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Basic Nutrition

Physical Therapy Department for surgery

Faculty of Physical Therapy- Cairo University
Teaching Prof. Dr /Wafaa H. Borhan
Staff Professor in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University

Ass.Prof.Dr /Samah H. Nagib

Assistant Professor in Physical Therapy Department for surgery-
Faculty of Physical Therapy-Cairo University

Dr /Haidy N. Ashem
Lecturer in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University
 Carbohydrates

Dr /Haidy N. Ashem
Lecturer in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University
By the end of this lecture, the students will be able to:
 Identify the importance of carbohydrates.
 Determine the different types of
carbohydrate
 Explain the digestion and absorption of
carbohydrate
Definition:
 Main source of energy
 organic molecules
 Include: simple sugars ( mono
&disaccharides)
 Starch & fibers(oligo& polysaccharides)
 Account for (50%-75%) of total dietary
energy
 One gram of CHO supplies 4Kcal
functions of CHO
Carbohydrates (glycans) have the following
basic composition: I
(CH2O)n or H - C - OH
I
 Monosaccharides - simple sugars. Based on number
of carbons (3, 4, 5, 6), a monosaccharide is a triose,
tetrose, pentose or hexose.
 Disaccharides - 2 monosaccharides.
 Oligosaccharides - a few monosaccharides.
 Polysaccharides - polymers consisting of chains of
monosaccharide or disaccharide units.
 Carbohydrates
• glucose provides energy for the brain and ½
of energy for muscles and tissues
• glycogen is stored glucose
• glucose is immediate energy
• glycogen is reserve energy
 Carbohydrates
• all plant food
• milk

• carbohydrates are not equal

– simple carbohydrates
– complex carbohydrates
 Simple Carbohydrates
• sugars
– monosaccharides – single sugars
– disaccharides – 2 monosaccharides
 Complex Carbohydrates
• starches and fibers
• polysaccharides
– chains of monosaccharides
 Simple Carbs
 monosaccharides
– all are 6 carbon hexes
 6 carbons
 12 hydrogens
 6 oxygens
 arrangement differs
– accounts for varying sweetness
– glucose, fructose, galactose
 Glucose
 mild sweet flavor
 known as blood sugar
 essential energy source
 found in every
disaccharide and
polysaccharide
 Fructose
• sweetest sugar
• found in fruits and honey
• added to soft drinks,
cereals, deserts
 Galactose
• hardly tastes sweet
• rarely found
naturally as a single
sugar
 Disaccharides
• pairs of the monosaccharides
– glucose is always present
– 2nd of the pair could be fructose, galactose or
another glucose
– taken apart by hydrolysis
– put together by condensation
– hydrolysis and condensation occur with all energy
nutrients
– maltose, sucrose, lactose
 Condensation
• making a disaccharide
– chemical reaction linking 2
monosaccharides
 Hydrolysis
• breaking a disaccharide
– water molecule splits
– occurs during digestion
 Maltose

• 2 glucose units
• produced when starch breaks down
• not abundant
 Sucrose
• fructose and glucose
• tastes sweet
– fruit, vegetables,
grains
• table sugar is refined
sugarcane and sugar
beets
• brown, white,
powdered
 Lactose
• glucose and galactose
• main carbohydrate in
milk
– known as milk sugar
 Complex Carbohydrates
 polysaccharides
– glycogen and starch
 built entirely of glucose
– fiber
 variety of monosaccharides and other carbohydrate
derivatives
 Glycogen
• limited in meat and not found in plants
– not an important dietary source of carbohydrate
• BUT
– all glucose is stored as glycogen
– long chains allow for
hydrolysis and release
of energy
 Starches
• stored in plant cells
• body hydrolyzes plant starch to glucose
 Fiber
• structural parts of plants
– found in all plant derived food
• bonds of fibers cannot be broken down
during the digestive process
– minimal or no energy available
 Fiber types

