Ch.

4: Carbohydrates
I. Describe how different types of carbohydrates are formed and their functions and food sources.
1. SIMPLE
i. Monosaccharides – basic unit
a. 6 carbon, 12 hydrogen, 6 oxygen atoms
b. GLUCOSE (dextrose, blood sugar)
i. Major monosaccharide
ii. Primary energy source for human cells (glycolysis)
iii. Sources: starch, sucrose, lactose
c. FRUCTOSE (levulose, fruit sugar)
i. Most is converted to glucose in the liver
ii. Sources: sucrose, fruit, HFCS, honey
d. GALACTOSE
i. Not found in nature
ii. Attached to glucose in lactose (milk sugar)
iii. Converted to glucose in the liver
iv. Sources: dairy, avocados
e. 5 CARBON MONOSACCHARIDE
i. Pentose (5 carbons)
ii. Very little found in food
iii. Ribose (ribonucleic acid – RNA)
iv. Deoxyribose (deoxyribonucleic acid – DNA)
ii. Disaccharides – formed when 2 monosaccharides combine
a. SUCROSE – glucose + fructose
i. Table sugar
ii. Sources: sugar cane, sugar beets, honey, maple tree sap
b. LACTOSE – glucose + galactose
i. Milk sugar
ii. Lactose intolerance
c. MALTOSE – glucose + glucose
i. Created when starch is digested/broken down
2. COMPLEX
i. Polysaccharides
a. Digestible = starch and glycogen
i. Composed of many monosaccharide units; mainly glucose
ii. STARCH – amylose and amylopectin
1. Amylose  long straight chain of glucose linked by alpha bonds; makes of 20% of starch
-found in veggies, beans, breads, pasta, and rice
2. Amylopectin  branched-chain starch with glucose linked by aloha bonds; makes up 80% of
starch
-affects blood glucose more because it has more sugar
iii. GLYCOGEN  storage form of glucose in humans and animals
1. Stored in the liver and muscles

b. Indigestible – FIBER
i. We don’t have the enzymes to break beta bonds
ii. SOLUBLE (viscous fiber or fermentable)
 iii. INSOLUBLE (non-viscous fiber or non-fermentable) – structural support of plants; not fermented
by intestinal bacteria
c. INSOLUBLE FIBER
i. TYPES:
1. Cellulose (CHO)
2. Hemicelluloses (CHO)
3. Lignans (non-CHO)
ii. PROPERTY IN WATER  doesn’t really dissolve in water
iii. BENEFICIAL FUNCTION  slows down digestion (fecal bulk); can also soften stool
iv. SOURCES: whole grains, bran, flax seeds, veggies
d. SOLUBLE FIBER
i. TYPES:
1. Pectins
2. Gums
3. Mucilages
4. Some hemi-celluloses
ii. Contained around and inside plant cells
iii. PROPERTY IN WATER  dissolves/swells in water
iv. BENEFICIAL FUNCTION  slows digestion in the stomach; decreases blood cholesterol
v. Readily metabolized (fermented) by bacteria in the large intestine to form acid and gases (H2 and
CH4)
1. Propionic acid (decreases cholesterol synthesis)
2. Butyric acid (fuel source by colon cells)
3. Acetic acid (skeletal and cardiac muscles)
vi. Soluble fiber yields 1.5-2.5 kcal/g
vii. NATURAL SOURCES: oats, citrus fruits, beans, lentils, seeds
viii. ADDED TO PROCESSED FOODS: salad dressings, frozen desserts, jams/jellies, yogurt
ix. Major type of soluble fiber in the diet  PECTIN (major source of viscous fiber – mostly in fruits
and veggies)
e. DIETARY FIEBR + HEALTH BENEFITS
i. Prevents constipation
1. Insoluble fiber retains water, enlarging and softening stools  eases elimination
ii. Prevents hemorrhoids
1. Not enough fiber = hard stools  excessive straining
iii. Lowers blood cholesterol (soluble fiber)
1. Binds with bile acid; bacteria in large intestine digest soluble fiber  propionic acid 
decreases synthesis of cholesterol
iv. Prevent diverticulosis
v. Lowers body weight
1. Fuller longer; slows digestion; insoluble; bulk fills you up; delayed gastric emptying; less
caloric intake
vi. Slows down glucose absorption
1. Slows gastric emptying, digestion, and absorption (rate similar to low glycemic index food)
-slows everything down  slower increase in blood glucose
2. Type 2 diabetes risk  fiber and glucose absorption
vii. Colon cancer (inconclusive)
1. Increased contact time on colon and large intestine  could potentially cause colon cancer
 f. OLIGOSACCHARIDES
i. 3-10 single sugar units
ii. Raffinose and stachyose
iii. SOURCES: legumes (kidney beans, soybeans), onions, cabbage, broccoli, whole wheat
