Module III

Food, Nutrition and Health

Lecture 1
Introduction to Nutrition
Carbohydrates

By: Dr. Dalia Rifaat

 Learning Objectives of Module III
➢ Understand Basic principles of nutritional science.
➢ Know how healthy/unhealthy food can impact your health.
➢ Identify and implement life style changes that may enhance
lifelong health.
➢ Return to simple home cooking for longer and healthier lives.
➢ Know the importance of physical fitness.
➢ Guide patients to improve their nutrition and health outcomes.
 What is Nutrition
➢ Nutrition is the science that studies how
nutrients in foods:
- Nourish our body.
- Affect body functions and overall health.
➢ Diet advice changes all the time, but knowledge
of nutrition doesn't change frequently.
What are Nutrients ?
➢ Chemicals in foods.
➢ Metabolized by the body to provide Energy to
perform all body functions and processes.
Six Classes of Nutrients are:
a. Carbohydrates.
b. Fats and Oil
c. Proteins
d. Vitamins
f. Minerals
e. Water
Foods also contain non-nutrient compounds:
1. Non-digestible fibers or Dietary fibers
2. Chemicals are added by food manufactures to:
o Enhance color
o Enhance flavor
o Add texture
o Extend shelf life
 Most Nutrients Are Organic
• Carbohydrates, proteins, lipids, and vitamins are organic
nutrients.
– Organic because their chemical structures contain carbon
– They can also contain hydrogen, oxygen, and nitrogen.
• Minerals and water do not contain carbon and are classified as
inorganic nutrients.

© 2014 Pearson Education, Inc.

The chemical structure of organic nutrients consists of
a) calcium, hydrogen, and phosphorus.
b) hydrogen, carbon dioxide, and nitrogen.
c) carbon, oxygen, and hydrogen.
d) oxygen, hydrogen, and sulfur.
Answer:
C
 Nutrients

Macronutrients Micronutrients

e.g. Carbs, Fats & Proteins Vitamins & Minerals

Macronutrients :
Carbohydrates, fats, and proteins provide ENERGY in
the form of kilocalories
Micronutrients:
Vitamins and minerals help regulate body processes,
including metabolism.

Water NOT a nutrient, BUT VITAL to life.

 How Does Nutrition Contribute to Health?

Proper Nutrition can help us;

–Improve our health
–Prevent certain diseases
–Achieve and maintain the desirable
weight
–Maintain our energy and vitality
 Healthy Diet Can Prevent Diseases

• Nutrition plays a role in osteoporosis development ( fragile

bones ) and cancer progression
• Nutrition is associated with chronic diseases: heart disease,
stroke, and diabetes
• Nutrition researches are dedicated to identifying dietary
pattern to lower the risk of development of chronic diseases.
 Good nutrition, adequate
Physical activity, and a
Healthy body weight are
essential parts of a person’s
overall health and well-being.
 Once digested and transported to a cell, a food
molecule can be used as:
- Building blocks to make new cell parts.
- Repair old ones
- Be burned for energy
 How is food digested…?
Chemical and Mechanical breaking down of food into smaller
units to be absorbed by the body

Occurs in the Gastrointestinal (GI ) tract

 Mechanical Chemical

• Breaking food down • Breaking food down

through chewing and with digestive juices,
grinding enzymes and
hormones .
 Chemical Breakdown :
Metabolism : The entire series of chemical
reactions that keeps cells alive.
▪ Metabolic reactions are divided into 2 classes:
1. Catabolism: The process of breaking down
biomolecules to produce energy . e.g.
Glycolysis
2. Anabolism: The process of building up or
synthesizing biomolecules from smaller
ones
The Energy obtained
from carbohydrates,
proteins, and fats are
released when their
chemical bonds are
broken and is
measured in
Calories…
What is Calorie….?
➢Calorie is a standard unit of
energy.

