Chap2 carbohydrates


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  • Exposure during childhood can affect our preferred level of sweetness. As we age, we can lose some of our sensitivity to sweet taste. Choosing too many high-sugar foods and beverages can compromise the nutritional quality of our diet by decreasing the intake of higher nutrient foods.
  • We use sugar as a preservative in jams and jellies – and it prolongs the shelf-life of many baked foods. Sugar is important for the volume and texture in baked goods and ice-cream, including helping yeast breads raise.
  • In addition to sugar, there are a number of sweeteners that are available, some that have calories, and some that do not. They’re often categorized based on whether or not they contain calories – nutritive contain calories; non-nutritive do not.
  • Many sugars can be identified by the fact that they end in “ose.” Sucrose and fructose are the primary sugars that are found naturally in the food supply or are added as sugars, in corn sweeteners, or in syrups. Glucose is the most simple form of sugar. Table sugar is known as sucrose that comes from beet or cane sugar. Fructose is found naturally in honey and fruit, but is also available commercially. Lactose is the sugar found in milk. Our bodies do not distinguish between energy from natural and refined sugars, therefore “natural” sugars are not nutritionally superior to “refined sugars.
  • Sugar alcohols, or polyols, are used to sweeten foods and to provide bulk. They are less sweet than sugar and are not completely digested. They usually have about half the calories of sugar. Sugar alcohols are found in many reduced-calorie or sugar-free products like sugar-free gum, cough drops, candy, and ice-cream. You should limit your use of foods containing sugar alcohols because they can have a laxative effect if you eat too much. Also, many of these reduced-calorie or sugar-free foods are not much lower in calories than the regular products they’re replacing. Although many of these sugar-alcohols are made commercially, some are found in foods naturally. For example, sorbitol is found naturally in prunes, apples and pears.
  • Sugar alcohols can be labeled “sugar-free” because they replace sugar sweeteners and contain fewer calories. Because they are absorbed in the intestines more slowly than sugars, they can cause diarrhea in some people, especially when consuming more than a few servings/day.
  • One major advantage of sugar alcohols is that they are not digested in the mouth; therefore, they do not promote tooth decay. If you have diabetes, you may see less rise in blood sugar after eating something sweetened with sugar alcohols compared to a similar product that contains sugar. Keep in mind that many foods sweetened with sugar alcohols have other ingredients that increase the calories, fat, and carbohydrate. The major factor that limits the use of sugar alcohols is the laxative effect. It varies with individuals, the type of sugar alcohol, and the amount consumed.
  • The high intensity sweeteners are good because they do not contribute calories or increases in blood glucose. There are limitations for their use in cooking and baking. Some are more stable with heat (Splenda, Neotame, Sweet One) than others. Aspartame especially becomes less sweet when it is heated in liquid for more than 15 minutes. It can also lose sweetness when it is stored for extended periods in a hot environment. For example, you may notice that soft drinks sweetened with Aspartame may seem less sweet in the hot weather. This is because the soft drinks may be stored in a hot warehouse for an extended period of time before they are sold.
  • Many foods sweetened with sugar substitutes have calories from other ingredients and may be contain a significant number of calories, carbohydrate, or fat such as sugar-free or reduced-sugar pie, cake, ice-cream, and chocolates. If you are watching your calories or you have diabetes, you should limit these foods that have more than 20 calories or 5 grams of carbohydrate per serving.
  • Sugar substitutes or high-intensity sweeteners offer a way to enjoy the taste of sweetness with little or no calories and no effect on blood sugar. However, they are often blended with other nutritive or nonnutritive sweeteners to improve the stability or taste. The FDA has approved 5 sugar substitutes in regard to their safety. Neotame is the newest sweetener approved, although it is initially being marketed to the food industry for use in processed foods, and is not in the form of a table top sweetener as yet.
  • You can use a high-intensity sweetener if sugar is only used for flavoring as in beverages, pie fillings, cheesecakes, sweet sauces, marinades, no-bake cookies without adversely affecting the food quality. Be sure to check the label on your sweetener as some lose their sweetness (Equal) or become bitter at high temperatures (saccharin). Some (Equal or NutraSweet) may work best added at the end of cooking.
