Nutrition 10 Today Tues. May 9 Thurs. May 11 Topics Finish Carbs Diabetes (DM) Market Assignment due today 20 points Thurs. May 11 Topic: Protein Calorie Estimate (PCE) and Diet Assignment PCE 5 points Due Tues. May 16 NO CLASS Thurs MAY 18 Diet Assignment 20 points Due Tues. May 23

Blood Sugar Lows and Highs NOTE: Blood sugar level and Blood Glucose Level are the same thing. The sugar in our blood IS glucose!

Tools for Blood Sugar Level Control Goal BSL ~80-100 mg % Insulin Protein based, pancreatic hormone Opens cells to let blood sugar inside Lowers blood sugar level Glucagon Raises BSL by breaking down glycogen or Trouble NOTE: Blood sugar level and Blood Glucose Level are the same thing. The sugar in our blood IS glucose!

sweaty, rapid heart rate How low can you go? sweaty, rapid heart rate Symptoms Low blood sugar grouchy, anxious dizzy, confused

Hypoglycemia (Low BSL) Acute danger but uncommon condition Need sugar (glucose, a simple carb) in blood 24/7 To treat give simple carb (sugars) immediately To prevent trickle in carbs over the day No meal skipping Healthy complex carb/protein at meals Limit simple (especially‘added’) sugar Why limit only simple sugar? CNS (brain and nerves) always need some glucose to use for fuel. RBC’s, part of retina of eye and part of kidneys can only use glucose as fuel. Specific cause of Hypoglycemia varies…exercise and failure to eat, tumor, insulin production not in sync with glucose demand, etc. Diet recommendations for low BSL is s diet good for all of us! There is no medicine treatment to prevent low bsl.

What’s to know bout Fast ‘n Slow…carbs? ‘Fast’and‘slow’ refer to rate carb enters blood. Ideal is for carbs to trickle into blood! Complex carbs….‘slow’ Whole grains best…. enter blood most slowly Enriched grains… enter blood more quickly (why?) Simple carb….. ‘fast’ Natural sugar (milk/fruit) enters blood quickly Added sugars by far, enter blood most quickly! ** ‘added’ sugars enter the blood most quickly of all. Hardly any digestion of them is needed at all. If have trouble maintaining BSL (e.g. hypoglycemia or diabetes) , then these really need to be limited. Some people with these problems need to limit their natural sugar and even their enriched grain intake.

Diabetes Projections: 2000 to 2030 About 30 million+ people in US have DM; 1 of 4 is unaware that they have Diabetes. 7th leading cause of death in the US >70% eligible for Medicare have diabetes or prediabetes. •One in three Medicare dollars is currently spent on people with diabetes. •Total national costs associated with diabetes exceeded $245 billion in 2012, up from $174 billion in 2007.

Diabetes: a global problem Diabetes in the US! 1 of 9 in US has diabetes only 1 of 4 aware of it 1 of 3 Medicare $ spent to treat DM

Diabetes Mellitus (DM) Hyperglycemia (high fasting BSL) Cause: not enough or ineffective Insulin Result: too much sugar in blood-not enough in cell Consequence: cells/tissues are glucose starved chronic inflammation occurs blood lipids and pressure rise, arteries harden tissue/cell function declines Basically in Diabetes, cells are in starvation mode…even though blood loaded with glucose (sugar)… kind of like starving to death in a supermarket. The key (insulin) is not working or is ineffective so the glucose cannot get into the cell. So the cell kicks into ‘starvation mode’, making protein into glucose to meet glucose need, burning fat inefficiently to make ATP since carb is missing (remember it has to be able to get into the cell to be useful to the cell. Without insulin, this cannot happen) Fasting BSL goal 100-125 mg% is still considered normal, but may be referred to as pre-diabetes. If > 126mg% = diabetic via 2010 ADA recommendations. Many causes of DM, but all categorized into ~ three major groups Type 1, 2 and Gestational DM Inflammation is OK, if acute as in when immune system responds to infection or irritation. Problem arises when inflammation is chronic. Then it triggers release of biologically-active substances that promote oxidation and other harmful reactions increase blood pressure, arterial blockage, elevation of blood lipids (cholesterol). Uh oh….bad stuff happens in the body : ( Note: ‘Fasting’ means 12 hours or more with no caloric intake from food or beverage.

