CARBOHYDRATE 2023.pptx

Basic Nutrition
CARBOHYDRATE
Melese.S(Chem,B.Pharm,Msc ,Ass.Professor , PhD©)
Jimma University
Institute of Health
Faculty of Public Health, Nutrition & Dietetics Department
April 7,2023
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Objecties
• Describe the function of macronutrients ?
• Describe the function dietary fiber
consumption ?
• Describe disease associated with abnormal
metabolisms of carbohydrate , proteins and
fats ?
• Mention the good source of foods for
macronutrients ?
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The 6 Essential Nutrients
What You Need to Know!
Carbs Protein
Fats &
Oils
Vitamins Minerals
WATER

“Essential” Nutrients
Nutrients are categories of substances we need
for our nutrition.
Essential Nutrients are nutrient substances that
we can only get from food, because our bodies
cannot produce them on our own.
**For example, your body can’t just decide “hey,
I need some calcium so I’m going to make it!”
You have to consume something that contains
calcium in order for it to get into your body

NUTRIENTS
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Nutrients
• Macro-nutrients
— Protein
— Fat
— Carbohydrates
• Micro-nutrients
— Vitamins
— Minerals & trace-elements
• Water
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The Nutrients
• Nutrients in Foods and in the Body
– Composition of foods includes the six nutrient classes of
water, carbohydrates, lipids, proteins, vitamins and
minerals. Foods can also contain nonnutrients and other
compounds, such as fibers, phytochemicals, pigments,
additives, alcohols and others.
– Composition of the human body is made of chemicals similar
to food.
– Chemical composition of nutrients includes both organic (those
that contain carbon) and inorganic (those that do not contain
carbon) compounds.
– Essential nutrients are those the body cannot make or cannot
make in sufficient quantities to meet needs. These are also
called indispensable nutrients.
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The Nutrients
• Energy-Yielding Nutrients: Carbohydrate, Fat and Protein
– Macro- vs. micronutrients
• Carbohydrate, fat, and protein are macronutrients
because the body needs them in large quantities.
• Water, vitamins, and minerals do not provide energy
and are known as micronutrients because the body
needs them in smaller quantities.
– Energy is measured in Calories (calories, kilocalories,
kcalories, kcal).
• Internationally, food energy is measured in joules.
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Energy-Yielding Nutrients
Calories and kilocalories
• Calories are units by which energy is
measured.
• Food energy is measured in
kilocalories (kcal)
– Carbohydrate = 4 kcal/gram
– Protein = 4 kcal/gram
– Fat = 9 kcal/gram
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Food is eaten and digested
in the body to allow the
absorption of energy and
nutrients.
There are two different
types of nutrients:
• macronutrients;
• micronutrients.
There are three
macronutrients that are
essential for health.
These are:
• carbohydrate;
• protein;
• fat.
Macronutrients are
measured in grams (g).