 cellulose
 pectins
 lignins
 resistant starches
– classified as fibers
– escape digestion and
absorption
 Fiber Characteristics
• soluble fibers, viscous, fermentable
– easily digested by bacteria in colon
– associated with protection against heart disease
and diabetes
• lower cholesterol and glucose levels
– found in legumes and fruits
 Fiber
• insoluble and not easily fermented
– promote bowel movements
– alleviate constipation
– found in grains and vegetables
 DRI and Fiber
• distinguish fibers by source
– dietary fibers: naturally in intact plants
– functional fibers: extracted from plants or
manufactured
– total fiber: sum of the 2
 Carbohydrate Digestion
• break down into glucose
– body is able to absorb and use
• large starch molecules
– extensive breakdown
• disaccharides
– broken once
• monosaccharides
– don’t need to be broken down
 Carbohydrate Digestion
• begins in mouth
– chewing releases saliva
– enzyme amylase hydrolyzes starch to
polysaccharides and maltose
• stomach
– no enzymes available to break down starch
– acid does some breakdown
– fibers in starch provide feeling of fullness
• small intestine
– majority of carbohydrate digestion takes
place here
– pancreatic amylase reduces carbs to glucose
chains or disaccharides
– specific enzymes finish the job
• maltase
– maltose into 2 glucose
• sucrase
– sucrose into glucose and fructose
• lactase
– lactose into glucose and galactose
• large intestine
– 1-4 hours for sugars and starches
to be digested
– only fibers remain
• attract water, which softens stool
– bacteria ferment some fibers
• water, gas, short-chain fatty acids
(used for energy)
 Carbohydrate Absorption
• glucose can be absorbed in the mouth
• majority absorbed in small intestine
– active transport
• glucose and galactic
– facilitated diffusion
• fructose
• smaller rise in blood glucose
 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
 Lactose Intolerance
• age, damage, medication, diarrhea,
malnutrition
• management requires dietary change
– 6 grams (1/2 cup) usually tolerable
– take in gradually
– hard cheeses & cottage cheese
– enzyme drops or tablets
• lactose free diet is extremely difficult to
accomplish
 Carbohydrate Metabolism
• 1/3 of body’s glycogen is stored in liver
– released as glucose to bloodstream
1. eat – intake glucose
2. liver condenses extra glucose to glycogen
3. blood glucose falls
4. liver hydrolyzes glycogen to glucose

Glycogen is bulky, so we store only so much:

short term energy supply
Fat is the long term energy supply.
 Glucose for Energy
• enzymes break apart glucose – yielding
energy
• inadequate supply of carbohydrates
– ketone bodies (fat fragments) are an alternate
energy source during starvation
– excess ketones can lead to ketosis: imbalance
of acids in body
• minimum of 50 – 100 grams of carbs/day are
needed to avoid ketosis
 Glucose Homeostasis
 maintaining an even balance of glucose is
controlled by insulin and glucagon
– insulin
 moves glucose into the blood
– glucagon
 brings glucose out of storage
• maintaining balance
– balanced meals at regular intervals
• fiber and some fat slow the digestive process down
• glucose gets into the blood slow and steady
 Imbalance
• diabetes
– after food intake, blood glucose rises and is not
regulated because insulin is inadequate
• hypoglycemia
– blood glucose drops dramatically
• too much insulin, activity, inadequate food intake,
illness
• diet adjustment includes fiber-rich carbs and protein
 Glycemic Index

• way of classifying
food according to
their ability to raise
blood glucose
• much controversy
 Sugar

• ½ comes from natural sources, ½ from

refined and added
– sucrose, corn syrup, honey
• excess can lead to nutrient deficiencies
and tooth decay
– empty calories
– sugar and starch break down in the mouth
 Sugar
 recommended intake
– added sugar = no more than 10% of energy intake
 Starch and Fiber
 diet that includes starch, fiber and natural
sugars
– whole grains, vegetables, legumes, fruits
 may protect against heart disease and stroke
 reduces the risk of type 2 diabetes
 enhances the health of the large intestine
 can promote weight loss
Starch and Fiber
• starch intake
– RDA is 130 grams
• fiber intake
– Daily Value is 25 grams/2000 kcal
 Groceries
• grains: 1 serving = 15 grams
• vegetables
– ½ cup starchy = 15 grams
– ½ cup nonstarchy = 5 grams
• fruit: 1 serving = 15 grams
• milk: 1 cup = 12 grams
• meat: none or little
• legumes: ½ cup = 15 grams
 Artificial Sweeteners
• help keep sugar and energy intake down
• anything we eat has FDA approval
– saccharin
– aspartame
– acesulfame potassium
– sucralose
– neotame
 Sugar Replacers
 sugar alcohols
– provide bulk and sweetness
 cookies, gum, candy, jelly
– do contain minimal kcal
– low glycemic response
 absorbed slowly
– do not cause dental caries