CARBOHYDRATE: THECARBOHYDRATE: THEEFFICIENT FUELEFFICIENT FUEL

CHAPTER 3CHAPTER 3

Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

22Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Carbohydrate: The Efficient FuelCarbohydrate: The Efficient FuelThe popular belief that carbohydrates have some The popular belief that carbohydrates have some

mysterious “fattening” power is unfounded. They:mysterious “fattening” power is unfounded. They:Add variety and palatability to the diet Add variety and palatability to the diet Are the most economical form of energyAre the most economical form of energy

Americans likeAmericans like

it sweetit sweetAverage intake is Average intake is

139 pounds annually139 pounds annuallyNeed to choose moreNeed to choose more

whole grainswhole grainsFrom Wells HF, Buzby JC: High-fructose corn syrup usage may be leveling off. From Wells HF, Buzby JC: High-fructose corn syrup usage may be leveling off.

Amber Waves, February 2008, USDA.Amber Waves, February 2008, USDA.

33Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Classification: Simple SugarsClassification: Simple SugarsMonosaccharides Monosaccharides

Glucose-dextrose, fruits, vegetables, corn syrup, honeyGlucose-dextrose, fruits, vegetables, corn syrup, honeyFructose-levulose, fruits, vegetables, corn syrup, honeyFructose-levulose, fruits, vegetables, corn syrup, honeyGalactose-lactoseGalactose-lactose

Disaccharides Disaccharides Lactose—milk onlyLactose—milk onlyMaltose—beer, cerealsMaltose—beer, cerealsSucrose—cane, beet, maple sugar,Sucrose—cane, beet, maple sugar,

fruits, vegetablesfruits, vegetables

44Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Classification: Other Nutritive Classification: Other Nutritive Sweeteners—Sugar AlcoholsSweeteners—Sugar Alcohols

Sugar alcohols or polyols sweeten with less Sugar alcohols or polyols sweeten with less energy per gram than sucrose (averaging energy per gram than sucrose (averaging 2.4 kcal/g)2.4 kcal/g)Common characteristicsCommon characteristics

Provide calories but are used in smaller amounts Provide calories but are used in smaller amounts Potential to cause gastric upsetPotential to cause gastric upset

Sorbitol and mannitolSorbitol and mannitol Essentially noncariogenicEssentially noncariogenic Maximum recommended amount <20 g/dayMaximum recommended amount <20 g/day

55Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Classification: Other Nutritive Classification: Other Nutritive Sweeteners—Sugar AlcoholsSweeteners—Sugar Alcohols

XylitolXylitolThe only CHO that is anticariogenic The only CHO that is anticariogenic Mechanisms of action against caries:Mechanisms of action against caries:

Inhibits growth of cariogenic bacteria Inhibits growth of cariogenic bacteria (Streptococcus mutans)(Streptococcus mutans) Inhibits plaque growthInhibits plaque growth Decreases transmission of cariogenic bacteriaDecreases transmission of cariogenic bacteria Promotes remineralizationPromotes remineralization Complements fluoride toothpaste useComplements fluoride toothpaste use

66Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Classification: Non-Nutritive Classification: Non-Nutritive SweetenersSweeteners

Five non-nutritive sweeteners with intense Five non-nutritive sweeteners with intense sweetening power have FDA approvalsweetening power have FDA approvalAspartame (phenylalanine and aspartic acid—two AAs)Aspartame (phenylalanine and aspartic acid—two AAs)

NutraSweet and EqualNutraSweet and EqualSaccharin (derivative of petroleum)Saccharin (derivative of petroleum)

Sweet’n LowSweet’n Low

Acesulfame-KAcesulfame-K Sweet OneSweet One

SucraloseSucralose SplendaSplenda

NeotameNeotame

77Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Alternative SweetenersAlternative SweetenersName/Brand NameName/Brand Name Sweetness Compared to Sweetness Compared to

