Role of Carbohydrate in

Health
and
Diseases

Presented By:
Uttara Singh
L-2008.H.Sc.-46D
 Introduction

 Carbohydrates are polyhydroxy aldehydes, ketones, alcohols,

acids, their simple derivatives and their polymers having
linkages of the acetal type.

 They may be classified according to their degree of

polymerization and may be divided initially into three principal
groups:

 sugars
 oligosaccharides
 polysaccharides
 Major Dietary Carbohydrates

Class (DP*) Sub-Group Components

Monosaccharides Glucose, galactose, fructose

Sugars (1-2) Disaccharides Sucrose, lactose, trehalose

Polyols
Malto-oligosaccharides
Oligosaccharide
s (3-9) Other oligosaccharides Raffinose, stachyose, fructo-
Starch
Polisaccharides
Non-starch polisaccharides
(>9)
Sorbitol, mannitol
Maltodextrins
oligosaccharides
Amylose, amylopectin,
modified starches
Cellulose, hemicellulose,
pectins, hydrocolloids

DP * = Degree of polymerization
 Physiological Effect of Carbohydrate
Carbohydrates have a wide range of physiological effects :
 Provision of energy
 Effects on satiety
 Control of blood glucose and insulin metabolism
 Protein glycosylation
 Cholesterol and triglyceride metabolism
 Bile acid dehydroxylation
 Fermentation
 Hydrogen/methane production
 Short-chain fatty acids production
 Control of colonic epithelial cell function
 Bowel habit/laxation/motor activity
 Effects on large bowel microflora
 Role of Carbohydrates in Maintenance of Health
Carbohydrates in the diet
• 50 g/day carbohydrate required to avoid ketosis.
• Carbohydrate provides the majority of energy in the diets of most
people.
• Carbohydrate-containing foods are vehicles for important
micronutrients and phytochemicals.
• Dietary carbohydrate is important to maintain glycemic homeostasis
and for gastrointestinal integrity and function.
• Diets high in carbohydrate as compared to those high in fat, reduce
the obesity and its co-morbid conditions.
• A diet should consist of at least 55% of total energy coming from
carbohydrate.
 Physical Activity
• Maintenance of energy balance is dependent both on energy intake and energy
expenditure.
• The combination of a high carbohydrate diet and regular physical activity is the
optimal arrangement to avoid positive energy balance and obesity.
• The increased energy needs of physical activity can be supplied by
carbohydrate .
• The importance of carbohydrate in the diet becomes more critical as the
amount and intensity of physical activity increases.

Carbohydrate and Behaviour

• It has been suggested that providing breakfast to children who do not typically
eat breakfast can increase cognitive performance.
• It has been suggested that sugar consumption leads to hyperactivity in children.
 Beneficial Effect of Carbohydrate in
Disorders/Diseases

• Carbohydrates may directly influence human diseases by

affecting physiological and metabolic processes.

• Carbohydrates may also have indirect effects on diseases, for

example, by displacing other nutrients or facilitating
increased intakes of a wide range of other substances
frequently found in carbohydrate-containing foods.
 Obesity