Macronutrient Best for
Protein Building muscles
Carbohydrates (carbs) Primary source of energy
Fats
Hormones, nerves, tissues,
vitamin absorption
Secondary source of energy
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MACRONUTRIENTS
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• Macronutrients: - are nutrients that are
required by our body in larger quantities on
a daily basis and need to be broken down to
smaller units for use by the body.
• They include carbohydrates, lipid and proteins.
• All of them contribute to the energy pool of the
body
• Alcohol also gives energy, but it is not a
macronutrient for we do not need it for survival.
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Macronutrients contribute to the energy
pool of the body
Energy Pool
of the body
(100%)
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Carbohydrates
(45-65%)
Fats
20% - 35%
Proteins
(10% - 35%)
45-65% Carbohydrates (sugar, sweets,
bread, cakes)
20-35% Fats (dairy products, oil)
10-35% Protein (eggs, milk, meat,
poultry, fish)
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Cont…
• While each of these macronutrients provides calories, the
amount of calories that each one provides varies.
– Carbohydrate provides 4 calories per gram.
– Protein provides 4 calories per gram (5.2 kcal/gram is removed as
metabolizable energy).
– Fat provides 9 calories per gram.
• Besides carbohydrate, protein, and fat the only other
substance that provides calories is alcohol. Alcohol
provides 7 calories per gram.
• Alcohol, however, is not a macronutrient because we do
not need it for survival.
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What are Carbohydrates?
• Definition:
a biological compound containing
carbon, hydrogen, and oxygen that is
an important source of food and
energy
• Your body uses carbohydrates to
make glucose which is fuel that gives
your body energy.
• Glucose can be used immediately or
stored.
• Healthier foods high in
carbohydrates are ones higher in
dietary fiber without added sugar.
• Carbohydrates can be found in the
following:
• Fruits
• Vegetables
• Breads, cereals, and other grains
• Milk & milk products
• Foods containing added sugar
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General Characteristics
• The term carbohydrate is derived from the French:
“hydrate de carbone”
• All carbohydrates are compounds composed of (at least)
C, H, and O
• The general formula for a carbohydrate is: (CH2O)n (e.g.
when n = 5 then the formula would be C5H10O5)
• Not all carbohydrates have this empirical formula (e.g.
deoxysugars, aminosugars, etc.)
• Carbohydrates are the most abundant compounds found
in nature (e.g. cellulose: 100 billion tons annually)
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General Characteristics
• In nature, most carbohydrates are found bound to other
compounds rather than as simple sugars
• Polysaccharides (starch, cellulose, inulin, gums)
• Glycoproteins and proteoglycans (hormones, blood
group substances, antibodies)
• Glycolipids (cerebrosides, gangliosides)
• Glycosides
• Mucopolysaccharides (hyaluronic acid)
• Nucleic acid polymers
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Photosynthesis: Sun’s energy becomes part of glucose molecule
energy
Carbon dioxide
Water
Chlorophyll
GLUCOSE
6 CO2 + 6 H20 + energy (sun) C6H12O6 + 6 O2
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120 grams of glucose / day = 480 calories
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Functions of Carbohydrates
1) Energy
• glucose fuels the work of most of the body’s cells
– preferred fuel of NERVOUS TISSUE (the brain, nerves) and
RED BLOOD CELLS (RBC)
• excess glucose is stored as GLYCOGEN in liver and
muscle tissue
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2) Sparing Body Protein
• if diet does not provide enough glucose, then other
sources of glucose must be found
• if carbohydrate intake < 50 - 100 g, body protein will
be used to make glucose
• an adequate supply of carbohydrate spares body
proteins from being broken down to synthesize
glucose
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3) Preventing Ketosis (Anti-ketogenic)
• carbohydrates required for the complete
metabolism of fat
• incomplete fat metabolism produces KETONES
• an adequate supply of carbohydrate (> 50 –
100 g per day) prevents KETOSIS
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WHY DO WE NEED CARBOHYDRATES TO SURVIVE?
We need this amount of carbohydrate because:
– 45% - 65% of calories should come from carbohydrate
– Carbohydrates are the body’s main source of fuel.
– All of the tissues and cells in our body can use glucose for
energy.
– Carbohydrates are needed for the central nervous system, the
kidneys, the brain, the muscles (including the heart) to function
properly.
– Carbohydrates can be stored in the muscles and liver and later
used for energy(glycogen).
– Carbohydrates are important in intestinal health and waste
elimination (e.g.. Dietary fiber).
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“GOOD” CARBS V. “BAD” CARBS
• “Good” Carbohydrates have more fiber
and complex carbohydrates.
• Guidelines recommend choosing fiber-
rich carbohydrate choices.
• Fiber-rich foods include:
fruits, vegetables, & whole grain breads
& pastas.
• “Bad” Carbohydrates are referring to
foods with refined carbohydrates.
• Refined Carbohydrates are items that are
made from white flour or added sugar.
• Examples: white bread, cakes, & cookies
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Complex carbs (good
carbs)
Fibrous and
starchy carbs
(good carbs)
Highly processed
carbs (bad simple
carbs)
Whole grains
Brown rice
Oatmeal
Quinoa
Veggies
Fruits
Lentils
Beans, peas
Sweet potato
Refined grains
Sugars
Honey
Syrups
Soft drinks
Candy etc
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Types of Carbohydrates
Simple Carbohydrates
– monosaccharides
– disaccharides
Complex Carbohydrates
– oligosaccharides
– polysaccharides
• glycogen
• starches
• fibers
Carbohydrates may be
A. Refined
B. Unrefined
Refined means that the food is highly
processed.
The fiber and bran, as well as many of the
vitamins and minerals they contain,
have been stripped away.
Thus, the body processes these
carbohydrates quickly, and they provide
little nutrition although they contain
about the same number of calories.
Refined products are often enriched,
meaning vitamins and minerals have
been added back to increase their
nutritional value.
A diet high in simple or refined
carbohydrates tends to increase the risk
of obesity and diabetes.
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Carbohydrates can be…
Simple Carbs
- Fruits
- Honey
- Milk
- Sugars added to cookies,
candies, soft drinks
Complex Carbs
-Grains (bread & pasta)
-Vegetables (potatoes &
beans)
-Rice
-Cereals
-Wheat
-Tortillas
-Whole-wheat rolls
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Dietary Carbohydrates
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Dietary Carbohydrates
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CLASSIFICATION OF CARBOHYDERATES
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Free
Sugars
Oligo-
saccharid
es
Polysaccharides (Complex
Carbohydrates)
1. Monosacch
arides (One
CHO
molecule)
e.g.
 Glucose
 Fructose
 Galactos
e
 manose,
 Ribose
 Deoxirib
ose
2.
Disaccharides
(Two CHO
molecule) e.g..
 Maltose
 Sucrose
 Lactose
 Trehalo
s
3.Sugar
alcoholes e.g.
 Sorbitol
 manitol
 Inisitol
 Dulcitol
These are
carbohydrate
s that
contain from
3-10
Monosaccha
rides units in
their
molecules.
The
following are
some
examples
 Raffinos
e
 Stachyo
se
 Verbasc
ose
 Fructans
 Galactan
s
1.Starch Polysaccharides.
 Amylose(straight chain
starch)
 Amylopectin (branched
chain starch)
2. Non starch polysaccharides
 Cellulose
 Pectin
 Hemicellulose
 Gums
 Mucilage
3. Glycogen
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Monosaccharides: Single Sugars
Glucose
– carbohydrate form used by the
body, referred to as “blood sugar”
– basic sub-unit of other larger
carbohydrate molecules
– found in fruits, vegetables, honey
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Monosaccharides: Single Sugars
Fructose
– sweetest of the sugars
– occurs naturally in fruits & honey,
“fruit sugar”
– combines with glucose to form
sucrose
Galactose
– combines with glucose to form
lactose, “milk sugar”
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Sugar Source Importance Clinical significance
D-Glucose
(Dextrose)
Grape sugar
Blood sugar
(Aldose)
• Fruit juices,
• Hydrolysis of
starch
cane sugar,
maltose &
lactose
• Stored as
glycogen
 The sugar of the body.
 The sugar carried by
the blood, and the
principal one used by
the tissues, RBCs,
brain cells
 Acts as immediate
energy source for
cellular functions like
muscle contraction,
nerve transmission and
tissue repair
 Can be converted into
other sugars or
derivatives required for
GAGs & Glycolipids
Present in the urine
(glycosuria) in
diabetes mellitus
owing to raised
blood glucose
(hyperglycemia)
Monosaccharides (Hexoses)
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Sugar Source Importance Clinical significance
D-Fructose
• Fruit Sugar
• Levulose
• Keto sugar
• Sweeter
than Glu
• Fruit juices,
Honey
• Hydrolysis of
cane sugar & inulin
• Seminal fluid is
rich in Fructose
Can be
changed to
glucose in the
liver and so
used in the
body
Herediatary
Fructose intolerance
leads to fructose
accumulation and
hypoglycemia
D-Mannose
• Aldo- Sugar
• Epimer of
glucose
Hydrolysis of
plant mannans
and gums
• A constituent of
many Glycoproteins
• When oxidized
gives IdUA-a
component of Heparin
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Sugar Source Importance Clinical
significance
D-Galactose
• Aldo- Sugar
• Epimer of
Glucose
• Less sweet
than Glu
Hydrolysis of
 Milk sugar
 Galactolipids
 Glycoproteins
• Can be changed
to glucose in the
liver and then
metabolized.
• Synthesized in
the mammary
gland to make
the lactose of milk.
• A constituent
of glycolipids and
Glycoproteins
Failure to
metabolize
leads to
galactosemia
and cataract
(Galactitol)
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Hexoses of Physiologic Importance.
Sugar Source Biochemical Importance Clinical Significance
D-Glucose Fruit juices, hydrolysis
of starch, cane or beet
sugar, maltose and
lactose
The main metabolic fuel for
tissues; "blood sugar"
Excreted in the urine
(glucosuria) in poorly
controlled diabetes
mellitus as a result of
hyperglycemia
D-Fructose Fruit juices, honey,
hydrolysis of cane or
beet sugar and inulin,
enzymic isomerization
of glucosesyrups for food
manufacture
Readily metabolized either
via glucoseor directly
Hereditary fructose
intolerance leads to
fructose accumulation
and hypoglycemia
D-
Galactose
Hydrolysis of lactose Readily metabolized
to glucose; synthesized in the
mammary gland for synthesis
of lactose in milk. A
constituent of glycolipids and
glycoproteins
Hereditary
galactosemia as a result
of failure to metabolize
galactose leads to
cataracts
D-Mannose Hydrolysis of plant
mannan gums
Constituent of glycoproteins
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Disaccharides
Sucrose (“table sugar”)
– glucose + fructose
Lactose (“milk sugar”)
– glucose + galactose
Maltose (“malt sugar”)
– glucose + glucose
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SUCROSE: Table sugar/cane sugar
It’s the main transport form of CHOs in plants.
Obtained from cane and beet commercially.
Made of 2 monosaccharides glucose and fructose which are linked by a glycosidic
linkage; α for glucose and β for fructose.
It can be cleaved to its 2 components by enzyme sucrase.
Provides 20-30% of the total calories.
Sucrose----------------------> Glucose + Fructose
Sucrase/invertase
Glycosidic linkage is α 1-2 bond.
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LACTOSE: (milk sugar)
Major dietary CHO for infants.
10% of total CHOs consumed. Lactose is the only natural source of
galactose.
Lactose is hydrolysed to its monosaccharides by lactase in humans
and by β-galactosidase in bacteria.
Synthesized also during lactation.
Galactose is joined to glucose by
a β-1,4-glycosidic linkage.
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MALTOSE: Malt sugar
Produced by the hydrolysis of starch and is in turn hydrolysed to glucose by
maltase.
Present in germinating cereals and not naturally found in diet.
Maltose in beer is produced by partial digestion of starch.
Glycosidic linkage is α 1-4 bond
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• Lactulose (Gal + Frc)
– Used in the treatment of some chronic liver diseases
associated with hyper-ammonemia
• Lactitol (galactosido-sorbitol)
– Also used in the treatment of some chronic liver
diseases
Disaccharides
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Oligosaccharides
– short carbohydrate chains of 3 - 10
monosaccharides
– found in legumes and human milk
– Examples:
• raffinose
• stachyose
cannot be broken down by human enzymes,
though can be digested by colonic bacteria
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• Glycoproteins containing oligosaccharide
chains include
– Integral membrane proteins,
– Receptors
– Hormones and
– Other proteins (like antibodies, clotting factors)
Oligosaccharides
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Polysaccharides
• long carbohydrate chains of
monosaccharides linked by glycosidic bonds
– alpha (a) bonds (starch)
– beta (b) bonds (found in fiber)
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Starch
– plant storage form of
carbohydrate
– long branched or
unbranched chains of
glucose
• amylose
• amylopectin
amylose
amylopectin
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Glycogen
– highly branched chains of
glucose units
– animal storage form of
carbohydrate
• found in LIVER and MUSCLE
• Humans store ~ 100g in liver; ~
400g in muscle
– negligible source of
carbohydrate in the diet (meat)
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Dietary Fiber
– non-digestible carbohydrates (chains of monosaccharides)
and lignin that are intact and intrinsic in plants (includes
oligosaccharides)
Functional Fiber
– isolated, non-digestible carbohydrates that have beneficial
physiological effects in humans
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• dietary fiber found in all types of plant
foods
• refining removes fiber from whole grains
and other foods
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• types of non-starch
polysaccharides include:
 cellulose
 hemicelluloses
 pectins
 gums & mucilages
 b-glucans
 chitin & chitosan
 lignans
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Dietary fiber
• Fiber refers to certain types of carbohydrates that our
body cannot digest (oligosaccharides and non-starch
polysaccharides).
• These carbohydrates pass through the intestinal tract
intact and help to move waste out of the body.
• Diets that are low in fiber have been shown to cause
problems such as constipation and hemorrhoids and to
increase the risk for certain types of cancers such as colon
cancer.
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Figure 4.12
Dietary Fiber
• Chronic constipation can
lead to diverticulosis and
diverticulitis
• Prevention of constipation
and diverticulosis
– Insoluble fiber helps reduce
transit time of foods in the
colon
– Soluble fiber helps make
stool easier to pass by
increasing bulk and softening
texture 57
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Benefits of Fiber
i) Prevent constipation
Insoluble fiber binds water, making stools softer and
bulkier.
Therefore, fiber especially that found in whole grain
products is helpful in the treatment and prevention of
constipation, hemorrhoids and diverticulosis.
Diverticula are pouches of the intestinal wall that can
become inflamed and painful.
In the past, a low-fiber diet was prescribed for this
condition.
A high-fiber diet gives better results once the
inflammation has subsided.

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Cont …
• beneficial for weight control by contributing to satiety
& delay gastric emptying
• soluble fibers lower blood cholesterol to help reduce
risk of cardiovascular disease
• minimizes risk of and helps control Type II Diabetes
• insoluble fibers help promote intestinal health by
enlarging stool size and easing passage of stool
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ii) Lower cholesterol levels
• Low blood cholesterol levels (below 200 mg/dl.) have been
associated with a reduced risk of coronary heart disease.
• The body eliminates cholesterol through the excretion of bile
acids. Water-soluble fiber binds bile acids, and hence a high-
fiber diet may result in an increased excretion of cholesterol.
• Some types of fiber appear to have a greater effect than others.
• The fiber found in rolled oats is more effective in lowering blood
cholesterol levels than the fiber found in wheat.
• Pectin has a similar effect in that it, too, can lower the amount
of cholesterol in the blood.

