The document discusses carbohydrates and their role in nutrition. It covers the classification of carbohydrates into monosaccharides, disaccharides, and polysaccharides. Key carbohydrates discussed include glucose, fructose, galactose, sucrose, lactose, maltose, starch, glycogen and dietary fiber. Sweeteners and their use, as well as diabetes and cutting back on sugar intake are also summarized.

1. Carbohydrates in Nutrition; Sweeteners; Diabetes Mellitus; Lactose Intolerance Chapter 2

2. Carbohydrates The most abundant organic molecules in nature. Are organic compounds of the elements carbon, hydrogen, and oxygen. They provide a significant fraction of energy, storage energy and some intercellular communication. the principal sources of energy in the diet, also act as starting materials for the synthesis of fatty acids and amino acids. Play a role in the structure of other biologically important materials, such as glycolipids, glycoprotein, nucleic acids and heparin. 2-

3. Carbohydrates The simplest and classified according to the number of carbon atoms in the chain Most common are pentoses (five-carbon monosaccharides) and the hexoses (six-carbon monosaccharides. 2- Monosaccharides Disaccharides Polysaccharides Classification

4. Pentoses (Five-Carbon Sugars) Are synthesized by the body, which are components of nucleic acids and nucleotides, which acts as coenzymes in energy production. Two pentoses are of vital importance: ribose and deoxyribose. The pentose sugars most commonly present in human foods are l-arabinose and D-xylose, which are widely distributed in nuts, fruits, and root vegetables. 2-

5. Hexoses (Six-Carbon Sugars) Also called dextrose, grape sugar and corn sugar A white crystalline solid that is soluble in water and is about half as sweet as sucrose (table sugar) Is the form of carbohydrate that the body tissue can best use It is oxidized in the cells for energy and the only fuel for the brain The major food sources are honey, fruits and corn syrup. 2- Glucose Fructose Galactose Types

6. Hexoses (Six-Carbon Sugars) Also called levulose or fruit sugar Is structurally related to glucose The sweetest of all the sugars and is found along with glucose in honey, fruits and corn syrup It is a constituent of common table sugar 2- Glucose Fructose Galactose Types

7. Hexoses (Six-Carbon Sugars Derived from the hydrolysis of lactose, the sugar found in milk and is a constituent of many plant polysaccharides During lactation, the human body converts glucose to galactose in the mammary tissue for the synthesis of lactose in breast milk 2- Glucose Fructose Galactose Types

8. Carbohydrates Are two joined monosaccharides and the simplest polysaccharides Composed of two monosaccharides units bound together by a covalent bond known as a glycosidic linkage formed via a dehydration reaction, resulting in the loss of hydrogen atom from one monosaccharide and a hydroxyl group from the other 2- Monosaccharides Disaccharides Polysaccharides Classification

9. Disaccharides A disaccharide that is readily hydrolyzed into glucose and fructose by boiling with acids or by the action of certain enzymes (invertase) forming “invert sugar” Available as a refined carbohydrate in such form as granulated, powdered, brown and raw sugar. Extensively used as a sweetener in food preservation, in food processing, and in pill- or tablet-making for pharmaceutical preparations 2- Sucrose Lactose Maltose Types

10. Disaccharides Or milk sugar, unique to mammals and found in mammary glands Makes up almost 40% of the solids in fresh whole milk A by product in the manufacture of cheese On hydrolysis with acids or enzymes (galactase), lactose yields glucose and galactose 2- Sucrose Lactose Maltose Types

11. Disaccharides Also known as malt sugar Formed by uniting two units of glucose that provide the first link in a process that eventually results in the creation of starch An important component in the process of creating fermented barley that in turn can be used to brew beer 2- Sucrose Lactose Maltose Types

12. Carbohydrates Are complex carbohydrates made up of many (more than 10) monosaccharides linked together They are tasteless and molecular weight ranges from 20,000 to 1,000,000 Some are used for storing energy (starch, glycogen, dextran and insulin) and others have strutural functions (cellulose, pectin, agar and carrageen) 4- Monosaccharides Disaccharides Polysaccharides Classifications

13. Polysaccharides The most important carbohydrate, providing about 50% of the total carbohydrate intake It is a major source of energy and provides texture and consistency to many food preparations Rice, wheat, sorghum, corn, millet and rye contain about 70% starch and are outstanding sources of carbohydrate 2- Starch Glycogen Dextrans For Storing Energ y

14. Polysaccharides The animal equivalent of starch and provides a food storage system for all forms of animal life. Found in highest concentration in the liver, where it serves as an important regulator of blood glucose concentration Also stored in muscles, where it serves as energy source for muscle contraction 2- Starch Glycogen Dextrans For Storing Energ y

15. Polysaccharides A complex, branched glucan (polysaccharide made of many glucose molecules) composed of chains of varying lengths Form the substrate for dental plaque and serve as the energy source for potentially dental caries – producing bacteria such as Streptococcus mutans 2- Starch Glycogen Dextrans For Storing Energy

