Module 4

Lecture 1

 Carbohydrates: contains C, H, and O in the same proportion as water.

 So, there are always twice as many hydrogens as there is oxygen.
 CHO:
1- Simple: glucose, fructose, galactose, lactose, maltose, sucrose
2- Complex: starch
 All carbs are made of monosaccharides. Ex: glucose, fructose, galactose.
 Disaccharides: is made of two sugars. Ex: maltose, sucrose, lactose.
 Maltose is glucose and glucose, sucrose is glucose and fructose, lactose is glucose and
galactose.
 Glucose: 6 sided, fructose: 5 sided, galactose: 6 sided (diff between glu and gal is on the
4th carbon).
 Disaccharidases are the enzymes used to digest disaccharides.
 Maltose  maltase enzyme, sucrose  sucrase enzyme, lactose  lactase enzyme.
 The disaccharides are the smallest absorbable units, they get absorbed into the portal
vein.
 Hydrolysis breaks down disaccharides using a water molecule.
 Condensation builds a disaccharide by removing a water molecule.
 We cannot do condensation, plants can.
 Oligosaccharides:
o Are prebiotics, found in yogurt
o 3-12 monosaccharides linked
o Food for healthy bacteria in gut.
o Probiotic: living bacteria
 Polysaccharide: many monosaccharides linked together.
 Polysaccharides and oligosaccharides are in-between simple and complex.
 Complex carbs = starch.
 Starch is many glucose units linked together.
 Starch is found in plants; glycogen is found in animal liver. (they’re both complex).
 Starch and glycogen are energy storage units.
 Fiber is not like starch; we do not have enzymes to break it down.
 Fiber is not digested, its fermented: bacterial breakdown of fiber.
 Cellulose is an example of fiber.

 Carbs in the diet:

 DRI values: 45-65% of daily intake
 Largest component of the diet.
 Grain products are the main source of carbs.
 vegetables like peas, green beans, carrots, potatoes are good sources of starch.
 Fruits have simple sugars.
 Milk has lactose, soy beverages have simple sugars and starch.
 Meat has glycogen, but the meat we eat has aged so it has no glycogen left, so it’s not a
source of carbs. But the alternatives like legumes and nuts have starch.
 In North America, the carbs intake is 53%.
 In Africa, it is 80%.
 In the Caribbean, it is 65%.
 In Africa and Caribbean, they got carbs from starch and fiber rich foods like cassava,
whole grains, legumes, and veggies and fruits.
 In North America, carbs intake has overall decreased by 25-30%, while having overall
higher intake of fat, protein, and refined carbs.
 Refined carbs: taking something like whole grains and milling it to remove the outer
layer.
 The layer has vitamin B and nutrients that are removed.
 Refined carbs are made of white flour, white rice, simple sugars.

 Carbs digestion and absorption:

 Mouth: some starch  salivary amylase  maltose
 Stomach: HCL acid  inactivates salivary amylase (any enzyme we eat is inactivated)
 Small intestine: main digesting and absorption site.

Starting CHO [ starch maltose sucrose lactose

Enzyme [ pancreatic amylase maltase sucrase lactase
Products [ maltose glu+glu glu+fru glu+galac

 Water soluble, so they head to hepatic portal vein  liver.

 Monosaccharide metabolism:
 In the liver:
a) Fructose and galactose  become glucose
b) glucose used by the liver for Kcal
c) glucose stored as energy in form of glycogen
d) glucose used to make non-essential amino acids
e) too much glucose  converted to fat  VLDL takes to adipose tissue
f) glucose can go in bloodstream to be used by other tissues
 in the bloodstream:
a) fuel (4kcal/g) for most body cells (red blood cells, brain, kidney cortex)
 o Body cells use a combination of sugar and fatty acids, but some tissues can only
use glucose.
b) Stored as glycogen in muscles.

 Glucose facts:
 Monosaccharide found in foods only in small amounts.
 Main energy source for the brain, CNS, red blood cells, kidney cortex.