Figure 4.13
Dietary Fiber
• Prevention of heart disease and diabetes
– Viscous, soluble fiber helps lower elevated blood
cholesterol levels
• Interferes with reabsorbtion of bile acid
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Cont…
• Diets high in fiber; however, have been shown to
decrease risks for heart disease, obesity, and
they help lower cholesterol.
• Foods high in fiber include fruits, vegetables,
and whole grain products.
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iii) Reduce the risk of some cancers
Dietary fiber may help reduce the risk of some cancers,
especially colon cancer.
This idea is based on information that insoluble fiber
increases the rate at which wastes are removed from the
body.
This means the body may have less exposure to toxic
substances produced during digestion.
A diet high in animal fat and protein also may play a role
in the development of colon cancer.

How does fiber prevent different health
problems?
Cancer (Colonic, breast..)
• Prevents secondary bile acid circulation
• Decrease intestinal transit time
• Decrease contact of carcinogens with intestinal
cells
• Fermentation product butyrate has apoptotic
effect
• Decreases absorption fats and sugars
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Cont…
• Dietary Fiber prevents Constipation,
Hemorrhoids & Diversticulosis by:
• Increasing perystalsis making stool bulk
• Decreasing straining to pass stool
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iv) Useful for losing weight
High-fiber diets may be useful for people who wish to lose
weight.
Fiber itself has no calories, yet provides a "full" feeling
because of its water-absorbing ability.
For example, an apple is more filling than a half cup of apple
juice that contains about the same calories.
Foods high in fiber often require more chewing, so a person is
unable to eat a large number of calories in a short amount of
time.

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Soluble Fiber
• examples include gums, pectins, mucilages,
some hemicelluloses
• functions:
– delay gastric emptying
– slow transit through the digestive system
– delay glucose absorption
– bind to bile, help decrease cholesterol
• food sources: fruits
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Insoluble Fiber
• examples include cellulose, hemicellulose
• functions:
– speed transit through the digestive tract
– delay glucose absorption
– increase fecal weight and soften stool to ease passage
– reduces risk of hemorrhoids, diverticulitis and appendicitis
• food sources: cereal grains, legumes, vegetables,
nuts
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Nutrient Sources
Water insoluble dietary fibers
β-glucans (a few of which are water soluble)
Cellulose cereals, fruit, vegetables (in all plants in general)
Chitin in fungi, exoskeleton of insects and crustaceans
Hemicellulose cereals, bran, timber, legume
Hexosane wheat, barley
Pentosane rye, oat
Lignin
stones of fruits, vegetables (filaments of the garden bean),
cereals
Xanthan production with Xanthomonas-bacteria from sugar substrates
water soluble dietary fibers
Fructans
replace or complement in some plant taxa the starch as
storage carbohydrate
Inulin in diverse plants, e.g. topinambour, chicory, etc.
Polyuronide
Pectin in the fruit skin (mainly apples, quinces), vegetables
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Sourec: Annals of Oncology, Jnaury, 2012
Effect of dietary fiber on breast Cancer
Systematic review
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Insoluble fibre has more effect on weight
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Fiber and Colorectal Cancer: review of evidence
Source: 74
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Adverse effect
• Although fiber is important, it is just one part of a
properly balanced diet.
• Too much fiber may reduce the amount of calcium, iron,
zinc, copper and magnesium that is absorbed from
foods.
• Deficiencies of these nutrients could result if the amount
of fiber in the diet is excessive, especially in young
children.
• Fiber supplements are sold in a variety of forms from
bran tablets to purified cellulose.

• Many laxatives sold as stool softeners actually are fiber
supplements.
• Fiber's role in the diet is still being investigated.
• Various types of fiber have different roles in the body.
• For these reasons fiber supplements should be avoided.
• Eating a variety of fiber-rich foods is the best way to
receive the maximum benefits from each type of fiber
present in foods, and obtain necessary nutrients.

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Fiber: Too much of a good thing?
Excessive amounts of fiber may lead to:
– displacement of other foods in the diet
– intestinal discomfort
– interference with the absorption of other
nutrients
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Butyrate and colon cancer.
• Butyrate has been shown to act as both preventive and inhibitory
in carcinogenesis of the colon. The chemopreventive effect is
mediated by upregulation of detoxifying enzymes for xenobiotics
and oxidants
 helps prevent and inhibit colonic carcinogenesis. Extra-intestinal
beneficial effects of butyrate include
1) increasing fetal hemoglobin production;
2) lowering serum cholesterol levels;
3) stimulating neurogenesis in brain after ischemic injury; and
4) providing positive effects in the treatment of obesity, insulin resistance,
cystic fibrosis, urea cycle enzyme deficiency, and sickle cell disease
 The role of butyrate in the inhibition and prevention of colon
cancer is likely one of its most important beneficial effects.
Source: Am J Physiol Cell Physiol 301: C977–C979, 2011;
doi:10.1152/ajpcell.00290.2011.
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Food sources of Carbohydrates
• Free sugars are found from: fruits, juices, confectionery, Soft
drinks, , milk, sugar, sugar cane, honey and yogurt, Cereal grains,
Legumes & dried fruits, vegetables, processed foods (pasta), jams,
pastries, breads, candies fruits like banana, dates, and sweet potato
• Starch is found from: starchy foods (like cereals and legumes
and potatoes), Other foods like fruits, vegetables, beans, nuts,
seeds
• OligoSacharides are found from : Garlic, onion, Whole grain
cereals and legumes (beans and peas)
• Non starch polysaccharides are found from: Fruits,
vegetables, Whole grain cereals and legumes
79
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6/4/2023
80
Soluble or Viscous Fiber
Goal
Increase to 10-25
grams per day
Soluble Fiber grams
Barley, ½ cup cooked 1
Oatmeal, 1 cup cooked 2
Psyllium seeds, ground 1T 5
Apple, banana, peach 1
Orange, grapefruit, pear 2
Beans, cooked, 1 cup 4-6
Broccoli, ½ cup cooked 1
Brussels Sprouts, ½ cup ckd 3
Carrots, ½ cup cooked 1
Source: ATP 3 TLC Guidelines
Melese .S