iv. Digestion and bacterial action
1. Bacteria in colon  oligosaccharides  acid and gases
v. Beano or soaking beans
1. Contains the “alpha galactosidase” enzyme  breaks down oligosaccharides  decreases gas
production
II. Compare the carbohydrate intake of Americans to the type of carbohydrates that are recommended.
1. Main sources of CHO in the American diet:
i. Refined grains
ii. Added sugars
iii. Starchy vegetables
a. White bread, soft drinks, cookies/cakes, jellies/jams, potatoes
iv. We should be consuming 45-60%  want to emphasize healthier carbs
a. Whole grains (not completely broken down  more fiber and nutrients)
i. Whole wheat and whole grain are different
b. Pasta, fruits, vegetables, low fat dairy, legumes
2. FIBER RECOMMENDATIONS
i. Total fiber intake: 14 g/1000 kcal
a. Double for standard 2000 kcal diet  20-30 grams/day
b. Soluble fiber intake = 15-25 grams/day
ii. 18-50 years: 25 grams/day (women) and 38 grams/day (men)
iii. > 50 years: 21 grams/day (women) and 30 grams/day (men)
iv. TOO MUCH FIBER = 60+ grams/day
a. Requires a high-water intake otherwise stool will be hard and difficult to eliminate
b. Produce intestinal gas
c. Decrease in mineral absorption
i. Binds with calcium, zinc, and iron  makes them unavailable
d. Too much fiber can make children feel full without getting enough energy
i. These calories are indigestible
II. Explain how high fructose corn syrup is made, the advantages of using it, and the food sources.
1. HFCS  55% is fructose (range from 40-90% and most of the rest is glucose
i. “high fructose” = 40% or greater
3. FOOD SOURCES:
i. Soft drinks, candies, jams, jellies, fruit products, and desserts (packaged cookies)
4. Cornstarch + acid + enzymes  glucose  some glucose is converted to fructose by enzymes
5. ADVANTAGES:
i. Sweeter  don’t need to use as much
ii. Cost effective  very cheap; used in bulk products
iii. Doesn’t crystalize
iv. Blends better
v. Better freezing properties (used in popsicles)
II. Describe the different types of artificial sweeteners available and any limitations when given.
1. SUGARS = middle ground of sweetness
2. Sugar alcohols = LOWEST relative sweetness
 i. Sorbitol
ii. Xylitol
iii. Mannitol
iv. Found in diabetic candy/gum
v. Contains 1.5-3 kcal/gram
vi. Doesn’t cause as rapid a rise in blood glucose as simple sugars
vii. Doesn’t cause cavities
viii. LIMITATION: pulls water from the blood (plasma)  may cause diarrhea
3. Alternative sweeteners = HIGHEST relative sweetness
i. ASPARTAME = phenylalanine + aspartic acid
a. NutraSweet (in food); Equal (as a powder)
b. 4 kcal/gm but 180x sweeter than sucrose  don’t need to use as much
c. Not linked to cancer; no tooth decay
d. COMPLAINTS: headaches, dizziness, seizures, nausea, allergic reactions
e. ACCEPTABLE DAILY INTAKE (FDA) = 50 mg/kg body weight
i. ~14 cans of diet soda or 80 packs of Equal/day in adults
f. Can’t be used in cooking (there is no bulk to it)
g. Phenylketonuria (PKU) – do not use this product
ii. ACESULFAME-K (SUNETTE)
a. 200x sweeter than sucrose
b. Provides no energy to the diet because it isn’t broken down
c. Can be used in cooking
i. Can provide more bulk than aspartame; still can’t break it down
iii. SACCHARIN (SWEET N LOW)
a. Used widely in soft drinks and table sweeteners
b. Alternative sweeteners  yields little/no energy
c. Linked with bladder cancer in ANIMALS
d. No longer listed as a potential in humans
iv. SUCRALOSE (SPLENDA)
a. 600x sweeter than sucrose
b. 3 hydroxyl groups on sucrose are replaced by 3 chlorines
c. Doesn’t break down under high heat  can be used for cooking/baking
III. Understand the breakdown of carbohydrates including the enzymes involved, where the action takes place,
the end products, and how the end products are absorbed and metabolized.
