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Carbohydrates

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carbohydrates chapter 5 – PowerPoint PPT presentation

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Title: Carbohydrates


1
Carbohydrates
  • Chapter 5

2
Recommended Intake of Carbohydrates
  • RDA 130 grams to avoid ketosis
  • AMDR 45-65 of total energy needs
  • Limit added sugars
  • Fiber (AI 14 g/1000 kcal)
  • 25 grams woman under 50
  • 21 grams woman over 50
  • 38 grams men under 50
  • 30 grams men over 50

3
Our Carbohydrate Intake
  • 50 of total energy needs
  • Added sugars 16
  • Recommended 6
  • Dietary fiber
  • 25-50 less than recommended
  • Average intake-1 fruit and 1 whole grain serving

4
Functions of Digestible Carbohydrates
  • Provide energy
  • 4 kcal/gm
  • Protein sparing
  • Body does engage gluconeogenesis
  • Prevent ketosis
  • Incomplete breakdown of fatty acids
  • Ketosis- increased urination so dehydration, loss
    of lean mass, and electrolyte imbalance

5
Functions of Indigestible Carbohydrates
  • Promoting bowel health
  • Diverticula and Diverticulosis (active disease
    low fiber)
  • Reducing obesity risk
  • Enhancing blood glucose control
  • Water soluble fibers
  • Reducing cholesterol absorption
  • Water soluble fibers

6
Negative health consequence of inadequate fiber
intake
  • Diverticulosis results when muscles of the colon
    wall become weaken and lose their
    elasticity. This is often d/t lack of fiber
  • If they become inflameddiverticulitis.

7
Carbohydrate digestion
8
Carbohydrate Absorption
  • Active absorption-Glucose and Galactose
  • Facilitated absorption-Fructose
  • Liver converts fructose and galactose to glucose

Extra-adipose tissue
Storage-muscle and liver glycogen
Blood glucose used by cells
9
Health Concerns
  • Very High Fiber Diets (above 50-60 grams)
  • High fiber low fluid constipation,
    hemorrhoids, blockage
  • Decrease absorption of certain minerals
  • High Sugar Diets
  • Increase risk of weight gain and obesity
  • Increase risk of dental caries

10
Health Concerns
  • Lactose Intolerance
  • Primary
  • Decreased lactase production
  • Secondary
  • Associated with disease that damage the lactase
    producing cells
  • Glucose Intolerance
  • Hypoglycemia
  • Hyperglycemia

11
Regulation of Blood Glucose
  • If your blood sugar is high your body will
    decrease it
  • Insulin
  • Hormone that increases glucose uptake by muscles
    and adipose tissue
  • Increase glycogen synthesis, suppress
    gluconeogenesis

12
Regulation of Blood Glucose
  • If your blood sugar is low your body will
    increase it
  • Glucagon
  • Increase glycogen breakdown, increase
    gluconeogenesis
  • Epinephrine, norepinephrine
  • Increase glycogen breakdown, increase
    gluconeogenesis
  • Cortisol
  • Increase glucose use by muscle and other organs,
    increase gluconeogenesis

13
Blood Glucose Regualtion
14
Type 1 Diabetes Mellitus
  • Insulin producing cells in pancreas are destroyed
  • Insulin shots required
  • Diet must be coordinated with insulin
  • Exchange system, carbohydrate counting
  • Increased risk for cardiovascular disease,
    blindness and kidney disease

15
Type 2 Diabetes Mellitus
  • 1 out of 10 Americans has type 2 diabetes now
  • By 2050 1 out of 3 Americans is projected to have
    type 2 diabetes
  • WHY the increase?

16
Type 2 Diabetes Mellitus
  • Caused by insulin resistance
  • Most common type of diabetes
  • Risk factors include ethnicity, obesity,
    genetics, inactivity, age, hypertension
  • Treatment
  • Diet
  • Exercise
  • Medications
  • Type 2 diabetes is reversible!

17
Development of Type 2 Diabetes
  • Insulin Resistance
  • High fasting insulin
  • When people are insulin resistant, their muscle,
    fat, and liver cells do not respond properly to
    insulin. As a result, their bodies need more
    insulin to help glucose enter cells. The pancreas
    tries to keep up with this increased demand for
    insulin by producing more. Eventually, the
    pancreas fails to keep up with the body's need
    for insulin. Excess glucose builds up in the
    bloodstream, setting the stage for diabetes. Many
    people with insulin resistance have high levels
    of both glucose and insulin circulating in their
    blood at the same time.
  • Insulin levels are usually not tested routinely

18
Development of Type 2 Diabetes
  • Diabetes and prediabetes can be detected with one
    of the following tests
  • Fasting glucose test. 
  • 8 hour fast (best done in am)
  • Fasting glucose levels of 100 to 125 mg/dL are
    above normal but not high enough to be called
    diabetes. This condition is called prediabetes or
    IFG. People with IFG often have had insulin
    resistance for some time. They are much more
    likely to develop diabetes than people with
    normal blood glucose levels.
  • Glucose tolerance test. -8 hour fast
  • - Drink sugary drink and have BG test after 2
    hours.
  • A blood glucose level between 140 and 199 mg/dL
    means glucose tolerance is not normal but is not
    high enough for a diagnosis of diabetes. This
    form of prediabetes is called IGT and, like IFG,
    it points toward a history of insulin resistance
    and a risk for developing diabetes.