81
Practical Steps To
Increase Your Intake
of High-Fiber Foods
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82
Fruit is a good source
of fiber; low in fat and
calories, and
cholesterol-free.
Two or more cups of
fruit per day are
recommended.
Fruits fiber, g
Apple, 1 medium 3.3
Applesauce, canned 1/2 C 1.5
Apricots, 3 medium 3.8
Banana, 1 medium 3.1
Blackberries, fresh, 1 C 7.6
Blueberries, frozen, 1 C 4.2
Cantaloupe, 1 C pieces 1.4
Kiwi, 1 medium 2.6
Orange, 1 medium 3.1
Peach, 1 medium 1.5
Pear, 1 small 4.6
Prunes, 1/2 C cooked 4.7
Strawberries, raw, 1 C 3.1
1
USDA National Nutrient Database
Dietary Fiber-Eat More Fruit
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83
Vegetables are low in fat
and calories and high in
fiber, vitamins, and
minerals.
Three to five or more
servings of vegetables
per day are
recommended.
Vegetables fiber g
Asparagus, ½ C cooked 1.8
Broccoli, ½ C cooked 2.6
Brussels sprouts, ½ C ckd 2.0
Carrot, ½ C cooked 2.3
Coleslaw, ½ C 0.9
Green beans, ½ C cooked 2.0
Green peas, ½ C cooked 4.4
Greens, ½ C cooked 2.1
Potato, baked, 1 medium 3.8
Summer squash, ½ C ckd 1.3
Winter squash, ½ C baked 2.9
Sweet potato, 1 med. Baked 3.8
Tomato, fresh, 1 medium 1.5
2
Dietary Fiber-Eat More Vegetables
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84
Eat More Whole Grains
Whole grains are a good
source of fiber. They are
usually low in fat, and they
tend to fill you up.
Three or more servings of
whole grains per day are
recommended.
Grains fiber-g
Bran Flakes cereal, 3/4 C 5.3
Grape-Nuts, 1/4 C 2.5
Oatmeal, 3/4 C, cooked 3.0
Pancakes, three 4” cakes 1.5
Pasta, 1C, cooked 2.5
Rice, brown, 1C cooked 3.5
Rice, white, 1C cooked 1.4
Shredded wheat, 1 C 5.0
Tortilla, 1, whole corn 1.5
Wheaties, 1 C 3.0
White bread, 1 slice 0.6
Whole-wheat bread, 1 slice 1.7
3
Dietary Fiber-Eat More Whole Grains
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85
Legumes are the foods
highest in fiber. They are
also good sources of
protein.
Eat three or more servings
per week. Daily intake is
ideal.
Legumes fiber g
Black beans, ½ C cooked 7.0
Burrito, bean & cheese, 1 15.0
Chickpeas, ½ C cooked 5.3
Hummus spread, ¼ C 3.8
Lentils, ½ C cooked 7.8
Lima beans, baby, ½ C 7.0
Pinto beans, 1 C cooked 15.4
Tofu, raw, firm, ¼ block 1.9
Tofu, raw, regular, ¼ block 0.3
4
Dietary Fiber-Eat More Legumes
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86
Pure fruit and vegetable
juices contribute some
fiber and are good sources
of vitamins.
Look for juices without
added sugar.
Juice fiber g
Apricot nectar, 6 oz 1.1
Grape juice, 1 C 0.3
Grapefruit juice, ½ C 0.1
Orange juice, 1 C 0.5
Pineapple juice, ½ C 0.5
Tomato juice, 1C 1.0
V-8 juice, 1C 1.9
Soft drink*, 1 can 0.0
* Soft drinks are loaded with
sugar and calories but not
nutrients.
5
Dietary Fiber-Choose Fruit/Veg Juice
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87
Nuts are good sources of
fiber, protein, and
unsaturated fats.
Nuts have been found to
reduce the risk of heart
disease.
Nuts fiber g
Almonds (23), 1 oz. 3.3
Cashews (18), 1 oz. 0.9
Filberts (21), 1 oz. 2.7
Mixed nuts, 1 oz. deluxe 1.6
Peanut butter, 2 T 2.6
Peanuts, 1 oz. 2.3
Pecans (15 halves), 1 oz. 2.7
Pistachios (49), 1 oz. 2.9
Sunflower seeds, 1 oz. 2.6
Pumpkin seeds (142), 1 oz. 1.1
Walnut halves, 1 oz. 1.9
6
Dietary Fiber-Eat Nuts and Seeds
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88
Much of the fiber is
removed in refined and
processed foods.
Choose more unrefined,
natural foods.
Sample Foods fiber g
Apple, 1 med. 3.3
Applesauce, canned 1/2 C 1.5
Apple juice, 1 cup 0.2
Soft drink, 1 can 0.0
Whole-wheat bread, 1 slice 1.7
White bread, 1 slice 0.6
Twinkie, 1 0.1
Soft drinks, ice cream, candy
sugar, butter, margarine 0.0
7
Dietary Fiber-Eat Less Refined Foods
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89
• When buying foods,
check the label for
fiber content.
• You will soon learn
which foods are
higher in dietary
fiber.
Nutrition Facts
Serving Size 2.5 oz. (71g)
Servings per container 4
Amount Per Serving
Calories 130
Calories from fat 25
% Daily Value
Total Fat 3g 5%
Saturated fat 1 g 5%
Polyunsaturated fat 0.5g
Monounsaturated fat 1.5g
Cholesterol 10 mg 4%
Sodium 290 mg 12%
Total Carbohydrate 18g 6%
Dietary fiber 5g 20%
Sugars 1g
Protein 8g
8
Dietary Fiber – Read Food Labels
6/4/2023 Melese .S

Glucose Production Glucose Consumption
Glycogen
(75%)
Glucose
Blood
glucose
125g
50g
50g
brain
rbc
wbc
muscle
fat cell 90
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Glucose Production Glucose Consumption
Glycogen
(75%)
Glucose
Blood
glucose
125g
50g
50g
pyruvate
lactate (10-15%)
certain
amino acids (10-15%)
glycerol (2%)
CO2
CO2
brain
rbc
wbc
muscle
fat cell 91
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Carbohydrate digestion
a. Digestion of starch and disaccharides
92
Absorbed by active transport
mechanism coupled with sodium
Sucrose
Glucose
+
Fructose
From the small
intestine
-Chemical
salivary Amylase
(Ptyalin) &
Pancreatic
amylase
 -Mechanical;-
biting action of
the teeth
Maltose
Glucose + Glucose
Lactose
Glucose
+
Galactose
Absorbed by simple
diffusion
Lactase
Sucrase
Maltase
Starch,
Dextrin,
Mouth and
small
intestine
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93
Digestion & Absorption
1. Mouth
• chewing
• salivary amylase
2. Stomach
• fibers remain in the
stomach longer, delays
gastric emptying
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94
maltase
lactase
sucrase
Small Intestine
• pancreas secretes enzyme pancreatic amylase
• enzymes located on the cell membranes of the intestinal
epithelial cells complete digestion
maltose glucose + glucose
sucrose glucose + fructose
lactose glucose + galactose
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They get fermented in the
colon by anaerobic bacteria
Oligosaccharides(eg. Raffinose, Stachyose)
and non-starch polysaccharides resistant
starch
Escape digestion in the
upper gut (small intestine
Increased faecal Biomass
resulting in increased
peristalsis
Production of
short chain fatty
acids (SCFA)
 Acetate
 Propionate
 Butyrate
Production of
gases likes co2,
methane and
hydrogen
sulphide
b. Digestion of oligosaccharides, resistant starch and non-
starch polysaccharides
95
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97
Small Intestine cont.
• only monosaccharides can be absorbed
– glucose & galactose absorbed by ACTIVE TRANSPORT
– fructose absorbed by FACILITATED DIFFUSION
• all three monosaccharides travel in the portal vein
to the liver
• three fates of glucose at the liver
– Energy, storage as glycogen, released to blood
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99
Large Intestine
• resistant starches and fibers may be digested
by bacteria
– produces short chain fatty acids
• absorbed by the intestine and used for energy
(dietary fiber yields about 2 kcal/g)
• other health benefits
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Digestion of
carbohydrates.
100
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Metabolism of Carbohydrates
102
Fructose-6-phosphate
Fructose1, 6-diphosphate
Glycolysis
Crebs Cycle
Glyceraldehyde-3 phosphate
bGlyceraldehyde 3-phosphatephosphate
3-Dihydroxy Acetone phosphate
CO2+ Energy+H2O
Acetyl CoA
Glucose –6-Phosphate
6/4/2023 Melese .S

Overview of Metabolism
acetyl-CoA
pyruvate ATP
ADP + Pi
polysaccharides
hexoses
pentoses
ADP + Pi
ATP
ADP + Pi
ATP
ADP + Pi
ATP
ATP
ADP + Pi
ADP + Pi
ATP
lipids
fatty acids
ATP
ADP + Pi
protein
amino acids
citric acid
cycle
urea
cycle ATP
ADP + Pi
urea
CO2
electron transport
chain
oxidative
phosphorylation
O2
ATP
e-
104
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Overview of Catabolic Processes
Carbohydrates Fats
Proteins
Simple Sugars Fatty acids
Amino acids
Pyruvate
Acetyl CoA
Oxidative phosphorylation
ATP
ATP
Citric acid cycle
Stage 1
Stage 2
Stage 3
Glycolysis
105
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Stage 1 – postparandial
All tissues utilize glucose
Stage 2 – postabsorptive
KEY – Maintain blood glucose
Glycogenolysis
Glucogneogenesis
Lactate
Pyruvate
Glycerol
AA
Propionate
Spare glucose by metabolizing fat
Stage 3- Early starvation
Gluconeogenesis
Stave 4 – Intermediate starvation
gluconeogenesis
Ketone bodies
Stage 5 – Starvation
6/4/2023 109
Melese .S

