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carbohydrates
By
      Zahraa Esmat Sayed Mahmoud

          Under supervision of

        Prof.Dr.Sonia Saleh Zaky
            Professor of nutrition
   Nutrition and Food Science Department.
         Faculty of Home Economic.
              Helwan University.

Prof.Dr.Ashraf Abd El-Aziz Abd El-Megeid
            Professor of nutrition
   Nutrition and Food Science Department.
         Faculty of Home Economic.
              Helwan University.
Introduction
  Food affects almost everything we do. It affects how we look,
feel, and act. It even affects our abilities – how well we function
every day.
  Food has an impact on life because it supplies nutrients,
which are substances in food that body needs to function
properly such as in growing, in repairing itself, and in having
supply of energy.
  Nutrition is both a pure science and a social science. As a
pure science it looks at how the body uses nutrients. As a social
science it looks at the relationship between food and human
behavior and the environment, or how and why people eat.
Nutrition and Nutrients
    There are six types of nutrients:

   Carbohydrates
   Fats
   Proteins
   Vitamins
   Minerals
   Water
carbohydrates
General characteristics

The term carbohydrate is derived from the French:
 hydrate de carbone.

compounds composed of C, H, and O

empirical formula: (CH2O)n
What are carbohydrates?

Carbohydrates, a group of molecules that
 include sugars and starches, provide energy to
 the body when the molecules are broken down.
 All carbohydrates contain carbon, hydrogen,
 and oxygen.
A carbohydrate with one unit of sugar such as
glucose, fructose, and galactose, are simple
sugars. Usually, the ratio of each of carbon to
hydrogen and oxygen is 1:2:1 such that there is
one carbon to two hydrogens to one oxygen.
Most of the sugars used in the body are six-
carbon sugars, so their formula is written as:
C6H12O6.
Two monosaccharides make a disaccharide.

There are three types of disaccharides:
Sucrose, which is made of glucose and fructose, is common
table sugar.

 Lactose, made of glucose and galactose, is the sugar found in
dairy products.

Maltose, made of two glucose molecules, is found in anything
“malted” .Because disaccharides are too large to pass through
the cell membranes, they must be broken down into
monosaccharides first.
Polysaccharides

Polysaccharides are several monosaccharides linked in a
chain. There are two types of polysaccharides of importance
to the body: starches and glycogen.
Polysaccharides must be digested to their individual glucose
units for the body to be able to use the energy.

Cellulose, another type of polysaccharide, is a major
component of wood. It cannot be broken down into smaller
units, so it is not digestible. When we ingest cellulose, it is
considered roughage or fiber. Although we get no nutritional
value from cellulose, it binds cholesterol in the intestine and
helps us eliminate this chemical. Fiber also helps to regulate
the digestive tract and keep people “regular.”
How do we get carbohydrates from the diet?

The main sources of carbohydrates in our diet
are:

 Foods made from cereal grains (e.g. bread,
 flour, rice, pasta, and breakfast cereal). These
 foods give us mainly complex or starchy
 carbohydrate.
 Fruit and vegetables especially potatoes, root
 vegetables (e.g. carrots) and pulses (beans and
 lentils) contain a mix of starches and sugars.
Lactose which is found in milk.
Table sugar, honey and soft drinks.
We break down most carbohydrates in the gut and
absorb them into our blood stream as individual sugar
units.




      What is the function of carbohydrates?
  Carbohydrates have five major functions within the body:

     Energy supply, particularly for the brain in the form
     of glucose
Avoiding the breakdown of amino acids for energy.
 Avoiding ketosis from the breakdown of fatty acids.
 Cellular , protein recognition, activation of growth factors and
 modulation of the immune system.
 Some carbohydrates are high in fiber, which helps prevent
 constipation and lowers the risk for certain diseases such as cancer,
 heart disease and diabetes.
What happens if we don't get enough carbohydrate?
Eating too little carbohydrate may lead to low blood sugar levels
(hypoglycaemia) .

Hypoglycaemia is a particular risk for some people with diabetes
who are on tablets or insulin. It can also affect very active sports
people, who may feel exhausted when their blood sugar and muscle
glycogen stores run low.
 If we eat too little carbohydrate, over time our body will begin
  to use up some stored fat but quickly moves on to burning its
  own protein tissue such as in the heart and muscles. A low intake
  of wholegrain cereals, fruit and vegetables rich in indigestible
  carbohydrate can also lead to bowel problems such as
  constipation.
     What does the Glycaemic Index of carbohydrates
                         mean?