16. Polysaccharides Provides the fibrous framework for the plant A good source for fiber Aids in the production of soft stools, in peristalsis, and in the elimination of water 2- Cellulose Pectin Agar For Structural Functions

17. Polysaccharides A polysaccharides that acts as a cementing material in the cell walls of plant tissues Found in small quantities in many fruits, young green plants, and root vegetables In the presence of sugars and a warm, slightly acid solution, pectin turns into jelly. This property is responsible for the setting of jams and fruit preserves 2- Cellulose Pectin Agar For Structural Functions

18. Polysaccharides Is extracted from seaweeds and is used in many foods as a gelling agents Is used as a food additive to improve the texture and consistency of such foods as ice cream 2- Cellulose Pectin Agar For Structural Functions

19. Sugars The refined granulated product used for table-top purposes. Three types of sugar mixtures for commercial use: Blended sugar (50% sucrose & 50% glucose) Pure invert sugar (50% glucose & 50% fructose) Common invert sugar (50% sucrose, 25% glucose & 25% fructose 2-

20. Why Do We Use Sugar? Sweet taste The desire for sweet taste increases with age in many people

21. Why Do We Use Sugar? Preserve jams and jellies Volume and texture in baked goods and ice-cream Fermentation in breads

22. Types of Sweeteners Nutritive sweeteners Contain calories Nonnutritive sweeteners (high intensity sweetener) Contain little or no calories

23. Nutritive Sweeteners Sugars: Glucose Sucrose Fructose Lactose Maltose Honey Corn syrup High fructose corn syrup Brown sugar All are equivalent in calories: about 4 calories per gram or about 16 calories per teaspoon

24. Nutritive Sweeteners Sorbitol Mannitol Maltitol Erythritol Xylitol Lactitol Isomalt Hydrogenated starch hydrolysates (combination of polyols) Sugar alcohols or polyols

25. Sugar alcohols/Polyols Used in many “sugar-free,” “low-carb,” and reduced calorie products gum, candy, desserts, ice-cream, cough drops and syrup Absorbed more slowly than “sugar”

26. Sugar Alcohols/Polyols Advantages Do not promote tooth decay May have less effect on blood sugar in people with diabetes Most have fewer calories than sugar (about 2 calories per gram compared to 4) Disadvantages May have laxative effect (gas, bloating, diarrhea) May be in foods that are not that low in calories or fat

27. High-Intensity Sweeteners Advantages Little or no calories No effect on blood sugar in diabetes Disadvantages Some have unpleasant aftertaste Cannot replace sugar entirely in baked products

28. Read the Label! Foods with high intensity sweeteners may be combined with other ingredients Check the Nutrition Facts label for calories, carbohydrate, and fat

29. Nonnutritive Sweeteners (high-intensity) Acesulfame potassium Sunette, Sweet-One Aspartame Equal, NutraSweet Neotame Saccharin Sweet ‘n Low, etc Sucralose Splenda Approved by Food and Drug Administration (FDA):

30. When Can You Use a High-Intensity Sweetener? Beverages Cooking and baking when sugar is not needed for volume, texture, structure Fruit cobblers and pies Sauces Puddings

31. What Foods Work Better With Sugar? Cakes Cookies Yeast breads

32. Sugar’s Role in Baked Goods Sugar provides to baked goods: browning tenderness structure volume texture

33. Why Reduce Sugar Intake? Contains calories, but no nutritional value Medical conditions: Overweight/obesity Diabetes High triglycerides

34. How Can You Cut Back on Sugar? Reduce added sugar by up to ½ Replace some or all of the sugar with a high-intensity sweetener Check guidelines for specific sweeteners for use in recipes Use canned fruit packed in juice

35. How Can You Cut Back on Sugar? Replace high-sugar beverages with sugar-free beverages Size Calories Super-size 410 Large 320 Medium 220

36. Points to Remember High-sugar foods and beverages are usually high in calories and low in nutritional value Cut back on sugar by using less added sugar or substituting high-intensity sweeteners Many “sugar-free” foods are not “calorie-free” Baked products often require some sugar for acceptable quality

37. Diabetes Mellitus This is a disorder of carbohydrate metabolism in which the ability to oxidize and utilize carbohydrates is lost as a result of disturbances in the normal mechanism

38. The disorder is characterized by: Elevated blood sugar (hyperglycemia) Polyuria-excessive urination Polydipsia-increased thirst Polyphagia-increased appetite Involuntary weight loss Visual disturbances (retinopathy/osmotic lens shape changes) Candidal pharyngitis/vaginitis Acute ketotic illness

39. Diabetes Mellitus : a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action , or both 20.8 million in US ( 7% of population) estimated 14.6 million diagnosed (only 2/3) Consists of 3 types: 1) Type 1 diabetes 2) Type 2 diabetes 3) Gestational diabetes Complications : - Stroke - Heart attack - Kidney disease - Eye Disease - Nerve Damage

