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The role of carbohydrate in human health

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Title: The role of carbohydrate in human health


1
TheFood DrinkInnovationNetwork www.fdin.co.uk
2
The role of carbohydrate in human health a case
for new products
  • Functional Foods
  • Melton Mowbray

3
Complex nature of the relationship between food
and health
4
Disease Risk and Body Mass
5
Obesity Past and Future
6
The problem we are faced with
  • An ever increasing rate of obesity
  • 1000 deaths a week are directly related to
    obesity
  • It will soon become the most common preventable
    cause of cancer
  • Type 2 diabetes
  • CHD rates remain high

7
Massive changes in life style
8
Massive changes in the life style
  • Energy expenditure down
  • Access to cheap calories energy dense calories
  • Public health looking into a bottomless precipice
  • If we go on as we are in the few generations time
    will be the first where children die before
    parents

9
Role of carbohydrates
10
Carbohydrate is a complex groupwith complex
absorption
Gut lumen Epithelium Portal vein
Small intestine
Monosaccharides Glucose, Fructose Monosaccharides
Disaccharides Sucrose, Lactose Brush boarder enzymes Monosaccharides
Rapidly absorbed and slowly absorbed starch Pancreatic amylase Brush boarder enzymes Glucose
Large intestine
Non starch polysaccharides Resistant starch Fermentation Butyrate Acetate Propionate
11
Carbohydrate The complex group
Class Free sugars Short-chain
CHO Starch Fibre (non-starch
polysaccharides)
Components Mono disaccharides Sugar
alcohols Oligosaccharides Insulin Rapidly
digestible starch Slowly digestible
starch Insoluble Soluble
Comments Sorbitol Large bowel effects,
stimulate bacterial growth Probiotic Amylose Amyl
opectin Little metabolic effect Metabolic
effect
12
Dietary fibre (non-starch polysaccharides)
Water Soluble Water Insoluble
Hemicelluloses Pectins Gums Mucilages Carageenan Agar Celluloses Lignin Resistant starch
13
Problems with definitions
  • Physiological definition does not help chemical
    analysis
  • Does not help interpretation of scientific work
    (dietary fibre v whole grain)
  • Does not help public understanding
  • Does not help labelling of produces

14
What is Glycaemic Index
Incremental area under the blood glucose response
curve for food
X
100
Corresponding area after equi- carbohydrate
portion of glucose
15
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16
Glycaemic index
FOOD White bread Wholemeal bred Brown rice White
rice Boiled potato Pasta Yam Green
banana Sucrose Baked beans Chickpeas
GI 100 100 81 81 98 65 74 65 83 70 60
17
Second meal effects
18
Epidemiological evidence
19
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20
Overall view of GI and diabetes
21
Review of glycaemic index and lipids (Ludwig 2002)
22
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23
Insulin Resistance
  • Insulin sensitivity insulin stimulated glucose
    disposal
  • Insulin resistance abnormal carbohydrate
    lipid metabolism
  • Insulin Resistance Syndrome (Reaven, 1988)

24
The Insulin Resistance Syndrome
Insulin Resistance
Hyperinsulinaemia
? Triglycerides
? HDL- chol
Glucose intolerance
?? B.P.
Small, dense LDL
? Uric acid
? PAI-1
Coronary Heart Disease
25
Insulin Resistance
  • Relative inability of insulin to stimulate
    glucose disposal

Insulin sensitive
Insulin resistant
GENES
ENVIRONMENT
? ? RISK CHD AND TYPE II DIABETES
26
Possible model of insulin resistance
27
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28
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29
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30
Effect of a HGI and LGI diet on glucose day
profiles in middle aged men
31
Post prandial metabolism
32
Obesity evidence
  • 16 single-day studies in humans, 15 found lower
    satiety, increased hunger, or higher voluntary
    food intake after consumption of high- compared
    with low-glycemic index meals
  • obese children were given high-glycemic index
    instant oatmeal or low-glycemic index steel-cut
    oats with identical energy and macronutrient
    content at breakfast and lunch, and ad libitum
    energy consumption was monitored throughout the
    afternoon. Energy intake was 53 higher after the
    high- compared with the low-glycemic index meals
  • Slabber et al found significantly more weight
    loss in obese hyperinsulinemic women after 12
    weeks of consuming an energy-restricted
    low-compared with high-glycemic index diet
  • Bouche et al found lower adiposity by DXA scan in
    11 obese men after 5 weeks on an energy- and
    nutrient-controlled low- compared with
    high-glycemic index diet

33
The Gut Hormones
Gastrin Ghrelin
Pancreatic Polypeptide
Secretin CCK
GIP Motilin GLP1 GLP2 Oxyntomodulin Neurotensin PY
Y
GLP1 Oxyntomodulin PYY
34
PERIPHERAL SIGNALS REGULATING APPETITE
HYPOTHALAMUS
PYY3-36
GHRELIN
LEPTIN
35
Can food release gut peptides
  • The big challenge

36
Nutrient Release of Gut hormones
  • Consistency of food makes a difference to peptide
    realise
  • Gasrtic emptying (Frost etal 2000)
  • Products of fermentation make a difference
  • Ileo break
  • Effect gastric emptying (Frost etal 2003)
  • Adding propionic acid increases GLP-1 release,
    lows gastric emptying and decreases hunger (Frost
    2003)

37
Evidance of effect of Low GI diets and gut
hormones
  • Evidence from a number of short term studies
  • Holt etal 1992 CCK
  • Juntunen etal 2002 GLP-1 and GIP (wholegrains)
  • Tappy etal 1986 GIP

38
Effect of GI on postprandial metabolism
Gut peptides
Gut peptides
Gut peptides
39
Glycaemic index
FOOD White bread Wholemeal bred Brown rice White
rice Boiled potato Pasta Yam Green
banana Sucrose Baked beans Chickpeas
GI 100 100 81 81 98 65 74 65 83 70 60
40
Problems of intake in whole grains
  • Benefit is seen at 2-3 servings a day
  • Consumption in a lot of Western countries is less
    then 1 serving a day
  • Scandinavians consume more whole grain. Norway
    has 4x US intake
  • Main sources are limited to wholemeal bread, rye
    bread and whole grain cereal

41
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42
Problem of who eats high fibre/wholegrain foods
  • US and UK
  • Older
  • High socio-economic group
  • Less likely to smoke
  • Do more exercise
  • Part of a healthy middle class lifestyle
  • Many chronic diseases are associated with low
    income, smoking, lack of exercise and are rooted
    in the young

43
Need a new raft of products
  • Need to compete with commonly consumed foods
  • Need to be seen as products with added value
  • Ongoing research collaboration with Holgrain and
    RHM is trying to do this with with bread
  • Is it possible to product a low GI white bread
    which will compete in the market place

44
TheFood DrinkInnovationNetwork www.fdin.co.uk
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