➢ The Energy released

when food is metabolized.
 Dietary Calorie
Calorie : The energy required to increase the
temperature of 1 gm of water by 1 degree
Celsius= cal ( c )
In Nutrition:
Calories measure the energy content of a
food and is used on nutrition labels
Dietary Calorie 1 kcal = 1,000 cal = C
 Bomb calorimeter to measure the
amount of calories in a sample of food

Heat released from burning a food sample in a calorimeter is

used to determine the energy value for the food.
You are a product of what you
eat, what you don’t eat, or
what you may eat too much of.
 Calculating the Energy in Foods

Number of kilocalories in one serving of a given food

can be determined based on
Grams of carbohydrates, protein, and fat in the food :
❖ Carbs 1g = 4 Calories

❖ Protein 1g = 4 Calories

❖ Fat 1g = 9 Calories

Main source of energy is fat

Fat provides 2.5X energy of other nutrients
 Example
A slice of bread has :
9g of carbohydrates
2g of protein,
1g of fat.
SO…
The total calories are…..
 9 grams carbohydrates x 4
calories/gram = 36 calories

+ 2 grams protein x 4
calories/gram = 8 calories

+ 1 gram fat x 9 calories/gram

= 9 calories
_____________________
Total = 53 Cal
• A person's state of nutrition is defined as:
– Healthy
– Malnourished
Malnourished:
Long-term consequence of too many or too
little nutrients. It is:
a. Undernourished
b. Over nourished
 Malnourished

Undernourished Over nourished

Too little energy or too few
Too much energy or too
nutrients over time, causing
much of a given nutrient
weight loss – at risk of
over time, at risk of causing
developing a nutrient-
obesity, heart disease.
deficiency disease
 What Is Healthy Eating …?

A healthy diet provides the proper

combination of energy and nutrients
A Healthy Diet is :
– Adequate
– Moderate
– Balanced
– Varied
 Tools for Healthy Eating
Involves the principles of :
1. Adequate : Provides enough energy, nutrients,
fiber, and vitamins to maintain a
person’s health
2. Balance : Provides all essential nutrients
to maintain a person’s health and
prevent diseases.
3. Variety : Eating many different foods from
the different food groups
4. Moderation : Enough amount of nutrients —not
too much and not too little
A Registered Dietitian (RD)- Trustworthy Nutrition
Experts can help determine your nutrition status
 Assessing your Diet-Read only
• To find out if the foods you eat are good for your health and provide you with all the
nutrients you need.
• Visit the USDA website, http://www.choosemyplate.gov/myplate/index.aspx,
which has various tools to help you assess your diet.
• You can track calories over time,
• Diet quality, and find many other tools to evaluate your daily food consumption.
The questions these tools can help answer include:
✓ How much food do you have to eat to match your level of activity?
✓ How many calories should you eat?
✓ What are the best types of food to get the most nutrients?
✓ What nutrients are contained in different foods?
✓ How do you plan a menu that contains all the nutrients you need?
 Mediterranean Diet- Read only
❖A Mediterranean Diet is a style of eating based on the Southern
Mediterranean region (i.e. Spain, Greece, and Italy).

❖This kind of diet consists of a lot of vegetables and fruit, salads

dressed with olive oil, fish, bread, pasta, and other grains.

❖Studies showed that those on a Mediterranean diet reduce their

risk of heart disease by 30%.
 1. Carbohydrates

➢ Molecules composed of the elements

C, H and O ( CHO )
➢ Primary source of ENERGY!
➢ Good sources: fruits, vegetables, grains
➢ Quickly digested to Glucose
➢ Glucose is the preferred source of energy for the
blood, brain, and nervous system
➢ Carbohydrates in our food primarily come from PLANT -
based sources.
➢ They come in the forms of sugars, cellulose (fibers ),
and starches
➢ Carbohydrate-rich plant foods make up the foundation of
diets all over the world.
➢ All forms of carbohydrate provide about 4 calories per
gram - 4 Cal / gm.
Dietary Carbohydrates are found in a wide array
of both Healthy and Unhealthy foods.

Grains ( breads, pasta, rice , noodles)

Legumes ( beans, lentils )
milk, popcorn, potatoes, cookies, soft drinks, corn,
processed foods , vegetables & fruits
Dietary carbohydrates are
classified into 2 forms
simple and complex forms
1.Simple Carbohydrates ( Sugars- Fast- releasing ) :

• Monosaccharides = one unit of sugar.