 Different carbohydrate-containing foods are digested and
  absorbed at different rates.
 The Glycaemic Index (GI) is the classification used to identify
  which carbohydrates are quickly broken down to glucose (high
  GI) and which are slowly broken down(low GI).
 Glyceamic index is defined
                    as the area under the blood
                    glucose curves seen after
                    ingestion of a meal with
                    carbohydrate-rich      food,
                    compared with the area
                    under the blood glucose
                    curve observed after a meal
                    consisting of the same
                    amount of carbohydrate in
                    the form of glucose or
                    white bread.

Glyceamic index
Examples of medium and low GI carbohydrate foods
                    include:

Wholegrain and seeded bread
 Pasta, basmati rice
 Oats and muesli
Beans and pulses
 Most fruit and vegetables including sweet
 potatoes and new boiled potatoes in their
 skins
 Milk and yogurt.
Preview of
Carbohydrate
 Metabolism
Storing glucose as glycogen
• 1/3rd of total glycogen is stored in liver and
  2/3rd in muscle.
• When blood glucose falls liver cells break
  down glycogen into single molecules of
  glucose, which becomes available to supply
  energy to central nervous system and other
  organs .
• During exercise the muscle cell themselves use
  up the glycogen they store.
Using glucose as energy
Glycolysis (“glucose-splitting”)

    Glucose (6C) is split into two pyruvate/pyruvic acid
                       (3C) molecules.

  – It does not require oxygen (gas O2).
  – Amount of energy harvested from 1 glucose:
      2 ATP
      2 NADH (actively transported into        mitochondria
    of eukaryotic cells)
Making glucose from proteins
Glycogen stores only last for some hours , if a
  person does not replenish the depleted
  glycogen stores, body protein are broken
  down to make glucose by a process called
 “gluconeogenesis”
Taking adequate amount of carbohydrate
  prevents the use of protein for energy, this
  role of carbohydrate is called protein sparing
  action.
Making ketone bodies from fat fragments

Inadequate supply of carbohydrates causes
 break down of body fat reserves. This not only
 supplies energy but also produces ketone
 bodies.
Some ketone bodies are used by muscle and
 other tissues for energy, but when produced
 in excess they accumulate in blood and cause
 ketosis (disturbance of bodies normal acis-
 base balance)
Converting glucose to fats
Excess carbohydrates can be converted to fats
 when glycogen stores are filled to capacity.
However storing carbohydrates as fats is an
 energetically expensive process. So, body fats
 mainly come from dietary fats.
Maintaining glucose homeostasis
• Blood glucose homeostasis is regulated mainly
   by two hormones:
(i)Insulin- secreted when blood glucose is high.
   Controls transport of glucose from blood to
   muscle and fat cells
(ii) Glugagon- secreted when blood glucose is
   low. Helps in release of glucose from storage.
Overview of Carbohydrate Metabolism
Requirements for carbohydrate
 Carbohydrates are not essential nutrients, because the
  carbon skeletons of amino acids can be converted into
  glucose .
 However, the absence of dietary carbohydrate leads to
  ketone body production ,and degradation of body protein
  whose constituent amino acids provide carbon skeletons
  for gluconeogenesis .
 The RDA for carbohydrate is set at 130 g/day for adults
  and children, based on the amount of glucose used by
  carbohydrate-dependent tissues, such as the brain and
  erythrocytes.
 Adults should consume 45–65 percent of their total
  calories from carbohydrates.
Requirements for carbohydrate

 It is recommended that added sugar represent no more than
  25% of total energy because of concerns that sugar may
  displace nutrient-rich foods from the diet, potentially leading
  to deficiencies of certain micronutrients.
Factors affecting requirements of carbohydrate

 The minimal amount of carbohydrate required,
  either from endogenous or exogenous sources,
  is determined by the brain’s requirement for
  glucose .

 The requirement for glucose has been reported
  to be approximately 110 to 140 g/day in adults.
  When glucose production or availability
  decreases below that required for the complete
  energy requirements of the brain, there is a rise
  in ketoacid production in the
liver in order to provide the brain with an alternative fuel This
    has been referred to as a ketosis .Generally this occurs in a
    starving person only after glycogen stores in the liver are
    reduced to a low concentration and the contribution of hepatic
    glycogenolysis is greatly reduced or absent .