19
Development of Type 2 Diabetes
  • Complications
  • Renal
  • Eye
  • Skin CVD
  • Management
  • Meal planning, Physical activity, and, Medication

20
Other Blood Sugar Disorders
  • Hypoglycemia
  • Reactive Hypoglycemia
  • Exaggerated insulin response after eating
  • Fasting Hypoglycemia
  • Low blood sugar after fasting

21
Other Blood Sugar Disorders
  • Metabolic Syndrome
  • Group of factors that increase risk for Type 2
    diabetes and cardiovascular disease
  • Criteria for diagnosis is at least 3 of the
    following
  • High blood pressure
  • High fasting blood sugar (glucose)
  • Large waist circumference (length around the
    waist)
  • Low HDL cholesterol
  • Triglycerides equal to or higher than 150 mg/dL

22
Glycemic Index
  • GI
  • Evaluate the GI
  • Glycemic Index
  • Ratio of a blood glucose response compared with a
    standard (white bread)
  • Based on a 50 gm carbohydrate serving

23
Glycemic Load
  • Amount of carbohydrate in a food multiplied by
    glycemic index and divided by 100
  • Takes into accounts GI and carbohydrate consumed
  • More accurately reflects blood glucose impact

24
Glycemic Index and Glycemic Load
Brown Rice (4655)/100 25.3
Food Serving Size GI CHO (g) GL
Brown rice 1 cup 55 46 25
White rice 1 cup 72 53 38
Lentils 1 cup 30 40 12
Sucrose 1 tsp 65 5 3
Apple 1 38 22 8
Coke 1 cup 63 26 16
Skim milk 1 cup 32 12 4
Ice cream 1 cup 61 31 19
25
Low carb diets
  • Atkins, Sugar Busters, Carb Addicts, South Beach
    (early phase)
  • Generally less than 100 g of CHO/day
  • Pros?
  • Cons?

26
Low carb diets- Whats Missing?
  • South Beach
  • Breakfast 2 eggs scrambled and grilled lean
    bacon. Small glass of tomato juice, decaf coffee
    or tea.
  • Morning Snack 1 small chunk reduced-fat Cheddar
    cheese.
  • Lunch Chicken Caesar salad (no croutons) with
    2tbsp Caesar dressing.
  • Afternoon Snack 3tbsp low-fat cottage cheese w/
    1 tomato and cucumber.
  • Dinner Grilled salmon with steamed asparagus and
    a salad (mixed leaves, cucumber, green pepper,
    cherry tomatoes and 2tbsp low-sugar dressing.
  • Dessert Mixing 4oz reduced-fat ricotta cheese
    with a little sweetener and lemon zest and
    vanilla extract.
  • Atkins
  • BreakfastSouthwestern omelet with tomato,
    avocado and ham
  • LunchCaesar salad with grilled chicken
  • DinnerSteak au PoivreRoasted AsparagusMixed
    green salad with lemon vinaigretteGelatin
    dessert made with sucralose
  • SnackCelery stuffed with herb cream cheese

27
DX
  • 65 yo F
  • Background High school education, now retired,
    lives with 72 yo sister
  • PMH HTN, high cholesterol, overweight
  • Family Hx brother heart disease, sister type 2
    DM
  • Complaint Cut on foot not healing, not seeing
    well
  • Step 1?

28
Labs
  • Normal Results
  • Glucose 70-110 325
  • Cholesterol 120-199 300
  • Triglycerides 35-135 400
  • HbA1c 3.9-5.2 8.5

29
What suggestions can we make about her diet
  • BF One egg fried in butter, 2 strips bacon, 1
    cup coffee w/cream and sugar, 1 cup orange juice
  • Lunch Ham and cheese sandwich on 2 slices
    enriched white bread, mustard, 1 glass
    unsweetened iced tea
  • Dinner 1 cup turnip greens made with butter,
    salt, and pepper (simmered on stove for 3 hours),
    1 baked potato w/butter and sour cream, 1 cup
    beans w/ham
  • Snack 2 vanilla wafers
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