• Carbohydrates that cannot be hydrolyzed into simpler compounds
 Glucose - Blood Sugar
Preferred source of energy and circulates in our
blood stream
Simple Sugars:
Disaccharides
When 2 sugar molecules join together, they can be hydrolyzed
into two monosaccharide units.
1) Sucrose ( Table sugar ) = Glucose + Fructose
(cane , beet sugar )
2) Lactose ( Milk sugar ) = Glucose + Galactose
2.Complex Carbohydrates ( Slow-releasing ) :
e.g. Polysaccharides
❖Are composed of large molecules that can be
hydrolyzed into many monosaccharide units..
❖Examples include starch, Cellulose (Fibers), and
glycogen.
Starch and dietary fibers can be found in foods
like cereals, bread, pasta, whole grains.
1) Starch – Plant starch is the primary carbohydrate component of
several foods such as potatoes, rice & beans. Plants store glucose in
chains of starch.
Starch is composed of two polymers : amylose and amylopectin.
2) Cellulose e.g. Fibers – (non-digestible polysaccharides )
primary structural component of plants cell walls.
3) Glycogen :
- Humans and animals store glucose energy from
starches in the form of a large molecule, Glycogen.
- Not a source of dietary carbohydrate
- Stored in the liver and muscles.
 Digestion and Metabolism of Carbohydrates

1.Glucose and fructose are absorbed directly into the bloodstream.

2.Sucrose ( Disaccharide ) is hydrolyzed into glucose and fructose.

Hydrolysis : split by adding H2O
Sucrose + H2O → Glucose + Fructose
Split here by
adding H2O
Lactose (in milk ) is hydrolyzed :
Lactose + H2O → Glucose + Galactose

➢ All babies have the enzyme to breakdown Lactose

➢ Galactose is converted to glucose during metabolism.
Some babies lack the enzyme (galactosemia)
necessary for this conversion and require a synthetic
formula for proper nutrition.
➢ Also, some people lack the enzyme( lactase)
necessary to hydrolyze lactose.
➢ This condition is known as lactose intolerance.
 Lactose Intolerance
➢ Metabolic dysfunction - difficulty to digest dairy products.
➢ Inability to break Lactose into simple sugars- Lactose
mal-digestion – why..?
➢ Insufficient enzyme lactase in the intestine to digest
lactose-containing foods
➢ Production of this enzyme decreases with age
➢ By adulthood, most people don`t
have enough of this enzyme
➢ Not to be confused with milk allergy
➢People with lactose intolerance can feel
bloated and uncomfortable if they drink regular
milk .
➢Lactose is fermented by the large intestinal
bacteria, producing : carbon dioxide gas ,
water and lactic acid that causes diarrhea.

( Digestive upsets)
 There is no cure for lactose intolerance.
The best way to deal with is :

-To limit your intake of milk, milk products

and foods containing lactose
- Look for substitutes for milk, e.g.
coconut milk, soy milk, almond milk,
and others…..
Carbohydrates metabolism :
a. Starches:
Are polymers of glucose connected by alpha linkages; most
animals and humans possess the enzymes necessary to hydrolyze
starch to glucose that can then serve as a source of ENERGY

b. Cellulose :
Is a polymer of glucose connected by beta linkages; most animals
and humans lack the enzymes necessary to hydrolyze cellulose,
and it serves as a source of roughage or dietary fiber.
▪ Are non-digestible
▪ Provide no energy
▪ Fiber passes through the GI tract undigested
 Both starch and cellulose ( dietary fibers ) are
polymers of Glucose, but they differ in the
linkage between the glucose molecules

Starch Cellulose

Alpha (α) linkages Beta (β) linkages

G G
G G G G
G
 The linkage between
glucose units in
starch are alpha (α)
linkages
( O is pointed down )

, whereas in cellulose
they
are beta (β) linkages
( O is pointed up )
 Humans are able to digest starchy
food (α) - linkages by breaking it into
Glucose units,
but we cannot digest dietary fibers or
cellulose
(β)- linkages
because our bodies lack the enzymes for
breaking them down
 Dietary Fibers:
➢ Fibers are complex carbohydrates (Polysaccharides )
➢ Present in fruits, vegetables ,whole-grain breads and
cereals.
➢ Are categorized into Insoluble and soluble forms.
➢ Both Fibers are undigestable.
➢ Our bodies can't break these bonds, so it doesn't provide
nutrients or calories.
➢ Fibers are excreted from our bodies.
Dietary Fibers : Soluble and insoluble Fibers- Read only

Soluble fibers dissolve in water

Help regulate cholesterol and
blood glucose levels
Insoluble fiber doesn't dissolve in water
it absorbs water, kind of like a sponge.
It prevents us from getting constipated.
Why are Dietary Fibers essential for
your health?