SucroseSucrose

SorbitolSorbitol 0.5x0.5x

MannitolMannitol 0.7x0.7x

XylitolXylitol 1.0x1.0x

Saccharin (Sweet’n Low)Saccharin (Sweet’n Low) 200200––700x700x

Aspartame (NutraSweet & Equal)Aspartame (NutraSweet & Equal) 160160––220x220x

Acesulfame-K (Sunett)Acesulfame-K (Sunett) 200x200x

Sucralose (Splenda)Sucralose (Splenda) 600x600x

Neotame (not yet available)Neotame (not yet available) 8000x8000x

88Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Classification: Polysaccharides Classification: Polysaccharides (Complex CHOs)(Complex CHOs)

Starch-grains, legumes and potatoesStarch-grains, legumes and potatoesAmylose Amylose AmylopectinAmylopectin

FiberFiberSolubleSoluble

Gums and mucilages: barley, legumes, oat branGums and mucilages: barley, legumes, oat bran Pectin: fruitPectin: fruit

Insoluble: speed stool through bowel reducing contact Insoluble: speed stool through bowel reducing contact w/carcinogensw/carcinogens Cellulose: wheat branCellulose: wheat bran Hemicellulose: cereals, vegetables, legumes, fruit/vegetable skinsHemicellulose: cereals, vegetables, legumes, fruit/vegetable skins Lignin: vegetablesLignin: vegetables

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Physiologic Roles of CHOPhysiologic Roles of CHOProvides energyProvides energy

Sole source of energy for the Sole source of energy for the RBCs, brain (CNS) and lens of the RBCs, brain (CNS) and lens of the eyeeye

Required for oxidation of fatsRequired for oxidation of fatsRequired for components Required for components

needed for development of needed for development of collagen and nervous tissuecollagen and nervous tissue

1010Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Physiologic Roles of CHOPhysiologic Roles of CHO

Spares proteinSpares proteinProvides the chemical structure that combines Provides the chemical structure that combines

with nitrogen to form nonessential amino acidswith nitrogen to form nonessential amino acidsNondigestible CHOsNondigestible CHOs

Involved in growth of bacteria in the gut that Involved in growth of bacteria in the gut that synthesize nutrientssynthesize nutrients

Involved in gastric motilityInvolved in gastric motility

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Carbohydrate RecommendationsCarbohydrate RecommendationsFirst RDA set for total CHO in First RDA set for total CHO in

20022002Minimal level to support brain Minimal level to support brain

activityactivityRDA: 130 g/dayRDA: 130 g/day

Dietary reference intake Dietary reference intake recommendationsrecommendationsAMDR for CHO: 45%-65%AMDR for CHO: 45%-65%Focus on whole grains, legumes, Focus on whole grains, legumes,

vegetables, fruits, and low-fat dairyvegetables, fruits, and low-fat dairy

1212Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Fiber RecommendationsFiber Recommendations

AI for fiber intakeAI for fiber intakeMen 19-50 yr: 38 g/dayMen 19-50 yr: 38 g/dayWomen 19-50 yr: 25 g/dayWomen 19-50 yr: 25 g/day

How much fiber?How much fiber?Apple (4 g)Apple (4 g)11½½ cups salad greens (2 g) cups salad greens (2 g)1 slice white bread (0.5 g)1 slice white bread (0.5 g)

vs. 1 slice whole wheat bread (2 g)vs. 1 slice whole wheat bread (2 g)½½ cup cooked beans (7.5 g) cup cooked beans (7.5 g)

1313Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Added Sugar GuidelinesAdded Sugar GuidelinesMyPyramid MyPyramid

Discretionary calories includes Discretionary calories includes added sugars and fatadded sugars and fat Calorie allowances are very Calorie allowances are very

small:100small:100––300 calories300 calories

Dietary reference intakesDietary reference intakesMaximal intake 25% of energy Maximal intake 25% of energy

intakeintakeAs intakes of added sugars As intakes of added sugars , ,

intake of vitamins A, Fe, Ca, Zn intake of vitamins A, Fe, Ca, Zn Age groups most likely to exceed Age groups most likely to exceed