1. MOUTH: SALIVARY AMYLASE (in saliva)  some starch  disaccharides
i. Some starch is broken down to MALTOSE by SALIVARY AMYLASE
2. STOMACH: NOTHING REALLY HAPPENS IN THE STOMACH
i. Salivary amylase is inactivated by the acid in the stomach and no digestion of CHO takes place in the stomach
3. PANCREAS: AMYLASE (from pancreas) breaks down starch into maltose in the small intestine
4. SMALL INTESTINE: PANCREATIC AMYLASE (pancreas)  polysaccharides (starch) in small intestine 
disaccharides (maltose)
i. Enzymes in the brush borders of the small intestine breakdown disaccharides into monosaccharides
a. MALTASE  maltose  glucose + glucose
b. SUCRASE  sucrose  glucose and fructose
c. LACTASE  lactose  glucose + galactose
5. ABSORPTION OF MONOSACCHARIDES (GLUCOSE, FRUCTOSE, GALACTOSE) INTO BLOOD TO BE
TAKE TO THE LIVER VIA THE HEPATIC PORTAL VEIN
 6. LARGE INTESTINE: viscous (soluble) fiber is fermented into various acids and gases by bacteria in the large
intestine
7. RECTUM AND ANUS: nonfermentable fiber escapes digestion and is excreted in feces, but few other dietary
carbs remain
i. Most of the carbs are absorbed
ii. Fiber is really the only thing excreted
IV. Describe the major functions of carbohydrate and how blood glucose level is regulated.
1. Bacteria in large intestines  undigested disaccharides  acids and gases
2. Bacteria in large intestines  soluble fiber (not insoluble)  acids and gases
3. Glucose, galactose, and fructose from absorptive cell of small intestine  hepatic portal vein  liver
4. METABOLISM – glucose
i. Glucose  bloodstream (blood glucose goes up)
ii. Glucose  glycogen (storage in the liver or sent back into the blood)
iii. Glucose  fat (very little stored as fat)
a. Least likely outcome of the 3 possibilities
iv. Galactose and fructose  glucose
6. FUNCTIONS OF CARBS:
1. CHO SUPPLIES FOR ENERGY
i. Needed constantly
2. CHO SPARES PROTEIN FROM USE AS AN ENERGY SOURCE
i. Long-term starvation (insufficient CHO intake)  muscles/organs break down  release amino acids 
glucose
ii. If we have to use proteins, we will break down muscles and organs
iii. Protein  GLUCONEOGENSIS  to produce glucose from amino acids
3. NEED 50-100 GRAMS CHO/DAY TO PREVENT KETOSIS
1. Low CHO diets  decrease insulin release  adipose tissue releases fatty acids into bloodstream  fatty acids
enter liver and broken down incompletely  ketones released into blood  enter urine and draw water and
electrolytes  dehydration and electrolyte imbalance
2. ATKINS DIET
i. Low carb diet
ii. Look out for ketones
iii. DO utilize fat more on low carb diet
iv. Can work for some diabetics and overweight people
v. Needs to be supervised – can be risky if not done properly
4. DIABETIC KETOACIDOSIS (DKA)
i. Caused by lack of insulin in the body
a. Body isn’t breaking down or utilizing the fats
II. Describe the recommendations for carbohydrates for healthy people and people with metabolic syndrome
or abnormal lipid profile.