  • Generally the quality of baked goods like cakes and some cookies suffer when sugar is reduced or replaced by a high-intensity sweetener. If you want to be sure a baked good will turn out well using a high-intensity sweetener, visit a sweetener company’s web site for recipes that they have tested or buy a special diabetes cookbook using the sweeteners with recipes you like. Yeast will not grow well if sugar is totally removed from bread recipes. A cake may end up flat, rubbery, and dry without much browning unless other ingredients are added to give bulk, texture, and color that sugar normally provides. Non-fat dry milk might be used to increase volume and baking soda to help it raise more. Cocoa or molasses might be used to give it color. The baking time is usually less.
  • We often think of adding sugar simply for the sweet taste, but sugar goes through certain chemical changes during baking that some foods require to result in an acceptable product. Sugar provides structure, volume and texture to recipes. It also add browning, helps retain moisture and provides tenderness to baked goods.
  • A small amounts of sugar eaten in the context of a healthy diet does not usually present a problem, even in people with diabetes. But when high sugar foods take the place of more nutritious foods, it can become a health issue. As we age, we tend to require fewer calories and our appetites decrease. If high-sugar foods or beverages make up a significant part of your calorie intake, you are limiting the amount of nutrients you get that are important for your health. They also may be contributing to your weight or diabetes control.
  • If you find you’re consuming too much sugar, cut back by using less in your coffee or tea, on your cereal and in many recipes. You can choose a high-intensity sweetener for many foods. You can use fruit packed in juice instead of heavy syrup.
  • If you drink regular sodas or tea sweetened with sugar, the calories can really add up. Even smaller drinks from fast food restaurants give you over 200 calories each. One 12-ounce can of soda contains 9-10 teaspoons of sugar.
  • Chap2 carbohydrates

    1. 1. Carbohydrates in Nutrition; Sweeteners; Diabetes Mellitus; Lactose Intolerance Chapter 2
    2. 2. Carbohydrates <ul><li>The most abundant organic molecules in nature. </li></ul><ul><li>Are organic compounds of the elements carbon, hydrogen, and oxygen. </li></ul><ul><li>They provide a significant fraction of energy, storage energy and some intercellular communication. </li></ul><ul><li>the principal sources of energy in the diet, also act as starting materials for the synthesis of fatty acids and amino acids. </li></ul><ul><li>Play a role in the structure of other biologically important materials, such as glycolipids, glycoprotein, nucleic acids and heparin. </li></ul>2-
    3. 3. Carbohydrates <ul><li>The simplest and classified according to the number of carbon atoms in the chain </li></ul><ul><li>Most common are pentoses (five-carbon monosaccharides) and the hexoses (six-carbon monosaccharides. </li></ul>2- <ul><li>Monosaccharides </li></ul><ul><li>Disaccharides </li></ul><ul><li>Polysaccharides </li></ul>Classification
    4. 4. Pentoses (Five-Carbon Sugars) <ul><li>Are synthesized by the body, which are components of nucleic acids and nucleotides, which acts as coenzymes in energy production. </li></ul><ul><li>Two pentoses are of vital importance: ribose and deoxyribose. </li></ul><ul><li>The pentose sugars most commonly present in human foods are l-arabinose and D-xylose, which are widely distributed in nuts, fruits, and root vegetables. </li></ul>2-