General Characteristics of the Energy
Systems
ATP/PC System Lactic Acid System Aerobic System
Anaerobic Anaerobic Aerobic (oxygen)
Very rapid Rapid slow
PC and ATP utilized Glycogen/glucose used Glycogen, fats, and
protein used
Very limited production Limited production of ATP Unlimited production of
ATP
Limited stores in muscle -
fatigue with depletion
By product - lactate and
acidity leads to fatigue
No fatiguing by products
Used in sprint and high-
power short duration
activity
Activities that are
maximal for 1-3 minutes
Long duration activities, 5
minutes plus
110
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TABLE 4.7 Major hormones involved in regulation of blood glucose levels
Hormone Gland Stimulus Action
Insulin Pancreas Increase in blood
glucose
Helps transport glucose into
cells; decreases blood glucose
levels.
Glucagon Pancreas Decrease in blood
glucose; Exercise
stress
Promotes gluconeogenesis in
liver; helps increase blood
glucose levels.
Epinephrine Adrenal Exercise stress;
decrease in blood
glucose
Promotes glycogen breakdown
and glucose release from the
liver: helps increase blood
glucose levels
Cortisol Adrenal Exercise stress;
decrease in blood
glucose
Promotes breakdown of protein
and resultant gluconeogenesis;
helps increase blood glucose
levels
111
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GLUCOSE TRANSPORTERS
family of proteins called the solute carriers (SLC)
GLUT1: RBC’s
GLUT2 :intestine, pancreatic β-cells, kidney and liver(glucose sensor)
GLUT3: binds glucose with high affinity
GLUT4: insulin-sensitive tissues, such as skeletal muscle and adipose tissue
GLUT5: fructose transporter
119
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Glucose transporters
Name Tissue Function
GLUT1 (erythrocyte) wide distribution, esp.
brain, kidney, colon, fetal
tissues
Basal glucose transport
GLUT2 (liver) Liver, b-cells of pancreas,
small intestine, kidney
Non-rate-limiting glucose
transport
GLUT3 (brain) Wide distribution, esp.
neurons, placenta, testis
Glucose transport in
neurons
GLUT4 (muscle) Skeletal muscle, cardiac
muscle, adipose tissue
Insulin-stimulated
glucose transport*
GLUT5 (small intestine) Small intestine, kidney,
skelatal muscle, brain,
adipose tissue
Fructose transport
*insulin low…GLUT4 in intracellular compartments;
insulin high…GLUT4 translocates to membrane
120
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Effect of food processing on Carbohydrates
• Polishing – loss of vitamines (eg. Thiamin)
• Fermenting
– increase mineral bioavailability (Fe, Zn, Mg, Ca)
– Functional foods (prebiotic VS probiotic)
• Germination
– Decreases viscosity due to gelatinization
– Increases nutrient density
122
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Probiotic vs Prebiotic
• Probiotics are live bacteria in yogurt, other dairy products
and pills. And while probiotics have been shown effective
in managing certain gastrointestinal conditions, they do
not have the same power that prebiotics do.
• The Prebiotic is a specialized plant fiber that beneficially
nourishes the good bacteria already in the large bowel or
colon. The body itself does not digest these plant fibers;
instead, the fibers act as a fertilizer to promote the growth
of many of the good bacteria in the gut.
123
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PREBIOTIC VS PROBIOTIC
PREBIOTICS PROBIOTICS
PREBIOTICS are a special form of
dietary fiber
PROBIOTICS are live bacteria in yogurt,
dairy products and pills. There are hundreds of
probiotic species available. Which of the hundreds of
available probiotics is best for the average healthy
person is still unknown.
PREBIOTIC powders are not affected by heat, cold,
acid or time.
PROBIOTIC bacteria must be kept alive. They may be
killed by heat, stomach acid or simply die with time.
PREBIOTICS provide a wide range of health benefits to
the otherwise healthy person. Most of these have been
medically proven.
PROBIOTICS are still not clearly known to provide
health benefits to the otherwise healthy. Some are
suspected but still not proven.
PREBIOTICS nourish the good bacteria that everyone
already has in their gut.
PROBIOTICS must compete with the over 1000
bacteria species already in the gut.
PREBIOTICS may be helpful for
several chronic digestive disorders or
inflammatory bowel disease.
Certain PROBIOTIC species have been shown to be
helpful for childhood diarrhea, irritable bowel disease
and for recurrence of certain bowel infections such as C.
difficile.
124
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Diseases associated with abnormal carbohydrate
metabolism include
Diabetes mellitus
Galactosemia
Lactose intolerance
Glycogen storage diseases
Hypoglycemia.
126
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Carbohydrate malabsorption
Lactose intolerance
• Most mammals normally cease to produce lactase,
becoming lactose intolerant, after weaning
• It is estimated that 75% of adults worldwide show some
decrease in lactase activity during adulthood
• The frequency of decreased lactase activity ranges from
5% in northern Europe through 71% for Sicily to more than
90% in some African and Asian countries
• This distribution is now thought to have been caused by
recent natural selection favoring lactase-persistent
individuals in cultures in which dairy products are available
as a food source. 127
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128
Cont …
• occurs as a result of insufficient lactase & low lactase
activity
• lactose molecules from milk remain in the intestine
undigested
• lactose intolerance  milk allergy
• undigested lactose digested by bacteria producing
irritating acid and gas
– symptoms include bloating, abdominal discomfort,
diarrhea
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129
Cont …
• individuals who consume little or no milk products
may be at risk of developing nutrient deficiencies
• dairy options: yogurt, aged cheddar, small quantities
of milk (~ ½ cup), acidophilus milk, cottage cheese
• best to consume with other foods and spread intake
throughout day
• gradual increases in milk intake may cause intestinal
bacteria to adapt
6/4/2023 Melese .S

There are 3 types of lactase deficiency:
1. Inherited lactase deficiency:
• In this syndrome, which is relatively rare, symptoms
of intolerance develop very soon after birth
• The feeding of a lactose-free diet results in
disappearance of the symptoms
• The occurrence of lactose in the urine is a
prominent feature of this syndrome, which appears
to be attributable to an effect of lactose on the
intestine
Hanadi Baeissa

2. Secondary low-lactase activity:
• Because digestion of lactose is limited even in
normal humans, intolerance to milk is not
uncommon as a consequence of intestinal disease
• Examples are tropical and non tropical (celiac)
spure,Crohn’s disease, kwashiorkor, colitis, and
gastroenteritis.
• The disorder may be noted also after surgery for
peptic ulcer
Hanadi Baeissa

3. Primary low-lactase activity:
• This is a relatively common syndrome, particularly
among non white populations
• Since intolerance to lactose was not a feature of
the early life of adults with this disorder, it is
presumed to represent a gradual decline in activity
of lactase in susceptible individual
Hanadi Baeissa

Cont …
• Lactose Intolerance - Dietary Changes
–Increase consumption of milk products
gradually.
–Mix dairy with other foods.
–Spread dairy intake throughout the day.
–Use of acidophilus milk, yogurt, and kefir
(fermented products)
–Use of enzymes
–Individualization of diets
–Must be careful that vitamin and mineral
deficiencies do not develop
133
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Mechanism of Lactose-Induced Diarrhea and
Flatus
Lactase-sufficient
people absorb
>80% of lactose
Lactase-deficient
people absorb
<50% of lactose
6-20 grams malabsorbed
lactose = flatus
(1 g = 44 ml H2)
>20 grams malabsorbed
lactose = flatus+diarrhea
Small
bowel
Colon
Lactose
Glucose
Galactose
Lactose
CO2+H2
SCFA
lactose
glucose
galactose
FLATUS OSMOTIC DIARRHEA
134
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Lactose Intolerance
• more lactose is consumed than can be digested
– lactose molecules attract water
• cause floating, abdominal discomfort, diarrhea
– intestinal bacteria feed on undigested lactose
• produce acid and gas
135
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Abnormal
lactose
metabolism.
136
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Consequences of chronic elevation in
concentration of hexoses in blood
 2 possible consequences are
• Enzymatic formation of sugar alcohols
• Nonenzymatic glycosylation (“glycation”) of
proteins
Both of these associated with long term pathologies
of nerves, blood vessels, kidneys, and lens as
found in diabetes and galactosemia
137
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Galactose Metabolism
• By far major source of galactose in human diet
is in form of lactose
• Major source of lactose is milk and milk products
• Major organ involved in galactose metabolism is
liver
• There are several inborn errors involving
metabolism of galactose
138
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2 types of galactosemia are caused by
deficiency or absence of:
D-galactose 1-P uridyltransferase and galactokinase
• The first more common (prevalence = 1 in 70,000)
than second (prevalence = 1 in 1 x 105) and has far
greater clinical importance in terms of associated
pathologies, especially in homozygotes
• In Illinois the incidence of the first defect is ~1 in
30,000 live births
139
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The pathologies associated with defective D-
galactose 1-P uridyl transferase include:
• severe mental retardation, hepatomegaly,
cataracts, and non-specific morphological changes
in the CNS
• In Illinois, all newborns are screened for
galactosemia
• Affected infants MUST be placed on a galactose-
free (i. e., milk-free) diet immediately to prevent
irreversible damage
141
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Fructose Metabolism
• Major sources of fructose in diet are fruits, honey,
sucrose and, now, in form of high fructose corn
syrup or solids as an added sweetener in soft
drinks, candy, etc.
• Fructose -in one form or another- may account for
30 - 60% of total dietary carbohydrates for some
• Major organ involved in fructose metabolism is the
liver
142
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There are two (rare) inherited diseases of fructose
metabolism
• Essential fructosuria - caused by deficiency in
fructokinase and leads to transitory elevation of
blood fructose level and to fructosuria (fructose in
the urine)
• Fructose intolerance - MUCH MORE SERIOUS
EFFECTS similar to those associated with
galactosemia - caused by a defect in fructose-1-P
aldolase (aldolase B)
• In fructose intolerance fructose and its sources
(sucrose!) must be eliminated from diet
143
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144
Regulation of Blood Glucose
Optimal functioning of the body is dependant on
keeping levels of glucose within certain parameters.
 Elevated blood glucose = Hyperglycemia
 Low blood glucose = Hypoglycemia
The ENDOCRINE SYSTEM is primarily responsible for
regulating blood glucose. The two main hormones are
INSULIN and GLUCAGON.
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145
Regulation of Blood Glucose
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146
Diabetes Mellitus
• a disorder of energy metabolism due to failure of
insulin to regulate blood glucose
• results in hyperglycemia
• acute symptoms include thirst, increased urine
production, hunger
• long term consequences include increased risk of
heart disease, kidney disease, blindness, neural
damage
• two forms: Type I and Type II
6/4/2023 Melese .S