 Insulin:
 When glucose is released from the liver  high blood glucose  activates pancreas 
makes insulin.
 Insulin is made by beta cells.
 Insulin is anabolic: tissue building.
 Effects:
1- Facilitates the uptake of glucose in the blood into cells for energy.
2- Stimulates the production of liver glycogen.
3- Blood glucose level returns to normal level (4.5-5.5 millimolar).
 When blood glucose drops  alpha cells in pancreas make glucagon.
 Insulin production drops and glucagon production rises.
 Liver glycogen  broken to glucose  released to bloodstream
 Results in blood glucose correction, now blood glucose returns to normal.
 When blood glucose drops, we get hungry.
 Figure 4.22 summarises this.
 Type 2 diabetes is closely linked with obesity and has been rising.
 Type 2 diabetes increased from 0.93% to 7.40%.
 Who’s at risk of type 2 diabetes:
1- Older people
2- Less physical activity
3- Family history
4- High blood pressure
5- History of gestational diabetes
6- Overweight
 Gestational diabetes: type 2 diabetes during pregnancy.
 Diabetes happens when pancreas responds differently to glucose levels.

Lecture 02

 95% type 2, 5% type 1

 Types of diabetes:
 Type 1: pancreas cannot produce effective insulin.
 They need to take insulin.
 It is genetic based, and environmental like a virus in infancy that infects beta cells in the
pancreas.
 Type 2: body cells become resistant to insulin.
 Treatments are exercise, diet change, medicine like metformin which increase insulin
sensitivity.
 Caused by genetics, environment, and obesity.
 Glucose tolerance: measure of person’s ability to remove excess blood glucose after a
meal.
 Glucose tolerance tests:
1- Fasting, you are given glucose drink
2- Take blood samples, from before drink and then every 30 mins after drink.
o Blood glucose should rise  pancreas responds  glucose is low
3- Plot blood glucose values.

 Differences:
 Higher basal level
 Higher peak
 Delayed peak
 Blood glucose levels stay higher longer
 10 millimolar is urinary threshold  kidneys are overwhelmed  urine has glucose
 Normal doesn’t reach 10, diabetic does and that’s why they pee a lot.

 Glycemic response: blood glucose response following eating certain foods.

 Not very effective to organize foods into high glycemic and low glycemic.
 Ex: boiled potatoes full of starch  High blood glucose
 We don’t worry about it because we eat these foods with other foods,
 If we’re eating these foods alone, we should replace them with higher fiber foods.
 Fiber slows down the rate at which glucose enters the blood.

 Fructose food sources:

 Sources include fruit sugar and honey.
 Less cariogenic (cavity causing) than sucrose (white sugar).
 High fructose corn syrup is our main source of fructose now.
 HFCS intake increased from 0 to 1/3 (1000%) in our diet.
 HFCS is linked with obesity.
 Average American citizen consumes over 62 pounds of HFCS per year = 130 kcal per day.
 Body uses fructose differently from other sugars: some fructose does not get converted
to glucose.
 It does not stimulate insulin or enhance leptin production.
 It stimulates liver fat synthesis and boosts blood triglycerides (VLDL increased).
 It increases blood pressure.
 Fructose doesn’t send the message that we have been fed  overeating.
 Humans cannot tolerate such high intakes of fructose.
 Diet pops leads to increased hunger and overeating.

 Disaccharides: sucrose
 It is made of glucose + fructose
 Ex: table sugar
 Isolated from sugarcanes or sugar beets.
 Has a sweetness value of 1.0.
 Some sucrose myths that are true:
1- Dental cavities
2- CHD  depends on obesity  depends on overall kcal intake
3- Dyslipidemia

 Do sugars cause obesity?

 “Low fat” foods: remove all fat and replace it with same amount of kcal from sugars 
net effect is more kcal  weight gain.
 Form of carb affects satiety (feeling of fullness).
a) Kcal in beverages is not detected in the same way by the body compared with
calories in solid form.
b) Food providing simple sugars (fructose) + refined carbs are less filling than foods
with complex carbs (starch) + fiber.
 Sugars have no nutritional value other than kcal  empty calories.
 Choose lower kcal beverages in smaller volumes.
 Select nutrient-dense over calorie-dense or empty calorie foods.

 Do sugars cause heart disease?

 Metabolic syndrome: set of 5 factors that may show that indicate CHD
1- Abdominal obesity
2- High levels of fasting blood glucose
3- High triglycerides in blood
4- Low HDL blood levels
5- High blood pressure
 Any 3 factors = metabolic syndrome
 Metabolic syndrome linked to high intake of sugars + refined carbs.
  Lactose:

 Milk sugar: relative sweetness 2.0

 All infants + children possess enzyme lactase.
 Lactase deficiency: drop in ability to make lactase enzyme.
 Lactose intolerance: symptoms associated with being lactase deficient.