1. METABOLIC SYNDROME
i. CAUSES:
a. Low levels of physical activity
b. Obesity
c. CHO rich diet (specifically refined CHO and added sugars)
d. Low fiber diet (leads to CHO rich diet and obesity)
ii. RESOLVE/IMPROVE THROUGH DIET AND EXERCISE
iii. RISK INDICATORS
 a. HIGH BP
b. LOW HDLC
c. ELEVATED GLUCOSE
d. ELEVATED TGs (BLOOD FAT)
e. ABDOMINAL OBESITY – in centimeters
iv. MEDICAL CONDITIONS RELATED TO METABOLIC SYNDROME:
a. Type 2 diabetes
b. Coronary artery disease
c. Stroke
III. Describe the problems with High-Sugar Diets.
1. DIETARY GUIDELINES: < 10% of energy from added sugars
i. Actually consume about 14%
2. LOW NUTRIENT QUALITY
i. Not nutrient dense foods
3. WEIGHT GAIN
i. Body gets addicted to sugar
a. Dopamine release – similar to how SSRIs work
b. Can have withdrawal symptoms and have to taper off of sugar
ii. More cravings  more consumption  more weight gain
4. TYPE 2 DIABETES
5. METABOLIC SYNDROME
6. CORONARY HEART DISEASE
7. TEENAGERS
i. The most added sugar consumption
ii. Higher soda consumption vs. lower milk (calcium) consumption  may have a higher risk for osteoporosis
IV. Identify the different types of sugars used in foods and foods that are considered “healthy” but contain a lot
of added sugar.
1. SUGARS USED IN FOODS:
i. Sugar, sucrose, brown sugar, powdered sugar, turbinado sugar, invert sugar, glucose, sorbitol, levulose,
polydextrose, lactose, honey, corn syrup/sweeteners, HFCS, molasses, date sugar, maple syrup, dextrose,
fructose, maltodextrins, caramel (from starch), fruit sugar
2. TYPES OF ADDED SUGAR:
i. HFCS, honey, fruit syrup, molasses, barley malt, maple syrup
3. Many foods that are considered “nutritious” are actually high in added sugars
i. Yogurt, granola, frozen fruit bars, juice drinks, sorbet, bran muffins, breakfast cereals
V. Define glycemic index (GI) and how it is calculated, identify foods with high and low GI, and explain the
factors that influence GI.
1. GLYCEMIC INDEX  blood glucose response to a given food compared to a standard such as glucose or white
bread
i. GI = the incremental area under the blood glucose curve after the test meal is eaten DIVIDED BY the
corresponding area after the standard food is eaten MULTIPLIED BY 100
ii. GI TEST:
a. subjects are given a test food and a standard food on separate days
b. each food contains 50 g of available CHO
c. change in blood glucose is measured for 2 hours
iii. LOW GI FOODS = BELOW 55
iv. INTERMEDIATE GI FOODS = 55-70
v. HIGH GI FOODS = MORE THAN 70
 vi. LOW GL FOODS = BELOW 15
vii. INTERMEDIATE GI FOODS = 15-20
viii. HIGH GI FOODS = MORE THAN 20
ix. GLYCEMIC LOAD  takes into account the servings needed to raise glucose
a. May be better to calculate GL rather than GI
b. GL = GI x grams of available CHO per serving/100
VI. Describe the relationship between glycemic index and lipids, blood glucose and insulin, and type 2 diabetes
and discuss the recommendations for the general public.
1. GLYCEMIC INDEX INFLUENCED BY:
i. Fiber content – soluble fiber
ii. Starch structure
a. Type: amylopectin vs. amylose
b. Baking vs. red potatoes
c. Different types of rice have different GI
d. Pasta: macaroni (68), star pastina (54), and spaghetti (41)
iii. Food processing: grinding, rolling, pressing a grain
a. More processed  broken down faster by the body  higher glycemic index
iv. Physical structure
a. Mashed vs. whole potatoes; whole apple, apple puree, and apple juice; thick vs. thin linguini
v. Macronutrients – fat
vi. Acid
a. Lowers GI by slowing gastric emptying
vii. Sugar
2. GLYCEMIC INDEX AND CHRONICALLY HIGH-INSULIN EFFECTS
i. Fat synthesis in the liver
ii. TGs and VLDLC
iii. HDLC
iv. LDL particle type
v. Fat deposition in adipose tissue
vi. Tendency for blood to clot
vii. Hunger
viii. Glycemic index and time to digest
3. GLYCEMIC INDEX + CONCLUSIONS
i. Limit amount of high GI foods at any one meal
ii. Combine low-GI foods with high-GI foods
iii. Total energy intake – how much a person eats may be more important than what they eat