Liver Breaks
Down Glycogen
and Produces
Glucose from Non-
Carbohydrate
Sources
Consume
Carbohydrates
Blood Glucose
Rises
Body Uses
Fat for
Fuel
Ketoadicosis
Blood Glucose
Rises
No Insulin
Available or
Cells
Resistant
Cell
Starves
Diabetes Mellitus
147
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148
Diabetes Mellitus
Type I
• accounts for about 10% of cases
• occurs when b cells of the pancreas are destroyed
– insulin cannot be synthesized
• without insulin, blood glucose levels rise because the
tissues are unable to access the glucose
• death occurs shortly after onset unless given
injections of insulin
6/4/2023 Melese .S

Forms of Diabetes
• Type 1
– Usually begins in childhood or early adulthood
– 5–10% of diabetics
– Immune system destroys beta cells of the
pancreas
• No insulin produced
– Common symptoms of elevated blood sugar
• Polydipsia
• Polyuria
• Polyphagia
– Require insulin and frequent blood glucose
monitoring
149
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150
Diabetes Mellitus
Type II
• occurs when cells of body are unable to respond to
insulin
• called “insulin insensitivity” or “insulin resistance”
• blood glucose levels rise
• insulin secretion increases in an attempt to
compensate
– leads to hyperinsulinemia
6/4/2023 Melese .S

Forms of Diabetes
• Type 2
– Overweight individuals develop this form
frequently
– 90–95% of diabetics
– Can go undiagnosed
• Damages vital organs without individual being aware of
it
• Polycystic ovary syndrome
– Hormonal imbalance in women
– Have higher incidence of insulin resistance and
hyperinsulinemia
• Increased risk of developing type 2 diabetes
151
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How Diabetes Develops
Copyright 2005 Wadsworth Group, a division of Thomson Learning
153
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154
Hypoglycemia
• dramatic drop in blood glucose
• symptoms similar to an anxiety attack: rapid weak
heart beat, sweating, anxiety, hunger, trembling,
weakness
• RARE in healthy people
• may occur as a result of poorly managed Diabetes or
other causes:
– reactive hypoglycemia
– fasting hypoglycemia
6/4/2023 Melese .S

Complications Of Diabetes
Copyright 2005 Wadsworth Group, a division of Thomson Learning
155
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Forms of Diabetes
• Prediabetes
– Impaired glucose tolerance
– Fasting blood sugar between 100 mg/dl and 126
mg/dl
– High risk of developing diabetes and heart disease
156
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• Tooth loss
• Gum problems
• Kidney disease
• Heart disease
Diabetes
• Long-term damage from diabetes
– Nerve damage
– Leg and foot amputations
– Eye diseases
– Blindness
• Slowing of onset of complications
– Control level of blood glucose through
• Diet
• Insulin or oral medication
• Monitoring blood glucose
• Regular healthcare visits 157
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• The major components of the treatment of
diabetes are:
Management of DM
• Diet and Exercise
A
• Oral hypoglycaemic
therapy
B
• Insulin Therapy
C
158
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Some dietary recommendations for diabetes
Components of dietary energy
- Saturated fatty acids, <10% of total energy
- w -6 polyunsaturated fatty acids, <10% of total
energy
- Protein, 10-20% of total energy
- Carbohydrate and cis-monounsaturated fatty acids,
for the remainder
Carbohydrate issues
- Low glycemic index foods and those rich in soluble
fibre recommended
- Vegetables, fruits, pulses and cereal-derived foods
preferred
- Sucrose, <10% total energy acceptable in certain
circumstances
- Timing of intake essential for those on insulin
Special 'diabetic' and 'dietetic' foods
- Non-alcoholic beverages sweetened with non-
nutritive sweeteners are useful
- Other special foods not encouraged
- No particular need of fructose and other 'special'
nutritive sweeteners over sucrose 159
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Whole Grains and Type 2 Diabetes
1.00
0.65
0.39
0.00
0.25
0.50
0.75
1.00
Low High 29+ g
Cereal
Fiber
• Finnish study:
– 4,300+ men/women
– 10 year study
• Those eating the most
whole-grains had 35%
less type 2 diabetes.
• Those with highest
cereal fiber intake had
61% less diabetes.
Whole Grain Intake
Amer Jour Clin Nutr 77: 527-529
6/4/2023 160
Melese .S

Whole Grains & Risk of Mortality
0.00
0.25
0.50
0.75
1.00
0.1 0.5 1 1.5 3
1.00
0.84
0.66 0.63
0.52
• ARIC study, 15,792
people 45-64, 11 yrs
• Those eating the most
whole-grains had a 48%
decrease in mortality.
• After adjusting for BMI,
exercise, cholesterol,
etc. they still had a 23%
lower risk of dying from
any cause.
Whole Grains, Servings/Day
(Quintiles)
Amer Jour Clin Nutr 78: 383-390
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Glycemic Index: Definition
• Glycemic index (GI) measures how fast a carbohydrate is
digested and raises blood sugar and insulin levels
• Measure of relative glycemic response to dietary carbohydrates
• Rate and degree of blood sugar elevation following
consumption.
• Reference food:
– White bread or Glucose = 100
– Higher index  faster and greater rise of postprandial
glucose and/or insulin
• Glycemic index debate
-low glycemic index supposedly helpful in reducing glucose load
via reduced insulin response required
162
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Blood Glucose and Insulin Curves
High energy
storage
zone
Hunger Zone
High insulin response
leads to obesity,
insulin resistance and
exhaustion
After eating:
• White bread (solid line)
and then
• Spaghetti (dotted line)
(each food was eaten on
different days)
JAMA, May 8, 287:2415
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164
The Glycemic Index
• a measure of the extent to which a food raises
blood glucose concentration & elicits an insulin
response compared to pure glucose
Low Moderate High
pasta
baked beans
bran cereals
apples
milk
banana
orange juice
ice cream
white bread
cornflakes
potatoes
jelly beans
watermelon
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165
The Glycemic Index
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166
The Glycemic Index cont.
Glucose 100
Baked potato 85
Jelly bean 78
Honey 73
Bagel 72
Sucrose 65
Boiled new potato 62
Brown rice 55
Chocolate 49
Boiled carrots 47
Orange 44
Spaghetti 42
Apple 38
Skim milk 32
Lentils 29
Fructose 23
6/4/2023 Melese .S

Glycemic Index (contd)
Fastest Glucose
Dextrose
Starch (branched-chain)
Sucrose/Corn Syrup
Fructose
Starch (straight-chain)
Lactose
Galactose
Slowest Sugar Alcohols
• Use of Glycemic Index
– Lower GI foods digest &
convert to glucose more slowly
– High-fiber slower than low
– High-fat slower than low
– Solids slower than liquids
– Cold foods slower than hot
– Type of sugar/starch affects GI
167
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Glycemic Index (GI)
The GI reflects the rate of digestion and absorption of
CHO
GI =
Blood glucose area after test food
Blood glucose area after reference food
X 100
169
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What Does the Glycemic Index Value Mean?
• The glycemic index (GI) is expressed as a ratio comparing the blood glucose increase caused
by a test food to that of a reference food (usually glucose [G], historically white bread [WB])
for 2 hours following ingestion:
• Conversion for different reference foods: GIG × 1.4 = GIWB
– The GIG for carrots (mean of 4 studies) = 47
– The GIWB for carrots (mean of 4 studies) = 68
• How about a ½ cup of carrots? GI of 47% and it contains about 6 g carbohydrate
GL + 47 x 6/100= 3g
• Let’s take a medium apple. It has a GI of 40% and it contains 15 grams of carbohydrate
GL = 40 x 15/100 = 6 g
• What about a small baked potato? Its GI is 80% and it contains 15 g of carbohydrate
GL = 80 x 15/100 = 12 g
170
Area Under the Curve for Test Food
Area Under the Curve for Reference Food
× 100 = GI
Atkinson FS, et al. Diabetes Care. 2008;31(12):2281-2283.
6/4/2023 Melese .S