DM: A chronic, progressive disease Common consequences Heart disease (#1 cause-diabetic deaths) Blindness Amputations Kidney disease All complications are associated with the negative effects of high blood sugar (glucose) on blood vessel walls…makes them narrow and harden…. making them more easy to block off (occlude). Dialysis is used when kidney function is too low (inefficient) to adequately filter the blood of toxins. For most it is required the rest of their life unless They are one of the few who qualifies for, and receives a kidney transplant. Many who need dialysis have had diabetes for a long time. High BSL,among other causes, is damaging to the kidneys.

Classifications of Diabetes Type 1 Uncommon Inadequate insulin Treatment requires insulin healthy diet regular exercise Most common in kids/young. Makes up small % of DM cases. May be an autoimmune reaction in some post viral exposure

Classifications of Diabetes Type 2 Majority of cases Ineffective insulin Treatment: Medical  pills and/or insulin Lifestyle  diet/exercise/stress mgt. Most common in adults, but now increasing in kids as well. Thoughts are this is associated with lifestyle choices (poor diet and lack of exercise). Problem is that damaging effects of high BSL take time. If diagnosed with DM at 60 years of age, then only ~20 years for bad stuff to happen. If diagnosed when 25 years old, then there are many decades for bad stuff to happen. Often young people do not appreciate their own mortality and do not take care of self even when diagnosed with DM.

Tips to manage BSL Trickle in healthy carbs over day More healthy complex (slow) carbs Less simple (fast) carbs No meal skipping Limit added sugar (~25g/35g) Replace saturated (animal) with unsat. (plant) fats Achieve a healthy weight Quit smoking Maximize exercise!!!!! Glycemic Index (GI). See text for more description. It is not a panacea (cure all). It does gives idea of the sugar load body sees from certain foods. Best to look at Glycemic Load which is GI x gms of CHO in the food. Short coming of GI and GL is that it measures a food in isolation for other foods…not very realistic. We eat mixtures of foods, not one food in isolation. We do not have measures of GI or GL for a peanut butter sandwich, apple, chips and milk. We have GI or GL for peanut butter, for bread, for apple, for chips, et. You will NOT be tested on GI or GL////mostly because I don’t think it is worth depending on as a tool to RX diabetes (or for that matter, weight control). Also advised that people with diabetes be monitored for vitamin D levels. Vit D is being studied for its relationship to normal blood sugar control. Currently vitamin D and BSL are being studied. By current standards many of us at our latitude (bay area) and north seem to be deficient, particularly those with darker skin pigmentation.

Optional slides follow

Concept Map: carb review Objective: learn to link terms with ideas covered in class Terms: Start with carbohydrate. Now add simple carb, added sugar, natural sugar, lactose, fructose, glucose, sucrose, complex carb, fiber, glycogen, starch, grains, honey, soda, plain yogurt, fruit and liver/muscle glycogen to your map Practice: Draw a diagram logically linking all of the terms. Identify blood, milk, fruit and table sugar and where glycogen stored. What is meant by the term ‘fast’ and ’slow’ carb? Purpose: practice drawing a concept map and to review carb knowledge.

Carbohydrate Simple carb fast Complex carb slow Fruit* Natural sugar Veg, grains, grain by-products Fructose Honey candy soda Added sugar Fruit* Sucrose Milk, plain yogurt Natural sugar Lactose Glucose Blood sugar No glycogen in food How would you connect this map to the DM map? Glycogen Our storage form of glucose Muscle/Liver storage sites Starch & Fiber Fiber

Concept Map: Blood Sugar Level Terms: blood sugar (glucose), hyperglycemia, hypoglycemia, glucagon, insulin, Type 1 diabetes (DM), Type 2 diabetes, ineffective insulin, inadequate insulin. Note: You may want to use descriptors along your arrows to clarify action occurring e.g. increase, decrease, etc. Draw a diagram logically linking all of the terms.