 The available evidence based on the majority of studies on
  the relationship dietary fiber to gastrointestinal health,
  several chronic diseases (colon cancer, breast cancer),
  glucose tolerance, insulin response as well as weight
  control and maintenance, indicated that the beneficial
  effects of fiber in humans are most likely related to the
  amount of food consumed but not the individual’s age or
  body weight .
Health effects of starch and fiber
Weight control: Food rich in complex
 carbohydrates provides less energy per bite and
 also provides satiety.

Heart disease: diets high in soluble fibers and
 low in animal fats and cholesterol is associated
 with lower risk of heart disease.

Cancer: high carbohydrate diet protects
 against some types of cancer (eg. Colon
 cancer).
Diabetes: High carbohydrate low fat diet helps
 in weight control , and this is the most
 effective way to prevent diabetes type 2.

GI health: dietary fibers enhance health of GI
 tract and hence blocks absorption of unwanted
 constituents of food. Insoluble fibers
 (cellulose) enlarge stool and prevents
 constipation.
Glucose and the nervous system


Glucose is the only fuel normally used by brain
cells. Because neurons cannot store glucose,
they depend on the bloodstream to deliver a
constant supply of this precious fuel.
Lactose intolerance
Lactose intolerance It also called lactasdeficiency and hypolactasia.
classified as one of three types:

Primary lactase deficiency

 is genetic, only affects adults and is caused by the absence of
a lactase persistence allele. It is the most common cause of lactose
intolerance as a majority of the world's population lacks these alleles.

Secondary acquired or transient lactase deficiency

is caused by an injury to the small intestine, usually during infancy
fromacute gastroenteritis, diarrhea, chemotherapy, intestinal
parasites or other environmental causes.
Congenital lactase deficiency

is a very rare, autosomal recessive genetic disorder that prevents
lactase expression from birth. It is particularly common
in Finland. People with congenital lactase deficiency are thus
unable to digest lactose from birth, and they are unable to digest
breast milk .
                        Symptoms
The principal symptom of lactose intolerance is an adverse reaction
to products containing lactose (primarily milk), including:
•Abdominal bloating .
• Cramps.
• flatulence
•Diarrhea.
•Nausea.
•Borborygmi (rumbling stomach) .
•Vomiting (particularly in adolescents).
Diagnosis
    Four tests are available:

  Hydrogen breath test
In a hydrogen breath test, after an overnight fast, 25 grams of
lactose (in a solution with water) is swallowed.

 If the lactose cannot be digested, enteric bacteria metabolize it
and produce hydrogen, which, along with methane, if produced,
can be detected on the patient's breath by a clinical gas
chromatograph or compact solid-state detector.

The test takes about 2 to 3 hours to complete.
Blood test
In conjunction, measuring blood glucose level every 10 to 15
minutes after ingestion will show a "flat curve" in individuals with
lactose malabsorption, while the lactase persistent will have a
significant "top", with a typical elevation of 50% to 100%, within
one to two hours. However, due to the need for frequent blood
sampling, this approach has been largely replaced by breath testing.

  Lactose tolerance test:
 In a lactose tolerance test, you will be given a drink of lactose
 solution, and then a sample of blood will be taken from your arm
 using a needle. The blood will be tested to see how much glucose
 (blood sugar) it contains.
Milk tolerance test:

 In a milk tolerance test, you will be given a glass of milk (about
500ml) and your blood sugar levels will be tested. If your blood
sugar levels do not rise after drinking the milk, you may be
lactose intolerant.

After an overnight fast, blood is drawn and then 50 grams of
lactose (in aqueous solution) is swallowed. Blood is then drawn
again at the 30 minute, 1-hour, 2-hour, and 3-hour mark. If the
lactose cannot be digested, blood glucose levels will rise by less
than 20 mg/dL  .
Stool acidity test

This test can be used to diagnose lactose intolerance in infants,
for whom other forms of testing are risky or impractical.
The infant is given lactose to drink. If the individual is tolerant,
the lactose is digested and absorbed in the small intestine;
otherwise it is not digested and absorbed and it reaches the colon.

The bacteria in the colon, mixed with the lactose, cause acidity
in stools. Stools passed after the ingestion of the lactose are tested
for level of acidity.

If the stools are acidic, the infant is intolerant to lactose.

