Chapter 4: Carbs, Starches, Fiber

Prediabetes

(May be a precursor to type 2 diabetes) • Impaired glucose tolerance; Blood glucose levels are higher than normal but not yet high enough to be classified as diabetes. • Heart disease and stroke can occur.

Monk Fruit

(Nectresse): Has a potential lingering aftertaste if large amounts are consumed

Aspartame

(Nutrasweet, Equal): Made with two amino acids - aspartic acid and phenylalanine; carries a warning label for People with PKU • People with phenylketonuria (PKU) need to monitor all dietary sources of phenylalanine, including aspartame

Sucralose

(Splenda): Sucrose units are chemically altered so that they cannot be digested

Acesulfame- K

(Sunette): The "K" in this name means potassium. This sugar substitute should be avoided by those with kidney disease.

Saccharin

(Sweet'N Low): Oldest sugar substitute, provides no calories, widely used in foods, beverages, vitamins, pharmaceuticals

Rebaudioside A

(Truvia, PureVia): Considered safe but has been associated with a sudden drop in blood glucose (hypoglycemia)

Diabetes Mellitus

An estimated 25.8 million American Adults have diabetes Diabetes mellitus: individual has high blood glucose levels due to insufficient insulin or insulin resistance • Glucose cannot enter cells. Cells are forced to turn to protein and fat for energy to fuel their activities • Use of protein as fuel removes protein from being used in vital body processes and structures • Without glucose, acidic ketone bodies build up, causing life‐threatening diabetic ketoacidosis - ketoacidosis left untreated can result in coma, death

Diverticula

Diverticula are pocket‐like swellings or bulges which can occur anywhere in the GI Tract. They occur most commonly in the intestines. Diverticulitis - infection of the Diverticula - ymptoms of diverticulitis can include nausea, vomiting, stomach pain, cramping, fever, and chills. - Insoluble Fiber: The bulky fiber mass acts much like a soft bristle brush gently cleaning out any diverticula pockets present in the intestines while moving the chyme and later the fecal materials through the intestines. • End result is a reduced risk of developing diverticula and reduced risk of diverticula becoming infected.

Maltose

Glucose + Glucose

Fiber

Fiber is plant structure such as branches, stems, leaves, flowers, fruit, roots, trunks Humans are unable to digest fiber • Humans lack the digestive enzymes needed to break the bonds between the glucose units in fiber

Sucrose

Fructose + Glucose

Lactose

Galactose + Glucose

Simple Carbohydrates (Sugars)

Monosaccarides ( Glucose, Fructose, Galactose) and Disaccarides (Maltose, Sucrose, Lactose)

Calorie Free Sweetners

Saccharin, Aspartame, Neotame, Acesulfame-K, Sucralose, Rebaudioside, Monk Fruit

starch

Starch is the plants' storage form of glucose •Holds water and swells • When wet, becomes sticky • Dries to a hard substance after being wet

Complex Carbohydrates (Polysaccharides)

Starch, Fiber, Glycogen

Excessive fiber intake (all fiber sources/greater than 40 g/day for adults)

h. Increased risk of dehydration and constipation i. Increased risk of ileus (intestinal tract blockage) j. Increased risk of mineral chelation (preventing the minerals from being absorbed)

Enriched Refined Grains

have a little of their initial vitamins, minerals, fiber, and phytochemicals plus a small amount of added enrichment nutrients

Enriched Whole Grains

have all of their vitamins, minerals, fiber, and phytochemicals PLUS the small amount of added enrichment nutrients.

Refined Grains

have the least vitamins, minerals, fiber, and phytochemicals present in their flours.

Whole Grains

have the most vitamins, minerals, fiber, and phytochemicals present in their flours.

Type 1 Diabetes

5 to 10 percent of cases • Autoimmune disease: insulin‐producing cells in pancreas destroyed—insulin injections required - therapeutic diet and exercise recommended • Usually develops in childhood, early adult years

Type 2 Diabetes

90 to 95 percent of cases • Cells are resistant to insulin. Excessive amounts of insulin are produced by the pancreas. Eventually insulin‐producing cells are exhausted and pancreas function decreases. Oral medication and/or insulin may be required - therapeutic diet and exercise recommended • May develop at any age.

long Term Damage of Diabetes

Because high blood glucose levels damage vital organs, diabetes can result in long‐term changes and damage such as: • Ketosis and acidosis • Blindness • Kidney disease and Renal (kidney) failure • Heart Disease (atherosclerosis and stroke) • Increased numbers of infections and increased severity of infections • Amputations (surgical removal of diseased/dead sections of the body - toes, fingers, feet, etc.) • Delayed wound healing and recovery from infections • Body wide nerve damage impacting muscle activity • Impotence • Complications of pregnancy • Premature death

