D., L.D.

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Dietary CarbohydrateRequirement

• Dietary Reference Intakes have been established
  tissues that require glucose as fuel
  ( brain, RBC, Kidney medulla )
•           substrates for
  maintenance of citrate cycle
  ( protein sparing effect)

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DIETARY REFERENCE INTAKE FOR CARBOHYDRATE

• RDA (g/d) AI
  (g/d)
• 0-6 mos.
  60
• 7-12 mos.
  95
• 1 yr-adult
  130
• Pregnancy 175
• Lactation
  210
  
  

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ACCEPTABLE MACRONUTRIENT DISTRUBTION RANGES

• AGE (yrs) CHO ( energy intake)
• 1- 3 45- 65
• 4- 18 45- 65
• Adults 45- 65

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CARBOHYDRATEHEALTH ISSUES

• Fiber
• Dental caries
• Identified Errors of Carbohydrate Metabolism
• Glycemic Response to Carbohydrate

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CARBOHYDRATE and OBESITY

• DOES A HIGH FRUCTOSE INTAKE
• CONTRIBUTE TO OBESITY?
• Research evidence has linked high fructose intake
  (on an isocaloric basis) with increased body
  weight and fat stores.

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CARBOHYDRATE and OBESITY

• FRUCTOSE- COMPARED TO GLUCOSE
• Decreased Insulin
• Decreased Leptin
• Increased Ghrelin
• Increased Lipogenesis

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FIBERFOOD SOURCES

• CELLULOSE Veg, Whole grains
• HEMICELLULOSE Whole grains
• PECTIN Fruit
• GUMS Legumes, Oats
• LIGNIN Seeds

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Digestion of Soluble Fiber in Gut

• Production of short chain fatty acids
• Butyrate used by mucosal cells of colon
• Propionate taken up by liver
• Acetate found in blood, used by various
• tissues

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CHARACTERISTICS OF A LOW CARIOGENIC
FOOD           Characteristics Relatively high
protein content Moderate fat content Minimal
concentration of fermentable carbohydrate Strong
buffering capacity (eg. Cheese, stimulates
saliva proteins act as buffer) High
concentration of calcium and phosphorus pH
greater than 6 Strong saliva stimulating capacity
(eg. Foods that require a lot of
chewing)     Some Examples   Cheese Potato chips
Peanuts Meat Eggs
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CARBOHYDRATE RELATED DISEASES

• PROBLEM --DIGESTION AND ABSORPTION
• DISEASE ----- Lactase
  Deficiency
• 
  Sucrase Deficiency
• CLINICAL SIGNS ---- Abdominal Pain
• 
  Flatulence
• 
  Diarrhea
• DIETARY TREATMENT ---- Avoid offending sugar

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LACTASE DEFICIENCY

• CONGENITAL Very Rare
• PRIMARY Lactase non persistence
• SECONDARY Result of damage to
• 
  mucosa

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CARBOHYDRATE RELATED DISEASES

• PROBLEM ---- UPTAKE BY CELL
• DISEASE ---- Diabetes
• 
  Type I
• 
  Type II
• CLINICAL SIGN ---- Hyperglycemia
• DIETARY TREATMENT ---- Weight Management
• 
  Regulate CHO Intake

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CARBOHYDRATE RELATED DISEASES

• PROBLEM--INTERMEDIARY METABOLISM
• DISEASE ---- Galactosemia
• 
  (galactose 1 (P) uridyltransferase
• or
  galactokinase (less severe))
• CLINICAL SIGNS --- Cataracts, Neurologic
  Damage
• 
  Vomiting, Diarrhea
• 
  Failure to Thrive
• DIETARY TREATMENT --Exclude galactose
• 
  Give vit. D, Ca and riboflavin

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CARBOHYDRATE RELATED DISEASES

• PROBLEM--INTERMEDIARY METABOLISM
• DISEASE ---- Hereditary Fructose
  Intolerance
• (fructose
  1 (P) aldolase)
• CLINICAL SIGNS---- Vomiting , Hepatomegaly,
  Jaundice,
• Hypoglycemia,
  Failure to Thrive
• DIETARY TREATMENT ----Exclude fructose, sucrose,
• 
  sorbitol, honey, molasses.
• 
  Supplement vit. especially vit. C

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CARBOHYDRATE RELATED DISEASES

• PROBLEM---- INTERMEDIARY METABOLISM
• DISEASE ---- Glycogen Storage
  Disease I
• (
  glucose 6 phosphatase)
• CLINICAL SIGNS---- Hypoglycemia,
  Hyperlipidemia
• 
  Lactic acidemia
• DIETARY TREATMENT----Frequent high starch
  feeding,
• 
  Limit lactose and fructose
• 
  Vitamin mineral supplement

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GLYCEMIC RESPONSETEST

• Give 100g glucose PO
• Measure serum glucose over next 2-3 hrs
• Should be back to normal by 2 hrs.

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RENAL THRESHOLD

• When serum glucose is greater than
• 180mg/dl
• The renal threshold is exceeded and glucose
• will be found in the urine

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INFLUENCING GLYCEMIC RESPONSE

• FIBER
• GLYCEMIC INDEX OF FOOD
• AMOUNT OF CHO IN MEAL
• EXERCISE

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PSYLLIUM(METAMUCIL)

• A viscous fiber not fermented by gut microflora
• Polysaccharide of pentoses
• Acts as a fecal bulking agent
• Decreases serum glucose
• Decreases serum cholesterol

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INFLUENCING GLYCEMIC RESPONSE

• SHOWN IN A RECENT STUDY
• Patients with Type II diabetes given a diet with
  CHO that had a lower glycemic index
• had lower glycosylated Hg (A1c) values than
  patients given an equal amount of CHO with a
  higher glycemic index

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SUCRALOSE
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