    5. 5. Hexoses (Six-Carbon Sugars) <ul><li>Also called dextrose, grape sugar and corn sugar </li></ul><ul><li>A white crystalline solid that is soluble in water and is about half as sweet as sucrose (table sugar) </li></ul><ul><li>Is the form of carbohydrate that the body tissue can best use </li></ul><ul><li>It is oxidized in the cells for energy and the only fuel for the brain </li></ul><ul><li>The major food sources are honey, fruits and corn syrup. </li></ul>2- <ul><li>Glucose </li></ul><ul><li>Fructose </li></ul><ul><li>Galactose </li></ul>Types
    6. 6. Hexoses (Six-Carbon Sugars) <ul><li>Also called levulose or fruit sugar </li></ul><ul><li>Is structurally related to glucose </li></ul><ul><li>The sweetest of all the sugars and is found along with glucose in honey, fruits and corn syrup </li></ul><ul><li>It is a constituent of common table sugar </li></ul>2- <ul><li>Glucose </li></ul><ul><li>Fructose </li></ul><ul><li>Galactose </li></ul>Types
    7. 7. Hexoses (Six-Carbon Sugars <ul><li>Derived from the hydrolysis of lactose, the sugar found in milk and is a constituent of many plant polysaccharides </li></ul><ul><li>During lactation, the human body converts glucose to galactose in the mammary tissue for the synthesis of lactose in breast milk </li></ul>2- <ul><li>Glucose </li></ul><ul><li>Fructose </li></ul><ul><li>Galactose </li></ul>Types
    8. 8. Carbohydrates <ul><li>Are two joined monosaccharides and the simplest polysaccharides </li></ul><ul><li>Composed of two monosaccharides units bound together by a covalent bond known as a glycosidic linkage formed via a dehydration reaction, resulting in the loss of hydrogen atom from one monosaccharide and a hydroxyl group from the other </li></ul>2- <ul><li>Monosaccharides </li></ul><ul><li>Disaccharides </li></ul><ul><li>Polysaccharides </li></ul>Classification
    9. 9. Disaccharides <ul><li>A disaccharide that is readily hydrolyzed into glucose and fructose by boiling with acids or by the action of certain enzymes (invertase) forming “invert sugar” </li></ul><ul><li>Available as a refined carbohydrate in such form as granulated, powdered, brown and raw sugar. </li></ul><ul><li>Extensively used as a sweetener in food preservation, in food processing, and in pill- or tablet-making for pharmaceutical preparations </li></ul>2- <ul><li>Sucrose </li></ul><ul><li>Lactose </li></ul><ul><li>Maltose </li></ul>Types
    10. 10. Disaccharides <ul><li>Or milk sugar, unique to mammals and found in mammary glands </li></ul><ul><li>Makes up almost 40% of the solids in fresh whole milk </li></ul><ul><li>A by product in the manufacture of cheese </li></ul><ul><li>On hydrolysis with acids or enzymes (galactase), lactose yields glucose and galactose </li></ul>2- <ul><li>Sucrose </li></ul><ul><li>Lactose </li></ul><ul><li>Maltose </li></ul>Types
    11. 11. Disaccharides <ul><li>Also known as malt sugar </li></ul><ul><li>Formed by uniting two units of glucose that provide the first link in a process that eventually results in the creation of starch </li></ul><ul><li>An important component in the process of creating fermented barley that in turn can be used to brew beer </li></ul>2- <ul><li>Sucrose </li></ul><ul><li>Lactose </li></ul><ul><li>Maltose </li></ul>Types
    12. 12. Carbohydrates <ul><li>Are complex carbohydrates made up of many (more than 10) monosaccharides linked together </li></ul><ul><li>They are tasteless and molecular weight ranges from 20,000 to 1,000,000 </li></ul><ul><li>Some are used for storing energy (starch, glycogen, dextran and insulin) and others have strutural functions (cellulose, pectin, agar and carrageen) </li></ul>4- <ul><li>Monosaccharides </li></ul><ul><li>Disaccharides </li></ul><ul><li>Polysaccharides </li></ul>Classifications