Cells which are strongly dependent upon glucose for their energy needs are these:

Brain Cells Nerve Cells Red Blood Cells

Energy + Human Cells

Depending upon the amount of oxygen available, the following energy can be generated from glucose using the cellular energy release pathway. Without adequate Oxygen: 2 ATP plus Lactic Acid With adequate Oxygen: 30 to 32 ATP

Tips for Tolerating Lactose

Gradually add dairy products to the diet • Eat smaller amounts of dairy products throughout day rather than large amount at one time • Eat dairy products with a meal or snack • Try reduced‐lactose milk and dairy products such as hard cheeses, cottage cheese, and live culture yogurts • Lactase pills can be consumed with lactose‐laden meals or snacks

Type 2 Diabetes Part 2

In Type 2 Diabetes, the pancreas produces sufficient amounts to excessive amounts of insulin to meet the cells' needs but the cells are unable to respond appropriately to the insulin. In Type 2 Diabetes, the cell membranes have developed what is called a resistance to the insulin. This developed resistance is actually the situation in which the cells will not allow the insulin to attach to their membrane surfaces. If insulin cannot attach to the cell membrane surface, it cannot activate the changes needed within the cell membrane to allow the cell to draw glucose into it. So even though there is excessive amounts of glucose in the fluids outside of the cells, the cells can draw in very little or none at all. The cell membranes have developed a resistance to the person's own personally made insulin. Gratefully, the cell membranes will accept an insulin made by something else (such as an animal or microorganism) and injected into the body.

Insoluble Fiber (Nonfermentable)

Increases fecal bulk, promoting normal bowel movements: • Reduces both constipation and diarrhea. • Reduces exposure time of the colon to potential carcinogenic (cancer causing) substances. • Reduces risks of diverticulitis, hemorrhoids, and appendicitis. Promotes a feeling of fullness, assisting with weight management.

Appendicitis

Insoluble Fiber: Just below the first pocket‐like area of the colon is a small finger‐like projection. This is the appendix. By moving the chyme from the colon's first pocket like area above the appendix so that bacteria and other wastes do not accumulate, the risk of inflammation and infection of the appendix is reduced. • Symptoms such as but not limited to: Abdominal pain with appendicitis usually occurs suddenly, often waking a person at night / Pain gets worse in a matter of hours Other symptoms may include loss of appetite, nausea, vomiting, constipation or diarrhea, a lowgrade fever that follows other symptoms, abdominal swelling

Dental Caries/Cavities

Issue: Fermentable sugars and starch feed bacteria coating teeth, producing acid to erode tooth enamel Other Factors encouraging bacterial action include not limited to: • Frequency of foods / beverages in the mouth • duration of time in the mouth • stickiness of items • acidity of items • To minimize tooth decay: • Eat three balanced meals daily • Keep snacking to a minimum, choosing whole fruits and raw vegetables • Include foods that fight dental caries: cheese, sugarless gum • Regular dental care and good dental hygiene

Lactose Intolerance

Lactose is the disaccharide found in some but not all dairy products. • Milk containing lactose comes from animals/mammals not plants. • People with a deficiency of the enzyme lactase cannot digest lactose into the individual glucose and galactose sugars • Lactose intolerance: when lactose maldigestion worsens and results in results in nausea, cramps, bloating, diarrhea, and flatulence • Modest reduction in lactase production and the development of the milder form of lactose maldigestion is considered to be a natural part of aging

Soluble Fiber (Viscous, more fermentable)

Lowers blood cholesterol by binding with bile, cholesterol and other dietary fats present in the small intestine • Once tangled with the soluble fiber, the bile, cholesterol, and other dietary fats are drawn through the GI Tract and expelled with the rest of the fecal material. As bile is expelled from the body, more must be produced by the liver. Cholesterol is the main ingredient in bile. As cholesterol from the blood is used to make more bile, the blood cholesterol level drops. • Some types of colon bacteria feed upon the soluble fiber and produce tiny fatty acids which are absorbed into the body. These fatty acids reduce cholesterol production by the body. Slows the digestion and absorption of monosaccharides allowing for a more gradual rise of blood glucose after eating meals

Neotame

Made with two amino acids - aspartic acid and phenylalanine; the amino acids are chemically bonded so that they cannot be digested so they are safe for People with PKU

Symptoms of Diabetes

People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms: • Frequent urination • Excessive thirst • Unexplained weight loss • Extreme hunger • Sudden vision changes • Tingling or numbness in hands or feet • Feeling very tired much of the time • Very dry skin • Sores that are slow to heal • More infections than usual. • Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin‐dependent diabetes, now called type 1 diabetes.