GI rating for some common carbohydrates
• A Glycaemic Index of
less than 55 is considered Low,
56 to 69 Medium and
Greater than 70 is High.
• Values will vary depending on brand, variety,
ripeness, preparation etc.
171
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Factors Influencing GI Ranking
• Type of starch
• Physical entrapment
• Viscosity of fiber
• Sugar content
• Fat and protein content
• Acid content
• Food processing
• Cooking
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Type of Starch
• Absorbs less water
• Molecules form tight clumps
• Slower rate of digestion
• Absorbs more water
• Molecules are more open
• Faster rate of digestion
Amylose Amylopectin
Lower GI
Kidney beans (28)
Uncle Ben’s converted LG rice (50)
Higher GI
Russet potato (85)
Glutinous rice (98)
6/4/2023 173
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Physical Entrapment
Endosperm
Bran
Germ
Bran acts as a physical barrier that
slows down enzymatic activity on the
internal starch layer.
Lower GI All Bran (38)
Pumpernickel bread (50)
Higher GI Bagel (72)
Corn Flakes (92)
6/4/2023 174
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Viscosity of Fiber
Viscous, soluble fibers transform intestinal
contents into gel-like matter that slows down
enzymatic activity on starch.
Lower GI
Apple (40)
Rolled oats (51)
Higher GI
Whole wheat bread (73)
Cheerios (74)
6/4/2023 175
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Sugar Content
sugar sucrose glucose + fructose
starch maltose glucose + glucose
(GI 60) (GI 100) (GI 19)
(GI 105) (GI 100) (GI 100)
Lower GI
Frosted Flakes (55)
Raisin Bran (61)
Higher GI
Golden Grahams (71)
Rice Krispies (82)
6/4/2023 176
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Fat & Protein Content
Fat and protein slow down gastric emptying,
and thus, slows down digestion of starch.
Lower GI
Peanut M&M’s (33)
Potato chips (54)
Special K (69)
Higher GI
Jelly beans (78)
Baked potato (85)
Corn Flakes (92)
6/4/2023 178
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Acid Content
Acid slows down gastric emptying, and thus,
slows down the digestion of starch.
Lower GI
Sourdough wheat bread (54)
Higher GI
Wonder white bread (73)
6/4/2023 179
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Food Processing
Highly processed foods require less digestive
processing.
Lower GI
Old fashioned, rolled oats (51)
Higher GI
Quick, 1-minute oats (66)
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Cooking
Cooking swells starch molecules and softens
foods, which speeds up the rate of digestion.
Lower GI
Al dente spaghetti – boiled
10 to 15 minutes (44)
Higher GI
Over-cooked spaghetti –
boiled 20 minutes (64)
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How does all this affect our glycemic levels?
How does all this make us feel after eating
carbohydrate-containing foods?
Type of starch
Physical entrapment
Viscosity of fiber
Sugar content
Fat content
Protein content
Acid content
Food processing
Cooking
6/4/2023 182
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The six elements to determine the GI of a food
1.Does it contain carbohydrate?
• Pure protein foods such as meat, fish, poultry and eggs, and pure
fats such as oils, butter and margarine, contain no carbohydrate.
As a result, the effect they have on glucose production is
negligible. These foods are therefore low Gl.
2.How much starch does it contain, and in what form?
• The easiest ingredient for our body to convert into glucose is
starch. When foods are raw, this starch is generally found in hard,
compact particles that the body finds hard to break down.
However, if something disturbs these starch particles (e.g. milling
into flour), the body finds it much easier to digest them and they
turn into glucose faster.
3.How much fibre does it contain?
• Fibre slows the time it takes the body to break down a food. This
is one reason why beans and pulses (which are wrapped in a
fibrous shell) have such a low Gl.
183
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Cont …
4.What kind of sugar does it contain?
• There are four main types of sugar, and they raise blood sugar levels
at different rates. Foods with a high concentration of glucose (such
as sports drinks) need no conversion, so they raise blood sugar
rapidly. Fructose (the sugar in fruit), however, converts slowly; as
does lactose which is the main sugar in dairy products. This gives the
majority of foods containing either fructose or lactose a low Gl. The fourth sugar,
sucrose, has a medium Gl.
5.Does it contain fat?
• As well as having no effect on glucose itself, fat slows the speed at which food
leaves the stomach and reaches the liver, slowing glucose production. This is the
reason why potato crisps have a lower Gl than most other types of potato.
6.How acidic it?
• Foods can contain acid ingredients - citrus fruits like oranges or lemons are a good
example of this. The tang they create on your tongue comes from the citric acid
they contain. Other acidic ingredients include lactic acid in milk products, and
added ingredients, such as vinegars, in pickled products, just like fat, acidity slows
a food's progress through the system, and therefore slows the rate at which it
converts into glucose.
184
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Glycemic load
• The glycemic index indicates only how quickly carbohydrates in a
food are absorbed into the bloodstream.
• It does not include how much carbohydrate a food contains, which
is also important.
• Glycemic load, a relatively new term, includes the glycemic index
and the amount of carbohydrate in a food.
• A food, such as carrots, bananas, watermelon, or whole-wheat
bread, may have a high glycemic index but contain relatively little
carbohydrate and thus have a low glycemic load. Such foods have
little effect on the blood sugar level.
• Glycemic load also includes how changes in blood sugar are
affected by the combination of foods eaten together. The glycemic
index does not.
185
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Glycaemic Load
• While GI is a very useful concept, it cannot be taken as the sole
predictor of the effects of eating a particular type of carbohydrate.
That is because blood glucose response is also determined by the
amount of food eaten. A more reliable rating system is the
'glycaemic load' (GL), which takes account of both the quality (GI
value) of a given carbohydrate and the amount consumed, so
more accurately predicting its effects on blood sugar.
• The glycaemic load, in units, of a portion of carbohydrate is
expressed as:
• GI rating x grams of carbohydrate in portion size / 100.
• Note that each unit of GL produces the same effect on blood sugar as eating 1g of pure glucose.
• A 120g banana contains around 24g of carbohydrate, which has a GI value of 58.
The GL is: (58 x 24) / 100 = 13.92 units.
• 120g of chocolate provides 75g of carbohydrate, which has a GI value of 49
The GL is: (75 x 49) / 100 = 36.75 units.
• By to talling up the GL units for foods you eat during the day, you can arrive at an overall GL for the
day. A Glycaemic Load of Less than 80 units is considered Low, 80 to 120 units is Medium and
greater than 120 units is High.
186
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What Is the Glycemic Load?
• The glycemic load (GL) takes into account the
amount of carbohydrate (CHO) in a common
serving in addition to its glycemic index (GI):
• Example:
– Carrots (peeled, boiled) have a GI of 47 and 5 g
CHO per serving
187
The GLG of carrots is: (47 × 5) ÷ 100 = 2.4
GL = (GI of CHO × grams of CHO per serving) ÷ 100
Abbreviations: CHO, carbohydrate; GL, glycemic load; GI, glycemic index.
Atkinson FS, et al. Diabetes Care. 2008;31(12):2281-2283.
6/4/2023 Melese .S

Glycemic Load
• Glycemic index relative to the serving size
• Some CHO have high GI but are consumed in
small quantities per serving
• GL = (GI x CHO/serving)/100
• Ratings of glycemic loads
– High GL = >20
– Medium GL = 11-19
– Low GL = <11
188
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189
High Glycemic Load Meals
• Eating high glycemic load meals, compared to
lower glycemic load meals, results in:
– Higher 24-hour blood sugar levels
– Higher insulin levels
– Higher glycosylated hemoglobin levels (HbA1c)
– Increased hunger following reactive low blood sugar
• It also results in increased risk for diabetes, obesity,
and coronary heart disease.
JAMA, May 8, 287:2415
6/4/2023 Melese .S

Glycemic Load (GL): What does it mean?
Glycemic load measures the degree of
glycemic response and insulin demand produced by
a specific amount of a specific food.
Glycemic load reflects both the quality and
the quantity of dietary carbohydrates.
GL = GI/100 x CHO (grams) per serving
Example: GL of an apple = 40/100 x 15g = 6g
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Glycemic Load (GL): Ranking
Individual food portion:
Low 0-10
Moderate 11-19
High 20+
Whole day:
Low < 80
Moderate 100
High > 120
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GI vs. GL
Glycemic Index: ranks carbohydrates based on
their immediate blood glucose
response.
GI = glycemic quality
Glycemic Load: helps predict blood glucose
response to specific amount of
specific carbohydrate food.
GL = glycemic
quality
quantity
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Benefits of Low GI Diet
Are there any documented benefits to
lowering the GI of one’s diet?
YES!
BG levels
cholesterol levels
weight
heart disease risk
type 2 DM risk
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Glycemic Load and Risk of Heart Disease
1.00 1.01
1.25
1.51
1.98
0.00
0.50
1.00
1.50
2.00
117 145 161 177 206
Risk
of
Heart
Disease
(RR)
Low glycemic load High glycemic load
N = 75,521
10 year study
Glycemic Load Quintiles
AJCN, 71:1455-61
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Women’s Health study
• Women who ate the least fiber
were twice as likely to get
diabetes as those who ate the
most fiber.
• Women with the highest
glycemic index were 51% more
likely to get diabetes then
women who ate the lowest GI
diet.
• Overall risk was 2.5 times higher
on the low fiber, high GI diet.
1.00
1.80
2.50
0.0
0.5
1.0
1.5
2.0
2.5
Risk
of
Getting
Diabetes
(RR)
Decreasing fiber
Increasing Glycemic Index
Journal of the American Medical Association 277 (6): 474-477
Glycemic Index and Dietary Fiber and Risk of Diabetes
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Glycemic Index - Oats
0 10 20 30 40 50 60 70 80 90 100 110
Table sugar
Cheerios
White bread
Quick oats
Oatmeal
Steel cut oats
65
74
70
65
55
52
Glycemic Index
Low GI is less than 55
Medium GI = 55-59
High GI = 60+
University of Sydney, Nutrition Department
Glycemic Index (GI) based on glucose
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Legumes Lower Glucose Levels and CHD Risk
• Legumes are high in fiber
and have a very low
glycemic index.
• Adding 1 cup of legumes
to the diets of 121
diabetics for 3 months
significantly lowered:
– Blood A1C levels
– Body weight and blood
pressure
– Risk of coronary heart
disease
Archives of Internal Medicine 2012;172(21):1653-1660
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Glycemic Index and Obesity
High Glycemic Index Meal
Postprandial Hyperglycemia
Hyperinsulinemia
Relative Lipogenesis
Reactive
Hypoglycemia OBESITY
Counterregulatory Hunger ↑ Food Intake
Hormones