Stool pH in lactose intolerance < 5.5.
Management

Lactose intolerance is not usually an absolute condition:

The reduction in lactase production, and the amount of lactose
that can therefore be tolerated, varies from person to person.
Since lactose intolerance poses no further threat to a person's
health, the condition is managed by minimizing the occurrence
and severity of symptoms.
Avoiding lactose-containing products:
Dietary control of lactose intolerance depends on people learning
through trial and error how much lactose they can handle. Label
reading is essential, as commercial terminology varies according
to language and region.
Alternative products

 Soy milk
 It has about the same amount of protein as cow's milk, though
the amino acid profile differs.

Natural soy milk contains little digestible calcium as it is
bound to the bean's pulp, which is insoluble in humans.

To counter this, many manufacturers enrich their products
with calcium carbonate available to human digestion.

 Unlike cow's      milk,   it   has   little saturated   fat and
no cholesterol.
 The American Academy of Pediatrics considers soy milk a
  suitable alternative for children who cannot tolerate human or
  cow's milk, or whose parents opt for a vegan diet. They find no
  medical benefit to using soy milk instead of human or cow's
  milk.

   Rice milk
Compared to cow's milk, rice milk contains more carbohydrates,
but does not contain significant amounts of calcium or protein,
and no cholesterolor lactose.

Commercial brands of rice milk, however, are often fortified
with vitamins and minerals, including calcium, vitamin
B12, vitamin B3, and iron.
Almond milk
 Unlike     animal      milk,     almond     milk    contains
  no cholesterol or lactose. As it does not contain any animal
  products, it is suitable for vegans and vegetarians who
  abstain from dairy products.

 Commercial almond milk products often come in
 plain, vanilla or chocolate flavors and are sometimes
 enriched with vitamins. Almond milk can also be made at
 home by combining ground almonds with water in a blender.
 Vanilla flavoring and sweeteners are often added.

 Almond milk is not a suitable replacement for breast milk,
  cow's milk or hydrolyzed formulas in children under two
  years of age due to the low protein content.
Coconut milk
 Coconut milk contains a large proportion of lauric acid, a saturated fat
  that raises blood cholesterol levels by increasing the amount of high-
  density lipoprotein cholesterol that is also found in significant amounts
  in breast milk and sebaceous gland secretions.

 This may create a more favourable blood cholesterol profile, though it is
  unclear if coconut oil may promote atherosclerosis through other
  pathways.

 Because much of the saturated fat of coconut oil is in the form of lauric
  acid, coconut oil may be a better alternative to partially hydrogenated
  vegetable oil when solid fats are required.In addition, virgin coconut oil is
  composed mainly of medium-chain triglycerides,which may not carry the
  same risks as other saturated fats.

 Early studies on the health effects of coconut oil used partially
  hydrogenated coconut oil, which creates trans fats, and not virgin coconut
  oil, which has a different health risk profile.
carbohydrates