iv. Maintain a healthy body weight
v. Perform regular exercise
VII. Describe the causes, symptoms, and treatment of lactose intolerance.
1. CAUSE: insufficient lactase
2. CONSEQUENCES:
i. Bacteria (large intestine)  lactose  acid + gases
ii. Lactose draws water from the blood  diarrhea
3. SYMPTOMS: abdominal pain, gas diarrhea
4. RISK FACTORS:
i. Age
ii. Ethnicity (African-Americans, Hispanics, Asians)
 5. TREATMENT
i. Can tolerate some milk (1/2 – cup) with meals
a. Include some dietary fat to slow digestion
ii. Cheese
a. Only trace amounts of lactose remain after processing
iii. Yogurt with acidophilus bacteria
a. Makes own lactase
b. Doesn’t apply to frozen yogurt
iv. Low-lactose milk
v. Lactase pills
VIII. Define hyperglycemia and hypoglycemia, and describe the different types of diabetes as well as diagnosis,
screening, causes, symptoms, and treatment.
IX. Complications of Diabetes
1. NERVE DAMAGE – microvascular damage
i. PREVALENCE: 60-70% have mild/severe forms of nerve damage
ii. DUE TO: glycated protein
iii. CONSEQUENCES:
a. Numbness in hands and feet
b. Impotence
c. Slows digestion; intermittent diarrhea and constipation
d. Carpel tunnel syndrome
2. KIDNEY DISEASE – microvascular damage
i. Diabetes is the leading cause of kidney failure
ii. DUE TO: too much pressure on glomerulus  glucose (and ketones) in the urine
iii. TREATMENT: ACE inhibitors (lowers BP)  prevents progression of kidney disease
3. BLINDNESS – microvascular damage
i. Diabetes is the leading cause of blindness
ii. Causes retinopathy
iii. TREATMENT: laser treatment can halt damage to retina; helps to stop the bleeding
4. CVD – macrovascular damage
i. DUE TO:
a. Glycated proteins  damages blood vessels
b. Glycated proteins  blood vessels more rigid (can’t vasodilate when they need to)
c. High blood glucose  increases TGs and small dense LDLC
ii. BRITISH STUDIES
a. Increase in CVD after type 2 diabetes
b. Need to control glycemia
iii. Aggressive glycemic control
7. INSULIN RESISTANCE AND CVD
i. Insulin resistance  hyperinsulinemia  increase TG  TG are incorporated into VLDLC and released into
blood  increase LDLC and decrease HDLC
ii. Insulin resistance  hyperinsulinemia  increase SNS activity  increase peripheral vascular resistance
(vasoconstriction) – TPR and increase cardiac output, HR, and renal sodium retention  increase BP
II. Explain the carbohydrate needs and sources for athletes and the recommendations for dietary fiber, fat, and
protein; describe CHO-loading regimen including the objective, method, disadvantages and possible
alternatives; describe ways to achieve the most rapid replenishment of muscle glycogen after exercise.
1. CHO-LOADING REGIMEN
 i. GOAL: energy storage (make sure the tanks are full) – glycogen storage in muscle
ii. DISADVANTAGE: lose ROM
iii. ALT. APPROACH: sugar load during physical activity
iv. COMMON PROTOCOL: can supposedly increase glycogen stores
a. Exercise hard before then deplete
2. CARB NEEDS FOR ATHLETES
i. Avoid high-fat foods (chips, fries)
ii. Fiber intake
a. Moderate during last day of training and before event to reduce bloating
b. Slows digestion
c. Decrease intake of high fiber foods prior to event
iii. Continuous intense aerobic events > 60-90 min:
a. CHO-loading regimen for anything over an hour
iv. Regular vigorous exercise > 1 hour/day  need to take in more carbs
a. 50-60% energy from CHO depending on total energy intake
b. SOURCES: fruits, vegetables, grains, low fat dairy