Lecture 03

 Consequences of undigested lactose:

 Normal: Lactose  lactase enzyme  glucose + galactose
 If lactose is not digested it goes to small intestine  lactose attracts water 
bloating/cramps
 Colon is supposed to reabsorb water  lactose has too much water  diarrhea +
bacterial fermentation (gassy).
 Food allergies: exaggerated immune response to a protein in the food.
 Milk allergy: milk protein causes an allergic reaction.
 Things in the small intestine can pass through the mucosal layer into the bloodstream
 This is called leaky gut, very important in first 6 months of infancy.
 Small chunks of protein in the small intestine are taken up to the bloodstream 
immune response  antibodies produced by beta cells  anaphylaxis.
 Lactase tablets have a special coating that does not allow the stomach to break them
down and they can go through to the intestines to digest lactose.
 With milk allergies that does not work, all milk products need to be avoided.

 CHO summary:
 Simple sugars: 3 monosaccharides + 3 disaccharides
 Oligosaccharides (prebiotics): 3-12 sugar units. Ex: raffinose, stachyose, verbascose.
 Dextrin: short chains of starch added to food for thickening properties.
 Glycogen + starch.
 Sugar alcohols: xylitol in gum, sorbitol in fruits.
 Resistant starch: like soluble fiber, resists amylase. Recooked or reheated potatoes, rice,
oats, barley become resistant starch.
 Fibers

 When looking for healthy cereal, look for fiber, sugars added, total carbs, and starch.
 Cereals have lots of nutrients added so they supply us without needed nutrients.
 With lots of fiber, no need to worry about amount of starch in the cereal.
 Dietary fiber: indigestible plant material
1- Soluble fiber:
o Oat bran, citrus, insides of legumes, psyllium.
o 1/3 of fiber intake.
 o Ex: pectin, gums, carrageenin.
o Forms a gel in the gut  slows down digestion.
2- Insoluble fiber:
o Psyllium, skins of legumes, veggies, and fruits.
o 2/3 of fiber intake.
o Ex: cellulose, lignin
o Increases movement speed of material through small intestine.

 Both fibers are NOT DIGESTABLE.

 Fiber in the colon:

1- Soluble fiber only: digesta  colon  fermented by gut bacteria  gases + short chain
fatty acids.
o Fatty acids are 2:O acetate which is absorbed.
o 3:O propionate  absorbed  to liver  shuts down cholesterol synthesis.
o 4:O butyrate is preferred energy source of colon cells  reduces colon cancer.

2- Insoluble fiber: very dense, tight digesta  does not hold water  less fermentation 
eliminated in stool  avoids constipation.
 Read about diverticulosis from book.
 Diverticulosis occurs when diet is low in insoluble fiber.

 Wheat bran: gold standard for insoluble fiber

 whole grain base has germ: high in polyunsaturated fat.
 vitamin E protects double bonds against oxidation.
 Outer covering is bran layer: has fiber
 Under bran is aleurone layer: has iron and B vitamins
 Inside is endosperm: has starch and protein

 Fiber and colorectal fiber:

1- Soluble fiber:
 Lowers PH of colon (higher acidity).
 Stimulates growth of beneficial microbes.
 Produces short chain fatty acids (4:O).
 Lower in ammonia (ammonia means basic).
2- Insoluble fiber:
 Because of its bulking effect, it dilutes the colons contents. The bad contents do not
touch the colon wall.
 Provides a surface for adsorption (sticking to).
 Decreases transit time (time from mouth  anus).
 Altered bile acid metabolism. Certain pathogenic microbes convert bile acids to
secondary bile acids (cancer promoter). Insoluble fiber reduces secondary bile acids.
 Fiber and blood cholesterol:
 Soluble fiber decreases total cholesterol and LDL.
1- Soluble fiber binds cholesterol and bile acids (revisit explanation from module 3)
2- Soluble fiber is fermentable. Acidic and buritic are energy, propionic 3:O is absorbed to
the liver and shuts down cholesterol synthesis.

 Fiber’s key role in weight loss and weight management:

 Habits, not diets, are what affect weight.
1- Increases satiety (feeling full). Soluble forms gel and reduces nutrient absorption,
insoluble fiber is bulk  feels full.
2- Delays gastric emptying.
3- Takes longer to eat (more chewing).

 Dietary fiber recommendations:

 Current intake: 12-15g per day in north America.
 In 1990, majority of carbs intake should come from starch and whole grain veggies and
fruits.
 Adequate intake: 14g fiber per 1000 kcal.
 There is no DRI.
 Ex: man consumes 2500 kcal per day. Cross multiply  35g of fiber per day.