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carbohydrates

  • 2. By Zahraa Esmat Sayed Mahmoud Under supervision of Prof.Dr.Sonia Saleh Zaky Professor of nutrition Nutrition and Food Science Department. Faculty of Home Economic. Helwan University. Prof.Dr.Ashraf Abd El-Aziz Abd El-Megeid Professor of nutrition Nutrition and Food Science Department. Faculty of Home Economic. Helwan University.
  • 3. Introduction Food affects almost everything we do. It affects how we look, feel, and act. It even affects our abilities – how well we function every day. Food has an impact on life because it supplies nutrients, which are substances in food that body needs to function properly such as in growing, in repairing itself, and in having supply of energy. Nutrition is both a pure science and a social science. As a pure science it looks at how the body uses nutrients. As a social science it looks at the relationship between food and human behavior and the environment, or how and why people eat.
  • 4. Nutrition and Nutrients There are six types of nutrients:  Carbohydrates  Fats  Proteins  Vitamins  Minerals  Water
  • 6. General characteristics The term carbohydrate is derived from the French: hydrate de carbone. compounds composed of C, H, and O empirical formula: (CH2O)n
  • 7. What are carbohydrates? Carbohydrates, a group of molecules that include sugars and starches, provide energy to the body when the molecules are broken down. All carbohydrates contain carbon, hydrogen, and oxygen.
  • 8. A carbohydrate with one unit of sugar such as glucose, fructose, and galactose, are simple sugars. Usually, the ratio of each of carbon to hydrogen and oxygen is 1:2:1 such that there is one carbon to two hydrogens to one oxygen. Most of the sugars used in the body are six- carbon sugars, so their formula is written as: C6H12O6.
  • 9. Two monosaccharides make a disaccharide. There are three types of disaccharides: Sucrose, which is made of glucose and fructose, is common table sugar. Lactose, made of glucose and galactose, is the sugar found in dairy products. Maltose, made of two glucose molecules, is found in anything “malted” .Because disaccharides are too large to pass through the cell membranes, they must be broken down into monosaccharides first.
  • 10. Polysaccharides Polysaccharides are several monosaccharides linked in a chain. There are two types of polysaccharides of importance to the body: starches and glycogen. Polysaccharides must be digested to their individual glucose units for the body to be able to use the energy. Cellulose, another type of polysaccharide, is a major component of wood. It cannot be broken down into smaller units, so it is not digestible. When we ingest cellulose, it is considered roughage or fiber. Although we get no nutritional value from cellulose, it binds cholesterol in the intestine and helps us eliminate this chemical. Fiber also helps to regulate the digestive tract and keep people “regular.”
  • 11. How do we get carbohydrates from the diet? The main sources of carbohydrates in our diet are: Foods made from cereal grains (e.g. bread, flour, rice, pasta, and breakfast cereal). These foods give us mainly complex or starchy carbohydrate. Fruit and vegetables especially potatoes, root vegetables (e.g. carrots) and pulses (beans and lentils) contain a mix of starches and sugars.
  • 12. Lactose which is found in milk. Table sugar, honey and soft drinks. We break down most carbohydrates in the gut and absorb them into our blood stream as individual sugar units. What is the function of carbohydrates? Carbohydrates have five major functions within the body: Energy supply, particularly for the brain in the form of glucose
  • 13. Avoiding the breakdown of amino acids for energy. Avoiding ketosis from the breakdown of fatty acids. Cellular , protein recognition, activation of growth factors and modulation of the immune system. Some carbohydrates are high in fiber, which helps prevent constipation and lowers the risk for certain diseases such as cancer, heart disease and diabetes. What happens if we don't get enough carbohydrate? Eating too little carbohydrate may lead to low blood sugar levels (hypoglycaemia) . Hypoglycaemia is a particular risk for some people with diabetes who are on tablets or insulin. It can also affect very active sports people, who may feel exhausted when their blood sugar and muscle glycogen stores run low.
  • 14.  If we eat too little carbohydrate, over time our body will begin to use up some stored fat but quickly moves on to burning its own protein tissue such as in the heart and muscles. A low intake of wholegrain cereals, fruit and vegetables rich in indigestible carbohydrate can also lead to bowel problems such as constipation. What does the Glycaemic Index of carbohydrates mean?  Different carbohydrate-containing foods are digested and absorbed at different rates.  The Glycaemic Index (GI) is the classification used to identify which carbohydrates are quickly broken down to glucose (high GI) and which are slowly broken down(low GI).
  • 15.  Glyceamic index is defined as the area under the blood glucose curves seen after ingestion of a meal with carbohydrate-rich food, compared with the area under the blood glucose curve observed after a meal consisting of the same amount of carbohydrate in the form of glucose or white bread. Glyceamic index
  • 16. Examples of medium and low GI carbohydrate foods include: Wholegrain and seeded bread  Pasta, basmati rice  Oats and muesli Beans and pulses  Most fruit and vegetables including sweet potatoes and new boiled potatoes in their skins  Milk and yogurt.