• The frequency of obesity has increased in many developed

and developing countries.
• This is public health importance because of negative effect of
obesity in relation to diabetes, coronary heart disease and
other chronic diseases of lifestyle.
• Genetic ,environmental factors and lack of physical activity is
believed to contribute to the increasing rates of obesity.
• As fat is stored more efficiently than excess carbohydrate, use
of high carbohydrate foods is likely to reduce the risk of
obesity in the long term.
• Excess energy in any form will promote body fat accumulation.
 Non-insulin Dependent Diabetes Mellitus (NIDDM)
• High rates of NIDDM in all population groups are associated with rapid
cultural changes in populations consuming traditional diets, and also
with increasing obesity.
• Foods rich in non-starch polysaccharides and carbohydrate-containing
foods with a low glycemic index appear to protect against diabetes.
• Some epidemiological evidence suggests particular benefit of
appropriately processed cereal foods, while other epidemiological and
clinical studies suggest benefits of non-starch polysaccharide from
legumes and pectin-rich foods.
• Avoid obesity and increase intakes of foods rich in non-starch
polysaccharide and carbohydrate-containing foods with a low glycemic
index offers the best means of reducing the rapidly increasing rates of
NIDDM.
 Cardiovascular Disease
• Genetics , lifestyle factors , dietary factors ,obesity and high intakes of saturated
fatty acids are involved in the etiology of coronary heart disease and influence
both the atherosclerotic and thrombotic processes.
• On the other hand, there is strong protective effect by a range of antioxidant
nutrients found in fruits and vegetables,increasing carbohydrate intake can assist
in the reduction of saturated fat.
• Among those who are overweight or obese it is more important to reduce total fat
intake and to encourage the consumption of the carbohydrate-containing foods.
• Non-starch polysaccharides (NSP) have an appreciable effect in lowering serum
cholesterol when consumed in naturally occurring foods and it may be used in the
management hypercholesterolemia.
• Plant foods are good sources of potassium and reducing the sodium to potassium
ratio may help to reduce the risk of hypertension as well as cerebrovascular
disease.
•
Cancer
Gene defects in somatic cells is thought to be through DNA damage and failure of the DNA
repair system ( apoptosis).
• Dietary carbohydrate is thought to be protective through mechanisms involving arrest of cell
growth, differentiation and selection of damaged cells for cell death (apoptosis).
• Butyric acid which is formed in the colon from fermentation of carbohydrates fight against the
abnormalities..
• The process of fermentation may protect the colorectal area against the genetic damage that
leads to colorectal cancer through other mechanisms which include:
 the dilution of potential carcinogens;
 the reduction of products of protein fermentation through stimulation of bacterial growth;
 pH effects;
 maintenance of the gut mucosal barrier; and,
 effects on bile acid degradation.
• Carbohydrate staple foods are a source of phytoestrogens which may be protective for breast
cancer.
 Gastrointestinal Diseases
• Intakes of non-starch polysaccharides(NSP) and
resistant starch (RS) are the most important
contributors to stool weight.

• Increasing consumption of foods rich in NSP & RS

carbohydrates like bran and cereals are very
effective means of preventing and treating
constipation, diverticular disease as well as
haemorrhoids and anal fissures.
 The Role of Carbohydrates in Exercise and Physical
Performance
Some general dietary considerations
• Health professionals argue that a healthy diet is one which
provides us with at least 50% of our daily energy intake in the
form of carbohydrates, 35% or less from fats and the
remainder from proteins.
• The common message is that we should move from high fat
meat-based diets to those that are made up of more
carbohydrates and fresh fruits and vegetables.
• Diet for athletes and active people should include more
carbohydrate-containing foods.
• Their diets should be such that about 60% of their daily
energy intake is obtained from carbohydrates,30% or less
from fat and 10 to 15 % from proteins.
 Carbohydrate Diets and Endurance Capacity :Studies
• A study exploring the link between diet and exercise capacity
found that after a period on a high carbohydrate diet,
endurance capacity on a cycle ergometer doubled in
comparison with the exercise times achieved after consuming a
normal mixed diet.
• In contrast, a fat and protein diet reduced exercise capacity to
almost half that achieved after normal mixed diets.
• This clearly showed the benefits of eating a high-carbohydrate
diet before prolonged exercise have been shown mainly
during cycling and establish importance of the carbohydrate
content in the diets of athletes preparing for competition.
• The importance of muscle glycogen during prolonged exercise
was confirmed in studies which showed that fatigue occurs
when muscle glycogen concentrations are reduced to low
values.
 Carbohydrate Diets and Endurance Capacity :Studies
• One study examined the influence of different nutritional states
on the resynthesis of glycogen during recovery from prolonged
exhaustive exercise.
• It found that a diet low in carbohydrate, and high in fat and
protein for 2 to 3 days after prolonged submaximal exercise,
produced a delayed muscle glycogen resynthesis, but when this
was followed by a high carbohydrate diet for the same period of
time, glycogen super compensation occurred ( Figure 1).
• This dietary manipulation not only increased the pre-exercise
muscle glycogen concentration but also resulted in a significant
improvement in endurance capacity (Figure 2).
• It was found that a carbohydrate-rich diet consumed for 3 days
prior to competition, accompanied by a decrease in training
intensity, resulted in increased muscle glycogen concentrations.
 Carbohydrate Diets and Endurance Capacity :Studies
• Studies on the influence of carbohydrate loading and
endurance capacity during running.
• The runner’s normal mixed diets were modified by providing
either additional protein, complex carbohydrates or simple
carbohydrates.
 The 'complex' carbohydrate group supplemented their
normal mixed diet with bread, potatoes, rice or pasta.
 The 'simple' carbohydrate group ate their normal mixed diet
but increased their carbohydrate intake with chocolates.
• The complex carbohydrate group improved their running
times by 26%, and the simple carbohydrate group improved
by 23%.
• There was no improvement in the performance times of the
protein group.
Fig.1Muscle glycogen concentrations before and after constant load cycling
to exhaustion, following three dietary conditions

Source: Adapted from Bergstrom, J.Hermansen,L., Hultman, E.,Saltin, B.