Milk Allergy Prevention

Prevention: Avoid all sources of milk proteins including casein. Terms to watch for on food and beverage labels include all of the following: • Milk from any animal source (cow, goat, yak, horse, etc.): • Any form of animal milk (fresh, canned, powdered, frozen, buttermilk, chocolate milk, etc.) • Any fat content of animal milk (fat‐free, ½%, 1%, 2%, whole etc.) • Milk Solids (dry or wet) • Whey • Casein

Milk Allergy Symptoms

Symptoms of an allergic reaction can occur within minutes or hours after contact with an allergen such as casein. • Tingling sensation in the mouth • Swelling of the lips, tongue, and throat • Irritated, reddened, swollen, itchy eyes • Vomiting (may be projectile), abdominal cramps, diarrhea • Swelling, rashes, hives • Difficulty breathing, wheezing • Drop in blood pressure • Loss of consciousness • Death

The Enrichment Act

The Enrichment Act requires that only the following five nutrients be added to flours made from grains. - B vitamins: Thiamin, Riboflavin, Niacin, Folate - Mineral: Iron The types of grains and flours below are listed from most nutrient dense to least nutrient dense: Enriched Whole Grains Whole Grains Enriched Refined Grains Refined Grains

Photosynthesis

Using carbon dioxide, water, and minerals, plants convert the sun's energy into glucose

Inadequate dietary fiber intake (less than 21 g/day for adults)

a. Increased risk of constipation and/or diarrhea b. Increased risk of colon disorders such as appendicitis, cancer, diverticulitis, and hemorrhoids c. Increased risk of type 2 diabetes and atherosclerosis

Low Fiber Intake

adult fiber intakes below 21 grams of fiber per day allows more dietary fat, cholesterol, and bile containing cholesterol to be absorbed.

Recommended Fiber Intake

adult fiber intakes of 21 - 38 grams of fiber per day - reduces dietary fat, cholesterol, and bile absorption. - This in turns lowers the risk of heart disease.

Gestational Diabetes

approximately 18 percent of pregnancies at any given time • Cells become resistant to insulin. The pancreas tries to compensate by producing excessive amounts of insulin. Eventually insulin‐producing cells are exhausted. Medication and/or insulin is required. • This form of diabetes may appear near the end of the 2nd trimester of the pregnancy. • After the birth of the baby, the majority of these women return to their non‐diabetic pre‐pregnancy state. However, a tiny percent of these women will remain diabetic after the birth of their baby. • These women have a greater risk of developing diabetes later in life. • Babies born from these pregnancies are at a much greater risk for developing diabetes during their lifetime.

Fasting Hypoglycemia

blood glucose level below 70 mg/dl Symptoms: hunger, shakiness, dizziness, perspiration, light‐headedness • Can cause fainting, coma Possible Causes: • Can occur in people without diabetes when they don't eat adequate amounts of carbohydrate sources regularly throughout the day • May occur in people with diabetes when they don't eat carbohydrate sources regularly to balance effects of insulin or blood glucose‐lowering medication

Reactive Hypoglycemia

blood glucose level below 70 mg/dl which can occur within minutes to within a few hours after eating • Less common condition in people often caused by excessive insulin secreted by the pancreas • Symptoms: hunger, shakiness, dizziness, perspiration, light‐headedness • Can cause fainting, coma • Possible Causes: • Person may be oversensitive to epinephrine/norepinephrine (adrenalin) • Pancreatic cancer leading to constant overproduction of insulin

Adequate dietary fiber intake (21 - 38 g/day for adults)

d. Decreased risk of intestinal disorders and colon cancer e. Decreased risk of constipation and/or diarrhea f. Improved glucose control g. Potential lowering of total cholesterol and LDL

Glycogen

the storage form of glucose in animals including humans Produced by, stored in, and used by: • Brain cells (less than 1% of total) • Liver cells (about 33% of total) • Muscle cells (about 66% of total) ONLY the liver can release glucose out of its glycogen stores to support the normal glucose blood levels

Colon Cancer

• A leading form of cancer and the second leading cause of cancer deaths • Symptoms: Often no symptoms are seen or felt, weight loss, internal bleeding, iron‐deficiency anemia, fatigue • Polyps may be fairly small up to the size of a mushroom or plum; may or may not be benign • Polyps developing within the large intestine (colon) may indicate an early stage of cancer developing Insoluble Fiber is thought to have four mechanisms by which it reduces the risk of colorectal cancer.

