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The role of carbohydrate in human health: a case for new
productsFunctional Foods
Melton Mowbray
Complex nature of the relationship between food and health
A Round Table of dietary and obesity factors in the prevention ofcoronary heart disease
ATHEROMA ANDFIBROUS PLAQUE
FORMATION
THROMBOSIS
INJURY TOCORONARYARTERIES
HEARTATTACK
PRO-COAGULANTSTATE
ATHEROGENICLIPID PROFILE
RAISEDBLOOD
PRESSURE
INTRAVASCULARINFECTION ANDINFLAMMATION
INCREASEDLIPID
OXIDATION
RAISEDBLOOD
PRESSURE
ARRHYTHMIA
PRO-COAGULANT
STATE
PLATELETAGGREGATION
INSULINRESISTANCE
INCREASEDHOMOCYSTEINE
INCREASEDHOMOCYSTEINE
IMPAIREDENDOTHELIAL
FUNCTION
IMPAIREDENDOTHELIAL
FUNCTION
REDUCESFA
n-3 PUFA
REDUCE SODIUM
REDUCE ‘BINGE’ALCOHOL
ANTIOXIDANTS,VITS C and E
n-3 PUFA
NOT TOOHIGHPUFA
REDUCEFAT
MODERATEALCOHOL
NSP
MODERATEALCOHOL
n-3 PUFA
REDUCEFAT
MODERATEALCOHOL
REDUCESODIUM
REDUCE‘BINGE’
ALCOHOL
n-3PUFA
FOLATE
FOLATE
VITAMINSB6, B12
n-6 PUFA AND cis MUFA
NSPMODERATEALCOHOL
REDUCE SFA, TFA & CHOL
FOLATE
VITAMIN E
VITAMIN C
FOLATE
VITAMINS B6,B12
PLANTSTEROLESTERS
SOY PROTEIN/PHYTOESTROGENS
FLAVONOIDS
POLYPHENOLS
CopyrightDr Margaret Ashwell OBE, 2000
VITAMIN C
VITAMIN E
FOODS WITHLOWGLYCEMICINDEX
POTASSIUM
POTASSIUM
SFA=SATURATEDFATTY ACIDS
PUFA=POLYUNSATURATEDFATTY ACIDS
MUFA=MONOUNSATURATEDFATTY ACIDS
TFA= TRANS FATTYACIDS
REDUCE TOTAL BODY FAT
REDUCE TOTAL BODY FAT
REDUCE TOTAL BODY FAT
REDUCE VISCERAL BODY FAT
REDUCE VISCERAL BODY FAT
REDUCE VISCERAL BODY FAT
REDUCE TOTAL BODY FAT
2000
Disease Risk and Body Mass
Obesity – Past and Future
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
Massive changes in life style
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
Role of carbohydrates
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 polysaccharidesResistant starch
FermentationButyrate
AcetatePropionate
Carbohydrate: The complex group
Class
Free sugars
Short-chain CHO
Starch
Fibre (non-starch polysaccharides)
Components
Mono & disaccharidesSugar alcohols
OligosaccharidesInsulin
Rapidly digestible starchSlowly digestible starch
InsolubleSoluble
Comments
Sorbitol
Large bowel effects, stimulate bacterial growthProbiotic
AmyloseAmylopectin
Little metabolic effectMetabolic effect
Dietary fibre (non-starch polysaccharides)
Water Soluble Water Insoluble
HemicellulosesPectinsGumsMucilagesCarageenanAgar
CellulosesLigninResistant starch
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
What is Glycaemic IndexWhat is Glycaemic Index
Incremental area under the bloodglucose response curve for food
Corresponding area after equi-carbohydrate portion of glucose
X 100
Glycaemic response of carbohydrates
0
2
4
6
8
10
12
0 30 60 90 120
Time (minutes)
Delta change in glucose
(mmol/l)
White Bread Wholemeal Bead White pasta Kidney beans
Glycaemic indexGlycaemic indexFOOD
White bread
Wholemeal bred
Brown rice
White rice
Boiled potato
Pasta
Yam
Green banana
Sucrose
Baked beans
Chickpeas
GI100
100
81
81
98
65
74
65
83
70
60
Second meal effectsSecond meal effects
0
2
4
6
8
10
12
14
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (minutes)
Glucose (mmol/l)
Low GI breakfast High GI breakfast
Standard Meald
Epidemiological evidence
Overall view of GI and diabetes
Review of glycaemic index and lipids (Ludwig 2002)
Insulin Resistance
• Insulin sensitivity = insulin stimulated glucose disposal
• Insulin resistance = abnormal carbohydrate + lipid metabolism
• Insulin Resistance Syndrome (Reaven, 1988)
The Insulin Resistance Syndrome
Insulin Resistance
Hyperinsulinaemia
Glucose intolerance
Triglycerides HDL- chol
B.P.
Small, dense LDL Uric acid PAI-1
Coronary Heart Disease
Insulin Resistance
“Relative inability of insulin to stimulate glucose disposal”
Insulin sensitive Insulin resistant
GENES ENVIRONMENT
RISK CHD AND TYPE II DIABETES
Possible model of insulin resistance
0 30 60 90 120
TIME
0
100
200
300
400
500
600
700
800
900
INSULIN PMOL/L
Low Glycaemic IndexInsulin response to OGTT
WEEK O WEEK4
0 30 60 90 120
TIME
0
10
20
GLUCOSE MMOL/L
Low Glycaemic IndexGlucose Response to OGTT
WEEK O WEEK4
*
* = P<0.001
HGI LGI
Diet
0
1
2
3
4
Uptake (attomol/min/cell)
basal stimulatedHGI=high glycaemic index, LGI=glycaemic index
*
* = inter-group significant difference P<0.05.
Insulin stimulated in vitro glucose uptake in adipocytesfollowing low or high glycaemic index diet.
*
Effect of a HGI and LGI diet on glucose day profiles in middle aged men
0 30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 480
Time (minutes)
4.00
5.20
6.40
7.60
8.80
10.00
Glucose (mmol/l)
High GI day 1 High GI day 21 Low GI day 1 Low GI day 21
Post prandial metabolism
1.00 72.75 144.50 216.25 288.00 4.00
5.60
7.20
8.80
10.40
12.00
Glucose (mmol/l)
BASELINE LOW GI
6 am 12 pm 6 pm 12 am 6 am
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
GastrinGhrelin
PancreaticPolypeptideSecretin
CCK
GIPMotilinGLP1GLP2
OxyntomodulinNeurotensin
PYYGLP1
OxyntomodulinPYY
The Gut HormonesThe Gut Hormones
GHRELIN
PYY3-36
HYPOTHALAMUS
PERIPHERAL SIGNALS REGULATING APPETITEPERIPHERAL SIGNALS REGULATING APPETITE
LEPTIN
Can food release gut peptides
The big challenge
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)
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
Effect of GI on postprandial metabolism
Gut peptides
Gut peptides
Gut peptides
Glycaemic indexGlycaemic indexFOOD
White bread
Wholemeal bred
Brown rice
White rice
Boiled potato
Pasta
Yam
Green banana
Sucrose
Baked beans
Chickpeas
GI100
100
81
81
98
65
74
65
83
70
60
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
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
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
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