1 = Mixed diet for 3 days

2 = Low carbohydrate diet for 3 days
3 = High carbohydrate diet for 3 days
Fig.2Cycling time to exhaustion at constant load under three dietary conditi
ons

1 = Mixed diet for 3 days

2 = Low carbohydrate diet for 3 days
3 = High carbohydrate for 3 days
 Carbohydrate Diets and High Intensity Exercise
• Multiple-sprint sports involve a mixture of brief periods of
exercise of maximum intensity followed by recovery periods
of rest or light activity, and last up to 90 minutes.
• There is rapid utilization of muscle glycogen during several
brief periods of maximal exercise, the rate of glycogenolysis
decreases as exercise continues.
• Sports which demand that their participants perform a
combination of submaximal running and brief periods of
sprinting, such as soccer, reduces muscle glycogen values.
• Performance is impaired when glycogen value lowered, so
carbohydrate loading would be necessary for participants in
multiple-sprint sports.
 Composition of Pre-exercise Meals
• Low glycemic index carbohydrate improve endurance capacity.

• Eating a high fat meal before exercise is not recommended as a

nutritional preparation for endurance competitions because these
meals take a longer time to digest.

• From animal studies to suggest that increased fat intake will result
in a lower oxidation of carbohydrate during exercise.

• The pre-exercise meals contained approximately 280g of

carbohydrate in the high carbohydrate meal and 84g in the high fat
meal.
 Recovery from Exercise
• Carbohydrate replacement is one of the most important
events during recovery.
• Several days participation in sport need a normal mixed
diet containing about 4 to 5 g/kg body weight (BW) of
carbohydrate to replace muscle glycogen stores.
• Increasing the carbohydrate intake to 8 g/kg BW per day
may not be enough to prevent a significant reduction in
muscle glycogen concentrations after 5 successive days
of hard training.
• A high carbohydrate diet and adequate fluid intake to
avoid dehydration are the two most important elements
in the formula for successful participation in sport.
 Disorder of Carbohydrate Metabolism in Health
Dental Caries
• Foods containing sugars may be easily broken
down by α-amylase and bacteria in the mouth and
can produce acid which increases the risk of caries.
• Starches with a high glycemic index produce
pronounced changes in plaque.
• The impact of these carbohydrates on caries is
dependent on the type of food, frequency of
consumption, degree of oral hygiene performed,
availability of fluoride, salivary function, and
genetic factors.
• Dental caries should be prevented by fluoridation
and adequate oral hygiene, and don’t take sucrose
intake alone.
 Glycogen Storage Diseases
• Glycogen storage diseases are caused by lack of enzymes
glucose-6-phosphatase,maltase,glycogen phosphorylase needed
to change glucose into glycogen.
• Symptoms include weakness, sweating, confusion, kidney stones,
and stunted growth.
• The diagnosis is made by examining a piece of tissue under a
microscope (biopsy).
• Treatment depends on the type of glycogen storage disease and
usually involves regulating the intake of carbohydrates.
• Give uncooked corn starch every 4 to 6 hours around the clock.
• Give carbohydrate solutions through a stomach tube all night to
prevent low blood sugar levels from occurring at night.
Types and Characteristics of Glycogen Storage Diseases
Name
Type O
Von Gierke's disease (type IA)
Type IB
Pompe's disease (type II)
Forbes' disease (type III)
Andersen's disease (type IV)
McArdle disease (type V)
Hers' disease (type VI)
Tarui's disease (type VII)
Affected Organ,Tissues or Symptoms
Cells
Liver or muscle Episodes of low blood sugar
levels (hypoglycemia) during
fasting if the liver is affected
Liver and kidney Enlarged liver and kidney,
slowed growth, very low blood
sugar levels, and abnormally
high levels of acid, fats, and
uric acid in blood
Liver and white blood cells Low white blood cell count,
recurring infections, and
inflammatory bowel disease
All organs Enlarged liver and heart and
muscle weakness
Liver, muscle, and heart Enlarged liver or cirrhosis, low
blood sugar levels, muscle
damage, heart damage, and
weak bones .
Liver, muscle, and most tissues Cirrhosis, muscle damage, and
delayed growth and
development
Muscle Muscle cramps or weakness
during physical activity
Liver Enlarged liver-Episodes of low
blood sugar during fasting-
Often no symptoms
Skeletal muscle and red blood Muscle cramps during physical
cells activity and red blood cell
destruction (hemolysis)
 Galactosemia
• Galactosemia is caused by lack the enzyme galactose-1-phosphate
uridyl transferase needed to metabolize the galactose sugar in
milk.
• Symptoms include vomiting, jaundice, diarrhoea, and abnormal