    13. 13. Polysaccharides <ul><li>The most important carbohydrate, providing about 50% of the total carbohydrate intake </li></ul><ul><li>It is a major source of energy and provides texture and consistency to many food preparations </li></ul><ul><li>Rice, wheat, sorghum, corn, millet and rye contain about 70% starch and are outstanding sources of carbohydrate </li></ul>2- <ul><li>Starch </li></ul><ul><li>Glycogen </li></ul><ul><li>Dextrans </li></ul>For Storing Energ y
    14. 14. Polysaccharides <ul><li>The animal equivalent of starch and provides a food storage system for all forms of animal life. </li></ul><ul><li>Found in highest concentration in the liver, where it serves as an important regulator of blood glucose concentration </li></ul><ul><li>Also stored in muscles, where it serves as energy source for muscle contraction </li></ul>2- <ul><li>Starch </li></ul><ul><li>Glycogen </li></ul><ul><li>Dextrans </li></ul>For Storing Energ y
    15. 15. Polysaccharides <ul><li>A complex, branched glucan (polysaccharide made of many glucose molecules) composed of chains of varying lengths </li></ul><ul><li>Form the substrate for dental plaque and serve as the energy source for potentially dental caries – producing bacteria such as Streptococcus mutans </li></ul>2- <ul><li>Starch </li></ul><ul><li>Glycogen </li></ul><ul><li>Dextrans </li></ul>For Storing Energy
    16. 16. Polysaccharides <ul><li>Provides the fibrous framework for the plant </li></ul><ul><li>A good source for fiber </li></ul><ul><li>Aids in the production of soft stools, in peristalsis, and in the elimination of water </li></ul>2- <ul><li>Cellulose </li></ul><ul><li>Pectin </li></ul><ul><li>Agar </li></ul>For Structural Functions
    17. 17. Polysaccharides <ul><li>A polysaccharides that acts as a cementing material in the cell walls of plant tissues </li></ul><ul><li>Found in small quantities in many fruits, young green plants, and root vegetables </li></ul><ul><li>In the presence of sugars and a warm, slightly acid solution, pectin turns into jelly. </li></ul><ul><li>This property is responsible for the setting of jams and fruit preserves </li></ul>2- <ul><li>Cellulose </li></ul><ul><li>Pectin </li></ul><ul><li>Agar </li></ul>For Structural Functions
    18. 18. Polysaccharides <ul><li>Is extracted from seaweeds and is used in many foods as a gelling agents </li></ul><ul><li>Is used as a food additive to improve the texture and consistency of such foods as ice cream </li></ul>2- <ul><li>Cellulose </li></ul><ul><li>Pectin </li></ul><ul><li>Agar </li></ul>For Structural Functions
    19. 19. Sugars <ul><li>The refined granulated product used for table-top purposes. </li></ul><ul><li>Three types of sugar mixtures for commercial use: </li></ul><ul><ul><li>Blended sugar (50% sucrose & 50% glucose) </li></ul></ul><ul><ul><li>Pure invert sugar (50% glucose & 50% fructose) </li></ul></ul><ul><ul><li>Common invert sugar (50% sucrose, 25% glucose & 25% fructose </li></ul></ul>2-
    20. 20. Why Do We Use Sugar? <ul><li>Sweet taste </li></ul><ul><ul><li>The desire for sweet taste increases with age in many people </li></ul></ul>
    21. 21. Why Do We Use Sugar? <ul><li>Preserve jams and jellies </li></ul><ul><li>Volume and texture in baked goods and ice-cream </li></ul><ul><li>Fermentation in breads </li></ul>
    22. 22. Types of Sweeteners <ul><li>Nutritive sweeteners </li></ul><ul><ul><li>Contain calories </li></ul></ul><ul><li>Nonnutritive sweeteners (high intensity sweetener) </li></ul><ul><ul><li>Contain little or no calories </li></ul></ul>
    23. 23. Nutritive Sweeteners <ul><li>Sugars: </li></ul><ul><li>Glucose </li></ul><ul><li>Sucrose </li></ul><ul><li>Fructose </li></ul><ul><li>Lactose </li></ul><ul><li>Maltose </li></ul><ul><li>Honey </li></ul><ul><li>Corn syrup </li></ul><ul><li>High fructose corn syrup </li></ul><ul><li>Brown sugar </li></ul><ul><li>All are equivalent in calories: about 4 calories per gram or about 16 calories per teaspoon </li></ul>