1. Supports weight loss

2. Lower cholesterol and blood sugar levels
3. Lowers risk of cardiovascular diseases such
as stroke, heart disease, and more
4. Prevents diabetes
5. Increases digestive and bowel health
6. Fuels healthy gut bacteria
 Tips for Adding in Fibers to your diet:

❖Eat whole fruits like pears and apples instead of drinking fruit
juices.
❖Swap in whole grain varieties instead of white rice, bread, and
regular pasta.
❖Snack on vegetables instead of pretzels and chips.
❖Eat beans and lentils daily.
❖Make sure you’re drinking plenty of water when you eat fibrous
food.
 Carbohydrate Metabolism
• All monosaccharides are converted to glucose by the liver.
• Glucose circulating in the blood is our primary energy source.
• Excess glucose is stored as glycogen in the liver and muscles
• Glycogen is a highly branched polymer of alpha glucose and is
sometimes known as animal starch.
• Between the meals, our body draw on
liver glycogen reserves.
• Excess glycogen is stored
as fat.
•

The structure of glycogen enables its rapid mobilization into

free glucose to power cells.
Have you ever wondered why you can
eat a bag of candy and feel hungry
just 30 minutes later…..?
How blood glucose levels are
regulated…. ?

Hormonal Control of Blood

Glucose
 Insulin Hormone
Carbohydrates are broken down and converted to
glucose, which can then be metabolized by the body to
produce ENERGY

What happens to Glucose once absorbed in our

blood stream…?
❖ After a meal the blood glucose level will go up.
❖The body wants to keep blood glucose between 70
mg/dl and 100 mg/dl.
❖This increase will trigger the pancreas to release a
hormone called insulin.
Function of Insulin Hormone :
➢ Released to lower the Blood glucose levels.
➢ Carries glucose in the bloodstream to your body`s
cells for energy.
➢ Directs excess glucose to be stored as Glycogen in
the muscles and the liver for future use.
➢ During Fasting, when blood glucose level
decreases, glucose will be released from stored
glycogen.
➢ If we overconsume on Carbs.,
the excess are converted into
Fats for storage .
 The Glycemic Index
The Glycemic index of a food is the measure of the
speed at which glucose is released into the blood stream
after it's digested.
It is a food’s potential to raise blood glucose

The glycemic index measures

the effects of foods on blood-
glucose levels.
 Glycemic Index

• A food’s potential to raise blood glucose

• Foods with a high glycemic index cause a sudden

surge in blood glucose, triggering a large increase in
insulin, which may be followed by a dramatic fall in
blood glucose.

• Foods with a low glycemic index cause low to

moderate fluctuations in blood glucose
(Cont’d)
High Glycemic index
Foods
 High Glycemic Index Foods
• Foods high in refined Carbs ( Processed foods ) will lead to a
more rapid release of glucose into the blood.
• The body will release a High amount of Insulin
( Spike ) to lower blood sugar
• The spike of glucose and insulin lead to dramatic fall in blood
glucose levels
• Resulting in an earlier return of hunger and a tendency to overeat.

(Cont’d)
• Low Glycemic Index Foods:
– Foods with a low glycemic index cause low to
moderate fluctuations in blood glucose
– Risk reduction for heart disease and colon cancer
– Examples are : Beans, fresh vegetables, whole
wheat
 How to Lower the Glycemic index of
Foods…?
The glycemic index of a food is lowered when
combining Food of Complex Carbohydrates with
some other sources of fiber, protein and a small
amount of healthy fat.

Complex Carbs ;
Take a longer time to
be broken down into
glucose, require more
time for digestion.
Example : A bowl of brown rice with stir fried
broccoli on top will result in a slower to moderate
release of blood glucose . This is a good way to
stabilize blood sugar.
 Diabetes
Type 1 diabetes :
• Starts during childhood.
• Type 1 diabetes is a metabolic disease in which insulin-
secreting cells in the pancreas are killed by an abnormal
response of the immune system, causing a lack of insulin in
the body.
• patients need daily injections of insulin to control their blood
glucose levels.
Type 2 diabetes :
• Starts at older ages.
• Coupled to obesity.
• Body response to insulin declines
Bottom Line :
➢U.S. Guidelines: 45-65% of calories from Carbs.
➢Heathier diets derive most of its carbohydrates
from Complex Carbs. ; whole grains , beans
..etc.,
➢ Choose foods with a low glycemic index .
➢Provide the body with long-term energy than
simple Carbs.
➢ Unhealthier sources include white bread,
pastries, sodas, and other highly processed or
refined foods.
➢ Contribute to risk of developing Type 2
diabetes- becoming overweight or obese
➢ It's probably okay to have a small amount
of sugar in our diets.
➢ Without any sugar, our bodies would shut
down. We need a certain amount of sugar
to fuel our brains.
➢ The bottom line : Practice moderation,
then no food is forbidden.
Tips for adding healthy
carbohydrates to your diet:

