1. CARBOHYDRATE: THE EFFICIENT FUEL CHAPTER 3 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

2. 2 Carbohydrate: The Efficient Fuel The popular belief that carbohydrates have some mysterious “fattening” power is unfounded. They: The popular belief that carbohydrates have some 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 energy Are the most economical form of energy Americans like Americans like it sweet Average intake is Average intake is 139 pounds annually Need to choose more Need to choose more whole grains From Wells HF, Buzby JC: High-fructose corn syrup usage may be leveling off. Amber Waves, February 2008, USDA.

3. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3 Classification: Simple Sugars Monosaccharides Monosaccharides Glucose-dextrose, fruits, vegetables, corn syrup, honey Glucose-dextrose, fruits, vegetables, corn syrup, honey Fructose-levulose, fruits, vegetables, corn syrup, honey Fructose-levulose, fruits, vegetables, corn syrup, honey Galactose-lactose Galactose-lactose Disaccharides Disaccharides Lactose—milk only Lactose—milk only Maltose—beer, cereals Maltose—beer, cereals Sucrose—cane, beet, maple sugar, Sucrose—cane, beet, maple sugar, fruits, vegetables

4. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4 Classification: Other Nutritive Sweeteners—Sugar Alcohols Sugar alcohols or polyols sweeten with less energy per gram than sucrose (averaging 2.4 kcal/g) Sugar alcohols or polyols sweeten with less energy per gram than sucrose (averaging 2.4 kcal/g) Common characteristics Common characteristics Provide calories but are used in smaller amounts Provide calories but are used in smaller amounts Potential to cause gastric upset Potential to cause gastric upset Sorbitol and mannitol Sorbitol and mannitol Essentially noncariogenic Essentially noncariogenic Maximum recommended amount <20 g/day Maximum recommended amount <20 g/day

5. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5 Classification: Other Nutritive Sweeteners—Sugar Alcohols Xylitol Xylitol The 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 (Streptococcus mutans) Inhibits growth of cariogenic bacteria (Streptococcus mutans) Inhibits plaque growth Inhibits plaque growth Decreases transmission of cariogenic bacteria Decreases transmission of cariogenic bacteria Promotes remineralization Promotes remineralization Complements fluoride toothpaste use Complements fluoride toothpaste use

6. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6 Classification: Non-Nutritive Sweeteners Five non-nutritive sweeteners with intense sweetening power have FDA approval Five non-nutritive sweeteners with intense sweetening power have FDA approval Aspartame (phenylalanine and aspartic acid—two AAs) Aspartame (phenylalanine and aspartic acid—two AAs) NutraSweet and Equal NutraSweet and Equal Saccharin (derivative of petroleum) Saccharin (derivative of petroleum) Sweet’n Low Sweet’n Low Acesulfame-K Acesulfame-K Sweet One Sweet One Sucralose Sucralose Splenda Splenda Neotame Neotame

7. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7 Alternative Sweeteners Name/Brand Name Sweetness Compared to Sucrose Sorbitol0.5x Mannitol0.7x Xylitol1.0x Saccharin (Sweet’n Low) 200–700x Aspartame (NutraSweet & Equal) 160–220x Acesulfame-K (Sunett) 200x Sucralose (Splenda) 600x Neotame (not yet available) 8000x

8. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8 Classification: Polysaccharides (Complex CHOs) Starch-grains, legumes and potatoes Starch-grains, legumes and potatoes Amylose Amylose Amylopectin Amylopectin Fiber Fiber Soluble Soluble Gums and mucilages: barley, legumes, oat bran Gums and mucilages: barley, legumes, oat bran Pectin: fruit Pectin: fruit Insoluble: speed stool through bowel reducing contact w/carcinogens Insoluble: speed stool through bowel reducing contact w/carcinogens Cellulose: wheat bran Cellulose: wheat bran Hemicellulose: cereals, vegetables, legumes, fruit/vegetable skins Hemicellulose: cereals, vegetables, legumes, fruit/vegetable skins Lignin: vegetables Lignin: vegetables

9. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9 Physiologic Roles of CHO Provides energy Provides energy Sole source of energy for the RBCs, brain (CNS) and lens of the eye Sole source of energy for the RBCs, brain (CNS) and lens of the eye Required for oxidation of fats Required for oxidation of fats Required for components needed for development of collagen and nervous tissue Required for components needed for development of collagen and nervous tissue

10. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10 Physiologic Roles of CHO Spares protein Spares protein Provides the chemical structure that combines with nitrogen to form nonessential amino acids Provides the chemical structure that combines with nitrogen to form nonessential amino acids Nondigestible CHOs Nondigestible CHOs Involved in growth of bacteria in the gut that synthesize nutrients Involved in growth of bacteria in the gut that synthesize nutrients Involved in gastric motility Involved in gastric motility

11. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11 Carbohydrate Recommendations First RDA set for total CHO in 2002 First RDA set for total CHO in 2002 Minimal level to support brain activity Minimal level to support brain activity RDA: 130 g/day RDA: 130 g/day Dietary reference intake recommendations Dietary reference intake recommendations AMDR for CHO: 45%-65% AMDR for CHO: 45%-65% Focus on whole grains, legumes, vegetables, fruits, and low-fat dairy Focus on whole grains, legumes, vegetables, fruits, and low-fat dairy

12. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12 Fiber Recommendations AI for fiber intake AI for fiber intake Men 19-50 yr: 38 g/day Men 19-50 yr: 38 g/day Women 19-50 yr: 25 g/day Women 19-50 yr: 25 g/day How much fiber? How much fiber? Apple (4 g) Apple (4 g) 1 ½ cups salad greens (2 g) 1 ½ 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) ½ cup cooked beans (7.5 g) ½ cup cooked beans (7.5 g)

13. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13 Added Sugar Guidelines MyPyramid MyPyramid Discretionary calories includes added sugars and fat Discretionary calories includes added sugars and fat Calorie allowances are very small:100–300 calories Calorie allowances are very small:100–300 calories Dietary reference intakes Dietary reference intakes Maximal intake 25% of energy intake Maximal intake 25% of energy intake As intakes of added sugars , intake of vitamins A, Fe, Ca, Zn  As intakes of added sugars , intake of vitamins A, Fe, Ca, Zn  Age groups most likely to exceed 25% are 9–18 years Age groups most likely to exceed 25% are 9–18 years

14. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 14 Sources Milk Milk Only animal product with significant quantities of CHO Only animal product with significant quantities of CHO Whole grains Whole grains Fruit Fruit Vegetables Vegetables Potatoes, beets, corn, peas Potatoes, beets, corn, peas Legumes Legumes Added sugars Added sugars Baked goods Baked goods Jams, jellies, honey, syrups Jams, jellies, honey, syrups

15. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15 Hyperstates and Hypostates Excess carbohydrates Excess carbohydrates Evidence suggests CHO intake at current levels does not directly contribute to chronic disease Evidence suggests CHO intake at current levels does not directly contribute to chronic disease Rather excess intake may result in energy imbalance and weight gain Rather excess intake may result in energy imbalance and weight gain WHO recommends limiting intake to 10% of total calories vs. DRI maximum intake of 25% of calories from added sugars WHO recommends limiting intake to 10% of total calories vs. DRI maximum intake of 25% of calories from added sugars Rise in consumption of soft drinks has Rise in consumption of soft drinks has negatively affected milk consumption Sugar is not the cause of obesity; it is intake of excess calories whether from CHO, protein, fat, or alcohol Sugar is not the cause of obesity; it is intake of excess calories whether from CHO, protein, fat, or alcohol

16. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 16 Hyperstates and Hypostates Carbohydrate does not independently cause caries Carbohydrate does not independently cause caries Dental caries is a process involving a tooth, bacteria and environment factors (e.g., saliva, CHO, fluoride) Dental caries is a process involving a tooth, bacteria and environment factors (e.g., saliva, CHO, fluoride) Sucrose promotes the volume and growth rate of plaque biofilm Sucrose promotes the volume and growth rate of plaque biofilm Promote production of used to facilitate adherence of plaque biofilm to the tooth Promote production of used to facilitate adherence of plaque biofilm to the tooth Metabolism of sucrose by bacteria lowers the pH, leading to decalcification Metabolism of sucrose by bacteria lowers the pH, leading to decalcification

17. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 17 Hyperstates and Hypostates Studies have not correlated caries rate with total sugar consumption Studies have not correlated caries rate with total sugar consumption Danger of soda and energy drinks is acidic content in addition to fermentable CHO content Danger of soda and energy drinks is acidic content in addition to fermentable CHO content Cooked and refined carbohydrates readily hydrolyzed by salivary amylase to lower pH and demineralize enamel Cooked and refined carbohydrates readily hydrolyzed by salivary amylase to lower pH and demineralize enamel Cariogenicity of CHO is most Cariogenicity of CHO is most affected by: Frequency of consumption Frequency of consumption Form of CHO (e.g., liquid, sticky, solid) Form of CHO (e.g., liquid, sticky, solid)

18. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 18 Nutritional Directions Limit between-meal snacks; eat cariogenic foods with a meal Limit between-meal snacks; eat cariogenic foods with a meal Include whole grains, vegetables, whole fruits, and low-fat dairy as snacks Include whole grains, vegetables, whole fruits, and low-fat dairy as snacks Limit simple and retentive CHOs like crackers, soft drinks, sports drinks, fruit juice Limit simple and retentive CHOs like crackers, soft drinks, sports drinks, fruit juice Recommend xylitol gum and/or mints when brushing is not possible Recommend xylitol gum and/or mints when brushing is not possible Use calcium-rich foods such as low-fat cheese or low fat-milk for snacks Use calcium-rich foods such as low-fat cheese or low fat-milk for snacks Encourage daily self-care and home fluorides Encourage daily self-care and home fluorides Refer patients with complex medical issues Refer patients with complex medical issues