    24. 24. Nutritive Sweeteners <ul><li>Sorbitol </li></ul><ul><li>Mannitol </li></ul><ul><li>Maltitol </li></ul><ul><li>Erythritol </li></ul><ul><li>Xylitol </li></ul><ul><li>Lactitol </li></ul><ul><li>Isomalt </li></ul><ul><li>Hydrogenated starch hydrolysates (combination of polyols) </li></ul>Sugar alcohols or polyols
    25. 25. Sugar alcohols/Polyols <ul><li>Used in many “sugar-free,” “low-carb,” and reduced calorie products </li></ul><ul><ul><li>gum, candy, desserts, ice-cream, cough drops and syrup </li></ul></ul><ul><li>Absorbed more slowly than “sugar” </li></ul>
    26. 26. Sugar Alcohols/Polyols <ul><li>Advantages </li></ul><ul><li>Do not promote tooth decay </li></ul><ul><li>May have less effect on blood sugar in people with diabetes </li></ul><ul><li>Most have fewer calories than sugar (about 2 calories per gram compared to 4) </li></ul><ul><li>Disadvantages </li></ul><ul><li>May have laxative effect (gas, bloating, diarrhea) </li></ul><ul><li>May be in foods that are not that low in calories or fat </li></ul>
    27. 27. High-Intensity Sweeteners <ul><li>Advantages </li></ul><ul><li>Little or no calories </li></ul><ul><li>No effect on blood sugar in diabetes </li></ul><ul><li>Disadvantages </li></ul><ul><li>Some have unpleasant aftertaste </li></ul><ul><li>Cannot replace sugar entirely in baked products </li></ul>
    28. 28. Read the Label! <ul><li>Foods with high intensity sweeteners may be combined with other ingredients </li></ul><ul><li>Check the Nutrition Facts label for calories, carbohydrate, and fat </li></ul>
    29. 29. Nonnutritive Sweeteners (high-intensity) <ul><li>Acesulfame potassium </li></ul><ul><ul><li>Sunette, Sweet-One </li></ul></ul><ul><li>Aspartame </li></ul><ul><ul><li>Equal, NutraSweet </li></ul></ul><ul><li>Neotame </li></ul><ul><li>Saccharin </li></ul><ul><ul><li>Sweet ‘n Low, etc </li></ul></ul><ul><li>Sucralose </li></ul><ul><ul><li>Splenda </li></ul></ul>Approved by Food and Drug Administration (FDA):
    30. 30. When Can You Use a High-Intensity Sweetener? <ul><li>Beverages </li></ul><ul><li>Cooking and baking when sugar is not needed for volume, texture, structure </li></ul><ul><ul><li>Fruit cobblers and pies </li></ul></ul><ul><ul><li>Sauces </li></ul></ul><ul><ul><li>Puddings </li></ul></ul>
    31. 31. What Foods Work Better With Sugar? <ul><li>Cakes </li></ul><ul><li>Cookies </li></ul><ul><li>Yeast breads </li></ul>
    32. 32. Sugar’s Role in Baked Goods <ul><li>Sugar provides to baked goods: </li></ul><ul><li>browning </li></ul><ul><li>tenderness </li></ul><ul><li>structure </li></ul><ul><li>volume </li></ul><ul><li>texture </li></ul>
    33. 33. Why Reduce Sugar Intake? <ul><li>Contains calories, but no nutritional value </li></ul><ul><li>Medical conditions: </li></ul><ul><ul><li>Overweight/obesity </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>High triglycerides </li></ul></ul>
    34. 34. How Can You Cut Back on Sugar? <ul><li>Reduce added sugar by up to ½ </li></ul><ul><li>Replace some or all of the sugar with a high-intensity sweetener </li></ul><ul><ul><li>Check guidelines for specific sweeteners for use in recipes </li></ul></ul><ul><li>Use canned fruit packed in juice </li></ul>
    35. 35. How Can You Cut Back on Sugar? <ul><li>Replace high-sugar beverages with sugar-free beverages </li></ul><ul><li>Size Calories </li></ul><ul><li>Super-size 410 </li></ul><ul><li>Large 320 </li></ul><ul><li>Medium 220 </li></ul>
    36. 36. Points to Remember <ul><li>High-sugar foods and beverages are usually high in calories and low in nutritional value </li></ul><ul><li>Cut back on sugar by using less added sugar or substituting high-intensity sweeteners </li></ul><ul><li>Many “sugar-free” foods are not “calorie-free” </li></ul><ul><li>Baked products often require some sugar for acceptable quality </li></ul>