growth.
• The diagnosis is based on a blood test.
• Treatment involves completely eliminating milk and milk products
from the diet.
• Most common and the most severe form is referred to as classic
galactosemia.
 Hereditary Fructose Intolerance
• Hereditary fructose intolerance is caused by lack of the enzyme
fructose-1 phosphate aldolase needed to metabolize fructose.
• A by-product of fructose accumulates in the body, blocking the
formation of glycogen and its conversion to glucose.
• Symptoms includes sweating, confusion, seizures and coma.
• Children who continue to eat foods containing fructose develop kidney
and liver damage, resulting in jaundice, vomiting, mental deterioration,
seizures, and death.
• Diagnosis is based on the chemical examination of liver tissue
determines that the enzyme is missing.
• Treatment involves excluding fructose ,sucrose, and sorbitol from the
diet.
 Mucopolysaccharidoses
• Mucopolysaccharidoses are a group of hereditary disorders caused by
the absence or malfunctioning of lysosomal enzymes like N-
acetylglucosaminidase,Galactose-6-sulfate sulfatase,Beta-galactosidase
needed to break down molecules called glycosaminoglycans.
• They show characteristics like rough facial appearance and
abnormalities of the bones, eyes, liver, and spleen, accompanied by
intellectual disability.
• Symptoms include short stature, hairiness, stiff finger joints, and
coarseness of the face.
• The diagnosis is based on symptoms and a physical examination.
• A bone marrow transplant may help.
• Excess mucopolysaccharides enter in the blood and are deposited in
abnormal locations throughout the body.
 Disorders of Pyruvate Metabolism
• Pyruvate metabolism disorders are caused by lack of the enzymes
pyruvate carboxilase and dehydrogenase which are involved in pyruvate
metabolism.
• These disorders cause a buildup of lactic acid and a variety of neurologic
abnormalities.
• Symptoms include seizures, intellectual disability, muscle weakness, and
coordination problems.
• Some children are helped by diets that are either high in fat and low in
carbohydrates or high in carbohydrates and low in protein.
• Problems with pyruvate metabolism can limit a cell's ability to produce
energy and allow a buildup of lactic acid.
• These disorders are diagnosed by measuring enzyme activity in cells
from the liver or skin.
 Protein glycosylation
• Proteins glycation is dependent on the concentration of glucose
and fructose in blood and the half-life of the protein.
• The reaction is between the monosaccharide and the amino
group of an amino acid, usually lysine, to form a Shiff’s base which
undergoes rearrangement and formation of Amadori products.
• As the reaction progresses, increasingly complex Maillard
products are formed with the eventual production of Advanced
Glycation End-products or AGEs which are associated with
irreversible loss of protein function.
• The extent of glycation of specific proteins, such as Haemoglobin
in diabetics serves as an indication of medium term control of
blood glucose.
 Fermentation
• Fermentation is the colonic phase of the digestive process and breakdown of
carbohydrates in the large intestine.
• This process involves gut microflora and is unique to the colon of humans because it
occurs without the availability of oxygen.
• It results in the formation of the gases hydrogen, methane and carbon dioxide, as well
as short chain fatty acids (SCFA) (acetate, propionate and butyrate), and stimulates
bacterial growth (biomass).
• The gases are either absorbed and excreted in breath, or passed out via the rectum.
• SCFA which are rapidly absorbed and metabolized by the body.
• Acetate passes primarily into the blood and is taken up by liver, muscle and other
tissues.
• Propionate is a major glucose precursor in ruminant animals such as the cow and
sheep, but this is not an important pathway in humans.
• Butyrate is metabolized primarily by colonocytes and regulate cell growth,
and to induce differentiation .
 Bowel habit
• Non-starch polysaccharides are the principal dietary component affecting laxation
through increases in bowel content bulk and a speeding up of intestinal transit time.
• The extent of the effect depends on the chemical and physical nature of the
polysaccharides and the extent to which they are fermented in the colon.
• Fermentable polysaccharides stimulate increases in microbial biomass in the colon,
resulting in some increase in fecal weight.
• More transit time ,less feacal weight and vice-versa.
Microflora
• Carbohydrate which is fermented stimulates the growth of bacteria in the large gut.
• The efficiency of conversion of carbohydrate to biomass is determined by:
 the type of substrate,
 the rate of breakdown and
 the transit time through the large intestine .