1. Start the day with whole grains.

.
2. Use whole grain breads for lunch or
snacks.
3. Choose whole fruit instead of juice.
4. Pass on potatoes, and instead bring
on the beans.
Go to ….Healthy Eating Plate
➢Choose more vegetables and fruits.
➢ Go for color and variety—dark green,
yellow, orange, and red.
Go to ….Healthy Eating Plate
Learning Checks….
A function of carbohydrates in the diet is
to:
a. Enable chemical reactions.
b. promote growth and repair of tissues.
c. supply energy.
d. maintain water balance.
Answer:
c
Which is a monosaccharide?
A. Cellulose
B. Glucose
C. Glycogen
D. Sucrose
Answer:
B
Which statement correctly describes starch and
cellulose?
A. Starch is a polymer of glucose, cellulose is not.
B. Starch and cellulose have identical structure but
different properties.
C. Starch and cellulose are both made from glucose
but have different linkages.
D. Starch and cellulose are both easily digested by
the body.

Answer:

C
Humans cannot digest cellulose because they lack enzymes
for the hydrolysis of
a. ß-amino acid linkages
b. §-glucose linkages
c. ß--glucose linkages
d. sucrose
Answer:
C
People who have lactose intolerance are
deficient in the
a. Enzymes that catalyze the oxidation of
lactose to CO2 and H2O
b. Taste receptors for lactose, leaving a
bitter taste .
c. Enzyme that catalyzes the hydrolysis of
lactose to galactose and glucose.
d. Enzyme that catalyzes the conversion of
galactose to glucose
Answer:
C
• You feel hungry sooner after eating foods with a
high glycemic index. Why? High GI foods cause
blood sugar to rise more _____, causing a
corresponding _____ in insulin levels. Insulin
spikes can cause blood sugar to drop below
normal levels and the low blood sugar levels can
trigger the sensation of hunger.
a. Quickly, drop
b. Slowly, decline
c. Quickly, spike
Answer:
C
You can lower the glycemic index of a food by
doing which of the following? Choose
A. Choosing complex carbohydrates over simple
carbohydrates.
B. Choosing simple carbohydrates over complex
carbohydrates
Answer :
A
Carbohydrates are stored in the liver and muscle tissue as
a. amylose
b. amylopectin
c. cellulose
d. Glycogen
Answer;
D
 Glossary of Terms:
1. Macronutrients
2. Micronutrients
3. Metabolism ( catabolism +anabolism )
4. Calories
5. Malnourished (undernourished +over nourished )
6. Hypoglycemia
7. Hyperglycemia
8. Dietary Fibers
9. Insulin
10. Diabetes Type I
11. Diabetes Type II
12. Glycemic index
13. Refined Carbs.
• Hypoglycemia:
Low blood sugar, is when blood sugar decreases to below
normal levels
• Hyperglycemia:
High blood sugar or abnormally high blood glucose levels
in the blood- sign of diabetes
• Dietary Fibers:
Is a type of complex carbohydrate that cannot be digested
by our bodies' enzymes
• The Glycemic index:
Is the measure of the speed at which glucose is released
into the blood stream after it's digested.
• Refined Carbs:
Are processed carbs or grain products that have been
refined like white bread, white rice, cereal, pasta, and
snacks.
• Insulin :
Hormone secreted by the pancreas ,that regulates the
level of sugar (glucose) in the blood.
• Diabetes :
Diabetes is presence of high levels of sugar (glucose) in
the blood. As result of absence or insufficient production
of insulin.
• Type I
An autoimmune disease in which your immune system
attacks and destroys the insulin-making cells in your
pancreas. No one knows exactly what causes it, but
genetics likely play a role.
• Type II
Body does not use insulin properly. Develops at any age,.
Major risk factors for type 2 include obesity and unhealthy life
style.
Go to Dietary Fats