    37. 37. Diabetes Mellitus <ul><li>This is a disorder of carbohydrate metabolism in which the ability to oxidize and utilize carbohydrates is lost as a result of disturbances in the normal mechanism </li></ul>
    38. 38. The disorder is characterized by: <ul><li>Elevated blood sugar (hyperglycemia) </li></ul><ul><ul><li>Polyuria-excessive urination </li></ul></ul><ul><ul><li>Polydipsia-increased thirst </li></ul></ul><ul><ul><li>Polyphagia-increased appetite </li></ul></ul><ul><li>Involuntary weight loss </li></ul><ul><li>Visual disturbances (retinopathy/osmotic lens shape changes) </li></ul><ul><li>Candidal pharyngitis/vaginitis </li></ul><ul><li>Acute ketotic illness </li></ul>
    39. 39. Diabetes Mellitus : a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action , or both <ul><li>20.8 million in US ( 7% of population) </li></ul><ul><li>estimated 14.6 million diagnosed (only 2/3) </li></ul><ul><li>Consists of 3 types: </li></ul><ul><li>1) Type 1 diabetes </li></ul><ul><li>2) Type 2 diabetes </li></ul><ul><li>3) Gestational diabetes </li></ul><ul><li>Complications : </li></ul><ul><li>- Stroke </li></ul><ul><li>- Heart attack </li></ul><ul><li>- Kidney disease </li></ul><ul><li>- Eye Disease </li></ul><ul><li>- Nerve Damage </li></ul>
    40. 40. Diabetes Mellitus <ul><li>Type 1 Diabetes </li></ul><ul><li>- cells that produce insulin are destroyed </li></ul><ul><li>- results in insulin dependence </li></ul><ul><li>- commonly detected before 30 </li></ul><ul><li>Type 2 Diabetes </li></ul><ul><li>- blood glucose levels rise due to </li></ul><ul><li>1) Lack of insulin production </li></ul><ul><li>2) Insufficient insulin action (resistant cells) </li></ul><ul><li>- commonly detected after 40 </li></ul><ul><li>- effects > 90% </li></ul><ul><li>- eventually leads to β -cell failure </li></ul><ul><li>(resulting in insulin dependence) </li></ul>Gestational Diabetes 3-5% of pregnant women in the US develop gestational diabetes
    41. 41. Testing : Fasting Plasma Glucose Test (FPG) - (cheap, fast) *fasting B.G.L. 100-125 mg/dl signals pre-diabetes *>126 mg/dl signals diabetes Oral Glucose Tolerance Test (OGTT) *tested for 2 hrs after glucose- rich drink *140-199 mg/dl signals pre- diabetes *>200 mg/dl signals diabetes <ul><li>80 to 90 mg per 100 ml, is the normal fasting blood glucose concentration in humans and most mammals which is associated with very low levels of insulin secretion. </li></ul>A.K.A.: Glycated Hemoglobin tests A1C
    42. 42. Management of DM <ul><li>Diet </li></ul><ul><li>Oral Hypoglycemic Agents </li></ul><ul><li>Insulin </li></ul>
    43. 43. Diet <ul><li>Cornerstone of diabetic therapy </li></ul><ul><li>Individualized, tailored to the needs of the patient </li></ul><ul><li>The goal is proper growth and development (for the young diabetics) and normalization of weight in the normal work or school setting without hyperglycemia or hypoglycemia </li></ul>
    44. 44. Oral Hypoglycemic Agents <ul><li>The oral agents sulfonylureas and arysylfonylureas are indicated for Type II DM patients </li></ul><ul><li>Side effects include: </li></ul><ul><ul><li>toxic reactions </li></ul></ul><ul><ul><li>Nausea, vomiting, </li></ul></ul><ul><ul><li>Dyspnea, </li></ul></ul><ul><ul><li>Palpitations </li></ul></ul>
    45. 45. Insulin <ul><li>Indicated (together with dietary manipulation as the primary mode of metabolic control for: </li></ul><ul><ul><li>Newly diagnosed Type I diabetics </li></ul></ul><ul><ul><li>Type II diabetics failing to maintain adequate glycemic control on oral hypoglycemic medications </li></ul></ul><ul><ul><li>Preoperatively </li></ul></ul><ul><ul><li>Drug pregnancy </li></ul></ul>