Glycemic Index and Diabetes
High Glycemic Index Meal
Postprandial Hyperglycemia ↑ FFA
Hyperinsulinemia Glucotoxicity Lipotoxicity
Relative INSULIN
Reactive RESISTANCE
Hypoglycemia BETA CELL
FAILURE
Counterregulatory
Hormones

The Low Glycemic Index Diet:
Epidemiologic Studies
• In some but not all studies, low GI diets
are associated with:
– Increased insulin sensitivity
– Reduced adiposity
– Reduced risk of metabolic syndrome
– Reduced risk of type 2 diabetes

Clinical Trials
• Low GI diets:
– Reduce postprandial glucose levels in normal
individuals and people with diabetes (Ludwig,
JAMA, 2002)
– Produce modest improvements in HbA1c in
patients with diabetes (Brand-Miller, Diabetes Care,
2003)
– May or may not affect insulin sensitivity
(improvements noted in 2 of 7 studies)

Clinical Trials
• Low GI diets:
– May be beneficial for weight management,
particularly in individuals with features of the
metabolic syndrome (Pittas, Diabetes Care, 2005)
– May reduce LDL cholesterol and TG and
increase HDL (Luscombe, EJCN, 1999 and Pereira, JAMA,
2004)
– May reduce inflammatory markers such as C-
reactive protein (Pereira, JAMA, 2004) and IL-6 (Kallio,
AJCN, 2008)
– May increase antioxidant capacity (Botero,
Obesity, 2009)

Questions
• Does the DASH diet or the low GI improve
insulin sensitivity, in the absence of weight loss?
• Does the DASH diet or the low GI diet improve
other features of the metabolic syndrome (such
as dyslipidemia and inflammation), in the
absence of weight loss?
• Do these dietary patterns and weight loss have
synergistic effects?

205
Glycemic Load of Common Foods
Food Glycemic Load
Instant rice, ½ C 25
Baked potato, sm. 20
Corn flakes, 2/3 C 21
White bread, 2 s. 21
Rye bread, 2 slices 19
Muesli, 2/3 C 17
Food Glycemic Load
Banana, 1 13
Spaghetti, ½ cup 16
Apple, 1 fresh 8
Lentils, ½ C 6
Carrot, 1 5
Peanuts, 1 oz. 3
Broccoli, ½ C <1
Journal of the American Medical Association 287:2415
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206
Glycemic Load Principle
High Glycemic Load Foods
• Snack foods
• Fast foods
• Pastry, cookies
• Sweets
• Soda pop
• White bread/rice
• Refined carbohydrates
• Potatoes
Low Glycemic Load Foods
• Fresh fruit & Vegetables
• Legumes, peas, beans,
garbanzos, soy, tofu
• Nuts
• Whole-grain breads and
cereals including oatmeal
and brown rice
• Protein rich foods
• Healthy fats
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207
Glycemic Index of Selected Foods
Foods Glycemic Index
White Bread 100
Table sugar 84
Baked potato 104
Cheerios 106
Pancake 119
Cornflakes 120
White rice 102
Instant rice 129
Fruit punch/soda pop 95
Banana 88
Pizza 86
Foods Glycemic Index
Oatmeal 82
Orange juice 75
Bran flakes 74
All bran 72
Pasta 71
Baked beans 60
Apple, raw 51
Skim milk 46
Soy beans (soy milk 43) 35
Peanuts 20
Broccoli 15
Harvard Nutrition Department, (white bread standard)
Based on a “White Bread Standard”. To convert to the “Glucose Standard”, multiply by 0.7 .
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208
Glycemic Standards - using glucose
Glycemic Index (GI)
Low GI Less than 55
Medium GI 56-59
High GI 60 or more
Glycemic Load (GL)/Food
Low GL 10 or less
Medium GL 11-19
High GL 20 or more
University of Sydney
Glycemic Load/Day
Low GL Less than 80
High GL 150 or more
A GL of 150 or higher was linked
to a high risk of heart disease in
the Women's Health Study.
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209
Grains – Glycemic Index
Food G.I.
French bread 136
White rice 126
Corn chips 125
English muffin 110
Doughnut 108
Waffle 109
Bread, White 100
Taco shells 97
Rye bread 92
Whole wheat bread 98
Food G.I.
Pastry 84
Rice (Basmati), white 83
Pita bread 82
Brown rice 79
Oatmeal cookie 79
Sweet corn 78
Pound cake 77
WW bread, stone ground 76
Steel-cut Oats 74
Bulgur 69
Oat bran bread 68
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210
Cereals – Glycemic Index
Food G.I.
Barley, pearled, ckd 36
All-bran 60
Oatmeal, old fashioned 70
Whole wheat, quick 77
Kellogg’s mini-wheats 81
Bran chex 83
Wheat kernels, whole 84
LIFE cereal 94
Grape-nuts 96
Food G.I.
Corn meal 98
Shredded wheat 99
Cream of wheat 100
Millet 101
Cheerios 106
Corn chex 118
Corn flakes 119
Rice chex 127
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211
Fruits – Glycemic Index
Food G.I.
Cherries 32
Grapefruit 36
Apricots, dried 44
Pear 53
Apple 54
Apple juice 57
Peach 60
Orange 63
Food G.I.
Grapes 66
Orange juice 74
Banana 77
Apricots 81
Raisins 91
Apricots, canned syrup 91
Pineapple 94
Watermelon 103
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212
Legumes & Vegetables Glycemic Index
Legumes G.I.
Soy beans 26
Soy milk 44
Lentils 41
Kidney beans 42
Butter beans 44
Split peas 45
Pinto beans 55
Chick peas 60
Peanuts 21
Vegetables G.I.
Parsnips 139
Potato baked 121
French fries 107
Pumpkin 107
Potato steamed 93
Beets 91
Sweet corn 78
Sweet potato 77
Carrot 70
Green peas 68
Broccoli, greens, cabbage 20
cauliflower, s. squash
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213
Sugars – Glycemic Index
Sugars G.I.
Fructose 32
Lactose 65
Honey 83
HF corn syrup 89
Sucrose (table sugar) 92
Glucose 137
Maltose 150
Misc. foods G.I.
Milk, skim 46
Milk, full fat 39
Yogurt, sweetened 51
Tomato soup 54
Ice cream, full fat 87
Coca Cola 90
Soft drink 97
Soda crackers 106
Dates, dried 146
Tofu frozen dessert 164
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215
Risks of Excess Consumption?
Which of the following are risks of excess sugar
consumption?
– nutrient deficiencies?
– development of dental caries?
– development of Type II Diabetes? Obesity?
– hyperactivity in children?
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216
Empty Calories?
Compare:
Honey Coke Apricots
Size of 100 kcal portion 1.5
tbsp
1 cup 6
Carbohydrate (g) 26 26 24
Protein (g) trace 0 2
Calcium (mg) 2 6 30
Vitamin A (mg) 0 0 554
Vitamin C (mg) trace 0 22
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217
Dental Caries
Sugars, whether
consumed from the diet
or from complex
carbohydrates partially
digested in the mouth,
contribute to tooth
decay.
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218
Which is more cariogenic?
more likely to cause
cavities
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219
Reducing risk of caries formation
• eat sugary foods with meals
• limit between meal snacks containing sugars
and starches
• brush and floss teeth regularly
• if brush and flossing not possible, rinse teeth
with water or chew sugar-free gum
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220
Can sugar free help with weight loss?
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221
How much carbohydrate do I
need?
AMDR (Adults)
– 45 - 65% of total average energy intake
RDA for Carbohydrates (Adults) = 130 g per day
Daily Value (2000 kcal diet) = 300 g per day
AI for Fiber (Adults)*
– Men: 38 g per day
– Women: 25 g per day
Sugar = max 10% of energy intake
*Note: after age 50, recommendations decrease to 30 and 21 g per day for
men and women respectively.
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222
Sugar Recommendations
DRI:
– < 10% of average daily energy intake should be from sugars
Tips for limiting sugar intake:
– use food labels determine amount of sugar in products
– use ingredient lists to identify multiple sugar sources and added
sugars
– use less added sugar
– limit soft drinks, juice, sugary cereals, candy
– choose fresh or frozen fruits
6/4/2023 Melese .S

Calculating the Energy in Foods
• Each energy-yielding nutrient provides a set
number of kilocalories per gram
– 4 kilocalories per gram of carbohydrates
– 4 kilocalories per gram of protein
– 9 kilocalories per gram of fat (lipid)
– 7 kilocalories per gram of alcohol (non-nutrient)
• Number of kilocalories in one serving of a given
food can be determined based on
– Grams of carbohydrates, protein, and fat in the food
223
6/4/2023 Melese .S

Thank You!
227
6/4/2023 Melese .S

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