  • 18. Storing glucose as glycogen • 1/3rd of total glycogen is stored in liver and 2/3rd in muscle. • When blood glucose falls liver cells break down glycogen into single molecules of glucose, which becomes available to supply energy to central nervous system and other organs . • During exercise the muscle cell themselves use up the glycogen they store.
  • 19. Using glucose as energy Glycolysis (“glucose-splitting”) Glucose (6C) is split into two pyruvate/pyruvic acid (3C) molecules. – It does not require oxygen (gas O2). – Amount of energy harvested from 1 glucose: 2 ATP 2 NADH (actively transported into mitochondria of eukaryotic cells)
  • 20. Making glucose from proteins Glycogen stores only last for some hours , if a person does not replenish the depleted glycogen stores, body protein are broken down to make glucose by a process called “gluconeogenesis” Taking adequate amount of carbohydrate prevents the use of protein for energy, this role of carbohydrate is called protein sparing action.
  • 21. Making ketone bodies from fat fragments Inadequate supply of carbohydrates causes break down of body fat reserves. This not only supplies energy but also produces ketone bodies. Some ketone bodies are used by muscle and other tissues for energy, but when produced in excess they accumulate in blood and cause ketosis (disturbance of bodies normal acis- base balance)
  • 22. Converting glucose to fats Excess carbohydrates can be converted to fats when glycogen stores are filled to capacity. However storing carbohydrates as fats is an energetically expensive process. So, body fats mainly come from dietary fats.
  • 23. Maintaining glucose homeostasis • Blood glucose homeostasis is regulated mainly by two hormones: (i)Insulin- secreted when blood glucose is high. Controls transport of glucose from blood to muscle and fat cells (ii) Glugagon- secreted when blood glucose is low. Helps in release of glucose from storage.
  • 25. Requirements for carbohydrate  Carbohydrates are not essential nutrients, because the carbon skeletons of amino acids can be converted into glucose .  However, the absence of dietary carbohydrate leads to ketone body production ,and degradation of body protein whose constituent amino acids provide carbon skeletons for gluconeogenesis .  The RDA for carbohydrate is set at 130 g/day for adults and children, based on the amount of glucose used by carbohydrate-dependent tissues, such as the brain and erythrocytes.  Adults should consume 45–65 percent of their total calories from carbohydrates.
  • 26. Requirements for carbohydrate  It is recommended that added sugar represent no more than 25% of total energy because of concerns that sugar may displace nutrient-rich foods from the diet, potentially leading to deficiencies of certain micronutrients.
  • 27. Factors affecting requirements of carbohydrate  The minimal amount of carbohydrate required, either from endogenous or exogenous sources, is determined by the brain’s requirement for glucose .  The requirement for glucose has been reported to be approximately 110 to 140 g/day in adults. When glucose production or availability decreases below that required for the complete energy requirements of the brain, there is a rise in ketoacid production in the
  • 28. liver in order to provide the brain with an alternative fuel This has been referred to as a ketosis .Generally this occurs in a starving person only after glycogen stores in the liver are reduced to a low concentration and the contribution of hepatic glycogenolysis is greatly reduced or absent .  The available evidence based on the majority of studies on the relationship dietary fiber to gastrointestinal health, several chronic diseases (colon cancer, breast cancer), glucose tolerance, insulin response as well as weight control and maintenance, indicated that the beneficial effects of fiber in humans are most likely related to the amount of food consumed but not the individual’s age or body weight .
  • 29. Health effects of starch and fiber Weight control: Food rich in complex carbohydrates provides less energy per bite and also provides satiety. Heart disease: diets high in soluble fibers and low in animal fats and cholesterol is associated with lower risk of heart disease. Cancer: high carbohydrate diet protects against some types of cancer (eg. Colon cancer).
  • 30. Diabetes: High carbohydrate low fat diet helps in weight control , and this is the most effective way to prevent diabetes type 2. GI health: dietary fibers enhance health of GI tract and hence blocks absorption of unwanted constituents of food. Insoluble fibers (cellulose) enlarge stool and prevents constipation.
  • 31. Glucose and the nervous system Glucose is the only fuel normally used by brain cells. Because neurons cannot store glucose, they depend on the bloodstream to deliver a constant supply of this precious fuel.
  • 33. Lactose intolerance It also called lactasdeficiency and hypolactasia.
  • 34. classified as one of three types: Primary lactase deficiency is genetic, only affects adults and is caused by the absence of a lactase persistence allele. It is the most common cause of lactose intolerance as a majority of the world's population lacks these alleles. Secondary acquired or transient lactase deficiency is caused by an injury to the small intestine, usually during infancy fromacute gastroenteritis, diarrhea, chemotherapy, intestinal parasites or other environmental causes.
  • 35. Congenital lactase deficiency is a very rare, autosomal recessive genetic disorder that prevents lactase expression from birth. It is particularly common in Finland. People with congenital lactase deficiency are thus unable to digest lactose from birth, and they are unable to digest breast milk . Symptoms The principal symptom of lactose intolerance is an adverse reaction to products containing lactose (primarily milk), including: •Abdominal bloating . • Cramps. • flatulence •Diarrhea. •Nausea. •Borborygmi (rumbling stomach) . •Vomiting (particularly in adolescents).