    46. 46. Dental Correlations <ul><li>Generally accepted that there is a direct relationship between DM and dental diseases </li></ul><ul><li>Symptoms can be related to salivary and dental changes, periodontal and mucosal abnormalities, opportunistic infections, acetone or diabetic breath and altered wound healing </li></ul>
    47. 47. Dental Management <ul><li>Obtain a comprehensive medical history from the known or suspected diabetic patient </li></ul><ul><li>Establish the severity and degree of control before instituting any dental management </li></ul><ul><ul><li>When the patient’s diabetes is well controlled and there are no concurrent medical problems, he may receive appropriate dental therapy without modification of accepted dental protocols </li></ul></ul><ul><ul><li>When the patient’s diabetes is uncontrolled, or when there is a serious underlying organic disease, elective care or surgical procedure should be delayed until blood glucose level has been regulated </li></ul></ul>
    48. 48. <ul><ul><li>When the severity of diabetics or the degree of control is not known, treatment should be limited to palliation </li></ul></ul><ul><li>In the dental treatment of all diabetics, reduce pain as much as possible. The stress stimulates the release of epinephrine, which in turn, increases the blood glucose level </li></ul><ul><li>Be careful with antimicrobial therapy, excessive use of unnecessary antibiotics can lead to oral or systemic fungal infections </li></ul>
    49. 49. Lactose intolerance
    50. 50. Overview Lactose intolerance is the inability to digest lactose (a type of sugar found in milk and other dairy products).
    51. 51. Symptoms *Abdominal bloating& Abdominal cramps *Diarrhea *Floating stools & Foul-smelling stools *Gas (flatulence) *Malnutrition *Nausea*Slow growth *Weight loss
    52. 52. Causes Lactose intolerance happens when the small intestine does not make enough of the enzyme lactase. Babies' bodies make this enzyme so they can digest milk, including breast milk. Before humans became dairy farmers, most people did not continue to drink milk, so their bodies did not make lactase after early childhood. Lactose intolerance is more common in Asian, African, African-American, Native American, and Mediterranean populations than it is among northern and western Approximately 30 million American adults have some amount of lactose intolerance by age Not having enough lactase (lactase deficiency) may also occur as a result of intestinal diseases such as celiac sprue and gastroenteritis, or after bowel surgery. Temporary lactase deficiency can result from viral and bacterial infections, especially in children, when the cells lining the intestine are injured.
    53. 53. Tests & diagnosis *Enteroscopy *Lactose-hydrogen breath test *Lactose tolerance test *Test for stool-reducing substances
    54. 54. Prevention There is no known way to prevent lactose intolerance. If you have the condition, avoiding or restricting the amount of milk products in your diet can reduce or prevent symptoms.
    55. 55. Treatment *Buttermilk and cheeses (they have less lactose than milk *Fermented milk products, such as yogurt *Goat's milk (but drink it with meals, and make sure it is supplemented with essential amino acids and vitamins if you give it to children) *Ice cream, milkshakes, and aged or hard cheeses *Lactose-free milk and milk products *Lactase-treated cow's milk for older children and adults *Soy formulas for infants younger than 2 years *Soy or rice milk for toddlers *Take calcium supplements *Eat foods that have more calcium (leafy greens, oysters, sardines, canned salmon, shrimp, and broccoli) *Drink orange juice that contains added calcium
    56. 56. Complications Weight loss and malnutrition are possible complications.