25% are 925% are 9––18 years18 years

1414Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

SourcesSourcesMilkMilk

Only animal product with significant quantities of CHOOnly animal product with significant quantities of CHO

Whole grainsWhole grainsFruitFruitVegetablesVegetables

Potatoes, beets, corn, peasPotatoes, beets, corn, peas

LegumesLegumesAdded sugars Added sugars

Baked goodsBaked goodsJams, jellies, honey, syrupsJams, jellies, honey, syrups

1515Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Hyperstates and HypostatesHyperstates and Hypostates

Excess carbohydratesExcess carbohydratesEvidence suggests CHO intake at current levels does Evidence suggests CHO intake at current levels does

not directly contribute to chronic diseasenot directly contribute to chronic disease Rather excess intake may result in energy imbalance and Rather excess intake may result in energy imbalance and

weight gainweight gain

WHO recommends limiting intake to 10% of total WHO recommends limiting intake to 10% of total calories vs. DRI maximum intake of 25% of calories calories vs. DRI maximum intake of 25% of calories from added sugarsfrom added sugars

Rise in consumption of soft drinks hasRise in consumption of soft drinks has

negatively affected milk consumptionnegatively affected milk consumptionSugar is not the cause of obesity; it is intake of excess Sugar is not the cause of obesity; it is intake of excess

calories whether from CHO, protein, fat, or alcoholcalories whether from CHO, protein, fat, or alcohol

1616Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Hyperstates and HypostatesHyperstates and HypostatesCarbohydrate does not independently cause Carbohydrate does not independently cause

cariescariesDental caries is a process involving a tooth, bacteria Dental caries is a process involving a tooth, bacteria

and environment factors (e.g., saliva, CHO, fluoride)and environment factors (e.g., saliva, CHO, fluoride)

Sucrose promotes the volume and growth rate of Sucrose promotes the volume and growth rate of plaque biofilmplaque biofilmPromote production of used to facilitate adherence of Promote production of used to facilitate adherence of

plaque biofilm to the toothplaque biofilm to the toothMetabolism of sucrose by bacteria lowers the pH, Metabolism of sucrose by bacteria lowers the pH,

leading to decalcificationleading to decalcification

1717Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Hyperstates and HypostatesHyperstates and HypostatesStudies have not correlated caries rate with total Studies have not correlated caries rate with total

sugar consumptionsugar consumptionDanger of soda and energy drinks is acidic content in Danger of soda and energy drinks is acidic content in

addition to fermentable CHO contentaddition to fermentable CHO content

Cooked and refined carbohydrates readily Cooked and refined carbohydrates readily hydrolyzed by salivary amylase to lower pH and hydrolyzed by salivary amylase to lower pH and demineralize enameldemineralize enamel

Cariogenicity of CHO is mostCariogenicity of CHO is most

affected by:affected by:Frequency of consumptionFrequency of consumptionForm of CHO (e.g., liquid, sticky, solid)Form of CHO (e.g., liquid, sticky, solid)

1818Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Nutritional DirectionsNutritional DirectionsLimit between-meal snacks; eat cariogenic foods Limit between-meal snacks; eat cariogenic foods

with a mealwith a mealInclude whole grains, vegetables, whole fruits, Include whole grains, vegetables, whole fruits,

and low-fat dairy as snacksand low-fat dairy as snacksLimit simple and retentive CHOs like crackers, soft Limit simple and retentive CHOs like crackers, soft

drinks, sports drinks, fruit juicedrinks, sports drinks, fruit juiceRecommend xylitol gum and/or mints when Recommend xylitol gum and/or mints when

brushing is not possiblebrushing is not possibleUse calcium-rich foods such as low-fat cheese or Use calcium-rich foods such as low-fat cheese or

low fat-milk for snackslow fat-milk for snacksEncourage daily self-care and home fluoridesEncourage daily self-care and home fluoridesRefer patients with complex medical issuesRefer patients with complex medical issues