Polyols (sugar alcohols): sorbitol, mannitol, xylitol

• Absorbed more slowly than sugar, don't cause spike in blood glucose but not calorie free • Not completely absorbed, can cause diarrhea, gas, bloating, abdominal cramps

controlling blood glucose level

• Diet must be adequate in all nutrients • Diet must contain adequate amounts of fiber • Controlled total carbohydrate intake per day • Limit added sugars ‐ any sugar used must be counted into day's carbohydrate allowance • Limit saturated fats and trans fats • Moderation in protein intake to protect kidney function

Insoluble Fiber

• Does NOT dissolve in water and is NOT fermented by large intestine bacteria • Does absorb and hold substantial amounts of liquids and swells in size ‐ thus increasing fecal bulk • Moves GI tract contents more rapidly through GI tract resulting in a normal to mild laxative‐like effect

Hypoglycemia Dietary Choice and Times

• Fasting Hypoglycemia: • Consume adequate amounts of carbohydrate‐containing food and beverage sources every 3 to 4 hours while awake. • Reactive (Postprandial) Hypoglycemia: • Diets should be adequate in all nutrients and energy • Diets should be adequate in grams of fiber, especially soluble fiber • Regularly timed meals and snacks should be consumed at roughly the same time each day - every two to three hours is suggested • Sugary items should be limited if possible. If consumed, they should be consumed with protein and fat items • Diets should control the total amount of complex carbohydrate • Diets should control the total amount of fat and saturated fats • Diets should control the total amount of protein • Alcohol use should be minimized or eliminated to avoid depressing (lowering) blood glucose levels.

Glucagon

• Glucagon is made and released by the pancreas in response to low blood glucose levels caused by the person not consuming carbohydrates for a number of hours or after an event occurs that demands the use of most of the available glucose. • Glucagon's main function is to raise blood glucose levels: • Directs release of glucose from stored glycogen in liver. • Signals liver to begin converting amino acids (proteins) into glucose‐like structures. • Glucose freed from the liver's glycogen stores is gradually released into the blood which in turn allows for a gentle rise of the blood glucose level back to within normal levels.

Monitoring Blood Glucose

• Hemoglobin is a substance within red blood cells that carries oxygen throughout your body. • When your diabetes is not controlled (meaning that your blood sugar is too high), sugar builds up in your blood and combines with your hemoglobin. • Therefore, the average amount of sugar in your blood can be determined by measuring a hemoglobin A1c level. • If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher. • The amount of hemoglobin A1c will reflect several weeks of blood sugar levels, typically encompassing a period of 120 days. • For people without diabetes, the normal range for the hemoglobin A1c test is between 4% and 5.6%. • Hemoglobin A1c levels between 5.7% and 6.4% indicate increased risk of diabetes. • Hemoglobin A1c levels of 6.5% or higher indicate diabetes. • The table below shows a slightly different range of numbers being used with hemoglobin A1c blood glucose meter.

Insulin

• Insulin is made and released by the pancreas in response to high blood glucose levels after a carbohydrate‐heavy meal or item is consumed. Insulin's functions are sequential. • Directs many types of cells to draw glucose inside their cells immediate energy needs. This removes the glucose from the blood which lowers blood glucose levels back to normal levels. • Directs conversion of excess glucose into glycogen (glycogenesis) in liver cells, muscle cells, and brain cells (limited capacity - short term energy storage form). • Once the glycogen stores have been restored, the liver converts the rest of excess glucose into to fat. The liver then sends these new fats out to the body. If not used by body cells, the fats would be stored in the fat cells (adipose tissue).

Milk Allergy

• Problem: (Animal/Mammal) Milk Allergy involves sensitization of the human immune system to the protein in milk. • The human immune system overreacts when the protein (an allergen) is consumed. • All animal/mammal produced milk contains a number of proteins. The protein present in the largest amount in milk is called casein.

Sugar Substitutes

• Sugar substitutes are as sweet or sweeter than sucrose (white table sugar), but contain fewer calories than sucrose. • Sugar substitutes must be approved by FDA and deemed safe before allowed in food products in the United States

US Recommendations carbohydrate intake

• Total Carbohydrate Intake = 45 - 65% of total calories consumed daily* (For a 2000 calorie diet, this would be 225 - 325 grams per day) • Added Sugar Intake = 0 - 10% of total calories consumed daily* (For a 2000 calorie diet, this would be 0 - 50 grams of added sugars per day) • DRI Minimum Carbohydrate Intake = 130 grams daily of digestible carbohydrate (starches and sugars) • DRI All types of Fiber - ranges from 21 - 38 grams per day (depending upon age and gender of person) All types of fiber refer to both the viscous, soluble fiber and the non viscous, insoluble fiber