40. Diabetes Mellitus Type 1 Diabetes - cells that produce insulin are destroyed - results in insulin dependence - commonly detected before 30 Type 2 Diabetes - blood glucose levels rise due to 1) Lack of insulin production 2) Insufficient insulin action (resistant cells) - commonly detected after 40 - effects > 90% - eventually leads to β -cell failure (resulting in insulin dependence) Gestational Diabetes 3-5% of pregnant women in the US develop gestational diabetes

41. Testing : Fasting Plasma Glucose Test (FPG) - (cheap, fast) *fasting B.G.L. 100-125 mg/dl signals pre-diabetes *>126 mg/dl signals diabetes Oral Glucose Tolerance Test (OGTT) *tested for 2 hrs after glucose- rich drink *140-199 mg/dl signals pre- diabetes *>200 mg/dl signals diabetes 80 to 90 mg per 100 ml, is the normal fasting blood glucose concentration in humans and most mammals which is associated with very low levels of insulin secretion. A.K.A.: Glycated Hemoglobin tests A1C

42. Management of DM Diet Oral Hypoglycemic Agents Insulin

43. Diet Cornerstone of diabetic therapy Individualized, tailored to the needs of the patient The goal is proper growth and development (for the young diabetics) and normalization of weight in the normal work or school setting without hyperglycemia or hypoglycemia

44. Oral Hypoglycemic Agents The oral agents sulfonylureas and arysylfonylureas are indicated for Type II DM patients Side effects include: toxic reactions Nausea, vomiting, Dyspnea, Palpitations

45. Insulin Indicated (together with dietary manipulation as the primary mode of metabolic control for: Newly diagnosed Type I diabetics Type II diabetics failing to maintain adequate glycemic control on oral hypoglycemic medications Preoperatively Drug pregnancy

46. Dental Correlations Generally accepted that there is a direct relationship between DM and dental diseases Symptoms can be related to salivary and dental changes, periodontal and mucosal abnormalities, opportunistic infections, acetone or diabetic breath and altered wound healing

47. Dental Management Obtain a comprehensive medical history from the known or suspected diabetic patient Establish the severity and degree of control before instituting any dental management When the patient’s diabetes is well controlled and there are no concurrent medical problems, he may receive appropriate dental therapy without modification of accepted dental protocols When the patient’s diabetes is uncontrolled, or when there is a serious underlying organic disease, elective care or surgical procedure should be delayed until blood glucose level has been regulated

48. When the severity of diabetics or the degree of control is not known, treatment should be limited to palliation In the dental treatment of all diabetics, reduce pain as much as possible. The stress stimulates the release of epinephrine, which in turn, increases the blood glucose level Be careful with antimicrobial therapy, excessive use of unnecessary antibiotics can lead to oral or systemic fungal infections

49. Lactose intolerance

50. Overview Lactose intolerance is the inability to digest lactose (a type of sugar found in milk and other dairy products).

51. Symptoms *Abdominal bloating& Abdominal cramps *Diarrhea *Floating stools & Foul-smelling stools *Gas (flatulence) *Malnutrition *Nausea*Slow growth *Weight loss

52. Causes Lactose intolerance happens when the small intestine does not make enough of the enzyme lactase. Babies' bodies make this enzyme so they can digest milk, including breast milk. Before humans became dairy farmers, most people did not continue to drink milk, so their bodies did not make lactase after early childhood. Lactose intolerance is more common in Asian, African, African-American, Native American, and Mediterranean populations than it is among northern and western Approximately 30 million American adults have some amount of lactose intolerance by age Not having enough lactase (lactase deficiency) may also occur as a result of intestinal diseases such as celiac sprue and gastroenteritis, or after bowel surgery. Temporary lactase deficiency can result from viral and bacterial infections, especially in children, when the cells lining the intestine are injured.

53. Tests & diagnosis *Enteroscopy *Lactose-hydrogen breath test *Lactose tolerance test *Test for stool-reducing substances

54. Prevention There is no known way to prevent lactose intolerance. If you have the condition, avoiding or restricting the amount of milk products in your diet can reduce or prevent symptoms.

55. Treatment *Buttermilk and cheeses (they have less lactose than milk *Fermented milk products, such as yogurt *Goat's milk (but drink it with meals, and make sure it is supplemented with essential amino acids and vitamins if you give it to children) *Ice cream, milkshakes, and aged or hard cheeses *Lactose-free milk and milk products *Lactase-treated cow's milk for older children and adults *Soy formulas for infants younger than 2 years *Soy or rice milk for toddlers *Take calcium supplements *Eat foods that have more calcium (leafy greens, oysters, sardines, canned salmon, shrimp, and broccoli) *Drink orange juice that contains added calcium

56. Complications Weight loss and malnutrition are possible complications.