  • 36. Diagnosis Four tests are available: Hydrogen breath test In a hydrogen breath test, after an overnight fast, 25 grams of lactose (in a solution with water) is swallowed.  If the lactose cannot be digested, enteric bacteria metabolize it and produce hydrogen, which, along with methane, if produced, can be detected on the patient's breath by a clinical gas chromatograph or compact solid-state detector. The test takes about 2 to 3 hours to complete.
  • 37. Blood test In conjunction, measuring blood glucose level every 10 to 15 minutes after ingestion will show a "flat curve" in individuals with lactose malabsorption, while the lactase persistent will have a significant "top", with a typical elevation of 50% to 100%, within one to two hours. However, due to the need for frequent blood sampling, this approach has been largely replaced by breath testing. Lactose tolerance test: In a lactose tolerance test, you will be given a drink of lactose solution, and then a sample of blood will be taken from your arm using a needle. The blood will be tested to see how much glucose (blood sugar) it contains.
  • 38. Milk tolerance test: In a milk tolerance test, you will be given a glass of milk (about 500ml) and your blood sugar levels will be tested. If your blood sugar levels do not rise after drinking the milk, you may be lactose intolerant. After an overnight fast, blood is drawn and then 50 grams of lactose (in aqueous solution) is swallowed. Blood is then drawn again at the 30 minute, 1-hour, 2-hour, and 3-hour mark. If the lactose cannot be digested, blood glucose levels will rise by less than 20 mg/dL .
  • 39. Stool acidity test This test can be used to diagnose lactose intolerance in infants, for whom other forms of testing are risky or impractical. The infant is given lactose to drink. If the individual is tolerant, the lactose is digested and absorbed in the small intestine; otherwise it is not digested and absorbed and it reaches the colon. The bacteria in the colon, mixed with the lactose, cause acidity in stools. Stools passed after the ingestion of the lactose are tested for level of acidity. If the stools are acidic, the infant is intolerant to lactose. Stool pH in lactose intolerance < 5.5.
  • 40. Management Lactose intolerance is not usually an absolute condition: The reduction in lactase production, and the amount of lactose that can therefore be tolerated, varies from person to person. Since lactose intolerance poses no further threat to a person's health, the condition is managed by minimizing the occurrence and severity of symptoms. Avoiding lactose-containing products: Dietary control of lactose intolerance depends on people learning through trial and error how much lactose they can handle. Label reading is essential, as commercial terminology varies according to language and region.
  • 41. Alternative products Soy milk  It has about the same amount of protein as cow's milk, though the amino acid profile differs. Natural soy milk contains little digestible calcium as it is bound to the bean's pulp, which is insoluble in humans. To counter this, many manufacturers enrich their products with calcium carbonate available to human digestion.  Unlike cow's milk, it has little saturated fat and no cholesterol.
  • 42.  The American Academy of Pediatrics considers soy milk a suitable alternative for children who cannot tolerate human or cow's milk, or whose parents opt for a vegan diet. They find no medical benefit to using soy milk instead of human or cow's milk. Rice milk Compared to cow's milk, rice milk contains more carbohydrates, but does not contain significant amounts of calcium or protein, and no cholesterolor lactose. Commercial brands of rice milk, however, are often fortified with vitamins and minerals, including calcium, vitamin B12, vitamin B3, and iron.
  • 43. Almond milk  Unlike animal milk, almond milk contains no cholesterol or lactose. As it does not contain any animal products, it is suitable for vegans and vegetarians who abstain from dairy products.  Commercial almond milk products often come in plain, vanilla or chocolate flavors and are sometimes enriched with vitamins. Almond milk can also be made at home by combining ground almonds with water in a blender. Vanilla flavoring and sweeteners are often added.  Almond milk is not a suitable replacement for breast milk, cow's milk or hydrolyzed formulas in children under two years of age due to the low protein content.
  • 44. Coconut milk  Coconut milk contains a large proportion of lauric acid, a saturated fat that raises blood cholesterol levels by increasing the amount of high- density lipoprotein cholesterol that is also found in significant amounts in breast milk and sebaceous gland secretions.  This may create a more favourable blood cholesterol profile, though it is unclear if coconut oil may promote atherosclerosis through other pathways.  Because much of the saturated fat of coconut oil is in the form of lauric acid, coconut oil may be a better alternative to partially hydrogenated vegetable oil when solid fats are required.In addition, virgin coconut oil is composed mainly of medium-chain triglycerides,which may not carry the same risks as other saturated fats.  Early studies on the health effects of coconut oil used partially hydrogenated coconut oil, which creates trans fats, and not virgin coconut oil, which has a different health risk profile.